Anna Nicole Smith was both a beauty and a joke—a caricature of all that we find admirable in the female sex. She was a former Playboy model with a strong personality who battled the demons of her weight, self-esteem and the endless criticisms of others.
I did not think very highly of her while she was alive. I viewed her with the kind of contempt that most people have for “reality TV stars.” I’ll admit to being fascinated by her TV show in the kind of way that people gawk at accidents.
Yet, in her death, Anna Nicole Smith has brought about a very important debate in the healthcare community. Smith’s accidental drug overdose, while personally tragic, was preventable. Many in the medical profession have been shocked to learn that nearly all of the prescriptions that Smith was ingesting with gusto were prescribed by the same physician—Dr. Khristine Eroshevich. My intent in mentioning this is not to find fault with Dr. Eroshevich’s professional medical judgment, which could surely be the subject of other blog entries. Rather, Smith’s death and Dr. Eroshevich’s role highlight several major problems with the health delivery system.
When I first got into the business, I had asked a physician friend to prescribe a PPI for my acid reflux, which had been diagnosed by a gastroenterologist. It was preferable to waiting months for an appointment with the gastro and dealing with HMO referrals. Citing ethics, my friend declined since it was inappropriate for him to treat me as his friend. Yet, Dr. Eroshevich was treating her friend Anna Nicole Smith. Slowly, the profession has wandered and somewhere along the way, the ethical concern of treating friends and family members has been lost.
This has coincided with the rise in opinion that physicians are not responsible for their professional medical decisions. At a recent dinner with physician, I was shocked to hear them discussing prescription errors with a detached view that it was the “drug” that caused the problem, not their decision to put the patient on it. One doctor felt no sense of ownership in his decision to put a patient with cardiovascular risk on Vioxx. I take the view that the drug wouldn’t have harmed the patient if the physician hadn’t instructed them to take it. Physicians must again “own” their professional decisions. This also includes admitting those instances in which they make mistakes. Dr. Eroshevich’s decisions led to Anna Nicole Smith’s premature demise.
The second issue that Smith’s death has raised is how a learned intermediary could not be aware of the various drug interactions. The alternative is that Dr. Eroshevich knew of the interactions, yet continued with her reckless professional behavior. Some are willing to make those charges, but I am not. Rather, I believe this is exactly the accident it appears to be. The doctor was treating the individual symptoms as they presented and was not considering the entire patient. This is not a problem with just Dr. Eroshevich, rather it is a failing of the healthcare system.
There are solutions to the problem of concomitant drug interactions. Electronic Health Records (HER)/Electronic Medical Records (EMR) could provide immediate warnings to physicians of interactions as the drugs are prescribed. This would not prevent errors attributed to “doctor shopping,” although would surely cut down on some of the 1.5 million physician prescribing errors.
A more active and comprehensive approach would be active prescription monitoring. Just as each doc has a DEA number, patients could be assigned a unique patient identifier to monitor the prescription and medical procedures they receive. This solution would also catch potential errors that slip by pharmacists when patient’s fill prescriptions at several different pharmacies. A patient ID system would certainly solve the problem. However, this is very “big brother” and too difficult for many people to swallow.
As a profession and an industry, we can view Anna Nicole’s death as an isolated incident and an oddity of Hollywood—something to be gawked at and joked about over our evening cocktails. We can allow it to be the sensational ending to the tabloid life. Or we can view it as representative of the drama that plays out in homes across America. The use and abuse of prescription products, and the doctor’s role in this crisis, is not a problem that the profession can sweep conveniently into the closet.
This lesson was brought home to me recently on a flight when I sat next to a family with a high school junior. She had a friend at her high school who passed away from an overdose of ativan. People, particularly young people, find it easy to get their hands on these powerful medications, and many physicians are eager to assist. Unless we take the problem seriously, there will be many more deaths like Anna Nicole’s. I hope we take the lesson of Anna Nicole Smith’s death as a prescription for a change.
I did not think very highly of her while she was alive. I viewed her with the kind of contempt that most people have for “reality TV stars.” I’ll admit to being fascinated by her TV show in the kind of way that people gawk at accidents.
Yet, in her death, Anna Nicole Smith has brought about a very important debate in the healthcare community. Smith’s accidental drug overdose, while personally tragic, was preventable. Many in the medical profession have been shocked to learn that nearly all of the prescriptions that Smith was ingesting with gusto were prescribed by the same physician—Dr. Khristine Eroshevich. My intent in mentioning this is not to find fault with Dr. Eroshevich’s professional medical judgment, which could surely be the subject of other blog entries. Rather, Smith’s death and Dr. Eroshevich’s role highlight several major problems with the health delivery system.
When I first got into the business, I had asked a physician friend to prescribe a PPI for my acid reflux, which had been diagnosed by a gastroenterologist. It was preferable to waiting months for an appointment with the gastro and dealing with HMO referrals. Citing ethics, my friend declined since it was inappropriate for him to treat me as his friend. Yet, Dr. Eroshevich was treating her friend Anna Nicole Smith. Slowly, the profession has wandered and somewhere along the way, the ethical concern of treating friends and family members has been lost.
This has coincided with the rise in opinion that physicians are not responsible for their professional medical decisions. At a recent dinner with physician, I was shocked to hear them discussing prescription errors with a detached view that it was the “drug” that caused the problem, not their decision to put the patient on it. One doctor felt no sense of ownership in his decision to put a patient with cardiovascular risk on Vioxx. I take the view that the drug wouldn’t have harmed the patient if the physician hadn’t instructed them to take it. Physicians must again “own” their professional decisions. This also includes admitting those instances in which they make mistakes. Dr. Eroshevich’s decisions led to Anna Nicole Smith’s premature demise.
The second issue that Smith’s death has raised is how a learned intermediary could not be aware of the various drug interactions. The alternative is that Dr. Eroshevich knew of the interactions, yet continued with her reckless professional behavior. Some are willing to make those charges, but I am not. Rather, I believe this is exactly the accident it appears to be. The doctor was treating the individual symptoms as they presented and was not considering the entire patient. This is not a problem with just Dr. Eroshevich, rather it is a failing of the healthcare system.
There are solutions to the problem of concomitant drug interactions. Electronic Health Records (HER)/Electronic Medical Records (EMR) could provide immediate warnings to physicians of interactions as the drugs are prescribed. This would not prevent errors attributed to “doctor shopping,” although would surely cut down on some of the 1.5 million physician prescribing errors.
A more active and comprehensive approach would be active prescription monitoring. Just as each doc has a DEA number, patients could be assigned a unique patient identifier to monitor the prescription and medical procedures they receive. This solution would also catch potential errors that slip by pharmacists when patient’s fill prescriptions at several different pharmacies. A patient ID system would certainly solve the problem. However, this is very “big brother” and too difficult for many people to swallow.
As a profession and an industry, we can view Anna Nicole’s death as an isolated incident and an oddity of Hollywood—something to be gawked at and joked about over our evening cocktails. We can allow it to be the sensational ending to the tabloid life. Or we can view it as representative of the drama that plays out in homes across America. The use and abuse of prescription products, and the doctor’s role in this crisis, is not a problem that the profession can sweep conveniently into the closet.
This lesson was brought home to me recently on a flight when I sat next to a family with a high school junior. She had a friend at her high school who passed away from an overdose of ativan. People, particularly young people, find it easy to get their hands on these powerful medications, and many physicians are eager to assist. Unless we take the problem seriously, there will be many more deaths like Anna Nicole’s. I hope we take the lesson of Anna Nicole Smith’s death as a prescription for a change.
