Remember Mrs. Norco? She was back yesterday with yet another prescription for Ambien. Mrs. Norco has another little problem in her life. She's managed to get herself up to 2 and 1/2 tablets of Ambien every day. She takes two at bedtime and another 1/2 in the afternoon for a nap.
Oh, I know you're not supposed to do that, and she knows I won't fill her prescriptions for Ambien. She just comes when I'm not here and the other "popular" pharmacist fills her scrips without paying any attention to the instructions, quantity, or date. She's just a "customer" to him.
So yesterday Mrs. Norco hands me a prescription for Ambien, #30, take one at bedtime. Fairly straight forward, right? Except I know what Mrs. Norco is up to. She sees several doctors and gets these prescriptions and the dates overlap. The last time she had Ambien filled was fifteen days ago. Same doctor, same quantity.
"This is too early," I tell her.
"Oh, I know, but I gots the doctor approval for an early refill cuz she told me to take two at bedtime instead of one."
"Why isn't that on the prescription?"
"Cuz she says she can't write it that way. You can call her."
Mrs. Norco is trying to push her way through this one. Hasn't she learned yet that this game doesn't work with me? I tell her I'll call the doctor. Her eyes dilate slightly.
I call the doctor's office. Now for those of you in pharmacy, you know that I'm not actually going to get to talk to the doctor. It's very rare that we pharmacists actually talk to the doctors. They have a staff of people who have the specific job of keeping the doctor secluded from the outside world.
I get to talk to the doctor's assistant. I explain the situation. I explain that it is two weeks early. The assistant verifies that yes, the doctor told the patient to take two tablets at bedtime.
"Well, ok, then, I'll change the prescription to indicate that the doctor changed the sig to read 'Take two tablets at bedtime.'"
Long, long pause...
"Nooooo, the doctor wants it to say 'one at bedtime.'"
"But you just told me she's instructing the patient to take two tablets at bedtime."
Longer awkward pause...
I add, "What you're trying to do is shift the burden of responsibility onto the pharmacy if something goes wrong. If Mrs. Norco takes two at bedtime and then decides she wants a taco at Taco Bell and kills someone on the road, you want me to bear the burden of responsibility. I will not fill this prescription."
"You can't deny filling that prescription! I'll have the doctor call you herself!"
I gave the prescription back to Mrs. Norco. I explained the situation. She accepted defeat and slowly walked away.
As you can imagine, the doctor never called. I won that battle that day, but I'm losing the war. A few days later I looked on her computer profile. She saw a new doctor the next day and brought the prescription to the other pharmacist who filled it... # 60, two at bedtime.