07 May 2014

Death by paperwork

A patient was admitted to our hospital service with a large mass that had been growing for months, as well as significant weight loss. When I examined him, it was obvious that he had an aggressive form of cancer. But had it metastasized?

With this particular type of cancer, the prognosis is fairly good if the primary mass is removed and there is no evidence of metastasis. But the prognosis is bleak if the cancer has spread. This patient was lucky, because there was no evidence of spread.

This patient was uninsured, which is why he had put off seeing the doctor for so long. But he was eligible for Medicaid and had never bothered to apply. After getting a tissue sample, we discharged him home, and advised him to get insurance as quickly as possible, so that the surgeons could remove the mass immediately. I figured it would take a few days for the state to process his insurance forms.

I turned out to be dead wrong. Processing the patient's insurance application apparently took months. By the time the patient came back, the mass had grown nearly 20 times bigger, and it had metastasized. His prognosis had gone from optimistic to terrible.

People get sick, and some inevitably die. Yet some die needlessly, and for the stupidest of reasons.