Jill's Medication

Case Study: Jill’s Medication
Case Study Questions:
1. Identify the lapses in care that occurred throughout the case and led to Jill’s medication crisis. Which of these lapses occurred as a result of an individual-level (provider) failure? Which were system-level failures? Throughout the Jill’s experience, there was many lapses between the health care team in regards to filling her prescription. First, Dr. Smith, the referred neurologist declined Jill’s medical records, as if they were of no importance to her serious neurological issue. Second, when she called Dr. Smiths’ office for a prescription renewal, there was no answer and she was not called back after she left a message. Third, when she called the office again the next day, she was told it would be an additional day for the refill to be ready; not filled in time before her trip to
Boston, so the doctor faxed the refill to the Boston pharmacy. Fourth, when she arrived in Boston, the refill had not been called in as it should have been. Fifth, there was no on call doctor available. Sixth, when she returned back to North Carolina, the receptionist told Jill that she had to come in for an appointment, when she had previously told her the doctor would fill her prescription over the phone. Seventh, the receptionist told Jill that she soonest she could be seen would be three days. Three days too long to wait for an important prescription for a life threatening condition. Eighth, the military hospital refused to treat her since she was not an enlisted patient with military insurance. Ninth, when Jill went to go pick up her prescription, the pharmacy told her that it had already been filled the previous night in Boston; when Jill had already been back in North Carolina. As for provider failure, there were many mistakes on Dr. Smiths’ part. Eight out of the nine lapses were his or his offices fault. A system failure would have been at the military hospital. Even though she was not an enlisted patient, her husband was. It was as if someone with no military relation went to the military hospital and asked for help. I feel that there was more they could have done to help Jill’s stressful situation rather than turn her away because she was not covered by military insurance.
2. How could Jill’s experience with the health care system be redesigned to illustrate the principles of patient- and family-centered care? It did not seem that Dr. Smiths’ office cared about Jill and her condition. They did not meet urgency with urgency when it came time to fill her seizure medication. Her medication was for a serious medical condition that could be life threatening, not a prescription for a cough suppressant. I felt that Dr. Jones did a good job in apologizing for referring Jill to such a lackadaisical doctor and wrote her prescription for her even though she was not supposed to. Dr. Jones showed compassion, and tried to alleviate the problem for Jill. I felt that the military hospital was quite harsh in turning Jill away. At any other hospital a patient is treated no matter their insurance policy or bias. Since her husband is enlisted, I felt that she should have been able to receive treatment as well and paid out of pocket for whatever the cost may have been.
3. Examine each of the individual providers in the story: Dr. Smith, Dr. Jones, the pharmacist in Boston, and her Boston neurologist. How could they have better provided patient- and family-centered care? Dr. Smith and his office were very unprofessional. They would tell Jill one thing and then go back on their words. The doctor did not follow through with his refill submission; it was not filled at the right time, nor to the right pharmacy in the correct state. Since Dr. Smiths’ office was preparing for the holiday weekend, he should have assigned an on call doctor; but there was not. This left Jill feeling hopeless. Since Dr. Smith is a neurologist, he deals with serious medical conditions as a career. The need to get an anti-seizure medication should be a concern when addressed to the doctor. He and his staff could be more comforting to the patient and addressing urgency with urgency, trying to find solutions rather than making excuses so that Jill could receive her medication before vacation. Dr. Jones was a wonderful primary care provider. Although she referred Jill out to a neurologist, she was mortified when she heard about her experience. She comforted her, apologized, and made sure that Jill received a two-month supply of medication to avoid any crisis. The pharmacist in Boston was extremely helpful. They offered her advice to call the on call doctor, which was nonexistent and was given an emergency three-day supply of medicine. The pharmacist in North Carolina was also helpful in calling the insurance company to resolve the issue of having the prescriptions filled twice, leaving Jill with no further worries. Her Boston neurologist, was the best neurologist Jill has had experience with and is familiar with her history and the importance of her medication and the seriousness of her condition. Jill appreciates the Boston neurologist and flies back to Boston from North Carolina ever six months for follow up exams.
4. Referencing the IPFCC’s definition of patient-centered care, describe how Jill’s experience relates to the core concepts of 1) dignity and respect, 2) information sharing, 3) participation, and 4) collaboration. The link for IPFCC is: http://www.ipfcc.org Dignity and respect were not shown from Dr. Smith. He did not listen to Jill as he did not want her previous medical records to see the seriousness of her condition. He did not respect his position as a doctor, since he left Jill two days without a call back, going into a holiday weekend when he could have easily written up a script. In regards to information sharing, the point is to share records between physicians in order for each other to see what one may have missed or address important topics. Dr. Smith was not interested in that. The definition also says that patients need timely and complete information in order to take part in their care. It is hard as a patient when he/she is more involved in their care and wanting answers than the doctors are actively participating. Collaboration was shown then Jill returned to Dr. Jones’ office. She was able to explain her horrible experience that occurred over the past week and Dr. Jones documented all that was said. This now opens up Dr. Jones’ thoughts and opinions on Dr. Smith and his practice, and she will no longer refer patients his way.
5. What barriers does the current health care system face to re-designing care around the patient as opposed to the provider? It would be helpful if doctors assigned on call doctors when it is known that they will be out of town for emergencies such as Jill’s situation. Doctors should want to hear all that patients have to say about their medical conditions and their concerns. Dr. Smith should have taken Jill’s medical records and examined them considering he is a neurologist and should be concerned with what type, duration, and how frequent Jill’s seizures can be, to better understand the seriousness of her condition.
6. Describe how patient- and family-centered care can improve patient safety and the quality of care delivered using examples from this case. When more family members become involved in the care, more questions and answers are demanded.
It can be overwhelming to the physicians but sometimes that is what is needed to demand proper and timely care that should be given regardless of the situation but if often omitted.
7. Put yourself in Jill’s shoes. What red flags would have concerned you? How would you handle this situation differently as the patient? I felt that Jill handled the situation very well. She did not seem to lose her cool as I feel I may have, especially with Dr. Smith’s office. The only thing I would have done differently would have been demanding a prescription filled from the receptionist. A week prior she said it would be no problem for the doctor to write a script and send it out and then went back on her word that an office visit was necessary in order to receive a refill. I would have been pertinent on the phone and demanded to speak with the doctor. Then she would have gotten her prescription on time, before her vacation.
8. How can you ensure that patients are involved in their care? List three actions you should perform with each patient.

1. I would make sure that patients are well informed about their condition, vaccines, etc and provide them credible information from websites such as the Center for Disease Control to help them make informed decisions when the time comes.
2. I would encourage my patients to ask questions about anything I do, touch, or say.
3. I would make sure my patients use the teach back method before they are discharged so they are aware of what their condition is, why they need to take certain medications, how to properly take them or administer then, how they can make differences in their lifestyles to improve their condition, and when it is necessary to call the doctor for possible side effects. I would also make sure they have transportation to future follow up exams and have a safe home environment filled with friends or family that support them