Blog # 8-The Inequalities of Health Care

I volunteer at The Good Neighbor Clinic in White River Junction, Vermont. It has been some of the most fulfilling work I’ve had over my 20 year career as a nurse practitioner. Every time I work, I am reminded how fortunate I am to have health insurance. You see, this clinic serves the working poor. People whose employer’s don’t offer health insurance coverage; who can’t afford to carry an insurance premium; and because they work, don’t qualify for Medicaid. Most of them at some point in time have had health insurance, but due to extenuating circumstances, have lost their insurance coverage.

When patients are scheduled at The Good Neighbor Clinic, many have lived with their condition for a while. They haven’t sought treatment at a private clinic because they worry about medical bills that they can’t afford to pay. Many arrive at our clinic through word of mouth.

With my recent diagnosis and treatment for breast cancer, I have a heightened empathy for women with breast issues. On my patient schedule it said, “Patient with a discoloration on her breast”. In two weeks through her current work, the patient would be eligible for health care, but heard that we offered free health care, and was worried enough about her breast symptoms that she didn’t want to wait two more weeks. The patient told me that her last screening mammogram was two years ago. She said she had to have a repeat mammogram because of worrisome findings, which ended up being benign, cystic breast changes.

In the examination room, she described over the past month how her left breast felt fuller, and in the last two weeks developed pain and hardness in her breast. She also noticed that the appearance of her nipple and skin surrounding the hardened area had changed over the past several weeks. Potentially very worrisome symptoms, but I was hopeful that she had mastitis which with antibiotic treatment, would make her symptoms resolve. I took her temperature which was normal. If she had mastitis, she most likely would have a fever…On physical examination, almost the entire outer aspect of her left breast was rock hard and her nipple was inverted.

She was scheduled for a mammogram and ultrasound that day. The preliminary report indicates that she has advanced breast cancer. Hearing about her preliminary results caused a spectrum of emotions to well up inside of me. I felt thankful that my breast cancer was diagnosed and treated early. I felt angry that because this woman didn’t have health insurance coverage, her cancer was diagnosed at an advanced stage. I felt guilty that I am among the privileged to have health insurance and to be able to seek preventive care. As I ride my bike across the country this summer, I will be able to advocate early detection and treatment for breast cancer, but what do I say to all of the people who can’t afford health insurance to pay for preventive care?