I don’t often tell stories about my actual experiences in the retail pharmacy. I probably should do it more. I tend to share only those events that I look at as “teaching moments” (Note: by that I mean usually that I have learned something too!)
Saturday a patient, oh…let’s call her Doris, came in with a prescription for HCTZ from the Emergency Room. HCTZ is a thiazide-type diuretic typically used to treat high blood pressure (hypertension). Doris is a hypertensive 30-something year old female, just a little overweight (aren’t we all?). While looking up her profile I noticed she is allergic to Sulfa drugs.
Now, for those who may not know, “sulfa drug” allergy can mean many things. Some patients refer to a severe side effect (like nausea or diarrhea) as an “allergy.” It’s not. Well, not usually. But a “true” hypersensitivity to Sulfa drugs (like the antibiotic Bactrim or Septra) only occurs about 3% of the time. So I asked Doris if she could remember what kind of reaction she had to a sulfa drug. She couldn’t.
I then proceded to explain to her that HCTZ “could” cause an allergic reaction to patients with a real sulfa allergy.
That’s when the communication conundrum began. She became aggitated and upset. She was noticably angry that I wasn’t going to fill her HCTZ without first speaking with her physician. She wanted the medicine. She wanted to go home. She was frustrated.
I know the drill. I tried to calmly explain that I was on her side and that I too wanted her to be able to get home as soon as possible. But my tactics were failing. It wasn’t working. She explained to me (as though I didn’t know it) that the MD wrote that prescription for her.
In the end I found out that her trip to the ER on Saturday was due to the fact that her lisinopril makes her tired. She wanted something different. We discussed that it would be safe for her to continue her lisinopril until we were able to contact the MD. She left, leaving me a cell number at which to contact her when I heard something (as it turns out, the cell number was her mothers…who doesn’t speak any English).
Later that day I heard back from the ER staff. Cancel the prescription. Have her call her own MD on Monday. End of story.
I share all this to say that these are some of the communication challenges we face in health care.
First, there is the challenge of communicating with a patient who was not really in the best state of mind, and explaining the potentially serious reaction (yes, I know it is rare) that could occur if she truly has a Sulfa allergy and took Hydrochlorothiazide.
Second, there is the challenge of communicating effectively with those involved in her health care, particularly on the weekend. Her own physician, of course, was not available. The ER was accessible, but required waiting while an already over-worked MD had to be tracked down and clued in on the situation. I’m suspecting the patient never told the ER about the allergy.
Third, there is the follow-up communication with the patient which…in this case…never happened. I made multiple attempts to call her, but each time her non-English speaking mother answered who could not even grasp that I was calling from the pharmacy for her daughter.
Good health care is (in my opinion) 50% education and 50% communication. Learning to communicate, and to do so effectively and efficiently is one of the challenges we all face. Sometimes I nail it. Sometimes I don’t. Hopefully I get it right more often than not. And hopefully I’m getting better as I get older.