I sit at work, my headset volume turned almost to mute. I still hear the screaming voice on the other end, berating me for what seems like the millionth time today for something completely out of my control. I know what you are thinking --collection agency. Unfortunately, you are wrong. I am an eleven-year veteran of a cut throat field--the medical field.

For those who do not understand what goes on behind the scenes at any medical facility, I am here to enlighten you. I guarantee that, at one point in their career, every single medical worker would love to tell you EXACTLY what is on their mind. Instead, we hold it all inside, secretly wishing we could scream right back at you. Here is a glimpse of things that we would LOVE for patients and their families to understand:

1. The Waiting Room is Just That --A Place To Wait

I can guarantee you that we don't sit behind the desks just looking for a reason to make you sit there, glaring at us through the useless glass window. Yes, your appointment time was ten minutes ago, but the patient before you WON'T STOP TALKING. When they are still in a room, guess what --we have nowhere to put you. Your scheduled appointment is not a guarantee that you will be seen EXACTLY at your given time. It is merely a guarantee that you have a spot on the schedule. That's it. We cannot plan around emergencies, the patient who takes extra time due to disabilities, or the patient who scheduled an appointment for a cough, but suddenly has a "suspicious mole", a sore foot, and a backache that has been going on since 1945. It's not just you who is inconvenienced by a late appointment --the workers are affected by EVERY SINGLE MINUTE that an appointment runs over. That means we don't get to go home on time. EVER.

2. That "Funny" Joke --We've Heard It. A Lot.

Yes, we will laugh at you when you tell us to "add ten pounds for the shoes". Deep down inside, we secretly want to cry. We hear it all......every single day. I worked for a cardiology group, and I can't tell you how many times I heard the age old "My heart rate is up because you're holding my hand" as I checked a pulse. Yes, it's flattering, but eventually we begin running on auto laugh. Sad, but true,

3. We Really Don't Like Going Over Your Medication List

I can't begin to tell you how many times in the past 11 years I have been griped at for simply asking to review a patient's medication list. Trust me, it isn't anything I would willingly choose to peruse at the local coffee shop. It is a necessity. What people don't realize, is that if you see multiple providers, your medications are constantly changing. It is our job to keep your list as accurate as possible. Many medications have severe reactions with each other, and if we don't catch it, you might not live to see your next appointment. For example, say you are a male having problems with getting an erection. You go to your family physician, who writes out a script for the famous little blue pill --but you neglected to tell him that your cardiologist has recently prescribed you nitroglycerin pills for chest pain. You take the two together --and BAM! Your BP drops to a critical level, and you most likely die. Simple way to prevent this? Keep a list of EVERYTHING you take, including vitamins and supplements, and keep it on you at all times. It is important to keep this list updated as well.

4. Prior Authorizations Are Our Worst Enemy

Medical insurance companies are constantly changing medication and procedure policies. At least once a year, these lists undergo changes--and not all of them are for the best. If you are on a medication that you have taken for 20+ years, and suddenly the pharmacy tells you they cannot fill it without your provider completing a prior authorization (commonly called a "PA"), IT IS NOT THE PHYSICIAN'S DECISION. This is strictly a measure imposed by your insurance company. Once the physician's office submits the needed paperwork and documents, it is up to the insurance company to approve or deny the request. There is absolutely NOTHING they physician's office can do. The physician and staff do not sit around and think, "Hmm....let's make Jane Doe's prescription deny at the pharmacy. I bet she'll be sooooo mad!" Nope. We generate multiple P.A.s every single day......and we hate them all.

5. Lack of Planning on Your Part Does Not Constitute an Emergency on Ours

It's Friday at 4:45 p.m., and you just took your last pill. Holy crap. Better call the doctor's office and scream at them for not keeping track of your refill. How dare they let you run out!!!! Stop right there. It is NOT the physician's job to make sure your medication refills don't run out. It is our job to authorize more, but NOT to keep up with the remaining refills. There is such a thing called "patient responsibility". *Gasp!* I know--seems unfair, doesn't it? Here's the thing --we have thousands of patients. There is absolutely no way this method could ever be feasible. You have a 30 day supply (or sometimes 90 day)--when you reach the last few days worth, you call for a refill. Simple as that. Oh, and don't believe the pharmacies when they tell you "we've called your doctor's office 3/4/5 times with no response". No, they haven't. They *might* have sent an electronic request, but with technology being so wonderful, there is no guarantee it ever arrived at the destination. In summary --be responsible with your medications. Plain and simple.

6. We Don't Have To Give You a Medication That Another Physician Provided

It's always a hassle to establish care with a new medical provider. One thing a lot people fail to realize is that just because you are currently on a medication from your previous provider, your new provider is not mandated to continue to refill said medication. For example, if you came from a provider who was comfortable providing you with Norco 10/325 every four hours, your new provider is not required to fill the same medication. He/She may only feel comfortable giving you this medication every eight hours....and that is their choice. You have to remember that their DEA license is on the line with every medication script they write. Also, no two doctors practice medicine alike. As long as they provide a safe wean on the dose or offer a referral to a specialist, the physician is fully in the scope of practice to change any given medication.

As you can see, there is so much happening behind scenes in any given medical profession. We have rules, regulations, standards, and policies that are ever changing. We have several steps that must be taken for even the smallest tasks, in order to make sure that we are providing the safest and most compliant care possible. So, the next time you are berating the receptionist or nurse because you had to wait fifteen minutes past your scheduled time, remember this: We very well could have just spent those fifteen minutes performing CPR on a man who collapsed suddenly in the exam room. You didn't see him leave in the ambulance because our protocols require EMS responders to enter and exit through the back door. I've been in that exact situation. Trust me when I say that getting you back to be examined for your yearly check up was the last thing on my mind. However, I will smile as I check your vitals, review your med list, and listen to you tell me about your chief complaint. After all, I'm just a medical assistant.