Years ago, when I worked as a certified nurse-midwife in a federally qualified health center in the South Bronx in New York City, I worried: Was I actually helping the women that I cared for? 

While I provided prenatal, gynecological, and primary care, I often felt I was just scratching the surface of what patients really needed. I prescribed antibiotics for the woman with a urinary tract infection, but what about that black eye? For the 16-year-old pregnant teen, I could make sure her baby’s heart rate was normal, but she was living in a shelter because her family had kicked her out. To ignore the “non-medical” issues that profoundly affected my patients’ health made me feel like I was applying band-aids to gaping wounds. We could refer some patients for behavioral health and social services, but access was inadequate, and care was siloed and uncoordinated. The care we provided was, by traditional medical standards, high quality, but it was not truly person-centered.

This blog post by Karla Silverman, MS, RN, CNM, senior clinical officer at the Center for Health Care Strategies (CHCS), relates her first-hand experiences as a nurse-midwife to explore the need and opportunities for a different care model — a reimagined approach where clinicians work together with the people they care for to fully understand their health needs. CHCS is a nonprofit policy center dedicated to improving the health of low-income Americans, and this blog post is a part of the Advancing Integrated Models initiative, made possible through support from the Robert Wood Johnson Foundation.

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