One thing I’ve always struggled with as a nurse practitioner is the balance between enabling patients to continue poor lifestyle habits, and giving them the resources they need to keep their bodies healthy. Let me explain. When I worked in primary care, for example, some patients asked for a quick fix for diseases like hyperlipidemia. Was putting these patients on medication to lower LDL levels robbing them of the motivation they might need to exercise and make better dietary choices? Or, were meds really the only option to keep the patient as heart healthy as possible?
Another similar tension I struggle with concerns prescribing, particularly now that I work in the emergency department. Patients routinely visit the ER for coughs, colds, sprains, strains, and other minor injuries and illnesses. While some patients lack the knowledge to ‘doctor’ these ailments at home, many others have the know-how, but come to the emergency department as a means for obtaining first aid supplies and over-the-counter medications free of charge.
Medical supplies and medications, of course, are not free. And, obtaining them from the emergency department is far costlier to our healthcare system than stopping by Wal-Mart. The way our healthcare system is set up, however, often creates a situation where visiting the hospital appears to patients less expensive than a trip to the drug store. So, in a way, I can’t fault patients for choosing the option that seems ‘free’.
Among patients that use the emergency department for non-urgent and non-emergent care, some truly do not have the financial resources required to purchase their own healthcare supplies and medications. Others, however, are gaming the system and they know it. In these moments, I have to make a choice. Do I enable the patient’s abuse of the system by writing prescriptions for over-the-counter medications, pushing the cost to insurance companies rather than the patient’s own wallet? Or, do I recommend an appropriate OTC treatment and send the patient out the door without a script?
I’m divided in my thoughts on this. Based on my interactions with patients, most feel more satisfied and confident in their care if they exit the hospital with a prescription in hand. More treatment equals better treatment in the minds of many. With patient satisfaction an increasing metric by which providers are paid and by which my employer measures performance, I’m inclined to make patients happy rather than take the ‘teach them a lesson’ approach.
When I write a prescription for a medication, even if the medication is available without one, I also feel more assured that my patient will take the medication correctly. Parents, for example, may find it difficult to dose antipyretic medications for kids correctly when treating a fever. Providing a written prescription ensures the parent will have the correct medication, dose, and measuring device to administer the med appropriately. Other factors like language barriers and illiteracy can prevent patients from successful navigation of pharmacy aisles, another challenge mitigated by offering a written prescription even when one isn’t required.
Finally, I as I grow more experienced (and also older…ugh), I am learning that you can’t judge patients by their appearance. Patients visiting the emergency department may not be in emergent need of medical care, but they are going through a tough time. Whether it’s the inconvenience of an allergic reaction, the pain of a sports injury, or a case of the coughs, when you’re feeling down, sometimes it’s nice to have someone lay things out for you rather than tackling the problem on your own. Sure, shopping the aisles of the local drug store may lead to the same health solution as the one you prescribe in the clinic, but prescribing the treatment regimen saved your patient from hobbling up and down store aisles on a bum ankle.
Yes, I still get annoyed with patients clearly looking for free handouts, gaming the healthcare system rather than taking personal responsibility. I’ve become inclined, however, to give people the benefit of the doubt. And, I have to wonder if those scripts I write for OTC medications are among the more than 30 percent of prescriptions that are never filled.
Do you write prescriptions for over-the-counter medications and supplies?
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