Anyone who has been in a relationship (professional – personal, it doesn’t matter) knows that it takes two to tango. Your patients come in, put their life in your good judgement, and in return you may have to do things that are ethically sound, yet legally grey at best.
I’m talking about the dreaded ‘0 refills remaining’ with the patient being out for 2 days. This phenomenon is so prevalent in pharmacy that we should have received a class on how to handle it. Since pharmacy schools give two-shits about retail, here is your class on the subject. Pay attention!
This is how 99% of the cases take place:
- The patient will call you over every little change on the label (expiration date, change in manufacturer, quantity, doctor) yet will gloss over how many refills remaining until they are out for exactly 2 days.
- The patient will let you know they are out of refills in person…. On a Friday… Before a 4 day holiday…. At 2 min’s to closing…
- The mediation won’t be Vicodin, Valium or any narcs. It’ll be something awesome like insulin. You know, the kind of shit that you ethically can’t tell them to go fuck themselves over.
- They won’t be out of something simple that you can drop a few tablets in their bottle, it’ll be something that comes in a unit-of-use bottle, like Januvia, Actos or Nexium.
- In the event that they are out of something simple and stupid, they will forget their old bottle despite you telling them 10 times “MAKE SURE YOU BRING YOUR OLD FUCKING BOTTLE”. This leaves you out the cost of ANOTHER bottle and ANOTHER label. Regardless of how shady this all is already, dispensing drugs into their open unwashed hands is just crossing the line.
- The patient will use the phrase “BUT I NEED THIS MEDICATION” or “CANT YOU JUST FILL IT”.
Here is where the legal waters get the product of Go-Lytely dumped into it. What do you do?
- Legally (sorta), you can only give a 3 day supply without authorization. Its insulin. Are you going to suck out a 3 day supply? If you are, I hope your employer fires you for being a dumbshit. Are you going to break open that box of Humalog Flexpens to dispense just 1? To make this worse, if the MD finds out (usually patient taddling) he/she could file a complaint against your license with the state board of pharmacy for filling without authorization. If you billed the insurance company, they can ding you for filling a fraudulent Rx and pull your contract. This is all worse case mind you.
- Realistically, you know you won’t get the OK from the MD for at least 5 or 6 days. A week to 10 days if the patient goes to a county-ran clinic at the local hospital.
- Ethically, you know that if you don’t dispense this insulin, the patient will have to go to the ER (or worse) thereby costing the taxpaying citizens a few thousand.
Pretty fucked situation all around? Yes, yes it is. For those of you at home, we deal with shit like this about 20 times a day. Now this is how I would handle it:
If it’s a regular patient (regular in the term that we have a professional relationship, not that they can poop fine), then I take the potential legal hit to my license (and to the store) and give them the insulin without the authorization. I figure the patient will stand with me against the state board (and their doctor) to justify my actions as being in their best interest. I politely tell them to bring me a new Rx before this amount runs out, and all is happy. Wait, can you hear the collective jaws of every MD out there dropping as I spill the beans that yes, we do dispense medication without your authorization in certain cases. Here’s a fucking reality check, your patients are dipshits. They can program their phones to play the most obnoxious ghetto rap-song ring-tone at 1000db while waiting for their drugs, yet they can’t program a simple alarm to remind them to call in their refills a week early so we can get the authorization. If you are unable to grasp this concept, then actually listen to the ‘blah blah blah’ that comes out of their mouth when they visit you and you’ll realize that you’re dealing with someone that’s half-step above my dog on the evolutionary chain.
If its Joe-Crackhead who treats me like utter shit, bitches at me about EVERY-FUCKING-THING and looks for things to argue about; fuck him. Let him sit in the ER for 10 hours. If he paid as much attention to his medication refills as he does his fucking cigarettes, we wouldn’t be in this mess.
Agree with me? Probably. Here is my rationale.
Personal responsibility is something isn’t to be taught by your Pharmacist. Sure, everyone has a brain-fart and forgets to call their medications in. However why should I legally put MY license on the line for someone who has no respect for me, doesn’t treat me like an equal, or always tries to pick a fight for me? This kind of bullshit patient would be the first one to throw me under the bus to not only the MD but the state board if the shit goes south. I’m not going to put my livelihood on the line for someone who doesn’t give me an ounce of respect, and doesn’t realize that I’m doing him/her a huge favor. Unprofessional? Sure, if you want to look at it that way, but you also need to look at the irresponsibility of the patient who put him/herself in that situation and expect me to put my ass on the line to remedy a situation that he/she put themselves in.
The easy solution is for everyone to have a little bit of self-awareness and personal responsibility regarding their own health. Yeah, I’ll get right on that after I finish filtering all the piss out of the ocean.