Close to Home: A voice from the medical trenches

  • Dr. Herb Brosbe treating a patient at his office in Santa Rosa. (KENT PORTER / The Press Democrat, 2007)

I am a family physician. I work in a private office setting. I see all types of patients. I would like to share with you real examples that I have dealt with recently.

Betty is a 72-year-old woman without insurance. I ask her why a 72-year-old is without Medicare. She explains that her husband's medicines were so expensive they couldn't afford her Medicare payment. At social services, she was told that since they own their home their assets are too high to qualify for Medi-Cal. She has been feeling unwell for over a year. She has lost 32 pounds, yet has very swollen legs. The studies I order confirm her metastatic cancer. She is admitted to the hospital for diagnosis and treatment. Her bills will end up being paid by Medicare and Medi-Cal.

Jane, 82, has Medicare and private insurance. She has fallen down and is in a lot of pain. A few years ago, despite aggressive oral treatment for her osteoporosis, she had a fracture of the large bone in her right leg. The consulting endocrinologist recommended changing to an injectable medication to rebuild her bone strength. When she went to pick up the prescription, her share of the cost was $600. She applied to the pharmaceutical company for financial aid. It was denied because she was $37 over their limit. I don't feel that she can wait until morning for X-rays. She is transported to the emergency room where X-rays confirm new lumbar and pelvic fractures. Her hospital stay, and later rehabilitation, will result in substantial costs — costs that don't affect the company that denied her medication.

Margaret is 67. She is a retired nurse. She has had two strokes. She has insulin-dependent diabetes and multiple other medical problems. She is wearing a jacket as a skirt. She explains that she is out of clean clothes because she cannot afford Depends. She has not eaten anything today and wants to have her blood sugar checked. She cannot afford to fill the prescription for her test strips. She has been out of medications for a week. She is waiting for her Social Security check to arrive. The costs of her multiple medications have been so high that she could not afford her rent. She has no living relatives. She is living in her car. Because she owns this car, she was told she would have a share of cost to receive Medi-Cal. She cannot afford to pay this share of cost. Her blood pressure is dangerously high. 911 is called to transport her to the emergency room. She is treated with intravenous fluids and medication and discharged “home.”

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