Medicine at the Margins of Society | James O’Connell, MD

Jul 25, 2025

Dr. James O'Connell is a pioneering physician and founding president of the Boston Healthcare for the Homeless Program, focusing on providing healthcare for the homeless. He shares impactful stories from the streets, highlighting the challenges of treating patients with complex conditions amid unstable living situations. Dr. O'Connell emphasizes the need for empathy and relational care, reflecting on personal experiences that shaped his approach. He advocates for comprehensive support systems and the importance of building trust with marginalized communities to create effective healthcare solutions.

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ANECDOTE

Unexpected Path to Homeless Care

Dr. O'Connell started working with homeless populations unexpectedly after residency due to a city grant.
He transitioned immediately into challenging work caring for homeless with TB and AIDS, which reshaped his career.

INSIGHT

AIDS Care Transformed Over Time

Early AIDS epidemic care among homeless was chaotic, with high mortality and lack of treatments.
The onset of protease inhibitors transformed HIV/AIDS from a fatal to a manageable condition for many.

ANECDOTE

Tragic Misdiagnosis of Homeless Patient

A homeless man with AIDS symptoms was dismissed as malingering in the emergency room and died shortly after.
This tragedy highlighted deep barriers to correct diagnosis and care for homeless with serious illness.

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Imagine practicing medicine not within the sterile confines of a hospital, but in the unpredictable world of city streets and shelters, where every patient encounter challenges conventional notions of care, empathy, and human dignity. We explore this reality through the extraordinary journey of Jim O'Connell, MD, whose groundbreaking work with Boston's homeless population has profoundly reshaped health care for society's most marginalized individuals.

Dr. O'Connell is the founding president of the Boston Healthcare for the Homeless Program and an assistant professor of medicine at Harvard Medical School. In this episode, Dr. O’Connell shares stories from his extensive frontline experience, detailing the unique challenges of treating patients facing complex medical and psychiatric conditions exacerbated by unstable living conditions. From addressing devastating public health crises such as AIDS and tuberculosis to establishing consistent mental health care, he provides profound insights into what makes healthcare effective for homeless populations. He also reflects on a formative early experience — being asked by nurses to wash patients feet — that deeply influenced his understanding of empathy and the essence of medical service. Through these reflections, we gain a powerful appreciation for the depth of patience, relational care, and respect required in caring for vulnerable communities.

In this episode, you’ll hear about:

2:00 - Dr. O’Connell’s unexpected path to medicine

11:34 - The distinction between a “country doctor” and a doctor who works in an academic setting

13:42 - How Dr. O’Connell began working with homeless populations

20:30 - The difficulties doctors faced in the early years of the HIV/AIDS epidemic

29:14 - Navigating the compounding challenges of access and continuity among the homeless population

37:12 - What has kept Dr. O’Connell dedicated to treating this population for 30+ years

51:24 - Dr. O’Connell’s recommendations to clinicians on how to compassionately serve the homeless

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