Re: [Gnumed-devel] further thinking on list of current medications

[Karsten Hilbert]

On Wed, Apr 01, 2009 at 12:04:17AM -0300, Rogerio Luz wrote:

> It´s called Manipulation
> 
> You instruct a pharmacist to make say:
> 
> - Enalapril 10mg
> - Metformin 500mg
> - Alopirinol 100mg
> 
> - 120 capsules
> * Take twice a day ...

This mailing list never ceases to amaze me.

> It is not very common, but some doctors like to do this, the biggest problem
> I see is that many patients that do this do not know what medication
> actually is being prescribed (but since I see about 1-2 patients that use
> this a month - and I work at a busy ER, I suppose it is not worth the
> trouble to make a feature just for this)
No, but it proves the point that we need to carefully
structure things as to allow this (even if we don't
facilitate it).

> But Homeopathic and Floral Medicines fit a lot of diferent remedies
> together,
True enough and since we want to encourage sort of tracking
these (by facilitating their capture) we better thoughtfully
design the system :-)

> and I seem to have the impression that in Europe these are
> somewhat mainstream ... right?
It depends on the patient. Some don't like taking effective
medication (*/me runs and hides*).

A recent story on that point:

Patient comes in with his first bout of gout located on the
first toe (anamnesis elicited regular significant
post-exercise protein intake ;-)  Anyway, I figure I
prescribe Colchicin in addition to Diclofenac. Colchicin
comes as "Colchysat" and "Colchicum" drops. So, I type
"colchic" into the prescription widget. Up pop two drugs
"Colchicum dispert" and "Colchicum Hevert". I select
"Hevert", the patient wanders off only to angrily call in
later because "Colchicum Hevert" is a homeopathic drug into
which said patient doesn't believe. Indications are joint
and bone pain. But it doesn't contain Colchicin.

So, in essence the drug company "Hevert" tricked me into
mistaking "Colchicum Hevert" for the same thing as
"Colchicum dispert" (made by another company and, indeed,
containing Colchicin). Sinister, eh ?

It probably didn't help that the pharmacist muttered to the
patient: "well, I've got my doubts that this is going to
help" thereby destroying the only chance of it helping in
the first place ...  He sold it to the patient anyway.

(yeah, I did call up the pharmacist and asked him to call
*me* when he detects potential problems with a prescription)

:-o

Karsten
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