The Marginalized of Society
I just finished watching an episode of ER where in the beginning it shows a man trying to break into a poor woman's house. She has her three young children with her, the oldest being 9. She is absolutely terrified that it is her ex-husband who has come back to kill her. A gun shot fires through the door. She takes her two youngest daughters and in a desparate attempt to save them from their abusive, violent father, tells them to jump from their three story appartment. Her son freezes on the spot and is unable to jump.
One of her daughters ends up dying and the other is seriously injured.
As the show proceeds, you realize that the father actually died a year ago in a robbery. She has been depressed ever since and seeking help from an outpatient psychiatric service. She was on benzodiazepines and recently had to stop taking them suddenly b/c she could no longer afford them. What actually happened was that she was undergoing benzo withdrawl and suffering from hallucinations and an acute psychosis.
The show got me thinking and I really wish many health care professionals would watch and learn a big lesson from this.
Over the last three years, I've often noticed and pointed out to my friends that there are many people in my medical school class who lack true compassion. In addition, they do not realize that an treating an illness is so much more than just figuring out the diagnosis and writing a prescription. This is best demonstrated by what happens to people who are marginalized in society and become ill. Let me explain.
Drug addicts, patients with mental illness, the working poor and those on social assistance, the native population, those without a post secondary education, etc. are all people whom our society pushes to the margin or periphery. When these people become ill, I find our health care system has a very difficult time dealing with them. Part of this is due to discomfort on our part dealing with these people. Part of this is ignorance on our part. Many people do not realize that there are people out there who often have to make the choice of feeding their kids or buying expensive medication. In fact, this is not something that even crosses their mind. And sometimes, it's just plain arrogance and a judgemental attitude. People form an opinion immediately in their minds and this affects their interaction with their patients. Talking down to a person is one of the most effective ways of alienating them...and in alienating them, you are almost guaranteeing that a patient will not listen to your reccomendations or advice.
I mentioned earlier that I feel many people in I work with lack compassion towards many patients. I find this often stems from the fact that many people have not had to deal with sick people in their families. Or even when there were illnesses, the best possible care was utilized because they had all the resources available to them. Many of them come from middle to upper class families. Money to buy medication, drug plans to cover rehab/physio/etc are present. Time off work is often paid and even if it is not paid, there is often enough money to fall back on. Their sheltered lives make them ignorant of most of the population's hardships. The marginalized do not have these luxuries. Most are on social assistant barely making ends meet or have jobs that even if they can get sick leave, they will not be paid. Those few days/weeks of lost pay is often detrimental to them and their families because every single penny counts. Their jobs do not provide insurance plans which cover for medication, physio etc. Hence people will go to the doctor, take the prescriptions, listen to the advice and then go home and go about their daily lives. As much as they would like to get better, they often have to struggle and work through their illness. In essence this means that despite our abilities to provide excellent health care, the unfortunate souls are unable to utilize all the options available to them. The lack of compassion does not necessarily stem from a consious effort. Often it is simply that the realization is not there that there are many more issues surrounding a person's illness than just the disease itself. A person's ability to take time off work, a person's ability to pay for meds/physio, a person's capability to understand the effects of the disease and the importance of treatment. And with addiction and/or mental illnesses, the addiction/illness often plays such a huge role in disabling a person's ability to make informed choices that it takes over their lives. Feeding the addiction at all costs or a mental illness impairing's one's ability to make proper choices are often factors that push everything else back on the back burner.
Now going back to today's episode of ER. A classic example of a poor woman, who was in an abusive and violent relationship becomes ill. In her case, clinically depressed. She's coping so long as she is taking her medication. However, when she can no longer afford the medication, she abruptly stops it. Anyone who has been on benzos for any significant period of time, cannot abruptly stop the medication; it needs to be tapered over time to avoid withdrawl. Unfortunately for her, she does not have that luxury and hence suffers from withdrawl. In her case, this results in the tragic, yet avoidable death of her daughter. Her fear during her psychosis stems from longstanding physical and emotional abuse. Extremely heartbreaking as all of this was avoidable.
It is extremely frustrating that there is not a system in place whereby people who are marginalized have programs/options available to them whereby they at the very least get the standard of medical care that is everyone's right. Living in a rich society like North America (rich in comparison to the rest of the world), there is no excuse why anyone should be receiving suboptimal medical care. But then again, those in power are from the same middle to upper class group that many in medical school come from and hence have led the same sheltered lives.
I know this is a long post. I mainly wrote it as a reminder to myself that despite not having lived a sheltered life, knowing what it is like not to have money for medication, etc. I too forget and lose my compassion. Especially with patients who have difficult personalities, who have addiction issues etc. I forget that I promised myself I would never do that. I forget that it is very difficult to leave an abusive relationship. I forget that with poverty comes anger, furstration and depression...all of which impact a person's well being. And most importantly, I forget that it is not my place to judge...it is simply my place to do my best to help people with the gift Allah has given me and the knowledge I have been provided with.
One of her daughters ends up dying and the other is seriously injured.
As the show proceeds, you realize that the father actually died a year ago in a robbery. She has been depressed ever since and seeking help from an outpatient psychiatric service. She was on benzodiazepines and recently had to stop taking them suddenly b/c she could no longer afford them. What actually happened was that she was undergoing benzo withdrawl and suffering from hallucinations and an acute psychosis.
The show got me thinking and I really wish many health care professionals would watch and learn a big lesson from this.
Over the last three years, I've often noticed and pointed out to my friends that there are many people in my medical school class who lack true compassion. In addition, they do not realize that an treating an illness is so much more than just figuring out the diagnosis and writing a prescription. This is best demonstrated by what happens to people who are marginalized in society and become ill. Let me explain.
Drug addicts, patients with mental illness, the working poor and those on social assistance, the native population, those without a post secondary education, etc. are all people whom our society pushes to the margin or periphery. When these people become ill, I find our health care system has a very difficult time dealing with them. Part of this is due to discomfort on our part dealing with these people. Part of this is ignorance on our part. Many people do not realize that there are people out there who often have to make the choice of feeding their kids or buying expensive medication. In fact, this is not something that even crosses their mind. And sometimes, it's just plain arrogance and a judgemental attitude. People form an opinion immediately in their minds and this affects their interaction with their patients. Talking down to a person is one of the most effective ways of alienating them...and in alienating them, you are almost guaranteeing that a patient will not listen to your reccomendations or advice.
I mentioned earlier that I feel many people in I work with lack compassion towards many patients. I find this often stems from the fact that many people have not had to deal with sick people in their families. Or even when there were illnesses, the best possible care was utilized because they had all the resources available to them. Many of them come from middle to upper class families. Money to buy medication, drug plans to cover rehab/physio/etc are present. Time off work is often paid and even if it is not paid, there is often enough money to fall back on. Their sheltered lives make them ignorant of most of the population's hardships. The marginalized do not have these luxuries. Most are on social assistant barely making ends meet or have jobs that even if they can get sick leave, they will not be paid. Those few days/weeks of lost pay is often detrimental to them and their families because every single penny counts. Their jobs do not provide insurance plans which cover for medication, physio etc. Hence people will go to the doctor, take the prescriptions, listen to the advice and then go home and go about their daily lives. As much as they would like to get better, they often have to struggle and work through their illness. In essence this means that despite our abilities to provide excellent health care, the unfortunate souls are unable to utilize all the options available to them. The lack of compassion does not necessarily stem from a consious effort. Often it is simply that the realization is not there that there are many more issues surrounding a person's illness than just the disease itself. A person's ability to take time off work, a person's ability to pay for meds/physio, a person's capability to understand the effects of the disease and the importance of treatment. And with addiction and/or mental illnesses, the addiction/illness often plays such a huge role in disabling a person's ability to make informed choices that it takes over their lives. Feeding the addiction at all costs or a mental illness impairing's one's ability to make proper choices are often factors that push everything else back on the back burner.
Now going back to today's episode of ER. A classic example of a poor woman, who was in an abusive and violent relationship becomes ill. In her case, clinically depressed. She's coping so long as she is taking her medication. However, when she can no longer afford the medication, she abruptly stops it. Anyone who has been on benzos for any significant period of time, cannot abruptly stop the medication; it needs to be tapered over time to avoid withdrawl. Unfortunately for her, she does not have that luxury and hence suffers from withdrawl. In her case, this results in the tragic, yet avoidable death of her daughter. Her fear during her psychosis stems from longstanding physical and emotional abuse. Extremely heartbreaking as all of this was avoidable.
It is extremely frustrating that there is not a system in place whereby people who are marginalized have programs/options available to them whereby they at the very least get the standard of medical care that is everyone's right. Living in a rich society like North America (rich in comparison to the rest of the world), there is no excuse why anyone should be receiving suboptimal medical care. But then again, those in power are from the same middle to upper class group that many in medical school come from and hence have led the same sheltered lives.
I know this is a long post. I mainly wrote it as a reminder to myself that despite not having lived a sheltered life, knowing what it is like not to have money for medication, etc. I too forget and lose my compassion. Especially with patients who have difficult personalities, who have addiction issues etc. I forget that I promised myself I would never do that. I forget that it is very difficult to leave an abusive relationship. I forget that with poverty comes anger, furstration and depression...all of which impact a person's well being. And most importantly, I forget that it is not my place to judge...it is simply my place to do my best to help people with the gift Allah has given me and the knowledge I have been provided with.
posted by Anokhi at
8:51 PM
0 Comments:
Post a Comment
<< Home