Debating Care Of The Poor In A Posh Setting

   I recently attended a seminar at a posh ski resort in Sun Valley, Idaho. The cost of transportation and lodging favored an older segment of our profession who were done paying off student loans and past worrying about productivity and overhead. It was refreshing not to hear about financial problems and the stress that plagues younger doctors.    I have known many of these podiatrists for the past 30 years. Ten years ago, we were talking about the terrible cost of college education and how our kids were making us go broke. Now we talk about the careers our kids chose and how our young associates are making us nuts. Life seemed good for all my seasoned friends and colleagues but there was one topic of conversation that bothered me.    Most of my 30 years in this profession were characterized by podiatrists struggling for inclusion in the medical community. Now I am hearing about podiatrists excluding segments of our patient population based on economic factors. A well-known leader of our profession announced from the podium that he no longer took patients with Medicaid.    Since he brought it up in an open meeting, I asked why he did not take care of these people. He said it was a personal choice and he worked in an affluent community. I asked if he felt any obligation to care for poor people. The room got really quiet. He became very uncomfortable, mumbled something and then quickly took a question from someone else.    I had been drinking coffee all morning and chose that moment to leave for a potty break. It looked to the rest of the audience that I was walking out on one of the most important leaders of our profession. I would have never been that rude. I just had to go really bad.    I spent the rest of the weekend hearing my colleague’s opinions on what I had done to the leader. Seventy-five percent of them thought it was great and agreed that we have an obligation to treat all people. Twenty-five percent thought I had disrespected an important leader of our profession and owed him an apology.    I take care of every patient who needs me. It is a personal decision based on the fact that I think we have a gift to offer as podiatric physicians. We are the most qualified medical professionals in the treatment of foot and ankle problems. I believe we are obligated to share this gift with any person who needs us, regardless of their economic circumstances.    If I excluded patients on welfare, my practice would become dull. Last week, I would not have seen the 2-week-old baby with multiple birth defects including a clubfoot. I would not see Della, a sick 80-year-old who brought me a picture of her as a beautiful young woman standing with her husband in front of their private airplane. I would not see Wallace, a chef who lost his restaurant due to his failing health. He doesn’t qualify for Medicaid but is broke and pays me with recipes and spices from his restaurant days.    Aside from my philosophical values on caring for the poor, I enjoy the variety in my patients. It is this variety that sustains me more than the bottom line of my productivity report.    Getting back to the leader at the Sun Valley meeting, I knew I had offended and embarrassed him. While I did not agree with his values, I realized that I had crossed a line in taking him on in an open meeting. I spotted him leaving the Saturday night banquet and followed him out.    I introduced myself and he remembered me from the meeting and from my picture, which graces this column each month. I apologized for putting him on the spot in front of a big group of podiatrists. We talked for a few minutes about our philosophies of care and agreed to disagree but in a more friendly manner. I decided not to mention his name in this article. Earlier, I had planned to take careful notes in order to ensure I quoted him accurately. We parted as friends. He went up to his room to watch his home team, the Red Sox, play in the World Series. (Congratulation on their victory, sir.)    The next day, I checked out of the resort and added up my expenses for the weekend. It was within a few dollars of what my son gets monthly for his Social Security disability allowance. He is also on Medicaid. Maybe that has something to do with my values and bias. Dr. McCord is a Diplomate with the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.