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So, my insurance has been trying to not cover my SNRI because it is new on the market and no generic available yet, so pricey.

I apply for a refill and the request gets locked for review. Again. For the 3rd time.

This time I call and immediately ask to speak to the actual doctor making these clinical decisions. Very politely. Must be a slow day because they allow it.

ME: [Teacher voice] I'm calling in regards to the SNRI you have placed a lock on. Why was this decision made?

DOC: Well, there are dozens of other medications on the market in that tier, and far cheaper for you and [insurer]. We have sent a request to your doctor to consider alternatives.

ME: I am aware of that. So, can you do me a HUGE favor and look up my prescription history really quickly and tell me how many SSRIs and SNRIs were only filled once in 2022 for me, showing they were poorly tolerated?

DOC: It looks like eight.

ME: Great job! Now, can you please look at my genetic test for psychiatric drug tolerance and tell me how many medications are listed in the safe category?

DOC: Two.

ME: Awesome! Now, can you tell me what type that other drug is that I'm not taking?

DOC: Yeah, totally, it's an MAOI.

ME: That's correct, you're really knowledgeable! Should I be taking something as dangerous as an MAOI with my other medications, or even just in general?

DOC: It's contraindicated for sure.

ME: It is! So true! So, last question since you've been incredibly smart and helpful. Is it less expensive for [insurer] to pay out for the medication knowing they already get a huge manufacturer discount anyway, or is it more expensive for them to pay for me to need potentially long-term inpatient psychiatric care?

DOC: I'll clear the code, ma'am and flag it as medically necessary. I'm sorry about this.

ME: I appreciate you SO MUCH. You have a great day now.

their dynamic is more fraught and tragic than you could ever comprehend……

I think Psych is more like a Shawn and Gus show even if Shawn is the sort of "main character" but really Shawn wouldn't be solving crimes without Gus, he even goes to him start of show, and that is just facts. Because for all of Shawn's great eyesight and super-skills Gus provides the encyclopaedia level knowledge.

EDIT This one

“Do you know why I pulled you over?” is a trap. It means there’s a good chance the officer doesn’t actually have a good reason to ticket you, and is trying to get you to waive your 5th Amendment rights and incriminate yourself. If you make a guess, that’s a confession of guilt.

"amab" and "afab" are not euphemisms for "male" and "female." not even a doctor should be using "afab" as shorthand for "has a vulva, uterus, high estrogen levels, low testosterone levels, etc," because HRT EXISTS! gender affirming surgeries exist! intersex people exist! you can be afab and change, remove, or not even have been born with any of the above features!!

you cannot use "amab" and "afab" as a shorthand for "has this or that set of features!"

it's not about using progressive language, it's about accurately accounting for people who exist outside the sex binary. those of us who do are under-studied, and the medical system is poorly equipped to handle us, often lumping us in with our agabs and failing to account for how our bodies actually work. this is a PROBLEM that cannot be papered over by finding new euphemisms for "male" and "female"

We had a web system where people were basically automatically triaged for certain conditions and when I was hired there was a question for UTI symptoms that asked are you a man or a woman, routing women to same-day nurse practitioner appointments (because they usually had uncomplicated UTIs) and men to physicians (because they usually had STIs, and if they DID have UTIs they were more medically complex) but this meant that trans people were getting sorted wrong. A committee of me, a doctor, one or two nurses, and another administrator sat down and talked through what that sorting logic actually needed to do, what the risks were of sorting wrong, and what language would be acceptable.

We did not need to know their gender, their sex assigned at birth, their transition history, any of that. What we needed to know is how long their urethra is, because a short urethra means the likeliest situation is an uncomplicated UTI where the top priority is getting antibiotics into them as fast as possible to prevent kidney involvement, and a long urethra means the likeliest situation (in our clinical population) is an STI, but if it IS a UTI kidney involvement may already be a factor, so either way they need a doctor. The language we came up with was "do you have a penis?"