Where's my Prescription Summary, Shoppers Drug Mart?

When I first saw the new Shopper's Drug Mart prescription receipt I did not understand what I was seeing. It changed to a label the size of a name tag with the backing still on it. I could peel it off but then what would I do? Maybe the idea is that I start a prescription scrapbook? 

I mentioned the difficulty I anticipated trying to save these slippery labels with 5 point type for my income taxes and my pharmacist said that I could ask for a list of the dollar value of my prescriptions every year for income tax purposes. That's a service that can help me, BUT I still need and want the listing of my last 20 prescriptions.

For me that list has been an essential tool. With it I can accurately give details of my medications to doctors. I also use it to list medications on forms at the hospital and in the Emergency Department. On Twitter yesterday some doctors said they also use those lists to go over medications with their patients, especially those who don't really know the medications they're taking.

Yet now that feature has been withdrawn with no notice, and no concern for patients, caregivers, doctors and customers.

Burden of care is added to by having no list.

When I look at the Loblaws Corporate website I see Chairman Galen Weston saying "We understand the breadth of our impact and influence." I appreciate that sentiment but wonder how many doctors and patients were consulted about this change that has a fundamental effect on my ability to manage my drugs and prescriptions.

I like the idea of the patient, family doctor and pharmacist as the basic unit for regular health management and decision making. But now, at the same time as Shoppers takes on more health services such as flu shots and Med Checks for profit, they are stepping back from the patient's needs.

My pharmacist responded to the problems I raised with:
"We all change and we expect our customers to change too." 
"You have to manage by yourself somehow." 
"Our expectation is that the patient will keep track of their medications."

Excuse me Shoppers, I am a highly literate patient and that is just one of the areas where I have challenges. Luckily at this moment I am not in a crisis but many of your clients are struggling with their health. Many of us stagger from crisis to crisis.

What about our aging population, people with low vision (Did I mention the 5 point type on the receipt?), and the more than half of Canada's population who are not health literate? 

Another statement on the Loblaw's website (Loblaw's owns Shoppers) is this:  "Our strong commitment to corporate social responsibility defines the way we do business and the role we play in society."

These statements do not match the Shopper's Drug Mart withdrawal of their useful and traditional prescription lists. 

I hope they will look for a solution to this problem which is either happening to us now, or will soon be apparent at a Drugstore near you if you are a Shopper's Drug Mart customer.

This is the top section of the form we will no longer be receiving.


Added after another visit to Shoppers: The pharmacist was able to produce a list for me on two full sheets of letter size paper that covered fewer prescriptions than the small summary of 20 that I am used to. Not convenient for me to carry and keep with me but at least I can use it for renewals. Not a solution, but as a stopgap it will help, though it required a lengthy conversation with the pharmacist before I was able to get that printout.

How To Develop Chronic Patient Syndrome

There are many stories about waste in healthcare. Some are ridiculous and some are based on misunderstandings and lack of knowledge.

Here's my waste story: While I was being treated for RA, injectable methotrexate was prescribed for me because the pills caused too much nausea. The shots were intramuscular and I assumed that I needed to have a doctor administer the injections just like with gold shots.  

So every Wednesday afternoon I would leave work early, go to the doctors office, park and wait (and wait). This went on for seven years. That means 364+ extra doctor visits and at least 1000 hours of my time that was wasted. Not to even mention the white knuckle winter trips.

                                    www.transportation-tech.com

My rheumatologist then happened to suggest a clinical trial.  As part of the start up process for it I met with a nurse for an interview and in the course of the discussion she asked why I did not inject myself. Thank goodness she did. 

I had seen at least 10 different doctors in those 7 years, allowing for travel, locums and vacations and not one of them said a word about this possibility. At last I was spared the weekly visit!

That is why I suggest that in some chronic diseases there should be a resource person or advice line, ideally staffed by a nurse who has the time to discuss treatment choices, possibilities and ways to make life with a chronic disease easier. If it had not been for that one nurse a lot more time and productivity would have been wasted.

Lego Nurse

This new service would give non urgent sensible advice to patients with chronic illness online or by phone. Of course the answer may often have to be "Check with your doctor" but even that is a helpful answer because you have an opinion on the relative seriousness of the question.

And with a few stories like mine resolved every week the position would pay for itself.

Of course seeing my doctor for those hundreds of extra visits has led to us having a very good relationship based on my chronic patient syndrome. Yes, you develop that "disease" by seeing the doctor often.

HCLDR Chat and Healthcare Mystery Shopping

Feedback from consumers and providers is a great way to make an organization work better for everyone. Once you start thinking about using these insights great changes can occur -- if there is a will to use it.

This should work in healthcare. A great discussion about the topic of patient feedback can be found here in a transcript of the #HCLDR tweetchat from Tuesday August 13 at 8:30 pm EDT. Below are the top 10 participants by mentions.

• @practicalwisdom @colin_hung @teammdrs @soulmirror @dandunlop 
• @jcs0716 @docnieder @joshgray_hcit @strangely_t1 @ruthcarlosmd  

I had a different type of experience in feedback after my diagnosis with RA. When my symptoms improved I noticed a small ad in a newspaper looking for part-time mystery shoppers. I answered the ad and a meeting was set up by the coordinator at a restaurant near me. Despite being somewhat dubious I accepted the job.

It was purely corporate information gathering for the purpose of quality control at a distance. I felt sneaky, like a gumshoe doing a job, but in an underhanded way.  At least the experience in critical evaluation and customer service was invaluable.

My assignment was to go to certain walk-in medical clinics as a new patient and evaluate all aspects of the experience. These included the signage and accessibility, and the staff from receptionist to doctor. The thought of evaluating doctors was totally new to me, and a little daunting. I was not sure it would be easy to critique authority.

In the Canadian health care system my Health Card would normally enable me to walk in, show the card and see the doctor. This job though was being done for a corporation doing market research so I needed a story that let me pay cash for the visit.

I said I had recently moved from Quebec to Ontario and had no Ontario Health card. This way I had to pay.  Letting Ontario tax dollars pay for my "care" would have been fraudulent.

Part of the job was phoning each clinic from a list I was given and asking questions. I felt sure some of the receptionists were able to tell I was a designated shopper.  One was rude and silly on the phone and I understand he was subsequently replaced.

I would love to give useful feedback about many of the healthcare facilities I see now. Cleanliness, signage, friendliness,efficiency and neatness were among the areas rated in that past job. The compliments would probably outweigh the complaints but I see things that could easily be improved.

Some of the doctors were outstanding.  Those who impressed me most showed interest by asking more questions. They involved me in my story instead of taking it at face value and sending me away with a prescription. The good ones seemed to want me to leave with more knowledge than I had at the start of the appointment

RA was a convenient reason for seeing the doctors. I told one I was taking 9 aspirin per day. He told me he personally would always take coated aspirins to protect his stomach. 

 with ring splints

Another time I told the doctor I was depressed because I had actually felt that way after my diagnosis. That did not work so well. Even though the story hung together the doctor commented that I was smiling more than he would expect to see in a depressed patient. He was right. I was having fun doing the mystery shopping because I found it so interesting at the time. 

Now the chain of clinics is gone but it left behind an interesting memory for me.

Pathways to knowledge

Turkey season is coming. Here is a picture that my friend Phyllis took of  "The Bird Itself" in her driveway in New York state. It scared her a bit. Look at that face.

Phyllis was an avid gardener and was part of a Yahoo RA group called RA-Factor that I have been in for the last 10 years. Needless to say we have all grown close. People come and go depending on circumstances but many of us stay with it for the support, information and for the freedom to complain about RA to people who understand the issues and do not take it personally.

She was the first person to offer advice and she enjoyed telling stories about Mr. Sticky Fingers - her grandson, making tags for people and sharing advice with the group.

She started feeling unwell in general with a cough and a cold, a headache and back pain.  Her doctor suggested bronchitis and gave her an inhaler and prednisone. It was not the first appointment she had that was inconclusive.  With RA it's easy to assume that any issue is connected to the inflammatory disease.  It turned out that she was fatally ill and died a few years ago.

So this is a reflective post.  I remember reading about morbidity and mortality in RA on the American College of Rheumatology website years ago when I was avidly searching for information. That was depressing though I know the outlook is better now.  I kept finding new complications and issues that might occur, but managed to keep my anxiety level low by doing what doctors call watchful waiting.  So I watched and I waited and nothing ever developed.  That was one good way to make the anxiety level drop, even though it took many years. 

I think anxiety is a real problem with a chronic disease and knowledge is a good way to dampen it.  Things have improved in access to information. When I was diagnosed 30 years ago if you wanted info the sources were magazines, newspapers or books. Of course doctors were a possibility but I was feeling so shocked that I had trouble absorbing what the doctor had to say.

The internet has been a big help to me.  It has made me much more informed and has speeded up my treatment because now I know the vocabulary and which questions are the right ones.  It also helps me to know the treatments and what to expect if the medications are working.

  

                                                                                    Merrimack Pharmaceuticals
                                                                     Pathways to Knowledge

Now there are so many pathways to find the information that you need.  It's like going from the horse and buggy to a spaceship - from library books to 30 gigabytes.  Our first computer was a Vic 20. That means the memory was 20K and I think it had 3K of RAM.  We could play Pong and it was fun.

We still have one of these in the basement

It was an exciting learning experience but still a long way from social media and smartphones.  So I would say we've come a long way in healthcare and every day we see the results of the progress.

Support and information is now available at any hour of the day or night. That alone is enough to help us all to feel a bit better.


                                                 

My Experience With Canadian Health Care

                                                                     My Alien Pen                                        

A few weeks ago I was asked to be a guest on the #hchlitss tweetchat that occurred on Thursday September 27, 2012.  The topic was Chronic Illness and the Canadian Healthcare System.  It was a new experience for me - That's why I added a picture of this alien.  You may still be able to read the transcript here 

http://hchlitss.blogspot.ca/

And here is the story I told of my life from a Canadian healthcare  point of view. Luckily not exciting, but it may have interest as a contrast.  I will answer any questions in the comments.

Before I was 20 healthcare was the farthest thing from my mind.  We were all very healthy and went to the Dr for checkups now and then.

Once I was married children came into our lives pretty easily.  Thank goodness we did not have to budget for doctor visits and delivery.  At that period of life we were just starting out and had very little money.

Years passed and I had to have a biopsy for suspected cancer. The biopsy was the treatment so another hurdle passed. Around that period 1 kid broke his arm twice.  We did have to pay for the cast.  It wasn't covered.

Then, before our kids were teens, I became sick and did not know what was wrong.  Unfortunately the doctors I saw did not know either.  Finally I got a diagnosis from an orthopedic surgeon - it was Rheumatoid Arthritis.  That's where the blog post titled "Things Were Different Then"  fits in to this story.  Since I was admitted to the hospital my drugs were covered at the start.

In our system only drugs adminstered in hospitals are covered unless you are 65 years old or above.  If you can't afford your prescriptions help is available from the Trillium fund which is based on a means test.

Since that diagnosis 30 years ago I have been cared for very well by all of the Health Care Practitioners I see.  I have had terrific rheumatologists. I would estimate 60 rheumatology visits over the years.  For a while I was seeing my GP every week for an injection.  Thank goodness I finally found  out I could do it myself.

I had 4 foot operations and a gall bladder removal, all at no cost beyond my taxes of course.  For massage and physio I have to pay; likewise if I wanted botox to look better it would come from my own pocket.

My husband has a job with health care benefits that covers items outside of the government health plan.  That covered the prescriptions and some dental care and a portion of eyeglasses, as well as some of the cost of orthotics.

So as is the case with everyone who has chronic illness it has been a struggle dealing with RA but it has helped a HUGE amount that we are not dealing with large medical bills every time we turn around.  And there are lots of expenses for over the counter medication and 10% copay on the drugs. 

If we have enough medical expenses they can be used as a deduction when we file our income tax returns.  So my teenage self, who read Ayn Rand and thought people should save up and cover their own ailments, was woefully uninformed about the realities of life.  I can see that now and not just because it has benefited me. 

I have often complained that things move slowly in RA but on the plus side that has let me plan ahead for surgeries that may have wait times. Everything has been within acceptable time frames  except for the diagnosis.  That was crucial but not the fault of the system.

Victory gums are liqorice. Too bad they don't conquer illness

Overall 30 years of chronic illness and still going strong!!