Letter from the Editor
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Frustration
I have been practicing neurology for a good long while now, and for most of those years I have been a clinical neuroscientist.
What exactly is a “clinical neuroscientist?” Although the job description varies on virtually a daily basis, if you toss into the blender clinical management of patients with neurologic disorders, research involving human subjects rather than cell cultures or rats, the training of medical students, residents and fellows, and medical writing for peers and a lay leadership, what emerges is a tasty salsa that has kept me engaged and generally content for over 4 decades.
Much of my research has focused on therapeutics – primarily for stroke and for migraine – and I was lucky to begin my neurology career at a time when clinical research in both areas was just beginning to accelerate. In migraine it has been my very good fortune to have helped in the clinical development of most of the medications we now are using for acute migraine treatment and for migraine prevention.
It is an exceedingly fine and reinforcing experience to help develop a new therapy, to help shepherd that therapy through the research process to FDA approval and across the doorstep to general clinical use, to prescribe that therapy in the ER and my clinics and to observe my patients respond so well. Little else in medicine has brought me so much pleasure.
It is an exceedingly frustrating experience to have insurers deny my patients access to the therapies I have assisted in developing, and that frustration is amplified by the time spent pleading in vain for those insurers to reverse their decision to deny.
Portions of this issue will reflect my frustration. This Provider versus Insurer struggle is no joke, and I can assure you that my own frustration is shared by legions of my fellow physicians. We live and work in a time when the agency of physicians is being sequentially whittled down by administrators, to the point where the practice of medicine is becoming increasingly less attractive to both active providers and to those who otherwise might step in to replace us when we pass on. At times it seems as if The System and those myriad administrators whom it employ are devoted to a strategy whose goal is the elimination of all physician agency and – as logically would seem to follow – physicians themselves. An odd goal. Once you have achieved total ascendancy, who precisely will provide you with the medical care you inevitably will need?
I guess with aging – both in life generally and definitely in medicine – one is fated to pass from “bold young innovator with unique insight and interesting ideas“ to “iconoclast” to “curmudgeon”, and with graduation to the last stage comes the inevitable compulsion to repeatedly utter “Now back in my day,…”. I fully acknowledge my lack of immunity to this evolution, but I also can promise you that – despite the stupendous advances I have witnessed in diagnosis and treatment during my career – much of what has reinforced my gratefulness for having the opportunity to serve as a physician is now being lost. It is time to fight back, and we need you – our fellow citizens and patients – to help us fight back successfully.
