Wednesday, July 17, 2013

The Public, the Providers, and the Plodding

As the routine daily tasks of pharmacy continue on these days,  I find myself thinking about the general state of our health care system and how uncertain/hopeful/apprehensive I can feel all in one day.  I'm thinking of three components..........

The "Public" Factor:

I just returned from a trip to a large, very busy city -- surrounded by people jammed in the streets, mostly looking at their cell phones, lost in that cell-phone world of whatever the heck they are looking at that can't wait until they have fully crossed the street.  Additionally,  I'm always stunned by the inability of large numbers of people to follow simple directions ("Turn off all electronic devices now."
"Order here."  "Pick up here."  "No parking." "Retain your ticket stub."  etc. etc.)    I always think it does not bode well for something like health-care reform, which is going to require people to 'do the reading', comprehend, and apply what they've learned.   People who have health insurance right now generally do a poor job of understanding it and reading the fine print.   It's only gonna get worse, and they are going to blame everyone but themselves. And they're still going to make a full-out $150 doctor's appointment and come out of it with a tube of $3 hydrocortisone cream.   I'm not hopeful at all.

The Providers:

 A physician is retiring from a medical office nearby, and I asked his nurse one day if they were going to replace him.  She said they hoped to, but  "it is very difficult to find a male M.D."   I found that interesting, and worrisome.   We have seen the trend of alternate prescribers (physican's assistants, nurse practitioners) take hold in the last few years,  and in many cases they are a great alternative for those minor ailments.  But they are probably going to be asked to do more and more that is outside the scope of their practice.  I have gotten phone calls from these folks asking me some prescribing questions that I would consider pretty 'basic,' and that's a little scary.  I had a nurse-midwife send a prescription for Seroquel the other day.  We needed some clarification on the dose and after calling her she realized that she didn't mean to write Seroquel at all, but something else.  Yikes.   And when you've got Americans consuming 80% of the world's prescription painkillers, you know that there are not enough M.D.'s (male or female)  anywhere to keep up with those scripts.

The Plodding:

On my recent trip I was surrounded by technology.  Buy something, and they e-mail you the receipt in seconds.  Wave a card in front of your hotel room door and it opens.  Your airline boarding pass is sent to your smartphone.  iPads are everywhere, for crying out loud......  I feel like the airport lounge has better technology than my pharmacy.  We are so FAR behind.  We are still fumbling with insurance cards (when we're lucky enough to be presented with one.)  We're still running out of drugs because our damn inventory system doesn't work properly.   I'm still getting electronic prescriptions that say "Take 1 tablet daily  Take 2 tablets daily."  (yes, an actual script from last week, that resulted in about a 48-hour delay and many phone calls until someone called us back. )  And of course, I'm still spending 15 minutes on the phone to find and retrieve a prescription, e-scripted to the wrong pharmacy, for frikkin' over-the-counter VITAMIN D.  And the customer is screeching "How LONG IS IT GONNA TAKE?"

Yup, this is gonna be interesting.