Meeting Patients Where They Are

October 28, 2025 - by Rebecca Handler

On a typical morning, Stanford resident physician Quan Le Tran, MD, climbs into a mobile clinic van with her attending and a team of case managers. Their destination isn’t a hospital or clinic but shopping plazas, encampments, and railroad tracks — wherever patients experiencing homelessness can be found.

“I imagined street medicine would just be a group of providers carrying backpacks,” Tran said. “In reality, it was so much more. The mobile clinic had supplies, medications, and case managers who knew exactly where to find patients. Sometimes we still carried backpacks, but often we’d open the van and invite patients in for care right where they were.”

This summer, Stanford’s Internal Medicine Health Equity, Advocacy, and Research (IM HEARs) program launched its first Street Medicine rotation, a new training block for residents to provide care directly to people living on the streets. The program, built in partnership with Healthcare in Action and LifeMoves, seeks to close persistent gaps in access to healthcare for patients experiencing homelessness.

“We see the same patients return to the hospital again and again because they don’t have access to follow-up care,” said Christine Santiago, MD, MPH, co-founder and faculty director of IM HEARs. “Prescriptions can get stolen, wound care supplies aren’t available, or transportation makes clinic visits impossible. This rotation helps residents learn a different model of care: one that goes to the patient.”

Care on the Margins

At the LifeMoves Navigation Center in Redwood City, residents see patients in on-site clinics. On other days, they join Michael Ryder, DO, medical director of Healthcare in Action, on the road. The team addresses everything from chronic conditions, like hypertension and COPD, to urgent needs, such as infected wounds or substance use disorders.

“I was struck by how resilient patients are,” Tran said. “One couple with severe leg wounds used toilet paper and menstrual pads to dress them. They were doing everything they could with what little they had.”

Some encounters are especially difficult. Tran recalled meeting a woman by the railroad tracks who had been physically assaulted and robbed. “She had lost all her medications and asked us for clothes and somewhere safe to stay,” Tran said. “We treated her injuries, renewed her prescriptions, and gave her what we could. But when we drove away, I kept wondering where she would sleep that night and if she would be safe.”

That experience stayed with her. It revealed how quickly the limits of medical care become visible when basic needs like housing, food, or safety are unmet. “A prescription can be life-saving, but not if someone has no water to swallow their pills or no secure place to keep them,” she said. For Tran, it highlighted the reality that street medicine often operates at the intersection of healthcare and survival, where the best clinical decisions must be paired with advocacy, coordination, and compassion.

A Model Built on Collaboration

Ryder stressed that the success of street medicine lies in coordination. “It depends on case managers, social workers, shelter staff, county officials, and community organizations,” he said. “When we stabilize someone medically, it makes the work of case managers and shelter staff more manageable. That collaboration has strengthened relationships and improved trust.”

The response from patients has been encouraging. Ryder described following individuals from first encounters in encampments to moving into stable housing. “Each journey is different, but what’s consistent is that patients recognize we are one part of a larger network supporting them,” he said.

A Bay Area Challenge

The Street Medicine rotation is unfolding in one of the most complex healthcare landscapes in the country. While Silicon Valley is home to the largest tech companies and some of the most expensive zip codes in the US, more than 10,000 individuals are experiencing homelessness across Santa Clara and San Mateo counties.

“This region has tremendous resources and innovation, but also profound inequities,” Ryder said. “Our homeless healthcare delivery system is still maturing, which creates both challenges and opportunities. We can learn from what’s worked in places like San Francisco while adapting those lessons to the unique realities here. The advantage we have is the ability to pair proven models with the problem-solving culture of the Bay Area.”

For Santiago, that duality is a call to action. In her role as divisional director of community partnerships in the Division of Hospital Medicine, she has worked to bring together physicians, advocates, and community leaders to create new approaches to care. She said, “This effort is part of a larger movement to look beyond hospital walls and ask: how can we as a health system better support patients facing housing instability?”

Preparing Residents for the Future

Before entering the field, residents complete Stanford’s Social Medicine Capstone rotation, which emphasizes cultural humility, harm reduction, and best practices for vulnerable populations. Ryder also meets one-on-one with each participant to discuss expectations and safety.

The Street Medicine rotation launched in June 2025. Five residents will participate in the first year, with plans to expand. Success will be measured not only by patients served but by the perspective residents carry forward. “We want them to gain the tools and insight to address health inequities throughout their careers,” Santiago said.

For Tran, the experience has already been transformative. “My time at a free clinic in Berkeley originally drew me to medicine,” she said. “This rotation reminded me of that commitment. I want to keep addressing health inequities, and I hope to stay connected with Healthcare in Action in the future.”

Looking Ahead

The program leaders envision expanding to more sites and engaging in policy advocacy to address systemic issues. They see Stanford as well-positioned to contribute to broader solutions.

“We have the clinical excellence of Stanford, the innovation of Silicon Valley, and the philanthropic capacity to make a difference,” Ryder said. “That combination creates an opportunity to build a stronger, more equitable system of care for people experiencing homelessness.”

Santiago agreed, adding that the first year of the program is only the beginning. “This is about building sustainable models of care that meet patients where they are,” she said, “and giving our residents the skills to serve those who are most often left behind.”