The Troubles with the Physician-Patient-Pharmacist Relationship

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I was sure this morning when I checked my face in my rear-view mirror one last time before entering the workplace, only to find that one of my basset hound’s squishy, gray eye boogers was plastered to my cheek, that it was going to be a bad day.

She is very pretty, though.  And definitely worth the eye boogers.

It wasn’t really overall very bad.  But there is one particular area of my day that was just usually awful.

I had a usually awful day dealing with very rude and unhelpful people who work in various doctor’s offices.  Here’s the thing, if I take the time to call a doctor’s office, I am usually doing for the patient as a courtesy, and about 98% of the phone calls I make are either the patient’s or the doctor’s responsibility.  But I generally like helping people and try hard to do that.

I am blogging about this issue to make myself feel better, but there are some outstanding problems with the way things currently work in the outpatient medical world.  Here are some of the problems that I have outlined in my mind today with the current physician-patient-pharmacist relationship.

1.  There is none

I feel as if there is a complete breakdown of communication between physicians and pharmacists.  It is no one side’s fault.  We are both guilty.  We are both busy.  The perfect example is the fact that the system that has been developed to renew a patient’s refills is a faxed form.  Pharmacists like faxing for refills, because it takes much less time than calling.  Doctor’s like it when we fax for refills, because all they have to do is check a box and enter the number of refills they would like the patient to have based on if the patient has kept appointments and, hopefully, the status of the patient’s disease state.  Faxes are convenient for both parties.  But a phone call gives opportunity for communication.

2.  The Phone Answering System at the Doctor’s Office

Scenario:  I have an 80-year-old woman turn in a prescription for nitrofurantion (an antibiotic commonly prescribed for the treatment of urinary tract infections).  She is going to wait in the store, since she knows it will not take too long.  My first reaction is, “This is not going to work for her.  This medication is contraindicated in patients older than 65 because their kidneys are ‘worn out’, for lack of a better term, and no longer have the ability to concentrate enough of the antibiotic into the urine to kill the bacteria causing the infection.”  But from my many experiences of calling doctors about this issue and having them refuse to change the medication, I go ahead and start to fill the prescription.  Then my system alerts me that this particular patient is highly allergic to nitrofurantion.  I have to call.

I pick up the phone, dial the number, and have to waste my time listening to a ridiculous number of options, none of which are appropriate for me to push.  Usually it goes something like this: “Press ‘1’ for appointments, Press ‘2’ for lab results, Press ‘3’ if you are physician, Press ‘4’ for medication refills”, etc.

Out of those options, the one closest to what I am trying to accomplish would be ‘3’.  But any pharmacist that has made this novice mistake knows that you should NOT PRESS ‘3’, unless you want a very hateful response and a complete waste of your time explaining that this line is for physicians only and you are not a physician.

If you are lucky enough to get an actual person on the phone instead of just a voicemail, as soon as the word pharmacist or prescription comes out of your mouth, the response is, “Hold on, I’ll get to the message line.”  I DO NOT need to leave a message!  I need to speak with someone right now about a serious issue.  I mean, I guess I could tell the 80-year-old lady to come back later, but that is not easy for everyone.  The patient only sees me as withholding medication from her and trying to give her a hard time.  She doesn’t understand that I have possibly prevented a serious reaction for her that the prescriber missed.

The thing that gets me is that if a doctor or a nurse wants to speak with me, I am available almost immediately.  I know that some of the chain pharmacies have a few options on their phones before you can talk to a human, but they are usually short and make sense.  At my pharmacy, we have NO menu to sit and listen to.

Phones are a major problem and need to be completely re-worked!

3.  Irresponsible Prescribing

A large portion of my job is to be the gatekeeper for narcotics entering the general population.  I have to spend a great amount of collective time each day checking to see if a patient is getting too much of a controlled substance.  If this does manage to slip by me, I am held accountable.  I am fine with this fact.  But the amount of responsiblity placed on me and the person who actually prescribed the medication is not proportional.  Some doctors write for ridiculous amounts of controlled substances.  It is almost as if no one has the power to regulate what a physician prescribes.  Anyone with a brain knows that 360 oxycodone 30mg tablets and 240 Xanax 2mg tablets is not appropriate therapy for ANYONE!  If you are prescribing absurd amounts of controlled substances, or if you are prescribing any amount of controlled substances without doing your homework to see if the patient is getting them from other prescribers, you are not prescribing responsibly, and you are contributing to the addiction epidemic in this country second only to obesity!

There.  I said it.  It is the prescriber’s responsibility to prescribe responsibly.

4.  Prescribers Do Not Know Pharmacy Law

The practice of pharmacy has like a gazillion laws, so I would not expect all prescribers to know every detail of pharmacy law.  But if you are going to write for a schedule II narcotic, than you need to know and understand the laws about schedule II narcotics.  It goes back to responsibility.

Scenario 2:  A man brings in a prescription for a powerful schedule II pain medication for his wife.  She is not feeling well and is at home.  They do not have prescription insurance, and need to pay cash for the several prescriptions they are bringing in.  The man states that his wife has never had the medication before and is concerned that it will be too strong for her or make her sick (which I agree), so he does not want to pay for the entire quantity of 120 tablets that were prescribed.  I explain to the patient that he may get filled as many of the tablets that he wishes, but the rest of the prescription will be voided, according to federal and state laws.  He says that’s ok, he just wants 20, and I document that I told him about the law.

A few days later I answer the phone to a prescriber completely blessing me out for mis-filling the schedule II narcotic prescription she wrote for the patient.  “Why would you withhold the medication I prescribed for my patient!?”, she frantically and somewhat abusively enquires, oblivious to before mentioned laws.  When I patiently inform her that I did not mis-fill the prescription and of the federal laws surrounding the prescribing and filling of schedule II drugs, her response to me is, “Well I don’t feel like writing another one.”

The truth is, if she had really listened to her patient in the first place, she would have been aware of her concerns about the medication.

I did later get an apology for the accusation, but it never seemed to occur to her that it was her responsibility to know that law.

There are many problems on the pharmacy side as well, most of them having to do with governing laws which are beyond the local pharmacist’s control.  I really think we should be working together to overcome these and other issues that stand in the way of patient care.  The patient and their well-being should be at the top of our priorities.  That may mean me making more calls and less faxes, or prescribers taking more time to communicate with their patients and us, but it needs to happen.  We all make mistakes from time to time, ad we need to ban together to make it harder for mistakes to happen.

Murphy’s Journey

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Today was the first time I have been directly involved in basset hound rescue efforts, other than “rescuing” my two.  I have wanted to be involved for a while now, but my schedule has been packed with residency work, and before that, school work, for years now.

Early this morning, my mother, my nephew, and I helped transport Murphy to his forever home.  Murphy is a senior basset that has been in a foster home in Unicoi, TN for a while.  He has finally found a forever home, but his adopting family was all the way in Iowa!

So, through a system of volunteers taking their turns driving short distances, Murphy is on his way home!

He was such a sweet boy!  And such a very large boy!  This is why I brought backup.  His 77 pounds of hound love could not get into or out of the car!

Here is some pictures of sweet Murphy , or “Hoss”.  I hope to help more in the future!

Empty Tomb Pastries

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When my friend, Ariel, shared this recipe with me yesterday, I had to try it.  It sounded delicious, easy, and clever.  Making the pastries with children – if you have human children, not just hounds – is a great way to teach them the story of the Resurrection.

Here’s what you need…

 Canned Crescent Rolls

Large Marshmallows

Butter (about a half a stick)

Sugar

Cinnamon

Icing-

Milk

Powdered sugar

Steps:

1.  Preheat oven per crescent roll package and roll out the dough on a cookie sheet.  I sprayed with some Pam, because the sugar and marshmallows will be sticky.

2.  Melt about 1/2 stick of butter and add some cinnamon and sugar.  Wisk together.  You don’t have to be exact.

3.  Dip the marshmallows in the butter mixture.  Cover them completely.

4.  Place the marshmallows in the center of the dough.

5.  Roll the dough into crescents, but make sure to seal off all of seems, or the marshmallows will make a mess!

6.  Brush the remainder of the butter mixture on top of the rolls and bake according to the crescent roll package.

7.  Mix powdered sugar, a tiny bit of milk, and vanilla (if you want) to make icing.  I think mine was a little too thin, but add milk or sugar for desired thickness.  Drizzle a little over the top and enjoy!

The tomb is empty!  Or, well, the marshmallow disappeared into the roll!

“He is not here, for he has risen, as he said. Come, see the place where he lay.” – (Matthew 28:6 ESV)

I’m about to have a spell over these pastries!

 

 

 

 

 

 

Hound Photos

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I decided last Sunday afternoon, as I often do, to take the camera out in the back yard for a few quick shots of my two basset hounds, Annabelle Mae and Earl Jefferson. I like to do this from time to time because you never know when you are going to get that one great shot, or at least I don’t! I am a novice photographer.
However novice I may be, my subjects are incredibly photogenic. I thought I would share a couple of my favorites.
The first one is of Annabelle and her fat rolls in a freeze frame as she runs towards me down the hill. The second one is my majestic Earl. I hope you enjoy!

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Too Cool For Facebook

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I have always been bothered by people deleting their Facebook accounts.  I don’t know why it bothers me.  It shouldn’t bother me.  What they want to do with their life is up to them completely.  And believe me, there are some people I wish would delete their Facebook and make my news feed a more pleasant place to be.

You may say, “Why don’t you just delete those people from your friend’s list?”  Here’s why — I don’t do that!  Deleting an internet friend is pretty serious to me, and honestly, rude.  In fact, I can recall only deleting one FB friend in my 7 years as a social networker, and this was because I felt I was being religiously attacked to the point of I had a nightmare about this person.   To me, deleting one friend is rude, and deleting an entire account is rude times 467 (or insert number of friends). That’s just my opinion, but I can see how other people would not agree.

People take offense when they find out they have been deleted in many cases.  This is why I have endured remaining friends with people that I do not agree with, are down-right annoying, or serve as a constant reminder of very painful situations in my life.

I know that many people have very pure and good reasons behind deleteing their FB, and truly are not being rude.  For example, I know many Christians who delete because they feel they are wasting too much time on FB and not focusing on God.  This is a very valid point, and I know true in my case a lot of the time.  But I personally think staying connected to 500+ people every day, knowing what is going on with their lives, and being able to quickly encourage them can’t be bad.

One excuse people give for not wanting to be on FB is that they do not want to read every detail of so many people’s lives.  While, I can agree in some cases, the truth is, I really do care what my cousin had for dinner or what one of the students I have worked with over the years is wearing to prom.  And I think that’s ok.

Some people state that they do not lilke the content of what others post.  Again, I agree that not every thing I read on FB strikes my fancy, but who cares!  I am always about freedom of the post!  It’s your life!  If my 13 year old FB friends want to post about Justin Beiber, I will not be interested, but post away!  If my basset hound friends (or I) want to post 46 pictures of your hound’s paw…please, be my guest!  I am erked when I see a post critisizing another’s post.

You have to choose.  Endure people’s posts or delete them.  But if you delete them, understand the consequences that come along with that.  They may resent being deleted by you.  That’s just the way it is.

Another reason people give for deleting is that they are too mature for FB.  While it is true that 13 year olds do share our cyber space, my MAMAW  and her even older sister have FB accounts!  I guarantee they  more mature than all of you guys put together.  I’m sure we can learn a lesson or two about life from these two ladies, and if we are lucky, they might share an insightful post on FB.

I know I am not one hundred percent right on my views of deleting FB and that there are plenty of valid reasons, but I have to admit every time I read someone’s threats to delete theirs, I can’t help but to think they are being incredibly arrogant.  To me they are saying, I really don’t care what is going on in your life, because my life is so full and enriched that there is no room for anyone else.

Most people that I think of off the top of my head that refuse to join the rest of the world on FB are arrogant people.  There are exceptions, but a lot of times these people will flat out tell you, “I’m too good for that.”  Whatever, that is up to you, but I don’t feel that way.

I have met so many wonderful friends through FB over the years, and though I may have never been privileged to know these people in person, I am lucky to have an avenue to be touched by so many lives.  You may not know this about me, or care to, but I have an extensive network of basset hound-owning FB friends from all over the world.  These people have helped me when my hounds were sick, encouraged me by seeing them all work together to find homes for homeless hounds, and at least one of them makes me smile every single day!  I have even had one extraordinary FB friend help me with Excel when NO ONE else in the world could it seemed!

What a wonderful age it is that I have friends all over the United States, in Canada, and even Italy that share the same passions for ridiculously long dog ears as I do!  I may not be able to read all of the posts from my Italian friends, but their pictures warm my heart!

I have also connected with people through an Adult Congenital Heart Disease group.  I have made some wonderful friends that I can share my concerns with, and they completely understand!

I have connected with old friends that I really missed out with getting to know well in high school or previous years.  I think sometimes to myself, “If I could just go back and not be so weird/quiet/snobby I really think we could have been bffs.”

If you are reading this and have considered deleting your FB, please do not be offended.  This is just my crazy opinion, and you do not have to agree.

If you are reading this and are my FB friend, thank you for improving my life and making my smile!

Mad Men Obsession and Contemplations

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In the past month, I have become somewhat obsessed with the television series, Mad Men.  Recently, I have watched more of this show than I have blogged.  I have found myself becoming completely wrapped up in the time period the show was set in, late 1950’s, early 1960’s.  The clothes.  The hair.  The over-all style of the show has become something I am striving to slip into my life anywhere I can get away with it.

For example, I want a retro hairstyle.  I’m thinking something like this…

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Maybe not exactly Mad Men hair, but still retro and something I could see for myself.

Anyways, I have caught myself thinking many times lately, “I really wish I had lived back then.”  I have this thought for a variety of reasons.  I would love to wear a dress, gloves, and pearls everyday.  I think I would have loved to live in a time when women were expected to stay home all day with the children, but still had “help” to do all the cooking, cleaning, and baby raising.  I think it would be neat to live in such a prosperous time for America and I cannot imagine what change that generation has been able to witness. 

But then I remember my nearsightedness.  The truth is, if I do not have my contacts in I really do not think I could see well enough not to walk into walls.  I am not sure about this, but I do not think contact lenses were invented in 1962.  My options in life would have either been…

thick-lensed cat-eye glasses or…

see the world as blurry as the guy in the background.

What would my life be like without contact lenses? 

After I am done silently thanking whoever the person is that invented contacts, I remember that if I had lived in this time period, I really wouldn’t have to worry about how well I see, because I wouldn’t have survived past 2. 

I was born with a congenital heart defect called tetralogy of Fallot.  I haven’t blogged much about this, maybe I will in the future, but I am completely fine now.  But I did have to have a series of 2 open-heart surgeries to correct the defects.  Without these surgeries, I would have died. 

The first successful total repair surgery for tetralogy of Fallot was performed in 1954, but the surgery was not considered routinely successful until the early 1980s.

Thank God for medicine, thank God for the practice of surgery, thank God for men and women who continue to advance these fields, thank God for Alfred Blalock, Helen B. Taussig, Vivien Thomas, and C. Walton Lillehei, thank God for whoever invented contact lenses, and thank God that I was born after the invention of such wonderful things!

I Live Here!

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Every once in a while, for a brief moment, I am able to allow my mind to escape the monotony of the everyday and notice the beauty around me in the place that I live.  I am able to see the natural beauty in the rippling hilltops of the Southern Appalachians, and the historic “man-made” charm of nastalgic downtown buildings. 

It’s funny how it just hits me every one in a while and I am thinking to myself, “I live here!”  It reminds me of my nephew, Charlie.  A few years ago he had been blessed with some new shoes.  He was so funny that day, because every now and then he would look down at his feet and say, in almost disbelief, “I got AirJordans!” 

Tonight I spent some time browsing the photos of an excellent local photographer, Rob Beverly.  I wanted to share a few of my favorites of his collection.  They are enough to make you fall in love with Kingsport, TN!

Good Morning Kingsport

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Good Night Kingsport

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Sunset From the Fire Tower

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Fall Colors

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Bays Mountain Sunrise

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Allendale Mansion Barn

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Holston River Sunrise

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Train Station

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There are many more that I love.  I hope you enjoy them also!

Hounds in the “Snow”

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Yesterday was, believe it or not, the most wintry day of the year for East Tennessee.  We actually had a few flurries of snow.  So, I took this opportunity to get a few shots of my basset hounds playing in the “snow”. 

Here is my sweet boy, Earl Jefferson, sitting at my feet on the deck.

He is not sure about playing in this cold weather.  Earl, as most basset hounds, is all about comfort!  Isn’t he pretty, though? 

Annabelle, on the other hand immediately started to violently roll in the 0.000003 inches of snow.

You can’t really see the snow, but there are a few flakes there, I promise!

Why do hounds dogs like to roll in stuff?

Now for a series of running basset hound photos.  I apologize if you aren’t as enthused about running basset hounds as I am!

How marvelous the effects of gravity on a running basset hound!  I bet when Newton discovered gravity he was watching a basset hound run.

Mom, I am tired.  And cold!  Can we please go in now?

Support Local Music

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You may have read about me in previous posts that I am absolutely in love with where I live and my Southern Appalachian culture. I have posted before that I like to support local business in any way that I can. But I have yet to post on my evolution over the past little bit on becoming an avid supporter of local music.

My love affair with local music really started with my first visit to the Carter Family Fold, which lies just across the state line in Virginia. If you don’t know about this place, you should check it out! Bluegrass heaven for me!

In addition to my many future goals of owning a store downtown, becoming mayor, and playing banjo in an all-girls bluegrass band, I have the undying desire to learn to dance like the folks at the Carter Fold. What I should be doing is forgetting the Zumba classes and find somewhere to learn to clog (is that what you call it?).

Sorry, I am rambling. I get very distracted by the allure of the Carter Fold. The point of this post is to mention that my love for local music has evolved to enjoying listening to local guys and girls that are majorly talented. Most of this has come from my friends and I spending Tuesday nights over the past year at Open Mic Night at the Bus Pit.

Unfortunately, a few weeks back, the Bus Pit has closed up shop. So, what does my husband do? Invite a couple of our favs to have a concert in our basement. This was more than ok with me! We had a very fun night full of good music. I bet you didn’t know that I was cool enough to have a concert in my basement. Ok, thruth is, I’m not. Never have been. But my husband is, I guess.

I wanted to share some pics from the evening.

Adam Lawson and the Suited Kings-

Thanks guys, for playing and to all who came out (which was a TON of people)! We will do it again!

-Em

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