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.