My Unspoken Words
and my pale, useless spoken words
Yesterday I held a mother in my arms so she could cry her tears of frustration.
She stays up all night to care for her crying child who scratches herself until she bleeds every day. She’s only 2 years old yet she’s spent most of her life putting creams after creams on her little body for severe eczema.
My patient needs Dupixent (injection). But her insurance won’t cover Dupixent until she fails crisaborole. It won’t cover crisaborole until she fails tacrolimus. It won’t cover tacrolimus until she fails 2 moderate to high-potency steroids. I know her insurance too well.
We have to go down the “list” of creams and fail each one of them against my clinical judgment because insurance dictates what I do. It will take us months.
My patient will spend these months not sleeping. And her mother will spend these months blaming herself and wondering if she’s done anything wrong.
So yesterday, when I prescribed more creams, the mother cried — as many mothers have cried in my office before. And I know why she did. She’s tired, hurt, angry, unheard, and desperate. She hates the world for not giving a da*n about her baby. And I’m in that world.
But I couldn’t jump ahead in this so-called “step therapy” imposed on me by the insurance company. To call it “therapy” is to insult my profession. It makes me want to scream.
How dare the insurance company practice medicine without a license, gateway what I can prescribe without EVER stepping foot in my exam room?
Because if they did, this is what they would see:
My little patient with weepy red cheeks sat on the exam table rubbing her little legs against each other and scratching her arms silly. Her eyes were playful but her body couldn’t afford to be.
She didn’t ask me to help her. She asked me to care about her.
She is not my child and I’m not a mother. But I speak the universal language of Loving a Child. And now, I also speak the shameful language of Failing a Child — as an adult, and a supposed healer.
My spoken words: “I’m so sorry. We will get her better. I promise.”
Pale. Meaningless. Cowardly.
My unspoken words: I wish instead of playing the stupid, unethical, unlawful, inhumane game with the insurance companies, we could just Help a Child, instead.
I felt this 🤍 Thank you for all you do!
Thank you for sharing this. As a patient with multiple chronic conditions I spend a huge amount of time ensuring that I know 1) what drugs are on formulary, 2) what is step therapy, 3)what needs prior authorization and, 4) when those authorizations should run out. Of course the formulary changes at least every 6 months and despite approving a medication for a year in a prior authorization, insurance companies often refuse to fill prescription and require new PAs.
I also love spending a year or two working through step therapy only to “get to the drug” only to find it’s no longer on formulary.
I recognize how much time and effort all this takes from the doctors office and I hate that the system has evolved into this. I’m a nurse who graduated in the late 1980s and became an advanced practice nurse the early 1990s. I’ve seen many improvements in healthcare, but I definitely don’t feel like the impact of insurance on practice has been overall positive.