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The head shrinker was on time. I was early as is usual. While I waited, I sat under a television blaring soap operas in the waiting room, trying to trick my brain into understanding the reconstruction of functions from power series.

In any case, he greeted me punctually at the doorway to the office corridor, and walked me back to his office, asking the usual questions on the way. Do I have any other appointments today? (With the implication that he'll be scrupulous to not go over on our allotted time if I do.)

It was clear to me within two sentences that he hadn't bothered to even read his notes from our first session. He spent the next 25 minutes fucking up, looking at the clock every few minutes, and answering inter-office instant messages on his computer while spitting out generic questions and commentary. After a brief recap of the laughable advice from our first session, he gave me the swift boot after exactly 25 minutes had elapsed.

I'm trying to give the doc the benefit of the doubt for his reluctant participation, but isn't that supposed to be the other way around? I've had more productive and therapeutic conversations with my dog.

On the way out, he reminded me of my upcoming appointment. I had no idea what he was talking about, and told him as much.

He sighed and commandeered a nearby workstation to pull up my schedule. It turns out my referral to the special PTSD clinic came through. It's just that nobody bothered to tell me anything about it, despite having updated my mailing address, phone number, email address, and so forth.

If the doc hadn't mentioned it, I would have been a no-show and would have been taken off the list. I'm sure that would have looked good on a spreadsheet somewhere - cured in only two half-hour sessions with a non-specialist!

As it is, I'm due to be "assessed" again by the same thorough professionals who hooked me up with nothing more than a single page questionnaire and a prescription the first time I tried getting my head screwed on straight.

The physician assistant that I hired is back from a trip to Europe.

The local hospital refused to assist us and supervise her until I am well and cleared to work. The hospital CEO said that the physicians were willing to be collegial and help with medical questions, but the malpractice had advised them not to supervise her.

I responded dryly that having the physicians be collegial would certainly be a change. The refusal to help is a load of nastiness, since the hospital has bailed out five clinics in the past fourteen years. They just don't like me. Now I have a letter of documentation. How nice.

Another local independent doctor is going to help.

We are doing the paperwork to file the physician assistant supervision play with the state of Washington, get the malpractice all arranged. For 60 days she can be my "locum tenens", that is, fill in for me being out sick and we can use some special code to bill the insurances under my name and numbers. During that time we will work on CAQH, that is, getting her approved by medicare and all the insurances. CAQH is a data base for the insurance companies to check on medical providers.

It is massive amounts of arcane paperwork. I talked to MQAC yesterday and they explained what we did wrong with the first batch faxed in. We are hoping to get approval by Monday because we have an extremely disabled patient who can only move her face on the schedule and her advocate comes from two hours away. I don't like this sort of paperwork, but I can do it if forced.

While I am doing that, I am also ramping up continuing medical education. I have to do 150 hours every three years. I have only done 80 hours. I thought, why am I behind? Then I thought, oh, sister died, father died, legal crap, complicated estate and I've had strep sepsis twice, in 2012 and 2014. I could write a letter to the AAFP and ask for an extension, but barring new crises, I will just try to get it done. I did pass my medical boards in that time, due every 10 years, so that is out of the way. I have to do my yearly 20 hours on the ABFM website.

There are free classes through my malpractice insurance and classes through the WSMA. Some of the WSMA classes are free, some aren't. There is a class from the malpractice about motivational interviewing Thursday, Friday, Saturday in Seattle, but it's full. Rats. I need 25 live class credits. Telemedicine with UW counts and they have three weekly conferences: chronic pain, HIV and hepatitis C.

There was a free class Tuesday night, but it was two hours and in Seattle. Would have taken two hours to get there and two hours back. I was too tired. Good decision, because today I had a doctor appointment at 4 pm 40 minutes away. I went to sleep at 7 pm. Still tired.

My DEA number is up to date and my state license is up to date. Clia lab waiver, business license, workman's comp, taxes, check. All the little details to keep track of.....

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