September 13, 2006

Pity for a Pass

Dave Attell is a comedian who used to be on the show Insomniac, where he bummed around bars in the middle of the night all around the U.S., filming his crazy exploits. In one of his stand up shows, he said "You know who I like to make fun of?!?!?"

"Amish people. That's right... they can't get offended seeing me on T.V.... they are never going to know!"

The same can't be said of the people at the homeless shelter I visit twice a month. You'd think that they are out of touch with the world around them, but they scrounge up the money for the television!

I turned my attention away from the cubicle with the family watching cartoons on repeat back to the patient at hand. He was equally distracted, flipping his cell phone open and closed absent-mindedly while the third-year medical student taking his case consulted with the family medicine resident.

"So he came in with this EKG and said that you'd sign off on his bus pass..." the MS-III said in a tired voice. It was close to the end of the clinic time, 9:15 pm, and Thursdays went on for far too long for him.

There was a problem, though. The rules and regs for getting a disability bus pass are such that you need to qualify by having difficulty with one of the following:
  • negotiating a flight of stairs, escalator, or ramp;
  • boarding or alighting from a City transit bus;
  • using the City Transit bus due to confusion or disorientation;
  • reading informational signs; or
  • walking more than 200 feet.
His EKG read "sinus arrhythmia." Unstable heartbeats aren't on the list of "things that get you a cheap bus pass," so he was claiming that he often "gets confused about which stop to get off at, etc."

The family medicine resident wasn't too happy about the situation. Obviously she had given the patient the impression that she would for sure sign off on his bus pass. We all sat down with the patient and she went through a long discussion with him about his past... what led him to homelessness... and he had been discharged recently from the military. There were some stipulations about his heart condition that complicated his health benefits with the military and he had been in Iraq for a while.

We went through a psychological assessment and she felt that he might be having suffering from Adjustment disorder and he needed some time to sort things out.


This is the point where I thought long and hard about the ethical issue at hand. Here's a guy who wants a cheap bus pass. He's only going to be using it for a short period of time while he gets adjusted and as a homeless person, it would help him out big time, since public transportation costs a pretty penny. However, fudging the data on his bus pass is a risky move. Doctors sign off excuse slips for sick patients all the time... could this be any different? What are the legal consequences of claiming that this man is disabled? He's a veteran for sure, rejected by the military no less. And that put him out on the streets with a bad heart. Surely a little pity could go a long way.

Nuh uh. I wouldn't do it.

Would you?

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