The young man was in his mid-20s when he came to see me for severe abdominal pain at my small community clinic. The pain, worse than any he’d ever experienced, had persisted for weeks and was getting worse. He cried out when I examined him.
I didn’t know the cause of his pain, but I could think of possibilities, including a ruptured appendix, a perforated ulcer or pancreatitis. He needed an urgent CT scan and a surgical consult. The fastest way to get both was to send him to the emergency room.
But the man said he couldn’t go. He was uninsured.
As his family physician, I had to convince him. I explained the need for further evaluation, the risk of waiting. I told him the ER was legally bound to assess and stabilize him. They could arrange a payment plan. Still he hesitated, explaining that he couldn’t pay the bill.
This young man is one of many patients I’ve seen over the years who needed care and couldn’t afford it. I knew that hospital charges might exceed his annual payments for rent. He could face years of debt, even bankruptcy. I don’t recall his diagnosis, but I think he managed to improve without surgery. I still wonder: Was I too quick to send him for emergency care? Did I do more harm than good?