At 8 years old, Jeremiah “Jay” Truel followed his dad’s lead walking near their home in downtown Milwaukee. Dotting the streets, people without homes waved and offered “hellos” to the father and son. His dad smiled and waved back, so Truel did, too. Often, his dad asked how they were doing. Truel did, too.
“Nice meeting you,” the young Truel said, waving goodbye as he and his dad continued their walk.
“It might seem small, but seeing my dad engage without the fear or derision that society tends to direct at people who are unhoused has greatly informed not only my approach to medicine, but my overall values,” said Truel, who soon will earn a medical degree from Washington University School of Medicine in St. Louis. “My dad volunteered his time with a local food bank, and I saw how he treated people living on the street with respect.”
These experiences influenced Truel to co-found StreetMedSTL. The nonprofit comprises interdisciplinary physicians who go to encampments and shelters to provide medical care, support and illness-prevention strategies. Since it began in 2022, StreetMedSTL has treated more than 1,000 patients.
In 2023, Truel founded Unhoused Health, aimed at training nearly 100 medical students in trauma-informed care that addresses the unique needs of that community.
With both groups, Truel said he led like his dad — by example.
In July, Truel will begin his residency in dermatology at New York-Presbyterian Hospital, affiliated with Columbia University in New York City.
Why are you interested in dermatology?
I went to undergrad at WashU, where there are a lot of pre-med kids. It felt as if, from day one, they wanted to be a doctor. They had this intensity for medicine I didn’t have because I hadn’t been exposed to it. I thought maybe my lack of intensity was a sign I shouldn’t be doing medicine. But I decided to shadow a dermatologist after my sophomore year at WashU. And it felt like everything I was looking for in terms of being able to help vulnerable people — to walk them through scary times and times when people are looking for guidance, but are unsure of who to trust.
Why is dermatology so important for people without housing?
If you think about somebody who is unhoused — it’s in the word — they are living without a structure around them. Their skin takes on this new importance and meaning. It’s the barrier between them and the outside world. But the skin also receives an onslaught of environmental aggressors, for example ultraviolet damage or weather in general. We also have a sizable number of unhoused patients who compromise their skin barrier by injecting substances. As a result, dermatologists deal with a lot of open wounds. From a prevention aspect, these wounds are treatable with antibiotics and wound care, if caught early. But oftentimes people who are unhoused, especially those with injection-site wounds, feel dismissed by the medical system. They’re reluctant to seek medical attention. Unfortunately, then, these wounds can grow and kill the skin tissue. They can also infect the muscle and bone underneath. It can lead to disfigurement, loss of limb, chronic pain, sepsis and death. It’s important to treat these wounds as quickly as possible, and often they aren’t treated because this population feels unheard in an emergency room or doctor’s office.
What qualities make a good leader, and how will you integrate those into being a physician?
A good leader has qualities such as adaptability, grit and determination. Communication is also important. But the curriculum at WashU Medicine also emphasizes well-being, and this, too, is essential in leadership. As a physician, it’s important to acknowledge how physically and emotionally demanding this work can be.
A good physician and leader recognizes that all voices matter. Sometimes, patients are the ones we need to listen to the most. I never want to act like I have all the answers. Everyone has unique perspectives and experiences that need to be considered. Because neither the patient nor the physician can walk these paths alone. We need each other.
