By Jennifer Lycette, MD
My alarm goes off at 3:30 AM for some early charting. I love these pre-work hours on my own unpaid time. I went into debt for hundreds of thousands of dollars to have the human physical need for sleep trained out of me. A neat side effect of this is that it also wiped the will to resist inane admin tasks from my brain.
While I’m pre-charting, my family wakes up. At least, I think they do. But I cannot look away from my screen. I love the Electronic Health Record (EHR) so much. I do not want to miss a single message that pops into my in-basket. Like the legendary hydra, two more messages magically appear for every task I complete. It’s mesmerizing. My spouse, who I haven’t seen during daylight hours for eleven years, feeds the children and takes them to school. At least, I think they do. But I cannot check on my family because I exist to serve the EHR. I am so happy.
My clinic day starts at 8:00 AM, but I arrive by 7:00 AM. I cannot wait to see what paperwork awaits me. On my way in, I pass our department admin leader. I sign up for every open call shift this month since our newest physician partner is still on some sort of imposed leave that we are assured is voluntary. I inhale the scent of freshly faxed insurance denials on my desk.
After fifteen minutes of seeing patients, I’m called away to make my first appeal call for a prior authorization denial. I don’t mind because I am a physician, and keeping people waiting is part of my job. My patients do not know the tricky nature of the insurance companies. But I am happy to be the verbal punching bag for my patients’ ire. This was also something they taught us in medical school. I remember to smile.
At noon, I log into the mandatory physician wellness lunch hour webinar. The hospital administrator has arranged for free pizza delivery to our clinic. Doctors can do anything as long as we are supplied with free pizza! I listen to the webinar and practice the mindfulness mantras while answering in-basket messages on the other monitor. I am so mindful of how good this pizza tastes! Those wellness gurus are so clever.
With my new mindfulness, the afternoon flies by. I keep many patients waiting while I do three more prior authorization denial appeal calls. I am so mindful of how far behind I am! It is wonderful! This helps me pretend I do not see how unhappy my patients are. I make good eye contact and smile and make validating statements.
When my new patient expresses worry over their insurance company denying their standard-of-care treatment that has been agreed upon globally by board-certified physician experts on their disease, I tell them not to fret. Because I will mindfully appeal the denial with the thirty-minute phone call in the five minutes I am given.
After clinic, there is a department meeting. We learn of the understaffing that is worsening. This is okay because we are resilient. Res-eel-ee-ent. We mindfully chant the word together until it loses all meaning. That is okay because our leaders have a surprise for us. There is MORE free pizza!
During the meeting, the administrator mentions our Press Ganey scores. The pizza coma dulls my mind, so I can only nod when we are told we must improve them. Or no more pizza!
After the department meeting, I head home. My spouse apologizes that the family already ate dinner. Surprise! It was pizza!
The dog barks at me as if I am a stranger. Come to think of it, I do not recognize the dog. It is possible the old dog died, and my family got a new dog without me. I give the dog a piece of pizza. Good dog.
I sit at the kitchen table with my laptop and log into the EHR. I must have forgotten to be mindful because when I look up, the house is quiet, and the lights are out. I don’t want to wake my spouse, so I crash on the couch. I cannot wait to wake up in three hours and do this all again. This life is exactly what I dreamed of when I gave up my twenties and thirties for medical training.
I fall into a deep sleep, chanting res-eel-ee-ent to myself over and over. I dream of pizza.
Originally published 6/4/23 on KevinMD