The poor are different from you and me.

There’s a medical student in the office today and we just saw a woman with pelvic inflammatory disease. We reviewed the guidelines for treatment and came to the catch — she can’t afford the treatment. Catches like this are common in my office, so off we go to the sample room to try and cobble together a reasonable alternative. I treat the working poor, refugees and immigrants. Many of these patients are on welfare or receive disability payments, and every day I see situations where socioeconomic status dictates treatment, particularly when it comes to drugs. We have the Ontario Drug Benefit (ODB) for seniors, disabled people and those receiving welfare. We also have the Trillium plan for patients facing huge drug costs because of catastrophic illness, but there’s a deductible. This week an AIDS patient told me he’ll be stopping all treatments designed to suppress the disease because his application to Trillium and the supporting documents have been lost — again. I probably know the number of every drug company’s “compassionate drug” hot line. I know their criteria and have all their forms, and every day I write to one of them or to the ODB seeking “special permission” to use nonformulary drugs. Several times a day I fill out forms for “limited-use” access.