One of the many reasons it sucks to be crazy

So, Thursday, this article was on the very front page of the local Raleigh paper, the News and Observer:



In other words, nobody cares about you if you're crazy and have no health insurance.

But the fact is, it's not just that mental care is failing the poor, it's that medicine seems to be failing the poor mental patient (as in, the psychiatric patient who also has no money, not necessarily "poor" in the pitiful sense). The medical unit, where I'm stationed now, of course, has become a hotbed of this all week. I threatened to safety pin this headline to one of my patients today when I sent him off to finally get his surgery, except that, well, he didn't.

My one patient, well, he's not exactly Gandhi. I know that. In fact, he can be kind of scary. But this kid, he's now been waiting ten days to get his broken bone surgically fixed. TEN! Because they "can't fit him on the schedule." You know, over at my hospital, which, let me tell you how much I want to own up to that right now! And now it's a holiday weekend, of course, so it's going to be at least another three. In spite of the fact that everyone at State Hospital has been pestering the crap out of them. Which, okay, has in a very big way been primarily me, but only because I pester like nobody's business (I pulled such ex-surgeon-like tricks as calling the OR directly and then calling the service back and saying "Okay, so I called the OR and they told me he isn't actually on the schedule. Can you explain this?"). And meanwhile, the whole thing (and the events leading up to it) has generated so much QA and Risk Management and damage control and legal CYA drama that one of the staff designated our unit today as "CSI:State Hospital."

We had another patient bounce from, again, my hospital, after she - completely psychotic, since her psych meds unmasked another medical condition and she had to be taken off of them, and then, of course, got all crazy again - "refused" a particular treatment. No discussion of capacity, just, okay, ick, get her out of my hospital. And a third one, today, whom we bounced to a private hospital yesterday because he came to us looking on the verge of death. They called this morning saying, he's fine now, you can take the scary psych patient back already. We said, um, no. Just because he has a psych history, doesn't mean he doesn't need medical care more. Now knock it off.

You know what? This pisses me the hell off.

This used to happen when I was an OB/G, too. I'd get called to take over care on pregnant women - or worse, just, women. You know, people who dared have a uterus - before they'd even been examined. They didn't need an obstetrician to manage their asthma attack when they were six weeks pregnant, or sew up their cut on their finger when they were thirty weeks.

Likewise, people with psychiatric illnesses get sick, too. Yeah, fine, some of them are a little "weird." Or "different". Or "straaaaaange."

You know what? So are some surgeons.

Now everybody play nice and quit labeling my patients.