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"I Hate to Ask You, But..."

Posted Nov 23 2009 10:00pm
Usually when I hear a patient ask me this question I brace for a request for some controlled substance, or to see their train wreck of a family member, or worse yet, to fill out a form. When the patient is a kind 83 year old woman taking care of her 85 year old husband with dementia I tend to fight this urge and hear her out.

He is currently on one medication for dementia started about six months ago to try to slow the progression of his decline, but, truthfully, the drug only seems to be effecting the couple’s pocket book. At $200 a month and in combination with the other medications he take’s he is squarely within the Medicare donut hole.

The problem with these medications is they are so darn hard to stop. I try to give family’s permission to stop the drug if the expense is too great and the benefit too little, but they have a very hard time doing it. They don’t want to feel like they’re placing finances over the health of their loved one, but this issue is really far more complex. For what little benefit is received, enjoying life with a little extra money or necessities like food should take precedence. She did ask for samples to get him through until January, but this wasn ’t what she hated to ask, well, too much at least.

He also came in to see me with an infected ingrown toenail. The wife had been treating her husband at home with topical antibiotics and Epsom salts soaks, but she was concerned the infection was worsening nonetheless. She wondered if he might be able to get some antibiotics to see if that would improve things and avoid a toenail removal.

She turned her head to the floor and said shamefully, “I hate to ask you, but could you put the prescription is my name? I haven’t hit the donut hole and we could get the prescription covered that way.”

I weighed the options knowing I could get an antibiotic for the man’s foot covered by Medicare Part D simply by writing her name instead of his, but knowing that this also was probably technically fraudulent. In the end, I think I made the right choice.

The Country Doctor
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