June 30, 2014

On Drugs and Healthcare Communication

Well, most of you know the saga of Missus JB and her bout with Bacterial Meningitis a couple years ago.

Her lingering neuro effect is having to deal with chronic headaches.  Not the "Oh, drat, I've a bit of a headache" variety, but the "curl up in the fetal position and turn off all the lights and put cotton in her ears to keep the sound out and have a bucket close in case she needs to puke" variety.

For this, after some experimentation, her neurologist finally found the right combination of medications: Celexa and Verapamil.  One of each, once a day, and she managed to go a good while without a headache.

Until last week.  When she mentioned that she was out of her Verapamil.

So, she calls the pharmacy requesting a refill last Monday.  They tell her that her neurologist hadn't called in a refill, but they (pharmacy) would reach out to the brain doc and get it called in.

It's worth mentioning here that, because of her insurance at the hospital where she works, she can only use the pharmacy in the hospital.  And, do recall that she was admitted to that hospital with the aforementioned life-threatening brain infection.  And she's been getting her Verapamil and Celexa at same pharmacy in same hospital for nearly 18 months now.

Two days later, no pills.  "Whiskey Tango Foxtrot, Mr. Pharmacy Man?"

"The doctor's office didn't call it in.  Said you need to call them."

So we did.  And they called us back the next day: "We won't give you a refill until Doctor Neuro has seen you for a 1 year follow-up in his office."

Wait, WHAT?  Why didn't you inform us of this condition, say, a few MONTHS ago?  Is there a reason you failed to tell us he wanted to see her again in July?

"OK, fine... When do you have an opening?"

"Thursday, July 10" (week and four days from today).

The hell you say?  No.  Tomorrow.  If not sooner.  Call in the damn prescription.

If they don't, we can have our Family Practice doc call it in.  He's really a fantastic doc.

I'm gonna raise some hell with her neurologist's office staff.  I wager that they don't want to hear "Your failure to communicate important information has led to increased health problems for my wife" from me.

They just angered a sleeping giant.  


Old NFO said...

Go get 'em!!! This is the BS that seems to be more and more endemic with practices these days...

Anonymous said...

Just stumbled across this entry.

Here is some perspective.

1.By law, there are limits to the duration and refills that providers are allowed to prescribe. I'm going to go out on a limb and suspect that they were generous and provided a calculated year's worth, which seemed to last just under 18 months. Happens all the time. It's a win for you.

2. Simply renewing a prescription for a patient that hasn't been seen for 18 months may not only be considered malpractice, it carries practice implications as far as the board is concerned. The board would take a dim view of a provider who renewed a prescription on a patient that has not been evaluated in 18 months. Licenses have been suspended, and DEA numbers have been revoked or restricted.

3. I'm not sure I understand your frustration about the physician apparently being solely responsible for notifying YOU what was required for a renewal of the prescription. It's not like they are doing a pill count and know when Ms. JB ran out of medication or know how many headaches she has had in the past 14 months. They can reasonably assume that you will call them when you are low on medication or if you have problems.

Additionally, I suspect there was instructions on the paperwork indicating when you should contact the office to schedule a follow up.

If your FP doc calls in the medication without an evaluation, that is malpractice, too. They may do it anyway.

I deal with this all of the time; hundreds of patients in the practice all seem to think that their failure to look at the gd bottle to see how many pills or refills are left become my fault. On a Friday. At 9pm. When I am heading to the wilderness for the weekend to camping with MY children who sacrifice a lot so I can put up with "sleeping giants" like you. I am here to help you, but my practice does not revolve around your failure to address these issues in a timely manner.

Raise your hell with the staff; it is not something they haven't heard before, and the instant someone treats my staff with disrespect, they are fired from my practice. Legally I am permitted, and it allows me to open my practice to other patients who are smart enough to know that it is their responsibility to keep track of their medication.

Wish you the best in obtaining your medication.

Jeff B said...

I'm fine with the legal limitations and duration and refills and such. I also understand the need for such limits and for follow up care (side note: I've got 15 years as a paramedic under my belt).

What I object to is the failure to effectively communicate with a patient. This is a patient who has been seen by the neurologist for a couple years now for treatment of recurring migraines after a battle with bacterial meningitis. We've been to the doctor several times over that 2 year period, and we finally found the combination of medications that work.

Then the physician's staff fails to follow up and inform us "If you want another refill, the doctor needs to see you."