Thank you, Loungers, for helping me get through another week. I love you all. [View all]

[Aristus]

I think I'm starting to get burned out again. Or more cynical. Or possibly losing my touch when it comes to healthcare for the homeless.

I think I'm a bad liberal.

I'll give you three examples:

Back when I first started in practice, if a patient came to me and wanted to try nicotine patches as a way of quitting smoking, I wrote prescriptions with wild abandon. If they wanted to quit, I was all for it. The thing is, they kept coming back for refills on their prescription. I refilled them, because I wanted them to quit smoking. It took me close to a year before I realized that many of them were just hitting me up for free nicotine. I instituted a 'no refill' policy when prescribing nicotine patches. I've had more success getting people to cut down gradually on their cigarette consumption, and then quitting. I feel like I was naive, and became determined not to be taken advantage of again.

When a patient would come to me with a behavioral or emotional health disorder, stating their pet was keeping them emotionally stable and could they please have a provider note requesting that they be able to take their pets in places where they weren't normally permitted? I wrote notes without a moment's hesitation, wanting the best for my patients. Then I read in several places about how this is a scam in which perfectly healthy people are circumventing regulations by duping an eager-to-please provider (like me) for a note. This is a circumstance made possible by the fact that, unlike with trained service dogs for disabled patients, there is no regulatory agency for 'emotional-support animals'. Now, I just refer any patients requesting such a note to our behavioral health provider.

Finally, and this is the one that has been causing me trouble all week, I have been in the habit of writing notes to the management of the nearby homeless shelter for my acutely-ill patients, requesting that they be permitted bed-rest during the day while they recover. When word got out that I was doing this, I was hit with a flood of patients request bed-rest notes. Most have chronic issues for which bed-rest would provide marginal benefit, and others are not ill at all. as a result, I've had to limit my bed-rest requests to no more than about two weeks per patient, with renewals made on a case-by-case basis. My rationale is pretty simple: if I have a patient with a severe respiratory illness, who can't be sleeping rough during recovery, and the day bed-rest slots are filled with patients who are not acutely ill, my sick patient could be harmed by exposure to the elements. We're not at that time of year just yet, but it's coming.

I'm fairly well-known in our homeless community as the guy to go to for good health care. I don't want to be the bad guy in situations like these. It's been bothering me a lot.

Thank you for listening.