Incident yesterday

[All4MyDaughter]

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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.

I agree. And, I think I'm a little in love with you. Don't tell the hubby. Seriously, great points. 🙂

 

[alwaystired]

I feel like people aren't reading or paying attention to the OP's story.



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.

that's kinda what i was thinking....the tech saw it as an insurance rejection and tried to take care of it.

As a side note, At CVS, the techs don't see DURs. They go through typing/insurance approval/filling and then the pharmacist sees the DURs at the final check (kind of annoying if you want to ask the patient something and they are already gone--but they just put notes/papers with the rx)

 

[Doctor M]

I feel like people aren't reading or paying attention to the OP's story.



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.

Yes, agreed; the patient was taken care off. But I can see the Op's feelings of being cursed at about something he really didn't know about. It seems like a simple misunderstanding that was blown way out of proportion. Maybe his pride? Can't blame him. we all work hard and want to do best for our patients and to be cursed at really sucks! Anyway, you are right, the patient was taken care off and in the end that is all that really matters.

 

[Doctor M]

I agree. And, I think I'm a little in love with you. Don't tell the hubby. Seriously, great points. 🙂

🙄

 

[All4MyDaughter]

Yes, agreed; the patient was taken care off. But I can see the Op's feelings of being cursed at about something he really didn't know about. It seems like a simple misunderstanding that was blown way out of proportion. Maybe his pride? Can't blame him. we all work hard and want to do best for our patients and to be cursed at really sucks! Anyway, you are right, the patient was taken care off and in the end that is all that really matters.

Dr. M - definitely! VCU is entitled to his/her hurt feelings about the way the doctor treated him/her. And the doctor sounds like a total tool. But my point was that in the end these situations are not about you or me or VCU or the doctor - it's ALL about the patient. And in this case, the patient was just fine. 🙂

 

[All4MyDaughter]

🙄

Jealous? OK...I love you too. 😍

Sheesh, now I've declared my love for two internet people within the space of 15 minutes and hubby is lurking nearby. I'm bad. 😉

 

[Doctor M]

Dr. M - definitely! VCU is entitled to his/her hurt feelings about the way the doctor treated him/her. And the doctor sounds like a total tool. But my point was that in the end these situations are not about you or me or VCU or the doctor - it's ALL about the patient. And in this case, the patient was just fine. 🙂

Yep, agreed. point taken! 🙂

 

[Doctor M]

Jealous? OK...I love you too. 😍

Sheesh, now I've declared my love for two internet people within the space of 15 minutes and hubby is lurking nearby. I'm bad. 😉

😀 lol. Internet romance...🙄 'sighs'

 

[sdn1977]

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.

I honestly don't care who did the faxing - its probably even worse the faxing took place by a tech since a tech cannot make a clinical decision. You may think your supervising pharmacist is not responsible for each & every decision you make - as a tech or intern...but I'm pretty certain that is indeed the case across the whole nation.

This individual is not operating under any commonly accepted definition of supervision I've ever heard of - and I'd go nose to nose with you on how many ancillary personnel you've supervised or have had involvement with the writing of the supervisory laws.

So - think what you want - his tech...intern.....whatever you want to call the person stepped out of line - on his watch & he takes the heat. Thats the way the system works. If in your opinion, I'm condemning him - ok - thats your opinion. A mistake was made on his watch - his responsibility.

The fact the physician used foul language is irrelevant & distracting to the actual clinical situation at hand. The pharmacist, admittedly did not have any knowledge of the interaction, since it was not brough to his/her attention - so we have one HUGE mistake here. We have a tech/intern making their own judgement that the severity of the interaction requires physician intervention AND in this format - Another HUGE mistake. Then we have a pharmacist who wonders what went wrong?

Who is running the show - the pharmacist or the techs??? As a pharmacist - YOU ARE THE BOSS. You decide what is clinically significant in each and every state in this nation. You are the one, as someone else said, setting the tone. Unless this person is a graduate intern with experience behing them - they don't do anything other than routine refill requests without my ok - particularly pregnancy alerts - which need a pharmacist to filter!!!

It is not my attempt to be collegial, because frankly,, he made a mistake. Own up to it - we all do. But don't come down on the rest of us who see it as a mistake & frankly - the patient's physician & now - the patient will see it as a mistake. Now....each one of them tells two more people, who tell two more people......think about it!

It is our job to be able to handle these things,which could have been easily handled by the pharmacist. Hiding behind (& I'm not saying the OP is), but others have alluded to how busy they are....hiding behind the excuse of being too busy to actually do clinical work is embarassing.

I felt each & every word I wrote was warranted - otherwise I wouldn't have written them!

 

[sdn1977]

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-

You can't control other's behaviors - only your own. You didn't nor do you get upset in similar situations.

Now - what did you do to reeducate your tech so this won't happen again?

 

[sdn1977]

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.

This post is even more appropriate if it was a tech. I misread intern - it wasn't even on my radar to have a tech fax something like this. Thus - there is even more criticism about things which are going on without this pharmacists knowledge - like faxing stuff like this. A big part of what you do is supervision & you are completely at fault no matter what happens. The physician doesn't care if a monkey faxed it - you allowed it to happen.

Again - you have no control over a physicians behavior, so that is irrelevant. You can & must control your staff! That is the law.

 

[sdn1977]

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.

The point you seem to be missing is the supervising pharmacist is the one who gets to decide at which point the intern can make independent clinical decisions - not the intern.

At no time can a tech make independent clinical decisions.

 

[WVUPharm2007]

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.

*cough*krogersucks*cough*

As for the OP...it's hard to tell how I'd have dealed with it. I have a history of not letting physicians think they are special. I probably would have have just asked him who would win in a fist fight, Mrs. Butterworth or Aunt Jemima and called it a day. **** him, he's not your boss. In fact, next time you get a script that is wrong, you should call him back and tell him he runs a poor practice. **** it, why should they have all of the fun and be the only ones that get to go around screaming at people.

 

[All4MyDaughter]

This post is even more appropriate if it was a tech. I misread intern - it wasn't even on my radar to have a tech fax something like this. Thus - there is even more criticism about things which are going on without this pharmacists knowledge - like faxing stuff like this. A big part of what you do is supervision & you are completely at fault no matter what happens. The physician doesn't care if a monkey faxed it - you allowed it to happen.

Again - you have no control over a physicians behavior, so that is irrelevant. You can & must control your staff! That is the law.

Techs fax insurance rejects all the time. That's all this was: an insurance kick out. There was NO CHANCE for patient harm by a technician writing "Is this patient pregnant?" on the printed out "reject form" and faxing it to the doctor. To suggest anything else is over-dramatic.

 

[sdn1977]

Not only is the physician's behavior unprofessional but the fact that you defended his misguided behavior shows you also lack proper judgement.

I defended his complaint - not the manner in which he delivered it. When you get a bit more seasoned, this won't come as any surprise. We just take it in stride - somewhat like you folks whose insurance change & you forget your cards, you get an unexpected bleeder in the ICU, you get a desating pt on maximal inhaled betablocker & steroid - get over it - physicians, nurses, all of us curse at times. Its unfortunate this pharmacist didn't have any alert (yet another mistake) & he was blindsided....but it sounds as though there are too many chiefs & not enough indians in this teepee.

I have great judgement now & have had for longer than you've been alive - now go bash someone else.

 

[All4MyDaughter]

*cough*krogersucks*cough*

As for the OP...it's hard to tell how I'd have dealed with it. I have a history of not letting physicians think they are special. I probably would have have just asked him who would win in a fist fight, Mrs. Butterworth or Aunt Jemima and called it a day. **** him, he's not your boss. In fact, next time you get a script that is wrong, you should call him back and tell him he runs a poor practice. **** it, why should they have all of the fun and be the only ones that get to go around screaming at people.

Yeah. VA techs are unionized too. At least some of them.

And doctors? Yep. They pull their pants on one leg at a time, just the same as the rest of us.

 

[sdn1977]

Pharmacy Technicians handling the prospective drug utilization review, that just screams patient safety to me.

I think 20/20 did a bit on that😉

 

[sdn1977]

Techs fax insurance rejects all the time. That's all this was: an insurance kick out. There was NO CHANCE for patient harm by a technician writing "Is this patient pregnant?" on the printed out "reject form" and faxing it to the doctor. To suggest anything else is over-dramatic.

Calling me over dramatic is a bit harsh. I wouldn't let you fax a physician back for a reject like this. There is harm, IMO. I can get that info fast without bothering the physician.

I'd appreciate a stop to the name calling - thanks!

 

[All4MyDaughter]

Not intended to hurt your feelings, '77.
I still don't see the harm to the patient.
But we don't have to agree.

 

[BMBiology]

When you get a bit more seasoned, this won't come as any surprise...I have great judgement now & have had for longer than you've been alive - now go bash someone else.

Here we go again with how much experience you had. I hope one day when I become as seasoned as you, I would not lecture my colleagues and try to justify degrading behavior over a simple, harmless mistake.

 

[bananaface]

Originally Posted by bananaface View Post
http://apps.leg.wa.gov/WAC/default.a...te=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.

The point you seem to be missing is the supervising pharmacist is the one who gets to decide at which point the intern can make independent clinical decisions - not the intern.

No, I included that point.

 

[sdn1977]

Not intended to hurt your feelings, '77.
I still don't see the harm to the patient.
But we don't have to agree.

Nope - perhaps not - but the physcian was worked up enough - is that not on your radar????

And - how do you know what occured after the physician had a discussion with the patient - nothing.

 

[sdn1977]

Here we go again with how much experience you had. I hope one day when I become as seasoned as you, I would not lecture my colleagues and try to justify degrading behavior over a simple, harmless mistake.

BM - go back - I did not justify the behavior. I explained why. How simple is that???

I wasn't lecturing - I was giving an opinion - just as you gave yours - albeit in a much more degrading manner by bringing into question my judgement when I was not involved, but just giving my take on what I would have done - which btw was asked for.

This was not simple - obviously - the physician felt worked up enough about it - until you walk a mile in their shoes.........as the saying goes. Its easy to be a thorn in someones side - you never hurt!

I attempted to give my persepective after receiving decades worth of rxs, faxes, angry phone calls & techs gone wild - the OP asked for input. You did not have to agree - that is certainly your right.

However - to bring my character & judgement into question is a whole different matter & one in which you have ABSOLUTELY NO RIGHT NOR STANDING TO MAKE..

Again - go away and bashh someone else! You've obviously got it all figured out at a very young part of your career - good luck with that!

 

[All4MyDaughter]

Nope - perhaps not - but the physcian was worked up enough - is that not on your radar????

It's on my radar, but I guess I just rank it lower than patient safety.

And - how do you know what occured after the physician had a discussion with the patient - nothing.

I'm honestly not sure what you mean here. Maybe I haven't been doing this long enough.


Like I said, we don't have to agree on this.

 

[sdn1977]

No, I included that point.

And....it appears obvious an intern who might have done this should not be operating using independent decision making since those skills need a litlle refinement.

But - we weren't speaking of an intern - my mistake. This was apparently a tech which cannot make any clinical judgements at all, thus all these quotes are meaningless.

As someone said - a very dangerous slope & one in which some of the media have already picked up on. If they only knew what goes on in some places under the excuse of being too busy.

I thought you had left WA???

 

[Jeddevil]

I'm honestly not sure what you mean here. Maybe I haven't been doing this long enough.

I don't either.

Let's summarize:

A tech did something on his/her own, which is wrong. But, the tech, being part of the pharmacy, sent a fax with a simple "Is this pt pregnant?". I don't know how that can be spun anyway except the pharmacy looking out for pt safety. Then the doc goes off on a rampage and acts like a total a$$hole.

There is no justification for the doc's behavior, and the prick should have just answered the question and moved on. The tech needs a butt-chewing also.

 

[sdn1977]

It's on my radar, but I guess I just rank it lower than patient safety.



I'm honestly not sure what you mean here. Maybe I haven't been doing this long enough.


Like I said, we don't have to agree on this.

You're right - you haven't been doing this long enough! Anytime you have an upset physician...some of that will filter down to the patient and may cause harm which you'd never even know about - unless you work in a hospital or the pharmacy which gets the other rxs.

Don't get so wound up over the language that you can't see the forest for the trees. The guy really had a valid complaint - poorly worded - but very valid. This is a pharmacist task - the physcian had already done his h&P & decided this was the drug of choice (trust me - pregnancy is a big question - even for MS students!!!) Our task is to follow thru on that - this pharmacist didn't even get the chance to do what he is trained to do clinically - he got cut off at the knees by a tech. Now the physician thinks the pharmacist is an idiot. He doesn't know this fax wasn't sent under the direction of the pharmacist. His reptuation has been diminished by what someone accurately called the actions of a rougue tech who needs closer supervision.

 

[sdn1977]

I don't either.

Let's summarize:

A tech did something on his/her own, which is wrong. But, the tech, being part of the pharmacy, sent a fax with a simple "Is this pt pregnant?". I don't know how that can be spun anyway except the pharmacy looking out for pt safety. Then the doc goes off on a rampage and acts like a total a$$hole.

There is no justification for the doc's behavior, and the prick should have just answered the question and moved on. The tech needs a butt-chewing also.

Because this is a normal & expected clinical interaction between a pharmacist & a patient. The physician does not need to document this on any prescription other than Accutane. They expect us to do what we're trained to do - not ask questions of them which we are expected to ask of the patient.

This is clinical people - clinical - what you all are wanting. Yet - you want to fall back on the physician input before you do anything at all.

 

[BMBiology]

Please claim down. The OP only asked if anyone had a similar experience. Instead of trying to find out what exactly happened, you lectured her and accused her of having bad managment skills. Don't judge others if you dont like others to judge you.

 

[All4MyDaughter]

You're right - you haven't been doing this long enough! Anytime you have an upset physician...some of that will filter down to the patient and may cause harm which you'd never even know about - unless you work in a hospital or the pharmacy which gets the other rxs.

Wait, you are suggesting that the physician, angered by the inconvenience of one wayward fax, might do something to harm the patient? Like what?

 

[omnione]

Man, I'm going to have a rude and rough awakening when I start interning with the frequent physician screaming soon.🙁😛

 

[sdn1977]

Please claim down. The OP only asked if anyone had a similar experience. Instead of trying to find out what exactly happened, you lectured her and accused her of having bad managment skills. Don't judge others if you dont like others to judge you.

"claim" down - yeah....I'm claiming down - I've just worked a 15 hour shift & I'm tired & going to bed - willl probably be calming - not claiming.

BM - do me a favor & stop pontificating. Go back - the OP asked if anyone had any experience like this - I did & gave my input. I didn't say he (stop saying she) had bad management skills - I told her he needs to supervise his techs more. You can translate that all you want into bad management skills - fine. Prescribers hate faxes - especially nonsense faxes - my husband turns his off at nights & on weekends - thats how much he hates them.

No - I did not find out exactly what happened - I responded to the post as it was written at 7AM this morning - then I went to work.

I am not judging anyone. VCU has made peace with the situation & the circumstance with the tech. If VCU or you had come back questioning or disputing my advice - great - there are many, many ways to skin a cat. Lots of ways to solve this situation - none of which involved demeaning my professional judgement.


But - be very,very careful calling someone's good judgement into question. This is exactly why those of some of us will not give out our personal information - people like you don't see how fast you can diminish a lifetime of work which is valued, published & held in respect by many people.

I could care less what you think of me - I'd just like you to go away, stop calling me names & diminishing the respect which I have earned over a lifetime - which you so glibly brush under the rug. You could learn some restraint yourself!!!

 

[BMBiology]

You're right - you haven't been doing this long enough! Anytime you have an upset physician...some of that will filter down to the patient and may cause harm which you'd never even know about - unless you work in a hospital or the pharmacy which gets the other rxs.

If a physician harms a patient because of a simple fax then that says a lot about the physician. Perhaps he needs to take an anger management class?

Look, I dont need to "walk a mile" in someone's shoes to know how to treat people and I certainly do not need to belittle others because they don't agree with me.

 

[sdn1977]

You are so totally off base......go work a bit - then come back.

No one agrees with offensive language - this has been dealth with many, many posts back....get over it. What would you have the guy do - hang up? Like that will help the situation....

The fact is - the pharmacist allowed a mistake to happen.

The harm may not be physical to the pt, but to the relationship both the patient & physician have with the pharmacy. Get it??? That, in and of itself, is harm - a lack of trust or reliablity of being able to get information when they need it.


You are the reputatation you build. Your emloyees are a mirror to your reputation.

But...go ahead - be that pharmacist. Goodness knows there are lots of you out there & people leave in droves & come back for coupons.

There you go again - name calling. I was not belittling the OP - I suggested he needed more work with supervising - same as I might suggest someone study pharmacology of antiarrhythimics a bit more.....

 

[BMBiology]

The harm may not be physical to the pt, but to the relationship both the patient & physician have with the pharmacy. Get it???

...You are the reputatation you build.

You misspelled reputation but it's okay because everyone makes mistakes. No big deal.

The physician ended the relationship with the pharmacy when he cussed out the pharmacist over a simple fax. Dont defend his behavior and then talk about the importance of the patient/physician/pharmacist relationship.

I dont need to pull out all of my credentials to defend my opinion. If you are going to be vocal on this forum, then you should expect to defend your views. You judge others and others will judge you. I am not going to ask you if you "get it" either because I expect someone with your credentials to know better.

 

[bananaface]

I defended his complaint - not the manner in which he delivered it.

Whether you intended to or not, you did state in your first post that the manner was justified. When parsing the first sentence, "it" refers back to the noun "manner". ("Well - altho the manner in which the physcian made his complaint was not the best - it was justified.") Perhaps we are all on the same page on this point and simply do not realize it.

You may think your supervising pharmacist is not responsible for each & every decision you make - as a tech or intern...but I'm pretty certain that is indeed the case across the whole nation.

This individual is not operating under any commonly accepted definition of supervision I've ever heard of - and I'd go nose to nose with you on how many ancillary personnel you've supervised or have had involvement with the writing of the supervisory laws.

So - think what you want - his tech...intern.....whatever you want to call the person stepped out of line - on his watch & he takes the heat. Thats the way the system works. If in your opinion, I'm condemning him - ok - thats your opinion. A mistake was made on his watch - his responsibility.

I never made any assertion that the pharmacist is not ultimately responsible for what happens in the pharmacy, be it an intern's clinical error or a tech giving out a medication to the wrong patient. The difference between states is instead the set of tasks that can legally be delegated. I'm not sure why interns in general think they are off the hook by way of being an intern. Someone could still sue personally them or challenge their license.

I also did not condone the actions of the technician in this case. I'm not sure how that came across, since I haven't actually addressed them directly so far. Since you seem interested, I'll tell you my stance. I agree that the tech should not have been the one to decide whether the physician's office was contacted regarding the issue at hand. But, because the OP indicates that this particular inquiry was relevant to patient safety and promoted good patient care, I do not feel that the physician's outrage was justified, unless there was something else going on that was not presented in the OP.

I can't challenge anyone on law writing at the moment, but I have an excellent showing of ancillary personnel. Now I'm super curious to know how many people you've supervised.

I thought you had left WA???

Not quite. I move to IA next week.

 

[sdn1977]

Whether you intended to or not, you did state in your first post that the manner was justified. When parsing the first sentence, "it" refers back to the noun "manner". ("Well - altho the manner in which the physcian made his complaint was not the best - it was justified.") Perhaps we are all on the same page on this point and simply do not realize it.

I never made any assertion that the pharmacist is not ultimately responsible for what happens in the pharmacy, be it an intern's clinical error or a tech giving out a medication to the wrong patient. The difference between states is instead the set of tasks that can legally be delegated. I'm not sure why interns in general think they are off the hook by way of being an intern. Someone could still sue personally them or challenge their license.

I also did not condone the actions of the technician in this case. I'm not sure how that came across, since I haven't actually addressed them directly so far. Since you seem interested, I'll tell you my stance. I agree that the tech should not have been the one to decide whether the physician's office was contacted regarding the issue at hand. But, because the OP indicates that this particular inquiry was relevant to patient safety and promoted good patient care, I do not feel that the physician's outrage was justified, unless there was something else going on that was not presented in the OP.

I can't challenge anyone on law writing at the moment, but I have an excellent showing of ancillary personnel. Now I'm super curious to know how many people you've supervised.

Not quite. I move to IA next week.

Good for you!

When I'm an inpt pharmacist, depending on the shift I work, I supervise 5-8 techs at any one time. If in the OR, only 1 at a time. As a clinical manager, I supervised all the techs & pharmacists on any day I worked.

When I work retail, depending on the day, I supervise as few a 1-2 on a weekend & as many as 4-5 with an intern on a weekday. I am the PIC.

When I taught in a tech school, I had the responsibility for 35 techs. When I taught in a pharmacy school, I had the responsibility for 25 students, for classroom work only. When they were doing a rotation at my site for credit - I supervised & taught 1 student (intern, but functioning as a student) in addition to whatever technicians I had.

Not so much supervisorial experience, I realize.....but, a mistake is a mistake. If I make one as a pharmacist, I own up to it. That makes it easier to correct. If this occurred during my shift or had been reported to me as a PIC, it would have been clearly designated as a mistake, the tech would have been reprimanded & the pharmacist reeducated on responsibilities as a supervising pharmacist. Harm is not a factor in the occurrence & ways mistakes happen. Its always best when there is no harm, but that is not the issue - the systems in place & those who are fulfilling tasks are facilitating an error prone situation. This is the basis for error theory & contributing change so it decreases. We want as few errors as possible - not just fewer errors which cause harm!

No pharmacist (or person for that matter) can control another's reactions - in this case the physician. As I have said many, many times - his manner was inappropriate, his reasoning was not. My major was not English, my using "it" referred back to the last prior noun, which was "complaint". Argue semantics all you want - the doctor was justified in his complaining. The way in which he did it obviously did not get the point across to the OP because he got hung up on the swearing - but, there was a whole different thread here on swearing.

If you cannot grasp his reasoning as to why this question was more accurately handled in the pharmacy rather than take up his time....I cannot help you grasp the meaning of clinical pharmacy in the outpt setting. This question is as random as asking did he do an HDL/LDL ratio? We assume they do their job and they assume we do ours. This is part of our job! The computer generated alerts are for the pharmacists to evaluate - they are not necessarily, altho sometimes they do require communication with the physician.

But - I indeed know too many pharmacists like those represented here.

Good luck with the move!

 

[tussionex]

i'm going to risk sounding redundant. this has been a fascinating thread!

1 - the tech deserves an a**-kicking. they have no clinical judgement, and no scope of practice, particularly in NY. i would have reamed the tech for making me take the heat for their mistake. busybody, over-inflated techs benefit no one!

2 - yeah, the physician should have been more polite, but guess what? MD's curse pharmacists and nurses and secretaries and respiratory therapists, etc, etc, out all the time. and all other health-care "professionals" do likewise. it happens. it's not right, but it happens. get over it. i guarantee that someday you're going to curse someone out in the heat of the moment, and at that moment you will be completely justified in doing so [in your mind, at least]

3 - if this was, as everyone is theorizing, just an insurance reject......well...last time i worked retail, which was a while ago, there were reject codes and override codes that could be plugged in to override whatever the particular reject is
....couldn't SOMEONE, pharmacist, tech, intern, clerk....have verified the pregnancy status of this patient, given that info to the data entry person and the override would have been performed without this whole messy ordeal?

4 - once again, had this been any other interaction either flagged by the computer or rejected by the ins, the tech would have scratched their head, said "that's the pharmacist's job" and passed it along like they should. because it had to do with the almighty pregnancy, the tech must have felt like he/she had the right and/or skills to procede without direction. see #1.

5 - i don't feel any of sdn's posts have been out of line. this is an anonymous forum. on the internet. it's a very small microcosm of the real world. if anyone can't deal with someone with more experience calling them out, and politely in this case, on an online forum....what are all you new pharmacists going to do when the 30-yearers ream you out for real, in person, at work?

 

[sdn1977]

You misspelled reputation but it's okay because everyone makes mistakes. No big deal.

The physician ended the relationship with the pharmacy when he cussed out the pharmacist over a simple fax. Dont defend his behavior and then talk about the importance of the patient/physician/pharmacist relationship.

I dont need to pull out all of my credentials to defend my opinion. If you are going to be vocal on this forum, then you should expect to defend your views. You judge others and others will judge you. I am not going to ask you if you "get it" either because I expect someone with your credentials to know better.

Again - you misread - I did not defend his behavior. I defended & still do - his reasoning behind his behavior.

If pharmacists cannot get over this issue of swearing, they will stay as the robots they are within the confines of the pharmacy.

This physician was entirely justified in being upset with the pharmacy. As the pharmacist on duty, the pharmacist takes responsiblity for everything & everyone who is in the pharmacy at the time. If that pharmacist is not making clear the expectations & limitations of each job, that pharmacist needs to be reeducated.

Someone started a previous thread on a tech running ragged over a pharmacy intern. She indicated the pharmacist allowed such behaviors. How do you think that starts?

What is you view of "clinical" pharmacy in the outpt setting? Is it really letting techs have control over all that gets sent to physician offices? I don't. This was a clinical mistake - plain & simple. This question of appropriateness of drug therapy should have been allowed to be handled by the pharmacist. If the pharmacist is not making clear that all "alerts" & DURs need to be reviewed by him - then, he is not carrying out his capacity as a supervising pharmacist. If you are the only one on duty - you are supervising. If it is not in someone's personality to be that person, that individual should always be scheduled with another pharmacist.

Trust me, BM - you can look at my post count. I have NO trouble defending my position.

Thanks for the correction! I had assumed, given your vehemence & name calling you had not worked the long hours I did yesterday. I'm sure I was wrong. But, fortunately, I have had some sleep - that may not improve my spelling. Feel free to correct me!

 

[All4MyDaughter]

In my pharmacy school we are actually taught to assess errors based on degree of harm or potential harm caused. There is a chart but I can't find it easily online and my notes are all at my school residence.

Basically, errors are assigned a level based on risk to the patient. So level I is - no error occured (existing systems prevented a potential error), Level II is - an error occured which did not reach the patient (I'd assign this particular incident to Level II or maybe even Level I) and it goes up from there to the most serious - an error occured and the patient died. My point is that I, at least, am being taught a system where harm to the patient is the yardstick.

Tussionex, I'm going to try to address your last point without making it personal about any of the people involved in this debate. Both the young people and the older people weighing in on this question have an equal right to their opinions. This is NOT a workplace where seniority counts and the 25 year old newly minted PharmD has to put up with a "reaming" by the 25 year veteran.

No one around here gets to say, "I'm older/more experienced than you and therefore my opinion carries more weight. So go away." More accurately, they can SAY it but they should expect to be challenged on it. So anyone who wants to play that card should not get upset when people don't immediately defer to their age/experience. And the age/experience thing isn't even a good trump card, IMO. I've worked with 60 year olds who didn't know their head from a hole and I've worked with 25 year olds who were gifted pharmacists and supervisors. Not to mention my supervisory and management experiences in my other career (before the switch to pharmacy).

Likewise, if a young person posts an ill-supported opinion, their age/lack of experience doesn't shield them from constructive criticism. But as a former educator, I'd suggest that those of us who are older and more experienced (in life or pharmacy or wherever) should take the opportunity to educate and not to give "a reaming." That, IMO demeans both us and the young person being "reamed." I know that there are many who would disagree. Medical education in general is full of deplorable examples of choosing "reaming" over "educating."

Just my observations based on how this thread has evolved.

Everyone is pretty much equal here - internet forum - free exchange of ideas, etc.

 

[tussionex]

this is an internet forum and we are all merely screennames...so yes, we ARE all equal. that's the beauty of the forum, and what makes it work.

but, in the real world, in any workplace, that is simply not the case. teachers, computer programmers, nurses, pharmacists, we ALL have to contend with the critique that may be foisted upon us by those who have been doing it longer. and yes, the 25 year old pharmd who has newly graduated DOES have a different perspective than the 25 year veteran.

i have been licensed for 3 years, have worked in a pharmacy for 12... but, i have been the only pharmacist in a 350 bed hospital in the middle of the night with an ER on diversion, admissions through the night, and very demanding NICU. i've gotten, shall we say, seasoned very quickly, out of necessity. when you're the only one, you learn how do it, and d**m quickly!

my AD gave myself and our clinical coordinator a problem with a methadone PCA recently. he's a year older than i am, and has also completed residency. we were the only pharmd's on staff that day, for what that's worth. we were concerned with making this error proof for nursing, as well as stable for as long as possible.

when we wondered about what concentration and what fluid to use, we turned to micromedex [my favorite!]...but....where else did we go for a second opinion? not the intern, not the the director, but two guys who had a cumulative 40 years experience between them.

experience does not give anyone the right to haze a newbie, but it is just that, experience. it's invaluable.

this thread has turned into a youth vs experience battle, which it shouldnt be. however, i'm going to come down on the side of experience. i may not have been doing this as long as sdn, but i have done a d**m lot!

once again, my point was that the tech needs a good whoopin'!

 

[All4MyDaughter]

Tuss (can I get about 50 mLs of that? - I feel crappy today) - absolutely. In the workplace, I agree. Experience wins, especially when patient care is at stake. Statistically you're likely to have a better outcome if you have the benefit of experience working for you.

I've also been in the workforce about 12 years (although not in pharmacy, mostly education and executive level nonprofit management) and I just don't have a lot of tolerance for bad behavior. Sure, sometimes you have to put up with it when it's your boss acting out (if you want to stay in the job), but you always have options of SOME sort.

I for one, am very proactive in defending the people who work for me. I've had cursing, ranting customers physically removed from my workplace if I felt my staff was in danger (once did the manhandling myself - shoved this dude out the door and locked it as he pounded on it - next move = 911). Last night I was up extremely late investigating a fairly harsh personal attack on an SDN staff member (not on the pharmacy forums - my responsibilities are site wide) b/c I think it's my job to protect the people who work for/with me. I was working on other stuff too but that was definitely a big part of why I stayed up.

To bring this back to pharmacy, I've definitely ended conversations with providers and their representatives when they turned inappropriate. More specifically I remember a 8:55 p.m. call from an immediate care doctor wanting to "call in" a CII so we could get it ready ahead of time. The pharmacist was with another patient and asked me to convey that we'd need a hard copy to fill in this instance and provide the physician with the name and address of a 24-hour pharmacy to which to refer (good patient care). When the physician began to swear at me, I simply said, "we can discuss this at a time when you are calm, please feel free to call back. Thank you." and ended the call. Next day the doctor called and apologized to the pharmacist (I was in class).

I do agree that this the tech referred to in the OP needs some instructions about how to handle less than run-of-the-mill insurance rejects. I can't say for sure that the techs at my retail pharmacy would do any better. They fax all of the rejects (at least the ones they can't clear on their own) as a matter of course. So I can definitely see something like this slipping by. It's given me something to think about and look into.

 

[Doctor M]

In my pharmacy school we are actually taught to assess errors based on degree of harm or potential harm caused. There is a chart but I can't find it easily online and my notes are all at my school residence.

Basically, errors are assigned a level based on risk to the patient. So level I is - no error occured (existing systems prevented a potential error), Level II is - an error occured which did not reach the patient (I'd assign this particular incident to Level II or maybe even Level I) and it goes up from there to the most serious - an error occured and the patient died. My point is that I, at least, am being taught a system where harm to the patient is the yardstick.

Tussionex, I'm going to try to address your last point without making it personal about any of the people involved in this debate. Both the young people and the older people weighing in on this question have an equal right to their opinions. This is NOT a workplace where seniority counts and the 25 year old newly minted PharmD has to put up with a "reaming" by the 25 year veteran.

No one around here gets to say, "I'm older/more experienced than you and therefore my opinion carries more weight. So go away." More accurately, they can SAY it but they should expect to be challenged on it. So anyone who wants to play that card should not get upset when people don't immediately defer to their age/experience. And the age/experience thing isn't even a good trump card, IMO. I've worked with 60 year olds who didn't know their head from a hole and I've worked with 25 year olds who were gifted pharmacists and supervisors. Not to mention my supervisory and management experiences in my other career (before the switch to pharmacy).

Likewise, if a young person posts an ill-supported opinion, their age/lack of experience doesn't shield them from constructive criticism. But as a former educator, I'd suggest that those of us who are older and more experienced (in life or pharmacy or wherever) should take the opportunity to educate and not to give "a reaming." That, IMO demeans both us and the young person being "reamed." I know that there are many who would disagree. Medical education in general is full of deplorable examples of choosing "reaming" over "educating."

Just my observations based on how this thread has evolved.

Everyone is pretty much equal here - internet forum - free exchange of ideas, etc.

Well said!

 

[Doctor M]

Ive never seen a rejection due to pregnancy. Anything of that nature pops up in my DUR screen. Interesting...😕

 

[All4MyDaughter]

I've seen insurance reject for similar reasons. Can't say as I've seen pregnancy as a "kick back," but I wouldn't rule it out.

I take a controversial medication off label for a disorder I have and I don't even bother to submit it to insurance any more.

I have also seen insurance kick out a script for lexapro that was above the FDA approved dosage even though the physician and the pharmacist had talked it out and both felt it was safe and appropriate to fill.

Insurance is annoying. It's one of the things I don't miss about working retail (I'm at the VA full time currently and on "intern leave" from my retail job). We don't do ANYTHING with insurance or co-pays at the VA. That, and I really like the giant optifill robot. 🙂

 

[Doctor M]

I've seen insurance reject for similar reasons. Can't say as I've seen pregnancy as a "kick back," but I wouldn't rule it out.

I take a controversial medication off label for a disorder I have and I don't even bothere to submit it to insurance any more.

I have also seen insurance kick out a script for lexapro that was above the FDA approved dosage even though the physician and the pharmacist had talked it out and both felt it was safe and appropriate to fill.

Insurance is annoying. It's one of the things I don't miss about working retail (I'm at the VA full time currently and on "intern leave" from my retail job. We don't do ANYTHING with insurance or co-pays at the VA. That, and I really like the giant optifill robot. 🙂

A bit off topic, but aren't pharmacists taking a greater role with ins companies in deciding what is covered, what is rejected (dosages and off label use)? I hate insurances but I feel its a battle that cannot be won. Anyway, back on topic, I thought the tech who sent the fax did it because it was rejected in the queue as a possible pregnancy? Maybe I misread, it was late last night.

 

[bananaface]

If you cannot grasp his reasoning as to why this question was more accurately handled in the pharmacy rather than take up his time....I cannot help you grasp the meaning of clinical pharmacy in the outpt setting. This question is as random as asking did he do an HDL/LDL ratio? We assume they do their job and they assume we do ours. This is part of our job! The computer generated alerts are for the pharmacists to evaluate - they are not necessarily, altho sometimes they do require communication with the physician.

Good luck with the move!

I don't perceive the question as random. Based on what is in the OP, it appears that there was an automated DUR that occurred because pregnancy was listed in the patient profile.

In general, if there is a potential for the drug order to be changed or canceled, I prefer it be taken care of before pickup time. There is no assurance that the patient will come in in person, or that a representative will know the answer to the question at hand. The physician should not be upset at being contacted about a potential contraindication. They should be glad that their patient's safety is being safeguarded, and that they have the opportunity to rectify the situation before the patient shows up to find out that the drug prescribed cannot be dispensed.

Thanks. 🙂 I am off to go scrounge for boxes. Pharmacy boxes are a great size for packing. I know a guy who once moved by borrowing like 100 totes from his drug deliveryman for the weekend.

 

[gaba101]

I don't perceive the question as random. Based on what is in the OP, it appears that there was an automated DUR that occurred because pregnancy was listed in the patient profile.

In general, if there is a potential for the drug order to be changed or canceled, I prefer it be taken care of before pickup time. There is no assurance that the patient will come in in person, or that a representative will know the answer to the question at hand. The physician should not be upset at being contacted about a potential contraindication. They should be glad that their patient's safety is being safeguarded, and that they have the opportunity to rectify the situation before the patient shows up to find out that the drug prescribed cannot be dispensed.

Thanks. 🙂 I am off to go scrounge for boxes. Pharmacy boxes are a great size for packing. I know a guy who once moved by borrowing like 100 totes from his drug deliveryman for the weekend.

well said (the middle paragraph, that is).

 

[no-see-um]

I agree. And, I think I'm a little in love with you. Don't tell the hubby. Seriously, great points. 🙂

hehe thanks! 😀

 

[ZpackSux]

In my pharmacy school we are actually taught to assess errors based on degree of harm or potential harm caused. There is a chart but I can't find it easily online and my notes are all at my school residence.

Basically, errors are assigned a level based on risk to the patient. So level I is - no error occured (existing systems prevented a potential error), Level II is - an error occured which did not reach the patient (I'd assign this particular incident to Level II or maybe even Level I) and it goes up from there to the most serious - an error occured and the patient died. My point is that I, at least, am being taught a system where harm to the patient is the yardstick.

Tussionex, I'm going to try to address your last point without making it personal about any of the people involved in this debate. Both the young people and the older people weighing in on this question have an equal right to their opinions. This is NOT a workplace where seniority counts and the 25 year old newly minted PharmD has to put up with a "reaming" by the 25 year veteran.

No one around here gets to say, "I'm older/more experienced than you and therefore my opinion carries more weight. So go away." More accurately, they can SAY it but they should expect to be challenged on it. So anyone who wants to play that card should not get upset when people don't immediately defer to their age/experience. And the age/experience thing isn't even a good trump card, IMO. I've worked with 60 year olds who didn't know their head from a hole and I've worked with 25 year olds who were gifted pharmacists and supervisors. Not to mention my supervisory and management experiences in my other career (before the switch to pharmacy).

Likewise, if a young person posts an ill-supported opinion, their age/lack of experience doesn't shield them from constructive criticism. But as a former educator, I'd suggest that those of us who are older and more experienced (in life or pharmacy or wherever) should take the opportunity to educate and not to give "a reaming." That, IMO demeans both us and the young person being "reamed." I know that there are many who would disagree. Medical education in general is full of deplorable examples of choosing "reaming" over "educating."

Just my observations based on how this thread has evolved.

Everyone is pretty much equal here - internet forum - free exchange of ideas, etc.

Age and experience of a competent pharmacist mean a lot in pharmacy education. At the same time, it's easy for someone without the experience to say "I'm equal." Frankly, no you're not. That's why supervisor or managerial positions require experience as one of the key qualifications.

In healthcare, because we deal with patient's lives, there comes a time when "reaming" happens. It's all part of the education. If one can't handle it..that's too bad. We're in a profession where patients trust their lives with us. This is no child's play.

How should we feel when our children think they know it all and discount parental advice? It's a feeling of floccipaucinihilipilfication. No one owes no one any respect on this forum. It's an anonymous internet forum.

But you can't deny the fact that there are members of this forum who contribute dearly not only to the forum but for the betterment of Pharmacy.

Let's not forget that some of us who've been involved with pharmacy for a while want nothing more than everyone to enjoy a competent pharmacy career. Our intentions are good.