The Constant Battle
Ben Ferguson -- It’s the most frustrating thing, really, to be in this position, to see it from their side for once. It’s a perspective they don’t explicitly offer in medical school within the bowels of biochemistry or pathophysiology or even the social context of medicine. I’ve had a few personal health issues come up recently -- not too serious, but serious enough that it definitely would have been mind-easing to have been seen by someone -- but because I’m poor, because I’d rather, if I must, spend large amounts of what money I do have on other things, and because my school’s insurance policy and inevitable red tape are so unbearable as to be less convenient to deal with than limping around all day, I’ve decided to largely opt for watchful waiting for pretty much everything that’s wrong with me.
And that is not good. That can never be a good thing.
I’ve never been in a position like this, but it really makes you empathize with patients you see on the wards who, at first glance, frustrate the hell out of you for seemingly having chosen to let their diseases go for as long as some of them have. My medical school happens to be in a pretty bad, pretty indigent part of town, which is bittersweet for us medical students. Sweet in that our clinical training is diverse, detailed, and not in any way cookie-cutter. Very bitter, though, in that such benefits come entirely at the expense of patients’ health. A huge reason our clinical training happens to be so good and varied is a direct result of the indigence of the surrounding population, simply because few around here can afford to pay for any of the procedures and medical attention they absolutely need, and so they make a difficult, conscious choice to opt out of medical care until it literally becomes a question of life or death.
While I’m not quite at that stage, I’ve caught a glimpse of this in my current scenario. It’s simply not worth it to me to spend several hundred -- if not several thousand -- dollars for referrals and physical exams and the briefest, most disengaged clinic appointment and imaging leading to a potential diagnosis of something I’m pretty sure I can diagnose myself, and something that would only present me with opportunities to spend even more money on treating the problem down the road, which itself may or may not be self-limited or all that detrimental to my overall health status in the end. It’s made me realize that patients I see -- patients everyone probably sees -- make value judgments like these all the time. Every time an appointment is made, you can be sure there was an internal conflict over whether the illness itself or the cost of attending to the illness would be more deleterious to their landlord’s quality of life.
Sometimes, things are just too expensive to fix, and so you live with them as long as you can.
As a medial student with multiple health problems I certainly value a patient's need to ponder over a visit with an MD or a great loss of money and no answer. What may be worse is the problem can be self diagnosed and should not need a $150 office visit for a consultation and 'cure'. If I ran to my own Cardiologist every time I had a new bout of angina or numbness in my left arm with chrushing chest pain I wouldn't be able to afford meical school or even eating for that matter. I hope when I am finished with my residency in Family Practice that I find a position where I can actually 'PRACTICE' medicine, and one of its most valuable skills - listening to the patient. Not many of my fellow students will agree with what I amabout to say, but I want to work where a pig on a rope, a new fence around my house, or even home made apple cider could be an acceptable payment. Then, maybe my patients will come in when they need to and not neglect the care they need for lack of ability to pay for it. On the top shelf of my desk are 108 pages of EOB's from May alone. God help our patients because the medical system as it exists can't. As for being a douche bag and going to a doctor, I'd rather pay 50 cents for a bottle of vinegar and use a douche bag up some pompous student's ass!
Posted by: Wanda Epley | Jun 24, 2008 10:36:53 PM
Your post is confusing. I'm not sure how things are at the vaunted University of Chicago (gasp!), but I thought every medical student was required to obtain health insurance, and that this was covered in the student budget (I know this is so at every school I considered going to).
Also, I must ask, what do you mean when you describe yourself as poor? I receive no assistance aside from loans (which, as a md/phd student you don't even have to worry about) and my wife and I (easily) qualify for food stamps, but I would never describe myself as "poor". Even though my wife suffers from a chronic condition (despite her young age and impecible health, otherwise) we've managed to keep up with all recommended health care without a problem. Having seen enough poverty-striken patients during (and even more before) my time as a medical student, I would never compare out situation to theirs.
Frankly, your post stinks of unmistakable egoism. As someone who has access to an almost unlimited steam of credit, I can't imagine how you can compare yourself to people who have to decide between medical care and food for their children.
Posted by: brian | Jun 25, 2008 8:41:03 PM
Wow, Brian, I'm sorry I've offended you so. To address your initial point, there's a difference between having an insurance policy that actually insures you and one that is called insurance but doesn't really pay for much of anything and makes you jump through holes to get reimbursed, provided you're even eligible for reimbursement.
Guess which type I have? (To their credit, they're switching providers and expanding coverage immensely next year.)
As for the rest, I'm not equating my situation to those of patients I've seen. I'm saying I can better empathize with them now that I've had some similar experiences and thought processes. Relax. I don't know what your financial situation is like, nor do you know mine. A dual degree program doesn't make life free of worries or financial strain, and I do have loan repayment looming, in fact.
Regarding the word "poor," my apologies. It's a word I admittedly throw around a lot to make light of the fact that I'd rather have a little more money. (Wouldn't we all?) Insofar as I don't have to choose between medical care and feeding myself, no, I'm not that poor.
Posted by: Ben | Jun 26, 2008 11:33:06 AM
This is just the main reason why I will never, never work in your country...here in Italy, medical care is free for anybody (if you aren't old or poor, or suffering from a chronic condition, you just have to pay a little amount of money, e.g. 25 dollars for an ultrasound or a consult). And I think the quality of our health system is simply excellent. Sincerely I don't know how you can bear that.
Posted by: mollybloom82 | Jun 27, 2008 12:23:05 AM
Being from South Africa - where two very distinct health systems co-exist - I can sympathise. On the one hand you can try the public health system, which is free of charge. Unfortunately you would need to have a lot of time on your hands, as you queue for you turn without a guarantee of being helped within the next eight hours (or, for that matter, being guaranteed the availability of medicine). The other option is very expensive "private" health care (with most/all the bells and whistles available to the Western world). Obviously you need money/ insurance (plus patience in dealing with the red tape) for that. The problem comes when you have neither time nor money -like many medical students?
The paragraph I identify with most is the third one, about learning/ seeing incredible things at the patient's expense. I see and experience things that the developed world only reads about in books, whilst being in the incredibly fortunate posistion of being able to go home - living the same life as what most of you do: running water, electricity, sewerage system, TV, internet... My patients do not have the same good fortune, but their misfortune is making me a better doctor than what I would have been had I been training anywhere else. Life is not fair.
Posted by: Elsje | Jun 27, 2008 2:42:02 AM
Thanks for this one. I´m not sure how we deal with our medical system either, I guess we just have to because we are trapped, but it´s a shame that physicians aren´t more vocal about changing the system.
As a young single mother, I have very often been on the "other side" of care. My children were covered by state insurance, but I was not. My valid concerns about my health and my children´s health were often ignored because I was flagged as a "welfare mom" the minute I walked through the door. After a screaming match with a resident in the Peds ER, who had directly lied to me about why she needed a blood sample from my 8 month old son (she had dropped the vial, but said something was worrysome with the initial test), she apologized PROFUSELY after I told her I was in nursing school, saying she had second guessed my judgment because she didn´t realize I had medical experience. This made me even more angry, a patient should be treated with honesty and respect because they are a human being, not because they do or do not have a medical background or financial security.
I am currently a second year medical student. Although these things (and many others) have been very frustrating for me to deal with, they make me 100% empathetic to patients I see now. I hope I never become so callous as to judge a person (or not provide care) based on their ability to pay or not. I have been in their shoes, and it is a very tough road to walk.
As a medical student, it´s much easier to deal with my health issues, I just ask a professor, and as of now, no one has refused to help me, and they never charge. Maybe ask a prof you trust if they could help you out, given your current circumstances, they are usually very understanding.
Also, another terrible thing about our medical system is the crushing debt most of us will graduate with. I plan to work mainly in underserved communities, probably overseas, not a career option that´s known to pay well. I fear I´ll be stuck in a big hospital in the U.S., dealing with an insurance system I despise, just to be able to afford my loan payments. I know there are ways around this, loan forgiveness, etc., but I just hope I can make something work. And if not, I guess I can just ask Angelina Jolie if she´s interested in helping out a financially strapped single-mom/doctor work in Africa. She might be up for it!
Posted by: shauna | Jul 1, 2008 6:13:22 PM
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