The Rotting Tooth analogy for our Health Care System

Link: The New Yorker: Fact.

This article really begins to show the complexity behind what individual doctors see in their offices every day.  I’ve always considered lack of dental care a problem, but mainly because of the DENTAL issues.  The author showcases lack of access to dental care as a marker for access in general, but also as a risk factor for future disease (leading to poorer nutrition, etc.). 

I read this for a while and only after getting to the end realized the author was Malcolm Gladwell (of Blink and Tipping Point fame).  I like how he puts things together, and makes points with stories.  Though as a proponent of evidence-based medicine I am wary of anecdotalism, I think Gladwell is a master of using narrative to his advantage.

The biggest frustration in my professional life is trying to provide good care for somebody that doesn’t have insurance or other methods of good access.  I saw a patient today who likes me (despite my having diagnosed him with essentially three new cardiac risk factors in the last few months) and would prefer to stay with me, but to do so, he must pay for EVERYTHING out of pocket.  When we discussed other options, he let it be known that he was easily eligible for the VA, but was willing to pay to see me.  While that’s a tremendous compliment, I had him peer into the crystal ball a bit and understand that in the next few years – with a history of diabetes, hypertension, hypercholesterolemia, obesity and cigarette smoking – he’s likely to be in for some big medical bills even if he controls everything sufficiently.  I really think it may be better for him to go to the VA – and put up with the vagaries of that system – rather than see me…just to make sure he can get everything he needs.  What a weird position I find myself in…