Lets face it, part of our jobs is dealing with Doctors of all shapes, sizes and colors. As you can see from this website, Pharmacists are a unique and special bunch. I hope this guide helps our MD readers out there (you cant hide from us!) understand and interact with us a bit easier. If some MD makes an “RPh’s guide to an MD” let me know and I’ll link it here.
Both MD’s and RPh’s need to drop the egos: Face the facts, MD’s aren’t the proverbial God of medicine anymore. The whole concept of a pharmacist being an MD’s bitch died when Lanoxin went generic (no, I wasn’t around for that). We both need to look at each other as allies against “to better the health of” the patient. Fortunately the doctors who pull the “This is Dr OldFart, I need this for the patient, I don’t care if its not covered do what I say *click*” are either close to retiring or already dead. Doctors can’t afford to stock their offices with $100k worth of expensive trade-name drugs, and pharmacists can’t prescribe stuff. Its mutual destruction if one of us goes under, so lets stick together and drop the egos. (me, the biggest pharmacy ego on the internet saying to drop the egos. I’m talking about at work, not on the internet!)
MD’s need to stamp their prescriptions: If you don’t have a stamp (and your pads don’t pre-print your name) , print your name and DEA/NPI on every prescription. Then spend the $4 and get a stamp after your pen explodes after the 4th Rx of the day. Having the correct doctors name on the Rx saves a ton of time for refill requests, and prevents us from playing “guess the signature” as the patient sits there staring at us. Oh, and you think the patient knows your name? Unless your name is “that Indian doctor”, “the doctor who I cant understand”, or “that cute doctor on 4th street with the huge tits” (no, I’m not joking); get a stamp.
Allow us to substitute in the same class: Unless there is some HUGE issue with dispensing Aciphex instead of Protonix, please write “OK to substitute per formulary” on Rx’s that you write. We went to school to dose drugs in the same class into ballpark ranges. This is what we are taught to do. Trust in our judgment! If this doesn’t convince you, lets look at the time savings:
Drug isn’t covered. We make a copy of the Rx and write down whats covered. We fax it to your office where someone that you pay stops answering phone calls to take the fax and put it on your desk. You need to look at the fax, roll your eyes at the bullshit that the insurance companies make us go through and write “OK”. Your staff then faxes it back to us where one of our clerks pulls out the original (in case the fax was lost in transmission) and gives it to us. All of this happens while the patient is cursing your name as to why you wrote for a drug that costs $150 when her copay should be only $15 (or $0, most likely $0) as if you know her shitty insurance formulary by heart. By spending 10 seconds to give us permission to substitute, look at how much time everyone saves and makes you (and us) look like rock-stars to the patient. The “Its not covered” speech turns into “What doctor wrote for isn’t covered, but he/she gave me permission to switch it to what is covered”. I’m no longer the bearer of bad news, but your wonder-twin counterpart.
Obviously this wouldn’t apply to tweaky drugs, we (I hope) know when something is over our heads and wont try to wing a Depakote dose because Lamictal isn’t covered. If this bothers you, we can even FAX you what we switched it to. Trust us, seriously. Trusting the insurance company (who is telling you what to write regardless of what you say) over us is pretty shitty.
Nobody’s shit smells any better than the other: Sometimes pharmacists fuck up. Benazepril gets dispensed instead of lisinopril, a 4 turns into a 1, I misread your lamisil for lamictal, anything can happen. We both make mistakes, and having a doctor throw me under the bus to the patient (or having him/her call me up and just give me both barrels) makes me more shitty than how I already feel when I make an error. When you write for something that has a life-threatening interaction, we “fax you for clarification” not throw you under the bus and tell the patient that you almost killed him/her. We are both busy, we both make mistakes. Lets not finger point, because in reality when that happens we both lose.
We need to talk more: No, this isn’t a chapter in some relationship self-help book. We need to stop using our minimum-wage staff’s as proxies and just call each other directly. This is going to sound sappy, but I love it when a doctor call me and asks me if something is covered, or how much something costs. Hell, even to bitch about this patient and what to give him/her to get them off of our backs. This makes us feel like part of the “team” than just pill-pushing human shields to the medicine side of health care. Yeah, we both are swamped all the time. A 30 second phone call as to whats covered will save us 20 min’s (and lots of bitching) later on down the road. You want to know the real scoop on a new drug that some big-titted rep is pushing? Give us a call, we’ll tell you how the drug she was pushing a year ago is going generic soon so she’s pushing the “new version” to keep the sale. Hell, even a simple “thanks” for informing you of a narc-shopper makes us feel like we did something good. Remember, pharmacists are the underestimated fat-kid of the football team of medicine.
Show us you care by giving us lots of refills: Mrs Jones has been on Atenolol 50 since the day it first same out. Why not give us 12 refills on that new Rx that you wrote for her? Help us save time (and thereby saving you and your staff time) by giving a bunch of refills on drugs that the patient has been on for years (and you have no plans to change). Obviously I don’t mean stuff that you need labs to monitor!
Med dosage/sig change? Write a new Rx: Telling the patient to take a medication differently without writing a new Rx is about as effective as giving a stripper $100 and asking for change (uh, don’t ask me how I know this). Save us both a fax and just write/call in a new Rx for any dosing changes. Our computer systems can put new Rxs on file for future fillings, so it just makes sense to make both of our lives easier. Spend 30 seconds now or 20 mins (and lots of phone calls by the patient) later.
Want to know the scoop on a patient? Ask us! Patients will tell you what you want to hear so you’ll give them an Rx. However we see when they are getting their refills, who they go to, and how they act. The patient that complains of a 10/10 low back pain to you may waltz into the pharmacy like nothing is wrong. You may not see how your patients act outside of your office, but we do. We usually see your patients enough to get a good gut feeling if something fishy is going on with them. If we don’t know, then their insurance company computers can tell us if they have been naughty or nice (like Santa!).
Hope this helps. I’m sure other pharmacists will comment on points that I missed.