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My affluent neighbors and I were talking about how low-income patients get their medical care. They were surprised to hear about the "WalMart List" that I keep in my pocket, with meds they sell to patients for $4 a month ($10 for 90 days--woo hoo!). It was a huge breakthrough in the care of low-income patients: need a beta blocker? See which one comes cheap at WalMart. Ulcers? Well, the PPIs are still expensive, but an H2 blocker is WAY better than nothing. And a whole handful of antibiotics are available, even a quinolone for community-acquired pneumonia.

This makes me feel good in all kinds of ways: I get to take care of my patients' problems and keep them out of the hospital. I don't have to help drug companies line their pockets with what they make from "me too" drugs that offer no advantage over older preparations. And once in a while I get to shock some well-to-do folks into realizing just how things are for people with no insurance.

A few weeks ago somebody at an upscale party mentioned that her favorite FP had left her previous location. "Oh, I know Dr. Roberts," I said. "That's the medical director of our clinic for uninsured people."

"Oh, great. So I can see her there?"

"No, I'm sorry, you have to pass a screening process and be below a certain income level to be accepted as a patient."

The lady's expression was priceless. Welcome to my patients' world, folks.

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