My wife has taken to describing the minor tragedies that occur in our life as our “first world problems.” This stems from a meme being used in popular culture about the petty concerns of those of us living in the richest areas of the richest countries in the world. You can post your own (I guess as sort of a soul cleansing confessional) at this website. The best example of a first world problem on it currently is

My iPad 3 doesn’t warm my lap as much as my MacBook Pro.

You get the picture.

The cab driver taking me to the airport in Kansas City somehow knew that I was in town  for the National Conference of Family Medicine Residents and Medical Students. Perhaps it was the fact that I caught the cab in front of the convention center where the conference was being held. Perhaps it was the name tag I still had on. Anyway, somehow he knew and wanted to talk to me, the physician.

“So, you here for the convention?” he said in good but accented English

“Yes, I have been trying to recruit young doctors to come and work in Alabama.”

“I am trying to get into pharmacy school in Louisville,” he said

“Oh,” I said, not wanting to hear his personal essay so trying exude only polite interest.

“Yes,” he said, “this is my weekend job. I am a pharmacy tech working for an insurance company. We do mail-order prescriptions for Medicare patients.”

We had a discussion about health economics, insurance companies, and the general state of the world. I offered my opinion when asked whether Congress could  fix the cost problem that we gave our seniors a blank check in Medicare and I did not see, 40 years later, anyone with the intestinal fortitude to tell seniors (who vote) that the rent was coming due. We both acknowledged that the Affordable Care Act offered some opportunities but not enough.

He said “I see it first hand. I get requests to fill drugs and when we review them there are 2 or 3 that are in the same class (such as simvistatin and Lipitor) we try to get the docs to make changes and they accuse us of trying to micromanage their patients.”

I said the average Medicare beneficiary has between five and seven doctors and have on average 7.1 prescriptions. No one doctor has a complete drug list for most of these people and many of the meds are duplicated. We agreed that there was a lot of waste and likely Congress didn’t care much. No one wants ask seniors to pay out-of-pocket to double up on their chance at better living through chemistry when they’ve been getting it for “free” for the last eight years. That would be an example of a first world problem.

He then asked me if Alabama was rural and I said parts of it were very rural. He said his country was rural as well and he asked me if folks in Alabama had trouble getting to adequate health care. I admitted that some did and that was what I was working on as part of my job.

“That is good,” he said. “I come from a rural area. In my country, there is not adequate health care because of corruption. My sister, she was pregnant and went to the dispensary. They said they could not help her and she would have to go into the city. We put her in the bed of [he pointed to a pick-up truck] one of those and we drive her on the bumpy road for 2 hours. When we get to the city, she was dead. This is not an unusual story in my country. I come to America to study but cannot go back because, my countrymen, they do not care. So I will be a pharmacist in America.”

I had to admit that though we had care delivery problems, death during transportation via flat bed for a routine pregnancy complication was not common, even in the Alabama blackbelt.

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