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dentist prescribing benzaclin

Discussion in 'Pharmacy' started by rxbaby, Mar 24, 2015.

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  1. rxbaby

    rxbaby 2+ Year Member

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    I had a dentist trying to prescribe Benzaclin gel- I think pharmacists obligated professionally to ask more information if we think its not directly related to oral cavity to make sure its in the scope of their practice. I had a dentist get very rude with on asking for information. What do you guys think? Have you had such experiences? Or when would you think a dentist will prescribe benzaclin?
     
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  3. Dred Pirate

    Dred Pirate 2+ Year Member

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    I can't think of a reason benzaclin should be prescribed by a dentist, my guess is he/she is just trying to help out a friend (which is technically against the law). You have every right to ask more,
     
  4. WVUPharm2007

    WVUPharm2007 "Bubs Depot!" 10+ Year Member

    Don't fill it under insurance, period. That will be audited by the insurance auditor like a moth to a light bulb.
     
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  5. npage148

    npage148 Senior Member 10+ Year Member

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    Nope, and if they push it offer to call the state board of dentistry for clarification on the issue
     
  6. W19

    W19 SDN Gold Donor Gold Donor 2+ Year Member

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    Don't dentists have unlimited prescribing privilege just like physicians?
     
  7. Lnsean

    Lnsean 7+ Year Member

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    Professionally, you should not be prescribing outside the scope of your practice. Any diligent pharmacist would not fill this rx.
     
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  8. msweph

    msweph 2+ Year Member

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    I wouldn't fill it.
     
  9. npage148

    npage148 Senior Member 10+ Year Member

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    dentists are restricted just like dpm's and od's
     
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  10. Screwtape

    Screwtape 7+ Year Member

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    Out of pure curiosity, lets say.... an anesthesiologist requested this. MD's obviously have full prescribing rights, but since an anesthesiologist's scope doesn't include acne stuff, would this be a similar situation? Or does the MD command full scope prescribing rights no matter what?
     
  11. fancymylotus

    fancymylotus A Whole New World 10+ Year Member

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  12. lt23

    lt23 7+ Year Member

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    ohh you're the dentist rxbaby is talking about?
     
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  13. fancymylotus

    fancymylotus A Whole New World 10+ Year Member

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    Negative, ghostrider
     
  14. waiter

    waiter 2+ Year Member

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    +1
     
  15. npage148

    npage148 Senior Member 10+ Year Member

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    An anesthesiologist is still an md first. They may not know what they are doing (one time a radiologist at my pharmacy was trying to manage his cholesterol with hilarious results) but there is not issue with scope of practice
     
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  16. txpharmguy

    txpharmguy 7+ Year Member

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    Many years ago I always had Doctor Soandso call in birth control pills. Finally found out it was a dentist calling them in for his girlfriend. I put a stop to that.
     
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  17. txpharmguy

    txpharmguy 7+ Year Member

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    Now there are oral surgeons who have DDS and MD.
     
  18. Screwtape

    Screwtape 7+ Year Member

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    So you do not consider it your professional duty to question MDs even when they prescribe outside their scope of expertise/specialty? Or are you saying MDs have the right to prescribe anything and everything, even though they may have never dealt with it in residency or medical school? Not trying to be argumentative, just trying to understand the pharmacy field's thought process in this type of situation.
     
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  19. BenJammin

    BenJammin No Apologies 5+ Year Member

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    Interesting. So you think it would be appropriate for an ADHD doctor to prescribe hydromorphone? What about a sports medicine doc prescribing risperidone?
     
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  20. npage148

    npage148 Senior Member 10+ Year Member

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    No issues with either of those scenarios as long as it is prescribed correctly Why wouldn't a fully licensed md that has been trained to practice medicine be able to prescribe diladid or risperdal? Should you stop a Ob/gyn a PP from giving a male partner Zithromax for Clamydia or some benzaclin for a teen with acne? What makes it more appropriate for a "pain specialist" to dole out dilaud compared to a psychiatrist? I'd say the psych is probably better equipped regardless then a pain doc
     
  21. mik30102

    mik30102 5+ Year Member

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    At one of my rotations a radiologist was treating someone's anxiety with just xanax and klonopin... She was a nurse so I'm assuming it was someone she prob knew. The pharmacist ended up calling and telling him he was prescribing out of his area of practice, but ended up filling it. I would not have though.
     
  22. Screwtape

    Screwtape 7+ Year Member

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    Interesting, so there does seem to be some differing opinions in regards to area of practice. Thanks for answering !
     
  23. SClENCE

    SClENCE 2+ Year Member

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    I think it is reasonable to question ANY script that is "out of scope of practice"... though in reality a phone call will only occur if it's for a controlled substance from my experience

    As for what the law state, I don't know.
     
  24. confettiflyer

    confettiflyer Did you just say something? 10+ Year Member

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    MD's/DO's have unlimited scope of practice, so they can pretty much write for whatever they want. There's no logic whatsoever to "restricting" specialists to prescribe in their field of expertise. It's idiot pharmacists who make up fake rules that make the rest of us look dumb.

    That logic would basically mean an internal medicine physician/GP can write for whatever comes up in clinic, but when he/she goes to complete an infectious disease fellowship, suddenly they can't prescribe anything except antibiotics/antivirals?

    That's stupid.

    On the other hand, if you have a young hospitalist attempting to treat MRSA infected hardware with clindamycin, as a pharmacist you have to identify that he/she is in over their head and intervene. Just because a trauma surgeon doesn't readily know the average starting dose of a beta-blocker, doesn't preclude them from being able to prescribing one. It's all fixed with some simple peer-to-peer communication.

    Being a little bitch about it and trying to shut down prescribing rights is infantile and a disservice to your patients.
     
  25. confettiflyer

    confettiflyer Did you just say something? 10+ Year Member

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    It's our professional duty to evaluate the order/prescription for appropriateness for the patient, not question the specific credentials of a particular physician and evaluate their previous training.

    I'm not going to dig into where they went to medical school, what classes they took, what symposiums or workshops they have done, what additional fellowships they may or may not have completed.

    Unfortunately for you and my other allied health friends, unlimited scope does not exist, so I do have to weigh credentials with the order.
     
  26. WVUPharm2007

    WVUPharm2007 "Bubs Depot!" 10+ Year Member

    I agree with confetti with the exception of narcotics. If I got an rx for oxy 30 from pathologist...no. The DEA has strict rules about the usual course of practice for those meds.

    I also find the dental student infiltration humorous.
     
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  27. Deja

    Deja 7+ Year Member

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    i caught a dentist calling in ambien to different stores within the same chain for a patient, everyone filled it, my pharm manager called to ask for doc notes on why he was prescribing ambien for llong term use, ofc, the dentist was cursing and hung up on us lol

    and as for scopr of practice, at a busy store, most don't have the time to check what kind of MD someone is fo some blood pressure med or smth (lol), but it is easier to catch dentist vs md
     
  28. Screwtape

    Screwtape 7+ Year Member

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    Merely asking a related question on a thread related to my profession in which there seems to be no clear consensus...
     
  29. fancymylotus

    fancymylotus A Whole New World 10+ Year Member

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    And I'm not a dental student so not sure what that person was talking about.
     
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  30. confettiflyer

    confettiflyer Did you just say something? 10+ Year Member

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    Yeah, but that becomes a question of appropriate prescriber-patient relationship, independent of credentials.
     
  31. NaOH

    NaOH IT'S PAAFEKTO! 7+ Year Member

    I saw a radiologist call in tramadol for a dog once.

    Surprisingly, it was appropriately dosed for a canine.
     
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  32. Digsbe

    Digsbe 5+ Year Member

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    Is that legal though? Technically isn't that practicing veterinary medicine?

    I remember a dentist calling in simvastatin once for a friend. The pharmacist called him about it and asked why and talked about monitoring and such and at the end they said "my friend was out of refills so I just called it in for them." Needless to say it wasn't filled.
     
  33. npage148

    npage148 Senior Member 10+ Year Member

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    No that's illegal for an md to prescribe for pets. I have trouble understanding how these scope of practice questions are so hard to grasp
     
  34. Digsbe

    Digsbe 5+ Year Member

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    That's what I thought. It falls under veterinary medicine which only vets can practice.
     
  35. Dred Pirate

    Dred Pirate 2+ Year Member

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    some scope of practice is obvious like this one.
    Some are fairly obvious - dentist prescribing acne meds
    Some are a grey area - if I ask my MD friend who completed an internal med residency, but is now a dermatologist to write me a script because I let my toprol xl run out? -getting to an iffy area.
     
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  36. npage148

    npage148 Senior Member 10+ Year Member

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    There is no grey area about a derm writing for toprol xl. It's legal full stop. Unless there are explicit laws preventing such like nys not allowing prescribers to write for CS for family members or their license is restricted a MD/DO can prescribe ANYTHING for another human
     
  37. Dred Pirate

    Dred Pirate 2+ Year Member

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    uh - a derm is an MD - they may have completed the same education as your internal med/PCP MD- but then did extra training,
     
  38. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

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    That's not really how you make a dermatologist. Its a separate residency, not a fellowship after IM.
     
  39. BenJammin

    BenJammin No Apologies 5+ Year Member

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    This is completely laughable. You're going on and on about nothing. I suppose you could find 5% of pharmacists who agree with your last statement and those are the 5% who think it's appropriate for docs to write outside of their practice for things completely outside of their scope.

    Enjoy court.
     
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  40. Dred Pirate

    Dred Pirate 2+ Year Member

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    true but
    1. This is ironically how my friend did it (he saw the $)
    2. the poster I was replying to specifically said "a MD/DO can prescribe ANYTHING for another human" and I was pointing out that a Dermatologist is a MD


    and to add on to a previous poster's point - we (in the hospital) allow orth surgeons to write for BP meds, and when I question them on a dose I get "How would I know? I am just a surgeon" It cracks me up, although I don't think they realize how many times we save their collective arse's
     
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  41. SClENCE

    SClENCE 2+ Year Member

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    Here my issue... yes a Dermatologist is an MD... but if they are prescribing Adderall it's not getting filled. Period... and I'v seen it happen. My goal isn't to undermine an MD... it's to protect myself. If it's not a control I'd probably just fill it depending on what it is/how I feel about the situation. The dentist sending in a script for simvistatin is obviously not getting filled... nor is birth controls. Now an acne cream... maybe...
     
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  42. PharMed2016

    PharMed2016 Eternal Scholar 7+ Year Member

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    Controlled substances I would be hesitant about but anything noncontrolled... Sure.
     
  43. Deja

    Deja 7+ Year Member

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    what about a Doc prescribing an antidepressant for him/herself... antibiotic and such, sure, but a psych med?
     
  44. Dred Pirate

    Dred Pirate 2+ Year Member

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    I agree - but what npage said is 1. it is illegal for a dermatologist to prescribe that 2. a MD can prescribe anything they want for a human. I was simply pointing out his contradiction and maybe thinking he doesn't know a derm is a MD??

    But yes, I agree with most of what you say. Although I did have cases where a sports medicine clinic was writing for ADHD drugs (which if you test positive for without a rx, you are rulled ineligible)
     
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  45. Ackj

    Ackj 7+ Year Member

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    Over 99.9% of these cases are for family/friends as a favor. I do not think any dentist is legitimately trying to manage someone's dermatological conditions, dermatologist managing bp, psychiatrist treating infections, etc. I go by the law for controls, and for non-controls I am usually okay as long as it is a one-time thing, or a renewal of an rx the patient has already had. If you want 11 refills, please see someone who is qualified and going to manage you over those 12 months. Dentist's wife with a sinus infection? Sure, you can have a zpak. Pediatrician's husband out of refillson Saturday? I'll let you do the renewal with no refills.
     
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  46. Carboxide

    Carboxide 7+ Year Member

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    The main issue I have with MDs prescribing outside their scope is the likelihood that they have performed a sufficient examination on the patient. Do they know their medical history? Allergies? When they last saw the MD? Even if it's just Toprol, what's the patient's BP today? Chances are that radiologist doesn't know. I'd still fill a non-controlled substance if it was a reasonable prescription in other aspects, but CS I would be questioning the MD.
     
  47. confettiflyer

    confettiflyer Did you just say something? 10+ Year Member

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    I think people took what npage wrote ("full stop legal") to mean "illegal" when it really means "it's completely legal wtf is wrong with you people, physicians have UNLIMITED scope."

    Again, we're not in a position to question a prescriber is competent, and it would be inappropriate to do so.

    Let's not get it twisted, unlimited scope is not carte blanche for writing anything/everything. As pharmacists in the outpatient world, you have to weigh other factors like appropriate patient/prescriber relationship, as I've alluded to above. A pain specialist writing for #360 OxyContin is one thing, it's another when you're in Florida, the patient is 22, paying cash, and is the 5th in line with the exact same Rx.

    EDIT: Found the article I was thinking of originally:

    http://www.nytimes.com/2012/01/31/h...crative-cosmetic-surgery-procedures.html?_r=0

    Not really Rx related, but related to this discussion.

     
  48. confettiflyer

    confettiflyer Did you just say something? 10+ Year Member

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    Prescriber-patient relationship is a valid concern, which is what you're describing. But this doesn't have anything to do with scope of practice. A radiologist is still a physician, and I don't know about you, but I'm pretty sure he or she will still remember how to conduct a nominal physical exam and know how to read a damn BP/HR.

    In any case, a) how do you even know if the physician is a radiologist, unless it says so right on the Rx pad? What if they use a creally crappy Rx pad which just has their name, phone #, and license info? b) the liability and legal issues stay with the physician. Failure to have an appropriate prescriber-patient relationship does NOT throw the pharmacist under the bus--unless it's blatantly obvious--instead the liability rests with the prescribing physician.
     
  49. zelman

    zelman 7+ Year Member

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    Monkey wrench: all legend drugs are "Schedule VI Controlled Substances" in Massachusetts.
     
  50. Old Timer

    Old Timer SDN Advisor SDN Advisor 10+ Year Member

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    NO NO NO NO NO a THOUSAND TIMES NO. The dermatologist is an MD and has license that is the exact same as the cardiologist, neurologist or any other ologist. Your specialty is ADDITIONAL training that expands your ability to serve patients and does not limit you to what drugs you are allowed to prescribe. No if there is no doctor/patient relationship and the doctor does not keep medical records of the treatment ordered, that is on the doctor.
     
  51. JoBreeze

    JoBreeze 2+ Year Member

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    So... you may have misread npage's post above.

    Why on earth would you ever think that a trained internist managing blood pressure medications is a "grey area?" That the same physician is a dermatologist has no relevance.

    I think there is a (not unreasonable) lack of understanding as to how physicians are trained in this thread as evidenced by the quotes.

    Sports med docs are usually family physicians, internists or pediatricians who have completed a fellowship in sports medicine. ADHD management would absolutely fall within their scope of practice.

    Further, radiologists complete a year of residency in internal medicine (that's 1/3 of an IM residency) prior to beginning formal training in radiology. The same goes for derms and many other specialists, who have usually had maybe 50-100x the internal medicine training compared to midlevel providers practicing primary care.
     

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