The Pharmacist Who Says No to Drugs

Neel rises early the next morning to drive to another nursing home about 20 miles south. There, too, he has a combative relationship with the facility’s medical director.

“I Gave Him His Life Back”

As soon as Neel arrives at the facility, he searches out a 73-year-old resident who’s lived in the nursing home for five years. The man, who has advanced Parkinson’s disease, brightens instantly.

When Neel first looked at his chart, the man was on 20 milligrams of the antipsychotic medication Zyprexa, a daily dose that by any measure is therapeutic overload; he’s down to 2.5 milligrams a day, and soon, Neel says, he may be off the drug entirely.

The man’s old symptoms — nonstop yelling, tongue-thrusting, pill-rolling (a Parkinsonian tremor that takes the form of a continuous back-and-forth motion of the thumb and fingers) — have all disappeared, and now he sometimes comes to sit quietly next to Neel as he works.

The physician overseeing the man’s treatment told Neel and the nurses that he would never be able to walk again. But walk he now does — and walk and walk. He visits other residents in their rooms and likes to sit near the main nursing station — the hub of activity. "I gave him his life back," Neel says matter-of-factly.

One problem, as Neel sees it, is that few of the 300 or so doctors who treat patients in the facilities he visits have a special interest in geriatrics. How many do?

"Maybe two," he says. "They’re not up-to-date with the physiology of the geriatric patient as it relates to the chemistry of the drug. That’s the easiest way to put it."

Neel reviews a few more patient charts, producing more small pink suggestion slips, each numbered sequentially, as he goes.

At another nursing home, where Neel has known the medical director for more than 30 years, the success of a collaborative approach is clear.

"If I write up a suggestion to paint the nose blue," Neel jokes, "when I go back the next time, the nose is blue."

The cost per patient for drugs at this nursing home is down to about $14 a day, the lowest in Georgia.

Next: Ask the Pharmacist. >>