Everyone Will Need a Bridgewell Patient Care Advocate at Some Point
Updated: Jun 29, 2022
Personal Health Crisis is Reminder of Why We Deliver Personalized Care
As a medication therapy management (MTM) pharmacist, I know why I do what I do. But sometimes, when things get personal, I realize how important our role is in patient care. My mother is a new retiree and, by all accounts, she’s in excellent health. She and her husband run a 40-acre farm on the southern Oregon coast, and they love to spend their time tending to their chickens, cattle, and various orchards. She stays incredibly active and is always proud to call me with the results from recent health checks that indicate her blood work confirms she is every bit as healthy as she thinks she is. Until recently, the only medications she took were vitamins, calcium, and a couple allergy medications. She even has all her immunizations and preventive screenings. Everything was great until last November when she caught a simple upper respiratory infection.
My mom is one tough cookie. She says,“It takes a lot more than a little cough to get this country girl down.” No joke, that’s a direct quote. So, she kept on going: mowing, tending to animals, and farming. Unfortunately, the infection kept getting a little worse each day and then each week, for months. It got to a point where she couldn’t sleep at night because she was coughing so much. Her abdomen was visibly bruised because she was breaking blood vessels during her coughing spells. At one point, I sent her a pulse oximeter because I was worried about her O2 stats and theorized that this might be COVID, despite her being triple vaccinated and testing negative during three urgent care visits and a visit to her primary care provider.
During one of those visits, she was prescribed an antibiotic (Z-Pak) and a 10-day course of steroids (prednisone). Her health improved until her course of steroids ended. She started going downhill again. We talked about returning to urgent care, but a scheduled primary care visit was just a couple weeks away and she decided to tough it out.
Then came that scary Saturday at midnight in early February. She could hardly breathe and that tough cookie asked her husband to take her to the emergency room. It takes a lot for my mother to admit that she needs help, but it is a good thing that she did. The doctors immediately admitted her to the hospital.
For four days in the hospital, my mom’s doctors worked through their differentials to identify what underlying etiology might be causing her four month-long upper respiratory illness. All the while she still insisted that she was fine and rebuffed my urge to fly home and visit her in person. Instead, I monitored her lab results via the online medical record from 400 miles away. We talked multiple times a day so I could stay abreast of what the doctors where telling her.
In the end, they ruled out the really serious stuff and she went home with a diagnosis of adult-onset asthma that was likely precipitated by her progressively worsening allergies. She was sent home with a trunk full of new medications.
As an MTM pharmacist, I went into full swing post-discharge medication reconciliation (PDMR) mode. My mom sent photos of all her discharge paperwork and the prescriptions she received from the pharmacy. I combed through everything with an eagle eye, and I had some questions.
She was discharged with the following new medications:
Ipratropium/albuterol 0.5-2.5mg/3ml nebulizer solution Q4H to help her breathing
Albuterol 90mcg inhaler PRN for shortness of breath
Levofloxacin 500mg QD x 7 days to continue fighting the infection
Lactobacillus rhamnosus GG BID for gastrointestinal flora
Prednisone 10mg taper to suppress respiratory inflammation
Cetirizine 10mg 2 BID for allergies
Montelukast 10mg QHS for allergies
Guaifenesin 100mg/5ml Q4H syrup for congestion & cough
Benzonatate 100mg to suppress her cough
Vitamin C 1000mg QD for prevention of illness
Zinc 50mg QD for prevention of illness
She was told to continue taking the following:
Calcium + Vit D 500mg/5mcg 2 QD for bone health
Cholecalciferol 25mcg (1000u) QD for general health
Olopatadine 0.1% soln OU BID for eye allergies
B Complex vitamins QD
My previously healthy, very active mom was now embarrassed that she had 15 medications. Additionally, she was frustrated because she was tied to a nebulizer every 4 hours. During the hospital stay, she’d accumulated so much fluid that she was now carrying 13 pounds of fluid weight and her blood pressure readings were in the 180’s/100’s.
During the visit with primary care physician the day after discharge, I had several things I wanted the doctor to address, including:
There was a discrepancy between her discharge instructions and the prescription bottle for her steroid taper. Instructions were for an additional 10-day taper, but she only had enough pills for 3 days.
She was on a budesonide nebulizer twice a day in the hospital, but wasn't discharged on a steroid inhaler.
She didn’t have a spacer for her albuterol inhaler.
Her prescribed dose of cetirizine was 4 times the normal dose.
It wasn’t clear if they were treating her for COPD or asthma. There was an ipratropium/albuterol nebulizer, but no steroid.
Using a nebulizer long-term wasn’t going to work for her lifestyle; I wanted to get her on a triple-drug inhaler, Trelegy.
I also wanted a pulmonologist to see her ASAP.
During the hospital stay, her sodium levels, white counts, thyroid, and liver enzymes were elevated at times; we needed to ensure that those were anomalies due to the stress of being in the hospital, and not indicative of something else that warranted further workup.
The night before her appointment, I coached my mom and her husband through these questions and insisted that they raise them with the doctor the next day. They were quickly overwhelmed. It wasn’t lost on me that it can be hard enough for patients to pronounce the names of the medications, not to mention ask the doctor a sophisticated medical question about what they should be taking. Doing so might even be interpreted as a challenge to the doctor’s authority.
Thus, my mom allowed me to join in the visit via telephone and I’m glad I did.
My mom’s primary care doctor is wonderful. I had heard good things already about how thorough and knowledgeable she is. So much so that she came into that appointment having already read the records and had a game plan that she was primed and ready to deliver. No doubt she was aiming to get in and out in 10 minutes and still provide the best possible care.
It was nearly impossible for my mom and her husband to get a word in. At that moment, I fully realized the challenge most patients face. Their aim to be efficient ends up being at the expense of listening and helping the patient understand their condition and medications they are prescribed.
Luckily, I have enough experience working with doctors and didn't have any problem stopping the conversation midstream to ensure that my questions were addressed. I spoke directly with the doctor and we worked through each and every concern. Once the visit concluded, we felt very comfortable with the treatment plan.
The doctor took my mom off the nebulizers and prescribed Trelegy, which I had researched to ensure the prescription would be covered by her insurance. We clarified all the instructions and came up with a plan for discontinuing the discharge medications. My mother also got a referral to a reputable pulmonologist. And, perhaps most importantly, she walked away confident about the next steps and that all concerns had been addressed.
We are lucky that our story is one with a happy ending, but there were some important lessons along the way and a great reminder about why we do what we do at Bridgewell Medical. The most significant lesson I learned with this personal challenge was that every patient needs an advocate. Someone who is willing to slow the doctor down and double-check all the medications and instructions.
Because doctors don’t have time for disease state education and instruction, it’s important that someone will listen to all of the patient’s symptoms, questions, and concerns in order to formulate the best treatment plan.
I realized that everyone will need a Bridgewell pharmacist at some point in their lives. When a health crisis pops up for you, your mom, dad, or another loved one, we are here to provide the same level of care that I provided my own mother. We truly care about all of our patients and are dedicated to delivering a level of care that we give our loved ones. Simply: It’s why we do what we do.