Where does our Duty Lie?

What if I had a tooth ache that prevented me from sleeping soundly through the night? Or, what if I had chronic chest pain that worsened as each day went by? I would probably schedule an appointment with my primary care doctor. With no second thoughts about where to go, what doctor to see, or how I would pay for it, I would comfortably know that my medical concerns would be promptly addressed. Having been privileged with health insurance, I must admit I never took the time to think about the other side of it until this summer…

For eight weeks this summer, I served as an intern at CrossOver Healthcare Ministry in Richmond, Virginia. CrossOver offers healthcare, dental, mental health, optometry, and social work services to those who are strictly uninsured and have a household income at or below 200% of the Federal Poverty Line. A few staff clinicians and numerous volunteer doctors and nurses run work together to provide care for their patients. In order to determine eligibility, patients must undergo financial screening. While most people who come into the clinic do qualify for care, there are many that fall between the cracks of not qualifying for CrossOver services and not being able to afford ObamaCare. Nonmedical considerations too often affect treatment decisions for uninsured patients and results in care that falls significantly short of something that lives up to the human dignity that everyone deserves. Over the summer I read a reflection from a physician published online on the National Center for Biotechnology Information from The Oncologist. There was a particularly poignant excerpt that I have shared below:

Where does our duty lie? With the patient? With our employer or health care system? With our country? More and more, I wonder whether the “special obligations to all [our] fellow human beings” that we swore to uphold as part of the Hippocratic Oath now comes with caveats: so long as they are American? Insured? Wealthy? I am not naïve in understanding that acceptance of even one uninsured patient by a hospital could be very cost-ineffective. I am also aware that the financial success of one health care system guarantees future medical care for more patients. Indeed, when the institution does well, that success often translates to a better work environment for the physician. But does economy come before duty?

-Dr. Debra Ann Ferman, Reflections on Caring for the International Uninsured Patient

Dr. Ferman urges the medical field to ask what is more important, the patient or the health care system. I had the privilege to witness the primary care providers and nurses at CrossOver bridge the divide between the unfortunate politics of healthcare and providing the utmost, compassionate care to patients from all walks of life. There were many moments where CrossOver’s providers and staff offered the epitome of compassionate care. For example, a male patient, confined to a wheelchair, came into the clinic for his scheduled primary care visit. A left leg amputee struggling with mental illness and hypertension, one could only imagine his daily struggles. After he saw the primary care doctor, I checked him out at the front office and attempted to schedule his next primary care visit. He wasn’t able to schedule one because he had no idea how he was going to get to the clinic. His car was stolen, he is borderline homeless, and has no other resources available. He also needed more bus tickets, but the CrossOver social worker was not in that day. A front office staff member then gave him a new backpack and some Ensure that she had bought to provide a little more nutrition for him. This act was a sign of true commitment and compassion to patients. Looking at him across the computer, I cannot explain how deeply moved I felt. He was so appreciative of the act of compassion shown by one of the patient advocates. This was just one of a myriad of moments.

The greatness of this clinic is in its level of benevolence and compassion it is able to show by caring for the weak and less fortunate, treating them with the utmost respect, dignity and compassion. I have learned about what it truly means to offer compassionate care to those in need, and I hope that this sort of care permeate the American health care system.

Diane Casini is a part of the Class of 2017 and is from Burr Ridge, IL. She is a Science Pre-professional and Spanish double major. In her free time she is apart of the Compassionate Care in Medicine Club and the newly approved ND Club Softball Team. She hopes to pursue a career in medicine upon graduation.