Fried Chicken with a Side of Diabetes

Any time I see a patient in motorized cart headed towards my pharmacy, I can usually see some sort of odd problem on the horizon. When the patients pulls up in a motorized cart, is over 100 pounds overweight and eating fried chicken straight off the bone (grease all over the prescriptions of course), I know it's going to somehow cause me a headache!

A morbidly obese patient slowly heads to my pharmacy in a motorized scooter because they are probably too large to walk any distance. They hand my technician several prescriptions with one hand while eating a few pieces of fried chicken in the other. My first thought is that that all of these prescriptions are probably for diabetes and hypertension and of course they were. Clearly this patient is not trying hard to control either by eating fried chicken for a snack (it was mid afternoon and I am sure she does not miss many meals) and not even trying to do simple exercise like walking.

The technician tells the patient that it will be just under an hour to get their prescriptions ready because there are so many of them and it is the first week of the month, so we are swamped. The patient scolds the tech with, "I can't believe this I need my medicine and I have to wait and hour!?! I am gonna go over there and I'll be back in half an hour they better be ready!" The tech tells the patient that she is welcome to come back but it will be closer to an hour. The patients scoots aways with the drumstick still in her hand.

Twenty minutes later, I finally am able to initially check the prescription before the techs fill it. I do so and then my computer tells me that her insurance won't cover the medication because the physician did not put clear and precise directions or a diagnosis code on the prescription. Although forgetting this legal bit of info to bill a government insurance, which the physician knows the patient is on, she did put her hemoglobin A1c which is 11.0. This measure is explained here. Despite being on high doses of every medication possible this patient's diabetes is still through the roof! Again, reinforcing my previous opinion that she really does not care but is rather riding this for what she can get out of the government.

Like any good pharmacist, I pass the task of calling the physician's office on to my intern. My intern calls and actually gets a hold of the physician. Odd, why can I never reach anyone of knowledge when I call that office? He explains to her the situation and the response by the physician is appalling. "This has happened before and your pharmacy always prevents my patients from filling their medications! It's only you guys! Just give her the damn medicine and don't bother calling me back! I have other patients who need help too and I am sick of you calling me on technicalities!" My intern looks at me with a look of disbelief, he knows I heard the whole conversation because it was that loud.

Now I am angry. People don't like me when I am angry...

I call back and get the office secretary and ask for the physician while explaining where I was calling from. "She's in with patients can I take a message for you?" I explain that I can hold it's that important. After several minutes on hold the physician picks up the phone. "How can I help you?" It's go time! "Hi, is this Dr. (protected so I don't get sued over slander)? It is? Good, I have to tell you to NEVER treat an intern, or pharmacist for that matter, like that again! We called you because you did not fill out a prescription in the correct and LEGAL way so we can help one our mutual patients! I heard what you said to my intern and am tempted to report this further to the institution you practice under. Are we clear? GOOD! Now can you get me the diagnosis code and the precise way she is taking her medicine so I can give her the DAMN medicine you prescribed? Uh, huh. OK. Thanks! I appreciate you giving me that LEGAL information. I hope when or if I have to call your office again your are more appreciative of what I do. Without my knowledge and skills your patient would not get their medicine and good medical care could not be provided. Have a great day!" **CLICK**

At this point my ears are red and my intern is in hysterics. It is sad how some people, particularly in medicine, have such a God complex. Now the patient is at the counter and asking why her medicine isn't ready. My intern quickly walks over and informs the patient who promptly starts into a fit of yelling. My intern is calmly explaining the situation to the patient but the patient is not listening. I don't expect patients to fully understand everything but I do expect that they listen to me or trust what I am doing is correct. They can even question me but there is never any reason to yell unless something is really messed up.

I scurry over to bail out my intern. As I start to tell the patient what all we had to go through to ensure that they get their medicine they shouts this, "I don't care! My doctor gave me those scripts and there is always some problem! I ain't waitin'! Let God figure it out! If he wants me, he'll take me! If he wants me to live he'll fix my diabetes!" Now I am fuming! For better or worse I was "blessed" with a sharp tongue and quickly state to the patient, "God only helps those who help themselves." The patient continues to raise a scene and putts away in her scooter (which is now leaning to one side as she has been rocking back and forth in it). My intern looks at me with disbelief, I tell him "Some people just don't care."

This was an extreme case of ignorance on multiple ends. However, this could be avoided by one simple way. Put a pharmacist in a physician's office. I understand this has some high costs with it as most pharmacists in my area get paid right around $100,000 a year. With the cutbacks by government programs, which are the biggest payer of health care, this can really strap physicians and their practices.

Here's my justification and solution.

If it takes me 10 minutes to get a hold of someone at an office who can help me, that's $10. Include the office help time and the nurse or physician's, that number jumps to ~$25-$30. This is assuming an office person spends 10 minutes at $20-$25/hr and that the physician only gets paid double what I do and spends 5 minutes on the problem. Multiply this by the number of calls I make daily for things like this, about 10-15, that's easily $250-$450. Extrapolate that number to all of the pharmacies in the metro area in which I work in, according to Google is 2,676, that number booms to $669,00 - $1,204,200. This number represents wasted time for pharmacists, physicians and office staff. The scary part is this number is probably low since most office staff have to hunt for answers after I leave them a message. Physicians have to go and look up more info and spend more time, which is more money. This number may also be low because my pharmacy is slightly below average for volume as well.

So what could reduce this cost?

If a pharmacist was to work one day a week in a physician office and work for 5 offices, that would only cost and each office ~$20,000 a year, which is less than they pay most, if not all, of there staff. Most practices have multiple physicians so they have higher patient volumes. A pharmacist could work with the staff and physician to review charts and ensure patients are getting correct prescriptions that can be filled by pharmacies easier thus resulting in less money being spent on wasted time. This would also result in the staff and physician being better educated on what it is pharmacies need to get patients their medications easier and possibly cheaper. I have no way of measuring the statistics of how much this could save patients and thus insurance companies as well as government programs but with my experience, I am sure it could easily be millions in just the one metro area I work in. This could be another benefit and cost savings which a pharmacist could help greatly reduce. Maybe the government would be willing to pay a little bit more to physicians if they saw a decrease in the back end of prescription costs. They may argue this is what their prior authorization process is for but, honestly, that just costs physician's offices and pharmacies more time. Most patients have more time untreated and end up frustrated or not getting their medicine. This problem can from here just snowball, but could have been prevented with a pharmacist on the physician staff. With the loose math above, this means that roughly 12 pharmacists could cover 60 physician offices! If you had several head pharmacists and made a residency program out of it you could cover even more!

Maybe I am aiming to pie in the sky, but to me this make to much sense financially and medically. Why not try to save money, decrease government spending and improve medical care. Many studies out there already back these claims up, so why are we not seeing more of this? I wish I knew, but until that day I feel that it is too many times we are, figuratively, just giving the fried chicken to the diabetics and only creating a worse situation for everyone involved.