BLOG: Insight gleaned from the med list
In the history of government and bureaucratic meddling in health care, I can recall precisely one instance where a random and useless rule actually led to better care.
You once had to include a specific system review item outside of the eye to code a Level 3 exam. While caring for patients with glaucoma, I specifically did a review or systems targeting medication side effects. You can’t believe how many men actually have ED, which starts shortly after they begin taking timolol.
I actually became a better physician because of that and literally saved a couple of lives (and marriages) along the way.
One can glean insight from other parts of the chart. One of the docs I follow on Twitter, Mark Reid, MD, (@medicalaxioms, a fellow Williams College grad) posted “Three essential elements of the patient med list”:
1. The medicines the doctor thinks the patient is (or should be) taking.
2. The medicines the patient actually puts in their guttiwuts* each day.
3. The patient’s explanation for the difference.
All of the doctors and techs got a huge chuckle out of his post!
Behind all of the humor there exists a very real opportunity to learn about how well your patient is doing with the brilliant treatment plan you conjured up at the conclusion of their last visit. At the moment I am finishing up another dry eye clinic session, and it is astonishing how low my batting average is on any patient who has been in to see us less than four times. That’s the over/under, the number of visits it seems to take for the average patient to find a way to adhere to a treatment program of literally any degree of simplicity or complexity.
This, my fellow medical masochists, is why it’s so hard to take care of dry eye disease of any degree of severity. Like any chronic disease, especially diseases that involve discomfort, the ebb and flow between feeling better (“Yay! I’m cured. No more drops/compresses/fish oil.”) and progressively worse (“I thought you were an expert.”) makes DED a constant battle for both patients and their doctors. Finding a patient where Nos. 1 and 2 correspond perfectly feels like finding a four-leaf clover in a 1,000-acre pasture (note: I’m writing this on St. Patrick’s Day).
The real lesson is in Dr. Reid’s No. 3, the patient’s explanation for their deviation from the flight plan filed at the completion of their last visit. It’s here that you learn how well they understand DED. Their explanation will also clue you in to both their learning style as well as their willingness to learn from you. Did they initially toe the line only to start freelancing after a period of time? You will learn about their stamina, how they will fare over the long haul; this is a marathon, after all.
Over time you will hopefully find that there is less and less to talk about in No. 3.
*It was worth writing this post if for no other reason than looking up the wondrous array of definitions of “guttiwuts.” Google it.
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