Insanity: doing the same thing over and over again and expecting different results
Albert Einstein.Smart guy, way smarter than me, and probably just a little smarter than R. Funny thing is, every day I show up at my pharmacy for work hoping it will be a great day, and every day I leave frustrated and shaking my head at the utter fatuity of a lot of my patients. (note that the online thesaurus is a great way to find ways to call people idiots without actually calling them idiots)
I must be insane.
So anyhow, on to my funny story of the ridiculous requests or accusations I receive in my pharmacy that seem absolutely reasonable. This weeks rant focuses on one of my favourite things: Exceptional Drug Status (or EDS). I work in Saskatchewan, so if you want to see the way EDS works (well in the eyes of the people who run it) just click here:
In layman’s terms, EDS means that even if a medication you are on is not paid for by the Saskatchewan Provincial Drug Plan (SPDP), it may be eligible for EDS, and if it gets approval that means it would be covered. Of course, there are hoops that have to be jumped through (some of them flaming). Now, I’m actually a fan of EDS. It forces would be prescribers to prescribe medications based on this horribly new thing called “Evidence-Based Medicine”. Which means your Doc can’t just prescribe you Zithromax for your viral induced sore throat, they actually have to give a justifiable reason for prescribing you a medication that isn’t needed.
for a definition of Evidence-Based Medicine click :
On the flip side, pharmacists also love getting yelled at, screamed at, berated and overall treated like a big steaming pile of S*!t over the entire EDS process (as if we were the ones who put up the road blocks just to make your life hell). In Saskatchewan I am afforded the ability to fill out and send in EDS forms on behalf of the patient and physician. All I need is the diagnosis from the physician to make sure the patient fits the criteria. If I choose to lie just to make sure the EDS goes through I could get audited and be forced to pay back the drug plan… (I won`t get into auditing, that will be the subject of a future rant). Once that is done the patient and physician receive a letter notifying them whether or not the EDS has been approved.
So, there`s a quick explanation. A little further background. I currently operate a pharmacy in my hometown which was run for 30+ years by the founder and for whom the pharmacy was named. (Trust me, this is background).
On to the rant.
So little Mrs. Smith (bless her sole, and I mean foot, not soul) is getting a little irate with me and my failure to get her EDS to go through. Now you will recall how I said I can do EDS for SOME medications. Some, means, by definition, not ALL. Little Mrs. Smith`s medication happens to be one of them (for my pharmacy colleagues it happens to be donepezil). For her EDS to go through she must have a test and meet certain DSM-IV criteria. Click here to take a peek at the form:
Now, I cannot give her this test, and the SPDP requires her to have it every 6 months. Note that I said that SPDP requires her to have it, not J the Grumpy Pharmacist. Once done the form is filled in by the physician and faxed in (once again, not me).
In any event, it is obvious to you from this explanation that it is clearly ALL MY FAULT that Mrs. Smith`s EDS has not yet been approved. Even though I contacted her homecare aid to set up her test and notified her physician`s office to inform them that it needed to be done. It is also, again obviously, my fault that after all of the paper work was done over a month ago it was put into her file at the Physician`s office (again, by me because I`m kind of an ass that way) and not actually faxed in to the drug plan by the physician`s office (again, my fault, apologies to Mrs. Smith).
So after some investigating, phone calls, explanations (all of which I have just boatloads of time for) I get to the bottom of "my error" and get the physician's office to actually fax in the form. Out of good faith, I even give Mrs. Smith some of the medication free of charge keeping my fingers crossed that EDS gets approved and I can actually get paid for the stuff. (Mrs. Smith informed me that if it`s not approved she`s not paying for the stuff I have given her free of charge and that I will personally have to pay for it). Please note, there is no intention to throw the physician or their staff under the bus, we all make mistakes (and all of them are my fault).
And after it`s all said and done the last thing I get from her is this statement: "You know, I don`t think you know what you are doing, back when (the previous owner) ran this store I never had this type of issue."
Further background, 5 years ago when the previous owner sold this store, Mrs. Smith was not on this medication, so no big surprise, she never had this issue.
I guess I should just stop screwing up and re-write SPDP's criteria for EDS. Or better yet, I guess I will just "Ramble On" (I told you there would be a tie in to Led Zeppelin)
J
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