askulapstab-837309_1920“What’s that,” I asked, as I wrinkled my nose. ”

“Oh that, that’s just some paperwork I have to do,” the doctor said as I stared at the pile of forms for another second.

“Is that for the month?” I continued.  The doctor I was shadowing answered with a smirk “Try for the week.”

This was my introduction to just some of the red-tape doctors and nurses have to deal with every day to get patients access to the drugs prescribed to them. What I was looking at was a stack of prior authorization forms that the doctor, a rheumatologist, was tasked with filling out to make sure his patients would get the biologics they needed. The Middlebury medical/advocacy internship allows students to experience America’s medical landscape outside the classroom, first by shadowing Dr. Jonathan Krant, GHLF/CreakyJoints Medical Director, Dr. Jonathan Krant and his nursing staff at an outpatient clinic in the Adirondacks of upstate NY and then by working with the CreakyJoints advocacy team. With this segment of the internship, I hope I can uncover the answers to some important questions. How does policy impact practice? How does practice influence lawmaking?

As someone who hopes to become a doctor one day, mountains of prior authorization forms are not what I want to sign up for. I’ve seen medicine on a first hand basis for most of my life. My father, a family practice doctor in Kansas City, has served a low-income, chronically uninsured and underinsured community for twenty-five years, a subset of our country that is regularly forgotten by America’s healthcare industry. I’ve seen from him how a smile and incredible work ethic can change lives and the tenor of an entire community. As I sat in Dr. Krant’s office, I witnessed him have to schmooze an insurance agent, someone whom I later learned was a “authorization manager”, in order to acquire the drug his patient needed. Here sat a man who made it through medical school, two separate residencies, a fellowship, and had the distinct honor of being recognized by the American College of Physicians. Despite all of this, he had to waste forty minutes on the phone dealing with bureaucracy to prescribe a drug. A doctor in an underserved community in New York, had to cut short his recovery from a recent knee surgery to make sure his patients didn’t have to wait for care, but it seemed that they had to wait regardless. But let’s not forgot who’s on the other side of the equation— the patient. They too can become confused and frustrated when a prescription that was working is switched to something that is less effective by someone who is not their doctor.

Nurses too often feel the brunt of this paper-work burden. Through-out my day shadowing Dr. Krant, I continually passed by Jan, his nurse practitioner, who feverously filled out paper work. Countless times, she’d walked into Dr. Krant’s office for signatures on multiple forms. Reminders, paperwork, and multiple details that where lost to Dr. Krant were constantly caught by Jan, but wasted her time and talent as a practitioner.

Fast Forward to my first week here at CreakyJoints, and I couldn’t help but think back to this experience from shadowing the doctor this past January.

“You see, insurance companies want to put the paper work on the doctor so they can blame patient’s inability to get drugs on someone else,” I was told by Stephen Marmaras, Director of State and National Advocacy here at GHLF.

“They know doctors are busy, and will get bogged down in the paperwork” he continued. To add insult to injury, insurance companies could make these forms any length they wanted, and change them on a whim. The worst part is, doctors and nurses will play this ridiculous game for the sake of their patients well-being. When the pills take a couple more days to come, or don’t come at all, the patient sees the doctor’s office as the villain, instead of the insurance company.

Having encountered these problems, albeit as an observer, I can empathize with both the doctor and patient when personal medical decisions are made by impersonal businesses. It’s a long road to change, but as patients and doctors know firsthand, it’s one worth fighting.

Hosain Ghassemi