During a visit to the ER, the doctor on duty prescribed medication that is virtually impossible to administer.
August 4, 2011 2:06 PM   Subscribe

During a visit to the ER, the doctor on duty prescribed medication that is virtually impossible to administer.

The original reason for the visit to the ER came after my girlfriend borrowed my bike 5 days ago, slipped on the pedal and fell onto the crossbar. This resulted in some fully expected pain that lasted a few hours. This happened to come right at the beginning of her period.

By yesterday morning, the pain had worsened to the point where she said it felt like pins in her urethra and labia minora. We went to the ER where they determined after a short observation and X-ray that it was a relatively minor contusion that felt worse because of its location. They advised on a normal regimen of ibuprofen.

About 8 hours after we left the ER, the condition worsened, became even more painful, the affected area became more swollen, there was a small amount of blood in her urine (possible related to menstruation), and a white discharge with an odor she was not familiar with We decided to sleep on it until it became unbearable so we went to the ER again.

This would be a good time to mention that my girlfriend has Vaginismus of the psychological variety. If you are not familiar with the condition, it's where the vagina will reflexively contract when any foreign object tries to gain entry. She has in the past compared it to trying to keep your eye open as you see a pencil coming towards it. The difficulty of trying to do this is compounded by it being extremely painful. She tells me that many doctors, even OB/GYN's have trouble fully understanding the issue, so I knew we might run into a little problem with the ER doctor if he needed any cultures or swabs.

And that's exactly what they needed. As expected, he seemed to not understand why putting as much as a q-tip in there was so hard. After about 10 minutes and a lot of tears and hand holding, she was finally able to provide the needed sample.

In the end, she tested positive for a Yeast infection and he prescribed Monistat 3 for this. He also prescribed an antibiotic for bacteria found in the urine. My girlfriend has never used monistat 3, which we found when we opened the box, which requires application with something considerably larger than a q-tip. In the past physicians, being aware of her vaginismus, have prescribed a topical cream in tandem with oral medication.

We are at a loss for what to do. We have already paid for two ER visits. We are currently a couple of nearly broke students and cannot pay any portion of her deductible to go to a physician. Is there any recourse we can take that won't result in having to pay for another ER visit?
posted by triceryclops to Health & Fitness (15 answers total)
Does your school have any sort of health clinic? They should be able to see you inexpensively and prescribe a pill to help with the yeast infection.
posted by needs more cowbell at 2:11 PM on August 4, 2011

Unfortunately Monistat oral version is prescription-only, but you shouldn't need another doctor's visit to switch types - I would call your regular physician and see if you can explain the situation over the phone to the doctor or her RN and get a prescription without an exam.

In the future, emergency clinics are often much cheaper and faster than an ER for matters that are not necessarily acute. I also second the suggestion to see if your school has a health clinic.
posted by muddgirl at 2:13 PM on August 4, 2011 [1 favorite]

Yes, call her usual doctor and explain the situation. You will likely have to leave a message for the doctor or nurse and they will call you back. It will help if you can have the name, fax, and phone number of your preferred pharmacy available when you call, so they can simply send the prescription to the pharmacy and you can go pick it up.
posted by vytae at 2:24 PM on August 4, 2011

Call them, explain that she cannot use the prescribed option and ask to have a new prescription or medical advice issued. Explain that the visits are expensive, intrusive and that she has been given medical advice that she cannot use. IANAD I think there is an oral option for medication.

Is it possible that external application that is somewhat vigorous will push some goop further up?

And I'm sorry that she has this difficult condition that is not being properly cared for by her health care providers. They may have a patient services manager to whom you can and should complain.
posted by theora55 at 2:27 PM on August 4, 2011

Are there any campus health services that you can use? Any 'urgent care' centers or low-cost health options you can use instead of going to the ER?
posted by bq at 2:54 PM on August 4, 2011

Realistically, if you go back to the ER you will end up frustrated (and so will the people at the ER). If you call the ER doc and ask them for a new prescription, you will probably end up frustrated as well because they are unlikely to prescribe you medication over the phone.

I can almost guarantee that they will tell you that it is an emergency situation, come in and be evaluated. If it's not, you need to see another doctor.

Your best bet would be a sliding scale women's health clinic, like Planned Parenthood, or your primary care doctor/OB-GYN.
posted by the young rope-rider at 2:58 PM on August 4, 2011 [5 favorites]

Can you get Canesten Oral over the counter in the US? It's available in Canada, it's a combo topical cream and oral medication, same as would be prescribed. Hopefully it's available to your girlfriend without a prescription.
posted by Felicity Rilke at 3:01 PM on August 4, 2011

At the ER where I work, it is not uncommon for someone to call regarding a problem with something they have been prescribed. Unless it's someone who is drug-seeking, the ER docs will rectify it for them. Just call the ER and explain the situation. If they won't do it over the phone, tell them you'll pick up a prescription...it really shouldn't be a big deal. Admittedly, I don't know if this works in all hospitals, but I would venture a guess that it won't be a problem.
posted by fresh-rn at 3:45 PM on August 4, 2011

It's worth a shot to talk to your pharmacist. Explain what is up and why it's needed. The pharmacist will have a lot more leverage in calling to the ER Doctor and getting a change in script.
posted by Mister Fabulous at 3:59 PM on August 4, 2011 [4 favorites]

Seconding fresh-rn. My (uninsured) brother was prescribed some antibiotics at an ER that cost about $100. The pharmacist called the ER back and got a prescription for a less costly alternative. It was no problem. Then after he started taking the antibiotics, he remembered that he is allergic to that particular antibiotic and started having symptoms. So we had to call the ER again to get a different antibiotic. We had to do a bunch of explaining, but it was fine.

Just call them and explain what you need.
posted by jeoc at 4:10 PM on August 4, 2011 [1 favorite]

Seconding the above: talk to the pharmacist. Pharmacists exist to deal with these kinds of "I'm having a problem taking my medication. What do I do?" questions. They actually went to school and got an advanced degree in this stuff, and the good ones are really serious about patient care when someone is having a problem. If you find a really awesome pharmacist, he/she might even have some suggestions to make the process easier, no matter what medication you wind up with.
posted by zachlipton at 6:39 PM on August 4, 2011

Planned Parenthood will provide knowledgeable, sensitive and affordable care.
posted by goggie at 6:41 PM on August 4, 2011 [2 favorites]

Chiming in to say it seems really odd that they prescribed her an antibiotic at the same time as medication for a yeast infection. Antibiotics frequently CAUSE yeast infections, because they kill off beneficial bacteria and affect ph balance... there was a thread late yesterday about this you might want to check. You should look for a second opinion, maybe just a call to ask for advice, should be free.

And nthing urgent care, around here a visit is a flat $50 without insurance and they can prescribe cheap generic meds and give advice.
posted by catatethebird at 6:46 PM on August 4, 2011

Diflucan is an oral yeast infection medication, and I find it works really well. I get a prescription for it every time I have to take an antibiotic, because those always cause them for me. I don't have vaginismus, but I'll still never do the suppository ones again, because they're really gross. Just call and tell them you need a switch, and I really can't imagine they'd refuse. Worst case, make the pharmacist make the request of the doctor who prescribed the antibiotics. Pharmacists are generally a little less stressed than ER doctors, and have more time to listen sympathetically, but still possess the ability to do something to help.

And if none of this works, Planned Parenthood is indeed the best. When I was really poor, they always worked with me to make sure I could afford care. People also recommend eating yogurt to help with yeast infections. I don't know how useful it is, but it can certainly be tasty, and that can only help.

My sympathies to your lady friend. Problems Down There (TM) suck. I hope this gets better soon.
posted by Because at 7:03 PM on August 4, 2011

Either call her regular doc or GYN and ask for Diflucan. Her GYN should understand why after explaining the ER trip and you could provide the discharge papers with the diagnosis to show she's been seen. FWIW I always ask for Diflucan when I get antibiotics because it seems like I get a yeast infection just by looking at an antibiotic. For women, it's not a big deal, it's either just one or two pills (that's it) and it's common. The pharmacist might be able to call and request it for you. Planned Parenthood is also a wonderful option if there is no regular doctor.

If she has the monist at cream and shes itching, she can use that externally (and as far internally as she can handle) to help soothe the itching while she waits form the Diflucan to work. Just make sure there's no broken skin down there anywhere else because it might burn or make things worse if it gets into an area it shouldn't be in.
posted by MultiFaceted at 9:38 PM on August 4, 2011

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