February 2020

CRUSTY OLD COOT

He was a crusty old coot. I can’t think of a single person he liked, or that liked him. He was abrasive and argumentative. He did what he pleased and didn’t give 2 cents about what you thought or said. That extended to his healthcare. He had diabetes, heart disease, history of embolisms, and a bad attitude. It landed him in the hospital. He was critical. Barely survived to be discharged with a fist full of prescriptions and instructions on how to manage himself.

He presented at my prescription counter. He was all huffed up. He didn’t like the way he was treated in the hospital, didn’t like the way he felt, and didn’t mind jumping your case. I looked at him and said “Hi Joseph” (not his real name). He kind of looked down and said, “Hi Richard” in a soft voice. Joseph and I got along. He got along with my staff and was always if not pleasant when he came to the pharmacy, at least subdued. You see, in addition to having diabetes, heart disease a history of embolisms and a bad attitude, Joseph had a mother. His mother was a sweet lady and had been our patient for years. We cared about and for her through multiple bouts of cancer and heart disease. Joseph loved his mother. His mother trusted us and Joseph trusted his mother.

When I told Joseph we would not fill his prescriptions, I could see he wanted to be upset. He was just out of the hospital, felt bad and just wanted to go home and go to bed. He really wanted to get mad. When I told him he needed to go home, about a 15 mile round trip, get all his medications and bring them back to me before I would fill them, he didn’t understand. But I knew Joseph was a hoarder, and from his record I thought it likely he had a stash of medication at home. Medication that wouldn’t mix with his new prescriptions.

Joseph didn’t get mad. Joseph went home and brought me his old prescriptions. ALL of his old prescriptions. Had I not known Joseph, had Joseph’s mother not trusted us, had Joseph not trusted his mother, Joseph would not have brought me his old prescriptions, he would have snatched them back and gone someplace else. Joseph could have died from any of three or four interactions and duplications I found in his sack of medications that day.

That’s the essence of longitudinal care, generational care, caring care. That’s the essence of community pharmacy. No PBM owned mail order pharmacy can do that. In order to meet their metrics, they could have sent him 90 days supply of his new prescriptions but they couldn’t look him in the eye and say “I know you. I know your Mama. Like me or not, I’m going to care for you the best I can.” Nor would they have had his confidence or be able to get him to agree to participate in his own healthcare.

Thank you, Community Pharmacists, for what you do for your patients. These days it’s a lonely thankless job. But, that doesn’t make it any less important.

Ask Joseph’s Mama.

Richard Logan, Jr. PharmD

rlogan@semorx.com

Richard Logan, Jr. PharmD, community pharmacist, community pharmacy advocate, and ESPhA founding member