So, I was working yesterday when I got a call from a physician (who basically cursed me out). Apparently, one of our techs faxed his office asking whether one of his patients was pregnant (there was a CI with pregnancy and zocor). I had no idea what was going on and that she even faxed his office. Nevertheless, he continued to tell me how poor my patient care was all the while cursing at me like crazy. I would have told him to go to hell, but he wouldn't let me get a word in. Actually, I think that is pretty good care to make sure from the office that she wasnt pregnant. Anyone have an experience like this or similar one?
Incident yesterday
- Thread starter VCU07
- Start date
Well - altho the manner in which the physcian made his complaint was not the best - it was justified.
You get all sorts of alerts with drugs & pregnancy. However, there were a few mistakes here....
First - your intern should not have that freedom to communicate a concern to anyone without clearing it with you first - that is what is called supervision. You are responsible for every action that person does & if the action involves an unreasonable communication with a pt or provider - its also due to you. So, you need to make it clear to this intern that nothing is communicated without clearing thru you first.
Now - was this poor communication? From my perspective - yes, it was. The reason is - we all know which drugs have a pregnancy alert (all cholesterol lowering drugs will) - so that is included in counseling. Likewise, prescribers know this as well. Now - they may miss something, but that is why we are the last step - to counsel. So, this might be a young woman or a young-appearing woman & could have had an OC or prenatal vits on her profile. The downside of computers is they screen for everything in the past - they don't filter for age. So - the prenatal vits could have been in 2003 - you'll still get an alert.
Of course, it needs to be communicated in counseling. For example....as you counsel the pt on what time of day to take it (evening or bedtime), the whole grapefruit juice possibility or not, then you mention it should not be taken if you are pregnant or want to become pregnant. That takes care of the issue & doesn't make the pt feel badly due to how they might appear & it doesn't imply they might have future children.
Now, if she said, I'm thinking of getting pregnant next year, or I might be pregnant now....then I would say, why don't we wait & I'll talk to your doctor. Then, a fax would be justified.
But....this is blindly responding to a computer alert without using good judgement - a mistake on your intern's part which needs to be brought to his/her attention.
Also - think about the number of faxes these offices get & the process it takes. In my husbands office, which gets just a few....each chart has to be pulled & he has to go back & review the issue. It takes up his paid staff time that has other things to do & his time in which he definitely has other things to do. Now - think about a cardiologist or IM or FP - they get hundreds of these faxes a day. Don't add to their mess - use good judgement.
Personally - I think both of you could have gotten the pregnancy info from pt in a delicate & nonintrusive manner without bothering the prescriber & have used better judgement in deciding what course to take. If you take the judgement out of the equation - we are no better than a tech & this is what a tech might do.
You also need to get back to supervising your intern!
I apologize if I came across blunt - but, this was a mistake on your pharmacy's part, IMO.
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One time I had a physician generously drop the f-bomb on me because he could not figure out how to phone in presciptions to our machine. He went on and on about how we were wasting his time and how we are idiots. This lasted about 3 minutes. He finally stopped and I asked if he was ok......he did not like that too much.
I later checked the messages to find this gem on there.
"This is Dr. XXXXXX I am calling in a script for.....click"
Next message:
"God D**n it! How the H*ll am I supposed to.....click"
I later checked the messages to find this gem on there.
"This is Dr. XXXXXX I am calling in a script for.....click"
Next message:
"God D**n it! How the H*ll am I supposed to.....click"
While I agree with you in how the situation was handeled, I do not justify any physician cursing at me. That is unprofessional and immature. Second, it was a tech and not an intern that made the mistake. As I am sure most of you know, it is very difficult to manage every aspect of work when you fill 400plus prescripions a day. At our pharmacy, the techs have the responsibility of faxing doctor's offices for request refills. Unfortunately, in this case she faxed a Drug-Disease CI, which should have been brought to my attention first. Additionally, do not question my supervision skills or tell me how to do my job. I do the best I can with the vast amount of prescriptions we fill. Unfortunatly, things like this will happen. I have had plenty of doctor's office fax back a refill request, then fax it again a few days later (adding to OUR mess), but you don't see me calling them and cursing them out over a mistake. I know what you were trying to say, but it shouldn't have been said in that manner-
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I think she agrees with you on the manner in which physician made his complaint.
It happens and it is unfortunate, but now you can talk with the tech and let them know that this was a mistake and next time it should be ran through you before the fax is sent to the office.
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i don't think sdn was questioning anyone's management ability. i have worked in pharmacies that dispensed over 700 in a given day and the techs did not do anything as out of line as your tech, b/c their duties and responsibilities were spelled out for them ahead of time and they did their job and only their job.
no one is saying you have to look over the tech's shoulder all day. god knows if im the only pharmacist with 300 patients and a busy ER and 4 techs i don't have that kind of time. but your tech should be counseled as to what their job entails and what the pharmacists' job entails.
your tech was out of line and while the MD should not use foul language, he was correct in being annoyed. it sounds like your tech was far too over-zealous in protecting the potential fetus to use common sense.
most computer systems are set up with very sensitive and specific interaction levels, so that everything is caught and reviewed. however, this specific interaction should not have warranted a time-wasting fax, ever.
this can be handled with patient counseling.
no one is saying you have to look over the tech's shoulder all day. god knows if im the only pharmacist with 300 patients and a busy ER and 4 techs i don't have that kind of time. but your tech should be counseled as to what their job entails and what the pharmacists' job entails.
your tech was out of line and while the MD should not use foul language, he was correct in being annoyed. it sounds like your tech was far too over-zealous in protecting the potential fetus to use common sense.
most computer systems are set up with very sensitive and specific interaction levels, so that everything is caught and reviewed. however, this specific interaction should not have warranted a time-wasting fax, ever.
this can be handled with patient counseling.
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VCU - you are right. Their is no excuse for anyone to cuss out anyone else over something like this.
Should the tech have faxed the doctor over that? Maybe not. At worst it was a misguided attempt at protecting the patient - and patient care is #1.
I'm trying to understand your pharmacy workflow so I can make suggestions about how this could be avoided.
When the zocor was logged onto the profile of the possibly pregnant patient - what type of alert was generated? Paper or electronic? Where I work retail, it would be an electronic alert that only a pharmacist could clear. Does it print something out at your pharmacy? And did that somehow make it into the refill faxes? Is that what happened?
Does zocor trigger this alert on every female patient? Or was there a reason to suspect pregnancy?
Should the tech have faxed the doctor over that? Maybe not. At worst it was a misguided attempt at protecting the patient - and patient care is #1.
I'm trying to understand your pharmacy workflow so I can make suggestions about how this could be avoided.
When the zocor was logged onto the profile of the possibly pregnant patient - what type of alert was generated? Paper or electronic? Where I work retail, it would be an electronic alert that only a pharmacist could clear. Does it print something out at your pharmacy? And did that somehow make it into the refill faxes? Is that what happened?
Does zocor trigger this alert on every female patient? Or was there a reason to suspect pregnancy?
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This post is out of hand. VCU said nothing of it being an intern. Sounds like some tech that likes to do things he/she isn't supposed to do. Everyone has to deal with that from time to time, no reason to rip VCU's supervision skills.
I think that pt should be contacted or asked during counseling, and that the doc shouldn't have been bothered. But it was a rogue tech, not the pharmacist. And there is no justification for the doc acting like a total a$$hole.
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Yeah I noticed the tech/intern thing too. Rogue techs...they are a problem. And in some (unionized) settings, it is impossible to get rid of them. It's an issue.
All., I am still kind of new to this system, but what happened is that when we submitted her claim to the insurance it rejected b/c of the pregnancy warning. So, the tech must have noticed that and faxed the MD's office. I didn't even see the interaction. I honestly had no idea what the doc was talking about when he called me.
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You answered the OP's question as if an intern were involved, so I'd like to point out something about your comments on supervision of interns. Supervision is making sure that you feel comfortable delegating tasks to an individual before he or she performs them, not having the final say-so in all clinical decisions. You may live in a state where interns can't do clinical tasks without the pharmacist being involved at every step, but many of us do not. To condemn another professional for what you percieve as operating under a different but commonly accepted definition of supervision is unwarranted and frankly, non-collegial.
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Got it. I figured you were a newly minted pharmacist b/c of your graduation year. Congratulations, by the way.
Sounds like something you couldn't have anticipated. It happens. It will happen to you again (on a different issue) and you'll learn from it. They don't teach this stuff in pharmacy school.
Ignore the nay-sayers. If you learned from the (very minor, IMO) mistake and used it as an opportunity to educate the technician, that is all you can do.
Good grief, cursing someone out over a wayward fax...VALIUM - STAT.
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Maybe you could reconcile this the next time the doctor calls. Try to be brief, but let him know that it was a mistake. Maybe he won't upset you again in the future.
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I agree as well. Even if someone is in charge, they can only do thier best to supervise and manage others. Things will still happen and it is unfair to blame it on VCU and how she supervises her interns (or to imply the lack thereof)..I think what the doctor did was completly unnecessary and very unprofessional and no excuses she be made for a nasty doc no matter how busy he/she is.
so it's okay for stupid customers (who are not even my patients b/c my company does not fill their prescriptions) to annoy ME with stupid questions regarding their health OR stupid MDs who can't even talk LOUDLY and CLEARLY when leaving a prescription on the voicemail for me (what a waste of my 3 minutes listening to the goofball and thus I have to call back later to clarify!!) but not okay for me (or my staff) to "annoy" the doctor in discussing the health of a MUTUAL PATIENT of ours???????? I thought that was part of our job.
yeah, the tech should've clarified with me before doing anything. Yeah, we COULD HAVE simply gotten the answer by asking the patient during consultation whether or not she's pregnant. Yeah, the stupid doc shouldn't have cursed at me.
doctors are not Gods. Pharmacists can be bothered by
1) Insurance claim rejections
2) patients
3) customers who aren't even patients of ours and ramble on and on and on before getting to their question all the while i've got 20 in the filling, a wailing baby, an insurance claim rejection, a pissed off patient, etc!!!!! (lady, I DO NOT CARE IF YOU **** IN YOUR PANTS B/C YOU'RE TAKING ALLI!!!!!!!!!!!!!!!!!!
) 4) doctors
5) illegible prescriptions
6) Insurance cards that have multiple insurance company names written on ONE card (ESI, BCA, BS, HNET, etc etc etc)
7) phony prescriptions for Controlled Substances
8) irresponsible patients who wait till the last minute for refills--"can you please call my doctor for more refills? I am out and I am leaving town today!"
9) etc etc etc
but doctors cannot be bothered by a simple question from the pharmacy?????
In reality, there were better ways to address the issue, I agree. But really, this way isn't wrong either. As a doctor, you have a duty to care for your patients--maybe this doctor was a jackass and didn't bother to ask whether or not the patient was pregnant (hey, it can happen! I once went to a doctor for a physical and the doctor didn't even ask me if I was taking any other meds, if I was pregnant, when my last period was, etc etc etc).
There shouldn't be double standards when it comes to being "annoyed" and dealing with patients' health. Yes, we are more out in the open and more easily approachable but still it wasn't like the tech was asking the Doc if he's had any hot sex w/ the lady patient recently
our pharmacy calls a lot and often times, the MDs thank us. VCU07, if this had been a sincere doctor, your pharmacy's efforts in caring for the customer would have been appreciated.
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I would have to disagree with your definition of supervision, and I would love to see the wording of your state's law, if the only expectation is that a pharmacist is "comfortable" with what the technicians or interns are doing. In Florida, the law explicitly states repeatedly that everything a technician or an intern does has to be under the direct and immediate supervision of a licensed pharmacist at all times. This is because the pharmacist is held responsible for everything that goes on in that pharmacy. This is also the reason for limiting the amount of technicians and interns a pharmacist can supervise at one time. I was also an intern in Nevada, and my manager there also made it clear that while I was permitted to take some initiative (counseling, making recommendations, etc.), that I had better make sure I was doing things correctly or ask someone because it was his ass on the line (>500 prescriptions per day, ran like a well oiled machine, and my manager easily was cognizant of everything going on with the individuals he was supervising).
I don't think the OP deserved to be cursed out by the physician, but if my technician thought he/she could fax a physician on a drug/disease interaction without running it by me, I would probably be the one doing the cursing. If an intern did something like this, I would then have to redefine what he/she was allowed to do before consulting me initially. The physician is probably the last place I would have someone I'm supervising attempt to obtain that information (how about asking the patient!?!?!)
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Okay lets take a tally of who responded here so far...
2 Licensed Pharmacists say VCU needs to whip her employees into shape on what's expected of them in the pharmacy (regardless of s/he being an intern or a tech...)
2 Pharmacy Interns that says your tech was in the wrong; 1 essentially makes lemonade out of lemons for the tech's version of "patient care", the other contradicted himself in his post and rant against an opinion given by one of the pharmacists
1 Pharmacy Intern gets on the moral soap box for another user giving a strong opinion
1 Pre-Pharmacy student explains another users post about justification of curse words
1 Pre-Pharmacy with no prior pharmacy experience entering school in the fall apologizing for VCU way of supervising people and shifting the blame elsewhere (not very clear where- btw the pharmacist is ALWAYS responsible for what happens in the pharmacy which is why it is a must to be able to multi-task if you decide to work retail)
Perhaps we can have a few more pharmacists that have been practicing for a while respond and give a critique the OP's situation as I am sure a student like myself would have no idea what it's like to actually be the pharmacist in charge and instead we have ideas of what its supposed to be versus what it really is...
2 Licensed Pharmacists say VCU needs to whip her employees into shape on what's expected of them in the pharmacy (regardless of s/he being an intern or a tech...)
2 Pharmacy Interns that says your tech was in the wrong; 1 essentially makes lemonade out of lemons for the tech's version of "patient care", the other contradicted himself in his post and rant against an opinion given by one of the pharmacists
1 Pharmacy Intern gets on the moral soap box for another user giving a strong opinion
1 Pre-Pharmacy student explains another users post about justification of curse words
1 Pre-Pharmacy with no prior pharmacy experience entering school in the fall apologizing for VCU way of supervising people and shifting the blame elsewhere (not very clear where- btw the pharmacist is ALWAYS responsible for what happens in the pharmacy which is why it is a must to be able to multi-task if you decide to work retail)
Perhaps we can have a few more pharmacists that have been practicing for a while respond and give a critique the OP's situation as I am sure a student like myself would have no idea what it's like to actually be the pharmacist in charge and instead we have ideas of what its supposed to be versus what it really is...
you seem to be on the fence, just giving a summary? *_*
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I like lemonade and so does my husband.
The tech was in the wrong but I doubt it was for any sinister reason. I'm willing to give the tech the benefit of the doubt that he/she thought they were doing the right thing.
As far as the pharmacist supervising the technician, well he/she has learned a lesson and probably was able to use it as a teaching opportunity with the technician. It happens.
This whole incident seems minor to me: was a patient harmed? It doesn't sound like it. In fact, the extra (albeit) unnecessary steps were in the interest of patient safety.
I can't speak to state law where bananaface lives but I can tell you that there is tremendous state to state variation and I trust her interpretation of the law in the state where she works. Furthermore, the laws are often vague and open to interpretation. In Kentucky an intern must be under "immediate supervision" until a certain point in their pharmacy education and from then on it is "general supervision." But what that actually entails is not codified. I have been asked/allowed to do a variety of progressively responsible tasks during my tenure at various places.
It's also pharmacist-dependent. I've been telling people all summer, "No, this VA does not give copies," but I sure was instructed to give a copy to a pharmacy in another town last week. Ordered, is a better word. Not that I minded; it was in the interest of good patient care. One of our diabetes patients got his insulin in the mail and it was broken. Our diabetes mgmt pharmacist instructed me to call his pharmacy (about 90 miles away) to transfer an RX for a vial so the patient could have enough to get by until another order could be sent out. So, everything is open to interpretation and often flexible.
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http://apps.leg.wa.gov/WAC/default.aspx?cite=246-858-040
My state law says says "direct and personal". Our board interprets that to mean that pharmacists are on site and aware of and approving of what sort of tasks their interns are performing. The board absolutely does not take it to mean running every clinical decision by the preceptor. (I know a few board members who would crap their pants if you suggested that.) Interns in WA are expected to use their own professional discretion in the absence of an objection from their pharmacist and learn to operate independently over time.
re: the definition of "supervision" - Pharmacy managers supervise all of their staff. That does not preclude the supervisees from making independent clinical decisions.
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I have my opinion about it but I'm an intern...until it's my ass on the line I won't really know what it's like.
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I totally agree with you. That the doctor cursed at you was very unprofessional . A professional is the one who knows how to deal when things get hectic. I wont agree with anyone who said that what the physician said was justified.hell no...
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Not only is the physician's behavior unprofessional but the fact that you defended his misguided behavior shows you also lack proper judgement.
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To cursing and unprofessional behavior, no matter the source.
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This isn't a character debate. There's really no reason to call people's judgement into question. Several things happened that shouldn't have. Advice has been given to assist in preventing future occurences. If you'd like to continue assisting, by all means do so, but it's possible to put forth a contrary opinion without being contrary.
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I completely disagree. This thread is about character and judgement. It's never justified to cuss out someone for asking a question. If you think it is, then you lack judgement in my book.
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I thought this thread was more about the tech acting beyond their capabilities....silly me
sticks and stones will break my bones......
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Yeah. It's an issue of professionalism. Even if someone is a douchebag, that doesn't give others the right to be abusive.
This post def. defied my origional question as to whether or not others of you have faced similar cirumstances. Apparently, I was put on trail as to whether I was responsible or not, which again was not my origional post. Nevertheless, I do wonder why all health professional can't just work together for the casue of patient care. Things will happen, but these things should be overlooked as long as patient safety is the goal. I think this post is a great example of the above. As a new pharmacist, it is def. difficult to manage all aspects of a busy pharmacy (esp. when your the only pharmacist). Your techs/interns may do things w/o your knowledge, but hopefully for patient safety (although it may annoy others). It is very hard to look over everyone's shoulders to make sure they stay w/in their job description. Perhaps the company should set more stringent guidelines. I dont know, but no need to argue over a stupid fax.
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You are correct, if I condoned the cursing out of a pharmacist by a physician it would definitely be a lapse of judgement on my part. Supporting someone who did the same would bear the same response, I'm sure. Perhaps I'm reading the original response a little differently than you. I'm not seeing the cussing out of VCU as having been condoned. Though its condemnation (if you can call it that) was certainly not as strongly worded as the rest of the response.
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Yes, silly you for thinking this is about a tech. The original poster just clarified that point.
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just to throw more gas on the fire:
a what-if...
to the OP, do you think your tech would have been so hasty to fax the MD [whether or not we have all decided that said fax falls under the tech's purview] if the interaction had been one other the the dreaded P-word. yes, pregnancy.
like i said before, i believe the tech in question was hastily trying to protect the possible pregnancy, which, in our culture, is apparently sacrosanct.
while the zocor/pregnancy interaction is dangerous...there are many, many more dangerous interactions...how about macrolides and coumadin?
[ps - this is why technicians can't make the judgement at all...they don't have the knowledge to decide what interaction has merit and what doesn't]
also, i hate to be redundant....in NY, interns and techs must be under DIRECT supervision. however, if this case were brought to the NY board for an answer, it would be said that the issue could have and should have been resolved with patient counseling.
a what-if...
to the OP, do you think your tech would have been so hasty to fax the MD [whether or not we have all decided that said fax falls under the tech's purview] if the interaction had been one other the the dreaded P-word. yes, pregnancy.
like i said before, i believe the tech in question was hastily trying to protect the possible pregnancy, which, in our culture, is apparently sacrosanct.
while the zocor/pregnancy interaction is dangerous...there are many, many more dangerous interactions...how about macrolides and coumadin?
[ps - this is why technicians can't make the judgement at all...they don't have the knowledge to decide what interaction has merit and what doesn't]
also, i hate to be redundant....in NY, interns and techs must be under DIRECT supervision. however, if this case were brought to the NY board for an answer, it would be said that the issue could have and should have been resolved with patient counseling.
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You aren't on trial.
As a new supervisor in ANY setting it's difficult to establish who is in charge and who does what and how things worked. If you learned something from this then that is all that matters.
Again, no patient was harmed. So at the end of the day, you did your job. The medication was dispensed safely to the patient.
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I guess it must simply be a disparity in how we interpret these statements, as our state laws sound pretty similar as far as the wording. Once again, I would take the words "direct and personal" a bit more literal if my professional license was on the line.
And what is all this talk about interns using their own "clinical judgment" without some sort of preceptor making sure that judgment is sound? Since you know, most interns are students and certainly shouldn't be making many completely independent decisions on things regarding patient care. While on rotations, I saw patients and interviewed them, then came up with what I thought was a rational plan. However, before sending the patient on his way, either a pharmacist or physician who was properly supervising me had to sign off or agree that my line of thinking was appropriate. In retail, I was certainly allowed to use my clinical judgment when counseling patients, but only to a point. In both retail settings I have worked in, my supervisor always placed himself at a computer near the out window where he could hear these brilliant clinical pearls I was coming up with only one year of pharmacy school under my belt. In fact, during my first year as an intern, I was only allowed to counsel on medications that my preceptor and I had a topic discussion on first, and he still put himself where he could directly monitor what I was speaking with the patients about. That is what I consider proper supervision.
And, if I would have pulled a stunt like faxing a physician on something like the original post discussed, my preceptor would have tightened the leash in a heartbeat, as I would have demonstrated that my clinical judgment wasn't at the level required to function even remotely independently. If a technician did something similar and thought for a minute they magically were allowed "clinical judgment", boundaries would be immediately re-established and complied with or they would not have a job anymore. Period.
I do not think the OP deserved to be cussed out by a physician, but that fax should not have been sent. If a technician does not know this, they need to be told this bit of information quickly.
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Actually, it would be said that the doctor in question was an idiot for being unprofessional and exacerbating a simple mistake that caused no harm to anyone but a minute of inconvenience.
There is nothing to assume that patient counseling- which is the last step (sometimes intermediary steps)- was not offered. We're looking at the situation in question- and no harm occurred, so the State Board would be wholely uninterested.
Had the pharmacist called the doctor to confirm that the patient was not pregnant there would be no harm in that and it could be considered an added measure of confidence (suppose Billybob picks up the patient's rx and someone else is on staff that day and forgets to cover pregnancy in their counseling points?), it wouldn't have been considered terrible to ask the physician (as the pharmacist is supposed to be a partner in health care and can request pertinent information).
Some folks may want to know whether the patient is pregnant BEFORE the filling process even continues (the insurance company block, perhaps, got it right!). The real harm could have occurred if there were no check-stop in the middle of the filling process and the tech, rather than being overly zealous for the benefit of the patient, is zealous in the opposite regard to cash that patient out without telling the pharmacist he/she needs to counsel! Now that would be a case.
This seems like a tech who wants to do the right thing, but made a simple error, and it's better that it came out in that light (that it was on the side of the patient), so it could be used as a learning tool so that the opposite never occurs.
Yes, State boards do evaluate reports of unprofessional conduct. The only reason it's an issue is because the doctor made it one. If I were the doctor, I'd tell my secretary to fax 'em back saying 'no'.
VCU, if anything, he wasn't cursing you, he was cursing his patient, his staff (or lack, thereof), and ultimately his profession...
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Pharmacy Technicians handling the prospective drug utilization review, that just screams patient safety to me.
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Not 'handling' it. But seeing a screen and reacting to it. We don't know how pervasive this behavior is or how far a technician could go in the previously discussed system- since we don't work there. The technician saw a screen that 'screamed patient safety', and didn't seek to do anything contrary to what was on that screen but ask a doctor if the patient was pregnant. Wrong, yes. Screaming patient safety? No, not really- this was rather minor and could be handled easily.
Had she done the final check herself, threw it in a bad and handed it to the patient without counseling the situation could have been a lot worse than a busy doctor's impotent verbal assault.
And this is where SDN1977's analysis is off: in assuming that VCU would not have counseled that patient. The way I read VCU's post, it appeared that VCU had no knowledge of this and therefore could not tell the tech, 'hey, I got this under control, because I'll counsel the patient on this'.
I'm sure VCU would have counseled this patient as a remedy- we all know this- no time to play holider than thou. S/he just didn't know that a tech was already coming into the process.
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Training techs to automatically react without thinking is a great idea...hell why bother having a pharmacist there if the computer can just as easily tell the technician what to do.
what in the hell are you talking about?
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I would've said "oh well" and forgot about it.
Some people like to make themselves feel big and yell and make a scene about minute issues.
Some people like to make themselves feel big and yell and make a scene about minute issues.
Well, I guess I will chime in and try not to start any fires Every tech I supervise knows very well that any faxing of doctors for DUR review or whatever must be ok'd by myself. Anything that warrants patient safety gets checked by myself (or my partner) before any call is made. I guess the techs just know that asking me is what must be done. I made this clear from day 1. As a pharmacist one must let the technicians know what is appropriate and what is not. The OP being a brand new pharmacist may need to set boundries with the techs. And by no means am I questioning the OPs supervision skills but sometimes it just takes experience to know what needs to be done. Just set your rules and boundries with the techs, learn from the experience and move on.
As for the Physician,very unprofessional; I've never had a physician talk to me like that but I have had a nurse or "represenative" of the physician try to treat me like crap. Right away, I cut them off and tell them if they wanna talk, it must be civil, otherwise i wont talk to them. Dont let it bother you anymore cause its retail and you just need to pick your battles carefully Good luck
Dr. M
Every tech I supervise knows very well that any faxing of doctors for DUR review or whatever must be ok'd by myself. Anything that warrants patient safety gets checked by myself (or my partner) before any call is made. I guess the techs just know that asking me is what must be done. I made this clear from day 1. As a pharmacist one must let the technicians know what is appropriate and what is not. The OP being a brand new pharmacist may need to set boundries with the techs. And by no means am I questioning the OPs supervision skills but sometimes it just takes experience to know what needs to be done. Just set your rules and boundries with the techs, learn from the experience and move on. As for the Physician,very unprofessional; I've never had a physician talk to me like that but I have had a nurse or "represenative" of the physician try to treat me like crap. Right away, I cut them off and tell them if they wanna talk, it must be civil, otherwise i wont talk to them. Dont let it bother you anymore cause its retail and you just need to pick your battles carefully
Good luckDr. M
Your are funny as hell!!
, no seriosly, I agree totally. Any other Rphs with an opinion?Old timer?
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Fax the doc again with the same question. Piss him off more.
Again, you must set the tone for when you are on duty! The techs must adjust to how you work. Dont let the company set the guidelines because that will never happen. You set the guidelines. No need to watch over everyones shoulders cause that will never happen either. Just be aware of your surroundings. Multitask. Sometimes as I am verifying I am also listening to what Tech "A" is telling Mr Smith on the phone and what Tech "B" is saying to the patient in drive thru. Dont worry and dont feel bad. Just move on and learn from it!
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If the doc starts cussin you out, you tell him "wrong number" and click.
He's going to call back "Is this the Pharmacy?"
If he did ask you that line, you can tell he has no life.
He's going to call back "Is this the Pharmacy?"
If he did ask you that line, you can tell he has no life.
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I think the reason the tech took it upon themselves to fax the doctor is because it was an insurance rejection. The insurance was rejecting the med with the prego warning. We all know that a lot of pharmacists do not like (or know how) to deal with the complicated insurance crap, so maybe the tech thought she was handling an insurance problem. Like: Protonix not preferred, our tech would print it out and fax it to the MD office for a change. If they were feeling really nice, they'd call and get the names of the preferred, write it on there and fax it over.
Should the tech have done it? No. They could've run it by the pharmacist and the pharmacist would have used 1 second of brain power and said, "oh, we'll check with the pt first, and then you can call the insurance to get the override code." If this was a good tech, I bet they took the liberty because it was an insurance rejection. If it was a bad one, you would have to reiterate procedure and watch them like a hawk.
I would also like to stand up for the OP. Busy stores can get very crazy and you can't hear or see EVERYTHING. Should you be able to? Yes, it's your license and job on the line, but it does not always work out perfect, and the corporations aren't going to easily staff you to facilitate this because they want to make lots of money off of as few people as possible, you gotta do your best (and perk up your ears and weild your whip
Should the tech have done it? No. They could've run it by the pharmacist and the pharmacist would have used 1 second of brain power and said, "oh, we'll check with the pt first, and then you can call the insurance to get the override code." If this was a good tech, I bet they took the liberty because it was an insurance rejection. If it was a bad one, you would have to reiterate procedure and watch them like a hawk.
I would also like to stand up for the OP. Busy stores can get very crazy and you can't hear or see EVERYTHING. Should you be able to? Yes, it's your license and job on the line, but it does not always work out perfect, and the corporations aren't going to easily staff you to facilitate this because they want to make lots of money off of as few people as possible, you gotta do your best (and perk up your ears and weild your whip
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I feel like people aren't reading or paying attention to the OP's story.
VCU07 said:
At walgreens and kroger, the DUR happens BEFORE the claim is submitted to insurance. And the DUR probably went through without a hitch b/c really it's not that big a deal (as others have alluded you, you handle it with counseling). But insurance rejected it for some odd reason (suspected pregnancy - who knows why) and at the stores where I work, techs handle ALL of the insurance rejects.
So no, the techs weren't handling DUR's and no, the patient was never in danger. When it all comes down, that's what is really important: not the doctor's busy schedule or annoyance, not VCU's feelings about the doctor, not the tech's pride or any of that: the PATIENT is most imporant. And this patient was well taken care of, from what I can see.
