Thomas Fisher, MD, MPH, author and emergency room physician for University of Chicago Medicine, might have made some members of the audience uncomfortable Tuesday at HFMA’s Annual Conference as he described a scenario that reflects poorly on at least one hospital.
The situation boiled down to this: A man with a broken jaw and without health insurance needed surgery, and the surgeons on call tried to hand the patient off to another hospital because of the lack of insurance, according to Fisher.
The patient ended up in the hospital as a result of getting into a fight.
“According to him, he was winning until somebody hit him from behind and knocked him out. And when he woke up, he was bleeding from his mouth and unable to open and close his jaw,” Fisher said.
He said, “That kind of straightforward history is really easy to take care of. You know exactly what’s going on. … It’s straightforward. A fourth-year medical student would know what to do with a broken jaw.”
But things only got more difficult at that point when Fisher spoke to a member of the surgery team to set up the operation.
“He had a sheepish tone about him,” said Fisher. The doctor said, according to Fisher, “Um, yeah, he doesn’t have insurance so uh, we can’t fix it here. We’re gonna have to send him somewhere else. So, if you can give him antibiotics and mouthwash, he’ll have to get the surgery to fix his jaw somewhere else.”
“This is someone who can’t chew and hasn’t eaten for three days,” Fisher said.
It took him hours, but Fisher said he was able to get the surgery scheduled.
Yet that doesn’t change the circumstances that led to the problem, that being a U.S. healthcare system in which inequity affects the poor and minorities.
In Fisher’s words: “Too often our systems deny, reject and defer, and bankrupt people who come to seek care. But not everyone. In these same systems, we often see the best care in the world being delivered in a timely fashion and humanely. The fact that these two things occur simultaneously in the same systems is not an accident. Over time I’ve learned they represent the silent transfer of the length and quality of lives from the poor to the rich and from the Black to the white.”
Fisher then went on to describe how Chicago’s healthcare system discriminates, including his criticism of the still-heard “no margin, no mission” approach.
Fisher finished with his call to action.
“I’ll wrap up by saying the best part of this journey where I find hope and optimism is that we can make a difference here. Caregivers are a part of every society. We touch people, we see them, we hear stories that people have never told anyone before if we listen closely. We have a chance to be that trusted guide.”