Why It’s Called Healthcare… Not Patientcare

God heals, and the Doctor takes the Fees…
Benjamin Franklin: Poor Richard’s Almanack , 1736. 

Maybe old Ben Franklin even recognized the beginning of a trend in healthcare. It’s not the fault of the doctors per se but healthcare is not always focused on patient care, it’s business… big business. Non-profit hospitals used to be dedicated to giving appropriate healthcare to all, even those who could not pay. Now we see non-profit hospitals, formerly operated by faith based organizations, being turned into for profit corporate systems providing care to a community based on direction from share holders and management teams.

In Ben’s day the physician, more times than not, received payment in kind  from his patients.  A basket of eggs or sack of potatoes from the garden for minor services. Possibly the chicken itself; a goat, pig or cow for more major transactions. If the patient couldn’t pay, or pay in kind, they usually provided service later on to repay the ‘debt’ of receiving treatment and to express their gratitude. I’m sure that most patients were more than happy to repay for appropriate health care services in that day and age, especially when they survived and got better.

Life was probably much easier before health insurance:

Although the concept of being protected through health care insurance is a great idea it’s contributed to a big business mentality. Third party payers and corporate insurance companies are in it to cut costs and make money, or at least not lose money.

Yes, healthcare is big business. We don’t see the family doctor working out of his home doing house calls much any more. They’re usually affiliated with a hospital or group practice of multiple physicians. We don’t see many ‘mom and pop’ pharmacies anymore either. We now have the Walgreens, CVSs, Walmarts and mail order pharmacy. All of them along with pharmacy benefit management groups (PBMs) selling patient information to generate more revenue.  And with this type of change we’ve seen the transition from real patient care focused practices to enterprises designed to ‘drive’ healthcare services and generate profits to satisfy stockholders. Is this truly in the best interest of the patient?

Patient care seems to get lost in the healthcare world today. Even the patient centered medical home model (PCMH), while touting the focus on patient care, is really designed to manage healthcare costs. Accountable care organizations (ACOs) and continuity of care organizations (CCOs) basic premise is to control healthcare costs.  That doesn’t say much about patient care, does it. So when did we lose patient care and how do we get it back?

Having a mission statement does not mean fulfilling the right mission:

I don’t think that patient centered care is totally lost. But patient centered care must come from the individual providers. Now I’m not saying that this doesn’t happen. It just happens less often than it should. Those of us involved in healthcare, whether physicians, nurses, pharmacists or other auxiliary personal all need to be focusing what we do around the idea of what is best for the patient. Sometimes it means taking a stand for what is right for the patient, even if it’s not in the best economic interest of the healthcare machine.

Providers can be the stimulus that changes healthcare to patientcare. Focus on what is best for the patient in the long run. If the system is broken or fails to take care of people by following the usual and customary ground rules, changes need to take place. Decisions based on positive patient outcomes need to be made as opposed to decisions base merely on economic factors. Maybe if providers start doing this, with each patient, the system can be changed from within. One could only hope that by doing so we can change healthcare to patientcare.

 

3 Reasons You Should ‘Phire’ Your Pharmacist

I’ve been in the profession of pharmacy for over half my lifetime. I’ve seen the ins and outs of what happens in independent, hospital, nursing home and chain pharmacies. There are many problems that have plagued pharmacists over the years that have made it difficult at times to practice real, patient oriented pharmacy.  Unfortunately patient care sometimes takes a backseat to all the headaches and stress involved in the prescription filling process.

For most pharmacists the profession has evolved to a hectic paced, overworked environment. Many are filling hundreds of prescriptions each day, dealing with difficult insurance issues and coordinating the prescription filling process understaffed and over-pressured. There are almost always issues and disputes between the overworked support staff. And then there are the interactions with cantankerous customers or the nurse ‘know it all’ that really makes a pharmacist’s day.

All of this can lead to a pharmacy professional that is run ragged by the shear volume of the workload. We often have ‘management’ that thinks they know a better way to fill prescriptions more efficiently to give us time to counsel with our patients. We even have customers that want to weigh in on how to fill prescriptions better. After all, we’re just putting pills in a little bottle that came out of a bigger bottle, right? Oh, and don’t you dare put the blue pills in Mrs. Smith’s bottle that should contain pink pills. We’re still expected to be exacting and perfect in all we do. No wonder so many pharmacists are bald or balding due to the natural phenomenon of pulling one’s hair out.

But even with all this going on, your pharmacist should still be able to satisfy your need for personal pharmacy services. If not, you may need to consider finding a new pharmacist.

Here are three valid reasons why you should consider firing your pharmacist:

1.  Your questions don’t get answered properly. 

Yes the pharmacist is always busy, but they’re still obligated to answer your questions. We’re not talking about questions like “what aisle are the toothpicks on” or “do you know when you will be getting more toothbrushes in stock”. In most states pharmacists are obligated to answer your questions when you pick up a prescription. If your questions can’t be answered at that time, your pharmacist should schedule a time to sit down with you uninterrupted. If you can’t get the answers you need you should fire your pharmacist.

2.  You can’t get a prescription filled in a reasonable amount of time.   

Here again, pharmacies are usually a busy place. But that’s no excuse for a pharmacist to tell you to come back tomorrow for your antibiotic. I’ve witnessed pharmacists telling a mom or dad with a sick child the prescription will be ready in 3 hours… or even longer. A 24 hour pharmacy recently told a young mother with a prescription from the E.R. to come back after 3 a.m. There were no other patrons in the pharmacy when she arrived 4 hours before that. What’s he doing? Taking a 4 hour break or something? Prescription refills are a different story but if you can’t get your new prescription in a reasonable length of time you should fire your pharmacist.

3.  Your pharmacist ignores you or fails to recognize you as a patient. 

There may be more than one pharmacist at a pharmacy location. And every one of them will know by sight some of the customers at that store. We don’t always recognize all of the good customers, but we all seem to know who the bad customers are.  It’s easy to remember Jane Doe because she is the one who never remembers to call in her refill for birth control pills. We all remember John White who repeatedly complains that we shorted him on his Vicodin. But it’s difficult to remember those ‘regulars’ who rarely complain or make a scene.  Regardless, it is unacceptable for a pharmacist to ignore or fail to recognize a customer, good or bad. If you don’t get greeted in a cordial and respectable manner you should fire your pharmacist.

The bottom line: 

If you are still unsatisfied with the service you receive and your pharmacist is as generic as most of the pills on his shelves or breathes negativity with every other word you should find a new pharmacist. One who is willing to go out of his way to ensure you understand your medications. One who will see to it the staff can take care of customers in a reasonable amount of time. And one who will recognize you with a smile on his/her face even though they don’t remember your name.  They’re out there and ready to assist you in transferring your prescriptions to their pharmacy with a promise and commitment to provide the service you deserve.

 

Why Can’t Pharmacists Prescribe: Response to @ThePharmerGuy

Twitter’s @ThePharmerGuy recently posted on his blog ‘Another Day Behind the Pharmacy Counter…’ asking the question:  Why Can’t Pharmacists Prescribe?  He details a very good argument as to why pharmacists should have prescription authority.   My thoughts on this topic follow below:

I totally agree it’s past time for pharmacists to be given prescribing authority, at least on a limited basis. There are so many instances where a pharmacist could make the decision to appropriately select and prescribe from a limited formulary of medications for a number of common disease states.

Pharmacists receive more intensive training and are more qualified to make decisions regarding appropriate medication therapy than most nurse practitioners or physicians assistants I know, and probably more qualified than many MDs as well.

Prescribing authority is given to MDs, NPs and PAs, in my opinion, after receiving basic training algorithms to assist them in making prescribing decisions based on their diagnosis. They don’t receive near the training or knowledge base in pharmacology, pharmacokinetics, adverse drug reactions and drug interactions that should be used in the drug prescribing process. They are also somewhat dependent on and easily swayed by the influence of pharmaceutical sales and marketing efforts, something which pharmacists are able to sort through by throwing out the hype and making better clinical decisions based on rational therapeutic approaches.

And, from what I have seen, most prescribers are easily swayed by their patients as well. All of the direct to consumer pharma advertising has created a patient population who go the the doctor with their expectations of what should be prescribed… and sometimes get upset when they don’t get what they want!

Pharmacist prescribing would expedite patient care and lower the cost of care by facilitating or streamlining the process of finding the correct medication and dose to reach and maintain therapeutic goals. This would tie in very well with a medication therapy management type of pharmacy practice that monitors new medications and makes changes or adjustments quickly and efficiently based on patient response to therapy.

All this would help to reduce costs associated with patient medication therapy,improve and streamline the process of reaching therapeutic goals, aid in assisting, educating and counseling patients to ensure compliance and adherence to drug therapy and improve patient outcomes.

The PharmD vs. BSPharmacy status for prescribing authority will need to be addressed in some manner. Pharmacists were making decisions regarding appropriate medication selection and use decades ago. It wasn’t until the prescriber and dispenser functions began to change that pharmacists  began to lose the authority to ‘prescribe’ all but those medications given OTC status. Generally speaking, most RPhs have as much knowledge and decision making skills when it comes to prescribing as those who prescribe the prescription orders they fill and dispense. Same with PharmDs.

Yes, it is time for pharmacists to be given prescribing authority, if even on a limited basis. I would expect that this authority would be expanded after a year or two of monitoring said prescribing authority based on the positive outcomes we would see.

 

Pharmacists Call to Action: Medication Therapy Management MTM is Here

Nearly three years ago I wrote a blog post titled ‘OBRA (’90), Where art Thou… and Where art We?’ .  In it I wrote  the following paragraph as I was questioning why many pharmacists are reluctant to be ‘patient pro-active’ and get involved with changing trends in the profession: 

” I don’t understand why some pharmacists have been reluctant to get involved with the evolution of their profession and provide effective patient counseling. Perhaps those pharmacists are practicing in a workplace not conducive to patient counseling or maybe they are fearfull of patient interaction. Possibly they are just not interested in getting involved, in which case I would suggest they consider a new profession. Regardless of the specific scenario, I think it is time for another call for action. Pharmacists need to get involved in counseling and educating their patients now!”  (Pharmacy 2.0 and 1/2 March 18th, 2009).

Fast forward to the year 2012.  The pharmacy world continues to watch and wait as we follow the WAG vs. ESI saga amidst reducing third party reimbursement, changing pharmacy regulations and many pharmacy Boards extending a ‘blind eye’ towards idiotic (or insane)  ’15 minutes or it’s free ’ types of corporate policies that are dangerous for the public and demeaning to the practice of pharmacy.

I’ve heard it for years… pharmacists will be providing counseling and cognitive services to patients and GETTING PAID FOR IT in the near future.   I remember first hearing it before I graduated from pharmacy school in the ’70s.  I always believed it and thought OBRA ’90 legislation might be the beginning of it.  But I was disappointed to see this happening only in a few areas of pharmacy like long term care.  Many pharmacists failed to recognize the potential for patient counseling and most members of the pharmacy corporate world continued to place profits before patients, ignoring the need and disregarding the future of the profession.

But I still believed it to be true.  Pharmacists will be providing comprehensive patient counseling and cognitive services and getting paid for it.  This is a valuable service to provide to our patients and customers that will improve their lives.  This is a service that saves health care dollars in the long run.

Early this century, MTM became the new pharmacy buzz word.   According to my ’trusted sources’ at Wikipedia, Medication therapy management (MTM) is a partnership between the pharmacist, the patient and their caregiver, and other health professionals that promotes the safe and effective use of medications and helps patients achieve the targeted outcomes from medication therapy.  (see www.pharmacist.com)

I like that definition of MTM.  Unlike the Medication Modernization Act 2003 it specifically states that MTM is a partnership between THE PHARMACIST, the patient and their caregiver.  Not a nurse, not a physician or any other health care professional.  The pharmacist is THE member of the health care team best qualified to provide medication therapy management services.

So who’s ready to get on board with MTM?  Will pharmacists finally step up to the plate and qualify themselves to be actively involved with MTM?  The future is happening right now!  Pharmacists are being paid for MTM and other cognitive services.  This is becoming reality and will become the norm in pharmacy practice.

There is power in numbers.  It will only be through the power of those involved in providing these types services.  It cannot be achieved any other way.  Not by by associations or organizations;  and certainly not through legislation or pharmacy boards.  It will only come from the strength of those providing the MTM services.  Everyone and everything else is only an appendage and supportive in nature.

Together, as a unified group, MTM pharmacists can make that happen.  You might ask “how are we to do this”?  

The Community Clinical Pharmacists MTM Group on LinkedIn is one of the ways to achieve this.  If you have not started a LinkedIn profile you need to consider it now, especially if you want to start an MTM practice.  The ccpMTMgroup is designed primarily for pharmacists who are interested in providing independent MTM consulting services.  This is the first step in setting up a network of MTM pharmacists committed to promoting and providing pharmacy MTM services.  I invite you to join this group and take part in the discussion and be part of this transition towards independent MTM consulting. As a group we can overcome the obstacles in our path and achieve this goal.

Albert Einstein  defined insanity as “doing the same thing over and over and expecting different results”.  Pharmacists cannot expect to continue with a ‘business as usual’ attitude and expect the necessary changes to take place.  We need to create an environment to accommodate these changes.

Now is the time for a new call to action that stimulates pharmacists to take steps to make this change happen. Pharmacists cannot continue (as @empress_penguin ’s Twitter profile translates) like  ”clumsy penguins swimming in the sea of mothers across health and welfare”  and expect this change to happen.  (Google Translate – Japanese to English).  (Since I don’t speak Japanese I don’t fully understand what that means but it seems to be representative and descriptive of the pharmacy profession at times.)

We need to change that now.  Pharmacists need to stop swimming ‘clumsily’ and erratically with the currents.  We need to set our sites on the goal and fight the currents in the river of Lethe we’ve been in for years.  Pharmacists must learn to swim upstream towards those goals that will maximize our efforts to improve patient care and strengthen our position as a health care professionals.

Decide now to commit to action or get out of the way of progress.  If you stood back with a ‘wait and see’ attitude when OBRA ’90 was put in place, we don’t need you now – unless you are ready to step up and make the necessary changes.  ”It’s time to get down and dirty and practical, so let’s focus on what might really work to make progress on… change at the grassroots level”.  (see ‘How to Create Change’, sustainablebusiness.com)

To be successful in this endeavor MTM Pharmacists need to:

• Decide to ‘DO IT’ and incorporate MTM opportunities into their pharmacy practice
• Commit to a PLAN OF ACTION to facilitate the necessary changes for practicing appropriate MTM principles
• FOLLOW THROUGH with their plan for implementing MTM within their practice setting
• Support and encourage their colleagues who are involved with MTM and educate the public to the benefits of MTM services

We cannot continue with the ‘wait and see’ attitude that has constrained the profession of pharmacy in the past.  If we educate ourselves, educate our patients, get involved and follow the course we will gain momentum in the process and our efforts will bring positive results.  But it’s up to us, YOU and I, to work towards this end.

 

My Cochlear Implant Story

After several years of pestering by my wife I gave in and had my hearing checked about 10 years ago.   I ended up getting hearing instruments (aids)  for both ears at that time. After wearing hearing aids for less than 2 years I began having problems with my hearing on the left side.   I thought my hearing aid was on the fritz, occasionally shorting out or something.

My hearing was evaluated by my hearing aid practitioner and it was discovered it wasn’t a faulty hearing aid at all.  It was my left ear that was failing.  I subsequently lost all hearing in my left ear on May 15, 2004 and lost the hearing in my right ear about 2 months later.  I was later told it was sensorineural hearing loss of unknown origin.

After being seen by an ENT/hearing specialist I was set up with an appointment for further evaluation at Oregon Health Sciences University.   This resulted in me being scheduled for cochlear implant surgery on September 2, 2004.    

I persuaded the doctor to activate my cochlear implant about 3 weeks later, two days before my eldest daughter was to be married.  Even though it sounded like a fusion between Mickey Mouse and R2D2, I was able to hear nearly every word at that memorable ceremony after being totally deaf.

Testing after my cochlear implant was activated showed that I had regained 98% speech recognition.   My good speech recognition scores are most likely attributed to only being totally deaf for about 9 weeks.  I guess that I was sort of a ‘poster boy’ in the OHSU Audiology department for awhile.  In less than a month I began to hear normal again.  My wife’s voice began to sound like it used to sound in less than 6 weeks.

It was only a few months later that I became involved with the Cochlear Awareness Network.  I’ve participated in Cochlear outreach activities since that time.  I recently was asked to represent Cochlear Americas at the 2011 Association of Medical Professionals with Hearing Loss conference.   I’ve done a number of presentations over the years at Lion’s and Rotary club meetings, church and civic groups, the School of Occupational Therapy at Pacific University, the Portland Medical Representatives Association and shared my personal story at a continuing education seminar for audiologists.   I just led Team Cochlear at the Walk4Hearing in Portland, Oregon raising money for the Hearing Loss Association of America’s efforts to raise awareness and provide programs and assistance for those suffering from hearing loss.

The challenge of going deaf and receiving my cochlear implant has truly changed my life in a number of ways.  Not only was I able to hear again but I gained a great deal of perspective and maybe even a little wisdom from going through the process.  This has resulted in personal growth in areas that I would not have otherwise experienced.

I now participate as an Ambassador for the Cochlear Awareness Network and believe that having a cochlear implant is a great conversation starter.   I have people ask me about it all the time.  I enjoy sharing my story with others and hope that I can help them learn that there are solutions available to many who are ‘hearing challenged’.

 

Personal Health Records for Emergency Preparedness

An emergency Personal Health Record (PHR) should be your family’s first priority in your emergency preparedness plan.

Disaster can strike with little or no warning, giving us little or no time to prepare.  Floods, hurricanes, fire, earthquakes or other natural disasters all pose serious concerns.  How well we prepare ourselves in advance of disaster will be determine the extent of how our needs are met.

As witnessed in recent years, natural disasters or emergency situations can occur anywhere at anytime.

In the wake of Hurrican Katrina in 2005, Americans witnessed just how fragile paper based health record systems really are.  Public health and medical response personnel were faced with the challenge of meeting the health care needs of the victims of Katrina.  Meeting the immediate medical needs of the injured or those with chronic conditions without access to their medical records was one of the greatest challenges.  Trying to care for the thousands who were displaced by the hurricane was hampered by the loss of access to their medical records as well.

Prepare your family for possible emergencies or natural disasters.  To learn more about preparing an emergency personal health record PHR click here or view this prezi  –

Why You Should Start a Personal Health Record

 

 

Why You Should Start a Personal Health Record

Starting a personal health record PHR is easier than you might think.  Store your personal health records in digital format… tools are available to assist you. Google Health, No More Clipboard and Microsoft Health Vault are just a few of the many available tools.  Learn how to gather your health information and build your personal health record.  Click the link below for more information:

Why You Should Start a Personal Health Record

 

 

I Know You Know… (Real world PHR applications II)

I know that you know someone in a situation similar to the following scenario.  Everybody does.   It could be one of your parents, grandparents or maybe the parent of someone you know.  Perhaps you are the primary caregiver for someone in a similar situation.  If you are a health care practitioner I am sure you see patients like this every day. 

This is the story of “Earl” and the personal health record (PHR).  Of course the names have been changed to protect the privacy of those involved. 

Subject:   87 y.o. white male Caucasian, hypertension, pacemaker, dementia/Alzheimer’s, history of strokes and multiple hip replacements, multiple medications, etc., etc.

History:   Earl still lives on the farm that he has worked for 60+ years of his life.  His wife passed away several years ago.  Earl lives alone except for the cats in the barn that he feeds twice daily.  His family members live nearby and check on Earl several times daily, bringing dinner to his house each evening. 

One sunny spring afternoon recently Earl decided to take a walk down the lane on the farm.  On his way back to the house Earl got tripped up in some rough grass and fell.  Earl was unable to get himself up and lay face down on the grass, his forehead bleeding from where his head hit the ground.  He tried to use his emergency alert button but he was out of range of the receiver connected to the phone in the house.  His repeated attempts to get himself up were fruitless and exhausting.  Earl lay helpless waiting for someone to find him. 

It was over an hour before one of Earl’s family members brought dinner to the house.  After searching the house and barn for Earl he was finally found down the lane.  After a 911 call was placed the EMS personnel arrived with the ambulance to transport Earl to the hospital.  After getting him in the ambulance the EMTs asked what medications Earl was taking… 

A few months earlier, one of Earl’s family members had prepared an emergency personal health record for him.  It was placed in the Emergi-Tube on the side of the refrigerator.  The information was retrieved from the Emergi-Tube and given to the EMTs and taken with Earl to the hospital.  The information was helpful in the emergency room as it not only contained information about Earl’s medications but also a brief outline of his medical conditions, allergies and other pertinent medical information. 

Earl was released from the hospital the next day, a little sore but happy to be home with his cats again.  The information provided on the emergency PHR was helpful to those medical personnel caring for him.  Having this information readily available ensured that the ER and hospital staff were able to continue Earl’s medications properly during his stay. 

We should be encouraging people to learn about PHRs and how to use them to protect themselves and their loved ones.  The use of a PHR will help protect them in the event of an emergency, help decrease the incidence of medication errors, allergic reactions and improve communications with physicians and clinicians.   More importantly, the use of a PHR will empower patients to better monitor and control their medical conditions and improve their overall level of health. 

If you are interested in learning more about personal health records visit:  

http://www.healthrecordresources.com/index.php

 

Starting a Personal Health History

Starting and keeping a personal health history is probably easier than you think. Although this might look like a daunting task at first, it is really quite easy once you get started. 

Begin by organizing all of the health information you have at home. Gather all information from:

• Files at home containing information from physician visits or hospital admissions
• Pertinent information that might be contained in billing records from physician or hospital visits
• Identification cards or immunization records prepared by health care providers
• Information provided by your pharmacy or with the prescriptions you receive
• Information contained in insurance billings or other documents
• All other sources or pertinent records containing relevent personal and family health history   

Once you have this information in a single location you are ready to begin building a personal health record (PHR).  You are also entitled to copies of all personal health information maintained by your physician or health care provider. You will want to discuss with them what information they have on file and how to obtain copies for your records as well.

Learn more about obtaining your health information from health care providers by reading Dave deBronkart’s ( @ePatientDave on Twitter  )  blog article entitled      ”Gimme My D*** Data “.    

Managing your health information is like balancing your checkbook….it will become easier if you work on maintaining and updating your information regularly.

Gather information, organize it and share it on a regular basis with your health care providers.

 

Your Personal Health Record (PHR)

 Most people don’t realize that it is unusual to find a complete record of all of their personal health information.  Our personal health information is not usually found in any single location or even in consistent format.   As we gather complete and accurate personal health information for our families and ourselves we create a personal health record or PHR.   This PHR is a resource that will help us take an active role in the quality of our health care.   It is important to gather and share this information with our health care providers to fill in the gaps that exist in our medical records.

Your personal health record (PHR) should be a collection of important information about your health (or the health of someone you are caring for) which you actively gather, maintain and update.  The information that your PHR should include (but is not limited to):

• Personal identification (name, birth date and demographics) 
• Emergency contacts 
• Names and contact information of your physician, dentist, eye doctor, and any other specialists
• Health insurance information
• Living wills, advance directives, or medical power of attorney
• List and dates of significant illnesses, injuries and surgical procedures
• Current medications and dosages
• Herbal supplements and pertinent dietary information
• Drug allergies or sensitivity and other allergies 
• Pertinent family history information
• Important test results; eye and dental records
• Organ donor authorization

Having access to your personal health information in an emergency can be critical.   Your emergency personal health record (ePHR) can provide lifesaving information necessary for your medical treatment.