I received this question from a doctor who frequents the site:
I have a question regarding changes in medication. I am a physician.
The way I usually handle it is that I tell the patient the new dose and
then write a prescription to reflect that dose. I then tell them that
they’ll have to go in earlier than usual to get a refill and to use the
new prescription to let the pharmacist know that the dose has been
changed. Is that the best way to handle it?
This is an excellent question. I far far too often have patients tell me (when they are out of medication) that doctor has changed the dose. Usually this is on a Friday night about 10 min before closing.
In the case above, you, Dr, are doing the correct thing. Seriously, I cannot express this enough that writing a new Rx for the patient to bring in (or fax over from your office) is the absolutely best thing to do. Telling the patient about the new dose is like talking to the sky (or filtering piss out of the ocean). I have seen more mistakes with patients getting their pills mixed up and taking double on something they shouldn’t have. Usually things turn alright, but when they get instructions to double up on their HCTZ and instead double up on warfarin, things turn sour really quick. If doctors always assume that their patients cannot wipe their own asses without written instructions, the world would be a better place.
This is what I do with a sig/dose change for which the MD has done “The right thing(tm)”:
When the patient comes in, I get the new Rx in hand, and right then I have verification that the dose has indeed been changed which I input into the computer and fill the Rx (if they are out). If the patient comes in and still has some medication at home I put the changed Rx on file, and if the drug & strength are the same I print out a new label and tell the patient to apply it to their old bottle (I write the Rx number down which to apply the label to). Usually the patient is smart enough to match 2 numbers together and apply a stupid sticker. However this is a huge judgment call, and on more than one occation I have told them to come back with all of their medications so I can do it myself. I instruct the patient to come in when they are out upon which I fill the Rx that was put on file and everything is happy in pharmacyland.
So if you are an MD/NP/PA/DO/CNM/Janitor who is reading this, here is a few tips on how to make your pharmacist love you.
- Any changes in dosage or sig, write the patient a new Rx. Using a sharpie on my pharmacy label is just going to waste both of our times with a fax over confirming what you wrote.
- If any medications are DC’d, let us know. Nothing annoys us more than to have to wait for a fax-back asking if the patients Lotensin needs to be DC’d because you wrote an Rx for Diovan. Its not that its a waste of our time, but the patient obviously has no clue what’s going on, and the terms “possible therapy duplication” is like speaking chinese to them. They have to come back to the pharmacy, or wait an unknown period of time until we get an answer.
- Write down any and all information on the Rx that might save a phone call or fax when switching to formulary alternatives. Unless you really want Protonix for some god-forsaken reason (like the reps are giving you lapdances), writing “or equiv” will save us both a ton of time. A PPI is a PPI for gods sake.
- If you have any questions about whats covered, a rule of thumb is that if its cheap and generic; its covered. Prilosec vs Aciphex, Lotensin vs Aceon, etc etc etc. Have you tried generic Mobic vs Celebrex? You should! If you don’t really care what NSAID the patient gets, then state “Feldene, but whatever is covered, therapeutic sig”. Any pharmacist worth his salt will take care of your patient and not bother you. We may fax you what we gave so you can keep your records updated, but we’re not going to ask you a bazillion questions if its okay. Remember, we went to school to learn about drugs; have a bit of trust in us.
- Hate to tell you, but most NEW drugs now days are just knock-off me-too’s that are out because their replacement is going off of patent soon and will be dirt cheap. Look at Paxil CR, Coreg CR, Adderall XR, Lexapro. All came out shortly after Paxil/Coreg/Adderall/Celexa went off patent. You have been using these agents for 10-15 years, and all of a sudden they suck because something new came out? Think of it this way, if they were so “new” and “breakthrough” and “revolutionary”, then why weren’t they out when there was 5 years left on the patent on the drug they are meant to replace?
- If you have any questions about pricing, call us. Seriously. Nothing makes me happier than churning my workflow to a grinding halt to answer a phone call from a local doctor wanting information vs some crackhead asking for their vicodin a week early. Believe it or not, we’re in the same boat, and we cant exist without each other, so lets actually talk once in a while.