Healthcare Woes

My most recent experience with traditional healthcare has been decidedly unreassuring.

I take thyroid medication regularly--that is, I take it if my prescription is filled in a timely manner.

At the beginning of last week, I saw that I would run out of medication by the beginning of this week, so I called the pharmacy to have it refilled. Oops. The bottle said "No refills." I wondered why that was so, since it's been less than a year since I've seen my primary care doctor. It was the first visit with that doctor. She was fresh out of medical school.

I expected that when Hiromi went to pick up the prescription, he would come home with medication and a message saying that the doctor said I needed to get a blood test before the prescription was filled another time. That's what has happened in the past.

The next day, on Tuesday, Hiromi came home from the pharmacy without medicine, except for two pills the pharmacist had given him, because I was completely out of medication. The pharmacist said the request was made, but the doctor had not called back. "You'd better call the doctor," Hiromi said to me. So I did.

I talked to someone in the front office and told her that I needed to have a prescription filled and it had not happened. I asked if the doctor had for sure seen the request. She works only half time, and I thought she might have been out of the office when the prescription request came in.
The receptionist told me she would be in this afternoon and she would see it and deal with it then. "Will you call me if there's any problem with getting it filled?" I asked. She assured me they would call. No one called.

On Friday, Hiromi stopped at the pharmacy again. "The doctor refused to fill the prescription," he told me when he got home. It was already 8:30 by then, and I could not make contact with the doctor until Monday morning. The pharmacist had kindly sent home three pills--nice, since I had not had meds since Wednesday. I was furious. It was probably a good thing I would not be talking to anyone at the doctor's office till Monday.

On Monday morning I called the doctor's office and asked by name for the person I had talked to earlier. She was out of the office for lunch, so I told the new person what I wanted to say. I said I was out of medication, and needed to know what should happen next. I asked the receptionist if a blood test was needed. I recounted the sad story of what had happened last week and politely said I was disappointed that no one called me. She looked at my chart and said she was sure that I needed to have a blood test since my last one was in March. What? I saw the doctor in September. Oh yeah. The endocrinologist did the blood test in March, and the primary care doctor didn't do one when I saw her in September. She wanted me to drive the 20+ miles to the doctor's office to have blood drawn. I said I would like to have the blood drawn by Lois Y., who is authorized through her medical practice to do such things. They sent her an order.

At this point, things began to look up. Lois drew blood at the first opportunity, which was the next day. She went out of her way to accommodate me and my schedule. I drove less than three miles to get it done.

Someone from the doctor's office called the next morning and said that the tests had come back and a prescription had been called in. By now the accumulated medication deficit had snowballed (more on that later) and I was feeling very bad. "Go in right away and pick up the prescription," Hiromi suggested. So I drove the 15 miles or so to the pharmacy where we've always gotten our medications.

The lady I talked to looked up my record. "It says it's denied," she said. She got her boss.

"When did you last see your doctor?" he asked.

"I had a blood test yesterday, and I got a call this morning from the doctor's office saying they had called in a prescription."

"We didn't get it," he answered. "You might want to call them again." Then, in another act of kindness, he gave me two more pills--free.

"You'll have to call them," I told Hiromi when I got home. "I've reached my limit."

Hiromi called the number on the caller ID from the person who said she had called in the prescription. She wasn't there, but someone gave him another number to call. She wasn't at the second place either. But the person who answered told Hiromi, after she heard the story and checked my chart again, that the prescription order was, in fact, called in, and had probably been left on voice mail, and the pharmacy had not yet checked their voice mail.

Hiromi called the pharmacy and asked them to check their voice mail. After holding a very long time, he was told that they had a prescription order for my medication. Whew.

It's Friday now, and I got my medication last night--11 days after I first called it in--after having done in a timely manner everything I was told to do . I do not feel well-served by anyone except by Lois and the pharmacists who gave me five free pills to tide me over.

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When I got the prescription, I read the accompanying paper very carefully in search of a bit of information I had come across elsewhere. It was not there.

Last week I read on a thyroid patient advocate site that it's very important to keep thyroid medication at room temperature, or just slightly below. Otherwise it loses potency. Even a few hours can make a difference, but at the temperature extremes, it doesn't take very long for the damage to occur.

A month ago, Hiromi picked up my last batch of medication on his way to work. He stowed it in the cubbyhole of his car while he was at work. Temperatures inside the car were doubtless well over 100 degrees if it was a sunny day--for all the hours he was there. In fact, ever since he started working at Wal-Mart last November, that's the pattern he's used: pick up the meds on the way to work. This was necessary because the pharmacy was almost always closed after he got off from work, so he couldn't do it on his way home. Neither of us saw any problem with this. During the winter, on a cloudy day in December, the temperature could have been below zero in the glove compartment of Hiromi's car.

Now my ongoing pain in my muscles and joints suddenly makes sense. This is a common symptom of thyroid deficiency. I have had some measure of this for most of the past six months. Initially, during school, I blamed my lack of exercise. Since school is out, I've been blaming it on too much exercise--with a heavy dose of garden work. I've also felt emotionally a little tipsy and mentally a little slow. More thyroid deficiency symptoms. My thyroid blood test came back still in the normal range, but at the low end of normal. (It's confusing because a high TSH number actually means a low amount of thyroid hormone is present.)

I wish someone had told me a long time ago that it's important to keep medications at a prescribed temperature. I think it would have saved me a lot of trouble.