There are so many reasons why I'm glad that repealing or replacing the ACA failed, but I want to tell you about just one of them.
There was a patient I saw one night in the emergency department. I was sitting there watching the tracking board, as you do when things aren't so busy, and I saw a patient's information pop up on the board. In the emergency department, we have a triage system which classifies people into five possible levels of severity. Level ones are essentially patients in cardiac arrest, or close to death. Level fives, on the other end of the spectrum, may be something like dandruff, or a stubbed toe (yes, they do come to the emergency department - that's a story for another day). Level fives are unusual. This patient was a level five, "Insect Bite." I couldn't help myself, I laughed.
I only laughed for a moment, because oftentimes when the triage complaint is "insect bite" it's actually a skin infection secondary to an insect bite, and the severity score is often incorrect. I previewed the triage note which read "patient with scabies since 6 months ago." This brought the smile back to my face, although it wasn't truly funny per se to think of a patient with scabies for 6 months, it certainly does make a physician wonder when a patient shows up with a complaint like this. Why now? Why, after six months of having this minor condition, was this the moment when you just couldn't take it anymore? You never sought help before, but now is the time? WHY? There often isn't any satisfying explanation, which is a source of humor in that "people never cease to baffle me" kind of way.
I walked into the room, and I couldn't even maintain the polite smile which I usually try to keep there as a customer-service minded physician - my expression changed to surprise tinged with mild horror. The patient indeed did appear to have scabies. All over his entire body. And he looked miserable. He couldn't stop itching as we talked. The red tracks made by his nails crisscrossed his arms, and some of the spots had become open wounds.
Surely you can guess the answer to the question now - the answer to the question WHY this moment? Why had this man been living in misery for six months rather than being treated for a parasitic infection that he well knew that he had? "I just got insurance yesterday," he told me. "so now here I am."
After pity, quickly I was overcome by a new emotion: rage. I'm normally a very calm person, but this situation made me feel angrier than if a school bus full of narcotic seekers had pulled up and started heckling me about my opiate prescribing patterns.
I had the answer to my first question about this patient, but I still don't have the answer to the logical next one: WHY, in this affluent nation of plenty where I reside, why should any person have to suffer with a contagious parasitic infection for months on end, putting others at risk of transmission for lack of healthcare coverage? This man couldn't sleep at night, he was so tortured by itching. He lacked the knowledge or tools to treat himself, and he was uninsured, so he did not see a doctor. Is it any wonder that many uninsured Americans die annually for lack of treatment of their less visible and palpable medical conditions, like high blood pressure or cholesterol?
This story isn't the story of a life threatening medical condition, but to me it is no less important, because it is an egregious example of what the simple lack of medical insurance does to people in our society. It has come to mind many days since then, but no day more so than today. I am grateful to all those who preserved healthcare coverage for Americans today.
There was a patient I saw one night in the emergency department. I was sitting there watching the tracking board, as you do when things aren't so busy, and I saw a patient's information pop up on the board. In the emergency department, we have a triage system which classifies people into five possible levels of severity. Level ones are essentially patients in cardiac arrest, or close to death. Level fives, on the other end of the spectrum, may be something like dandruff, or a stubbed toe (yes, they do come to the emergency department - that's a story for another day). Level fives are unusual. This patient was a level five, "Insect Bite." I couldn't help myself, I laughed.
I only laughed for a moment, because oftentimes when the triage complaint is "insect bite" it's actually a skin infection secondary to an insect bite, and the severity score is often incorrect. I previewed the triage note which read "patient with scabies since 6 months ago." This brought the smile back to my face, although it wasn't truly funny per se to think of a patient with scabies for 6 months, it certainly does make a physician wonder when a patient shows up with a complaint like this. Why now? Why, after six months of having this minor condition, was this the moment when you just couldn't take it anymore? You never sought help before, but now is the time? WHY? There often isn't any satisfying explanation, which is a source of humor in that "people never cease to baffle me" kind of way.
I walked into the room, and I couldn't even maintain the polite smile which I usually try to keep there as a customer-service minded physician - my expression changed to surprise tinged with mild horror. The patient indeed did appear to have scabies. All over his entire body. And he looked miserable. He couldn't stop itching as we talked. The red tracks made by his nails crisscrossed his arms, and some of the spots had become open wounds.
Surely you can guess the answer to the question now - the answer to the question WHY this moment? Why had this man been living in misery for six months rather than being treated for a parasitic infection that he well knew that he had? "I just got insurance yesterday," he told me. "so now here I am."
After pity, quickly I was overcome by a new emotion: rage. I'm normally a very calm person, but this situation made me feel angrier than if a school bus full of narcotic seekers had pulled up and started heckling me about my opiate prescribing patterns.
I had the answer to my first question about this patient, but I still don't have the answer to the logical next one: WHY, in this affluent nation of plenty where I reside, why should any person have to suffer with a contagious parasitic infection for months on end, putting others at risk of transmission for lack of healthcare coverage? This man couldn't sleep at night, he was so tortured by itching. He lacked the knowledge or tools to treat himself, and he was uninsured, so he did not see a doctor. Is it any wonder that many uninsured Americans die annually for lack of treatment of their less visible and palpable medical conditions, like high blood pressure or cholesterol?
This story isn't the story of a life threatening medical condition, but to me it is no less important, because it is an egregious example of what the simple lack of medical insurance does to people in our society. It has come to mind many days since then, but no day more so than today. I am grateful to all those who preserved healthcare coverage for Americans today.
