The smart alecks that post wise guy comments on my, and other pharmacist websites, usually only have one or two things they say regarding the worth of pharmacists. The root of their hatred for the profession that does so much for the common citizen is seeded in their jealousy of the wages paid to such highly trained professionals. Along the same lines, they only see pieces of paper (money and prescriptions) coming in and bottles filled with 30 pills each going out. Haters see it as overly simplified. Exoterically, from the outside looking in, it is, but for those of us that spent 6 to 8 years getting a doctorate, we don't agree. Compared to backbreaking labor outside in the hot sun, I can at least understand.
I've also had a recent brash of problems with patients being rude/uncaring about the difference between requirements of a pharmacist versus services provided by a pharmacy. Some things we do are required by laws, federal or state, while some things are done to ensure patients have a good pharmacy experience and return with more pieces of paper.
1. I take the prescription from you. I ensure it meets all legal requirements (Name, Date, Drug name, directions, quantity, refills, doctor signature, and in my state, the Rx symbol on the face of the prescription).
2. I input in the computer (the computer system is not required. I could use a typewriter or even hand write the labels).
3. A prospective DUR (Drug Utilization Review) is performed by either the pharmacist manually and/or the computer system automatically ensuring that there are no drug-drug, drug-disease, or drug-patient interactions requiring concern. If there is, the physician in contacted. The patient is educated or the drug is changed to an alternative at this point. If there is no problems, we move on:
4. A label is generated and placed on an amber bottle.
5. The appropriate drug is counted and placed into the bottle.
6. Final check is performed by pharmacist and all aspects of the process is verified again. Finalized product is bagged and put into the pharmacy's WCB (Will Call Bin).
7. Patient picks up medicine. Patient is provided the opportunity to ask a pharmacist any questions concerning the medicine with the magic question, "Do you have any questions for the pharmacist?" -- this requirement not being added until 1990.
1. Billing your prescription insurance (or Medicaid) for the cost of your medicine (I don't have to take any insurance - let alone YOUR insurance). Some compounding pharmacies refuse to accept insurance and are cash-only.
2. Calling your insurance if their is a problem such as them not wanting to pay for the expensive name-brand drug your doctor wrote for, the quantity he wrote for, or for any of millions of other reasons they could dream up. Perhaps you remember when CVS made the decision to not call your insurance for problems any more. They accomplished this by placing a phone in the waiting room. It didn't go over well, but it proves my point.
3. Calling your doctor for refills when your prescription runs out. This is the job of the PATIENT that has been performed by pharmacy's striving to merely keep patients from having the opportunity to take their pieces of paper elsewhere if they are forced to visit the doctor for refills.
4. An easy open lid is placed on your bottle instead of the safety lid which is the legal requirement. (Screw your arthritis - I don't have to cater to you!)
5. Paging your name overhead when your prescription is ready -- that's all southern hospitality, buddy!
6. Taking checks or credit cards is also optional. Cash is the only requirement -- read the dollar bill. Does your credit card or check say that I *have* to take it? Nope.
7. Flavoring your child's antibiotic with out FlavorRx system.
8. Anything or everything related to having a drive-thru or providing services through it.
9. Being nice to you in any way, shape, or form. I just have to be there and be sober...I don't have to be my normally delightful self...
I'm sure this second list has a BUNCH more items on it. Fill in the holes for me...I'll add them to the list.
Late this afternoon, I got an electronic prescription sent in from, let's call him Dr. Lou Pressor. It was written as follows:
1t po qd #90+0rf
What's missing here? That's right -- a salt! We have two different drugs we could fill this with. It could be Metoprolol TARTRATE (Lopressor) or Metoprolol SUCCINATE (Toprol XL). Both are available in a 50mg dose, but since the doctor did not specify, we have no idea.
Upon looking at the patient's history, we have no way to guess what the patient should get as this is an entirely new drug for him. I called the patient to see if he could tell me exactly what he was getting, and unfortunately, he had a touch of elderly dementia / senility and was unhelpful. I will, from time to time, ask a patient to fill in the blank here. If, without any prompting, they can tell me exactly what medicine they are supposed to be getting I will go ahead and fill it based on that fact with a quick note jotted down. Now, if that's correct or not, I don't know, but it sure beats the hell out of waiting on hold for a nurse for 20 minutes and waiting 3 HOURS for their return call!
So, since Mr. Magoo was unhelpful, I reluctantly made the call to the doctor's office. I relayed the message to the nurse and about an hour later, a jerk ass doctor called me back.
"And what was your question about Mr. Magoo's prescription?"
"Well, we got an electronic prescription that just said Metoprolol 50mg, one a day, #90, but it did not say succinate or tartrate. So, I wasn't sure which it would be. The patient wasn't capable of filling me in so...."
"Well, you must have been able to assume it was succinate since it was a once a day dose..."
"Not necessarily. There are tons of people that take the tartrate once a day and do just fine."
"That's ridiculous. Tartrate has to be dosed B-I-D. "
"You'd be surprised. In any event, I simply can't make assumptions in my position. Would you want me making assumptions on all your prescriptions? If you wrote Diltiazem 240mg daily, would you want me to assume you meant CD or XR because it makes sense to me? While the world should operate based on logic and reasoning, it simply doesn't..."
"Guess not...Thanks for calling..."
The Angriest Pharmacist -- converting doctors into pharmacy fans one at a time....
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?
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."