ever encountered a situation where doctors didn't accept your recommendations?

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ice712

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When I contact the office, it is mostly to clarify an order or if the dose is too high the doctor changes right away. Anybody got a situation where a doctor insisted on their original scripts?
 
ice712 said:
When I contact the office, it is mostly to clarify an order or if the dose is too high the doctor changes right away. Anybody got a situation where a doctor insisted on their original scripts?
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Haha.... yes.....
 
Yup. Document, and then switch to “will this seriously injure or kill the patient, bankrupt my department, or it’s just plain stupid?” mode. If neither, approve.

This is more me suggesting an alternative abx based on antibiogram and getting shut down.


Sent from my iPhone using SDN mobile
 
zelman said:
Medicine is an art. Evidence based practice is for losers.
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There's a middle ground there too, not every patient fits with EBM.

That said, if the doctors aren't listening to you they might not be the problem.

I about lost my cool with a pharmacist a few years back. Sent patient with sinusitis home with an RX for Augmentin XR. Too expensive. Changed to Doxy. Too expensive. Changed to Levaquin. Too expensive. Pharmacist asked me to change to regular Augmentin. Explained that with our local strep pneumonia resistance of 18% that was not indicated. Pharmacist said she was going to tell the patient that she should seek a second opinion.

I wasn't pleased.
 
VA Hopeful Dr said:
There's a middle ground there too, not every patient fits with EBM.

That said, if the doctors aren't listening to you they might not be the problem.

I about lost my cool with a pharmacist a few years back. Sent patient with sinusitis home with an RX for Augmentin XR. Too expensive. Changed to Doxy. Too expensive. Changed to Levaquin. Too expensive. Pharmacist asked me to change to regular Augmentin. Explained that with our local strep pneumonia resistance of 18% that was not indicated. Pharmacist said she was going to tell the patient that she should seek a second opinion.

I wasn't pleased.
Click to expand...

Your adherence to EBM left this patient without antibiotics whereas standard-dose amoxicillin likely would have sufficed
 
It happens occasionally. Usually, they give a valid (or somewhat valid) reason why they want it to remain the way it is. As an example, got a script for mucinex w/codeine recently. I noticed the patient has been getting this for a few months in a row (maybe an 8 oz bottle every 2-3 weeks). I called Dr office, told them what gives. At first, they just said "please dispense as ordered", but after much prying, they said patient has a stubborn wooping cough, has been on zpak, has had CT scans, has tried tessalon perles with no success, and that she was also being treated by a pulmonologist who is aware of the cough syrup. So, still risky, but at least now its all documented.
 
VA Hopeful Dr said:
There's a middle ground there too, not every patient fits with EBM.

That said, if the doctors aren't listening to you they might not be the problem.

I about lost my cool with a pharmacist a few years back. Sent patient with sinusitis home with an RX for Augmentin XR. Too expensive. Changed to Doxy. Too expensive. Changed to Levaquin. Too expensive. Pharmacist asked me to change to regular Augmentin. Explained that with our local strep pneumonia resistance of 18% that was not indicated. Pharmacist said she was going to tell the patient that she should seek a second opinion.

I wasn't pleased.
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Why not give half an augmentin 250 plus amoxicillin 875?
 
I'm lucky if I can get an MA to "put a note on the doctor's desk".

That's after 10 minutes of exaining the issue to them while they try to read me the prescription and ask "is that what you needed?" Over and over.
 
VA Hopeful Dr said:
There's a middle ground there too, not every patient fits with EBM.

That said, if the doctors aren't listening to you they might not be the problem.

I about lost my cool with a pharmacist a few years back. Sent patient with sinusitis home with an RX for Augmentin XR. Too expensive. Changed to Doxy. Too expensive. Changed to Levaquin. Too expensive. Pharmacist asked me to change to regular Augmentin. Explained that with our local strep pneumonia resistance of 18% that was not indicated. Pharmacist said she was going to tell the patient that she should seek a second opinion.
I wasn't pleased.
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Ehhhh... I don't know about this one.
They were certainly unprofessional.

I think the boys over at GSK found very clever ways to exaggerate the difference in AUC between XR and regular.

Oh, and the big selling point to FDA was
 
Rockinacoustic said:
Your adherence to EBM left this patient without antibiotics whereas standard-dose amoxicillin likely would have sufficed
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There is literally no guideline that says amoxicillin is good for sinus infections.

Maybe you meant augmentin?
 
VA Hopeful Dr said:
There's a middle ground there too, not every patient fits with EBM.

That said, if the doctors aren't listening to you they might not be the problem.

I about lost my cool with a pharmacist a few years back. Sent patient with sinusitis home with an RX for Augmentin XR. Too expensive. Changed to Doxy. Too expensive. Changed to Levaquin. Too expensive. Pharmacist asked me to change to regular Augmentin. Explained that with our local strep pneumonia resistance of 18% that was not indicated. Pharmacist said she was going to tell the patient that she should seek a second opinion.

I wasn't pleased.
Click to expand...

Eh this is a tough situation for everyone involved. Each patient has their own cost sensitivity and those often don’t fit into the EBM mold. The pharmacist on the other end may have frustrated as well if they had to keep asking the patient if each one was low enough. They probably lost it when the next cheapest option they could think of was shot down... in lieu of not thinking of the creative option above... what should the pharmacist ideally do? They can’t force a patient to buy something they can’t afford...
 
Me: “This patient is tweaking out on PCP and is yelling at me that they don’t want a needle. He says he’ll take a pill. Can we change the haldol to a PO dose?”
MD: “There’s no such thing as PO haldol.”
Me: *pulls out haldol pills from the Pyxis*
MD: “oh.”
 
VA Hopeful Dr said:
There is literally no guideline that says amoxicillin is good for sinus infections.

Maybe you meant augmentin?
Click to expand...

Correct. The only difference between Augmentin XR and standard Augmentin is the amount of amoxicillin.

Edit: My argument is the patient would have been better off with standard-dose Augmentin vs. no antibiotics. IDSA rec on this is weak.
 
PharFromNormal said:
Eh this is a tough situation for everyone involved. Each patient has their own cost sensitivity and those often don’t fit into the EBM mold. The pharmacist on the other end may have frustrated as well if they had to keep asking the patient if each one was low enough. They probably lost it when the next cheapest option they could think of was shot down... in lieu of not thinking of the creative option above... what should the pharmacist ideally do? They can’t force a patient to buy something they can’t afford...
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And I totally get that. It just caught me off guard because I always have great relationships with the local pharmacists. I'll call and ask their advice quite often, and usually am 100% behind any changes they want to make (I dated a pharmacist in med school, might be why I work better with y'all than most). I have just never been spoken to like that in the 5 years I've been out of med school and it really pissed me off.

As an aside, since then I've been completely broken and every case of the sniffles gets a z-pack. So much easier on my mental well being.
 
VA Hopeful Dr said:
As an aside, since then I've been completely broken and every case of the sniffles gets a z-pack. So much easier on my mental well being.
Click to expand...

I laughed at this. I had a pharmacy manager that got a Zpak every time she got a URI. All I could do was shake my head and give her a little side eye/roll of the eyes while I filled it for her.
 
owlegrad said:
I laughed at this. I had a pharmacy manager that got a Zpak every time she got a URI. All I could do was shake my head and give her a little side eye/roll of the eyes while I filled it for her.
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Honest to God, I've lost 2 different jobs for being strict on antibiotics for URIs so I finally just said "**** it".

In the 2nd of those jobs, my satisfaction scores were awful. My boss said it was just a matter of not explaining well enough to patients why they didn't need antibiotics or not spending enough time with them. After that meeting, everyone got a z-pack. I actually spent less time per patient after that. My satisfaction scores went through the roof.

But yeah, it was totally that I wasn't spending enough time with them.
 
Rockinacoustic said:
Correct. The only difference between Augmentin XR and standard Augmentin is the amount of amoxicillin.

Edit: My argument is the patient would have been better off with standard-dose Augmentin vs. no antibiotics. IDSA rec on this is weak.
Click to expand...
My last post was incomplete.

The amount of Clav was their big selling point to the FDA
 
VA Hopeful Dr said:
Honest to God, I've lost 2 different jobs for being strict on antibiotics for URIs so I finally just said "**** it".

In the 2nd of those jobs, my satisfaction scores were awful. My boss said it was just a matter of not explaining well enough to patients why they didn't need antibiotics or not spending enough time with them. After that meeting, everyone got a z-pack. I actually spent less time per patient after that. My satisfaction scores went through the roof.

But yeah, it was totally that I wasn't spending enough time with them.
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This is so...disappointing. How frustrating!
 
radio frequency said:
This is so...disappointing. How frustrating!
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Honestly? It's made life much better. I have more time for people who want my help and since azithromycin is basically useless anyway I don't feel bad about over using it.
 
VA Hopeful Dr said:
Honestly? It's made life much better. I have more time for people who want my help and since azithromycin is basically useless anyway I don't feel bad about over using it.
Click to expand...

Are we soul mates? I used to use this justification all the time to myself whenever I had someone who just wanted me to confirm that whatever they heard from Doctor Oz/their neighbor was true. My life became so much easier when I stopped trying to persuade people that no, mucinex is not a wonder drug and that Airborne is just garbage. "Oh your neighbor's cousin said to try Green Tree Extract? Well he sounds like a really smart guy. it can't hurt so you might as well give it a shot, right?" And as an added bonus I had so much more time for people that came to me with actual questions and wanted to be informed.

Most days I hardly even noticed how little soul I had left 😉
 
VA Hopeful Dr said:
Honestly? It's made life much better. I have more time for people who want my help and since azithromycin is basically useless anyway I don't feel bad about over using it.
Click to expand...

It being useless doesn't stop me from draping myself in the flag of Antimicrobial Steward Champion and chewing out dentists for prescribing it to their staff.

Lmao
 
My recommendations get turned down sometimes, but the issue always get resolved so the patient is taken care of and that' what is important.

I did have one time to suggest to a patient to seek a second opinion. Child had aom, np had written illegible rx. When called supervising md, he could not clarify it, offer a substitute or doing anything to resolve it. Without seeing another dr, the disease would never have gotten treated.
 
johnpharm01 said:
My recommendations get turned down sometimes, but the issue always get resolved so the patient is taken care of and that' what is important.
I did have one time to suggest to a patient to seek a second opinion. Child had aom, np had written illegible rx. When called supervising md, he could not clarify it, offer a substitute or doing anything to resolve it. Without seeing another dr, the disease would never have gotten trated.
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I tried to get a few doctors put on Target's "do not fill" list.
One was a stubborn old white pediatrician that spoke no Spanish, yet would see nearly 100% Spanish speaking Medicaid population.
She once tried to yell at me when I refused to fill a script for augmented betamethasone for a 4 month old.
More than one patient told me "Well, the (male doctor in Spanish" we saw said..."
I'd pause and ask if they ever saw a fat, middle aged blonde lady.
"No, just the doctor"
She didn't have a pa or np. Scary stuff.

Another was a pediatrician that I was almost certain was actually illiterate.
The drugs he prescribed were the same for literally, LITERALLY every single patient he saw, and I learned that those depended on which drug rep stopped by the office.
I'd call to check him on doses sometimes. a
After walking him through it, he'd pretend to calculate things but just mumble nonsense numbers.
"Mmm... 754... Yeah that's right. 77 times 121... 943... Hmmm.... Divided by 27' Ok yeah you're right."

I stopped calling him after a while
 
VA Hopeful Dr said:
Honest to God, I've lost 2 different jobs for being strict on antibiotics for URIs so I finally just said "**** it".
In the 2nd of those jobs, my satisfaction scores were awful. My boss said it was just a matter of not explaining well enough to patients why they didn't need antibiotics or not spending enough time with them. After that meeting, everyone got a z-pack. I actually spent less time per patient after that. My satisfaction scores went through the roof.
But yeah, it was totally that I wasn't spending enough time with them.
Click to expand...

This is sad that you get punished for trying to prevent antibiotic resistance. People do love their z-paks, the only thing they love more is Vicodin. Since the DEA frowns on giving Vicodin to everybody, the best you can do is a Z-pak. The next option after Z-pak's is Hyland's. Next to Vicodin, and Z'pak's, people love their placebo/homeopathies. You could even tell people that Hyland's isn't a prescription, because the FDA is in the pockets of Big Pharma and keeping the the true cures from people. Sell people on homeopathies and make them happy, save the world from antibiotic resistance, it's a win/win situation.
 
BidingMyTime said:
This is sad that you get punished for trying to prevent antibiotic resistance. People do love their z-paks, the only thing they love more is Vicodin. Since the DEA frowns on giving Vicodin to everybody, the best you can do is a Z-pak. The next option after Z-pak's is Hyland's. Next to Vicodin, and Z'pak's, people love their placebo/homeopathies. You could even tell people that Hyland's isn't a prescription, because the FDA is in the pockets of Big Pharma and keeping the the true cures from people. Sell people on homeopathies and make them happy, save the world from antibiotic resistance, it's a win/win situation.
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Hahahahaha

Edit:

I shouldn't laugh. There are lich-u-rully doctors that do this in Austin.

"Do you have Red Yeast Rice? My new doctor stopped my lovastatin because it's a plot by big pharma to give me diabetes."

LOL
 
I work in the hospital so its a little different. If its an eye roller I let it go. Ive had a hard STAHP on like maybe 2 things they've said no to. I got zero with the doc so I told the RN not to give, rejected the order and waited until they admitted so I could talk to the hospitalist when it became "their" patient. Both times they were like OMG NOOOO so I felt good.

With PCN allergies that are BS I have 100% getting it changed from something stupid bc of the allergy by talking to the patient first. "Can we get this Azactam changed? The patient states the allergy isn't that bad so they feel comfortable trying a cephalosporin."
 
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