I had a great day in the office today. Not that I came up with any brilliant diagnosis nor cured anyone. I was able to just be a physician. No time wasted on the phone with insurance companies. No prior authorizations to do. It was a reminder of how much I love my job. I love my actual job — the one I trained for — being a physician. Listening to patients — I do find it a privilege to be part of their lives — to hear their stories as I start to work the puzzle of the possible diagnosis in my head and create the plan. Examining, looking for cues, asking more questions. Labs ordered, medications tried, procedures to do.

I am reassured that I still am happy with my career choice 22 years after graduating medical school.

Now how do I keep this joy every day?

With medicine ripped from the hands of physicians and taken over by corporate greed in the form of insurance companies this is not an easy question. Every day the rules change. Every day another hoop to jump through. If it were one set of rules, it would almost be tolerable. But alas with a number of insurers each with assorted plans there is a byzantine array of rules that is ever changing.

Imagine if you will, working hard through high school to get into college where you worked hard and studied to get into medical school. In medical school, you studied long hours, were often sleep deprived learning all you could about the human body and its various disease states. After graduating, you pursued from 3 to 11 years of post-graduate training (residency) where for pittance of pay you worked longer hours with less sleep and learned as much as you could so you would make the right decisions. Then you take board exams, apply for state licensing, hospital privileges — mountains of forms and bureaucracy. Finally, you can practice the craft you studied.

Now, as a practicing physician, your expert opinion is overruled by someone on the phone who maybe has a high school diploma. They are reading from a set of rules. But you see my patient’s illness has not read the rules. Just as medicine will not be taken over by computers, it takes an expert human to interpret what to do. It is cheaper for insurance companies to continue to deny claims, find ways to justify those denials than to allow those of us who trained long and hard to decide on treatment. I could understand if they were reigning in doctors who indiscriminately order imaging, but they apply the same draconian measures to all of us.

Of course to the detriment of patients.

Instead of my days spent being a physician, the majority of my days are mired in prior authorizations, different medication lists, and of course trying to get paid.

Our noble profession is being batted about by legislators and administrators. They have created this mess. A morass of huge expenditure that mostly does not got to actual care. The middle men have to go. It is up to us as a profession to take back control. First, do no harm.

Cathleen London is a family physician.

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