Shirah Vollmer MD

The Musings of Dr. Vollmer

Health Care Disparities

Posted by Dr. Vollmer on July 26, 2011

Rant alert-I am angry! In teaching my Family Medicine Residents about the delicate and complex role of benzodiazepines in the treatment of anxiety, one of my students informed me that at the low-income clinic where many of my students work, they have eliminated this class of drugs from their formulary. I could hardly contain my rage. In fact, I did not contain it and I began to try to turn my rage into an important teaching point. That is, regardless of income level, patients are entitled to have access to medication which can make their lives significantly better. Instead, this policy has made it so getting treated for anxiety is now a middle to upper middle class possibility, but lower-income folks have to find other means of dealing with anxiety. The unfairness of this discrepancy is hard to understand. The medications are cheap. There is no cost barrier.

  I do see how prescribing benzodiazepines are time intensive and therefore costly in that way. The medications need to be monitored. As with prescribing any medication, there is a risk of liability. Yet, it is a clinic, and the mission of the clinic is to help low-income people receive health care. Treating anxiety with available medications is part of that mission-I would think. Second, and terribly obvious, how are my residents supposed to learn how to prescribe these anti-anxiety agents if where they work does not allow them to use these agents? Yes, they do get experience with the likes of Xanax, Klonopin and Ativan on their other rotations, but they should also be able to learn to see how these medications impact people who are struggling with unemployment, foreclosures, and high intensity exposure to violence and substance abuse. Helping someone with anxiety, whether with medication and/or behavioral techniques, enables the patient to cope with what might otherwise feel like impossible situations. Further, anxiety causes medical problems to get worse, so if the doctors can’t treat their anxiety with psychotropics then they will be treating their medical problems, such as their increased blood pressure, their increased sugars, and their irritable bowel disorder. Treating the mind, helps the body, and treating the body helps the mind. Why is that not clear to policy makers?

7 Responses to “Health Care Disparities”

  1. Danny said

    The reason is one word : greed. The do not give a crap about helping people , let alone poor people !!! who have no voice or “lobby”. In europe there is health care , specially some countries, where health insurance covers everything and most if not everyone has it ! By the way , are these meds, like xanax , klonopin, etc, addictive ?

    • I am not sure that this particular situation is about greed. There is no one in this low-fee clinic that is making bundles of money. Yes, these medications can be addictive, but when used appropriately they can also significantly improve quality of life. Thank you for your comments.

  2. Dan said

    I agree with you that at these clinics no one is making bunch of money , those working there are there to help those folks. But i was talking about at the higher levels where money allocation decisions are being made, ie the policy makers, where cutting budgets for these sorts of places/programs is the easiest to do, vs for example medicare for seniors where there is a bigger lobbying force. thanks for your informative blogs.

    • Hi Danny,
      I see what you are saying. The administrators, not the clinicians, might be benefiting from these types of policy decisons. Thanks again for reading my blogs. Shirah

  3. said

    So are you saying that the reason why these meds were cut is because it would cause more appointments for followup, which costs more, and therefore the alternative is to prescribe cheaper meds which require little or no followup? What about the teaching patients the behavioral techniques you mentioned? How can you effect change in policy, perhaps by speaking to the Congressmen in the district where the low-income clinics are located about this issue? The disparity between the haves and haves-not might interest someone who is looking for reelection….

    • That’s what I am saying
      I am not sure who made this policy, but I could try to find out.
      Yes, a voting block could sway a politician, but I am not sure that this population votes.
      Thanks, as always for your comments.

  4. Steve said

    In a way I am on of the lucky ones, with tapering beznodiazapines ; Is not a problem for me; The panic attacks that come some 6 to 8 weeks later are. That is why I ended up on these drugs, I could bot understand the fuss but I guess some really do get their life rapped up in these things. However for others they are quite useful and they work where nothing else will. So they are useful and gack! I have been on/am on medicayions for pain that cause physical dependence. When by the way did physical dependence become separated from addiction in the medical world? In the mind of much of the public if you can’t just quit cold turkey you are addicted end of discussions. Of course cigarette smokers never can their use addiction. It’s sociaally blessed so it is not addiction.

    Thanks and Have fun,
    Sends Steve

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