Sunday, January 17, 2010

No Insurance, No Physician, No Medication

No insurance, No physician, No medication

They arrived early - before the doors opened. The National Association of Free Clinics had organized a one day medical clinic in Little Rock Arkansas provide free care to anyone without health insurance.

Volunteers, health professionals and others, came from around the country to provide their services.

I came from Boston where I have practiced primary care medicine for the past thirty-three years. I was asked to triage the registration line for anyone needing urgent care. As the line grew, I made my way through the crowd.

Many were working. Others had been laid off. None had health insurance. Five men had untreated blood pressures greater than160/100. Current practice treats pressures greater than 140/80. Two said they had not seen a doctor in two years and the others had never seen a doctor. Either they did not have cash or insurance. Those who had been to the doctor could not afford to fill their prescriptions.

A man with a below knee amputation was in a wheel chair. He hoped the clinic would assist him to obtain the prosthesis his medical insurance had denied devastating hopes to walk again and return to his job and be able to provide his family.

A woman grimacing in pain had cancer treatment two years ago but was unable to continue treatment without insurance. No insurance, no physician, no medication.

Another woman was wearing a trench coat to cover her emaciated frame. She had come without an appointment. Her concern was having three seizures in the past two weeks. A local emergency room where she had sought help told her that the level of her seizure medications was “OK” and then discharged her. No follow up was arranged. During her seizures she had bitten the inside of her mouth that she barely opened. I could not see an intact tooth in her smile. She could not eat.

A young man with labored breathing and sweaty brow was slumped in a wheelchair. His weak voice told me five days ago he was in the intensive care unit of a local hospital for swelling. He did not understand why his legs had swelled then or why the swelling recurred. For a month, he experienced chest pains walking across the room. He needed three pillows to avoid awakening from sleep breathless. At discharge, he was handed a list of unaffordable medications that he did not understand. Continuing care was not arranged. HHe was had an unstable heart condition I wheeled him to the front of the line.

An ambulance was called. He was taken back to the emergency room with a possible heart attack. Why was this man’s leg swelling and chest pains not completely evaluated before discharge. Because he did not have health insurance? Had the free clinic not occurred and his daughter not insisted that he come to the free clinic, he may have dropped dead!

A young man tried to avoid eye contact. His slouched posture said he did not want to talk, but had something to say. Afterwards, I learned the plans to commit suicide of three young people had been averted. Surely he was one. Would they have completed their plans were it not for the free clinic?

The day was overwhelming. I knew that I was in Little Rock, but it felt like I was in a remote undeveloped country. I had seen patients with this burden of illness, but that was 40 years ago in medical school.

The American Medical Association claims to support health reform, but they were not in Little Rock. Absent was the American Association of Medical Schools planning the education of tomorrow’s physicians remote from the health crisis of today. My profession shames me.

Absent were the politicians, bragging with self-righteousness, that they cannot support a ‘public option’ for a multitude of hypocrisies and fictions, as they reform our health system without reforming health insurers.

The cost of reform is not the question. We already incur the expense with the loss of manpower. The question is how much it will cost not to reform. The question is equality. The question is how we value our neighbor. The question is how long our nation will allow 43 million citizens to be marginalized. The question is of how we see ourselves.

Can one honestly believe that without a public option private insurance companies will write policies to alleviate the suffering I witnessed in Little Rock.

Ralph B Freidin,MD

Lexington, MA

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