Everyday stories...

I'm still here! And, so is the work...

We have been implementing an EMR in our practice, or rather, RE-implementing. But that's another story, for another blog. And, in the middle of that, I'm still seeing patients a couple of days a week, at least.

So, I thought I'd share a few of the stories from the past few weeks. I think these stories help to show some of the struggles we are facing...

I am seeing a middle-aged guy for wound care, on a nearly every-day basis. ("Middle-aged" - he was born the same year I was!) He has suffered for years from gastroesophageal reflux disease - "heartburn". To the point that he was best treated with surgery. So, he had his surgery in November, and developed an infection at the wound site. The infection resulted in a four-inch long dehiscence - the surgical site opened up. This wound was about 3 inches deep. He was treated in the hospital for a while, by his surgeon, and then sent to a nursing home; he left there when he became concerned about medical errors. He was sent back to our clinic by the wound care clinic at our local (nonprofit) hospital -they didn't "take his insurance", which is Medicaid. So, I've been seeing him, in my office, nearly every day, with my partners helping on weekends, so that we can change his dressings. Looks like it'll take another couple of weeks for his wound to heal. The other day, he thanked me with a small gift, a bottle of specialty grape juice from his hometown in California. He told me that he had the impression that I was the only one who cared about him, everyone else was trying to avoid seeing him. As a family doc, and one who cares for the poor, I can say that it seems that I am often taking care of problems that others don't/won't care for...

I met a young woman a couple of weeks ago. She had been stricken by seizures about fifteen months ago. She was transferred from our local hospital to the regional medical center of a local university, and was started on medication for her epilepsy. She then enjoyed several months without seizures. This care was funded by Medicaid. Well, she came to see me because she is now uninsured. She is no longer eligible for Medicaid. You see, she hasn't had any more seizures, so she doesn't have a medical condition warranting ongoing insurance coverage. All she has to do is keep taking her medication. Oh, yeah, there is one thing. The medication costs $700 per month. And she works full-time at a minimum wage job. Let's see, that's ~$9/hour for 40 hours per week, 4 weeks a month - that's about $ 1440 per month. So, it seems she is being given a choice - pay for her meds, and skip "luxury items" in her budget, or quit her job, become unemployed, and therefore qualify for help once again...

I was on call for our practice last weekend. I got a call from the Emergency Department physician Sunday afternoon about a patient he was seeing. She was experiencing "the worst headache of her life", and had developed right facial and right arm weakness. He was calling me because there is no neurologist available to him - the neurologists in our community have elected NOT to be available for uninsured patients who present in need to the local hospital. So, he was going to send her home, and hoped that I could help her get in to see a neurologist "somewhere". All we can do is ask...

I sat with a young man in my office yesterday. He has had ongoing back pain for years, and finally got an MRI done a few months ago. He was insured at the time, so didn't imagine that he'd be burdened by the cost of the test. Well, when he presented to the radiology suite, he was told he was too big to fit in the MRI machine. But, they could do the test at their other facility, about seven miles away. He had driven himself to the appointment, and thought it was odd that they had chosen to transport him by ambulance to and from the other facility. He never imagined that, since it wasn't "medically necessary", the insurance company would refuse to pay for the ambulance ride, and he would have a $3000 bill - that's only $214 per mile...

I'm listening with interest as "healthcare reform" is discussed at rallies and debates by our presidential candidates. But, I'm not sure any of them get it. We don't need a better set of incentives, as promised by the "Pay for Performance" movement. We need more compassion for our neighbors, and less concern for the stockholders of the pharmaceutical and healthcare insurance companies.