Compounded Intranasal Ketamine, that you prescribe then for mental health. Or perhaps their PCP does for pain.
Why are you worried about their finances? People drop money on starbucks, cell phones, cannabis, cigarretes, all the time. Or they can find a part time, under the table cash pay job. Their finances are their problem to resolve.
In summary for Students/Residents: Don't enmesh yourself with being a rescuer mindset, and stay far away from the cult of The Victim Olympics.
Yes, those "under the table" cash jobs (interesting you would tell your patient to break the law to afford medication) are not easy to find and frequently will not work around your primary job's schedule, and often require special skills or equipment, and such scheduling can be a problem for childcare as well. And surely all this work could be a strain for someone with chronic pain.
Lyft and Uber require a vehicle newer than many people have/can afford. Door Dash and Instacart are getting to where you can hardly make any money for the time it takes, unless you do it full time now, and even then it's crap. Mowing lawns is physical labor and has its own issues with scheduling. Same with plasma. Pizza delivery isn't worth it unless you're getting home at 4 am. There is serious competition for bottles/cans in states that have deposits.
I wonder, do you regularly troll craigslist to see what of these kind of gig jobs or part time or weekend jobs there are and how they mesh with a primary job? And do you think working every spare minute to survive with chronic pain to afford your electricity and Ketamine, might not be just a tad self defeating?
Not showing an appreciation for the current financial realities many face now, sounds like someone who has very little idea about what they're talking about. It sounds like it's based on outdated information.
I have people in my own family I've been trying to help, I've dealt with a lot of working poor/SSI/SSDI folks. For most people, their primary job is going to be it for them and it's going to be hard to work around or find opportunities to get more money. Like I said having kids being a big limiter. And these people are not spending a dime on anything you've listed, except a secondhand phone when one dies. Or hardly any money on their kids either, not even on toys or clothes which they get secondhand.
I think it very widely misses the mark to chalk these struggles up to "luxury spending" such as on coffee that creates such an issue. As a psychiatrist, do you think being so poor you have no entertainment budget whatsoever, not even for coffee, is a recipe for good health? I thought we acknowledge that all humans need entertainment and should have *some* budget towards that, even if they were dirt poor. I get people don't have this, but that doesn't mean they shouldn't or be shamed for getting some coffee.
Also surprising one wouldn't account for other medical expenses they are trying to keep up with, or their family's, that they may likely have.
Or car repairs, or any number of things making it hard for people to get by.
Ironically it's the working poor who don't get much government assistance that frequently this is what things look like.
It seems like a very ill reasoned or ignorant take to me, or a very callous one.
It's not common that I would say to a physician, maybe you are the one that needs to consider another line of work. Because going by your comments on SDN, the regard you seem to have... I hope you are just venting here and you don't treat anyone like this IRL. I think perhaps you need to be better educated about people with financial constraints in our line of work in the current environment.
You're not entirely wrong about trying to be someone's savior, victim mentality, or that some people don't manage their money and their lives as well as they could.
But of anything here assuming people could get under the table cash jobs, and expecting people to break the law (that's what under the table means) is where I think such an attitude towards the working poor ventures into something very toxic.
I think as an answer it is very lacking in its focus, when someone was asking questions about trying to help a patient locate an affordable option of medication that has significant benefit and of course might not be covered or more difficult to source.
Your comments upset me greatly. As feedback, they often come across to me as having a casual cruelty and indifference to described patient plights. I think that you have some wisdom in all this, but I'm just overwhelmed at what seems to me to be a casual expectation that people to break the law, when I think being sensitive to them or even offering advice in good faith about where they think they are at, would be more helpful. I wouldn't assume they could break the law or find these opportunities you suggest.
Even if you suggest they go above board and claim those cash wages and pay tax on them, this advice isn't much better imo.
#truth
