Sound Off: Professional Infighting Hurts Us All

[pacpod]

Please discuss!

http://studentdoctor.net/2013/08/professional-infighting-hurts-us-all/

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[MaxillofacialMN]

Who is Peter Cohron?

A quick google search revealed there is a RPh Peter Cohron which is likely the author.

I'm not sure if the author purposefully left his credentials out of his authorship title, or if it was by accident, but I think it is important to realize the author was a pharmacist.

All that being said, I don't think he was being overly unfair to the physicians, but I do believe it should have been disclosed...

 

[JGimpel]

A pharmacist knows enough to be able to tell what drugs are in what class, what each individual one should be doing when inside the patient's body and watch for interactions that the doctor, even with a ton of free drug interaction tools instantly at his disposal, may somehow miss. Do the pharmacists have the ability to check every drug THEY have ever filled for a patient in their chain, maybe. Can they do that across multiple chains, no. Doctors do this all the time for the best coordination of care with the patient's other providers.

Doctors are trained in the classes and mode of actions of drugs they prescribe and the complex pathophysiology that they must account for when writing for these prescriptions. Pharmacists will never come close to having this much training and experience. If their 100k/year salary isn't enough and the retail pharmacy life is not what they intended, let them go to medical school and earn the same privileges that doctors have.

 

[1800callsaul]

Doctors are trained in the classes and mode of actions of drugs they prescribe and the complex pathophysiology that they must account for when writing for these prescriptions. Pharmacists will never come close to having this much training and experience. If their 100k/year salary isn't enough and the retail pharmacy life is not what they intended, let them go to medical school and earn the same privileges that doctors have.

This article isn't about questioning your antibiotic choice or use of clonidine first line for HTN. This isn't about playing doctor.

This is about a patient who:

1. Never came to my pharmacy before
2. Presents a script from a doctor that practices 5 states west of mine
3. Wants to pay straight cash for:
4. Oxycodone 30 mg #200 i-ii q4-6h
5. Doesn't bat an eye when I tell him it's >$500

ABUSE ISSUES ASIDE: that's a big total daily dose, wouldn't you say doc? This dude has never been my pharmacy before and I have no records of him taking any sort of opioid dose this large. Last time I checked you can stop breathing with an opioid OD. And last time I checked you sorta need to breathe to live. So, wouldn't you think it would be reasonable call to figure out if dispensing such a large dose is legitimate and safe for this guy?

ABUSE ISSUES IN PLAY: this is a typical pill-mill type script and scenario. The DEA is telling pharmacists they will lose their licenses (therefore livelihoods) if they continue to fill scripts as described. Again, don't you think a call is reasonable?

 

[MaxillofacialMN]

Personally, I believe there is a huge difference between all the questions mandated by "MDC," verses just calling the physician and asking him if he wrote the scrip.

I am also concerned over privacy. If this becomes a more mandated policy, what's stopping Joe Schmo on the street from calling a physician and questioning him why Jane Schmo got a prescription? It's certainly not the physician's job to verify if the pharmacist is legit.

I don't think I'd have a problem telling a pharmacist that I indeed wrote the scrip, but any information past that I would hesitate to be forthcoming. If the pharmacist had a legitimate concern about drug interactions, he could call me and explain that to me, but I don't think I should be obligated to explain any reasoning (privacy issues) to him other than to say, "I indeed prescribed this medication to my patient."


Also the author of the article says something like, "most pharmacists know what drugs their customers are taking." In my experience, that is NOT the case. I don't talk to my pharmacist about anything when I fill a scrip. Heck, that's why they have drive-thru windows!

 

[JGimpel]

This article isn't about questioning your ****ty antibiotic choice or use of clonidine first line for HTN. This isn't about playing doctor.

This is about a patient who:

1. Never came to my pharmacy before
2. Presents a script from a doctor that practices 5 states west of mine
3. Wants to pay straight cash for:
4. Oxycodone 30 mg #200 i-ii q4-6h
5. Doesn't bat an eye when I tell him it's >$500

ABUSE ISSUES ASIDE: that's a big ****ing total daily dose, wouldn't you say doc? This dude has never been my pharmacy before and I have no records of him taking any sort of opioid dose this large. Last time I checked you can stop breathing with an opioid OD. And last time I checked you sorta need to breathe to live. So, wouldn't you think it would be reasonable call to figure out if dispensing such a large dose is legitimate and safe for this guy?

ABUSE ISSUES IN PLAY: this is a typical pill-mill type script and scenario. The DEA is telling pharmacists they will lose their licenses (therefore livelihoods) if they continue to fill ****ty scripts as described. Again, don't you think a call is reasonable?

So you prefer to only fill prescriptions from pill-mills you're established with? Whether a patient new to you comes in with a C2 prescription that's legit with all the right watermarks and NPI numbers or one scribbled in crayon with Sesame Street as the doctor's address; your main defense against a DEA fine or license surrender is to call the number on the prescription, get in touch with the doctor and verify everything on it and that's all. The DEA runs reports on everyone every so often and it's their job to catch the worst offenders, then down on to the rest of the obvious diverters. Once pharmacists get to start questioning medical doctor's line of thinking about anything, they might as well start writing the prescriptions themselves. Shouldn't the person questioning a doctor's decision making be a person also trained in his method of decision making, i.e. another medical doctor?

 

[1800callsaul]

So you prefer to only fill prescriptions from pill-mills you're established with?

Frankly I really don't care. If it's a legit script for a "legit" medical purpose, I don't care. I don't care what's done with it. It's good for my company's bottom line.

your main defense against a DEA fine or license surrender is to call the number on the prescription,

You never call the number on the script. Drug rings forge scripts and the numbers on the script are often a cell phone number of a ring member. So it's really not defensible. Gotta call the number in the computer bro.

Once pharmacists get to start questioning medical doctor's line of thinking about anything, they might as well start writing the prescriptions themselves. Shouldn't the person questioning a doctor's decision making be a person also trained in his method of decision making, i.e. another medical doctor?

1. It's federal law, not us playing doctor, but LAW for us to dispense controlled substances for a legitimate medical purpose. As long as I get that diagnosis code for low back pain for the guy I described above, I'm done with my questions. I don't care if the doctor has tried other modalities before drugs for the back pain. I don't even care if the doctor goes right to opioid analgesics for initiation of drug therapy. I'm not going to ask why you decided to use the dose that you used or the drug that you used from the retail setting. I just need to cover my rear. Frankly, I really don't care.

2. You ever heard of a clinical pharmacist? They round with the medical team and often give recommendations regarding optimal drug therapy. Not sure where you are training, but I'm not making this up.

 

[owlegrad]

I guess no one here has heard of corresponding liability?

 

[MaxillofacialMN]

I guess no one here has heard of corresponding liability?

I looked it up (here's my source: http://elf.procampus.net/refs/CP8007EX_Lesson.pdf )

And it seems like the regulations put forward by the major chain went beyond the scope of corresponding liability.

Basically corresponding liability means that a pharmacist cannot fill a fraudulent prescription.

"The CSA [Controlled Substance Act] does not require pharmacists to practice medicine or judge legitimate versus illegitimate medical practices. However, the DEA in the course of interpreting corresponding liability recommends that pharmacists take three steps when confronted with questionable or suspicious prescriptions for controlled
substances:
1.Examine the prescription for face validity;
2.Contact the prescriber directly to verify the
prescription and patient if the medical
practitioner is not known; and
3.Talk directly to, and identify, the patient. "

In other words, the pharmacist has a responsibility to make sure the scrip is legitimate - it does not force (or necessarily allow) the pharmacist to question a physicians treatment plan.

 

[JGimpel]

Frankly I really don't care. If it's a legit script for a "legit" medical purpose, I don't care. I don't care what's done with it. It's good for my company's bottom line.

Well, at least you're telling us what your motivation is.

You never call the number on the script. Drug rings forge scripts and the numbers on the script are often a cell phone number of a ring member. So it's really not defensible. Gotta call the number in the computer bro.

My point was that, whether you call the number on the Rx, the number out of the yellow pages or the one in your computer, once you get the doctor of medicine's office, verify that the Rx and all of its details are correct and fill it. I can't imagine a drug ring ever paying one of the pharmacy techs making $10/hour a couple hundred to call whatever number you want them to Save the complicated printing of illegal documents to the currency counterfeiters.

1. It's federal law, not us playing doctor, but LAW for us to dispense controlled substances for a legitimate medical purpose. As long as I get that diagnosis code for low back pain for the guy I described above, I'm done with my questions. I don't care if the doctor has tried other modalities before drugs for the back pain. I don't even care if the doctor goes right to opioid analgesics for initiation of drug therapy. I'm not going to ask why you decided to use the dose that you used or the drug that you used from the retail setting. I just need to cover my rear. Frankly, I really don't care.

2. You ever heard of a clinical pharmacist? They round with the medical team and often give recommendations regarding optimal drug therapy. Not sure where you are training, but I'm not making this up.

The clinical pharmacists that I've rounded with in various hospitals have usually been very sharp and helpful. They push the nursing laptop cart around with us, however, the most input they usually get to give is to check what is on the med list, how it would interact with the other drugs and to order a dilantin, vancomycin, level or other labs to titrate them and heparin for us. They are there for when our group doesn't want to do this ourselves. Please don't overstate their role in the practice of clinical medicine. That fallacy is no longer defensible.

 

[1800callsaul]

My motivation is to avoid to passing bad prescriptions. That's the only motivation. Who knows what kid's hands this might get into. If the CII has a legitimate medical purpose (again, I am not a doctor so it's above my pay grade to say some doctor's use of an opiate is unwarranted) why would I want to: turn away business and prevent someone who's truly in pain from getting relief?