You know the pts… routinely calling – when can I get my “drug” refilled and then the day that they can get it refilled… they call every hour “has the doctor called back yet on my refill ?”
First of all… how many disease states do we DEMAND that the pt waits until the very last day/dose taken to ask for a refill?
Second of all… we are dealing with SUBJECTIVE DISEASES – pain and anxiety in particular..
Most of us fail to realized that the same perception that these people have with their pain and anxiety are the same/similar perceptions that all of us have with our own personal perception of hunger, sleep, thirst…
Just imagine that New York City’s Mayor Bloomberg because our President and he appoints the “Food Police” as part of his cabinet… There have been people out there that has calculated how many barrels of oil that we could save.. if everyone was their “ideal weight”… the savings in growing and transporting food.. is estimated to be substantial.
It would appear that CVS is moving in this direction… literally mandating that their employees bring two of four medical/biological measures (weight, lipids, blood pressure ) to be brought within what is considered acceptable ranges… and if the fail… there appears to be financial penalties for failing to do so.
What if, in order to get everyone’s primary biological measures within what is considered normal range… each of us is told how many calories you can have every day, how many ozs of liquids you can have every day and limits the number of hours you can sleep.. all based on your height, age and ideal wt.
What if you want to go for a walk, run, play tennis or round of golf… you know that you are going to get thirsty… but you must stick within the limits of your allotted fluid intake and if this extra activity makes you hungry… you still have your caloric intake limits you must adhere to… you can take more today to compensate for today… but that will end up leaving you “short” before the end of your 30 day cycle .. when your “new supply” is provided you..
How many of us have “good and bad days”… you some days.. you just don’t “feel like yourself”… maybe you are unusually tired… don’t even think about a nap… the number of hours that you can sleep are regulated..
How many of you … look forward to the end of the day… going home for a drink or two.. to deal with the stress of life… nope.. can’t do that… alcohol is not part of your “healthy life style” as mandated by the Food Police.. you will just have to deal with the stress/anxiety of the day … go to the gym, take a run… but don’t forget .. you can’t exceed your fluid intake limits.
Just remember all of these limits that you are having to live with/by.. have been developed by EXPERTS… so if you are having trouble staying within these limits.. you must be some sort of “odd-ball”… non-conformist … have an “abusive personality”
Now place yourself in the shoes of the typical chronic pain pt… if you are lucky you are provided enough pain management to keep your pain level < 5 on your average day.. but what do you do when you a “bad day” and your pain elevates to 7-8+… do you just “suck it in” or do you take a extra dose or two trying to manage get your pain back to <5 level hoping that you will have some “good days” before you can refill your meds?
It is a nice day outside… you have been putting off doing some things in the yard or you need to do some other activity.. but.. you know that in doing so… your pain level is going up… you know that if you don’t take some extra pain meds.. or do you risk getting part of the way thru the activity and just having to go back home and lay on the couch…
The pts that you complain about with early refills on controls generally can be placed in three categories … the person that really is an abuser/diverter, the patient is only being provided a token dose or inadequate therapy, those that are being provided an adequate amount of meds… only if they do nothing but sit/lay around the house.
Try to talk to these pts, get some background of where their pain is .. what their pain is level is on a average day… if you work in retail pharmacy… their life probably sucks just as bad as yours does.. except in a different way.. you can try and escape your crappy life.. by going home… they are trying to deal with their crappy life by taking some meds… your crappy life ends at the end of a shift.. theirs never does without some adequate medication to manage their pain.
Try working with these pts.. if they are provided a 30 days supply… allow them to refill them early – every 28 days – that means that they will get the refill every four weeks on the same day of the week… try to balance them out so that their refills are due on Monday thru Thursday … that means that you won’t shouldn’t have any refill requests while the doctor is out of the office or on weekends. You should also be able to “balance” the number of pts requesting refill requests on each of these days…. helping you to balance out – to a certain degree – the amount of controls you keep in inventory.
Under such a process… the patient will be told which day of the four week cycle is their refill date… no exceptions… they pt will have the ability to have some reserve meds on hand to handle any natural disaster that would/could shut a area down and the patient being unable to obtain their meds and/or have some extra doses to take care of the increase need from having a “bad day” or having a “good day” and wanting to be able to do some extra activity..
For those pts who will not/ can not follow some simple rules… it is perhaps time for some “tuff love”..if they don’t like the flexible 28 day program.. there is always the rigid 30 day program option…. it is the pt’s option to chose…. which suits them better 🙂
Filed under: General Problems
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