I was on rounds with the subinterns recently and I met a man admitted for GI bleeding and anemia. He has a relatively straightforward presentation. On colonoscopy he had a mass found that was biopsied. Since I was not the attending of record, I was careful not to overstep how much I revealed to him.
The man saves me the trouble by volunteering “So, it looks like I have cancer, isn’t that so Doc?”
Colonoscopy reports are so efficient. You can, with a color printer, place a report with actual pictures of the patient’s lesion directly into the chart as a routine matter of care. The lesion was almost certainly cancer and he had lesions in his liver as well.
I ask the intern and students taking care of him where he will follow up after being discharged . they had not thought it through. In-patient care is very intense. Fill the tank with blood. Get a diagnosis. Discharge.
Key issue: “Does he have insurance?” NO
“How will he come here for chemotherapy without insurance to pay his visits?”
THe man works full time as a carpenter. unfortunately, he works for a small business that could not possibly afford $15,000 a year per family plan for insurance. Full time work. Just enough to render him ineligible for medicaid, but not enough to afford ANYTHING we were doing for him today.
And…”How old is the patient?” …..”54″
“So, at what age does screening begin?” it’s an easy question. Colonoscopy is to begin at age 50. Time enough to have detected and removed the cancerous polyp long before it invaded his colon, and now his liver.
A working man. Just enough to live. Not enough to get him the colonoscopy that would have saved his life had he been screened at age 50 like all the patients with insurance get.
Tags: Patient Story