Glancing at my blogroll tonight I came across a recent post by Kent Bottles entitled, "How to Practice Medicine in a World We Can Never Truly Understand". While it is a little esoteric for this family doc's brain, reading it jogged my thought processes. He begins by discussing the pursuit of happiness, an ofttimes elusive goal in life. Is it unusual that happiness was never something for which I aimed? The closest value for me was satisfaction. As my children grew, I encouraged them to give the best they could in life--whether that was grades or friends or sports or art. Never once did I suggest they try to be happy. For me, happiness is something one may find, but when you make it a value, now there's a recipe for disaster.
My patients will tell me "I just want to be happy". They believe they will achieve that goal if they marry the right man, find the right job, get the right grades or buy the right ______ (insert necessary object here--car, house, dress, purse). Doing the best job in the job they are in, making the best grade in the most challenging class they feel competent to take, being the best friend to the friends they have...these are not enough. If they are not happy in their job or class or relationship, it is of little value, unless it can be justified as bringing happiness in the future. They search in chemicals to achieve happiness, be that legal (Prozac, Paxil, Adderal, etc) or illegal. If they are not happy, then something must be terribly wrong, even if they are unhappy for legitimate reasons; their mother just died, they lost their job, their boyfriend broke up with them. Their friends encourage them to take medications to be happy again.
This can be a type of cultural divide in an exam room. In the same way that language barriers can reduce good care, value differences make for dissatisfied patients who may intellectually understand that exercise will improve their health but if it doesn't make them happy to do it, it may not get done.
Happiness has followed me in my life many times. Most would consider me blessed. I wasn't looking for it. It's nice to have. But at the end of the day, I don't want to be happy, what I want is to believe that today's accomplishments were the best that could be done under whatever circumstances I found myself.
In other words, satisfaction without regrets. Happiness may follow.
Monday, May 13, 2013
Wednesday, May 8, 2013
Sunday, April 28, 2013
Last week my office received a call from a distressed patient who went to the pharmacy to fill prescriptions following a hospitalization. The cost for a month's worth of three medications she was expected to stay on indefinitely was over $800. With mortgage rates being what they are, most people don't have mortgage payments that big. She called our office in a panic. As she related her story, I wondered how this fiasco could have been avoided. When I prescribe medications, either my EHR or my Epocrates program gives me an idea of what the patient's price will be based on her insurance. Is that too difficult for hospitalists to do? That sounds sarcastic, but I'm serious. Are the logistics for a hospitalist such that running medication through software to determine the likelihood a patient can afford them not realistic? What about the pharmacists in the hospital? Could this become part of the discharge process? Patients should not have to deal with "sticker shock" after a difficult hospitalization.
I changed two of her meds to inexpensive generics and called a cardiologist to ask what to do with the anti-arrhythmic. He told me that the new medication was only slightly better than placebo in studies. And for that she was paying over $300/month!
One of the Affordable Care Act provisions is that hospitals will be penalized for readmissions within a month of discharge. It will become incumbent on the hospital team to have a better understanding of medication costs, one of many reasons why patients are non-adherent with their therapy. As the family physician getting panicked phone calls I view this as a good thing. My patients will be discharged on medications they can afford and will take. Then we can spend our time in the office taking care of health problems instead of fixing something that shouldn't have been broken to begin with.
1. Medication Adherence: WHO Cares? Brown MD, Marie T. et al. Mayo Clin Proc. 2011 April; 86(4): 304–314. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/