Raging MD's @ Poor PharmD's

[Mags]

(yes I rhymed)


So I had a doc call back and rage at me today. B/c I had called saying an insurance wouldnt cover item A;
him: why not?
me: probably b/c its an inappropriate use (this slipped out before I could stop myself.)


It was, and EXTREMELY inappropriate use. Comparative to using systemic chemotherapy (take your pick, MABs, anthracyclines) for a skin wart. And also not FDA approved.

So 10 minutes after changing to something insurance would cover, he calls back raging at me that it was inappropriate for me, a pharmacist to tell him, what is and isnt appropriate. Then proceeds to verbally assault me with his resume and schooling.

Any one else had a old school doc yell at them?

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[tussionex]

um, maybe a little more details on the drugs, please? just curious!

 

[sdn1977]

um, maybe a little more details on the drugs, please? just curious!

I'd have to agree here. You can't know its inappropriate therapy unless you know the exact dx, prior therapy given with response, staging of the lesion, etc...

You refer to it as a wart - are you referring to using 5-FU???

If thats the case, you send him/her a pleasant note stating the drug requires prior auth & give the info for the office staff to take care of it.

Just because it doesn't "fit" with the official package label for indications doesn't mean it isn't standard of therapy. Likewise, it would have been horrible if you had told the pt it was inappropriate tx. That is undermining the pt-physician relationship unnecessarily, IMO.

Now you've put the physician as the "bad" guy. You both want to be on the same team for the pt. So -there are other wasys you might have approched this.

 

[Mags]

You refer to it as a wart - are you referring to using 5-FU???

No its just an example b/c I would rather not give out specifics.

Likewise, it would have been horrible if you had told the pt it was inappropriate tx. That is undermining the pt-physician relationship unnecessarily, IMO.

I did NOT do that. So no I didnt tell the patient that no. And as I said above unfortunately it did "slip out" before I could stop myself. It wasnt intended

 

[WVUPharm2007]

Oh well. Some dingus physician thinks you are undermining his God-like authority and brilliance. It happens. Now personally, I would have hung up on his ass. He isn't your superior in any way what so ever. Of course if you work in a corporate retail environment, he could bitch to your DM. There's always that. Good 'ol CVS, chopping off all of our balls with a pair of hedge clippers.

Physicians that try to flash their credentials always crack me up. Seriously, who the **** are you? I've got a doctorate in drugs. Hell, I can draw the chemical structure of the drug right now off the top of my head, let alone tell you what it does.

Further, you were right in what you told him. It didn't go through because the insurance indicates that it is an inappropriate use of the drug for that indication. Tell him you're just passing along what they say.

 

[Mags]

O I would have hung up on his ass.

I eventually had to. Wouldnt let me get a word in edge wise, was rallying off his qualifications and residency and why I was , pretty much, beneath him in superiority, and I had a line full of patients waiting for counseling, two transfers holding and an otc consult waiting as well. I couldnt even get a word in edge wise to say I had to go

 

[BMBiology]

I tried not to question a physician therapy because frankly, I have not examined the patient and can't say what's in the best interest of the patient. However, if a patient asked about my experience with a particular drug then I would give my honest opinion.

 

[OSUpharmy]

It seems really strange at a pharmacy forum. But alot of times when a pharmacist has a conflict and blows off steam about it here there is a rush to judgement against the pharmacist? Aren't you guys supposed to band together instead of immediately thinking the pharmacist must have been in the wrong?

 

[PharmDstudent]

I eventually had to. Wouldnt let me get a word in edge wise, was rallying off his qualifications and residency and why I was , pretty much, beneath him in superiority, and I had a line full of patients waiting for counseling, two transfers holding and an otc consult waiting as well. I couldnt even get a word in edge wise to say I had to go

I think you "won", if that's any consolation.
You were a target for the physician. It was unlucky for you that this happened, but I think he was out to scold someone.
You stopped him short, therefore you "won" your dignity back. Anyone who rants over the phone to another health professional should reconsider their tact.
Patients chose their pharmacists just like they chose their physicians. No one is godly!

 

[sdn1977]

It seems really strange at a pharmacy forum. But alot of times when a pharmacist has a conflict and blows off steam about it here there is a rush to judgement against the pharmacist? Aren't you guys supposed to band together instead of immediately thinking the pharmacist must have been in the wrong?

No - we're expected to use our best clinical judgment, whether we are the ones actually working or giving our input into a situation which was someone else's case. So, we give our opinion on what is presented to us - which, in this case, was not the whole story.

After being presented with a few more facts, and leaving all emotion from all sides out - there are lots of valid opinions on what perhaps could or couldn't have been done to change or improve the situation. Sometimes, nothing can change what happens or you look back & say you'd do the same thing all over again. The OP knows once the prescriber started his rant, he wasn't going to "hear" anything (this works with disgruntled patients & unhappy children of your own).

The profession is not a fraternity where we "band" together in all circumstances & at all costs. It is not "us" against "them" (the "them" being the prescriber, patient, corporation, whomever). We are all supposed to be working together for the good of the patient, which obviously the OP was trying to do.

But, medicine is not black & white. What is listed in package inserts tells only a minor part of what that drug can & will do.

The OP came here to vent, which hopefully helped him/her feel better & perhaps to get another take on what he might have done differently (he obviously mentioned he let something "slip" which indicates he wished he hadn't said that).

Our comments might be taken to heart to help as he continues in his profession - or they might be totally ignored. But, it is not mature to try to see the situation as observed from a different perspective,whether it is the prescriber, as in this case or the patient. That helps to determine how much & how far you want to go in using particular language - not question, but just in how you present the question.

 

[sdn1977]

In an attempt to keep my posts short (I do try Caverject!!!!!) - I'll give an example of mine from last week that might have turned out differently had I not handled it the way I did.

I have a pt who had a PE a few months ago - got standard tx, currently on warfarin. But, altho I knew she was not improving, I didn't know the extent of her disease.

So - I'm sent a Lovenox rx by e-rx with a HUGE, WHOPPING DOSE - even for a woman her size.

So, I talk to the pt. She is going to a major university in S CA for a procedure which is only done by some great person down there. I tell her I have the rx & get the time frame of her departure & tell her I want to just get the dose clear so I am sure to send her with enough. See - in her mind, I've got no questions - I just want to get her what she needs so she doesn't have to chase around in an unknown area getting Lovenox.

Now - I call the Dr office - one of these huge clinic type things that you have to go thru lots of people & leave messages & I knew I'd probably get something cryptic back - yes, thats what I want.

But - surprisingly no. I talk to the nurse & verify the dose. But, she says - I think the Dr was expecting your call. I explain this is a really, really large dose & one that was twice what she was on after her initial PE and I'm just concerned that I was not reading his rx clearly. So...we have this conversation about what this woman has suffered - multiple emboli in both lungs which are not resolving, scarring in not just her lungs, but in her PA, PV & all this is impacting her CO. She is going to this physician who is only one of two on the west coast (the other is in Seattle) who will do this surgery to remove some of the emboli & scar tissue in hopes to lessen further damage to the lungs & heart.

He says he knew I'd call & wonder if he'd gotten the decimals right or done the math right, but he was following the protocol sent to him by this S CA physician & gave me the article reference. He wanted me to read it & get back to him if I had a different take on what the dosing was - I didn't.

So - we had a great discussion, he thanked me for facilitating her access to medication (I had to bill it twice since insurance limited payment to $1000 per billing & there was no time for a PA), I learned something & when I actually did the counseling with the pt, I could answer her questions more completely than I might have otherwise.

This is how the "best" encounters go. They don't always go this way & I've had those just like the OP - a phone rant. As time goes by though, I've learned that if I present my question in such a manner that I'm trying to be careful I've not made a mistake or misinterpreted the prescribers instructions (self-deprecating perhaps)...then, the prescriber is more open to a "coversation" rather than a "confrontation".

Just a different experience which may or may not help your encounters in the future.

Good luck!

 

[Mags]

The OP came here to vent, which hopefully helped him/her feel better & perhaps to get another take on what he might have done differently (he obviously mentioned he let something "slip" which indicates he wished he hadn't said that).

Our comments might be taken to heart to help as he continues in his profession - or they might be totally ignored. But, it is not mature to try to see the situation as observed from a different perspective,whether it is the prescriber, as in this case or the patient. That helps to determine how much & how far you want to go in using particular language - not question, but just in how you present the question.

Um excuse me. "Ahem"
Look up above, I'm a female. Mags is a female name. So its "she"

also, what the heck is OP, Im not familiar with that abbreviation at all.

Also I think you made a typo
I personally think it is EXTREMELY mature to try and see anothers perspective, as it aids in care

 

[BrownSound]

I think OP means Original Poster.

 

[sdn1977]

Um excuse me. "Ahem"
Look up above, I'm a female. Mags is a female name. So its "she"

also, what the heck is OP, Im not familiar with that abbreviation at all.

Also I think you made a typo
I personally think it is EXTREMELY mature to try and see anothers perspective, as it aids in care

Sorry Mags - I've been mistaken for a male many times as well!

How could anyone mistake these legs, I say!!!

 

[Mags]

Sorry Mags - I've been mistaken for a male many times as well!

How could anyone mistake these legs, I say!!!

Haha! ditto! Mine are 2/3's of my body I swear. No worries