Grinch

I don’t like denying patients anything. I always try to find a way to make things work. An appointment time on a day I don’t usually work? I can swing that. A diabetes supply that isn’t covered by their insurance? I will do my best to figure something out.

But the other day I was asked to sign off on a wish – of the Make-a-Wish variety. Except the Make-a-Wish foundation had already deemed the patient medically unqualified for their services, so they forwarded the requested wish to a similar foundation. That foundation called me.

I asked them what their criteria are for granting wishes so I could better assess this patient’s qualifications. They told me they fund wishes for children aged 2 ½ to 18 years with “life-threatening illnesses” that are either “progressive, degenetrative, or debilitating.”

I mulled it over in my mind.

Is diabetes a life-threatening illness? Yes, it can be.
Is it progressive? Maybe. Taming it does not always become MORE difficult over time, but some people do develop hypoglycemia unawareness later in life.
Degenerative? No, that term is usually reserved for horrible neurologic diseases that render patients unable to communicate, feed themselves, ambulate, etc.
Debilitating? Yes. But only with poor control for years and years. And even then, it isn’t debilitating for everyone.

Our office knows this patient well. His family is lovely and his father has a prominent position in the community. His diabetes has been impressively controlled since he was diagnosed seven years prior. He actively participates in multiple sports and after-school activities. He is planning on attending a competitive university. Diabetes has never held him back and was showing no signs that it ever would.

I decided that I had no choice but to sign that the patient was not medically eligible for the wish as he did not meet the criteria put forth by the organization. The woman on the phone – clearly seeking the opposite answer – told me that their criteria are “more open to interpretation” than those of the Make-A-Wish Foundation.

I mulled this over, as well.

There are other patients in our practice that qualify to have the rules bent a little more in their favor. For instance, there is a child that had to be taken from his home because his father is in jail and his mother has a drug addiction that left her unable to care for him and his diabetes. Foster homes are difficult for ANY child, but even more so for him because few families are willing to undergo the training and devote the time necessary to care for a child with diabetes. His diabetes is holding him back and making his life palpably more difficult – a life that is gut-wrenchingly difficult already.

It made me uncomfortable to tell the foundation representative that I could not sign off on the request, even though this particular patient is living such a full and vibrant life.

“It breaks my heart to have to call them and tell them they were denied,” she said to me.

“I’m sorry. But it breaks my heart even more to use your funds on this request that would be better served for a child that needs it more,” I responded. I signed the denial and faxed the form with resolve.

Nevertheless, I have felt like a grinch ever since.