This customer comes up to the counter to collect a Z-pack and some codeine-containing cough syrup for what appears to be a respiratory ailment. He seems thoroughly pissed off and grumbles to me, "Why do I get this every month? Why is it when I ask the doctor why I keep getting this, he just says 'I dunno'??"
Well, sir (ran my inner monologue) it might be related to your being about 150 pounds overweight. I don't sense a lot of physical activity here. I sense a general state of unhealthiness exacerbated by a lack of some good air moving in and out of those lungs on a regular basis --- like the ol' cough-and-deep-breathe they make you do in the hospital when you're bedridden so you don't get pneumonia and things like that.
But boy, was he mad at that doctor.
My second thought today has to do with the dreaded Hospital/Nursing Home/Rehab Center DISCHARGE. No pharmacy wants to see this horrendous fax coming because it usually means mass confusion, multiple questions and unanswered phone calls, a long, long list of medications both new and old that need to be filled and a thoroughly hysterical patient or family who don't know what the hell is going on (and are completely OUT of medication). I'm sure there are many places that try to do their best in sending the patient out the door with a clear set of instructions. Most of the time, it doesn't seem to work very well. The medications have usually been copied down by someone who doesn't know what they are writing. Most of the stuff wasn't even meant to be continued after discharge. Doses or medications have been changed from what the person is used to taking, and they don't know why. Some people get really upset by this and when they are elderly or confused to begin with, it's never good.
The companies that provide pharmacy services to long-term care facilities, as well as every hospital pharmacy, should have a Discharge Specialist. Some hospital pharmacists do discharge counseling on a regular basis --- that's good. They sit down with the patient or family, go through that list of medications, weed out the unnecessary stuff and clearly show them THIS is what you were taking before, and THIS is what you're going to start taking NOW.
They also set up a mechanism for them to get those medications filled and deal with the 'refill too soon' because the nursing home has already billed for them. Wouldn't that be great??