People are Dying and it Has to Stop

It's a remarkable challenge trying to help patients, difficult even under the best circumstances.

This is not the best of circumstances, however. The growing number of patients unable to afford medical care is changing typical patterns of diagnosing and treating common medical conditions, increasing complexity and costs in our medical system, and of course, impairing our ability to provide care.

A recent patient presented with four weeks of sinus symptoms. In fact, the very day the patient came in they had finally begun to feel much better (I take credit for that). They'd had the typical array of annoying cough, nasal congestion, facial pressure and pain, and ear pain. The symptoms had continued for an entire month, but remarkably, on the day of this appointment, had suddenly improved. As the symptoms had improved on their own, albeit slowly, there was no need for any particular treatment.

At the end of the appointment, however, the patient asked when the diarrhea would improve. Diarrhea? What diarrhea? It had started a few days earlier. My intuition told me that something was awry. Diarrhea isn't typical for a sinus infection. I questioned the patient, had they taken anything to treat the symptoms? In fact, unable to afford a doctor's visit at the time, and worried about the possible costs of treatment, they had located some old unused antibiotics, and had taken them. It just so happens that this particular antibiotic, not typically used for sinus infections, is associated with a potentially dangerous type of bowel infection, Clostridium Difficile colitis, which presents with diarrhea.

Now, rather than a simple sinus infection, we have a bowel infection as well, one that is sometimes difficult to treat, and has become increasingly prevalent, and aggressively infectious. Would have been much easier had she just been able to come in earlier, and not taken to self-doctoring that so many feel forced to try.

I discussed the case with a colleague who told me about another patient who, sadly, unable to afford care, had fared much worse. The patient had complained of pain, but when a diagnostic test was recommended, deferred due to excessive cost. They returned once more months later with the same pain, but once again, could not afford any testing. Finally, they came back, again months later, and the test was done, revealing what was then a late-stage cancer to which they would succumb a short time later.

Effective health care reform is a necessity NOW. The human toll of a broken health care system is real and expanding; the economic toll is immense, both in terms of the costs of later-stage and more serious health conditions, and also lost wages and productivity.

Health care reform is the civil rights of this era. We must attack this issue with the same passion and energy NOW, and not let the moment slip away again, as it has so many times in the past.