medicine, primary care

Tick PSA

It’s a beautiful holiday weekend.  I’m sure many of you are outside, getting the yard ready for summer.  I’m also sure that several of you will be calling me on Tuesday morning because you got bitten by a tick.

Here’s how to deal with a tick bite.  First of all- prevention is key.  Wearing long pants with the cuffs tucked into socks (I know, I know. Not very attractive.) is the best way to prevent a bite.  Check for ticks every night.

If you find a tick, remove it with a pair of pointy tweezers.  Grasp the head of the tick as close to the skin as possible and pull the tick off in one smooth motion.  Here is a good video.

Occasionally, the head will break off and remain embedded.  In this case, it is best to see your doctor to have it removed.  I don’t recommend digging around to get it out, as this can increase the chance of infection.

If a tick is attached for less than 24 hours, there is very little chance of contracting Lyme disease.  If it is on longer, there is a chance of transmission (about 60% of deer ticks in my area carry Lyme disease), so see your doctor if you have concerns.  A prophylactic dose of antibiotics given within 72 hours of the bite can basically negate the chance of transmission.

Here’s how NOT to remove a tick.  I have seen all of these methods tried.  They are…unwise, to say the least, and generally lead to more damage than if nothing had been done at all.  Don’t burn a tick off with a lit match.  It’s an awesome way to get a nice burn.  Don’t take a really sharp knife and start hacking at your skin.  Don’t “smother” the tick with petroleum jelly, nail polish remover, mineral spirits, or whatever caustic substance is lurking in your garage.  Please, people, just use common sense!  If your tick removal method might lead to a referral to a plastic surgeon, re-think your actions.

insurance insanity, primary care

You Better Shop Around

Everybody knows that some medications can cost a lot of money.  I always try to take the cost to my patients into account when prescribing a medication- after all, if someone can’t afford it, they are not going to take it.  When it’s appropriate (and 9 times out of 10 it is), I try to prescribe a generic medication.  They are much cheaper and work just as well as the brand name (almost always).
Imagine my surprise when a patient recently presented me with this receipt, along with a request to change medication because the one I gave her was too expensive.
The medication was diltiazem ER, the generic form of Cardizem CD.  The patient pay portion was $0.  However, this patient is on Medicare, and the cost of every drug inches her closer to the “donut hole.”  Basically, when the cost of drugs gets up to a certain amount (around $2700), the patient enters a coverage gap and must pay 100% of medication costs.  If you look in the upper right hand corner of the receipt, you will see that the cost of this drug was $536.84.
To say I was stunned is putting it mildly.  So much so that I was convinced it was a mistake.  After, the cost of brand name Cardizem CD is $288.99.  How could a generic be more expensive?  Cardizem went generic in 2010- that’s plenty of time for the price to come down.
I called Walmart to see what the story was.  I spoke to the pharmacy tech and asked her how much diltizem ER costs.  Her answer was that there was one that was $54 and another that was $84.   I then gave her my patient’s information and asked her why she was charged $536.84.  After a lot of hemming and hawing, she said that that was the cost for one particular pill made by one particular manufacturer.  I then asked her why my patient was given this one, instead of the one that was 10x cheaper.  She couldn’t answer the question, so I got the pharmacist on the phone.  
I wish I could say I got a good, reasonable explanation.  I did not.  She told me that there are several versions of generic diltiazem ER.  They are all basically the same, but range in price from $53 to $536, depending on the manufacturer.  She had no idea why my patient was given the most expensive one.  I have some ideas, but I’m not going to speculate here, since I was always taught that if you can’t say anything nice, then don’t say anything at all.   I clarified to her that my patient was to only get the cheap one.  However, the damage is already done and she has edged an extra $500 closer to the donut hole.
So, what’s the moral of the story?  Don’t just accept that the price of a drug is what it is.  If something seems much more expensive than it should be, talk to the pharmacist or your doctor.  Shop around and bring your business elsewhere if a pharmacy is not willing to assist you.  
behind the scenes

Coffee Talk

Last summer, we moved into our swanky new digs.  It was a big improvement, because our old office space looked something like this:
Ok, not really.  But it was kind of dark and dank.  At any rate, the new space is great.  One of the things that our patients really seem to love is our new and improved waiting room.  First of all, it actually is big enough to fit more than three people.  It’s light and airy.  It has a television.  The most popular addition, however, is our little coffee bar.  Everyone loves it.  We have coffee (in different flavors!), tea, and hot chocolate.  
The coffee is complemented by our fabulously cerebral reading material.
As I said, everyone loves it.  Even kids who get dragged to their parent’s appointment.
The thing is, some people love it too much.  We often see people grabbing a few K-Cups or hot chocolate packets “to go” and stuffing them in their pockets on the way out.  We’ve even had people come in, give a cheery wave, say, “Oh, I’m just seeing another doctor in the building,” take a cup of coffee, and leave to go sit in some other doctor’s waiting room.  Just remember- we know who you are. 

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