An open letter to my doctor's Medical Assistant

Dear Medical Assistant:

I've been out of a medication for a month. My pharmacy has called and faxed you and I've called and faxed you. We've left message after message - to the point that the last two times I called your voice-mail was full and you couldn't even get any more messages.

Really? Are you that busy or are you just overwhelmed? Could it be you're just not equipped for the job you're doing? I think it might be the latter because the last time I actually spoke to you you had no idea about  medicine. You had no idea about liver enzymes or what they were, you were puzzled about what the normal readings on something as simple as an A1c test were and you couldn't even pronounce most of the medications we discussed. That's a little scary.

Look, I know. You have six months of training at a "college" that used to be a Circuit City or an abandoned car dealership. I get it. You probably owe in the tens of thousands of dollars for that "education" and may never be able to pay off what you owe. But that doesn't excuse your mistakes and inability to take care of patients. If you want to be in medicine that comes with a big heaping helping of sacrifice. I know, I used to be there.

Once upon a time there used to be someone who helped the doctor called a nurse. Specifically, there used to be someone who helped the doctor called a Registered Nurse. A Registered Nurse (or RN) has an actual college degree from an actual college. Some have two year degrees and some have four. Regardless, they all study very hard and take lots of weird classes like pharmacology, anatomy and physiology, microbiology, psychology, and even spend a lot of time working practically in hospitals and clinics. After all that and the hundreds of tests they take while in school they have to take another big test to actually get their license to practice. Then, they still have to go to school for a certain amount of time every year to keep their license! It's a lot of work and they were very good at their jobs for the most part. They understood patients' problems and could react quickly and prioritize their duties. They also got paid handsomely for all this knowledge and skill.

Then the insurance companies looked at how much doctors charged. They thought doctors charged too much because, well, those RN's had to be paid good money. So the insurance companies began cutting back on what doctors were allowed to charge. Enter the Licensed Practical Nurse or LPN. The LPN didn't have quite as much education as the RN but still, it was a minimum of one year of training and most of the classes were the same. They still, generally, attended real colleges or community colleges and still had to take lots of tests. They also had to take a licensing test before they could get a job. While the LPN's weren't quite as knowledgeable as the RN's about their patients' health and needs they still did a pretty good job.

But, as things go, the insurance folks decided LPN's were just too expensive too. So, they cut those rates until there had to be someone to fill the gap. The doctors knew they couldn't just turn loose their secretary on the patients so a new "profession" was created - the Medical Assistant. The MA was three parts secretary (or administrative assistant) and one part health care associate. The education requirements were minimal - as little as six months in most cases and there were no licensing requirements. If you made it out of school, you were golden. And most of the new for-profit colleges springing up on street corners made sure you made it out - whether you actually got the knowledge or not.

And that brings us to you and why you don't know what ALT means or even what liver enzymes indicate. And why you can't pronounce illnesses or medications - much less understand what they are or what they do. But what it doesn't explain is why you can't figure out phone messages. That's the one thing looking at the curriculum for your program that you should be able to do. Ninety-nine percent of your college time was spent on office systems of one type or another. Surely, phones and fax machines were covered. So, why have I been out of my medicine for a month?

Maybe it's not just the slow decline of quality of care because of the for-profit medical system we have in the United States. Perhaps, I'm over-analyzing things as is my wont when I'm out of a certain medication. Of course, maybe... just maybe... you're an idiot.

Your Patient