"The Art of Medicine with Dr. Andrew Wilner" explores the arts, business and clinical aspects of the practice of medicine. Guests range from a CPA who specializes in helping locum tenens physicians file their taxes to a Rabbi who shares secrets about spiritual healing. The site features physician authors such as Debra Blaine, Michael Weisberg, and Tammy Euliano, and many other fascinating guests.
Welcome to Episode #2 of The In-Between Episodes. If you remember, these in-between episodes will occur in between the more formal interviews that happen every other week and that have happened every other week for the last seven years.
Last week on the Art of Medicine, I had a great discussion with 401k specialist Ross Powell. I learned that a 401k is not only a retirement vehicle, but can be a powerful real estate investment tool as well.
Next week, September 13, Jess Wright is going to tell us about his debut novel inspired by years of practicing psychiatry. It's titled, Dance in a Madhouse, and I can't wait to read it.
Today, I'm going to tell you a story about how a 3rd party, in this case a corporation, slid between a well-meaning pharmacist and a desperate patient, which potentially fatal results.
Learn about rabies with Dr. Wilner here: https://www.vumedi.com/video/rabies-update
Psychiatrist and medical ethicist Ronald Pies, MD, assisted me with the research for this episode.
As always, your feedback is appreciated!
Please click "Fanmail" and share your feedback!
If you enjoy an episode, please share with friends and colleagues. "The Art of Medicine with Dr. Andrew Wilner" is now available on Alexa! Just say, "Play podcast The Art of Medicine with Dr. Andrew Wilner!"
Welcome to the Art of Medicine. Today is Thursday, September 3rd, and I'm recording episode number two of the in-between episodes. If you remember, these in-between episodes will occur in between the more formal interviews that happen every other week and that have happened every other week for the last seven years. With these in-between episodes, we're going to have a little fun. Last week on The Art of Medicine, I had a great discussion with 401k specialist Ross Powell. I learned that a 401 is not only a retirement vehicle, but can be a powerful real estate investment tool as well. Tune in to the August 30th episode to learn more. Next week, September 13, Jess Wright is going to tell us about his debut novel inspired by years of practicing psychiatry. It's titled Dance in a Madhouse, and I can't wait to read it. It's just me today, but I'd like to tell you a story. It's one of many, I'm sure, that illustrates how third parties are compromising the doctor-patient relationship and medical care. In this case, corporate policy created a chasm between a pharmacist and her patient, which could have proven fatal. I'm not betraying any confidential patient information here because I was the patient. And I think the story merits telling. Luckily, I survived. Here we go. In July, I had the opportunity to visit Cabilau Island. Cabilau Island is a very tiny island which is next to Bohol Island, which is a much larger island, which has regular cities and cars and an airport, and it's in the middle in the Visayas section of the Philippines. I was in Cabilau to go scuba diving, and of course, I'm I've been diving since I was a teenager, and I'm well aware of decompression sickness, air embolism, the danger of sharks, wasp jellyfish, sea urchins, and a lot of the other concerns that you need to be aware of when you want to dive safely. However, it did not dawn on me to consider a dog bite. So while I was there, a friendly little dog came up behind me, licked and scratched my leg, startled me, and I ran off. I didn't think much of above it. There wasn't an obvious wound, although it was scratched, and I was there's sticky saliva on my leg. So I washed it off, sprayed some alcohol on it, and uh didn't worry too much about it. Then I thought, gee, you know, I'm not in the United States where dogs are vaccinated for rabies. I'm in the Philippines where dogs are not routinely vaccinated for fill for rabies, and I wondered, gee, is that a problem? But I'm in such a remote area, really, should I be concerned? So I had internet, I looked it up, and sure enough, rabies is very common in Africa and Southeast Asia, where the Philippines is located. And as I researched further, I discovered that the little tiny island that I was on, in fact, had many cases of rabies and deaths of children from you know playing with stray dogs and getting scratched or nibbled on, were not uncommon. That provoked a ride on a motorcycle, which I had sworn never to do since in motorcycle accident years ago, but it was the only way to get to the boat, to get to a car, to get downtown, to find a clinic that would give me a tetanus shot and a rabies shot. So I've researched this for a grand rounds, and it's on a site called View Medi. I'll put the link in the show notes. But what I learned is that after a rabies exposure, the recommended treatment is five shots over a month. So I got my first one. I left Cabelo Island a few days later, went to uh Pampanga, got three more shots, but the fifth would shot would have to be administered in the United States. So where would I get it? So I Googled Raby Shot in Memphis, Tennessee, and sure enough, one of the local pharmacies was willing to provide it. And I made an appointment and I showed up on the designated day and at early at the designated time because I had to go off to work. And then had a very strange and unsettling encounter. The pharmacist asked some routine questions. Did I have allergies, take medications, and then asked me, was this a pre-exposure vaccination or a post-exposure? I learned later that the vaccine itself is exactly the same. For pre-exposure, you get three shots. For post-exposure, which was my case, you get five. The vaccine itself, identical, dose identical. I told her that in fact it was a scratch and it wasn't really that clear if it was truly an exposure, but to be safe, I had decided to get the post-exposure vaccinations, and that was recommended by the local doctor. And I had a little card, kind of like the COVID card, you know, with fancy stamps and dates and the type of vaccine I so I showed it to her. Oh, she says, we can't give you post-exposure vaccination. It's corporate policy. I said, I have to have it today. That's what it says on my schedule. Now, rabies, if you don't already know, is 100% fatal. Now I didn't know if I had rabies or not. The dog took off, never saw it again, even though I searched for it for a couple days. So maybe I was inoculated with rabies, and maybe not. But once you have symptoms, you die. Pretty much without fail. So this was serious, and there is a protocol for the shot, and today's the day. She said, I can't give you the shot. She said the I was at a pharmacy chain, and I won't mention their name, but she said we have a policy because we're we don't want to take responsibility in case the patient doesn't follow up. I said, Well, I'm not gonna follow up. This is day five, shot five, it was actually day 28, shot number five of a series of five. There's no follow-up question. So even if there is a policy that has a concern about follow-up and some liability, uh it doesn't apply to me. Oh no, she says, I can't give you the shot. I said, here, just between you and me, why don't we call it a pre-exposure shot? And then you can give it. Oh no, you already told me that it's post-exposure. I can't give it to you. I said, so you would rather that I would die than trespass on this corporate policy, which number one makes no sense because I researched it. There's never been a legal case like the one this corporate policy is supposed to prevent. Never, ever, ever in the United States, and it doesn't apply to me anywhere. No, she says. Well, this is a problem because the duty of the pharmacist is the ethical duty, the moral duty is to the patient. I was the patient. The primary duty is not to the corporation. Doctors, pharmacists, other health care providers have an ethical duty to the patient that surpasses other concerns. At the very least, she should have taken responsibility and said, I need to help you. Let me get a supervisor. Maybe we can override this corporate policy, or let me find a place where you can get the vaccine. She did make a suggestion, but that place was closed and just totally left me hanging. This is inappropriate. This is wrong. And stuff like this is happening every day. So because I was highly motivated, I called the emergency room at my hospital and found out whether they had the uh vaccine, and they did. So I went to employee health and after a couple hours managed to get number five out of five. And so far, I'm good. Now, rabies has an incubation period of up to five years, and this just happened a couple months ago. So I don't know if I'm in the clear yet or not. But I did what I was supposed to do. No thanks to the pharmacist. But this story is just to highlight the duty of the physician, of the pharmacist, of the medical professional, morally and ethically, must be to the patient. Well, so that's the story for today. Thanks for watching or listening. Tune in next week for a formal interview with Dr. Jess Wright. As always, I appreciate your feedback. Just press that little button on your podcast player. I'm Dr. Andrew Wilner. See you next time. This program is hosted, edited, and produced by Andrew Wilner MD, F A C P, F A A N. Guests receive no financial compensation for their appearance on the art of medicine. Andrew Wilner MD is a professor of neurology at the University of Tennessee Health Science Center in Memphis, Tennessee. Views, thoughts, and opinions expressed on this program belong solely to Dr. Wilner and his guests, and not necessarily to their employers, organizations, other group, or individual. While this program intends to be informative, it is meant for entertainment purposes only. The Art of Medicine does not offer professional, financial, legal, or medical advice. Dr. Wilner and his guests assume no responsibility or liability for any damages, financial or otherwise, that arise in connection with consuming this program's content. www.andrewwilner.com.
