I’d just started seeing patients, as an intern at Ben Taub Hospital, in Houston, when the senior resident on my team received notice from the emergency room that a woman needed to be hospitalized overnight, to receive treatment. He wasn’t the type to argue with other doctors over the phone. Still, it was clear by his questions—“So no fever? And she’s totally hemodynamically stable?”—that he wasn’t impressed by what the doctor in the E.R. was telling him.
I asked him more questions, and soon enough I’d built a hypothesis in my mind: this woman had early Alzheimer’s—or Lewy body dementia, or Wilson’s disease, in which the copper we eat isn’t properly processed, leading to buildup in the brain. I flipped to the neuro chapter in “Pocket Medicine.” I decided that I’d organize my patient history, which I’d soon present to my senior resident, around these neurological conditions, rather than the urinary-tract infection.
“Let’s go,” he said, motioning quickly toward the computer. He logged into the system with two index fingers. I gave him the patient’s name and medical-record number and he began scrolling through the data.He examined the woman’s latest head CT scan. Then he released the mouse and sank back in his chair. “Well, I definitely don’t think she has early-onset Alzheimer’s, or any of that other stuff you mentioned,” he said.
As I spent more time in the hospital, a belief began to take shape in my mind: whether someone had insurance could affect their health as much as, or possibly more than, their genetics. I wasn’t the only one wrestling with this idea. In 2017,published a review of eleven studies that examined whether people are more likely to die if they lack health insurance. Two of these studies found that Medicaid expansion reduced adult mortality by as much as six per cent.
I was now a senior resident, and Graham was my supervisor. Nothing about the patient’s history or physical exam changed my understanding of the case. After organizing my presentation, I called Graham so that he could sign off on my plan of attack. We met at the patient’s bedside. “Thirty-eight-year-old male, history of uncontrolled diabetes, presents with dizziness and malaise,” I said.
I’d learned about this aspect of doctoring from my dad. Once, he’d brought me, my mother, and my girlfriend along as his guests to a gala held by the Houston Hispanic Chamber of Commerce. I was in line for hors d’œuvres when I felt a tap on the shoulder: “Be right back,” my dad said, already walking away. We didn’t see him again for almost an hour.
i guess to be a doctor u have to be less human otherwise u can't function. + pls do an audio version of the article.
riconuila Cost has been THE dominant force in shaping medical outcomes for too many years to count. Welcome abord the clue train doc.
riconuila Especially so in mental health where wounds are not visible. It requires money to “see” them, and add to it: they’re all different. Walk into an E/R with a broken bone, so much easier.
riconuila Many inconsistencies in this story. A patient with uncontrolled diabetes, misdiagnosed as a UTI—nope. The author’s father, delivering a baby in a tuxedo—this would never happen, and the scenario about the young man with liver disease, who was given up on—nope again.
riconuila Notice the crucial yet invisible role the social worker plays in both examples from this article? Why isn't their perspective uplifted?
riconuila Of the 36 developed OECD nations, the U.S. is the only one without some form of universal or national health care. We live like animals because of our lack of majority-rule democracy. ElectoralCollege Senate Filibuster Gerrymandering JimCrowVotingLaws
riconuila 'Access to' is nonsensical. Everyone has 'access to' most anything, but only if they have the $$$$$$.