Let's try monetary therapy

December 2, 2005

A doctor ponders how well a crisp green Rx would work to cure what ails his patients.

Although it has long been believed that individuals in the lower socioeconomic classes receive less-adequate medical care than the wealthy, only recently has there been solid statistical and demographic confirmation of that. In fact, I believe it's now universally recognized that people fall victim to a condition I've named "Impecuniosity Syndrome." It's simply the lack of money.

Yes, it's now a fact that the lack of money can make you sick. No germs or malignancies necessary.

The medical profession, however, has failed so far to recognize poverty as a treatable therapeutic problem worthy of its own code and insurance reimbursement. It's still common practice to prescribe an analgesic when the patient complains of a tension headache, a tranquilizer or antianxiety agent for stress, and an acid neutralizer or blocker when the patient's symptoms are gastrointestinal, such as heartburn or indigestion.

It's common to solve most mathematical problems by trying to ascertain what factor is missing-"What does 'x' stand for?" Medicine has made many advances doing the same thing; we conquered vitamin deficiencies, for instance, by identifying each vitamin and restoring what was lacking. But when a patient comes to a doctor's office complaining clearly of symptoms caused by a deficiency in money, we offer him no direct relief by correcting his deficiency. Instead, we're more likely to hand him a costly prescription and send him on his way.

It should be very easy to provide appropriate therapy for those suffering from Impecuniosity Syndrome. Legislation can be passed that enables physicians to prescribe money or money orders in much the same way that they write prescriptions. Careful records would need to be kept and patients would have to submit proof of identification, but the necessary rules and regulations would be much less complicated than those that currently regulate Medicare.

Here are two hypothetical examples to illustrate how monetary therapy could be applied:

Case A. Helen J., a 38-year-old mother of two, complains of an inability to catch her breath. On physical examination, it's obvious that she's hyperventilating. A chest X-ray is negative. Asthma, emphysema, or other significant pathologic problems are ruled out. The diagnosis is hyperventilation, a psychosomatic illness. Further questioning reveals that her older daughter has been admitted to college, but she can't attend due to a lack of money for tuition. "How much do you need?" you ask. "It's $10,000 for the first year," Helen J. replies. "Okay," you say, as you write out a check. "Tell your daughter to send me a copy of her grades. I want to know how she's doing." By now, the hyperventilation has completely stopped and Helen J. is breathing normally as she leaves your office.

Case B. Jane H., a 46-year-old-housewife married 24 years, has been under your care for high blood pressure for the past 12 years. When she last visited your office, it seemed as if her pressure had stabilized at about 140/80. Today, however, she complains of exceptional fatigue and malaise, and her blood pressure is 176/94. She's taking the same medications and has made no changes. Aside from the hypertension, her physical exam is negative.

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