Wednesday, April 6, 2011

Stating the Obvious on Medical Costs

In editing this piece, I realize that it is fairly hot and heavy handed. I simply cannot apologize for my vehemence, but now you know that it is there.

Many don’t take prescriptions because of the cost

I saw this on abbyjean's Tumblr.

Wow, LA Times, really?!? Gee, next they will find out that people break compliance with follow up or specialist visits due to money or circumstance. Holy fuck, do folks really have their heads buried quite that deeply up their own asses?

Yes, people want to follow up with their doctor’s orders, recommendations, prescriptions, suggestions, and referrals. This is why low income folks have such terrible compliance levels. Fucking hell. I can think of three big roadblocks right off the top of my head: no money, no time off from work or childcare, and no ride. We can dig deeper: some people are neglected and abused, at home and maybe at previous providers. Have you shamed a patient away because they were fat, slutty, or sloppy*? Did you do it with some snide comment in the hallway you thought they couldn’t hear?

We want to get better, just like everyone else does, dammit! There’s just a lot in the way that you cannot see, because you see a diagnosis waiting to be made, not a whole person. Can you just take one damn minute before you put your hand on the blasted door knob, and deliberately employ a gestalt point of view for just sixty bloody seconds? Are they seeing you on Medicare, Medicaid, or their own dimes? If the patient has transportation programs, sliding scales, pharmacy discounts, and/or drug manufacturer discounts available to them do they even know? Because it is just as bad as having no options if you do not know they exist.

Sure, maybe you and your staff just cannot handle trying to keep track of that on top of every thing else you have to manage. I get that, I really do. So help the economy by hiring someone to do it for you – all they would need is a high school degree, some empathy, and some tenacity. With the additional people you can help, maybe it will even cover an additional employee.

* Fat, slutty, or sloppy were just a few adjectives I have heard office or hospital staff use regarding patients. I offer no judgments to folks that are fat, appear to numerous sexual partners (people suck), or folks who have a hard time bringing themselves around to what their community considers acceptable appearance standards. Neither should their damn medical professionals!


  1. When my rheumatologist prescribed Humira, his nurse called and made arrangements with Humira for them to pay all but $3.75 of my $389.00/month co-payment before I even knew what my co-pay was. On the other hand, I fired my gynocologist because her office manager continually screwed up my account. The professionalism and quality of a doctor's staff is just as important to your health as his/her personal qualifications.

  2. @Lunabug - I completely agree! I think that part of it is simple professionalism. I think that another part of it is an intrinsic empathy that is quite undervalued today in favor of a detachment, that faux "objectivity" that people seem to strive to achieve. I do not want my doctor to be objective, I want them on my side!

  3. When I worked at the state HIV office, one of the sites whose software I wrote was a charity that provided transportation to and from doctor's visits for persons with HIV either via bus or taxi vouchers, or their staff picking people up and taking them. They were always swamped with requests. I think that the damage caused by barriers to services for the people who need them is certainly a problem that those who do not have such barriers simply cannot fully understand.

  4. @Vargr - That is a great service!

    I am boggled sometimes by the inability to put one's self in the position of less-well-off-people. Hell, how many of us is just a month with no paychecks away from that anyway? Or is that it - not considering it serves as some kind of superstitious protection?


I will get to your comment as soon as possible! Moderation is to guard against some of the vile things that happen on this series of tubes...