Day 23 - I Weep For the Future

One of the best lines from the movie "Ferris Bueller's Day Off."



I worked triage over the last couple of days during my ED shifts.  No where can you see the failure of the health care system, and society in my opinion, so readily as on the Front Line of medicine... the Emergency Department triage room.

- patient with three year history of stomach pain who came in because it hurt more the day before while they were driving but they couldn't get a ride to come to the ED until tonight and they came because their mother told them they should have it checked out because there might be something wrong.  Um...

- patient with very high blood pressure can't get needed prescription because insurance won't cover combination med.  Pharmacy has been calling cardiologist for over a week to get new prescription but no one returns their calls.  Insurance will cover meds separately so I write a prescription for them.

 - pregnant patient can't get doctor because they don't have MediCal yet and has to wait to be able to get into a practice that accepts MediCal.  She goes to a free clinic where she can get prenatal vitamins but none of the recommended blood work or other prenatal tests.  She's now almost 5 months' pregnant.

 - patient with kidney stone blocking their ureter gets sent home with scripts for antibiotics and pain medication and told to follow up in urology clinic to have stone removed.  They never get a follow up appointment because they don't have insurance and their MediCal application wasn't filled out because they neglected to do it.  They didn't fill their prescriptions because they "don't have any money to pay for medication."  Crystal meth, alcohol and "pain medication they borrowed from someone else with kidney stones" are what they've been using to help with the pain until tonight when 3 weeks later "the pain is like the first time."

 - patient with gallbladder pain who tells me they "can't just change my diet that easy" and who wants to see if they are "sick enough to have it taken out" because they are "tired of waiting for the referral from my doctor" to see a surgeon to schedule surgery.

 - child brought in with a cold.  They have a "runny nose and are congested."  Do they have a fever? "No."  Are they eating/drinking/peeing/pooping normally? "Yes."  What are you concerned about? "Well, I wanted them checked out."  Did you call your pediatrician? "Yeah, but they can't see them until Monday, and I didn't want to wait."

 - patient with chronic pain who was upset that they had to change doctors and insurance because of the ACA (affordable care act) and who now can't get the pain medication they were used to because it is no longer on their insurance formulary.  "Can you write me a script for it?"  Are you going to pay out of pocket for it?  "No, I don't have any money." Um...



**please read my disclaimer that these views are my own and do not reflect the medical groups for whom I work nor the professional organizations with which I am affiliated.