Calling a prescriber to ask a question.

[MountainPharmD]

I have been licensed as a Pharmacist for three years. I remember a few years ago when I was brand spanking new, I called prescribers on everything. A T wasn't crossed I called to verify it was supposed to be a T. Didn't specify ointment or cream, I called to verify. Drug interactions, I called on every single one.
So today I get a call from a physician assistant. He prescribed Floxin otic drops the day before. The patients insurance would not cover it because it required a prior authorization. I wrote a short explanation on the insurance reject message and faxed it over to the PA and told the patient I would call him when I heard an answer. Today the PA calls and is annoyed with me because I did not call him right away so we could get it changed to something else.
I proceed to explain to him exactly why I don't call prescribers. First, I call and talk to the receptionist, after holding for five minutes. She tells me I need to talk to the med tech and before I can argue puts me on hold for another 5 minutes. The med tech gets on the line and has no idea what I am talking about and tells me I need to talk to the nurse, again on hold for a least five minutes. Finally, the nurse gets on the line, has no idea what I am talking about and says she will go ask the Doctor. God forbid I actually talk DIRECTLY to the prescriber. After going back and forth with the nurse three or four times I finally sort of get my question answered. All this happens if I get really lucky. What usually happens is I leave a message at each of the above steps and if I am lucky get my question answered in about a week. So Mr. PA says that sounds terrible but that is not how he operates so I need to call him if ever I have any questions on his prescriptions. Sure buddy no problem, right on it, thanks for calling. Whatever.

So the end of the day is approaching and I am filling a script for Ketek 400mg take 1 bid #14. I fill it, bag it and am ready to move on to the next RX. I know this is not the recommended dosing for Ketek but a little voice in my head says "not my problem that's how they wrote it just fill it and move on." But I stop, and recall my conversation with the PA earlier in the day. So I decide to call and verify the RX with the nurse practioner who wrote it. I go through all the above steps and tell everyone what the problem is. The last person I talk to says, "oh I will have to go ask her hold on." AGAIN, GOD FORBID I ACTUALLY TALK DIRECTLY TO THE PERSON WHO WROTE THE SCRIPT!!!! So someone gets on the line and says, "oh okay, she said change it to 1 twice a day is fine." I resist the urge to smash the phone into a million peices againts the counter. I again explain that it is dosed 2 tablets once a day for 5 days , 7 to 10 days for community aquired pnemonia. The idiot on the phone tells me "I guess I don't understand the question because 2 everyday and 1 twice a day is the same thing, its two everyday". I didn't say a word a just hung up the phone.

Why do I bother...I will ponder that question the rest of the evening....

---

Members don't see this ad.

 

[alwaystired]

yep.....crap luck on our part. prescribers would never put up with that method of getting to the pharmacist either, i mean we have freakin direct lines, can they not extend that courtesy.....or at least directly to the nurse.

 

[WVUPharm2007]

They have power, we do not.

Society has decided this.

So to hell with society.

When Ketek inevitably doesn't work anymore, they can't blame us and we'll all die of The Plague ver. 2023.

I'll laugh at them all from my grave.

Then the monkeys can take over as dominent species. Hopefully the monkey state legislators will give their pharmacists some form of line item veto to play around with on individual Rxs with ******ed problems.

Then they will live for several million years and harness the power of the sun.

 

[alwaystired]

ketek may still work for this area (prescribers over here prefer zpak candy)

 

[ZpackSux]

Ketek sucks as well.

So I guess 2tabs Qday is same as 1 tab BID. Who cares about t1/2.

 

[MountainPharmD]

Sorry for the long rant but it did make me feel better. The whole point of that was to ask if anyone bothers calling the doctor on stuff that is obviously wrong. The Ketek from above is a good example. There is nothing in the literature that suggests it should be given anything other than one time per day. I could have just changed it to two QD worte on the script nurse ok'd change per Doctor and went on with my life. Which is essetially what I did anyway only I wasting 10 minutes calling.

 

[Requiem]

Sorry for the long rant but it did make me feel better. The whole point of that was to ask if anyone bothers calling the doctor on stuff that is obviously wrong. The Ketek from above is a good example. There is nothing in the literature that suggests it should be given anything other than one time per day. I could have just changed it to two QD worte on the script nurse ok'd change per Doctor and went on with my life. Which is essetially what I did anyway only I wasting 10 minutes calling.

This is why retail seems like it would only develop into a continually abrasive profession to me, all the monotony and frustration and insurance.

I wanna try rounding as a clinical pharmacist.

 

[Doctor M]

I have been licensed for around 2 years and experience the same crap. I fax everything whether the P/A, nurse, or doctor likes it or not. If they give me lip, i explain to them that is how i do it. Now, if its urgent or what not, i will make a personal phone call. I do not waste my time talking to incompetent secretaries who have no idea what i am talking about. I have actually requested to speak to a doctor personally and if they refuse then i tell them well then the patient will not get what they need. They usually comply. Anyway, i hand everything off to a tech and just tell them to fax it. My time is to valuable for nonsense. As for drug interactions, i counsel the patient and if it a complete contraindication, i do not dispense until I SPEAK to the Doctor himself. Take care

Doctor M

 

[bananaface]

You have to realize that the nature of a prescriber's business keeps them from being immediately available all of the time. They are often going to be in a room with a patient when you call. That said, there is no excuse for an office not to provide quick contact with someone competent who can facilitate clarification within an hour or so aside from it being outside of office hours. I hate being forced to leave voice messages for MAs who may get back by the end of the business day or maybe sometime during the next.

 

[rpie]

Wow, I came upon this thread and was some what surprised at what you have to put up with.

I can tell you that in our practice, we appreciate and welcome an Rx verification call. Since we consider it to be very important, our policy is that when ever a pharmacist calls on an Rx, the receptionist is to direct the call immediately to the prescribing doctor, busy or not.

 

[Doctor M]

You have to realize that the nature of a prescriber's business keeps them from being immediately available all of the time. They are often going to be in a room with a patient when you call. That said, there is no excuse for an office not to provide quick contact with someone competent who can facilitate clarification within an hour or so aside from it being outside of office hours. I hate being forced to leave voice messages for MAs who may get back by the end of the business day or maybe sometime during the next.

This is true, however, 24-48 turnaround time is not right. Even for refills. Anyway, I fax everything.

 

[Doctor M]

Wow, I came upon this thread and was some what surprised at what you have to put up with.

I can tell you that in our practice, we appreciate and welcome an Rx verification call. Since we consider it to be very important, our policy is that when ever a pharmacist calls on an Rx, the receptionist is to direct the call immediately to the prescribing doctor, busy or not.

Unfortunatley, your nature of business is rare. Just like a pharmacist is always available, there should always be at least 1 person who can help the situation. On tuesday I called to verify an rx for a pain med that was written wrong. No call back that day or today. I was told the doctor would be in after 3 pm and they would get back to us. Well, to me, i do not suffer or feel pain. To the patient, he SOL.

 

[primadonna22274]

I'm sorry you've had this experience. I have to say as a practicing PA for the past six-odd years I've been grateful when a pharmacist calls me for clarification (and, occasionally, a little chagrined when my excellent memory remembered a particular dose or schedule incorrectly...woops). Most pharmacists I've worked with have been particularly gracious, and (I hope) my practice has prioritized pharmacist calls, and when I can't pick up right away my MA has tried to answer the question if she could (she knows my prescribing habits intricately well) or has given me the chart to call back right away.
Now, in the ER, I don't get all my own calls but when I do get a call, the pharmacist gets through right away. Maybe they have telephone karma, I dunno.
I know bad apples have a way of coloring all of our experiences but try to remember that the majority of prescribers appreciate your services and really want to practice safe and appropriate medicine and are grateful that you're double-checking us.
Lisa

 

[Doctor M]

I'm sorry you've had this experience. I have to say as a practicing PA for the past six-odd years I've been grateful when a pharmacist calls me for clarification (and, occasionally, a little chagrined when my excellent memory remembered a particular dose or schedule incorrectly...woops). Most pharmacists I've worked with have been particularly gracious, and (I hope) my practice has prioritized pharmacist calls, and when I can't pick up right away my MA has tried to answer the question if she could (she knows my prescribing habits intricately well) or has given me the chart to call back right away.
Now, in the ER, I don't get all my own calls but when I do get a call, the pharmacist gets through right away. Maybe they have telephone karma, I dunno.
I know bad apples have a way of coloring all of our experiences but try to remember that the majority of prescribers appreciate your services and really want to practice safe and appropriate medicine and are grateful that you're double-checking us.
Lisa

Lisa,
I agree with you that most prescribers are glad we call, but for me it is the people who answer the phone. I have encountered some of the most rude and obnixious people (receptionists, secretaries) when I have called. I do not like to call and have it ruin my day. I prefer to speak to prescribers and i understand that sometimes it is not possible, but some people do not know how to communicate. The wait time sometimes is very long. Anyway, i prefer to fax on issues unless it is an emergency or cannot wait.

Dr. M

 

[BME103]

I really make an effort to talk to the prescriber directly because if the prescriber made a mistake, then he should know about it so he wouldn't make the same mistake the next time.

I sometimes call because a patient cannot afford the medication but there are some prescribers that don't seem to care. That is why I also encourage the patient to call the prescriber directly and ask him to call the pharmacy back.

 

[JMH5145]

We now have a local office that only accepts faxes. NO phone calls from pharmacies allowed..no questions, no prior auth requests, no drug not covered can we change, zip-zero-zilch. How's that for patient-centered care?

 

[twester]

Unfortunatley, your nature of business is rare. Just like a pharmacist is always available, there should always be at least 1 person who can help the situation. On tuesday I called to verify an rx for a pain med that was written wrong. No call back that day or today. I was told the doctor would be in after 3 pm and they would get back to us. Well, to me, i do not suffer or feel pain. To the patient, he SOL.

I'm new, but I have some worldly experience and agree with Dr. M. It's always easy to put ALL the responsibility on the last guy in the chain. The last guy has a choice. He/she can either bow to it or turn the backflow on. Pharmacist's careers and reputations are on the line for correct and legal dispensing. What's wrong with leaving a message with the prescriber that the scrip goes unfilled until you get an answer? When the patient throws the requisite fit, just hand them the phone.

Again, I'm sure I'm being somewhat naive, but people usually don't walk on others unless it's allowed to happen in the first place.

 

[PharmD2MD]

I recently got out of the pharmacy business, but here's what I noticed myself doing. Especially when it got really busy. I would look at goof ball doses in terms of "is it gonna hurt someone"...I'm not recommending this practice at all, but it's so easy to slip into this mode when you are getting hammered from several angles. It's also easy to rationalize other stupid little short cuts.

Don't go down this road. Once you start rationalizing, then it gets progressively easier.

 

[npage148]

We now have a local office that only accepts faxes. NO phone calls from pharmacies allowed..no questions, no prior auth requests, no drug not covered can we change, zip-zero-zilch. How's that for patient-centered care?

We have a couple of those offices. You simply tell the patient how it is and its their doctor's fault that they cant get the medicine becasue they wont take to us

 

[WVUPharm2007]

You should start prank calling them from random pay phones and vow to never stop until they begin taking phone calls.

 

[BME103]

That is the sad thing about this profession. No one seems to care. Not the patients, not the prescribers, and certainly not the employers. It is also sad that many pharmacists, who are really caring people, start not to care themselves. I am not proud to say I am becoming one of those pharmacists.

 

[bananaface]

Lisa,
I agree with you that most prescribers are glad we call, but for me it is the people who answer the phone. I have encountered some of the most rude and obnixious people (receptionists, secretaries) when I have called. I do not like to call and have it ruin my day. I prefer to speak to prescribers and i understand that sometimes it is not possible, but some people do not know how to communicate. The wait time sometimes is very long. Anyway, i prefer to fax on issues unless it is an emergency or cannot wait.

Dr. M

You could always have your tech route you past the front office staff then connect you once the prescriber or their representative is on the line.

 

[Doctor M]

That is the sad thing about this profession. No one seems to care. Not the patients, not the prescribers, and certainly not the employers. It is also sad that many pharmacists, who are really caring people, start not to care themselves. I am not proud to say I am becoming one of those pharmacists.

It's not that you or I do not care. I believe that it's just that you know in your head that when you make that phone call to verify the rx or what not, its the same story. And I am sure that some offices go through the same thing. Once a day, i get this phone call "This is Dr. X's office and we called in a prescription yesterday on your voice mail and the pt states its not there" blah blah. It must be very frustrating for the pt. I am all for the pt. But I hate these phone calls. The doc thinks were incompetent, the pt goes w/o therapy, and we are in the middle of both! Anyway, after filling 400+ rx per day in a 12 hour period (1 Rph), it becomes very difficult to keep focus and care, but i must keep focus and treat every Rx the same.

 

[Doctor M]

I'm new, but I have some worldly experience and agree with Dr. M. It's always easy to put ALL the responsibility on the last guy in the chain. The last guy has a choice. He/she can either bow to it or turn the backflow on. Pharmacist's careers and reputations are on the line for correct and legal dispensing. What's wrong with leaving a message with the prescriber that the scrip goes unfilled until you get an answer? When the patient throws the requisite fit, just hand them the phone.

Again, I'm sure I'm being somewhat naive, but people usually don't walk on others unless it's allowed to happen in the first place.

There is nothing wrong with leaving a message, but some of these offices only accept faxes. Here is my conversation: "good morning, this is Carlos from CVS and I'm calling to clarify a prescription(or medication not covered) that the doctor wrote for Mr X today" "Could you fax it to us?" "Well, the patient is here waiting" "Well, the doctor is busy, we'll have to get back to you". And so it goes, the patient may wait 20 mins or go days. To me, I do not suffer, but to the patient, come on! If you write the script, write it right or at least be available for consult. Thats just my feeling. A 24-48 hour turnaround time is too long in my opinion.

 

[Doctor M]

You could always have your tech route you past the front office staff then connect you once the prescriber or their representative is on the line.

This is true, but then my techs get the brute force of some of these people. No one really deserves to get treated rudely, on either end. I get paid the big bucks (so as they say), so I usuaslly take the beating

 

[Doctor M]

I recently got out of the pharmacy business, but here's what I noticed myself doing. Especially when it got really busy. I would look at goof ball doses in terms of "is it gonna hurt someone"...I'm not recommending this practice at all, but it's so easy to slip into this mode when you are getting hammered from several angles. It's also easy to rationalize other stupid little short cuts.

Don't go down this road. Once you start rationalizing, then it gets progressively easier.

I believe this is retail practice. Today I saw an 11 year old receive an 81 mg dose of concerta (54mg + 27mg). Damn! I dispensed it after reviewing her profile and seeing that she had been on 54mg and that here specialist had just added more. I questioned this for a moment and saw that the max for an adolescents is 72 mg/day. However, dosing is also based on weight! There is just so many issues that occur in a pharmacy that does 400+/day. Questions, ins, from every angle! And 1 pharmacist on duty? Anyway, end of rant😀

Dr. M

 

[sdn1977]

I believe this is retail practice. Today I saw an 11 year old receive an 81 mg dose of concerta (54mg + 27mg). Damn! I dispensed it after reviewing her profile and seeing that she had been on 54mg and that here specialist had just added more. I questioned this for a moment and saw that the max for an adolescents is 72 mg/day. However, dosing is also based on weight! There is just so many issues that occur in a pharmacy that does 400+/day. Questions, ins, from every angle! And 1 pharmacist on duty? Anyway, end of rant😀

Dr. M

400+ rxs/day & only 1 pharmacist?????😱 That just seems unsafe...but you may have just mad machinery so I won't judge...

But...I gotta agree with Twester....you only get walked on if you allow it. What would happen if you only did 300 out of those 400??? Is that outcome the worst that could happen or is the error a pharmacists make because he/she is checking (or not checking!) too many the worst outcome??? So...the guy the next day has 100 more & so on & so on...eventually...your management will get the message...to give good patient care (they call it customer service)...they need more help!

As for those offices which won't accept phone calls.....I'd put it right back on the patient - sorry..I can't reach your dr & I can't fill this rx the way its written - just as npage said. Trust me....if its important enough - the office will calll you to rant - just tell them simply....I can't do clarifications like this by fax - you must give me a phone number or its not filled. Who cares if they take it somewhere else???

 

[rpie]

If you write the script, write it right or at least be available for consult. Thats just my feeling. A 24-48 hour turnaround time is too long in my opinion.[/QUOTE]

This is exactly the same feeling we have about any Rx that is written from our office. 👍

Besides, it doesn’t take too long to look up and verify your Rx. The docs that don’t do this are either being sloppy or lazy. However, since mistakes do happen, the prescribing doc. needs to be available…..IMO

 

[npage148]

As for those offices which won't accept phone calls.....I'd put it right back on the patient - sorry..I can't reach your dr & I can't fill this rx the way its written - just as npage said. Trust me....if its important enough - the office will calll you to rant - just tell them simply....I can't do clarifications like this by fax - you must give me a phone number or its not filled. Who cares if they take it somewhere else???

Its amazing how fast a doctor will get back to us when you sic an angry patient on them. I had a patient ripping pissed about not having refills. I told them I called the doctor 3 times in the last 3 days. I told the patient this and said its all your docotors fault. I got the refill auth in the next 30 mintues

 

[Doctor M]

400+ rxs/day & only 1 pharmacist?????😱 That just seems unsafe...but you may have just mad machinery so I won't judge...

But...I gotta agree with Twester....you only get walked on if you allow it. What would happen if you only did 300 out of those 400??? Is that outcome the worst that could happen or is the error a pharmacists make because he/she is checking (or not checking!) too many the worst outcome??? So...the guy the next day has 100 more & so on & so on...eventually...your management will get the message...to give good patient care (they call it customer service)...they need more help!

As for those offices which won't accept phone calls.....I'd put it right back on the patient - sorry..I can't reach your dr & I can't fill this rx the way its written - just as npage said. Trust me....if its important enough - the office will calll you to rant - just tell them simply....I can't do clarifications like this by fax - you must give me a phone number or its not filled. Who cares if they take it somewhere else???

Well, its called a budget😡 The way it works out is that the overnight will do around 30-60 rx's and the day time Rph will do around 360-420 during the day😱 Anyway, i'll just keep faxing!

 

[rx1]

PharmD2MD--> I agree whole-heartedly with your point that the more that you bend the rules or "let things go" the easier it gets. I think that is why as a new grad you call to verify quite a bit.
I have problems with pharmacists that pester physicians b/c it makes it harder for those of us that need to talk to the doctors for valid reasons. As pharmacists we are highly trained and it is within our ethical guidelines ( non-maleficance (sp?) or beneficence) to help these patients and make rationalized decisions based on the information that we can gather. If there is inadequated information then so be it, call the doctor. But if there is no quantity on a cipro 500 mg rx for a un-complicated non-recurrent UTI is it within our "power" to suggest a 5 day treatment to the patient? What about putting the decision in the hands of the patient if the patient understands the implications ( cost, coming back to pick up rx later after dr calls back, probably a 3-5 day treatment anyways) What do you all think??

 

[rx1]

.....and one more thing...SDN1977 has a good point and it works well, get the patient to call the office. You dont have to be the pestering pharmacist and the receptionist/nurse/doctor actually has some accountability to the pt whereas they dont know (usually) the pharmacist and could care less about them waiting for a reply. I love this technique.

 

[MountainPharmD]

PharmD2MD--> I agree whole-heartedly with your point that the more that you bend the rules or "let things go" the easier it gets. I think that is why as a new grad you call to verify quite a bit.
I have problems with pharmacists that pester physicians b/c it makes it harder for those of us that need to talk to the doctors for valid reasons. As pharmacists we are highly trained and it is within our ethical guidelines ( non-maleficance (sp?) or beneficence) to help these patients and make rationalized decisions based on the information that we can gather. If there is inadequated information then so be it, call the doctor. But if there is no quantity on a cipro 500 mg rx for a un-complicated non-recurrent UTI is it within our "power" to suggest a 5 day treatment to the patient? What about putting the decision in the hands of the patient if the patient understands the implications ( cost, coming back to pick up rx later after dr calls back, probably a 3-5 day treatment anyways) What do you all think??

That was kind of the whole point of this thread. I think it is fine, if you are missing key information on a script, to fill it with what is appropriate based on current guidelines. As long as you have made a good faith effort to consult the prescriber and document that you did on the RX. This is especially true on nights and weekends when these types of things usually happen. I filled a script the other day that was written Levaquin 500 1 QD may substitute with Cipro. Why they wrote it like that I do not know but the patient had no insurance and of course wanted Cipro because it has a generic. So do you replace the Levaquin with Cipro and fill the script as written. I tried to call and clarify if we used Cipro were we to change the directions but I had to leave a message. Patient was waiting and in a hurry so I filled it with Cipro and changed the directions to 1 BID for the same duration of therapy.

 

[sdn1977]

That was kind of the whole point of this thread. I think it is fine, if you are missing key information on a script, to fill it with what is appropriate based on current guidelines. As long as you have made a good faith effort to consult the prescriber and document that you did on the RX. This is especially true on nights and weekends when these types of things usually happen. I filled a script the other day that was written Levaquin 500 1 QD may substitute with Cipro. Why they wrote it like that I do not know but the patient had no insurance and of course wanted Cipro because it has a generic. So do you replace the Levaquin with Cipro and fill the script as written. I tried to call and clarify if we used Cipro were we to change the directions but I had to leave a message. Patient was waiting and in a hurry so I filled it with Cipro and changed the directions to 1 BID for the same duration of therapy.

I'd say that was a good call on your part! I've done exactly the same & exactly what the previous poster has suggested.....used what current guidelines suggest to start therapy. However...I've done a few extra things to "cover" myself. I've left the msg w/ the answering service &/or receptionist letting them know I need a call back & documenting the day & time. I've also faxed what I've filled with a request the prescriber calls me to document that is in agreement with what his/her intent was or to make a change.

Using this method....I've been running about 75% agreement with what I chose..the other 25% has been ususally lengthening the duration of antbx tx.

I only do this for drugs & therapy which I'm really comfortable with. I don't stick my neck out unless I'm willing to take whatever heat I may suffer for using my judgement.

I also make it a rule to NEVER give out narcotics to those who I know abuse them unless I have a clear & complete rx. That's just my personal peeve though......I have started a discharged post op pt (who is not a know abuser to me) on a narcotic when the qty is not clear....I just give a 24hr supply & get it clarified later.

 

[Caverject]

When in doubt on a friday night, just do it!

Had Nexium 30 mg prescribed tonight at 7:30pm. Instead of the bullshi* hassle I would have gone thru verifying the rx, I instead filled the 40mg after the patient showed me she has been taking 40 mg before. Doc could of been thinking qty of 30 and wrote 30 mg or was thinking of prevacid 30 mg but when in doubt, use your brain.

7:50pm Friday Had a patient discharged tonight from a hospital in full renal failure. (one of my favorite pt's too) She will be in hospice soon enough im sure and was written an rx for Zyvox. "DRUG NEEDS PA- STEP THEREPY" Okay, so how many of you would just stop right there and wait till monday to call the doctor to change it to a formulary or for PA auth? (keeping in mind that zyvox is one of those last line items so OBVIOUSLY there is a reason why it's being prescribed) Im sure there are a few bird brains out there that would do that. Instead, I called the number to explain the situation. After explaining to the Cigna folks that she was on Zyvox in the hospital and will be in hospice, they performed the PA override immedietly. (sp?) WHOO! bottom line, patient got needed drug and the family is happy with me on a friday night....

*does the mini me Geico dance* Go Caverject...it's your birthday...

 

[ZpackSux]

You wanna talk about Zyvox?

 

[Sosumi]

You wanna talk about Zyvox?

Let's talk about Cubicin instead.

 

[ZpackSux]

Let's talk about Cubicin instead.

Daptomycin is an old drug...sat on Lilly's shelf for over 20 years before the recent effort at marketing.

Your turn.

 

[All4MyDaughter]

Daptomycin is an old drug...sat on Lilly's shelf for over 20 years before the recent effort at marketing.

Your turn.

I dunno, the Suprax rep has been in our pharmacy a lot lately.

I just looked at their website and there is a nekkid baby on it.

 

[npage148]

Only time I ever see Suprax is when someone was been misbehavin and they got the clap. Then since it doesnt come in tablets I got to get it switched to Vantin cause nothing i funnier than handing a man a bottle of Suprax suspension and tell him to drink it

 

[sdn1977]

Only time I ever see Suprax is when someone was been misbehavin and they got the clap. Then since it doesnt come in tablets I got to get it switched to Vantin cause nothing i funnier than handing a man a bottle of Suprax suspension and tell him to drink it

👍