I had been waiting since 10:00 AM to talk to this doctor. It was now after 3:00 PM. My first hurdle was the maternal receptionist.
“You will have to fax the request,” she said. “We do not okay prescriptions over the telephone.”
“I’m not faxing this one,” I said. “I need to talk to the doctor and I need to talk to the doctor today.”
“Why can’t you fax?”
“What’s your name?”
“Why is that important?”
“Because I am documenting every conversation I have about this transaction.”
“Well, if it is about this woman, good luck. She has not paid her bill.”
The nurse was next, around noon. “The doctor will not okay this prescription. She owes us over $100.00.”
“Taking this patient off this drug abruptly could be dangerous. The doctor needs to make a more informed choice about this prescription.”
“The doctor knows about the prescriptions he orders.” Huff, huff! Imagine her eyes wide. How dare simple pharmacist questioning her doctor.
“He does not know enough about this one.” This doctor was dangerous. He was my age, stuck in his ways. He did medicine by the numbers and memory. Drugs the same. He finally called around 3:00 PM.
“What is the problem? Both Virginia and Doris told you that I will not refill the clonidine for this woman.”
“Because she owes you money?”
“Okay. I will not refill without your permission, but you need to be fully informed about the drug before you make that decision.”
“I know all about Catapres. I have been prescribing it for years”. Harrumph! Posture!
“I am talking to you about this because I want full documentation that you refused after my telling you exactly what is in the literature.”
“I know what is in the literature.”
“No one knows exactly what is in the literature, Doctor.”
“What difference does it make?”
“You and I are supposed to know. Any jury would agree that you and I are responsible for knowing the dangers and that both of us need to protect the patient. It would not even take a good lawyer. Any lawyer could make the case. If something bad happens, it’s going to be on you for refusing to refill.”
“What are you talking about?”
“I’m not getting sued, man, because I am making sure that you know what is in the literature. If you refuse and this woman suffers withdrawal, you are on your own.”
There was a long silence, then a huff. “What is in the literature that is so damned important.”
I read it to him:
Catapres should not be stopped suddenly. Headache, nervousness, agitation, tremor, confusion, and rapid rise in blood pressure can occur. Severe reactions such as disruption of brain functions, stroke, fluid in the lungs, and death have also been reported. The doctor should gradually reduce the dosage over several days to avoid withdrawal symptoms.
“That enough for you, Doctor?”
“Fill it,” he said. A pause. A sigh. Then, “Thanks for the warning.”
The truth is that every single prescription is a potential lawsuit. With thousands and thousands of pages about drugs available on the Internet, a smart rat patient could choreograph a law suit. A hungry attorney would be all over it.
The worry is that the drug could cause damage, even minimal damage. We are supposed to know. We are supposed to warn. Hell, you don’t even have time to warn your patients about what metronidazole is going to do to their comfort level. When was the last time you warned about clonidine?
If it is in the literature, a judge and jury will agree that it is your job to know and to warn.
You work in a mine field, my friends.