By Ashby Wolfe
Ashby Wolfe is a resident physician in the Department of Family and Community Medicine at the UC Davis Medical Center in Sacramento. She holds an MD as well as masters degrees in public policy and public health. She blogs at www.ashbywolfe.com and is a guest blogger for HealthyCal.org on issues of family medicine and community health. Her opinions are her own and do not necessarily represent the views of UC Davis or HealthyCal.org
As our Congressional representatives and Senators continue to negotiate and compromise in order to draft a universal piece of health reform legislation, I am reminded of a statement paraphrasing Virchow:
“Medicine, if it is to improve the health of the public, must attend at one and the same time to its biologic and its social underpinnings. It is paradoxic that at the very moment when the scientific progress of medicine has reached unprecedented heights, our neglect of the social roots cripples our effectiveness.” (Eisenberg 1984)
These words could not have rung more true than in a recent visit with one of my new patients. For purposes of the example, let us call him Mr. Smith. He is a 40-something gentleman, a 2 pack-a-day smoker, who has never needed to visit a doctor in his adult life until two weeks ago when he could not catch his breath and was running a high fever. Mr. Smith was seen in the emergency room, treated, and told to “follow up with his regular doctor” for further management of his severe obstructive lung disease – likely a consequence of his 30 year smoking history. Fortunately, he had health insurance and the fact that he didn’t have a regular doctor was not lost on him.
So he ambled into my office for the first time last week for a check-up. At first glance Mr. Smith was slightly out of breath but an otherwise healthy-looking gentleman, with an athletic physique. As I talked with him, it became clear that he was struggling at his construction job primarily because he could not catch his breath; and his single inhaler was not relieving his symptoms. He told me that he didn’t want to quit his job because he would lose his health insurance, but that he was worried that he would get fired if he could not do his duties as a result of his current state of health. He also informed me that he was running out of his medication, but could not afford the $30 co-pay at the pharmacy to pick up his remaining refill. “Doc,” he said, “I have to put food on the table and pay the rent, you know.”
This is a situation many of us have heard before – either spoken by a politician stumping for votes, or by community members advocating for a better system of care. It is a different feeling entirely when you in a position having a direct effect on another person’s health. As I talked with Mr. Smith, I felt that his future held one of two outcomes that I could