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...