“That’s what CVS said too,” the young woman looked at me. “What am I going to do?” She was biting her lip.
At first glance the prescriptions looked normal. Pantoprazole 20 mg and Trimethoprim 100 mg. Both indicated Disp 60. What she wanted was the price. I stopped at the Protonix 20mg. Why bother pricing the trimethoprim? I didn’t think she could afford the first Rx.
“Listen,” I said, “If you can’t afford that, you can buy omeprazole over the counter and the store brand is on sale this week. You can call the doctor on Monday and discuss the medications he wants and how they fit in your budget.”
Ever helpful, JP. When am I going to wise up? It takes time and some effort to actually try to assist a person who is asking for help. And, I really do try. Especially when the matter is price. These are tough times and people often just don’t have the money.
A boy, about 14 years old, was sent by his aunt for a packet of 8 tablets of Zantac 150mg. I showed the kid the store brand and explained that she could get 24 tablets for only $2.00 more than the Zantac.
For this young man, it was a no-brainer. He bought the private label version of Zantac. Right about the time that alligators were up to my ass, I get a phone call from the aunt. She tried to work me over, but I was too busy to listen. She pissed me off. No trust. No sense. I told her to send the boy back and we’d make an exchange. A half dozen other similar incidents about price last evening and the customers thanked me.
Back to the pantoprazole. Alien download “You can’t change it. My baby has to have that. Nothing else. It is what they gave him in the hospital.”
Egads! The prescriptions were for a 2 month old. Had I gone beyond price, I would have looked at the Sig and would have known. The dose was tiny. The doctor, however, did not indicate that she wanted liquids. She didn’t say 20mg or 100mg per what ml. I explained that we could not compound these two prescriptions, but I could send them off to a compounding store in Houston. That is what CVS told her, but apparently I was not dismissive as the CVS RPh had been. I told her the doctor could have written discharge prescriptions to be filled at the hospital before her baby was released.
I had to put up with the doctor next. “Why can’t you mix those prescriptions? You are a pharmacist, aren’t you?”
Now that irritates me. Should I ask, “You’re a doctor, aren’t you?”
“Because we do not have pantoprazole powder or trimethoprim powder in stock.”
“Why not?”
I do not like “WHY” questions. They indicate that the questioner does not trust me. In this case, it was the young doctor using a trial lawyer’s trick. Put me on the defensive.
I did not bite. “Doctor, why couldn’t you have given this young mother a thirty days supply at discharge? You had to know that retail pharmacies do not do specialized compounds such as these.”
“I asked you a question.”
What? Did she think that I was on the witness stand?
I said, “about that discharge supply, doctor.” Is this where I should have said it, “You’re a doctor, aren’t you?”
“What about it?” She was huffing and puffing.
I said it gently, “It is too late now isn’t it? You can’t go back. This baby may have to go without.”
She ended the conversation abruptly. Her ass was grass and she knew it.
Very disappointing to hear the discussion you had with the physician. Sadly it is all too common in every environment we function in as professional pharmacists.
We are just stewards in a mansion that is owned and operated by physicians. If they would approach things with a solution instead of blaming the people interpreting their orders incorrectly, I am sure there would be more positive outcomes around. They seem to never take fault for anything, and that can really get frustrating.
Thanks for sharing as always.
As an Intern who works in an outpatient-clinic setting at a local hospital – I can tell you first hand how awesome – and terrible it is to interact with doctors about this exact thing.
What I’ve come to notice – especially with the pediatric patients, is that the doctors discharging them either have “it” or they don’t.
And you can tell to – they’ll call on the weekends at 10:00 AM for a 3-4PM discharge for me to start compounding various medications, or they’ll call and leave a message on my voice-mail while we’re at lunch (from 1:00 – 2:00). So, either the parents grab some medicines on the way out and I get to instruct them on what to do after 30 days if their child still needs these medicines, or they’re SOL, I tell them I haven’t had time and Baby Boy has to go without. Extremely rewarding when everything works – and extremely disappointing when it doesn’t. Good post, JP.
Lucky for me, the physicians at the hospital I work at aren’t total jackasses (except one of them…).
Who did that physician think she was? “I asked you a question.” Really? If it weren’t for being professional, I would’ve set her in her place in no time at all.
If I were really pissy, I would’ve asked her “Do I tell you how to practice medicine?”
*silence*
“Then don’t tell me how to practice pharmacy.”
Some physicians are just terribly unprofessional. That may be why some of them don’t see us as colleagues.
Not to mention the pantoprazole would take quite a bit of extra effort compounding. Couldn’t you have just converted to prevacid solu-tabs and counseled the mother how to dissolve and dispense the correct equivalent dose. Also, the trimethoprim could have easily been crushed and mixed with a little suspending agent at least to get her through the weekend. If you didn’t feel comfortable doing that, grab the Sanford and find something liquid that would work. We’re not paid the big bucks to pass medication problems off to someone else.
Sure the prescriptions sounded woefully incomplete but it sounds more like a pharmacist problem than a physician problem. With a little ingenuity, the child shouldn’t have to go without.
6-17-09 Comment from Jay Pee
Gravy, I have done plenty of compounding and I love doing it, but I was not about to prepare an inelegant product. This is a baby. Crushing pantoprazole (Protonix) tabs would have
been a sludgy suspension.
I once had a doctor tell me I should be able to fill any prescription given to me by any doctor. He could not understand why I could not do the complex compound he had demanded for his patient. I asked him what he did when his patient needed a MRI. He said he sent them to a clinic with a MRI machine and then started to tell me in detail how much it would cost for him to have a MRI machine. He then paused and said ‘I now see your point’. Sometimes things do line up in the pharmacist corner.
You would need sodium bicarbonate and other probably not readily available products to create a usable protonix product. Prevacid solu-tab on the other hand can be made on the fly by Mom and completely dissolves. I don’t mean to ride you, sometimes you need to defer to experts and I totally support the transfer to a compounding pharmacy, but if the only option is go without? Well, that’s not an option…
6-20-09 UPDATE from JP. Gravy, I left a detailed note about this for the following pharmacist. When I saw him yesterday, he told me that the doctor had called the next morning (6-17-09)and asked how long for the compounding store in Houston. He suggested that the doctor put on her I-am-the-top-of-the-medical-pyramid hat and get the hospital to get this ready stat. When she called, they already had plenty made up. The baby got the medicine, the doctor breathed a sigh of relief and the mom credits our pharmacy for getting the job done. You are absolutely correct about the Prevacid.