I Remember When
(Column: Ask the Pharmacist)
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Instead of answering a specific question I thought we might discuss some things that have crossed my mind over the last year in my first column of this new millennium. Let's look at what medical care was like this past century and what changes, such as the Internet and managed care, might we expect as we start the 21st century.

A few weeks ago I was riding home on the train and noticed a poster at the front end of the car. It showed an elderly man, bald head and hair growing out of his ears. He was not dirty but quite disheveled and wearing a pharmacist badge. The caption read, "Is this the man you want to talk to about breast tenderness?" I wondered what this could possibly be an advertisement for. It turned out to be an ad for one of those Internet drugstores. A few things entered my mind after seeing this sign:

How do we know that this man is not the foremost expert on breast tenderness in the world? After all, pharmacists have a minimum of five years schooling and years of on site training.
Why would I want to dial up the Internet and talk to a machine when I can speak to a person?
Why would they try to degrade pharmacists like that instead of just promoting the virtues of their website?
Unless there are no advantages to their website. After all, pharmacists have been voted America's most trusted profession 10 years in a row.
Later that same week I was watching television and a gentleman from one of the insurance companies was on the air. He was explaining how managed care is making medical care more efficient and that local doctors and neighborhood pharmacies are dinosaurs that have outlived their usefulness. I wondered who decided this. Was it patients? Did they take a survey of their members? Or was it the insurance company executives who came to this decision. Personally I have yet to come across a patient who prefers to go to a big medical center 45 minutes away than see a local doctor around the corner. Recently a large chain store bought out a local pharmacy in the area. Not one person has told me how nice it is to have a big chain store in the neighborhood. In fact most of the people seem to be upset about losing the independent store.

I remember my doctor when I was growing up. His name was Dr. Aldberg and his office was on University Avenue in the Bronx. My mom would take me to him when I was sick. After the examination we would go into his office and he would talk to me for a few minutes about general stuff. I had two heroes when I was growing up, Mickey Mantle and my Dad (not necessarily in that order). Dr. Aldberg always asked me about both of them. I was eight years old and he was my friend as well as my doctor. How many of us can say that today about our doctor?

I used to go with my grandmother to the doctor. She would complain to him about various aches and pains. He would take her blood pressure and pulse and sometimes give her a shot (probably a vitamin B12 injection). He would then talk to her for 15 to 20 minutes. He would ask how Grandpa and Uncle Herman were doing and she would leave feeling much better. I wondered what this miracle cure was. I now know it's something called bedside manner. For those of you who are too young to know what bedside manner is, it is the ability of a doctor to listen and be sympathetic to a patient. Can you imagine a doctor billing an insurance company for bedside manner?

Technology has improved dramatically over the last 20 years. Doctors are doing things today that were science fiction only a few years ago. There are medications available that cure conditions that were terminal less than 10 years ago. But as technology improved, has the quality of care improved? I recently had my first HMO physical. The nurse took my blood pressure, an EKG and some blood. The doctor then came in and asked me a dozen or so questions and said, "Okay you're healthy." The whole physical took less than 15 minutes. It seems medical care has become quantity not quality. How many patients can I treat a day, not how well do I treat the patients. In many pharmacies it's how many prescriptions do we fill a day, not how well does the patient understand how to take their medication and are their any drug interactions or dosing errors. But is this the fault of the medical provider or is the problem low reimbursement rates and other contractual obligations from insurance companies that force providers to take on such a heavy workload. I recently read that one HMO boasts that their doctors can treat five patients an hour. Simple math says that's one patient every 12 minutes. How can you provide proper high quality medical care when you spend only 12 minutes with a patient? I think back to the days when I used to sit and talk with Dr. Aldberg in his office for almost an hour.

People have been getting sick and receiving medical care since the beginning of time. It's only the last 30 years or so that health insurance has become a necessity. Now we have insurance company executives making medical decisions, medical professionals who don't even know their patients' names and patients who are switching doctors and pharmacies every couple of years because their provider no longer accepts their insurance coverage.

Maybe it's not the doctors or pharmacies that have become dinosaurs. Maybe it's the insurance companies that have outlived their usefulness. One person recently said the high cost of medical care was a direct result of the insurance company. If you do away with insurance companies no one would be able to afford medical care. Therefore the prices would have to come down (law of supply and demand). This might be an extreme idea but somehow a compromise must be made to ensure quality medical care and proper reimbursement from insurance companies.

As we start this new millennium I would like to wish everyone a happy and healthy new year with the hope that the 21st century will bring a renewed sense of quality and fairness in medical care.
Steve Kaufman, RPH, is Supervising Pharmacist, Manhattan Plaza Pharmacy, 619 Ninth Ave., New York, N.Y.
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