Taking Care of Ellen

10.15.10: When getting health care is a luxury.


Ellen (not her real name) came to the Emergency Room (ER) at seven months pregnant with severe back pain, a fever and vomiting. She couldn’t pee and couldn’t stop crying. Ellen hadn’t seen a doctor yet for prenatal care and was deeply embarrassed about that. She worked two part-time jobs, but didn’t have medical insurance. She couldn’t afford prenatal care, but planned to see a doctor soon and deliver at a hospital. She recognizes now that wasn’t a great plan. Ineligible for public health care (Medicaid), there was no safety net to catch her before she fell through the cracks into the crisis she shares with more than 40 million uninsured Americans.

Ellen’s crisis began as a urinary tract infection that could have been treated quickly and cheaply at home. Since Ellen didn’t have a doctor, she tried clearing it up on her own by drinking cranberry juice. Within a few days however, it progressed to a severe kidney infection and she landed in the ER, super sick. As if her infection wasn’t making her miserable enough, she was embarrassed about her financial situation and worried the staff would judge her as a bad mother for not getting a doctor sooner. Ellen was admitted to the maternity unit for IV antibiotics and professional-quality pampering and though her physical relief came quickly, her fear for her financial future terrified her.

Ellen’s story is pretty routine. Our current financial crisis has created countless “Ellens.” Her problem could have been averted with a $20 prescription, but will now wind up costing tens of thousands of dollars she may never be able to pay back.

Not too far in the future, doctors, nurses and hospitals will see more patients than we’ve ever seen before. That’s because the Healthcare Reform Act will insure millions of patients who currently have none. These patients will finally have the privilege of having a doctor, rather than the ER, provide their healthcare. They won’t have to worry that getting sick might bankrupt them.

As the system currently works (not!), uninsured patients like Ellen, don’t see doctors for “front-end care,” the little things insured patients take for granted, like:

• Seeing a doctor when we’re sick but not super-sick

• Vaccinations,

• Screenings,

• Check-ups, and

• Preventative care that keeps us from getting super-sick.

Instead, our “Ellens” wait until they’re sicker than sick, then go to the one place they’re guaranteed healthcare: the ultra-expensive ER that can’t turn them away for inability to pay. Since they don’t have a doctor for follow-up care after that ER visit, they may wind up in the ER again. This is called back-end care. Front-end care is cheaper, easier, more effective and healthier. Back-end care is crisis care – priceless yet unaffordable.

About 13% of pregnant women in the US are uninsured. Some qualify for public insurance but many are Ellens, who earn enough to support themselves but not enough for luxury items like insurance and healthcare.

These women come to the hospital vulnerable and scared. They assume hospital staff will judge them. What they don’t realize is how many of their doctors and nurses totally understand their situation. They may be Ellens themselves. Lots of hospital staff work part-time or on-call without benefits. Plenty are one paycheck away from an ER visit that could mean financial ruin.

Doctors and nurses are as frustrated as patients. We come into this business to help people, to provide patient care, but too often, we’re blocked by insurance and legalities. I’m sure there are some providers who resent uninsured patients, but the doctors and nurses I know just want to help Ellen. Ellen was extremely well cared for by a group of doctors who fell all over themselves trying to do their best for her. She provided them an opportunity to be what they always wanted to be when they grew up: a doctor who really helped somebody who needed them.

We’re not currently equipped to handle the volume of patients coming our way via the Healthcare Reform Act. We’ll face new opportunities, new obstacles and growing pains. But finally, there will be hope for Ellens. There’s a lot of work to be done and I say, “bring it on.”

Oh, by the way, if you’re Ellen, the answer to your health care crisis isn’t to avoid getting prenatal care. It’s usually a package deal and total-pregnancy care costs the same as end-of-pregnancy care. When you’re pregnant, healthcare isn’t a luxury. It’s a necessity. You can’t afford an uninsured crisis. Start talking to doctors, midwives, hospitals and health services early. Be frank about your needs and let these health care providers rise to the occasion of helping you. That’s why we’re in this business. We want to take care of Ellen.

The new health care legislation has perks, starting now. Here are the ways in which the new law benefits pregnant women, new moms and babies, in order of implementation, click here.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to labornurse@fitpregnancy.com and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.