Before we begin let me get a few things out of the way. First, I am a healthcare professional. Yes, a pharmacist is a healthcare professional. Second, Iâ€™ve spent a large portion of my adult life working in the healthcare industry, both inpatient and out. This includes more than a decade working in a hospital as either a â€œstaffâ€ pharmacist or a â€œclinicalâ€ pharmacist. Third, the average person has no idea what goes on in a hospital or their physicianâ€™s office. A majority of people that are misdiagnosed, receive unnecessary labs, get the wrong drug, etc. will never know because they have no reason to think theyâ€™re getting anything but the best of care. And finally, Iâ€™ve been called a pessimist. I donâ€™t see it that way, but Iâ€™m simply giving you all the data I have.
Ok, lets get down to business. In the 14 years that Iâ€™ve been a pharmacist Iâ€™ve had hope for the healthcare industry even though itâ€™s done nothing to bolster optimism. Iâ€™ve seen nothing to prove that the healthcare industry is doing anything to actually improve the care that patients receive. Oh sure, governmental agencies have lots of rules and regulations, but a significant portion of those are kneejerk reactions to some problem that could have been dealt with in a much more effective manner. Medication errors continue to happen at an alarming rate, patients continue to have surgeries they donâ€™t need while others sit waiting for surgeries they desperately need. Pharmacists scream for more authority in the healthcare system, but cower when confronted by anyone questioning their opinion. Physicians refuse to take advice from anyone besides the voices in their heads, and sometimes those voices are wrong; flat out wrong. Nurses find themselves in the unenvious position of being the first line of defense in the healthcare system only to realize that they’re unarmed to defend themselves or too hurried to care. And yes, we continue to develop new treatments and procedures to prolong life, but that doesn’t mean better care.
Unfortunately the years continue to go by without much changing. Has it gotten worse? In my tenure as a pharmacist I believe it has. Why do I believe this? Well, letâ€™s just say that Iâ€™ve been on the wrong end of some interesting healthcare problems involving loved ones over the past several years. I shudder to think that this happens to every person, but I have no evidence to suggest otherwise. I’ve seen some pretty interesting things inside the walls of a hospital. I believe some stories are better, while others are worse, making my experiences average.
Exhibit 1: Physician induced drug overdose and failure to communicate â€“ 5 years ago
My mom has a rare autoimmune disease that is destroying her liver. That’s a bad thing. She’s on the liver transplant list at the University of California San Francisco (UCSF) Medical Center. Thatâ€™s a good thing. Several years ago she was overdosed on tacrolimus because her physician ordered 10mg bid instead of 1mg bid. Yep, a tenfold overdose. That’s a bad thing. She was admitted to a small hospital here in the Central Valley with a diagnosis of â€œdehydrationâ€. She continued to go downhill and her primary care physician at this particular hospital refused to talk to me and my brother about it. Yes, he refused. My momâ€™s condition continued to deteriorate and when I asked to see the physician the hospital sent me a priest instead. He asked if I was ready to pull the plug on her. Uh, no, not yet. I made some calls to some people I still knew at UCSF, got her transferred and admitted to the ICU. Several weeks later she left the ICU, went to a general med floor followed by a couple of months of rehab and on to home where sheâ€™s still alive and well. That was 5 years ago.
Exhibit 2: Drug error â€“ 4 years ago
Upon discharge from a hospital stay from a local hospital in the Central Valley my mom complained to me about being dizzy. The first thing a pharmacist does when someone complains about being dizzy is check their drug regimen. Sure enough, one of the physicians at this podunk hospital had prescribed methyldopa instead of magnesium. How the heck do you go from magnesium to methyldopa? It was soÂ bizarre that it took me a couple of phone calls to get it straightened out.Â We discontinued the methyldopa and lo and behold she wasnâ€™t dizzy anymore. Go figure.
Exhibit 3: Lack of caregiver attention â€“ 2.5 years ago
My wifeâ€™s mother, Mary Lou died from lung cancer in December 2008. We had several problems with her care during her battle with the disease. Over anti-coagulation, under treatment of pain, inability to get ahold of physicians when needed, lack of communication with the hospital, pharmacy and oncology center, and so on. I mentioned it briefly in a previous blog. What made the entire experience so terrible was the toll it took on both Mary Lou and my wife, Lori. There were a lot of sleepless nights, tears shed and words of frustration spoken during a short six month period. And it was all because the healthcare system refused to deal with Mary Lou as an individual. Many times I argued with her physician because she would say “this is what we typically do“. A “typical” patient is not every patient.
Exhibit 4: He gave you what? â€“ 1 week ago
I received a call from my Grandma last weekend. Thatâ€™s not all that unusual. Sometimes Iâ€™m a bad grandson and forget to call her for a few weeks. She always finds time to call me and remind me that I havenâ€™t called.
G: â€œHi Hun, you busy?â€
Me: â€œAt Mikaelaâ€™s track meet. Whatâ€™s up?â€
G: â€œThe doctor gave me some sulfa drug and now I have red bumps all over. I called him and he gave me some c-e-t-i-r-i-z-i-n-e for the itching and rash.â€
At this point Iâ€™m thinking two things: First, arenâ€™t you allergic to sulfa? And if so why did your doctor give it to you? Second, why on earth would he give you cetirizine for a rash that sounds pretty bad and uncomfortable? â€¦ok, back to the scintillating dialogueâ€¦
Me: â€œYeah, it’s an antihistamine. Is it helping?â€
G: â€œNo, not really. Is there something else I can take?â€
Me: â€œYou know what Benadryl is?â€
Me: â€œTake 2 of the 25mg tablets. It will make you sleepy, but it should work a lot better than that other stuffâ€
G: â€œOk, Hunâ€
Me: â€œCall me if you donâ€™t feel better in a couple of hours, ok?â€
Seriously? The physician gave her cetirizine for what I would consider a fairly significant allergic reaction to sulfa. Holy under-treatment Batman!
Exhibit 5: Poor communication, lack of empathy and stupidity â€“ today
My father-in-law, Wayne, was involved in a rather nasty car accident about a week ago. He will survive, but heâ€™s got a long road ahead to recovery. Heâ€™s already had one surgery to repair some damage to his spinal column, will require another surgery for a compound fracture to his ankle, has several stiches in his face and the pleasure of a couple of broken ribs. Each time Iâ€™ve been to visit him he seems to be improving. That’s good. But here’s the thing…
Problem one: Heâ€™s getting discharged to a skilled nursing facility today for rehab. Thatâ€™s good. No one told my wife, a.k.a. his daughter thatâ€™s responsible for his care. Thatâ€™s bad.
Problem two: The little pack of trauma surgery folks came by to see him while my wife and I were visiting. Thatâ€™s good. They wouldnâ€™t really answer our questions. They kind of danced around the subject. Thatâ€™s bad.
Problem three: Wayne is an incredibly sharp, fit and healthy man. He was acting a little weird so I asked the physician and nurse about it, and they just shrugged their shoulders. The physician actually said, â€œfrom a physical standpoint he’s doing surprisingly wellâ€. Thatâ€™s good. â€œBut as far as mentally, well, we have no way of knowing what his baseline is.â€ Thatâ€™s bad. No further explanation was offered. No promise to think about it. No question as to whether we thought it was a problem. No discussion as to whether it would be permanent or temporary. Nada.
Problem four: WayneÂ doesn’tÂ take medication. As I mentioned above, heâ€™s very healthy. But I decided to ask the nurse what he was on, thinking that something might be affecting his cognition. Hey, it’s what pharmacists do. And to my surprise theyâ€™d put him on a medication that I thought was a little odd. The med didnâ€™t really seem to fit any of his needs and in addition it requires routine labs to monitor drug levels. I voiced my concern to the nurse and she said â€œall drugs require levelsâ€. Really? Hmm, Iâ€™ve been a pharmacist for a while and this is the first time Iâ€™ve heard that. Thanks for the education. Of course I didnâ€™t tell her that I was a pharmacist because it typically creates problems. Nurses hate pharmacists. It’s just part of the circle of life; like cats and dogs.
I pressed the nurse on the issue and she grabbed one of Wayneâ€™s physicians. The physician briefly looked up from her patient list as I ran through my concerns. In fact she acted annoyed that I was wasting her time with such trivial matters. She ended the conversation by saying that that wasnâ€™t her area and Iâ€™d have to talk to someone else. Nice. Very nice.
Needless to say my wife and I left the hospital with more questions than answers.
As you can see, things really havenâ€™t changed much in the past five years. Everyone is so caught up in healthcare that theyâ€™ve forgotten about the patient. And when healthcare forgets about the patient, well, let’s just say it’s over. Just sayinâ€™.