When Poverty and Unemployment Are Misdiagnosed . . . The Limits of “Medicine”

“I diagnosed ‘abdominal pain’ when the real problem was hunger,” admits Dr. Laura Gottlieb in a wonderfully candid Op-ed that explains why physicians so often fail to recognize poverty as the true cause of what appears to be a physical disease.“I confused social issues with medical problems in other patients, too. I mislabeled the hopelessness of long-term unemployment as depression, and the poverty that causes patients to miss pills or appointments as noncompliance. In one older patient, I mistook the inability to read for dementia,” writes Gottlieb who is a Robert Wood Johnson Health and Society Scholar at the University of California, Berkeley, and the University of California, San Francisco.

“My medical training had not prepared me for this ambush of social circumstance,” Gottlieb adds. “Real-life obstacles had an enormous impact on my patients’ lives, but because I had neither the skills nor the resources for treating them, I ignored the social context of disease altogether.” (Many thanks to HealthBeat reader Dr. Rick Lippin, who called my attention to Gottlieb’s superb Op-ed.)

The patient who suffered from abdominal pain was only 8 years old. “I had known and adored Jeremy's family for several years,” Gottlieb confides. “So when the sandy-haired, good-natured 8-year-old came to see me in my clinic with abdominal pain, I bent over backward to find out why his tummy hurt. I poked and prodded; did tests of his urine, stool and blood; and took X-rays, over the course of several months. When those tests came back normal, I did more. I had trained at a top medical school and gone on to one of the best residencies in my specialty; in Jeremy, I thought I had identified a real clinical mystery. But in the end, the mystery was not a best-seller: It turned out that Jeremy's family couldn't afford to buy food.

“It had never even occurred to me to ask his mother about how much food there was in the house.”...

Editors Take: This is a very poignant commentary by Maggie Mahar. How many hundreds of millions of dollars, or perhaps billions, are being spent to use routine medical tests to "diagnose" the effects of widespread poverty and malnutrition in the U.S? Wholeheartedly agree with Maggie on this and highly recommend reading her blog post as well as Dr. Gottlieb's article. [RAM]