Dollars and Sense
The issue of personal finance affecting the standard of medical care is forefront in my thoughts due to my experiences with a few patients this past week. During my Medicine clerkship this issue didn't come into play, as all patients had either insurance or qualified for free care in the hospital. Here in Middletown, Connecticut I'm seeing quite a few uninsured patients - whether these patients can afford the health care that their providers deem necessary becomes quite a barrier.
The first patient was a 55-year old woman who came in with severe epigastric abdominal pain - history and labs led to the conclusion that this was a classic presentation of gallstone pancreatitis. Ultrasound confirmed the presence of many small stones within her gallbladder. Standard medical care for a case like this is a cholecystectomy, preventing recurrence of further episodes. Upon presenting this information to her, the patient became visibly upset. She explained that she had only just finished paying off almost $1000 in dental bills, and it was clear that the cost of the procedure (in addition to several days in the hospital) was going to be difficult on her family's financial situation. We assured her that the hospital would her come up with a solution, but it feels like such an empty reassurance. I get upset with the cost of repairing my car - which is chump change to the cost of health care most of the time.
The issue arose again, this time when I was in the OB/GYN clinic observing a prenatal visit. Earlier in the pregnancy, an ultrasound of the fetus suggested a heart abnormality, but the report was inconclusive because the fetus was rotated at an angle that made it difficult to visualize. Echocardiogram was recommended, but the family declined at that time due to the cost of the test (this family had insurance which would not cover a fetal echo). A later ultrasound, this time at 30 weeks gestation, hinted that the abnormality might be transposition of the great vessels. (Briefly, in a normal heart the aorta leaves the left ventricle and the pulmonary artery leaves the right. In the aforementioned condition, these vessels are switched, a serious life-threatening congenital defect. Neonates essentially have to go right to the operating room to correct this abnormality if they're going to survive.) While management of this condition might not be changed with an earlier diagnosis, at least the family would have had more options at the time.
Perhaps I could conveniently ignore the issue during previous clerkships, but it weighs pretty heavily when economics plays such a prominent role in decision-making. It also makes me wish that I'd done a Masters of Public Health rather than the MD/PhD. So...Cathy, I'm looking at you to solve the economic problems in the health care industry. Have at it.
The first patient was a 55-year old woman who came in with severe epigastric abdominal pain - history and labs led to the conclusion that this was a classic presentation of gallstone pancreatitis. Ultrasound confirmed the presence of many small stones within her gallbladder. Standard medical care for a case like this is a cholecystectomy, preventing recurrence of further episodes. Upon presenting this information to her, the patient became visibly upset. She explained that she had only just finished paying off almost $1000 in dental bills, and it was clear that the cost of the procedure (in addition to several days in the hospital) was going to be difficult on her family's financial situation. We assured her that the hospital would her come up with a solution, but it feels like such an empty reassurance. I get upset with the cost of repairing my car - which is chump change to the cost of health care most of the time.
The issue arose again, this time when I was in the OB/GYN clinic observing a prenatal visit. Earlier in the pregnancy, an ultrasound of the fetus suggested a heart abnormality, but the report was inconclusive because the fetus was rotated at an angle that made it difficult to visualize. Echocardiogram was recommended, but the family declined at that time due to the cost of the test (this family had insurance which would not cover a fetal echo). A later ultrasound, this time at 30 weeks gestation, hinted that the abnormality might be transposition of the great vessels. (Briefly, in a normal heart the aorta leaves the left ventricle and the pulmonary artery leaves the right. In the aforementioned condition, these vessels are switched, a serious life-threatening congenital defect. Neonates essentially have to go right to the operating room to correct this abnormality if they're going to survive.) While management of this condition might not be changed with an earlier diagnosis, at least the family would have had more options at the time.
Perhaps I could conveniently ignore the issue during previous clerkships, but it weighs pretty heavily when economics plays such a prominent role in decision-making. It also makes me wish that I'd done a Masters of Public Health rather than the MD/PhD. So...Cathy, I'm looking at you to solve the economic problems in the health care industry. Have at it.
*******
What I'm listening to now: A Momentary Lapse of Reason, Pink Floyd
posted by Mikey at 6:53 PM
4 Comments:
Yah, uh-huh.
You may not have gotten this from my previous postings, but...
I'm tired of being in school.
Anything that prolongs my "student" status is to be avoided at any and all costs.
You know my solution to this issue, Mikey. Love you. K.
What - Kill all the lawyers?
I think that's a bit extreme.
That's right. We could smother them all under the corpses of condescending doctors. How many doctors do you think that would be?
;)
You know I love you, Mikey.
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