What low-income patients need from providers

Low-income vascular patients need understanding from medical professionals

CHICAGO, Illinois, September 2018/PRNewswire – Low income vascular patients, whose conditions are often chronic and debilitating over time, face complex life issues that deserve acknowledgment from medical professionals, says the new co-chair of the Society for Vascular Surgery’s physician assistants section.

PA Erin Hanlon has many patients who live in poverty, such as a middle-aged woman who works 60 hours a week at two jobs. Cigarettes are one of her few pleasures, but only after she has her foot amputated does she quit smoking. Another is an obese unemployed man with diabetes who does not want to exercise and enjoys drinking beer.

For these people and many others like them, smoking and drinking may not be healthy, but are among the few pleasures that relieve stress. If it is important that they change their habits, she said, medical staff at least need to listen to their concerns, be non-judgmental, and understand that those patients may have little else that makes them happy.

"It's no secret that poverty is associated with vascular disease," she said. Vascular disease is often caused by hardening of the arteries, which narrows the path for oxygen-rich blood to get to all parts of the body. The disease may cause heart attack, stroke, peripheral artery disease and a host of other diseases that arise when parts of the body are starved for oxygen. Vascular disease is typically managed by vascular surgeons, who treat patients with medication and sometimes with surgical procedures.

Low-income patients tend to have more advanced disease when they show up in a vascular specialist's office. They may not have insurance or may have high deductible plans that don't cover treatments. They may have transportation problems that keep them from getting to medical appointments. They may be employed where they don't get sick days. They may be caretakers for a sick relative but ignore their own problems. They may not  understand how their habits contribute to disease and it may seem normal to smoke and drink heavily and to be obese.

Fortunately, the nature of her job as a physician assistant gives Hanlon the chance to talk with patients and find out their concerns, she said.

“They don’t want to be judged, they want to be understood,” she said. “If medical staff understand that patients need some pleasure in life, and they have chosen smoking, we can talk about how not smoking might open a door for other pleasures, like being able to play with one’s grandchildren.”

The vascular disease process is very much affected by poverty, she said. "Smoking is one of several key factors, since nicotine has such a negative effect on the blood vessels."

Nicotine damages the inside of the vessels, making vascular disease more likely. Nicotine also constricts blood flow, which is dangerous for those who already have vascular disease.

Other health issues, such as diabetes and obesity are also over-represented among the poor and are associated with vascular disease.

Hanlon said her lower income patients may be surprised to learn that smoking, diabetes and obesity are associated with their vascular disease.

"We have learned things in recent years that we didn't used to know," she said. "Most people don't think they are doing anything harmful because the disease progresses slowly and doesn't show up until later."

Some of the topics that low-income vascular patients should discuss with their medical professionals include:

  • Smoking. The PA or physician are not there to judge a patient's life choices but can help them understand the consequences. They can also prescribe smoking cessation medication or help find other assistance.
  • Budget concerns. If the doctor prescribes a new, name-brand prescription, patients should ask the office to determine if insurance will cover the medicine. Occasionally a physician has no idea what a drug costs or its availability.
  • Lost wages. Patients who may lose hourly pay while waiting to see the doctor, should explain their situation and see if they can be accommodated early in the day or after their shift ends.
  • Transportation. When scheduling the next appointment, patients should discuss any transportation problems, such as if the bus doesn't run at mid-day, or a vehicle is unreliable. Most offices have some flexibility on scheduling.

“Above all,” said Hanlon, “patients need hope, regardless of their circumstances. It may start with making lifestyle changes. But they also need to know that with good medical therapy, including medications and lifestyle modifications, they can have a fulfilling life living with peripheral arterial disease.”

The Society for Vascular Surgery® (SVS) is a 5,800-member, not-for-profit professional medical society, composed of specialty-trained vascular surgeons and professionals, which seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness.