fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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Pamela Adelstein

Medication Automation

I should have said no years ago when the person at the register kindly asked, “Would you like to sign up for auto-refill?” Smiling, I replied, “Sure!” and volunteered my information to be uploaded into their computer.

Back then, this seemed revolutionary. No more remembering to call every month before I was out of pills, no searching my medicine cabinet for the most recent prescription bottle to get the seven-digit number I needed to punch into the phone for a refill. Now I’d never run out of medication!

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Original Scars

My chest tightens, then relaxes, as the tears roll down her face. She gradually bares her soul, revealing the events that led her to my exam room. She may have been born to a mother whose own experience with trauma stunted her ability to be a supportive parent. She may have suffered abuse at the hands of people who were supposed to be trustworthy. Or she may have experienced the loss early on of the primary person in her life who understood her.

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The Portal

“Hello?” I answered the yellow phone with its coiled cord dangling from the kitchen wall. To my surprise, my doctor was calling ME, a seventh grader, with results of my blood tests. (Mono.) I still recall my shock that a doctor – practically a celebrity! – would call my home. Shouldn’t his staff be calling?

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The Greatest Health Care System in the World

One might reasonably assume that diabetes testing supplies could be simply obtained. Continuous glucose monitoring (CGM) eliminates fingersticks and enables more precise knowledge of sugar levels. Recently insurance denied coverage of CGM supplies for a patient I see. My patient’s blood sugars were higher than last year. My patient was upset about their elevated blood sugars AND their lack of glucose monitoring supplies. I pressed the pharmacy to learn the reason for the denial. Insurance would not cover CGM because the patient’s diabetes control had worsened, which indicated that the CGM did not help lower their blood sugars.

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Long Grief

There used to be much to do. Reciting the Mourners’ Kaddish daily. Making phone calls, waiting on hold, filling out forms, managing the estate. Sorting and donating Dad’s personal goods. Answering panicked phone calls and texts from my mother. Explaining my status as a mourner—taking a year off from dancing at celebrations, declining blindingly joyous events that chafed against my mourning soul. Responding to friends checking in. Processing feelings. And marking all the “firsts”—first Thanksgiving, first Father’s Day, first birthday—without Dad.

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Inner Duality

If you have ever been in therapy, you likely discovered that while you share personal details about your life, the therapist reveals little information about theirs. From my understanding, when and what to disclose is part of a therapist’s training. In contrast, in medicine, relatively little about self-disclosure is taught. Instead, it is up to the individual to figure it out on their own.

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Skin Rash

Being a child of medical parents brings special challenges. For example, such children grow up with a unique idea of appropriate dinner conversation. When I exclaim, “Guess what I saw at work today!” my children interrupt to inquire if my story has blood or something “gross” in it. And they regularly yell, “HIPAA!”—a reference to the federal patient privacy regulations—even though I always deidentify patients.

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Priorities

Two dreaded words for medical providers and patients: Prior Authorization (PA). For the fortunate few who have not needed to engage in this process, here’s a definition from the American Medical Association website: Prior authorization is a health plan cost-control process by which health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

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Hard Questions

My routine clinic day was interrupted by a startling message. During a moment of extreme stress, a long-term patient of mine left a threatening voicemail on my colleague’s phone. The target of her anger was me. It was difficult to discern her garbled speech in the recording of her screaming, but I heard loud and clear that she intended to find me at my clinic and physically hurt me – or worse.

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