The *Angriest* Pharmacist You want your prescription filled when? Eat shit…

Professional courtesy

I got an email from "The Chick in the White Coat" asking me about professional courtesies and my take on them. She was asking about things such as the loaning of pills, calling doctors for refills, and how they have become expected of pharmacy rather than something a pharmacy does as a courtesy for patients. These things have become the rule rather than the exception.

I've never worked in pharmacy when these things weren't the norm. I'm sure once upon a time, these things were done by a few pharmacists as a way to keep customers, gain new customers, and go above and beyond what was expected....as a way to expand business. Yet, now they must be done to merely keep business and ensure people are happy. I personally think it's kind of bogus.

Loaning of Pills. I do it. We all do it at one time or another. Most pharmacy statutes allow pharmacists to dispense an "emergency" 3-day supply to a patient when a doctor cannot be contacted (and a patient had been taking the medicine for an adequate amount of time). These statues also allow pharmacists to use their professional judgment in these situations -- meaning that we wouldn't give little Timmy another bottle of Amoxicillin but we would give Grandma Johnson a few more lisinopril. Most all of us do this on a case-by-case basis. I will usually give the person three days worth if they have been on the medicine for longer than three months. If a person is a really good customer and thought of by my staff in good regard, I will give them the benefit of the doubt and front three days after only one-month of therapy. That's not exactly fair, but me giving anyone any pills is not required by law. I personally think that the patient's should take more responsibility in their healthcare and actually read the fucking bottle. When it says ZERO REFILLS, don't wait until there's 1 pill left in the damn bottle to call your doctor (or pharmacy -- see below). If a patient wants a week's worth because they are going on vacation, they are shit out of luck in my pharmacy. As a reader has said in the past (and now I say all the time): "Lack of planning on your part does not constitute an emergency for me." You can either call your doctor's exchange/emergency line or take your bottle to a pharmacy at your final destination. They can call your doctor from there. [It goes without saying that no one fronts controlled meds to any patient under any circumstances.]

Contact doctors for refills. Again, this has become the norm. Each morning, we all have a tech chained to the phone making the daily, "doctor calls." I've handled this in a few different ways. Sometimes, I come in a little early to make the calls -- before the pharmacy opens. Most MD offices open earlier, and I can get them done before my staff even arrives. Over the past 6 months or so, I've made a huge push to convert all of my calls to faxes. I've got a pretty decent relationship with most of the nurses around town (and know most of the doctors), so I've gotten them to either buy a fax machine or allow me to fax in refills. I still have one doc that absolutely refuses to accept faxes for some weird reason -- but I am down to making only 4-5 actual calls each morning. I merely told them like this, "When I call you, I get a receptionist who makes me wait on hold before she actually inquires to what I want. Then she sends me to your extension where I have to listen to your obscenely long voicemail explaining the same thing over and over again that I hear 20 times a day -- what information to leave, how to do it, and to spell everything out. Then I have to leave the message and wait for you to get back with me later in the day -- at your convenience. Why don't I just send you a fax, save my time, and you can still get back to me at your convenience. The fax will have all the info on it and will add to patient safety. It will also reduce the amount of prescriptions called in by non-medical personnel that have little to no training in medicine." -- No one has ever told me to fuck off because I'm trying to increase patient safety. I even made one trip to a doctor's office to meet with him about it. He, of course, listened to reason -- regardless of how his nurse wanted it done.

I also do my best to try and get the patient active in the process. I've tried telling them that, "Hearing from the patient that they need a refill usually gets them in gear," after we've contact the physician once. I've also flat out told other patients to call the doctor themselves in instances of early refills or for refills of antibiotics and drugs that usually do not have refills for a reason. The patient's standard response is always the same -- "I just talked to them. They said you need to call." -- Well, I don't play that game anymore. As I said above, enough of my time and my staff's time is wasted on the phone holding for a nurse. Let's waste your time, dear patient.  "You need to call the doctor and tell them to either call or fax me, because if I call, all I'm going to get is a voicemail line instructing me to leave a message -- after I wait for 5 minutes for someone to answer the phone to transfer me to the voicemail."

I've also recently installed a TTY-type device which connects me to a nearby medical group which houses something like 30 doctors. I just type my message, the doctor's extension, and it's done. They still get back to me whenever they damn well please, but it's convenient and really fast. I just take the receipt-paper printout and staple it to a blank Rx and it serves as my prescription.

I still haven't addressed the issue yet -- should we be doing this? Honestly, I think not. I think that patients should take a more active role in their healthcare. I believe that when they are out of refills, rather than depending on us to loan them pills and/or call their doctor, they should call the doctor themselves and state that they need more refills. I also think that doctors should ACCEPT THIS! Many doctor's voicemail lines boldly state, "If you are a patient, have your pharmacy call us." -- Why? I have no clue. If the doctor wants them to continue the therapy, what's the fucking issue? I understand that the office may want to know when the last fill date was, but that can be easily ascertained by even a technician when they call in the new prescription. At that point, the nurse can note that date (to track compliance) and decide whether or not the patient is actually due for a refill based in the sig and quantity dispensed. I think the nurses can handle that much...

There will be those out there that say our loaning of pills and calling MDs for refills does a lot in terms of ensuring patient compliance. I call this a load of bullshit. If a patient is not compliant with their therapy for themselves, why should I give a flying train full of antelope shit? The answer is, I don't. Here's what I think. I will help those that cannot help themselves -- the sick, the dejected, the broken, and the poor. I will not help those that refuse to help themselves. I will not care about you if YOU don't care about YOURSELF. Your health should be enough initiative to remain compliance with drug therapy. You took the time (and perhaps paid the money) to go see the doctor, bring the prescription to me, and get it filled. If your compliance depends on whether or not I give you three pills and call your doctor for additional refills, not only are you pathetic, you are doomed to have poor outcomes from your therapy.