PRESCRIPTION BY DEMAND

You know I have to admit the family practice office had been a good experience in many ways. It was a very busy environment by seeing patients every fifteen minutes or less. I have a better appreciation of family practice providers. They work their butts off! The thing that intrigued me the most was how the patients manipulated the providers based on what they had heard from their friends or on television. As much as the provider’s try to teach their patients, they still will not listen. They are there for a prescription and nothing more. They want the same medication their friend was on because it worked for them even though they did not know how the medication worked or if their might be a better treatment plan. Here is one example.   

I looked at the piece of paper that told me why the next patient wanted to be seen in the family practice office. I looked at the chief complaint. It read, “Wants Wellbutrin.” I looked at it for a while thinking, “Well, I guess they probably had watched some of the commercials on t.v.” I then looked at the age of the patient. It was a 32-year-old female. There was no other significant medical history. I was ready to go into the examination room. I lightly knocked on the door.

When I opened the door I saw an obese female sitting on the fake leather bench reading a gossip a magazine. She smiled at me as I walked in and introduced myself as the nurse practitioner student. I looked at her and wondered why she wanted to go on Wellbutrin. I sat down on the roller stool and was ready to get my history for my SOAP notes.

“Why are you in the office today?” I asked.

“I want to go on Wellbutrin,” said Tracy. I wrote that down wondering why she thought that was the best treatment.

“Why do you want to go on Wellbutrin?” I asked. I was curious because I had seen quite a few females who wanted to go on anti-depressants in this office. I was curious why.

“I have a friend who started Wellbutrin and started to feel so much better than she had been before,” said Tracy. She sat on the bench getting almost agitated I was asking questions instead of writing her the prescription for Wellbutrin.

“What kind of symptoms have you been having that you think you need to go on this medication?” I asked. I wrote my note as I asked my questions.

“Well, one day I am angry and want to punch somebody. Then the next I am sad and depressed,” said Tracy. I sat there and thought for a second. I took out my Pocket PC and looked up Wellbutrin and other antidepressants. I saw Wellbutrin was not the medication for somebody with agitated and depressive moments. I loved the fact every day in the office was a new learning experience. I did not have a lot of experience with anti-depressive medications and the family practice office saw a lot of patients who were on them. I knew Effexor would possibly be an option instead of Wellbutrin.

“What do you mean about punching somebody?” I asked. Tracy looked at me like I was crazy.  

“My friend felt exactly like me. And she went on Wellbutrin and she is so much better than she was. I want to go on Wellbutrin!” said Tracy. I wrote that down.

“How else do you feel besides punching somebody out?” I asked.

“Sometimes I am so depressed. I want to sleep all of the time too,” said Tracy. I wrote that down.

“You know I don’t think Wellbutrin would be the best medication for you with the symptoms you say,” I told her.

“No. I want Wellbutrin. My friend is on it and she is feeling much better. She told me I should go on it because I have the same problems she had before going on it. I don’t want anything else. I won’t take it,” said Tracy. She picked up the gossip magazine and started flipping through it in some sort of protest from the nurse practitioner student.

“How long have you been feeling this way?” I asked Tracy.

“Months, “ she replied still flipping through the gossip magazine.

“What kind of work do you do?” I asked more out of curiosity than anything.

“I work in one of the psych facilities as a tech. My friend is a nurse and she knows it would be the best for me and I believe her,” said Tracy.

“You know it will take at least a month before you will see any significant symptom improvement on Wellbutrin. With Effexor you will start to see improvement with your depression and anger in half that time,” I said. I was trying to make her see some difference and to also tell her once again about my recommendation.

“No. I will not take it. I want to go on Wellbutrin,” said Tracy.

“Okay.” I assessed the usual heart and lungs. They were normal. Then it was time to go to my preceptor. There was a stern voice in the patient who knew what she wanted days before she came into the office. How lucky for me to be in the office at that time.

I discussed the patient’s history and my personal recommendations for medications with my preceptor we went into the exam room. We talked about starting her on Effexor XL because of her violent phases. My preceptor agreed and we walked back into the exam room.

Tracy was sitting on the bench flipping through the gossip magazine. She looked up as we walked in. My preceptor told Tracy everything I did and it would probably be a better choice to start Effexor instead of Wellbutrin. Tracy once again told her she would not take anything else. Tracy’s foot started to go up and down in frustration. After a few minutes my preceptor told Tracy she would write her a prescription for Wellbutrin XL and give her samples to last her a month. Then she would need to be re-evaluated before she would get another prescription. Tracy was happy with that. She got what she wanted. She left the office after giving me a glaring eye.

Tracy knew what she wanted and got it although I thought it was not the best treatment option. I personally believe my preceptor hands out too many anti-depressive medications instead of referring them to a psychologist for evaluation or trying to figure out if there would be other options besides going on medication. Is that what our society has turned into? I feel like this so give me a pill? This will be a challenge when I start practicing on my own. By the look of frustration on Tracy’s face after I tried to do a little teaching, I may not have any patients who would want to see me. They would rather go to the provider who writes out the prescription they came in for.