One of my jobs is to call insurance companies and provide information for a Prior Authorization.  This is done to prove to the insurance company that the medication or treatment is necessary.  There have been times I have spoke with someone who was obviously reading from a script and had no clue what the actual terminology was.  As long as I said a word that matched something in the column, we could have approval, if the actual diagnosis was a shade different, we were disapproved, or at best put on a review list for a pharmacist or doctor to review.  With the latter in mind, read this.  From my experience, I have not the slightest doubt as to the truth of the information.  After all, I am one of those on the back end of this snake getting drug through the weeds.  All the while, the patient in need of treatment, gets to sit home and wonder if she/he has been forgotten, while the ailment continues.  I have been on the back end of many of those phone calls as well.


The surgery is done.  The cancer is removed.  Spouseinbox stated that the doctor lied.  I was anticipating it, but tried not to say too much.  The presentation was sort of like this comic:

“You will be a little more sore than when they did the biopsy.” We were given Norco 7.5’s and morphine IV in the hospital room.  Yeaaaa, just a little more sore than post needle stick.  Now, I know how practitioners like to downplay the bad stuff.  We are trying to help expectations.  That strategy doesn’t really work with someone in the business.  That comic is so accurate.  Don’t think I don’t notice the preparatory medications either.   Just saying.

I had out my appendix many moons ago.  What I discovered was that lying was fine, standing was fine.  Going between them was horrible.  That said, I only took one pain medicine that first night.  That shot changed the way I give shots to this day.  I wasn’t even a nurse at the time.  Tell the patient they are going to be stuck.  I was waiting for the verbage and received a poke instead.  I jumped, looked at the nurse.  He gave an odd face, completed the injection and then told me I had just jumped off the needle and back on it again.  I got stuck twice for a single shot.  There’s nothing like personal experience to change one’s mind and approach.  That said, I decided the nurses were going to make me walk and I didn’t want to get out of bed any more than was necessary – as getting up was the worst – so I decided that I would walk out in front of the nurses station any time I had to get up for the bathroom.  It worked.  The nurses came and provided such compliments how I was energetic and walking wonderfully and they were happy with such progress.  I didn’t tell them I was just doing it so they would leave me alone.  Keep that in mind if you ever have to go to the big house.

Spouseinbox discovered that post surgery, standing was fine, lying was fine, going between them hurt.  That sounds so familiar.

Some time ago, I noted how the growth of pendulous chest area was a normal physiological response to presence of hormones.  That is called gynecomastia in men and breasts in women.  Gynecomastia in a man doesn’t change him into a woman.  It’s just the natural growth of that area of anatomy.  The cells haven’t changed.  Now we have this.  I know it seems to obvious, but for this crew an explanation must be in order.  Junior was a cute movie, comedy of sorts, and fantasy of thought.  I actually enjoyed watching Arnold go through all of the symptoms a pregnant woman experiences.  However, a uterus is required to be pregnant.  Period.  There is only one sex sporting a uterus – the woman.  Period.  When a woman is pregnant, she is called a mother.  Period.  Words mean things.  Pretending they don’t is to associate with the mental illness present.  I’m done with this.

I am missing my medial meniscus.  This is due to a tear from some activity I did which should not have been done.  Oh well.  The surgeon promised me a knee replacement and said that the surgery he did was only to buy me time.  How’s that for an encouraging follow-up office visit?  Anyways, I have been walking on the site for some time now and know the difference as I can’t jog or do impact activities any more as they cause pain.  With that in mind, I found an article of a surgery center a bit north of here.  In association with this, I have discovered that there is a MRI center a couple cities away with cash rates about 10% of what our hospital charges for a MRI.  I paid cash and received the same scan I would have received here for three times the price.   When money is an issue because of the deductible, I am directing customers to that location.  For those who want to cry foul and fuss about the hyperinflated prices, remember that the federal government mandated that hospitals provide services to anyone who needs them whether they can pay or not.  The hospital is a business and requires income to survive.  That income has to come from somewhere.

I work in a neurologist’s office.  My doctor is a specialist who analyzes body operations according to the neurological standpoint.  This doctor further uses electrical analysis to decide what nerves are having problems and what diagnoses are related to the problems presenting.  This doctor went to college, then medical school, then residency, then fellowship.  I would placed in the realm of highly skilled.  What is the medical profession?  Back in the 80’s, the federal government decided that when people needed help, it was up to the medical professionals to provide that help – without being paid.  After all, when people need help, why should we worry about such a thing as compensation?  This is where the free ER visits originated and by the way, where the removal of ER’s in California originated.  It is also where the philosophy of “your labor belongs to me” originated as well.  We have patients who have the full expectation that our medical services should be free of charge.  After all, their health matters, doesn’t it?  Why should we make money off of their health?  Well, when was the last time someone went into a restaurant and told them that their food was necessary for life, and therefore should be free of charge?  In the end, the cost of the services is compensation for the time of the server.  That is the bottom line.  A person pays for the painter because that person spent their time and skill applying a coating in a pleasing fashion.  A person pays the restaurant as they spent their time and skill cooking the meal.  A person pays at the gas pump as that business – a little less directly – provides the result of time and effort of individuals to remove the fuel from the ground and turn it into a source of usable power.

There are three reasons for a person to enter into medicine.  There are plenty more, but here are a few obvious ones at the start.  My doctor mentioned getting into neurology because it was difficult.  There was a challenge in ascertaining neurological problems by looking at squiggly lines and numerical results of a needle placed in a muscle.  Treatments for neurological issues are not like an antibiotic which removes the bacteria and the person is “cured.”  We tend towards long-term treatments to make the symptoms of whatever issue more tolerable.  The problem will never be removed.  Another possibility of entering the profession is to help people.  There is a good feeling to provide decent information and have the person utilize it for their betterment.  Lastly, there is the income related to utilizing one’s skills.  Doctors maintain a good income.  Similar to the professional athletes, the reason for the higher income is that fewer individuals can do the task.  It is simply a notation of the marketplace, that those professions having skills that fewer individuals can do, allow incomes higher than the normal level.

Here we get to the nub of the idea.  Medicine is a business.  We, in the business, spend our time learning skills and giving our time in anticipation of receiving income related to our expenditures.  We also have bills.  Just because we have chosen a “helping profession” doesn’t mean our time is less valuable.  As the market dictates, certain professions have a higher than average income as the skills to be in that profession are not as prevalent.  Instead of those who look at us and think “rich doc”, maybe they should look and say “12 years of school”.  I had an acquaintance who finished up a MD PHD by the age of 29.  There was still residence and fellowship to go.  This person was in a meeting with a loan officer for a mortgage.  The mortgage officer asked about a job and my acquaintance stated she had nothing but little assistant jobs here an there.  The officer then asked about school and my acquaintance asked about college, or later training.  The officer stated everything, going back to kindergarten.  My acquaintance stated 24 years.  Let that sink in for a moment.  Realize that more training was going to begin as well.  How much of this doctor’s time should be free for the patient?   Wasn’t the purpose of all that training to become skilled in the anticipation of helping people and being compensated for that time?  Just like a hair-dresser going to training and then the workplace, the doctor spends time in school in anticipation of being compensated.  It is a job.  It is business.

I work in a neurologist office.  Dr. Grumpy stories are so normal.  Part of me wishes it weren’t true, but as I have talked with people in other professions, it has occurred to me that the stories presented are simply a reflection of people of the culture.  The actions show in whatever profession is out there because the people are the same.  Every once in a while, though, we have one that leaves a warm spot in the back of the dendrites.  Every once in a while, there is a patient who you just want to hug.  I sit in on the end of visits and create the visit summary and receive orders.  As such, I hear the discussion of symptoms and plans for treatment.  We had a patient with a tumor.  The description was: take a bowl of jello and right before it sets throw a handful of sand into it.  After it sets, cut out the sand.  That was the description of the issues related to this tumor.  There were a couple of possibilities, but nothing really good.  I typed all I was  supposed to and wished the patient and family a good rest of the day and advised them of the direction out of the clinic.  As the patient started down the hall, I noted the back of the tee shirt – “Never Give Up” in six inch tall letters.  When I was in chemotherapy, all things being equal, the attitude of the person was the saving or destroying factor related to their prognosis.  This tee shirt showed me an attitude on the plus side of the equation.

We, at the office, are anticipating a worklist of excessive proportions.  After all, there have been 4 days available for people to call in and we not available to answer and remove those messages.  Such is life in the medical office.  That’s not a complaint, just reality.  For those of you who have called in and are waiting, realize we are not playing games on the computer, we are just answering another one of the calls to the worklist and each call takes time, which is why we haven’t called you yet.  I say yet, because we will call, when we get down the worklist to your message.  For those of you who call with a question requiring a doctor – realize that those questions have to wait until there is a doctor available.  That might seem an obvious characteristic, but considering the questions I have fielded… Also: a phone call is not an office visit,  therapy should be done in a therapist’s office, and I can’t diagnose – especially over the phone – that’s doctor material.

The doctor has a schedule, and shows up to the office accordingly to see patients here.  The doctor also has two other facilities requiring attendance, and as such sees patients in three locations.  Questions from the phone calls, mail, signatures, all get shoved into the theoretical funnel, and eventually the doctor looks at them.  It may be after clinic, in the evening, or the following day.  We nurses have no control over when the doctor wants to review stuff.  We have a place to put those items and the doctor gets to them whenever.  Remember that there’s a clinic to run.  That means there are patients are sitting in the waiting room as well as in the exam rooms.  They don’t appreciate distraction by paperwork since they are physically present and have paid for their time there.   We do appreciate the patience of the patients as all of this stuff hits the desk and we slog our way through.  I just wanted you to know.

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