Can You Just Fill Whatevers Due

I’m fairly certain I’ve covered this before, but lately this request has been on the rise again. Seriously people, act like the Adults you go around pretending to be. Relying on the pharmacy personnel and/or their computer system to know when YOUR medication is due is complete and utter bullshit.

What’s worse is that a lot of patients only know they are a specific number of medications and that’s it. Let me break it down for you people. We are there to educate you on your medication and make sure that everything jives in terms of what your are taking. That truly is the watered down version of it. However, between your doctor and us once you leave that day you have had several opportunities to ask questions and will have been informed about said medications(s).

If after that point you can’t remember what does what and when its due that’s on you. We have way to many other things to worry of which involves educating the next patient who is going to ignore/forget about everything we just tried to convey to them.

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Just Shut Up and Take It

The title is exactly what I wish I could say to patients some time, but since I generally try not to come across as an a**whole I avoid using that phrase. One of the biggest things that make patients repeat offenders for office visits and hospital re-admittance is therapy non-compliance. As a result of this many patient education opportunities are created and mandated across the board as well as the development of many patient out reach programs.

I can’t site any specific examples from the perspective of a physician or physical rehab specialist, but I have a couple of pharmacy specific examples to share.

First is that of a friends grandmother. She had a thyroid issues and was prescribed levothyroxine. She would take the medication for a few days and when she returned to her normal self would stop taking the medication until she got sick again and then would be taken to the doctors only to figure out that she was not taking her medication. This cycle happened a few times until her doctor threatened to cut her from services due to non-compliance. Then it just turned into a constant battle for the family getting her to take the medication.

Second was a more recent non-compliance issue. On regular basis a patient comes in to have their blood pressure checked. We share the data with her physician on a regular basis and said patient also keeps their own record. From the infrequent times that I have entered the blood pressure information into the medical record myself it is not well controlled. The patient has started blood pressure medication since the beginning of the year but there was little improvement. We had just recently learned that the patient, “doesn’t really believed in taking medication.” Yet upon checking records has been filling it on time without question so there is most likely a stock pile of medication at their home. One of the many daily WTF moments, but share worthy none the less.

I could wax on about other non-compliance issues, but let me put a point on this. At the end of the day it is up to the individual to realize what is best for themselves and then follow through on it. There is a surplus of education opportunities they just have to be taken advantage of.

Medication: Ibuprofen

Ibuprofen better known by its trade of Motrin is a NSAID. Non Steroidal Anti-Inflammatory Drug. Over the counter it is available as 200mg tablets and a liquid for children. As a prescription it is available as 400, 600, and 800mg. I can say with much certainty that the prescription strengths are a bunch of shenanigans. Most patients who need some sort of chronic anti-inflammatory medication do not use it because of how much it could beat up on the gastro intestinal system.

Lets circle back to the fact that it is available OTC in the 200mg dose. On several occasions I have taken 3 to 4 tablets at once for my aches and pains that. They are relatively small and easy to swallow. As you increase in strength the tablet size increases as well. This is a complaint I hear from patients on a weekly basis about not being able to swallow due to large tablet size. I guess it is convenient to only have to swallow one tablet, but to that I say suck it up and just swallow more of the smaller dose tablets.

If you look at the cash cost of just getting 15 tablets of the higher strength doses it is equal to or more expensive than a 500 count bottle of store brand ibuprofen. I’m all for filling prescriptions. Means more man hours in the budget, but honestly I think this is just another way to pad the bottom line. That and wasted money dolled out by the insurance companies.

What I am getting at here is just buy the bulk bottle of ibuprofen. Most manufacturers are good for about 2 years so the 12 bucks you are fronting will go a long way.

Medication: Flagyl

Flagyl or more commonly known by its generic name metronidazole is used to treat a variety of bacterial infection. One of the first things every patient is counseled on other than how to take the medication is to avoid alcohol. Avoiding that combo is so important that we warn patients not to use mouth washes and certain cough syrups due to the amount of gastrointestinal distress it can cause. I bring this up for two reasons.

  • To convey how important it is to listen to our warnings when talking to someone about medication from the pharmacy.
  • There’s normally a story to go along with it.

So of course I’ve had the patient say to me, “Why didn’t you tell me the medication would react poorly with alcohol?” Well the fact of the matter is we did. The consultation upon pick up, the hand written note on the bag, or the warning sticker that is on the bottle. Three strikes and you’re out. The only person to blame is you. It was the equivalent of driving your car off the end of the unfinished highway because the warning signs, flares, and cones weren’t a great enough signal.

The first story comes via my manager. When first starting out in San Francisco she worked alongside a female pharmacist of the Asian persuasion. While consulting a patient on why not to consume alcohol while taking Flagyl the pharmacist expressed it as such “you drink while taking this you die”. (Insert best bad Asian accent here.) While I agree with this sentiment it probably could have been expressed better.

The second story is a patient interaction of my own. After informing the patient that they needed to avoid consuming any kind of alcohol while taking the medication they proceeded to ask me if just one beer would be ok. If I go to the extent of warning you to avoid mouth wash and cough syrups that contain alcohol CLEARLY ONE BEER IS NOT GOING TO BE OKAY! I ask the patient how intimate they wanted to get with their toilet because that would most likely be the end result.

The patient then proceeds to tell me that they had a party they needed to attend and would just start the medication on Monday so as not to ruin their weekend. I advised them about delaying the medication was not a wise decision, but since I was not their mother that I cannot make them take the medication either. Said patient took the medication and went on their merry way. Find out about a week later that the patient did not heed our warning and ended up vomiting so much that they dehydrated themselves enough to end up being admitted to the ER. Not a huge believer in Karma, but I’m pretty sure it caught up with them on this one.