Life in Ambulatory Care

Having spent over 16 weeks in a hospital environment, I have found the ambulatory care world a bit shocking. Life in the hospital is pretty controlled - nurses titrate your IV drips, nutrition feeds you, and doctors examine you. However, ambulatory care is anyone's game. When turned loose in the world, the average patient is non-compliant with their medication regimen and their diet. They may come in to see the doctor when their leg falls off from gangrene. Today I spent an hour with a lady who I came to find out is not taking any of her medicine. She brought me her medicine bottles - all of which had labels stating they were last filled on 11/30/2005 except the potassium which was filled 5/24/04. When I questioned her, she replied that she just dumps her new pills in her old bottles. Having worked with patients like this before, this wasn't surprising. I called the pharmacy...yea, she hadn't had those pills filled since November and the potassium hadn't been filled since 2004. Best part - her insulins hadn't been filled since March 2005. Did I mention she's a type 2 diabetic? Consequently her sugars are through the roof and her kidneys are shutting down. I tried to explain this to her. Her response - "That pharmacy is lying on me!" Yes that's right, the pharmacy is out to get you! *Sigh* My final patient of the day had mixed his Prinivil and Zocor in the same bottle because the pills were somewhat shaped the same way. Actually, they're not shaped the same way. His Prinivil 10mg is tan and a trapazoid. His Zocor is pink and shield shaped. So apparently, whatever pill fell out of the bottle each morning is what he took. Best part - he had another bottle of just Zocor which he took each night. Put it together and some days he was taking Zocor twice a day. But, at least he was taking them!!! I know it's a long day when I rationalize this behavior with, "Hey, at least he took them."