Caring for Our Uninsured Patients
Many patients may feel embarrassed or self-conscious about the fact that they cannot afford their medications. For example, while rotating through my gastrointestinal oncology clinic, I had a patient with locally advanced rectal cancer undergoing neoadjuvant treatment with concurrent capecitabine and radiation. Despite extensively educating this patient on the importance of compliance with twicedaily capecitabine, he consistently missed doses. As I discussed the case with my attending, I was frustrated and angry at this patient, as I felt he had a potentially curable cancer but was compromising his care by not complying with his medications. My attending was able to further explore why he was noncompliant, and the true reason was that he was forced to choose between paying for his medications or food for his family. Because he was underinsured, he could not afford his medications and therefore was rationing them by taking them every other day. He was too embarrassed to admit that he did not have enough money and was therefore willing to compromise his care. This situation could have been avoided with better communication with the patient. As fellows, we may sometimes feel unequipped to deal with these treatment-cost issues and may avoid asking our patients if they need financial help.Utilizing Resources
As insurance coverage becomes increasingly more complex, we have all learned that some of our best allies in the hospital and clinic are our social workers. As fellows, many times the responsibility falls on us as the junior members of the team to communicate with the social workers to ensure that the patient has adequate insurance. There are services through government agencies, the American Cancer Society, drug companies, private funds, and other organizations to help our uninsured patients. Utilizing these resources can require patience, time, and paperwork, all of which can be made easier if you have a good social worker helping you through the process.