The single worst #medical job I ever had involved no hands-on patient care at all.

Now, I experienced some very bad days as a #military #medic, and more as a #civilian #EMT. I worked on #ambulances, in #emergency #departments, and in safety net #clinics. I saw suffering on a scale I had never even imagined before. Of course I did my best to relieve that suffering—both because it was my job, and because I'm a decent human being—but a lot of the time I just couldn't, and neither could anyone else. I celebrated my successes and mourned my failures. The memory of the former sustains me to this day, but the accumulation of the latter did lasting damage to the inside of my head. Practically anyone who's ever been in the biz can say the same.

But all the #gunshots and car #crashes and #overdoses and #child #abuse cases and long, steady descents into the grave, over the course of years, didn't burn me out like two months in a #cardiology practice.

You may wonder why. Okay, cardiology patients are generally pretty sick: you don't get assigned a #cardiologist, rather than having your primary care provider take care of it, unless your #heart's in bad shape. Even so, could it really be worse than all the above? After all, cardiology offices tend to be clean, well-lit, organized places. Patients have *appointments*. Fairly routine care, and if there's really bad news, it's the #physicians who have to give it—which is not the situation in #emergency #medicine, let me tell you.

Well, it did, and here's the reason. Like I said, I wasn't taking care of patients directly. My interaction with them was brief, in exam rooms after they'd already been checked in and seen by their providers, and I never touched them. It was all paperwork.

My job was to be their advocate with the #insurance companies. I did most of my work in an office, with a comfy chair and a phone and a coffee cup close at hand. The job was actually supposed to be an #RN position, but I impressed them enough at the interview to get it, and I got paid more for it than any other medical job I had before or since.

I read their #charts and #prescriptions, studied insurance claims, and—now we come to the crux of it—looked over the reasons those claims were denied. Sometimes very elaborate reasons, with lengthy justifications. Other times the feedback from the insurance companies was basically just "NO."

And then I called those companies, and worked my way up through the phone tree until I got someone on the line with some actual decision-making authority, and explained to them in great detail why they should approve a particular medication or procedure that would keep our patients from dying.

I succeeded ... maybe a quarter of the time? Probably less. Occasionally the failures weren't complete: I couldn't get them to approve whatever the cardiologist had recommended, but I could at least squeeze something out of them. Something that would keep our patients, the people entrusting us with their lives, going for a little while longer. Some sliver of hope for the patients and their families. Some human connection that reminded the people on the other end of the line that their job wasn't actually to condemn people to death, at least not on paper.

Usually not. But often enough to keep me there for a little while. The nightmares stayed under control as long as I had a bottle waiting for me when I got home. Now that I think about it, that may have been when my drinking problem got serious, although it would take several more years to fully manifest. Good thing it wasn't a #hepatology practice, I guess.

A friend's post dredged this memory up. I was going to leave it as a comment there, but I didn't want to make it all about me. They have enough of their own problems. Just know, if you're fighting this particular war right now, I'm with you.

Oh yeah, also? #Vote. Specifically, if you can't vote for someone who will make it better, at least vote for someone who won't make it worse. Because it can always get worse.