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Bearing Witness

By Dr. Nilesh Kalyanaraman
. 1 Comment(s)

Normally I’m full of statistics and studies but this past month I’ve been thinking about this blog post and all I can think about are the stories of the people I’ve met. After taking a year off to work on policy issues, I’ve returned to the world of community health centers and the plight of the people I see feels new and shocking.

One of my new patients is a young woman with thyroid cancer. She was diagnosed about a year ago and was treated with surgery followed by thyroid hormone replacement. Subsequently she lost her job and with it her health insurance. When she came to see me a few weeks ago it had been over half a year since she had last seen her endocrinologist. She needs specialized blood tests to see whether there is any recurrent thyroid cancer and she may need radiology tests as well. These tests are complicated and require an endocrinologist to manage them. They’re also very expensive. As of right now I don’t have a good resolution to this story but I’m working hard on an endocrinologist who can see her and provide the follow up care and services she needs as charity care. While I’m doing this we hope that there’s no cancer there that’s growing while we spend time navigating this broken system.

 Yesterday I saw a man with high blood pressure who, in the past, was on 5 medications with good control. Earlier this fall, he lost his job and along with it his health insurance. He finally ran out of medicine two weeks ago and was only able to see me yesterday. When I looked at his flow sheet his blood pressure was sky high, technically it was a hypertensive emergency because of the imminent risk of stroke or heart attack. Much as I wanted to send him to the emergency room I knew that this would only make his financial situation worse by foisting an expensive hospitalization on him. Yes, they could have monitored his blood pressure as they brought it down, but he had been walking around with this blood pressure for two weeks without any symptoms. So I gave him a prescription for four medications that are on the $4 program at Walmart and told him to start each one two days apart and then follow up with me 3 to 4 days after that. This is not the first time I’ve done this, but time I do this I cross my fingers and hope that in my sensitivity to his finances I haven’t been insensitive to his health.

 These are just two people who did nothing wrong other than get caught in the perverse system that ties your health insurance to your employment status. There are thousands of people who have similar stories and I see a lot of them come in to my community health center.  I don’t have a miracle solution to these problems right now, I just wait until 2014 and trust that health care reform will make stories like these a thing of the past. Until then we must all bear witness so that these injustices don’t fade into obscurity.

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  1. Frances Griffin

    Nice sentiments. Want everyone to have decent health care? Join Physicans for a National Health Plan and support Medicare for All!

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