Tuesday, December 2, 2014

Sometimes "NO" is What is BEST for the Patient

Two weeks ago... Trudy appeared at the pharmacy window.

"Mickey isn't here?" she asks.

She's asking about our pharmacy manager. On this particular day I'm here in the morning. Mickey will be here in the late afternoon.

"No, he'll be here at 4pm today."

"Oh. I just need a couple of tablets of morphine to get me through until my appointment tomorrow."

I'm silent, waiting for her to ask me to give her morphine so I can tell her no.

"I suppose I should just come back when Mickey is here."

"He'll be here at 4pm today."

I don't know exactly what arrangement Mickey has with this lady and morphine and I'm sure I don't want to know. Mickey bends the rules, a lot. But that makes him a popular pharmacist.

She turns to leave, then steps back up to the counter.

"You know, I'm NOT a BAD person," she says, with emphasis.

I have absolutely NO IDEA what she's talking about. Perhaps she's inferring that I have passed judgement because I have told her no in the past. I don't know.

"I never thought that you were," was all I could reply.

One week ago... I see a card that was left on the counter. I guess it was purposely left on the counter for me to see and read.

"Mickey, I wanted to thank you for all your help and support. I believe that YOU truly CARE and I cannot tell you how much that means to me. Thank you so much for your care and support and for believing in me. I will get there someday and I will have ONLY YOU to thank. Signed, Trudy"

Well isn't that sweet.

Today... Trudy is here at the pharmacy again. She looks like she hasn't bathed in two days. Her hair is a mess and she looks grubby. She wants to know when Mickey will be back at the pharmacy. She's obviously out of her week supply from the doctor, again.

Here's the problem with pharmacists that feel bad for patients and "loan" them a few tablets of narcotics until they go see their doctor and get a new script: You see, doctors write specific regimens on their scripts. If they prescribe 7 tablets for 7 days, they expect the patient to take one tablet a day. By giving patients a few tablets before they actually have a new script, the pharmacist is interfering with the doctor's plans, especially in cases where the doc is trying to wean the patient off the narcotics. And when the patient runs out, they go back to the pharmacist that "believes" in them... AND the doctor has no idea that the patient isn't being compliant with his/her treatment.

Mickey, all good intentions aside, is actually making it harder for Trudy to get off her medication entirely, and unfortunately, Trudy doesn't get that. She just sees me as the mean pharmacist who doesn't care.

Doing what is best for the patient doesn't always mean giving them whatever they want.


Anonymous said...

I do not understand how Mickey can get away with just handing out narcotics. I'm not a pharmacist, but I would expect the tablets have to be accounted for by a prescription for them. So how can he get away with that without putting everyone he works with at risk?

Crazy RxMan said...

I assume when Trudy comes in with her next prescription, he deducts the loan from the count. All tablets and capsules are accounted for.

But you're right, it does put all of us at risk.

me. said...

I would like to believe that as a prescriber, that this sort of thing happens exceedingly rarely...