The pharmacy sent a fax to me, announcing that I had to call the patient’s insurance company to request prior authorization for the medication.

But… but… bupropion is generic, I thought. Why do I need to explain why I am prescribing a medication that costs cents?

I shrugged, resigned. One enters medical school and expects only to provide direct patient care: How shall I apply principles of physiology and pathology today? After graduation, one does provide direct patient care… and also fill out reams of paperwork and spend a lot of time on the telephone, arguing with bureaucrats.

These are the details that are not glamorized on television shows.

An automated voice greeted me after I called the 1-800 number and, after pressing “1″ to “initiate a prior authorization”, the telephone blared music that was meant to fill space, not pleasantly stimulate auditory neurons. I cradled the telephone between my head and shoulder. During the intervening five minutes, I scribbled ideas into my planner.

Suddenly, a woman began to speak: She told me her name. She did not ask for mine.

“What is the name of the patient? Date of birth? ID number? Group number?”

My urge was to sardonically comment, “Why do you care about all of these details when the medication is generic? It’s not like anyone will either make or lose money from this prescription…”

There are the things we say to assert that we are right. Then there are the things we don’t say so we are effective. I bit my tongue.

“What is the name of the medication?” she chirped.

“Bupropion,” I replied.

“Can you spell that for me?”

There are also the things we spell so we remain effective.

After asking me for the dose, she then said, “Thank you. I will now transfer you to a prior authorization specialist.”

Oh! And I thought that I had glimpsed the finish line.

More noise filled the phone. I spied a past copy of Newsweek on a nearby table and began to mindlessly flip through it. I began to read an article about the police officer who, as a decoy, arrested Senator Larry Craig for soliciting sex in the men’s restroom.

Seven minutes passed.

Another woman’s voice interrupted my reading.

“Hi, I’m a pharmacist in Las Vegas,” she said.

I suppressed my snarky urge to ask her about the weather in the desert.

“I will now proceed with the prior authorization inquiry,” she said.

Bupropion is GENERIC! I wanted to shout. You know this! Why are we doing this?

“Okay,” I said instead.

“Are you prescribing this medication for smoking cessation?” she clucked.

“No,” I answered, awaiting the next question.

“Alright. That is all,” she said.

What?

“The patient will receive an automated phone call to announce that the prescription is now authorized.”

Are you serious?

“We will also send a letter to the patient’s home address.”

I was on the phone for 15 minutes to answer one question about a generic medication?

“Thank you for calling,” she concluded.

“Thanks,” I automatically replied, incredulous. I hung up the phone.

Only the four walls of the room lent a sympathetic ear to my expressions of umbrage that followed.