We fling open the doors of America’s emergency departments to help those who can’t afford healthcare. We have legislated this protection; no person can be turned away for financial reasons. This is very compassionate, and represents the higher angels of our culture. Alas, it also is emblematic of the stupider demons of government. You see, the ER demonstrates the inverted priorities of American society.
In the ER, expensive tattoos abound. Piercing is ubiquitous. Almost every adult and child has a smart-phone, it seems. All too many spend the duration of their ER visit glaring at the screen of said phone; barely looking up at the physician who is attempting to engage them in meaningful conversation about the reason they came for care.
Cigarettes populate purses and drug screens are notoriously positive for at least chronic narcotic pain medications, but often other substances, among them marijuana and amphetamines.
Dental care? It is regularly ignored because, in the words of my patients, ‘I don’t have dental insurance.’ Guess what. Neither do I, and I pay a lot for insurance. Dental care has typically been a cash business. That’s why dentists, crafty guys and gals that they are, spend their time mucking around the human mouth. Floss and toothpaste? Seems a bit excessive compared to a nice new tattoo!
But, on the southern end of things, carefully groomed pubic hair is not at all out of the question. The teeth may fall out; the nether regions will be carefully tended.
It’s all about priorities; those of individuals and those of leaders. Our leaders, ever convinced that we must give medical care to those perceived to be ‘in need,’ often forget that modern definitions of poverty and need may be a bit different from need throughout human history. And that if a family has an expensive cell plan, new truck and big-screen TV with satellite, it might not be unreasonable to ask them to put up a little money for their own healthcare.
A woman told me, recently, that her daughter (at birth) had a minor congenital abnormality that required daily application of a cream. ‘And I had to spend $200 of my own money!’ She was aghast. As are all of those who will gladly pay anything for Oxycontin (legal or otherwise) but who are offended and downtrodden when their antibiotic isn’t free at the local pharmacy.
We can’t keep this up. We’ve created a monstrosity of entitlement. I care for the poor; I love the poor and have always tried my best to help those in genuine need. Those truly hurting.
But when cosmetics, vices and electronics are considered reasonable expenditures while the rest of us pay for necessities like prescriptions (or over the counter Tylenol and Motrin as I’m often asked to prescribe for Medicaid), then we are entering the death spiral.
I remain ambivalent about prescribing Tylenol or Ibuprofen to those of our fellow citizens who feel entitled.
On the one hand complying with their request just reinforces that sense of entitlement; but on the other hand they will be more likely to give me a higher score on the hospital’s “customer satisfaction” survey.
Ted, first, thanks for the nice comment on my earlier post. I agree with you about co-pays. I’d love to see one that we could waive if we felt it necessary or reasonable. Second, I try not to prescribe those either. It absolutely reinforces the belief that nothing pertaining to one’s health should be one’s own responsibility. I want to help those in need, as I know you do. But everyone needs a little ownership! The customer satisfaction garbage is killing the practice of medicine and driving us deep into unscientific behaviors!
JM
9 years ago
Sounds like a lot of the typical blaming the victim and marginalizing and judgement of people living in poverty I hear every day at work. Yeah, people make poor decisions. But as long as we’re working in a healthcare system where obscene profits for those at the top outweigh every other concern, it seems fairly petty to be complaining about your patient’s tattoos.
This is literally one if the most disturbing things I have ever read. I seriously hope I never end up in your ER. Judging a person’s pubic hair when you should be trying to help them is the creepiest thing I’ve ever heard. You literally made my stomach turn. I have no doubt that you are Christian, and that judging people is your favorite pastime. For profit healthcare is obsurd anyway. You are the one that is sick.
Remember, Nicole, it’s really not about judging. It’s about irony. Those of us who work in emergency care are faced with these ironies all the time. People focus so much on things other than those few, simple things that might make them healthier. They won’t stop smoking, but they want medicine for their cough. They are worried about STD’s but continue to have unprotected sex. I really don’t care what they do with their pubic hair. It was simply an observation about priorities. And if this is the creepiest thing you’ve ever read, then you haven’t spent much time on… Read more »
Julie
9 years ago
I loved this article. I work in veterinary medicine and routinely see the same thing. I have people walking in with electronics and purses I can’t afford on my salary, but they tell me they can’t come up with 50 bucks for the cost of an office visit, much less the cost of any treatment. (These same people are frequently holding cups from the Starbucks down the road.) They will also tell me how awful we are because we’re only in it for the money. I grew up poor, so it’s not like I don’t get it. But my family… Read more »
william md
6 years ago
This article just made an appearance in my e-mail via KMD. Thanks for your thoughts and cogent reply responses. Thanks for your thoughts on Family Vacation too. I wish every family could have some, I do enjoy ours very much also.
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I remain ambivalent about prescribing Tylenol or Ibuprofen to those of our fellow citizens who feel entitled.
On the one hand complying with their request just reinforces that sense of entitlement; but on the other hand they will be more likely to give me a higher score on the hospital’s “customer satisfaction” survey.
Ted, first, thanks for the nice comment on my earlier post. I agree with you about co-pays. I’d love to see one that we could waive if we felt it necessary or reasonable. Second, I try not to prescribe those either. It absolutely reinforces the belief that nothing pertaining to one’s health should be one’s own responsibility. I want to help those in need, as I know you do. But everyone needs a little ownership! The customer satisfaction garbage is killing the practice of medicine and driving us deep into unscientific behaviors!
Sounds like a lot of the typical blaming the victim and marginalizing and judgement of people living in poverty I hear every day at work. Yeah, people make poor decisions. But as long as we’re working in a healthcare system where obscene profits for those at the top outweigh every other concern, it seems fairly petty to be complaining about your patient’s tattoos.
JM, it’s not about the poverty!
Amen! You speak the truth!
This is literally one if the most disturbing things I have ever read. I seriously hope I never end up in your ER. Judging a person’s pubic hair when you should be trying to help them is the creepiest thing I’ve ever heard. You literally made my stomach turn. I have no doubt that you are Christian, and that judging people is your favorite pastime. For profit healthcare is obsurd anyway. You are the one that is sick.
Remember, Nicole, it’s really not about judging. It’s about irony. Those of us who work in emergency care are faced with these ironies all the time. People focus so much on things other than those few, simple things that might make them healthier. They won’t stop smoking, but they want medicine for their cough. They are worried about STD’s but continue to have unprotected sex. I really don’t care what they do with their pubic hair. It was simply an observation about priorities. And if this is the creepiest thing you’ve ever read, then you haven’t spent much time on… Read more »
I loved this article. I work in veterinary medicine and routinely see the same thing. I have people walking in with electronics and purses I can’t afford on my salary, but they tell me they can’t come up with 50 bucks for the cost of an office visit, much less the cost of any treatment. (These same people are frequently holding cups from the Starbucks down the road.) They will also tell me how awful we are because we’re only in it for the money. I grew up poor, so it’s not like I don’t get it. But my family… Read more »
This article just made an appearance in my e-mail via KMD. Thanks for your thoughts and cogent reply responses. Thanks for your thoughts on Family Vacation too. I wish every family could have some, I do enjoy ours very much also.