Prior Auth Parasite

Author(s)Richard M. Berlin, MD

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Key Takeaways

Prolonged payer-driven hold time is framed as a parasitic extraction of attention, time, and emotional bandwidth, requiring rehearsed dissociative coping strategies.
A trumpeter’s sustained performance under assault by a fly mirrors clinicians’ need to maintain composure and precision despite persistent, petty system irritants.
Graphic entomologic detail underscores the indignity of administrative friction, translating bureaucratic intrusion into visceral bodily violation and itching.
The closing shift from endurance to readiness to swat captures escalating burnout dynamics and the impulse toward confrontation when delays finally resolve.

"A “Prior Auth” parasite dumps me on hold, sucks another hour from my life..."

While the novelist is banging on his typewriter,
the poet is watching a fly…” —Billy Collins

A “Prior Auth” parasite dumps me

on hold, sucks another hour

from my life, one more chance

to practice my “Close-Your-Eyes-

And-Imagine-a-Blank-Screen”

coping skill, my mind filling the space

with a white-gowned trumpeter,

her horn flashing spotlight silver,

face focused like an athlete

determined to beat the buzzer.

The maestro flicks his baton—

a melody rising just as a housefly

circles on-screen and claims

the trumpeter’s temple, tarsal toes

digging for sugars, the fly liquifying

dead skin cells with vomit

before sucking them up with its soft,

spongy mouth, the trumpeter ignoring

the fly’s itch while she plays through

and nails the finale, right hand

suddenly a blur toward her head –

a slap and triumphant smile when

her middle finger flicks the dead fly

and she trumpet-pumps the air,

just as The Prior Auth Parasite’s voice

buzzes back on my phone. My itch returns.

Skills rehearsed, I’m coiled to swat.

Dr Berlin has been writing a poem about his experience of being a doctor every month for the past 28 years in Psychiatric Times in a column called “Poetry of the Times.” He is an instructor in psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts. His latest book is Tender Fences.