Thursday, January 25, 2007

No Retreat



I've never written a post to respond to one of my own posts before, but I think this time I have to. I have gotten enough "Clink is a heartless bastard" comments that I need to write, for the last time, that my post on the Retreat was a criticism of the service, not the patients. It got warped into an animated and a bit of an angry discussion about who I thought was or was not deserving of treatment---as if I my opinion about that actually mattered.

It's no revelation to state that America has a three-tiered healthcare caste system: the have-nots, the have-somethings (with insurance) and the boutique set. I work with the have-nots. My patients are poor. I don't mean poor in a "don't-have-insurance" sort of way. I mean poor in a "My family died in a house fire because they were using candles for heat and light" kind of way. The kind of poor who come in psychotic from the streets after living over sidewalk grates in the wintertime. The kind of poor who will die fast unless they get locked up.

So when I see a web site like the Retreat it's like getting a punch right between the old values. It's a visceral reaction, an "oh...my...gawd" kind of feeling that can't even come close to comparing with what my patients will never have. It's a sense that the cosmic balance of justice has gone far far out of whack and that we are in for an upheaval of our own making if we don't do something proactive to address the problem.

I am not stating that the boutique patients are undeserving of care. I am saying that we as a society need to make sure that all who need healthcare receive it. We as a society need to make these decisions. They cannot be left to bureaucrats or businessmen, or even solely to doctors and patients. We have all created this system and we must resolve it. Boutique medicine is not the solution.

To do this we will have to answer difficult questions about where to put our resources and how far to go with them. We will have to weigh the pros and cons of a fifty minute therapy session for non-psychotic patients versus two med check appointments for psychotic folks. People who are receiving treatment now may have to give a little to make room for those who are receiving none. I don't think that's too much to ask.

[Addendum: While I was working on this post I read on CNN that all the current Democratic candidates are in favor of universal healthcare coverage. A national health system is on the way. Hopefully Shrink Rap's posts will help us prepare for this by leading some discussion.]