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?

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2 Responses to “‘Real’ disability”

  1. nursesally Says:

    i hear ya, sister. working under the table? probably… if you count watching your daughters and sisters children while they work random jobs. really disabled? good question. it’s an interesting thought that they have done manual labor all of their lives – the 60 year old housekeepers kill me – my mom can barely stoop down to the ground. do they have a pension waiting for them? probably not. but, then again, there’s always disability. lazy? you try to cross the border, battle racism, keep track of your children without a husband. how beat down would you feel, ms/r resident. how do they get money? they share it in their community. they live in the same house as their grand kids. they figure out a way to make it work. it’s pretty incredible if you think about it. but soooo frustrating for providers, just the same. if only there was a pill for body aches/insomnia/depression and/or PTSD.

    thanks for all of your posts! about to graduate in 4 short weeks, just got a job at a community health center in denver, and can’t wait to finish my stupid scholarly project!

  2. LB Says:

    I’ve been doing some math lately, and I realize that (at bare minimum) I was violently raped over 750 times before I was ten, suffered severe daily beatings by more than one family member – being the youngest, also there was the ‘kinder, gentler sexual molestation’ of family – strangers – teachers, being kidnapped/tortured and left for dead by an uncle (now in prison) when I was in kindergarten, was physically tortured by another sibling on a weekly basis for many many years up to early teen – sessions that could last up to 3 hours, received massive skull fractures from being dropped on my head from the height of one story, was in 3 drunk driving accidents – always a passenger, never the drunk: lower back injury, multiple skull and knee fractures … and was born with deformed legs and feet which was never properly attended to. (too expensive!) You know I am leaving out yet more horrors, there’s no way to summarize my life in a comment.

    PTSD aside, I’ve got arthritis on top of all the old injuries and the chronic pain, I can’t get through one night without nightmares, one day without flashbacks – and am facing the slow painful disintegration of another relationship because it’s really all too much for her to bear. Too overwhelming. And eventually, everyone ends up somehow believing that I choose to wallow in this.

    There’s no avenue of healing for someone like me, no way to get the $150 an hour shrink (the kind who *might* be able to help me – I’ve been in and out of therapy that I could afford for 25 years now), the operations that would at least fix my legs and back: all I get is treated like a junkie for the 80mg a day of Kadian and 80mg a day of Baclofen. When I state that I am still in pain? Can you imagine the sneers? I get treated like a piece of crap from reception, to Doctor’s assistant, to Doctor, to Pharmacist … life in America. Good luck to you decent practitioners. You have few peers.


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