In a nutshell, here’s a perfect illustration of why our social engineering system will fail, and why every attempt to make life ‘fair’ will only punish those who do the right thing.
48 year old white female comes to the ER for chest pain, accompanied by well-meaning, smiling, university-based social-work interns from the local free clinic. Her pain sounds legitimate. She has no money and can’t afford her prescriptions.Â
Indeed, she needs help. Of course, she smokes one pack per day, drinks beer on the weekends, and uses crack cocaine.Â
Whose help does she need? Does she need the intern’s time? Does she need the free clinic’s samples? Does she need my free care?Â
Or does she need to stop smoking, stop drinking, stop using crack and get on with life; including buying her own prescriptions.Â
Sorry, if it sounds mean, it isn’t. We evaluated and admitted her. But sometimes hard truths stick in our throats, and we refuse to speak them.
Not that this has anything to do with the legitimacy of your observation. You are absolutely right. This has to do purely with curiosity. What percentage of your patients would fit into the same category as this woman?
Good question. I’d have to think on it a bit. But which category do you mean? Smokers? Excessive drinkers? Drug users? People with no income or insurance? Users of charity services? I guess I’d need to break it down more according to which of those descriptors you refer to. If you refer to people who present as if everyone should help them, and pay for them, but who spend their own money on unhealthy behaviors, I’d have to say it must hover around 10-15% at least. But that’s a ball-park.
Sounds all too familiar of the typical inner-city emergency ward. What we don’t really know is how much money she really has (or doesn’t have). After all, they must have a supply of cash somewhere if they’re buying alcohol, cigarettes, and drugs.
Precisely! I’m confident that she has economic difficulties, but I doubt if any of the individuals supplying her with her substances of choice (legal or illegal) have a ‘subsidy’ program, coupons or free samples.
I think most of us want to be compassionate towards folks like my patient here described, but at some point the financial realities, and the stark realization of the role of choice, has to come into the equation.
Thanks for your comment!
Edwin
Pattie, RN
15 years ago
New and happily impressed reader. At what point in the history of this great country did personal responsibility become passe? I do not waste a nanosecond of time or a micron of concern on this cohort of patients, and am often viewed by my soft-hearted (and soft-headed) coworkers as “mean”. So be it. I allocate my compassion to children and others who are in deep doo-doo through no fault of their own.
If said patient was your family member and instead of chest pain, had again lost their job and had no money due to bad life choices, would you take them in? probably not if these were repeaed occurrences. This is the great quandry healthcare professionals find themselves in daily. A certain amount of co-dependency is just inherently in out job descriptions. We don’t turn people away because with some conditions they could die even if we know after treating the immediate problem, the underlying cause still exists. I have no answers to this only observations and am always left with… Read more »
Elizabeth
15 years ago
Do you find that there is a rise in ED visits toward the end of the month?? (ie: “out of my medicine and I can’t get it for another week” or “I need a shot for my nerves because I can’t quit shaking. I think I’m having DT’s cause I ain’t got no money to get my whisky”)…happens in my rural ER a lot!!
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Not that this has anything to do with the legitimacy of your observation. You are absolutely right. This has to do purely with curiosity. What percentage of your patients would fit into the same category as this woman?
Good question. I’d have to think on it a bit. But which category do you mean? Smokers? Excessive drinkers? Drug users? People with no income or insurance? Users of charity services? I guess I’d need to break it down more according to which of those descriptors you refer to. If you refer to people who present as if everyone should help them, and pay for them, but who spend their own money on unhealthy behaviors, I’d have to say it must hover around 10-15% at least. But that’s a ball-park.
Sounds all too familiar of the typical inner-city emergency ward. What we don’t really know is how much money she really has (or doesn’t have). After all, they must have a supply of cash somewhere if they’re buying alcohol, cigarettes, and drugs.
Precisely! I’m confident that she has economic difficulties, but I doubt if any of the individuals supplying her with her substances of choice (legal or illegal) have a ‘subsidy’ program, coupons or free samples.
I think most of us want to be compassionate towards folks like my patient here described, but at some point the financial realities, and the stark realization of the role of choice, has to come into the equation.
Thanks for your comment!
Edwin
New and happily impressed reader. At what point in the history of this great country did personal responsibility become passe? I do not waste a nanosecond of time or a micron of concern on this cohort of patients, and am often viewed by my soft-hearted (and soft-headed) coworkers as “mean”. So be it. I allocate my compassion to children and others who are in deep doo-doo through no fault of their own.
If said patient was your family member and instead of chest pain, had again lost their job and had no money due to bad life choices, would you take them in? probably not if these were repeaed occurrences. This is the great quandry healthcare professionals find themselves in daily. A certain amount of co-dependency is just inherently in out job descriptions. We don’t turn people away because with some conditions they could die even if we know after treating the immediate problem, the underlying cause still exists. I have no answers to this only observations and am always left with… Read more »
Do you find that there is a rise in ED visits toward the end of the month?? (ie: “out of my medicine and I can’t get it for another week” or “I need a shot for my nerves because I can’t quit shaking. I think I’m having DT’s cause I ain’t got no money to get my whisky”)…happens in my rural ER a lot!!