This is a topic that I know everyone in pharmacy knows about. Every pharmacist has dealt with it, yet like the floating turd in the punchbowl of medicine, everyone just looks the other way and pretends it doesn’t exist. So thats where I come in. I’m scooping out the turd and asking how it got in here.
I hope Doctors (MD’s, not you uppity PharmD asses) from all over reply to this post, because I want to know if this actually happens or are we just delusional. You know that all comments are anonymous, so you have no reason to not post for fear of angry lynching (at least in real life).
Say you are a doctor, and you fuck up on a patient bad. Not like “to error is human forgive me” error, but “sue me for lots of money” error; and the patient is fully aware that he/she has you by the balls. Is it practiced to just bribe the patient with lots of narcotics so they won’t turn you in/sue you?
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Example 1:
Patient comes in with an Rx for Vicodin ES #180, 1 q4 prn pain **must last 1 month** x 4 refills. I start to get a huge pharmacy boner because I think this is a dead set forgery. I run to the back room as giddy as a schoolgirl who gets her period after the prom, and call the doctor. Its legit. I tell the doctor (or his minimum wage staff) about the limit on Tylenol, and at 6 a day this woman is going to blow out her liver. He tells me its only for prn and to not worry about it. I document everything and fill the Rx.
15 days pass (the Rx was for a 30 day supply for those a bit slow on the pickup). Patient wants a refill. I tell him to (politely) take a flying leap because the Rx says that it must last 30 days. He says to call the Doctors office, so I (feeling as if i’m trying to filter piss out of the ocean) send over a call tag requesting an early fill and expect a huge NO on it. Patient must call about 20 times during the hour asking if its ready or not. Totally pissing off my frontend staff and myself. Tag comes back that its approved. I call the office and ask why the put the “must last 1 month” if they aren’t going to abide by it. They blow me some bullshit excuse and just say to fill it. I document everything and fill it (which in hindsight I shouldnt have done). Then I fill one, and 18 days pass, he wants another refill. I get on the horn with the Doctors office and ask what the deal is. I tell him that unless he makes the sig 1-2 q4 there is no way that I’m going to fill it (even then he’s really going to blow out his liver). He refused to change the sig and says that its ok to fill. I suggest Norco to lower the APAP, nada, he wants this filled (everyone knows that VicodinES by Watson Labs has a huge black-market value). I plain out ask what the deal is. He says “Doctor-Patient” confidentiality. I tell him thats great, but I dont want to ride my license on his “confidentiality” and hang up on him. I boot the patient from our place (haw haw, Walgreens got him) and blacklist the doctor. I run the sheets on the Dr, and there isn’t anything really strange about him. Handful of patients, not a big writer in our store, but blood pressure, diabetes, the usual. Just this ONE patient is a huge red flag out of the sea of normality.
Example 2:
Patient comes in with an Rx for Fentanyl Patches and some Norco. I don’t give this a second thought and fill it. Everything is cool, patient comes back on time and gets them filled, no problems.
A week passes…
His wife comes in, Fentanyl Patches and Norco. I start to wonder if something is up.
A week passes…
His DAUGHTER comes in with an Rx for Norco. Something is going on.
I fill the Rx’s with a watchful eye. They aren’t early, they aren’t assholes about it. Just having all 3 family members on exactly the same drug (when he is clearly the one with any sort of ailment) raises a huge red flag with me.
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So what’s the deal here? In example 1 we have a doctor who will not budge from changing an Rx when its CLEARLY too early (and he put down that it must last 30 days) and CLEARLY too much Tylenol. Example 2 we have everyone and their family on some pretty high caliber narcotics.
Does this problem exist? Yes or No. I don’t want to hear whiners about how the patient in Example-1 was obviously mis-dosed and in chronic pain, blah blah blah. No, it wasn’t that. He was on Mars every time he called, and he doesn’t remember calling our store or even coming in. There was something that was obviously wrong that you cannot put into writing, and every pharmacist knows what that feeling is like.
If it is true, the Dr’s are putting the pharmacies in a really shitty position. We have to stand up to the patients when you wont over something that /you/ did and /we/ didnt. Plus, when the shit hits the fan and this person gets caught for selling, who’s going to be put under the gun first.
If you’re a doctor, put some sort of explanation in the comments, if you’re a pharmacist who obviously is as paranoid as I am, put your story in the comments.