Wednesday, July 8, 2015


   We in medicine often talk about socioeconomic issues and how it affects various aspects of health care, It is well known that the socioeconomic differences do make difference in patient seeking medical help , the time of diagnosis, acceptance of treatment and the outcome . It also makes difference in preventive medicine. But there is another problem in medicine . This one I call socio-medical. The medical conditions are treated , but we in medicine often face social conditions , that we have to address or at least take in to account the social problems when treating the medical conditions. When we diagnose a patient with cancer and they need radiation treatment , sometimes we find problem in out patient treatment plan . These radiation treatments are given on daily basis, 5 days a week , each time the time needed is couple of hours. But there is a need for some one to bring them to radiation center. And we find NO ONE in family to do the jab. Then the patient gets transferred to rehab center or some such facility, approved and paid by medicare. So essentially WE are PAYING for it and I am not sure if this is essential medical care or essential social care.
      This I have seen in many other conditions , when we need to keep some of these patients in other facilities when one could easily treat some if not all of these patients as out patients ,patients staying home . But I came across a patient some times ago ,that made this issue worse and I felt like writing about it. I saw this 68years old female , who had smoked all her like and gave up smoking ,about 3 years ago . She was on home oxygen and over period of last year she continued to get worse and could do less and less ,as far as physical activities are concerned. She was pretty much room bound , if not bed bound . She was then referred to Hospice. But then she was sent to hospital .The diagnosis was COPD, but real reason was different. She was comfortable , but could do hardly any activity. She could not get out of bed or even turning in bed . We started treating her , but pretty soon we realised that she was not going to get any better. So when we talked about the discharge planning, I realised the problem and as to why she came to hospital; .She was leaving on one of her relatives and that person could not 'keep' her anymore.This was due partly to her deteriorating physical condition and partly duo to other reasons. She had her own kids, and they lived near by , but they had 'no space' in their house.
       So she had no place to go . We worked with the social service , but she had no physical therapy potential as she could not even get out of bed on own .The hospice could not help as she could not be accepted in their in patient facility as she was not 'dying' .So this is the socio-medical problem . We are going to face it more often as we are seeing 'aging' population and kids getting older and unable to care for the older parents.
     May be society has a solution. I had thought about a" social bank ". It is not my original idea. But it is not only great , but practical. A small group like a church can 'set up ' bank . When some one needs a help, So if one family needs his or her parents to be taken to doctor or physical therapy or radiation treatment, and he does not have time, some one who has time can do that job . So in the church 'bank' one gets balance of +2 hours or whatever time he spent and the other person gets debt or negative balance.So in future positive balance person can 'cash in ' his balance from the person who has negative balance . And ideally it could be done among many families . Only one condition --every body has to be HONEST. 

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