No, not national politics, although they are not helping matters either, hospital politics. Ever wondered why your provider has a forced smile sometimes (well except you Karen and we know why)? They may have had to deal with outside influence on their practice.

These frustrations are often Insurance companies, corporate style bean counters, or just plain Karens or Chads (female Karen) throwing their undeserved entitlement around. All of these are a daily crap fest for a provider and often, this is thrown in with life’s usual frustrations.

See, and you thought that everything was all Roses and Honey baths (or treasure baths…if you get the reference, we should get to know each other better). It’s not.  Most commonly, we see the things I mentioned above and of course, what kind of bitchy Queen of the Damned if I didn’t dish a lot.

Insurance companies can be the worst.  In fairness, I worked for an insurance company where the bottom line is profits.  I know you are shocked, take a moment to rest, keep your head down by your knees and take some deep breaths. They need to regulate those payments to make any money; I get that.  How they accomplish this is to make sure is that the cheapest test and treatment comes first.  It doesn’t mean they skimp; it just means they would rather you do a physical exam than jump right to the MRI.

Medical shows have screwed us as providers since Karen shows up after seeing House order an MRI and thinks she needs one. Sometimes it is tough to say, “Your insurance won’t cover it without doing x first.”  To which, of course, Karen is back in your office a week later to tell you, “it didn’t work, “ because, in her mind, she needed an MRI (she knows how to play a system better than you). After all, why are you wasting her time with rest and NSAIDs after a non-conclusive physical examination is beyond her?  Yeah, Karen, I forgot that Karen University’s (KU) Medical degree is one of the most excellent Google searches money can buy.  Sorry folks, but any medical professional hates Google as much as getting paged at the golf course. The worst for us is when we know you need the test and have to submit info to your insurance company so they will approve it.  Often this is a guess as to what they need since they are very nebulous with instructions.

Now, not all insurance is tough to deal with, but some are, and they are frustrating to both the provider and office staff.

Everyone has a bean counter, someone who makes sure that costs do not overrun in the clinic or the facility. “efficiency experts” (The Bobs…if you get that reference, we also need to get to know each other better). They look to keep costs down and often through ways that do not seem to have any logic.  Many times these “Bobs” are not medically trained at all and are not versed in actual necessities. I’ll give you an example.

Bob: Why do you need so many specimen cups?

NP: Uhh. So we can diagnose.

Bob: Is there a way you can use less or reuse them (I shit you not)

NP: …

Later as I woke up in an exam room with a nurse checking my vital signs… Just kidding, but I was speechless (I know shocking for many of you). They are a source of frustration, though, and often it is with office supplies.  It is bad enough that I keep my personal pen supply. Asking for a pen in most places is like asking to borrow someone’s virginal (legal age you pervs) daughter for an evening of debauchery and human sacrifice. I found it easier to spend the $10 bucks periodically to buy some at Office Max and keep my trap shut. None of this, however, is terrible as Chad.

No, not a real name, although this man exemplified entitlement. In my line of work, I consult on patients in the ED that present with suicidal ideation. We medically screen all of our patients to determine if they are appropriate for inpatient psych. In walks or, this case rolls Chad with paramedics and an “advocate” at his side.  Chad is homeless and many times homeless folk play the suicide card to get a hot meal and a bed on the psych unit. This was the case. Both the ER staff and I caught this quickly, but the “advocate” was on the phone to the hospital administration (who he knew) and threatening all kinds of reports to everyone from the City Council to the White House.  The administrator was demanding his admission.

Now before I go too much further, make no mistake, we take someone’s claims of wanting to kill themselves VERY seriously. We often place an involuntary hold on the patient that prevents them from leaving our care. We do not take these cases lightly as I said above.

The problem is that the administrator has no admitting privilege, and the patient’s physical issues (he has problems walking and for safety reasons cannot be on the psych unit) violated the unit policy for admissions ( Ironically a policy that the administrator signed off on). The administrative work took about 2.5 hours of staffing time that could have been with patients that need it.  After much debate, the patient didn’t admit to psych, but a medical bed.  So instead of a locked psych unit, he went to a busy medical unit where he had a bed, a TV, and a supply of snacks all at the push of a button.  Isn’t entitlement wonderful? I would love to see us justifying this to insurance.

The worst, of course, was the frustration of dealing with someone that did not need to be there, tying up the resources and my time contacting my medical director to get him to agree that this person was inappropriate (it was Valentines and he was out with the Mrs.). Oh well, that is part of patient advocacy.

Yeah, patient advocacy.  Sometimes the worst thing you can do for a sick person is put them in the hospital. Oh well, I am just a lowly NP that has to deal with all of this.  Don’t get me wrong; I dig the hell out of my job. It is just these little bumps that are frustrating to me.

Be the kind of person that your dog and your mom hope you are.