Nelson Mandela, past president of South America, once said, “Health cannot be a question of income; it is a fundamental human right.” Being a medical school student myself, I hear the question ‘Is healthcare right or privilege?’ a lot. Truth be told, I do not have a clear answer to this question. However, I do believe it is unfortunate that patients come out with different health outcomes because of disparities. I witnessed this type of events numerous times, but the most memorable and impactful event took place on the third day of spinal cord injury (SCI) rotation during the medical student summer clinical externship.
It was just a regular day like always. Dr. Kirksey, Dr. Hutts, and I were making our regular rounds, meeting and talking with patients. As we were walking towards our next patient room, we heard someone speaking from that very room. “Don’t put your arms around me. While you are at it, bring the blanket just up to my thighs. Hand that document to doctors when they come in, will you George?” As we entered the room, we were greeted by an elderly gentleman, surrounded by his family members, a nurse, and an occupational therapist. Despite being at a hospital for 2 weeks, the elderly patient looked as if he just came out from a business meeting. His face was well-groomed, looked well younger than his actual age, and it was clear for everyone to see that the impairment of his lower extremities, which could have permanently damaged him, did not break him one bit. Another thing that was very noticeable was his demanding demeanor. Being a wealthy businessman himself, it seemed as if he knew exactly what he wanted and made sure everybody in the room knew that as well. Making sure they get all the information that the patient wanted, his family members asked the doctors information regards to optimal care, home health options, follow-up appointments, different physicians, wheelchair selections, and other ancillary healthcare services. With immediate medicalmanagement following SCI, he and his family members taking ownership of the patient’s own health and deciding the best rehabilitation process, the elderly patient seemed to be able to regain the similar quality of life he had prior to the injury.
That very afternoon, a young man in his 30s showed up in front of Dr. Kirksey and I at the outpatient SCI clinic by an ambulance with his parents. As soon as we entered the room to examine this patient, a stench of urine greeted us. This young patient had fallen from a ladder 18 months ago and was bedridden since then, without any medical assistance. Unlike the elderly patient that was just discharged this morning, this young patient seemed as if he had not taken a shower for weeks and was in a diaper. The reason why we were able to tell that he was wearing a diaper was because he was hardly covered with any clothing, which exposed his scrawny body and contractured limbs. When we asked him a question, he was barely able to make eye-contact, mumbled a few words, and lacked facial expression or emotions. This was his first doctor’s visit since theaccident and the only reason his parents brought him in was because they themselves were getting too old and taking care of their son had become too overbearing for them, physically, emotionally, and financially. Already spent hundreds of dollars on ambulance fee alone, patient’s parents asked Dr. Kirksey about inpatient care at UAB, in the hopes of his son improving from his current state. When they were told about the high cost of the medical fee for other subacute facilities and that the timeframe for a possible recovery from SCI is about one year, but the patient does not have much room for improvement because of late response post-accident, the room was filled with silence and looks of devastation.
Different types of disparities are present everywhere, whether that be racial, financial, or medical. Sadly, these disparities hugely impact patient outcomes.
