I’m always on the lookout for useful books to recommend to parents about their seriously ill children. It was a lack of such a book for parents of children in the PICU that led me to write my own book. But my perspective is inevitably skewed by being on the doctor side of the equation; I can’t really see things as a parent does, even though I am one myself. If you know of any particularly good books to help parents of seriously ill children I would appreciate hearing from you about it, especially why you think it is a good book.

No matter how you feel about Michael Moore, his new movie has highlighted an often overlooked issue in healthcare: many who think they have insurance find that, when they need it, their coverage falls short. I don’t think of his movie as a true documentary because he is, as usual, highly partisan in how he presents things. He is a polemicist, and opinionated polemicists are always loud and sometimes obnoxious. They are also wrong at times.

None of that matters here to me. What he has accomplished is to get this issue to the forefront, at least for a while. Even the New England Journal of Medicine is talking about Sicko; you can find a fairly dispassionate discussion about the movie here. It is a good review of the situation, and I recommend it.

For myself, I have encountered families who suddenly find their insurance contains key coverage gaps regarding what their critically ill child needs in the PICU, or at least in how reviewers at their insurance company interpret that coverage. It is difficult enough to have a child in the PICU; haggling with an insurance company over the telephone can add a crushing additional emotional burden to their situation. All parents want the best for their child, so a PICU admission is not the appropriate time to ask them to weigh the costs of a particular treatment and decide on that basis if they want it or not.

Medicaid is the huge cooperative state and federal program that pays for health care of children in lower income families. Just how low a family’s income needs to be to qualify varies from state to state. The official federal poverty line, when last I checked, was $18,400 for a family of four; some states allow a family to make a little more than that and still qualify.

Medicaid covers around a fifth of the children in America. One would then expect, all things being equal, that one fifth of the critically ill and injured children in our PICUs would be Medicaid patients. This is not so; about half of such children are enrolled in Medicaid. Why is that? Are poorer children over twice as likely to become critically ill as more affluent children? I don’t know the answer to that question. I do know that children on Medicaid often find it difficult to get regular medical care, meaning any chronic problems they have, like asthma and diabetes, often don’t get optimal management. This makes it more likely they will end up seeing me in the PICU when their problem gets out of control.

Whatever your political persuasion, I encourage you to find out more about this vital issue. You can find some excellent links elsewhere on this site to help you get started. The problem of how to fund health care for poor children won’t go away. It affects everyone who votes, pays taxes, and is concerned about children – in other words, all of us.

I have a colleague who has lost his nerve to continue practicing critical care medicine. It didn’t happen suddenly; it came on gradually over a year or so. It also didn’t follow from a single event or bad experience. It was just a creeping uneasiness that culminated in his unwillingness, after two decades, to go on doing this. I don’t share his discomfort, at least for now, but I understand it.

Critical care medicine as a specialty has a fairly high burn-out rate. Some of this comes from the hours we keep and some comes from the continual crisis mentality you find in many ICUs, but most of the reason comes from within us. Each of us has a finite capacity for tolerating stress, a fact known for many years. When that limit is reached, we are done and our bodies make us stop, even if we don’t want to. This is something worth remembering for everyone — not just ICU doctors, but everyone.

Have a look into the eyes of Abraham Lincoln in portraits taken at the beginning and at the end of the Civil War. His trial was a terrible one, far worse than any of us face. But if a man like him was so used up in four years, how can any of the rest of us avoid it unless we find ways of sharing our stress with others. It may be a blow to our medical egos, inflated as they often are, but it must be done.