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Breaching the gap in health care
Patients should not have to perceive everyday medicine as heavenly act.
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For the past year and a half, since I have been running my blog, I have received hundreds of messages from people around the world who are in need.
A woman with metastatic cancer who kept writing me from her hospital bed until the last minute before she was taken for a major operation; she was in need of support. A now friend of mine, whose daughter was diagnosed with neurogenic bladder at age 6; she had been trying to get in touch with specialists in the United States for years but none of them had the time or interest to return her emails or letters. She was in need of some networking. A devastated father, whose 12-year-old son suddenly collapsed while practicing sports and needed a heart transplant; he was a father searching for hope.
I have returned every single one of these medical, emotional, objective or subjective queries. Did I have all the answers? Of course not, but you would be surprised with how little it takes for a human heart to be able to feel stronger, happier, more positive or supported. Sometimes three words suffice: “I hear you.”
Routine health care or miracle?
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A young Hispanic woman living in the United States wrote me months ago because she had been experiencing palpitations, difficulty swallowing and could feel a bump on her neck. She was uninsured and visited three or four doctors at different charity clinics who told her to treat her symptoms with an over-the-counter throat spray. She did, but her symptoms persisted.
When I read her message, it was obvious to me – as it should have been to any physician – that these were symptoms that needed further investigation. But our situation here in the United States can’t be clearer: no money, no insurance, no testing; no ticket, no laundry. The exception being, of course, landing in the ER with an exacerbation or progression of the baseline disease process.
I wrote the woman back saying that her symptoms needed further evaluation, and that if possible, she should see an endocrinologist.
About a month later, she wrote me a heartbreaking email. She had collected money from friends and family members and consulted with a private physician. To make a long story short, she was diagnosed with thyroid cancer. In her note, she expressed her frustration with our health care system, blamed herself for being poor and painfully described how she had lost respect for the medical profession. She was tired of being ignored by a system more powerful than our principles. In her last sentence, she described me as an angel on earth, stating that I had been the only doctor who did something for her in a time of need. But far from feeling pride, self righteousness or at peace with myself, I felt bitterness, shame and despair.
In what society do we live, when the right thing to do, an ordinary act, the need to care for each other and to look out for one another, is perceived or confused with a miracle or a heavenly act?
There is a dangerous disconnect between scientific discovery, health policy efforts and community service. We get excited about regenerative medicine but 47 million people in our country lack basic health care. We have PET scans and yet some can’t have a good physical exam.
What are we doing? We are in the business of helping people. I could care less if you are a big shot investigator who comes up with the 10th ACE inhibitor or statin to feed the market. I am sure that if you are that guy you would not care about what I think or write on this column. But these are not my thoughts or my words, but those of millions and millions of people in this country that do care and struggle and expect more from us.
Once you look beyond the boundaries of your lab, your practice or your career, it will become clear that there is a huge gap that needs to be breached, a challenge that we should embrace with the same enthusiasm, idealism and pride that put a smile on our faces the day we officially became MDs.
For more information:
- Juan Rivera, MD, is a Fellow at the Johns Hopkins Ciccarone Center for Prevention of Heart Disease and a Member of the Cardiology Today Fellows Advisory Board. He also writes a cardiovascular prevention blog for Hispanics called Corazon Hispano. The blog can be viewed at: corazonhispano.blogspot.com.