Statement: Time is a non-renewable resource.
Though I accept this, I currently do not approve of it. (And by “do not approve of it”, I mean “am frustrated and displeased that I cannot spend the time I wish on friends, projects, and plans due to competing obligations, significant preoccupations, and general life entropy.”)
24 Jan 2008 | Comments Off
Umbrage!
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.
22 Jan 2008 | 11 comments.
Transience.
I recently received my New York State medical license. It arrived in a large, white, stiff envelope that bears the command “DO NOT BEND OR FOLD”. A few ladies were sorting through the oversized mail tray in the lobby of the building and, upon seeing me come through the door, handed me the envelope.
“Here’s something for you,” they said. “It looks official.”
Inside the envelope were (and are) the following items:
- Registration Certificate (which features a green background and the seal of the education department in New York; it resembles the document you may have in your car for vehicle registration or the document that hairdressers have in their salons)
- Registration Parchment (which resembles a diploma; everything is in capitalized letters in large font sizes)
- a document listing the provisions for unprofessional conduct (apparently revised February 2007)
- a letter (addressed to “Licensee”) informing me of the length of my licensure (”Physicians and medical physicist [sic] have a two-year registration period”)
- an Important Notice explaining the differences between the Registration Certificate and Parchment, along with several capitalized and bolded exhortations to KEEP MY NAME AND ADDRESS CURRENT
- an address and name change form
- a sheet with “Important Information Concerning Reporting Abuses of Persons Receiving Care or Services in Residential Health Care Facilities and Important Information Concerning Federal Narcotic Stamps”
I was particularly surprised to receive the Registration Parchment. Washington State does not distribute parchments; they only hand out Certificates. On blue background. (Perhaps had I applied for a full license, instead of a training license, I would have obtained a Parchment….)
Contrast this shiny, uncreased Parchment to my medical school diploma. I had stored my diploma in the basement and, sometime last year, the basement flooded. The sheet is now obviously warped and sports several smudges (aye, I avidly appreciate alliteration). The lower corner looks like someone held a flame to it. A splash of turquoise blue ink decorates the left edge.
Not that I’m particularly attached to diplomas—I’m not even sure if I’ll ever display them. Though I understand that these documents are meant to reflect years of schooling, academic achievement, blah blah blah, they are, ultimately, just pieces of paper. (… though I do have Arnold Schwarzenegger’s autograph on my medical school diploma.)
Furthermore, I can’t even imagine having my own office or space where I could display them. Medical training involves so much transience—our rotations are divided into month-long blocks, where we work closely with a group of individuals for thirty days… and we may never interact with them ever again. We may rotate through a number of hospitals or clinics, where we leave right when we begin to feel comfortable with the system. Even if we spend a day a week in a particular clinic, that is only a total of 52 days (if that, given vacations, holidays, sick leave, etc.).
Of course, the transience extends to our patients, too—”continuity of care” is continuous for only a few years. Maybe four. At most. If the resident is involved in outpatient care. (Though, of course, there are the patients that are admitted to the hospital numerous times over the course of a year….)
It’s remarkable how appropriate acquisition and application (…) of knowledge can be distilled into a single sheet of parchment paper adorned with a seal and black ink.
And perhaps one reason why we receive this sheet of paper is to remind us of our efforts because of the transience of our training.
21 Jan 2008 | 3 comments.
Numbers.
If people actually notice her, they probably deem her eccentric and, distracted by the colorful, flashing lights of Las Vegas, quickly forget her.
Time has not treated her well. Though she looks younger than her physiological age, the wrinkles now permanently creased into her face reflect decades of anxiety and rage. Her default expression is one of discontent; her lips naturally droop into a frown and her unplucked eyebrows are frequently furrowed. The dark bags underneath her eyes are stuffed with burdens and pain from years past.
Her smile—once beautiful, once her best feature—has lost its charm: It is now uneven, asymmetrical. Her lips usually obscure an errant front tooth, one that hangs limply from her dark gums in defiance of her other teeth.
The silvery-grey hairs that sprout from her scalp are often pushed back away from her face. They are thick, wiry, and stubborn, much like her personality.
She dresses for function, not fashion: Oversized blue jeans cover her short legs. She insists on wearing collared shirts and ensures that the collar lays over the heavy cotton sweater that features a bright logo. Over the sweater is a dark puffy jacket. Over her right shoulder is a drab brown handbag and in her right hand is a sixteen-ounce bottle of water. She might carry an unlabeled baseball cap in her left hand.
Everything she wears she purchased at the local swap meet. She takes pride in the cost savings.
In Las Vegas, she can put her talents to good use.
Inside her handbag are stacks of Keno sheets. She has saved them from years past and, prior to her arrival in the desert, she had studied them diligently: There is a pattern in the called numbers. There is always a pattern. And from this pattern, she can accurately predict what numbers will be called in the future.
She asserts her clairvoyance. She is confident in her gift. She already knows what numbers will lead to success and profit.
“But,” others argue, “the numbers are drawn randomly. There is no pattern. You can’t predict the numbers—no one can.”
Her lips easily shift to form a snarl. “I have done my homework! God has shown me the pattern! I know what numbers they will call. I can predict the future. God has told me what the right numbers will be.”
She seethes.
In Las Vegas, she grasps the crayon tightly in her right hand and presses firmly into the numbered grid printed onto the cheap paper. With too much force, she places an “X” into the boxes of her selection. She retraces the lines to ensure that her choices are clear. Sometimes the paper tears under the stress of her hand.
God has foretold the numbers. And God blesses her.
She sits on the faux-leather bar seats, clutching the water bottle tightly as she stares at the oversized screens hanging from the ceiling of the Keno lounge. She hasn’t bet a lot of money—one should always adhere to rules of frugality—and waits patiently to learn the results of her plays.
If people actually notice her, they probably deem her lonely and alone. Distracted by the garish displays of money within the casino, they walk past her, completely unaware that God is communicating to her at that moment in the language of numbers.
God bless her.
20 Jan 2008 | 1 comment.
Break.
This week, I
>> saw a video of a woman undergoing a thyroidectomy with no anesthesia or analgesia. This film, shot sometime in the 1950s, shows Dr. William Kroger demonstrating the effects of hypnosis. His technique, frankly, makes me cringe, but the results (on this tape, anyway) are incredible: The surgeons are slicing open her neck and she’s laying there, still, without any tubes or lines entering or leaving her body. After the procedure, she awakens, smiles, sits up, and hops off of the table without problems.
Physicians have little difficulty believing that the mind can produce symptoms of pain and discomfort (”psych consult!”), though they balk at the idea that it can also relieve pain.
>> learned that there is apparently an eight-month old infant in the state of Washington who has been prescribed olanzapine (Zyprexa). This makes me angry.
>> realized (more fully) that I am soon moving to New York. I skimmed the ads on Craigslist and was thoroughly amused to read that there are 200 square foot studio apartments that rent for $1600 a month in Manhattan. And by “amused”, I mean “flabbergasted”. And by “flabbergasted”, I mean “kinda horrified”. And by “kinda”, I mean “really”.
I’m. So. Excited! (About moving to New York City. Not so much about finding a place to live.)
>> resumed running. I’m behind the pace bunny for my 1000-kilometer goal for 2008. (Never in my life did I anticipate that I would ever use the term “pace bunny”.) I blame the virus that infected my respiratory system for the break. I’d like to run at least one 5K in 2008… and it’d be nice to say that I ran one in Seattle. How about the St. Pat’s Dash?
>> learned a little about Sandor Ferenczi. He was a Hungarian psychoanalyst. He experimented with “mutual analysis”, where he would analyze a patient for a session… and then the patient would analyze him for a session. Oy.
>> resumed teaching. The medical students have returned from their holiday and they remain as curious, enthusiastic, and engaged as ever! (They make a good group. Their buoyancy rewards my efforts.)
(More stories to follow, Muse permitting.)
18 Jan 2008 | 7 comments.