The View From Your Recession

A reader writes:

I'm an infectious disease specialist.  Today I saw a patient with a horrible foot ulcer from diabetes. She likely has infection in her bone, will need weeks of treatment, and may lose her foot.  She cried with guilt, regret, and disbelief at her condition.  She had been an excellent patient.  She saw her doctor, managed the complicated treatment of her diabetes, saw her foot specialist. 

Until her husband lost his job and insurance. She couldn't afford her insulin pump supplies, started stretching her doctor visits. Paid cash when she could. And ignored...pushed away her pain. Tried to hide the smell coming from her foot.  For 4 months.  Now it may be too late.

Another writes:

I am a pediatric emergency room physician in a small southern city, and I regret to tell you, business is booming. 

Sadly, we are the ultimate countercyclical business.  As poverty increases, access to routine and preventative healthcare declines. Thanks to SCHIP, children have access to medicaid in my state.  But as more children lose private insurance secondary to their parents' losing their jobs, as more parents lose their homes and become displaced and return to live with their parents, fewer and fewer children have a primary care provider they can go to for routine care and minor illness.  They turn to the emergency department for care.  We have therefore seen an increase in volume and a decrease in "acuity" (the severity of illness or injury). 

Great for my job security (and I am grateful to have secure, well-paid, and fulfilling work in these times), but bad for our department as we are overwhelmed with volume, bad for the "really" sick and injured kids who have to wait longer to be seen and are therefore at greater risk of poor outcomes, and bad for society as a whole as our children suffer the effects of losing access to routine and preventative care.