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    The poor will always be with us, and they want and need healthcare

     

    Physician professionalism and compassion

    When providing medical care, physician professionalism mandates that we examine factors that include:

    • the social and cultural contexts from which our patients come;

    • the complex interplay of patients’ values and beliefs of patients from different backgrounds and circumstances; and

    • patients’ conceptions of their health and illness.

    The March 2017 residency match informed senior medical students of the city and community in which they will begin residency training and the practice of medicine in their chosen specialties and subspecialties. This spring at “hooding ceremonies” at medical schools across the country, students will recite the Hippocratic Oath in the presence of family, friends, and classmates. Several stanzas of that oath should weigh heavily upon these new physicians, as well as on all our colleagues (see below).

    We say to these students: if you have reached the level of cynicism that is expressed by some politicians, that poor people “just don’t want healthcare,” perhaps you should refrain from reciting the Hippocratic Oath that has become the ritual that marks the transition from medical student to medical doctor.

    The good news is that most physicians believe that not only do poor people want healthcare, but that they deserve healthcare—especially preventative health services that may often be unavailable without requisite financial resources being made available. While cancer and heart disease, the leading causes of death and healthcare costs in the United States, have risk factors affected by social and environmental circumstances, these 2 conditions occur regardless of household income or insurance status. 

    So we, as providers of medical care to all Americans, must challenge this physician-turned-legislator and his colleague on their statements that poor people just don’t want heathcare and that low-income Americans value gadgets more than healthcare coverage. 

    While caring for patients has become more challenging for many reasons, the mission to provide healthcare to all regardless of circumstances should never be in question.

    References

    1. Facher L. Two months ago, this doctor was delivering babies. Now he’s at the nexus of the Obamacare fight. Statnews. Available at: https://www.statnews.com/2017/03/03/roger-marshall-kansas-obamacare/

    2. Chait J. Republication congressman: Repeal Obamacare because poor people don’t want to be healthy. New York. March 3, 2017. Available at: http://nymag.com/daily/intelligencer/2017/03/obamacare-repealer-explains-poor-dont-want-to-be-healthy.html

    3. D’Angelo DV, et al. Patterns of Health Insurance Coverage Around the Time of Pregnancy Among Women with Live-Born Infants—Pregnancy Risk Assessment Monitoring System, 29 states, 2009. MMWR Surveill Summ. 2015 Jun 19;64(4):1-19.

    4. U.S. Census Bureau data prepared for the March of Dimes (MOD), September 2007. MOD summary, Census Data on Uninsured Women and Children. See also March of Dimes, The Distribution of Health Insurance Coverage Among Pregnant Women, 2001.

    5. Kaiser Family Foundation. 2004 Kaiser Women’s Health Survey.

    6. Kaiser Family Foundation. Women and Health Care: A National Profile: Key findings from the Kaiser Women’s Health Survey, 2005.

    7. Wagnerman K, Chester A, Alker J. Medicaid is a smart investment in children. Georgetown University Health Policy Institute, Center for Children and Families. Executive summary. March 2017.

    8. Brown D, Kowalski A, Lurie I. “Medicaid as an investment in Children: What is the Long Term Impact on Tax Receipts?” National Bureau of Economic Research. January 2015.

    9. Frost J, Sonfiel A, Zolna M, Finer L. Return on Investment: A Fuller Assessment of the Benefits and Cost Savings of the US Publicly Funded Family Planning Program. 2014.

    10. The Henry J. Kaiser Family Foundation. Paradise, Julia and Garfield, Rachel. What is Medicaid's Impact on Access to Care, Health Outcomes, and Quality of Care? Setting the Record Straight on the Evidence. August 2013. Available at http://kff.org/report-section/whatis-medicaids-impact-on-access-to-care-health-outcomes-and-quality-of-care-setting-the-record-straight-on-the-evidence-issue-brief/

    11. Markus A R, Andres E, West KD, Garro N, Pellegrini C. Medicaid covered births, 2008 through 2010, in the context of the implementation of health reform. Women's Health Issues. 23(5):273-80; Guttmacher Institute.

    12. Sommers BD, Blendon RJ, Orav J, et al. Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance. JAMA Intern Med. 2016;176(10):1501-1509.

    13. Conry JA, Brown H. Executive Summary, Well-Woman Task Force, Components of the Well-Woman Visit. Obstet Gynecol. 2015;126:697–701.

    14. Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2002

    15. AAMC.org. Diversity in the Physician Workforce Facts & Figures 2010. https://www.aamc.org/download/450388/data/diversityphysicianworkforcefactsandfigures2010.pdf

     

    Haywood L. Brown, MD
    Dr. Brown is the F. Bayard Carter Professor and Chair, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, ...
    Lucia DiVenere, MA
    Ms DiVenere is Officer, Government and Political Affairs, the American College of Obstetricians and Gynecologists.

    3 Comments

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    • Anonymous
      The poor have had health care via Medicaid. The middle class though have lost health care compliments of Obamacare. High premiums and higher deductibles have taken away health care from those that are in the middle class without insurance from their jobs. Lucky if even one plan is available and no physician takes it. As far as abortion restrictions, I believe that women should have a choice but using the logic that states save money by aborting fetuses (penny wise and pound foolish the article says) is a poor response. If we want to really save money we could also force sterilization of individuals or even more savings by not providing any health care and promoting an early demise. The problem with healthcare is not just the poor, they have healthcare and we pay for it. The problem is that the middle class has lost their health care.
    • Anonymous
      The poor have had health care via Medicaid. The middle class though have lost health care compliments of Obamacare. High premiums and higher deductibles have taken away health care from those that are in the middle class without insurance from their jobs. Lucky if even one plan is available and no physician takes it. As far as abortion restrictions, I believe that women should have a choice but using the logic that states save money by aborting fetuses (penny wise and pound foolish the article says) is a poor response. If we want to really save money we could also force sterilization of individuals or even more savings by not providing any health care and promoting an early demise. The problem with healthcare is not just the poor, they have healthcare and we pay for it. The problem is that the middle class has lost their health care.
    • Anonymous
      duplicate

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