Sunday, September 08, 2013

Can I Be Your Doctor If....?

Last week, ClinkShrink wrote an article about a heinous criminal who committed suicide while in prison.  She titled her post: Your Patient Died. Who Cares?

Such a post begs the question of whether all people deserve equal medical care, equal physician devotion, and equal medical resources.  I think we all have our own beliefs about such things.  Some of us can minister to the physical and mental disorders of those who've done awful things, some of us can not.  I guess you could go further and say what's an awful thing?  Can you treat Hitler?  His bodyguard died a few days ago, having made it to the ripe old age of 96.  Can you treat someone who only killed 5 people, and not 13 million?  Can you treat someone who drove drunk and killed a single young child?  Can you treat someone who beats their children?  Who cheats on their wife?  Who causes their own illnesses by drinking, drugging, and eating pizza (~I ate pizza and ice cream at the beach today, it was sooo good, but I do know this is not good for me).  Who has religious beliefs that your own religion deems unacceptable?  And if your father ends up in jail because he drove while intoxicated, committed some sort of financial fraud, or there was a weird case of identity confusion that took a little while to sort out, would you want him getting reasonable medical care during his stay in jail?

Does everyone deserve the exact same medical care?  Is is wrong if one person can afford to pay out of pocket for more attentive care or better doctors or more expensive medications if those things aren't allowed by the Blue Insurance that most people get?  What if the person who says he can't afford such concierge type care puts in granite counter tops, wears designer clothes, and drives a luxury sports car, while the person who opts for high-end concierge care drives a used Chevy and shops at Wal-mart?   I've found that even in our world of haves and have nots, that often those with private health insurance are the have nots because certain treatments are deemed 'not covered' and there is no rhyme or reason as to who can get what.

Questions of how we divvy up our medical resources are difficult.   

But I'm going to move us back to the question of treating Clink's prisoners.  A doctor doesn't have to work in a jail, but if a doctor does  choose to work in a jail, or in an ER that happens to service the drug dealers who shoot at each other,  then that doctor is obligated to provide the best possible care to those patients.  Sure, people quietly judge, but if a doctor can't turn that off and offer the best they have to offer any patient, then they have no business being a doctor in that setting.  Should prisoners get the same care as model citizens?  No one's asking me, so I won't bother with an opinion, but I do think that those carrying for the prisoners need to be their agents, they need to advocate for reasonable standards of medical care for their patients.  Just like those taking care of the medical needs of those who are obese, mentally ill, or smoke, doctors need to offer the best care they have available, without stigmatizing the patient.

So Clink, I don't care that your patient died, but I'm glad you do.