If Liz were Queen

Liza Fitzpatrick MD

I just got back from clinic. I got a slap in the face….a wake up call today. I saw a 64 y/o taxi driver who has both HIV and Hepatitis C. He really needs treatment for Hepatitis C but no one is willing to do a liver biopsy we need to outline his treatment plan because….he doesn’t have insurance. He is one year too young for medicare and he can’t qualify for Medicaid because they say he makes too much money. He makes $900/month. So what is he to do? Wait for treatment for another year when he turns 65? On top of it all, since he has no insurance, the private lab our hospital uses is sending threatening letters to him because he owes thousands of dollars for lab work…..critical lab work we order every visit to ensure he is responding to therapy. I had to order additional labs today but felt embarrassed telling him he needed more lab work knowing that it would only add to his bill. A bill he has no way to a pay. He suspects they will soon begin refusing to service him. It seems criminal to deny care to people who are poor. I am sick about it. Our system is so broken. There must be a better way.

Catharine Malmten MD
Too many times during my training I have come in contact with patients who received inadequate care because of their lack of insurance. I had one patient sent home from another hospital after a heart attack, after being given a list of appropriate coronary artery disease medications that she should go to the county clinic for. After working on getting her county insurance set up, we finally had her able to get a cardiac catheterization, and she went for coronary artery bypass grafting that same day. That this woman was sent out of the hospital in the first place without prescriptions or proper care because of her insurance status is unconscionable.

The one patient that will always haunt me is a young woman in her thirties who developed heart failure presumably because of congenital heart disease and lost her job, lost her car, her home, her insurance. She had to move herself and her three children in with her mother. I remember her saying to me, “I did everything I was supposed to do, I love to work, but I just can’t do it.” Her heart function was so poor at this point, that she was under evaluation for a heart transplant, and on speaking with her, one of her fears was what was she going to say to her children about her heart failure, and would she be able to see her eldest child graduate from high school. Unfortunately, her transplant workup was postponed while we (myself, my attending, the social workers) had to work to get her set up medicare approval so that a cardiologist would evaluate her.

It is patients like this that make me support the Obama plan because these women would have had access to appropriate care and medications under his plan. Everyone should have access to health care, but when a physician’s hands are tied in terms of doing what is best for her patient because of insurance, it is not right. I became a doctor because I wanted to help people, and I’m training to be a cardiologist to help women like the ones I’ve mentioned.

Alice Chen, MD