Falling through the cracks

In private practice I was always worried a patient would, as we say, "fall through the cracks." The cracks are spaces in the health care system where patients, especially those with few resources, get lost to follow up and go months or years without care. They finally reappear in an emergency room in crisis.

In my new position, most of my patients have fallen through the cracks. Examples I have come in contact with just today are:

O who had a fibroid uterus so large it was obstruction her intestinal tract. While she has government supplied health insurance due to her mental disability, she fell through the cracks because she is schizophrenic. The county system gives her medication for her schizophrenia. She can manage with her son's help to get to the Mental Health and Mental Retardation office for her medication checks but she tells me the paper work for the primary care doctor is too difficult for her to fill out.

Or there is D. She was going to a Medicaid clinic run by a doctor who doesn't have privileges at any local hospital. When D's bag of waters broke prematurely, she called her doctor but no one ever called her back. That was three days before she came into the emergency room with an infection from the premature rupture of membranes. And just so those of you out there who are thinking, "We don't understand why she didn't go to the hospital right away!" know, I thought of that too. When I asked her, she explained she has had two babies and two miscarriages at the county hospital. I don't think she was treated very well on any of those hospital visits.

Now there is B. I am waiting on the OR to call me. She has an ectopic pregnancy. She had a positive pregnancy test two weeks ago. She has a job and a three year old son. She was trying to figure out whether she qualified for Medicaid since her employer doesn't provide health insurance. I am hopefully we will be able to do an minimally invasive procedure and get her back to work in a week or two since she and the three year old depend on this job, which she is afraid she will lose. In this economy you can understand.

The cracks are scary. Most of my friends cannot imagine they would every fall through them. I believe the cracks are a hazard for those of us who make a good living, as well as those who live on the edge of a crack economically. We are all just one serious illness, just one disability away from a crack. A crack which all but the richest could fall through.