06 December 2006

The Uninsured Patient

My fiance is a fan of green tea. I have been shopping for his favorite green tea and my favorite hot sauce at a small family-owned Asian market near my house. Since I am in the store at least once per week, I have been introduced to many new tastes and foods by its very-knowledgable owner. Having something of an advertursome palate and being a lover of travel and new cuisines, I always appreciate the discussions and tastings that the owner offers regularly.

The owner of this store is a 50-something gentleman from Korea. He has a wife and three children who are high school and college-aged. He and his wife take turns in the store and I have gotten to know them all in a neighborly sort of way. They are hard-working and offer a very wide variety of great items in their spotlessly clean market. They will special order items for customers at request too.

Some time ago, I was called to the Emergency Room after the intern on my service had seen a 50-year-old gentleman with abdominal pain. The intern had completed his patient history and physical exam and had told me that he suspected that the patient might need surgery (likely gall bladder problem). He had reviewed labs and wanted to discuss the case with me so that I could notify the attending surgeon on call.

When I arrived in the Emergency Department, I found my beloved shopkeeper in considerable pain and agreed with the intern, that the patient would likely need surgery. We ordered a some tests (Right Upper Quadrant Ultrasound) and I relayed the case to my attending who agreed with out plan. I informed the patient of our plans and what to expect in the next few hours. I also made liberal use of pain medication as indicated.

Our patient continued to have a significant amount of pain and the right upper quadrant ultrasound did reveal gallstones so we added the patient onto the end of the day schedule. He was in good health and had been having some indigestion from time to time but nothing that kept him out of the shop or that he felt the need to consult a physician for.

The patient was prepped for a lap cholecystectomy (the usual procedure) and was given IV fluid hydration along with pain medication. The anesthesiologist was happy with administering a general anesthetic and the patient had given consent for the surgery after all of his questions were answered. His wife arrived after closing the store and sat at the side of the stretcher in the anesthesia prep area. She said that she was happy that I would be doing the surgery and liked the attending surgeon very much.

As we proceeded with the surgery, we found that the patient's gallbladder was gangrenous and friable. We converted from the laparoscopic procedure to an open cholecystectomy (happens in about 5% of cases anyway) so that we could get the gallbladder out safely under the conditions that we had found. The case went smoothly and I accompaned the attending surgeon out to speak with the patient's wife while the intern finished closing the incision and writing post operative orders.

When we spoke to the patient's wife, she told us that they didn't have any insurance. They just poured all of the profits from their store into providing necessities for their family and college tuition and had dropped their health insurance. Both had been in good health but things like mammograms for the wife and regular exams were had not been done. (Not that these things would have prevented the gallbladder problem anyway).

My attending told the wife not to worry because we would keep the costs as low as possible and the hospital would pro-rate charges based on the patient's ability to pay. My attending told me as we walked back to the recovery room, that he would not charge the patient for his professional fees under the circumstances but this would be an expensive illness for this previously healthy gentleman.

Our patient made an uneventful recovery and was released from the hospital, feeling better but walking a bit slower. He returned to our office the next week for a wound check and two weeks later, I saw him in the store helping his wife take care of customers. He was doing great even though we had asked him to not work for at least three weeks. He was worried about his business and wanted to at least work half a day.

Two months later, the store closed. The family was not able to make the payments for the hospitalization and keep up with the store. My beloved shopkeeper had lost his business and was in danger of losing his house had it not been for a business associate who had hired him to work in another store.

My patient lost his business because he was not able to afford health insurance for himself and his wife (his children were insured). He was hard-working and contributing to the economy of our locale and country by operating a store. Yes, he took a chance and lost but why not put out best and brightest folks on solving the problem of providing basic healthcare for the uninsured patient.

I am not an advocate of a "federal program" for taking care of this problem. One need only look at Medicare and Medicaid to realize that having the "feds" do anything is not cost-effective and more costly. Why not have an "Apprentice" type show where folks come up with solutions to this problem? It's not as sexy as a multi-million dollar real estate deal but it's a huge problem where we all could benefit.

There are millions of folks out there like my wondeful shopkeeper who contribute to the economy and provide a wonderful service in their neighborhoods. These are hard-working folks who want to provide for their families and keep a roof over their heads. They are not looking for a "government handout" but some kind of affordable insurance plan that would take care of their basic needs and emergencies.


Randall Sexton said...

Sad story. I think there should be some type of option for all those who fall through the cracks. I just don't know what it would be. Private business might be slightly better, but HMO's certainly didn't help much in my opinion. Maybe a global insurance with offices in a foreign country would have cheaper operating expenses and could offer affordable policies. The kicker would be the expensive health care costs in the USA. A friend just spend a week in the hospital here in Bangladesh and his total bill was $1,200. You'd go through that in a single day in the USA. Our policy is somewhere around $2,000 a year per person so the insurance company will have a little left over on this client...if he stays out of the hospital.

Meg said...

This is a sad story, but I can't help but feel some of the blame falling on the patient. There are affordable health insurance policies available, and you mentioned that this patient and his wife were paying for their kids' college expenses (I think?). Could the children not take on loans in this time of need? Also, health insurance paid out of pocket by the self-employed is tax-deductible, and while it does take away money during the year, there is a benefit seen during tax season (which I am familiar with first-hand).

I do absolutely agree that there is something inherently wrong with people "falling through the cracks" in this country. I personally would like to start with the insurance companies themselves and have them be held to some sort of standard as far as cost goes and what they claim to cover vs. what they actually cover in their plans. I am torn between advocating for the patient and advocating for the health care provider/insurance company when it comes to healthcare reform. I have seen wrong priorities when it comes to all. I've seen the family that can't afford shoes for their children yet have a new big screen TV. I've seen the middle-class family where parents have decent jobs and do what they should in life, but due to the cost of living have no options and no available programs for help.

The big question is how can everybody be happy? Or at least content with the model of healthcare delivery? Does it mean having a system where general and urgent care are federally-funded but elective surgeries come from insurance or out of pocket - who knows? How can doctors' salaries be paid while providing universal care?

You're right - it's the $64,000 question, and a good one to propose to the Donald for his game-show think-tank.

P.S. I like your blog. You have only 3 posts so far and are writing about things I'm passionate about. I may agree or disagree with you, but I'm glad you address them. Keep up the good work!