My lecturer tells the story of a colleague who, to break the ice with an uncomfortable patient, joked he should put the suppositories she made for him in his ear. His furious physician storms in two weeks later, with red-faced patient in tow, and exploded that she had lied to and misled their mutual patient.
It is beautiful how quickly and thoroughly any care one might have had for patients evaporates after any length of time actually working with them. The sheer idiocy that avalanches through my doors every day is astonishing.
Perhaps what is more surprising is the number of patients who think they know more about medicines than my colleagues or me. As a student, I clearly know best.
Codeine is an addictive middle-strength opiate painkiller, and licensed pharmacists can prescribe certain strengths of it, and I regularly have patients request it. Recently, a spiteful middle-aged woman told me that she didn’t need to try any other meds because this one worked, and that no, she was quite certain that no other medicine would work as well, what would I know, she’d been using it for twenty five years.
A recent patient waltzed in and demanded all the scripts on file for Zarolta (he meant Xarelto), and insisted on an explanation of why his wife had paid the full cost instead of the PPS cost. He meant Authority under the PBS, which he had not supplied, so we were powerless, but he expected us to find him a cardiologist who would write him one and then pay for the appointment to make up for charging him so much (about $100).
Another patient returned a dusty haul of drugs (which I calculated to have cost the taxpayer about $5000) because ‘I don’t think I need them anymore’. As I was unpacking them, I discovered one was a highly toxic chemo drug, which he had poured loose into the bag (and onto my hands).
I had a patient ask if they could have tablets instead of capsules for their antidepressant, because breaking tablets is easier than capsules and he wanted to bring his dose down. After incredulous questioning, I discovered he had been taking them on alternate days for two months and had essentially been going through withdrawal the whole time because he decided to do it without talking to anyone. He also forbade contacting his psychiatrist, then left.
A patient asked if homeopathic copper would interact with the herb she had bought for her dog from a herbalist because she thought it was ‘feeling down’.
I work in a high socioeconomic area, and I have few patients without the money to pay for their drugs, but I had a private script come in for a recombinant monoclonal antibody, which costs somewhere in the order of $3000 per dose and has to be specially ordered. I asked if he knew of any reason he shouldn’t be getting a PBS script for this medicine, since my files showed he had previously, and that he had the condition for which the authority could be issued. He didn’t know, but said he was happy to pay the private cost.
The end of this story is that the physician told us he didn’t have the time to look up the code. He didn’t have time to click on the link his software shows him and copy out the four numbers it would give him onto the script he wrote to save his patient $3000.
This level of incomprehensible stupidity is a daily ordeal.
Physicians, in particular GPs, are on balance completely incapable of following guidelines or listening when they are given advice by pharmacists.
It’s ridiculous the amount of time I spend weighing up whether it’s worth calling a physician and telling them they’re wrong and subsequently being told I should know my place, or just dispensing the medicine I know is either not first line treatment or at the wrong dose. Even if I quote the Australian Medicines Handbook (drug bible) or the Therapeutic Guidelines (the last word in therapeutic decisions), I am told that if I wanted to be the doctor I should have chosen a different degree.
I recently saw a patient prescribed high dose propranolol for uncomplicated hypertension, condemning them to an inability to walk up stairs and constant exhaustion, because the physician ‘was more familiar with it than these new blood pressure meds’ (which are virtually side effect free and very safe and have several decades of experience).
I saw a physician prescribe oxycodone, a very powerful opiate, for a mild wrist sprain.
I regularly have to explain how important vaccines are.
I had an out of town patient bring a script for her thirteen year old with the dose I calculated would be appropriate for a thirteen kilogram child.
I saw a woman burn a hole in her stomach because her doctor told her she could ignore the pharmacist’s advice not to exceed six tablets a day.
I was told I didn’t need to counsel a patient on her meds because, as a naturopath, she knew at least as much about them as me.
I saw a woman spray her Ventolin on her tongue.
On her tongue.