Agraphia Medical Tragicomedy


And yet I debate…

I watched Barack Obama's acceptance speech tonight, which made me think a couple of things. I should first say that I thought it was one of the most amazing speeches I've ever seen. I'm a staunch Obama supporter, but a few things tweak me the wrong way, being on the inside of healthcare.

Simple laceration repairs, heart attacks, food poisoning... these things make me feel happy inside. I can cure/diagnose/treat these things. These are the type of medical diseases I truly enjoy working up. Quick, easy, fixable.

However, truly "sick" people - like the woman I took care of tonight with diabetes, hypertension, COPD, neuropathy, hyperlipidemia, hypothyroid, congestive heart disease, end-stage renal disease, fibromyalgia (and more) - scare the crap out of me. She defines herself by her illnesses and the 20 medications she takes daily. I dislike caring for these patients simply because anything under the sun can and does go wrong, and the sheer quantity of healthcare dollars they vacuum up is phenomenal.

These people will never get better, return to their PCP/ER/hospital every few days, and require every laboratory, radiology, and clinical exam under the sun - every time. If my mother was one of these people I would want everything done for her, but as a healthcare worker can't help but view her as a money sink... that could be far better spent on healthier, more acutely ill patients.

Lastly, in principle, universal health care is a fantastic thing†. In practice, 3 of my 14 patients today were very clear drug seekers, who came to Urgent Care because it was a free, easy way to get narcotics. Insurance pays for their visit, insurance pays for the prescription. People removed from responsibility abuse the system. Paying for "affordable, accessible healthcare" is one thing. Freeloading visits to the urgent care daily for 7 years like my good friend Mr. Ramirez is an entirely different story††.

†One of the huge advantages of universal healthcare is the hypothetical ability to introduce one standardized system for all hospitals. This would decrease redundancy in lab tests, CT scans, and more, allowing faster, more accurate care. In the setting of the ER, however, it would also quickly identify people who hop from ER to ER seeking narcotics.
††I kid you not. Pulling up his record on our system reveals at least one visit, daily, to the ER, for the past 7 years. Thanks, EMTALA!

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  1. I just wanted to let you know that I recommended your blog on my Blog Day 2008 list:

  2. The bit about defining yourself by your disease is something that comes with chronic illness. It’s hard not to see yourself as something inseparable from it because it’s as much a part of everyday living as the normal stuff is.

    Not that it’s a good thing. It’s a crappy way to live. I have a hard time trying not defining myself by MS, because it’s always there and in my face. But I think I’m probably healthier for the trying.

  3. I actually went through just now and edited this post a bit; wrote it at 4 AM last night after my shift was over, I think I got a bit punchy.

    This is a really difficult topic to talk about, because I hate to imply that I don’t like chronically sick patients, just that I prefer to care for the acutely ill. It’s an important distinction to make.

  4. I didn’t think you were saying that you didn’t like them. It must be pretty frustrating when you can’t help the way you’d like to.

    People who define themselves, utterly and completely, by what’s wrong with them…they’re kind of weird. And creepy to talk to. Accepting limitations is one thing. Embracing them and talking about them like soap opera characters in your life…that’s another.

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