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At a wedding recently, I met a woman, a freelance photographer in her early 40s. She was intrigued by my work as a doctor and began asking me questions related to her own health. When she showed me a picture of herself with her four children, I realized why. This gaunt woman had lost almost 20 pounds in the month since the photo had been taken and, despite efforts to stop the weight loss, was still losing more.

When I asked what her primary care doctor thought, she mentioned that she had gone once to an urgent care facility. I urged her to see a specialist to undergo testing, perhaps even a colonoscopy; but she brushed aside my suggestions, preferring instead to ask for my professional opinion on foods that might help her gain weight and treatments she could obtain over the counter.

After a few minutes of this awkward exchange, I realized that there was an elephant in the room. The woman had no health insurance. Even if she wanted to follow my advice, she couldn’t afford it.

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