"The Doctor Will See You.....Eventually" : the Wait Time for Resolving Medication Issues for Daymark Recovery Psychiatric Patients in Western NC

The American Psychological Association has a Code of Ethics which psychologists are supposed to abide by. Its not just a professional organization so much as it is a guide-post for practice. Beyond that, however, I attempt to 'treat others as I would be treated' and frankly this seems like a good rule of thumb.

For over the past 28 hours, I have used up about two hours doing the following in an attempt to get an answer for the re-fill of a prescription for a client of mine that has been in place for about the past year and a half. The medication is Clonidine which doubled as an anti-hypertensive and more and more commonly, treatment for PTSD. It's not a controlled substance. I am now, as in the past, less well liked, as a professional and in general, that I was about a day ago.

The client ran into a debacle as regards the refill as the medication was, a few months ago, stolen from the trailer where the client lives, assumably because it has the appearance of a narcotic medication and boy, they are all the rage in terms of consumables in western NC. You can make a lot of money if you're poor, selling some pills.

The medical record of the company apparently did not reveal that the psychiatrist had 'reset' the time for writing the prescription due to that episode or at least that is what the executive of the company, whom had access to the medical records, inferred. Other than that small piece of information, I cannot understand why this became the boondoggle it did and why the client continues, even this evening, to suffer due to the lack of medication. It would do no good to go the ER as the client would not be given what is appropriate (if you're a betting person, contact me and we can bet on that).

And as times becomes more and more desperate, the selling of pills happens more and more frequently. I can't tell you how many times I have had clients whom left a window open, left a window unlocked, had someone knock down the door of their trailer, or left out their purse, or generally did not guard with their lives their medication.

The client is treated by a psychiatrist at Daymark Recovery whose base is in eastern NC. They have a contract via Appalachian Counseling to offer telemedicine at The Balsam Center in Waynesville, NC, where I have quite a few clients.

I practice as a clinical / health psychologist (my PhD was in that arena) and I not infrequently engage with physicians and physician extenders (PA's or nurse practitioners) re: medication issues or health issues. Indeed, one of the agendas of newer legislation regarding mental health care is to 'wrap around' to physicians and physician extenders in order that we all be on the same page. Trying to stay in touch w/ other providers is the most difficult part of my job. I write letters, usually cc'd to the client; I make telephone calls; in general, if necessary, I harass----the medical providers in order to get the job done for the client.

I was for many years a registered respiratory therapist working in ICU's and ER's of large city hospitals. I know my western medicine.

And so, it is troubling to me to find that regardless of my efforts----and they are an extensive bombardment inclusive of phone calling, e mailing, texting, etc.,----that I could not----after 4 text messages, one phone call when I talked to the psychiatrist, and numerous voice mails left for an executive of the company----resolve the problem of this rural client of mine, whom I have seen for several years. I even sent the executive the name and date of birth of the client to his specific e mail in order to try and get something done as I could turn no one up to help w/ the situation. This is perhaps not in keeping w/ HIPAA but given the APA Code of Ethics, it seems to me that I had best attend to the APA Code of Ethics regarding the treatment of others whom are my clients. I could not, in good conscience, dabble and make a few non-tethered calls----until I finally came to the conclusion----which I discussed with the client-----that I could not make an impact.

The client works hard to try and stabilize physical health issues. It is very sad and maddening to see how little impact I can have on the very large Daymark Recovery system re: my rural client, calling and calling----again and again to the local pharmacy----to the point that the client gave up as there are numerous medications they fill for said client and enraging the pharmacy was not something that was wise to do. We understand they are busy; however there is no efficient system for knowing if the script has been filled or not.

Lo and behold, the NYT has today in the Science Section an article about just that: "The Doctor Will See You....Eventually." ".....Nationwide, the average wait time to see a doctor last year was 23 minutes, according to the health care consultants Press Ganey." (I wonder what the wait time is to get an answer over the phone, however). See the article here: http://www.nytimes.com/2011/08/02/health/policy/02consumer.html

I am sorry to have perturbed the executive of the company but my allegiance is to the client and not to the extended provider network that throws up its hand when it hits the wall of not being able to get the prescriber to address the issue.

You need a new prescriber, I told the client. The issue is this, however: there are so few psychiatric providers in rural western NC. Pick your poison, I suggested.