Opinion: Prescriptions: It's Out Of Our HandsBy Susan Bush
12:00AM / Monday, April 10, 2006
With hindsight firmly in place, I guess I'd have to say the blame for the "incident" rests on my shoulders. I am the person who, after hearing a relative's rattling, deep, cough, suggested that a trip to the doctor might make sense.
Another Example of Mama Being Right...Again
And although I was informed that "it's nothing, just a cold," the next day, the relative did seek medical guidance, and traveled to a Northern Berkshire-based medical practice for an April 6 late afternoon appointment with a physician's assistant.
The physician's assistant prescribed two medications but, as many local folks are learning, the practice of dispensing hard-copy, paper prescriptions to a patient at a medical office is being eliminated in favor of using technology to send the 'scripts to pharmacies. My relative -now diagnosed with an illness most people would consider serious- moved on to a second appointment and then drove to the appropriate pharmacy to retrieve the prescriptions.
One had been received and filled; the other, which was the medication that would actually treat the illness, was not. The on-duty pharmacy staff informed my relative that the only prescription received at the store was the one my relative had in hand. And by this time, the medical practice was closed. My relative traveled to home, and gave me a call to alert me to the illness. When I asked how the illness was being treated, I learned that two medications had been prescribed but only one prescription had been filled. I asked why only one of the prescribed medications was in hand. I was not happy with the answer.
Desperately Seeking An Antibiotic
I inquired why the medical practice hadn't been contacted and learned that my relative's primary care physician was away, not expected back until April 10, the office had been closed at the time of the pharmacy stop, and my relative did not believe that anything could be done about the allegedly absent prescription until the next day.
I again involved myself [will I never learn?] by suggesting that the on-call physician be contacted and the situation explained. Since my relative was, in the expert opinion of the physician's assistant, ill with something that can easily become life-threatening, I believed that the more quickly the prescribed medication could be picked up and then ingested, the better off my relative was going to be.
My relative did speak to an on-call physician and that doctor did call the prescription in to the appropriate pharmacy. However, by that time, the pharmacy had closed. My relative did have to wait until mid-morning of the following day to begin the antibiotic that would treat the diagnosed respiratory illness.
Hot On The Trail
I know when the pharmacist learned of the prescription called in by the on-call doctor because I was on the telephone with the pharmacist when the prescription was discovered. I know precisely what time my ill relative received the medication because I am the person who drove to the store, picked up the medication, and delivered it.
I made morning inquiries of the pharmacy and the medical practice. Pharmacy staff answered my questions on the spot; a medical practice employee did contact my home and leave a voicemail message, which was of course necessary because I wasn't home. I was on medicine patrol.
As one might suspect, medical practice administrators insisted that both prescriptions were relayed to the pharmacy at the same time. There is irrefutable evidence that both prescriptions were received, according to the practice's leadership. Subsequent calls to the pharmacy drew equally insistent responses that only one prescription was received.
This might seem like much ado about nothing, a flukey "he said, she said" situation, except that this experience is not unusual locally.
It's All Old News To Me
I have had numerous similar experiences involving prescription refills and one new prescription, which also happened to be an antibiotic. I have waited in the line at pharmacy counters and heard, on numerous occasions, the customers who are ahead of me, waiting to pick up a technology-transported prescription, being told "nothing yet " by pharmacy staff.
I have heard the frustrated replies from folks who report that they've been waiting for extended time periods for their prescriptions. I have heard that frustration vented at pharmacy staff members - who are not protected by insulating layers of receptionists- when a prescription is not ready within the expected time frame.
Calling, Sending, Forwarding, Signing, Re-Sending,It's EASY
Launched during September 2004, one locally enforced prescription refill process requires a person to alert their pharmacy when a refill is needed. This can be done in person or by telephone. Pharmacy staff then transmit the information to the medical practice, which then forwards the request to the appropriate physician. The physician then "OKs" the prescription and the information is relayed back to the pharmacy. It is allegedly a safer system than dispensing hard-copy prescriptions, and is allegedly a more efficient method for medical practices.
Even when the system works as it should, it is often inconvenient for consumers who regularly rely on prescription medications. People must either call pharmacies repeatedly or make repeated trips to pharmacies to see if a prescription is ready for pick-up.
Those who reside in outlying areas, such as Florida and Savoy, or Readsboro, Stamford and Pownal, Vt., have shared anecdotes about checking on a prescription before driving home from work or running errands, only to be told "nothing yet," and then, minutes after arriving home, learn that a prescription is ready for pick-up.
"But I Was Just Down There!"
For some, making a return trip means 25- to 30-mile round trips, and burning costly vehicle fuel. "Back in the day," when a prescription could be picked up at a medical practice front desk and filled at the convenience of the patient, people could choose for themselves when and where a prescription was filled.
Had my relative been handed a hard-copy prescription, the antibiotic would have been hard at work kicking bacteria butt by 7:30 p.m. on April 6, as opposed to 10:30 a.m. April 7.
And there is confusion about how long one should wait before reporting a suspected prescription problem.
Some time ago, I asked several staff members of different pharmacies when a person might reasonably expect that a prescription wasn't simply delayed but was being held up by a genuine issue that might require additional attention. Answers varied, with most pharmacy staff suggesting that, in the case of a routine prescription refill, it may take up to 48 hours for the refill process to be completed.
Now, with new, first-time prescriptions going the electronic route and patients walking out of the doctor's office without that handy piece of paper in hand, what are the protocols?
Who's In Charge Here?
When my relative arrived at the pharmacy and found that the antibiotic was not ready for pick-up and the store staff reported that the prescription had not been received, what actions should have been taken, especially when the medical practice was closed for the night?
Since "e-prescribing" between medical practices and pharmacies is apparently here to stay, who has the ultimate responsibility of overseeing that new prescriptions are successfully transmitted to pharmacies, that prescription refill requests are received by the medical practices in a timely manner, are signed and returned to the pharmacies in a timely manner, and are provided to the patient in a timely manner? Is the "he said, she said" game the best that patients can expect?
Who is making the determination about what is a "timely manner?" Why should patients accept extended waiting times for prescriptions?
Are patients really supposed to willingly and happily trade a system of hard-copy, in-hand prescriptions that could be filled immediately for a system of uncertainty; uncertainty about when the prescription is being sent, received, signed, and then sent back, uncertainty about when to call or drive to a pharmacy for pick-up, and, possibly the most important uncertainty of all, who is responsible when the system fails?
I recently made plans for a veterinarian visit for my dogs. While I was making the arrangements, I pondered about how the canines have absolutely no voice in their care. They would go to vet that I selected, whether the vet was actually the best vet for them or not. Any veterinary care delivered, other than the legally-mandated rabies shot, would be determined by me, whether the decision was the best for the dogs or not. Every facet of my dogs' care is completely under my control, and my canines have absolutely no say about it.
Then I was struck with a sudden realization. Dawn broke on marble head, so to speak.
Choices Are Going, Going...
While recently attempting to schedule two separate physician appointments for members of my household, I explained to the medical office staff that an employer has gotten very strict about workday doctor appointments and frowns quite heavily upon it.
The response from both medical offices was the equivalent of "too bad, so sad."
One office doesn't usually make any appointments after 1:30 p.m., the other refused to consider anything later than 4 p.m.. What was workable for us was 4:30 p.m., but like a famous fast food restaurant, they had it their way.
The health insurance plan that allows us to see our preferred primary care physician controls our every move. Referrals and pre-approvals are required for just about everything. If what we want is in line what with what they want, there are no problems. If what we want is different from what they want, well, still no problems, again, they have it their way.
Over the years, doctor-patient conversations have eroded from what treatment options may be available to what treatment options a specific insurer will cover. Patients have less and less control over anything that directly involves their care, including choice of doctor, choice of treatment, choice of medical facility,and choice of medication.
And now, even how patients fill prescriptions is out of their hands.
All I can say is "Woof."
Susan Bush may be reached via e-mail at firstname.lastname@example.org or at 802-823-9367.