These are Clinic Patients

They get to clinic early in the morning, often before any of the staff have arrived. They do this because they realize they need to register early, or they might face a 2 hour wait to be seen. If they are lucky, they are able to secure a seat in the crowded waiting area, otherwise they stand in the doorways and hallways waiting for their name to be called. They are one of 40 patients waiting to be seen by one of two doctors during a 3 hour clinic session. If you do the math, this leaves roughly 9 minutes for the doctor to see each patient, and this includes the time needed to document and bill for the visit. The doctors these patients are seeing are actually residents. The attending physicians presiding over the clinics sit in a back room on the computer or phone, signing the charts as the residents bring them to their desk with hardly a glance at what is actually written. They are getting paid by the hour, and therefore have little concern for the patients themselves. As long as they are there, they are getting paid. The number of patients seen or the procedures done have no bearing on their salary, so why put in the effort? Many of these patients have no insurance. If they do have insurance, it is either medicaid or medicare.

I take a chart from the massive pile and call in the next patient. He is young male in his late 30s with diabetes. He seems shocked when I explain to him that he has a large diabetic pressure ulcer on both of his feet. He tells me he can not see his feet well, and thought that whatever was there had already healed. He explains to me that he has stopped taking his blood pressure and diabetic medications because he ran out and is unable to get an appointment with his medical doctor for months. This is common, as all of the clinics are overbooked. I suggest he go to the ER, realizing this means a 6 hour wait time since all of the other patients who can not get appointments with their medical doctors are down there as well. He realizes it also means a huge medical bill in the mail in a few weeks. I explain to him that he needs a special boot to wear to offload the ulcers so they can heal. He has no insurance, and the boot costs $150. He tells me he can not afford it, nor can he afford to take off from work in order to stay off his feet. He has few options. He is the uninsured working poor. I build a makeshift pad for his shoe with some felt padding, realizing this is only a temporary solution. I feel helpless as I send him back to the waiting room.

I pick up the next chart and call in a female in her 40s. She limps into the examination room. I review her history and discover that she is suffering from a chronic ankle sprain. She has no insurance, and is unable to afford the $700 lace up brace. She is already struggling to pay off the bill from the MRI that was performed a few months ago. She cries as she tells me she can not take this pain much longer. She is looking to me for an answer, but I do not have any cheap ones. I explain that she would probably benefit from physical therapy. She tells me that even with the payment plan, this costs $40 per session, or $80 per week. I apply another soft cast to her leg, one I realize will become dirty and fall off long before her next appointment in clinic. I explain she may want to consider surgery to repair the torn ligament in her ankle, but this would also require speaking to a hospital based financial counselor to discuss payment options. I send her back to the waiting room as well.

I sit in the quiet examination room and take half a moment to contemplate these patient's situations...I can not take too long, the massive pile of charts is still waiting, and it keeps growing larger. I count the pile..20 more. These are clinic patients..the poor, the uninsured..or just another number in the pile my attending wants me to rush through so he can leave before the traffic gets heavy. I am tired.