Pharmacist rejecting/objecting on Pods scripts

[cool_vkb]

hey iam kind of confused. since no one is posting anything now a days, i was getting bored , so i was browsing older posts and found a post, it was saying that Pharmacists objecting to fill prescription for Pods (if they think are unnecessary) or something. i exactly didnt got it.

Can someone explain me once again, wat that debate was all about and right now, if i prescribe anything are there any chances that now a Pharmacist will detrmine if my script is appropriate or not.

i feel very uneasy, its going to be very insulting if ur prescription is turned down and how wud it affect my repuation among patients. Am i understanding the concept wrong or it is true that Pharmacist will determine whether my scripts are appropriate or not, before dispensing.

And another question was, do we get any bacterial or viral infections in Feet. i never saw any disease or ailment where there are bacterias affecting feet and pod treating that. I know tat we get Fungal infections in feet. Bcoz even in Curriulum there isnt any class like "Infectious Diseases", etc where students could be prepared for infections. is pods basic practice mainly focussed on orthopedics(foot and ankle) and treating Diabetes and wound management more than infectious diseases.

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[cool_vkb]

hello where r u guys! r the pod schools having exams ? nobody is on SDN.

 

[OOK]

hey iam kind of confused. since no one is posting anything now a days, i was getting bored , so i was browsing older posts and found a post, it was saying that Pharmacists objecting to fill prescription for Pods (if they think are unnecessary) or something. i exactly didnt got it.

Can someone explain me once again, wat that debate was all about and right now, if i prescribe anything are there any chances that now a Pharmacist will detrmine if my script is appropriate or not.

Just FYI, it does happens in Chiropractor's case. not in prescription (haha! they dont prescribe). But in Imaging Center, we once had a Chiropractor referred a patient for a Brain MRI, when we contacted the insurance company they were so furious as it was well out of the range of a chiro, so they declined to pay for it. And same once happened for a Podiatrist who wanted to had an MRI for something else which had nothing to do with foot. But this applies to regular MDs also if the insurance thinks its a waste of money, they dont pay for it.

So in a way, i can understand if they are doing for saving money. but regarding prescription issue, i feel very uneasy. Am i understanding the concept wrong or it is true that Pharmacist will determine my scripts before dispensing.

Pharmacists have the right to question prescriptions from any doc.
example: if a neurologist prescribes naftin the pharmacist can call to ask why. But if you explain to her why you prescribe the med. she has no right to object

 

[IlizaRob]

hey iam kind of confused. since no one is posting anything now a days, i was getting bored , so i was browsing older posts and found a post, it was saying that Pharmacists objecting to fill prescription for Pods (if they think are unnecessary) or something. i exactly didnt got it.

Can someone explain me once again, wat that debate was all about and right now, if i prescribe anything are there any chances that now a Pharmacist will detrmine if my script is appropriate or not.

i feel very uneasy, its going to be very insulting if ur prescription is turned down and how wud it affect my repuation among patients. Am i understanding the concept wrong or it is true that Pharmacist will determine whether my scripts are appropriate or not, before dispensing.

And another question was, do we get any bacterial or viral infections in Feet. i never saw any disease or ailment where there are bacterias affecting feet and pod treating that. I know tat we get Fungal infections in feet. Bcoz even in Curriulum there isnt any class like "Infectious Diseases", etc where students could be prepared for infections. is pods basic practice mainly focussed on orthopedics(foot and ankle) and treating Diabetes and wound management more than infectious diseases.

Pharmacists can refuse to fill any prescription, regardless of who prescribed it. But unless you are prescribing birth control pills, this wont happen much.

As far as infectious deases go, are you talking about systemic infections or local infections like osteo? A pod can treat a systemic infection by admitting the patient to the hospital and starting IV antibiotics with a consult to medicine. The infection will most likely be derived from some foot ailment (ulcer) otherwise Im not sure why you would be seeing the patient in the first place. Did I understand your question correctly?

 

[cool_vkb]

As far as infectious deases go, are you talking about systemic infections or local infections like osteo? A pod can treat a systemic infection by admitting the patient to the hospital and starting IV antibiotics with a consult to medicine. The infection will most likely be derived from some foot ailment (ulcer) otherwise Im not sure why you would be seeing the patient in the first place. Did I understand your question correctly?

nope u didnt understood my question,

my question was is are there any infections caused by bacteria or virus on the foot or ankle just there only not systemic, like how fungus causes athelete foot, something like that. lemme explain again, are there any infections or diseases where bacterias or virus attacks the foot (just the foot, nothing else)

i never heard of a pod who treats any disease where a bacteria or a virus is involved, are these cases very rare. is our practice's bread and butter are orthopedic surgery and wound management (including diabetes) usually or are there some cases where we prescribe antibiotics to kill the microorganisms.

 

[dawg44]

Pharmacists used to question me occasionally when I was an intern and writing all kinds of scripts. Now since I'm an orthopod I never get called, because all I know how to write for is Vicodin and Keflex and I can typically get those right.

 

[jonwill]

nope u didnt understood my question,

my question was is are there any infections caused by bacteria or virus on the foot or ankle just there only not systemic, like how fungus causes athelete foot, something like that. lemme explain again, are there any infections or diseases where bacterias or virus attacks the foot (just the foot, nothing else)

i never heard of a pod who treats any disease where a bacteria or a virus is involved, are these cases very rare. is our practice's bread and butter are orthopedic surgery and wound management (including diabetes) usually or are there some cases where we prescribe antibiotics to kill the microorganisms.

We prescribe antibiotics a lot with diabetic foot infections, gangrene, nec fas, osteo, or even as simple as an ingrown infected nail. You will also prophylax a lot of your surgical cases and keep them on antibiotics after the surgery.

6 weeks ago, we got called to the ER for an open ankle wound. The patient subsequently devleloped osteo of the distal tibia. We went in and resected the bone and then put him on 6 weeks of antibiotics. After that, we went back in (after a negative bone scan), cleaned him out again, and took a bone culture. It came back negative so last Friday, we placed a femoral head in the defect and threw an IM nail.

You will use antibiotics a lot so learn them well!

 

[cool_vkb]

We prescribe antibiotics a lot with diabetic foot infections, gangrene, nec fas, osteo, or even as simple as an ingrown infected nail. You will also prophylax a lot of your surgical cases and keep them on antibiotics after the surgery.

6 weeks ago, we got called to the ER for an open ankle wound. The patient subsequently devleloped osteo of the distal tibia. We went in and resected the bone and then put him on 6 weeks of antibiotics. After that, we went back in (after a negative bone scan), cleaned him out again, and took a bone culture. It came back negative so last Friday, we placed a femoral head in the defect and threw an IM nail.

You will use antibiotics a lot so learn them well!

hey iam just curious, just as we have athelete foots which we is caused by fungus. Are there any classical foot diseases (apart from gangrene and diabetic patients) which are caused by bacteria and virus. like as soon as u see the foot u cud say "oh tat is a ..... and its a .......... bacteria or a ......virus. just as soon as u see a athelete foot u assume its a fungus.

the reason iam asking so many questions abt that is, iam currently enrolled in Clinical bacteriology class in Marquette and we are now beginning to learn different bacterias but i didnt came so far which effects only foot. so i was asking.

 

[dpmgrad]

nope u didnt understood my question,

my question was is are there any infections caused by bacteria or virus on the foot or ankle just there only not systemic, like how fungus causes athelete foot, something like that. lemme explain again, are there any infections or diseases where bacterias or virus attacks the foot (just the foot, nothing else)

i never heard of a pod who treats any disease where a bacteria or a virus is involved, are these cases very rare. is our practice's bread and butter are orthopedic surgery and wound management (including diabetes) usually or are there some cases where we prescribe antibiotics to kill the microorganisms.

There is a viral infection that Podiatrists do treat on the foot. They are plantar warts, which is caused by the virus, Human Papilloma Virus (same virus that causes genital warts, cervical cancer, etc...). In terms of bacterial infection, there are many bacteria that can cause infections in the foot and ankle (as well as the rest of the body). Many infected diabetic foot wounds are infected with a variety of bacterias. Some bacteria that we may treat in the foot and ankle include Staph Auerus (MSSA and MRSA) and other Staph bugs, Strept family (there are a couple including VRE), Pseudomonas Aeruginosa, Clostridium infections, Enteric bacteria (E. Coli, Proteus, Serratia, etc...), Cornybacterium Mintissumus (Erythrasma), Actinomycetoma (Madura Foot), Peptostreptococcus, Mycobacterium (yes, you can get a TB lesion in the foot/ankle), and many more other bacteria. There are couple of fungus we treat besides the Dermatophytes (T. Rubrum, E. Floccosum, etc...). We also see Candida Albicans (yeast infection) in the foot, Eumycetoma (Madura foot). We sometimes treat parasitic infections of the foot as well.

By the way, the bread and butter for Podiatry is NOT orthopedic surgery.

 

[cool_vkb]

By the way, the bread and butter for Podiatry is NOT orthopedic surgery.

Sir, can you plzz say me what are the cases a Pod see usually (ofcourse georaphical location matters) but give a general idea.

And can u also plzz comment on the prescription issue. since u r currently in practice, ur view will be really appreciated.

 

[dpmgrad]

Sir, can you plzz say me what are the cases a Pod see usually (ofcourse georaphical location matters) but give a general idea.

And can u also plzz comment on the prescription issue. since u r currently in practice, ur view will be really appreciated.

The bread and butter of Podiatry still include routine foot care, diabetic foot care, conservative management of various foot and ankle ailments, and forefoot surgery. I am not saying that Podiatrist do not do any reconstructive rearfoot and ankle surgeries. If you look at what percentage of the surgical procedures that a Podiatrist does, I can easily say that more than 50% of the procedures are forefoot procedures. There are a very few Podiatrists that have surgical practices that do not have any routine foot care / diabetic foot care in their practice. This is not the norm. A good amount of the DPMs in the Orthopedic groups do perform some degree of routine foot care (granted, it is a lot less than a local DPM that does not do surgery).

As for prescriptions, the Pharmacist has a right to question the prescription and not fill the prescription of ANY practictioner until the problem has been resolved. Some states do have rules and regulations that limit what a DPM may prescribe. In general, if you write scripts that pertains to the treatment of the foot and ankle ailments, you should not have problems. One should expect problems from the Pharmacist if a DPM writes a script for Viagra, Birth Control Pills, Asthmatic medications, etc....

 

[PharmD/DPM]

O.K. most of you are right about the RX writing. I am still a practicing pharmacist and a soon to be podiatrist (June '08) so I can give some advice from both worlds. As a pharmacist I was taught to call doctors on obscure written RX's just to verify. Most pharmacists will not question a doctor's written RX unless it shows a drug interaction or may bring harm to the patient. Podiatrists have a DEA# to write for RX's, meaning LEGALLY they can write for whatever they want, but ETHICALLY a pharmacist may challenge the podiatrist (or any doctor) if he/she feels that the podiatrist (or MD) is not prescribing within his/her scope. That doesn't mean that I haven't seen endocrinologists write for anti-anxiety meds or psychiatrists for Viagra. I've seen it and it maybe ETHICALLY WRONG, but LEGALLY it's o.k. But, as doctors we always watch the malpractice side of things, so 99% of doctors will not write outside there scope.

 

[cool_vkb]

O.K. most of you are right about the RX writing. I am still a practicing pharmacist and a soon to be podiatrist (June '08) so I can give some advice from both worlds. As a pharmacist I was taught to call doctors on obscure written RX's just to verify. Most pharmacists will not question a doctor's written RX unless it shows a drug interaction or may bring harm to the patient. Podiatrists have a DEA# to write for RX's, meaning LEGALLY they can write for whatever they want, but ETHICALLY a pharmacist may challenge the podiatrist (or any doctor) if he/she feels that the podiatrist (or MD) is not prescribing within his/her scope. That doesn't mean that I haven't seen endocrinologists write for anti-anxiety meds or psychiatrists for Viagra. I've seen it and it maybe ETHICALLY WRONG, but LEGALLY it's o.k. But, as doctors we always watch the malpractice side of things, so 99% of doctors will not write outside there scope.

so lemme get this straight! the Pharmacist just verfies the drug but he cant deny the drug right! being a practising Pharmacist do u see these cases always or its just a rare incidence.

 

[PharmD/DPM]

A pharmacist has the legal right to deny filling and dispensing any RX from any doctor(DPM/MD/DO/DDS). All RX's are up to the discrepency of the pharmacist verifying it. Remember, the pharmacist is the last check point for a medication to go out to the patient. Rarely, will you see RX's become denied, but it does happen. Example: pharmacist uneasy with RX written(drug, dose, strength, quantity), drug-drug interaction, patient doctor shopping with multiple controlled RX's(narcotics, stimulants), doctor overprescribing(controlled substances) and side effects for the patient from the medication. I'd say for example, I'll deny to fill an RX 1/1000 RX's. Remember, as a pharmacist we are taught to look for fake scripts too. So, I know if one is written by a real doctor, or a patient who stole a doctor's script pad.