Taking Issue

There's a post circulating of a letter written to a paper in Jackson, Mississippi from an ER doc in 2009. In it he details having to provide care for a woman who has a gold tooth, multiple, expensive looking tattoos, wears an expensive brand of tennis shoes and has an R&B ring tone on her cellphone. The patient received medicaid. His letter stated he didn't like that he was paying for this patient's health care when clearly the patient is choosing to spend her money on vices rather than getting herself health insurance and taking care of herself.

I find so many problems with implications made by the doctor in a letter like this, I'm almost not sure where to begin, but what I think it comes down to race and class.

The doctor doesn't name the patient's race, but gives enough cultural related hints, I think, for the reader to assume that she is black. This article from CNN.com discusses study findings of how doctors view and subsequently treat black and white patients differently. If this doctor were presented with another medicaid case of, let's say, a white woman who has a gold tooth and maybe some other non-typical items for a poor person, would he feel so resentful? For the record, my 93 year old grandmother is on medicaid, has a gold tooth and has many times needed care at the hospital that there is no way she could have afforded to pay for.

Does the doctor know where the patient's tattoos came from? Did the patient tell him she went to the city's best tattoo parlor? Or, did the patient do some jail time and get ink on the inside? There are so many ways they could have happened, that who knows and why try to imply something?

A quick look on the internet tells me that the current cost of milk per gallon is around $4.50. You can buy a 12 pack of Pepsi for $3.69 and a 12 pack of Natural Light Beer for $7.99 (this price was from a Mississippi liquor store). Does the extra $3.50 spent on beer rather than milk give the patient enough to pay for her own health insurance each month? Having provided my own healthcare in the past to the tune of nearly $500 a month, I'm guessing that answer is no.

And what about her food choices? There is a modified version of the letter circulating on Facebook that references the woman's eating fast food take out. While snopes.com puts that letter into the false category, someone thought it was worthwhile to ramp up the evils committed by this woman. Surely people know just how easily it is for the poor community to just walk down the street to Whole Foods and get high quality food at a low cost as well as finding nothing but fresh fruit and vegetables at their local convenience store. There is a reason why the poor are obese. Little Debbie swiss rolls cost $1.33 for 12 at Kmart.

Is she on medicaid because she isn't working and is just living off the system? There are an awful lot of people out of work in our country right now and that may be the case, but there are also a huge number of 'working poor' who can't afford healthcare even though they are employed. The doctor in his letter didn't seem to know how she ended up on medicaid, but again the implication is there.

First do no harm, doctor, which would imply to me you won't judge your patients, you will work to educate them and provide them with the care they need. Be aware of your own racial biases and perhaps inform yourself about what comes along with living in poverty before you pass judgment on another poor woman who comes into your ER.