IIb. How to Avoid Prescription Medicine Mistakes

IIb. Proposal 2- How to Avoid Prescription Medicine Mistakes

     How many times have you received a prescription from your doctor and said to yourself, “I hope the pharmacist can read this because it looks like Chinese characters”? There is a standing joke about the poor penmanship of physicians. However, this is no joke when it recklessly endangers a patient’s health.

     According to an analysis by the Institute of Medicine’s Committee on Quality of Healthcare in America, medical errors, including prescription errors caused by poor handwriting, might be partly or wholly responsible for 98,000 deaths a year. These medical error costs are in the billions of dollars. An analysis by the Institute for Safe Medication Practices stated,  
     “Virtually all of the prescriptions issued each year in the United States are written by hand. Indecipherable or unclear prescriptions result in more than 150 million calls from pharmacists to physicians, asking for clarification, a time-consuming process that could cost the healthcare system billions of dollars in wasted time. At the very least, that process can delay the time until patients receive their medications. At worst, a misread order can lead to injury or even death.”

     A number of commentators have suggested that physicians use electronic ordering tools to electronically transmit the prescription to the pharmacy. This suggestion has a number of weaknesses. First, the cost to equip all doctors and pharmacists with digital prescription ordering machines may be prohibitive and the cost will be passed down as higher physician fees, higher medical insurance premiums and higher drug costs. Second, authentication of the digital prescription has to be secure to prevent hackers from causing harm to the patient through mischief. The most important weakness in the use of a digital ordering system that is directly between the physician and the pharmacist is that it leaves the patient out of the loop. What we need is a secure electronic ordering information tool that enables the patient to be part of the loop.

     As stated in Part One, Maximizing Your Medical Advice, the patient must be actively educated about his or her medical care to be a successful patient. The patient should see the prescription, be able to read the prescription and question the prescription before leaving the physicians office. For example, if a patient has been treated for high blood pressure or high cholesterol, he or she will be familiar with the medication. If the prior medication provided for 10mg per day and the prescription says 100mg per day, the patient should immediately question the physician before leaving the office. In a digital ordering process between the doctor and the pharmacist which excludes the patient until the medicine is in the patient’s hands, the above mistake may not have been caught. Always look at the prescription before you leave the doctor’s office to make sure you can read it and understand what it is for. Ask the doctor to explain what the prescription is for and to clarify illegible handwriting. If your doctor is unwilling to explain and clarify the prescription, then get another doctor.

     A second proposal for change to our broken medical system, is to require all physicians to print or have office staff type the paper prescription. A hand printed prescription of 3 or 4 words and 1 or 2 numbers is not an unreasonable burden on physicians. In fact less cost will be associated with a printed prescription than a script prescription. The mandate to require printed prescriptions will require either legislation or state regulation by the medical licensing authority in the state. Significant monetary fines and warnings should be imposed on doctor’s writing script prescriptions. Two warnings will result in fines only, while a third infraction will result in a one week suspension of the physician’s medical license.

     This is a simple, no cost fix for a large physical, emotional and financial problem. All we need is the political will to mandate the use of printed prescriptions either by hand or machine and the cooperation of physicians. Since physicians take an oath to do no harm to their patients, this rule change should be readily accepted by physicians. 

 

IIa. Lowering Prescription Drug Costs

     Contolling the cost of medical care in the US is the touchstone to repairing the broken US medical system. By broken, I mean the delivery of care is inefficent and too expensive. This post will discuss some of the cost issues facing the US healthcare system. Make no mistake, I believe the healthcare in the US is the best in the world. However, outcomes are equally favorable in Europe and yet the per capita heathcare bill is significantly less than the US.  Healthcare in the US is big business. Roughly 16% of the US GDP is spent on delivering healthcare. By the year 2015, that figure is expected to reach 20% of US GDP. Controlling the cost is an imperative.

     Recently I attended a party with a number of doctors of Indian descent who practice in the US. One doctor in particular cornered me to tell me of his experiences in returning to India to practice medicine. He told me that the cost of dissolving kidney stones in India is 75% less than the cost in the US. The procedure which costs $40,000 in the US costs $10,000 in India. The equipment is manufactured in Germany  and used in the US and India. He stated to me that the doctor’s fees for the procedure are unreasonable compared with India. He then smiled and said “But I am not complaining. It goes in my pocket.” It is true that US laws and patient malpractice suits increase the cost of medical services as compared to India. The real reason for the higher cost in the US verses any other industrialized country is that medical costs are not controlled in the US where such costs are controlled everywhere else.

     If we assume a free market in the US, then the laws of supply and demand apply. However, even Adam Smith would recognize that medical costs must go up if demand is inelastic. Stated differently, patients have no choice to consume if they are ill. Basic economics teaches us that if prices go too high consumption will decrease thereby reducing the price. This only works in a scenario where demand is elastic, that is, moves downward when prices are high and up when prices are low. Medical services are consumed when needed regardless of the price. Some form of price controls are required to affect the inelastic demand for medical services, and in the case of prescription drugs, a free market exists only in the US.

     Advocates for the free market of prescription drugs point to the US as the leader of a free market policy. I absolutely believe in a free market if there is a level playing field. Let me give you a simple example. Pfizer, a leading drug company develops a drug for a cost of $1billion. The board of Pfizer authorized the development based on the assumption of a 10% return each year for 15 years. In the first year, Pfizer must earn $100 million. Sales in all parts of the world except the US are running at a $30 million rate for the year. Since the US is the only free market for the drug, Pfizer must price it to earn $70 million in the US to reach $100 million for the year. Thus, because of foreign price controls, US prescription drug consumers pay more than double the amount paid by foreign consumers. In short, the US public is subsidizing the cheaper drug costs for the rest of the world. Two possible approaches are apparent: 1) enact a law that US drug costs cannot exceed 110% of the average cost for the rest of the world, or  2) foreign markets will not be supplied unless the price is at least 90% of the average cost in the US market.

     Prescription drug costs in the US will continue to outpace inflation unless the US goverment recognizes that demand for prescription medicines is inelastic and the pricing mechanism is distorted by foreign price controls. The US people can no longer subsidize the rest of the world by turning a blind eye to the fact that a free market for prescription drugs exists only in the US. Legislation to require drug companies to price in the US based upon worldwide pricing is needed to stem the spiraling costs of presciption drugs.  

 

BROKEN US MEDICAL SYSTEM

      This blog will endeavor to open up for discussion 2 primary issues facing consumers (patients) serviced by the broken US medical system: I. How to maximize your medical advice within the limited time given to patients by doctors, and II. How to reform the existing US medical system so that quality medical care is available to everyone at a price that is affordable.

              I. Maximizing Your Medical Advice

                 You make an appointment with your doctor and wait to be called. Finally when you are called, the doctor spends 10 minutes with you examining and explaining your ailment and your treatment. You say you understand but do you? You fill the prescription but don’t know what the medicine does or the side effects. Your doctor simply does not have the time to explain all you need to know to determine if the medicine is appropriate. By appropriate, I mean every medicine has side effects. You as the patient have to be in charge of your own body and make informed decisions regarding your care. Most doctors are caring professionals but cannot spend the time to push you up the learning curve.

This blog will attempt to give straight forward advice and knowledge to help educate you when seeing your doctor. You are not competing with your doctor but rather becoming an educated consumer of medical care who makes your doctor’s advice more meaningful.  For example, you should know that if you have a virus, antibiotics do not work. Antibiotics only work on bacterial infections. You should ask, is the infection viral or bacterial? When the doctor gives you the answer that it is a viral infection you will know antibiotics will not be prescribed because they will only work on bacterial infections.

I am attending a series of lectures at a leading medical school and will report on this blog what I have learned so that we can together be better informed consumers of medical services.

          II. Reforming US Medical System

              I will comment frequently about the weaknesses of the US medical system and how to reform it.

The major problem with our medical system is the cost explosion. Only people who are employed and have access to a large medical pool can afford medical insurance. Employers subsidize their employees’ cost to make employee premiums reasonable. However, employer provided healthcare is a historical accident. During WWII, wages were frozen by price controls. Raises could not be given so benefits such as free medical insurance was provided instead. Today, medical insurance is very expensive even to the employed with healthcare benefits. No other western country provides healthcare the way it is paid for in the US. For a working family with no employer subsidized healthcare, the cost is prohibitive. For example, Aetna’s individual POS policy for southern NY is $9,696 for an individual per year and $28,840 for a family per year. This is not affordable healthcare.

The costs are continuing to rise at a rate far in excess of the inflation rate and by the year 2015, $1 in every $5 spent in the US will be spent on healthcare. Reform is long overdue. Politicians will only move on healthcare issues if there is a groundswell from the electorate. I will be posting ideas for reform on this blog. 

Lastly, if quality medical care is a citizen’s right just like the right to vote, then the US Government and state government must be major players in the medical reform movement. If quality medical care is merely a privilege not a right, then the private sector restrained only by market forces will continue to maximize profits. Unless demand decreases (which is not likely with the aging of the baby boomers) medical costs will continue to sap the economic strength of this country. Since most states prohibit a hospital to refuse to treat a patient without medical insurance, it seems clear that this country has determined quality medical care to be a right not merely a privilege. I will post my ideas for reform on this blog.