The patient in question clearly requires the direct care that can only be provided by a rheumatologist and once admitted to the practice of a rheumatologist should continue to be provided under his or her care unless the patient decides otherwise or the rheumatologist can arrange for adequate alternative care, presumably by another rheumatologist, even if the rheumatologist has to donate his services gratis.
We rheumatologists are a fortunate lot of physicians. We are privileged to practice in the interface between startling advances in science and patients who can really benefit from our application of that science. While not wealthy compared to some other medical specialists, we are well enough off that compassion and charity should not be foreign to our patient populations. Do we need a reason to be altruistic? Well here is one amongst many: Me did not get where we are all by ourselves. We owe our success and positions to countless others, some whom we know and can either thank or repay and many others whom we will never know. The only way we can repay or thank them is by helping others through anonymous charity or direct delivery of our expertise without the requirement for compensation. The latter is a tradition for our profession—it should continue to be encouraged if not demanded.
Unfortunately, the problem for this patient goes beyond that of finding a rheumatologist who will care for her. Her poverty precludes her receiving the medications she cannot afford and the laboratory tests that are necessary to ensure the safety of those drugs, neither of which the rheumatologist can be expected to donate. In this case the rheumatologist also should do his or her best to assist the patient in applying for whatever sources for those medications and tests might be available. To me this is the true frustration with caring for the impoverished patient.
Sidney R. Block, MD
Bangor, Maine
Duty to Care
This note is in reference to the question of ongoing obligation for care for patients who cannot pay.
My comments are based on 27 years of solo private practice of rheumatology in a rural area. I work 70 hours a week and make pretty good money. I believe that any rheumatologist today has a duty to care for a portion of patients who cannot pay. I do not have an infusion center, nor do I use a physician extender. I have recently started a electronic medical record.