American College of Physicians: Internal Medicine — Doctors for Adults ®


Doctor follows Golden Rule to overcome cultural divide

Infectious diseases expert is guided by respect in caring for Nashville’s growing immigrant population

From the June ACP Observer, copyright © 2006 by the American College of Physicians.

By Christine Bahls

In the Nashville faith-based primary care clinic he helped found more than a decade ago, David W. Gregory, FACP, has to go beyond complex diagnoses. He also has to clear major language and cultural hurdles treating an immigrant population that has suffered "enormous hardships."

In a primary care clinic he helped found, David W. Gregory, FACP, treats a population that has suffered 'enormous hardships.'

He mentions one middle-aged Vietnamese patient who waited a year—"until he trusted me"—to have his congenital atrial septal defect fixed. He talks about a young Vietnamese woman misdiagnosed with cervical cancer in her own country where such a diagnosis is invariably terminal.

"She wouldn't seek medical care because she was sure she had a fatal illness," said Dr. Gregory. "Finally, members of her community encouraged her to come, saying the doctors here loved their patients. We were able to assure her that she was cancer-free."

It is hard, he added, to provide the necessary cultural competence when treating patients from more than 100 countries. "But being respectful and observing the Golden Rule gets you a long way. So does being modest and humble. "For his efforts, Dr. Gregory was honored at Annual Session this year with ACP's Oscar E. Edwards Memorial Award for exceptional volunteerism and community service.

Planting a seed

An associate professor of medicine at Vanderbilt University School of Medicine and a staff member at Vanderbilt University Hospital and Nashville VA Medical Center, Dr. Gregory first got the idea for the clinic after seeing native Tennesseans struggling to get adequate health care at the city hospital.

"I wanted to be able to address, in addition to the biomedical aspects, the spiritual and psychosocial aspects," of care, he said.

He talked to a like-minded nurse from his church in 1989. Two years later, he had helped put together a board of directors, $20,000 in seed money and a handful of volunteers to open the 1,000-square-foot Siloam Family Health Center.

Today, the annual budget of Siloam—a Hebrew word that means "sent"—exceeds $1 million, secured from local foundations, dozens of churches and individual contributions. It has 14 paid providers and at least 200 volunteers. It just opened a new clinic with 12 examining rooms and space for diabetes-management education classes.

Volunteer specialists see the toughest cases in their private offices while Vanderbilt takes on 12 cases a year gratis and other Nashville hospitals donate diagnostic tests. Siloam this year anticipates having 12,000 patient visits.

What wasn't anticipated when the center first opened was how fast Nashville's immigrant and refugee populations would grow. Most of these patients earn minimum wage or less, and don't qualify for the state's TennCare program, started in 1994 to replace Medicaid.

The center provides formally trained language interpreters in Arabic, Spanish and Vietnamese who stand behind the patient in the examining room. The doctors are trained to keep their eyes on the patient, ask simple and straightforward questions, and observe a patient's body language.

A teacher first

Dr. Gregory spends at least 75% of his time educating medical students and residents. An infectious disease specialist, he lectures first-year students about microbiology and immunology, and consults with older students about infectious diseases on the wards at either the center or the VA hospital.

Second-year students interact with him at Siloam on Monday nights, when he volunteers. Students not only see exotic cases such as malaria and leprosy, but also are exposed to health care systems from other countries.

One current staff member, Morgan J. Wills, FACP, first volunteered at the clinic as a student, while one of the clinic's board members is going back to her native China to start a clinic there. It is that kind of commitment that leads Dr. Gregory to cite his many colleagues' contributions when speaking of the awards he wins. "I feel," he said, "undeserving."


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