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One of my first patients in the inpatient medicine unit was a what we call a “bounce-back.” He had been in the hospital two or three days before with severe blood clots in his legs. During that first trip to the hospital, his doctor put him on blood thinners to prevent new clots, which can be deadly if they dislodge and get caught in the lungs. His doctor discharged him with a prescription for an anticoagulant that he was supposed to take for 90 days.
A few days later, he came back to the hospital with severe breathing problems — the clots had traveled to his lungs. When he was stable, I asked him why he didn’t take the medication his previous doctor prescribed. He told me that when he went to the pharmacy to pick it up, he learned his insurance wouldn’t cover it. He could not afford to pay out of pocket.
I empathized with this patient because he was ill, but I was also frustrated — why didn’t he contact his hospital care team or primary care doctor when he encountered this obstacle? Any of a number of people could have easily prescribed him a different medication.
What went wrong? Could we have done more at the hospital to find out if his prescription was covered? Why is there no simple system doctors can tap into to check this out?
Did my patient fail to take ownership of his health and exercise some personal responsibility, or were those blood clots in his lungs a side effect of a fragmented health care system, where speed bumps (getting a new prescription) become road blocks? Either way, that hospital stay could have been avoided altogether.
At that moment, my mind raced back to my patient with the blood clots. An automated text from his pharmacy could have saved him a lot of trouble, too. His doctors could have used that information to maximize efficiency, reduce his health care costs, and help him take steps forward instead of unnecessary and preventable steps back. We could have solved a little problem before it spiraled into a big one.
About 95 percent of Americans have cellphones, and about 77 percent have smartphones. I work with a lot of patients of limited means — not all of them have cellphones, or even cellphones that receive text messages, but many of them do.
Whether they were about vitamins or vital medications, those text messages gave me a valuable an opportunity to intervene and reflect on what went right instead of lamenting what went wrong.