• Rosalind Kaplan, MD

Brittle and Breaking

by Rosalind Kaplan, MD

Last week at work, a patient I have never met told me to ‘f-ck off’ over the phone. She’d

seen another doctor in the clinic two days earlier and he prescribed a basic, generic antibiotic for an uncomplicated infection. For some reason, her medical insurance company denied payment for the medication, and she was asking me to intervene, since the other doctor wasn’t there on this particular day.

“Did the pharmacist or the insurance company tell you what the problem was?” I asked her.

“They said something about it being a refill, that it was too soon for a refill,” she said. I could hear the edge of frustration in her tone, a tightness in her voice.

“I see here it was written as a new prescription, not a refill. Have you taken this same medication in the recent past? Maybe someone else prescribed it before?”

“I can tell you’re not going to fix this. Forget it. You can f-ck off!” she yelled at me before slamming the phone down.

I checked myself. Was my voice irritable when I spoke to her? Had I been frustrated by her call? Had I said something offensive? The answer to all my self-interrogation questions was ‘no.’ I was just trying to understand what the problem was so that I could, hopefully, solve it.

I called the pharmacy to ask what was going on. As it turned out, the pharmacy re-submitted the prescription and it went through. Her prescription was waiting for her. The red-tape glitches in the system of provider-pharmacy-insurance had delayed the process a bit, which, in this case, would not affect the patient’s recovery. But the damage was done: she’d been sick and vulnerable, and the trauma of one more hurdle to her healing had pushed her over the edge. In a rush of adrenaline, she’d dropped the f-bomb on me, which probably just made her feel worse, and now she’d be unlikely to contact our office again for care.

As for me, well, I just felt bad all around. I could have felt angry or indignant, but I didn’t. Instead I just felt an all-too-familiar sense of loss and despair. It was the end of a long day full of sick, anxious and frustrated patients butting up against the roadblocks of the current healthcare system, such as inability to get timely appointments and high insurance copays, and slow processing of lab tests. This particular situation was a failure of the system. A failure to heal, a failure to protect the patient from further harm, and a failure to protect healthcare workers, already burnt-out, exhausted and overburdened, from further trauma.

As a seasoned doctor, I know not to ‘take it to heart.’ This patient’s anger had nothing to do with me, or with my actions. It was not personal. It was because she was suffering. I have the intellectual perspective to handle such incidents with grace. I would let the prescribing doctor know about this and he would call the patient a few days later, when the whole thing wasn’t so raw, and check in. Outwardly, I just sighed and moved on with my day.

But all the little assaults on me, on other healthcare professionals, add up over time. It’s a natural human response to have a little flight-or-fight response when someone yells and curses at you, and that surge of anxious neurotransmitters erodes our energy and our tolerance, especially when it happens over and over every day.

I am close to the end of my clinical career, and I work part time, with plenty of opportunity to recover in between my work shifts. I don’t worry about myself; if it gets too hard, I can think about retirement. But I fear for my younger colleagues. The system is more broken than ever, and patients are not getting their needs met. Add the anxieties of the pandemic and political unrest and climate change, and the result is that people are emotionally brittle. Instead of bouncing back from frustrations, they are breaking. Healthcare workers feel broken too, but we have to be strong while we’re on duty. It’s an uphill battle.

And still, I stay. Here’s an example of why: An hour or so after the above patient cursed me out, I had a telemedicine appointment with an older couple. They were both under the weather, having contracted covid two days earlier, on a Saturday. They’d waited until Monday to call their primary care doctor, knowing that medication could be prescribed to prevent severe consequences of covid in the elderly, and that there was a 5-day window to obtain it while it was still effective. They’d left several messages at the doctor’s office answering machine, but nobody had called them back. It was now early evening, and though their symptoms were mild, they were starting to worry.

I spoke with them, got a medical and medication history on each of them, and arranged for them to get Paxlovid, the oral antiviral drug authorized for use in covid patients at high risk for complications. I adjusted their other medications to minimize interactions, and we talked about what symptoms should prompt them to seek in-person care. It was a short and simple call, but their relief was palpable.

“Thank you for being there and for helping us, Doc,” the husband said, and we hung up.

Simple. No big deal. I was just doing my job, and they’d just said a simple, ‘thanks’. But this is why I stay.

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