Saturday, December 29, 2007

People... Please talk to your doctors!!

I got 2 absolutely idiotic questions yesterday:

1) Customer brought in a prescription for an antibiotic and cough medicine. "Does this cough medicine have Codeine in it? I can't take codeine."

2) Customer brought in a prescription for a 2 week course of Bactrim DS. She had already been given a prescription by another doctor for a 2 week course of Bactrim DS 8 days ago. "This doctor didn't know I was already taking Bactrim. Should I take a second course?"

These are questions that should be asked BEFORE LEAVING THE DOCTOR'S OFFICE!

I want every patient in the world to pay attention to what I'm going to say: TALK TO YOUR DOCTOR!

I know that a doctor can be intimidating. A lot of doctors come across as being too busy to take time to talk to their patients. In addition, many doctors (whether consciously or unconsciously) give off this vibe that they're smarter than you are, they're doctors, and they're judgement should never be questioned, especially by a lowly patient.

However, as a patient, you must get over this fear and intimidation and ask the doctor whatever comes to mind about your therapy. Patients don't realize just how important a role they play in the whole healthcare process. If you have a concern about taking a medication, talk to your doctor about it. Let your doctor know what other kinds of medication you are taking. In addition, don't, UNDER ANY CIRCUMSTANCES, let a doctor write a prescription without telling you what drug he's giving you, and what it is used for.

Looking at my previous examples:

1) This woman went to the doctor looking for cough medicine. The woman knew she couldn't take a codeine product (due to GI intolerance). She knew that many cough medicines have codeine in them. Despite this, she waited until she got to the pharmacy (and actually until we already filled the prescription) before she asked whether the medication had codeine in it. Of course it did, and she would not take it, so we had to call the doctor's office, wait on hold for 5 minutes to speak to a receptionist, only for her to tell us that the doctor was with another patient and would have to call us back. Had she just asked the doctor that simple question before leaving the office, we would have avoided all of this trouble.

2) The woman with the Bactrim script knew she had been on Bactrim before. When she asked me if she should take another course, she said, "I think the new doctor thought I was taking Cipro before, so he wrote me a prescription for Bactrim instead." Then why the fuck didn't you let the doctor know this????? It's fucking asinine to ask the pharmacist this question. I don't know what you're being treated for. Even if I did, I don't have access to whatever susceptibility cultures you might have. What can I do besides track down the doctor and ask him the question you should have asked before you left his office?

This sort of thing pisses me off maybe more than anything else. The worst of them all are the people who are on Coumadin and don't tell their doctors that right off the bat.

Here is a lesson that I want everyone who takes Coumadin to learn:

If you are on Coumadin and you go to a new doctor or any doctor who would have no way of knowing you are currently taking Coumadin, the first words out of your mouth should be, "Hi, my name is so-and-so, I'M ON COUMADIN."

Because so many different medications interact with Coumadin, that knowledge is absolutely critical to a prescriber. All too often, I see Coumadin patients come to our pharmacy with a prescription for Cipro or Bactrim. In almost all cases, they failed to let the prescriber know they were taking Coumadin, and now the responsibility falls on the pharmacist to track down the prescriber and try to get the antibiotic changed.

Basically, the take home points of this post are

1) Don't be afraid to ask your doctor any questions or express any concerns over your therapy.

2) Always know what medications the doctor wrote and ask any appropriate questions BEFORE leaving the office.

3) Patients on Coumadin absolutely have to tell each and every doctor they see that they are taking Coumadin.

If Patients would just adhere to these simple rules, it would save a lot of time, confusion, frustration, and, not to mention, it would cut down on prescribing errors and adverse drug reactions.


The Ole' Apothecary said...

"A lot of doctors come across as being too busy to take time to talk to their patients." AND HOW! I think that's the problem, more of a problem than the white coat intimidation effect. I've often felt myself getting the bum's rush in the exam room. The doctor should at least ask if the patient has any questions about anything done with him/her during the visit (including prescriptions), but I cannot remember one occasion where I've been treated that way. I do, however, get that treatment in department stores, i.e., "Did you find everything you were looking for?"

Also, doctors discourage conversations about drugs by referring to them as "I'll give you something." What? Eye of newt? Sarcoptic mange tincture? Compound peppercorns and lactated pepsin in a ranch dressing burrito? They turn the doctor-patient relationship into a stupid prescription scene from a B movie(where the doctor puts two scribbles on a piece of paper and says,"That'll take care of it.")I wish they'd stop the voodoo style and NAME the goddamn thing as they're writing it out."I'm giving you Tussionex," "I want to order Augmentin, but are you allergic to penicillin?" Even I have to pry out of them what they're about to write for me. So, then they leave the struggle to the real information man or woman, the pharmacist. It's not fair at all when it's too late and we have to deal with these issues.
I agree with you that the patient should be full of questions about their medications, but they don't feel welcome to ask at the right time.

Teeney said...

Thing is, it isn't the patients' fault that they don't know to ask these questions. They are not experts of drug actions and interactions, neither are doctors as it goes,,,but the pharmacist is.
Pharmacists are usually great human beings, FACT. Patients feel more at ease talking to the frindly pharmacist than the doctor.
Perhaps pharmacies could have posters in them reminding the patient of things to ask the doctor the next time they go, or hand out cards with prescriptions. In actual fact, I do not think doctors should be prescribing at all. The doctor is an expert in diagnosis and referrals, not drugs. Doctors should diagnose and write the diagnosis on a 'prescription'. This should then be taken to a pharmacy where the expert in medicines (the pharmacist) can select the best medicine for that patient according to the full patient notes s/he would also have access to. yep.