August 31, 2010

Patient Dumping

Earlier this year, a friend and I were eating at a relatively upscale restaurant in Beverly Hills. Just as we were about to dig into our salads, a man walks into the restaurant and declares he has an announcement to make. His voice was strong but composed, and he immediately captured the attention of the entire dining room. I'm paraphrasing here, so bear with me:

"I would like just five minutes of your time please," he begins. "I need $75 to pay for my lithium medicine. I have just been released from Cedar Sinai Hospital, and I can't afford my medicine." To my surprise, waiters and busboys continued to serve patrons in the restaurant. He continued, "This is known as PATIENT DUMPING. I can't afford my medicine," he repeated, "and I need $75 to pay for my lithium."

Two things happened next. A man stood up from his table and handed the guy a $20 bill. Then, just as the maitre d tried to escort him out of the restaurant, the police arrived and removed him from the restaurant.

Anyone who has taken an introductory course in psychology, or seen a psychological thriller knows that lithium is prescribed for people with Bi-Polar Disorder, otherwise known as Manic Depression. My reaction to what I just witnessed was first shock, and second sadness. I was sad a homeless has an oppressive mental illness. I was sad he felt he had no other options but to enter a restaurant and beg for money. I was sad that even after he was taken into police custody, he would be released without a solution to his original problem.

The reason I wanted to share this story is twofold. I am about to embark on my first internship as a social work student, and it happens to be in the Department of Mental Health at the UCLA Harbor Hospital in Torrance. There is no doubt in my mind I will come face-to-face with similar situations: patients who are unable to afford treatment. As a social worker to be, it is my responsibility to provide the best possible assistance to people, regardless if they have insurance or the funds to pay for treatment. When a person is diagnosed with a serious illness and cannot afford to pay for treatment, what exactly are they supposed to do with the diagnosis? To say I am anxious about how these situations might unfold is a huge understatement.

This leads me to the second reason why I wanted to share this story. Marion Nestle recently wrote a post on public health. She defines the concept beautifully:

"My definition of public health isn’t much different from mainstream definitions.  But to me, public health is a critically important expression of democracy, and the antithesis of  a “corporate” concern.  Public health approaches [to] promote good health for everyone, not just those who can afford it or are educated enough to make appropriate choices."

What I liked so much about Nestle's definition is that she allows the reader to conceptualize Public Health as a democratic right, as opposed to just a heated political issue. What Nestle's definition implies is that Public Health might help solve the issue among those who can't afford medical expenses by allowing them to choose survival.

I'm not going to imply that I have a solution to myriad of problems that confront individuals such as the homeless man I saw at the restaurant. Nor can I offer a brilliant plan for exactly how to fund Public Health issues like these. However acknowleding and speaking to the multi-faceted layers that confront these individuals, is certainly a start.

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