Flu Diligence

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There’s stupidity afoot in the Peach State.

A recent complaint to the pharmacy board caused them to recommend that all patients who get flu shots in a pharmacy be required to have a prescription. The rumor I hear is that the complaint was by a physician who was bothered by how the pharmacies are taking all the flu shot business. Under the interpretation of the law, flu vaccine is considered a “dangerous drug” that cannot be dispensed without a prescription. This development has been very disruptive for both the physicians and the pharmacies – causing a deluge of phone calls to the physician and frustrated customers for the pharmacy.

So the doctors are annoyed, as are the pharmacists. The governor apparently said that pharmacists who gave flu shots without a prescription would not be prosecuted. Problem solved? Not so fast. The pharmacy board didn’t like being ignored in the process and said that they would not guarantee safety for pharmacies breaking the law. They can’t send pharmacists to jail, but they can take away their licenses.

So there is no way to avoid the stupid law.

A friend of mine owns a local pharmacy. He recently had the chance to talk with one of our representatives. He asked him, "when you pass stupid laws, do you actually consult with the people who are affected by them?"

Good question. Were any physicians (aside from the goofball who pushed this stupid law) or pharmacists asked if this law was a good idea? I think the answer is obvious.

This is why the upcoming election and respective healthcare reform plans scare me. The plans are being made by the politicians, the bureaucrats, and "health advisors." I am sure some of the advisors are physicians, but I doubt that any are practicing primary care physicians. In fact, I suspect that very few of those healthcare workers most affected by any healthcare policy will be consulted in the process of making the policies. So what will result is a bunch of “good ideas” that will be poorly thought out and have lots of unintended consequences.

Why aren’t the parties involved going to our community for solutions? Academic knowledge about our system does not equate with wisdom. Plenty of well-meaning laws have become an incredible burden because the full due diligence was done.

I am that due diligence.

Unfortunately, I don’t have time to meet with politicians – I am spending too much time writing prescriptions for flu shots. It’s a dangerous drug, you know.

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Frank Drackman

Y'all might be right turning over Vacines to the Yankee Occupational Government, 1/2 of them come from Red China and probably don't work anyway. The Flu shots probably the real thing, cause they want us all healthy when they take over. Might want to pass on that Tuskeegee Syphillis Shot, though.
Frank, M.D.
Peggikaye

Wait ... I've got gnomes building a house in my head ..so I'm a bit behind in comprehension (twitterspeak for headache) .... So ... J.C. ..no, don't like that .. the Calvanist is mad at you because you're a part of the NASTY AMA that didn't get us appropriate healthcare under Clinton ...and then when you say you're not part of the NASTY AMA ... you're supposed to JOIN the AMA ... (so you can be yelled at and group with 'those doctor's I suppose ....)

or ...are there just too many gnomes building houses in my head?
Ken O.

Rob, I think you've touched a nerve or several on one of the other posters. ;)

Getting serious, I think you've identified what's wrong with politics today. Too much time spent passing bad laws based on the actions of vested interests (particularly those of what the UK calls NIMBYs), and not enough on thought and analysis.

In particular, I'd agree in principle with the idea of nationalised immunisations, as long as you don't just shuffle the work onto private businesses, or leave people waiting in lines for 12 hours for a 1 minute vaccination.
Rob

The thing about the Calvinists is that they can't help but write comments.

I honestly think that immunizations should be nationalized. It is one thing probably done better by the government. The current system is just chaotic and expensive. I would gladly get rid of the job of immunizing my patients. Take the money equation out of the giving of prescriptions (or at least simplify it).

Regarding the physicians for a national health system - I wonder how they come up with those numbers. Most physicians (Frank aside) think that some nationalization of care is probably good. I want to know details, however. It is easy to say you are for nationalized healthcare - just like saying you want to pull out of Iraq - but how do you intend on making it really work?

I personally believe that there are too many fingers in the pot (oh yeah, I did start writing posts on holes in boats, didn't I?). Too many people profit off of the inefficiency of the system (I get paid more if I see you more often and spend less time with you). The inherent problem of our system is that it is geared for inefficiency and waste. It is made to promote bad ways of doing things.

That needs to change.
Suzy

Rob! Calvinists have no sense of humor!

We had a similar to-do a few years ago, although it was local. Some docs got up in arms about the fact that supermarket pharmacies were giving flu shots (which is perfectly legal in this state), threatened to boycott the pharmacies, told their patients it was bad health care — and then told their patients they'd have to wait at least a month to get an appointment. Unfortunately, the way the allocation worked, some practices had flu vaccine left over, while the hospital, the county health department and the supermarket pharmacies ran out. We had a horrible flu year. We all had too many sick patients. But heaven forbid they get reimbursable care from some other source! We probably ought to get the legislature to ban that, because the point is to make money, not to actually improve people's health, doncha know?
Dana Riell

I read your blog regularly, and often agree with what you say. I am interested in hearing your opinion of Physicians for a National Health Care , an organization that describes itself as "a non-profit research and education organization of 15,000 physicians, medical students and health professionals who support single-payer national health insurance."

Thanks for your blog.
littleoldladyinashoe

I am extremely scared of what is going to happen to the health care system. Maybe someday it will be in favor of the patient.
Rob

I wrote a post on this http://distractible.org/2008/04/03/primary-care.... The bottom line is that the nature of our work means that those of us who are most affected by political decisions are those with the least time to get involved. We are represented by academics and semi-retired physicians who do not bear the consequences of their decisions. Yes, I would like to get involved, but I am a practicing physician - which means I work about 60 hours per week. I run my own business, which means that if I take time off to go lobby the AMA, I am losing money and still have to pay my staff.

What do I do about my situation? This. I write. I put into words the reality of the situation the primary care physicians are in - making it in plain enough English that the average reader can understand. My blog is widely read and so I feel my time documenting the situation we are in is well-spent.

If you think all I do is complain, I don't think you have read much of my blog. I do complain, but I also try and figure out solutions. I am a huge proponent of EMR and have been a national speaker on the subject. I write about the joys of doctoring more than the trials - the joys are what keep me doing medicine. Yet I consider myself the canary in the mineshaft - I am passionate about what I do and will be the last one to leave the sinking ship of primary care. If I am struggling, then the average PCP is dying. My job is to give a voice to that despair.

If you are so involved, then have your legislators read my blog and other physician bloggers. If anything, they represent the happier side of things (go to Sermo if you want to find whiners).
Joan Calvin

Unfortunately, you (all) have allowed the major medical professional organization to speak for you. Perhaps you should join the AMA and have some impact on their policies. I do know several physicians who favor single payor and have pushed for it for decades. They have worked hard and tirelessly for reform. Have you? Do you financially contribute to those groups that are looking for an alternative? Or do you just complain about the situation?

I've been around the political process for most of my life (I'm in my 60s). I've been an elected official at the local level. I know legislators. Most of them want the best for their state and their country. Yes, they like the rest of us, are tempted and swayed by money and influence (that's my Calvinist leanings showing through). But, in the end, we get the government we deserve.
Rob

I asked him that. He said the politician just changed the subject.
Dr_Dredd

How did the representative respond to your friend?
Rob

Joan (any relation to John?): you make my point exactly. The presumption that this physician or the AMA represent the rank and file is in error. I am not an AMA member. They have some policies I agree with, but represent the old way of medicine rather than reform and change. The bottom line is that the patient/doctor relationship is the center of healthcare, and the two people most involved in that relationship are largely ignored. The AMA lobbyists are not practicing PCP's. When you say "...you folks have opposed reform for decades" and "It is the doctors who have opposed working with the goverment...", you assume we speak and think as one. I have never opposed reform. People are fleeing primary care because the situation is so bleak - and has been for quite some time. Policy is too often made by professional lobbyists (some even with MD behind their name) that misrepresent the real beliefs of physicians.
Joan Calvin

So, a DOCTOR lobbies the politicians for a law you don't like and you blame the politicians. Why should politicians consult doctors about health care reform when you folks have opposed reform for decades? If the AMA hadn't opposed the Clinton administration, and had worked with them, we might have a decent health care system. It is the doctors who have opposed working with the government and politicians lo these many years.