Friday, July 18, 2014

When Your Physician Forgets

Everyone has moments when you forget something. It's part of the natural cycle of life, especially in a world that is ever more demanding of your attention. The problems arise when your physician begins to forget things you expect to be no-brainers. One example came to me today.

Whenever a new medication comes on the market for any indication, there are always things that physicians have to check out before prescribing it to a patient. This just makes good sense, but it also is something the pharmaceutical firms stress in their literature and it is then up to the physician, not the patient, to watch this. What tests need to be run before you begin this med? Which patients are not good candidates for it? What is the side effect profile in patients in particular ethnic groups? Do you know that some patients have genetic differences that can make a med not work as expected in them?

A casual remark regarding diet and glycemic control brought up the topic of a new med that utilizes a different biological route of action. The route involves the kidney and in anyone who is now a member of the senior citizen class, this can be a real concern. As we age, our bodies don't metabolize things as they did earlier in our lives and our kidneys are asked to do a lot of work with, perhaps, less horsepower than before. If you knew this, what would be the first thing you'd think the pharmaceutical firm would have advised physicians to do? Yes, make sure this patient's kidneys are working appropriately before the med is taken.

After a bit of back and forth communication, I mentioned the route of action and it was a bit of information that came in handy for this patient the very next day. At that appointment, the patient mentioned my tidbit about the kidneys and it was an "Oh, my!" moment. The physician had forgotten to order blood work to check on the patient's kidney function. Immediately, the patient was dispatched for a blood test, but guess what. This was only after the patient had been on the med for weeks already. How was this missed? How many other patients had he neglected to check kidney function on before he prescribed this med for them? This is a very disturbing question.

Another instance of disturbing oversight was when a patient went to a cardiologist and was taking meds that pushed a lot of potassium out of his body.  They're called diuretics but most people refer to them as "water pills." The usual course would be not only to check these levels, but a prescription to address this might have been considered and discussed. It wasn't and it was only when the wife found out about this potassium need that she called her husband's doc. The reaction was another "Oh, my!" moment. He had forgotten this and immediately called in a script to their pharmacy. If you know anything about potassium levels, you're aware that it can be involved in abnormal heart rhythms. This man already had a pacemaker so he had rhythm problems to begin with.

A young teen, whose mom works at a hospital and has lots of interactions with physicians each day, had the usual teen acne. The dermatologist ordered a popular systemic antibiotic. Of course, the dermatologist wanted to help this teen, but was there any mention that this medication can be involved in the development of black thyroid disorder? Sure, there are lots of potential side effects and there's only a chance that you may experience one, but shouldn't you have the choice whether you want this med knowing about these side effects? This particular type of thyroid disorder can be associated with cancer of the thyroid. Which is worse, acne or thyroid cancer?

Another specialist prescribed a particular product for providing eyelash regrowth in older women who tend to lose both length and quantity of lashes. Three side effects, which may not be usual, but are still present and of concern, are cataracts and changes in both eye color and pigmentation of the eyelids. The patient, who developed two of these side effects, alerted the physician about this and was rather flabbergasted to hear that the doc was totally unaware of these side effects. The doc was advised to check out the PDR (Physician's Desk Reference) because it is right in there. More disturbing than the lack of knowledge about this side effect was the fact that this doc sells the product right out of the office.

The most serious of physician slip-ups, however, was the case where a woman was given a script for a CT scan at a local hospsital. Clearly indicated on the patient's chart was her allergy to specific dyes used for some of these scans. The script did not note her allergy and the tech in the hospital, who had a chart indicating her allergy, too, followed the script instructions and used dye for the test. Although the hospital prides itself in being prepared to respond quickly in emergency situations, the woman died. Of course, the result was a malpractice suit which the patient's family won for an award in excess of $1M.

What's the moral of this blog? Do your research, bring it with you and make sure you keep copies of all your tests and have all your questions about medications and treatments answered. Considering these examples, it almost sounds like you have to be more knowledgeable than the docs in some cases. Shouldn't be that way, but if you don't take care, you may not be taken care of appropriately.

No, I'm not a physician but I am an advocate for patients' rights and helping them learn what they need to know to maintain their health.