Personal Physician

Emily Dow could have gone anywhere--a posh private practice, a secure HMO position.

But instead, the soft-spoken physician works long hours navigating the turbulent world of inner-city medicine.

In a spartan gray building straddling a corner of San Pedro Place in South-Central Los Angeles, Dow spends her days maneuvering through the narrow maze of halls and exam rooms squeezed into the crowded structure, hurrying past crying children and a flurry of conversations in Spanish.

Dow, the new medical director at the South-Central Family Health Center, is trying to maintain the tradition of old-style family doctoring in a community starving for physicians and facing stiff hurdles in preserving access to health care.

In this mostly Latino community, there is only one primary care physician for every 5,000 residents, a mostly low-income and uninsured population. (In Santa Monica and other more affluent communities, there is often one primary care physician for every 1,000 residents.) The ZIP code the clinic falls in--90011--has the highest rate of teen pregnancy in the state. And the nonprofit health center is the only community clinic in the area.

Dow said she can’t imagine being anywhere else.

“I just wanted to be involved in doing something of universal need and concern,” said Dow, 39. “I walked in the front door and it struck me as the place I belonged. This is a community clinic in the truest sense of the word. When I drive to work, I see my patients walking their kids to school. We know the families, not just one person.”

Dow--who was born in South Korea and moved to the United States when she was 10--said the clinic has provided the environment she was searching for when she entered medicine: a place that serves those with the most urgent need. Founded in 1981 by a doctor and a nurse practitioner who wanted to create a nonprofit health center, the clinic relies on Medi-Cal reimbursements, private donations, government contracts and patient fees to stay afloat. Last year, the center served almost 5,000 patients who visited a total of about 18,000 times.

Dow was promoted to medical director in December after working as a staff physician for a little more than a year. She came to the clinic right after her residency at Harbor-UCLA Medical Center’s Department of Family Medicine. Now, Dow juggles her new position with her duties as a full-time physician at the center and her role as a faculty member at USC’s Department of Family Medicine.

The balancing act is a feat in itself, she said, but it is even more difficult because she tries to give each patient personal attention and consistent care--with only about 15 minutes per person.

Her patients say it works.

Maria Luisa Montoy rides two buses and two Metro Rail lines from her North Hollywood home to reach the small clinic in South-Central Los Angeles, where she gets prenatal checkups every month.

The journey takes her two hours, but Montoy, who is eight months pregnant, makes the trek because she says the doctors treat her with a special kind of personal care.

“I went to a clinic up there [in North Hollywood], but I didn’t like how they treated me,” said the 27-year-old woman, who relies on Medi-Cal for health care. “They didn’t explain things and sometimes I didn’t understand them. Here, they treat you well.”

She smiled fondly as her son Eric, 2, wriggled on the seat next to her in an exam room. “They ask how I am. They call me if I miss an appointment,” she said in Spanish. “They care.”

The clinic is bracing for federal and state policy changes that will affect who will continue to qualify for medical benefits.

Looming federal welfare cuts and a state ban on prenatal care for illegal immigrants, the latter tied up in the courts, cast a shadow on daily activities at the bustling center.

“I think the best way to describe the challenges our clinic and others like it face is like being on a roller coaster with tracks that change between every cycle,” said John Kotick, the executive director.

In an effort to keep up with changes, the center plans to expand its appointment hours and to open a new site, and officials are considering creating a fee-for-service prenatal care system with California Hospital Medical Center to continue serving residents even if they are cut off from state aid.

Dow inherited her drive for both social justice and medicine from her mother, who supported her five-member family by working as a registered nurse.

“She’s always taught us community service,” Dow said. “She’s had an attitude that we’re part of the community, and that when we see injustice being done, we have to correct it.”

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At the center, Dow takes that lesson to heart and says she wants to use the clinic to effect change in the community and people’s attitude toward health care.

“I feel like if we are going to make a difference, we have to stop them here with preventive medicine before we see them at the county [emergency room],” she said. “This is where we can make the impact. It’s not enough just to treat--we have to educate and empower.”

The women who make up the majority of her adult patients often come in suffering from depression or are beaten down by their circumstances, she said.

“When I try to tell them how they are in charge of their own lives, that they do have options. To them, it’s as though they’ve never heard those words before,” Dow said. She encourages them to stand up for themselves and pushes the teen-age mothers she treats to finish school.

Sometimes, the days are rough, with too many patients and too little time or resources to treat them. “But every day there’s at least one patient, who for one reason or another, reinvigorates my desire to stay with the program,” Dow said. “The humanity of the people is something that really keeps me going.”

The Beat

Today’s centerpiece focuses on Emily Dow, the new medical director of the South-Central Family Health Center. The nonprofit community clinic provides old-fashioned family doctoring to a mostly low-income population. For more information, call (213) 233-1626.