She walked into the office appearing as if she was chewing something. Only a few years older than myself she had already lost her teeth and her mouth was puckered and sunken. I looked at her. It had been several months since our first visit together. There had been many missed appointments. Where should I start. Do we talk about her detectable viral load, or her psychiatric illness, or the respiratory problem, or the health maintenance issues? So I did what was easiest. “What would you like to talk to me about today?” I asked fearing the laundry list of complaints and requests such a question could elicit. “Well doctor”, she sighed, “I suppose I need to tell you that I haven’t been taking my meds…all of them…” She just let it all out and we methodically went through all her concerns.
I would like to think that I’m not judgemental. I don’t know what it is like to have a psychiatric illness, or to have an addiction problem, or to not have a home, or to be quite familiar with the penal system, or to have a chronic illness or several, or to be impoverished. The majority of my patients however do in one way or another so I would like to think I understand their needs and concerns.
However, I was not ready for what came next. In discussing why she had not kept appointments for various studies, procedures, and referrals made, my patient explained to me that transportation was a barrier. Fair enough. But then I remembered I had signed a transportation waiver for her so I asked her about it. My patient, overweight but able-bodied and only slightly older than myself and I’m barely out of my twenties, qualifies for transportation assistance to make sure she’s adherent to medical care for her chronic illnesses. Not because she cannot walk and not because she gets out of breath with minor exertion but just because she has at least one chronic illness that requires her to keep medical appointments. I signed that waiver so she would be picked up from home and brought directly here to keep her appointments. Since free is good and this was a service available to her for one reason or another who am I to impose my value system on her and deny her access?
Eh, but in my ignorance I had requested transportation assistance from her home to my clinic. Would you believe that the excuse she gave me for not making any of the outside referrals and procedures was that they were not in the same building as me and she had no way of getting there. None whatsoever. Never mind that we are talking about an appointment in the building next door and another just across the street. Never mind that she can walk and whatever distance she walked from where she got dropped off to my door would likely be the same distance to any of the other sites.
She looked at me like it was my fault that she would never ever be able to keep a medical appointment if the provider was not in my building. For a minute I started to feel guilty for causing her anguish and being responsible for her ill-health. I actually entertained discussing getting a wheelchair from my clinic to be wheeled over to wherever the outside referral was. I entertained filling out a new transportation waiver to cover the whole hospital system instead of just the one building I am located in. I entertained these ideas for one brief second before the absurdity hit me. There is no reason, NONE WHATSOEVER, that I should enable such behaviour.
Seriously? At some point each of us just has to take responsibility for our own health. Our own life.
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