Rant Alert: Attention, Pharmacists
To the friendly, trusted neighborhood pharmacist who told my 74-year-old diabetic patient with coronary artery disease and arthritis to stop his Zocor because maybe that's what was making his knees and hips hurt:
You fucking moron! Do you have any idea how hard I worked to get this guy to take this stuff in the first place? Do you know how long it took, how many visits over how many months of teaching, explaining, describing, convincing, persuading, cajoling and begging to get him to agree to even try this medication in the first place? Are you even aware of evidence-based guidelines that recommend statins for patients with diabetes and CAD? I assume you're aware he has these conditions BECAUSE YOU FILL HIS FUCKING Avandaryl, Diovan and Procardia!
And guess what, asshole: his knees and hips still hurt. Think it might be osteoarthritis? You think you'd never seen that in a septuagenarian before.
So thanks for nothing, fucktard. No matter how hard I work my ass off trying to educate my patients about the need for their various medications, you go and undo it all -- why? Because you can? Just to prove to yourself that patients hold you in higher regard than they do me? Think I can get you named as a co-defendant when he has a stroke and the wife sues because I wasn't following the guidelines? No, of course not. You'll just keep smirking there behind your counter, saving poor patients like him from us arrogant docs whom you claim don't know one tenth as much about drugs as you do. Well guess what, you cum-burbling trout-fucker [thanks, CrankyProf!]: you may think you know all about drugs, but you don't know the first motherfucking thing about using them in people.
So why don't you go down a bottle or two of tylenol and chase it with a quart of vodka for good measure. Your basal metabolism is contributing to global warming, and there are slime molds who'd make better use of the oxygen you consume.
End Rant.
posted by #1 Dinosaur @ 6:00 AM
88 comments
88 Comments:
Feel better now?
"Morally bankrupt intellectual midget?"
Or you could just default to vulgarity, and call him a "cum-burbling trout-fucker."
Yes; yes I do; thanks, TBTAM.
CrankyProf: Knew you'd come through for me! Cum-burbling trout-fucker; I love it!
You, of all people, should know that what is *really* said is often not what is actually *heard*.
Particularly by the elderly.
Scenario: elderly idiot incapable of taking care of him/herself REALLY doesn't want to take this cholesterol medication. What does s/he do? They look for a reason not to take it.
How do they phrase the question?
"My hips and knees hurt. Could this simVAStin be causing it?"
Answer: "It's possible, but *very* unlikely."
What the person hears: "Yes."
So they stop taking it because that's what they wanted in the first place.
Who loses? You. Me. The patient. Professional relationships as a whole because you took information filtered by someone else not appropriately equipped to filter that kind of information at face value. It's like playing the old party game "Telephone" and then getting mad at the person at the end of the chain because you didn't like what they told you after. The dude in the middle is going "Hey man, that's not what I said."
The phenomenon is otherwise known as selective hearing.
All because the patient is too stupid to get out of their own way. You rant at the pharmacist, the pharmacist informs you that what they really said was X, and what the patient heard was Y, and said patient stands in the middle, cow-eyed as always. Of course it then turns into a giant pharmacist-doctor shitshow when really the emotional energy would be more productively channeled in the vein of "Hmm, well then how can we get this person to take this medication, then, if that's not what you said?" And then work together proactively from there.
I bet the rant felt good though, right? Well-written, too.
Oh, RJS; quit trying to rain on my parade (although it turned out it was actually two different pharmacists reported to have said the same thing.) Of course I focused on getting the patient back on a statin. It did feel good to rant, though.
Lame
Aww, s'okay. I enjoyed reading it. :)
Well, I for one am very disappointed in you Dino.
Number 1: Your language. Did you forget that old saw about sleeping on an angry letter (rant)? Like it or not, the internet is a public place and language that is appropriate for your cronies in a bar is not appropriate here. It also makes you look unprofessional.
Number 2: You voiced what has been my fear for sometime. Namely, that doctors view their patients as potential lawsuits and are treating and prescribing from that mindset.
Adieu, M. le docteur.
Dear Anonymous: Congratulations, you read what you wanted to see. You must feel quite satisfied at having your suspicions confirmed.
Psst. We aren't legally required to "spend months cajoling people". Legally, we can probably get away with telling them why they need a statin and then documenting their stubborn refusal. Nobody's going to get sued because a dude refused to go on statins.
We spend all that extra time over all those visits for one nefarious reason: because we don't want to see them drop dead.
Anon 1:34 - Actually, the language is one of the draws of Dr Dino. It means that he's a real live human being driven to cursing a blue streak by stupidity, which is something I do a lot. I never loved my GP of 14 years so much as when he lost his marbles in front of me (I don't think he would have done it in front of another patient, but he liked me like that), because it was nice to see an imperfect human under the coat.
Bah! I used to think pharmacists were part of the health-care team. Stuff like this (and believe me, it happens all over) indicates such is not the case. A couple of weeks ago I was trying to call in a script for a patient. The pharmacist wanted to put me on hold (after already a 5-minute wait) because she was busy "counseling" a patient. I wonder where she thinks the "patient" came from? She had somebody to "counsel" because somebody like me wrote a prescription. I told her I would tell my patient to take their business elsewhere and called the script to another pharmacy. "Counseling", indeed.
Here's what *I* want to know. Why don't pharmacies ever get Rx's left on their voicemail? I swear to God, it happens like once a day in my office. The patient calls me upset because the pharmacy doesn't have their Rx at all, it wasn't left on the voicemail. The voicemail fairy stole it I guess... and it's not only one pharmacy! It's different ones. I don't get it. Any ideas?
wow. it almost seems like someone hijacked dino's blog.
It may not apply to your patient, but particularly those of us who exercise are worried about statin side effects and influenced by cautionary analyses like this one:
http://diabetesupdate.blogspot.com/2008/05/yet-another-drug-study-shows-lowering.html
Loved it Dino. Loved it - made me laugh.
Voice mail RX...ah yes. They lie to the patients and say it's not on the voice mail, they lie to the patients and say it wasn't called in, and now that we have electronic prescribing, they lie to the patients and tell them it's not in their computer. Anybody seeing a theme here?
As for every patient being a potential litigant, gee, ya think?
Dude. Maybe you should use the "draft" feature next time and post later - after the steam has evaporated. : -)) Then again, this was an entertaining change of pace. Hope you're feeling better...
Well said! Let's hope that this post gets around to pharmacists everywhere.
Dude, how do you think pharmacists are regarded by the public? Our advice is thrown away in the light of recommendations from their friends or something that a nurse told them a few years back.
It’s time for a little defense.
Of course it's not on the voice mail. Its painful having to tell some of the smartest people in the world they keep calling in the RX to the pharmacy down the street. It's not on my voice mail because you didn't call me, dipshit. This accounts for about 1 in every 50 scripts called in. At 500 rx/day that’s 10 you or your staff called to the wrong location. I know you're busy, I am to the point where I can't counsel patients unless it's important. If I keep you on hold, it's important. Call in the RX somewhere else, believe it or not I don't need you and your prescribing. There are more MDs than PharmDs and we have more work than we can handle. When you hate your own job to the point you project that on others it is time for a change guys. Believe it or not some of us are trying to look out for you, not just your patients.
Brilliant.
John
Dino,
It's time to come home now. You don't need to be alone any more.....
The Dr Rant Foundation
(and thanks to Dr Crippen for pointing out to us where you were hiding!)
Anon 9:52: Are you kidding me?? I suspect you would be LIVID if someone insisted you stop speaking to a patient because their time and what they had to say was "more important". What makes you think it's ok to pull another healthcare professional (yes, really) away from someone who could very well be one of your patients?? Of course pharmacists have "patients" to "counsel"! First off, they're required by law to counsel on new scripts. Second off, the vast majority of them aren't the jerks that the ones featured in this post seem to be, and really do care that their patients understand how to correctly and safely take their medication, and what side effects may ensue.
I just don't get the vitriol here. Yes, pharmacists need doctors or there wouldn't be prescriptions to fill. But doctors need pharmacists too, or their prescriptions wouldn't be filled. I know it's not a popular idea, but I don't understand why we can't... oh, I don't know... work together for the good of the patient??
And yes, I realize that a lot of pharmacy blogs out there rant on doctors too. I don't much like those posts either. :)
A-fucking-men, brother-man!
But then a patient with a non-controlled prescription in hand wants to change pharmacies. Heaven forbid the pharmacist check with the previous pharmacy. Call the doctor to re-write all the prescriptions he wrote a few weeks ago.
My favorite is when they don't have a drug in stock and tell the patient the drug is no longer manufactured. I got that once from a patient, and I tracked it down to the pharmacist who really said it. Admitted same. Pointed out I was looking at a filled prescription of the same medicine, prescribed to me, and filled by a neighboring pharmacy.
No, I've noticed similar things with pharmacies these days. They're too busy playing doctor to.....how should I put it.....check prescriptions and count out pills.
Gee. Perhaps the pharmacist told the patient "Check with your doctor about this Zocor, perhaps it is making your knees and hips hurt." And that is exactly what the patient was doing.
Someone seems to have anger issues here.
you're an idiot...bet you eat up the shit being served by every pharma rep walking in your door...READ something other than what they give you. Bet you're one of the TARDS that also believe in Noahs Ark, Santa Claus and other fairy tales. Statins are horrible, misguided drugs for lazy doctors...the sooner you realize that the better. You're just too lazy to have an honest conversation with your patients and tell them it's THEIR DIET STUPID!!!! Your stupid enough to believe what the Pharma reps feed you...good job "doctor"!
Kudos to the Pharmacist...they're doing your REAL job.
I'm going to have to agree with RJS.
If I had a dollar for every old geezer who remarked his doc is a moron, I could retire early.
PS- Would it kill you to use the generic names? Or would that require you unhinging your jaw from the teat of Big Pharma?
Pharmacists don't typically flat-out tell patients not to take their medicine unless its an obvious answer, ie no Tylenol to put down a killer hangover. Doctors yell at pharmacists who do things like you describe and send their patients to other pharmacies. Believe me, patients bitch at us enough without us needing your wrath, and losing the business you send, on top of it. Then again, there are pharmacists who are morons just like there are doctors who are too. My guess is the pharmacist was a moron or the paitient heard what he wanted to (it could be caused by versus stop taking simvastatin...), he saved $10 a month in copays since he doesn't have to take the drug anymore.
I got a good one! This really happened today at work. A patient brings in 2 rxs from a local emergency room. The first is of course Vicodin and the second is...LOPID 200mg BID for pain. Now in pharmacy school, they did not teach me that LOPID was for pain. So I called to clarify the Rx and the doctor acted like I interrupted his day or something...like Heaven forbid I do my FUCKING job! That's right I saved his ass so the next you say a pharmacist is a fucktard, look in the mirror.
Last time I checked "counseling" was legally required, and in my state they are handing out fines like Halloween candy. If not for counseling I wouldn't have known the doc didn't mean to write for sulfadiazine, that he really wanted sulfasalazine. Or that the patient was expecting clonazepam not clonidine. How many times I call a doc's office to clarify an rx.. to find out if they really wanted Levaquin 750 bid or Tussionex 1-2 tsp q 4-6h, or today..an IV antibiotic for a patient who was expecting an oral med...there's a good chance that the reason you're on hold is I'm on hold to some other physician's office. Luckily most of the drs are very pleased when I catch their 'typos'.
As to playing doctor...I'd be thrilled if people would quit showing me their nasty skin conditions...I am not, nor have ever claimed to be a dermatologist.
You forgot the part where the doctor is only dealing with one patient at a time and*wait for it*--no telephone interuptions while he is with a patient. If only the pharmacist (I'm talking retail here because this seems to be where the beef is!) could counsel the patient without someone hovering in the back asking where toothpaste is or somthing like that while the phone is ringing. The techs are trying to stay on top of the phone calls, but being that there are usually more phone lines than techs there will be some times when they can't answer all the lines at the same time. Then you have the transfers because of patients cherry-picking pharmacies for the new scrip coupon being offerred this week, that tends to tie up two pharmacists for the price of one! On top of that, people coming in for OTC recommendations because they don't want to wait a week or more to get in to see the doctor because they feel bad now and would like some measure of relief. Then top that off with making sure that the patient's medication he is getting from one doctor is not going to interact with something from the other one. Then comes hour two........
Anon 12:04 (re: me and pharma reps): Check this out. Oh, and ever heard of Type IIa hyperlipidemia? They can eat no fat whatsoever and still have LDLs over 200. Believe me, they'd far rather pop a pill than try to swallow four packets of sand (aka cholystyramine) a day. I know; that's all I had to offer them when I started practice.
It's called rhabdomyloysis. You should check it out. I'm sure you can find a CME on it somewhere...
Typical "know-it-all" physician who doesn't like the thought of others knowing more than him. If you had pulled your head out of your ass long enough to treat this gentleman's pain, he wouldn't be going to the pharmacy with complaints like this.
Has it occured to the holier-than-thou posters here that the voicemail we didn't get either got erased by you when you pushed 1 to re-record and hung up or was unintelligible? I have had voicemails that I couldn't make out the doctor or patient. How am I to call someone for clarification???? then there is the fax machine. The fax I sent you 4 times MUST have gotten through at least once. Yet you tell the patient you never got it. the pharmacy must have screwed up.
why is it always the pharmacists fault?
why must we assign blame at all? Argh.
Yeah, pharmacies love lying about prescriptions not being on voicemail/electronic retrieval when they really are.
A little known secret is that pharmacies actually make more money by NOT filling prescriptions. Just ask any pharmacist in retail. It's like golf. The lower the number of prescriptions you fill, the happier management is.
Damn, Dino, quit beating around the bush, and tell it like it is.
First, Why in the hell would I lie to a patient about a voicemail being called in or not? Like I want them calling me every 10 minutes looking for it...no! Maybe if doctor offices would not wait until the end of the day until after they are closed to call Rxs in, patients would not be calling me 20 times a day looking for their damn Vicodin prescription. And same thing with faxes...I get notices from my fax machine if a fax is not transmitted...yet I hardly receive those messages b/c the faxes go thru, but patients will call saying the MD office never received it. Hmm...what did you do...lose that like I lost the voicemail. Genius know-it-all nurse must have left that comment b/c nurses now EVERYTHING.
Second, For the care of the patient, who we are all in business for, maybe it would be a brilliant idea to work together instead of thinking the other is a complete moron. Have you ever heard of COMMUNICATION. Has in open you fucking mouth or write it down legibly b/c I'm not a fucking mind reader if you D/C or add a medication and have to wait 2 business days to find out or not from your incompetent staff or your failure to communicate.
you're an idiot and should just kill yourself
I don't presume to know what it's like in Dino Doctor world, but in pharmacy world, people hear what they want to hear, we are always "losing" their prescriptions because either it didn't get called/faxed in, and instead of admiting they forgot to do it, they say they did, or they do call it in to voicemail, which is checked hourly, and the md's office said it was called in 2 hours ago when it actually was left on VM 10 minutes ago, or people are just stupid.
Or all of the above. We have to work together, dude.. it's the only way :)
About calling in scripts to the voicemail... I spell out the patient's first and last names, REITERATE my phone number, give the pt's DOB, pt's phone number, etc. etc. . . Do they need the patient's shoe size before they will fill a script?
Hey moron (anon may 13 08:39):
It's actually called "Rhabdomyolysis". I am sure dino knows it well. It doesn't seem that you do.
Voice mail, shmoice mail. I've had techs tell my patient the rx hadn't been called in when I had talked to the pharmacist myself. (He did, bless him, remember the conversation, although it had been an hour or two). Patient ticked--at me! My all time favorite: years ago I called in an rx for a neighbor's kid at XYX pharmacy before I left the office at noon. Later that day, I go to pharmacy to pick up rx for neighbor's kid (since I was doing some other shopping for neighbor) at 4:00 pm. The tech tells me "the doctor hasn't called it in yet." So don't try to tell me this stuff never happens.
I'm so glad to know some of you don't need my patient's business--I'll continue to write all the 90 day scripts for mail-in services I can and save you the troulbe.
a lot of times they tell the patient that the rx has been called in , and then pik up the phone and call the pharmacy. sometimes I am tempted to disconnect the voice mail, so I don't have to keep calling back and ask to clarify. even electric prescribing sucks, if the doc's staff doesnt know how to enter the drug/sig/etc. and god forbid if you call the Dr office. after pushing 10 different buttons and listening to bunch of idiotic messages, maybe you get a real person, and then they put you on hold or maybe call you back the next day.
and everytime you complain, you hear the samething: well... "we will not call rxs to your store anymore"!! and believe me we dont get a shit if you call the rx to mail order... i am sure you patient be in good shape waiting for it while having a UTI.
I dont know what a doctor would be without his rx pad... but i wish they knew how many times we save their ass and their patients on daily basis, and they have no idea about that.
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Hey doc, climb off your high horse, stop eating your big pharma drug rep supplied meal during your 2 hour lunch break, and go suck a dick. Spend one day - no, one hour at a busy pharmacy during 5pm hammer time and maybe you'll begin to realize.
Hey Doc, I bet you wouldn't even survive one day in a pharmacy. Honestly, doctors are the most spoiled people out there. How about you stop bitching, practice your handwriting, and write a dosage that actually exist? And how about you actually try spending time with your patients instead of churning them in and out of your office and leaving us to be the one to explain how to take their medications. Idiot.
No, genius! The point was that I had called in the rx. Myself. so don't give me they told me "it was called in and then picked up the phone."
Well, I think the pharms have now removed all doubts that they are part of the healthcare team. It used to be when you went to a new place you visited the pharmacies so you could meet the pharmacists. Back in the day we helped each other. Clearly, not so now. These are some of the most hateful people I've ever encountered in cyberspace. Just confirms what I aready suspected. Wonder if they teach them to hate doctors in pharm school or they get that way after working a few years?
5:00 pm hammer time, my fanny. Try it a 3:00 am, sport.
A few examples from today -
Mary from Dr. X’s office: Dr X is very angry that he is being questioned on this rx. Do you have it in front of you?
Me: yes
Mary: What does it say?
Me: It says glipizide 2.5mg – 1 po qd.
Mary (in a snotty voice)- Well, Pharmacist, then that’s what Dr X wants
Me: Well, Mary…I would be happy to give that to patient X except that glipizide is not avail in 2.5mg. Glipizide er is avail in 2.5mg, but reg release glipizide is avail in 5's and 10's. The patient was on reg release glipizide 5mg bid for a year prior to now. I suspect that he wants gilpizide 5 – ½ tab bid, but he may also want glipizide er 2.5 qd.
Mary: Well, if it’s only avail in 2.5mg ER, give the ER.
Me: I would appreciate it if you could check with the md. This is a sig change from his current regimen and I need to be sure – he could’ve completely blown it and wants him to stay on the 5’s bid.
Mary: I’m not going to ask him. If you want to, you can fax your request and I will put it on his desk.
10 min wasted printing and faxing with other patients waiting, five hours and 12 calls from the patient later, gilpizide 5 – ½ tab bid via fax - no thanks needed and none given.
Pt presents script for Vicoden ES 1-2 Q4-6, #360/30days. He got 30day supply 1 Q6 14 days earlier and is perpetually early on this and every other rx. Told him no. He comes back an hour later and says that he spoke with Dr. A who told him it was ok and that I should call over to Dr. A’s office for approval. Unless the guy is single-handedly responsible for the malpractice mess, there’s no way he’s letting that one by, if only b/c apap dose…great…this should be interesting. Call Dr. A and he tells me that yes…he told him to bring it back to me and could I destroy it and tell the patient no and that he would need to find a new md. And the fun continues…
I could go on and on, but I don't care to revisit my day anymore than I already have
"These are some of the most hateful people I've ever encountered in cyberspace. Just confirms what I aready suspected. Wonder if they teach them to hate doctors in pharm school or they get that way after working a few years?"
It comes with experience. After you've been kicked on your ass the first 100 times, you don't bother to get up anymore.
yes... we get that way after few years .. of dealing with doctors like you, who think they are better than the rest of us. You said you called in your own rx? Someone should report you to the medical board!
I am not here to rip on pharmacists. I love my pharmacist (he's my husband) But it is very true, my md sent a electronic script to Walgreens. I called once each day to see if it was in, got no no!! I called from my doctors office and I ask, they said NO I put my MD on immediatly and suddenly it materialized....
I love these guys, they think all pharmacists just count and fill prescriptions.
Well, all physicians do is write prescriptions. I count in fill accurately, and yet you can't seem to write legibly or give a proper dosage.
I guess I do have to play Dr., calling to let you know of the interactions you have missed, the patient that is obviously abusing medication yet has you snowed, and the massive overdose you apparently want the patient to receive.
Don't bitch about how I do my job, when apparently I have to cover your ass too!
Bitching aside, it is a two way street, you expect professional courtesy, as do we. You get dicked around by insurance companies and so do we. You are in a profession aimed at improving the lives of others and so are we. You are not gods, and neither are we. Can we all grow up?
Here's my own dealings with your type TODAY. Doc one wrote script for desloratadine 5/pse 240mg #100 1po bid...first off, thats not made commercially, its 2.5/120mg Second, bid is completely inappropriate for a 240mg pse dose. I wasted 15 minutes on hold getting the rx right.
Then Dr Brilliant mind writes HCTZ 12.5mg "1qd for 10 days after HCTZ"
WHAT?!? Even the nurse had no idea what he meant. She had a good laugh but I didn't.
Regarding statins, I have had several people with extremely painful joints on simvastatin.
I'd prefer not to be disrespectful, but piss off.
"Voice mail RX...ah yes. They lie to the patients and say it's not on the voice mail, they lie to the patients and say it wasn't called in, and now that we have electronic prescribing, they lie to the patients and tell them it's not in their computer. Anybody seeing a theme here?
As for every patient being a potential litigant, gee, ya think?"
WTF ??????, I thought pharmacies were in the business of selling prescriptions...what could possibly be the motivation to intentionally lose electronically transmitted orders. If I follow this logic then the best business model for a pharmacy would be to close the doors.
This problem is not a one-way transmission issue since I've had doctor's offices say they didn't receive something I know I faxed to them. I just chalked it up to the foibles of the electonic age, but apparently I should be enraged and assume it is intentional. Good grief.
Its interesting that this post has led to a debate over voicemails left at the pharmacy. As a pharmacist the most frequent thing I see happen is this: MD tells pt that they will phone in the rx, and then hands it to the nurse/receptionist to phone in. Pt leaves heads right to pharmacy, and gets pissed when rx is not ready, calls MD office, and bitches. MD office calls and says this was phoned in, gives me the rx to fill for pt. I think the problem lies not with the PharmD. or the MD, but whoever the hell is supposed to be phoning the scripts in. My honest opinion.....usually the person is too stupid to work voicemail. My proof...my personal favorite is when they say "M-G" because the MD wrote milligrams, and I will also add that all the best mispronunciations of med names have come from receptionists at MD offices!!
Interesting to hear the take from both sides of the fence... I agree with above (anon 3:17.)
It sounds to me like pharmacists need a receptionist (to do faxing and wait on the phone for confirmations from the MDs) and MDs need receptionists who can follow up better. In regards to pronunciations -- perhaps a verbal readback by receptionists when you hand them the script to call in would fix a lot of the problems (and perhaps legibility so the patient can read the script they hand in too.)
Everyone needs to recognize the faults that they can fix instead of grumbling about the ones that they can't. :)
"A couple of weeks ago I was trying to call in a script for a patient. The pharmacist wanted to put me on hold (after already a 5-minute wait) because she was busy "counseling" a patient."
Oh my god, anon9:52. Have you called your own office EVER?
You know how long we have to wait on hold? 15, 25 mins, and thats just to get a receptionist! Then its another 25 mins until your phonemonkey tracks down either you or a nurse.
You think a 5 min hold for the pharmacist is bad?
We're not only attending to your patients, be some from every other Md/PA/NP in your office, and every other office within 25 miles.
"It sounds to me like pharmacists need a receptionist (to do faxing and wait on the phone for confirmations from the MDs)"
They have them. They are called Technicians, but most states either treat them as glorified cashiers, or have them so restrained to what duties they can preform, they are basically glorified cashiers.
I love the voice mails that are so rushed it makes us think your nurse sidelines as a auctioneer.
You all love to invent new medications, or strengths on a regular basis. Today for example, I had both Fluoxetine 30mg (which doesn't exist) and Vicodin 7.5/500 (which does, but its not called Vicodin)
Dear Dr Dick,
Until you have spent a day walking in my shoes, don't presume I'm a fucktard who gives bad advice, loses scripts, lies about it, and lives for the drama that ensues. We are just as busy as you are, and get just as pissed off at the system when things fall through the cracks.
I actually have worked both sides. 17 yrs in a hospital pharmacy. Yes orders get lost, yes faxes don't go through. I can't tell you how many times I get a call that I faxed this hours ago, blah blah blah. If we don't have it, I tell them I will keep an eye out for it if they re-fax (even though we are being pummeled with faxes an inch deep). 5 min go by. No fax. I call back to inform floor I haven't received fax. They call back. Did you get the fax I sent again? No. Please send it to xyz number instead of pushing the speed dial and sending it to God knows where. 5 min later I FINALLY get the fax. Busy staff misdial all the time. It's a fact of life. Put your big boy pants on and deal with it. I do not want the drama.
The only RX writing applications in electronic charting systems I have seen are nothing more than glorified typewriters stuck in a POS system.
That includes the POS system we use in the busy Medical Oncology clinic I work for on the same hospital campus. All the docs and staff are very busy. It gets very chaotic. They are alloted 15 min for a follow-up, so they really rely on their staff to pay attention to detail and make sure things don't fall through the cracks. Our docs really appreciate it when we bring things to their attention and clarify big and small details because we all care about the patients and are doing the best we all can to juggle it all. If I had a dime for everything I've caught that the doc, NP, and nurse missed, I'd be retired by now.
And please do try to call a mail order pharmacy. You will spend 5 min working through the phone tree, then wait 30 min to speak to a live person, then be put on hold again to speak to a pharmacist. When your patients have a question about their meds, they don't call that 90 day pharmacy. They call us because we are down the street. And we 'counsel' them for free, even though they never fill their scripts with us. How many patients do you see each day that you don't bill for your 'cognitive' services?
I guess we can't bill for that because we are a bunch of asswipes.
BTW, I would never tell a pt to quit taking something without discussing it with the MD. I always preface advice by telling them I cannot tell them to not take something or change the dose.
I guess I should ask why you are so angry. But I don't because I would think just about anyone who has worked in a healthcare system for any length of time would be able to tell you about a time they were pissed off beyond belief. It comes with the territory. You vent, we vent. It doesn't make us all bitter hags.
Pharm D's:
If you haven't noticed dino has a lot of growing up to do (or find another career). She insults medical subspecialists, hospitalists, surgeons, radiology, etc with the same brush as you guys. Are there bad people in each field, of course and I personally believe they are the minority. The problem dino has, is she turns a rant against one person (event) into a rant against a whole specialty. I could spend a whole ream of paper on stupid PCP antics but I won't because the vast majority work hard and try the best they can in a bad situation and I know it. I strongly suggest to dino she take a good long hard look at her career and consider making a change if it is that bad where she has to rant on a different field each day.
I'm sick of docs having to write scripts for their frequent-fliers in the er and getting burnt out that they actually get to help a small percentage of people. Then, those said narcotics seekers come in to my retail pharmacy and whine and complain because they got there after a sick child who's script we are hurrying to get ready so maybe her and her mother can feel better and get some rest. They always watch over our shoulders to make sure we're not calling you to clarify you did indeed tell them that it's okay to fill it early. And, for those md's that do okay it early, we want to scream because they get the must smug look on their face ever and continue to stare at you while you fill the script and perhaps take a phone call while they impatiently wait for the script. To those who work at an md's office, I'm sorry that the quality of those that call in scripts has plummeted. The nurse shortage in many states means that idiots who have never even taken any kind of classes that nurses are required to call in scripts! They are always the ones who are nasty when I call to verify a script and when I wait on hold for 10 mins to speak to a nurse, she is polite and thorough and even if talking to the md requires another 10 mins on hold-I know it's the truth. As for the whole voicemail thing-SLOW DOWN!!! I hate having to listen to the vm more than once even though it happens more often than not. Again, I miss the nurses who are so good! And the patients who say "But they called it in 30 mins ago!" don't account for the whole script process! And as for saying we don't have it, I think both md's and pharmacists need to work that out a little better. Despite other comments, e-script is a God-send! You know DEA#, can see a signature, DOB, etc, etc. Love that! As for the comments about ranting and hateful people, trust me if you don't get it out to fellow health care professionals-you WILL go insane. Especially when you share a similar elderly patient who you know will hear one thing and claim you said another. And to the doc who went to all the pharmacists to introduce herself, that is GREAT! We have a face to a name and you're not just another doc who sends us patients. We know md's hate being on hold but remember this, at my said retail pharmacy, there are up to 4 techs to 1 rph and they are overworked, not given even a simple lunch break sometimes and deal with things that I'm sure you're glad to never deal with and then phone calls for the pharmacist that are patients who are lonely and want to just talk. Did we mention how much we love to have a good nurse at your office to make it easier? Thanks for the rant though. I'm glad you feel better and won't take it out on me or God-forbid the idiots seeking narcs at your office
I hope my med school friends won't turn out to be as nearly as ignorant and idiotic as you are. My guess is that you're one of those physicians that gets an orgasm every time you write all the letters after your name.
Have a nice life Jane Smith, MD, FASDB, FAUOSDI, FASUDI, FGHIJKLMNOPQRSTUVWXYZ
Anonymous at 9:52 said...
"The pharmacist wanted to put me on hold (after already a 5-minute wait) because she was busy "counseling" a patient. I wonder where she thinks the "patient" came from? She had somebody to "counsel" because somebody like me wrote a prescription. I told her I would tell my patient to take their business elsewhere and called the script to another pharmacy. "Counseling", indeed."
Yes you stupid fucktard quack.... we need to counsel patients usually because their doctor did not have time to explain anything to them as they were "too busy" - yeah too busy getting another consultation fee from the "customer".
If I had a dollar every time I've gone out to counsel my patient and they've given me a blank stare or the response "nothing" to my question - "What has your doctor told you about this medicine?"... well I wouldn't have to be here deciphering your unreadable "too fucking lazy to write proper letters" handwriting or having to deal with your "I am GOD" attitude on the phone when I ring you up to save your sorry arse from another prescribing error/drug interaction/made up medication you've written on your itty bitty little paper.
So you tell your patient's to take their business elsewhere??? Well you sound like the type of doctor to who I tell their patients to go and get a second opinion........
Fucktard...
Um, Anon May 16 @3:33 a.m (and you too, 10:38pm), Dr Dino is a dude. You'd probably know that if you actually read the blog regularly, rather than dropping by to react to a single rant.
Dr. Dino, I've been reading for a while, but never commented. I can totally relate to this situation. I'm an RD and I manage a bunch of home parenteral nutrition patients including writing all of the orders and dealing with the home infusion pharmacists almost daily. I love most of the pharmacists I work with, but it's the bad ones (e.g.,asking for orders based on labs that were drawn off of the PN line...hmm, glucose > 1000, K = 7, triglycerides 700, why, yes, I most certainly will base my orders on those labs) that really stick out.
Thank you for such an entertaining blog!
You've been beaten...badly
http://www.theangrypharmacist.com/archives/2008/05/paging_doctor_sandy_pants.html
Sirky:
Anon 3:33 AM here (was at work by the way). I don't know dino's sex and frankly it's not really relevant in this discussion now is it. I HAVE read "his" blog fairly regularly in the past (hence my comments about his rants). I will say it again bluntly, ranting against a whole field because of the activity of one member is FUCKING STUPID CLEAR AND SIMPLE. You are an RD, how would you react if I ranted against your whole field because of one RD's "concern" to me of a very low prealbumin in an actively dying hospice patient (true story). Not in a positive way I suspect. Think about it.
OK - Dr. Dino and all you other MD's out there who think that being a retail pharmacist is so easy and all the pharmacists are so stupid - I challenge you to go to your neighborhood chain pharmacy, and just sit in the waiting area for a bit and observe - right about the time you and your staff are busy taking your hour long lunch break on a Monday should work really well. I want you to watch the pharmacist, and seriously think about how different this work environment is compared to yours. The bottom line is that there are MANY reasons why the things you are complaining about happen in a pharmacy. One of the big ones is simply that most pharmacies are understaffed and our corporate office makes decisions that negatively impact non-healthcare related work quantity (such as sending out transfer coupons and loyalty cards) that we at store level have no say in. Go watch with an open mind - you really might gain some insight into why pharmacies don't operate the way you think they should. Oh - and do us all a favor - please tell your staff who call in prescriptions that they need to spell names, give us a birthdate for the patient, and for heavens sake don't talk so fast. I don't take speed writing classes in pharmacy school - I learn about the medications.
this doesnt like physicains. nice to see he can ride another dr who he thinks is smarter than us MDS.GIVE HIM HELL. TRISTAN V,STONGER,MD PERU
Wow. You pissed off a lot of people.
Doc's do suck though. You acutally put some time into a patient and the patient decides to continue their life long practice of noncompliance so you have to blame somebody- and since everybody is inferior to the MD you might as well blame them. In this case, a pharm.
But the funny thing is most pharms think that they are your equal-education wise- so you really hurt some pharm feelings becuase quite clearly they DON'T EVEN COME CLOSE TO COMAPRING WITH YOUR BRAIN POWER.
But since you might be cool, and I say MIGHT, because you actually have a pretty cool blog and seem to have a soul- I explain this piece of psychology to you (I'm writing from my moderate experience with MD's that they are possess questionable social skills). Don't put all your precious time and energy into a 74 year old who is prone to noncompliance- think of it like a sales gig. They'll tell you "yes, I'll buy tomorrow" just to get you to shut the fuck up.
The bottom line is though- IT'S YOUR JOB TO BUST YOUR ASS GETTING 74 YEAR OLD PAIN IN THE NUTS TO TAKE MEDS THEY COULD GIVE A SHIT ABOUT.
But you've got a right to let out some written steam like the next medical professional.
But...its cool that you tried. Most of your ilk don't even give a shit.
Doc here:
Talk about generalizations angry nurse. I am glad I don't view the nursing profession as you view the medical profession.
Here is my experiences being a patient
1) pharmacist proudly exclaiming he had just turned 83 and then shorted my prescription by fifty pills and gave me double the dose. If I hadn't caught it I would have overdosed and probably died. Same pharmacist advised that I should just cut the pill in half,pill was a long acting extended release narcotic. He was completely unaware that this was dangerous. Formal complaint and he was forced into retirement thank god.
2) Doc ordered wrong strength , pharmacist caught it one year later and told my daughter who was picking up the prescription that "your mother is taking too much medication" and she questioned my daughter on why I needed pain medication.Privacy violation anyone..pharmacist said she "counseling"
It did explain why I was having uncontrolled twitching and early onset menopause though, both resolved when I discontinued this med.
3) Because I suffered a traumatic spinal injury which resulted in surgical rescue and permanent neuro deficits with chromic disabling pain I get the wonderful experience of the baleful looks and the snide comments from the pharmacists despite the fact I don't actually take much narcotic at all but they consider any long term use of pain medication as an affront and assume immediately that I am some low life scum..until I tell them I work one floor above them in the Intensive Care Unit as a critical care RN.
Surprise! Most of us broken backed chronic painers go to work and the only reason why we can still do our job is because our doctors prescribe enough medication for us to be able to move.
My biggest pet peeve about any pharmacy is the lie..the it will be twenty minutes lie. You and I both know there is no way in hell you can fill my prescription in twenty minutes so why do you say it? and more importantly why do I fall for it every damn time?
I know that filling a prescription is a complicated thing but let me tell you something..it ain't that complicated. I worked for a vet for ten years before becoming a nurse. I had to do your job all day long along with everything else that running clinic entails. You have to look at the prescription and make a label and then find the right pills,count them out and then read the label to the patient..or in my case the patients owner. It's not rocket science and you have the benefit of having techs doing the labeling,the finding and the counting. Your only job is to look at the script and compare it to the label and then compare them both to the bottle and count the pills out again. It should take about three minutes max.
And here is a novelty here in Toronto, most clinics are moving away from calling in scripts anymore. You have to go back to the doc and get a written script every time now. Calling in refills without seeing the patient loses clinics money.
Pharmacists need to chill out they are getting kinda scary.
to "adventures in disaster"...
I'm glad to see that you've got such a firm grasp on what a pharmacist's job entails. ...about as accurate as the perception that all you RN's do is wipe people's asses and steal nicotine patches from the Pyxis machine.
I agree with the post stating physician offices call in rx's to the wrong pharmacy ALL the time. They never apologize...just act like you are bothering them when you say there isn't a Steve here..even though that is who they wrote down they talked to. In my town, we have a clinic that has receptionists with NO training call in prescriptions. We have to call and clarify about 20 rx's from them a day. So take your rant on pharmacists and stuff it. Maybe you should spend your time training your staff to CORRECTLY call in prescriptions, and make sure YOUR patients understand what you are saying. Patients call us because YOU are too busy for them.
Damn, i'm forever thankful that i had the smarts to finally get the hell out of retail so i don't have to deal with asshole doctors, ignorant nurses and douchebag customers. Life is so much better now when i get to do what i was trained to do as a pharmacist without being bitched at, yelled at, insulted and told that i'm nothing more than a pill-counting label-licking monkey by moronic holier-than-thou idiots who barely managed to graduate from some dinky medical school at the bottom of their class but still think that they are Gods .
The arrogance of MD's never ceases to amaze me. As usual, there are always the ones who use a collaborative approach with us PharmD's and it works out very well. The added knowledge (when put together) is priceless and should be utilized more often. This is what they teach us PharmD's in school, and what they neglect to show the MD's (or which some choose to ignore). You are not the know-all, be-all. It's impossible to acquire all of the medical knowledge to know everything.
For every in-patient, a clinician (MD, PharmD, NP, PA) should be looking up new information 3 times per patient, for every 3 outpatients, should be looked up 2 times. How much do you think this happens? A patient we just had on the GI ward was on warfarin and during the weekend (without the PharmD present like they usually are on rounds) the resident MD decides to put the patient on bactrim for an upper respiratory infection. Acceptable if the patient wasn't on warfarin! Where was the all-knowing MD on that one!?!?!? Could have even looked in up in her palm beforehand, which was in her pocket. Ends up her INR hits the 8 area, now which the patient spends 2 extra weeks in the hospital at $3,000/day and her treatment is delayed.
Next time the PharmD's are on the floor, we get peppered with questions and demands on how to fix the "situation". After, the attending MD comes up to us and tells us he doesn't know how he would get all the work done on the floor without us there. He is one of the good ones and would recommend patients to every time.
As for you "other" MD's, I would be scared to send patients to some of you. You prescribe narcotics just to get them out of the office. PRESCRIBE DARVOCET TO EVERY GERIATRIC WITH RENAL IMPAIRMENTS EVEN THOUGH IT'S ON THE BEER'S LIST. Send them to us so we have to deal with them and tell them they really don't need to take 5 capsules of omeprazole a day because they are really just taking it wrong and THAT is why it's not working. Have to describe the PK of fentanyl patches to you gods because the amount of medication releases at the same rate no matter what from the patch, changing them in 2 days does nothing more for the patient than doing it every 3!!! I've worked in retail before, it's high stress, high volume.
Patients wait in your waiting rooms all day, go into the local drug store and expect that out of patients while you are short-staffed, have 500 scripts to fill, have 10% of those need to be verified because of MD error or secretary error. Not a chance! They already waited in YOUR office for 2 hours, they want to be out of there in 10 MINUTES. Do they want it done right or do you want it done fast, then come to me later on and sue me for negligence? (or have the likes of YOU have to call and bitch at me??)
Like there are bad MD's, there are bad PharmD's, there is nothing to prevent it, but more often than not, the arrogance factor is what makes the bad MD even worse.
I received a bachelor's degree in genetics and molecular biology, I've done research, I wrote a thesis, and received a DOCTORATE degree in pharmacy (and a residency), just like your DOCTORATE in medicine. I don't tell you how to do an angioplasty, but I do know how to treat them afterward, so don't treat me (or my colleagues) like an idiot. I respect MDs (many do great things), so do the same to me.
This post makes me not respect you whatsoever.
Dear Doc,
I understand physicians offices too, like pharmacies, are busy, understaffed, and staffed with human beings who are not infallible. I also share your frustration with "holes" in the system. Many of our mutual problems, so eloquently scribed by your blog and my fellow colleagues, could be managed with better communication. I love a lot of our local MD, DO, ARNP, PAs,etc... they are hard working practitioners that want to improve patient care and patient outcomes, like myself (I am a PharmD by the way). In my experience running an independent community pharmacy "wellness center" I see these issues daily. I think as a joint force of health care practitioners we need to clarify, not be upset when asked to clarify, and communicate with each other. I have many times helped a physician reach HIS/HER goals for a patient, caught errors that saved a patient, helped refer back into care a patient who was a. not an appropriate canidate for self-treatment, b. was having an issue beyond my scope of practice, as well as the physicians I have worked with have read my recommendations and decided against a recommendation, b/c of a piece of information I was not privy to. I also, by simple means of med reviews done for pt receiving meds at other pharmacies, saved patients b/c ALL of their providers have an updated med list. Physicians with each other, don't always communicate well, and as 1 part of the health care team or triad (physician-patient-pharmacist) I see many areas that we can help each other-which in the end helps the patient, helps the health care system, saves the patient money, save the system money, helps us to support our practices. In the end it's not about doctors vs. nurses vs. pharmacists vs. office staff vs. technicians... It's about what you were trying to do with the months of cajoling... help the patient. We'd be happy to help you do that, if you'd just communicate.
Respectfully, CyHawk 9804
Good on you Dino! Pharmacists are glorified cashiers that get a sense of satisfaction because they feel they are 'saving lives' from poorly or ineptly written scripts from MDs.
P L E A S E pharmacists, stop using this bullshit excuse that you are saving lives!!!
YOU COUNT PILLS!!!! PERIOD!!!!
Keep on Dr. Dino. Remember, your work and status as a physician is respected; pharmacists have cashier-level status and zero respect. (as it should be)
It's funny you get what you give. There are all levels in both professions. If you are a good at your profession, either Pharmacist or Physician, you use everything available to you. If you don't, maybe you rethink your position. If either thinks he/she knows everything then you are not good enough to have me as a patient.
Doug B RPh
You should check out the episode in season 6 of Curb Your Enthusiasm where Larry David takes the recommendation of the Pharmacist over the Doctor on a prescription for his dad!!! Sure, its just TV but it warmed my heart!!
So why is it that pharmacists have to call doctors numerous times a day to verify the little things that apparently are unnecessary on prescriptions (dosages, quantities, licensure information, etc.)? Why is it that the perfect doctor could not be bothered to know the laws regarding the prescribing of medications in both the state and the country they word in? Why is it that doctors write prescriptions that DO have serious interactions with other medications the patient happens to be on --- and why is it that NO doctor will ever admit to being wrong?
You're not the ones who went to school to learn about medications and how they work. You know what the latest sales representative can tell you, not the actual pharmacological workings of the medication. You read your book, prescribe a medication, and just "know" that it's correct for the patient.
Never mind the fact that if the medication is too expensive, the patient won't be compliant and your "hours of cajoling" will do nothing. You have no sense of what goes on in the pharmacy, only that you have no respect for the people who DARE call you out on your mistakes.
Tell you what, I'll respect you about the time you stop making mistakes that first year students would recognize.
I wish the Dr's office in the area I am in would even try to use the voice mail. I work for Walgreen's and we do over 400 rxs a day and only 20% of our call ins go to voice mail. The rest are called in directly and the person on the other end has to wait until I can get to them, and when I do they cop an attitude. If they were in a hurry they should have used the voice mail like my wife does ( a Dr.s nurse). Also most of the time they are not a nurse and cannot even pronuciate the drug name or speak english ( what do they do find the person with a speach impediment and a stutter to call in?). Also patients will hear what they want to, when we tell them why the insurance will not fill the med they call the MD's office and claim that we wouldn't give them thier rx and nothing else. Bad communication and nothing else. We are both ends being played by the middle.
"So why don't you go down a bottle or two of tylenol and chase it with a quart of vodka for good measure. Your basal metabolism is contributing to global warming, and there are slime molds who'd make better use of the oxygen you consume."
Nice, Mr. Professional. Scumbag.
Hi all! I just read this blog and I have been a PHARMACY TECHNICIAN for 7 years. I must say, why are doctors and pharmacists in a CONSTANT fight against one another? We're on the same team, working for the same people: the sick, the elderly, the young, the stupid. I'm in agreeance with some things and opposed to other things that Dino said. 1, I have met a LOT of doctors in my 7 years that didn't know a DAMN thing about what they were prescribing. They just know it's for cholesterol or for blood pressure, or something to help you with something. 2, I know a lot of pharmacists who are COMPLETE morons who don't know that Biaxin can cause Transient CNS, or even what it is. 3, patients hear what they want to hear; that's why they ask you something, then turn around and ask their pharmacist, then turn around and ask their neighbor, Bob, and vice versa. So, let's not knock each other's professions. We all deal with these grumpy and miserable patients on a daily basis.
And one more thing, NOT directed at Dr. Dino...do you know that some pharmacies do over 500 prescriptions a day? And MOST pharmacies don't have the hours or staff to handle the volume, which is something corporate America has control over? So, please don't knock when the pharmacist can't get to the RX left on the voicemail immediately upon it's arrival. We don't know it's there until we are notified by a ring or tone of some sort. And I've had PLENTY of medical assistants say they are going to call in a patient's prescription and don't do it until the next day, but who gets yelled at...the pharmacy personnel! We're all human! And remember that a lot of pharmacies have those infamous (and ever annoying) drive-thru's! And insurance issues (we really don't want to bother a Dr. for a P.A. but most insurance's REQUIRE the MD to make the call, NOT the pharmacy.)
So, can we have some peace? We all have to deal with the same bullshit but we're at each other's throats and for what?!!?!?!?!
Food for thought...
We don't just count pills! Hate to say it but pharmacists have to know every working part of that medication and how it works in a particular patients body, because they don't work the same for everyone. I've been through med. chem and kinetics...if we were just counting pills, we wouldn't be making 80-90k a year to start. And we have saved lives! What are you talking that nonsense for? You're probably one of those people who think a Chiropractor is a REAL doctor...he just went to school to specialize in massage therapy and dislocated parts!
"Dear Dr Dick,
Until you have spent a day walking in my shoes, don't presume I'm a fucktard who gives bad advice, loses scripts, lies about it, and lives for the drama that ensues."
Yes, and the best part is that people seem to get off on arguing and flinging insults than focusing on the task at hand - patient care - hello?
blah blah blah
beyond all of the dumbass he-sucks she-sucks crap...
where is the study that shows that starting a statin with a person this age has any postive effect on morbidity/mortality etc? at this age there is no evidence (that i have read) that there is any reason for medication.
so go screw your self, doctor.
:)
I can understand that all parties can be wrong, and that EVERYONE makes mistakes. Doctors work in a well controlled environment, and should be able to set aside a little extra time for patients. Pharm's can be like everyone else and make mistakes, but not everyone is blowing off work behind the counter. And the patient will still do what he/she wishes at the end of the day when it's all said and done, REGARDLESS of what either of the other two say. I remember a quote from a movie that went as such: "Assumptions are the mother of all fuck-ups." Everyone should not jump to the first assumption they have and think things through. I think everyone's life would be a little less stressful if they did.
My personal opinion on the two professions is I do believe that doctors should spend more time with patients. Even if its 2 extra minutes to make sure EVERYTHING is covered. Ever notice that a professor will ask his class "Are there ANY questions?" multiple times before they dismiss class?
I once had a doctor, who also performed surgery on my leg, try to bounce me out of his exam room so fast on my preliminary follow up that it pissed me off royally. I was in a car accident and was describing the pain I was having, and that it was severely painful and was more than just soreness/bruising. He blew me off, assured me I'd be fine, and tried to walk out of the room. I stopped him and said, "Give me an x-ray, I want one, my insurance will cover it, I know for fact you don't have to do it personally, and you wont be bitching when it gets tacked onto my billing. Now give me one, I'm not asking." Guess what turns up? Broken bones! I understand these may not have been visible initially due to swelling, but was he even ready to hear me out? No. Because his little piece of paper above his desk says he's smarter than me and I don't know what the fuck is going on in MY body.
Little lesson to learned by all. Quit passing blame, and take one extra second make sure it gets done RIGHT.
Okay I understand that a pharmacist can and will make mistakes. But I work in a pharmacy for 3 long years now and I assure you that the 5 minute hold time is a blessing and the counseling is real. I work in one of the busiest pharmacies in my state, doctor's go straight to voicemail, because voicemail can be checked by a tech. But a pharmacist has to take the call to speak to a person. Which be honest is never a doctor it's almost always a receptionist of some sort. Because when we get a Dr. on the phone we know it and they get passed to the front of the line. So don't get pissed at the pharmacist, and we will try our best not to get pissed at you when you leave vital info of scripts. And we can both live in happy patient hating worlds.
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