This blogpost first appeared on new*normal*gal.  This is a great blog about newnormalgal’s journey with breast cancer.  She’s funny and sassy and honest.  While convalescing from surgery, she asked me to fill in for her and this is what I came up with..

i·de·al·ist  noun  a person who is guided more by ideals than by practical considerations

 I used to be an idealist.  I used to think I could make a difference.  I used to think what I did mattered.  I used to think that if I just persevered, powered through, kept fighting, outlasted the naysayers, I would win in the end.

 I fancy myself an unsung, B-movie, flawed superhero.  You know, one of those fringe superheroes with superpowers that are tempered by some equally devastating affliction.  Like a commanding voice with a speech impediment.  Or the fastest runner with a limp.  Or possessing great physical strength, but blind from birth.

 That’s what being a doctor is like.

 You have all the knowledge and abilities at your fingertips, but something always gets in the way.  There’s always some roadblock.  Someone telling you no.  Maybe it’s good for me in some strange way.  It humbles me.  I can’t have it my way all the time.  Except when I can’t have it my way and someone tells me I have to do it another way, and things go south, I still get blamed for any bad outcomes.  It’s still my fault. It still weighs on my conscious.  Even when it had absolutely nothing to do with me.

My patients get caught in the middle and they are the ones that suffer.

 Who is this super villain that keeps rendering me powerless?  Like any superhero franchise there are many -because you’ve got to make sure there is a sequel.  The insurance companies.  The hospitals.  The government.  The ACO’s.  The drug companies.  Corporate medicine.  All vying for control.  All with their own evil master plan.  All looking to make a profit.  All looking to cut costs.

 Money.  Profit.  Control.  Power.

 Sitting in my rolling chair, facing you while you are on the exam table, my computer perched on my lap. Looking at each other -eye to eye.  Listening to you tell me your fears, your hurts, your sadness.  My mind reeling with the possibilities.  What could be the problem?  What tests should I order?  What’s the worst thing that this could be?  Should I try a medicine first?  Which one?

 I reassure you.  I’ll figure it out.  You breathe a sigh of relief because you know we are going to get to the bottom of it.  And I want so much to fix it.  Heal.  Restore.  Calm.  Just me and you.

 And then the insurance company denies the test.  The labs go to deductible.  The medication I prescribed is not covered.  The medication that is covered didn’t work the first time you took it.  I have to fill out a form asking for them to reconsider.  That takes 3 days for them to deny it again.  By now you’ve gone to the emergency room and had the test I wanted to order in the first place.  You’ve been referred to a specialist that isn’t covered by your insurance company.  And the hospital was out of network.

re·al·ist  noun  a person who tends to view or represent things as they really are

These super villains tend to get in their own way.  I could have saved everyone money, because I know my patient best, but instead the burden of the cost is placed on my patient.  The companies/hospitals/corporations probably made a profit.  But the system is sicker for it.  The patient is sicker for it.

I will not be deterred.  I will continue to fight the small battles for the greater good, for the good of mankind.  And just like any second rate, underrated, B movie superhero, I will take the beatings and live to fight another day.  I’ll do it for my patients.