Prescription For Vexation

Vexation

Everyone has occasional vexations. Here is one I experience twice a month. It surely vexes others too, particularly seniors and those in need of painkillers.

My Situation

I’m blessed with a good share of chronic conditions to which my doctors, to their great credit, have amassed effective palliatives. One of these is peripheral neuropathy in feet and hands; this started in the 1980s and requires the use of painkillers. I’ve had the same schedule of prescriptions for over a decade. That’s the good news. Nothing much has changed, for good or ill; I just age ungracefully all the same. For years, this good luck meant I could order ninety (90) day supplies of all my prescriptions. I only had to do this four (4) times a year. But then the Controlled Substances Act (CSA) came along, and two of my prescriptions were moved into a schedule which requires monthly action. Thereafter, the ninety day supply option ended and the doctor had to issue fresh prescriptions every thirty days. That makes for two (2) new prescriptions a month, summing to twenty-four (24) for the year. That’s how the merry-ground began. It set off a monthly round of surreal calls between patient, physician, pharmacy, and, occasionally, insurance company.

Basic Runaround

The basic runaround involves, at minimum, a patient, a doctor, and a pharmacist. In virtual reality, the doctor is located in an “office” within a “physicians network,” and the pharmacist practices with assistants in a “pharmacy” connected to a national chain. In my case, the pharmacy is in the CVS chain, and is located in Xville. The doctor’s office is located in Yville and is part of MaineX, a statewide network. I’m making up these clever names to protect the innocent. One could go directly to the doctor’s office and to CVS Xville pharmacy, but appointments are required for office visits and pharmacy visits are usually fruitless; the prescription hasn’t been received and/or isn’t ready. Pragmatic people therefore use the telephone.

The phone user should be aware that both the physician and pharmacy networks are accessible only through automated answering services that value automated responses and discourage human conversation. These answering “services” are not designed to facilitate conversation with either doctor or pharmacist, but to pass mediated messages to the right party. The patient is therefore the only human being on the line until she or he is able to navigate a successful automated response or consummate a connection to a human “representative.”

There is, it’s true, much to grouse about with these arrangements. For example, while one waits for an alive representative to pick up the phone, more health information is involuntarily piped into one’s ears than is conveyed in the average health section of the Sunday newspaper. But let’s be positive. Taking the phone networks as given, these are the actions I usually take and the kinds of surprises I experience in requesting monthly prescriptions:

• I dial up the pharmacy and attempt to automatically renew the existing prescription. The machine responds deadpan: “There are no remaining prescriptions. Would you like us to contact your physician?” I push “1” signifying “Yes.” This doesn’t work. The doctor’s office doesn’t respond.
• I then call the physician’s office directly a week before the prescription is needed to make the office aware of my upcoming need. The network representative confirms the need, but says it is too early to refill it. The representative suggests I call three days before the current prescription runs out.
• I call the doctor’s office first thing in the morning three days before my current prescription runs out. The network representative confirms the need for the drug, confirms my pharmacy preference, and sends the request to the doctor’s office. The rep says: “The request has been sent.” I say: “Many thanks!”
• I call the pharmacy later that same day, just before closing time, to ask if the prescription has been received. It hasn’t.
• I call the pharmacy mid-day of the next day, two days before the current prescription runs out, to ask the same question. The pharmacy reports that no prescription has been received. I then call the doctor’s network to let them know that the pharmacy hasn’t received the prescription. The representative confirms my previous call to them and assures me that the request had been sent the previous day to the doctor’s office as promised. The representative will follow up with a reminder.
• I call the pharmacy the morning of the day my pills run out and ask whether they’ve received the prescription yet. Usually they haven’t. They say they’ll call the doctor’s office.
• I call the physician’s network line after noontime to let them know that the prescription hasn’t yet arrived at the pharmacy. They review the actions taken and say: “It should have arrived by now.” They promise to “look into it” and “see it gets done.” I ask whether it’s possible to talk directly to someone in the doctor’s office about the situation. The rep says: “Yes, I’ll ask the office to call you.”
• One of the doctor’s nurses calls in mid-afternoon to assure me that CVS Xville definitely has the prescription now and that it can be picked up at the pharmacy. The nurse cites the high volume of work demands on the office and apologizes for the slowness of action.
• I pick the prescription up at CVS Xville late in the afternoon of the day the pill is needed.

That’s basically how it goes twice a month between me, the machines, and the cutout human voices representing the pharmacy and doctor. This stripped-down, generic story gains richer meaning from minor embellishment. I restrict myself to this:

• The pharmacy at CVS Xville regularly robocalls the house on other matters to let us know that other prescriptions (we have plenty) are ready for pickup. Very often, we drive the five mile roundtrip to pick up these other prescriptions. To save trips, we request that the two painkiller prescriptions be combined with the others when possible. It has not yet been possible. Additional trips have always been required.
• The two painkiller prescriptions by happenstance run out a week apart. It has never been possible to combine them into one trip. This means, as I’ve previously said, that twenty-four additional trips a year are required to comply with CSA.
• On two occasions this year, CVS Xville pharmacy has in fact failed to fill a painkiller prescription on time. In the first, the doctor’s office failed to send the prescription over. In the other, the pharmacy’s data base wrongly indicated that the request had been “denied.” Bottom line: two nights of suffering without the prescribed painkillers.
• There is one stand up nurse in the doctor’s office who sometimes calls to clarify the situation. She has told me more than once that: “We don’t send over a prescription until the day before it’s needed.” “So don’t call to ask for a prescription early!” “We will send the prescription over either the day before or the day it is required.” “The pharmacy can’t by law fill the prescription anyway until the day it is needed.” “So don’t expect to get the prescription until late in the day it’s prescribed.”
• What the nurse doesn’t say, but insinuates, is: “You’re part of the problem. These substances are controlled for good reason because of abusers like you. Straighten yourself out. Get off our backs.” I have felt the need to say to her “please do us both a favor and talk to the doctor, he’s prescribed these medicines for good medical reasons. If he wants to make a change, I’m willing to try something else. But please, I’m not an abuser of drugs. That’s untrue.”

Cost

To sum up, the cost to me of changes made by the Controlled Substances Act are anxiety, worry, lost time spent on roundabout calls, uncertainty of outcome, absence of pills twice this year, the likelihood this will soon happen again, twenty-four additional roundtrips a year to CVS Xville pharmacy, and a bit of negative stereotyping by pharmacy aides and nurses.

I’m 84 with health conditions addressed by medications prescribed by an experienced, credentialed physician and I shouldn’t have to deal with all this phone-tag claptrap crap! (Isn’t that a satisfying phrase to use in these vexing times?)

Implications

This situation, while vexing, is not a huge deal in the great scheme of things. I get along well enough despite the work and irritation. My problem pales in comparison to ones others face, and is as nothing compared to the problems poor, troubled, unemployed, and homeless people suffer daily.

Nevertheless, the case is of some public importance. It affects other people besides myself. It appears to be an unintended and unanticipated consequence of the Controlled Substances Act when implemented nationwide to address a massive problem of opiod abuse and addiction. It’s unlikely that anyone sought to diminish the health and well-being of non-abuser’s in the process. Yet, it has happened. Millions of non-abusers are affected. It’s a glitch that should be fixed.

The labyrinthine telephone system referenced in my story—is a basic—some would say “essential”—component of the health system as a whole. That’s the way communications are handled between needful patients, physicians, pharmacies, and insurance companies everywhere. The absurd runaround, touch-tag character of health communication is associated with the telephone system rather than the CSA. It’s not special to the need for painkiller prescriptions.

Yet, the dependence on these circuitous telephone network systems is destructive. The patient feels like the weak outsider, a human in the belly of a whale of a machine, desperately looking for other human voices, while being ground up by wallpaper music, uninvited health lectures, impossible to navigate menus, pleas to remain on line, and repetitive syrupy assurances of one’s importance and self worth. They protest too much! Unexpected interjections, rude cutoffs, and ejections from the system are routine events. Although “empowered” with the “case manager” role, the pleading patient feels like low person on the totem pole with pharmacies, doctors, and insurance companies peering from on high. Worst, the patient doesn’t get the needed care in an efficient, caring way

I’m cynical. I expect to be obliged to seek the two painkiller prescriptions monthly for as long as I need them. Nothing is likely to change despite complaint. Attention to detail hasn’t worked. Diligence hasn’t worked. Explanation hasn’t worked. Follow-up hasn’t worked. Sad stories haven’t work.

My case may fall into a growing category in modern life, the “unsolvable problem;” one everyone knows about and is tortured by but perceives as unsolvable. We live with the problem rather than try to change it. Global warming, nuclear weaponry, racism, war, and wealth inequality are biggies in the category. Mine may signify the spread of hopelessness toward the solution of lesser problems in daily living.

That’s a trend I don’t want to promote. In that stout spirit, I’ll publish this blog essay, consult physicians, call my congressional delegation, and appeal to the public! Maybe you can help! We had best not allow minor vexations—as systemic, irritating, and pervasive as they may be—to defeat us.

by

Will Callender, Jr. ©

October 20, 2021

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