Most prescribers, nurses, and doctors that write prescriptions know what they're doing and write excellent prescriptions that pharmacists have no problem reading and filling for the patients. It's those others... a small percentage, that drive pharmacists nuts. This blog post is for these people:
Dear Doctor,
If you've had several calls from different pharmacies about your handwriting, MAYBE it is time you slow down when penning a new script, or have someone else write it for you.
Dear Doctor,
Calling in a new script just before you leave for the day and saying "Give our office a call if you have any questions" just before you hang up doesn't really help, does it?
Dear Doctor,
Telling the patient "I just sent the e-Script over, it will be ready when you get there" isn't something you really know, is it?
Dear Doctor,
Printing out the cash price of some med at CostLow warehouse and telling the patient WE will match that price isn't really professional, is it? Should I tell the same patient YOU will match a competitor's price?
Dear Doctor,
Coming to the pharmacy to ask us to fill a prescription for you or a family member AND then not even knowing how the med should be prescribed... that really isn't such a good idea, is it?
Dear Doctor,
Leaving a voicemail on our phone system as fast as you can because you're in such a hurry to get to the golf course, well that isn't such a good idea either, is it?
Dear Doctor,
Making it nearly impossible to reach you for clarification of a medication YOU prescribed isn't really that helpful for the patient, is it?
Dear Doctor,
Using the e-Script system to send over "prescriptions" that the patient will see and not get because it is a reminder to them to get the OTC version isn't really nice to us, is it?
Dear Doctor,
Refusing to authorize a refill on a maintenance medication for a high blood pressure or diabetic patient puts us in a position to loan them medication. That's putting the burden of care on us, and it's just not right, is it?
Dear Doctor,
Telling the patient you never received our fax request when we have a confirmation in our hand is pretty lame, don't you think? Liar, liar, pants on fire.
Dear Doctor,
Calling in several prescriptions on the voicemail takes us a lot of time to go through, especially when you're rattling them off as fast as you can. That's not very respectful of the pharmacy or the patient, is it?
Dear Doctor,
Writing a seven day supply of a pain medication for a patient when you know you're going to be out of your office for a week starting in six days isn't really cool, now is it?
Dear Doctor,
Writing "take as directed" on a prescription ~ isn't that way too lazy, doc?
Dear Doctor,
Writing "1 BID x 7 days" and then "quantity sufficient" on a new prescription? Really? You can't handle basic math?
Dear Doctor,
When you're writing instructions on a prescription that wouldn't fit on a billboard, let alone a tiny label we need to stick on a bottle, did you do any thinking about that ahead of time?
Dear Doctor,
You squeezed in six prescriptions on a standard size prescription pad. Are you really that short on paper, doc? Or are you really just trying to make us miserable over here?
Dear Doctor,
If you don't really know how the medication should be given to the patient, should you really be prescribing it? Seriously.
Dear Doctor,
ReplyDeletePlease train your staff to be professional at all times so that they're not miserable pieces of crap to me when I call with a question. Whether you like it or not, people look up to you so try to lead by example. If a mere peasant of a RPh like me can do it, it should be childsplay for an exalted god of healthcare like you.
Dear Doctor,
If a patient requests a refill on one medication, DO NOT send eRx's for every medication in their profile. Take a few seconds and see if they actually need it before you blindly bang out dozens of scripts.
Dear Doctor,
I know the drug rep that Big Pharma sends to your office is super cute and brings tasty food for those 'lunch CE's.' Sometimes, I find myself missing them. But please don't prescribe for the latest and greatest brand drugs (that NO insurance covers FYI) just because she's hot. That's just lame as hell.
Dear Doctor,
You know and I know that there's an opiate overuse/overprescription epidemic out there. C'mon now. If I can say no to these junkies, so can you. Repeat after me. "You are too early and I'm worried about you. No, I will not give you this prescription. Let's talk about what else I can do for you." See how easy it is?
Dear Doctor,
When your eRx program calculates out wacky weight based doses (i.e. 2.4881 mL), be a pal and round up to something that the patient can actually measure.
I write #QS in essentially one situation: being discharged from the hospital and you need to complete your 10(7,14,28, whatever) day prescription for the antibiotic. I will write Omnicef 300mg PO BID thru 5/19/16 with a #QS. Because even though I discharged the patient on 5/12 who knows when they'll actually getting around to going to the pharmacy. And if they show up on 5/24 I really don't know that they need the antibiotic anymore anyway.
ReplyDeleteAnd about the only time I write 'as directed' is one it is dosepak where the directions are literally on the packaging OR for coumadin because the directions this week might be different than next week and having a direction written on the bottle that is wrong is not really good medicine.
We are all worse off in some respects with e-prescribing. As a doc, I get refill requests for old meds the patient is no longer taking, requests for refills on dead patients, weirdly spelled drugs with capitals in the middle that I have to reconcile to the med list before I can fill, requests for "90 day" scripts for a med the patient only need 10 days of, I have to listen to sales pitches for flu shots in July when I call in to fill a med, I get repeated requests as mentioned above to put directions on warfarin or insulin when the dose may change next week. Medicine in general sucks these days, and I feel you pain.
ReplyDeleteWhile the Coumadin example sited above is reasonable to folks with common sense like us, we are dealing with insurance companies here. They require specific directions with specific days supply. We will have to call for specific directions EVERY TIME. This is a waste of both of our time. And while the directions may in fact change next week, the new directions require a new Rx/order to be written every time it is changed. I dont like it any more than you do but insurance reigns supreme in everything we do. We might as well help each other out
ReplyDeleteThe problem with "as directed" is that most insurances (including medicare) will not accept it. If the pharmacy is audited, they will rescind payment for these rxs since there is no way to accurately calculate days supply. So here's what you do, dear doctor : warfarin 5mg, #90, take as directed, current dose is one tablet daily. Humalog 100 u /ml, use in insulin pump, maximum 80 units per day. Give us something to work with! Thank you.
ReplyDeleteSo when I write 'warfarin 5mg, #90, take as directed, current dose is one tablet daily' as suggested above and then a week later they are changed to 5mg 1 PO QTuThSaSu and 1.5 PO QMWF and that #90 will now only last 10.5 weeks I am supposed to write a new script and those extra 83 pills just get tossed? Or even better, left at the patients house along with their 37 other bottles of half used drugs even though they are only currently being prescribed 8.
ReplyDeleteWhen do we tell insurance to let the medical people do the medical things.
Half my coumadin patients take it wrong half the time now. So now we want to make it more confusing by having bottles with wrong directions on them?
Anon at 9:34 AM covered it perfectly. If you issue a new rx then at least the pharmacy can print a new label for the pt. The insurance won't cover a refill 7 days later, so the pt won't have 83 tablets to toss, but they will have up to date directions as long as they stop by the pharmacy for the revised label. It's all about working together. Sure, it's more WORK than in the old days but "take as directed" just doesn't fly anymore.
ReplyDeleteI understand that insurance requires it. It's just stupid.
ReplyDeleteAnd for my patients who live 20 minutes away from ANY pharmacy it is a significant inconvenience for them to go get a label.
You're preaching to the choir here.
ReplyDeleteBelieve me when I say, pharmacists hate the red tape that insurance companies and PBMs dream up just so they can make an extra buck. The fact that we're blamed for many of the hoops that everyone has to jump through is part of the reason why we're so frustrated by the very healthcare providers we work with everyday. And if we're not blamed for it, we get used as emotional punching bags.
Not cool.
Do I blame the doctor for all the ignorant, mouth-breathing morons that treat me and my staff like garbage everyday? No. Do I blame the doctor when insurances change reimbursement rules and throw in prior auths just to increase profits? C'mon now.
We're all on the same team here. Reality sucks. I've reluctantly accepted it. You should do the same.