The Uninsured, Hospitalized Patient

Diabetes leads to many hospital admissions each year, and also complicates hospital stays for people who are admitted for other reasons. When patients don’t have insurance, or are underinsured, who takes care of them in the hospital?

In our area, I only know of one group that participates in Medicaid, and they see those patients in a clinic separate from their private office. They are part of a teaching hospital so when these patients are hospitalized, they are not consulted, often because the residents take care of the patients.

In community hospitals though, the endocrinologists on staff are called upon to see these patients. I have always considered it just part and parcel of being on staff. We see the patients, treat them like any other patients, and generally end up writing it off. Every now and then, there’s an uninsured patient who turns out to have money – like a small business owner who just never bothered to pay for insurance and pays for all his medical bills in cash. We do a happy dance when we get one of those, but for the most part, we just accept that there are some cases we end up doing pro bono.

Unfortunately, I have discovered that not all physicians do the same. There are some who are refusing to see patients based solely on their insurance. Now, I understand that in the outpatient setting; there are insurances with which we do not participate and there are patients with no insurance at all. Those patients either pay in full or are not seen. But when someone is in the hospital and needs to be seen, especially by a specialist, particularly a specialty such as ours where there are so few of us, I don’t understand how one can just refuse. 

I don’t know what the “rules” are. I’m fairly certain no law is being broken. I don’t know if it can be stopped. But it seems unethical to me. “Scummy” was how one other physician put it. It delays patient care. It puts undue burden upon those who must pick up the slack. In my country, we had a term for it  Ì¶ “sibakin.” It derived from a word which means that little splinter of wood that goes flying like shrapnel when you chop wood. It is not only useless, it is potentially harmful.

I wish there was a way we could be compensated for our time seeing these patients, but until there is, we will continue to do our pro bono work and will hope our colleagues do the same.