Another patient submitted article. I have no idea what medical facility this person attended, but the medical facility is obviously missing some key components of meaningful use. No drug interaction checking or e-prescribing systems should allow for this to happen.
Over the last few weeks, I’ve faced what many of us have over the last months: stress. Besides the economic hole, an over-busy lifestyle, working full-time while completing my degree and studying to take my LSAT in a couple months, not to mention all the rest of the garbage that comes with taking on humanity at its messiness. Like most women (and certainly plenty of men, too), I feel like I need to be there for anyone and everyone, despite the time or personal possibility of it. Needless to say, I’ve developed a decent case of insomnia. By decent, I mean that I’m getting about 12 hours of sleep a week, on average. Side note, the less I sleep, the faster my pulse goes; adrenaline response at its very best. Knowing how awful this is on the body, I went in to see my physician to get help.
By my physician, I mean that my PCP was booked solid (likely with other folks going through proverbial hell at the moment, too), and I was seen by another doctor—on his last day in that department. Besides the extreme sleep deprivation, my heart rate was, let’s say, not ideal. I mean, 145 sustained for at least a day and a half. Mind you, I felt like crap, and I’m sure the international-sized luggage under my eyes didn’t help.
No, I’m not depressed. No, I’m not suicidal. No, I’m not homicidal. Bloody hell! No, all I want is to be able to sleep. That’s it. Give me 7 glorious hours of sleep, and I’ll be back to taking on the world. Follow-up scheduled for an “emergency” appointment; supposed to be the next day, except that it’s over a week out. Fine; except that the sleeping pills aren’t working and the doctor I saw is lost in the bureaucracy of departmental such and such.
Again, I try to see my PCP, or at least have her switch meds. No on both accounts, I have to be seen again; fair enough considering I’m still knocking out a rhythm well over the normal limit. Both the scheduling person and the nurse rooming me confess that they’ve both had bouts of major insomnia in recent weeks. Enter the provider; very kind, but again with the psych questions. Is there some sort of quota? They’ll just keep asking until the person really does get bloody pissed? It seems stereotyped that women who can’t sleep must fit one of the aforementioned categories, but it’s unfair to all of us that manage to effectively run households, businesses, families, and all the other commitments demanded by the rat-race society but don’t sleep enough.
New meds, follow up after the weekend. Brilliant, except that these ones aren’t cutting it either. My only back-up instructions are to go into the ER to get shot up with some cocktail equivalent of ketamine and kryptonite. Given the outrageous cost, even with my insurance, of doing this… I suffer through yet another sleepless weekend. I can’t actually remember the last time that I’ve slept for more than 3 hours in a night.
I follow up on the Monday morning with the same nice provider (an NP). The sedatives have brought my pulse down to a rough 100 beats per minute, so she’s not so worried. The only problem? I’m still… still… not sleeping. If you pulled a CBC at the moment it would come out pure adrenaline. However, my brain is bloody shot; I’d lose an IQ contest with a jellyfish, and the pet rock would have better hand-eye coordination. Solution? Let’s try another drug (going on the 5th one in under a week). She wants to put me on an antidepressant. Again, I explain: I am not depressed. Overwhelmed, stressed, and stretched too far, but not depressed. Besides that, I have a medication induced prolonged QT. (For those of you who don’t know, the easiest explanation of a prolonged QT is: oh shit!) Best med to kick that condition into gear? Antidepressants, particularly tricyclic antidepressants. She thinks for a minute, and decides that she’s got the answer. She’ll send me with another sleeping pill, and it’s going to work great, although she cautions not to eat any grapefruit or cheddar cheese, and not to use my epi-pen, since the interactions could be fatal. Fine, I don’t intend on inducing anaphylaxis anytime soon, and I don’t like grapefruit. That’s it, no more questions, no concerns about interactions… I fill the prescription at the pharmacy, where right on top of the script there is a list of allergies. Odd, no one notices that the damned pill she just prescribed me is almost the same thing as what nearly killed me, and cost me a week on a cardiac unit with the threat of a pacemaker. I didn’t even receive the usual hand-outs from the pharmacist.
Thank God for the internet! Before taking it, I did a little Google search, and, low and behold… yeah, this is likely to induce the prolonged QT. I guess when I asked to sleep I should have specified that I would also prefer to wake up again! Given the incredible extent of PHI available to my provider, complete with a listing of allergies (including ANYTHING THAT HAS CERTAIN SIDE EFFECTS), how is it that this completely fell through the cracks, not only at the doctor’s office, but also at the pharmacy (who also has an updated and accurate list of allergies). Is there some more effective way to streamline this information? Ultimately, who is responsible? It might be too much to ask that the patient research and understand the formulary of each and every medication prescribed, but who is looking out for this? What can be done to improve the communication about the cross-over and familial relationships between drugs? Is it simple enough to chalk it up to a medication error (certainly potentially fatal, though in this case luckily not), or a ridiculous mistake on the part of the prescriber? There has to be some way for certain elements of PHI to be transmitted between the provider and the pharmacist, and someone has to be responsible for checking for interactions and known conditions that could cause fatality when mixed with certain drugs. As the Baby Boomers age, and as pharmaceutical companies pitch their pills alongside the evening sitcoms, who’s going to protect the population from gross stupidity and malpractice?
To clarify, it was not my PCP that made the mistake. She’s still swamped in the red-tape of the easy access concept of medicine, and I won’t be able to see her for yet another week. She contacted me to encourage me to ‘hang in there’ until I can finally see her (who really is a very clever physician that listens when the patient tells her that the drug could kill them).