Refusing to fill for an extremely rude patient

[ChasingMyDreams]

How do you guys feel about this?

Recent Scenario:

Patient drops off and is extremely rude to the technician once they are given the price ($8). Complains loudly that they have never paid more than $3 and that this is bull****. Uses profanity about 5-7 more times during the conversation before agreeing to come back to pick up the Rx.

Rx is filled and when the patient returns to pick up they are again using profanity to express what an outrage this is. Patient is asked to refrain from using profanity and only uses more. When asked to verify information (DOB, address, etc.) patient insults employee, uses more profanity.

Patient is then refused service and hardcopy Rx is returned to them.

Leadership decides to force RPh to fill the Rx and provide an apology and a gift card.

RPh facing possible disciplinary action for refusing to fill initially.

Should we just fill Rxs even if patients are rude, using profanity and insulting staff? There is no legal obligation in my state to do so but apparently corporate feels that any legitimate Rx should be dispensed regardless of the patients behavior.



Thoughts?

---

Members don't see this ad.

 

[mentos]

If it's not a control, just fill it and get them out of the store unless you want corporate on your back. Rude customers are expected in retail.

 

[Lnsean]

How do you guys feel about this?

Recent Scenario:

Patient drops off and is extremely rude to the technician once they are given the price ($8). Complains loudly that they have never paid more than $3 and that this is bull****. Uses profanity about 5-7 more times during the conversation before agreeing to come back to pick up the Rx.

Rx is filled and when the patient returns to pick up they are again using profanity to express what an outrage this is. Patient is asked to refrain from using profanity and only uses more. When asked to verify information (DOB, address, etc.) patient insults employee, uses more profanity.

Patient is then refused service and hardcopy Rx is returned to them.

Leadership decides to force RPh to fill the Rx and provide an apology and a gift card.

RPh facing possible disciplinary action for refusing to fill initially.

Should we just fill Rxs even if patients are rude, using profanity and insulting staff? There is no legal obligation in my state to do so but apparently corporate feels that any legitimate Rx should be dispensed regardless of the patients behavior.



Thoughts?

You don't have to fill anything you don't want to...but be prepared to face the consequences. The scenario you described occurs often enough in retail that I would have thought the rph or staff would had been better prepared to address it. You guys created mountains out of molehills.

 

[Amicable Angora]

How do you guys feel about this?

Recent Scenario:

Patient drops off and is extremely rude to the technician once they are given the price ($8). Complains loudly that they have never paid more than $3 and that this is bull****. Uses profanity about 5-7 more times during the conversation before agreeing to come back to pick up the Rx.

Rx is filled and when the patient returns to pick up they are again using profanity to express what an outrage this is. Patient is asked to refrain from using profanity and only uses more. When asked to verify information (DOB, address, etc.) patient insults employee, uses more profanity.

Patient is then refused service and hardcopy Rx is returned to them.

Leadership decides to force RPh to fill the Rx and provide an apology and a gift card.

RPh facing possible disciplinary action for refusing to fill initially.

Should we just fill Rxs even if patients are rude, using profanity and insulting staff? There is no legal obligation in my state to do so but apparently corporate feels that any legitimate Rx should be dispensed regardless of the patients behavior.



Thoughts?

So this is pharmacy today eh?

 

[Lexington2012]

"Sorry, we don't have this in stock"

 

[6GodPharm]

Out of stock is the easiest. Sorry Ma'am Xanax 2mg just hasn't been coming in.

 

[lt23]

what company? controlled or not? If controlled, not even corporate can make you fill it. Red flag: unwilling to provide ID, unable to verify patient information

 

[VA77]

Hit the panic button. Cops with guns usually shut people up real quick.

 

[RxPreceptor]

I would usually just try to deflect the issue back to the insurance company...agree with the patient regardless (to keep from causing a scene/going "ape ****"). Pretty common in your community setting

 

[Slippers]

I don't think you should refuse to fill unless you believe it would be illegal or unethical for you to do so (e.g. suspected drug abuse with history of doctor shopping on controlled substance database). For the sake of playing devil's advocate, what if this person is mentally unstable? Should they be denied prescription drugs that they need because of it?

If it makes you feel any better, emergency room nurses sometimes get stuck in the same scenario. I've had a rotation in an emergency room and one day, we had a patient who was literally screaming not only profanity but racist slurs at her nurse, and accusing the nurse of "not getting her a room" and not getting her pain medication (there were no rooms available at the time, the ER was full). Meanwhile, the admit nurse was attempting to get necessary information from this patient (date of birth, past medial history, insurance, etc.). While the patient refused to directly answer most of these questions, her nurse tried to explain to her that the doctor couldn't order her pain medication until she'd been admitted to the hospital, which they could not do until she actually answered their questions. I think eventually someone had to call a security guard, but they couldn't turn her away because she was injured and needed treatment.

Obviously, the situation you described didn't require the patient to be hospitalized and so was nowhere near as serious, but it's still patient care nonetheless.

 

[CommyO]

I don't think you should refuse to fill unless you believe it would be illegal or unethical for you to do so (e.g. suspected drug abuse with history of doctor shopping on controlled substance database). For the sake of playing devil's advocate, what if this person is mentally unstable? Should they be denied prescription drugs that they need because of it?

Agreed. You're filling drugs that someone may need to live and behave normally; not serving up mcchickens. Get some tougher skin

 

[Seriously Serious]

I think you should fill regardless of their rudeness. You should fill for the safety of the patient and the pharmacy staff. Who knows what the rude patient is going through that day, or if they are acting that way due to needing their meds. If the patient is acting so severely to a 4$ difference in their meds, imagine how they would act if you turned them away? Who knows if they have a gun in their car. I only say this because I have experience a similar situation.

 

[Digsbe]

I don't think you should refuse to fill unless you believe it would be illegal or unethical for you to do so (e.g. suspected drug abuse with history of doctor shopping on controlled substance database). For the sake of playing devil's advocate, what if this person is mentally unstable? Should they be denied prescription drugs that they need because of it?

If it makes you feel any better, emergency room nurses sometimes get stuck in the same scenario. I've had a rotation in an emergency room and one day, we had a patient who was literally screaming not only profanity but racist slurs at her nurse, and accusing the nurse of "not getting her a room" and not getting her pain medication (there were no rooms available at the time, the ER was full). Meanwhile, the admit nurse was attempting to get necessary information from this patient (date of birth, past medial history, insurance, etc.). While the patient refused to directly answer most of these questions, her nurse tried to explain to her that the doctor couldn't order her pain medication until she'd been admitted to the hospital, which they could not do until she actually answered their questions. I think eventually someone had to call a security guard, but they couldn't turn her away because she was injured and needed treatment.

Obviously, the situation you described didn't require the patient to be hospitalized and so was nowhere near as serious, but it's still patient care nonetheless.

On the flip side what about the other patients? Do you think most people in the store or parents with kids want to be around someone acting like an incoherent barbarian using profanity and storming in and out? It's also about those around you too, the second a situation becomes unsafe where a patient threatens a tech or myself I'd call the cops because at that point it's a safety concern. I usually just fill things for those patients and say very little, just ignore them and give them the pills and they'll go on living their hateful existence.

 

[ChalupaBatman86]

They pushed your buttons. You've got to learn to push them back without getting in trouble. That's the greatest revenge. Don't take the bait. Smile like you are amused during their tantrum. Talk to them like they are a mentally slow 10 year old. Don't show any agitation or distress. Make sure they know the whole thing is very funny and amusing to you without outright insulting them. You win.


Sent from my iPhone using SDN mobile

 

[ldiot]

My manager used to kick people out all the time for being rude after giving them a warning first. The only exception is if delaying the med could put them in danger. Never had a problem with middle management, though to be fair I'm not sure any of the people ever put in a compliant. If your employer wants you to suck on customers' balls while they insult you over an 8 dollar co-pay then do you really want to work there?

At the end of the day though the easy solution that would probably give you the least amount of headache is to just fill it and not get into a pissing match with these kind of idiots. Just say as little as possible and nod your head... after they leave have a good laugh with your techs. If you own the pharmacy you can tell them to blow it up their ass.

 

[deleted480308]

If you don't own the shop, you fill it.

 

[lord999]

The approach that I use to take was the airline industry's indeterminate "soon" when it'll be done when I had a problem customer. Don't commit to a specific timeframe (like an hour). Say that I'm as concerned, and that we'll do it "a little while", and when the guy blows up, say "just a little bit longer". But internally, be clear that it'll be a two hour wait or more like sitting on the tarmac.

 

[Slippers]

On the flip side what about the other patients? Do you think most people in the store or parents with kids want to be around someone acting like an incoherent barbarian using profanity and storming in and out? It's also about those around you too, the second a situation becomes unsafe where a patient threatens a tech or myself I'd call the cops because at that point it's a safety concern. I usually just fill things for those patients and say very little, just ignore them and give them the pills and they'll go on living their hateful existence.

I would agree that you should absolutely call the police if the patient threatens you or anyone in the pharmacy or surrounding store with violence. It becomes a different story if the patient is endangering someone's safety. Correctional facilities also have a pharmacy, so if it escalates to that point and the patient has a medical necessity they can get it from there.

In the situation described, however, no threats were made. I do understand that this particular patient and others like him/her make it difficult for pharmacy staff and the other patients, and that getting upset over $8 is clearly ridiculous. I honestly think that most people that lose their mind like that clearly have either reached their breaking point for the day due to other issues, or they have some psychological problem. You can rest assured that if this person treats others the same way they treated the pharmacy staff, they more than likely have significant issues in other areas of their life as well.

 

[zelman]

You should call corporate and pretend to be a customer who was in line behind them. Tell them your family will never use their services again due to the acceptance of such a vulgar and aggressive environment. Also, you have two children with cystic fibrosis and had planned on getting all your vaccines there and purchase most prescriptions without using insurance or discount cards. Let corporate choose between those customer options.

 

[VA77]

Corporate is the same as independents. The same as Blacks vs. Whites. It all boils down to money no matter which side it is. Who has it and who it willing to get it. The bottom line is did the OP feel threatened or just dismiss it. Personally I don't take chances and I not willing to be a statistic for a f-ing gift card. You, as an employee, have a right to the standards under FSHA and OSHA. Think about how hard you worked for your degree to have it degraded.

 

[WVUPharm2007]

We really need to unionize.

 

[Dr Wario]

Wow are you guys serious? In my store if you pull this crap once, the script is handed back to you, twice and you are banned. Don't give me this bs about him being unstable and needing this medication, you thinking this way and giving in to this behavior is what encourages people to continue to try this crap. Maybe it is the fact that I am financially independent, but I would never tolerate this kind of stuff and corp can shove it up their asses and hand the giftcard to these jerks themselves because I sure as hell won't be doing it.

 

[Mounjaro]

Gift card?

"Thank you for those kind words you provided us last time, here's a gift card so you can purchase some chapstick"

 

[radio frequency]

I won't work for a place that doesn't allow me to call security on unruly patients (actual security, not fake Walgreens security) or refuse to fill for them. I have asked patients to shape up and be respectful or else we would transfer their prescriptions to the pharmacy of their choice. They always shaped up. If you let people walk all over you, they will.

 

[ldiot]

I won't work for a place that doesn't allow me to call security on unruly patients (actual security, not fake Walgreens security) or refuse to fill for them. I have asked patients to shape up and be respectful or else we would transfer their prescriptions to the pharmacy of their choice. They always shaped up. If you let people walk all over you, they will.

Exactly. I simply ignore it and if they get vulgar they get the "I'm working on your prescription, but if you are going to talk like that you'll have to go somewhere else". Most of them settle down and if not bye bye. The more you enguage them the worse it gets in most cases so I just let them vent. Even if someone isn't profane you still have to step in and resolve it if they are giving a tech a hard time, they are getting like 8 dollars an hour to put up with this crap so the least you can do is have their back imo

I didn't know there were pharmacies with security... WAGS has actual on duty security? The heck?

 

[FarmD711]

I do not tolerate swearing or yelling from my customers. They get one warning. After that they are not getting any prescriptions from me.

I work chain retail and have never been written up/counseled etc for banning customers that violate this rule.


Sent from my iPhone using SDN mobile

 

[sosoo]

you would think 1 person insulting you is bad. your other customers will look at u in a pathetic way, and they will gang up and jump in to give u more insults..... it's bad for business and u have to turn them away from the very beginning (the very first profanity/insult).. and flag their profile so you know what to do next time.

 

[radio frequency]

Exactly. I simply ignore it and if they get vulgar they get the "I'm working on your prescription, but if you are going to talk like that you'll have to go somewhere else". Most of them settle down and if not bye bye. The more you enguage them the worse it gets in most cases so I just let them vent. Even if someone isn't profane you still have to step in and resolve it if they are giving a tech a hard time, they are getting like 8 dollars an hour to put up with this crap so the least you can do is have their back imo

I didn't know there were pharmacies with security... WAGS has actual on duty security? The heck?

I work in a nontraditional setting. We have security.

Back when I was in a regular setting I had patients who would make my techs cry. That was horrible. I didn't even know what to do other than ask them to not be disrespectful, but it didn't feel like enough.

 

[zelman]

Drug topics got this covered:
http://drugtopics.modernmedicine.co...3B-98A5-C114477DC635&rememberme=1&ts=18022017
Problem solved.

 

[Albo]

I think the original question was not what would you do in this situation but it is legal for us to refuse a non controlled RX based on patient behavior.

 

[Wickett]

I think the original question was not what would you do in this situation but it is legal for us to refuse a non controlled RX based on patient behavior.

I don't think legality was the question, since retail pharmacies aren't legally obligated to fill any prescription.

 

[Mao263]

Since Rx became electronics, you predict now if that patient will show up again.
In the medical office I used to work, we constanly received phone calls from the patients complaining that doctors never sent the e-Rx. I logged into the program to verify and it was sent. I don't the real story whether it wasn't received or pharmacist forget to fill it or whatever.
Next time tell the patient that you never got e-Rx. Don't bill the insurance so he won't have a proof.
This story reminds one of the patient in our office. Every time I called the pharmacy for any issues about her, I heard how their voices changed, she annoyed everyone there being rude. Finally, my friend (pharmcist there) told me one day that they kicked her out by keep telling her medications were out of stock. And it was emergency meds, the one when you can't miss a day.

 

[Slippers]

In the medical office I used to work, we constanly received phone calls from the patients complaining that doctors never sent the e-Rx. I logged into the program to verify and it was sent. I don't the real story whether it wasn't received or pharmacist forget to fill it or whatever.
Next time tell the patient that you never got e-Rx. Don't bill the insurance so he won't have a proof.
This story reminds one of the patient in our office. Every time I called the pharmacy for any issues about her, I heard how their voices changed, she annoyed everyone there being rude. Finally, my friend (pharmcist there) told me one day that they kicked her out by keep telling her medications were out of stock. And it was emergency meds, the one when you can't miss a day.

If you're avoiding billing the insurance company to avoid anyone "discovering proof" of what you actually did, then clearly, what you're doing is wrong. If you feel that refusing service to a patient is the best decision for the safety and well being of other patients and your employees, so be it, but I don't think you should lie to the patient and tell them "you're out of stock" or "never received Rx" when you know that's not the case. Besides, if you tell them that you're out of stock, won't they just ask you when your new supply will be ordered and return another day?

 

[Mao263]

Besides, if you tell them that you're out of stock, won't they just ask you when your new supply will be ordered and return another day?

What if he doesn't want to wait few days and will go to another place??
I am not a pharmacist. But I had example what others did to avoid that patient. I guess they were so desperate... Besides i know that patient, and I supported their idea.

 

[Mao263]

Yes, they are legally obliged in some states. They can only refuse for certain reasons like drug being abused, drug interaction, etc.

I think pharmacist have the program now where they can access patients history in case he gets controlled substance in other pharmacist. Plus it's easy to ID drug addicts

 

[Beezlebub]

Legality shouldn't even matter in this case. No matter how rude the patient is, as a health "professional" the pharmacist should fulfill his duty and dispense the Rx. It is a disgrace to medicine to jeopardize a patient's health under any circumstance.

 

[lt23]

I re-read the OP and I don't see any mention of what medication it was - particularly, controlled or not. To me, this is important piece of information.

If it is non-controlled, refusing will have consequences - not sure about legal or not, but you will have to deal with it. That's why, in this case, I would just fill it and get them out

If it is controlled, nobody can make you fill the prescription - refuse it with no consequences (assuming your company supports pharmacist professional judgment and your ability to exercise corresponding responsibility like my company)

 

[Beezlebub]

"Sorry, we don't have this in stock"

Hope this is a joke b/c I'm not amused. If a patient needed a particular Rx, regardless of temperament, and you made this sort of excuse then you are essentially endangering his/her life. I assume they don't teach this sort of BS in pharm school.

 

[FarmD711]

Legality shouldn't even matter in this case. No matter how rude the patient is, as a health "professional" the pharmacist should fulfill his duty and dispense the Rx. It is a disgrace to medicine to jeopardize a patient's health under any circumstance.

Lol. No.


Sent from my iPhone using SDN mobile

 

[FarmD711]

Hope this is a joke b/c I'm not amused. If a patient needed a particular Rx, regardless of temperament, and you made this sort of excuse then you are essentially endangering his/her life. I assume they don't teach this sort of BS in pharm school.

I am perfectly upfront with customers that are dinguses to my technicians. If you swear or yell you are not welcome in my store and I will not be filling any prescriptions for you controlled or otherwise.

No patient is going to die bc they were an dingus to my staff and as a result had to pick up their medication at whatever pharmacy I transferred it to. They don't want to drive across town they should have thought about that before they swore and screamed at my staff. They work hard enough to not put up with that BS.

That said I and my staff bend over backward to help our customers that do not abuse us.




Sent from my iPhone using SDN mobile

 

[Mao263]

Hope this is a joke b/c I'm not amused. If a patient needed a particular Rx, regardless of temperament, and you made this sort of excuse then you are essentially endangering his/her life. I assume they don't teach this sort of BS in pharm school.

I assume you never been to NEw York pharmacies. Looks like they are all over the place on top of each. And they constantly out of stock, especially controlled substance. Many students can't get adderall right away, and run around. Why do they give them hard time? I have to mention also, with a such competition, pharmacist are very rude especially in retail.
P/s. I am not taking one. I used to work in the mental health clinic, where we always hear these stories.
I have a feeling that when a patient needs to refill any controlled substance, especially young (25-30), he is being "judged" by pharmacist.

 

[Beezlebub]

I am perfectly upfront with customers that are dinguses to my technicians. If you swear or yell you are not welcome in my store and I will not be filling any prescriptions for you controlled or otherwise.

No patient is going to die bc they were an dingus to my staff and as a result had to pick up their medication at whatever pharmacy I transferred it to. They don't want to drive across town they should have thought about that before they swore and screamed at my staff. They work hard enough to not put up with that BS.

That said I and my staff bend over backward to help our customers that do not abuse us.




Sent from my iPhone using SDN mobile

I assume you never been to NEw York pharmacies. Looks like they are all over the place on top of each. And they constantly out of stock, especially controlled substance. Many students can't get adderall right away, and run around. Why do they give them hard time? I have to mention also, with a such competition, pharmacist are very rude especially in retail.
P/s. I am not taking one. I used to work in the mental health clinic, where we always hear these stories.
I have a feeling that when a patient needs to refill any controlled substance, especially young (25-30), he is being "judged" by pharmacist.

I think we are off topic. This topic pertains to the patient's behavior, not controlled substance. If the pt has valid Rx, and pharmacist has no reason to suspect any harm resulting from said Rx, then he/she should dispense regardless of patient's behavior (unless the pharmacist is in physical danger then he/she should contact law enforcement).

This is healthcare and people's lives are at stake, it is extremely wreckless and unprofessional to deny a valid Rx based on deterrence from patient's behavior.

@FarmD711, it's great to know you have the ability to forcast patient's life expectancy.

 

[radio frequency]

Legality shouldn't even matter in this case. No matter how rude the patient is, as a health "professional" the pharmacist should fulfill his duty and dispense the Rx. It is a disgrace to medicine to jeopardize a patient's health under any circumstance.

I think it's safe to assume you've never worked retail pharmacy...

 

[Mao263]

I am perfectly upfront with customers that are dinguses to my technicians. If you swear or yell you are not welcome in my store and I will not be filling any prescriptions for you controlled or otherwise.

I will pray for you! And pray to get a boss like you!

 

[zelman]

I don't think you should refuse to fill unless you believe it would be illegal or unethical for you to do so (e.g. suspected drug abuse with history of doctor shopping on controlled substance database). For the sake of playing devil's advocate, what if this person is mentally unstable? Should they be denied prescription drugs that they need because of it?

If it makes you feel any better, emergency room nurses sometimes get stuck in the same scenario. I've had a rotation in an emergency room and one day, we had a patient who was literally screaming not only profanity but racist slurs at her nurse, and accusing the nurse of "not getting her a room" and not getting her pain medication (there were no rooms available at the time, the ER was full). Meanwhile, the admit nurse was attempting to get necessary information from this patient (date of birth, past medial history, insurance, etc.). While the patient refused to directly answer most of these questions, her nurse tried to explain to her that the doctor couldn't order her pain medication until she'd been admitted to the hospital, which they could not do until she actually answered their questions. I think eventually someone had to call a security guard, but they couldn't turn her away because she was injured and needed treatment.

Obviously, the situation you described didn't require the patient to be hospitalized and so was nowhere near as serious, but it's still patient care nonetheless.

Agreed. You're filling drugs that someone may need to live and behave normally; not serving up mcchickens. Get some tougher skin

I think you should fill regardless of their rudeness. You should fill for the safety of the patient and the pharmacy staff. Who knows what the rude patient is going through that day, or if they are acting that way due to needing their meds. If the patient is acting so severely to a 4$ difference in their meds, imagine how they would act if you turned them away? Who knows if they have a gun in their car. I only say this because I have experience a similar situation.

Yes, they are legally obliged in some states. They can only refuse for certain reasons like drug being abused, drug interaction, etc.

Legality shouldn't even matter in this case. No matter how rude the patient is, as a health "professional" the pharmacist should fulfill his duty and dispense the Rx. It is a disgrace to medicine to jeopardize a patient's health under any circumstance.

Hope this is a joke b/c I'm not amused. If a patient needed a particular Rx, regardless of temperament, and you made this sort of excuse then you are essentially endangering his/her life. I assume they don't teach this sort of BS in pharm school.

As stated above, ER nurses have to put up with this BS. However, that is because they work in federally funded hospitals and cannot refuse critical services. Retail pharmacies have no such obligation. Those patients can go to the same hospital's outpatient pharmacy instead. We're operating a business, not a public service.

 

[Beezlebub]

I think it's safe to assume you've never worked retail pharmacy...

I don't need to work in retail to follow basic medical ethics. OP already stated that this is not a matter of legality but of the patient's behavior. There are difficult people throughout life but we should treat all of them with equanimity and fairness. Too much is at stakes to play with people's health.

 

[Beezlebub]

-

As stated above, ER nurses have to put up with this BS. However, that is because they work in federally funded hospitals and cannot refuse critical services. Retail pharmacies have no such obligation. Those patients can go to the same hospital's outpatient pharmacy instead. We're operating a business, not a public service.

Really? I didn't know retail pharm's had no obligation in this sort of matter. Health system is more broken than I thought.

 

[Old Timer]

Legality shouldn't even matter in this case. No matter how rude the patient is, as a health "professional" the pharmacist should fulfill his duty and dispense the Rx. It is a disgrace to medicine to jeopardize a patient's health under any circumstance.

Dream on. Pal. I guy came in this week and let out a string of profanity directed at me. I gave him his script back and I didn't loose a moments sleep over it. There are 225 pharmacies in my city and he can go anywhere.......

 

[Slippers]

On a slightly off topic, but related note:
http://www.pharmacytimes.com/contri...s-refusing-to-fill-spark-national-controversy

"Pharmacists' refusal to fill for birth control and emergency contraception has sparked national controversy...Only 8 states (California, Illinois, Nevada, Maine, Massachusetts, New Jersey, Washington, and Wisconsin) have laws explicitly prohibiting medication refusals. Six states (Arizona, Arkansas, Georgia, Idaho, Mississippi, and South Dakota) have laws that specifically allow pharmacists to refuse to provide medications for religious or moral reasons."

"Pharmacy industry associations such as the American Pharmacists Association have issued policies stating that pharmacists should fill all valid prescriptions or transfer them to a pharmacist who can, according to the NWLC. Although these policies encourage pharmacists to check their personal beliefs at the door, the policies are not legally binding and are nothing more than recommendations."

"Many major pharmacy chains also have policies in place that prohibit pharmacists from refusing to fill prescriptions for birth control, but some stores have “refuse and refer” policies. Like other retail store policies, a pharmacist’s failure to comply could result in discipline or, at worst, termination."

 

[zelman]

You are wrong about this. As I said previously, it depends on the state.

No. You are wrong about this. Federal laws prohibit hostile work environments.