Over the course of the past few years of school I have thought hard and tried to be as honest and non-biased as I can while I wade through the mess and waste that is health care in the U.S.. There have been times where I ask myself a question and try to figure out the why/how of it as it pertains to health care. I think over time medical students see and hear a lot of things and begin to shape their view of humanity based on people who are sick. It may not look fair on the outside, but I don't know of a better way to see people for who they really are. The "right to healthcare" debate is always on the table and there are a lot of people who SEEM to deserve and need it and above all else, APPRECIATE it. But in my experience more who don't.
As a physician you sometimes know more about someone than anyone else and you see them with their guards down. It can go both ways though and isn't always negative. For example, I have seen "gangbangers" teardrop tattoo and all, crying because they are in pain. They may want to cut my throat on the streets but in the hospital they are just as needy as the next person. In fact, one of the most humbling things I have had to do was wipe the butt of a 50 year old prisoner with gang tattoos who had lost control of his bowel and bladder. Twice. He turned out to be one of the most appreciative patients I have ever had and would be so grateful anyone came to see how he was doing.
You see people at their worst in the hospital. People in denial, people who have put things off for too long because of one reason or another, people who find out their 4 year old child has a brain tumor, people who find out they will die...soon. People who have no option but to let down the wall they have had for so long in order to ask for help. It can be very interesting at times. But it always gets me thinking. Here is one thought that has been heavy on my mind at times.
Why do we not take better care of the resources we give away?
As a society we have chosen to provide health care through medicaid and medicare and through our emergency rooms. Right or wrong, we are doing it. Why aren't there stipulations to free things? For instance shouldn't we say "We are giving you this resource for free, but in order to make sure it is used for its intended purpose to the best of its capabilities, you can't smoke, do drugs, commit a crime or have more children than you can afford which is zero due to the fact that you are needing this resource"? And before you start with the "freedom to have children" argument, watch a meth addicted newborn go into withdrawals only to die a few days later. Or listen to someone have to choose between medicine for their baby or food or electricity.
I think the notion is that these resources are permanent cures. Is that what they are intended for? It isn't a green-eyed-blue-eyed situation, it is a fat-skinny situation meaning being the recipient of some free government resource doesn't have to be long-term. But have we created a system and mindset that makes it long-term? If medicaid weren't looked at as a long-term solution, it wouldn't be a "can't have babies" argument, it would be "can't have babies right now" argument. Can we as a society do a better job of "helping" those in need? Should there be some form of reciprocity instead of just a one-way freebie? Always open to thoughts and comments as I am no 'expert' unless I fool you into thinking I am.