A Prescription Error, A Relationship Preserved

The refill request was for a muscle relaxant, one with significant potential for addiction. I opened the patient’s chart to see when it has last been filled. I had approved a refill 25 days prior. This request was 5 days early.

Early requests are not entirely unusual, as patients are often afraid that waiting to the last minute can result in them running out of medications. A pattern of early refills can indicate a problem so I decided to log into the state controlled substance database to view the patient’s prescription history. It seemed that he had consistently been filling the medications 3-5 days ahead of the due date. I decided to investigate further.

I scrolled back through the online history and saw something that made my heart sink. The database showed that 2 months earlier the patient had filled the medication at two different pharmacies one day apart. If this was true, the patient was abusing the medication.

I could not believe it. This patient was one of my favorites, our interactions had been consistently enjoyable, often with interesting conversation. (He is a passionate and hard working man and we have much in common.) The thought that he might have been abusing his medication, that I might be forced to confront him and possibly dismiss him from the practice filled me with dread. Unfortunately, the evidence on my computer screen was hard to ignore.

I called my receptionist over and asked her to call each of the pharmacies to confirm that they had indeed filled the medications on the dates indicated. A few minutes later she handed me a note. Both pharmacies had confirmed the refills.

I wondered how to address this with the patient. The evidence was pretty clear but something just didn't feel right. I wondered if my unease was more about the possibility that I had been deceived than it was about the patient’s circumstance. I decided that I did not need to be confrontational immediately, that I would give the patient a chance to explain.

I called him on the phone and he answered immediately. “I received your refill request,” I told him, “but it was a few days early.” I went on, “ So I checked the state database to review your history, and according to them, you refilled the medication twice in January only a day apart, on the 16th and 17th.”

“Doc, there’s no way. I didn’t get two prescriptions. Let me call the pharmacies!” He was adamant, yet not defensive. I told him that I would not be able to fill the medications without him coming to the office, as we would have to address the issue and I would need to document it in the record. As much as I wanted to trust him it would be a mistake to assume that the pharmacies were at fault. I told him he would need to sign a controlled substance agreement and that his practice of using different pharmacies based on his work schedule would need to end.

He did not argue at all. “Of course, I understand. I will come in tomorrow!”

I received a text from him within a few minutes, saying he had just called and only one of the pharmacies had confirmed a refill. The state database must be wrong.

I decided to call the pharmacies myself. The first pharmacist came on the line right away and looked up the patient’s medication history. She read off the record for the date in question. “We show a prescription on January 26th that was deleted. The patient never received the medication.”

I was so relieved! The patient had been telling the truth! (When it comes to controlled medications this does not often happen.) I called the patient back and gave him the news. I told him I could refill his medications but that it would need to be on the due date, that I could not refill the medications early. He was in total agreement.

When I hung up the phone I breathed a sigh of relief. I had dodged a bullet. There was a time not so long ago when I would have assumed the worst and been more confrontational. If I had done that, a relationship might have been lost. Giving him the benefit of the doubt had made all the difference.

-Bart

The Wrong Kind of Easter Message

They had a megaphone, held up sloppy handwritten signs and a GoPro camera and were shouting as church members walked by them on the way to the cars after Easter service. From a distance I could not tell what they were protesting about. I wondered if they were atheists are some anti-Christian cult. When I came even with the protesters I learned the cause was even more ridiculous. They were animal rights activists.

One of them called out to my wife, “Who died for you this morning?” Surprised, she gave the answer appropriate for the morning, “Jesus.” The protester clarified his “point", rephrasing the question, “Who did you eat this morning?” It took me a moment to realize that he was telling us that it was not right that animals die for our sustenance. He apparently believed that animals have feelings and desires, just like people do. He didn't know us, did not know if we were carnivorous or vegan, yet he was convinced that we were evildoers in need of nutritional repentance. 

He and his colleagues rained down taunts and jeers as people walked by. They were clearly not interested in dialogue. They only wanted to attack us for the wrongness of our thinking.

Among the claims I heard as we passed-

- Animals want to live just like people do.

- Animals want to be with their families too.

- Animals have feelings.

- Eating meat is tantamount to murder.

These claims were repeated over and over, in  loud voices and with condescending tones. The message they were trying to proclaim was not the message their audience received. They wanted us to believe that animals have rights and feelings. What we believed was that they were terribly misguided and deceived. 

Those who walked by them were Christians, people who hold to the biblical teaching that mankind is unique, that people alone are created in the image and likeness of God. Unlike animals, we alone possess body, soul and spirit. We alone have reason and creativity, we alone will live eternally. We all know that animals are not at all like us.

We also know that the Bible does not advocate for the vegan lifestyle. The Old Testament gives detailed instructions for offering animal sacrifices. The most holy feast in the nation of Israel, the Passover, involves a meal centered around a ceremonially killed, unblemished lamb. Jesus himself participated in the celebration of this feast. These facts did not stop them from condemning us as we walked by.

As I walked away I wondered what it was they were hoping to accomplish by their diatribe. They could not expect that anyone would be persuaded by their angry shouts. Increased volume does not make up for the ignorance of an argument. I suspect their goal was one shared by many political protesters, Facebook commenters and internet trolls. They wanted to feel morally superior. What they did not realize was that they were creating the same feelings in those who walked by.

- Bart

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Two Choices at Easter

When it comes to Easter there are only two options. Either the holiday celebrates an actual historical event, or it doesn’t. The man Jesus either rose from the grave as the Christian scriptures proclaim or He didn’t.

If Jesus did not rise from the grave, if he died and stayed dead like an ordinary man, then Christians are fools. If Christ is not risen we are to be pitied as deceived losers who have wasted our time, talents and resources for nothing. The church is nothing more than a social club based on outdated morality.

If Jesus is indeed risen from the dead then the opposite is true. The deceived losers are those who plot the course of their life apart from Jesus’ teaching, for If he is risen he is no ordinary man. His teaching must be followed. If he is risen God is real and so is eternity. If he is risen then faith matters.

While most people have an opinion on whether or not the Easter account is true, only a fraction of those I have encountered have actually taken the time to consider their choice and fewer still have invested any time in evaluating the evidence in support of Jesus' resurrection. Given the ramifications of an incorrect answer to the question of whether or not Jesus is risen it would behoove everyone to take the time to answer carefully. Lives are at stake.

Something to consider at Easter time. 

- Bart

Wanted- Real Men

While my career plans changed often after I started college my main goal in life did not. For as long as I can remember I wanted to be a man. Not in the John Wayne, Arnold Schwarzenegger, action hero sense, but in the head of the household provide for your family, love your wife sense.

I was able to hang on to this goal through the years because it had meaning. It was clearly defined and easily understood. I knew that God desired all boys to become men and I knew what it meant to be a man in God’s eyes. I have spent my life pursuing this definition and the pursuit has led to success in the most important areas of my life, my roles of husband and father.

The definition of manhood was simple and straightforward to me 35 years ago. Times have changed and for many in our world the term now has so many meanings as to have no meaning at all. The result is a generation of young people who are rudderless and fatherless. It is not politically correct but I think it is time for real men to speak out about what true manhood is.

Real men love and live sacrificially, work to better themselves everyday and worry more about who they are instead of what they have.

Real men-

- Devote themselves to one woman, for a lifetime. I meet far to many males who go through life seeking casual relationships with as many women as they can find who are willing to service their sexual desires. Real men understand the importance of devotion.

- Are committed to their children. They realize being a father is the most important job they will ever do. They are willing to put parental success ahead of professional success.

- Practice self-control. They work to control their negative impulses. They set aside anger. They make home a safe place for their wives and children.

- Are men of faith. They submit to a higher authority. They live their lives according to the values defined by God. They live according to God’s moral code and not their own. They pass these values on to their children.

- Work for the long term security of their families. They deny themselves temporary pleasures and toys in order to save for the future.

- Make their own way in the world whenever possible. No job is beneath them and they do not look for a handout. They value work.

These characteristics of manliness are accessible and achievable by all men regardless of their background, ethnicity, education or status. They need not be defended, explained or justified, because they are true.

-Bart

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An Easy Diagnosis- Missed

He was worried. He had lost over 30 pounds in the last few months and he did not know why. He had seen another doctor but the doctor did not give him an answer. Worried, he turned to a friend in the medical field. The friend referred him to me.

The visit started off as most new patient visits do, with a lot of paperwork and time spent reviewing his medical history. He had a history of high cholesterol but not much else of significance. He had no symptoms of depression and no obvious reason for the weight loss.

Until I looked at a copy of his blood work.

In December he had a fasting blood sugar of 295, nearly three times the upper limit of normal. He was diabetic. I asked him if he had been informed of the high blood sugar. He told me that the doctor had told him it was “something to keep an eye on” but that no additional tests had been recommended nor treatments suggested.

I explained to him that this was almost certainly the answer to his weight loss, as this was a common manifestation of diabetes. I ordered a repeat of his fasting blood sugar as well as additional tests to confirm the diagnosis. The results were as expected, confirming that he had been diabetic of a while.

At the end of the visit he asked why it was that the other doctor had failed to make the diagnosis. I did not have an answer for him. There was no rational reason that a blood sugar as abnormal as his would be ignored. The only explanations I could think of were ignorance, laziness or incompetence. I kept these reasons to myself, stating only that I did not know what the other doctor had been thinking.

I m not sure that the doctor was thinking at all or that he was truly concerned about the patient. The patient’s diagnosis was simple and straightforward and could have been made by most third year medical students. For several months the patient had needlessly worried about cancer or a life-threatening disease. I wished he had come in sooner and was grateful his friend had advised him to come to my office.

I wish I could say that his story was rare, but it is nowhere near as rare as it should be. Doctors are human and we make mistakes. We can get busy and distracted and we can be lazy and inattentive. Years of advanced training and education bring knowledge but they do not remove our innate tendency to mess things up. There have been many times when I was tempted to cut a corner or to tell myself I would address the problem "the next time." I have thus far been able to fight this tendency. This patient reminded me of why that is important.

- Bart

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