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Today is my father's birthday. I miss him. We are coming up on three years since he died, in June.

Between the family legal stuff and the corporate fraud of the insurance companies I feel tired and discouraged. I like my patients just fine. I am very comfortable with doing primary care medicine, I love it, it's fascinating. I caught an error in a cardiology discharge recently, patient not given the medicine, called them, fixed it. The cardiologist called me a week later to thank me personally... that was nice.

I run my own business, my own small corporation, just me and a front desk office manager. I do all of the prior authorizations with the patient in the room on the phone, and bill the insurance company for "face to face counseling and coordination of care". The insurance companies clearly have very few doctors calling them. One patient was outraged in the last few weeks because the insurance company rep kept calling me "ma'am". "Doctor!" hissed my patient. "What is the matter with him? It's disrespectful!" I shrug, because we have a culture of fraud.

I mind. Doesn't anyone else mind? Why are we ok with corporate dishonesty especially in healthcare where it is clearly hurting people and nickel and dimeing them? I have various friends who tell me they avoid paying taxes as much as possible: well, yes, but sir, you are a veteran and the taxes are what pay me, at least in theory because so far I can't get triwest, the northwest VA contractor, to pay me. Scams to the left of me, jokers to the right of me, here I am, stuck in the middle....

The two most recent Alice in Wonderland calls for prior authorization left me thinking that I like my addict patients, like my angry grumpy patients, like practically ANYONE better than calling a health insurance company. After the second one, I thought, I am not sure I can continue in medicine, at least in the United States. I want, long for, fantasize about one set of rules, one set of paperwork, one number to call..... we have the most insane inefficient system on the planet. And the insurance companies have done a spectacularly impressive triangulation game of getting the patient to blame the doctor.....

A clinic in Sequim is melting down: I hear rumors about HIPAA problems or that they are only going to see native american patients. One doc that I know has left, bummer, since he was one of only 3 buprenorphine prescribers in that county.... I have already gotten two patients from that clinic. Yesterday I saw a new patient, 87, with her daughter, they live in Sequim. I have five patients coming by ferry from Whidby Island. I called the neurologist's office in Sequim: his partner left. "Is he taking new patients?" "No," they said. "In six months?" because that's what they said last week. "No. We don't know when or if he will take new patients." So, he's the only neurologist in Clallam County, ours retired and then died, so my patient will have to drive from Sequim to Silverdale, two counties away, to see a neurologist. And my favorite pulmonologist, also in Sequim, retired. A dermatologist sent a letter to us in the fall, saying "I quit October one because of ICD 10, unless they cancel it." Our local hospital has 12 primary care doctors in clinics and three left last year. One of the three general surgeons left. The main orthopedist just left....

The system is melting down.....

Time to buy that DIY home appendectomy book....

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