By Jennifer Menjivar
I grew up most of my life avoiding doctors and hospital visits. I never fancied getting shots or blood draws as a child, and without health insurance; I didn’t have much of a choice. This lack of access is what drew me to volunteer at the county hospital I was born at. Every Wednesday morning, I would report to the Pediatric Asthma Allergy Clinic at San Francisco General Hospital. Most of the children seen at this clinic came from Spanish speaking low socioeconomic families.
That afternoon, I was observing the attending allergist examine a patient. She was 8 years old girl with a history of asthma and unknown allergies. You could sense her nervousness about being at the hospital; she said very little and only answered the doctor’s questions when her mother coaxed her to answer. I reminisced on some of my early doctor visits; I knew she was not looking forward to being poked and prodded.
This patient, we will call her “Suzy,” was having occasional sneezing and nasal congestion when she played indoors which would also trigger her asthma. A nurse came in to place a basic environmental allergy skin prick test and told her not to scratch. 15 minutes later, she returned to analyze the results. Three large wheals appeared on her left arm. She complained that her arm was still itchy and the nurse applied some hydrocortisol to relieve her discomfort. They exchanged smiles. The nursed then turned to the doctor and informed him that she had a positive reaction to histamine, the positive control, dust mite, and cockroach, both of which are very common allergens for children living in urban areas.
The doctor then talked to the family and explained that there was no cure to allergies. One simply manages them and avoids the allergen. He also told them to buy generic allergy medicine at a wholesale store. He then recommended, playing outside when mom or dad vacuumed and dusted, washing the sheets more often and gave them allergy proof mattress covers. He also instructed them to keep her stuffed animals in plastic bags so as not to collect dust. These simple housekeeping measures would not break their budget and would ultimately save Suzy from having allergy induced asthma exacerbations and symptoms. These simple cost effective measures would prevent Suzy from being on tons of drowsy allergy medications. Although some patients require a more intense therapy regime, Suzy’s mild allergies could be managed by controlling the environmental allergens and reducing her exposure to them. And only when symptomatic, would she need to take her low cost generic brand over-the-counter medication. He explained that these medicines, worked just as well as the brand name, and would cost a fraction of the price.
At the time, I was surprised that a doctor would recommend a medication that anyone could get at a drug store. It wasn’t until my first pharmacology lecture in medical school that I realized he was right: Both drugs were pharmacologically equivalent. After learning more about America’s exaggerated spending on health care, and with only average outcomes, I reflect back to this physician who taught me an important lesson in personalized patient care. He not only lessened the financial burden for this low income family, but also helped in reduce the overall healthcare spending.
With these small changes in her lifestyle, including education on allergen avoidance, Suzy avoided unplanned urgent care visits and came back to her follow up appointment with fewer complaints of allergies. By her third follow up visit, Suzy’s allergies remained well controlled and she was discharged from the Asthma Allergy clinic and she would continue to follow up with her Primary care provider. The physician’s low cost healthcare alternative to expensive brand name medications and blood tests for various different allergens, provided the template for Suzy and her family to better manage her allergies and reduce her asthma exacerbations. After witnessing this initial visit, I became more aware of how healthcare providers care for their patients and how innovative their treatments can be. Suzy still reminds me to this day how a few simple changes in medicine can lessen the financial burden for the patient without sacrificing promising results. It’s up to healthcare professionals, as well as patients, to be aware of the costs of healthcare in order to raise healthcare cost awareness as well as work together to decrease the excessive costs of healthcare.
Jennifer Menjivar was a contestant in the 2012 Costs of Care Essay Contest and an MS2 at The David Geffen School of Medicine at UCLA.