Insults

It hit me today while on hold with an insurance company to get a preauthorization.  The call took thirty minutes.  The medication was denied.  And I knew that I was going to get an earful from the patient when I delivered the bad news.  As I dialed the phone number, a disturbing and yet all to familiar feeling overtook me.

Helplessness, powerlessness, impotence.

I struggle with these feelings daily.  In the beginning of my career, they were spurred by the complexity of disease, the willfulness of bad luck.  Battling the human condition was a long, difficult slog fraught with trap doors and missteps.  Many patients improved, but others suffered.  And I often suffered with them.

Years of practice brought a hard earned humility, the wisdom of acceptance.  I learned to rejoice when interventions were beneficial, and comfort when a kind heart was all I had to offer.  I felt great peace in this middle ground.

These were the battle scars that I carried proudly.  My wariness was never a sign of failure, it was the toughness and patience developed by the skilled art of warfare.   I wore my badge proudly.

Yet these feelings have returned, even more powerful than before.

My enemy, however, is no longer the thoughtful, wily adversary of the past.  Instead of the foibles of humanity, I am hereangued with a litany of administrative tasks with no trace of nobility.  Preauthorizations, face to face, peer to peer, meaningful use, ICD, CPT.  The list goes on.

A long line of administrators, insurance employees, and government workers await my attention.  They tell me that my care plans are incorrect.  Improbable.  Not covered.  Out of the question.

And as my blood pressure rises and my temperature boils, I see no silver lining.  No lesson learned.  

I always expected that I would be bludgeoned by the awe-inspiring task of practicing medicine.

Not broken by a thousand, tiny, thoughtless insults.