Scope of Practice Question

[ldsrmdude]

That is the funniest statement I have ever read on SDN! Someone on the podiatry forum calling pharmacists "peripheral service providers." If thats not the pot calling the kettle black I do not know what is!



When I run into one of those podiatrist that thinks they are an MD I will chuckle. If I need my calluses trimmed or my toenails cut I be sure to see a podiatrist. Otherwise I will see an actual MD if I have a medical problem.


I found this thread by doing a search on scope of practice. I was looking for threads in reference to dental sop. When I started reading I had no idea this thread would turn into a pissing contest between pharmacists and podiatrists. Anyway I found it to be a good read. I think Spiriva had the best post which should end all discussion.

My best podiatrist prescription was about a month ago. Levaquin 1 bid. Called the guy up and he said he wanted it twice a day because the patient had a really "bad" infection and he thought twice a day would be better. I shudder everytime I get a prescription written by a podiatrist.

In a thread filled with ignorant posts, this has to be the most ignorant of them all. Why anyone would come to the the Pod Residents Forum to resurrect a thread like this one only to act like a little kid trying to get a cheap shot in is beyond me. Honestly, you added nothing to this discussion other than adding fuel to a fire that had been put out. You are a troll :troll:. Please let this thread die!

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[jonwill]

In a thread filled with ignorant posts, this has to be the most ignorant of them all. Why anyone would come to the the Pod Residents Forum to resurrect a thread like this one only to act like a little kid trying to get a cheap shot in is beyond me. Honestly, you added nothing to this discussion other than adding fuel to a fire that had been put out. You are a troll :troll:. Please let this thread die!

The person is obviously out of touch with the medical field and has no idea what podiatrists do. And there are still pods out there that largely do palliative care. Meanwhile, I'm on plastic surgery medically managing all of their inpatients right now. Sure, I could go on and on about all of the ankle/pilon fractures, calc fractures, and the over 500 cases I've done in residency blah, blah, blah. But who really cares. If that's what they think, then that is what they think. When they jack themselves up and I have to fix them, they will have a different take on it. I'm a surgeon so I get the last laugh anyway!

That was kind of a cheap shot with the Levaquin. If people really form their opinion on an entire medical specialty based on a few crack pots, pretty much every medical specialty is screwed. And of course, I've got my pharmacist stories but I won't go there.

In other news, my wife is having pretty bad morning sickness so I wrote her a script for Zofran yesterday. SSHHHHH, don't tell!!!!!!!!!!!!!!!!!!!!

 

[cool_vkb]

When I run into one of those podiatrist that thinks they are an MD I will chuckle. If I need my calluses trimmed or my toenails cut I be sure to see a podiatrist. Otherwise I will see an actual MD if I have a medical problem.


I found this thread by doing a search on scope of practice. I was looking for threads in reference to dental sop. When I started reading I had no idea this thread would turn into a pissing contest between pharmacists and podiatrists. Anyway I found it to be a good read. I think Spiriva had the best post which should end all discussion.

My best podiatrist prescription was about a month ago. Levaquin 1 bid. Called the guy up and he said he wanted it twice a day because the patient had a really "bad" infection and he thought twice a day would be better. I shudder everytime I get a prescription written by a podiatrist.

Its your own personal choice if you wanna go to MD for medical problem regarding foot or come to a DPM. as long as you get proper care iam happy.but there is a good chance that you will be referred to a podiarist if its a foot & ankle problem medical problem for consultation

Awww thats so cute that you shudder everytime you get a prescription written by a podiatrist. My dog wags his tail everytime he sees me with a candy from him.is it something like that? automatic reflex? . for some reason i love reflex actions. you know that concept of If <---> then <---->.

Can you do us a favor and plz give us the location of your practice. we will ask APMA to inform the pods in that area to make a special note about your pharmacy/pharmacist policy on pod prescriptions. I mean you know we all can save some time. pods will not bother sending patients to your pharmacy or try to warn the patients in advance that there is a good chance that the PharmD in that pharmacy will automatically act anal when he will see the prescription and they better go to a different pharmacy if they need proper care. You know, its good for everybody. You will not see any Pod prescriptions and pods will not have headaches dealing with you. everybody happy

Its a free country and you are well within your limits to reject/question a prescription. Well the actual law is supposed to help the patient and not to be abused in profession related discrimination as being done by you. but who doesnt abuse powers. i dont ask you to change or want to educate you.

In my town alone there are 7 pharmacies. infact we have more pharmacies then mcdonalds & burgerking combined. if my patient trusts me. he will go to other pharmacy two blocks away. In the end you will be losing business. now you know basic pharmacy store economics-101. Patient just doesnt buy drugs from pharmacy while they are waiting for prescriptions they end up buying other stuff also. so yeah its a good loss. Well 250mg levaquin itself is around $110 for a pack of 5. so you already made a $110 loss for your company. unless your intentions were really noble and your priority was patient safety and not some deep rooted animosity towards other professions.

 

[Aznfarmerboi]

Its your own personal choice if you wanna go to MD for medical problem regarding foot or come to a DPM. as long as you get proper care iam happy.but there is a good chance that you will be referred to a podiarist if its a foot & ankle problem medical problem for consultation

Awww thats so cute that you shudder everytime you get a prescription written by a podiatrist. My dog wags his tail everytime he sees me with a candy from him.is it something like that? automatic reflex? . for some reason i love reflex actions. you know that concept of If <---> then <---->.

Can you do us a favor and plz give us the location of your practice. we will ask APMA to inform the pods in that area to make a special note about your pharmacy/pharmacist policy on pod prescriptions. I mean you know we all can save some time. pods will not bother sending patients to your pharmacy or try to warn the patients in advance that there is a good chance that the PharmD in that pharmacy will automatically act anal when he will see the prescription and they better go to a different pharmacy if they need proper care. You know, its good for everybody. You will not see any Pod prescriptions and pods will not have headaches dealing with you. everybody happy

Its a free country and you are well within your limits to reject/question a prescription. Well the actual law is supposed to help the patient and not to be abused in profession related discrimination as being done by you. but who doesnt abuse powers. i dont ask you to change or want to educate you.

In my town alone there are 7 pharmacies. infact we have more pharmacies then mcdonalds & burgerking combined. if my patient trusts me. he will go to other pharmacy two blocks away. In the end you will be losing business. now you know basic pharmacy store economics-101. Patient just doesnt buy drugs from pharmacy while they are waiting for prescriptions they end up buying other stuff also. so yeah its a good loss. Well 250mg levaquin itself is around $110 for a pack of 5. so you already made a $110 loss for your company. unless your intentions were really noble and your priority was patient safety and not some deep rooted animosity towards other professions.

Wahhhh 110 loss for our company. Wahhhhh. Lets take all the fake narcs script too because wahhhh we would lose millions if we dont. Wahhh. Reminds me of the hundreds of addicts that threaten us with company complaints on stolen narc scripts filled in with crayons. Wahhhh I didnt know podiatrists were such money ******. That alone seperates us from you guys.

It is hard to believe that most of you guys are still missing the point. Refer to spirivas among other pharmacists posts on laws and regulation. Point is this was answered a long time ago.

Tell your patients to bring the script to another pharmacy. I have yet seen a pharmacist in this forum saying that they will fill it. Why? Fact is because it is not a valid script.

Most of the podiatrists here reminds me of a child ignoring the realities of the real world out there. Instead of facing the facts, they go about attacking an entire profession they know nothing about.

IDSRM, I sure saw a lot more ignorant ones out there. Yours including.

 

[Aznfarmerboi]

The person is obviously out of touch with the medical field and has no idea what podiatrists do. And there are still pods out there that largely do palliative care. Meanwhile, I'm on plastic surgery medically managing all of their inpatients right now. Sure, I could go on and on about all of the ankle/pilon fractures, calc fractures, and the over 500 cases I've done in residency blah, blah, blah. But who really cares. If that's what they think, then that is what they think. When they jack themselves up and I have to fix them, they will have a different take on it. I'm a surgeon so I get the last laugh anyway!

That was kind of a cheap shot with the Levaquin. If people really form their opinion on an entire medical specialty based on a few crack pots, pretty much every medical specialty is screwed. And of course, I've got my pharmacist stories but I won't go there.

In other news, my wife is having pretty bad morning sickness so I wrote her a script for Zofran yesterday. SSHHHHH, don't tell!!!!!!!!!!!!!!!!!!!!

I agree with people taking cheap shots based on a few examples of crack pots. However mountainpharmD is one of the older and respected guys in the pharmacy forums.

We are aware that podiatry is surgurical as well as dental. However that is all it is after that. After a few weeks, any insomnia should be managed by MD. There is no reason a surgeon should be doing primary care work.

 

[MountainPharmD]

It never fails on any forum on SDN. Whenever someone posts a dissenting opinion the idiots come out of the woodwork screaming troll. If you cannot form an intelligent reply than please do not post anything.

As I said in my earlier post I happened upon this thread by accident while searching for something else. The title "scope of practice" caught my eye because I was searching for information on dental scope of practice. Once I got to reading I was intrigued by the pissing match that developed between pharmacists and podiatrist.

One of the things I like about SDN is the interaction different providers can have that they normally would not. We can learn a lot from each other. I do not think this thread is a waste of time. Several people have provided good information concerning scope of practice prescribing.

I am a pharmacist. My apologies for intruding on your forum.

 

[Aznfarmerboi]

If you guys think differently, tell your lobbying boards to refer to pharmacy boards. So far all of the pharmacists here in their EXTENSIVE law training have all concluded that we can’t fill podiatry scripts that are more "systemic" in nature used for longer periods of time.
That is one of the major problems with pharmacy out there. I have called my state boards and this is what they have told us. The scope of practice question has been repeated in many pharmacy journals and they have all concluded similar to what we have said. Maybe you guys can post some laws from regulation books on this issue via boards governing podiatry. They should have a commission on this. I am sure they will expand the laws to rule in your favors but until then, rules are rules as it is right now.
Insurance companies also seem to agree with us when auditing time comes around. A pharmacy I was recently at out on tens of thousands filling these scripts. They looked up “weird scripts” and from there, pull up a database of ALL the scripts the person filled and looked at each one. Who’s going to reimburse that pharmacy for the loss?
Pharmacists are here as check and balances. If you guys are making fun of a pharmacist doing his/her job, it is no different than the Bush administration mocking Congress/Judicial for doing theirs. You guys might know things that we don’t (and vice versa) just like how the Bush administration might know stuff about terrorists Congress don’t, but the rules are still in place so people don’t go around abusing it. If we are more lenient as Congress was (which we are), people would abuse the system just like how the Bush administration did. Heck, one pharmacist did her job and you guys are calling her an *******. I mean give me a break. I hope that was a good enough analogy to people who probably are studying too much and can’t see things from another point of perspective, another problem with health professional students.

 

[cool_vkb]

Wahhhh 110 loss for our company. Wahhhhh. Lets take all the fake narcs script too because wahhhh we would lose millions if we dont. Wahhh. Reminds me of the hundreds of addicts that threaten us with company complaints on stolen narc scripts filled in with crayons. Wahhhh I didnt know podiatrists were such money ******. That alone seperates us from you guys.

It is hard to believe that most of you guys are still missing the point. Refer to spirivas among other pharmacists posts on laws and regulation. Point is this was answered a long time ago.

Tell your patients to bring the script to another pharmacy. I have yet seen a pharmacist in this forum saying that they will fill it. Why? Fact is because it is not a valid script.

Most of the podiatrists here reminds me of a child ignoring the realities of the real world out there. Instead of facing the facts, they go about attacking an entire profession they know nothing about.

IDSRM, I sure saw a lot more ignorant ones out there. Yours including.

Dude! if you are genuinely rejecting the scripts from pods because patient safety is your top priority than hallay looya. you should not stop at all. plzz continue rejecting. you guys are the last line of defense and the most responsible as you are the ones who dispense drugs.

but mountainpharmD said he shudders automatically if he sees a script from pod. It doesnt matter for him if the pod script is proper or not. he already has an opinion of his own.So its better we send our patients to a different pharmacist who has an open mind rather than sending to narrow minded pharmD. whats childish about that?

 

[cool_vkb]

If you guys think differently, tell your lobbying boards to refer to pharmacy boards. So far all of the pharmacists here in their EXTENSIVE law training have all concluded that we can't fill podiatry scripts that are more "systemic" in nature used for longer periods of time. That is one of the major problems with pharmacy out there. I have called my state boards and this is what they have told us. The scope of practice question has been repeated in many pharmacy journals and they have all concluded similar to what we have said. Maybe you guys can post some laws from regulation books on this issue via boards governing podiatry. They should have a commission on this. I am sure they will expand the laws to rule in your favors but until then, rules are rules as it is right now.
Insurance companies also seem to agree with us when auditing time comes around. A pharmacy I was recently at out on tens of thousands filling these scripts. They looked up "weird scripts" and from there, pull up a database of ALL the scripts the person filled and looked at each one. Who's going to reimburse that pharmacy for the loss?
Pharmacists are here as check and balances. If you guys are making fun of a pharmacist doing his/her job, it is no different than the Bush administration mocking Congress/Judicial for doing theirs. You guys might know things that we don't (and vice versa) just like how the Bush administration might know stuff about terrorists Congress don't, but the rules are still in place so people don't go around abusing it. If we are more lenient as Congress was (which we are), people would abuse the system just like how the Bush administration did. Heck, one pharmacist did her job and you guys are calling her an *******. I mean give me a break. I hope that was a good enough analogy to people who probably are studying too much and can't see things from another point of perspective, another problem with health professional students.

Oh plzzzzzzzzzzzzz! dont you say "WE cannot fill" . Say "i cannot.." . just because 10-20 anonymous "self styled respected older pharmds" say something it doesnt mean a squat. you do not represent the entire pharmacy association here. you are an anonymous person posting on a public forum. Just speak for yourself and not give this false perception that all pharmDs have mentality like you or mountainPharmD.

May be your point is valid or your concern is genuine. but thats just your own opinion and not the view of thousands of pharmDs out there. unless you wanna come out of the closet and reveal your real credentials that you are some president or head of some big pharmD association and speak for all of them.

 

[cool_vkb]

Wahhhh 110 loss for our company. Wahhhhh. Lets take all the fake narcs script too because wahhhh we would lose millions if we dont. Wahhh. Reminds me of the hundreds of addicts that threaten us with company complaints on stolen narc scripts filled in with crayons. Wahhhh I didnt know podiatrists were such money ******. That alone seperates us from you guys.

It is hard to believe that most of you guys are still missing the point. Refer to spirivas among other pharmacists posts on laws and regulation. Point is this was answered a long time ago.

Tell your patients to bring the script to another pharmacy. I have yet seen a pharmacist in this forum saying that they will fill it. Why? Fact is because it is not a valid script.

Most of the podiatrists here reminds me of a child ignoring the realities of the real world out there. Instead of facing the facts, they go about attacking an entire profession they know nothing about.

IDSRM, I sure saw a lot more ignorant ones out there. Yours including.

"Walgreen Co. of Deerfield, Ill., has agreed to pay $35 million to settle claims that from 2001 to 2005, it improperly switched patients to different versions of the prescriptions drugs Ranitidine, Fluoxetine and Eldepryl in order to increase its reimbursement from Medicaid, the Justice Department announced today" ...http://www.news-medical.net/?id=38956


Oh! Stealing taxpayers money. hmmm! i guess thats not a big deal. you guys dont care about profits. bullllll ****ttttttt! now What does this makes you. St.Pharmacists?

 

[Aznfarmerboi]

"Walgreen Co. of Deerfield, Ill., has agreed to pay $35 million to settle claims that from 2001 to 2005, it improperly switched patients to different versions of the prescriptions drugs Ranitidine, Fluoxetine and Eldepryl in order to increase its reimbursement from Medicaid, the Justice Department announced today" ...http://www.news-medical.net/?id=38956


Oh! Stealing taxpayers money. hmmm! i guess thats not a big deal. you guys dont care about profits. bullllll ****ttttttt! now What does this makes you. St.Pharmacists?

Besides assuming that a settlement is an admission of guilt, it shows how naive you are as a student. I can start posting malpractice lawsuits against pod. (and pretty much lawsuits everywhere) where there was a settlement early on.

With that said, for other posters. . . most physicians do not write what form they want the medication in. A basic rx is Fluoxetine 20mg, 1 po qd. Although most pharmacists do pick the formulation, we do not know what costs more. It is more of a preference to the patient. Capsules are usually chosen because it is easier to swallow, tasteless, and that we know it is exact. Tablets are just powder forms clumped together with binders and can easily break depending on the quality from the manufacter. One of the little things that is not equal between generic and brand.

 

[uberconfuzzled]

I really don't understand why everyone is getting so upset. Both pods and pharmacists are under-appreciated by the general public. Many people underestimate the knowledge and capacity of podiatrists and pharmacists alike. But when Professionals like yourselves spend time to hash out back and forth on who is more "qualified," it will only give the public and, possibly MDs/DOs, more reason to doubt your medical expertise. So, stop the fighting!

 

[MountainPharmD]

TEXAS STATE BOARD OF PODIATRIC MEDICAL EXAMINERS
Physical Address: 333 Guadalupe, Suite 2-320; Austin, Texas 78701
Mailing Address: P.O. Box 12216; Austin, Texas 78711
Phone: (512) 305-7000
Facsimile: (512) 305-7003

1. Can a Podiatrist write prescriptions?
Yes, for a valid medical purpose, Podiatrists can write prescriptions to treat any disease, disorder, physical injury, deformity or ailment of the human foot. All "Controlled Substances" prescriptions are subject to related U.S. Drug Enforcement Administration, Texas Department of Public Safety and Texas Health & Safety Code provisions. For further information, please click on the following "License Verifications" page.

Emphasis in bold is mine. As a pharmacist I have a corresponding responsibility to ensure all prescriptions are issued for a legitimate medical purpose. I take no pleasure or delight in deciding not to fill a prescription. I have no choice if it is not written for a valid medical purpose or is outside of a prescribers scope of practice.

The days of filling prescriptions without question are long over. The courts have found a pharmacist can be held liable along with the prescriber for improperly issued prescriptions.

 

[Aznfarmerboi]

TEXAS STATE BOARD OF PODIATRIC MEDICAL EXAMINERS
Physical Address: 333 Guadalupe, Suite 2-320; Austin, Texas 78701
Mailing Address: P.O. Box 12216; Austin, Texas 78711
Phone: (512) 305-7000
Facsimile: (512) 305-7003

1. Can a Podiatrist write prescriptions?
Yes, for a valid medical purpose, Podiatrists can write prescriptions to treat any disease, disorder, physical injury, deformity or ailment of the human foot. All "Controlled Substances" prescriptions are subject to related U.S. Drug Enforcement Administration, Texas Department of Public Safety and Texas Health & Safety Code provisions. For further information, please click on the following "License Verifications" page.

Emphasis in bold is mine. As a pharmacist I have a corresponding responsibility to ensure all prescriptions are issued for a legitimate medical purpose. I take no pleasure or delight in decided not to fill a prescription. I have no choice if it is not written for a valid medical purpose or is outside of a prescribers scope of practice.

The days of filling prescriptions without question are long over. The courts have found a pharmacist can be held liable along with the prescriber for improperly issued prescriptions.

The problem is that a lot of podiatrists here do not know how strictly people enforce the law. They just assume its something written as a FAQ when it it meant to be carried out strictly. A lot of them think they are mavericks that can push the laws to the extreme until one day it comes back and bite them in the ass. I have seen it happenned already and i am a noob in the profession.

Are the laws outdated? Maybe but that is not for me to decide.

 

[Aznfarmerboi]

From NYS board of Podiatry

§7001. Definition of practice of podiatry.
The practice of the profession of podiatry is defined as diagnosing, treating, operating and prescribing for any disease, injury, deformity or other condition of the foot, and may include performing physical evaluations in conjunction with the provision of podiatric treatment. Podiatrists may treat traumatic open wound fractures only in hospitals, as defined in article twenty-eight of the public health law.
The practice of podiatry shall not include treating any part of the human body other than the foot, nor treating fractures of the malleoli or cutting operations upon the malleoli. Podiatrists licensed to practice, but not authorized to prescribe or administer narcotics prior to the effective date of this subdivision, may do so only after certification by the department in accordance with the qualifications established by the commissioner. The practice of podiatry shall include administering only local anesthetics for therapeutic purposes as well as for anesthesia and treatment under general anesthesia administered by authorized persons.

 

[jonwill]

From NYS board of Podiatry

§7001. Definition of practice of podiatry.
The practice of the profession of podiatry is defined as diagnosing, treating, operating and prescribing for any disease, injury, deformity or other condition of the foot, and may include performing physical evaluations in conjunction with the provision of podiatric treatment. Podiatrists may treat traumatic open wound fractures only in hospitals, as defined in article twenty-eight of the public health law.
The practice of podiatry shall not include treating any part of the human body other than the foot, nor treating fractures of the malleoli or cutting operations upon the malleoli. Podiatrists licensed to practice, but not authorized to prescribe or administer narcotics prior to the effective date of this subdivision, may do so only after certification by the department in accordance with the qualifications established by the commissioner. The practice of podiatry shall include administering only local anesthetics for therapeutic purposes as well as for anesthesia and treatment under general anesthesia administered by authorized persons.

It should be noted that NY is one of the only states left where pods can't treat ankle fractures.

 

[jonwill]

It never fails on any forum on SDN. Whenever someone posts a dissenting opinion the idiots come out of the woodwork screaming troll. If you cannot form an intelligent reply than please do not post anything.

Yea, but sometimes it can be quite amusing.

I think the bottom line is that podiatrists are physicians and surgeons of the foot and ankle. And we write scripts for any and all etiologies of the foot and ankle. While some can be argued, most are pretty clear cut. I would more than welcome any pharmacist to call me concerning an error (which they have done) or question concerning a script I write. It means they are not just mindlessly filling prescriptions and actually have a concern for my patients. Afterall, this is why they go to eight years of school.

On the other hand, I'll be the first to admit that I've written a few scripts for friends/family for obvious medical issues that I have received training to treat throughout my residency. No pharmacist has ever made an issue of it but if I made it a habit, I'm sure they would and rightfully so. As aznfarmerboi stated, we are not primary care docs and quite frankly, don't have time to be. In the end, every physician has their place. Everybody has their expertise and limits. That's why referrals exist!

 

[Coastie]

Ok, but is bipolar disorder best managed by a "generalist?" Does the one month clerkship + behavioral science class the nephrologist had say 10 years ago in med school qualify him to act as a psychiatrist? Let's imagine that the bipolar patient commits suicide and the family decides to sue--will that nephrologist not be sued for practicing outside his area of expertise and for mismanaging the patient? Should he not have referred the patient? I would imagine the psychiatrists would disagree with you here.

As far as the Ambien thing goes, I understand where you are coming and I more or less agree, but I do think a short course would be appropriate post-op if the pt. is having trouble sleeping; anything beyond that needs a referral.

Licensed physicians have an unlimited scope of practice within medicine and surgery, so yes, we are qualified to treat bipolar patients, if fully licensed.

Whether or not we will do a good job is a whole 'nother story.

Podiatrists rx'ing that much Ambien? Scary. Podatrists should be sending patients to their physicians for scripts of this nature.

 

[Coastie]

You are a young Padawan learner. You will be humbled over your upcoming years of pharmacy practice.

Also, it's hard to take you seriously with that picture. It would look more appropriate if activate your extensor pollicis longus to form an "L".

at this ^ guy. Who does he think he is, anyway?

 

[Coastie]

Laughable. No it isn't. The etiology of RLS DOES NOT stem from the foot or ankle, it stems from neurological dysfunction. It is not something that should be treated by a podiatrist. That's like a dentist prescribing drugs to treat a patient's epilepsy because they might harm their teeth in a tonic-clonic seizure.

And who uses Ambien for that, anyway? I don't believe that you actually are treating people with Ambien. I hope not at least...there are so many superior options...specifically some of the selective dopaminergic agonists. And if you are going to use a drug that agonizes the BZD receptor...why Ambien? Why not something like, I don't know...a real BZD? You are REALLY reaching with that one....seriously...

Not restless leg syndrome..He meant restless foot syndrome..

 

[Coastie]

So can a DPM. I have Rx'd Lasix for my mom. I've even Rx'd for myself - Augmentin and Naprosyn. Keeping an accurate log is a must. There is no special privilege of an MD/DO to Rx for family/friends or self.

Where are you in NY? I did my residency at the B/Q Saint Vincent's System (which is no more - I heard!).

Rx'd Lasix?

This has got to be a flame.

 

[PMSIII]

Licensed physicians have an unlimited scope of practice within medicine and surgery, so yes, we are qualified to treat bipolar patients, if fully licensed.

Whether or not we will do a good job is a whole 'nother story.

Podiatrists rx'ing that much Ambien? Scary. Podatrists should be sending patients to their physicians for scripts of this nature.

It isn't scary and it is within our scope with all due respect. Whenever a patient undergoes a major reconstructive foot or ankle procedure, they're in a great deal of pain for the first week especially. It is a common standard to Rx pain medications when safe to do so (i.e. percocet, vicodin, and sometimes Morphine if patient is admitted for the night) and Ambien to help them sleep. I can't speak for every DPM but I am merely pointing out that the Ambien Rx is not out of question. Good luck to you in your training.

 

[Coastie]

It isn't scary and it is within our scope with all due respect. Whenever a patient undergoes a major reconstructive foot or ankle procedure, they're in a great deal of pain for the first week especially. It is a common standard to Rx pain medications when safe to do so (i.e. percocet, vicodin, and sometimes Morphine if patient is admitted for the night) and Ambien to help them sleep. I can't speak for every DPM but I am merely pointing out that the Ambien Rx is not out of question. Good luck to you in your training.

Note, I said: "That much" Ambien. If after a week a patient is still having this problem, send him to his physician.

 

[cool_vkb]

Licensed physicians have an unlimited scope of practice within medicine and surgery, so yes, we are qualified to treat bipolar patients, if fully licensed.
.

You sure about it? So can my ENT surgeon start fixing ankle fracture and deliver babies?

Please dont give the standard definition of physician.All i know is that in this modern world with malpractice and other factors lingering over head, you are severely restricted to your chosen speciality (unless its family practice or IM).

Dare to do something outside your chosen speciality in real practice(like perform Abortions in your daily Derm practice) and then use this lame excuse of "we have unlimited scope and we are qualified" when questioned by the patient's attorney. i can guarantee you a malpractice suit on your hands.

The present day MDs are no different than Pods or dentists. like us you guys are mostly limited by your chosen specialities and subspecialities. The malpractice, the patient's insurance, potential law suits,etc etc all have changed the system.

 

[diabeticfootdr]

Licensed physicians have an unlimited scope of practice within medicine and surgery, so yes, we are qualified to treat bipolar patients, if fully licensed.

There is a difference with being licensed and being qualified to perform a service or procedure.

Licenses are granted by the state, qualifications (privileges) are granted by your facility. So no, you will never be qualified to perform everything in medicine and surgery, no matter what your degree is.

 

[diabeticfootdr]

at this ^ guy. Who does he think he is, anyway?

<- this guy probably thinks he's an attending with actual practice experience, director of a limb salvage center, respected expert in his field with 50+ publications.

Who are you?

 

[RxWildcat]

<- this guy probably thinks he's an attending with actual practice experience, director of a limb salvage center, respected expert in his field with 50+ publications.

Who are you?

SNAP!


I wish this thread would die already.

 

[aphistis]

<- this guy probably thinks he's an attending with actual practice experience, director of a limb salvage center, respected expert in his field with 50+ publications.

Who are you?

A physician--the kind that doesn't have to attach qualifying adjectives to the term.

Next caller.

 

[Coastie]

You sure about it? So can my ENT surgeon start fixing ankle fracture and deliver babies?

Please dont give the standard definition of physician.All i know is that in this modern world with malpractice and other factors lingering over head, you are severely restricted to your chosen speciality (unless its family practice or IM).

Dare to do something outside your chosen speciality in real practice(like perform Abortions in your daily Derm practice) and then use this lame excuse of "we have unlimited scope and we are qualified" when questioned by the patient's attorney. i can guarantee you a malpractice suit on your hands.

The present day MDs are no different than Pods or dentists. like us you guys are mostly limited by your chosen specialities and subspecialities. The malpractice, the patient's insurance, potential law suits,etc etc all have changed the system.

Your ENT surgeon can absolutely do those things. Able to do those with any reasonable amount of skill? Highly unlikely. Able to do those per hospital by-laws? 99.9% no. If took it up, in his own place, and sought malpractice insurance, is he insurable? You bet your life he isn't.

Can he go back to a residency and retrain? Yes. Has he been trained and fully licensed in medicine and surgery? Yes. Can you do this as a podiatrist? No. Neither of these options are available to you.

I wasn't slamming podiatrists, I was just calling someone out for "rx'ing lasix" and for talking down to a pharmacist because he doesn't like the fact that they provide a check and balance scripts.

MDs are different than podiatrists, we are trained within all fields of medicine and surgery, and can pursue those specialties at our choice after medical school. You guys can't. Does that mean you are lesser human beings, less intelligent than us? Heck no. It's not a personal slight, it's just the facts.

 

[Coastie]

There is a difference with being licensed and being qualified to perform a service or procedure.

Licenses are granted by the state, qualifications (privileges) are granted by your facility. So no, you will never be qualified to perform everything in medicine and surgery, no matter what your degree is.

Next time, quote my entire response without editing.

I don't see the point of your response. You, as a podiatrist, are limited to the foot (sometimes ankle, sometimes up to the knee?). Physicians are not limited in their scope of practice. Physicians are qualified to practice in any field of medicine or surgery, and by qualified I mean able to by law.

The point of this thread was to discuss what is appropriate for a podiatrist to Rx and what isn't. I agree with the pharmacists: They are the end game when it comes to scripts, and they can deny to fill any script when justified. This applies to 30 days of ambien by a podiatrist, if the Pharm.D. chooses, and it definitely applies to a podiatrist rx'ing lasix. <~~

 

[Coastie]

<- this guy probably thinks he's an attending with actual practice experience, director of a limb salvage center, respected expert in his field with 50+ publications.

Who are you?

I'm glad we have that clear! Thanks for coming on down to this thread to discuss what is and isn't appropriate within a podiatrist scope of practice! As a physician, I'm always interested to see what people think they are qualified to do within the law, and how they are interested in changing things to promote their personal philosophies and goals.

By the way, I still think the claim of rx'ing lasix is just a flame to stir things up.

 

[cool_vkb]

.

Can he go back to a residency and retrain? Yes. Has he been trained and fully licensed in medicine and surgery? Yes. Can you do this as a podiatrist? No. Neither of these options are available to you.

MDs are different than podiatrists, we are trained within all fields of medicine and surgery, and can pursue those specialties at our choice after medical school. You guys can't. Does that mean you are lesser human beings, less intelligent than us? Heck no. It's not a personal slight, it's just the facts.

"he can go back to a residency and retrain" huh! you make it sound its as easy as a 3 day continuing education course in Miami or Hawai. Suppose an Internist wakes up one day and decides to become Ortho or Cardio surgeon . then by your so called Universal scope and retraining option, its still gonna be 3-5 yrs in residency with another 1-2 yrs of fellowships,etc. I dont know what sane person will call that "flexibile". Thats a big sacrifice and not as easy as you mentioning especially when you are making 200K-300k. So yes he is severely limited to his scope of training/speciality!

See the way you posted your last post. it sounded as if MDs can do anything. but thats not that the case. if spending 3-5yrs is a joke for you then may be it is universal scope. if retraining is the option then we can also apply to med school and then get trained in whatever speciality we wanted to.

So where is your so called UNIVERSAL SCOPE? even you guys need to put in 3-5 yrs before you do anything other than speciality.

 

[cool_vkb]

MDs are different than podiatrists, we are trained within all fields of medicine and surgery, and can pursue those specialties at our choice after medical school. You guys can't. Does that mean you are lesser human beings, less intelligent than us? Heck no. It's not a personal slight, it's just the facts.

Ofcourse we cant because we chose our speciality before we entred Pod school. Podiatry school is for serious minded people who are genuinely interested in Foot & Ankle. its a shame and really unfortunate that we have a good number of unwanted MD-wannabees and med school rejects who give an impression that Podiatry is a backup option or are people who always push the limits of their scope of practice. A good podiatry student or Podiatrist is happy as long as he/she is given the oppurtinity to practice what they are trained for i.e Foot & Ankle pathologies.

A true Podiatry student genuinely wanted to be a Foot & Ankle surgeon (for whatever reasons he/she had) and thats the reason he joined pod school. I always advise people including my younger cousins to join Medical school if they have even 1% of doubt in their mind. medical school gives you another 4yrs to decide what you wanna be. But does it give you a golden ticket of changing specialities whenever you want? heck no! 5-7 yrs (fellowship included) is a big deal. no one has time for that mess once they are in real practice unless you close down everything and begin life with humble $45k salary & 70 hrs/week. Medical school gives you another 4yrs of serious exposure to all fields and one can decide what they want to be.

Podiatry is a serious commitment and as you mentioned in your earlier post to change speicality its gonna be a very lenghty retraining journey. So one has to be honest to himself whether he really likes this profession or just entering for other reasons and later end up disgruntled with limited options of changing field.

 

[diabeticfootdr]

I'm glad we have that clear! Thanks for coming on down to this thread to discuss what is and isn't appropriate within a podiatrist scope of practice! As a physician, I'm always interested to see what people think they are qualified to do within the law, and how they are interested in changing things to promote their personal philosophies and goals.

By the way, I still think the claim of rx'ing lasix is just a flame to stir things up.

This issue is one of credibility. You have no credibility in what you are saying. You're an MD resident who is in the midst of your training and are just figuring out hospital policy, procedures, roles of other practitioners, and state licensure. I was in your same position at one time and was learning the same things.

This is an important issue to those who may consider entering the profession and they need a credible source.

I make posts on here as an attending in a real full-time hospital practice where I train students. I sit on our state board of trustees, my partner sits on our state licensing board.

I believe I have a handle on our scope of practice better than you do (and better than a pharmacist). The pharmacist's job is not to determine scope of practice. Their job (among many safety issues with polypharmacy) is to validate the DEA and dispense validly written Rxs. A podiatrist has an unlimited DEA. Since the state board of pharmacy does not control the practice of medicine or podiatry, they can not make opinions on what is in scope or out of scope - that is deferred to the state board of podiatry.

If a pharmacist feels like any practitioner is practicing out of scope, they are certainly obliged/entitled to file a complaint with whatever board that might be. But they shouldn't make legal judgement since they don't know why the medication was written (unless they phone the physician first).

This is not meant to be demeaning toward any profession or professional. They are just the facts.

 

[aphistis]

This issue is one of credibility. You have no credibility in what you are saying. You're an MD resident who is in the midst of your training and are just figuring out hospital policy, procedures, roles of other practitioners, and state licensure. I was in your same position at one time and was learning the same things.

This is an important issue to those who may consider entering the profession and they need a credible source.

I make posts on here as an attending in a real full-time hospital practice where I train students. I sit on our state board of trustees, my partner sits on our state licensing board.

I believe I have a handle on our scope of practice better than you do (and better than a pharmacist). The pharmacist's job is not to determine scope of practice. Their job (among many safety issues with polypharmacy) is to validate the DEA and dispense validly written Rxs. A podiatrist has an unlimited DEA. Since the state board of pharmacy does not control the practice of medicine or podiatry, they can not make opinions on what is in scope or out of scope - that is deferred to the state board of podiatry.

If a pharmacist feels like any practitioner is practicing out of scope, they are certainly obliged/entitled to file a complaint with whatever board that might be. But they shouldn't make legal judgement since they don't know why the medication was written (unless they phone the physician first).

This is not meant to be demeaning toward any profession or professional. They are just the facts.

So, a scenario:

A podiatrist (or, hell, a dentist, if that makes you feel less picked-on) writes a beautiful, flawless script for at-home dilaudid 20mg IM qid scheduled for sprained ankle (toothache) pain. Are you saying the pharmacist should defer to the prescriber, dispense the prescription, and allow the patient to kill him/herself while they're on hold with the board of podiatry's (dentistry's) receptionist? Like it or not, if you answer anything but "yes," you're conceding that pharmacists have a legitimate supervisory role in prescription management. Anything after that is just window dressing and ego salvage.

 

[diabeticfootdr]

So, a scenario:

A podiatrist (or, hell, a dentist, if that makes you feel less picked-on) writes a beautiful, flawless script for at-home dilaudid 20mg IM qid scheduled for sprained ankle (toothache) pain. Are you saying the pharmacist should defer to the prescriber, dispense the prescription, and allow the patient to kill him/herself while they're on hold with the board of podiatry's (dentistry's) receptionist? Like it or not, if you answer anything but "yes," you're conceding that pharmacists have a legitimate supervisory role in prescription management. Anything after that is just window dressing and ego salvage.

That is a different matter. It is a safety issue, not a regulatory (scope of practice) issue as discussed before. Pharmacists play an important roll in medication safety. Also, if a prescription appears to be a forgery, that's another issue too.

But you mention it above .... call the prescriber for clarification/verification. That is the most prudent action.

 

[aphistis]

That is a different matter. It is a safety issue, not a regulatory (scope of practice) issue as discussed before. Pharmacists play an important roll in medication safety. Also, if a prescription appears to be a forgery, that's another issue too.

But you mention it above .... call the prescriber for clarification/verification. That is the most prudent action.

OK, fair enough: upon inspection, the prescription appears genuine in all respects, the sig clearly states "20mg qid for severe pain" (i.e. the medication is being prescribed for an appropriate indication), and despite multiple attempts the pharmacist is unable to contact the prescriber. The patient is becoming noticeably impatient and is in obvious pain. Now what?

 

[diabeticfootdr]

OK, fair enough: upon inspection, the prescription appears genuine in all respects, the sig clearly states "20mg qid for severe pain" (i.e. the medication is being prescribed for an appropriate indication), and despite multiple attempts the pharmacist is unable to contact the prescriber. The patient is becoming noticeably impatient and is in obvious pain. Now what?

We're speaking 2 different languages .... I'm not saying the pharmacist shouldn't do their job and assure Rx safety. Certainly Dilaudid 20 mg QID is far above the typical dose. Perhaps there is a good reason for it, maybe the patient is tolerant to narcotics, etc? Maybe the patient altered the script and put a 0 after the 2 mg? But without confirming it with the prescriber, the pharmacist has to act in the best interest of the patient - an err on the side of safety. Furthermore, the prescriber (or covering partner) shouldn't be unreachable. There should be an after hours contact # on the Rx (ours have them). That onus falls upon the prescriber.

This is entirely different from the theme of earlier posts which are in the vane of .... the prescriber is a DPM or a DDS, therefore I (pharmacist John) judge this to be out of scope, therefore I refuse to fill this validly written Rx. That is what I was disagreeing with - not a medication safety issue.

 

[cool_vkb]

We're speaking 2 different languages .... I'm not saying the pharmacist shouldn't do their job and assure Rx safety. Certainly Dilaudid 20 mg QID is far above the typical dose. Perhaps there is a good reason for it, maybe the patient is tolerant to narcotics, etc? Maybe the patient altered the script and put a 0 after the 2 mg? But without confirming it with the prescriber, the pharmacist has to act in the best interest of the patient - an err on the side of safety. Furthermore, the prescriber (or covering partner) shouldn't be unreachable. There should be an after hours contact # on the Rx (ours have them). That onus falls upon the prescriber.

This is entirely different from the theme of earlier posts which are in the vane of .... the prescriber is a DPM or a DDS, therefore I (pharmacist John) judge this to be out of scope, therefore I refuse to fill this validly written Rx. That is what I was disagreeing with - not a medication safety issue.

I have a question for u, and all other practicing pods out there (except trachaedoc, who is now MD )

Honestly how many times in real life did you encountered problems coming from pharmacists who rejected your prescription flat outright (like some anonymous *****s are posting here/some even claim to shudder as soon as they see a pod prescription without even reading it)

Yesterday i dropped by the office of two pods who i shadowed before joining pod school and asked them abt this issue. i took the printout of this thread as i was genuinely irrtated and worried by some posts frm pharmacists.

they said to me that they never ever had any problem with the area pharmacies (may be few regarding dosage,etc but never abt "HOW CAN YOU PRESECRIBE THIS, YOU ARE JUST A PODIATRIST" as some anonymous self styled pharmacists claim here). They said me that if thats the case then why subject podiatrists to 6-7 yrs of training or give them an unrestricted DEA number. lets just give pharmacist the power to decide who get to write what and dispense drugs accordingly.According to them (not me), the main function of a pharmacist is to ensure the safety of the patient. It doesnt matter what a pod prescribes as long as it doesnt affect the safety of the patient the pharmacist has no right to deny the prescription (unless its something against their beliefs like pregnancy pills,etc).

Can you please comment on your REAL LIFE EXPERIENCES ON THIS ISSUSE. LIKE HOW MANY TIMES DID YOU HAD PROBLEMS WITH REAL PHARMACISTS (not the anonymous ones here)

I personally feel that SDN is becoming a ground for insecure/repressed people who in real life cant do a squat abt anything and they come here and post questions or pass comments about other professions which they woudnt dare to do in their real life. i mean imagine this resident going to you or a succesfull pod sitting in the dept of orthopedics and say him "We guys have unlimited scope of practice and you guys dont so stop prescribing this or that" or a pharmacist calling a pod and saying "you know you are a pod so dont write this medication".

 

[Aznfarmerboi]

I have a question for u, and all other practicing pods out there (except trachaedoc, who is now MD )

Honestly how many times in real life did you encountered problems coming from pharmacists who rejected your prescription flat outright (like some anonymous *****s are posting here/some even claim to shudder as soon as they see a pod prescription without even reading it)

Yesterday i dropped by the office of two pods who i shadowed before joining pod school and asked them abt this issue. i took the printout of this thread as i was genuinely irrtated and worried by some posts frm pharmacists.

they said to me that they never ever had any problem with the area pharmacies (may be few regarding dosage,etc but never abt "HOW CAN YOU PRESECRIBE THIS, YOU ARE JUST A PODIATRIST" as some anonymous self styled pharmacists claim here). They said me that if thats the case then why subject podiatrists to 6-7 yrs of training or give them an unrestricted DEA number. lets just give pharmacist the power to decide who get to write what and dispense drugs accordingly.According to them (not me), the main function of a pharmacist is to ensure the safety of the patient. It doesnt matter what a pod prescribes as long as it doesnt affect the safety of the patient the pharmacist has no right to deny the prescription (unless its something against their beliefs like pregnancy pills,etc).

Can you please comment on your REAL LIFE EXPERIENCES ON THIS ISSUSE. LIKE HOW MANY TIMES DID YOU HAD PROBLEMS WITH REAL PHARMACISTS (not the anonymous ones here)

I personally feel that SDN is becoming a ground for insecure/repressed people who in real life cant do a squat abt anything and they come here and post questions or pass comments about other professions which they woudnt dare to do in their real life. i mean imagine this resident going to you or a succesfull pod sitting in the dept of orthopedics and say him "We guys have unlimited scope of practice and you guys dont so stop prescribing this or that" or a pharmacist calling a pod and saying "you know you are a pod so dont write this medication".

As a student, I really dont think you should be commenting on this without thinking things over.

However the answer to that is you are given an unrestricted DEA license (which means you can prescribe all schedule drugs) is because the DEA deems that you need schedule 2 drugs for your practice. That is different from what you might translate to unlimited prescribing abilities.

The main function of a pharmacist (seriously, now you are telling us what our job is when you have no training what so ever) is more than ensuring patient safety.

As quoted before. . . from DEA guidelines

To be valid, a prescription for a controlled substance must be issued for a legitimate medical purpose by a practitioner acting in the usual course of sound professional practice. The practitioner is responsible for the proper prescribing and dispensing of controlled substances. However, a corresponding responsibility rests with the pharmacist who dispenses the prescription. An order for controlled substances which purports to be a valid prescription, but is not issued in the usual course of professional treatment, or for legitimate and authorized research, is not a valid prescription within the meaning and intent of the CSA. The individual who knowingly dispenses such a purported prescription, as well as the individual issuing it, will be subject to criminal and/or civil penalties and administrative sanctions.

Its as simple as that. If patient is experiencing insomnia and requires 30 days of Ambien, refer him to his primary care physician please. Anything from there on leads to a slippery slope arguement.

Before you respond anymore, keep in mind that there are also state laws that you have to follow. State laws are always more strict than Federal law because it is based on Federal law which is a standard for all states. As I have posted before,

From NYS board of Podiatry

§7001. Definition of practice of podiatry.
The practice of the profession of podiatry is defined as diagnosing, treating, operating and prescribing for any disease, injury, deformity or other condition of the foot, and may include performing physical evaluations in conjunction with the provision of podiatric treatment. Podiatrists may treat traumatic open wound fractures only in hospitals, as defined in article twenty-eight of the public health law.
The practice of podiatry shall not include treating any part of the human body other than the foot, nor treating fractures of the malleoli or cutting operations upon the malleoli. Podiatrists licensed to practice, but not authorized to prescribe or administer narcotics prior to the effective date of this subdivision, may do so only after certification by the department in accordance with the qualifications established by the commissioner. The practice of podiatry shall include administering only local anesthetics for therapeutic purposes as well as for anesthesia and treatment under general anesthesia administered by authorized persons.

PS: And yes, we routinely turn down illegitimate prescriptions. Keep in mind that since we dont want to interfere with patient physcian relationship, we only do it when after we exercise our most extreme professional judgement. You know, just like how you guys do the same. Something that you might not understand yet.

 

[Aznfarmerboi]

And please, I feel hard pressed as so far, besides jonwill and diabeticfootdoctor, a lot of the other podiatry doctors and students here just post irrelogical statements that are just opinions and believe it is a legtimate statement. Just because you say it is so does not mean it is so. If you are truly asking a question such as why can does a podiatrist have a unrestricted DEA license, ask it nicely without trying to answer your question or look it up yourself.

That is the equivalent of the arguement hey, how come I cant buy pot legally when I can legally buy alcohol.

The law is the freaking law. As I have suggested before, if you guys have a problem (I really do believe you guys should be able to do more than what is allowed especially in NYS), lobby the DEA and your local state legislation.

 

[diabeticfootdr]

Honestly how many times in real life did you encountered problems coming from pharmacists who rejected your prescription flat outright (like some anonymous *****s are posting here/some even claim to shudder as soon as they see a pod prescription without even reading it)

Never once. I have a good working relationship with all our area pharmacists.

They phone me to point out potential interactions or to report a possible fraudulent script, but never (in thousands of Rx's) have I had an issue where a pharmacist rejects a script due to degree discrimination.

I even phone in Rx's in other state for patients who have traveled to see me, and still no issues (and that is where a pharmacist can have a legitimate concern).

 

[cool_vkb]

Never once. I have a good working relationship with all our area pharmacists.

They phone me to point out potential interactions or to report a possible fraudulent script, but never (in thousands of Rx's) have I had an issue where a pharmacist rejects a script due to degree discrimination.

I even phone in Rx's in other state for patients who have traveled to see me, and still no issues (and that is where a pharmacist can have a legitimate concern).

Thats what i was expecting. This is the same reply i got from the pods i shadowed. This whole issue is being exagerrated by anonymous insecure people (i mean common anybody can call himself a pharm or resident or surgeon on SDN, there aint no guarantee they are for real) who have nothing else to do in their real life and write bizzare comments or stuff on SDN.

These people are potraying as if they stand for all pharmacists or represent a view held by majority of pharmDs.

 

[cool_vkb]

From NYS board of Podiatry

§7001. Definition of practice of podiatry.
The practice of the profession of podiatry is defined as diagnosing, treating, operating and prescribing for any disease, injury, deformity or other condition of the foot, and may include performing physical evaluations in conjunction with the provision of podiatric treatment. Podiatrists may treat traumatic open wound fractures only in hospitals, as defined in article twenty-eight of the public health law.
The practice of podiatry shall not include treating any part of the human body other than the foot, nor treating fractures of the malleoli or cutting operations upon the malleoli. Podiatrists licensed to practice, but not authorized to prescribe or administer narcotics prior to the effective date of this subdivision, may do so only after certification by the department in accordance with the qualifications established by the commissioner. The practice of podiatry shall include administering only local anesthetics for therapeutic purposes as well as for anesthesia and treatment under general anesthesia administered by authorized persons.

PS: And yes, we routinely turn down illegitimate prescriptions. Keep in mind that since we dont want to interfere with patient physcian relationship, we only do it when after we exercise our most extreme professional judgement. You know, just like how you guys do the same. Something that you might not understand yet.

Off all the 50 states why do you always give reference from NY (you posted this few days back also). Thats the least developed state (and only few remaining) when it comes to Podiatry. Why dont you give references from Florida or georgia or california.

 

[NatCh]

I have a question for u, and all other practicing pods out there (except trachaedoc, who is now MD )

Honestly how many times in real life did you encountered problems coming from pharmacists who rejected your prescription flat outright (like some anonymous *****s are posting here/some even claim to shudder as soon as they see a pod prescription without even reading it)

Yesterday i dropped by the office of two pods who i shadowed before joining pod school and asked them abt this issue. i took the printout of this thread as i was genuinely irrtated and worried by some posts frm pharmacists.

they said to me that they never ever had any problem with the area pharmacies (may be few regarding dosage,etc but never abt "HOW CAN YOU PRESECRIBE THIS, YOU ARE JUST A PODIATRIST" as some anonymous self styled pharmacists claim here). They said me that if thats the case then why subject podiatrists to 6-7 yrs of training or give them an unrestricted DEA number. lets just give pharmacist the power to decide who get to write what and dispense drugs accordingly.According to them (not me), the main function of a pharmacist is to ensure the safety of the patient. It doesnt matter what a pod prescribes as long as it doesnt affect the safety of the patient the pharmacist has no right to deny the prescription (unless its something against their beliefs like pregnancy pills,etc).

Can you please comment on your REAL LIFE EXPERIENCES ON THIS ISSUSE. LIKE HOW MANY TIMES DID YOU HAD PROBLEMS WITH REAL PHARMACISTS (not the anonymous ones here)

I personally feel that SDN is becoming a ground for insecure/repressed people who in real life cant do a squat abt anything and they come here and post questions or pass comments about other professions which they woudnt dare to do in their real life. i mean imagine this resident going to you or a succesfull pod sitting in the dept of orthopedics and say him "We guys have unlimited scope of practice and you guys dont so stop prescribing this or that" or a pharmacist calling a pod and saying "you know you are a pod so dont write this medication".

While I was in residency and on Internal Medicine rotation I was questioned a couple of times by Pharmacy as to why I was writing prescriptions to manage congestive heart failure, hypertension, and the like. After telling them that I was on Internal Medicine rotation and therefore practicing as an internist for the month, they stopped questioning the orders.

Since starting practice however, I've been called only a few times (i.e., three or four) but never to question the appropriateness of a prescription. Sometimes they called to tell me that they have the gel version versus the cream version, or caps versus pills. Sometimes they called to tell me that they do not have a certain medication in stock and asked if a similar medication would suffice.

I've never been confronted with the contentiousness that we're seeing in this thread here, but I did hear through the grapevine that a certain pharmacist here in town could not understand how a podiatrist, "with only a high school education" (his words, not mine) could write prescriptions and he could not. I think his complaints should have been directed inwardly towards his own profession rather than outwardly towards ours.

If anyone on this thread truly believes that Dr. Rogers (diabeticfootdr) prescribed anything inappropriately, then by default they also believe that the pharmacists in his hospital acted inappropriately by filling the prescriptions. Dr. Rogers, have any of your prescriptions been rejected by Pharmacy? If not, then the pharmacists in your hospital who filled the prescriptions agree that you are prescribing appropriately.

If anyone on this thread honestly believes that Dr. Rogers and his hospital's pharmacy staff was in any way a danger to the public, then they should contact both the Iowa state board of podiatry and also the Iowa State Board of pharmacy to report suspected infractions. Otherwise, it's all just meaningless Internet chatter.

 

[aphistis]

We're speaking 2 different languages .... I'm not saying the pharmacist shouldn't do their job and assure Rx safety. Certainly Dilaudid 20 mg QID is far above the typical dose. Perhaps there is a good reason for it, maybe the patient is tolerant to narcotics, etc? Maybe the patient altered the script and put a 0 after the 2 mg? But without confirming it with the prescriber, the pharmacist has to act in the best interest of the patient - an err on the side of safety. Furthermore, the prescriber (or covering partner) shouldn't be unreachable. There should be an after hours contact # on the Rx (ours have them). That onus falls upon the prescriber.

This is entirely different from the theme of earlier posts which are in the vane of .... the prescriber is a DPM or a DDS, therefore I (pharmacist John) judge this to be out of scope, therefore I refuse to fill this validly written Rx. That is what I was disagreeing with - not a medication safety issue.

Works for me.

 

[Forkit]

I don't want to get into a flame war just seeking opinions. I have a Pt who has a significant foot injury and the DPM who is writing for ambien as needed for insomnia. We filled a couple of 2 week prescriptions for her but the Dr. has now written for 30 with 2 refills. I don't doubt the seriousness of her injury but she is not consistently filling any type of pain medication, narcotic or non-narcotic, no neuroleptics, no nsaids, just ambien from the DPM and phentermine from a different Dr. I declined to fill the Rx and the Dr. is upset. Am I being a butthead pharmacist from your point of view?

You denied somebody ambien for insomnia, even after prescribed by a doctor. You sir and an idiot. Stick to the scope of your practice and follow the doc's prescription. For the love of god, she is asking to fill AMBIEN, NOT some strong ass and highly addictive barbituate/xanax/dilaudid/oxycontin (the last of which she could easily get prescribed to her by some doctors here in Florida). Ambien is a relatively weak narcotic, with a low abuse potential. Even disregarding that fact, dont act like you know more that the doc, since you will never have role of diagnosis a patient. Next time chill the f out and get your head out of your butt Even if she gets "hooked" on ambien, that's NOT your problem.

 

[Ferocity]

You denied somebody ambien for insomnia, even after prescribed by a doctor. You sir and an idiot. Stick to the scope of your practice and follow the doc's prescription. For the love of god, she is asking to fill AMBIEN, NOT some strong ass and highly addictive barbituate/xanax/dilaudid/oxycontin (the last of which she could easily get prescribed to her by some doctors here in Florida). Ambien is a relatively weak narcotic, with a low abuse potential. Even disregarding that fact, dont act like you know more that the doc, since you will never have role of diagnosis a patient. Next time chill the f out and get your head out of your butt Even if she gets "hooked" on ambien, that's NOT your problem.

You bumped a 3 year old thread for this?

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