Lexington Minuteman Feb 4, 2010

Freidin: Suffering continues while reform in D.C. collapses

By Ralph B Freidin, MD

GateHouse News Service

Posted Feb 05, 2010 @ 08:42 AM

Lexington —

The line formed long before the doors opened. As a primary care doctor, I had come to help the National Association of Free Clinics run a two-day medical clinic in Kansas City, MO. Previously, they had had clinics in New Orleans, La. and Little Rock, Ark. All were organized to provide free services to anyone without health insurance.

Volunteers and health professionals came from around the country.

I came from Boston where I have practiced primary care medicine for 33 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.

Most were working. Others had been laid off. None had health insurance. Half had not seen a doctor since 2000. A third did not go anywhere. They did not have insurance or cash. Those who had seen a doctor could not fill their prescriptions.

A man with a below knee amputation rested in his wheel chair. His medical insurance had denied his prosthesis. He hoped the clinic could assist him in obtaining a prosthetic leg so he could return to work and care for his family.

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

A trench coat covered the emaciated frame of another woman. She had had three seizures in the past two weeks. A local emergency room told her that the level of her seizure medications was “OK” and discharged her. No follow up was arranged. During her seizures she had bitten the inside of her mouth. She could barely open it. There was not an intact tooth in her smile. She could not eat.

A young man with labored breathing was given a wheelchair. His weak voice told me five days ago he had been in the intensive care unit of a local hospital for leg swelling. He did not understand why his legs had swelled then or why the swelling had recurred. For a month, he experienced chest pains walking across his living 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.

He 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? Was it because he did not have health insurance? Had there been no free clinic, and his daughter not insisted that he come, he may have died.

A young man avoided eye contact. His slouched posture told me he did not want to talk, but had something to say. Later, I learned the suicidal plans of three people had been averted. Surely he was one. Without a free clinic, would their plans have succeeded?

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” giving a multitude of reasons filled with hypocrisies and fictions.

The cost of reform is not the question. We already incur the expense with the loss of manpower and the extraordinary cost of end of life care. The question is how much it costs not to reform. How much do we value our neighbor? How long will our nation allow 43 million citizens to be marginalized without access to medical care?

No informed person could honestly believe that without a public option private insurers will write policies to alleviate the suffering I witnessed in Little Rock. My country embarrasses me.

We squabble over health reform and across the country patients suffer and die daily without proper care. Doing nothing cannot be an option.

Ralph B Freidin, MD lives in Boston but has a practice on Bedford Street in Lexington.

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