P!ssed @ pharmacist...

Started by Daurang
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Daurang

Daurang

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The Costco pharmacist just told me he can't fill my script for simvastatin 20mg 100 tab for myself because I'm "a DMD". What hell is that supposed to mean? I didn't know I can give out Percocet to other people but I can't refill some cholesterol med for myself. If he won't fill a script due to whatever reason, isn't it his job his obligation to call and inform me so I can cancel or correct it? Should I file a complaint against him?😡
 
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Daurang said:
The Costco pharmacist just told me he can't fill my script for simvastatin 20mg 100 tab for myself because I'm "a DMD". What hell is that supposed to mean? I didn't know I can give out Percocet to other people but I can't refill some cholesterol med for myself. If he won't fill a script due to whatever reason, isn't it his job his obligation to call and inform me so I can cancel or correct it? Should I file a complaint against him?😡
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Speaking only about the law in my home state, simvastatin would not be within a dentist's scope of practice, which is limited by law to "the oral cavity."
 
I need to find out where you practice so I can get my teeth cleaned and my maintenance medications refilled all in the same visit.
 
You should read up on your pharmacy law.

If the board of pharmacy decided to do an audit on that store, the pharmacist would potentially face fines for dispensing to a practitioner practicing out of their scope of practice. You would also be in trouble for illegally practicing medicine.

And if there is insurance involved, they WILL come in and audit. They keep track of prescribers and drugs. They will look up all of the DDS/DMDs in their records and go looking for any nondental meds. Back when I used to do retail, we lost a few thousand dollars from allowing a dentist to prescribe birth control to his wife and daughter over the course of a few years.

Just how it goes. It's nothing personal, it's just the law and finance of the situation.
 
I have an honest question and legit gripe. If I'm wrong please let me know but no need to flame me.
 
WVUPharm2007 said:
You should read up on your pharmacy law.

If the board of pharmacy decided to do an audit on that store, the pharmacist would potentially face fines for dispensing to a practitioner practicing out of their scope of practice. You would also be in trouble for illegally practicing medicine.

And if there is insurance involved, they WILL come in and audit. They keep track of prescribers and drugs. They will look up all of the DDS/DMDs in their records and go looking for any nondental meds. Back when I used to do retail, we lost a few thousand dollars from allowing a dentist to prescribe birth control to his wife and daughter over the course of a few years.

Just how it goes.
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Thank you very much. That's all I needed to know.
 
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All4MyDaughter said:
Speaking only about the law in my home state, simvastatin would not be within a dentist's scope of practice, which is limited by law to "the oral cavity."
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Thank you. I thought that was the reason but he should have called me and said so.
 
All4MyDaughter said:
Speaking only about the law in my home state, simvastatin would not be within a dentist's scope of practice, which is limited by law to "the oral cavity."
Click to expand...

I would venture to guess that this law applies to all states. In Texas, any prescription written by a dentist must be required to have a "dental purpose."
 
I have a question for the OP. Did you ask the pharmacist for clarification when he told you he couldn't fill the RX? Was this a called in or dropped off RX? If you dropped it off with a tech, I can see why you weren't informed up front b/c the tech probably didn't catch it or doesn't know any better.
 
WVUPharm2007 said:
Well. You predict WRONG.
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It may still happen. Your answer was very reasonable. I didn't say YOU were going to start the flamewar!! I just referenced that DPM incident b/c it's the one that came to mind. 😀

The thread title alone is enough to bring on the flames. How long before someone calls someone else a douchebag or a *****?
 
In my state we aren't allowed to write scripts for ourselves. I'm a little surprised that you are able to. I imagine however that the Pharm is giving you grief because they feel that you are "practicing outside the scope of dentistry". I usually make a point of going to the pharmacies that I call Rxs into frequently and meeting the PharmDs so that they know who I am when one of my scripts comes their way. It tends to cut down on most of the BS like this.
 
All4MyDaughter said:
It may still happen. Your answer was very reasonable. I didn't say YOU were going to start the flamewar!! I just referenced that DPM incident b/c it's the one that came to mind. 😀

The thread title alone is enough to bring on the flames. How long before someone calls someone else a douchebag or a *****?
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*****!
 
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It's nothing personal. A dentist prescribing cholesterol meds is out of scope of practice. I wouldn't have filled it either. I had a prescription one time that an OD called in for "Levitra 20 mg 1 tab po 1 hour prior to intercourse." I wasn't licensed at the time, and the pharmacist on duty filled it even though I told her not to. She said she wasn't going to get into a scope of practice argument with a doctor. I said well, this guy isn't a real "doctor", at least in the common vernacular the word is used. I told the pharmacist that she was as much of a "doctor" as the OD was and tell that eye dude he has no business prescribing ED meds. I should of contacted the optometry board. It would have been totally different if it were an ophthalmologist prescribing it, since they are MDs.
 
Daurang said:
The Costco pharmacist just told me he can't fill my script for simvastatin 20mg 100 tab for myself because I'm "a DMD".
Click to expand...

couldn't the pharmacist report you to your dental board? a dentist has as much of a right to prescribe simvastatin as the actor who played doogie howser.
 
WVUPharm2007 said:
You should read up on your pharmacy law.

If the board of pharmacy decided to do an audit on that store, the pharmacist would potentially face fines for dispensing to a practitioner practicing out of their scope of practice. You would also be in trouble for illegally practicing medicine.

And if there is insurance involved, they WILL come in and audit. They keep track of prescribers and drugs. They will look up all of the DDS/DMDs in their records and go looking for any nondental meds. Back when I used to do retail, we lost a few thousand dollars from allowing a dentist to prescribe birth control to his wife and daughter over the course of a few years.

Just how it goes. It's nothing personal, it's just the law and finance of the situation.
Click to expand...

This.
 
BMBiology said:
couldn't the pharmacist report you to your dental board? a dentist has as much of a right to prescribe simvastatin as the actor who played doogie howser.
Click to expand...

Yes, the pharmacist could report the Dentist and the Dentist would be disiplined. I have done it myself to a Dentist who called in a script for Bactrim DS and stated it was for a urinary tract infection. The Dentist told the investigator from the state police that he was a Doctor and could prescribe whatever he wanted. Last I heard the Dentist was getting his license suspended. (I was unofficially told this wasn't the Dentists first infraction.)
 
Daurang said:
The Costco pharmacist just told me he can't fill my script for simvastatin 20mg 100 tab for myself because I'm "a DMD". What hell is that supposed to mean? I didn't know I can give out Percocet to other people but I can't refill some cholesterol med for myself. If he won't fill a script due to whatever reason, isn't it his duty to call and inform me on the phone so I can cancel or correct it; so a patient or me don't waste our time in line to pick up nothing?😡
Click to expand...

Where in the hell did you get the idea that you could prescribe whatever you wanted? Did you miss the day in Dental school where they covered scope of practice? Percocet for pain after a detal procedure is a whole hell of alot different than simvastatin for cholesterol.

Yes it is his duty to call and inform you that you are a ******* and he will be reporting you to the State Dental Board.
 
Daurang said:
The Costco pharmacist just told me he can't fill my script for simvastatin 20mg 100 tab for myself because I'm "a DMD". What hell is that supposed to mean? I didn't know I can give out Percocet to other people but I can't refill some cholesterol med for myself. If he won't fill a script due to whatever reason, isn't it his job his obligation to call and inform me so I can cancel or correct it? Should I file a complaint against him?😡
Click to expand...

Gee I thought it was YOUR job to know what the hell you can and can't do. Good thing the pharmacist was paying attention. Just in case you were wondering you can't perfom open heart surgery or do brain surgery either. You are a Dentist you do teeth. Next time you wonder if you can do something ask yourself this, does it have to do with teeth? No...then you can't do it.

Yes, please file a complaint against the pharmacist and let the pharmacist file one against you and see who gets the smack put down on them. I will give you a clue...it has do with teeth.....
 
MountainPharmD said:
Gee I thought it was YOUR job to know what the hell you can and can't do. Good thing the pharmacist was paying attention. Just in case you were wondering you can't perfom open heart surgery or do brain surgery either. You are a Dentist you do teeth. Next time you wonder if you can do something ask yourself this, does it have to do with teeth? No...then you can't do it.

Yes, please file a complaint against the pharmacist and let the pharmacist file one against you and see who gets the smack put down on them. I will give you a clue...it has do with teeth.....
Click to expand...


You can go back to counting pills now... 😎
 
Reminds me of the time some dentist called up while I was still at CVS and prescribed Cipro 4 grams four times a day for a UTI. I asked the dentist to verify the dose again and she kept insisting that it was correct.

My reaction was this:

thesituationwat.gif


Ended up finally 4 days later after massive arguing that the dose was gonna be Cipro 750 mg 4 times a day. Still too high IMO and still for a UTI.
 
MountainPharmD said:
Gee I thought it was YOUR job to know what the hell you can and can't do. Good thing the pharmacist was paying attention. Just in case you were wondering you can't perfom open heart surgery or do brain surgery either. You are a Dentist you do teeth. Next time you wonder if you can do something ask yourself this, does it have to do with teeth? No...then you can't do it.

Yes, please file a complaint against the pharmacist and let the pharmacist file one against you and see who gets the smack put down on them. I will give you a clue...it has do with teeth.....
Click to expand...

Hate to see such a harsh response, but you speak the truth. Ideally, you'd see the same type of restrictions placed on psychiatrists prescribing something "out of scope" like simvastatin, but from what I gather, as an MD of any type, all of your Rx's will be filled by pharmacists nationwide.
 
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MountainPharmD said:
Gee I thought it was YOUR job to know what the hell you can and can't do. Good thing the pharmacist was paying attention. Just in case you were wondering you can't perfom open heart surgery or do brain surgery either. You are a Dentist you do teeth. Next time you wonder if you can do something ask yourself this, does it have to do with teeth? No...then you can't do it.

Yes, please file a complaint against the pharmacist and let the pharmacist file one against you and see who gets the smack put down on them. I will give you a clue...it has do with teeth.....
Click to expand...

mmmmmmmhm. as a pharmacist, you may want to look into what our job entails so you can perform your job. Legally and ethically, we can prescribe anything to the patient regarding the oral cavity, relating structures, and their visit to the dental office. So yes, we can prescribe a antianxiety medication if it will allow us to perform our job.

I do know states differ by law, but here is Indiana for you:
"IC 25-14-1-23
Practice of dentistry; delegation; procedures prohibited to be delegated; dental students; pharmacists filling prescriptions; services dental assistants may perform
. . .
(f) Licensed pharmacists of this state may fill prescriptions of licensed dentists of this state for any drug necessary in the practice of dentistry."

Source: http://www.in.gov/legislative/ic/code/title25/ar14/ch1.html

So, technically speaking, if the OP could not practice dentistry without the prescription, then the pharmacist should have filled it!

Okay! does everyone understand now? Do they teach you that in pharm school?
 
Doc Smile said:
mmmmmmmhm. as a pharmacist, you may want to look into what our job entails so you can perform your job. Legally and ethically, we can prescribe anything to the patient regarding the oral cavity, relating structures, and their visit to the dental office. So yes, we can prescribe a antianxiety medication if it will allow us to perform our job.
Click to expand...

Who said that you couldn't perscribe an anti-anxiiety medication for procedural sedation? The question in the OP was about simvastatin.

I do know states differ by law, but here is Indiana for you:
"IC 25-14-1-23
Practice of dentistry; delegation; procedures prohibited to be delegated; dental students; pharmacists filling prescriptions; services dental assistants may perform
. . .
(f) Licensed pharmacists of this state may fill prescriptions of licensed dentists of this state for any drug necessary in the practice of dentistry."

Source: http://www.in.gov/legislative/ic/code/title25/ar14/ch1.html

So, technically speaking, if the OP could not practice dentistry without the prescription, then the pharmacist should have filled it!

Okay! does everyone understand now? Do they teach you that in pharm school?
Click to expand...

Okay! Now, please explain how an HMG-CoA reductase inhibitor (self prescribed, even) is necessary to the practice of dentistry. What disease of the oral cavity is being treated and/or what procedure requires simvastatin and for what purpose?
 
joefosho315 said:
Hate to see such a harsh response, but you speak the truth. Ideally, you'd see the same type of restrictions placed on psychiatrists prescribing something "out of scope" like simvastatin, but from what I gather, as an MD of any type, all of your Rx's will be filled by pharmacists nationwide.
Click to expand...

The law in my state says that scope of practice for MD/DOs is "the human body." So legally, they are entitled to write for any medication. Not that it is a good idea for physicians to be practicing way outside of their scope... It's also within the pharmacist's professional judgment and ethical responsibility to refuse to fill any RX that isn't in the best interest of the patient or is legally/ethically questionable. But most of the time, an MD/DO is allowed to prescribe just about anything.
 
Sparda29 said:
Ended up finally 4 days later after massive arguing that the dose was gonna be Cipro 750 mg 4 times a day. Still too high IMO and still for a UTI.
Click to expand...

Why did your pharmacist even fill that? Cipro is BID and while there are a few indications that have TID dosing, UTI isn't one of them and definitely not TID. Plus, a dentist can't treat a UTI. I'm surprised your pharmacist didn't just turn that RX down.


EDIT: The last time you told this story, the dentist was treating a respiratory infection: http://forums.studentdoctor.net/showthread.php?t=719918&highlight=cipro

🙄
 
Doc Smile said:
mmmmmmmhm. as a pharmacist, you may want to look into what our job entails so you can perform your job.
Click to expand...

Thanks for the tip I will have to get right on that. Maybe you can help me out and find the law or regulation that says it is okay for a dentist to prescribe cholesterol medicince for themselves.

Doc Smile said:
Legally and ethically, we can prescribe anything to the patient regarding the oral cavity, relating structures, and their visit to the dental office. So yes, we can prescribe a antianxiety medication if it will allow us to perform our job.?
Click to expand...

Wow!!! You guys are geniuses over here. Really? A dentist can prescribe anything related to the oral cavity and related structures? I had no idea!!! What a great bit of info. Now it all makes sense....after all this time practicing pharmacy I never knew. Oh, thanks for the antianxiety example but we are talking about a dentist prescribing cholesterol medicince for himself. A bit of a different situation.

Doc Smile said:
So, technically speaking, if the OP could not practice dentistry without the prescription, then the pharmacist should have filled it!

Okay! does everyone understand now? Do they teach you that in pharm school?
Click to expand...

I am going to let this brilliant comment slide. I assume you are being facetious here.
 
All4MyDaughter said:
Who said that you couldn't perscribe an anti-anxiiety medication for procedural sedation? The question in the OP was about simvastatin.



Okay! Now, please explain how an HMG-CoA reductase inhibitor (self prescribed, even) is necessary to the practice of dentistry. What disease of the oral cavity is being treated and/or what procedure requires simvastatin and for what purpose?
Click to expand...

Actually, statins may prevent periodontal disease. So, stick that in your pill bottle and shove it 😎
 
dentaldawg32 said:
Actually, statins may prevent periodontal disease. So, stick that in your pill bottle and shove it 😎
Click to expand...

I asked a serious question and was polite while I did so. Any particular reason you're trying to be an ass to me?

I don't think your explanation is sufficient. Uncontrolled DM can contribute to peridontal disease as well. That doesn't mean that dentists should RX insulin and manage diabetes.
 
dentaldawg32 said:
Actually, statins may prevent periodontal disease. So, stick that in your pill bottle and shove it 😎
Click to expand...

Wow. That's a malignant response to a legitimate question.

So, as a dentist, if you prescribe a statin for periodontal disease, do you:

a) Check cholesterol levels?
b) Have the patient come back in a month to follow up? and
c) Do you recheck their cholesterol levels (AND at least LFTs, if not a CMP!) every 3-6 months until stable?

If you don't, then you have no business prescribing statins. Statins aren't benign drugs and if you don't do the followup, then that's just bad medicine.
 
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All4MyDaughter said:
I asked a serious question and was polite while I did so. Any particular reason you're trying to be an ass to me?

I don't think your explanation is sufficient. Uncontrolled DM can contribute to peridontal disease as well. That doesn't mean that dentists should RX insulin and manage diabetes.
Click to expand...

I was being a smartass, clearly you didn't catch that. You asked me, and I quote, "What disease of the oral cavity is being treated and/or what procedure requires simvastatin and for what purpose?"

I just gave you an answer. You're welcome.
 
smq123 said:
Wow. That's a malignant response to a legitimate question.

So, as a dentist, if you prescribe a statin for periodontal disease, do you:

a) Check cholesterol levels?
b) Have the patient come back in a month to follow up? and
c) Do you recheck their cholesterol levels (AND at least LFTs, if not a CMP!) every 3-6 months until stable?

If you don't, then you have no business prescribing statins. Statins aren't benign drugs and if you don't do the followup, then that's just bad medicine.
Click to expand...

The person asked a question concerning what condition in the oral cavity statins could be used to treat. I gave her a completely legitimite answer. My follow-up remark, while childish, was tounge-in-cheek.

The link between statins and periodontal disease is well documented in the literature and I wouldn't be surprised if it becomes one of the many weapons in the arsenal of treating perio disease in the future. Obviously, any treatment plan using a statin for that purpose would be done in collaboration with the patient's physician.
 
dentaldawg32 said:
I was being a smartass, clearly you didn't catch that. You asked me, and I quote, "What disease of the oral cavity is being treated and/or what procedure requires simvastatin and for what purpose?"

I just gave you an answer. You're welcome.
Click to expand...

I got the smartass part. That's why I asked you why you were trying to be an ass, which you continue to do. It's childish and not necessary. It doesn't strengthen your position.

I read your answer to my question, but I think it's insufficient. I don't believe a dentist should prescribe a statin for that purpose. While statins may help reduce a risk factor that can contribute to peridontal disease, general management of that risk factor is outside of the scope of dentistry, in my opinion.
 
dentaldawg32 said:
In medicine, there are no "requirements," only options or alternatives.
Click to expand...

Not really. There IS something called "standard of care." Statins are not yet part of the standard of care for periodontal disease, and I find it unlikely that dentists could uphold the standard of care for prescribing statins. And not everyone with hyperlipidemia should be on a statin, anyway.
 
smq123 said:
Perhaps. There IS something called "standard of care." Statins are not yet part of the standard of care for periodontal disease, and I find it unlikely that dentists could uphold the standard of care for prescribing statins. And not everyone with hyperlipidemia should be on a statin, anyway.
Click to expand...

Perhaps, indeed.
 
dentaldawg32 said:
In medicine, there are no "requirements," only options or alternatives.
Click to expand...

I don't agree with this. Type 1 DM requires exogenous insulin. Hypothyroidism requires replacement of thyroid hormone. And so on...

smq123 said:
Not really. There IS something called "standard of care." Statins are not yet part of the standard of care for periodontal disease, and I find it unlikely that dentists could uphold the standard of care for prescribing statins. And not everyone with hyperlipidemia should be on a statin, anyway.
Click to expand...

Agree with all of this. Statins are not within the DMD/DDS scope of practice in my state and I'd venture to say that most pharmacists wouldn't fill them for "prevention of peridonal disease." I also think most DMD/DDS prescribers wouldn't try to write for them, and probably wouldn't want to deal with the hassle of monitoring and follow up that statins require anyway.
 
All4MyDaughter said:
I don't agree with this. Type 1 DM requires exogenous insulin. Hypothyroidism requires replacement of thyroid hormone. And so on...



Agree with all of this. Statins are not within the DMD/DDS scope of practice in my state and I'd venture to say that most pharmacists wouldn't fill them for "prevention of peridonal disease." I also think most DMD/DDS prescribers wouldn't try to write for them, and probably wouldn't want to deal with the hassle of monitoring and follow up that statins require anyway.
Click to expand...

You're missing my point. I repeat,

"The link between statins and periodontal disease is well documented in the literature and I wouldn't be surprised if it becomes one of the many weapons in the arsenal of treating perio disease in the future. Obviously, any treatment plan using a statin for that purpose would be done in collaboration with the patient's physician."

Never did I say that statins are being utilized now to treat periodontal disease in the population (research is still being done obviously). In the near future, though, it is likely that they will be used. We very well then may see the role of the dentist expand to reflect that of the important relationship between oral and systemic health. Despite what you think, not all dentists are interested in just drilling and filling.

In response to your statement that dentists wouldn't want to "deal" with monitoring statins, well, that is why I said that any sort of treatment plan would be carried out in collaboration with the patient's physician.
 
dentaldawg32 said:
Never did I say that statins are being utilized now to treat periodontal disease in the population (research is still being done obviously). In the near future, though, it is likely that they will be used.
Click to expand...

Who sold you *that* line? Pfizer?

There are cheaper, easier, and more benign ways to prevent and treat periodontal disease. If anything, I would bet (and hope) that more money goes into teaching common sense ways of preventing disease. It's cheaper to tell people to stop smoking, brush their teeth, and floss more often, than putting a statin in their hand. If nothing else, brushing and flossing don't jack up your LFTs or your CPK like statins potentially can.

dentaldawg32 said:
In response to your statement that dentists wouldn't want to "deal" with monitoring statins, well, that is why I said that any sort of treatment plan would be carried out in collaboration with the patient's physician.
Click to expand...

This is not the way it works. You don't prescribe a medication and expect the PCP to do all the followup work. If you prescribe it, then it lies on YOU to follow it up. The reverse holds true - if you do the followup, then it's up to you to adjust the dose as necessary. I don't see that as being a "collaborative" effort. What you're basically saying is that the dentist will advise that the patient start a statin, but will leave it up to the PCP to figure out if a) this is feasible, and b) at what dose. In any case, the dentist isn't going to be prescribing it.
 
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