By Danielle Ofri
New York Times
“I used to have a doctor,” she said, matter-of-factly, “but when I got laid off six months ago I lost my insurance.” Ms. C. shifted in her chair while I took notes during our first medical visit. “So I didn’t do anything about my knee, but when it got so painful that I couldn’t walk, I had to go to the emergency room.”
Then she gave a wan smile. “Cost me $400 to learn that I just have arthritis and that I need to take Tylenol.”
As a primary care doctor in a city hospital clinic, I see patients from all cultures, speaking all languages. But lately there have been patients from a new culture — the recently-laid-off-now-without-insurance culture.
Ms. C. was emblematic. Employed her entire life, for the past decade at the same bank, she was fired along with her entire division at age 52. She’d never been to a public hospital before.
I asked her about her screening tests — Pap smears, mammograms. “Sure, I had them every year with my regular doctor…” Here her voice trailed off, almost wistful, as though she were watching her previous life melt away.
Then I asked her about her life during the past six months.
“Stressful,” she said. “And when I’m stressed, I eat. I’ve gained more than 20 pounds.” She looked ruefully down at her midsection, grasping a handful of her waist. “I didn’t have any of this when I was working.”
Ms. C. had always been healthy, but now unemployment was taking its toll. The increased weight had put stress on her knee joints, causing a flare of osteoarthritis. Her blood pressure was now elevated — something she’d never had before. And when I checked her labs, her glucose was elevated. The extra weight had pushed her across the line to prediabetes. And without insurance, she could no longer afford physical therapy for her knee.
A study in the journal Demography documented what physicians continue to observe and what everyone seems to know in their gut: that losing a job is bad for our health. People who were laid off suffered more adverse health events, many of which persisted even after they were rehired, if they were lucky enough to get another job.
The proposed reasons included loss of insurance, lack of income to attend to medical issues, and increased stress which could lead to poorer eating and exercise habits as well as increased stress hormones that could worsen blood pressure, diabetes and arthritis. Ms. C. seemed to fit this to a T.
The best thing for her health would be to get her back on track as quickly as possible. If she were fully employed and not chronically stressed it would certainly be easier to nip the hypertension and diabetes in the bud. But there was no way, obviously, to prescribe employment, no easy medical intervention that would eliminate the pervasive anxiety and stress that accompanies such an upheaval in life.
It seemed like an unfair double-whammy. Dealing with unemployment and its attendant financial worries is difficult enough. Being dealt an additional hand of medical problems feels like an insult added to injury.
But this was what circumstances had delivered, and there was no way around it. Ms C. took the news of her new health conditions grimly, head bowed. I went through my standard discussion about cutting down on salty and sugary foods, increasing fruits and vegetables, starting an exercise program, but my words felt brittle. I couldn’t help feeling that I was just heaping on more pain instead of trying to relieve pain.
As she gathered her things to leave, I thought about the larger implications of Ms. C.’s situation. Nearly 15 million Americans were in the situation she was in — unemployed, uncertain financial future, under stress and likely to face more medical problems.
In terms of public health, this is like a natural disaster wreaking havoc on society. The fallout could be as calamitous as that seen with hurricanes, floods or earthquakes, but all the more insidious because of how quietly and individually this disaster is taking place. There were no flames as Ms. C. made her way to the door, no collapsing buildings or surging levees, but the devastation was obvious. (from the New York Times)