Medicaid patients are exhausting (U.S. issue)

And not every medicaid patient, but a big portion of them.

Social determinants of health is such a bigger problem than almost anything else in this country. As I am sure every PCP in this country has, I have collected a stable of people with multiple comorbid issues (morbid obesity, DM, lymphedema/venous stasis, chronic low back pain, personality disorders, fibromylagia/other chronic pain). I try very hard to give everyone a fair shake and not dismiss them, but my god this population can be exhausting.

I just finished getting my fourth URGENT phone call today because insurance won’t pay 40 dollars for a pair of compression stockings, FIX THIS. On a pt with a BMI in the 60s with legs that chronically weep lymph, horrible superimposed venous stasis, chronic back pain that every specialist has fired because he’s unfixable and not an operative candidate. I fought with medicaid to get him a shower chair (how much even is a shower chair, ffs) which he didn’t use, then fell and broke something on one of his lower extremities. Continues to fall frequently. Told him last visit either he sees a bariatric surgeon or he will have a catastrophic fall and break his femur and wind up in a nursing home. Also told him that he is maxxed out on everything and his back hurts because he’s enormously fat and sits around all day and that I cannot fix or improve things. Yet despite trying to coordinate for him, i get lots of calls about things not being affordable (and he doesn’t pay a dime anyway, AND always has the cash somehow for 1-2 ppd of cigs). Shows up on my schedule about every week or two for ER follow-up. (Seen for back pain – FOLLOW UP WITH PCP). Cool.

I would be concerned about HIPAA but this is so general, it describes a whole population of genuinely sick but, in my opinion, unfixable people with unfixable chronic problems inextricably linked to policy problems (finances, living situation, life outlook, food habits/availability) and honestly an accountability/entitlement issue. They are frequently rude, demanding and consume an exorbitant amount of resources. It’s never just one thing.

I don’t know if I have a point, per se, but does anybody have any insight/thoughts on how to address this? I honestly don’t think it can be done on an individual patient level. Or, I guess, I could do what other people do and not accept medicaid, because f ’em, right? I see this all the time – everybody needs dental work, it’s 8 weeks out MINIMUM if you’re medicaid to get a rotten/broken tooth pulled, so they keep rolling up in my office/ER. Great solution.