Saturday, April 18, 2009

The Most Excellent Doctor's Appointment

In my work setting, a lot of the patients we see are coming right out of their doctor's appointment -- as in, across the hall right into the pharmacy, with their prescription in hand or having been transmitted to us electronically. As I am handing the prescriptions over and giving the appropriate spiel, I can tell immediately whether I can rate that doctor's appointment as a SUCCESS or as a FAILURE.

SUCCESS: The patient has a basic idea of what they are getting and why. They can confirm that what I am telling them matches what their doctor said. They know how long to take it for and when (or if) they need to see the doctor again. They may have a handwritten note from the doctor with some of these things jotted down. If the prescription is a device (like an inhaler or Epi-Pen) they may have even been shown how to use it or watched a video. Beautiful.

FAILURE: "What did he give me?" Total deer-in-the-headlights look. "Why did he give me X when I thought he was giving me Y?" "No, I don't know which of those 3 creams goes where." (and the prescriptions don't say either)... "No, they didn't say how long to keep using it." "What am I supposed to do if I don't feel better after 3 (7,10) days?"
"Am I supposed to keep taking my other blood pressure medicine with this one?" "Am I only supposed to use it if I need it, or all the time?" "He told me to get some Vitamin B52.... do you have that?" And so on.

I might be able to take a stab at some of these questions, but I really cannot answer (legally or practically) for the prescriber. What I would really like to do is tell the person to march back over to the office and have a 're-do' of the whole thing. But more often I am obligated to get on the phone and pull the doctor or nurse out and ask them what this person is supposed to DO who was just sitting in their office ACROSS from the doctor, not FIVE MINUTES AGO. Annoys the crap out of me when I am up to my eyeballs in prescriptions.

Now I know there are lots of people who are given perfectly good instructions who just don't listen. It goes in one ear and out the other -- they're nervous, preoccupied, whatever.
But I also think that some people do get the bum's rush out of the doctor's office and just aren't given clear instructions, and I have experienced it myself even though I know what questions to ask. And the doctor may be really nice and all, but sometimes they are TOO casual -- I mean, you really gotta spell it out. We pharmacists have to tell people the same things over and over and it's tedious and routine, but part of being a 'professional' is just doing it. It's like doing the same Broadway play for 9 performances a week.

My "Good Doctor" will:
1. Tell you what he thinks is wrong with you.
2. Tell you what he plans to do about it.
3. Tell you what will happen if it doesn't work and exactly when to come back.
4. Write it down if necessary.

That way I can concentrate on doing my part of the job. Excellent......!!


The Ole' Apothecary said...

In courses on counseling, I was taught to ask, "What did the doctor tell you that this is for?" I recall from my retail days that the answer to this question was usually, "He didn't say anything." Either he said nothing or the patient heard nothing,but I think the former is more common.

Both the doctor and I should be telling the patient what the drug is for. It at least confirms the prescription, which is what counseling is also for--a double check against prescribing and dispensing errors.

No matter what the hurry, I cannot believe that the doctor would not do the required medical act, which is to explain to the nature and the purpose of the treatment.

Anonymous said...

I have experienced that as a patient to. I never tell my doctor that I am a pharmacist because my older friends found that the doctor treated them differently and made assumptions. I was prescribed sporonax (itraconazole) on a pulsed dosage regime. The gp printed off the prescription, handed it to me and sent me on my way, script just said to be taken as instructed. Luckily I knew my dosage schedule, but if I were Joe Muggins off the street, i would not have had a clue. I dont know if the pharmacist would have given me advice as I went to a friend's pharmacy for my script, so obviously they know who I am.