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The MD’s guide to an RPh

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Lets face it, part of our jobs is dealing with Doctors of all shapes, sizes and colors.  As you can see from this website, Pharmacists are a unique and special bunch.  I hope this guide helps our MD readers out there (you cant hide from us!) understand and interact with us a bit easier.  If some MD makes an “RPh’s guide to an MD” let me know and I’ll link it here.

Both MD’s and RPh’s need to drop the egos: Face the facts, MD’s aren’t the proverbial God of medicine anymore.  The whole concept of a pharmacist being an MD’s bitch died when Lanoxin went generic (no, I wasn’t around for that).  We both need to look at each other as allies against “to better the health of” the patient.  Fortunately the doctors who pull the “This is Dr OldFart, I need this for the patient, I don’t care if its not covered do what I say *click*” are either close to retiring or already dead.  Doctors can’t afford to stock their offices with $100k worth of expensive trade-name drugs, and pharmacists can’t prescribe stuff.  Its mutual destruction if one of us goes under, so lets stick together and drop the egos. (me, the biggest pharmacy ego on the internet saying to drop the egos.  I’m talking about at work, not on the internet!)

MD’s need to stamp their prescriptions: If you don’t have a stamp (and your pads don’t pre-print your name) , print your name and DEA/NPI on every prescription.  Then spend the $4 and get a stamp after your pen explodes after the 4th Rx of the day.  Having the correct doctors name on the Rx saves a ton of time for refill requests, and prevents us from playing “guess the signature” as the patient sits there staring at us.  Oh, and you think the patient knows your name?  Unless your name is “that Indian doctor”, “the doctor who I cant understand”, or “that cute doctor on 4th street with the huge tits” (no, I’m not joking); get a stamp.

Allow us to substitute in the same class: Unless there is some HUGE issue with dispensing Aciphex instead of Protonix, please write “OK to substitute per formulary” on Rx’s that you write.  We went to school to dose drugs in the same class into ballpark ranges.  This is what we are taught to do.  Trust in our judgment!  If this doesn’t convince you, lets look at the time savings:

Drug isn’t covered.  We make a copy of the Rx and write down whats covered.  We fax it to your office where someone that you pay stops answering phone calls to take the fax and put it on your desk.  You need to look at the fax, roll your eyes at the bullshit that the insurance companies make us go through and write “OK”.  Your staff then faxes it back to us where one of our clerks pulls out the original (in case the fax was lost in transmission) and gives it to us.  All of this happens while the patient is cursing your name as to why you wrote for a drug that costs $150 when her copay should be only $15 (or $0, most likely $0) as if you know her shitty insurance formulary by heart.  By spending 10 seconds to give us permission to substitute, look at how much time everyone saves and makes you (and us) look like rock-stars to the patient.  The “Its not covered” speech turns into “What doctor wrote for isn’t covered, but he/she gave me permission to switch it to what is covered”.  I’m no longer the bearer of bad news, but your wonder-twin counterpart.

Obviously this wouldn’t apply to tweaky drugs, we (I hope) know when something is over our heads and wont try to wing a Depakote dose because Lamictal isn’t covered.  If this bothers you, we can even FAX you what we switched it to.  Trust us, seriously.  Trusting the insurance company (who is telling you what to write regardless of what you say) over us is pretty shitty.

Nobody’s shit smells any better than the other: Sometimes pharmacists fuck up.  Benazepril gets dispensed instead of lisinopril, a 4 turns into a 1, I misread your lamisil for lamictal, anything can happen.  We both make mistakes, and having a doctor throw me under the bus to the patient (or having him/her call me up and just give me both barrels) makes me more shitty than how I already feel when I make an error.  When you write for something that has a life-threatening interaction, we “fax you for clarification” not throw you under the bus and tell the patient that you almost killed him/her.  We are both busy, we both make mistakes.  Lets not finger point, because in reality when that happens we both lose.

We need to talk more: No, this isn’t a chapter in some relationship self-help book.  We need to stop using our minimum-wage staff’s as proxies and just call each other directly.  This is going to sound sappy, but I love it when a doctor call me and asks me if something is covered, or how much something costs.  Hell, even to bitch about this patient and what to give him/her to get them off of our backs.  This makes us feel like part of the “team” than just pill-pushing human shields to the medicine side of health care.  Yeah, we both are swamped all the time.  A 30 second phone call as to whats covered will save us 20 min’s (and lots of bitching) later on down the road.  You want to know the real scoop on a new drug that some big-titted rep is pushing?  Give us a call, we’ll tell you how the drug she was pushing a year ago is going generic soon so she’s pushing the “new version” to keep the sale.  Hell, even a simple “thanks” for informing you of a narc-shopper makes us feel like we did something good.  Remember, pharmacists are the underestimated fat-kid of the football team of medicine.

Show us you care by giving us lots of refills: Mrs Jones has been on Atenolol 50 since the day it first same out.  Why not give us 12 refills on that new Rx that you wrote for her?  Help us save time (and thereby saving you and your staff time) by giving a bunch of refills on drugs that the patient has been on for years (and you have no plans to change).  Obviously I don’t mean stuff that you need labs to monitor!

Med dosage/sig change? Write a new Rx: Telling the patient to take a medication differently without writing a new Rx is about as effective as giving a stripper $100 and asking for change (uh, don’t ask me how I know this).  Save us both a fax and just write/call in a new Rx for any dosing changes.  Our computer systems can put new Rxs on file for future fillings, so it just makes sense to make both of our lives easier.  Spend 30 seconds now or 20 mins (and lots of phone calls by the patient) later.

Want to know the scoop on a patient? Ask us! Patients will tell you what you want to hear so you’ll give them an Rx.  However we see when they are getting their refills, who they go to, and how they act.  The patient that complains of a 10/10 low back pain to you may waltz into the pharmacy like nothing is wrong.  You may not see how your patients act outside of your office, but we do.  We usually see your patients enough to get a good gut feeling if something fishy is going on with them.  If we don’t know, then their insurance company computers can tell us if they have been naughty or nice (like Santa!).

Hope this helps.  I’m sure other pharmacists will comment on points that I missed.

Comments #

Comment by Lucy Connors on 2010-08-10 22:50:51 -0700 #

ha ha….pharmacist-doctor relationships are EXACTLY like that in Canada, too! I can totally relate! Nice blog.

Comment by Dr. MParker on 2010-08-10 23:19:46 -0700 #

In one of my pharmacies we have a community doc who only accepts phoned refills that he ok’s himself (usually only for 3 fills), writes like a madman and often hangs up mid-pile of refill requests. If any other communication is necessary, it’s usually done in barks, grunts and yelling!

Comment by Phathead on 2010-08-11 00:04:16 -0700 #

Maybe a couple amendments:

  1. When you give a patient a prescription, do not tell them that it will be waiting for them at the pharmacy when they arrive. You do not know how our day is going and should not be giving the patient an idea on when it would be ready. If this continues to happen, we shall start telling patients to swing by your office because we know you’ll be there. You can deal with the aftermath just as we do.

  2. Just because a drug is ‘new’ doesn’t mean everyone needs to be on it. You know that extended release Aricept that will be out shortly? That doesn’t mean you have to switch everyone that you have on Aricept to the new one. Newer does not always mean better nor does it always mean the insurance will pay for it.

  3. Say thank you once in a while. You really have no idea how many times a pharmacist will save your ass on a daily basis. Whether its the fact a patient was not explained something clearly or a prescription that has errors on it, we’re the ones that pacify the patient. Remember, we’re on the front lines and not behind a series of offices and exam rooms.

  4. Have a sense of humor. Medicine cannot be serious all of the time. When we make a small joke to alleviate a stressful situation, don’t come across as an ass. We’re all in the same boat here, let’s support each other some.

  5. Be responsible for your nurses. You know what happens when a tech fucks up something in a pharmacy? It falls onto the pharmacist on duty. When your nurses make a serious mistake, as so many do on a regular basis, apologize for it. Offer that this type of thing will not happen again. Just as our tech’s represent us, your nurses represent you.

  6. You may think you’re busy, but we may be busier. Ever had to work an eight hour day where you’re luck to get a piss break? We have, and it’s not fun. While you may have an opportunity between exam rooms to swing in the bathroom or grab a quick bite of a sandwich. Sometimes, we cannot do either of those things, but we don’t complain about it. You’re not the only medical professional that is excessively busy.

Whew, it’s late and that’s about all I’ve got for now. Once you have this completely nailed out, I’m gonna repost it on my site if that’s okay with you.

Comment by Dr. Grumpy on 2010-08-11 05:36:08 -0700 #

Great post, TAP. I’m going to print this up and put it in the doctor’s lounge. It may get ignored, but you make some damn good points.

Believe it or not, I already try to do these things. I wish my colleagues would.

Comment by John Woolman on 2010-08-11 06:05:04 -0700 #

Hmm. Good arguments for generic prescribing here….

Comment by GoGatorsTech on 2010-08-11 06:25:25 -0700 #

All excellent points. I would like to add “E-Prescribing” to the list of things that need to be fixed. Those stupid electronic prescriptions come across to the pharmacy with some horrible (and potentially dangerous) typos! All Doctors need to make sure they are double-checking their typing before hitting the “send” button. We have to waste many valuable minutes each day on the phone trying to get clarification for sig, qty, or “what the hell medication are you trying to write for”? Maybe 1 out of every 10 e-“PERscriptions” come through with no errors or at least errors that are close enough that we can figure it out. Example: Mrs. Jones has been on “Meddaformin” 500mg bid. An e-rx comes through for Metformin 500mg ER bid. Well, was the doc planning on changing the med or just a typo? Try asking the patient and you get the glossed over “I’ve been taking my Meddaformin for years! I don’t know what “you people” are talking about! Just give me the same thing I had before!” Our response: “I’m sorry Mrs. Jones, but your doctor has sent over a new Rx for a different med than what you had before. We have to call to get it clarified.” I’m sure we’ve all been down this road many times before. It’s just a huge waste of time for all of us.

Comment by Naomi CPhT on 2010-08-11 06:33:05 -0700 #

Also, please actually call us when you have fianally gotten the prior authorization to go through.
And, those controlled substances: please sign them. It’s the law here.

Comment by purplesque on 2010-08-11 07:22:47 -0700 #

Beautifully written. These are important points that are not always taught in medschool.

I’m happy to note that as part of the new generation of MDs, I do most of the things on this list- which is probably why the pharmacists I routinely call are so nice to me. 🙂

Not sure about getting the scoop on the patient from the pharmacist, though- it would be great to be able to ask the pharmacists if they see what I see, but wouldn’t that be a HIPAA violation unless we got express permission from the patient?

Comment by The Redheaded Pharmacist on 2010-08-11 08:27:40 -0700 #

I agree 100% Angry but I would add one more thing. Tell doctors to not give price quotes for prescriptions. If you don’t work at the pharmacy then don’t tell patients what our prices will be because you are wrong more times than right!

Comment by Jeff on 2010-08-11 10:40:58 -0700 #

As long as the patient is under your care and gets Rx’s from us it is not a HIPAA violation. All of our patients sign a disclosure that states that we may share information about them with any other health care providers that they see, as well as with their insurance company. Basically, as long as you are acting in the patient’s best interest (from a health and safety standpoint), HIPAA does not apply.

Comment by Leo on 2010-08-11 13:38:45 -0700 #

Funny. A website by a guy who is angry and knows just exactly how to fix his industry by anonymously yelling from behind his alter EGO screen name says those other people in the industry should drop the ego.

Yeah dude, definitely drop the ego Senor Know-It-All.

Comment by Frantic Pharmacist on 2010-08-11 13:51:05 -0700 #

Yes, please don’t tell the customer the drug is generic, so it’s \really cheap.\ And for those chronic meds, if the patient says they are not sure if they need more refills yet, go ahead and write a new prescription anyway. Don’t say, \Just call if you need it.\ They’re GONNA need it, and they’re gonna wait until they’re completely out, and then I will have to ‘spot’ them some while we wait for your callback. Waste of time.

Comment by Jeff on 2010-08-11 17:24:17 -0700 #

Hey dipshit why don’t you read all of paragraph #2, entitled \Both MD’s and RPh’s need to drop the egos.\ TAP fully recognizes that he has a big ego (on the internet). This blog is for entertainment purposes, a place for TAP to vent his frustrations. How many people would read this blog if TAP didn’t get a little theatrical with it occasionally? I know you probably wouldn’t.

Comment by IAPharmer on 2010-08-11 17:40:23 -0700 #

One thing to add about e-prescribing.

Most drugs in our local hospital’s system have to have a diagnosis attached to it. BP, High cholesterol, diabetes, CHF, RA etc.

How difficult would it be to have that diagnosis somewhere on the e-prescription. Do you know how many errors I could catch because you chose the wrong drug, Metformin instead of metoprolol, lamictal instead of lamisil? How about the weight of the child when you prescribe an antibiotic and what mg/kg dosage you are using?

I have ONE physician that does the pedicatric dosage thing, and it is AWESOME. Too bad they call cannot follow along

Comment by Well Illbe on 2010-08-11 19:14:02 -0700 #

Don’t assume that just because you had 4 years of medical school you know more about a medication than the pharmacist. You often get 1-2 semesters about pharmacology. Guess what all four years of our training is on? Also dont assume just becuase your a great Doctor that you partner is, there are idiots in all professions. We are here to help each other and provide the best care for the patient, Great post TAP!

Comment by Steve on 2010-08-11 19:38:40 -0700 #

The biggest problem I have with e-prescribing in my area is the nurses/office aids sending them to the wrong stores. Sometimes even sending the same e-rx to multiple stores. I seem to spend way too much time each day calling other stores to have claims reversed while the customer yells at me as if I was the one that sent it to the wrong store.

Comment by DisgustedRPh on 2010-08-11 20:51:25 -0700 #

Agree with all the stuff…and most important is to teach your nurses how to call, write or e-script a prescription. I do not know what meprolol is?? That will save us a lot of shitty hoops to try and get clarifiction from the office. you always have to leave a message and never get and answer till days later!!!!

Comment by pill pusher on 2010-08-11 22:26:57 -0700 #

I think I speak for TAP and every other pharmacist who comments on this thread. Pharmacists have the utmost respect for physicians. First, we are trained extensively from every angle known to mankind to understand the implications of every prescription we would be expected to fill. Just knowing that gives us a great deal of respect to the person behind the order, from giving a child a fluroquinolone who may truly need it to save their life, to giving a child with cystic fibrosis Cipro.

Knowing that there is someone on the other side of that order making these tough decisions is not always simple for us. Many times we have no idea of the patient’s history, or even a glimpse of their chart.

It’s not always clear to the pharmacist that the prescription he/she fills has the best interest of the patient in mind, however, the respect that we hold for those prescribing trumps our profession. If we have doubts we call you and go in defense mode and document everything. But this shouldn’t be happening. The problem is we are forced by the insurance companies who pay us to make split second decisions about therapy that could affect someone for the rest of their life. Do I know that you know x, y and z about this patient.

Are you the prescriber relying on me to give you information? Are we both aware, completely aware of all the information that we both need to know to keep the patient’s quality of life at its best? A rift has formed here between our two professions. I am forced to call you by the insurance company to get directions for a freeking Z-pack 10 times a day! No wonder when I call you to ask about the appropriateness of giving Cipro to a teenager I get blown off.

The impression here is that pharmacists are annoying, they don’t even know how a Z-Pak is given and they have to bother me all day long with minutia. I give Z-Paks all day long but it will be every so often I give it to a patient to treat chlamydia and when I get audited I will be asked, how is this patient taking it and why I didn’t document 2 stat and 1 po qd for 4 more days. My honest answer to the auditor is that I didn’t have time. His answer is ca ching! $50 for him.

We are forced to call you to clarify minutia because of the insurance companies. The insurance companies force us by way of audits that we have to exact directions, exact quantity exact everything. If you write a prescription for warfarin and the sig reads UD I have no problem with it if the person is paying out of pocket. If there is an insurance company involved I never ever want to see UD not for a medrol dose pack, not for a Z-pack. Because now I have to lie, I am not going to call you to get directions, I have to lie that I spoke with you about the directions and document on the prescription that you said this this and that at 12:30am on Thursday August 12, 2010.

You see the wedge that the insurance companies are trying to drive between us. Pharmacists love Doctors, without doctors pharmacists can not be in business. Why is a pharmacist even needed if the insurance company doesn’t even trust the doctor’s ability to convey directions to the patient appropriately? Basically, when you get sick just go to the insurance company, fuck the doctor, she doesn’t know shit, and the pharmacist forget him too he is just taking a cut of our money that he doesn’t deserve. As for your child with no allergies that was prescribed Levaquin as a first line therapy for a uti don’t worry because we get kick backs from JNJ so we will never be sued. It’s really a shame that your kid has suffered arhalgias but we’ll pay for that later and get out of I most of it. Just like BP. Just keep bringing me your children and buy our stock the money is rolling in.

Comment by GolfMoosePharmD on 2010-08-11 23:09:38 -0700 #

Not a HIPAA violation when your are both providing healthcare to the patient. I think you miss the point. The post is telling docs that if they are questioning whether Johnny Norco really needs all that hydrocodone they’ve been prescribing or if he has been Dr. or pharmacy shopping, Pharmacists can clue you in.

Comment by Jenn (tech) on 2010-08-12 08:36:10 -0700 #

Wow, pill pusher, I thought we were anal about exact sigs in my pharmacy. We don’t call on Z-paks or Medrol DPs that say “use as directed” since those are set things.

Our major thing is insulin and test strips. I will stop the script right at drop off if it says UD – we need a maximum units per day, or times testing per day. If they aren’t on insurance, it’s ok if it’s not there; we’ll send them to the register to buy it OTC anyway. But if they are on any insurance at all, exact directions must be on there. It’s quite annoying how much of our doc call box is scripts that need sig or qty.

And for the love of all that’s holy, pretty please *hand sign* all controlled substance scripts. In Texas, your pretty stamp won’t fly. “electronically signed” is no bueno. We will not fill it until you fax or call in a new one. There is one doc office we fill for daily that can’t seem to grasp the concept of following the state law. We fax them almost every single day with a copy of the script and a note saying what they left off that is required (Spell out the qty, write your DEA and DPS numbers, and hand sign it!)…yet they still have yet to write a correct script. Well, one I got yesterday from them was correct. I wanted to frame it.

Argh I could go on and on…it’s sad that the awesome docs are the rare ones. I would seriously give a hug to one endocrinologist in the area who I called *one time* to ask for max units/day on an insulin script and never again had to call him for further info. Since I explained that time that we need it for insurance billing (the doc himself called and spoke to me by the way!), he writes all his scripts with directions. And this was probably 2 years ago, if not more.

Going to be a few minutes late to work…wonder if “sorry, was commenting on TAP’s latest post” will be a good enough excuse? Somehow I think it will…

Comment by PharmIntern on 2010-08-12 09:14:17 -0700 #

FOR REAL. Please, doctors, properly train whichever staff member calls in prescriptions. Here is your training checklist:

*speak clearly, succinctly, and intelligibly in the language you’re giving the prescription in.
*speak at a medium pace, not at break-neck speed. We do have to write down what you say, and no one is in too much of a hurry to make sure the right patient gets the right drug.
*be familiar with the pronunciation and spelling of drugs before picking up the phone.
*be familiar with which drugs require the doctor’s DEA # to be given
*for Pete’s sake give the doctor’s first and last name; respecting a doctorate does not forbid you from speaking his given name.
*spell any names that are more complicated than “Smith.”

And I also agree that if a pharmacy staff member is always available to field a phone call, the doctor’s office is entirely capable of it as well. “We will respond to messages within 24 to 48 hours” is a lie.

Comment by Doc Truli on 2010-08-12 10:32:16 -0700 #

Ah! Now I see more clearly why, as a veterinarian, I get frantic pharmacist calls:
“TID Glargine, really, are you sure?”
“1,000 mg of Doxycycline? Really?”
“Fentanyl patch? For a dog? Really?
Or my favorite, “They don’t make that!” (Plumb’s vet drug book says “they” do. And “we don’t carry that” I say,”but your pharmacy filled it last night for another patient.” cell phone noise “rustle-rustle, oh sorry, it’s here on the back shelf next to the liver-flavored aspirin.” heh. Heh. I knew you had it!
Maybe I’ll start writing my mg/kg intentions, like you said for the pediatricians. Just to make your day a little less weird.
Your partner in healthcare,
Doc Truli

Comment by Andrea on 2010-08-12 11:41:35 -0700 #

Don’t let HIPAA scare you. It explicitly allows for the sharing of PHI between health care providers. I would much rather have you call and learn that our mutual patient has not filled their blood pressure medication in 6 months than have you increase the dose. Too many health care providers hide behind HIPAA because they are worried, and the patients end up losing out.

Comment by Andrea on 2010-08-12 11:46:35 -0700 #

Please don’t tell a patient that the Seasonale generic is only $4. You can call us and we can give you a quote. We really don’t mind. It’s better than have a patient flip out at our counter.

Comment by was1 on 2010-08-12 14:28:14 -0700 #

Re: item 6). I know we don’t get to piss or grab a bite whenever we want to but since when don’t we complain? All we do is complain. It doesn’t change things but we keep on complaining, anyway. After reading all my favorite pharm-bloggers I feel like complaining must be one of our greatest strengths. (trivia… ‘strengths’ is the longest single sylable word in the english language).

ok, back to the bitchfest.

Comment by The Angry Intern on 2010-08-12 16:53:45 -0700 #

Doctor’s, don’t come into the pharmacy and lecture from what you saw in a drug insert for a particular drug, we already know the drug (its what we do all day everyday) and you are insulting our intelligence; especially when you’re trying to flex your brain muscle in front of your wife, we really don’t care how much you know or how great you can regurgitate simple factual information; if you already think you know everything about the drug, then why are you telling us about it, we honestly could care less about what you think you know.

Comment by sumotoad on 2010-08-13 19:36:57 -0700 #

@purplesque: No, it’s not a HIPAA violation for caregivers to discuss what is the best care for a mutual patient. Please call us!!
Great post; and I trust Dr. Grumpy absolutely!!

Comment by Hueydoc on 2010-08-13 20:13:01 -0700 #

When I get a Medical student or a Resident assigned to me for the month, the first thing I do is send them over to the pharmacy for most of the day. Then tell the pharmacist to “help raise them right” and teach them what they want them to know, especially the costs of drugs. I also point out the brown stain on the floor in front of the cash register where people sh#t themselves when they see what their brand name drug costs.
They also learn what the pharmacists DON’T know, which helps everyone

Comment by Hueydoc on 2010-08-13 20:18:12 -0700 #

All too often I’ll not specify what strength to use (100mg/5cc) because that usually means getting a phone call stating “We don’t have that strength- can we use the 200mg/5cc?”.
Yes. I like to try to give the pharmacist some leeway to avoid unecessary phone calls.

Comment by Claudia on 2010-08-14 13:48:28 -0700 #

I love this – I was a Pharm ATech for a while and it seemed like the pharmacist only HAD to tell me I shouldn’t get mad – Good to know he was mad too; MAKE IT CLEAR; our jobs are to NOT kill ppl, thx!

Comment by Joe on 2010-08-14 19:32:44 -0700 #

If the staff in the doctor’s office took an extra ten seconds to proofread the scripts they print off the computer, it would save everyone time. The biggest offenders are dental offices. We get:

  1. Scripts with no sig code at all
  2. Patients with scripts that have another patient’s name on them
  3. The ever so common antibiotic script, 1 BID X 10 days, dispense #14.

At least dental offices are usually easy to get through to for clarifications. The doctor’s offices that have 16 options on phone messages are annoying as hell, and typically I always end up having to leave a message, and wait for a call back, which may come in ten minutes, but usually in four hours if at all.

Comment by New MedHead (OMS-1) on 2010-08-15 22:15:36 -0700 #

@TAD: I just had the pleasure of reading the post and the comments (via Grumpy). My D.O. schooling starts tomorrow and the first thing I am going to do is find a place to post your thoughts for all of us to read and hopefully take into consideration in a few years.

Comment by Linda on 2010-08-16 15:50:16 -0700 #

Oh, this article was great! I laughed so hard because it’s all true!!!

Since I’ve started working as a pharmacist, I introduce myself as “Dr.” to all patients, all physician offices, etc. My name badge states the same thing. It’s been amazing at the difference in attitude it has made for me. My co-workers openly made fun of me when I started this practice after graduation, but not anymore. My pharmacy school was big on encouraging us to change the face of pharmacy by changing attitudes about pharmacists…I took their challenge seriously.

I enjoy reading your articles!

Comment by Firefly on 2010-08-18 07:46:44 -0700 #

It depends on which type of MD you’re talking to. If you’re talking to specialists, i.e., who had fellowship training, they are generally quite good with the meds they’re prescribing, even down to the receptor level. If it’s some FP or some old timers, they usually know the general info of the med and that’s it. The ones that scare me the most are NP or PA. The ego is often way too big for the prescription pad!

Comment by CL on 2010-08-19 05:03:24 -0700 #

MD here who appreciates this post. I’ve worked so far in systems where we have to enter our prescriptions electronically and now in the VA — never actually used a “real” prescription pad. The one exception I would take is that even on the printed RX that I would give to the patients I’d omit my DEA# because of concerns of patients having that info…. (not an issue at the VA)

I have — and I wished more of my colleagues did — so much respect for pharmacists and their training and appreciate that y’all are the go to guys (and gals) for much info. Love the site and the rants!

Comment by CL on 2010-08-19 05:13:02 -0700 #

Forgot to add.. the non-VA environment that I practiced had patients who usually used a limited number of pharmacies, and when I had an initial appt with a patient or was discharging a patient with new prescriptions would ask them which pharmacy they were going to use. 95% of the time they were using pharmacies that my patients used routinely so the pharmacy would already have my DEA number on file.

And in residency all I can say is that pharmacists were the warfarin gurus. I learned much more from them about dosing and helping getting people to goal INRs than I did elsewhere. Thank goodness I don’t have to mess with INRs now (well, I like to see if my patients are on coumadin and being followed, if it interacts etc., but I’m not the prescribing dr any longer).

Comment by family MD on 2010-08-20 10:42:11 -0700 #

That’s because, when you sk the patient which pharmacy they use, they say it’s the one next to the dry cleaners.

Comment by family MD on 2010-08-20 10:44:15 -0700 #

Sure, if you’ll call me and tell me if the insurance company is going to pay me for the office visit. I’m sorry, but I can only do so much free secretarial work to help you get paid.

Comment by family MD on 2010-08-20 10:54:00 -0700 #

The above was meant to be a response to the request to send all e-scripts to the correct store.

I actually love pharmacists. You have saved my ass many a time, and I realize you get 10 times the insurance hassles I do.

I will gladly comply with all the above recommendations, IF, you agree not to send me any computor generated fax requests for refills. We did a one month study in our office, and found that 75% of these were wrong in some way: the patient was not on that med any longer, not my patient, was using a different pharmacy, had a written script at home, was dead, etc., etc.


Comment by family R.Ph on 2010-08-20 14:51:54 -0700 #

75%?? That’s unacceptable! For DC’d meds., any idea why those requests were sent in the first place? Did the pt. know the med. was DC’d? I certainly wouldn’t send a refill request if a patient didn’t ask me for another refill.

I’m curious to see of the 75% error rate, how many of the errors are from an independent store vs. a non-independent one?

Comment by JoshTxPharmD on 2010-08-20 23:46:11 -0700 #

for purplesque: item #2 in Joe’s comments above is a perfect example of a HIPAA violation, and a BAD and HILARIOUS one at that!

Comment by JoshTxPharmD on 2010-08-21 00:17:05 -0700 #

oh yeah, and every day, WITHOUT FAIL, there are at least a handful of controlled substance Rxs with no DPS numbers (which, are required to be present on the Rx in addition to the DEA number in the state of Texas).

at least the schedule 2’s must be written on the official form (or the old school triplicate if some docs still have those sitting around) and those forms already have the preprinted DEA and DPS #s (and…the special control number unique to that specific official form). Texas did get that right.

I actually like that idea of having the official form for C-IIs…in fact, I like it so much that I think it should be done for ALL controls, CII-CV. think about it…no more annoying Dr. calls to get a frickin DPS #. and…the Rxs would be monitored more closely since even CIII-CV Rxs will contain a specific control #, just as the CIIs do. this would hopefully deter a lot of the corrupt, quacky pill mill docs here in Houston from writing bogus Rxs for \The Cocktail,\ which consists of generous helpings of #120 hydrocodone/APAP (in the ratio du jour that suits the doc’s and patient’s taste), #90 Soma (a C-IV in Texas–and quite possibly the entire US soon), #90 benzo du jour (usually Xanax, but sometimes will write for Klonopin or Valium to try and get a curve ball by us), and some bogus filler Rx such as #30 multivitamin or #30 Colace. I bet if control #s were assigned to those Rxs, the quack shacks would be monitored much more closely and would be shut down much more quickly for their poor medical practices.

but…maybe that innovation of mine is not without possible defect. I suppose the docs would argue that if the forms already had preprinted on them, the DEA/DPS/control #s, that those #s would become too accessible to crackhead patients who, would then, impersonate the docs office staff and call in phonies using the docs legit info. and…the control # would be difficult for a nurse/MA to phone in, since a phone-in would not be on the \official form.\

darn, i thought that i was on to something. (shrugs) oh well…

Comment by Sofia on 2010-08-23 20:08:41 -0700 #

An understandable, reasonable response, despite the low rating on this comment. We get reimbursed crap for the brand name OldAsHellDrug XR. However, we are possibly busier and still take the time to call you to at least let you know that the drug you prescribed (that the RX rep sold you on) is not covered. Also, the insurance not paying for CrapDrug(other salt form) ER negatively affects the patient. Are you just after money? Otherwise, why wouldn’t you care? If the patient is barely able to afford seeing you, why are you prescribing something that is highly unlikely to be covered on any formulary?
We are not here to chase you, nor are you there to chase us. It’s called having respect for a fellow health professional that knows just as much about drug therapy as you know about diagnosing.

Comment by Sofia on 2010-08-23 20:12:59 -0700 #

Pharmacists are health care providers. That’s one of the giant points of this post. I guess they still haven’t taught the “new generation” of MDs to respect health professionals that don’t have the letters MD behind their name, even if it DOES contain a “D”.

Comment by Sofia on 2010-08-23 20:17:13 -0700 #

Again, in the profession, and not understanding why this comment is so low rated. We DO have to get up and get together, as pharmacists, in defense of our profession from being dissolved into nothing more than a person handing out meds instead of burgers. “do you have any questions about your Big Mac—I mean lisinopril?”It’s the big corporations that are taking advantage of pharmacists by waving large salaries in their faces. While the large salaries are not unjustified, it does NOT mean you are obligated to stand for 12 hours with no break and get verbally abused by custom–I’m sorry, I mean “patients”.

Comment by Sofia on 2010-08-23 20:20:29 -0700 #

I read it regularly but get distracted by the numerous grammatical errors. Dipshit.

Comment by Sofia on 2010-08-23 20:25:03 -0700 #

You know what I love? When someone speaks as fast as humanly possible with no pauses, but repeats the order TWICE. Why not just speak like a normal person and just say it once? I’m not impressed that you can say “HellopatientJohnSmithDOB4/20/80needstoprolxl50onepoqd#30norefillsThat’sDr.JoeBloWilliamsoffice#9195555555ThisisKatieThanks!” twice in a row as fast as you can. You are NOT that busy, and most of the time you don’t even give all that info.

Comment by Sofia on 2010-08-23 20:30:37 -0700 #

General doctors really don’t know that much about the medications they prescribe. They are taught what to prescribe for what; do they know the pharmacology and how the drug affects the patients based on their stats? Probably not. The gist of your post seems to be “the insurance companies are just a screen to keep you, the pharmacist, from seeing that MDs are smarter, better trained, and are the only health professional that matters because they are the ones prescribing”. There’s a reason a pharmacist is required to check prescriptions. I cannot tell you how many times I have to call on stuff that is not “minutae”; could have killed someone, really.

Comment by Sofia on 2010-08-23 20:35:12 -0700 #

I actually had a patient the other day upset about this. But guess what, he didn’t blame me for the insurance saying “refill too soon” on a drug that had “use as directed” directions. We don’t know the days supply or whether the patient’s even using it safely if you don’t put directions. This practice of “use as directed” should be severely frowned upon. It’s almost a complete shut-out of pharmacist involvement, saying “you are not to judge what I prescribe, even though you’re the drug expert and know how it should be used.” The patient said he was going to switch doctors for refusing to write out directions. Think about that.

Comment by Sofia on 2010-08-23 20:41:16 -0700 #

Is it just me or are dental offices notorious for signing all scripts “dispense as written”. I stopped asking after the very first clarification on a DAW1 Amoxil. C’mon, I know you’re right-handed…just …shift to the left a little. I know, it’s a lot of effort. 🙂

Comment by Sofia on 2010-08-23 20:44:57 -0700 #

I strongly encourage this, as superfluous as it seems. I will insist “PharmD” be printed on my nametag when I go out in the world. Most people are just not aware of the amount of schooling pharmacists go through to “throw pills in a bottle” and “slap a label on a box” and tell you, the patient, “for the love of god, do not drink a drop of alcohol while on metronidazole”.

Comment by Sofia on 2010-08-23 20:48:13 -0700 #

This is funny, only because it’s drilled into our heads that medical residents routinely “chase” INRs because they haven’t been told it takes 2 or 3 days to reach a steady level before deciding to adjust the dose.

Comment by Sofia on 2010-08-23 20:53:09 -0700 #

“We did a one month study in our office, and found that 75% of these were wrong in some way: the patient was not on that med any longer, not my patient, was using a different pharmacy, had a written script at home, was dead, etc., etc.”

And how are we supposed to know ANY of those things listed, unless the patient had died, or the patient (or YOU) tells us those things? I get more notices of patients being deceased than a new RX for a drug the MD told the patient to just “double up on”, without notifying the pharmacy. I can’t read your mind!

Comment by Sofia on 2010-08-23 20:57:31 -0700 #

I know how you feel. I am routinely harangued by patients who insist they had something filled “here”…they called it in two days ago “here”….and by “here” they meant the CVS across the street and not the Walgreens on the corner where I work. How can one not keep track of these things, and then abjectly NOT apologize for insisting on something one was TOTALLY wrong about?

Comment by Sofia on 2010-08-23 21:02:25 -0700 #

I’ve been in pharmacy for 5 years and have not yet graduated, but I can count the number of times I’ve spoken to a doctor on the phone about a therapeutic issue on not more than one hand. It makes me sad. There was a SINGLE occasion where a pediatrician actually picked up the phone on the other end of a number I dialed listed on her RX pad…like the one she gives to her patients. I was floored.

Comment by KarriRx on 2010-08-23 21:14:19 -0700 #

I REFUSE to fill ANY controls from Houston any longer unless they are from a customer we know or from somewhere like MD Anderson!!! It’s ridiculous!!

Comment by family MD on 2010-08-24 09:54:04 -0700 #

Don’t let your computer send out automatic refill requests. Request a refill script when the patient says they need it.

Comment by Blonde on 2010-08-24 17:03:58 -0700 #

Glad to see you still kickin’. LOL

Comment by Family PharmD on 2010-08-26 20:04:53 -0700 #

You’re a dick. All we are trying to do is work together. It’s docs like you that are the problem, not the solution to working together

Comment by Family PharmD on 2010-08-26 20:32:18 -0700 #

THANK YOU!!! I’m sick to death of these egotistical NP and PAs who have about zero knowledge but then treat pharmacists like crap. Somebody seriously screwed up when they thought these “professionals” were a good idea. I will say, I have a few that are really good, or ask a lot of questions. For the most part, I find them to be unqualified, dangerous idiots who will not take advice from a pharmacist.

Comment by MellowMedStudent on 2010-08-27 19:58:18 -0700 #

I was a pharmacist before going back into med school. I agree with the physician posted near the top (whose comment was hidden because it was deemed unfavorable). Get over yourselves, pharmacists. Your really, REALLY, have no idea what it is like seeing 50 patients a day, trying to heal, determine what is going on, and taking care of them. At the end of the day, you count pills. The end.

Comment by theangrypharmacist on 2010-08-27 20:19:51 -0700 #

Couldn’t cut it in retail so you had to go to med school eh?

Well you need to get over yourself, because who does damage control to your 50 patients because you dont have time to answer their questions? Who deals with your patients when you haven’t answered the refill requests? Who doesn’t hide behind a front office staff, appointments, and an on-call exchange after hours?

At the end of the day you stir up the shit, and we end up dealing with it face-to-face with the patient. Look at it, you even have ‘pharmd’ in your email address? Upset because the patients wouldn’t call you doctor? They didnt give you the respect you deserve because you have a mighty PharmD? Had to take your red wagon and go to medical school so people would treat you nice instead of dealing with it like every other pharmacist out there?

Obviously if you arent 100% behind this post you were never a “pharmacist”. You were a PharmD graduate who never stepped a foot in a pharmacy until you graduated, got yelled at by the patients, and decided to go to med school so you could boss people around and feel important to your pharmacist peers.

I’m sorry if the patients were mean to you while you were a pharmacist. I’m sure the pharmacists that fill your Rx’s think you’re a dick just like everyone on here will.

I think you need to get over yourself.

Comment by pharmacist on 2010-08-27 20:23:51 -0700 #

When I stepped into retail shoes a few times last year, it seemed to me that the request from the patient was, ‘I’m going on vacation in xx days, can you refill all my prescriptions?’ “Well, which ones?’ ‘All the ones with refills” was the inevitable reply. So, we’d pull a specific patient name, and print off their request, and fax it. It’s not too easy to get a wrong name on file when we used date of birth as a double-check for names, but the business about all scripts with refills has to do with the prescriber calling in a script with PRN refills or a script with refills GOOD FOR YEAR. Very, very, very rarely do I see doctors address pre-existing orders when calling in a new script for a different agent in similar therapeutic class, or strength, quantity or sig. ‘Oh, by the way, please cancel previous script’ would be nice, but I never, ever saw that information. So, when the patient requests non-specific refills, and we send the fax on to the doctor’s office, it would sure be nice if the MD addressed the issue with a little note, e.g. ‘please discontinue this drug’ or ‘do not refill’ etc. Thanks!

Comment by pharmacist on 2010-08-27 20:44:43 -0700 #

At the end of the day WE pharmacists don’t count pills. At the end of the day we finish lunch, check the phone to see if the doctor’s office ever returned the call we’ve been waiting all afternoon, and back up and turn off the computer. If we’re handing off the shift to someone else coming on, we don’t even turn off the computer.

My guess is that the pharmacy grad med student did not work one single day as a registered pharmacist. Intern and extern assignments are notably rough as the student may tend to be belittled by other certified techs, given grunt jobs and bs expected to function as almost pharmacists without monetary benefit nor respect, plus work under critical eye of a preceptor, This sometimes is a final ‘weeding out’ process for those that might have the stamina to work as a sole professional.

Comment by rph3664 on 2010-08-27 20:56:53 -0700 #

Extended release Aricept? Let’s see, do you take it once a day, or do you take it once a day?

Comment by pharmgirll on 2010-08-27 21:21:08 -0700 #

In 20+ years of practice, only a few doctors have thought of me as a member of a team. Mostly MDs called me to chew my ass or ridicule me. Good times.

Comment by Angie on 2010-08-27 21:39:25 -0700 #

@Hueydoc- you are awesome for sending your med students and interns to hang with the pharmacists. Though they are probably a pain in the ass, they could use a dose of reality early on.

Comment by ripov on 2010-08-27 21:44:34 -0700 #

the day i let any doctor ‘chew my ass’ is the day i find another profession. i have to spend half my day calling dipshit doctors who have no clue what they are doing when theyre writing scripts. most of these idiots cant spell or dose the drugs properly and a few would kill their patients if it wasnt for the lowly pharmacist.
f@*k doctors. its rare you meet one who knows their head from a hole in the ground…especially in nyc.

Comment by Maxwell on 2010-08-27 21:56:52 -0700 #

This is why the profession is tanking, idiot pharmacists like you can’t differentiate real patients from druggies. HELLO MORON! Some people actually need pain medication. Leave the judgement for when you place your to go orders for lunch, if you even get that.

Comment by ripov on 2010-08-27 21:57:32 -0700 #

youll fit right in being a doctor seeing as youre already a first class asshole. pharmacists wouldnt have you.

Comment by The Rxer on 2010-08-28 04:44:43 -0700 #

Hey Mellow Yellow …. 50 patients is a drop in the bucket … I take care of 425 every night I work. I am the only pharmacist on duty in the whole hospital.

All I do all night long is keep med students, nurses, and physicians from killing patients.

It’s obvious you never worked a day/night as a pharmacist anywhere or you would know better.

Comment by MellowMedStudent on 2010-08-28 08:12:09 -0700 #

Pharmacist=whine whine whine whine about physicians, how they’re not appreciated by physicians, how nobody respects them.
Physicians=attempt to heal patients, and pay no attention to whining pharmacists.

Comment by Missy on 2010-08-28 14:29:17 -0700 #

While I do not work for a pharmacy or ever have for that matter, I agree with TAP, there have been a couple times where my MD had made a mistake, once was an allergy and the other was an antibiotic while pregnant that could have killed my baby. Thank God for pharmacists or else I wouldnt have had my oldest child, and may have even been dead by now… Thankyou all pharmacists who in some ways are better then doctors!!!

Comment by Maxwell on 2010-08-28 16:24:10 -0700 #

Sad but true. This is the attitude of most med students.

Comment by pharmacyphil on 2010-08-28 20:21:03 -0700 #

Most healtcare professionals/providers have a safety net when an error occurs. There is a team of people responsible for the welfare of the patient. When an error occurs, it is usually the “system” at fault, not an individual.
In the case of a Pharmacist error, he or she is pretty much alone in there defense. It is a practice whice requires 110% accuracy, no room for error, no one to catch or correct your mistakes. As we Pharmacists do for other practitioners.
I find it disheartening that so many doctors are more than willing to throw us under a bus, when day after day, we save their ass by correcting their stupid mistakes!
When are Pharmacists going to get some balls, and unite against the daily injustice and horrible treatment that we endure from the feds, state agencies, insurance providers, doctors, nurses, PA’s, retail corporate idiots, irate customers, druggie etc,etc,etc!!
We are so over regulated it is sickening!

We need some form of unity NOW!!

Comment by MellowMedStudent on 2010-08-28 22:56:17 -0700 #


See below reply. You are the perfect illustration. And counting pills for 425 patients is not the same as taking care of them.

Comment by tony on 2010-08-29 05:27:11 -0700 #

We need to talk more about the pbm monopolies. Pharmacist are probably the dumbest medical “professionals” that we have. If they continue to be quiet and say nothing about the PBM MONOPOLIES, independents will be gone and the majority of chains. There will be massive unemployment for pharmacists, especially for chain pharmacists….remember the law of supply and demand. How do u morons think ur going to continue to be paid your salaries with the worsening reimbursements and the ever increasing mandatory mail order. You chain and mail order pharmacist never excepted the fact that your employer hates pharmacist and have been trying to figure out how to distribute rx’s without pharmacists. That time has come and you now must feel like a dumbass for helping these companies destroy your profession. So let’s remain quiet about the corrupt pbms/chains and i hope you guys figure out what else to do for a paycheck because it wont be for being a pharmacist. Cheers

Comment by Anon on 2010-08-29 17:14:45 -0700 #

You as the Pharmacist: whine whine whine that you had to go to pharmacy school first because you had substandard credentials to get into med school the first time. Whine whine whine I couldn’t cut it as a pharmacist. Whine whine whine I just wanted to go into a medical field for the money and the p***y . Whine whine whine I have to actually work.
Let’s call it what it is. You’re a miserable troll who’s life didn’t quite work out as planned and want to take it out on a pharmacy blog. I’m sorry everyone told you that you were a winner your whole life and then the reality check cashed. Take your Kleenex and your dolly and go home. May God and other honest MD’s, RN’s, and PharmD/RPh’s save your future patients (if you are actually being honest) because you certainly won’t.

Comment by phrEx on 2010-08-29 21:33:39 -0700 #

Mds shud not be allowed to prescribe.

Comment by HospitalRPH on 2010-08-30 01:16:42 -0700 #

Maybe you don’t know what a pharmacist does. I am a inpatient clinical pharmacist at a hospital and I don’t fill medications or IV’s. I spend my day verifying your prescriptions, monitoring your patients labs and keeping you from killing patients (for example; whose CrCl is 30ml/min and you want to give zosyn 4.5 q8h or vanco 1500mg q12h)
I see and follow up on every patient that you see every day. Plus I continue to monitor them after your done examining them. I take care of them just as you do.
I just hope that once you graduate that you actually come to understand that pharmacist actually cover your ass on a daily basis and keep you from killing your patient and getting sued. If you can’t learn to work with us and stop treating us like all we do is count, lick, stick and pour then your in for a very long frustrating career!

Comment by Ann on 2010-08-30 09:15:48 -0700 #

It’s obvious that you don’t know what a retail or hospital pharmacist does! If you think pharmacists don’t take care of patients you are nuts! Try to run the hospital without us, then you’ll see what we really do, protect you MDs from yourselves.

Comment by Ann on 2010-08-30 09:24:47 -0700 #

I completely agree with you, pharmacyphil. I think about our colleague in Ohio who was jailed for a human mistake almost every day. Has a physician every been jailed for an honest mistake?
It’s not just physicians throwing us under the bus, it’s our state boards of pharmacy and the institutions/companies that we work for, too.

Comment by Maxwell on 2010-08-30 12:12:09 -0700 #

Oh, right? Because the doctors prescribing Naprosyn to a patient with a naproxen allergy is saving them? Please, why don’t you go fuck off. You’re as annoying as those little brats in movie theaters…you start crying then cry louder when people tell you to shush.

By the way bitch boy, I doubt you could get into the University of Chicago’s law school with that laughable 3.7 GPA you had in med school. Paid for by the GI Bill I might add. I have the brain to back up my education, you have the mouth to back up the usual stereotypes that flood doctors.

You as the doctor: whine whine whine about pharmacists that want to do their job correctly and efficiently because you guys can’t cut it.

Comment by Cindy on 2010-08-31 16:21:09 -0700 #

“You people” has got to be one of my favorite names,and we get it a lot.

Comment by Bek the Tech on 2010-08-31 21:22:25 -0700 #

Especially if it’s a Friday evening, at 6:00p, when all the doctors have gone home, and they’ve run out but couldn’t get it refilled because it wasn’t important at all…

Comment by Bek the Tech on 2010-08-31 21:26:16 -0700 #

It’s like putting the Pharm Technician in charge of the pharmacy and explaining to the patient what his/her medication is for and how it can help them, how it needs to be taken, etc…. I know I for sure couldn’t handle that properly. So how can PAs?

Comment by Bek the Tech on 2010-08-31 21:37:53 -0700 #

One thing we get a lot here (in Oklahoma–just my town at least) are scripts from doctors that contain two Rx’s, one which is a controlled substance! Such as Cipro 500, and Lortab 5, both on the same hard copy script pad. I know it’s “against the law” but a lot of docs do it all the time (usually the ER doctors) and I want to say no, but I’m only a tech and it happens every day.. Don’t the doctors know the laws, too?

Comment by Al on 2010-09-02 06:48:47 -0700 #

Have to agree with the doctor here. “please actually call us when you have fianally gotten the prior authorization to go through”. I wouldn’t call pharmacy for something of this nature if i was a doctor. I have too much else on my plate. And pharmacists are morons for taking on this responsibility. Let the patient take some responsibility. The patient can call the insurance company and let us know when the prior authorization is approved.

Comment by mdb on 2010-09-03 19:29:18 -0700 #

I’ve met a number of med students like this when I did rotations in hospitals and usually they would be getting yelled at by the attendings for such attitudes. I remember a well respected trauma doc was an attending in the surgical ICU and would often turn to the clinical pharmacist and I and ask what the pharmacy team though of the intern’s or resident’s care plan with regard to meds. A number of times there were huge errors, especially the med students. Alot of double coverage by the same class of antibiotic or using a drug that was not going to cover that critter causing the infection as it had about a 1% susceptibility rate according to the hospital antibiogram.

Comment by WatsonIsBrandName on 2010-09-07 19:37:07 -0700 #

Very good post, unfortunately state laws don’t allow us to substitute for class in Arizona and Michigan thats a problem I wished would get resolved. Funny off topic when I first moved to Michigan “patients” would ask if i had brand name vicodins and I would say no, then the tech would come and say yes we do. Everyone here thinks watson is the brand name. I once tried explaining it to a crack head and he thought i was the dumb one lol.

Comment by MellowMedStudent on 2010-09-09 17:08:31 -0700 #

mdb – why do you have md in your name? When you are a pharmacist?

Comment by JoshTxPharmD on 2010-09-10 13:54:51 -0700 #

No no, I know which Dr’s offices are not legit. And so do all the other pharmacists in the area! The quack shacks always, ALWAYS write for the cocktail. I mean, if sometimes these practices would write for something else, like Flexeril or Skelaxin in place of Soma, Buspar instead of Xanax, or Ultram instead of Vicodin/Norco/Lorcet, then I would take them more seriously. And by writing for a multivitamin?!?! COME ON!! That just REEKS of bogus!! That is CLEARLY not legitimate medicine!

Comment by Ranya Elguendy on 2010-09-15 20:13:30 -0700 #

I sincerely hope all MD would read this post!!

Comment by seenitallrph on 2010-09-18 10:11:33 -0700 #

@Tony- There so many errors in your post it is actually funny.

  1. If you ever looked at data on sites like medscape and looked at the demand that is heading our way, you’d realize supply and demand is not an issue. Pharmacists fill about 5 BILLION rx’s a year.
  2. You can not dispense rx’s without a pharmacist so that is a moot point.
  3. Whether the rx’s are filled at an independent, chain, mail order pharmacy (whatever), a pharmacist(s) will be employed to deal with those 5 billion rx’s. Mail order is simply another employment venue for pharmacists (and may be appealing if we don’t have to deal with assholes like you face to face).
  4. Given the number of prescriptions that need to be processed, there will always be a need for pharmacists as who is going to distribute the meds and oversee all the regulatory/insurance issues? Doctor’s can barely handle samples, let alone deal with Medicare Part D, etc,etc,etc. Donut hole anyone?

Let me summarize, I’ll be collecting my overinflated paycheck for a LONG time because the government mandates that I be in the process, demand is huge, and who else is going to do it?

Comment by “that cute doctor on 4th street with the huge tits” on 2010-09-27 13:23:55 -0700 #

You’re an asshole.
My tits are large not huge.
I am sending all my patients to Walmart.

Comment by Rkto on 2010-09-29 20:52:18 -0700 #

I would like to tell a short story
we got a forgery. WE filled it. we are not policemen. I prefer to err on the side of the patient (especially on a Saturday at 11pm) I would rather give it to the forger than let someone who is actually in pain be denied his drugs because he is suspicious.
The doctor whose Rx pad was stolen showed up on Monday (after we called him to let him know what happened. We filled the Rx, but we still called to confirm) The doctor lost it on me. He said that we should know that he never writes for that many Percocets. Um, I should know that? His office is a 10 minute drive away – there are about 1000 doctors in between his office and my store.
Then he said he was going to report me for filling the Rx. I explained calmly that we are not the police and we do our best.

he got all up in arms again. I told him he should shut up since obviously something unfortunate happened at his office if his pad was stolen.

Comment by sarah on 2010-10-05 10:12:46 -0700 #

And how many docs call you for advice or treat you with respect? There are idiots in every profession. Multiple studies show that NPs/physicians provide the same type of care and NPs actually have better outcomes. Sounds like you have a 1980’s ass-backward ego.

Comment by The Rob on 2010-10-09 20:21:57 -0700 #

I think the E-scribes that have MD squeezed into the name field (which messes up the doctor’s name search in our system). Dude – we KNOW you are a doctor if you are escribing!! Thats like me pulling up to a drive thru and saying “Hi its Rob, driver!” Argh!

Comment by Tex NP on 2010-10-16 22:15:17 -0700 #

Nice stereotyping – NPs and PAs are providers that provide quality health care to offload the uncomplicated, routine stuff so that MDs can focus on the challenging stuff they have the training to manage. I work in a specialty practice and the MD I work for often asks me for info on meds because he just doesn’t keep up with the details.

I have to say I am shocked at the hostility and defensiveness on display here. I didn’t realize that the pharmacist on the other end of the line likely thinks I’m a “dangerous idiot”. If you are on board with Obamacare, you’d better get used to having your care provided primarily by these dangerous idiots because that’s the only way the feds will be able to provide “free” health care for everyone and manage costs.

Comment by Tex NP on 2010-10-16 22:21:03 -0700 #

Um, yes, we really are that busy. Go visit any pedi or family practice and learn something about how the other half works.

Boy, you people really hate your jobs.

Comment by Tex NP on 2010-10-16 22:45:02 -0700 #

I applied for a job two years ago which turned out to be one of those pill mills in Houston. They offered me a ridiculous six-figure salary to write the same three Rx every day. I turned them down flat and turned in the clinic name (they never would name my supervising MD) to law enforcement but it sounds like the problem is as bad as ever.

Comment by SmartyPharm on 2010-10-21 16:49:31 -0700 #

…and your point being, ‘doc’? She asked for the MILLIGRAMS PER KILOGRAM prescribed, not the strength. Are you the same ‘doc’ I had to prevent giving a 4 gram phenytoin load today?

Comment by bitchypharmd on 2010-10-21 18:09:57 -0700 #

@Mellow, shallow, dumbass, med student….maybe the md doesn’t actually stand for m.d. not everything revolves around “md” in the world

Comment by Hello Tex NP on 2010-10-21 23:56:44 -0700 #

@Tex NP: You ARE THAT BUSY? Too busy to take care of helping ensure your patients get medications dispensed correctly? maybe one reason you are so busy is because we have to call to clarify your speed talking record rx. spell names, enunciate drugs, and speak at 0.7x speed of what you normally do and don’t get any call backs from us. sounds simple enough right?

speaking clearly and effectively (or teaching your staff to) will save you phone calls , faxes, and time on the back end.

Comment by Dr Namewithheld on 2010-10-26 16:02:50 -0700 #

great post man, i’m an MD, and i didn’t know most of this stuff.

Comment by ChemoQueenRPh on 2010-11-12 20:32:40 -0800 #

You obviously have no experience with obtaining prior authorizations. You might not be a doctor, but you play one on websites talking out your ass.
Neither the Patient or the Pharmacist can call the insurance company for prior authorization. The DOCTOR’S office has to call the insurance company for a PA. The insurance companies want information about the patient such as diagnosis, what cheaper medications has the patient tried and failed, or could not tolerate before the doc prescribed this medication? Is this medication being prescribed as a substitute for an injectable form of the same medication that the doctor can give in their office or clinic. Sometimes they won’t take that info over the phone. They fax the doctor’s office a 2 or 3 page form that must be filled out by someone in the doctor’s office who is qualified to read the medical records and answer the questions appropriately, and then signed by the doctor. Sometimes they want doctor’s notes, office visit notes, lab results, diagnostic testing results such as x-rays, CT scans, pathology, or genetic testing results faxed with the PA form to support the reason the doctor prescribed the medication. This information is ONLY available from the doctor’s office. So the morons here are the doctor’s offices that take on this responsibility, or say screw it, I’ll prescribe something else. And since I am a Pharmacist that works in a cancer clinic, I get the fun job of doing a lot of PA’s because I am in the unique position of being able to target the info the insurance companies want very quickly, and argue with them on behalf of very sick patients that don’t have time for the insurance to get their heads out of their asses to approve it. I can go back to the doctor & suggest alternatives if I don’t think insurance is going to go for it. And they appreciate it.

Comment by selise on 2010-11-18 14:47:50 -0800 #

Where have you been all my life? Well, at least during the 13 years of my life that I’ve spent working in pharmacy.

Comment by Disgusted Pharmacist on 2010-11-19 21:06:43 -0800 #

Any conversation between an md/nurse/pharmacist that is involved in routine patient care is considered just that–it is NOT a HIPAA violation. If discussions of this nature were–wouldn’t the “junkies” be happy.

Comment by Disgusted Pharmacist on 2010-11-19 21:11:45 -0800 #

Sofia–we need to get together. I HATE what the “chain” pharmacies have done to this profession–which is why I quit my job, without having another one. I think they are just awful–never mind the fact that they “own” the pharmacy schools who keep pumping out new grads for them to abuse!

Comment by Nate on 2010-11-20 06:25:44 -0800 #

Actually, what you do (if you’re a doctor, clerks and interns don’t count) everyday is diagnosis. Doctors just prescribe drugs to follow basic protocol. Pharmacists don’t need a lecture on drugs from doctors, who don’t respect or know the duties of anyone else in healthcare professions.
Who do you think writes the information on those inserts? Researched on it? Or developed that drug in the first place?
Pharmacology is just a two semester subject for doctors. It’s what pharmacists study for years

Comment by Disgusted Pharmacist on 2010-11-22 23:37:11 -0800 #


Comment by MoeshaPharmD on 2010-11-27 09:24:47 -0800 #

Can you also write a guide for pharmacists entitled Common Sense for the Pharmacist!
MDs will respect us more and think we are healthcare professions with drug knowledge if we do not call MDs about stupid stuff like: MD writes rx for HCTZ 12.5mg T QD product selection permitted, pharmacist calls Is it OK to dispense capsules? She even reviews profile and notices pt has been taking capsules for 3 years! DUMB then tells patient that it is the law, she has to call, WTH!!

Comment by Betsy R on 2010-11-28 22:37:53 -0800 #

The MellowMedStudent expounded on a big personal beef of mine with the medical gods without even trying.

The biggest contributing factor to my own elevating health care costs was the umpteen and 100 more docs I went to who could not do anything besides prescribe blood pressure medicine, order cholesterol tests, and suggest cancer screening.
They had no clue as to how to treat an illness with symptoms nor an inclination that there were supposed to treat people who were in sickness and pain.

So, at the end of his imperfect day, the MellowMedStudent has no idea what caused most of his patients’ symptoms. So he probably reviews the one thing that can be easily “diagnosed” and treated. If blood pressure is over some agreed-on level, he has a reasonable chance of knowing certain chemicals will put that number under the acceptable level.

Meanwhile, the patients are still writhing in pain, feverish, vomiting, and god only knows what else while taking blood pressure meds.

Since cholesterol and cancer screening are currently profitable in-vogue tests, he may have suggested them too.

Comment by AO on 2010-12-02 20:26:31 -0800 #

I’m not actually a pharmacy tech and I have never worked in a pharmacy, however I am the person at the doctor’s office who answers the phones all day. I have taken numerous calls from pharmacies where the tech or pharmacist has explained to me that they need clarification or to change something. These callers have always been courteous, patient and understanding, for which I am eternally grateful. I will be giving my doctor this link and suggest that he read it, even though he will happily get on the phone and talk to the pharmacist or tech about a medication. Thanks for all of your hard work, I know you deal with FAR more crap than the offices have to, even if we do have to manage PA’s. Thanks also for the advice, I will try to implement what I can to make your job easier. Good luck dealing with the crazies!

Comment by Deanna on 2010-12-21 17:29:41 -0800 #

We had to call patients a year ago and let them know their Adderall was part of a recall. Naturally, we didn’t have valid numbers for all of them and decided to call the local “Adderall clinic” to see if they had a current number. Naturally the voice of authority was a nurse who explained that would be a HIPPA violation. It was nice that once we were able to get in touch with the doctor via voicemail he called us back and gave us the numbers himself. . . and the nurse received HIPPA training.

You can always call as long as it’s involving all of us. You can’t call to ask what your neighbor gets because you’re curious, but as soon as you see the patient and we have filled anything for them, it’s cool.

Comment by Deanna on 2010-12-21 17:40:14 -0800 #

Um, wow. So are we. It’d be nice to not have to call you. And actually, I love my job. I love it enough to ask birthdays, addresses, drug allergies and the like of all the patients coming into the store. If you’re to busy to call in a prescription safely, you’re obviously in the wrong profession and dolling out cheeseburgers sounds more your speed. “Would you like fries with that?”

Comment by TennPharmD on 2010-12-23 01:48:11 -0800 #

I once called another pharmacy to get a patient’s insurance info and the pharmacy wouldn’t give it to me because they said it was a violation of HIPAA!

Comment by HospitalCPHT on 2011-01-14 11:16:16 -0800 #

Excellent post…and let’s face it: I’m the one counting the damned pills, not the pharmacist. The pharmacist is too busy calling back nurses and doctors all day and all night trying to figure out why you’re trying to kill people. So MellowMed Student, and people who “think” as he/she does can drop the fucking attitude.

Comment by Chain RPH on 2011-02-14 23:27:27 -0800 #

I also wish that we would stop sending so many faxes. But some of the computer generated faxes are linked to the ready fill system and the computer sends them automatically without request from anyone in the pharmacy or the patient. When an rx is scheduled to be refilled the computer will automatically fax the md if there are no refills. There is no way for me to stop it. It is part of our corporate system. So at least from the chain drug stores, this is out of our hands to a certain extent.

But I also have a problem where doctors in my area will now tell pts who call the office for refills that they can’t do the refill until they get a refill request from the pharmacy.

Comment by Chain RPH on 2011-02-14 23:41:49 -0800 #

I can tell as soon as they walk up. Something just puts you on alert. I always make up excuses and mock apology. Currently it is the no controls from out of town story. Although I actually fill controls from out of town all the time but it gives me another reason not to fill the bad ones that doesn’t include the standard “we’re out of stock” line.

We also have such a problem with the meth heads that we have moved all sudafed products to an area not visible to customers, so that I can tell them we don’t carry the 96 count.

Comment by MDAdministrator on 2011-11-07 17:01:09 -0800 #

This is what I would like to know:

  1. My understanding is that a pharmacist can refuse to fill a prescription when it is illegal, dangerous, or against their conscious. I have numerous instances when a pharmacist refuses to fill a medication because they don’t like the dose, etc. I could appreciate this if there was a discussion with the provider which there is not. It is usually when the medication is controlled and it puts the patient in the middle. Can the pharmacist legally do that or have they just taken over the medical care of the patient? My personal opinion is the latter.
  2. A pharmacist refused to fill a controlled medication because the patient could not produce a urine drug screen. The patient left and suicided. The provider was peer reviewed. It is my feeling the pharmacist should have been peer reviewed because she was practicing medicine. When I brought this up to the pharmacy supervisor she argued that the pharmacist was within her right to unilaterally make this decision.
  3. A pharmacist refused to fill peg interferon because the patient had a psychiatric diagnosis (not depression). There was no discussion with the prescriber.
  4. When the pharmacist is confronted by the provider about refusing to fill the medication, they are anonymously reported repeatedly to medical boards (each have the complaints unsubstantiated)
  5. When these issues are brought up to pharmacy supervisors, the pharmacists actions are defended followed by some discussion about working together. That would be fine but it does not occur.

These pharmacists are hospital based and the only game in town for individuals to get their medications.

If this is within the rights of the pharmacists, I would appreciate the resources where I can find this. If they are not practicing in their scope, I would appreciate the same. As an MD and hospital administrator I find these practices unprofessional and dysruptive.

Comment by PharmDinWA on 2012-01-03 15:54:21 -0800 #
PHARMACIST PRESCRIBING (on the rise worldwide)

The healthcare professional who takes the most pharmacology, pharmacokinetics, p’ceut, med-chem, should make the final prescription (that would be pharmacists). The diagnosticians should just focus on that. Then again, most diagnoses are triage-obvious and PharmDs can handle them too.

The MDs, PAs, NPs should send in height, weight, gender, age, diagnosis, and labs and leave prescribing to the Pros.

Comment by CPhTNH on 2012-04-27 21:22:52 -0700 #

Thank you TAP! The only thing I would say in addition is MD’s, please print clearly. As I spend much of my time doing data entry, it gives me a headache ( as I’m sure it does to my pharmacists as well) when I have to bring them the hard copy and play, “do you see what I see?” And stop with the brand new drugs! Just because it just came on the market doesn’t mean it’s covered by everyone’s insurance! There are days when I send out 10 prior auth requests for new drugs only to have you send back an rx for a different drug, and a generic at that. Last but not least, if you give your patient a new prescription, at least tell them what it’s for. If I can’t read an rx, my first stop will be the patient…”did your doctor tell you why your taking this?” “No he just said I needed it.” Yeah that’s helpful. Then I have to place a call to your office, which no doubt interrupts your day and takes away from your time with your patients when a nurse has to track you down to clarify a drug name, strength, dose, sig, whatever. I respect all you doctors, NPs, PAs, etc, but help me help you. We’ll all be more efficient and look more professional in the eyes of our mutual patients if we work together.

Comment by alextech on 2013-03-03 21:53:15 -0800 #

one more thing: Doctors, don’t tell your patients that you are going to call the rx in right away, or worse still, you called it in, when you have not done so. yes, you are busy and cant call it in til later today… fine. but we look like the assholes when the patients say, are you sure you dont have anything b/c i was right there when they called. haha bullshit!

Comment by Robert on 2014-06-24 13:07:54 -0700 #

Huh. I’m an ER doc and I do that all the time. So do my partners. You do an electronic prescription with the discharge instructions and all the scripts print on one page. Is this wrong? What’s the relevant law/regulation?

Comment by Robert on 2014-06-24 13:19:46 -0700 #

When you say “we honestly could care less about what you think you know” you are exemplifying the kind of arrogance you hate when you see it in MDs.

Let’s say, for the sake of argument, that you know far more about X than the doctor, who thinks they need to instruct you about it. Galling, I know. It’s a situation I face every day when talking to patients, families, techs, nurses, and MDs from other specialties.

How you handle it says a lot about who you are. Here is what I try to do and what I recommend to you:

  • Appreciate that this person is interested in your field and has taken time to learn about it and develop an opinion.
  • Realize that even if you know more than they do, they can still know something you don’t. Keep an open mind.
  • If they say something wrong, try to find the element of what they said that is accurate. Recognize where they are right before you — as gently as possible — correct them.
  • Remember that you like all medical professionals are also an educator. Teaching people is part of your profession, even if it’s not formally a part of your job.

I recognize that it’s hard to be patient with know-it-all MDs because we also have some advantages in terms of income and public recognition that you don’t. But please do your best. Doctors never know enough to do the impossible job that we have, and many, if not most, are always looking to learn more from an expert.

Comment by Mughal on 2017-04-20 22:59:27 -0700 #

Is there anyway I can hide my DEA number for my patients to copy?