Medical treatments for the poor (not)

Medical treatments for the poor (not)

I recently finished reading a book by a newly-minted doctor called No Apparent Distress: a Doctor’s Coming-of-Age on the Front Lines of American Medicine, by Rachel Pearson. As the blurb says, it’s “a brutally frank memoir about doctors and patients in a health care system that puts the poor at risk.” Pearson is a good writer.

While she was a medical student, the author volunteered at a free clinic in Galveston, Texas. One man, who lived at the Salvation Army shelter, came to the clinic with cancer of the esophagus. The local hospital had diagnosed the cancer but did not treat it because he was uninsured. He was 61, ineligible for Medicare, and, as an adult with no dependent children, he was also ineligible for Medicaid in Texas. At the clinic, all the staff could do was try to get him something for pain, which was extremely difficult because of the clinic’s non-opioid policy—even though opioids are the “standard of care” for cancer pain. They managed to get him a prescription for methadone, which his brother helped pay for. But not all pharmacies always carry methadone, and he’d have to ride his bike all over Galveston to find a pharmacy that had it on hand.

The clinic staff also tried to get him treatment by applying for indigent care, filling out endless paperwork and applying to hospitals all over Galveston County. The applications were denied over and over again. After eight months, the patient was finally accepted into the Galveston County indigent care system. But the county said he had to live within walking distance of the hospital that would be treating him. It was nowhere near the Salvation Army shelter. The patient’s brother came through again and bought him a trailer near the hospital. The patient was scheduled to begin chemotherapy. But the treatment never occurred. The county told the patient that he no longer qualified for indigent care because he owned a trailer. He was too wealthy.

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