Oct

Do the doctors even care?

Posted by The *Angriest* Pharmacist as Work Sucks

I let my keystone tech take scripts off the phone. Today, she took a script that read: E-mycin 500mg po qd #30 with one refill. I verified with her that this is what the doctor intended. She concurred, and said that was exactly what the person calling it in said. I also noticed in our computer that the patient had reported an allergy to Clarithromycin….great call, doc!

So, I called the office back to verify the prescription. I, of course, had to leave a message and wait for them to get back with me. A few hours later (and the patient yelling at me twice over the phone) the script was changed to E-mycin 500mg 2 po qd x14d with no refills. So, we went from a 30 day (subtherapeutic) supply to a 7 day supply that still subtherapeutic — not to mention that E-mycin is going to be pretty hard on the stomach at that dose. They didn’t give two shits about the allergy and said it was okay — probably an upset stomach. I’m sure she’ll be allergic to this as well.

Does this doctor even care? The patient obviously doesn’t care since she yelled at me twice on the phone for trying to get her a dose that would DO something for a bacterial infection and NOT kill her. Unfortunately, the doctor couldn’t provide either of those — as I’m not completely sure what type of reaction (if any) the patient had with erythromycin.

Nonetheless, I filled it and the patient picked it up. I told her that this medicine was usually given four times a day, but the doctor specifically told me he wanted it 2 tablets in the morning. I told her she should definitely take it with a big breakfast to help with the upset stomach that will occur.

I’m wondering if perhaps this is one of those instances where the patient goes to the doctor and pressures him/her into writing something…anything. “Why not? They paid the copayment…write me a damn script!” Of course, it’s redundant to say that this all leads to antibiotic resistance. The doctor either doesn’t care, succumbs to the pressure, or something else is going on — I’d imagine it’s a viral infection. The doctor just wanted to give her something rather inert to make her think he “made her all better” with his “life saving prescription” — we’ll see.

Or Print it...

Simon says October 23rd, 2008 at 9:14 pm

Erythromycin can be used for other reasons than killing bacteria. It can be used as a pro-motility agent, similar to Reglan (metoclopramide). It is quite effective as it is a very common side-effect of the drug.

Still, in my experience physicians dont really care much about allergies, or proper dosing or even breeding resistance which is what they do every time they use antibiotics for any sniffle or in this case probable constipation!

Keep up the good work!

Meg says October 23rd, 2008 at 9:20 pm

I just found your blog the other day. Your posts are awesome. So funny, and so true! I have a lot of respect for pharmacists and try to be as easy to deal with as possible. :)

I wanted to comment on this post because wow I hate erythromycin. About 5 years ago I had tonsillitis and I went to an emergency doctor office. They gave me erythromycin and I proceeded to throw up everything I ate. Not pleasant in any circumstance, but especially not with tonsillitis! So we went back to the office and another doctor gave me another antibiotic (and said “I don’t know WHY the original doctor even gave you erythromycin!”). Since then, every time I need an antibiotic I have to tell the nurse/doctor NOT to give me erythromycin, yet twice they’ve handed me a script for it anyway (which I hand right back of course). Sigh. Sorry, just had to rant a bit.

The Ole' Apothecary says October 23rd, 2008 at 10:31 pm

Sure turns all concepts of clinical practice into cow shit, doesn’t it? The only thing of importance is how the doctor treats a case of “gimme, gimme, gimme!”

On the flip side, however, my colleague told me yesterday about the time he intercepted a lethal dose on a pediatric chemotherapy order. The doctor said he was overworked when he wrote it. Pharmacists often do have the “key role” that academia and the pharmacy press talk about.

SKSutton says October 24th, 2008 at 5:45 am

Simon makes a good point about erythromycin for gastroparesis except the usual dose is much lower and TID still. I haven’t got a clue what this was for. And the original 30 day thing AND 1 refill is still weird. I’d be waiting for the doc to call you back and yell at YOU for giving this Rx out when you should have known it wasn’t what he REALLY meant to give the patient.

Yeah, that was my thought against that idea. Going from 60 days to 14 days is not indicative of anything other than, “I don’t give a fuck.”

sickofstupidpeople says October 26th, 2008 at 1:18 pm

Once daily e-mycin could be for acne… And, if you’re in a sunny area, a good alternative to doxy- or tetracycline. The ignoring the allergy thing? Plain stupid.
And, Meg - e-mycin is an excellent drug for strep throat if you can tolerate the GI effects. As a matter of fact, it’s a drug of choice if you have a penicillin allergy or have mononucleosis simultaneously (been there, done that). The second Dr you saw should have said that rather than just bashing the first Dr. He, in my opinion, was worse than the first one you saw - a little high & mighty…
And, for all you patients out there - ALWAYS ask the doc what they’re prescribing for you if you have allergies - BEFORE you leave the office.

Mono is a virus. Does E-mycin have antiviral activity that I’m not aware of? Or some how palliate those symptoms?

Also, if it was for acne, the doctor wouldn’t have shortened the days supply and removed the refill — acne vulgaris has to be treated for many months.

I also agree with you though — one doctor should never bash another or talk ill of their treatment options. If the doctor has a real issue, he can call the other. I’m sure that could easily straighten out the issues. Or, the doctor could simply say, “Okay, so Dr. 1 tried this. In my practice, I have had a lot of success with this (or I just read a study about how this worked well for people)…so let’s try it this way now.” Bashing is unprofessional — and it makes the other doctor look unqualified even though the bashed may actually be a better physician than the basher!

Eric says October 27th, 2008 at 2:27 pm

My eyes were opened a few years after graduating. I had an ER doc who kept writing for Erythromycin 250mg bid. Finally I caught her in the hall (I work at a VA) and asked what was up with the funky prescribing. She said ‘If I could prescribe a placebo I would.’ Since we are at a time in health care where placebos are illegal I suppose this is the next best thing, although I’d prefer to pick something with no antibiotic qualities whatsoever.

sickofstupidpeople says October 29th, 2008 at 12:22 am

If you have mono, and a simultaneous case of strep tonsilitis, amoxiciliin causes a rash - so, e-mycin is a better choice for the strep. I wasn’t suggesting emycin helps mono. sorry for the confusion.