Why is it that 9 out of 10 Rx’s with a huge glaring mistake are written by NP/PA/CNM/Janitors who somehow got prescriptive authority before the people who actually went to school to learn about drugs?
Maybe its just where I’m at the PA/NP cribs are painted with lead paint, but its to the point now where when I see an Rx from one I just sigh and prepare to be frustrated.
Real life shit I deal with on a daily basis:
- Amoxicillin 250/5 – 4.5mL q8 x10d
- Come the fuck on, 4.5mL? What the fuck is 25mg of amoxicilin going to do? You can’t make it an even teaspoon? A palm pilot is not a substitute for common sense. Get your head out of your ass.
- Amoxicillin – 158mg q8 x7d
- (Just from today) Amoxicillin 648mg q8 x10d
- This makes me want to murder people. You get 1s, 1/2ths or 1/4ths of either 125, 250, 400. Those are your only choices. Choose wisely.
You know, dosing amoxicillin isn’t rocket science. What the problem of PA/NP’s have is that their common sense is in the little electronic device that spits out a dose when you put in the patients weight. The entire concept of having a mother who is barely able to wipe her own ass by herself is NOT going to be able to measure out anything that does not have easy to read numbers and big lines. Thats 1/2, 3/4 and 1 teaspoon. Case closed. If this somehow involves fucking and having children you cannot afford, then maybe she’ll be competent enough to be okay, but dosing amoxicillin doesn’t fall into that group.
So I call the PA/NP and ask if they have a syringe they can give the patient that has readings out to the hundredth mL. When they get the bitchy “Why would they need that?” I respond with “To measure out the amoxicillin dose that you wrote for.” Once in a while they’ll get the idea, but usually it just goes right over their heads. Rx authority people, this is who you are giving it to. A fucking monkey can use a palm pilot and get a dose. Some days I think I would have a better chance with a money.
- Nebulizer, Ventolin HFA, Xopenex neb solution (DAW-1 of course), prednisone 60mg x5d with a huge note “DX: ASTHMA”
- Steroid? What the fuck good is this person going to get from all this shit with no steroid. Lets just take care of the symptom without taking care of the cause. I bet they would just throw vicodin at pneumonia without even thinking about antibiotics.
- Metformin 750mg bid
- 1.5 of the 500mg tablets? 100mg isn’t going to kill someone, just do one of the 850’s and save the patient the hassle.
The list just goes on and on and on. Its gotten to a point now where if I see an Rx, and see that its written by a PA/NP I expect to spend about 20 min trying to sort out their fuckups.