A Piece of My Mind Section Editor: Roxanne K. Young, Associate Editor.
The nursing note for my next patient stated simply, “Follow-up of nose injury.” Randy (not his real name) was a young man, new to the clinic, so there was no background information available from the chart. I knocked on the door, stepped into the small examination room, and introduced myself to a short, unshaven young man with a bandage covering the end of his nose. I learned he was involved in a fight three nights ago and that his assailant had “bitten him on the end of his nose.” He had been treated at the local emergency department and had been referred to a plastic surgeon for follow-up. Upon calling the surgeon's office for an appointment the next day, however, he was told that because he had no medical insurance, he would need to bring $500 cash up front just to be seen for the first appointment. When he called the ED back to complain, they gave him the number of our community clinic. Randy looked at me angrily. “I make minimum wage, Dude—no way I have that kind of money lying around. What am I supposed to do?”
Kilgore DB. The Imaginary Safety Net. JAMA. 2006;296(14):1701-1702. doi:10.1001/jama.296.14.1701