July 25, 2012

Electronic Prescriptions vs. Chicken Scratches

This is an interesting article from the New York Times about our handwritten prescriptions and the errors they cause. It is also alarming the carelessness of the medical and pharmacology professions in not preventing this. I have never understood how people can have such poor handwriting. If the handwriting is that poor, I have to wonder about their skills as a doctor, physician's assistant, nurse, or nurse practitioner. Generally the two do go hand in hand, but not always.

Is it the fault of our school system, or the people we allow to be doctors? By any stretch of the imagination, allowing 37 percent of hand written prescriptions to have errors says volumes about the quality of the doctors writing them. Admittedly, seven percent is still poor, but this will go higher when the careless doctors start using the computer to click buttons.

I can only say that patients had better learn to pay closer attention to prescriptions in the future and become more knowledgeable about many medications. I have heard pharmacists ask patients if they were being transferred to a new medication, or ask if they knew what the medication was for. Many had absolutely no idea, so the pharmacist had to call for clarification. Many times I could see the frustration on the face of the pharmacist when the call resulted in no change or even a medication that could not be deciphered from the prescription. I felt very sorry for a pharmacist one day that was trying to do the right thing for a patient and unfortunately the phone was not muffling the sound of the doctor screaming at the pharmacist.

On this particular day, the doctor was changing all of a patient's medications. As I was waiting for a medication for my wife, the patient came in and started with foul language at the pharmacist for not having the prescriptions ready. The pharmacist was doing her best to explain why she had questioned all the changes. Patient then unleashed a litany of profanity about the doctor not supposed to have changed any medications. Pharmacist suggested he talk to the doctor (office at most 15 minutes away) as the doctor had instructed her to change every one. More profanity, so I spoke up and said the pharmacist was attempting to help him and he should be thanking her for that. More profanity directed at me, telling me to but out. Did I? Not a chance. I stood up and told the person to apologize to the pharmacist and get a civil tongue. If he chose not to, I would be making a phone call and we would see if that changed his tune. I was surprised that I stood taller than him and he apologized immediately.

He asked what needed to be done and the pharmacist asked if he was aware of the changes in his prescription. He stated that he had made it clear to the doctor he did not want any changes although the doctor had said he should on two medications. The pharmacist asked if he knew which two and he answered. The pharmacist said that was understandable as the one medication had been pulled from the market and for the length of time he had been on the other, he should consider the change since the one the doctor prescribed was generic and not a brand name. This left three other prescriptions and he and the pharmacist discussed these. He agreed that he could change on two others, but said he had a allergy to the third one. Pharmacist checked his record and agreed that the doctor had missed the allergy.

She picked up the phone and stated she would call him. Even I could hear the doctor on the phone as he was upset. She handed the phone to the patient and he said he would be filing a complaint with the medical board unless he calmed down. He then asked if the doctor was trying to put him in the hospital as the one medication he was allergic to and would become very sick. He handed the phone back to the pharmacist and then she said okay and hung up. Pharmacist asked the patient if he was satisfied. He agreed and the pharmacist said his order would be ready in 20 minutes.

Then fellow turned to me and apologized. I said good as I did not like seeing pharmacy customers verbally abuse the pharmacists, especially when they were trying to help the customer. He agreed that he had come in with a chip on his shoulder and was not intending to be this way. He was angry at the doctor for changing prescriptions like he did without discussing the reasons for making the changes. I said that would make me upset as well, but I would have come directly here and asked the pharmacist some questions as she would have covered them like she did. Since two of the medications were for diabetes, I asked if they were for him. He admitted they were and how did I know what they were.

I said as a person with type 2 diabetes, I was fairly familiar with most diabetes medications. He asked which I was taking and I said insulin. He looked at me and said you don't look that bad. I laughed and said he had to be referring to the insulin myth, probably promoted by his doctor, that this was the medication when nothing else worked. He looked puzzled and said that this is what he had been taught by his mother and his doctor. I said that is such a lie and I would never go back to oral medications.

I stopped him and asked if he was a veteran? He said he was and I asked him if he was seeing the Veterans Affairs office for medicines. He said no, but until a year ago had a good medical insurance policy that covered most of his medication expense. He continued that he had seven months left on COBRA and then he would be fully on Medicare and a supplemental policy. I asked if he would be interested in talking to the local office and getting his application started. He was, and I asked if he had time to do it then. He said he was not sure where to start, but he had some time. I talked to the pharmacist and said we would both be back later, I was taking him to the VA office and we would both be back.

After we had been to the local veterans office, he was even more talkative and asked why I was promoting this so hard. I said it was still his choice, but that his medications cost would depend on his income less qualifying medical expenses (or a means test) and this could save him some money. He needed to get his DD214 form from the recorders office and complete his application. He agreed that it could save him some money especially when he found out some of the other benefits he probably qualified for.

When we arrive back at the pharmacy, he again apologized to the pharmacist for his language, saying he would make sure that it never happened again. The pharmacist thanked him and asked if he would qualify for VA assistance and he stated more than likely. She stated that it could probably save him money and have less business with the pharmacy. I covered the point that on many generic medications, he could probably get them more reasonably through the pharmacy and gave him an example. He asked if that was for real and the pharmacist assured him that was what he was paying. She also stated that the doctor would need to send the VA office a list of medications once he was accepted and he should check with her before letting the VA prescribe the medications from the central VA pharmacy on most generic medications.

He had his prescriptions and then asked me for my phone number and if I had an email address so we could communicate. We have continued since then and he is now be waiting for his VA approval.

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