Is effecting social change a pipe dream?


  • Specializes in Hospital medicine; NP precepting; staff education. Has 22 years experience.

I'm not naive enough to believe I'm going to save the world in any capacity. But it still disturbs me to see disparities in health care that just shouldn't happen.

When a down-on-your-luck patient seeks assistance whether the circumstances are of their own making or not, it's frustrating as a provider to be unable to connect them with requisite resources. Sure, those who are noncompliant or blatantly making poor lifestyle choices repeatedly makes it simple to not tap into compassion and just wash your hands of it.

But then there are those who really are having an immensely unfortunate run of bad luck and circumstances.

One such creature presented yesterday. Her TSH was greater than 100 because she has been without her medications since February. She is on her way to a myxedema crisis. Weak, forgetful, cold intolerance, diminished reflexes.

So many social issues impacting this lady have made it almost hopeless that she can get her head above water and it breaks my heart. I felt helpless. All I could do is admit her for medical management and get social services involved.

It confounds me that such disparities should happen.

You're right that it is heart-breaking, but I have to ask to what end can we really help as healthcare providers? I think we have a mountain of evidence saying how people -could- be treated for the best outcomes but it never goes on to address the x-factor, which is what I refer to as the social barriers that impede patients in taking care of themselves.

While I won't start down the political rabbit hole of health policy in the United States, I think we all can agree that we are such a long way from where we could be. We need a fundamental paradigm shift if we are ever to start having lasting and improved health for our populations. The insurance-big pharma establishment complex is highly complicit in disparities we see all too frequently these days.

The financial barriers of treatment for diabetic patients routinely contribute to non-compliance and worsening disease, particularly when insurance companies only want to cover the most difficult drug regimens for patients to use (such as 4 accuchecks and 4 insulin shots a day + oral meds). In my neck of the woods, this becomes a huge deal for my patients who are already financially strapped with having to come in 2-4 times a year, have an annual eye exam, etc. It would be great to just give patients medications that are easier to deal with at a FAR lower cost so these people aren't racking up 2-3+ DKA admissions a year, the development of multi-organ failure, and possible vascular complications that will ultimately lead to amputations and early mortality. One hospitalization (say $30-60k for a DKA) would cover a patient's diabetic medications for a long, long time. This is what we should be thinking about with our health models... not just slinking by with the bare minimum and dealing with the ramifications of such mediocre care.

It's the great dilemma of our time and we have no one in Washington to get us there. What a disaster for our country.

Darth Practicus, NP


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Specializes in Hospital medicine; NP precepting; staff education. Has 22 years experience.

Exactly. The biopsychosocial needs are disregarded for the point of service needs only without taking into account the whole system and dynamics between them. Entropy is ever present and any momentum away from it is thwarted on a macro level, trickling down to individuals. So disheartening. But we can only do so much with what we have.