Persnickety

As reported in The New York Times the awful U.S. healthcare "system" has one shining virtue: It forces people to marry. Philip Swift wanted to marry his sweetheart, Katie Robbins. But she didn't seem to want the commitment, in a reversal of the normal man-commitment-phobia. Three years went by and Mr. Swift developed kidney stones. Mr. Swift, like millions of other Americans, doesn't have access to health care. But Ms. Robbins did. Thus: Katie and Philip Sittin' in a tree. M-E-D-I-G-A-P.

Which is better, a store with many registers where you have to guess which line will be faster (think Wal-Mart, Target, grocery stores)or a store where there is but one queue, one line, and where you are directed to a eventual open register (think Best Buy, Marshalls, TJ Maxx, Borders)? Well, Richard Larson, an engineer at MIT, but also known as Dr. Q--a "queue psychologist"--says that there are definite advantages to the single queue line. Though wait times average the same, anger issues are lessened by the knowledge that there is a definite first-come, first-serve. There is also an advantage to the store. While Q-ing up, your attention is focused on all the little things up for sale along the way whilst you wait. Nice for impulse buys (always high profit items for stores). But while Q-ing up at a local Marshals, I thought of another advantage to such a queue: privacy. Here I was waiting for a register with a pair of pants and socks, and I noticed that I was about fifteen or...

Mail order prescription service is now 6.7% (as of 2008) of all retail prescriptions sold in the U.S. That's 238 million scripts...and growing. Want to know what happens--and the pitfalls along the way--when filling your prescription through mail-order? Well, follow along. 1) You've got the prescription from your doctor. You need to contact your PBM (that's your Prescription Benefit Manager which you probably think is your insurance but really is a partner with your insurance). The largest PBMs are Express Scripts, Caremark, and Medco. They will send you a form--maybe you already have it--for you to complete and send in along with your prescription. But wait--before you lick that envelope take a good look at that piece of paper. (It would be better to do this at the doctor's office, but if your already home, don't worry.) Looking at the prescription, does it look right to you? Any mistakes? No? Good, but it's a good idea to fill in your address, or better, write...

Ken Lawton of Newfoundland has a point in his blog. It's not necessarily speed that kills, but recklessness. Not merely a fast driver, but a fast, drunk driver. Or a fast impatient impatient driver holding a cup of coffee and talking on his cell phone while driving with is knees. That sort of thing. The illustration made me think of what happens in pharmacy. It isn't necessarily how fast we fill prescriptions that causes us make errors, but the lack of focus while we are filling at the speed of light. Try filling a prescription every minute or two WHILE answering the phone, counseling a patient, troubleshooting some insurance rejection and answering a technicians question...oh, and the computer just went on the fritz. Great! That's what leads to errors, and why people end up in the hospital, or in a grave. Robots can fill ridiculously fast...and accurately. But you start to introduce the human element in there with all that other multitasking stuff...watch out. You're p...

The Christian Church and Climate Change Persnickety is branching out... I began this blog as a way to teach others what pharmacy is really about; it was my intent to show life within the profession to those outside. I want to branch out now to other ideas, and focus on all the things that it takes to make me persnickety. What riles me, what disgusts, nauseates and sickens me. All of my little pet bete noires that lurk in the shadows of my own particular dark forest. Up for discussion right now is the prospect of global warming, better known as climate change. I've been so nauseated recently by the comments of right-wing congressmen who've felt compelled to be ironic now that Washington D.C. has received a couple of snowstorms. "It's going to keep snowing in DC until Al Gore cries 'uncle,'" tweeted Sen. Jim DeMint, R-S.C. I understand why Republicans are against the idea of climate change. If the science is accurate then businesses are going to have to pony...

Wait just one sec; I've got to interrupt Newt's fancy schmancy song and dance with this bit of reporting hot off the presses (see Nadja Popovich's piece on NPR.org or http://www.npr.org/blogs/health/2010/02/insurers_post_big_profits_cut.html). According to documents filed with the U.S. Securities and Exchange Commission, over the last five years the big five health insurance companies' profits have soared to 56 per cent since 2008. That's UnitedHealth Group, Wellpoint, Aetna, Humana, and Cigna. (Aetna was the only one of the five to not post an increase.) How'd they do that? I mean, especially with the recession and all. Well, according to Avram Goldstein (head of Health Care for America Now, and advocacy group), all they had to do was raise their rates and increase the cost burden for the little guy AND drop 2.7 million sick people who were Oh such a drain on the corporate coffers. So higher premiums, higher copays, made for a nice little "cha-ching"....

Newt's Tip #3 of our continuing saga: • Meet the needs of the chronically ill. Most individuals with chronic diseases want to be in charge of their own care. The mother of an asthmatic child, for example, should have a device at home that measures the child's peak airflow and should be taught when to change his medication, rather than going to the doctor each time. Having the ability to obtain and manage more health dollars in Health Savings Accounts is a start. A good model for self-management is the Cash and Counseling program for the homebound disabled under Medicaid. Individuals in this program are able to manage their own budgets and hire and fire the people who provide them with custodial services and medical care. Satisfaction rates approach 100%, according to the Robert Wood Johnson Foundation. We should also encourage health plans to specialize in managing chronic diseases instead of demanding that every plan must be all things to all people. For example, special-needs...

Continuing our Newt's Greatest Ideas About Healthcare, his second bullet hits close to the mark, kinda: • Make health insurance portable. The first step toward genuine portability—and the best way of solving the problems of pre-existing conditions—is to change federal policy. Employers should be encouraged to provide employees with insurance that travels with them from job to job and in and out of the labor market. Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve. I've put the key words in bold. Making insurance portable has been one of those EUREKA ideas for quite a long time. People lose their jobs and find that they are quite vulnerable to catastrophic illnesses that can bankrupt them. Or worse. What's worse than bankruptcy? How about death? It's well known that every two months as many people die from our so called healthcare mess than died in the...

Continuing our Newt's Greatest Ideas About Healthcare, his second bullet hits close to the mark, kinda: • Make health insurance portable. The first step toward genuine portability—and the best way of solving the problems of pre-existing conditions—is to change federal policy. Employers should be encouraged to provide employees with insurance that travels with them from job to job and in and out of the labor market. Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve. I've put the key words in bold. Making insurance portable has been one of those EUREKA ideas for quite a long time. People lose their jobs and find that they are quite vulnerable to catastrophic illnesses that can bankrupt them. Or worse. What's worse than bankruptcy? How about death? It's well known that every two months as many people die from our so called healthcare mess than died in the...

In todays Opinion (found at http://tinyurl.com/ybltpld) Newt Gingrich has deigned to give us his take on the healthcare debate. Obama said he wanted new ideas, and Newt has some, or thinks he has some. The question is, Are Newt's ideas just more Republican blather? Well, I thought we should look at his list, one item at a time. Here's the first bullet in Newt's gun: • Make insurance affordable. The current taxation of health insurance is arbitrary and unfair, giving lavish subsidies to some, like those who get Cadillac coverage from their employers, and almost no relief to people who have to buy their own. More equitable tax treatment would lower costs for individuals and families. Many health economists conclude that tax relief for health insurance should be a fixed-dollar amount, independent of the amount of insurance purchased. A step in the right direction would be to give Americans the choice of a generous tax credit or the ability to deduct the value of their health i...

We're being invaded by Canada! Pretty soon we're going to just have to institute the dreaded National ID card...just so we can lock our ER doors to those pesky neighbors to the north. At least that's the impression given by FOX "News". “This should be a wake-up call to Congress and the administration,” said a Fox News medical commentator. “It is a fact beyond dispute that the United States remains the global destination for patients from all over the world.” Canadian conservatives weighed in as well. “It’s symbolic,” said Brett Skinner, president of Canada’s right-wing Fraser Institute. “These services are not available at all, or not available on a timely basis here in Canada.” As Daniel Johnson of Salem-News.com states (in much nicer terms which I feel are lost on FOX) these allegations are lies. What the FOX liars don't tell you is that the folks who come down south (41,000--if true--are a drop in the bucket of the people being treated in America) are seeki...

What is that you say? Your PPI doesn’t work? Well, that’s OK, as you are in a lot of company. First, for those of you who don’t know, and still care to know, a PPI is a Proton Pump Inhibitor, like Prilosec, or Omeprazole (Prilosec), or Prilosec OTC (Prilosec again), or Nexium (Prilosec’s active metabolite), or Prevacid, or well, there’s quite a few of them. They are used for GERD (fancy for heartburn) and ulcers. You might know that the regular dosing of one of these gems is once a day. You know how many times I see a Take one capsule twice a day dosing on a prescription? Lots. Many many times. Why is that? These drugs though dosed at once a day intervals do not actually have long half lives. Some are quite short, four or five hours. So why do they last so long? Because they bind to an enzyme irreversibly and it takes a while for the body to come back on board. The drugs bind to ACTIVE receptors, which means that timing is crucial: take an hour before eating, so that the drug can bind ...