3 Real #FirstWorldProblems

Many of us millennials toss around the term #firstworldproblems so easily. I know the fact that there’s whole milk in your skinny vanilla latte really bursts your bubble, but that’s beside the point. We often take for granted the basic amenities that we have, and the access that we have to good healthcare. It’s easy to think of impoverished nations to compare our own good fortune with, but we don’t need to teleport over to third world nations to gain some insight. Often, if we open our eyes, we can see striking examples of inequities in our own backyards and cities.

During my family medicine rotation, I had the pleasure of working in a discharge clinic, where a multidisciplinary team of doctors, pharmacists, and social workers team up to work with at-risk patients who have been recently discharged from the hospital. The goal is to keep them from being readmitted to the hospital for the similar reasons. That same afternoon, I went on house call visits to see patients in their homes in inner city Baltimore. (Fun fact – one of the patients lived in the same apartment complex where most of season one of The Wire was filmed.) I was moved and jolted into the reality of my life compared to many of these patients. Thus, I present to you, three REAL #firstworldproblems.

1. Getting your medications – As medical students, we are familiar with the hassles that patients often have to go through in order to get prescription medications at a reasonable price. Different insurance companies cover different medications to different degrees, creating a quagmire that no one wants to deal with. In the discharge clinic, we spent a great deal of time comparatively shopping between two different pharmacies to see which would be the least costly for our patient. However, what was most poignant to me was how much patients have to struggle to get seemingly cheap over-the-counter medications. When we have headaches, it’s easy enough to pop over to your local CVS or Walgreen’s and pick up some ibuprofen. Without hesitation you have the option of choosing among various brand names or generic brands to suit your personal and financial needs. However, in Baltimore, many of our patients could not even afford the cheapest bottles of baby aspirin – about $4.00 for three months of cardio-protection. I also encountered a patient suffering from chronic crippling constipation because her insurance wouldn’t cover Dulcolax (docusate/senna), making it necessary for us to think of alternative bowel regimens that would be covered. Although we think of these medications as innocuous and easily accessible, there are still patient populations who are struggling to gain access to these “inexpensive” drugs.
2. Knowing how to take your medications – Once you traverse the world of insurance and get your medications, the next step is to figure out how and when to take them. In a vast sea of bottles, pill-boxes and instructions to take your medications – daily, BID, q6h, PRN, with food, before bedtime, etc. etc., it’s no wonder that patients can easily become noncompliant due to feeling overwhelmed. On top of that, how are you supposed to read your medication instructions when you have worsening diabetic retinopathy and you don’t have insurance to get laser photocoagulation? Even more commonly, what do you do when you don’t even know how to read the words that are written on those pill bottles? It’s not surprising to understand from a patient’s perspective why they’re not adhering to their insulin regimen or why their edema doesn’t improve because they’re not sure how often to take their Lasix.
3. Showing up for doctor’s appointments – At the end of the day, the previous two points are completely moot if you are unable to even get to your doctor’s appointments. It’s very much understandable that with our hectic rotation schedules, it’s not easy to get a suitable time slot to see our own physicians for yearly physicals. It’s even more difficult when you might be dependent on taking three different city buses to get to the doctor. If a patient is living a hand to mouth existence, and their trip costs $4 each way, they may not come because they are simply unable to afford the bus fare to the clinic. Add inclement weather conditions or comorbidities such as chronic weakness from stroke, previous injury, and diabetic foot amputations, and it becomes even more difficult.

In medical school, we are taught of how the big things can impact patient care – insurance companies, hospital bureaucracy, patient handoffs, etc. It’s important to remember that the little things in healthcare (as well as in the community) impact patients just as much. In the words of a wonderful primary care attending I worked with, “[The situation] is not complex medically. It’s complex in a way that’s frustrating.”