When A Medical Professional Turns Into The Patient...

I woke up the other morning with pretty badly irritated eye. Apparently I forgot to take my contacts out before going to bed. WHOOPS! I walked into the bathroom and looked into the mirror just to see how seriously red my eye was. I decided to take my contacts out, not sure whether it would make the situation worse or not. It made it worse, much worse! My eyes had a sharp stabbing pain whether it was open or shut. I continued to cover and wipe my eyes of drainage and decided to lay down and see if it passed. This did not help very much so I got the idea to put some contact solution into my eye in hopes it would bring some relief. It only stung more.

I guess I had to go to the pharmacy to see if something like Clear eyes or Visine would help. I figured that if this didn't do the trick, I might have to get some further medical attention that was above my own skill as a pharmacist.

The pharmacy I went to was the one I currently work at. I called a friend and he went with me in case my eye really bugged me. I made it to the pharmacy, picked out the eye drops I had in mind and left. My friend drove me home and stuck around to make sure I was alright. Thank God for good friends. The eye drops burned and did not seem to help much. I waited awhile and tried them again still to no avail. It was time to seek further care.

My friend drove me to an Urgicare which I used to know some nurses at. When we got there I had to fill out 4 forms and give them my insurance and identification. Filling out forms with one hand over your eye is not the most fun, especially after a 20 minute car ride which simply looking out the window makes you nauseated. I turn in the forms and waited to be seen. I waited about an hour and fifteen minutes in the waiting room before being called back to an exam room. Finally!

Once in the exam room the nurses came and asked some basic history and pain questions. They also took my blood pressure and they took it wrong. They raised my arm just over shoulder height and took it. Blood pressure readings should be done at heart level, at least that's what they taught me. I then continued to wait 45 minutes for the physicians to come into the room. He explained what he thought it was (since I gave a very detailed explanation he probably could have diagnosed it without even seeing me) and what he was going to do to examine it. Overall, he was very professional and I was pleased with his work. He then explained he did not see anything serious but was going to give me and antibiotic just to be safe. I then told him I was a pharmacist and wondered what he was thinking for an antibiotic. He said I should have mentioned it earlier and said he was going to write for Vigamox.

Wrong answer.

I knew Vigamox is over $100 a bottle and requires a prior authorization for every insurance I have every dealt with including my own. I suggested tobramycin and explained to him what I knew. He agreed and appreciated my knowledge then left to write the prescription. He came back and gave me follow up instructions if needed, including an ophthalmologist he knew personally, as well as the prescription for tobramycin eye drops, then showed me out to the nursing staff to sign one more item.

When I saw the nurses and signed their document, I asked them to call my prescription into a pharmacy near by that was part of the chain I work for. They were hesitant and said they do not do that.

Wrong asnwer.

I told them I am a pharmacist and that I knew the pharmacist they would be calling it into. They checked with the physician who literally said, "Ya, why wouldn't we call it in?" They agreed and I left with my friend to go to the pharmacy.

We got to the pharmacy 30 minutes prior to close and to no surprise my prescription was not ready. I asked how long and the intern, who I knew, said that the pharmacist did not take it because they were out of stock of it. Personally, I would have still taken it and then offered the patient to transfer it, but to each their own. The pharmacist said the Urgicare was going to call me to call another pharmacy with it or to preferably to pick it up. One problem, my cell phone was dead. Thankfully, my friend let me use his phone to call the Urgicare and call it into the exact pharmacy I work at, to which the Urgicare nurse obliged.

We drove to my pharmacy, speeding a little since we know we would be getting there with in 5 minutes of closing. I called ahead as we pulled off the highway and my pharmacist partner said it was ready and he would stay open until I got there and that he rushed it since he knew it was mine. Again, I am thankful I know how the medical system works and some people in it, which allowed me to get my prescription in a fairly timely manner.

As I was rung out by my cashier, I thought to myself, "What if I wasn't a pharmacist?" This would have meant that the doctor would have written for an expensive prescription which my insurance wouldn't have covered. I would have gotten to the first pharmacy and been pretty frustrated since I had spent 2 hours plus at the Urgicare and still had a sore eye. If the pharmacist would have called the Urgicare to change the prescription, she would than have not had the antibiotic in stock. I then would have to go to another pharmacy to get my prescription. I also would not even be able to stay with the same chain to get my prescription that night since they all would have been closed. I may have even not gotten my prescription that night. On top of all of this the antibiotic I did receive needs to be applied every 3 hours while awake. This is fine by me, since it was $4 instead of over $100, but even as a medical professional applying an eye drop every 3 hours is hard to remember. Imagine if I were a patient again, I would probably be annoyed and not understand why the drop needs to be used so often.

This whole experience really did make me think differently about patients who come in last minute. Ironically enough I had a patient about my age come in with an antibiotic 5 minutes prior to close while I was already busy the night prior to my eye injury. I told him to stick around as I would make sure he got it before he left. The man was grateful for my services and that I took care of him despite being busy. I now fully appreciate his appreciation for me taking care of him despite the fact that I was closing really soon. Thankfully, karma must have paid off and taken care of me when I needed it. I can definitely say I look at the last minute patient with a little bit more respect considering what they might have just been through. If a last minute patient just hurried to make it in, I will definitely take care of them as long as they are in a true urgent need and not just filling a prescription they had for 2 weeks. This is especially true if a patient has an antibiotic or is from an Urgicare!

Why Herbals Are So Popular

"Is there anything over the counter I can take for my menopause?"

"Where's your glucosamine at?"

"Can you recommend something natural?"

These are some very common phrases around most retail pharmacies these days. Many consumers are turning to herbal supplements to help them improve their health or to aid them in other ways. This boom in herbal remedies is due in large part to the amount of information available on the internet and the ease of access it provides now more than ever.

On a daily basis I have handfuls of patients that ask me question pertaining to a variety of health issues and remedies for them that they have researched on the internet. In many cases, these patients come to me asking what I think about specific products and "do they work" or "how well do they work". With the availability of information many of my patients can filter out their symptoms and essentially find their "diagnosis". I use that word loosely since only limited medical professionals can actually make a diagnosis.

To be fair to lay people, I put myself in their shoes...

I am sitting at home with knee pain and wondering what I should take? Should I take the Celebrex (celecoxib) the physician prescribed for me? I just saw a commercial of which half it was the risk of side effects including possible heart issues (by law 1/2 of all prescriptions advertising must be focused on things such as side effects, just look at the next printed medication ad you see in a magazine). Well that seems a little bit serious. I remember there was a commercial for Osteo-Bi-Flex when I was watching the price is right and it didn't list any side effects. No side effects must mean that it's safer, right? There was also a commercial for One-A-Day Energy which said it would give me that little kick I needed. I am going to go the the drug store...

After arriving at the drug store, I grab a generic pain reliever (that is similar to Celebrex but cheaper as my pharmacist said) and what appears to be a generic for Osteo-Bi-Flex. I look at the labels...

First the herbal supplement...

Just like I thought, there aren't very many warnings. Now let's look at the over the counter (OTC) pain reliever...

WHOA!! That's a lot of information on a bottle about the same size. I think I am going to try the herbal instead. Let's look at the energy vitamin. It looks like the rest except it has guarana with an asterisk by it. It's probably alright...

Now this is in now way an all encompassing example. Many of my patients will actually listen to what I recommend for them, especially if I tell them it's what I would take if I were them. However, there are also several patients a day that now matter what I say they believe that the natural is better. I do what I can to help all but sometimes, they will not simply listen.

With such strong FDA restrictions on prescription and some OTC medications while have little to no regulation over herbals it is no wonder why advertising and the billion dollar herbal industry has lead consumers to think they are much safer than FDA tested and regulated medications. Many patients, even when they look up herbals on the internet, are not aware of the side effects or drug interactions of many herbal medications or that many of the herbal products are not tested and in many cases are not regulated for quality.

Just to highlight a few common areas I see in a daily basis I will keep this herbal review short. VERY SHORT. Here are some herbal basics:

1. ALWAYS consult a pharmacist/physician before taking them. At the very least do some homework and look up possible indications and directions for use as well as potential side effects.

General Rule: Beware of the G's - Ginseng, Guarana, and Garlic. These have the most interactions and the first two can increase blood pressure signigicantly. Glucosamine is generally safe but may interact with Coumadin (warfarin)

2. If it makes some cure all or miraculous claim, it's garbage and will not live up to the hype

This includes: most weight loss remedies (Alli will work but with proper diet and exercise only minimally), male enhancement or erectile dysfunction (ED) herbals (some with yohimbe or horny goat weed may work but all of them I have seen have ingredients that will raise blood pressure which may worsen ED), and colon cleansing products to name a few.

3. A lot of the herbals have some basis as to why they work. However, many may only work mildly if at all. They are not replacements for prescription medications.

4. Look for the USP or ISO certification stamps. These mean these herbals where tested by an independent third party and actually have what they claim in them. Thus these are safer than most.

5. Do not ask advice at a store that strictly sells these products. Many of the employees have numbers they need to reach and will sell you a variety of things to meet THEIR NEEDS, not yours. Instead ask a health care provider, like a pharmacist. We must be able to legally back up what we recommend. Would you trust someone who must back up their recommendation in a court of law or someone who was hired last week and is still in high school?

With all of that being said herbals are not always a bad thing and can actually help many people live better lives. They are not cure alls but should be used with the same discretion as prescription medications. Everything has side effects even foods. If a person eats too much fat, they gain weight. BOOM! Side effect! Always ask advice of a professional. Yes, they may make a little bit off of selling you something but they are held accountable for what they tell you. That's why they are PROFESSIONALS!