too poor to go to hospital

In surgery this morning I meet a young woman recently registered with us. My receptionist calls me to let me know she is downstairs, angrily demanding yet another ventolin inhaler (a widely used asthma treatment) and that she has gone through no less then 11 inhalers in 9 weeks. Either her asthma is well out of control or there is something badly wrong with this picture. I call her up to see me and question her about her use of the inhalers. At first glance it is clear that she is not at this moment in severe difficulties, but also that there is an edge of aggression about her (this was reported by my receptionist as well) which is really quite scary. I point out that we have over 200 asthmatics on our books, some of them really severely disabled by their condition, but she was using more ventolin than any of them. She scowls ominously at this, and just says: "Well I need it"

I listen to her chest and there is indeed a slight wheeze present. I then offer to refer her to the local chest clinic for a thorough assessment of her problems. But she responds thusly:
"Is that at the hospital just outside town?"
I confirm it is.
"Well in that case I shan't be able to go. I'm a student and I don't even have enough money to buy Christmas presents this year"
At this point I almost snarl at her:
"To be perfectly frank, that is the most ridiculous thing, the most stupid thing I've heard anyone say in this room. Here you are with your asthma which is clearly not adequately, or certainly not appropriately, treated, yet you tell me you can't even come up with the fare for a 4 mile bus journey. It's absurd!"
She wouldn't have it though, accusing me of failing to appreciate her problems, addressing her in a rude and unacceptable manner. She then announced she would leave the practice, but not before putting in an official complaint about my treatment of her.

I prefer it when I get pre-warning of a complaint. In between seeing other patients I wrote out in longhand a response to her imminent written assault, making sure to mention her comments about refusing to have a hospital appointment on the grounds of cost.
Even my wife was totally behind me when I explained the situation to her. And she's usually highly objective about such things. The reality here, of course, is that the patient is quite obviously psychologically addicted to ventolin, but doesn't yet have the courage to admit it.