I’m constantly awed by the fact that I get to be part of one of the best hospitals in the world, especially because as a kid, I grew up without health insurance.
These were the days before the Affordable Care Act; there was no penalty for going without health coverage. As a non-citizen, I was ineligible for Medicaid, and private health care was prohibitively expensive for my family. Fortunately, I was a healthy kid with a robust immune system, and I never had to go to the doctor’s office except for mandatory school physicals and vaccinations. When I rotated through my pediatrics rotation, I was struck by how many well-child visits that I had unknowingly missed.
But not having insurance meant that when my family had to pay, we paid big time. When I was in high school, my otherwise healthy dad developed an acute infection — just a stroke of terrible luck. He was whisked away in an ambulance, evaluated in the emergency room, and admitted to the hospital.
Fortunately, he made a full recovery, but the financial costs of the ambulance ride, the expertise of numerous medical providers, and the medications, were astronomical. It took months to negotiate the bill with the numerous parties — hospitals, physician groups, diagnostic services — that had contributed to his care. On the advice of a patient financial counselor, I wrote letters to various offices to beg for discounts. Fortunately, many recipients acquiesced, but even so, it took years to pay off the bills.
From this experience, I got the sense that health care was a privilege for those with the means to pay for it, like a good union or white-collar job. In a way, it sparked my interest in medicine because I wanted to be a doctor to those who needed my services the most.
So far, I’ve been able to pursue this goal at Stanford. I’m starting my third year as a specialty clinic coordinator at Arbor, one of two free medical clinics run by Stanford students under the guidance of residents and attendings who graciously volunteer time out of their busy schedule.
Even after the implementation of the ACA, the clinic’s waiting room is packed with people wanting to be seen. Some of our patients are undocumented residents who are ineligible for Medicaid or Medicare. Others are elderly parents of savvy graduate students and postdoctoral fellows visiting from developing countries for a rare opportunity to see their children and get care from U.S. physicians. Then there are people who are just down on their luck or between jobs and haven’t been connected to the social services available to them.
At the specialty clinic that I co-manage, I receive referrals from the general free clinic, call patients to make appointments, organize student and physician volunteers, and arrange supplies for various in-clinic procedures. I’ve seen students and physicians help underserved patients by treating illnesses, preventing downstream consequences of chronic conditions, and coordinating a care plan to make sure that patients can get the follow-up that they need.
It is a team effort: The amazing attendings have volunteered for years to help patients and teach trainees, and the residents ensure one of their own is present to help every clinic date and that our supply closet is appropriately stocked. The medical students learn more about the specialty from the attendings and the residents, and, most importantly, patients get the care they need.
Some patients have been harboring their illnesses for years, using folk remedies or over-the-counter medications to treat their symptoms instead of going to see a physician. An ounce of prevention may be worth a pound of cure, but I understand their rationale because the same thing kept me awake at night as a kid: what if the doctors find something wrong with me or my parents, how will we be able to pay for the treatment? Maybe it’s better not knowing, but what if the condition gets worse and becomes more difficult and expensive to treat? How will we pay for the treatment?
Now that I have insurance and have more flexibility with my schedule during my research gap year, I’m finally catching up on my health, including well-woman’s exams, recommended vaccinations, minor surgeries, and dental check-ups. I’m acutely aware of how lucky I am that I can get care and follow-up from incredible Stanford providers, some of whom I’ve worked with before (this is admittedly a bit awkward, but that’s a story for another time), but many others still struggle to access even the most basic medical services.
Growing without health insurance helped me to understand the plight of many individuals who still face similar challenges, and as a medical student, I am awed and inspired by the physicians at Stanford who make time out of their busy schedules to help the underserved.
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