The Pharmacy Chick

Flying the coup in retail

The new definition of “emergency” I guess…

Filed under: Uncategorized — pharmacychick at 6:56 pm on Monday, January 17, 2011

Today, like always, Pharmacy Chick was doing her little thing in the pharmacy (filling prescriptions..what else) when this guy came in with a script from the Hospital emergency room. On it was a Z-pak and some cough syrup. Not surprisingly, he wants to know how long it will take, to which I reply “20-30 minutes”. He said “I just want to get home, I had to spend 6 hours at the ER today and I have this terrible sinus infection”.

Puhleeze. He lost me at “sinus infection”.

Lets review: He didn’t go to the walk-in family clinic..he didn’t go do his PCP, or an urgent care, zoom-care, immediate-care, or zippity-do-dah minute clinic. He went to the HOSPITAL EMERGENCY ROOM….for a sinus infection. This is the same place that you bring a dude wheeled in on a stretcher whilst somebody else has a bag or cooler  carrying one of the dude’s appendages ripped off in a car accident. This is also the same place you bring somebody who has had a heart attack/stroke/SAH or the like. But give me a break…

It just irritates me that we have become a people that uses an ER like a daily fee clinic. I feel really bad for these ER people. You have drunks on a binge, (filled one of those detox Librium 25mg scripts today too.. he was drunk by the way at the time he filled it too). You have people with colds, sinus infections, a rash, or whatever that decide that NOW they have an “emergency” and need to be seen so they haul their sorry butt down to the ER, and get in line.

Mr Cough Syrup didn’t understand why he had to wait 6 hours. I didn’t elaborate much other than to say that if they had somebody more URGENT than himself, they would take them first..thats how it works in trauma. I guess he thought his sinuses were world class trauma.

We have no less than 6 centers around the 10 mile radius of my store that specialize in ‘walk in’s. That is their core. they dont take just come in and wait.  We get lots of their scripts…90 percent of them are one of three groups.  Pain/muscle relaxants, Antiobiotics, and Cough syrups.   You slice your finger on the bagel?  Go here.  You AMPUTATE your finger?  Go to the ER.    You sprain your ankle playing basketball?  Go here.  You  shred your ankle on the riding mower?  ER.   You bump your head and need a couple stitches?  Go here.  You slam your head on the pavement and you think you are Napoleon?  ER.   Your back is sore because you helped your neighbor move that huge couch?  Go Here.  You can’t move from the waist down?? ER.

Do you get the gist of what I am saying?  Maybe we need to better define what EMERGENCY is..

I might just add that it is also NOT an emergency that I rush your prescription so you can take your daughter to dance class and NOT be late…but thats another day and another post.

Happy Monday!


Comment by Jade

January 17, 2011 @ 7:53 pm

Maybe he thought his head was gonna fall off. I’ve had sinus symptoms so bad when I first moved to a different area of the US that I was afraid my face would crack and break off if it was touched. Not to say that the pain was something else. Patient could very well have been at risk for hemorrhagic stroke, so had a little anxiety, to boot.

And, so when he is telling the pharmacist, he has a bad sinus headache, he is actually somewhat relieved that it’s only that, though he’s been assured that the situation will be rectified much sooner once he gets a Z-pak in him and gets some rest.

If I hadn’t been aware of the possibility of sinus infection symptoms (pressing spongy sinuses is a dead giveaway), I’d have probably asked someone to unzip the neck fastener at the collarbone and carry my head gently over to a vacuum cleaner! Also, when headaches get that bad and nausea starts to threaten, nothing expedites one’s visit to the doctor in case one’s head will explode on impact.

I’m not exaggerating! Sinus symptoms can be as bad as impacted wisdom teeth, toothache, migraine, and brain tumor all rolled into one hurting head.

Comment by Debbie

January 17, 2011 @ 8:17 pm

Sorry, Jade, dear. I must agree with our wise pharmacist. I am a nurse practitioner, and really, many, many people have NO idea what an emergency is! A toddler who has had a fever 100-101 degrees with a runny nose for all of 18 hours? A patient whose car rolled over several times?? A strep throat? (Really, I have had strep, and yes, I waited clear thru the weekend to get a test and treatment). Or maybe someone whose asthma is so bad they might die without immediate treatment? And yes, I have had a screaming, throbbing sinus infection, too. And yes, I waited until the next day to see my primary provider. Code blue? Come to the ER! Can’t breathe? Come to the ER! That is what we are there for! Sinus infection? Wait till the next day, or go to a same-day care.

Comment by Kat

January 17, 2011 @ 10:05 pm

I could maybe see how this would happen *if* he lived around where I do. Around here it’s either the ER or you wait all weekend. We don’t have any weekend clinics/urgent care centers etc. I’m of course the one who has toughed out asthma flares cause I’m not *bad* enough for the ER (as I gasp for breath… not my brightest moments).

Comment by Mary

January 17, 2011 @ 10:49 pm

Well when I have Strep Throat, and you have insurance like myself, who wont pay for any of the “instant-care” places, and no matter how much you beg your doctor’s office to get you in, they still try to scheadule you 3 weeks out, and your in ALOT of pain from the strep throat, what are you suppose to do?? I’ve only had to resort to this once several years ago, and I am not fan on the ER, but they actually treated me pretty well. (and yes, I have changed doctors since then)

But I agree, people should know when to use the ER and when not too…I know way too many people that do this, and I think it’s dumb. When I think of ER, I also think of heart attacks/Strokes, body parts came off, buckets of blood type of things. Actually not too long ago my daughter burnt herself on accident and I took her straight to her pediatrician and he saw her right away and got her treated, I was in and out within 15 minutes and he faxed the script to the pharmacy where I picked it up. I don’t get why more people don’t do this….

Comment by rxkerber

January 18, 2011 @ 1:02 am

My hubby wanted to go to ER last week for a bad cold. Wanted a breathing treatment. Asked if he used his proair…….no too sick to go get it (I was working). Later he fell when he got out of the shower (using it for steam) and hit his head HARD on the counter. Really wanted ER I’m still at work for 2 hours. Told him to lie down until I got home. Bought him a Vicks personal steam inhalant device. Works great! Checked out his head. Half inch gash in forehead, barely swollen, not really red, eyes normal, gait normal. Had bad headache and a bit dizzy . I determined no ER was needed. Nothing they had there that I didn’t have t home.

He survived the night….what a miracle! 😉

He’s feeling better today btw. That personal steam device is great!

Comment by Dr. Grumpy

January 18, 2011 @ 5:10 am

Yes. ER overuse is a BIG problem.

Comment by chris

January 18, 2011 @ 6:31 am

We have a parent that takes her daughter to the emergency clinic near us practically every single weekend, I just looked through her daughters records, we have over 50 entries for antibiotics from the clinic and not a single prescription from a normal doctor surgery.

Our local hospital also had to put a letter out to everyone in town saying that they would no longer be issuing prescriptions for repeat medication. It was getting to the point where they had hundreds of people every weekend (always the same people) go in for their repeat medication rather than go to their doctor. Never for anything urgent either, just things like statins etc.

When you said new definition of emergency though, the first thing that sprung to mind was the classic “I forgot to order my medication, its an emergency, what are you going to do about it?” I think one of the most repeated quotes in pharmacy must be “poor planning on your part does not constitute an emergency on mine”

Comment by The Ole' Apothecary

January 18, 2011 @ 9:27 am

The Emergency Department of a hospital is for saving lives, not patching up minor problems.The most likely candidates for the E.R. come by ambulance. If the public was better at triaging itself, the E.D. would function much more smoothly for the people who really need it.

Yesterday, I took my severe ear pain to a walk-in clinic. Yes, my insurance did not cover the whole thing, but I was in and out in less than two hours.

Comment by Jones

January 18, 2011 @ 5:42 pm

I wonder if it would be possible to implement a penalty for misusing ER services, the way that there’s a fine for calling 911 because McDonald’s ran out of nuggets.

Comment by HollyD

January 19, 2011 @ 8:32 am

My local news (in Atlanta) carried a story yesterday about how a man had a medical emergency when the recent snow/ice prevented mail delivery. On Monday, Day 1 of the storm. He was waiting for his Rx refills.

Now, I understand some folks for insurance reasons have to use mail-order pharms. I also understand that there are limitations on when they can submit refills. BUT I highly doubt they require patients to cut it so close that the day they take their last pills in the morning, they need the afternoon mail for the refill.

IMHO another example of poor planning on his part did not make it an emergency for the pharmacy, the USPS, or anyone else.

Comment by Texas Pharmacy Chica

January 19, 2011 @ 12:31 pm

Chris – the first thing on my mind was Munchhausen syndrome by proxy. 50 trips to ER? I’m cold enough to guess the parent is using another pharmacy for the primary care/pediatrician prescribed items.

ER overuse – definitely. Really irks me when it is COPD patients who run out of their nebulizer drugs and run to the ER instead of calling their own physician on, say, a TUESDAY at 11 am. The boxes ain’t small. It is pretty easy to see that you are getting low.

Comment by Mallory

January 19, 2011 @ 4:17 pm

If he’s never had a sinus infection, it could *feel* like an emergency. For the majority of the population who lack medical education, it can be hard to tell the difference between ‘My head feels like it’s about to explode, but it’s nothing serious’ and an aneurism.

Maybe there should be a call line, like they have here in the UK (NHS direct). You phone in, and they take you through basic questions, and tell you if you should go to the ER, make an appointment with your GP, or just take some OTC meds. They’re on the cautious side, but at least it means that triage is happening off-site, and so the obviously non-emergent cases aren’t left sitting in the waiting room for 6 hours.

Comment by Pharmacy Mike

January 19, 2011 @ 9:46 pm

And of course… sinus infections are almost always viral, so that Zpak was most likely completely useless against it. In all likelihood, even without taking the Zpak, the sinus infection would have resolved itself anyway in 5 days.

So let’s get this straight… He went to the EMERGENCY ROOM for a sinus infection, which was a gigantic waste of money in the first place, and then further burdened the health care system by being prescribed an antibiotic for a viral infection.

Great job all around.

Comment by chris

January 20, 2011 @ 6:22 am

MSBP was my thought to, I did contact the emergency room but the daughter is a sickly child and has had cultures done, so she is not fabricating/causing any illness. The issue is her using emergency room rather than her regular GP where she could get regular treatment.

Comment by Mickey Blue Eyes

January 21, 2011 @ 9:19 am

He was only in the ER for only *six* hours? Holy cow that’s fast! Based on my most recent visit to the ER — the local urgent care clinic said my issue was more serious than what they handle, and PCP office had already closed for the day — and overhearing conversations of those around me, 10-12 hours is more the norm.

Comment by loveinmyjob

January 22, 2011 @ 10:53 am

Can the ER triag nurses legally turn these cases away and refer them to a walk-in facility? Do the walk-in facilities take his insurance? That’s the big one around here. The majority of our ER scripts are for very, very minor issues that could easily be taken care of at a walk-in facility. The problem is that the walk-ins don’t take the state Medicaid and not being an emergency facility they can turn away patients that can’t pay. It’s a problem with no decernable solution.

Comment by MV

January 29, 2011 @ 11:58 pm

I suggest that you also take it up with other medical professionals. I’ve gone to the ED for migraines as directed by my treating neurologist. I’ve been directed to the ED (versus a clinic) for a severely cut finger by EMTs. In both cases the ED visit was not needed. Don’t blame the patient if regular doctors don’t want to prescribe needed medications or medics can’t evaluate wounds.

I’ve only been questioned once by a doctor why I went to the ED. This was for the migraine noted above. His annoyance rapidly went away when I stated that it was the neurologists orders. And that is probably the problem. If people aren’t told not to do it again and actively encouraged, why wouldn’t they?

Of course, if most paying patients in the ED are not there for emergencies, can the hospital actually afford not to treat them?

Comment by NP Amber

October 16, 2011 @ 9:34 am

Pharmacy Mike,

Sinus infections are not always viral. Ever heard of chronic sinusitis? In fact, recent studies have shown that a majority of recurrent sinus infections are caused by fungal infection. True, antibiotics won’t work against fungi, but an antifungal will.

BTW, for all of you in the health care field that are complaining, just be happy you have a job. Lack of compassion and nursing/doctoring don’t really go together well. Maybe try doing something else for a living.

Comment by Sherry

November 29, 2011 @ 8:50 pm

To those in heatlhcare that complain when I frequent your emergency room… Just maybe I have a history of sinus infections that for some reason turn in to a life threatening condition almost overnight. Maybe I have had sinus infections that have caused permanent damage to my eyes. Maybe, just maybe, I have had enough sinus surgical procedures that have resulted in permanent scarring and I don’t have the luxury of waiting since there is very little healthy tissue remaining that protects my brain tissue. What may appear to you as an abuse of emergency care could mean the difference of whether I live or die. You don’t know my medical history, and shame on you for making assumptions that you aren’t qualified to make…. Just sayin..I still say that urgent care, zoom care, or walk in clinic is more appropriate. Any of these options would provide you the medical care you need in a flash, and if you needed a hospital admit then they can make those arrangements. no shame here.

Comment by milly

February 9, 2012 @ 2:08 am

So tonight I have been in tears because of a sinus infection. For those of you to say it isn’t an emergency is a crock, especially coming from a nurse practioner. My infection is extremely painful and right now I feel better because I went to an Emergency room. My face is swollen beyond recognition, and I will tell you what, I have had two children naturally without any anesthesia and this is by far more painful. Do not judge someone else’s pain based on ur own experience for everyone has a different pain threshold, ms. Nurse practioner you should know that. So for someone else childbirth is the worst they felt, and I cannot argue that because that was there pain, and I agree with the others, waiting for 6 hours only to find out it was a sinus infection could have been a relief. In my opinion u sound like a bitch, ur job is to dispense medication, not write about ur experience with someone who apparently was in a hurry to feel better.and AGAIN YOU JUST SPENT A LOT OF TIME NAME CALLING AND DISPENSING YOUR SPEW AND COMPLETELY MISSING THE POINT. GO TO AN URGENT CARE CLINIC, AN IMMEDIATE CARE CLINIC OR A WALK IN CLINIC. A HOSPITAL EMERGENCY ROOM IS FOR EMERGENCY TRAUMA, NOT YOUR SINUSES. SO SINCE YOU THINK I AM A BITCH, YOU MAY QUIT READING MY BLOG…RIGHT NOW….

Comment by Jess

March 8, 2012 @ 11:17 am

You know as if i didnt already get the vibe that everyone in the healthCARE field lacked the root of the profession. It is not anyones right to leak information about a patients perscriptions or diagnosis. Ive had a sinus infection for the last 2 weeks because i refuse to get mediocre care from the likes of anyone like you. People are still people nomatter if it is your “job” to deal with them. Nobody signed up for it but you, so man up or shut up.well have a good time suffering with your sinus infection because you dont want mediocre care. Im sure you are using brilliant judgement.

Comment by Jo

June 27, 2016 @ 6:52 pm

I came across this post because I was looking up when to go to er with a sinus infection as everyone who looks at me says jo you need to go to er now ..I think you have to realize that urgent care doesn’t take most insurance and if you leave a sinus infection it can go into sepsis and even cause a brain infection. I am sitting here with my face so swollen and lips so swollen that people can barely make out what I am saying. The tissue rock hard and turning black and blue . My fever 103 -104 fluctuating, I tried to go to two different urgent care today they did not accept my insurance and I had no money to pay 260.00 for the visit. my face is so swollen that it feels like its going to split. you cannot even tell its me looking at me. Everyone has a different reaction to sinus infections and there are times you need to go to er. I have a rare disease which causes connective tissue problems thus the sinus overreacting to the extreme to ragweed pollen. I think its going to be a case by case basis depending upon the severity of the sinus infection.

Comment by Alex

December 18, 2016 @ 9:39 pm

When I broke my wrist when I was out of the state this summer I was pretty adamant about not going to the ER because I was in Nevada Medicaid and I didn’t think they would take my insurance, however I was forced to go by my sister. I’ve had a sinus infection for over a year now because my last doctor refused to do any sort of treatment and told me to move out of Las Vegas for it to go away. Well I did and because I can’t get Medicaid in Idaho (I have schizophrenia and SSI thinks I’m fine so I can’t get SSI or even Medicaid unless I get pregnant, I can’t find work and due to insomnia I’ve had since a child the Behavioral Health Center has given me literally everything available on their program and nothing works, no sleep makes finding a job difficult) I’ll just let this sinus infection kill me (which apparently is possible, apparently I also have a deviated septum and have had a post nasal drip for over 10 years) because I can’t afford the hospital bill if emergency surgery is required. It’s pretty bad when America’s health care system is so fucked up that people would rather die than get the medical care they need just because medical costs are so ridiculous.

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