An entry from Facebook.

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Wednesday, July 22, 2009 at 3:12pm

A striking phenomenon occurred in the emergency department at Parkland Hospital every morning around 6AM: about twenty to thirty patients with kidney failure would show up at the emergency department, would have their blood drawn and EKG checked, and each person would hope that he was sicker than the other, because only a lucky few would be selected to receive emergent dialysis that day. Patients with insurance who have kidney failure normally receive dialysis three times a week; without it, fluid builds up in their lungs, making them feel like they are drowning; nitrogen levels build up in their bloodstream, causing severe abdominal cramps and muscle aches; their blood pressure becomes drastically elevated, causing intractable headaches and putting them at risk for a brain hemorrhage; and their potassium levels grow unchecked putting them at risk for sudden death. The swarms of uninsured kidney failure patients that would come to the emergency department every morning were lucky if they were chosen to receive dialysis once every few weeks. The “lucky” ones in this scenario were the people whose potassium levels were the most elevated, the ones who might die from a heart rhythm abnormality at any moment. I once had one of these patients go into cardiac arrest while waiting to be seen in the ER. We rushed her into a resuscitation room, performed CPR and defibrillated her, and we were fortunately able to get her back, after which she quickly received the life-saving dialysis treatment that she needed. I later found out from her that she had consumed numerous bananas and soft drinks that morning in a deliberate attempt to elevate her potassium level so that she would be chosen to receive dialysis. That’s why her heart stopped. This is how desperate she was to get the treatment she needed, and the only way she knew how to do it.

This is the situation that millions of Americans face today – access to health care only when their situation has become so grave that they are knocking on death’s door. And what I came to discover very quickly in my training as an Emergency Medicine physician is this: the vast majority of people who do not have health insurance are hard-working, good people who simply cannot afford it. And because they cannot afford health insurance, they receive no preventative or maintenance health care, which leads to worsening of their illnesses. They are then forced to visit the emergency department where thousands of dollars are spent to deal with the complications and consequences of their untreated illnesses that could have been prevented if only these people had received access to regular, basic, and much cheaper health care from a primary care physician. The system, as it stands today, refuses to provide basic services to persons who need those services the most, but then is forced to provide far more expensive services to these same people when it is already too late.

When I finished my residency and started working at a private community hospital in the suburbs of Washington, D.C., I was eager to see what it would be like to work in a system in which the majority of patients have health insurance and good access to health care. I’ve been here for two years, and I am still eager to see what that would be like. In talking to numerous colleagues that practice emergency medicine in a variety of settings, the consensus I get is that the situation is the same at all emergency departments across this country – a very large percentage of the patients seen have no health insurance and no decent access to health care once they leave the emergency department. I’ve seen far too many patients come to the ER in very difficult situations that shouldn’t be allowed to occur, like the gentleman who comes in with an arm splint that he has been wearing for months, originally placed for a broken bone. This splint should have been taken off and replaced with a cast a few days after his injury, and now his broken bone will never be able to heal properly, and he can no longer function in his job. But no orthopedist is willing to see this patient and provide this very basic service because the patient doesn’t have health insurance. And more and more, specialists are refusing to take call for emergency departments because they know that they will wind up having to care for numerous patients without health insurance. This results in a dangerous situation for emergency department patients because the expert help required for certain emergencies is no longer available. I often have to transfer patients who have a very treatable problem to other facilities because I have no specialist on-call to treat the patient. These transfers result in dangerous delays to patient care and are extremely expensive, putting a drain on the health care system’s valuable resources, and so the cycle of inefficiency continues.

I’ve been fortunate to experience health care in our country from many angles – as a resident training in a county hospital that serves the poor, as an attending physician working in a private, community based hospital, and as a patient who must fend for himself in the private health insurance system. The issue has become very dear to me – every day I see numerous patients that deserve so much more than what we as a country give to them. It is wrong to have to prescribe a man an inferior antibiotic for his pneumonia because he can’t afford the more expensive antibiotic that he really needs. (By the way, he will later come back to the Emergency Department and require admission for his pneumonia.) It is wrong to tell a patient to follow up with an endocrinologist to manage her thyroid condition when I know the endocrinologist will refuse to see her because she can’t afford his fees without health insurance. (She’ll be back, too.) It is wrong to have to intubate a patient who has a brain hemorrhage caused by uncontrolled high blood pressure that existed simply because the patient couldn’t afford to see a primary care physician. It is wrong to have to send that same patient by helicopter to another facility, dangerously delaying the patient’s care, because my hospital can’t convince a neurosurgeon to take call for the emergency department because he doesn’t want to have to deal with uninsured patients. Day in and day out, the inadequacies of our current system force me to do things as a physician that are not in the best interest of my patients.

I used to believe that healthcare was a privilege, but what I have come to discover is that when healthcare is treated as a privilege, only the privileged receive it. I now fervently believe that health care is a fundamental human right. It is morally wrong for a society to have the basic resources that are necessary to save lives and prevent suffering and to distribute those resources in a fashion that favors the lucky few and ignores the millions of people who need those resources the most. Furthermore, denying millions of uninsured and under-insured persons access to basic healthcare results in a system

that is appallingly inefficient, costly, and impotent; it costs us more as a country to persist in restricting access to healthcare than it would cost us to provide that care. And health care, much like education, a police force, and a military, is something that is so crucial to the welfare of our society that it cannot and should not be relegated solely to a for-profit system whose goal is not the welfare of the public but the financial profit that can be made at the expense of the public. Every day that I work in my emergency department and see patients coming in whose needs I cannot meet because of the inadequacies of our system, I become more steadfast in my belief that it is our duty as citizens of this country and as members of the human race to work quickly towards finding a system in which we all have access to basic health care, a fundamental human right.

(If you agree, please contact your district’s representative and both of your state’s senators and let them know! Specifically, let them know that you support a public health insurance option as an alternative to compete with private health insurance. Here’s a website where you can get your senators’ and representative’s contact information: http://www.usa.gov/Contact/Elected