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
14 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!!
{"id":null,"mode":"form","open_style":"in_place","currency_code":"USD","currency_symbol":"$","currency_type":"decimal","blank_flag_url":"https:\/\/edwinleap.com\/wp-content\/plugins\/tip-jar-wp\/\/assets\/images\/flags\/blank.gif","flag_sprite_url":"https:\/\/edwinleap.com\/wp-content\/plugins\/tip-jar-wp\/\/assets\/images\/flags\/flags.png","default_amount":100,"top_media_type":"none","featured_image_url":false,"featured_embed":"","header_media":null,"file_download_attachment_data":null,"recurring_options_enabled":true,"recurring_options":{"never":{"selected":true,"after_output":"One time only"},"weekly":{"selected":false,"after_output":"Every week"},"monthly":{"selected":false,"after_output":"Every month"},"yearly":{"selected":false,"after_output":"Every year"}},"strings":{"current_user_email":"","current_user_name":"","link_text":"Leave a tip","complete_payment_button_error_text":"Check info and try again","payment_verb":"Pay","payment_request_label":"EdwinLeap.com","form_has_an_error":"Please check and fix the errors above","general_server_error":"Something isn't working right at the moment. Please try again.","form_title":"EdwinLeap.com","form_subtitle":"If you enjoy the content you read here, please consider dropping something in the tip jar!","currency_search_text":"Country or Currency here","other_payment_option":"Other payment option","manage_payments_button_text":"Manage your payments","thank_you_message":"Thank you so much! I appreciate the tip!","payment_confirmation_title":"EdwinLeap.com","receipt_title":"Your Receipt","print_receipt":"Print Receipt","email_receipt":"Email Receipt","email_receipt_sending":"Sending receipt...","email_receipt_success":"Email receipt successfully sent","email_receipt_failed":"Email receipt failed to send. Please try again.","receipt_payee":"Paid to","receipt_statement_descriptor":"This will show up on your statement as","receipt_date":"Date","receipt_transaction_id":"Transaction ID","receipt_transaction_amount":"Amount","refund_payer":"Refund from","login":"Log in to manage your payments","manage_payments":"Manage Payments","transactions_title":"Your Transactions","transaction_title":"Transaction Receipt","transaction_period":"Plan Period","arrangements_title":"Your Plans","arrangement_title":"Manage Plan","arrangement_details":"Plan Details","arrangement_id_title":"Plan ID","arrangement_payment_method_title":"Payment Method","arrangement_amount_title":"Plan Amount","arrangement_renewal_title":"Next renewal date","arrangement_action_cancel":"Cancel Plan","arrangement_action_cant_cancel":"Cancelling is currently not available.","arrangement_action_cancel_double":"Are you sure you'd like to cancel?","arrangement_cancelling":"Cancelling Plan...","arrangement_cancelled":"Plan Cancelled","arrangement_failed_to_cancel":"Failed to cancel plan","back_to_plans":"\u2190 Back to Plans","update_payment_method_verb":"Update","sca_auth_description":"Your have a pending renewal payment which requires authorization.","sca_auth_verb":"Authorize renewal payment","sca_authing_verb":"Authorizing payment","sca_authed_verb":"Payment successfully authorized!","sca_auth_failed":"Unable to authorize! Please try again.","login_button_text":"Log in","login_form_has_an_error":"Please check and fix the errors above","uppercase_search":"Search","lowercase_search":"search","uppercase_page":"Page","lowercase_page":"page","uppercase_items":"Items","lowercase_items":"items","uppercase_per":"Per","lowercase_per":"per","uppercase_of":"Of","lowercase_of":"of","back":"Back to plans","zip_code_placeholder":"Zip\/Postal Code","download_file_button_text":"Download File","input_field_instructions":{"tip_amount":{"placeholder_text":"How much would you like to tip?","initial":{"instruction_type":"normal","instruction_message":"How much would you like to tip? Choose any currency."},"empty":{"instruction_type":"error","instruction_message":"How much would you like to tip? Choose any currency."},"invalid_curency":{"instruction_type":"error","instruction_message":"Please choose a valid currency."}},"recurring":{"placeholder_text":"Recurring","initial":{"instruction_type":"normal","instruction_message":"How often would you like to give this?"},"success":{"instruction_type":"success","instruction_message":"How often would you like to give this?"},"empty":{"instruction_type":"error","instruction_message":"How often would you like to give this?"}},"name":{"placeholder_text":"Name on Credit Card","initial":{"instruction_type":"normal","instruction_message":"Enter the name on your card."},"success":{"instruction_type":"success","instruction_message":"Enter the name on your card."},"empty":{"instruction_type":"error","instruction_message":"Please enter the name on your card."}},"privacy_policy":{"terms_title":"Terms and conditions","terms_body":null,"terms_show_text":"View Terms","terms_hide_text":"Hide Terms","initial":{"instruction_type":"normal","instruction_message":"I agree to the terms."},"unchecked":{"instruction_type":"error","instruction_message":"Please agree to the terms."},"checked":{"instruction_type":"success","instruction_message":"I agree to the terms."}},"email":{"placeholder_text":"Your email address","initial":{"instruction_type":"normal","instruction_message":"Enter your email address"},"success":{"instruction_type":"success","instruction_message":"Enter your email address"},"blank":{"instruction_type":"error","instruction_message":"Enter your email address"},"not_an_email_address":{"instruction_type":"error","instruction_message":"Make sure you have entered a valid email address"}},"note_with_tip":{"placeholder_text":"Your note here...","initial":{"instruction_type":"normal","instruction_message":"Attach a note to your tip (optional)"},"empty":{"instruction_type":"normal","instruction_message":"Attach a note to your tip (optional)"},"not_empty_initial":{"instruction_type":"normal","instruction_message":"Attach a note to your tip (optional)"},"saving":{"instruction_type":"normal","instruction_message":"Saving note..."},"success":{"instruction_type":"success","instruction_message":"Note successfully saved!"},"error":{"instruction_type":"error","instruction_message":"Unable to save note note at this time. Please try again."}},"email_for_login_code":{"placeholder_text":"Your email address","initial":{"instruction_type":"normal","instruction_message":"Enter your email to log in."},"success":{"instruction_type":"success","instruction_message":"Enter your email to log in."},"blank":{"instruction_type":"error","instruction_message":"Enter your email to log in."},"empty":{"instruction_type":"error","instruction_message":"Enter your email to log in."}},"login_code":{"initial":{"instruction_type":"normal","instruction_message":"Check your email and enter the login code."},"success":{"instruction_type":"success","instruction_message":"Check your email and enter the login code."},"blank":{"instruction_type":"error","instruction_message":"Check your email and enter the login code."},"empty":{"instruction_type":"error","instruction_message":"Check your email and enter the login code."}},"stripe_all_in_one":{"initial":{"instruction_type":"normal","instruction_message":"Enter your credit card details here."},"empty":{"instruction_type":"error","instruction_message":"Enter your credit card details here."},"success":{"instruction_type":"normal","instruction_message":"Enter your credit card details here."},"invalid_number":{"instruction_type":"error","instruction_message":"The card number is not a valid credit card number."},"invalid_expiry_month":{"instruction_type":"error","instruction_message":"The card's expiration month is invalid."},"invalid_expiry_year":{"instruction_type":"error","instruction_message":"The card's expiration year is invalid."},"invalid_cvc":{"instruction_type":"error","instruction_message":"The card's security code is invalid."},"incorrect_number":{"instruction_type":"error","instruction_message":"The card number is incorrect."},"incomplete_number":{"instruction_type":"error","instruction_message":"The card number is incomplete."},"incomplete_cvc":{"instruction_type":"error","instruction_message":"The card's security code is incomplete."},"incomplete_expiry":{"instruction_type":"error","instruction_message":"The card's expiration date is incomplete."},"incomplete_zip":{"instruction_type":"error","instruction_message":"The card's zip code is incomplete."},"expired_card":{"instruction_type":"error","instruction_message":"The card has expired."},"incorrect_cvc":{"instruction_type":"error","instruction_message":"The card's security code is incorrect."},"incorrect_zip":{"instruction_type":"error","instruction_message":"The card's zip code failed validation."},"invalid_expiry_year_past":{"instruction_type":"error","instruction_message":"The card's expiration year is in the past"},"card_declined":{"instruction_type":"error","instruction_message":"The card was declined."},"missing":{"instruction_type":"error","instruction_message":"There is no card on a customer that is being charged."},"processing_error":{"instruction_type":"error","instruction_message":"An error occurred while processing the card."},"invalid_request_error":{"instruction_type":"error","instruction_message":"Unable to process this payment, please try again or use alternative method."},"invalid_sofort_country":{"instruction_type":"error","instruction_message":"The billing country is not accepted by SOFORT. Please try another country."}}}},"fetched_oembed_html":false}
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!!