Where My Idea of Service Started

Long before I became a physician, my parents taught me something simple. If you are fortunate enough to help someone, you should.

I grew up in Los Angeles, and I saw early that people living in the same city can have very different experiences with healthcare. Some people have specialists they can call, insurance that gives them choices, transportation to appointments, and time to take care of themselves. Others are trying to decide whether they can afford to miss work for a doctor’s visit.

Those differences stayed with me.

When I eventually became a physician, I had spent years studying science, medicine, kidney disease, and vascular care. I had specialized knowledge that had taken a large part of my life to acquire. A question kept coming back to me. What was I supposed to do with that knowledge?

For me, the answer could not only be to build a career. I wanted that knowledge to be useful in the community that helped shape me.

Free Care Is Not Free to the Physician

People sometimes talk about pro bono medicine as if it is an easy decision. You simply decide to see a patient without charging, and that is the end of it.

It is more complicated than that.

A medical practice has employees, equipment, supplies, insurance, rent, and many other expenses. A physician also has a limited number of hours in a day. Every hour given away is an hour that cannot be used somewhere else.

I have had to think about that tradeoff.

How much can you give while still maintaining a practice that allows you to keep serving people tomorrow? Where do generosity and responsibility meet?

I do not think there is one perfect answer. There probably never will be.

What I do know is that I have never been comfortable with the idea that the ability to pay should determine whether someone deserves compassion.

Sometimes People Arrive With More Than a Medical Problem

When you work with underserved patients, you begin to notice that illness rarely arrives alone.

A person may have kidney disease, but they may also have trouble getting transportation. Someone may need a vascular procedure, but they may be worried about losing a day’s wages. A patient may not completely understand what is happening because English is not the language they are most comfortable speaking.

As a bilingual physician, I have seen how different a conversation can become when a patient can speak about their health in Spanish and know they are understood.

Sometimes the most important thing I can do is explain.

What is happening? What are our options? What happens if we wait? What should you be worried about, and what should you not be afraid of?

Those conversations take time. They do not always fit neatly into the business side of medicine, but they are still medicine.

Los Angeles continues to have organizations devoted to free and accessible care for people who are uninsured, underinsured, homeless, or otherwise underserved. That tells us the need has not disappeared.

The Recognition Was Never the Point

Over the years, I have been fortunate to receive recognition from the City of Los Angeles for pro bono medical work serving underserved and homeless people.

I appreciate that recognition. I would be dishonest if I said it meant nothing to me. When your city acknowledges work that you care deeply about, you feel proud.

But an award cannot be the reason for doing it.

There were patients long before any recognition, and there are patients after it.

That is what matters.

I sometimes think about how strange medicine can be in this respect. We celebrate complicated procedures and advanced technology, and we should. Those achievements can save lives. Yet some of the moments that stay with you are much quieter.

A patient finally understands what is happening to their body. A frightened family becomes a little less frightened. Someone who believed nobody would help them discovers that somebody will.

There is no plaque for most of those moments.

Giving Back Also Gives Something to the Physician

I do not want to make pro bono care sound romantic. It can be difficult. It can be tiring. There are days when the need seems much larger than anything one physician can possibly address.

That can be discouraging.

You help one person, then another person walks through the door with an equally serious problem. You start wondering whether your effort is actually changing anything.

I have asked myself that.

Maybe that is the wrong way to measure it.

A physician cannot solve every problem in a city. We cannot repair every weakness in the healthcare system ourselves. But we can change what happens to the person sitting in front of us.

That is smaller than fixing the system, but it is not small to that patient.

Pro bono work has also reminded me why I entered medicine in the first place. When medicine becomes schedules, paperwork, procedures, billing, and administrative responsibilities, it is easy to lose sight of the human reason underneath all of it.

Service brings me back to that reason.

What We Pass Along Matters

I hope younger physicians understand that giving back does not have to look exactly the same for everyone.

One doctor may volunteer at a homeless clinic. Another may mentor medical students. Someone else may provide free screenings, participate in community education, or dedicate part of a practice to patients who otherwise struggle to receive specialty care.

Los Angeles has a long tradition of physicians, students, hospitals, clinics, and community organizations trying to close these gaps. That work continues because the problem is bigger than any individual physician.

For me, giving back has always returned to the lesson my parents gave me.

Help when you can.

After all these years in medicine, I still wonder whether I have done enough. I suspect anyone who spends time around people in need eventually asks that question.

I do not have a satisfying answer.

What I have learned is that I would rather keep asking the question than become comfortable enough to stop noticing the need.

Medicine gave me an education, a profession, and the ability to do work that I care deeply about. Giving some of that ability back to my community does not feel separate from being a physician.

To me, it is part of the job.