*apply desk to forehead*

(or, Medicine meets New Math)

Today I did the most mind-numbingly stupid bureaucratic thing I’ve ever had to do as a doctor.

A patient calls my office. She has diabetes and is on insulin via insulin pen- she uses 42 units per day (this is relevant to the story). Insulin pens come preloaded with 3 mL cartridges (300 units of insulin), so over the course of a month the patient uses a little over 4 pens. As one can’t dispense a partial pen, of course, she’s written for 5 pens a month- except that her insurance says that’s more than a month supply. “That’s 34 days’ supply,” Insurance Company says. “You have to pay two months’ copay for that. $94.”

The patient is understandably confused and calls us. We call the pharmacy. “The insurance company’s right,” the pharmacist says, “she has to pay two months’ copay. She only needs 4.2 pens a month. If she was using 50 units a day, it’s be 5 pens even and she’d only have to pay for a month. Can’t she just increase her dose?” (A pretty big jump. Not appropriate for the patient, incidentally.)

I scream silently into the Void for about 30 seconds, contemplating how to divide a plastic insulin pen into fractional segments.

This is literally the stupidest fucking thing I have ever heard. And I have heard a LOT of stupid shit. 

I hang up. I consider. I have an idea.

I generate a new prescription in her chart: 50 units of insulin daily. I create a note beneath it in the EMR: patient taking differently. Uses 42 units of insulin daily. (Anyone who looks at her record in the computer can see the note right away. Important for patient safety.) I call the pharmacy back. 

“Okay,” I say. “Fill it for 50 units a day.” 

“Great,” says the pharmacist. “One month copay.”

I call the patient. “Keep your dosage exactly the same. 42 units. Ignore what it says on the label.”

“But-” (I can hear the gears turning over the phone)- “oh. Oh. Got it! Thanks!”

Problem solved. 


is it so wrong of me to be… kinda happy that my tag is filled almost exclusively with kindness cures / kindness campaign response asks? like that is what i strive for so hard in this community. to be that level of positive to those in need. thank you all for being so wonderful and for loving me as much as i love you. 
— xoxo manon ♥

The Initiative Tree

I just showed up to my buddy’s house for our weekly D&D Night, and he pulled out this awesome creation that he built.

After we roll for Initiative, we each put on our clothespin to remember the order of our turns. I was so immediately impressed that I asked him if I could snap a pic and share with the rest of you. He graciously agreed.