So last week I did something unorthodox. Even for an eccentric guy like me. Mrs. G has had longstanding refractory Graves' disease. For some reason, resistant to antithyroids (which usually means some component of noncompliance).
And so, push came to shove and we opted instead to refer her to surgery.
As you know, the Graves' thyroid is enlarged and usually very vascular which makes surgery more complicated. And taking a thyrotoxic patient into surgery obviously carries its risks. So a short course of high dose iodine is usually warranted preoperatively, to take advantage of the Wolff-Chaikoff effect; to transiently shut down thyroid hormone production and decrease the vasculature.
I attempted to get her started on this, except she calls me a week before surgery, crying on the phone that she has only a few dollars left to last her for the week and cannot afford the medication. Nevermind that SSKI is relatively cheap.
And so I told her: "Never mind the cost. Just promise me you will take it."
After all, with her paroxysmal a-fib and recent stroke, she needs the thyroid out ASAP.
She did. And so I told her I would pay for it. I called up Walgreen's and called in the prescription, and gave the pharmacist my credit card information.
I saw Mrs. G 3 days ago post-op. She was sore- but otherwise looked great. And her thyroidectomy went smoothly, thank heavens.
In the 7 years of practice, this was the first time I actually paid for a patient's medication, and I'm still partially expecting this will come back to haunt me. I'm half expecting my supervisors to come back with a reprimand, that this is 'not professional', and may open us up to legal action citing discriminatory action, if other patients get wind of it.
After all, I've been cited for crap like this before, like the time I underbilled a patient because he couldn't afford it.
Often, I wish we lived in simpler times. Times when it comes back to two human beings, one a doctor and the other his patient, and that decisions are made just between them. Far away from the attorneys, the administrators, the insurors, the PR department.
To me, it's a simple matter. She needed it. I could help, and I made a judgment call. So what's the big deal?
A doctor and his patient. That's it.