Yesterday I held a mother in my arms so she could cry her tears of frustration.

She stays up all night to care for her crying child who scratches herself until she bleeds every day. She’s only 2 years old yet she’s spent most of her life putting creams after creams on her little body for severe eczema.

My patient needs Dupixent (injection). But her insurance won’t cover Dupixent until she fails crisaborole. It won’t cover crisaborole until she fails tacrolimus. It won’t cover tacrolimus until she fails 2 moderate to high-potency steroids. I know her insurance too well.

We have to go down the “list” of creams and fail each one of them against my clinical judgment because insurance dictates what I do. It will take us months.

My patient will spend these months not sleeping. And her mother will spend these months blaming herself and wondering if she’s done anything wrong.

So yesterday, when I prescribed more creams, the mother cried — as many mothers have cried in my office before. And I know why she did. She’s tired, hurt, angry, unheard, and desperate. She hates the world for not giving a da*n about her baby. And I’m in that world.

But I couldn’t jump ahead in this so-called “step therapy” imposed on me by the insurance company. To call it “therapy” is to insult my profession. It makes me want to scream.

How dare the insurance company practice medicine without a license, gateway what I can prescribe without EVER stepping foot in my exam room?

Because if they did, this is what they would see:

My little patient with weepy red cheeks sat on the exam table rubbing her little legs against each other and scratching her arms silly. Her eyes were playful but her body couldn’t afford to be.

She didn’t ask me to help her. She asked me to care about her.

She is not my child and I’m not a mother. But I speak the universal language of Loving a Child. And now, I also speak the shameful language of Failing a Child — as an adult, and a supposed healer.

My spoken words: “I’m so sorry. We will get her better. I promise.”

Pale. Meaningless. Cowardly.

My unspoken words: I wish instead of playing the stupid, unethical, unlawful, inhumane game with the insurance companies, we could just Help a Child, instead.