Tuesday, June 30, 2009

Michael Jackson and Respiratory Depression

Darn, those tapes of the Jackson 5 are cute, and I really liked "Off the Wall" and "Thriller." The guy really was talented, especially when you look at him in his pre-surgical prime and put him next to the fake pop stars of today.

But as soon as you heard that he was found 'not breathing' you knew, right? Prescription painkillers, narcotics --- how many times can you say "side effects include respiratory depression?" You take too much, your breathing slows down and then it stops. Unless someone's standing by with a syringe of Narcan or a respirator, you're in big trouble. It happened to Heath Ledger, Anna Nicole Smith (and probably her son), Elvis, Marilyn Monroe, Lenny Bruce, etc. ---- it's a loooong list. It happened to a kid in my neighborhood. There are lots of celebrities who have died as a result of illegal drug use, but the 'prescription' drug deaths always catch my interest, cause I want to hear what did it.

I have customers who I worry aren't going to wake up one day. And these are people who, as far as I can tell, are playing by the rules. They don't have multiple doctors or an entourage of enablers. So I can only imagine the precarious position of those that do.
There is speculation that Michael Jackson was on Oxycontin. I see prescriptions for Oxycontin all the time and wonder, as I look at the customer, what the HELL do you need this for? I know for a fact you don't have terminal cancer pain. So.....????? We had a surgeon who had pre-printed postop knee replacement orders for Vicodin, Celebrex (which was never covered) and OXYCONTIN!!! It's a bunch of crap. I see the FDA is getting all wound up about acetaminophen overdose right now. Maybe all these prescription narcotics that we shovel out the door every day could get some attention too.

Don't get me wrong; I'm not trying to take it away from the people who need it. It's just so maddening to see these (young) celebrities who have punished their bodies go out and find a Dr. Feelgood to prescribe something that's so frikkin' dangerous, and end up dead. There will be another one soon, no doubt.

On a lighter note, I got to vacation in California last week (land of the celebrity?). Just let me say, I have learned that there is no swimsuit on God's green earth that should be advertised as 'slimming.' This is the most unforgiving garment in existence. I have been schooled.

Wednesday, June 17, 2009

Go Ahead, Ask Me Why

Did you ever fill prescriptions for a customer who WORKS for the very insurance company you are billing, and argues with you about the copay? This guy today is telling me how the copays are wrong and proceeds to explain some complicated formula of how they are supposed to come out. I also had a guy get mad because the insurance company (that his wife works for) didn't cover his Golytely. Of course both these individuals decided to launch into their little discourse right at closing time.

....... the hell???? You guys know darn well that the prescription is billed online and your company's computer tells us how much to charge you. Why is it such-and-such a copay? ----

I dunno, YOU tell ME !!!

Monday, June 15, 2009

Care for a Sample?

A family friend (already on metformin) recently visited his doctor for high blood sugars and got put on an expensive, brand name medication (Janumet) which I view as being completely inappropriate at this stage in his initial treatment. To my simple mind, the prescriber seems to have leapfrogged over several other steps in the algorithm for Type 2 diabetes treatment.

I was curious and asked him if he'd filled the prescription yet, and how much it had cost. "Oh, I didn't fill it yet" he said, "the doctor gave me a whole bunch of samples, so I'm good for a while."

Damn, that irritates me. Does the doctor (who I know is kind of an old-timer) just pick this drug because he's got a bunch of samples to unload? Makes him look like a nice guy to give free drugs to this elderly patient? And what happens when the samples run out and the patient goes to fill the prescription? Yep, you got it ---- the duty falls to a pharmacist like you or me to break the bad news ---- either it's not covered at all, or the copay is astronomical.

This friend lives in a different part of the country than I do. The clinic system I work in, with very few exceptions, no longer accepts samples. I can remember a few times in the past where physician samples occasionally came in handy --- like, for someone who couldn't pay for a prescription, or lost it, or spilled it, etc. --- kind of a one-time deal. And I can honestly see where a physician might want to give a patient something to 'try', without committing them to a full month's supply of a medication. But it became too much of a hassle to document the dispensing of samples and of course the accepting of gifts and samples from drug companies is now being reined in. I can remember sifting through PILES of samples in an out-patient clinic where I used to work, checking for outdates and looking at drugs I'd never even heard of !

Now we're not supposed to have ANYTHING, even behind the pharmacy counter, with a drug company logo on it. But I don't have a sense if there are certain areas or independent practitioners out there who still readily accept these.

I actually don't think that these things affect the prescribing habits of a doctor who really knows his/her stuff. Any more than having a beautiful "Airborne" travel thermos would ever make me recommend the stuff to anyone.

But this incident with my friend's diabetes treatment was, shall we say, disappointing.

Monday, June 8, 2009

Crazy Talkin' with Oprah

I was pleasantly surprised to read this week's Newsweek article entitled "Crazy Talk: Oprah, Wacky Cures and You". The article discusses how Oprah, wielding considerable influence with her talk show, often features health, beauty and medical topics; unfortunately she doesn't always feature credible people to discuss these topics (for example, the actress Suzanne Somers, who apparently takes 60 supplements daily including 'bioidentical hormones" and does some pretty crazy stuff ). The gist of the article as Newsweek suggests, is that "some experts offer useful information. Others gush nonsense. Oprah can't seem to tell the difference." And for the many daily viewers of Oprah, this can be hazardous to their health.

I'm no medical genius, but I have a little more background than the average person. I love the arts, but my training was in the sciences. I have a really low tolerance for 'experts' on TV who babble stuff that is totally nonsensical from a scientific standpoint. I truly believe our country will be left in the dust if we don't start doing more than paying lip service to the need for more math and science training. I wish that shows like Oprah (or the science and health segments of cable news) would really spend a little more time with the actual doctors, researchers and scientists who study these subjects. But of course the problem is those people aren't the pretty people. They don't do sound bites. They would need time to explain the background information to viewers. And that's boooo--riiing -- we'd rather listen to the pop culture folks who entice us with suggestions we can cure our psoriasis by thinking positively. Sure, a good attitude helps and a good overall state of health helps, but what people really need is to be educated about their illness with solid scientific information.

And I love how these people call themselves "Dr." Whatever. Dr. Phil is NOT a doctor.
Dr. Drew is NOT a doctor. Which is not to say you can still be an actual doctor and not be a little loopy (sorry Dr. Grumpy, I don't mean you.) Check out this tidbit from the website of one of Oprah's frequent guests, Christiane Northrup, M.D. , as mentioned in Newsweek:

"In many women thyroid dysfunction develops because of an energy blockage in the throat region, the result of a lifetime of "swallowing" words one is aching to say. In the name of preserving harmony, or because these women have learned to live as relatively helpless members of their families or social groups, they have learned to stifle their self-expression."

WTF ??????? How do you think your professor would have graded that answer on your endocrinology unit? Energy blockage?

No, I'm sorry. That is NOT what causes thyroid dysfunction.

But Oprah's got a big platform, and if she's got no one there to challenge that then we've got a long way to go. I was glad to see a news magazine shine a light on this subject.

Thursday, June 4, 2009

More Fun with Electronic Prescribing

We send a refill request to Dr. XYZ for a patient's medication and get back a faxed note which reads, "NEVER seen by Dr. XYZ'--- please send to primary care doctor."
We retrieve the hard copy which unmistakably shows "Electronically signed by Dr. XYZ".
We send BACK the refill request and attach a copy of the previous prescription, highlighting the 'Dr. XYZ' part on it, almost like you'd do for someone who has trouble reading. We have NO time for this, but we must do it anyway.

Later in the day we get a new prescripton from Dr. XYZ for the medication we requested.

This happened not once today, but three times.

Something is not working here. It's not like Dr. XYZ pulled a prescription pad out of his pocket, scribbled it out and slipped it to the patient. The thing is computer-generated, saved, archived --- there's a TRAIL here. It's in the electronic medical record, isn't it?

Just another reminder that the system is only as good as the humans using it. And today they weren't paying attention.