It was a few weeks ago when I told Ashley Peterson of Mental Health at Home that I’d have this blog post ready soon, and just yesterday that I got it done. It still only says about one-third of what I’ve felt is needed. But that’s a good thing. There will probably be a couple sequels.
Much as I hesitate to draw from immediate personal experience in order to support any greater social theories of mine, I can’t help but have noticed how the events surrounding my difficulty in getting my thyroid medication point to a larger phenomenon. In this case, I’m going to forego my usual hesitations, on the basis of reasonable suspicion that my hesitation could be lifelong if I don’t speak up at some point.
Besides, the “larger phenomenon” to which I allude may have a lot more to do with my personal development than with anything universal. So if I focus on how I personally have been affected by certain perceptions and expectations of the medical industry, I can only speak my truth at this time. How my personal truth may reflect a greater reality is a matter for one’s searching. I can’t claim to know – only to search.
When I received my retirement income, I noticed a very nice package combining two forms of insurance: MediCare and MediCaid. At the time, I was also somewhat disappointed with the treatment from the local low income clinic (where the doctor I had was only a P.A. – a Physician Assistant – not a full-fledged M.D.) It occurred to me a while later that the low income clinic was geared toward those who may not have any insurance at all, and that maybe now that I was more fully insured, I ought to find a small family practice center, and hopefully a more knowledgeable doctor.
While I believe I did find an extremely knowledgeable, experienced doctor, I have noticed over the past few months that the people at the small family practice center seem more stressed in general. Waits are much longer, which one might think would be the other way around. While they still smile and try to comport themselves professionally, one does not get the feeling that they enjoy what they are doing.
Often I waited a very long time, and sometimes the doctor himself seemed hurried when he did see me. But when it seemed to take a lot longer than it should have been taking for me to receive my levothyroxine, I returned to the low income clinic to see if I could get a quick scrip from the previous doctor.
As I entered the clinic, I was immediately greeted with the warmth of familial recognition. They shouted out: “Hey Andy! How’s it going?” There was something distinctly genuine and caring in their vibration. They weren’t just smiling because that’s the professional thing to do.
I quickly got a hold of the doctor there, who wrote me a prescription after a single meeting. Then, ironically, when I went to pick up the prescription, it was blocked because the doctor at the family practice center had finally filled the prescription two days beforehand. I not only had received no notice from either the pharmacy or the doctor’s office, but how was I supposed to believe that the prescription would even be filled at all, if this had been going on for over two weeks?
While the wait at the low income clinic’s pharmacy would have been less than five seconds, the wait at the Walgreens where I had been getting meds from the family practice center was well over an hour. Also consonant with this theme is that no one at the family practice center other than my doctor himself ever learned my name, even though I’d been going there for months. The people at the low income clinic remembered me even though I haven’t been going there at all, and in fact went there as infrequently as possible, when I did go there.
Throwback to Homelessness
What this all flashes me back to is an experience I had when I was homeless, which recently has been on my mind because of developments in the musical — things that Kelsey and I have been trying to illuminate in the weekly podcasts. The experience was that of having found a nice “wellness center” in a low income district in Oakland CA where almost all the patients were African-American and where I was treated very kindly — with true caring — despite long waits and a generally congested staff.
At the same time, if I showed up in the Emergency Room in the hospital in Berkeley, and it was known or determined that I was a homeless person, I was given distinctly less preferential treatment than the person who lived indoors. Sometimes, the medical problem I came to Emergency for was overlooked completely, as they proceeded to give me all kinds of printed information on where the shelters and services were — as if I wouldn’t have known all of that stuff already.
So naturally, my mind has drawn a parallel. I’m not homeless now, but I am low income. My insurance isn’t exactly Blue Shield – it’s the kind people have who are elderly or disabled. Family practice? I wondered if I even belonged there. My mind began to imagine what they might be saying about me:
“We’re a respectable family practice!! This guy doesn’t have a family, he’s just a transient, there’s substance abuse on his medical chart, he’s probably just passing through town . . .”
Of course, they probably weren’t thinking that. The point is that my experiences would be such that I would even think that they would be thinking it!
A Theory in the Making
It seems that there are institutions populated by people who are naturally compassionate and even empathetic towards those who are down and out. There are also institutions where such people are given lower priority. This present situation may or may not exemplify this phenomenon, because it could easily be a function of the two individual organizations I have described. That specific family practice center may be particularly understaffed or otherwise swamped due to the pandemic, and this particular low income clinic may happen to be expanding, and gaining more personnel, and apparently State funds of some kind.
Still, the thing that intrigues me is that, whether or not the recent experience exemplifies a larger phenomenon, it was brought to mind in my interactions with the people involved. There could have been a kind of confirmation bias going on. But if so, what exactly is the theory I am trying to confirm?
Only bits and pieces of this “theory” are in place. That’s why I haven’t been writing. But I am beginning to believe that my intellect alone is insufficient to piece the entire theory together. And that’s why (if this makes sense) I finally am writing.
What is being brought to light in the podcasts is how, when we were homeless, we were not in the position to be able to distinguish, among all the authority figures and “pseudo-authorities” in our midst, who were the ones who represented benign agencies whose role it was to assist us, and who were the ones who represented more-or-less adversarial institutions designed to investigate and incriminate us. All these “higher ups” were relegated into the box of our “observers from inside” – and thus it was difficult to distinguish them, one from another.
In a corresponding way, it was difficult for those who lived indoors to discern from among those who were outside who was a legitimate candidate for genuine assistance, and who was of a criminal bent. Those in the latter camp often feigned a need for assistance in order to gain benefits. They were also often very good at it. Whatever the case, I can assure you that I didn’t look much different than any other person on the streets — at least not at first glance.
Unfortunately, that first glance often seemed to be the only glance I got. Even if the glance became a stare, or a series of stares, I felt like I was being observed with an ulterior motive. I felt as though people were watching me, just waiting for me to somehow screw up and incriminate myself. Years of living with that feeling seem to have led to years of trying to find a feeling to replace it.
So I still resort to ways of dealing with feelings that don’t differ widely from how we approached the matter when we were homeless. How does one, after all, deal with the inner feeling of being dismissed, overlooked, disregarded? On the other side of the coin, how does one deal with the feeling of being embraced, respected, and accepted — especially if one is not accustomed to it?
When we were homeless, we lived with eyes in the backs of our heads. We couldn’t drop our guard long enough to process difficult personal feelings. So instead, we looked for the larger phenomena that they might represent — and we analyzed, and drew conclusions about society. We conducted such conversations vocally, publicly — encouraging others nearby to join in. We were a lot more powerful that way, and much less vulnerable, or at risk.
In a way, this doesn’t seem like all that bad a thing to have been doing — in the greater picture.
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2 thoughts on “In the Greater Picture”
I think there’s a very different mindset between providers who choose to focus on working with marginalized populations, whether that be homeless or otherwise, and providers who see helping marginalized people as something they have to do some of the time.
Part of that mindset difference is a shift in what’s expected of someone in the role of patient. People with means are expected to interact with providers in a certain way, but providers who focus on disadvantaged patients recognize that’s just not possible. When I was working on skid row, I didn’t phone my clients, because most of them didn’t have phones. If I needed to pass something on to them, I would go out and find them where they lived or where they hung out. It was a unique way of relating to clients that would be totally foreign to anyone not used to working with that population.
I happen to have these stats handy because I’d been looking for psychiatry, but in 2019, 71% of all physicians were accepting new Medicaid patients, 85% accepted new Medicare patients, and 90% accepted private insurance patients. That doesn’t reflect so well on those docs that just don’t want to take Medicare/Medicaid patients.
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Those statistics are pretty enlightening. It would be interesting to find the statistics that refer to psychiatry in particular, and not just to the medical profession in general.
I’m glad you brought up the difference in mindsets between those who would choose one type of employment context over another, their credentials otherwise being equal. Though I’m sure there’s a continuum and that many people have different degrees of both kinds of motives, I can see how those who are mainly into making money — (and perhaps pleasing others in their social set) — might view having to help an underprivileged person as an “obligation” that “comes with the territory.” That wouldn’t be the case among those who choose to work somewhere that specializes in assisting marginalized populations.