electrical pole against the sky 

“Doc, they denied my MRI. The paper says… let me read it to you… ‘Must use six weeks of conservative treatment with a physician, including rest, ice, and antiinflammatory medication before eligible for approval.'” 

She was angry. I could hear the implied accusation through the phone: You screwed up!

“As you know, this is a problem because the MRI was already done. This is going to out me over a thousand dollars.”

I couldn’t blame her for being angry. 


“Ok, first, I do not understand why the imaging place did the study without insurance approval. Unfortunately, I have no control over that. The main problem, though, is that the insurance company is denying your MRI as if it is for joint pain instead of a mass which makes absolutely no sense whatsoever.”

I hung up with her and dialed the insurance company, hands shaking with anger.

I spent two minutes wrangling through their automated system, got hung up on, tried again. I was transferred to a person who took the info and again told me why the study was denied.

“Look, a mass is not going to go away with rest, ice, and antiinflammatories for six weeks.”

“So you want to talk to someone about that?”


I got transferred to another person and gave the info all over again.

“Ok, let me transfer you for a peer to peer…”

On hold for a few minutes…

“Hello? This is Dr. So-and-so. What is the problem?”

I gave HIM the story all over again.

“Well, we did not have all of that information. It says here the MRI was done for hand pain.”

“That is not the diagnosis code that I used when I ordered it.”

“I see that.”

It should have been a quick call. 

What followed was a twenty minute lecture about how the bone mass was worked up incorrectly by me and that I should involve ortho from the beginning in the future because an MRI was not indicated.

What? Since when do you not do an MRI for a bone mass? I looked it up while he was talking just to make sure. I am over ten years out from residency, after all. Guidelines change. Yep. There it was. For this particular bone lesion, next step after plain films? MRI. The jerk was trying to cover up their ineptitude by pointing the finger at me. 

I kept my mouth shut as he prattled on even though the anger was reaching a boiling point. All I wanted, ultimately, was for the MRI to be approved so my patient did not have to take the hit financially for something that was not her fault.

“I will go ahead and approve the study, but…” Blah, blah, blah.

You don’t know crap, sir. 

I hung up and let the patient know that it was approved.

I was well over thirty minutes behind schedule on patients now and spent the rest of the morning having to apologize to everyone. 

That afternoon there was a message from her husband. I braced myself as I clicked on it, expecting the worst.

“Thank you for everything you do for us, Doc. Have a good Mother’s Day!”

Here’s the thing: I teared up. Getting a thank you doesn’t really happen much these days. It threw me off balance and the rawness of the whole unpleasant experience that I had been carrying with me all day bubbled up and then melted away. 

It’s my job. I am happy to do it. But I had forgotten how much power a “thank you” can hold. So… I will remember. I will hold onto this and I will work harder to show my own gratitude to those in my own life.


122 thoughts on “Imaging

  1. It astonishes me how much of your time is spent on everything but taking direct care of your patients because of this unwieldy system you’re forced to practice in. And your patient’s husband reminds us all of the power of kindness and consideration.

    Liked by 2 people

  2. I was so there with you as you described your anger…. I HATE insurance companies, only secondary to the Gas and Electric company here.
    what a great story….. and by the way…
    Thank you so much for sharing pieces of your life with us all. You make us smile, you make us cry but mostly, you remind us what being human means.
    Happy day not just because you’re a mother.

    Liked by 2 people

  3. We don’t have to battle with insurance companies… just lack of resources and a system so overloaded with paperwork that the primary professionals seldom have real time for their patients. The good ones make time regardless. Thank you.

    Liked by 1 person

  4. It doesn’t matter what our job is, a little recognition and an occasional thank you go a long, long way in improving our outlook and peace of mind. As for the insurance hassle, oh yes, I feel your pain. ‘Cause I’ve been there.

    Liked by 1 person

  5. There are many ways to tell someone that you appreciate someone’s effort. You can fill enormous libraries about appreciating someone’s efforts.

    The simple and genuine “thank you” still are the most powerful two words in that situation in my opinion. Thank you for this good read.

    Liked by 1 person

  6. Happy early mothers Day Victo, and as several other people wrote today, thanks for pulling back the curtain and giving us a glimpse into your world on a regular basis. Yours is one of my favorite reads. DM

    Liked by 1 person

  7. Victo, Maybe your patients and staff fail to thank you when it should be a matter of course. But when it isn’t a matter of course the thankyou comes from deeper down. From my room here I am often alone and I love my contacts through my blog. And every time I post something you seem yo respond almost immediately. And I really want to thank you for that. It means more to me than you can know.

    Liked by 1 person

  8. Vic, your stories are always such a pleasure to read — emotional, and real, and usually painfully raw. I doubt this little comment will make such an impact on you, but I thank you. I thank you and I praise you every time I read one of these, and I think you deserve to be satisfied with yourself.

    Liked by 1 person

  9. That is so cool that someone would call and say Thank-you! Very rare these days.
    We fight with insurance companies every single day for the simplest of things, the poor patients and families feel like they are getting bounced around. It is so frustrating. The thing I don’t get, 99.9% of the time we are prescribing treatments according to the standards of care and the insurance companies just want to fight tooth and nail all the way. Why – why oh why does it have to be so difficult (I’m putting my fists up in the air, shaking them towards the skies).

    Liked by 1 person

  10. I feel for you with the system the way it is. You handle things well, and still manage to get things done. In a world where some truck drivers make as much as doctors, I wonder if all the training and liability is still worth it. Then there are people like you who genuinely care, and I can see that it is worth it to some.

    Liked by 1 person

  11. Very candid and touching post, doctor.
    Your job is tough, and I commend you for giving more to your patients than what the medical profession prescribes. You choose to be the doctor and the human being, contrary to what many of your colleagues do. You go out of your way to help patients, even sacrificing your personal life.
    You give a lot to us to, by teaching us through your lessons and reminding us in each and every post, that we too, can do the same to those we deal with in our different professions.
    Thank you!
    And happy Mother’s Day!

    Liked by 1 person

    • I think it is part of the cultural shift toward patient satisfaction. We teach people to expect the moon on their terms. They should be treated with the utmost care and respect and when you deliver that consistently, it takes more to impress them.


      • That’s a very profound statement Victo. You know 2,500 years ago Socrates said (in Plato’s republic) that a democracy will degenerate eventually into a dictatorship partly because in a democracy the most important and central concept is “me”, the individual. And the further that concept leaches into the day to day workings of our society, the further apart we drift and more we want. Couple that with capitalism and you get the rich getting richer and the poor getting poorer – which eventually leads to us trading freedom for security to protect our material goods. Hence the establishment of a dictatorship – one person chosen by the rich to protect the rich. (By the way, I think that a capitalistic democratic political-economic system is the best the world has yet designed – BUT – it needs limits and controls to spread wealth and ensure fairness and access to fundamental services , like health care and food)

        Sorry, mini-rant. :D.

        Liked by 1 person

  12. I’m still annoyed at Dr. So and So. Wondering if your read him the guidelines and if he ever admitted he was wrong, but, on the other hand, maybe I should let it go and not give the insurance company any more of our time. You did a great job of keeping your cool. Thank you, and have a lovely mother’s day!

    Liked by 1 person

  13. Did they talk about this sort of thing in medical school? That at various points in your career you were going to, you know, get jerked around a lot? Probably not much they can do to prepare you for that kind of onslaught.

    Ah, nuts. Happy Mother’s Day, indeed.

    Liked by 1 person

  14. Wonderful, wonderful insight into what MDs have to do besides practicing medicine. I’ve heard about these conversations with insurance companies so many times. Good on you for putting in that effort – and thanks!

    Liked by 1 person

  15. I have worked with United Health Care for quite a while and I know how you must feel. I just hope you don’t have to go through a lot of stuff like that in future. Hugs!!!

    Liked by 1 person

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  17. I’m so glad you got your “thank you.” About ten years ago, a really sharp ER doctor determined that my 30-year-old daughter had a pulmonary embolism, most likely from her contraceptive medication. Not everyone involved in her care that day suspected that, but he did and he was right. She recovered, but it could have been far worse—another local girl had collapsed and died from that while jogging a year before. I wrote a “thank you” letter to the ER doctor to let him know how grateful we were for his expertise. Too many people are quick to complain when something goes wrong, but sit on their hands when they could offer a simple “thank you” to someone who’s gone out of their way for them.

    Enjoy your Mother’s Day!

    Liked by 1 person

  18. VD, it is so gratifying to read your actions. As patients we are all there sooner or later — with an unexpected charge that should be covered or enormous bills for who knows what. I think the reason the impressions of the medical field are going down is actually because of insurance companies.

    So glad that you got a well-deserved thank you!

    Liked by 1 person

  19. You deserve it! I don’t know a doctor who would have gone out of their way like you did. Give yourself a pat on the back, and know you are making a difference.


    Liked by 1 person

    • Thank you! Do you really not know a doctor who go to bat like that for a patient? I can promise you that probably a lot of this is going on behind the scenes. We don’t generally talk about it to patients, though. πŸ™‚

      Liked by 1 person

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  21. Funny…I’ve always had this thought that wading through the phone tree of insurance companies was specifically designed that way to give us time to get over being angry about whatever issue we are calling about. It then gets replaced by anger and frustration over the automation and time invested on the phone, trying to navigate through the options. By the time we get someone that can maybe help, they are so precious to us that we do our best to stay pleasant, lest we have to go through it again. It’s a conspiracy, I tell you.

    Liked by 1 person

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