Tuesday, October 25, 2011

Even if the truth hurts

Several days ago I stopped by a local pharmacy on my way home from the hospital to pick up an item for my wife. While waiting in the checkout line, I overheard the conversation of two senior women who were ahead of me. One of the women was telling the other about her husband, who was hospitalized due to a diabetic foot ulcer. She said that he had known about the sore on his foot for quite a while, but he had chosen to ignore it. Upon admission, the ulcer had reached through all of his tissue and the bone of his heal was exposed.

Upon hearing this, most people would think “poor guy, hope it heals”.

But that wasn’t my thought.

Maybe my years in community pharmacy have jaded me. Maybe seeing patients admitted repeatedly for the same diagnosis has hardened me since my move to the hospital setting a few months ago. Whatever the reason, my sympathetic side took a backburner to my practical side. My thought was a simple one.

This admission was totally preventable.

Seriously. It is 2011 and we are living in the United States. There is no reason that anybody should be admitted for a diabetic foot ulcer.

We have the best medications to control blood glucose levels. We have at-home testing machines that can tell you what your blood sugar (and hemoglobin A1c) levels are. We even have little mirrors on the ends of poles to help diabetics inspect the bottoms of their feet.

We have home health care companies that go to patient’s homes three, four, even five times a day to help people take their medications. There are social services that come into people’s homes to help with meal preparation and housekeeping.

We have a vast amount of information available to us over the internet. With a few keystrokes we can find out about our medical conditions and how to stay healthy. If your physician is tech-savvy, you can have access to him or her with a few keystrokes on your cellular phone.

With all of the advances in technology and medicine, there really isn’t a good reason that I can think of as to why somebody should be admitted for a diabetic foot ulcer that has reached the bone.

Other than patient apathy.

The hospital administrator side of me started thinking about how, in the near future, hospitals aren’t going to get paid by Medicare for patients who are readmitted within 30 days for certain conditions. Even if the hospital does everything correctly, a patient who doesn’t care about his/her health is going to receive thousands of dollars of care for which the hospital will not be reimbursed. Diabetics who bounce back into the hospital because they can’t manage their disease are going to drain my facility of resources that could be used to treat patients who genuinely desire to get well. It makes me kind of angry.

Then there’s another side of me that wonders why nobody said or did anything. Why did this guy’s wife let the foot go untreated? Has this guy ever been educated about his disease? When was the last time this guy saw his physician? Is he taking his medications correctly? Has he ever talked with his pharmacist about his medications? Can he afford his medications?

These thoughts are running through my mind and I remember a comment that somebody recently left on one of my older blog posts. The jist of the comment centered around a thought that I had shared when a patient asked why they needed to be on a medication. My thought was “because you are fat, lazy, and need to exercise”. The commenter thought it was unprofessional of me to think like that, and who was I to judge.

Maybe I was wrong to think like that (even though I saw the grocery items that were in the cart). But then again, maybe I should have said what I was thinking. So much of our effort in pharmacy is dedicated to keeping the person as a customer rather than speaking to them as a patient. Are we doing our patients a disservice by sugarcoating our message? Sometimes being blunt is what is required to get the point made.

Would this woman’s husband have been better served if somebody had actually said “keep your blood sugar under control or you are going to get a nasty infection on your foot that may require amputation” Most people are afraid of losing body parts so that may have resonated more than “Jim, are you taking your pills right? No? Well you better. That’ll be $4.00.” When I worked for one of the chains offering $4 prescriptions, I didn’t have the opportunity to even have that discussion.

I did have a position at a regional grocery chain (where we filled 120-180 scripts/day) where I was able to talk to my patients. I got to know my patients and their families. And when warranted, I would be blunt with them. They understood that it was coming from somebody who cared for them and wanted to see them healthy. It has been three years since I left that position and I still get stopped at football games and swim meets by my former patients who thank me for how I helped them with their medical conditions.

I didn’t become a pharmacist to sugarcoat the truth to make people think that they are being healthy. If pharmacists want to impact the health of our patients, we need to be truthful.

Even if the truth hurts.


Anonymous said...

Eric, you're thinking like an educated person.

I've been a hospital pharmacist all my professional life. I might have thought like that at one time, until I started working in a small (16 beds) county hospital in a small county.

The educational level in this country is pathetic. People believe anything and everything on TV or the billboards, in magazine ads, and newspapers, but they don't KNOW basic information like what diabetes or heart disease, and do not realize the impact until it keeps them home from a trip to the bar, or they have to quit smoking because they've had triple by-pass. Not only is there rampant misinformation, but there's a lot of psychological illness in this country--people don't know who to trust (not even their doctors, sometimes) and they for sure don't want to puzzle anything out for themselves. One thing my 90 year old neighbor tells me occasionally...'there's just one thing wrong with the concept of commonsense, it's not always very common'. I would probably say that because people lack basic informational processing skills where we too often rely on regurgitated advertisement and propaganda of some media outlet.

Anonymous said...

Well, there is a professional side of being truthful and then there is a judgmental way to be truthful as well. I agree with most of your points, but looking at someones foodcart and being judgemental on the content of the food seems well, unprofessional. Sure you can educate the patient from your perspective and of course you should, as this is part the ideal pharmacy practice. You can even talk to them about weight control and perhaps recommend some great places where they could exercise and learn more about diabetes, you can help tremendously this way, and show that you do indeed care about them and their health. However, I would never call someone fat and lazy and stupid. The new medicare rules will indeed be a tremendous burden on hospitals everywhere, and I can see SOME of the reasoning behind it, BUT, at the same time, most of the expectation is ridulous and totally unworkable. Under the new rules, if you treat and heal the patient in the hospital, and they fall and get hurt, and get in an accident, and need hospital care, the hospital has to pay for it???? Really?? YES REALLY!!! and now they want to cut medicare costs in the federal budget even further? On one hand you have to get the patient out of the hospital under DRG's or you won't get paid any extra, and then if you send them home too soon, and they have to come back, guess what? NO PAYMENT for anything? I don't know if this is OBAMA care or not, but who ever thought of this is either a genius or a nut...I just hope hospital fight it as much as they can, or many will be closing.

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