The post, When Plans Go Wrong, shows why it’s important to learn how to use the health care system and be an advocate for yourself to safeguard your health.  (For your convenience you can find a copy of it under Cases To Consider.)  This post is all about Discharge Plans.

A word about Discharge Plans:  Transitions from one health care setting to another are always risky.  Whether it’s going into the hospital from home from the hospital back to home, mistakes in communication are more likely to happen.  To try to prevent these miscommunications from happening in the transition from hospital to home the attending physician, the doctor who cared for the patient in the hospital, gives the patient a Discharge Plan.  It is a written plan that tells the patient what medicines to take, what diet to eat, any limitations of activity, what tests they need to get and where they are to get them, any physical therapy they may need and from whom they should get it, any referrals to specialists they need to have, and finally, when the attending doctor wants to see the patient in their office.

When Plans Go Wrong outlines several issues that went wrong with the implementation of Susan’s discharge plan:

1. Susan couldn’t get the medicine that worked for her in the hospital
2. Her physician hasn’t called back
3. She is unable to get to her doctor visit

I heard about a situation the other day that I’d like to share with you to get your thoughts:

It seems a 62 year old woman, I’ll call her Susan, had been in the hospital for a few days due to vertigo.  She would feel the room spinning when she moved her head in certain positions.  It was so bad that she could hardly walk let alone drive, and she lived alone.  The vertigo was also accompanied by nausea and vomiting.  While in the hospital she was given a medicine, meclizine, that controlled her symptoms.  Her doctor discharged her with a prescription for the medicine.  He also wanted a home health nurse to visit her several times a week and a physical therapist to come to her home to give her some treatments that usually help control the symptoms as well.  Finally, her doctor wanted her to come to his office a week after discharge from the hospital to make sure she was progressing.  All in all, it sounded like a great Discharge Plan.  The trouble is – it just didn’t happen.

First, since meclizine is available over the counter, her insurer wouldn’t pay for it even though she had a doctor’s prescription for it.  Next, though she went home on a Friday, by the following Wednesday she had yet to have a visit from the home health nurse.  When Susan called the nursing agency to find out why the nurse hadn’t visited, she was told they had not received an order faxed to them from the attending physician.  And because the nurse was going to arrange for the physical therapist, she had not had any physical therapy either.  Susan called the physician’s office when she learned of this, but hadn’t received a call back from the doctor after several days.  Finally, because she didn’t get the medicine that was prescribed she was feeling worse since coming home and couldn’t drive herself to the doctor’s office for her Thursday follow up appointment.

For Your Health – Dr. Bob

I want to talk a little about how to get the most out of your medications and save money in the process. 

1. It should come as no surprise that your medicines won’t work if you don’t take them properly.  Properly means routinely as they were prescribed without missing doses.  For antibiotics it is critical to take them all just as your doctor has prescribed.  Stopping when you start to feel better will leave the infection incompletely treated and likely to recur.  Since different infections usually require different antibiotics, the antibiotics you save with incomplete treatment may not be effective for your next infection.  There is nothing to be gained by not taking all the antibiotics prescribed.
2. Another point needs to be made in regard to taking medications that control certain conditions such as hypertension, diabetes, elevated cholesterol or asthma.  Your doctor will monitor your condition’s response to the medication he has prescribed.  If you do not take your medicine as prescribed, and do not let him know, he will assume the state of control of the condition is the result of the regimen he has prescribed.  So if your blood pressure is still high, he may either increase the dose of the current drug or prescribe another.  In either case, you will be paying more for the treatment and the proper dosage will be uncertain.  If you take the increased dosage as prescribed, it could lower your blood pressure too much.  Also, the increased dosage can make side effects more likely.
3. If your health plan has a mail order pharmacy benefit for your chronic medications you should check it out.  Usually you’ll get a discount, such as paying a two-month copay for a three-month supply.  However, check with local retailers that may have especially low prices for some of the more common medicines.
4. Another way to save money on your prescriptions is to ask your physician to prescribe generic medications whenever possible.  For most drugs where there is a generic available, it is just as effective as the brand name and much less expensive.
5.   First, of course, check with your doctor or pharmacist that they can be taken with meals.  Other people use an alarm set on their Smartphone as a reminder.  People who take several medications, often use a pill box with seven compartments that correspond to the days of the week to help them keep on track with their medications.
6. Another good policy is to use one pharmacy for all your medications so they can check more easily for drug interactions.  Many pharmacies have software built into their systems to screen for these potential problems.
7. If you are ever in an emergency situation and are unable to speak, the emergency personnel will check it and use it to guide your treatment.

For Your Health – Dr. Bob

There are some basic things to consider about any medications you may be taking and things you should do to use them effectively:

1. Make sure you tell all your doctors about any vitamins, supplements, herbals, prescription or non-prescription medications you may be taking.  Any of these may cause an interaction with certain prescribed medicines.
2. When prescribing any medication for you, your physician should explain a few things to you.  He should tell you how the medicine is going to help you and how often you should take it.  He’ll explain whether you should take it with food or without?  Be sure to take them as prescribed.
3. You’ll need to know whether it is a medicine that you should take for only a certain length of time or indefinitely to control a certain condition.  Be sure to take it as long as your doctor wants you to.  This is worth further explanation:

Antibiotics that treat infections are usually taken for a specific number of days.  Antibiotics truly cure infections.  The doctor gives you the number of doses that need to be taken to completely cure the infection.  Stopping the antibiotic too soon can lead to a recurrence of the same infection that may be more difficult to treat.  Pain medication is another class of medications that needs only be taken while you are having pain.  They are often given to relieve the pain after surgery while the tissues heal.

Other drugs that control conditions such as high blood pressure or cholesterol need to be taken indefinitely.  If you have high blood pressure and are taking a medication that lowers your blood pressure to normal levels, the medicine has not cured your hypertension.  It is controlling it, and will do so only as long as you are taking it.  When taking medications that control a condition, you should not stop them without discussing it with your doctor first.  Abruptly stopping some medications may cause a worsening of the condition they were controlling.  In the case of blood pressure, stopping a medication suddenly may result in the blood pressure reaching dangerous levels.

4. Your doctor should warn you about potential side effects the medication may cause.  Notify him if you notice any new or worsening symptoms after you start the medicine.
5. Because some drugs may affect other systems of your body without causing symptoms you would notice, your physician may want to check some blood tests after you have been taking the medication for awhile.  Make sure you get the recommended tests.

If you have any questions about any of your medications, ask your doctor or pharmacist.  Next time I’ll talk a little bit more about using your medications effectively and controlling your costs.

For Your Health – Dr. Bob

In the last post I talked about what characteristics of your symptoms should lead you to contact your physician. This time I want to discuss what else to consider.

Sometimes they know the on-call doctor isn’t their own, and they don’t want to talk to them.  The reality is that all physicians are trained to handle such after hour calls.  Delay can sometimes lead to complications that can be life threatening.