Access Denied

A woman with uncontrollable whole body shakes, arms flailing, legs jerking, stomach muscles folding her in half goes into the emergency room in a small town hospital. (Eufaula) The doctor does a CT scan, takes history, and can’t figure out why this is happening. He sees a possible stroke on the CT but that may be old. Over the next 12 hours he figures out that they can suppress the symptoms using a Parkinson’s medication, but still has no answers as to the underlying cause.

Community Hospital

He calls the state’s most prestigious and well known hospital system(UAB) to have the woman transferred. They won’t take the patient, no available beds and no option for a later admit. Unable to do more than keep the woman medicated and barely comfortable, the small town hospital just sends her home with medication, no solution, no diagnosis. That capability is beyond the resources of the small town.

It is now up to the patient to find a neurologist/specialist before either her medications run out or she returns to an emergency room with another acute event. She has a primary care doctor in Birmingham at UAB but that doctor retired. A referral from that practice would get her seen. They will see her, in 45 days well past the end of the medications that control the tremors. It’s an emergency only held back by medication.

The absolute indifference to the plight of the patient by UAB and I am sure, a multitude of other institutional medical centers has become the trend not the exception. The primary care has its processes, and won’t budge, the specialists use this as a shield against seeing new patients and the result is patient lives are at risk. The time to diagnosis and treatment is extended and maybe the patient survives until they can find the right resource, and perhaps the patient dies while waiting.

This certainly seems to be the approach at UAB where the wearing of flimsy paper masks is still required even though there is no medical evidence that the masks prevent any disease, Covid-19 or otherwise. The patient is left with calling every neurologist across the state in hopes of finding one that will look at her case.

Medicine has become more focused on the process of limiting access, even to fully insured patients, than making any attempt to resolve the most serious cases as soon as possible. Is it equity that ties up the resources now, not the need to treat the most serious cases first? Do serious cases no longer matter? What ever happened to the oath physician’s take?

Life expectancy has fallen precipitately over the last two years. While therapeutics for Covid were discouraged, critical patient needs ignored, cancer screenings delayed and fear promoted, the result has been increased death. There has to be a point where doctors stand up and say that this is not acceptable. Still, I see few signs that in the face of increased administrative burdens, the push for more expensive pharmaceuticals, greater interference by insurance companies that the doctors, the people most invested in this system other that the patient are willing to say anything.

Doctor’s and nurses have gone from being perceived as heroes, fighters for their patients, champions of good health, to being perceived in large part as bureaucrats, too scared to take up for their patients, too frightened of consequences to state even the obvious. Science now means less than personal security. Of course there are a few that stand up to the pressures put on them and they pay a high price for stating the obvious. There are far too few champions to change this trajectory.

In the meantime, the case of the woman above remains unresolved and it is only a matter of time before things become life threatening again.