Neel hits the road later in the day to make his way to two nursing homes in rural Georgia, where he will review the charts of dozens of residents and carry on his long-running crusade against the overmedication of geriatric residents in long-term care facilities.
Neel does this two or three days a week, nearly every week, and has been doing it since 1968, when he decided to focus exclusively on clinical consulting. He’s one of a few thousand consultant pharmacists nationwide who specialize in identifying, resolving and preventing medication-related problems that affect, and afflict, older people.
"You see so many cookie-cutter approaches to taking care of old people," Neel says. "Almost 100 percent of the people I see as outpatients are overmedicated, because the ones I see are the ones who are having problems. If I go into a long-term care environment, it’s about 80 percent."
Typically, medication levels in nursing homes can be cut in half or better. "If I can get the drug therapy management correct," Neel says, "there are fewer hospital stays, fewer hospital admissions, lower labor costs involved in care and a better quality of life for residents."
A Rebel With a Cause
Neel is a rebel with a cause — namely, advancing the idea that pharmacists must serve and protect the people who take the medications they dispense. "I get paid by the patient," he says, "not the doc."
The way Neel sees it, pharmacists are often a patient’s last line of defense in a nation of doctors who, more often than not, don’t know much about the drugs they are prescribing and the geriatric population they are treating.
The renegade streak goes way back. In 1963, for instance, just two years out of pharmacy school, Neel opened an apothecary shop in Griffin that, just like a doctor’s office, had a carpeted reception room and a separate consultation room. He also set up prenatal counseling programs as well as hypertension and diabetes clinics. Neel thought the new approach would earn praise; instead it drew ridicule from many of his peers.
In the late 1960s, Neel, at the request of a friend, started doing some clinical consulting in nursing homes, and what he saw both shocked and transformed him.
Next: An epidemic of overmedication. >>