Should We Educate Patients More?

One of the aspects of the pharmacy profession is to educate patients. Educate them on the drugs they take, the interactions they cause and to offer advice when needed. The first two portions are followed religiously, but that can also be attributed to the legal aspects. The last portion, to offer advice when needed, is a highly gray area. It is an area of which I personally would like to explore.

As of late, especially with our current economic troubles, I have been wondering if it is time that we educate our patients on more than just the side effects of their drugs. I have been seeing patient after patient paying ridiculous copays for Nexium and I then ask them if they have ever tried Omeprazole. Most say no, some even say they've never heard of it.

The question then becomes, do I explain the connection between Nexium and Omeprazole? Granted on a chemical level they will not understand it, but it can be easily explained in layman's terms. They could easily save a hundred bucks a month just from that one drug. There's countless other similar situations that this could be applied to.

In my marketing class we have been taught that it is best to educate the company into today's competitive environment. To give them choices, show them all their options and let them make informed decisions. Now I am not suggesting that we let patients decide their medication therapies, but they should be at least be aware of these cost effective options, especially if they are on a fixed-income. So why can't we do that? Why can't we tell the patient paying cash for Lexapro that Citalopram is much less expensive, but will most likely work just as well? That they don't need to pay the $50 copay on Coreg CR when generic Coreg will be covered for a much lower copay.

I think the first hurdle would be to get over the 'MD is god' mentality that a lot of patients have. To me, it appears, that hurdle is eroding under its own weight as it is. Often we are asked second opinions on drugs despite what their doc may tell them.

We all know the Big Pharm is in bed with PBMs. We also all know that it is nearly impossible to bring them down at this moment. Perhaps, though, we could use this to chip away at that formidable facade. Perhaps it would educate the public to the point that maybe a majority will start to speak up for more equality. Then again this is highly idealistic.

Our jobs are to help ensure the health and well being of our patients. If we can help them save money so they can afford their insulin or blood pressure meds, why shouldn't we help them? I know I will be from now on.

A Bunch of Hens

Ever heard that phrase before? Often in class there is a section of students whom are always talking. Always kissing up to the prof. Always being an annoyance to the class. To me, that is a bunch of hens. It annoys the hell out of me.

I switched from a science related major to a business major because, in the long run, I know it will suit me better. The problem with that notion is that I generally cannot stand the classmates in my major. The vast majority of the them, to me, are nothing more than a bunch of hens.

Do you know what it's like to sit in an upper level business course? Generally people talk all the time, interrupt the prof and ask so many questions that little progress is actually made. It is mindless, it is tedious and it drives me nuts. And these are the upper level courses.

I am used to science courses where the students pay attention and take notes. Yes there is random discussion and fun involved, but everyone is respectful and much is accomplished. That does not happen in my business courses. Do you know that in three years not once, not ONCE, have I been intellectually challenged? That used to happen weekly in microbiology, biochemistry and the likes. I'm not trying to brag about intelligence, I'm referring to how little is accomplished in these classes.

Earlier today, prior to my finance class, I was chatting with the person sitting next to me. I asked him what he was going to do after his B.S. (he is an accounting major) and he goes "I'm gonna make lots of money!" When he asked me and I responded he had a dumbfounded look on his face. "You mean you're going to go to school for at least another four years? Why?" I mentioned that I found it interesting and that it is my passion to which he responded "... but don't you want to make money now? I mean you'll be almost 30 by the time you're done!"

Perhaps that is my problem with the department. Everyone is so set on making money yesterday. I like learning, no scratch that, I love learning. I love having my mind challenged. And I am especially fond of learning about the human body and chemistry. And, on many levels, I really want to have an impact on my field. Sure I want to make money, but I want much more than that.

I'm not any older than most of my classmates, but I feel as if I'm on another level from them. It's awkward at times, especially when I see how much harder I am working for something while they coast their way to a C. I cannot comprehend living like that.

What sparked this? A post by the Old Md Girl discussing her age difference from her classmates.

I thoroughly look forward to the day when I can sit in class with my peers. Perhaps then I won't be so tempted to smack the hell outta all of them.

Something Pharmacy Folk Should Be Thankful For

For as much as we all bitch about job, talk about how much we hate it and how unbearable it may be at times, at some point we must step back and look at a simple fact that not many can say today. Our jobs are relatively secure. That nature of the business dictates this facet. And if you are a pharmacist, you have quite literally little worry about applying for unemployment. It is one of the perks, if you wish to call it that, of the profession.

That being said one must wonder just where on Earth are we headed. We have become a society that is wasteful and selfish. Pharmacy is perhaps the epitome of this fact. Can someone explain to me why our state's medicaid will only pay for brand name Risperdal and Imitrex? How about only Xopenex being formulary? Do we really need Nexium when we have Omeprazole? Should they not be the first to jump on the lower cost bandwagon? I cannot fathom how they can be so wasteful with taxpayers money. Personally I am glad I am not a resident of this particular state and that my money does not go to such money pits. Yet this is what happens in numerous aspects of our cultures. We were blessed with many years of economic prosperity and seem to have forgotten that steps that brought us to that prosperity. We've taken it for granted and, in essence, have become lazy.

One of the reasons I voted for Obama was not that he was a democrat. It wasn't because I believed in his views 100%. It wasn't because he was African American. It wasn't because I was completely certain he was the better candidate. I voted for Obama because, to me, he appears to be the beacon of change. Whether or not it is for the good, I do not know. I am sure that we could not stay on the path we ride at the moment and expect to recover from our current situation. I believe massive changes are on the horizon and I am waiting rather impatiently for them.

Now what does this mean for us in pharmacy? I think it's time to start standing up to some of the bullshit we see on a daily basis. I know several pharmacists who call the state almost daily to ask them what the hell their problem is with their decision on Xopenex. Daily I hear of patients who are foregoing insulin and other needed meds just to save a few bucks.

This is more of a rambling post and I apologize for that. I have just become frustrated with our way of life and expectations. If I take solace in anything it is that this too shall pass. And when those changes finally do come... I'll be one of the first goddamn people on the front lines fighting for them.

I survived the PCAT

Never before, in all of my schooling years, have I finished a test and been physically exhausted. Not to mention I enjoyed a splitting headache once I was done. One of my review books called the PCAT, "a test of endurance as much as it is a test of your knowledge." Ain't that the fuckin' truth?

All in all it went pretty well. Everyone I talked to was in agreement that the chemistry portion was by far the hardest. Otherwise I breezed through everything else.

One note for those who are going to take it. It is good to practice under timed conditions so you learn how to budget your time. When you take the actual test, however, you do not get to see the clock. You also are only given a 5 minute warning. There is no one minute morning. Which means when I found that out I had two blank answers I was debating over and quickly had to fill them in. Just a word of advice for future takers.

In any case I feel much better today, like I have this elephant that's been removed from my shoulders. Tis a damn good feeling.

The Last Test

Five years of sleepless nights, five years of endless studying, five years of brutal classes is leading up to my PCAT this coming Saturday. After this test, providing I do well enough, the rest of college will be smooth sailing. No more microbiologies or organic chemistries to keep me on my toes 24/7 studying.

The problem with that thought is, it's a lot of fuckin stress. I am having to go over material I haven't seen in four years in some cases. I don't really remember too much about calculus, but I have to become proficient in it in six days. I have been studying off and on all throughout break, only to discover the practice book I have been using is one of the worst. Go figure.

So for the next six days (including the start of a new semester) I shall probably be the only one engrossed in textbooks in the library. The only thing I keep telling myself is that this is the last test. Goddamn does that sound like a good thought...

Oh E1 Screens, How I Love Thee

Perhaps the one jewel that has come out of the clusterfuck that is Medicare Part D is the E1 screen. I have no idea what others call it, but every place I have worked it's been known as the E1 screen (probably because that's what CMS calls it). It is easily the most brilliant thing ever created for pharmacy use.

Now those of you outside of the business are probably goin, what the hell is he talkin' about? You've seen myself and many others in the field bitch about how patients show up with new insurance, but no cards and no idea what they have. In that case you are up shit's creek, with no paddle and, in my case, a shitload of bats are chasing you.

With the E1 screen, that is not the case. Simply input the patients Medicare number, hit submit and viola, it gives you the current prescription plan for the Medicare Part D member. Thus you do not have to hassle with the elderly who barely know their own name, yet alone which plan they are under. Sure it has it's hiccups occasionally, but its far better than nothing.

Which begs the question, why can't this be brought nationwide? Why can't BCBS or Caremark or any of the other insurances procure a similar database. Maybe it doesn't have to be connected directly to our computer system, but surely they could create some sort of secure website? Medicaid in our area has a similar setup which works wonderfully. Think of all the headaches it would save!

Then again that's the precise reason we shall never see such a system devised. Oh well, it was a good idea while it lasted.