Should I Always Call the Doctor?

By James N. Dillard, M.D.

Mrs. Ballentine gets confused sometimes. She forgets where her keys are, and sometimes she will walk into a room and not know why. She doesn’t really have dementia; she’s just occasionally a bit foggy. It was a good thing her pharmacist wasn’t.

She started having irregular heartbeats — funny bumps in her chest. She went to her regular doctor’s office, and they did an EKG. Her doctor told her that she was having atrial fibrillation. She had to go into the hospital to see if they could bring her back into normal rhythm.

They couldn’t. After intravenous medications and some uncomfortable shocks, she was still having the irregular beats. They might have caused clots to form in her heart, and possibly travel to her brain, so her doctor put her on the powerful blood thinner Coumadin. She wasn’t happy about all this, but she understood. They were taking good care of her.

About six weeks later, she was in the pharmacy, getting her prescriptions refilled. Her pharmacist, Rob, was checking her out when he looked down and saw several dark blotches on her arms.

“Mrs. Ballentine, are those new marks on your arms?” he asked her.

“Oh Rob, I’ve got blotches everywhere! It’s just old age,” she replied.

“Are you taking anything for pain?” he asked.

“Well, I’ve always taken gobs of aspirin. It’s the arthritis, you know.”

“Does Dr. Cullen know about all the aspirin you take?” Rob asked.

It turned out that when Mrs. Ballentine started on Coumadin, she forgot that the doctor told her to be careful about using aspirin. She was bleeding under the skin all over her body. The pharmacist caught it.

If you think a pharmacist is someone who just comments on the shade of lipstick you are considering and counts your pills, you’re dead wrong. A pharmacist is a highly trained and seriously under-acknowledged member of your health-care team, one of the most important. These men and women are the last line of security before a drug goes into your system.

These days, pharmacists do a tough six-year program after high school, and come out with a PharmD degree. They work in hospitals and other settings before they graduate, and take some challenging exams. They know a lot about the approximately 3,000 medications in use today. And many of them know a lot about herbs and supplements as well.

I don’t want to scare you, but good research indicates that somewhere between 44,000 and 98,000 deaths occur in the United States each year from medical errors. And, according to the Food and Drug Administration, there is at least one death per day, and 1.3 million people are injured each year, due to medication errors.

If your pharmacist knows everything you are taking, including over-the-counter pills, vitamins, herbs, and supplements, he or she is in a great position to reduce these numbers and keep you safe.

We doctors make some sort of error, mostly insignificant, on about 1 in 25 prescriptions we write. We move quickly under pressure, and nobody’s perfect. Somewhere between 1 in 1,000 to 1 in 10,000 prescriptions will have a life-threatening error. The average local pharmacist will see minor prescription errors maybe 10 to 20 times a day. But three to five times a week, he or she will have to call the doctor for something more serious.

The point is that your pharmacist may be saving your life right now, and you don’t even know it. Pharmacists have computer programs that double-check that they have the right medicine in the bottle, and they check for drug interactions. They catch problems every day.

For example, your pharmacist knows that taking any antibiotic, such as doxycycline for Lyme disease, will disable your birth control pills. Your pharmacist also knows that taking a “statin” cholesterol-lowering drug with the antibiotic erythromycin can cause muscle and kidney damage. There are many more examples.

Two weeks ago, I wrote a column referring to the time pressures in the doctor’s office. For many issues, your pharmacist can be the relief valve. They have great training and experience in many minor complaints, and they can guide you to cheap, over-the-counter remedies.

If you have a question about drug interactions, side effects, adverse reactions, interactions with vitamins, herbs, or supplements, whether to take a medicine with food or on an empty stomach, or at a different time from another medication — start with your pharmacist. If you’ve been on the Internet looking up your drugs and now you’re confused, call your pharmacist. The doctor is usually much harder to reach, and the pharmacist has the answers anyway.

I have to tell you — I did very well in medical school, but most good pharmacists know the details better than I do. More than 40 new medications come out each year, so I have to look things up all the time. I try to be very careful, but these professionals spend their whole careers just dealing with the drugs. I’ve got a lot of other things to keep up with, so sometimes I even call them with questions on the details.

Frank Calvo, R.Ph., the owner of East Hampton Pharmacy, gave me some helpful do’s and don’ts:

• If you live in East Hampton part of the year, or on the weekends, make sure the pharmacist who fills any prescriptions out here has your entire medication and supplement list, and vice versa for your regular home pharmacy.

• Don’t play multi-drug roulette, even with over-the-counter pills. We know you want to be private, and that is your right. But if nobody knows everything you are taking, you are engaging in very risky behavior. Please let a smart doctor and pharmacist know the whole list and keep you safe.

• Please don’t get mad at the pharmacist if your insurance doesn’t pay for your prescription. It’s not his or her fault. If you are on complex therapies, you need to have a dialogue with the pharmacy to make sure things will get paid for — before you go in.

• Anticipate your need for an unusual or very expensive drug from a local pharmacy. Our pharmacies can easily get these drugs, but a couple of days’ notice can make all the difference. You may need to obtain prior authorization from your insurance company.

• Trust your pharmacist. Talk to your pharmacist. He or she wants to be part of your health-care team and to keep you safe.

There is no substitute for your own doctor. We have the extensive training in diagnosis and treatment to be the captain of your medical ship. But the pharmacist is a darn good first mate. And Mrs. Ballentine is glad to be aboard.