Irritation 1 – digoxin PA

It seems like every day some entity wants to question my medical judgement. I am not a perfect doctor but in the grand scheme of things, I know my patients’ health needs better than their  insurance company, the government, or their employers. The constant interruptions by individuals who want to believe their algorithms fit every patient does little to serve patient care and much to reduce my efficiency. To make a point of how often this occurs, I’ve decided to TRY to document each interruption, within the confines of my limited time. Here is todays irritation:

PBM (pharmacy benefit manager) requires a PA (prior authorization) to refill digoxin. Patient has been on digoxin forever. It is a med that is rarely used anymore, though was once commonly prescribed for congestive heart failure or rhythm control. Unfortunately it has some negative side effects and typically there are better drugs for the conditions it is used to treat. However, in this case, patient came to me on digoxin. I sent her to a cardiologist to see if she could substitute another drug. She was intolerant to other medications and ultimately the cardiologist felt that digoxin was the least risky choice and continued it. This was last checked as recently as two years ago.

Sigh. PA applied for.

 

 

 

Facebooktwittergoogle_plusredditpinterestlinkedinmailby feather

Thoughts on MedX

This morning I sit in my daughter’s San Francisco apartment pondering the barrage of information that I was exposed to during the previous three days at the Stanford MedX conference. My mind is full of images that begin with Regina Holliday‘s beautiful pre-conference canvas

Representation of a part of the canvas

and end with my friends Lisa Fields and Ruth Ann Crystal; relationships made over the internet through Social Media and cemented by meeting IRL (in real life).

Ruth Ann Crystal, myself, Lisa Fields

The conference was a showcase of healthcare innovation and opportunities to network with empowered patients from the Society for Participatory Medicine and other like-minded health professionals. The epatients’ stories along with Regina Holliday’s exhortations to “change the world NOW” were the most compelling part of the program. Over the next few weeks I hope my mind processes what was learned and results in more ideas for changes that improve patient experience in my practice and, who knows, even in my healthcare system.

Flash mob on stage with Regina Holliday (in red)

At first, when asked by other participants why I came to Stanford, I wasn’t immediately sure. I made the reservation out of a gut reaction but by day two my motivation was obvious: MedX provides the energy and focus necessary to change our broken healthcare system. Tim Autrey of the Practicing Perfection Institute commented in his workshop that change must start with the individual. This individual began over a year ago but the MedX conference provided a powerful infusion of energy to improve my personal relationships with patients and exhort my system to do the same. Thank you Dr. Larry Chu, Nick Dawson and the staff who worked so hard to make the conference the success it has become.

Facebooktwittergoogle_plusredditpinterestlinkedinmailby feather