What do you get when you take the venom out a cobra? …a belt
How a vasectomy works. Courtesy of Family Guy and Vaudeville.
No comments on its accuracy. 
Can you read these prescriptions? (Round 2)
Update: Thanks to Kevin, MD, The Consumerist, and The Wall Street Journal Health blog, this entry is getting a lot of traffic. If you enjoy it, please take the time to Digg it. 
The first round was popular, so I thought I would share another round of Bad Prescriptions. Answers will be posted tomorrow (Thursday) night around midnight.
Remember there's more to a prescription than the drug. You need to get:
- Drug name
- strength
- directions
- quantity
- number of refills
The last prescription is totally legible. I have included it so you can cringe along with me. It was for a 6 year old child. And the folks in the Ivory Tower think MinuteClinics are bad…
Exhibit A:
Exhibit B:
Exhibit C:
(Standard disclaimer about electronic prescribing not being the perfect answer applies.)
[tags]Medicine, pharmacy, prescriptions, bad handwriting, doctor's handwriting[/tags]
Did you know that being a Doctor of Osteopathy means you don't prescribe drugs?
Yeah, I didn't know that either.
The Eagle Tribune munges what a D.O. is:
Baez is a doctor of osteopathy, a hospital spokesman said yesterday. Osteopathy is a drug-free, non-invasive medical practice that focuses on total body health by treating the musculo-skeletal system, including joints, muscles and the spine.
Bzzt. Wrong. DOs are NOT chiropracters or physical therapists.
Another reason ERs are overcrowded
Overheard:
"Why did she go to the ER? Why didn't she just see her regular doctor?"
"Because then she'd have to pay money."
*Cue us filling some non-urgent prescriptions.*
God Bless the entitlement mentality.
OK so it's expensive but would you really rather go without it?
Generally little things cost small amounts of money. Unless it's a diamond. Or some medications. And this was brought to my attention most recently by a comment left on an old Plavix post. My premise is that the public thinks about the cost of medical intervention the wrong way. (Duh!)
It's not uncommon to hear people complain about the cost of Ambien (with apologies to Dr Dino ). Until recently, Ambien was one of the most expensive, yet most common medications. And also widely complained about. Patients don't like the fact that it's costing them $45/month to take some tablets to help them sleep.
But this anger is the result of a flawed perception. Instead of valuing the tablets as something that you hold in your hand and swallow, you should be valuing the quality of life that they afford you. Is it worth $1-1.50 per night to sleep well? If you asked a person with insomnia if they would pay $1.50 to enjoy a full night's sleep just before they're about to go to bed, most would pay without complaint.
It would be foolish NOT to.
It amuses me that people pay the high cost of Viagra without any problems. And that they'll throw down $10-15,000 on plastic surgery, or $75/month for Propecia, but they complain about a medication that is keeping them alive. Honestly, if having high cholesterol was a cosmetic issue, and relative attractiveness correlated with your LDL levels, there would be NO complaining about the cost of a given statin.
"Proactive chemotherapy"
Proactive chemotherapy?? Sign me up!!
Oh wait…
A final note on MinuteClinics
This will likely be the last time I post about MinuteClinics here at OTP, because I think I've said enough already. I had mixed feelings on the concept of one-stop medical shopping so to speak, but some time has gone by, and my opinions have changed.
I'm growing tired of reading posts like this one on places like Kevin, MD that complain about retail health clinics, and letters like this one from the Massachusetts Medical Society making the same tired arguments:
Concern #1: Safety. We’re worried that medical care will be delivered without the knowledge of the patient's primary care physician and without the knowledge or availability of a patient's medical history. This raises the risk of medical error. Elderly persons with multiple chronic conditions, on multiple prescriptions, are even more challenging.
Concern #2: They could kill our fragile primary care system. Our primary care network is already in crisis. Allowing mini-clinics to skim the easy, less complex patients might be the death knell of primary care, and our community health centers, too. Who would pick up the slack if that happens? Our emergency departments, of course, which are already over capacity. In other words, these clinics could replace what already exists — with something worse.
Concern #3: Conflict of interest. It's an inherent ethical conflict when a pharmacy is located at the same site as a primary care clinic, owned by the same company. There's good reason why most doctors can't dispense drugs in their own offices; the same reasoning applies to mini clinics like these.
Concern #1, while valid, isn't terribly relevant. While PCPs would like to think that they're the responsible for managing the entire continuum of care, this isn't always the case. In many cases, PCPs are out of the loop, leaving the pharmacist as the repository of one of the most important aspects of patient care: medication management. The number of phonecalls that we get asking us what Mr Smith is taking, how is he taking it, and could we please give him six months worth of refills, and thanks for getting us up to speed, have a nice day — is on the rise. In an average day, it happens probably 2-3 times. Six months ago, it happened once or twice. We have HIPAA and specialization to thank for this phenomenon. In the context of retail health clinics, I don't believe drug allergies and interactions are a problem — most people don't play musical pharmacies, and are pretty knowledgeable about their own special health issues. And the pharmacy, at the very least, is aware of them.
Concern #2 speaks to the bread and butter phenomenon that I saw mentioned at Flea's blog a while back: the easy patients that can be cranked out at a high rate of speed. These people are the targets of the MinuteClinics. Easy to diagnose, easy to treat. In and out in five minutes, and you can bill the insurance company for an office visit. Or in MinuteClinic's case, run the credit card for $60 bucks a whack.
Concern #3 is a fallacy. Pure and simple. It's also hypocritical. The nurse practitioner isn't going to get a bonus based on how many prescriptions s/he writes. If anything bonuses will be based on the number of people seen. But this is exactly how primary care operates today: more patients = more money. CVS is up-front about its bonus structure for pharmacists. (Which, I should mention, is far more complex than more scripts=bigger bonus.) There is no mention of bonuses (or "incentives") in conjunction with MinuteClinic primary care providers. Just to be sure, though, I have contacted some management types at CVS to get the final word on this.
Regarding physician-owned pharmacies: they can and do exist. My PCP, for example, owns his own pharmacy. And there's no pharmacist running it. There are some limitations — he can't dispense controlled medications, for example — but physician-owned pharmacies do exist, and no one seems to have a problem with it. So this argument rings hollow.
What PCPs and the folks in the Ivory Tower need to do
Rather than complain about how MinuteClinics are possibly the end of primary care, you all need to start using your influence in a more productive fashion. Whining about MinuteClinic isn't going to make it go away, because MinuteClinic owes its existence to you. It fills a niche perfectly that you've created by not seeing patients same-day.
You want MinuteClinic to go away? Great! Compete with it on their terms. Set aside a regular time slot each day to see patients with the types of ailments that MinuteClinic treats. That means a clear policy on not allowing people to chat about their diabetes. One (possibly two) complaints and out the door, and then bill the insurance company.
If someone doesn't have insurance, don't charge them $90-120 for an office visit. Charge them $60, or create a sliding scale like MinuteClinic has. If you can see ten patients in one hour, you're looking at $600 for your time. I'm not a physician, but that must be pretty close to what you'd bill an insurance company to see four patients. Probably a lot more. Do this two hours a day, and that's $1200×5 days a week… $300,000 a year for what amounts to two hours of work per day. You might even find that these two hours become your biggest revenue-generators.
Yes, that means you'll have to start early and set goals. Like not scheduling people between X and Y times each day, beginning six months from now. Start announcing this new policy (and availability!) immediately. Tell patients in your office when they come to see you, especially peds. Create an easy-to-read flier about what kinds of cases you will and will not see during this time slot; WHY you are setting this time aside; and print out 1,000 copies so that you can distribute it to all of your patients when they come in the office. Your patients will become your biggest advertisers — patients love being able to see their doctor when they have something wrong. Being able to actually see YOUR doctor when you are sick is a very sexy idea.
The Massachusetts Medical Society ought to be encouraging physicians to compete with MinuteClinic, not decry its existence. You folks lot carry a lot of weight among your own. If you want to make a difference, advocate that physicians work towards making themselves more accessible instead of issuing specious warnings to the public that MinuteClinic is possibly dangerous, because trust me, they wouldn't give a damn even if your arguments did hold water. They'd still be lining up like people at the deli counter take a number please, thank you.
If PCPs made themselves more available, I bet you'd see fewer numbers of people going to the ER for things like ear infections, and a small resurgence of primary care instead of watching it wither on the vine. If you think primary care is eroding, maybe it's time to take a risk, instead of trying to cling to the old, broken system? I also wonder if respect for physicians would go up, instead of down? Do you know how frustrating it is to try to see your doctor for an acute complaint, only to be told that you'll have to wait 3 days? Talk about facilitating hostility on the part of your clientspatients.
[tags]Medicine, MinuteClinic, CVS, primary care[/tags]