The magical mystery land of community health

I don't make this stuff up!…but I do change identifying information.

‘Real’ disability March 27, 2008

Filed under: Uncategorized — lesbonurse @ 12:04 am

I feel confused about the whole disability form issue. At our clinic we have many patients who come in with state disability forms, asking their PCP to help them get the monthly payment. Of course, this ends up being a philosophical and political issue for the providers. We have a relatively small amount of patients who are completely and totally incapacitated–but a very large amount of patients who report that they have disabling conditions such as chronic pain, anxiety, crippling depression (and, as a few people have claimed, disablingly high blood pressure). In fact, one of the “get off your fat ass and work”-minded residents told me that in a recent chart review of 250 randomly sampled patients, only 10% reported that they were employed. This leads to some questions:

  • Are our patients working under the table?
  • Are our patients really all disabled?
  • Are our patients as lazy as this resident thinks they are?
  • How DO our patients get money?

Despite the fact that this resident pulled out the tired old “If our patients are so poor why do they have nice sneakers and acrylic nails?” argument, I really don’t see that our patients are living the high life. I don’t see gucci and facelifts…I see ratty t-shirts and cheap knockoff bags. And part of me thinks that if our patients feel that getting $600 a month is the best they can do for income, it bespeaks a bigger socioeconomic problem that points to the need for education, literacy and…well, some kind of magical motivational quality that is lacking in our society. And I kind of feel like I don’t care that marginally-disabled people are pulling in 7 G’s a year. As I see it, the problem is that only a few exceptional people can manage to pull themselves up by their bootstraps while juggling family, job and school–yet there’s a societal expectation that everyone will be the exception to the rule. The majority of our patients are either too busy, too depressed, too learning-disabled or too crushed by the unrelenting demands of their lives to achieve greatness. So does a life of depression and crushing poverty justify granting someone disability for their chronic tension headaches?