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MODULE 2:  Ethical, Quality Volunteering

Role of the Volunteer

Community health volunteers help reduce barriers to sustained health care in underserved communities. Their role is to raise awareness through education, provide logistical help, connect patients with health care resources such as free health coverage programs, aid with relevant health screening tasks, and more, all while maintaining enthusiasm and humility.

Training

Proper training is essential for volunteers. Well-prepared volunteers can make an immediate, high-impact difference in increasing awareness about and reducing barriers to health care. Before beginning, volunteers who will work in underserved communities need to be apprised of demographic and cultural norms to facilitate interaction and communication with patients. The other component to their training is more pragmatic. Volunteers must be competent to carry out their duties, which may include publicizing free health coverage programs, providing education, performing appropriate health screenings, teaching about the importance of regular health care, and more. Incompetent volunteers can do more harm than good by propagating false information or by interfering with proper medical care. All volunteers for community health programs must therefore have a basic knowledge of available health resources, as well as best practices in public health.

Worst Practices in Community Health Volunteerism

Despite good intentions, it is possible for volunteers to do harm through community-based health efforts in underserved areas. Student-run clinics in needy communities are an example of such health care efforts. While physicians at these clinics can and often do provide quality medical care and education to those who otherwise wouldn’t have access, they can cause harm if organizers have not carefully considered relevant matters of volunteer training and ethics.

“Depending upon the organization and operation of a particular student-run clinic, unintended, counter-productive lessons that might be conveyed verbally or non-verbally include:

• It is acceptable to provide less privacy to patients living in poverty.
• It is acceptable to provide lower quality care to patients living in poverty (e.g., using expired medications, practicing with few opportunities for specialty referrals).
• Doctors should focus on medical issues and avoid talking explicitly about non-medical issues affecting their patients' health.
• It is preferable for students to learn by practicing their skills on people living in poverty.”(1)

It is important that community-based involvement is not seen by student volunteers as an opportunity to practice clinical skills on unknowing medically underserved community members. Volunteers should be prohibited from using community members to practice skills. A volunteer's role should be to connect community members with resources to receive quality care by a doctor. 

“Over-practicing”

Volunteers must fully understand that they are not permitted to participate in any activities that could constitute the unauthorized practice of medicine. Working in underserved communities gives many medical students and volunteers valuable clinical exposure, and it is easy to falsely believe that giving some care is better than giving no care. Practicing beyond one’s training not only has the potential to be fruitless, it can often cause significant harm including misdiagnosis, administration of counterproductive or unsafe treatments, and missed diagnoses. In his examination of student-run clinics, Dr. David Buchanan observed the consequences of over-practicing:

“Depending on the resources available, patients may receive diagnostic evaluations or treatments that would be considered unacceptable within the traditional medical system.”(2)

While volunteering in underserved communities can be a productive and profound learning experience for students and volunteers, patients are not a means to learning or practicing procedural skills. Underserved patients must be given the same rights and dignities as private, paying patients.

Giving the illusion of comprehensive medical care

When a resident or physician sees patients outside their standard clinical environment they cannot be accused of practicing beyond their skill set. Even the best-trained physicians, however, cannot perform a complete medical exam without the proper equipment. When a doctor sees a patient, no matter how cursory the examination, the patient will think they have received a “doctor exam.” This is especially true when the patient is not accustomed to regular doctor visits and doesn’t know the extent of a complete exam. No matter how firmly volunteers, students, or practitioners insist that the patient must obtain a complete doctor’s exam, the patient is unlikely to seek care if they believe they have already been examined. In this way, medical professionals who see patients outside a clinical setting are preventing patients from obtaining health care. Ultimately, the goal of community-based health organizations is not to provide comprehensive medical care, but rather to connect underserved patients with resources that reduce barriers and encourage them to seek continuous, quality health care.(3) Such comprehensive care can only be provided by doctors in a clinic setting, where all equipment is available. 

Module 3: The Importance of Care By Doctors>>

Footnotes

Public Health Course

• Table of Contents
• Module 1
• Module 2
• Module 3
• Module 4
• Module 5