Jun 5, 2012

How NOT to Treat High Blood Pressure

Photo credit: Morning Calm News

I recently took a trip to Colorado with my husband to visit his grandmother. Before we left, Matt went by the pharmacy to pick up my blood pressure medication for me because I had run out the day before we were leaving. I had sent a refill request to my pharmacy the week before because I knew it required permission from the doctor and that sort of thing takes time.

When he went to the pharmacy, however, my medicine was not there. The pharmacy said they sent a request to my doctor, but he never responded. We needed to leave at 6 am the next morning for our flight, which put me into an emergency situation.

My blood pressures at times reach around 167/118, levels which are considered Stage 3 High Blood Pressure and require treatment. I was not comfortable with the idea of possibly reaching those highs for even one minute, much less for several days, and my doctor himself had advised me in the past not to let that happen because it causes damage to arteries and vital organs.

After several calls to my doctor's office, dealing with the nurse's attitude (Nurse: "You are supposed to request refills 48 hours in advance." Me: "I know. That's why I had my pharmacy contact you last week." Nurse: "You'll be fine without your medication for awhile." Me: "That's not what the doctor told me."), I finally had to call the doctor on call at 9 pm (who was not my regular doctor) and get my medication filled at a 24-hour pharmacy. She had no problem calling it in immediately.

Me, tired, stressed and pretty rough-looking at one of my many other doctor visits.

My doctor, however, appears to be under the impression that not only did he fill it (he didn't), but that it required a return to his office (why?), and that he has no idea why I am taking this medication (high blood pressure, which he has been treating me for for years) and doesn't know if he is even the doctor who wrote the original prescription (he is.)

I was already upset that getting my refill had turned into such a hassle...the stress and worry certainly were not good for my blood pressure...but to come home and find this error-ridden letter from my doctor was very infuriating!

Dear Dawn,

Please help me help you.

Nobody like (sic) emergencies. You recently called for a prescription and requested same day turnaround. While I completed this order for you, you should know that I had to return to the office specifically for you in order to complete this.

I do want to remind you of my prescription refill policy. Prescription requests are fulfilled in 48-72 hours. I feel this is a resonable turnaround time for patients taking chronic medications.

Please consider making your requests in a more timely manner in the future.

While reviewing this medication, I note that I've not refilled this for you in some time (ever?) and that I don't have an indication for it listed in your chart. I presume it's for blood pressure. I do have some questions regarding why it's used for (sic) and who prescribed it previously and so, (sic) I'd like for you to follow up with me upon your return.

As someone who suffers from several chronic medical conditions, I can attest to the fact that dealing with doctors, pharmacies, prescriptions, etc. can sometimes feel like more of a hassle than the conditions themselves. The last thing a patient needs on top of health problems is having something like this thrown at them.

I figured I had been a pretty good sport about him and his office not handling the refill situation properly and was going to let it go. But to be sent a letter chastising ME for all of this? Unacceptable.

Not to mention how troubling it is that the doctor who has been treating my condition and was the one who put me on this medication has no recollection of it and apparently has such poor record-keeping that it's not even in my chart.

One of my high blood pressure readings.

I debated how to handle this situation and was very close to trying to find another doctor. But I have had this doctor for years and he usually is very friendly, compassionate and kind. And trying to find another doctor would be another hassle in itself.

So I decided the best thing to do would be to write a letter in response:

Dear Dr. X,

You recently sent a letter to me that has raised several concerns on my part. In it, you stated that you completed a prescription request for me that had a same-day turnaround and that it required you to return to your office specifically to complete the order. You reiterated your prescription policy which requires 48-72 hours notice. You also stated that you are not aware of filling this medication for me previously, that you have no indication for it in my charts, and that you presume it’s for blood pressure.

I am aware of your prescription policy, which is why I had my pharmacy send a request to you several days before I needed to pick up my refill. They informed me that they sent you the request but that your office never responded. This put me into an emergency situation as I needed to go out of town at 6 am the next morning and did not have any medication left.

As you are aware, emergencies such as these sometimes arise, and I would expect my doctor to be able to handle such a situation, especially when it was not my fault but apparently a fault of your office for not responding to the original request in the first place.

For context, there was an insurance mishap on a different medication of mine a few months ago and my doctor who prescribes that medication immediately called the pharmacy that same day to fix the error for me without it being any sort of issue or problem. It did not require a trip back to her office, but merely a simple phone call to the pharmacy.

Secondly, you did not complete the order. After calling your office several times that day, during regular hours (and finding that you were not in the office), I had been told you had been contacted and would be handling the issue. However, that evening, the prescription had still not been called in.

I had to phone the doctor on call (not you) around 9 pm to have the prescription called into a 24-hour pharmacy for me (again, without a need to drive to any office first) and my husband picked it up on his way home from work at approximately 12 am so that I would have my medicine for my trip and so that I would not have to worry about my blood pressure going too high while I was out of town.

While this was upsetting to me and caused me much undue stress and worry, I tossed it up to the fact that there might have been miscommunication and/or some other such issue that prevented you from handling this situation. Coming home from my trip and finding your letter to me, however, was a bit unnerving to say the least and I don’t quite understand the need for it. (I won’t even get into the grammatical errors in it which are concerning as well.)

What I am most concerned about though is the fact that you are not aware of discussing my high blood pressure treatment with me (which we have discussed during several of my visits, including my last one which was just two months ago), and that you had to “presume” the medication was for my high blood pressure.

How is the treatment for my blood pressure condition not in your charts when this has been an ongoing condition for me for years? I have brought you written records of my blood pressure readings, and have been told by you that it’s very important to take my medication or it will be “my heart and not my kidneys” (another condition I suffer with…kidney stones) that I will have to deal with in a few years.

When Altace was dropping my blood pressures too low, you switched me to Lisinopril. At my last visit two months ago, after I discussed with you that I was still having drops that were concerning, you advised me to cut my dose of Lisinopril in half (which has been working).

My previous insurance required that the Lisinopril be filled via mail order and I was sent a three-month supply by them, which you approved. Because it was a three-month supply, and because my dosage had later been cut in half (there were also times in the past I had to skip doses because of the drops I was having), it has been awhile since you last filled this for me. It has, however, only been approximately two months since we discussed my high blood pressure condition and my Lisinopril treatment/dosage.

I do not feel that is fair to me to charge me $20 to come in and clarify all of this for you, and I do not understand how this information is not in my medical chart. If you can take the time to chastise me in a written letter for something that was not even my fault, I hope that you will also take the time to explain this situation to me as well.

You have been my doctor for several years and have usually been very kind and helpful, so I want to give you the chance to explain this, hence this letter.

I can be reached by phone or email (listed above) if you prefer, and I will be happy to discuss it in person without being charged for it, despite the fact that my time is precious as well.

Thank you.

Hopefully, my doctor will respond with an apology and explanation and not with defensiveness. It's almost like dealing with a relationship whereby you want to be the dumper and not the dumpee. I am aware that he may very well "break up" with me himself, which would be pretty infuriating. And the last thing I need is more stress or to be "under pressure" (get it?) as one of my favorite stress-songs goes:

But I have decided the hassle of trying to find another doctor is not something I want on my plate, and he has been a good doctor in the past, so I am giving him the chance to make this right.

And you better believe if he doesn't, I will make sure everyone knows about it.


Michel Marcheterre said...

I like how you still took the time to make a cute face for the picture.

I hope your doctor is not an asshole and apologizes.

BlondeBlogger said...

Ha! Thanks, Michel! I don't know about cute, but definitely tired! lol So far, no word from the doctor.

Paul Burgess said...

I have an experience also with a doctor which I dislike and that is the reason why I didn't visit him again. I think what he really need is money even he doesn't gave a good check up.