Saturday, February 13, 2010

It's all about the Hamiltons, baby!

NewFNP realized that she censors herself and that is so weak. So fuck it, let's talk about poverty.

It feels a little like a Seinfeld episode to say "not that there's anything wrong with it," but perhaps it is not entirely transparent that newFNP thinks that there is nothing wrong with being poor. That being said, there is also nothing wrong with wanting to not be poor either.

Poverty sucks. Urban poverty super sucks. Almost five years into practice, newFNP continues to be struck by the difficulties experienced by her patients -- difficulties truly unknown to her. Urban poverty often means gangs, school failure, cockroaches in ears, overcrowding, poor nutrition, medical debt, precarious housing, stress.

NewFNP grew up kinda poor after her parents divorced. Her dad often didn't pay the $400 child support payment that was to be shared between newFNP and broFNP. The first duplex in which we lived post-divorce was in the shadow of the interstate. But newFNP's mom had a college education and newFNP very frequently heard the mantra of the importance of a college education. And this was when she was in third grade. So while newFNP's family was financially poor, she had some socioeconomic buffer based on her mom's education.

NewFNP's patients, by and large, have no such buffer. They often live day to day, hand to mouth. Daily life beats them down enough that there is very little future orientation.

A patient today, a 30-year old unemployed woman with three children, eight year-old rippled breast implants and a tubal ligation, was interested in A) reversing her tubal in order to have another child with her boyfriend of four months and B) getting a do-over on the implants. Yes, get those rippled things switched out before something bad happens, absolutely. Yes, your health is worth the $5000 or whatever the new boobs cost. Reversal of tubal ligation? Likely very expensive and likely not covered by one's state-funded insurance program.

But are these out of pocket expenses financial priorities? Does she have Suze Orman approved savings? Do her children have college savings funds? Is it a universal truth that all parents want their children to succeed and be financially stable?? Does newFNP have any fucking business in encouraging her patients to think about such things or even thinking these thoughts in the context of patient care?

NewFNP doesn't know, nor is she any kind of sage financial guide. Lord know that if newFNP had an extra three grand laying around, she would have a Bertoia Bird Chair faster than you can say sham-wow!

But newFNP's gut says that even the least educated, financially marginalized champurrado vendor would prefer that her child be a teacher than sell shoes on a corner. But how does she help her child get there if she herself has no idea, if she's illiterate, if she hasn't set foot in a classroom since the 7th grade?

Or what is a family teaching their children if the parents don't work, if they hang out and watch TV and have state aid? Like, if the goal is state aid, end of story? If there are four fathers of four children?

(Is newFNP completely losing her liberal credibility for even thinking such things??)

There is definitely an argument that goes like this: NewFNP, just shut the hell up and see your patients for their ear infections, et cetera et cetera.

Then there is the argument that goes like this: People need help and they often come to clinic for more than just what their chief complaints might have one believe. And people who impact the lives of others do more than the bare G.D. minimum.

Perhaps she should adopt the former approach when she notes feelings of judgment towards a patient, as she did with the BTL-reversal wannabe today. Providing good medical care is, after all, a good outcome in and of itself.

But helping to teach someone avenues through which to escape poverty - that seems like an okay thing to do as well. Is that just too pie in the sky? Is it classist? Is it even a realistic goal given the constraints of clinic? Ah, fuck it. Who knows.


BostonFNP said...

I think a very important point that you touched on, is that some people appear to be OK with being poor (living off state aid while watching TV) and others aren't. And some of this plays into your interaction with them as patients because you have never been the type of person to take the easy road. When confronted with different values like this, it is natural to treat someone differently than someone else whose values are more akin to your own. I don't think this makes you conservative, I think it makes you human. We can't help it that we just don't like some patients and their decisions, poor or not. That's life... and seriously, that chair? I think my butt would go numb in about 1 minute.

Anonymous said...

you know what? you're thinking about it. kudos.

Anonymous said...

As Anonymous at 5:39 said...bravo for thinking about it. And thinking about it with respect and insight into your own stuff. Your patients are lucky to have you.

Karen said...

As someone who has worked with a variety of different at risk groups, I think, especially as an outsider, you start to feel a certain amount of disbelief in folks who don't seem interested in changing or bettering anything in their own lives if there is no immediate payoff FOR THEM. It is by no means all of these people, but it can simply seem so daunting to provide pre-natal counseling to a 17 year old mother of 4 or 5 kids who seems to do little to no actual parenting and ismore interested in getting a 3D US than making a decision about birth control for after the baby is born. You are not the only one who feels this way, trust me, and it does not make a "conservative". I suppose you just keep chugging along, do your patient education and try to empathize with them best you can. Le sigh.

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Candi said...

Love your blog, HATE that chair. I wouldn't pay $3.00 for it. JMHO :)