Healthcare vs Culture: My thoughts on the matter:

Recently I've been spending a great deal of my time working and experience the Emergency Room. As part 2 out of 3 pieces toward becoming a Paramedic, I've been required to spend a minimum of at least 160 hours (3 or more 12 hour days) in the Emergency Department where under the direction of a preceptor and emergency physician, I triage patients, start IV's, take vitals, push medications, chart my findings, and whatever else needs done. During this time I've been able to see a lot of different things, I'm not a great writer, but I'm going to attempt to put into words the beginning of my experiences there and how it has shaped my way of thinking;

During my first few days taking shifts at the ER, I came across a letter written to President Obama by a Dr. Roger Jones who is an emergency physician. (You'll need to read the letter for the rest of this post to make much sense) The letter states simply this:

Dear Mr. President:

During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone. While glancing over her patient chart, I happened to notice that her payer status was listed as "Medicaid"!

During my examination of her, the patient informed me that she smokes more than one pack of cigarettes every day, eats only at fast-food take-outs, and somehow still has money to buy pretzels and beer. And, you and our Congress expect me to pay for this woman's health care? I contend that our nation's "health care crisis" is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a "crisis of culture" a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one's self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that "I can do whatever I want to because someone else will always take care of me".  Once you fix this "culture crisis" that rewards irresponsibility and dependency, you'll be amazed at how quickly our nation's health care difficulties will disappear.

Respectfully,
Roger Starner Jones, MD

As stated above the letter, I came across this via a facebook post from a friend of mine and having seen several "Medicaid" patients with similar surroundings as Dr Jones mentioned and "luxuries" of a wide variety, I immediately re posted the letter on my own facebook account with the statement that "I could not agree with this letter more." A few of my close friends quickly noticed the letter and we began discussing the matter publicly, Now that I've spent my fair share of time working in the emergency department and actually getting to know my patients on a personal level - often times even checking in on some of the more severe ones in the ICU after hours, My outlook on Dr Jones letter has completely changed, and although he raises a few good questions, I really can't agree with the way he chooses to state his thoughts.

What I do agree with:
Many medicaid patients come into the ER with what could be called "luxuries"
As a nation, more needs to be done to cut down addiction to alcohol and tobacco.
Irresponsibility should not be rewarded.

What I do not agree with:
The so called "luxuries" that many patients have are compromising the quality of health care available.
The government alone is responsible for fixing both our culture and healthcare crisis
Fixing the "culture crisis" will cause our nations health care issues to disappear entirely.

  I chose to work at my specific ER from a plethora of bay area hospitals for a few specific reasons, One reason is that the community surrounding me is one that has been struggling with gang activity and poverty while at the same time, million dollar homes cover the hillside. The ER with which I am affiliated is also a community clinic for low income families and the uninsured. My reasoning for choosing this ER is because, here, I have had the opportunity to see a wide variety of medical patients come in with differing conditions, I have had the chance to assess these patients and become familiar with how patients with a wide variety of medical conditions present and exactly how these conditions are treated. The chance to work with a variety of medical patients will no doubt help me when I get out into the field and get to treat patients of a medical aspect. We also get our fair share of trauma in this hospital, but lets face it, trauma is easy... Control the bleeding, stabilize the patient, and transport to the hospital for proper treatment, and now for me to stay focused on my thoughts regarding Dr. Jones letter:

I certainly agree with Dr Jones point that we as a nation are suffering from a culture crisis and as well as a healthcare crisis, however I do not necessarily believe that fixing one or the other will immediately fix the other, rather, I think that these 2 crisis' need to be addressed  individually, and collaboratively we will begin to see progress in both directions. It is my opinion that the culture crisis to which Dr. Jones was referring also stems from part of a financial crisis which often times rewards irresponsible behaviors and actions, I think more time and effort needs to be put toward a quality education in budget management on any level of income, I believe this would be a great start to fixing the culture crisis. -I can't help but think of a patient I had the other day who had just been released from prison, He was on a psych hold because he mentioned that all he wanted to do was get back into prison since while he was there, he didn't have to worry about where his next meal would come from, and he was willing to do almost anything to get back inside.

Dr Jones mentions that many of his patients use medicare to pay for their healthcare while at the same time having in their possession things like gold teeth; tattoos, cell phones with R&B ringtones, Brand name shoes, etc. However as my friend Sam pointed out to me: " I think it is fair to say that Dr. Jones did not ask his patient what the actual cost or relative "newness" of these objects was; instead, he made assumptions." Dr Jones then goes on to cover that many of these patients also have access to beer, cigarettes, and a days supply of nourishment in the form of fast food, These are often the types of patients who I have personally seen coming into the ER and using medicaid to pay for their medial services, since reading Dr. Jones letter I have been paying close attention to these patients and I've been impressed, It seems to me that most of the time, They've worked quite hard for what they've got and who am I to judge them or how they pay for their healthcare because they've got a sweet ringtone, tattoo, etc?

 I also see a lot of prison inmates come in, I've never bothered to ask why they were in prison or jail, and these patients are often some of the most kind and understanding patients that I've had the pleasure of working with. I've seen patients come in under the custody of police officers who were simply looking for a day out, and I've seen them come in on the brink of death and I have medicated patients who didn't speak a word of English,  Either way, Every patient I've had the pleasure of working with had ended up with the same quality of health care, regardless of their stature in life and I truly believe that this is how it should be. I am currently uninsured myself because as a student I can't afford the cost of good family health insurance, and while I am confident and grateful that I can still get health care when I need it, I don't agree with the idea that health care should be free to everyone and anyone, There are those who need free healthcare, and there are those who do not. What I do agree with is that health insurance needs to somehow be made affordable to as many people as possible. This is another topic for another day; What I'm taking out of all this is that if we keep rewarding irresponsible behaviors without properly educating people, we won't see any problems fixed in either of the crisis brackets mentioned above:

That's my 2 cents on the matter, Thanks for your thoughts so far! I'll get back to posting regularly shortly

(To see what my friend Sam has to say on the matter, click this link:)
http://oldbuddysam.blogspot.com/2010/09/foreigner-in-strange-land-dr-roger.html