Sunday, February 22, 2009

What ever happened to personal accountability?

Some days even my jaw can hit the floor.

Recently, a patient came into our ER with a request to be evaluated after surgery. This struck me as odd since surgical patients are expected to follow up with their surgeon after they are discharged. They normally are given instructions for home care and an appointment to meet with the surgeon in the next 1-2 weeks. This patient explained that he was not going to be following up with his surgeon because he had moved. Not the surgeon - but the patient. And on the day of his discharge from the hospital no less. The patient then further offered that he had moved to our state from one over a thousand miles away.

The patient had surgical drains still in place and wounds that were still fresh. When asked why he decided to move to our state, he replied that his cousin lived here and told him how good our state Medicaid program was and that it would be easy to move here and collect disability so he would not have to work. Since the patient was relatively young and untethered to a family, he decided to come north and try and make a go of it (on the state's dime).

I'm not sure what was worse – the fact that the patient thought this was a good plan, or the fact that he was willing to share it with people.

The patient, not surprisingly, was dumbfounded when we asked if he had told any of his physicians about his decision to move. He also seemed more than a bit confused when asked if he had contacted any providers here to follow up with him and his on going medical problems and needs as time went forward. A simple “no” was all that was provided in response.

The patient has complicated medical problems that will be expensive to address and will likely not improve. His complete lack of understanding about what medicine can and cannot do for him is not much of a surprise, as many people struggle with this, but his absolute disconnect from responsibility was amazingly irritating. This patient, through his own personal choices, had managed to severely damage his body to the point that his life expectancy is likely less than 5 years. But he wants us (that's a collective us, as in the American public) to take care of him. That, he feels, is his right - to be taken care of despite his egocentric behavior and without delay (hence the move to Maine).

It was not clear to me when exactly this patient had resigned his position within the banking industry. He was a young man, and so he must have moved up the ranks in a quick fashion. Interestingly enough, he left his previous state on a bus instead of his private jet. He must have left it behind so it would be easier to make his case for disability and Medicaid. A trick he learned, no doubt, by watching the auto industry executives on their second trip to Washington to beg for aid.

What has become of us? If this is the mentality that is prevalent throughout all socioeconomic levels in our country, we are in more trouble than I have feared. When the poor, the middle class and the wealthy all feel like they are victims and deserve to be made whole again by the rest of society, despite any and all evidence that their situation has been self-inflicted, then perhaps it is time for a serious discussion about the permanence of consequences.

Bank executives who watched and encouraged their loan officers to give large sums of money to people who should have had a hard time borrowing cab fare; home buyers who thought they should be able to afford a $750,000 home on a $50,000 salary; investors who bought real estate at over inflated prices thinking the value could only ever rise; alcoholic drug abusers who trash their liver and pancreas before they reach 40 because the only thing that mattered was the “high” - all these people have the same disease. None of them have the ability to take responsibility for their actions and live with the consequences. They represent the worst in us as a society.

I think I may just take a page out of the Alcoholics Anonymous book and start my own support group for people who feel entitled to everything at everyone else's expense. I can see it now – a poorly lit church basement with bad coffee brewing and white styrofoam cups on the folding table. A man stands and walks to the front of the group to address them:

Speaker - “Hi everyone. My name is Ted.”

Group - “Hi Ted.”

Speaker - “I'm a greedy and irresponsible American.”

Group - “Suck it up Ted! And that coffee's not free you know.......”


  1. Sounds like the democratic agenda to me....More and more on the government's dole until we become unable to care for ourselves, think for ourselves, exist for ourselves....are you sure you're not a closet republican John?

  2. Bovie -

    You know I don't belong to either. They both suck.

  3. What we need is a liberatarian senate/house/presidency....Your story above incensed me.

  4. I think you need to elaborate on your plan for universal healthcare, because what most are envisioning is exactly what this guy has. Although this jerk is extreme, people are going to expect exactly what he does, i.e., "take care of me". And most importantly, I reiterate to you the need to stifle the medicolegal system so ultimately we can tell this "patient" to fly.

  5. maybe we could improve MaineCare. Since most of them come to the ED for treatment that they don't really need, I have a couple ideas. We could pay for the cab ride to and from the hospital, stop at McDonalds to get them lunch, stop by Mardens and get them a new outfit, and finally give them some money so they can buy another half gallon of coffee brandy to ensure they come back again tomorrow.
    Better yet, why not but them on a bus? that would be a lot cheaper.