Her healing journey has been labyrinthine. No practitioner knows its history completely. Her needs are much greater than the health care available to her.
She asks, "What do you do for people who can't afford your services?"
Her experience has been that even a little treatment can make an important difference in her life. Currently she's working on paying her debt (at $5 per month) to a chiropractor in another town for a few $50 treatments. It will take her about two more years to complete her obligation. She's happy to do it, but wishes she could afford to pay it off sooner to get out of debt.
As she speaks, I'm astonished to realize how her payment is a significant amount out of her total monthly discretionary budget. She must plan carefully, fend off competing priorities and save to meet this obligation.
I hope the chiropractor appreciates the money. When I've been on the receiving end of this type of arrangement, I find I don't usually appreciate the money or the patient who is sending it to me.
"Every once in a while I take a patient who is on Medi-Cal. I don't actually bill Medi-Cal because at eight dollars per visit with a two treatment per month limit, it's not even worth the cost of billing," I say, somewhat indignantly. I remember how I've been burned by other patients who pleaded poverty, and weren't on welfare. I've reduced my fees to almost free, then I've been inadvertently told about things they've bought that I can't afford. Delving into patient finances makes me uncomfortable. At least a person who qualifies for welfare has had the government offices inspect their finances.
The question of making my treatments available to people who can't afford the fees makes me uncomfortable. I believe that as helping professionals we should serve such people. Sometimes I congratulate myself by counting the people I serve through the workers' compensation or PI systems, but this doesn't really answer the matter. The question is how do I, as a helping professional, serve people in situations where I'm asked to work without decent remuneration?
A friend has developed a coherent office policy I admire. She decides to do a certain percentage of pro bono work each month. She keeps track of the amount she's doing. When that percentage is filled, she'll tell inquiries she's sorry but she can't help them. By setting comfortable boundaries on her involvement, she is in control. She helps more people who can't afford services than the vast majority of DCs in her area.
We are about to enter the season of giving. Let's each look at how we do pro bono work, and try to make some improvements. Our goals should be to give regularly, to give what we should, to grant people who can't afford our fees dignity and respect, and to feel comfortable in this situation.
Linda S. Elyad, DC
