Monday, October 30, 2006

Paperwork

The baby's great-grandmother, the guardian of the baby's teenage mother, had called me to ask if I would help them fill out some paperwork to get the baby some state sponsored insurance. It's kind of like Medicaid, but for children with special needs. She had received an application packet in the mail and seemed a bit overwhelmed by it.

When she brought it in, I had to sigh a little bit. None of us like to do more paper work. The forms, although written in the stilted formal language so typical of government applications, weren't that hard to figure out. With a little patience and persistence , she should have been able to complete them. It made me realize once again how great the gap is sometimes between me and my patients' families. I don't mean to sound arrogant, but I'm fortunate enough to be educated and intelligent. Many of my patients' family members are not, and the difference can make it hard to relate to them at times. Certainly it makes explaining NICU issues and diseases challenging, and sometimes it seems downright impossible to make parents understand.

On the other hand, I was a little miffed at the state for not making the applications easier. We know that many people in the inner city are functionally illiterate, and they should accommodate them when they design these forms. The state used to have the local health departments meet with families to complete the applications for this insurance program, but in a cost cutting move the state decided to skip that and just send the applications directly to the families. I suspect the state might have been hoping that some families would just give up on the applications, and then the state wouldn't have to pay as much for this program.

As we started going over the application, though, I noticed that this family had done a surprisingly good job with it. They had most of it completed correctly. I added some medical information to it, explained a couple of the more difficult points to them, and made sure they knew the right places to sign. I complimented them on the good job they had done.

I'm not sure why the family chose me to help them with it. Any nurse or another doctor could have done so. It was a little weird. A few minutes before I had been thinking somewhat derogatory thoughts about this family's ability or inability to complete the application; now, though, I was honored that they chose me to help them.

14 Comments:

Blogger Dream Mom said...

They chose you because you were kind and because they trusted you. You should be honored. It took a lot of courage for them to ask you.

By the same token, I am sure you don't have time for that kind of thing. That was nice that you helped them instead of passing it on to someone else.

8:56 PM  
Blogger Laura said...

raising my little man and wending my way through SSI, the California Children's Services , which he qualifies for because of his b.w. of less than a kilo, and our own insurance then dipping my toes into the wonderful world of special education, i have on occasion out of frustration scolded pencil pushers who make it so hard for someone in the profession, who knows the lingo and what buttons to push to receive servicies my son needs and is more than entitled to. if it is so hard for me, how hard is it for my patients' families for whom english is not their primry language and for some whom are not educated past the 9th grade. it saddens me to think how hard it must be for some of these families i have known while caring for their babies. some, i imagine from our brief acquaintance often just give up because all the barriers make it too hard. shame on all of this bureaucracy because it is the children who suffer.
jmho

2:03 AM  
Anonymous Christina said...

I think you do a good job of capturing the ambivalence that one can feel in working with families in a healthcare setting. It is both (and many times simultaneously) an honor and a frustration to work with people on issues related to their health/the health of their loved ones. Sometimes as a nurse I can feel so annoyed/irritated/frustrated by a family in one moment, then a hour later they make a comment or do something so wonderful that I feel touched and completely shamed about how I was annoyed with them. I suppose this is because relationships in healthcare settings tend to be honest ones- it's hard for either side to hide behind the usual social conventions in such an intense environment- and honest relationships involve both intense glory and struggle!

3:20 AM  
Blogger Flea said...

Think for a second: why make the paperwork easy if doing so means you'd have to pay more out of a small pool?

If the state really knew what it was doing it would make the paperwork harder, not easier to fill out.

best,

Flea

8:38 AM  
Blogger Kelley said...

I guess I'm just irritated that the functionally illiterate have everything given to them. I think they should HAVE to think about it and work on it, hell, it's FREE. I guess this is coming from a middle class family who pays for their own private insurance to the tune of $400.00 per month, then for whatever is beyond coverage, meds, etc. When you do what is right and be responsible you don't get any breaks. (not that I'm asking) But these folks can take some initiative. Anyway, kudos to you for taking the time to help them.

12:15 PM  
Anonymous Anonymous said...

Kelley: It's not the functionality illiterate who suffer when this paperwork is really hard for them, it's their special needs babies.

2:10 PM  
Blogger Ex Utero said...

I don't know. I hate these forms. And I don't use the word lightly. Insurance forms, state forms, forms, the word form... They make you write down information in a specific form..at. Maybe I don't want to give it in that specific format. Maybe I want to give in it plain english. Maybe I want to write a sonnet.

Maybe I just don't want to waste heart beats dealing with crap like that. I feel for these people. Every time I do my taxes, have to go the doctor and give my history, or even fill out a credit history. I hate it all. When are we going to get these universal magnetic strips that do it for us?

Okay, I'm done now.

3:26 PM  
Blogger Irishdoc said...

Sometimes I think a thousand little papercuts is what is killing medicine.

11:26 PM  
Blogger Anne said...

I think it's very kind of you to take the time to fill out the paperwork. I have a college & graduate degree and filling out these forms can be a bit daunting. In my state there is a trick to filling out the forms and your request for aid can be kicked out for trivial mistakes.

10:12 AM  
Blogger The Imperfect Christian said...

I think it is very obvious why they chose you! For one, you took the TIME they needed. You'd be surprised at how hard it is to get anyone to do that nowadays

1:01 PM  
Anonymous Sammy's mom said...

How many conversations have you ended with, "Let us know if there is anything we can do"? Obviously, this great-grandmother took that statement to heart and has chosen you because you're a partner in this infant's medical "team". It truly does take a village to raise a special child, and it sounds as if this great-grandmother has taken on her fair share.

5:27 PM  
Blogger neonataldoc said...

Thanks, everyone. Christina hits the nail on the head. It is both and honor and frustration, sometimes at the same time.

Ex utero, I hope you feel better. Flea, that's my point exactly.

6:35 PM  
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7:23 AM  
Blogger The MSILF said...

One time, a professor of ethics, who was a good guy who spent a lot of time yelling at us to make sure we didn't miss the point of medicine, said to us to keep in mind that if the average medical doctor has an IQ of 140, the difference between an average doctor and an average patient is similar to the difference between a normal person and someone with mild mental retardation. Then, to make sure he got the point, he finished with, "I don't care how insensitive you all are, but if you're smart enough for all the entrance tests and that, you're smart enough to explain things in a way that someone can understand. And remember - your numbers make YOU the freak, not them!"

Stuck with me.

11:31 AM  

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