From the Globe and Mail, Saturday, Jan. 7 /06

In “Shooting from the Hip” Margaret Wente tells the story of how she used her considerable influence to jump to the front of the queue when she required a hip replacement. Not only did she get prompt service, ahead of people who had been waiting for years, she also got the best, most expensive hip replacement available.

Although it is a fact that intelligent people are able to make any system work for them, there was reference to a form of triage practiced by some health care workers in order to deal with their shrinking budgets. There aren’t enough resources to care for everybody, so doctors now have to decide who is the most worthy of the best care. Unfortunately, the poor, the homeless and the mentally ill are always at the bottom of such a list.

The same decisions are being made to prepare for a possible epidemic. There probably won’t be enough vaccine available for everyone. It will be the front line services during such a crisis to decide who will live and who will die. The first priority will be the doctors, the nurses, the police and other front line workers. They would have the highest risk of being infected and their services would be essential during such a crisis. After that though, there will be some very hard choices to make. In a time of shortage, it is always the poor who wind up with nothing.

Some of these decisions are being made every day in walk-in clinics. The doctors there are known to be suspicious of the poor. They think they are being manipulative, and that they are only looking for drugs, or for a hospital bed to sleep in. The poor however have far more serious medical problems than their average patients, due to the conditions in which they are forced to live.

We can only hope that, even though resources may be scarce, that doctors consider the poor and try to create a system that will benefit everyone.