I practiced good medicine today. It wasn’t to impress the attending. It wasn’t to give community medicine a good name. I ran around filling out Medicaid applications–for the patient.
At the drop-in clinic, medical students and walk-ins mostly battled one chief complaint—the medical insurance assessment form. Some patients cannot find their diabetes prescriptions while others cannot afford them or worse yet, never knew they had diabetes. Some might be battling panic attacks and severe depression. Others are struggling with infection or lack of food or addiction. Despite their medical conditions, they’re seeking care for paperwork to ensure they’re insured.
It drives me crazy to scribble on pieces of paper instead of bandaging wounds or teaching relaxation breathing. The clinic even comes stocked with clipboards, blood pressure cuffs, and your standard ambulatory fare. Maybe someone somewhere along the line of medical recruitment lied. Here, students skip fancy lab diagnosis and hope for follow-up while forking over papers. Begrudgingly.
What if we saw the same opportunity in Medicaid applications that patients do?
Entering “the system” may be the chance to resume control of their lives. If we ask, the frustration is mutual. The patient often does not know the last time he or she saw a doctor. They cannot remember who last probed their diet/exercise/mental/smoking/alcohol/drugs/sex health behaviors. When we ask, the patient finds another piece in the puzzle of their own health journey.
In recognizing patient initiative, I find the Medicaid application as an opportunities for health behavior intervention. Together, we co-author health narratives and swap forms. Amidst paperwork for insurance and identification, we chat about vaccines and less politicized food pyramids. Certain patient populations, like drop-ins and repeat ER offenders, remain unaware. When I prompt conversations about obtaining health insurance, our discussion does not necessarily need to be limited to the document at hand!
Not everyone who pushes paper really means to push paper. You may be a student doctor or patient. You may be a insured or uninsured. Regardless of your adjectives, the health insurance application gives pause to collaborate and initiate and push “refresh.”
Thinking more thinking, I wonder what happens to those after I fill out their forms… What health behavior and/or quality of life measures change after health insurance?? Students have sooo much time to explore creative ways of practicing medicine! What does this look like for attendings/residents (i.e. less time than students) to make visits out of filling out Medicaid application forms for the uninsured? I welcome discussion!
Meta-analysis of Question-Behavior Effect (QBE)
What’s in your water? #ecopharmacostewardship