“If she were a normal patient…”
Physicians use the words “normal” and “abnormal” to differentiate lab values and physical exam findings. But on this evening in particular, in our student-run free clinic in Pennsylvania, our patient had no apparent anomalies. When the physician implied she was abnormal, he wasn’t referring to her health. He was referring to her insurance status.
Normal equals insured. Not normal equals uninsured. And this patient, a female in her mid-thirties with a normal Pap smear and physical exam but persistent lower abdominal pain, was an undocumented, unemployed, and certainly uninsured individual. Absolutely, without a doubt, NOT “normal”.
This distinction never sits well with me. As a first year medical student, I commonly hear physicians in free clinic use this phrase to begin teaching moments. The clause usually follows with a list of diagnostic tests and procedures that would be used to determine the cause of the illness or injury , presuming the patient is insured. Then it is followed by the edited version for the uninsured. This patient likely needed a diagnostic laparoscopic procedure to visualize any organ injury not seen through other methods. But she got pain medication.
Student doctors rely on syllabi to outline what they will learn. Nobody tells you how much you’ll learn outside of the lecture halls. A major concern for physicians and patients in our country currently is health insurance, but the options for health insurance particularly for the unemployed or impoverished that rely on state aid are convoluted and intimidating. Many health centers and doctors’ offices in the United States have begun hiring nurses or social workers to operate as case managers whose sole purpose is to liaison between the patient and an insurance provider (private or government) to ensure best coverage. Student doctors are not educated about these options either, at least not until they graduate. Because I do not want to be ignorant until then, I sought out a summer internship with a group that seeks to provide affordable medical care regardless of income level and employment, and I found that with RHAP. The Reproductive Health Access Project (RHAP) recognizes that family practitioners play a critical role in women’s reproductive health. RHAP’s unique partnership with the Institute for Family Health also allows me to work closely with a team of physicians that provide free or low-cost care to patients with a wide range of needs in addition to women’s health. Care that is tailored to the patient’s needs, not their insurance status. Care that changes patients’ lives. I RHAP because I care.
-Mia Mattioli, 2012 summer intern/Pennysylvania State University Medical Student