Patients – call the doctor yourself
I got this comment in response to PROFESSIONAL COURTESY. My response is below in bold. Now, I'm not trying to single this person out or make them feel bad, this question just applies to so many people -- and the response actually applies to ALL patients...:-)
I respect pharmacies and pharmacists. I honestly see them put up with a lot of rude, direspectful people. I have a question. I don't want to irritate my pharmacy in any way. they are a large chain and I am not the only customer who needs help. I have a family member in their 80's who needs a refill on hydrocodone..sp ?. and there are no refills. We called in the request yesterday morning and the pharmacy said they are waiting to hear back from the doctor. We are going out of town for Thanksgiving and the medicine did not actually run out until today. Would there be a reason why the doctor would not call back or fax back or whatever the procedure is? I don't want to irritate them. And I know our family member will not need this medication after this refill. They were hit by a car 4 months ago and have gone through therapy, etc. But they are too afraid to tell the doctor they hurt. There have only been 2 refills requested since that time.
What would be your best advice for us?
Regardless of the situation or time frame - the best advice is always the same:
PATIENTS CALL DOCTOR'S OFFICE
If the patient calls the doctor's office, it truly makes the office give a shit. They hear from me EVERY DAY -- they here from you every other month...and you pay their bills! I won't call that office and raise hell, but you will! So, do it...you fucking call me raising all kinds of hell, why not them too?
Patients like to say that "their doctor is so slow", "he always does this", "I can't believe he didn't call in the refill!" News flash, you can go to any doctor you like -- so do it! Find a new doctor that runs a better office -- one that will take care of you when you need it and not when it's convenient for THEM.
I guess all this boils down to is YOUR RESPONSIBILITY. Yeah, it sucks that you have some, but I cannot be expected to do everything -- I can't call your doctor every 2 hours asking for your refill. You gotta take some initiative of your own rather than floating through life like lumps of crap expecting everyone else to powder your ass.
Anything to add?
Stupid Voicemail
I've never really bitched about this much, but the quality of the voicemails I receive has deteriorated to a point that I cannot take it anymore. I'm tempted to shut my VM system off and require all practicioner's offices speak with a pharmacist. I have the powah! I can do it...
I've got a pretty good system installed. I can replay or even fast forward or rewind a second by pressing a button (many seconds if hit repeatedly). But, when nurses are calling in these fucking scripts as one long word, it doesn't matter. Worst of all, no one spells anymore - Not patient names, not doctor names, nothing.
Case in point: Nurse today called in an Rx that sounded like this (read as fast as possible and slur the words together) -- "Hey this is Ann calling from doctor Badduda first name Mowaffaq prescription is for Shalonda Teddleston date of birth 5-5-75 for Lortab 7.5 #15 taken 1 BID prn pain office call back number is 555-6969."
Here's what is wrong with this voicemail:
1. She works for a foreign doctor. You have GOT to spell those names. I could care less where they are from, but I'm not familiar with spelling of their names. If it were John Smith, I'm cool with it. It's not. Spell the fucking name.
2. Patient's name could be spelled multiple ways. Is the last name spelled with T's or D's -- they sound the same in a crappily left message.
3. Birthday of May 5th? FIVE FIVE sounds like NINE NINE. Make sure you are audible!
4. Lortab was mumbled. I misheard it. I originally wrote down FORTAZ. Of course, once I reread it, it didn't make sense. So, I read between the lines. (Fortaz is an injectable antibiotic and wouldn't be given prn and it's a 1g+ dose -- not 7.5mg).
5. In a fast, mumbled message, BID can sound like TID. How much fucking more time does it take to say twice a day or every 12 hours?
6. Office number is always given so fast it's pretty much inaudible. You know it by heart, I don't. Would you fucking slow down?
As you can see, the voicemail system has given me 6 opportunities to screw something up in a 15 second voicemail. If the voicemail had been 30 seconds and the bitch had slowed down a bit, there would have been no problems on my end and no gripes.
There's just no rationalization these fucking LPNs and RNs can give that makes this ok. It's unsafe. They sound more retarded than they actually are, and they are putting our 'healthcare team' at risk for making a dangerous mistake...all because they don't have an extra 15-20 seconds to speak slower. Way to go, bitches.
Now, the fun goes both ways. I've been known to leave a fast voicemail in my day -- mostly in response to this kind of bullshit. Next time I have a refill request for this bitch, I'm gonna talk as fast as possible. She won't get it. She won't put one and one together (well, if she does, she'll get eight).
Most of my calling has been converted to faxing. I'm pushing to move ALL of it there....because of this bullshit.
I'll probably call her tomorrow and explain the situation to her...slowly. See if maybe I can reason with her. It won't work, but maybe, just maybe, the hamster wheel in her head will turn a few times and she can spare 15 seconds for me.
-=+=-
Here's a fun game I like to play. Some nurses call in and "want to talk to the pharmacist" to phone in a prescription. When I get fast talked, and I'm actually TALKING to the asshole --err-- nurse, I always take my time. I write as slow as possible. I repeat everything, maybe even twice. I speak as if I've had a stroke and in a thick southern accent...think Deliverance mixed with Cleveland from Family Guy. I love it when they get frustrated and try to hurry up and get off the phone. "Just to make sure I get everything right, please repeat the prescription back to me again." I end the phone call by saying that they need to slow down a little bit or the patient could be the one that pays for their haste. "Would you rather me fill your child's prescription as fast as possible, or diligent and correctly? Only one can happen. Your haste makes mistakes. If you don't have time to call in a prescription get a fax machine, hire more help, or call them all in at the end of the day when you have time. Your patients will wait, they have no choice, and they will rejoice that you are giving them Toprol rather than Topamax."
Discharge Scripts
Do they even look at these damn things?
I have a hospital near me that generates discharge scripts via computer. It's all based on what meds the patient was on during the stay in-house. I know the process there because I called and spoke with their pharmacist on duty one night. We hate our jobs equally.
It goes like this. The Ward Clerk generates a list of all current meds on the MAR (Medication Administration Record). This sheet includes PRNs, parenterals, orals, rectals -- the works. The doctor then goes down the list and circles YES or NO. This sheet is then sent to the pharmacist who removes the NO drugs from the profile (by D/C'ing them). Then, the pharmacist prints these sheets directly on the floor and they are reviewed by the patient's nurse based on what was said and what s/he expected. There is a space for the doctor to sign. My pharmacy will fill these w/o the docs signature because we deal with the hospital so much and these sheets are not "fake able." I will admit though, that only 1 out of every 50 are unsigned. So, for the most part, the doctor has the OPPORTUNITY to review these sheets again. A quantity is written in on the bottom as well -- usually it's ONE MONTH.
So I can say, without a doubt then, that at least THREE sets of eyes see (or should see) these damn things before being given to a patient -- Pharmacist, [Ward Clerk perhaps?], Nurse, and Doctor.
Why in the fuck did I get a sheet today that listed:
1. Fentanyl PCA 10mcg/hr Basal with 10mcg on Demand Every 10 Minutes.
2. D5NS 100mL/hr
3. Naloxone
- This was obviously in a 'set' with the Fentanyl to pull from a Pyxis if needed.
4. Heparin Lock Flush 100 Units prn
5. Ancef 1g one hour pre-op
How did this shit get by? It was fucking signed by the doctor. He even wrote in *his* DEA number to cover the fentanyl...the only Narc on the script.
There was more on the script of course - they always leave OTC/PRN stuff and we just use our professional judgment on how to get those things to the patients (Ibuprofen, Docusate, Baby ASA). Usually we just grab it off the shelf if they want it.
But seriously? Dextrose in Normal Saline? Would you like me to educate the patient on how to start a line on himself? Should I also work through with him on how to operate the PCA Pump he has in his bedroom - making sure he sets it for MICROgrams rather than MILLIgrams since it's fentanyl? [End Sarcasm]
I'm expected to review my work before it leaves my pharmacy. Why is this healthcare team not expected to do the same? I could get in serious trouble for not checking my final product prepared by my technicians.
If you care about the outcome I reached - I just scratched the bullshit out. Later in the night when it slowed down, I called the pharmacist on duty there and let him know that that stuff snuck through. He attributed it to "a student screwing around on the computer." I attributed it to his laziness or lackadaisical demeanor. He did not like my analysis -- nor did he apologize for the actions of himself or his student. If his lame-ass excuse was valid/true -- it's still his fault for not staring over the student's shoulder...which would be the law for the student entering orders in my state of residence.
"Omnipotent" Assholes and Dirty Ol' (wo)Men….
This post comprises of the last few weeks of work, which have been unusually uneventful for me.... I start to worry as NOTHING EVER goes quietly for me. I couldn't write as the last post dive bombed, so I'll see how this goes, and if I cock up, I shall blog no more.
The *Angriest* one's funniest post to date (IMHO) comprised of a complete arse of a "pharmacist" (no way was that real) trying to communicate with a patient (which makes me think it is a couple of medical students taking the piss out of our profession-because doctors don't know or care how the drugs work).
There are two types of medical students-the chilled and relaxed (the minority) and the stressed and partied out (the majority, that become "omnipotent" assholes). So unfortunate that my little sister will fall into the latter category, though my blog is fast becoming an icon amongst the med students in her class-not quite what I intended!! Though a few have decided to try dentistry instead....as they now fear the wrath of the pharmacist!!
Omnipotent....used when describing a god because they are faultless and are never wrong, they know everything. Doctors may play with lives and like to play god, make mistakes like all humans do (otherwise they'd never learn ANYTHING-and usually we pharmacists are their reference guide) yet know FUCK ALL. I always laugh when a patient says they'd rather take their doctors word for it....because the very next week they are banging down your door because the doctor couldn't be bothered with them! For example, yesterday I had to call for an ambulance for a patient who was suffering from severe dehydration after a bout of food poisoning-which the GP dismissed as "hyperchondrical".....(fucking knob).
A local doctor (the same one as above, ahem) made the mistake of missing a patients adverse drug reaction to ibuprofen (Advil). I spotted it, reported it and did my duty. The doctor said to just dispense the prescription ("omnipotent" asshole). I told the patient that if he had any further trouble to talk to the doctor, as I was overruled. Like Pilate, I washed my hands....
Now, for the Dirty Ol' (wo)men. Now, you'd think that for all the censorship, rules and regs we have to face in our personal lives, that those that set the standard originally would adhere to it-apparently this is not the case in Bonnie Scotland....
Last week, a woman, in her 70s asked to speak to me. In front of other customers, she proceeded to describe how itchy her lips were and that the doctor had given her a cream for them. I could see nothing wrong, until she uttered the words that nearly put me off sex for life "NO, not those lips dear. The lips DOWN UNDER" and pointed. Nice. Then there's the "confident" (i.e. limp) men over the age of 60 getting Viagra for free, and they ALWAYS wink at me when I hand them their items (shudder). The worst has to be a man in his 90s (yes, over NINETY YEARS OLD), telling me that my name was very "Victorian" and he imagined me in a corset and crinoline dress... Never have I felt so used....
I think as a pharmacist you develop immunity as you always have to appear professional. When it happens to my staff though, I really laugh. These are women 20 years older than me, and they still get embarrassed, even though they've probably seen it all before! A member of my staff got very embarrassed the other day as she was witnessing a man take his trousers off-she froze and didn't know what to do! Thankfully he had another pair on under them! HAHAHAHAHA! I stood watching her face getting redder and him wrestling with his trousers in front of a shop full of people. Fair enough, I probably should have intervened, but I couldn't. (Probably the reason why I have an impacted wisdom tooth now, and am on antibiotics-which means that the alcoholic beverages are out for the next week, and the pain of it makes me VERY bitchy.Karma).
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