I am a patient fellow and so even when I advocate for patient treatment, I’m willing to wait. Sometimes our patients aren’t that cooperative.   I work within an FQHC (Federally Qualified Health Center) ^[1] and we provide safety net ^[2] services to those who have no other choices, including the un-insured. Our difficulty is not providing the services but having no upward paths to tertiary care.

While the hospitals protest that they “turn away no-one” we find that they “see” the patients, but then give them paths to care which are inaccessible to them.  A lot of times it’s turning them away from admissions or surgical care which would impact their ‘bottom lines ^[3]‘.

In our state (Connecticut)  most of the hospitals are not-for-profit.  Even our state-run hospital routinely buffs or turfs (sends patient’s back out through the revolving door) poor patients or patients with poor insurance.

It’s a terrible time to be poor. It is rarely the physician who won’t see the patient but most often the services within hospitals that are inaccessible.  I do understand that the insurers of last resort ^[4] (Medicaid and their ilk) have so undervalued such services as Operating Room so that none can afford to register those patients except at a loss.  The charity exemptions don’t always cover.  There are many examples of hospitals that have failed (gone out of business) because of overwhelming demand for non-compensated services.

What does this twisted path portend?  I fear that like business, the corporatization of medicine ^[5], has become the norm.  When the bottom line and not the patient’s bottom becomes the most important thing, we all lose. Mostly, our patients lose.

Dr. Buchbinder is a board-certified Podiatrist practicing within an FQHC (Federally Qualified Health Center) in Hartford, CT.   He is director of the FreeMED Software Foundation, a non-profit dedicated to making accessible and extensible medical records available worldwide.   Dr. Buchbinder also blogs at  A view from the provinces. A new Yankee’s view of the world. ^[6]