I started this past week actually leading the visits with the patients, instead of just watching and listening. By the end of the week I was charting and leading the visit at the same time (putting notes into the computer during the visit, rather than taking them on paper and putting them in later). I started off nervous, but my first patient was excellent! She totally played into me being the student pharmacist and leading the visit. She even caught herself directing a question or two to Ben, stopped, turned to face me, and started over. Great confidence builder. :)
My patients on Friday however, were not so easy. Mr. D, my first patient of the morning, is an older gentleman with diabetes, high blood pressure and cholesterol, sleep apnea, depression, and a history of two heart attacks. When he came in a few months ago his blood sugars were in the high 100s/low 200s, now they are consistently in the 300s (we want them <110).>
My next patient, Mrs. F, wasn't in much better shape. She's an older widow, lost her husband in 2006 to lung cancer, has heart failure, high blood pressure and cholesterol, and depression. She has Medicare Part D and the Low Income Subsidy which is "extra help" for your medications. She came to us because she fell into the donut hole. Matt, my pharmacist, didn't even know that was possible. It wasn't the true donut hole, because she wasn't paying cash prices for her meds, but it was something like it. All of her medications had been fully covered, until this month when she went to pick them up. Her generics were now $2.40 and her brand name drugs were $6 for a months supply (this is even better than the Wal-mart $4 list, which if $4 for generic meds). What this amounted to was an extra $15-ish a month for her prescriptions, and she was coming to us because she couldn't afford it. For her, $15 for drugs meant giving up some of her groceries. She drove to us that day on an empty tank and she has no way to heat her house (the lows are in the 30s this weekend). She's budgeted down to the wire and she thought she was covered. As a patient, she has made enormous strides in her health over the last three years; she's lost weight, she's improved her nutrition, she's taken care of her mental health, she's worked really hard to take care of herself since her husband died. Matt decided to give her as much of her medications as we could to last her until January.
Ben wasn't in the meeting with Mrs. F, and for the first time, I heard one of them question giving a patient medications. Thus far, I've been a little surprised at how freely Matt and Ben give away medications. I know its a medication assistance program, but practically everyone that has called needing a medication has received it if they have it. For once, it was questioned if we should fill all of her meds. The concern was not over whether she needed it and couldn't afford it, but over how that restricted MAP's ability to help the next patient that came along. MAP has a limited budget to buy medications with because most of their function is getting medications for free for designated persons, so giving this woman a 2 week supply of her depression medication (all that we had) would cost us $80, and maybe we could spend $80 on two or three other medications that would help two or three other people. Matt filled it because he couldn't justify turning her away without everything we had that would help. This rotation has really been a great one. I'm learning a lot about pharmacy, as well as getting to know some pharmacists I really admire. I'll be sad to leave in a couple weeks.
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