Blind to patient’s income

In a letter published in the October 2015 issue of Canadian Family Physician, Milburn wrote the following:

[M]any authors talk of income equality as if there were a direct pathophysiologic pathway that leads from one’s bank account to one’s coronary arteries. How does one’s heart sense that one is poorer than others in society? …

[P]eople’s life circumstances … are an outcome of their education, socialization, abilities, genes, and life choices.

The thought that somehow giving poorer people more money will automatically result in health improvements is incredibly naïve and overly simplistic. Any physician … is well aware that extra money can have a negative effect ….¹

These observations are mean spirited and unprofessional. “Free will” is an illusion. Each person is influenced by his or her surroundings. Members of the College of Family Physicians of Canada are expected to follow “evidence-based guidelines,” but some aspects of guidelines can later be proven wrong. People who watch television and read magazines can be convinced to eat cheeseburgers, drink colas, drive cars, and smoke cigarettes. People who consume cheeseburgers and sugary drinks and who get around by driving (rather than walking or cycling) will tend to be overweight and to have elevated glucose and low high-density lipoprotein cholesterol levels—risk factors for coronary arteriosclerosis.

Early life experiences have a big effect on a person’s performance and outlook. A person whose parents were not attentive or who did not encourage education and polite behaviour will find it difficult to get a safe, well-paying daytime job. Economic deprivation and sleep deprivation from shift work induce the release of stress hormones, which have a deleterious effect on the cardiovascular system.

It is a privilege for a doctor to serve his or her patients. It is easy to look after well educated, polite people who speak like we do, and we tend to offer better care to people from an affluent background.² We must use our knowledge and skills to help every patient, regardless of the patient’s income.

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