discouraging, but with a silver lining

As I have mentioned in a previous post, part of my MS in Nursing involves working with a nurse practitioner one day per week. The NP I work with is in private practice in downtown Manhattan, and has a healthy HIV caseload. On a typical day, I see about 12 of her 20ish patients, and my participation in the visit can range from being the primary provider (as in cases where someone is there for their annual exam) to just observing (as when someone needs a pap smear, something I haven’t been trained in yet.) Last week, I saw eleven patients. They were a diverse group, representing a wide range of ages, backgrounds, and health conditions. Three had one thing in common: they were about to lose their health insurance.

To be honest, the current economic crisis has not affected me much personally. As a student, I have debt, not savings. My parents, like so many other people who followed the commonsense strategy of long term, diversified investing, have taken a bath, but my finances have been largely unaffected. Only one person I know has even been in danger of losing his job, and ultimately he didn’t. So the crisis has been more or less abstract to me up to this point. That said, for three of my patients, it was very real. Below is a little bit about them, although I should note I have changed some important info in the interest of patient privacy.

One patient lost her job a few months ago and will only have health insurance until the middle of 2009. She was in the office for her annual physical, but she has a significant heart defect, for which she has already had serious surgery, that makes it incredibly risky for her to go without health insurance for any length of time. She is also overweight (although she is using the opportunity unemployment provides to go the gym and cook more). Another patient was in for a quick follow up; he had come in as soon as he lost his job for a bunch of tests, so he would have the chance of dealing with anything that might come up before his insurance ran out. Fortunately, he was in good shape. Finally, there was a young man pursuing a graduate degree who for reason would be dropped from his school’s insurance policy within a month or two; I believe he intended to take a semester off for financial reasons, but the calculus of his decision was obviously affected by the fact he would have to go without health insurance during that time. The third patient’s situation is perhaps not as much a consequence of the recession as the other two, but it does reinforce the point that’s been made over and over, that Americans need to have access to affordable insurance not tied to education/employment.

The silver lining last Thursday was the three patients who presented for a full STI panel. None of them had any signs or symptoms of an STI, or even any reason to think they had been exposed; they just had either recently switched partners or felt “it was time”. All had been tested less than two years ago. As a future provider, I’m sure I’ll wish all my patients were as conscientious and engaged as that group, and they definitely made a frustrating day better.