Tuesday, October 6, 2015


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.

1 comment:

Anonymous said...

The silver lining lies only in having a heart of gold. Ultimately, it is all you have to offer as a warrior, a wounded warrior--but still fighting the good fight. Also you have years of useful training and experience, which helps.

Historically, medicine began as altruism by the independently wealthy. There was great status in such self-sacrifice. The wealth and status was something others coveted so they demanded their rights to get into medicine and have their piece of the cash-cow and social status. And so medicine evolved into the Healthcare Industry. And as stock prices soared, and as Anti-Trust Laws were ignored we got bigger and bigger and bigger "Healthcare Industry". And it was global and profitable.

And the money whores could never get enough, chasing fiscal sin like a donkey in heat. Before long they had to globally dominate and force everyone to buy into their HEALTHCARE INDUSTRY. And this too was not enough, so health had to be intentionally shipwrecked so that people would pay all they have, which was less because of rising healthcare cost--all just for a try at buying back their health. But some of them were able to sometimes get their health back. And so the money whores had to find a better price-point, lest they sing those P&L blues of not making exponentially more money. And they raised some taxes too because the burden money whores had on storing their money and having trouble finding new ways to waste it faster to justify asking for MORE MONEY.

So when your heart breaks because you have a difficulty in helping a patient, at least you are not part of the Beast. And though you are a doctor, deep within you know you still are a Warrior. And you know that there are more like you because when you go to lunch not that many people you see would actually kill you for an extra fraction of one percent profit--though some would--and they are in the HEALTHCARE INDUSTRY. (I know this because some of them have literally conspired to destroy me and cover it up, not that criminal conspiracy charges are brought against the Elite few.)

So ARISE Warrior and fight a good fight. Slay the Beast. Look for which doctors have broken hearts because they might not be able to help a patient and feel 'impotent' and tear down those doctors who are broken hearted because they might not get enough MONEY MONEY MONEY because there is never enough money. Be Santa: keep the list of whose naughty and nice. Fight the good fight. Arise: fight and win.
-Anonymously Lisa @lisa30092 as twitter is maybe less of a data whore than google.