Why It Pays To Do Good Deeds
I stepped out the back door of my home on a cold December morning and noticed a new pile of firewood sitting at the edge of my driveway. I knew it must have been delivered by a guy named Eddy. Eddy is an unemployed carpenter who visited my office a month ago with a fractured third metatarsal. He ran out of unemployment benefits and was getting along by gathering and selling firewood. He injured his foot with a splitting mallet.
Eddy told me he would pay cash but said he had less than $100 left and asked if I could do just the bare minimum to heal his foot. I assured him I wouldn’t go over that amount. Then I took X-rays which showed a displaced fracture of the third metatarsal. I placed the third toe in a finger trap and placed counter pressure on the tibia, bringing the third ray into improved alignment.
While I was working on his foot, Eddy described his economic circumstance, saying he was in survival mode. He lived in a cabin with no electricity or running water and heated it with wood he gathered. He needed to continue some weight bearing to bring in water from a nearby well and wood. That meant I could not consider any surgical reduction or internal fixation.
After setting the fracture, I dispensed a CAM walker splint and instructed Eddy to use his crutches as much as possible. I asked him to return in three weeks so I could check his progress.
He reached into his tattered wallet and asked, “How much, doc?” I mentally calculated we had gone way over his $100 limit and speculated that if Eddy paid anything, he wouldn’t be able to afford food. I made a deal with him. I told him I was almost out of firewood and would trade him a load, worth about $80 in these parts, for the care of his foot. Eddy agreed to this arrangement and I suggested he wait until his foot healed to bring my wood. He was worried about me being almost out of wood and brought a partial load to help me get by.
Despite Eddy’s circumstance, he is a proud man and I have a rule in my practice about patients with limited financial means: There should be no barriers to care. This is not an easy rule to live by. Some are more skillful at hiding their limitations than Eddy. When we encounter a patient with no insurance and no employment or a low-paying job with no benefits, we assume the person has limited ability to pay for care.
My office manager, Amy, has a short interview with the patient and determines an affordable amount and then adjusts our usual fee for the patient. We have done a lot of $100 matrixectomies. Amy arranges payment plans when needed. Some patients drop $20 payments at the office each month. The patients get the care they need from me and keep their dignity.
The upside of all this is it simply feels good. I don’t do this because of some religious zeal. I do believe those of us with the knowledge and gift of healing are obligated to share it unconditionally with all patients in need. If there is a deity, we are likely to face a big audit at the end of our earthly journey and I want to pass the thing. I like Pascal’s wager: If there is a God, you’ll live forever. If there isn’t, you’ll be just as dead.
Another upside to having no barriers to care is many of these patients are in transition to better economic circumstances. There is a wealthy contractor in my community. Twenty years ago, when he was out of work and broke, I did a nail procedure for his daughter and took care of his fractured ankle for practically nothing. These people don’t forget you when their ship comes in. My practice is full of patients who have been through tough times but knew they could get care no matter what.
None of this has hurt my bottom line. I live in a beautiful home. I fly my airplane to a small island in the San Juans in northwest Washington where I have a cabin. My wife and I vacation in Europe almost every summer. I enjoy all the tripe that goes along with being a successful physician. I couldn’t look myself in the mirror if I ever denied care to a person like Eddy because of his financial limits.
Now I have to go stack that wood.
Dr. McCord is a Diplomate with the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.