Refills

Imagine:

You see your doctor; he writes a prescription.  You fill it, take all the pills, get a refill, take the pills…  Simple.

Then you see another doctor for something else and are given a new prescription.  You fill it and start taking these pills, too.  Since you didn’t fill your prescriptions at the same time, they don’t need to be refilled at the same time.  Now you’re at the pharmacy twice a month.

You have a follow-up with your doctor and he writes an additional prescription as well as increases one of the existing meds to three times a day instead of twice a day.  Now you have two prescriptions to refill on one day, and another to refill on a different day.  Except that you still have part of a bottle left from when the one med was bid, so really you run out on three different days.  Next your tid rx is reduced to bid, so a two month supply lasts you three months (and the pharmacist thinks you’re not taking your pills regularly).

Now you’re at the pharmacy so often that everyone who works there knows you.  When they glance up and see that it’s you standing in line, they smile, “Oh, hi,” go grab your bag off the shelf, and ring up your purchase without you having to ever say your name.  They show you their latest knitting projects and ask about your kids.

And you’re given another prescription.  And another.  You need a separate appointment calendar just to keep track of when the various pills need to be refilled.

I never really let it get that bad; I gave up way before it got to that point.  My refills usually all get picked up at the same time and I just dump the remains of the old bottle into the new one.

Last night I got curious and dumped everything out to count.  In theory (if you go by the dates on the bottles) I should refill everything by next Monday.  My mtx bottle is empty.  The folic acid will run out on Monday.  But there are thirteen days of one med, seven days of another, and 48 days of yet another (guess I don’t need to fill that one this month)!

My cupboard is FULL of prescription bottles!  I’ve heard of people whose insurance company won’t pay for medicines more often than every thirty days.  I’m so glad that my insurance pays without squawking so that I can fill everything in one trip (even if there’s a bottle that isn’t empty yet) instead of making me visit the pharmacy weekly.

Wasted Opportunity

Medbloggers have a tremendous opportunity to enlighten people about various aspects of healthcare.  One such blogger has yet again wasted an opportunity.  His recent post does nothing to enlighten the general public about any aspect of healthcare.  It does nothing to help guide our Congressmen as they deal with the issue of healthcare reform.  It is yet another scratch on a broken record, spinning in useless circles, stuck on, “healthy lifestyle choices! healthy lifestyle choices!” without going on to any useful information about how to go about doing such a thing.

What we need is health reform, not health insurance reform.  If we do nothing about health care inflation, we are all doomed.  Every last one of us.  Taking care of sick people is expensive. The only way to get rid of health care inflation is to stop spending money.  At some point we will either have to

1) decrease illness
2) decrease treatment and/or
3) decrease the cost of treatment

There are no alternatives.  As an American which action plan would you rather see take hold?  Realize that every cost action has a reaction.  You can decrease disease by prevention.  You can decrease treatment by bundling.  And you can decrease the cost of treatment by making it more efficient or simply paying less until access becomes an issue.    I am certain that  keeping the financial stability of America will require all three.  But the only one you as a patient have control over is #1.  As a country, we can prevent 80% of diabetes, heart disease, stroke and cancer by taking care of ourselves with lifestyle modification.

You as an American could prevent being exposed to the unintended consequences that will present themselves as our country eventually learns it must decrease treatment and the cost of treatment if we are to survive and prosper as a nation. If you want to be subjected to the restrictions on your care that must happen in this country, then the action plan you must take as an American is to do nothing for yourself.  For everyone else, it’s all about how you choose to live your life.  Live well and die old, but young.

Encouraging healthy living is one thing.  Berating people for simply being human doesn’t exactly fit the image of a good physician.  Where are some menus?  Where are suggestions of exercises that will help people get started when they’re too out of shape to go jogging?  Where are the links to smoking-cessation programs that have proven to be effective?

Aside from the post’s wasted opportunity, it is inaccurate.  It is simply not true that patients are helpless victims with no say in what takes place.  Patients can influence all three of the factors mentioned.

#3) Patients can decrease treatment costs.  Whether it’s shopping around for prices on medicine, purchasing medical supplies, or selecting a doctor, patients have some control.

  • When my son broke his hand I could have taken him to the emergency room on Saturday; instead we waited and saw our PCP during regular office hours.  I was able to significantly decrease the treatment cost.
  • When my mom needed hearing aids, I could have taken her to the Medicare-approved provider and run up a $6K tab.  Instead I did a little research and learned that there was better technology available for significantly less money.  We paid only $2K for a much better product.  Once again, the patient was able to decrease treatment cost.

#2) Patients can choose to decrease treatment.  You’ve never heard anyone say that they chose to stopped taking their medicine?  You’ve never seen anyone die prematurely because they opted out of treatment?  You’ve never seen anyone select hospice instead of aggressive, futile treatment?  Exercising control over a decrease in treatment is something patients do all the time.

#1) Maybe exercising, maintaining a healthy weight, etc., can reduce the likelihood of certain diseases.  However, I find it not the least bit helpful to hear that 80% of those diseases could be prevented if people would just make better choices.  If those numbers are right, 20% of those diseases occur despite a healthy lifestyle.  Additionally, there are a whole lot of other diseases out there that are not caused by unhealthy lifestyle.  Quite frankly, it sucks to get hit with a disease over which one has no control.

Reading that blog makes me thankful that I haven’t had to be hospitalized.  I shudder to think what it would be like to be at the mercy of a physician with so little compassion for his patients.  I am grateful that my PCP still sees his hospitalized patients; if someday I end up in the hospital, I know who my doctor will be – someone who knows his patients and helps them compassionately instead of being judgemental.

I also have a great rheumatologist who listens to patients and is willing to try whatever is necessary to get my disease under control.  She considers cost when ordering tests.  She postpones tests to spread out my cost a little bit, yet finds a way to get the data she needs to diagnose and treat most effectively.  It’s not about the money.  It’s about the patient’s health.

What a wasted opportunity!