Nov
30
2007
17

Pharmacists, TRIAGE and money

Last week, this happened.

A guy with a distresssed look on his face says, “Can you help me?”

” My heart burns.”

“What does it feel like?”

“I think I should go to emergency. My friend says it could be a heart attack.”

“Relax,” I said, “Tell me what it feels like to have your heart burning.”

Of course, he described esophagitis. I sat down with him and we talked. “I don’t think it is your heart that is burning. I think it is what people call heart burn and it has nothing to do with your heart.”

“You sure? My friend said…..”

“Is your friend a medical professional. A pharmacist or a nurse?” Or did he stay at a Holiday Inn Express?”

“Well no, but….”

“No buts please. I am busy. I think I can help you right now. Your heart burn will be gone in minutes.”

This was a real pain in the ass. The guy argued with me that he was about to have heart failure. Again, his friend at the bowling alley. I was about ready to throw up my hands and let him go to emergency……but the cost to the system compared to Gaviscon.…. when he finally agreed to take my advice and try Gaviscon.” The cost to the medical system. $7.99.

Fifteen minutes later, he came back with a smile on his face, “It’s gone. My heart is not burning any more.’

No shit, Sherlock.

If there are 200,000 working pharmacists and only 25% of us do something like this only ONCE a week to prevent an emergency room visit, we are the triage queens and kings of the American medical system We save the system millions and millions of dollars every year. Why in hell isn’t it recognized? Why aren’t we compensated. This guy’s insurance company should be thrilled to give us $12.88 instead of the hundreds at the emergency room. I’m blowing smoke, I know. You guys take up the challenge. I’m busy.

Lately, I have shook my head when, on two occasions, men came in with emergency room prescriptions for “Anusol HC Suppositories”.
I talked with both of them. The both panicked when they found a couple milliliters of blood on the toilet paper. They were probably meat eating Texans and had to do some straining. Geezus, how much did their insurance companies have to pay for a hemmorhoid?

Consider this: Pharmacists are the POINT for triage in the United States of America. How many times have you defused a flaming, panicky patient with an OTC for the symptoms. Without you, what do they do? Seek help that could cost hundreds of dollars.

Written by in: Jp Enlarged |
Nov
06
2007
17

Nobody I know has ever….

“Nobody I know has ever had an abortion,” is what people often say when the subject comes up.

That is just not true according to Dr. Susan Wicklund, author of “The Common Secret”. She added, “Their sisters, their mothers have had abortions.” It made me wonder about their aunts and cousins. Abortions are secret procedures. Women, and men, have strong opinions on the subject and what they think is nobody’s business. That was shown to be true when the people of South Dakota, anonymous in the voting booth, overwhelmingly defeated the legislative law banning abortions, making South Dakota pro-choice by election, giving control of their lives back to women.

40%, Four out of every ten women in the United States have had an abortion during their child-bearing years. This makes abortion more common than tonsillectomy or the extraction of wisdom teeth. It is such a secret that we don’t realize how common it is.
According to the Guttmacher Institute, about a quarter, 25%, of pregnancies in the USA end in abortion.

Dr. Wicklund talks about recognizing a woman who regularly appeared as a shouting protestor at a clinic where the doctor worked. Only now the woman was in the waiting room, desperate to end an unwanted pregnancy. Dr. Wicklund performed the procedure.

Personally, I don’t think that it is any of my business what women do. I don’t want any control over their bodies. I dispense birth control pills and Plan-B. I am a proponent of easy access to birth control information and condoms. Talking abstinence is fine until you find yourself in the back seat of a car and the panting becomes urgent.

I don’t like the idea of women using abortion as a birth control method. “You don’t have a condom? Well, go ahead already, I can always get an abortion.” I don’t like that attitude and I don’t much like women who think like that.

All of this is to set you up for a difficult encounter I had with a patient last week.

A young woman with an infant in her arms, motioned that she would like to talk with me. When I went out front, she led me to a more private area near the Coca-Cola machine. She rocked as she stood there to calm her fussy baby. She spoke idiomatic English with hesitation. She was Hispanic, legal or illegal, and she was dressed in clean, if well-used, clothes. The baby had chubby cheeks and looked well taken care of.

This woman explained that she needed the stick used in abortions and the pills that she took after she put the stick inside. Apparently, these products were easy to get in Mexico, at any pharmacy.

She lamented that she was pregnant again. Her baby wasn’t even three months old. Another baby now would put the young family under. This was a very smart, educated girl. She spoke idiomatically American English and you don’t learn those language skills
in Mexico unless you attend an expensive school.

“I cannot have another baby now,” she said, “I have to buy the stick and the pills.”

“Is someone going to help you with this?”

“No, I can put the stick in myself.” She seemed entirely in control, no hesitation at all. She was going to take care of this all by herself.

Oh, shit, Plagakis, what do you do now? From her story, we were well beyond the
Plan-B 72 hours. She did not need the “What the hell were you thinking?” lecture. She needed help and not with a stick and a pill.

I touched her on her arm and said, “You have to do this right. You cannot take chances with doing an abortion yourself. You could bleed. You could die.”

“I’ll be careful.” Her brown eyes were wide, beseeching me to give her the stick.

“Have you heard of Planned Parenthood?” I didn’t even know where the closest office was, but this beautiful, dark-haired girl needed to be directed to a safe place. The idea of a friend using a stick bothered me.

We talked for awhile and I think she understood that I was concerned that she would do something dangerous. I found the telephone number of the closest Planned Parenthood.
It was only 15 miles away.

She took the piece of paper with the number on it, kissed her baby on the forehead, smiled at me and tried to give me a ten dollar bill. I refused to take it. I am accustomed to rich Americans taking my time and knowledge and never, ever offering me anything but a thank you and some can’t bother with the thank you.

I watched as this young woman with decades ahead of her, a life of watching her baby grow up, walk out of the store, jabbering in Spanish to her friend. I wondered if they would call the Planned Parenthood number or find the stick.

I know that some of you are so heavily invested in this subject that you have invited me to hell in the past. Others have indicated that I have already punched my own ticket.
You are loud and loquacious in expressing yourselves. I want to hear from you. What would you have done?

And, you people who are South Dakotans, in fact or in spirit, let me hear from you too.

Written by in: Jp Enlarged |

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