When thinking of the topic of accessibility most people tend to think in terms of physical access in public spaces. While this is definitely a legitimate and very important aspect of accessibility and one with which many people must contend, I would like to broaden the consideration of accessibility.
Think, for a moment, of the individual with health insurance, but without dental insurance. The age of this person is irrelevant in the aspect that it could just as easily be your 18-year-old brother, sister, or cousin just as easily as it could be your middle-aged or elderly person, be it a stranger or a family member.
Let’s say, for the sake of this discussion, that this particular person has a health, medical, or dental condition that precludes them to very soft teeth, resulting in cavities, which left untreated begin to erode the tooth. As much as they might want to seek dental care it is nearly impossible while living paycheck to paycheck, and simply trying to pay enough of the bills to escape being homeless, and occasionally even eat a little bit.
Even with stellar credit, most healthcare providers, which can and should include dentists (among other professionals), are reluctant at best to provide any services on a payment plan unless it happens to be through a pre-arranged third-party credit provider. Even then unless you have superb credit and typically a large amount of cash for a down payment, you may easily find yourself out of luck.
Okay, let’s assume one is able to ignore the pain of the cavity as it continues to grow, and as time goes it further erodes and weakens the already damaged tooth until you can no longer simply ignore the pain. As the pain worsens you feel what seems to be a lump on the side of your face in the area of the tooth in question.
Unable to manage the pain anymore you visit your primary care physician who, while sympathetic, explains that there is little he can do to help you short of possibly writing a prescription for antibiotics. They further explain that the antibiotics may well solve the immediate problem of the infection, but as eroded as the tooth (or maybe even teeth at this point) is the only solution is to have it extracted.
You explain that you don’t have dental insurance and the wait list for any type of so-called reduced fee care is a minimum of a 12 to 18 month wait, and that you must have a few hundred dollars up front as the dental students will do the procedure of the extraction for free through the teaching hospital or dental school, but the cost of the supplies for anesthesia, local or otherwise, are not included in that service.
You’ve already lost time from work to visit your PCP, but you forego paying a bill to fill the prescription for the antibiotics hoping it will buy some time. A period of time goes by during which you think maybe, just possibly, the nerve has killed itself or otherwise been damaged beyond repair as it no longer hurts like it did. Then one day while at work you notice a vague pain in your jaw, very unlike the previous infection, but you also notice that when you look in the mirror there is noticeable swelling on the side of your face where the pain is.
Unable to afford any more time off from work you decide to simply take over the counter pain relievers. They work for a while, at least a little bit. Eventually, as time goes by you feel generally ill. You no longer smile at work because the broken teeth are visible. You withdraw from family or social functions because you are self-conscious that you will be judged harshly for the state of your teeth despite still dutifully brushing what’s left of them two or three times per day.
One day you become so ill that your boss takes notice and sends you home stating that you can’t return to work without a physician’s note stating you are cleared to return to work. You’ve tried for months, maybe even years, to get the dental situation remedied, but there are no resources to help you since dental is typically considered “cosmetic” by many.
Eventually, you resign yourself to the fact that you now have no choice but to go to the emergency room, where you are promptly admitted for not a simple tooth abscess. You think to yourself that while this is not ideal, you will deal with being in the hospital for a few days worth of IV antibiotics.
The admitting doctor explains to you that this is no longer a simple infection. It has progressed beyond your mouth and jaw. For that matter, it has progressed beyond your head and neck. You are being admitted for sepsis, which when untreated can result in life-threatening and yes even fatal consequences.
My question to those reading this is how can this happen in the United States healthcare system, which is often touted as being the best in the world? What does it say about us as a society that we will let people suffer until it becomes a life-threatening issue, and then we’ll step in rather than offering them a hand when the rest of the consequences could have easily been prevented?
There are no right, wrong, or simple answers to this, or many of the topics I may bring up. Rather they are designed to make us stop what we are doing, think about the other point of view, and ponder what we can all collectively do together to change things. Don’t think this can happen to you or someone you know? Think again for it happens regularly and more often than you would like to think.
What are your thoughts? What can we do as either the patient or society to prevent this from happening?