Time To Take A Breather

CONTENT WARNING: This story contains content of a medical nature. It is not intended as medical advice.

(I am a medical assistant in a community health clinic, with a fully-stocked retail pharmacy on the premises. This patient uses our pharmacy and has been put on a strict refill schedule for his emergency inhalers due to extreme overuse. Normal use is a maximum of two of each per month. He had gone through nine of [Inhaler #1] in two months before the pharmacist contacted the doctor. The pharmacists have counseled him multiple times on proper use, and I’ve reached out multiple times to offer an appointment to address the root cause of his trouble breathing. He declines every time, claiming he needs his inhalers to breathe, that he’s going to have a coronary without them, and that we just want him to not be able to get enough oxygen. Every time I hear this rant, I note that it is extremely long-winded and that he can get through multiple run-on sentences without having to take a breath. His doctor has even called him personally to lay down the refill schedule and explain the cardiac-related consequences of continued overuse. I receive a voicemail from this patient, in which he goes on with another long-winded rant about how the doctor NEEDS to refill his medication. Because of a very well-documented refill schedule and the doctor’s notes that he will NOT refill early under any circumstance, as well as previous in-person discussions with this doctor about this patient, I don’t even need to ask the doctor to advise on the situation. I see that one [Inhaler #2] should be available for a refill, but [Inhaler #1] won’t be available for another week and a half; he’s literally filled it just a few days ago! I call the patient. This is part of the way into the call, and yes, he is yelling the entire time.)

Me: “With all due respect, the inhalers are only treating your symptoms. Continuing to use them at the rate you were doing so puts you at serious risk for a cardiac event, including a heart attack—“

Patient: “NOT GIVING ME MY INHALERS PUTS ME AT A RISK FOR A CORONARY BECAUSE I’M NOT GETTING ENOUGH OXYGEN. YOU PEOPLE JUST DON’T WANT ME TO BREATHE!”

Me: “Sir, we don’t want you to have a coronary, either, which is why we want to address the root cause of your condition.”

Patient: “NO. YOU STOP THERE. JUST TELL THE DOCTOR THAT HE NEEDS TO MAKE THE PHARMACIST FILL MY PRESCRIPTION! THEN THE PHARMACIST FILL BE REQUIRED TO FILL IT!”

Me: “[Doctor] can’t make the pharmacist do anything.”

Patient: “YES, HE CAN! ONCE HE WRITES THE PRESCRIPTION THE PHARMACIST IS REQUIRED BY LAW TO FILL IT!”

Me: “Sir, [Doctor] is a doctor; he is not a supervising pharmacist. He can only write the prescription. Pharmacies are allowed, by law, to question and even deny prescriptions at their own discretion for patient safety.”

Patient: “DON’T YOU INSULT MY INTELLIGENCE!”

(He didn’t get his inhaler refilled early. I later went down to the pharmacy and told the supervising pharmacist. He found it even funnier than I did!)