Thursday, May 14, 2009

You Have To Try This First!


The patient is agitated and intrusive. He shows up without an appointment, and when I say I'll see him, but he'll have to wait, he is not pleased. He knocks on the door while I'm with another patient. He's been off his medicines, and he's decided he felt better with them. I think we both felt better when he was on them. Oh, but he didn't like those medicines. He wants something else. He needs something else. Maybe he needs to be in the hospital? He won't hear of it.

Okay, go back on Old Medicine you've been on before.

No.

How about Medicine X?

No. That stuff made his see dead bodies floating in space.

How Medicine Y?

No. Friend is on that stuff and it's awful.

How about Medicine Z?

No. Oh, you think that will help? Okay, he'll take that.

I think it will help. Oh, but then I remember that the state requires pre-authorization forms and I'm already behind here and there's all sorts of other issues, this patient isn't really in a great place for a detailed risk/benefit discussion, he's demanding something that will make him feel better now and I'm starting to feel his pain.

How about Medicine ZZ? I suggest a similar medicine.

Okay, he'll take that. In fact, he likes the name.

I write a prescription, he leaves and I resume my regularly scheduled clinic morning.

And then there's yet another knock at the door.

"But if you think that other medicine is better, I'll pay for it."

No, no, it costs hundreds of dollars, Just take the other stuff. Really, he's so bouncing off the walls that anything will take the edge off. The morning goes on. Yup, another knock at the door. The pharmacy couldn't fill the medication, not sure why. I've now drowned. I don't have pharmacies and calls to the state, and finding the right form, and pre-authorization phone calls and faxes...and whatever else it might take, in me right now and oh, he's not sure his insurance is even active. I surrender and grab samples (in the clinics, we save these for patients who have no other means of getting meds). He takes them and he actually leaves.

Next clinic day: Thank you, that medicine helped. The patient is much calmer, I don't once utter a word about hospitals. No side effects. And his insurance is now active. I write a prescription.

Fast forward to the next day. My cell phone rings, it's the pharmacy--- remember that patient (I do, but I see him at a clinic and I don't have access to his chart and why are you calling this number?). His insurance requires documentation that he's failed two other medications in the same class (and yes, those two medications both cost a small fortune as well, they aren't even asking if he's failed cheap meds!). I don't have a chart, but I think one of those meds made him see dead bodies floating in the air.

So let me get this right, I have a patient who was really sick, who's been in the hospital before, who is now better, and I'm supposed to take him off that medicine that's causing no side effects and put him on another, equally expensive medication---actually two-- and watch him maybe get sick twice, before I can put him back on the medication that is currently working just fine?

And how was your day?