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Thursday Jan 17, 2019

What Does the Government Shutdown Mean for Patients?

Editor's note: As the partial government shutdown stretched into its fourth week, we asked a few of our new physician bloggers how the shutdown was affecting patients. Here are their stories.

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Cutting Back on Health Care

No more eating out. No gifts for friends' birthdays. And, no, he will not be going to physical therapy. My patient is one of the roughly 800,000 federal employees impacted by the government shutdown. He feels uncertainty and wishes he had saved more money before this crisis began.

He now deems health care spending a luxury he will have to cut. He is fine forgoing PT, he said, and the home exercises I gave him will have to suffice for now. He is trying to remain optimistic that the shutdown will end soon, hoping it will all just have a short-term impact on his life. But I see the look of worry on his face.

For some, the government shutdown is an inconvenience. For others, it means choosing between critical medications or groceries. More than 1,000 GoFundMe pages have been created(www.theguardian.com) by furloughed employees seeking help with expenses like health care, child care or food. As family physicians, we hear their stories.

Although the individual, personal stories related to the impact of the government shutdown have been making news across the country, the broader public health consequences are largely unrecognized by the public, but those consequences could be dire.

  • Food safety inspections(www.cnbc.com) of products like vegetables, fruits, canned goods, baby formula and prepackaged foods have been curtailed, increasing the risk of foodborne illness.
  • The Agency for Toxic Substances and Disease Registry is not providing health exposure assessments(www.theguardian.com) for things like chemicals in water.
  • The shutdown is threatening access to care through the Indian Health Service,(www.deseret.com) which provides care for more than 2 million Native Americans. Roughly 9,000 employees of the agency are working without pay.
  • The CDC has furloughed more than 60 percent of its employees. Although flu activity will continue to be monitored -- for now -- it's not clear what other public health services provided by the agency will be stalled.

Natasha Bhuyan, M.D., Phoenix

Heightened Anxiety

During the past week, I saw several patients in clinic or in the emergency room who have been furloughed by the government shutdown.

For example, a young mother who is a federal employee presented with worsening anxiety and panic attack, which caused her to end up in the emergency room and then follow up with me in clinic. The somatic symptoms she presented with are real, and although she had some underlying depression and anxiety prior to her recent experience, she was well controlled on medication and psychotherapy. The uncertainty surrounding her next paycheck -- or if her job would be eliminated altogether -- has been significant, not only for her but also her family.

She has elevated blood pressure, headaches, insomnia and poor concentration. This has also resulted in psychosocial strain on her family, as she is historically the core of the family and the shutdown has affected her ability to be an effective parent and spouse. She reported that she and her husband have had more arguments, she has yelled at her children more, she has been unable to attend to family and household responsibilities, and she has not been as available for her young children. Although there are good treatments for her symptoms, none of them work quickly, and the underlying cause of much of her mental health struggles will remain as long as her employment is in limbo.

Alex Mroszczyk-McDonald, M.D., Fontana, Calif.

Working Without Pay

I initially didn't think many of my patients were directly affected by the shutdown, but recent survey data that shows nearly 40 percent of the U.S. population is impacted in some way(thehill.com) made me realize that I likely was mistaken.

I have a proud, self-reliant patient base. When my county suffered a devastating flood a few years ago and my clinic tried to distribute monetary support, we were often told to take our offer to a patient's neighbor or a church member instead. My patients told me that others needed my help more, even though I was standing right in front of them, knowing they had literally lost everything but the clothes they were wearing.

But we also live in a state that depends on federal support and is not shy about it. We have a disproportionate share of federal prisons,(www.prisonpolicy.org) including one made famous by housing Martha Stewart. Unfortunately for our prison guards, Stewart wasn't the typical inmate. They routinely find themselves breaking up fights, which means getting injured themselves and being covered with pepper spray in the process.

Now these brave folks, including one of my patients, are doing this dangerous work for free. They have no paycheck to buy their eyedrops or ibuprofen. They can't afford a stress-relieving activity like taking their kids to the movies.

My community depends on its food banks, which rely both directly and indirectly on federal support. Our community has residents that won't receive paychecks to buy food(www.wvnstv.com) and other essentials, and we find our food safety net impaired.

Food security could become a bigger challenge for millions of Americans if the shutdown persists. The Supplemental Nutrition Assistance Program, and the Special Supplemental Nutrition Program for Women, Infants and Children are funded through February.(www.cbsnews.com) These programs are designed to ensure those in the lowest poverty ranges have access to basic vital nutrition. But if the shutdown drags into March, the USDA's contingency fund won't cover a full month of benefits for the nearly 40 million Americans who depend on them.

Kimberly Becher, M.D., Clay, W.V.

Posted at 02:02PM Jan 17, 2019 by Natasha Bhuyan, M.D.

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