Refusing to fill for an extremely rude patient

[owlegrad]

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

And having a customer curse at you counts as hostile work environment? I would think pretty much every retail environment would classify as hostile in that case.

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[zelman]

No, you are wrong. You do not have the pharmacy laws of every state memorized. Like Slippers stated, some states prohibit the refusal to fill valid prescriptions. I recently took the MPJE for one of those states, so that's how I know. You're calling others wrong who are actually correct. SMH

If you have a valid prescription, you cannot be refused service based on the prescription. If you pull down your pants and defecate on the floor, you can be refused service for that.

 

[zelman]

And having a customer curse at you counts as hostile work environment? I would think pretty much every retail environment would classify as hostile in that case.

Being cursed at is an event. Requiring that to continue is an environment.

 

[FarmD711]

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.

It is not unprofessional in the least to protect my staff and other customers from the abuse certain people attempt to dole out.

You wanna force retail pharmacists to serve customers screaming profanity and threats at us? Then I want to be able to administer haldol shots to those customers before dealing with them.




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[ldiot]

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.

Give me a break. Forcing someone by law to provide a particular good or service is a violation of civil liberty. Unless you are discriminating against a protected group or refusing a med that is immediately necessary you can and should be able to do whatever the hell you want. When some guy is going ballistic because his Viagra is $500 and asks if the female tech comes with it he's going to get kicked the **** out. Don't try to tell me that I put his health at risk. Believe it or not pharmacists know a little bit about drugs and can tell which ones are important to get to the patient quickly.

 

[VA Hopeful Dr]

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.

This is nonsense. As a doctor, if I fire a patient for bad behavior that is not against any medical ethics I'm aware of. Why would a pharmacy be held to a different standard?

 

[CetiAlphaFive]

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?

That RPh needs to activate their "I was in fear for my safety" card and ask management why they were forced to fill a script for a belligerent customer.

"Safe & non violent workplace" stuff doesn't just apply to employee / employee interactions.

NEXT TIME:

If the patient is totally unreasonable and won't provide demos just ask them to leave.

If they won't leave, call the cops.
Management will try to tell you they'll discipline you for calling the cops / only loss prevention can call the cops. Baloney.

Try to get the person that tells you that to put it in writing. Unless they're an idiot, they won't.

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.

Your posts are totally wrong.
Yelling is a pre-verbal way of expressing a threat.
If you went into an office in Germany and started shouting obscenities in English, what would happen?


You're romanticizing community pharmacy to be something it's not.

If a patient is on psych / anti psychotic meds and they're decompensating in the pharmacy, you're doing the patient a disservice by simply giving them an Rx to save yourself from being uncomfortable / getting in trouble with management.
That's the truth.
Pretending you're some noble avatar of healthcare by filling Rxs regardless of social norms is laughable.

Go over to the Allopathic forum and ask if they'd allow anyone to act that way in a family practice.

 

[eagles22]

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.

It doesn't seem like you're too far along in your medical education, but 99.9% of the time meds in the ambulatory setting are not life and death and people easily go days without their chronic meds. Based on the cost (8 wing wangs) this was likely a chronic med and not some specialty I'm going to die if I don't get it med (which cost a lot more). This patient was not going to be harmed by having to go to another retail pharmacy. If it were actually life and death, he would be in the hospital or would actually be nice because he realized this med is life sustaining.

 

[Seriously Serious]

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.

Well, as a business, you should not turn away a paying customer on the basis of "they were mean". Just because you have the right to turn away a customer/patient/client, does not mean you should (unless they pose a threat to your license). Don't be such a cupcake and fill the damn script.

I worked for a pharmacist who was being patronized at by a frustrated customer while the pharmacy was being slammed, and he literally crumbled up the customer's prescription and threw at her face. I personally laughed (on the inside), but it was pretty childish of him to do so.

 

[TheBlaah]

I've started to notice a trend in this thread that most of the students are of the mindset that "the prescription needs to be filled" while the practicing pharmacists/physicians agree that refusing service is perfectly fine.

Seems like the whole pharmacy passion thing all over again.

 

[Mao263]

I've started to notice a trend in this thread that most of the students are of the mindset that "the prescription needs to be filled" while the practicing pharmacists/physicians agree that refusing service is perfectly fine.

Seems like the whole pharmacy passion thing all over again.

Because what they teach at school is 20% used in the reality. nothing better than experience and a lot of practice. It's very easy to be a theoretician. Even doctors psychiatrists who expected to have a patience and understand, and better knowledge how to handle the situations... Also lose their patience and kick out patients

 

[zelman]

Well, as a business, you should not turn away a paying customer on the basis of "they were mean".

Why not?

 

[Seriously Serious]

Why not?

Because $$$

 

[ldiot]

I've started to notice a trend in this thread that most of the students are of the mindset that "the prescription needs to be filled" while the practicing pharmacists/physicians agree that refusing service is perfectly fine.

Seems like the whole pharmacy passion thing all over again.

Students have not yet dealt with the general public, and most of them are left wingers, indoctrinated, that don't care about liberty and believe that government intervention is the answer to everything (force them by law to provide service). Med students for some reason tend to think that anything a doctor orders is a message from heaven that the pharmacy must fill.

 

[ldiot]

Well, as a business, you should not turn away a paying customer on the basis of "they were mean". Just because you have the right to turn away a customer/patient/client, does not mean you should (unless they pose a threat to your license). Don't be such a cupcake and fill the damn script.

I worked for a pharmacist who was being patronized at by a frustrated customer while the pharmacy was being slammed, and he literally crumbled up the customer's prescription and threw at her face. I personally laughed (on the inside), but it was pretty childish of him to do so.

If it's your pharmacy what you should do, believe it or not, is up to you to decide. Is the $20 dollars a month worth having to deal with a patient who has no personal responsibility and spends 30 minutes swearing at the pharmacy every month because they never called in their scripts and expected them to magically be ready?

 

[PharmDBro2017]

Because $$$

Whos pockets are you lining, again? No independent owner that I know would take that crap.

If you're at a chain, who gives a **** about the money... it's not yours to begin with.

I feel awful for pharmacists whose upper management doesn't back them enough to side with them over these unruly customers.

 

[Dr Wario]

Because $$$

So says a person whom likely has no actual business experience. I can tell you that as a business owner, it is very easy to fall into the trap of having the last 10% of your money cost 50% of your effort. If you are looking for more money, it is much more efficient to cut the difficult money and focus on your easy money.

If 10% of your customer base causes 50% of your headaches, it is time to to cut those customers and to treat your good ones like gold.

 

[Beezlebub]

ahh capitalism... treating healthcare as a commodity.

 

[eagles22]

ahh capitalism... treating healthcare as a commodity.

You do realize that if a business doesn't have revenue equaling or exceeding expenditures, then it will collapse not matter what it is. The electric company doesn't supply power based on the good of society that a consumer may provide.

 

[Beezlebub]

You do realize that if a business doesn't have revenue equaling or exceeding expenditures, then it will collapse not matter what it is. The electric company doesn't supply power based on the good of society that a consumer may provide.

Did you write that on your personal statement?

 

[a student]

If 10% of your customer base causes 50% of your headaches, it is time to to cut those customers and to treat your good ones like gold.

Can you buy walgreens?

 

[eagles22]

Did you write that on your personal statement?

There's nothing wrong with wanting compensation for work you perform. It's how I pay my loans back, buy my food, and enjoy my free time. Medicine is a profession, not a calling, and the sooner you realize that, the better off you'll be when you actually practice medicine.

 

[Beezlebub]

There's nothing wrong with wanting compensation for work you perform. It's how I pay my loans back, buy my food, and enjoy my free time. Medicine is a profession, not a calling, and the sooner you realize that, the better off you'll be when you actually practice medicine.

I have no problem with that. You reap what you sow. However, I believe that medicine is a profession AND a calling. They should not be mutually exclusive. The best drs are the ones who truly care for their patients and that aspect alone improves pt outcome, builds trust, and solidifies a more robust 21st century healthcare system, instead of the broken entity we have today.

This will be my last post since I have to focus on my studies and don't really want to drag this out.

My 2C:
1) Corp reprimanded the RPH b/c patient prob had the law on his/her side in terms of getting the Rx dispensed. Most likely a PR stunt to prevent future problems.
2) Not enough info from OP to adequately assess the situation. No implication of the severity of the incidence.
3) Doesn't really hurt to drop pride and accomodate difficult patients once in a while. Unless they're outright belligerent, the RPH should have tried to defuse the situation instead of making a mountain out of a molehill. People skills...

 

[eagles22]

I have no problem with that. You reap what you sow. However, I believe that medicine is a profession AND a calling. They should not be mutually exclusive. The best drs are the ones who truly care for their patients and that aspect alone improves pt outcome, builds trust, and solidifies a more robust 21st century healthcare system, instead of the broken entity we have today.

This will be my last post since I have to focus on my studies and don't really want to drag this out.

My 2C:
1) Corp reprimanded the RPH b/c patient prob had the law on his/her side in terms of getting the Rx dispensed. Most likely a PR stunt to prevent future problems.
2) Not enough info from OP to adequately assess the situation. No implication of the severity of the incidence.
3) Doesn't really hurt to drop pride and accomodate difficult patients once in a while. Unless they're outright belligerent, the RPH should have tried to defuse the situation instead of making a mountain out of a molehill. People skills...

Please tell me you're a first year.

 

[a student]

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.

You do need to work in retail to understand what retail rphs go through everyday. Pharmacists are not chilling in a chair ready to deal with situations. They're usually running around like dogs, multitasking, with the phone ringing on two lines, kids crying in the waiting area, 5 people waiting for their prescriptions, and talking to a doctor on the phone and trying to figure out an insurance problem at the same time. Meanwhile corporate probably expects a bunch of numbers be met, including filling the prescriptions for the waiters within 15 minutes. They are stressed enough already they don't have the mental energy to leave everything aside and go please the rude customer for 30 minutes.

 

[Seriously Serious]

So says a person whom likely has no actual business experience. I can tell you that as a business owner, it is very easy to fall into the trap of having the last 10% of your money cost 50% of your effort. If you are looking for more money, it is much more efficient to cut the difficult money and focus on your easy money.

If 10% of your customer base causes 50% of your headaches, it is time to to cut those customers and to treat your good ones like gold.

Fair enough.

 

[Sine Cura]

A lot of low-effort virtue signaling from naive students... yawn.

 

[Deja]

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.

I agree 100%... I was getting pissed off at some of the responses here lol in dire need of an $8 med? dire need my ass, prices aside, if he was really in danger, he would be in the hospital

 

[Deja]

ahh capitalism... treating healthcare as a commodity.

you are clueless, please read your future colleagues, VA Hopeful Dr, response

you are a first year student, aren't you

 

[CetiAlphaFive]

ahh capitalism... treating healthcare as a commodity.

Hahaha, I'm sure you're joining the IHS or another agency to practice medicine with an underserved community, right?
Or are you gonna be another pseudo socialist that decries capitalism while taking home hundreds of thousands a year?

Patients only value what they perceive as having value.

If a patient sees a physician or pharmacist as just an inconvenience in the way of their medicine, they're not going to get much out of it.

If you allow someone to scream in your face and treat you as less than human, they're never going to benefit from your professional training, no matter how high up your ass your whitey tighteys are.

You can be the finest doctor in the history of medicine working for $7.50 / hour, but if your patient / provider relationship has deteriorated to the point where they're comfortable screaming in your face in the outpatient setting, do you really think you can help them?
Will they listen to your advice & instructions?

That's my personal experience.

 

[VA Hopeful Dr]

I have no problem with that. You reap what you sow. However, I believe that medicine is a profession AND a calling. They should not be mutually exclusive. The best drs are the ones who truly care for their patients and that aspect alone improves pt outcome, builds trust, and solidifies a more robust 21st century healthcare system, instead of the broken entity we have today.

This will be my last post since I have to focus on my studies and don't really want to drag this out.

My 2C:
1) Corp reprimanded the RPH b/c patient prob had the law on his/her side in terms of getting the Rx dispensed. Most likely a PR stunt to prevent future problems.
2) Not enough info from OP to adequately assess the situation. No implication of the severity of the incidence.
3) Doesn't really hurt to drop pride and accomodate difficult patients once in a while. Unless they're outright belligerent, the RPH should have tried to defuse the situation instead of making a mountain out of a molehill. People skills...

Your first paragraph has a lot of truth in it, but its a generalization that misses quite a few points. First, difficult patients take a lot of time no matter the outcome. If I spend an hour trying to convince a jackass to take his metformin and lisinopril, even if I succeed that's an hour that I could have seen 3-4 other patients in who wanted my help from the start. Second, not every difficult patient can be reasoned with. Its called pre-contemplative for those who like motivational interviewing. Third, I could write a small book on the dysfunction we have in the system but that's off-topic

I generally make one good attempt to diffuse a situation. If that fails, I'm out. Had a patient just yesterday who wanted to go back on her methadone for her chronic back pain. The oxycodone the orthopedic doctor gave her for her hip replacement didn't agree with her. I offered celebrex and/or pain management referral, she accepted neither and got angry. I spent 15 minutes trying to calm her down. When it didn't work, I fired her and didn't give the encounter a second thought.

 

[BidingMyTime]

Because $$$

Well, you need to look at the big picture. The customers who repeatedly cuss and/or threaten and/or otherwise are disruptive, are probably likely to shoplift because they feel entitled to over not getting what they wanted immediately from the pharmacy. They are also probably more likely to have an "accident" walking out the pharmacy door and then turn around and sue the pharmacy. I suspect pharmacies will lose a lot more money from these customers in the long run, then they will make.

 

[cj98]

Usually what I do is agree to fill it, but tell them that if they are unhappy with our services, I am able to transfer them out to any pharmacy of their choice.

 

[ChasingMyDreams]

Did not think this would generate so many replies. I will provide a few clarifying points.

-RX for ophthalmic abx

-No legal requirement in this state to fill

- Large chain store

-large metro city with 5 pharmacies in a 1 mile radius

After further thought, discussions with management and responses from here it seems the best course of action next time will be to just fill the RX. Much bigger headache from refusing to fill.

Once I own my own shop (hopefully) the discussion is different. I will be more inclined to fill if the reimbursement is going directly into my pocket. It is (sadly) all about the bottom line. Whether or not the chain makes more money is not a concern of mine as this RX will have a near 0 effect on my "bonus", but disciplinary action will.

I still disagree that there should be any disciplinary action but those who created at-will employment could care less whether I agree or not. Until I have enough saved to escape I will put my head down, say very little and fill every script.

side note: I have gotten push back for refusing to fill controls even though we have a policy in place that states I can use my professional judgement to do just that. Not sure what happens to pharmacists when they are promoted to multi-unit management positions but they definitely seem to have forgotten what it's like in the trenches.

 

[CetiAlphaFive]

Did not think this would generate so many replies. I will provide a few clarifying points.

-RX for ophthalmic abx

-No legal requirement in this state to fill

- Large chain store

-large metro city with 5 pharmacies in a 1 mile radius

After further thought, discussions with management and responses from here it seems the best course of action next time will be to just fill the RX. Much bigger headache from refusing to fill.

Once I own my own shop (hopefully) the discussion is different. I will be more inclined to fill if the reimbursement is going directly into my pocket. It is (sadly) all about the bottom line. Whether or not the chain makes more money is not a concern of mine as this RX will have a near 0 effect on my "bonus", but disciplinary action will.

I still disagree that there should be any disciplinary action but those who created at-will employment could care less whether I agree or not. Until I have enough saved to escape I will put my head down, say very little and fill every script.

side note: I have gotten push back for refusing to fill controls even though we have a policy in place that states I can use my professional judgement to do just that. Not sure what happens to pharmacists when they are promoted to multi-unit management positions but they definitely seem to have forgotten what it's like in the trenches.

"I don't like aspects of management that I passively reinforce out of fear"

 

[ldiot]

Yeah the patient isn't going to drop dead without their eye drops, it's just a matter of company policy. I don't agree with it but I guess if you are going to take their money you have to do what they want.

 

[ldiot]

ahh capitalism... treating healthcare as a commodity.

Goods and services are commodities. It's why you get paid, or will get paid since you are still a student telling everyone else how the world should work.