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‘Lack of insurance can be lethal,’ UofL faculty write in New England Journal of Medicine

by Jill Scoggins, HSC communications and marketing last modified Oct 29, 2013 08:32 AM

Physicians have a fundamental responsibility to treat people in need, to educate their patients about health care reforms and to work with their professional organizations to demand health care for everyone, regardless of their ability to pay.

That is the thrust two University of Louisville physicians, Michael Stillman and Monalisa Tailor, put forth in a “Perspective” for the New England Journal of Medicine. Their article, “Dead Man Walking,” will be published in an upcoming print issue of the publication and was posted online last week.

The two Department of Medicine faculty tell the story of a man they call “Tommy Davis” who was chronically uninsured despite being employed full-time. Davis spent a year experiencing severe abdominal pain and constipation. Only when the pain was at its most severe did he go to the emergency room for relief.

The diagnosis? Metastatic colon cancer. Davis will die too soon because he was uninsured.

“If we’d found it sooner,” Davis said to the physicians, “it would have made a difference. But now I’m just a dead man walking.”

Stillman and Tailor note that this patient’s circumstances are not unique.

“For many of our patients, poverty alone limits access to care,” they write. “… a fair number of our patients — the medical ‘have-nots’ — are denied basic services simply because they lack insurance, and our country’s response to this problem has, at times, seemed toothless.”

While the physicians cite elected officials for bearing the brunt of the blame for the “appalling vulnerability of the 22 percent of American adults who currently lack insurance,” they also point to each physician’s responsibility for improving conditions for the un- and under-insured.

“In discussing and grieving over what has happened to Mr. Davis and our many clinic patients (like him) we have considered our own obligations. First, we can honor our fundamental professional duty to help. … the Hippocratic Oath compels us to treat the sick according to our ability and judgment … .

“Second, we can familiarize ourselves with legislative details and educate our patients” so they can receive the fullest possible benefits due them.

“Finally, we can pressure our professional organizations to demand health care for all. … Lack of insurance can be lethal, and we believe our professional community should treat inaccessible coverage as a public health catastrophe and stand behind people who are at risk.

“We find it terribly and tragically inhumane that Mr. Davis and tens of thousands of other citizens of this wealthy country will die this year for lack of insurance.”

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