We met Tommy Davis in our hospitals clinic for indigent persons in March 2013. He and his wife had been chronically uninsured despite working full-time jobs and were now facing disastrous consequences. The week before this appointment, Mr. Davis had come to our emergency department with abdominal pain and obstipation. His examination, laboratory tests, and CT scan had cost him $10,000 (his entire life savings), and at evenings end hed been sent home with a diagnosis of metastatic colon cancer. The year before, hed had similar symptoms and visited a primary care physician, who had taken a cursory history, told Mr. Davis hed need insurance to be adequately evaluated, and billed him $200 for the appointment. Since Mr. Davis was poor and ineligible for Kentucky Medicaid, however, hed simply used enemas until he was unable to defecate. By the time of his emergency department evaluation, he had a fully obstructed colon and widespread disease and chose to forgo treatment. Mr. Davis had had an inkling that something was awry, but hed been unable to pay for an evaluation. As his wife sobbed next to him in our examination room, he recounted his months of weight loss, the unbearable pain of his bowel movements, and his gnawing suspicion that he had cancer. “If wed found it sooner,” he contended, “it would have made a difference. But now Im just a dead man walking.” nejm.org/doi/full/10.1056/NEJMp1312793
Posted on: Thu, 07 Nov 2013 21:32:32 +0000
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