Bad Things Happen...

I saw a 50 yo Hispanic gentleman who came into the ED because his blood sugars were running high. He was recently treated for a "bronchitis" and placed on an antibiotic...at that time his sugars were high and he had not been compliant with his diabetes medication. He had no insurance and paid for his medications himself. He started back on the medication but his sugars were still high and wondered what was going on.

He also was complaining of continued shortness of breath with some wheezing. I repeated his chest x-ray which showed a large mass (probably cancer) and a new pneumonia secondary to the tumor. I then performed a CT scan of his chest which confirmed my suspicion. The man had a tumor that had also spread to his lymph nodes in his chest. I was shocked since he was relatively young, a nonsmoker, and no history of any occupational exposure to explain why he had the tumor.

He was subsequently admitted for further treatment. He, of course, has no insurance so I will not be paid and the hospital will receive some money from the state to cover some expenses. All the other physicians who care for him will not receive any payment either. I'm not complaining about the money, I at least made the unfortunate diagnosis and was able to get him help. Perhaps he has a lymphoma that may respond to treatment. My point is...did his lack of insurance lead to a delay in diagnosis and if he had better care would the diagnosis have been made earlier? Who knows...