Health Care for All

I have come to the conclusion that if you need health care and can't get it any other way, (i.e., you have no insurance, you have no money, you have no credit cards....) you go to a small town or country doctor. Many people have caught on to this. I don't know quite how... maybe it is word of mouth from their country cousins. All I know is that the small rural practice where I work has recently been flooded with new patients -- from the nearby big city.

It struck me as odd from the beginning. The nearby big city is full of health care providers of every ilk and specialty. They have several large hospitals to which they may refer extremely ill patients. They have excellent reputations (well, some of them, anyway.) It blew my mind to see a patient with several serious, non-routine diagnoses in my office recently. I am not even a doctor, I am a nurse practitioner. Not to belittle my expertise in any way, but hey, I know my limits! The woman listed the names of her specialists for her various conditions. I sat there bemused, and finally asked her, "Why did you come here? You were getting the best of care." Her answer? Money, of course. She had lost her insurance when she was laid off from her job. She couldn't afford the specialists' fees. She couldn't afford her medications. She had heard that we would see patients on a sliding fee basis, and that we would help them get free medicine.

So I got out my books, and with her knowledge of her own condition, what I was able to look up, and her list of her current meds, we were able to map out a care plan for her. She was stable on her meds. I had forms from the companies that made them so that we could apply for free or reduced cost medicines. I did a physical exam and documented her current condition so we could be alert for changes. I looked up what labs to order and ordered them.

She fully understands that I have no expertise in her conditions. I fully understand that she is stuck with me because her financial situation won't pay for the specialists she needs. Perhaps I should refuse to take on the care of a patient so complex, but surely I am better than nothing.

But I deeply resent out current system in which patients must utilize care that is less than optimal. Yes, I'll do my best for her. But she deserves better.