As our elected officials consider to weigh the future of our nation's health care, I thought I would take the opportunity to share a few vignettes of patients that I've encountered this year who exemplify the way that access to health care can make the difference between life and death.
The undocumented immigrant with seizures
We recently met a young undocumented Californian in his twenties in the emergency department, who came after experiencing a seizure. His brain scan showed an abnormality that makes it likely that he'll continue to have more seizures without treatment, so we knew that he would need to be started on anti-seizure medication. Ordinarily, we would like to have him see our outpatient neurologists to manage his treatment - to ensure that he's taking the medicine, that it's working well and that there are no serious side effects. Without insurance, however, this is unfortunately out of the question. This makes his chance of being treated successfully much smaller, and will almost certainly put him at higher risk of injury with activities such as riding a bike, cooking, swimming, and using equipment or machinery.
The insured patient with preventable late-stage cancer
A middle-aged man presented to our care in the midst of a months-long illness that he hadn't sought medical attention for. Over the years, although he qualified for full government-sponsored health insurance, he generally avoided interacting with the medical system and tried to avoid the doctor's office. He hadn't had his routine recommended cancer screenings that would have been fully covered by his insurance. Unfortunately, our diagnostic work-up revealed a late-stage, metastatic cancer that had spread to multiple areas of his body. It's likely that this could have been caught earlier and cured by surgery alone if he had undergone his recommended screenings.
The child with a chronic condition managed in the county health system
On my pediatrics rotation, we saw an elementary-aged child in clinic who was sent directly from school for wheezing, shortness of breath, and inability to participate in activities. Asthma, one of the most common chronic illnesses of childhood, requires regular follow-up with an outpatient doctor and close compliance with medications to prevent unexpected emergency room visits. This child, with state-provided health insurance through Medicaid, was able to come see us the same day so that we could adjust his asthma medicines and prescribe him a short course of steroids. Without health coverage, the emergency room would have become the main avenue of care - and by then, the illness could have been life-threatening.
The bottom line is that adequate health coverage is a necessity for patients to have any chance of getting the care that they need. I've seen firsthand that uninsured patients simply do not have the opportunity to get even the most basic standard of care management for medical conditions that are likely to be life-threatening over time. The second lesson, though, is that "access to care" encompasses much more than just health insurance. The availability of providers at the right time and place as well as the ability and willingness of patients to participate are critical issues as well. We need to do a better job on all fronts: providing people with the health coverage they need and offering outreach and education to help people interact with the health system in appropriate ways.
Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.
Nathaniel Fleming is a third-year medical student and a native Oregonian. His interests include health policy and clinical research.
Photo from Pixabay