{"id":2189,"date":"2016-11-04T15:02:17","date_gmt":"2016-11-04T19:02:17","guid":{"rendered":"http:\/\/blogs.nejm.org\/general-medicine\/?p=2189"},"modified":"2016-11-06T08:31:39","modified_gmt":"2016-11-06T13:31:39","slug":"from-the-prescription-pad-to-reality","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/11\/from-the-prescription-pad-to-reality\/","title":{"rendered":"From the Prescription Pad to Reality"},"content":{"rendered":"
\"April<\/a>

April Edwards, MD, is the 2016-17 Chief Resident for Internal Medicine\/Pediatrics program at the University of North Carolina School of Medicine.<\/p><\/div>\n

A harsh reality I am coming to terms with, as a newly minted “pre-tending,” is that we don’t know the cost of the care we provide. There are recommendations for things like High Value Care, from organizations like the ACP<\/a>. But how much do things actually cost? Certain apps and websites, like the Healthcare Bluebook<\/a>,\u00a0give you an idea of the cost of tests,\u00a0procedures, and\u00a0medications that you are ordering for your patients. But often, especially at hospitals like mine, public hospitals that serve\u00a0many uninsured, under-insured, and Medicare\/Medicaid patients, we encounter situations\u00a0 where patients\u00a0can’t afford the services and medications that they need. I often find myself turning to sites like Good Rx <\/a>to get coupons for patients, but, beyond this,\u00a0the reality is that I don’t know where they can get affordable care.<\/p>\n

I live in North Carolina, and I recently had a patient with\u00a0presumed Rickettsial illness who was unable to afford doxycycline. I assumed this antibiotic was so basic and simple and been marketed for such a long time that surely it had to be accessible.\u00a0But he wasn’t able to afford it. So how can we help? What tools are at our disposal?<\/p>\n

Good Rx is one.\u00a0If you type in a drug name, it will show you the pharmacies near the patient’s\u00a0home that have that medication;\u00a0the patient can compare prices at different pharmacies in the area. You can get printable coupons; you can print\u00a0a voucher for the medication. We use the old standbys of the WalMart $4 list and the Target $4 list, and many medications are on those. Other resources exist, like Formulary Search<\/a>,\u00a0to\u00a0tell you\u00a0what is preapproved by a patient’s insurance. Remember all that prior auth paperwork? There are budding apps to help you with that.<\/p>\n

But this is one of the things that we just don’t receive any training on during medical school and residency.\u00a0I wish that it doesn’t matter \u2014\u00a0that “I’ll just prescribe the Best Therapy for my patient.” But\u00a0I’m realizing that is a real struggle. In real life, if the benefit of the Best Therapy is something like 0.05%, but that Best Therapy is\u00a010 times more expensive than the next best drug, sometimes it makes sense to recommend\u00a0the one that is technically inferior but affordable. Because\u00a0my patient will then actually be getting treatment.<\/p>\n

\"red<\/a>

By Lilly_M [GFDL or CC BY-SA 3.0], via Wikimedia Commons<\/p><\/div>It’s hard when your best intentions are met with a roll of red tape.\u00a0It’s a real issue for all of our graduates fresh from residency. We are still shiny and hopeful. We haven’t become so jaded that we don’t want to Do Good. But we could use the tools to help us accomplish that.<\/p>\n

Post your favorite resources that help you Do Good! Help others to stop grasping in the darkness!<\/p>\n

 <\/p>\n

 <\/p>\n

\"NEJM<\/a><\/p>\n

Residency isn\u2019t easy. But it doesn\u2019t have to be quite <\/em>so hard. Explore NEJM Resident 360 now.<\/a><\/p>\n<\/blockquote>\n","protected":false},"excerpt":{"rendered":"

A harsh reality I am coming to terms with, as a newly minted “pre-tending,” is that we don’t know the cost of the care we provide. There are recommendations for things like High Value Care, from organizations like the ACP. But how much do things actually cost? Certain apps and websites, like the Healthcare Bluebook,\u00a0give […]<\/p>\n","protected":false},"author":1274,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[72,31,37,41],"class_list":["post-2189","post","type-post","status-publish","format-standard","hentry","category-about-residency","tag-medical-education","tag-patient-care","tag-resident-experience","tag-technology"],"yoast_head":"\nFrom the Prescription Pad to Reality - Insights on Residency Training<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/11\/from-the-prescription-pad-to-reality\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"From the Prescription Pad to Reality\" \/>\n<meta property=\"og:description\" content=\"A harsh reality I am coming to terms with, as a newly minted “pre-tending,” is that we don’t know the cost of the care we provide. 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