Understanding Drivers of Health to Overcome Them

The patient I come back to all the time about why I went into medicine is my mom. My mom was diagnosed with breast cancer when I was 15, she died when I was 20, and right after that I went into cancer research for three years, then I went to medical school. When I think about the patients who couldn’t access care, I have so many that were subjected to all sorts of barriers because they couldn’t afford their care. Interestingly, most recently, I had a patient—this is a true story—I had a patient who came in who actually had private insurance and I said, “where do you live?” and she said, “well, in Frisco,” and I asked, “do you rent or own a home?” and she said, “well, I’m embarrassed to tell you this, but I live in a women’s shelter.” I said, “really, you live in a shelter, and you just got a job,” and she said, “yeah, the rents are so high that I can’t really afford rent, so I live in a shelter.”  

So, she needs surgery, she has a 13-centimeter ovarian mass that needs surgery. But because she’s in-between, she can’t qualify for Medicaid, but can’t also pay her deductible. She has useless insurance that precludes her from getting something that may turn into a surgical emergency, and I don’t even know if it’s a malignancy. There are a lot of people like that.  

I have a lot of patients, also, because I’m not in Dallas County, that can’t go to a place called Parkland, which is a big county hospital. We don’t have county hospitals in a lot of the rural counties where I work. So, interestingly, my patients will have malignant diagnoses; it’s hard for them to get care anywhere, and that’s a real heartbreaker when I have to discharge a patient, not only to a homeless situation or food desert situation, but also into a situation in which I know they need life-saving care, and they can’t get it. That is really, really disturbing for me.