She was a stressed-out mother of six, working a grueling job as a kitchen manager that required her to wake up at 4am every day. She came to her doctor for her headaches: searing, throbbing pain that made her vomit. She slept fewer than five hours a night. She had tried every over-the-counter pain medication I had heard of, and she had maxed out all of those doses. I met this woman during my family medicine clerkship, and like is the case for so many other patients with chronic pain, we didn’t have any great solutions for her.
Somebody down the line had tried prescribing her a drug for migraines, a drug she was taking more often than she probably should have, but that’s beside the point — she stopped taking it because suddenly it got too expensive. She had gone from paying about $4 a month to her drugstore charging her about $190.
It was hard to understand exactly why this happened, and the patient didn’t seem to know. Maybe she had lost her insurance, or maybe her insurance company no longer covered it. Whatever the reason, this price hike wasn’t something she could afford.
“It’s because of Obamacare,” her fiancé, whom she had brought along to the doctor’s visit, interjected. He crossed his arms and smirked.
“Well, actually,” and I bit my tongue. Actually, I wanted to say, the Affordable Care Act is probably the best thing that could possibly happen for your fiancee’s headaches. They were a working-class couple living in rural, central Pennsylvania. They were too rich for Medicaid, too poor to afford decent private insurance, and bouncing between part-time jobs gave them spotty coverage and a lot of anxiety. They are exactly the type of people for whom the health insurance exchanges were designed.
This suffering woman did not need to hear a medical student diatribe, so I refrained. But politics and patient care are inextricably linked, especially as of late. Does policy have no place in the exam room? Or just as I have an obligation to explain biomedical facts objectively and accurately, do I also have an obligation to the facts of American public health?
The facts of American public health, as any medical student learns in the classroom and sees firsthand in the hospital, are not encouraging. You’ve heard it before: we spend more money and yet are still sicker than all the world’s wealthy nations. And as a recent New York Times article lucidly explains, we also spend much more money on medications.
What role do those facts have in day-to-day interactions with my patients? Thus far in my training, I have often felt painfully underprepared when it comes to helping patients with healthcare-associated red tape. One might argue that information about emergency childcare centers for stressed teen moms or how to retroactively pay for your hospital stay when your Medicaid application is still being processed are beyond the scope of medical education; I can say that I have learned multitudes from our social work colleagues who help patients navigate scant social services.
But what about when patients are vocally opposed to health policy reforms that will probably make them healthier — healthier in an objective, quantifiable, pretty indisputable way? Take my patient with the headaches, for example. Access to reliable health insurance will help her get to the doctor regularly, help her pay for prescription medications she needs, help her access mental health services to get her stress under control. The Affordable Care Act will allow her to do that. Is it her doctor’s role to say something?
I’m not sure what I would do if I were her doctor, not just a student meeting her for the first time. I don’t think it’s appropriate for doctors to talk about their voting habits or to make patients feel bad for having different political views, but I do think doctors should, at the very least, encourage their patients to get health insurance. Lately that can feel like a partisan political act. Soon, I hope, it will feel as objective as measuring a blood pressure.
Mara Gordon is a medical student who blogs at Mara Gordon’s Blog.
