Sunday, June 24, 2007

In These United States

The quality of care in the U.S. varies quite a bit. Everyday, I see patients who might do better elsewhere but can not afford specialist care. There are lots of docs here who specialize in diseases of the rich and well-insured.

Case in point. 55 year old woman with no health insurance. She has an epidermal inclusion cyst of the left inner canthus. It was 2 mm from the lacrimal duct.

I said: You should see an ophthalmologist.
She said: I have no insurance. Can't you do this?
I said: I can try, but I am not sure this will shell out easily.
She said: Please try -- anything will be better than this. How much will it cost?
I said: Okay. How about $45.
She said: Fine, I thought you'd ask a few hundred.

Procedure: Under local 1% xylocaine with epi I dissected the cyst. Luckily, it shelled out nicely. I had hoped not to have to close the defect; but needed to place a 6-0 nylon suture.
I guess it will look better.

I felt like a doctor for a brief moment. The doctor who was there. I knew an ophthalmologist could have done better; but most of them take their patients to an operating room where there is a big charge. This is the reality of health care here.

George Bascom said it better. See "Being There" Click on poem to enlarge.


  1. Great poem ! Your management of the lesion was as good as any Opthalmologist. Once you empty these the sac lining will usually just peel away. Even if it does not it will look much better and you can always do the same in 12 months if it fills up again.

  2. Megan MooreJune 25, 2007

    Thanks for sharing this case and poem. I finish residency this week and this is a good reminder that it all starts with being there and doing the best that we can. Thank you, David!

  3. AnonymousJune 25, 2007

    Nice job. What our world needs is your type of doctors. I wish you could mulitply yourself. Cheers,

  4. I congratulate you for being there for the poor patient. I also highly appreciate your thoughts. In third world countries like Pakistan, hundreds and thousands of poor and non affording patients do not have access to even symptomatic treatment for their ailments.


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