So should we raise a BS flag on Sparda since he can't keep the story straight? 
P!ssed @ pharmacist...
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No. I just don't agree. Your "point" has been kind of like a moving target interspersed with telling me to shove it and being a self proclaimed "smartass."
At any rate, the question has never been what statins MAY do in the future. My question was is there a CURRENT, medically accepted, standard of care reason for a dentist to RX a statin AT THIS TIME. The answer is no.
The question in the OP was why the DMD could not RX his own simvastatin. The answer was that it was out of scope. Almost everyone in the thread seems to agree on this point except this guy, who said:
Which seemed to imply that the pharmacist should have filled the simvastatin. In response to that, I said:
You responded with your theories about how statins would one day be indicated for primary prevention of peridontal disease. This COULD be true but we're not talking about a hypothetical future question. We're talking about whether statins are within the dentist's scope CURRENTLY. I maintain that they are not. Whether they might be in the future is pretty much irrelevant to the topic at hand. Marijuana *may* someday become legal in my state. That doesn't mean I can start selling it at my pharmacy today...
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My physician prescribed for me simvastatin 30tab with 10 refills. I switched it to 100 tabs so I don't have to return to the pharmacy unnecessarily every month plus I don't want to call my physician over something so simple. The pharmacist at his discretion wouldn't do and that's understandable; but he should have called and saved me the trip and the wait. I didn't give him a hard time or anything as I'm sure he used his best professional judgement. It's no big deal really.
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This is embarassing. I hope the pharmacists in this thread don't take these select responses as a representative of our entire field. The OP is in the wrong. Simply put, dentists don't have any business prescribing statins to anyone, including themselves. Yes, we can make all the arguments we want linking increased cholesterol with various pathologies of the oral cavity, but that still does not empower us the right to be prescribing drugs that are not directly related to the delivery of dental care. If we're truly concerned about a particular patient's cholesterol levels, HbA1C, white count, etc, it's our responsibility (as defined in the ADA code of ethics) to refer that patient to the appropriate, competently trained health care provider. Dentistry is a great field, and we can immensely improve the lives of our patients by acting as responsible health care professionals, which also entails that we must acknowledge the scope of our practice.
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he should have done this...but sometimes the pharmacy is overwhelming. A pharmacist can do so much at one time. Not to push this on you. But you can always call the dr. and tell him to phone in for that.
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ilike
i don't care if i can prescribe drug or not, i'm just so grateful to be in this field...
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So should we raise a BS flag on Sparda since he can't keep the story straight?
Why did your pharmacist even fill that? Cipro is BID and while there are a few indications that have TID dosing, UTI isn't one of them and definitely not TID. Plus, a dentist can't treat a UTI. I'm surprised your pharmacist didn't just turn that RX down.
EDIT: The last time you told this story, the dentist was treating a respiratory infection: http://forums.studentdoctor.net/showthread.php?t=719918&highlight=cipro
Hmm, it was in April this year. I think forgetting some details of a script written a while back can happen. Besides, Aznfarmerboi was floating at my store at the time, he can vouch.
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ilike
i don't care if i can prescribe drug or not, i'm just so grateful to be in this field...
best post in the thread. dentistry is an awesome field!
please let this thread die. it's pointless and is of no value to dental students.
i didn't enjoy wasting my time reading this pissing match between pharmacy and dental students/professionals
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Yeah, my quote was regarding the fact the pharm idiot said: your job is to do teeth. if it isnt teeth we wont fill a script" or something to that effect. That was the gross misconception I was correcting
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You also have to take into consideration that you essentially asked the pharmacist to break the law for you. If he assumed that you actually knew how your scope of practice limited your prescriptive authority, it may have offended him.
Not to mention the fact that statins are rather dangerous drugs in some patients. If you push back a visit an extra 60 days and develop rhabdo, it leaves the pharmacist open to a lot of legal liability for illegally allowing a dental practitioner to practice medicine.
I mean no offense, but you have pretty much zero room to be pissed off at anyone. You asked someone to act illegally and introduce themselves to added liability for the sake of your convenience. You should be apologizing to him.
...
Also, if you want something elementary on a script changed - ask the pharmacist to do it. We'll have one of our interns call the physicians office and get it changed. Legally. We call out to physicians' offices about 30 times a day.
Not to mention the fact that statins are rather dangerous drugs in some patients. If you push back a visit an extra 60 days and develop rhabdo, it leaves the pharmacist open to a lot of legal liability for illegally allowing a dental practitioner to practice medicine.
I mean no offense, but you have pretty much zero room to be pissed off at anyone. You asked someone to act illegally and introduce themselves to added liability for the sake of your convenience. You should be apologizing to him.
...
Also, if you want something elementary on a script changed - ask the pharmacist to do it. We'll have one of our interns call the physicians office and get it changed. Legally. We call out to physicians' offices about 30 times a day.
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why mike?!?! you found a job?!?!
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This is exactly one of the reasons I hate retail....patients expect you to get their refills....
it's a shame pharmacists have to be more a businessman than a healthcare advocate.
Cant wait until we start selling fries out of the drive thru.
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No. All that's hypothetical "if Mike was a retail pharmacist" type of stuff.
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i was about to say....retail man....RETAIL!!?!?!?! i was going to call you a sell out.
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I'm probably going to wind up doing retail if I can't find something else soon. I can only live the life of a beggar trailer park person for so long. I got loans about to come due. It also depends on who you work for. I'd work for Kroger (or any grocery store)...or Sam's...or Costco...or Target. Just keep me away from Walmart and Walgreens...
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best post in the thread. dentistry is an awesome field!
please let this thread die. it's pointless and is of no value to dental students.
i didn't enjoy wasting my time reading this pissing match between pharmacy and dental students/professionals
Yeah, we need a moderator over here alrea....no wait.
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Ain't that the truth..
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You wrote yourself for 100 tabs with 10 refills?
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I am thinking that's gonna raise some red flags once the pharmacist sees it plus I doubt insurance will cover 100 tabs of simvastatin in one fill.
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That's what I was thinking. I'm an MD and I couldn't get away with writing that. That basically implies that you'd be taking simvastatin at that dose for about 2 and a half years straight, without getting your labs checked.
I do sometimes write for a 90 day supply of medication for patients to participate in mail order (Medco, etc.) In those cases, though, it usually a 90 day supply, MAX.
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It is a common sense.Who likes to waste time at doctors office.Anyone got high on that drug?What is the problem?just to show who is more important?
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* If your cholesterol levels keep going up despite taking the drug, you'll need to adjust the dose. The only way to know what your cholesterol level is is by getting it tested.
* Statins DO cause liver damage and muscle breakdown in some people. Again, you need to get your liver checked once a year.
* Not going to the doctor for annual checks just because you can't "get high" on that drug is like saying that patients don't need to see their dentist every 6 months, as long as they floss and brush.
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Is it his obligation to call you? Hmm maybe not. It would be nice so you don't make the trip all the way to the pharmacy for nothing, but I don't think he's required to call. Sure you may have felt insulted that he said you couldn't fill your Rx because you were "just a DMD". This is way outside the scope of dentistry. You really don't have a leg to stand on filing a complaint. How about if he decides to file a complaint against your state board for practicing outside the scope of dentistry?
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Switching to a single wide soon?
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You're correct on all points and I have no disagreement.
It was for 100tab NO refill until my next checkup in a few months when I'll tell my physician to write it for 100 tabs. Whether insurance pay for it is besides the point because I've always pay for it myself since it's less than $10 bucks for 100 tabs.
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OK so if the OP presented me with a script for Simvastatin #30 with 10 refills from Dr. Dee Kim, MD (hypothetical PCP) and told me he wanted to get a 90 day supply, I would be happy to call or fax Dr. Kim and get his RX changed to a 90 day supply with a refill or two. If Dr. Kim agrees and his insurance allows him to get a 90 day supply at my pharmacy (or if he pays cash) then everyone is happy. That's what the OP should have done.
One prescriber can't take a script another prescriber wrote and "switch" the quantity. You'd have to write a totally new script, and in this case, the new script wasn't valid so it wasn't filled.
One prescriber can't take a script another prescriber wrote and "switch" the quantity. You'd have to write a totally new script, and in this case, the new script wasn't valid so it wasn't filled.
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I am in a single wide.
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First, dentists as of now really should not be writing for Zocor.....and then switching the MD Rx around.....not great idea either....
Basically, I think the OP needs to read up on what he can do.....
plus there are insurance issues where the company will be audited and lose money if they filled that Zocor under a dentist...and then the company will have a talk with the pharmacist....
it's that simple.....not legal or ethical
not a matter of who is more superior....
Basically, I think the OP needs to read up on what he can do.....
plus there are insurance issues where the company will be audited and lose money if they filled that Zocor under a dentist...and then the company will have a talk with the pharmacist....
it's that simple.....not legal or ethical
not a matter of who is more superior....
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Merged threads.
One comment, this whole fiasco (meaning this thread) probably would have been avoided had the pharmacist had one of the staff call daurang and tell him it couldn't be filled as written. I understand there's not always that much time, but it's good customer service, and what I'd consider common courtesy.
Carry on.
One comment, this whole fiasco (meaning this thread) probably would have been avoided had the pharmacist had one of the staff call daurang and tell him it couldn't be filled as written. I understand there's not always that much time, but it's good customer service, and what I'd consider common courtesy.
Carry on.
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Is this the dental forum or what?
As far as this overall thread goes, there is a legal, ethical, and moral side of this argument:
Legal: Probably outside the scope of dentistry for the OP but in some cases what can be thought of outside our scope actually makes sense. The Hammer, I think, said that is why it is important to have a relationship with your pharmacist so it all makes sense
Ethical: The OP should not be writing his own scripts. Especially for statins.
Moral: The pharmacist should have been courteous enough to call the OP and inform him of the situation.
I think that sums it up. we all win.
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I'm surprised they'd even dispense as few as 30 tabs at Costco.
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This is the most recent disciplinary action from NYS board of professions for NYS dentists.
http://www.op.nysed.gov/opd/jul10.htm
Seth M. Black, New York, NY
Profession: Dentist; Lic. No. 033118; Cal. No. 25032
Regents Action Date: July 19, 2010
Action: Application for consent order granted; Penalty agreed upon: 2 year stayed suspension, 2 years probation, $5,000 fine.
Summary: Licensee did not contest charges of writing prescriptions for medications for himself and members of his family that were unrelated to any dental condition for which said persons were treated.
Park East Oral and Maxillofacial Surgery PC, 521 Park Avenue, New York, NY
Profession: Dentistry; Cal. No. 25033
Regents Action Date: July 19, 2010
Action: Application for consent order granted; Penalty agreed upon: $5,000 fine, 2 years probation.
Summary: Registrant did not contest charges that its president wrote prescriptions for medications for himself and members of his family that were unrelated to any dental condition for which said persons were treated.
Just understand that it is nothing personal. Pharmacists who are caught filling these prescriptions are fined also.
http://www.op.nysed.gov/opd/jun10.htm
BPB Drugs, Inc. d/b/a Gallery Drug, 131 East 60th Street, New York, NY
Profession: Pharmacy; Reg. No. 009990; Cal. No. 24840
Regents Action Date: June 22, 2010
Action: Application for consent order granted; Penalty agreed upon: $5,000 fine, 1 year probation.
Summary: Registrant did not contest charges of dispensing a prescription-required drug on 2 occasions pursuant to 2 prescriptions written by a dentist when registrant knew that the drugs were prescribed for non-dental-related purposes.
Neil Subes, Forest Hills, NY
Profession: Pharmacist; Lic. No. 032018; Cal. No. 24839
Regents Action Date: June 22, 2010
Action: Application for consent order granted; Penalty agreed upon: 1 year stayed suspension, 1 year probation, $5,000 fine.
Summary: Licensee did not contest charges of dispensing a prescription-required drug on 2 occasions pursuant to 2 prescriptions written by a dentist that licensee knew were prescribed for non-dental-related purposes.
http://www.op.nysed.gov/opd/jul10.htm
Seth M. Black, New York, NY
Profession: Dentist; Lic. No. 033118; Cal. No. 25032
Regents Action Date: July 19, 2010
Action: Application for consent order granted; Penalty agreed upon: 2 year stayed suspension, 2 years probation, $5,000 fine.
Summary: Licensee did not contest charges of writing prescriptions for medications for himself and members of his family that were unrelated to any dental condition for which said persons were treated.
Park East Oral and Maxillofacial Surgery PC, 521 Park Avenue, New York, NY
Profession: Dentistry; Cal. No. 25033
Regents Action Date: July 19, 2010
Action: Application for consent order granted; Penalty agreed upon: $5,000 fine, 2 years probation.
Summary: Registrant did not contest charges that its president wrote prescriptions for medications for himself and members of his family that were unrelated to any dental condition for which said persons were treated.
Just understand that it is nothing personal. Pharmacists who are caught filling these prescriptions are fined also.
http://www.op.nysed.gov/opd/jun10.htm
BPB Drugs, Inc. d/b/a Gallery Drug, 131 East 60th Street, New York, NY
Profession: Pharmacy; Reg. No. 009990; Cal. No. 24840
Regents Action Date: June 22, 2010
Action: Application for consent order granted; Penalty agreed upon: $5,000 fine, 1 year probation.
Summary: Registrant did not contest charges of dispensing a prescription-required drug on 2 occasions pursuant to 2 prescriptions written by a dentist when registrant knew that the drugs were prescribed for non-dental-related purposes.
Neil Subes, Forest Hills, NY
Profession: Pharmacist; Lic. No. 032018; Cal. No. 24839
Regents Action Date: June 22, 2010
Action: Application for consent order granted; Penalty agreed upon: 1 year stayed suspension, 1 year probation, $5,000 fine.
Summary: Licensee did not contest charges of dispensing a prescription-required drug on 2 occasions pursuant to 2 prescriptions written by a dentist that licensee knew were prescribed for non-dental-related purposes.
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I just hope those were actual infractions. I've heard stories of RX for "actual" dental-related purposes being rejected because they didn't seem "dentalish" enough, e.g. afrin, zyrtec for sinus precautions, flexeril/soma for TMD/myofascial pain, etc...
Just curious if you would dispense anything by an Oral and Maxillofacial Surgeon DDS, MD who holds both a dental and medical license (basically 50% of new oral surgeons). Do you use your powers and say No?
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Personally, I dont care. I know what OMFS can do including things outside of dentistry such as facial reconstruction and botox. I always fill whatever I can unless it is a clear violation. A lot of us work long hours (14 hours shift) back to back and we have to do a lot of things that we do not get compensated for. The last thing we want to do is get into an arguement. We argue enough with addicts and patients who think they should get their medication for free because they have insurance...
For example, a 90 day supply of simvastatin might cost 9.99 in Costco. The profit margin on that is almost nil. Is it really worth it for the Costco pharmacist to spend 10 minutes fighting with OP? I would probably waste the 10 minutes doing insurance calls, "courtesy" refill calls, etc. Stuff that we dont get paid for and extremly time consuming. To put things into perspective, try calling up your office. After the machine tells you the time that you guys are open, direction to your office, and then list all the options, it is already 2 minutes. Average insurance calls are 5 minutes after being put on hold. All this while filling 400 prescriptions in a day making sure everything is accurate, dosage is right, no interactions, etc. I am sure you can understand why we would give you guys the benefit of the doubt and fill it, or if we do turn it away, why we wouldnt give you a professional call.
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And again, what does this have to do with Simvastatin? Simvastatin is not an anti-anxiety med. It is not good practice to prescribe drugs not knowing what they are for. I hope, for the sake of your future patients, you get some basic drug knowledge under your belt before you become a dentist.
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Come on, it's patently obvious doc smile wasn't assuming simvastatin was an anti-anxiety med, he was using anti-anxiety meds as an example of a medication not directly related to "teeth" (as they're indirectly related for procedure "sedation").
The funniest thing about this thread is the endless harping about how we dentists couldn't possibly handle "dangerous" drugs like simvastatin or a z-pack, yet none of you would have a problem doling out fentanyl, versed, and propofol by the kilo so we "just dentists" can do our in-office, unsecured airway TIVA's with no MDA support.
Not that I'm supporting DDS prescribing statins or UTI abx or whatever but the irony of what y'all consider dangerous is quite delicious.
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Who said simvastatin was more "dangerous" than anything else? It's not that it's too dangerous for dentists to use. It's that it's outside the scope of dentistry. I'm not going to rehash everything that's been said in the thread, but that's the real issue. As far as the other drugs you mentioned, if they are being used for a legit dental purpose, and the dentist is trained to use them, then of course we'd dispense them, regardless of how "dangerous" they are. We assume you can do the job you were trained to do. I've never seen propofol dispensed at a community pharmacy.
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RX for Afrin? It's OTC...
As far as the other drugs you've mentioned, I'd think most pharmacists, when presented with a script that isn't obviously "dentalish" would do the following:
1. Ask the patient what the dentist is treating. "What are you taking this for?"
2. If it seems weird or the patient doesn't know, call the dentist and ask.
Not really a big deal. I'd do at least that much instead of sending a patient away outright. Taking care of the patient and all that stuff...
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I couldn't have agreed more. Tinman is absolutely correct. It would really be to that persons benefit to know exactly what his/her scope of practice is. There is really no real obligation for R.Ph. to call DDS/DMD other than that person to personally call as ask if he/she does not know what they can and cannot prescribe.
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I wont 'rehash' everything that has been said in this thread so far but you obviously arent informed on what this new argument is about. WAAAAAYYY back when, a pharmacist or pharm student (dont recall) said something to the effect: Dentists do teeth and nothing else.
So, in response to that ignorant comment, I politely corrected that poster with a cited reference that proves otherwise with an example of antianxiety medication (which has nothing to do with the OPs original question, but it is in response to the "dentists do teeth" comment showing we can prescribe something that isnt DIRECTLY related to teeth).
Next, someone quoted me and said, "you is stupid, you not make sense becarse you not respond to OP question, you no longer legitamite poster"
THEN, in my defense, Armorshell backed me up re-explaining the point of my post.
IN CONCLUSION:
1) we DO NOT know as much as you about medications, their MOA, indications, counterindications, etc. That is why you went to school for it. Please be a resource to us instead of mock us with our lack of knowledge. We are doing our best to try and explain our position using allegories and maybe a metaphor or two (you know they way writers do things). I apologize if you can not see past a "that is OTC not rx" and, therefore, sidetrack this thread even more.
2) The OP should not have prescribed something outside his scope. His intentions were legit, but methodology incorrect.
Can this thread die now before we get in a pissing match about scope?
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Thanks but I've been following the thread and am familiar with it. You're referring to MountainPharmD's sarcastic remark about dentists doing teeth. Obviously, he could have stated his point differently, but your respose didn't tell him anything he didn't already know. We all know that you are allowed to RX things related to providing care for "the teeth" or "the mouth" or "the oral cavity." I'd argue that anxiolytics for pre-procedural sedation do directly relate to the care of teeth, but that's ok.
Oh, and I'm not sidetracking the thread. I'm responding to issues raised by other posters and asking legitimate questions. Spend some more time on SDN and you'll probably notice that threads often turn into discussions of things other than the original question. It happens and it's not against the rules of SDN. If you don't like my posts, don't read them.
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If we're going to get ticky-tack with definitions in this thread, the comment about OMFS doing things outside the scope of dentistry is off the mark. By definition, anything an oral & maxillofacial surgeon does under a dental license is within the scope of dentistry. And yes, I realize the response to this is going to be
to which I'm going to preemptively respond:
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I have to admit I don't know very much about OMFS training. Are all OMFS dentists first? And then some go on to earn an MD but some don't. Do those who also complete an MD go through the Steps and residency? Are they dually licensed?
As a pharmacist, if I see an OMFS prescribing birth control or antihypertensives or whatever, would I fill them? Are they within the scope? In this state, MD/DOs have "the human body" as their legally defined scope. Would that also apply to a DMD/MD? Are there any DO OMFS practitioners?
Let's play 20 questions...
If the dds, md has both licenses, they are full blown dentist and physician. I believe some dds, md do NOT maintain active physician licensure due to costs, ce, and the lack of true benefit due to the dental license.
As an intern I have prescribed tons of stuff outside your definition of dentistry that have already come up on this thread. My attending co-signs, they are majority dds only.
It is interesting that in an inpatient setting, I/my OMFS team could probably prescribe ANYTHING. Yet when I leave the hospital 6 years from now, I will apparently get quite a bit of resistance.
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I'm pretty sure within the last few weeks I have prescribed spermicidal vaginal foam.
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