So yes, big long gap there for a minute, but I have not had anything more notable happening in my life than anyone else on the planet has (masks, long lines to buy food, child at home, obsessive checking of IHME stats), but there's a wee gap in patient care duties and a situation which is just so, so indicative of how completely stupid the medical system is that I can't resist; it is truly a self-sustaining industrial monster at this point, absolutely definitely not set up to serve any actual human beings other than possibly the corporate overlords. To wit:
1. I work several different jobs.
2. Each job requires that I get fitted for the particular type of N95 mask that they stock.
3. I have been successfully fit-tested for multiple types of N95 mask without difficulty.
4. The one exception was for my one un-busy job, which already has presented me over the last year with a number of bizarre and surreal situations, not the least of which is insisting that I physically come in to clinic at the height of the pandemic to see exactly zero patients. At the fit-testing for this job, (outsourced to an outside company), the technician seemed unsure of herself, saying it was her first time fit-testing someone. She had trouble decanting the saccharin into the test sprayer gizmo, and when she sprayed it, I couldn't smell anything. I suspected that she had just done it wrong, but I also have had a stuffy nose since March because of wearing an N95 all day every day, so who knows. I therefore failed that particular fit test; I wasn't terribly worried because there was another provider at that job who was willing and able to see any/all potential COVID patients and the total number of patients seen is very low, and I have other N95's from other jobs that I can wear to help keep myself safe.
5. Fast forward six months, we got a fit-testing kit to actually have at the clinic so it seemed reasonable to have another go. I filled out the preliminary questionnaire, marking 'no' to every question about symptoms other than 'Have you ever had difficulty getting fit-tested because of inability to smell?" The medical assistant sprayed saccharin at me, confirmed I could smell/taste it, and successfully fit-tested me.
6. I got an email from the clinic manager saying that before I could _wear_ the N95 mask I had just been fit-tested for to see actual patients with actual COVID symptoms I would need to get signed off by the medical director, because bureaucracy.
7. This is the waking-up-as-a-cockroach part: the medical director, who is a doctor, declined to sign off on my using the N95 mask I had been fit-tested for because I had marked 'yes' in answer to the question re: smell above, and told me I needed to get signoff to use the mask from... a doctor. (At my own expense, they made a point of telling me). Full disclosure: I am a doctor. I have no idea how I would evaluate someone's fitness to wear an N95 mask other than asking them if they'd passed their N95 fit test. I asked the medical director (a doctor whose job it is to provide other doctors with medical advice) this, and he has thus far declined to answer.
9. I now have a telephone appointment with my own lovely doctor, to ask her to write a letter either clearing me (or not) to wear the N95 mask I have been fit-tested for. She is way smarter than I am, so if there is some other way of determining fitness to wear an N95 mask other than doing an N95 fit test, she may know about it, but am I cynical to think this is more about keeping lawyers happy than about keeping me or patients safe? Hmm.
10. What I will likely ask my own lovely doctor to write (and what she will likely write): "Clearance given to wear N95 mask." What I want to ask her to write: "ARRRGHGHGHGHHGHGHGHGH what the FUCK this is a ridiculous farce if your own N95 fit testing procedure is not enough to guarantee someone's ability to wear an N95 mask, you shouldn't bother doing it; what the hell additional objective criteria is someone supposed to apply - over the phone, mind you - to determine this? I hereby grant permission for the patient to hide under a rock until the pandemic is over, at time-and-a-half pay."
Note that this is the same institution that, back in April (remember April? widespread asymptomatic transmission, no tests, completely overwhelmed Public Health... eerily similar to December except for the test part...), was instructing providers to "rule out COVID-19 over the phone" and to refer anyone for whom we could not magically, telephonically and definitively rule out COVID to, yup, Public Health, that same Public Health not answering the phones or website inquiries because they were at max capacity just trying to figure out how to test people with both symptoms AND recent travel history to Wuhan.
Can someone just make Atul Gawande God already?
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