Everyone can write prescriptions!

Its amazing how the medical community has ‘evolved’ in the past few years. Back when I started this profession, only Doctors (MD/DO/DDS/DVM/etc) and Nurse Practioners/PA’s could write prescriptions. Everyone was happy, and the world was at peace.
Well some idiot decides to allow Certified Nurse Midwifes and Holistic Medicine (or some bullshit like that) to write prescriptions. Head, meet table.
When is the madness going to stop? Are janitors going to be the next ones to have prescriptive authority?
I went to college for 7 years, and I only have the ability to prescribe the morning after pill. Some idiot goes to a Career College, pops out a CNM in 5 months, and can write for anything (yes, I know they are under protocol, but thats not my point).
It makes my blood boil when I see these idiots churn out Rx’s that look like this:
Amoxicillin suspension, 234.3 mg three times a day for 10 days.
Now that may look good to you, but any pharmacist will say “Hey! Amoxicillin suspension only comes in 125mg/tsp, 250mg/tsp and 400mg/tsp!”.. Are we to have some mother who can barely wipe her own ass (but can pop out a kid) measure out 4.7372143 mL’s? Hell no! Its fucking amoxicillin! You round up to the nearest strength! Its not rocket science! You could give the kid 2 grams of this shit three times a day and nothing will happen.
If you dont work in the profession, you may wonder where im going with this. Well its a fact of book learning vs common sense. Obvously a “real” doctor would use common sense and just dose said amoxicillin 250mg/tsp three times a day for 10 days and make it easy for everyone. However some CNM looks up in her little drug book (which is probably wrong) and uses her little calculator to do 20mg/kg/day (or something like that) and just blindly writes for whatever number appears as the result. Use your fucking head!
It doesnt end there, oh no!
I’ve seen them write Hydralazine for itching (supposed to be Hydroxyzine, whoops, you just killed someone). As well as give strengths for drugs that they obvously pulled out of their ass (Ultram 100mg when it only comes in 50’s) as well as write for the latest and greatest shit not knowing that it costs 1000 bucks (Zyvox)..
Blah is all I have to say.. But of course because of them us pharmacists can never be replaced by machines.

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31 Comments

  1. Not a CNM... says:

    Most CNMs have Master’s Degrees…hardly career college.

  2. Tammy says:

    I just read your entry on prenatal vitamins, and while I think much of your argument makes good sense, I find your references to blonde obstetric pateients in low cut shirts, pelvic exams and that reasoning with a pregnant gal is like reasoning with a turd are very offensive. And that’s the opinion of someone with whom a pharmacist with good sense argument about what prenatal vitamin to take COULD reason. I have a feeling it might be hard to reason with you about a lot of things, too.

  3. Roscoe says:

    Damn! .. just found your blog .. can’t quit reading it .. it really hits home!
    I’m a pharmacist – used to work retail (7 years) – then couldn’t stand the 2% assholes, and switched to the hospital scene.
    This post hit one of my pet peeves – the resident that is a number hound! S/he whips out his trusty PDA for the dose – punches in the raw numbers and just writes the result! Or better yet, so lazy they don’t even write it out – just write “Mannitol, 1.5 Gm/Kg – IVP over 3-5 min.”
    Had to call that last one back because her calculation would have resulted in a volume of about 500ML .. the equivalent of ten 50ml vials .. over 3-5 minutes?!!! WTF!
    They are so STUCK on the NUMBERS without thinking of reality!! The doses listed in textbooks are approximations – not the bible! Many drugs are not distributed to the fatty tissues – so an obese person does not necessarily get 3x’s the dose of a normal person! And how do you know the sensitivity of the damn bug you’re treating? At least, not empirically – you need to do some sort of Culture/Sensitivity test.
    I love the pediatric dosing of Zinacef(cefuroxime) … (the usual ADULT dose is 750mg, Q8hr) – but, at the top suggested range of 150 mg/Kg/day for children, you can often get a result of 3Gm, Q8hr for a 5 year old!! They fail to read the end of the dosing paragraph that says “.. up to the normal adult dose.” Mainly, because they have NO FUCKING IDEA of the NORMAL ADULT DOSE!
    And the latest thing?! “Pharmacist to dose” Usually because it’s a new patient that they haven’t obtained the weight yet. But weight is not the only criteria!! Especially, an antibiotic .. “Levaquin, pharmacy to dose” .. what the hell am I treating!! I made one call just tonite to the nurse: “What are we treating? a UTI or pneumonia?”, “Let’s see, I have listed dehydration, chest pain and r/o MI .. nothing about an infection.” Grrrrrrrr.
    Well, have a beer on me after one of those days! Everything you mention has been said by me or a peer many times!

  4. kj says:

    certified nurse midwives now have to complete a masters degree in order to get a license. They are usually on the same level as a nurse practioner. I date a pharmacist who discovered why he thinks pharmacists will never be able to write prescriptions.. Its because that would open up too much debate. As a consumers, I would not like the person who is filing my prescription to also be able to write my prescription. How do I know he has my best interest at hand and not the financial incentives from the pharmaceutical companies.

  5. pharmd07 says:

    KJ:
    That’s a dumb argument:
    “As a consumers, I would not like the person who is filing my prescription to also be able to write my prescription. How do I know he has my best interest at hand and not the financial incentives from the pharmaceutical companies.”
    The same could be said of the doctor/NP you see for your Rx. How do you know your doctor isn’t in bed with the pharmaceutical companies?

  6. Heather says:

    Have you researched OBGYNs and how screwed up they are? I’m sure midwives are able to prescribe things because of the fear women have of OBGYNs. My body can have a baby without drugs and all the crazy, unneccessary interventions a Dr. would perform. Have you read “The Thinking Woman’s Guide to a Better Birth”? If a Dr. has high rates for C-section, epidurals, episotomies, induction, etc. – I’m determined to stay FAR from them. BTW – So far, being 6 months pregnant, the only thing my CNM has prescribed is hemroid medication…

  7. Haseeb Sattar says:

    hello. to all
    i m from pakistan im doing Pharm-d.Can any body tell me can i do M.D after doing Pharm-d???
    and which subjects will include and abut the duration of M.D After Pharm-D…thankss

    • khalid ahmad says:

      Hi,
      I am also doing Pharm-D from Pakistan and my question is the same as that of yours.i just want to know whether you have found any answer to this question yet.If yes,then we would also like to know about it.i think we both should help out each other.i shall be eagerly waiting for ur rply

  8. By gosh, Jove, jiminy, cracky, and the NABP,why would I want to add prescriptive liability to my OBRA,HIPAA,CSA-corresponding, and pseudoepehedrine potential liability, and more?
    As Bishop said in “Aliens,” I may be a synthetic, but I’m not stupid.

  9. I think that you need to get off your high-horse….Doctor’s can be getting more done with other’s (MA’S, LPNs) writing the prescriptions …You just want to complain because you are a pharmacist, not a Doctor….Disappointed

    • PharmD student says:

      “You just want to complain because you are a pharmacist, not a Doctor….Disappointed” Shows your uneducated.. A pharmacist is a Doctor also. We Are a Doctor Of Phamracy and they are a Doctor of Medicine

  10. Student says:

    @Medical Assistant:
    You’re an Idiot…. seriously. This writer is not complaining about Doctors. She’s saying leave the prescription writers to the doctors. She’s saying how midwives, etc have the ability to write prescriptions when they don’t know what the hell they’re doing!

    You seriously have issues with forming a conclusion when reading something. If you were an MA and I was the patient, your ass would be out of the room. Idiots like you that make mistakes in the medical field and cause crap loads of problems. Speaking of problems…

    Who cares if “Most” midwives have a master’s degree now. Please! Do you know how hard medical school is? Taking the MCAT, getting in, the crazy license exams and then freaking residency. Gee…. medical doctor or freaking master’s degree. I wonder which one is more qualified.

  11. Tim Donovan says:

    “You just want to complain because you are a pharmacist, not a Doctor….Disappointed”

    haha, you just read my mind!

  12. nauman says:

    salams and hi all.i am doing pharm.d from pakistan and my 3 years experience shows that doctors are jaloeous of the pharmacists just because only a pharmacist can argue them.doctors are trained in such a way that they feel them selves as kings and no body can rule them…but silly doctors just think that if a pharmacist can manufacture a drug he can also give it and prescribe it.but u people cannot manufacture a drug and i know from my experience that almost all prescriptions written by mbbs are wrong i challange.if u have the ability kindly contact me at naumanjanjua_786@yahoo.com

  13. Dr 2 U says:

    Fuck his and fuck that! What a bunch of losers. They teach yo that in pharm class?

  14. pill pusher says:

    nauman, I am not even sure why I am replying to your post but I think your head is looking at your smelly ass. What the fuck are you talking about? What do you learn about practicing medicine in Pakistan? I am not sure what happens in Pakistan but I am quite certain that physicians there don’t get a license to practice from a prize they won in a crackerjack box. Your colleagues (and I am not certain that I can even call them your colleagues) devote their lives for a mere pittance to help the sick. First of all, you need to learn how to respect yourself, otherwise you can not even think about respecting the physicians that give you work. If you can’t understand that with your 3 years experience you would do better to serve yourself digging ditches for the people that your physicians kill. Can it be clearer to you? Here is some friendly advice, get your head out of your ass and do the job that you are supposed to do instead of blaming others for mistakes. Have you ever made a mistake? I have made plenty in my day, I think the last one was replying your post. The next time you need a doctor do you think he would be too stupid to help you? Or do you think he will let you die? Let me elaborate: SHUT THE FUCK UP AND GET OUT OF PHARMACY, YOU ARE A DISGRACE TO OUR PROFESSION!

  15. khan says:

    hi even i m about to start my new academic year for pharm d in India
    even i have the same question.. what am i going to do after completing this 6 yr course of pharm-D.

  16. khan says:

    so wats d biggy d question is still not answered yet n as a fresher i dun hav much info…

  17. FL RPh says:

    This is funny shit! I agree, and I like the comment about not being replaced by machines. Although, I feel like a machine most of the time.

  18. Dr Jay says:

    Doctors prescribe medications and pharmacists counsel patients on their proper use. Let’s draw the line here.

  19. brad kessler says:

    can a pathologist write rxs for a family member? im a rph from pa and nobody can verify this. i know he is a md but they are not practioners. i realyy dont care if he can write but id like to know my liability based on the poathologist writing things and not following up his prescribing with tests to verify the pts wellbeing. any insight would be great thanx.

    • pill pusher says:

      Brad,

      It is outside the scope of a pathologists practice to prescribe drugs to living people. It’s also illegal in some states for any physician to treat or prescribe medication for their family. However, Pennsylvania law does not directly address the legality of physicians prescribing for their family members. I will say this, it is clearly out of the scope of their practice for a dentist to write a prescription for a family member or for anyone else for that matter for birth control pills. If you fill such a prescription you would be taking part in insurance fraud if you billed it to an insurance company.
      Certainly, you can make a similar correlation with doctor who doesn’t practice in any other capacity other than pathology that it is outside the scope of their practice to write prescriptions for living people.

  20. Shawn says:

    Wow, you’re kind of a moron

  21. Dr. B says:

    Hahahahahah!! This blog is hilarious. As are the comments. I found it because I am a dentist and don’t usually prescribe antibiotics or analgesics for kiddos and had no clue how to write out my rx for amoxicillin (what the heck is a suspension vs elixir? or troche vs lozenge?). And I went to school for 11 YEARS!!! I spent the last 20 minutes agonizing about how to prescribe this damn rx. Thank God for you pharmacist geniuses. I don’t have the mathematical mind to have become a pharmacist and am so thankful for my local pharm who I can call anytime and ask how a particular drug is manufactured. I just know what drug I want to give. I can’t keep up with how every drug is packaged.
    And to all you bagging on MDs vs Pharms vs nurses vs janitors, WE ARE ALL A TEAM! WE ALL NEED EACH OTHER. So quit bitchin and lets all be friends. Anyone for a beer?

  22. kim says:

    A Certified Nurse Midwife is a Master’s prepared nurse you moron. They have the same level of education as a Nurse Practitioner. You are thinking of direct entry midwives and they CANNOT write prescriptions. Here in Oregon the CNMs go to OHSU, the same University that has a medical school and graduates tons of MDs. They don’t go to some school they saw on daytime TV. Before you bash an entire group of highly educated people, you should do some research about what you are talking about.

  23. unbeliever says:

    Anyone SHOULD be able to write prescriptions. The entire medical field is completely ass-backward. From record keeping to routine diagnosis and prescription, the entire process can and will be completely automated at some point, to the benefit of all patients. Keeping humans in the loop for anything other than high level quality control does nothing but introduce error. I don’t think I’ve ever been to a doctor who subsequently told me some useful information that I didn’t already know. On the other hand there are many time where I’ve been given bad or incomplete information in the same way.

  24. Mike Singer says:

    Dude, shutup… ur a lousy pharmacist who doesn’t do their homework and misrepresents the facts b/c a few people out the write prescriptions poorly. FACT: your article makes it sound like CNM takes 5mos of schooling when REALLY its 4yrs undergrad (just like u and everyone) and then a masters degree (minimum) before entering the CNM program. Btw, this took me 2min to look up and educate myself.
    FACT: I went to pharmacy school at UW-Madison and fell into research because I believe in the path of least resistance. If I had conformed and become a pharmacist like everyone else, I would have turned out just as miserable and frustrated as you.

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