Today in clinic, my attending got really frustrated with a patient. Patient was a middle-aged person with the usual outpatient cocktail of diabetes, hypertension, and hyperlipidemia. Patient had lost their insurance around 2008 and had stopped coming to clinic then; they also self-discontinued all their medications. Now in 2010, patient wants to resume treatment, having re-established health insurance.
My attending was furious.
Why?
Because in the intervening 2-3 years this patient had made absolutely no effort to eat well, lose weight, find a physician, get cheaper medication, or do anything regarding their health. Now, patient has insurance, and the doctor is supposed to magically fix the damage done in the past years.
Now, don't get me wrong, I know all about the barriers to care. I'm for expanding access, improving access to health insurance, etc. I know it is not easy to get to the doctor, that the visits aren't cheap, that labwork isn't cheap, and that medication isn't cheap.
However, so many people take absolutely no responsibility for their own health that if they lose health insurance it's like they have no health care at all.
There are free or pro-rated county health clinics available. Sure, the lines are long, but if you navigate the system you can get seen by a doctor, get your labwork done, and get your prescriptions written. You may even qualify for free or reduced-price medication.
Many of this patient's medications could have been changed into $4 for 30 or $10 for 90 type medications. If you can afford a Big Mac or a pack of cigarettes, you can afford a month's supply of many effective medications. Certainly the main treatments for Patient's conditions--diabetes, blood pressure, and cholesterol--are available in SOME form at very cheap prices.
My attending was mad in part because she would have worked with Patient to change their medications, had they asked. They could have worked out a plan to check in by phone, to change medications to cheaper ones if needed, to get labwork done at cheaper facilities if need be, or to spread labwork out. If Patient still had not been able to afford to see my attending, again there are other clinics that may cost less.
I find it amazing that being healthy is just not a priority for many people. We want a pill to fix our couch-potato drive-thru lifestyles that allow us to eat fast food every day and still be thin, beautiful, and heart attack free.
The plan that I've used my retrospectoscope to create for Patient would have taken effort, time, phone calls, etc. Sure, doing nothing was cheaper and easier, but now Patient will pay for it. Is that 2+ year period really going to do that much damage? I don't know, but it certainly didn't help.
No matter who provides your health care plan, be it private insurance or government-funded Medicare or Medicaid, health is still YOUR job (and my job, as I am a patient too, and I don't always practice what I preach). Your insurance can't guarantee that you see a doctor, can't guarantee that you take your meds, that you quit smoking, that you eat healthy, or that you exercise. And treatment isn't free with insurance. Health insurance is something of a misnomer; we expect all of our treatment to be covered, our doctors' visits free, our meds cheap or free, our tests free, etc. My car insurance doesn't cover routine oil changes, so I find it odd that we rely on "health insurance" to provide all of our health care.
Perhaps Patient didn't know what I know. Patient may not have known about $4 medications, or about free-standing labs, or about the county clinics. Patient may not have internet at home, and may not see the commercials for cheap meds. However, Patient did not ask the person who did know--my attending.
Certainly the opposite type of patient exists; my father-in-law has much the same cocktail of problems and is unable to get health insurance accordingly. So, he shops around, gets the best deals on his tests and meds, and even knows which hospitals he would go to if the occasion arises. He decided that it was his own responsibility to stay healthy, treat his chronic conditions, and live longer.
The current generation of elderly became adults in leaner times than us. My 70 and 80 year old patients grew up with the Great Depression and WWII; they did not grow up with easy access to burgers and fries at the window of their vehicle. The younger generations I see (myself included) did grow up with cheap, quick, tasty food available at all hours. I gained weight eating this stuff; at some point I realized I was killing myself. It was a big lesson to learn, unlike the young woman I saw today, with a BMI of 38 who said "I just have a slow metabolism" (despite describing a terrible diet and no exercise with a sedentary job). I wonder often if our long lifespans will start to shrink, as the fatter, less active generations start to age.
I'm now sitting on the couch typing, waiting for the heat to dissipate a bit so I can go jog without suffering a heat stroke. I'm not good at exercising, and I struggle with my eating habits every day, but I'm trying. I keep reminding myself it's worth it. Because it is worth it, to me, to be healthy, to learn healthy habits now that I can teach my kids someday. The government isn't going to exercise for me, nor is my health insurance company going to eat salad so I don't have to. Although sometimes, I wish they would.
