Tuesday, January 31, 2012

Practical

Yitro is one of my favorite Torah portions. The reason is that it depicts one of the things I like most about Judaism: how practical it is.

Here's the story of Yitro in brief: Yitro is Moses' father-in-law. He comes to visit Moses in the desert shortly after the Children of Israel leave Egypt. He sees that the people come to Moses all day long so he can hear their troubles and administer justice. Yitro watches this for a while, and says: "You are working too hard! You can't do this all alone. You are going to burn yourself out! Choose some good men, and have them help you judge the people, and you can handle the most difficult cases."

This is just such a wonderful and practical piece of advice! And so modern!

I am chanting a portion of Torah in a few weeks from Yitro, and I love it! Here is what it says:
Moses took his father-in-law's advice, and did all that he said. He chose capable men from all Israel, and he appointed them as administrators over the people, leaders of thousands, leaders of hundreds, leaders of fifties, and leaders of tens. They administered justice on a regular basis, bringing the difficult cases to Moses, and judging the simple cases by themselves. Moses let his father-in-law depart, and he went away to his homeland.



Saturday, January 21, 2012

Bad timing

So this whole bar mitzvah thing...the timing seems to be off.

This is my problem. When J was a little kid, he loved all the Jewish stuff. He loved Shabbat at preschool. He loved the wine, the candles, the challah... He loved saying the blessings. He loved being the Sabbath King. He loved Chanukah. He loved Purim. He loved the seder at Passover.

So we sent him to Jewish day school because we loved how seamlessly his preschool had moved between our two worlds, the American/secular world and the Jewish world. And he loved kindergarten, and he learned to read English, and then in first grade he learned to read and write Hebrew, and he learned some Hebrew words. He liked the bible stories, and he liked learning the morning prayers. He liked the Hebrew songs and Israeli dances. And we went to temple, and he liked the kids' services. And it continued this way, through about fourth or fifth grade.

But now J is 12-1/2, in sixth grade, in middle school, on the brink of adolescence. Currently, he loves 1) basketball 2) x-box 3) his friends, especially if he is playing either basketball or x-box with them. (And playing basketball on x-box with a friend is the ultimate.) But what he isn't really interested in anymore is school, or Judaism. Those things are, to quote J and all his friends, are "boring."

And now it's time to prepare him for his bar mitzvah. He's not resisting, but he's not really into it, either.

So here we are. Now what do we do? How do we make this meaningful at this time in his life?

Friday, January 13, 2012

Non-adherence and mail orders

I've always been somewhat peeved by the term "non-adherence," as in "the patient is non-adherent to his/her medication." It puts the blame squarely on the patient. It's as if someone is saying: "Why won't you just take your medication? I told you it's good for you! I told you that you need it! What is wrong with you?"

So here's a little story...

I take two medications, one prescribed by my PCP and one prescribed by my oncologist. For some reason, my PCP will not give me a prescription for a year, and insists on giving me a script for 6 months or even 3 months. (This is a medication I've been on for years. It's not like something is going to change.)

My new job has a mail-away drug program, and you can get 3 months of your prescription for a slightly lower cost than ordering it from the local drug store. So the last time I was in to see my PCP, I asked her to send the prescription to the mail-away drug program. She assured me that it would go through quickly and that I'd receive the medication in a few days.

I checked the mail-away drug program's website and my prescription didn't appear there. After about 10 days, I heard from my PCP's office: there had been some problem with getting the mail-away drug program to accept my prescription. They think it has been resolved.

Next, I get an automated call from the mail-away drug program, asking me to confirm my zip code and address. They say that the address in their system and in the PCP's system don't match. I'm starting to realize that my doctor's office probably has my zip code entered incorrectly (there are 2 zip codes in my town and people tend to confuse them). This has caused all this delay.

So now the prescription is on the website, and everything looks okay. Except it hasn't been filled or mailed.

What the hell is going on? And my medication supply is dwindling.

Probably a week later, I get another automated call from the mail-away drug program. There has been a delay in my order (no explanation for the delay). Am I running out of medication? If I am, I should call them.

So by now I really am running out of medication. I call my PCP's office. Since I'm calling about a prescription, they transfer me to the nurse's voice mail. I explain the situation and that I need a refill from the local pharmacy because the mail order one is being delayed. The voice mail says that if you are running out of a prescription, you should call the pharmacy and have them fax a request to the PCP's office.

I call the pharmacy, and they tell me that they can fax a refill request to my PCP's office. So I have them do that. And then I leave another message at my PCP's nurse's voice mail.

Finally, I take my last pill. Now I am starting to get very nervous because if I miss these pills for more than a day, I'll start getting side effects.

I decide to call the mail order drug program. (I don't know why I am protecting them: Medco is the company.) A very polite woman says that my prescription was sent 2 days ago and should arrive soon. I tell her that I am now out of medication. She offers to authorize a "bridge" prescription of my medication, but...my PCP has to authorize it before the drug store will fill it. Also, since I've already run out of medication, do I want counseling?

Counseling? No, I want my prescription. Thank you very much.

I call my PCP's office again. This time I am able to talk to a human being who discovers 2 interesting things while looking at my record: 1) my zip code is incorrect in their system (as I suspected) which caused the delay in the first place with the mail order company, and 2) the nurse did indeed already call the prescription into the local drug store. I am relieved, and plan to pick up the prescription at the drug store when I get home.

When I get home from work, the medication has arrived from the mail order company. I take my pills. All is well with the world.

Or is it?

Why did I have to jump through all these hoops just to get my prescription filled? This is absolutely ridiculous.

So back to where we began: non-adherence. It's easy to see how people get off-track with their medications when you have to deal with #$%@ like this. Sure, some folks probably don't take their medications for other reasons. But I'll bet that a lot of the non-adherence now-a-days is due to ridiculousness like this. It just isn't right.

P.S. As a final nail in the coffin, I just tried to pick up my prescription at the local pharmacy. The emergency prescription that was supposed to hold me over in case my mail-order prescription didn't arrive soon enough? It was denied by the insurance company.