Dr. Christine Hancock: Following the Breadcrumbs to Change Lives in Northern Washington

“One of the things I really love about family medicine is that your patients or your practice often lead you to a focus you might not have considered. I describe it as ‘following the breadcrumbs,’” said Dr. Christine Hancock, family physician and medical director of Sea Mar Community Health Centers in Bellingham, WA.

For Dr. Hancock, those breadcrumbs led to a unique county nestled between Seattle and the Canadian border where a city of 100,000 is surrounded by an equally populous farming region one and a half times the size of Rhode Island. A place that families from southern Mexico, Guatemala, Pakistan, India, Russia, and Ukraine, call home.

“I imagined myself working in rural medicine and, at first, I wasn’t sure I had come to a rural community. As I became acquainted with our patient population, however, I realized our county is very interesting from geographic and many other perspectives” Dr. Hancock said, explaining that many of her patients come from the county’s farming region, where the predominant language other than English or Spanish is Mixtec (or Mixteco), a highly diverse indigenous language that rarely overlaps with more traditional Spanish.

“There’s no other clinic in our area that specifically serves this population, and they have tremendous needs. They often don’t have transportation or documentation, and they sometimes don’t speak any Spanish,” she said. In particular, the women of this farming population face unique challenges.

“A common patient encounter I have is a woman working in agriculture or laundry who has all these aches and pains… joint ailments, tendonitis, tennis elbow. On top of the normal work they’re doing, these women are scrubbing the floors at home or caring for their kids as well. That puts a lot of strain on their bodies.”

Dr. Hancock explained that it is often difficult to recommend physical therapy or specialists because her patients rarely have time to meet those appointments. Additionally, in Mixtec households, it is common for the male partner to lead the medical visit as they may be the only person who speaks English or Spanish. “That makes it difficult to know if these women are in a safe environment or have the resources they need. We see a lot of vulnerability in our female patients, and there’s a complexity in making sure they receive adequate interpretation and treatment.”

Many who visit Dr. Hancock’s practice also struggle with chronic pain. Treatment may be challenging as those same patients often suffer from opioid use disorder as well. Physicians in the community are constantly seeking a balance between easing debilitating pain and avoiding addiction.

“We all know prescription opioids helped to develop our current opioid epidemic,” said Dr. Hancock. “Many of these patients were started on medications 10 or 20 years ago by a physician. Now a significant percentage are facing addiction. The medical community has a responsibility to these patients. We can’t just disregard them and say ‘Good luck. We can’t help you now.’”

Dr. Hancock’s clinic has worked with the Six Building Blocks program at the University of Washington to develop evidence-based roadmaps designed to guide primary care teams in implementing effective, guideline-driven care
for chronic pain and long-term opioid therapy patients. Additionally, Dr. Hancock has been trained in Suboxone treatment for opioid addiction.

“The area I grew up in struggled with methamphetamine use, so this is a topic that’s close to my heart,” she said. “After I started treating patients with buprenorphine, I learned what recovery actually looks like. It’s been amazing to see patients’ lives turn around.”

These formidable experiences led Dr. Hancock’s to help start Sea Mar’s Medications for Opioid Use Disorder (MOUD) program. MOUD treatment combines the use of FDA-approved drugs with counseling and behavioral therapies for patients diagnosed with opioid use disorder. Since its inception in 2017, Sea Mar’s program is now active in seven clinics across western Washington, with intentions to spread it to 32 in the coming years.

“It’s been exciting to work on and also hugely educational as I’ve had to develop new skills and abilities that I didn’t learn in medical school,” said Dr. Hancock, who serves as physician lead on the project. “That’s partly why I love family medicine. I like to challenge myself, push my limits, and learn new things.”

So far, the breadcrumbs she followed have led Dr. Hancock to a busy but rewarding life of service in Bellingham. When not practicing medicine, Dr. Hancock enjoys being outdoors with her husband, two children and dog named Tango. The family are avid cyclists, hikers, and campers.

Thank you, Dr. Hancock, for speaking to ABFM about your patients and practice!