Retired, cheap sob, ophthalmologist wants us to order and dispense Fluorouracil Injection 2.5gm/50ml(50mg/ml) for himself or wife for topical use not injection. I can find nothing that recommends topical use of this product. Yes, he ordered it but not sure that means a thing in this case if something goes south. He only wants it because its the very cheapest way to go. Personally uncomfortable with this. anyone have experience with using this topically? would you fill this?
would you fill this?
- Thread starter Old
- Start date
owlegrad
Uncontrollable Sarcasm Machine
Staff member
Administrator
Volunteer Staff
Lifetime Donor
15+ Year Member
- Joined
- Mar 19, 2009
- Messages
- 25,393
- Reaction score
- 12,073
Unless he plans to inject it opthamolicly (j/k), no.
- Joined
- Nov 24, 2007
- Messages
- 8,446
- Reaction score
- 9,762
That's nonsense.
You know exactly what he's using it for.
If he has a valid license to practice medicine, why would you deny the prescription?
My medical license doesn't limit my practice nor does it require me to not use off label drugs, etc. If it did, I'd be out of business as many common anesthesia drugs are off label in pediatric patients.
I could open an Aesthetic and Wellness Center tomorrow and sclerose spider veins and do topical treatments, laser fat reduction nonsense, etc after a weekend class and free manufacturers support. Not to mention nutritional support, aura manipulation, etc.
I actually know two anesthesiologists that did this in CA and AZ, they are doing better than ever and never work late, take call or weekends. Though they probably prescribe the usual cream for AKs and not topical injectables. And of course I would never try to manipulate an aura without an experienced practitioner guiding me, very dangerous indeed. Lol.
I agree. An ophthalmologist may prescribe it. A medical doctor has no limited scope of practice. I would probably fill it after of course consulting with him. Now, if it was written by an optometrist , i would deny it for sure
If he's that cheap he's probably compounding it with some form of ointment and using to treat a precancerous lesion. As long as he has an active medical license I'd probably go ahead and fill it. Mind you, I'd document on the back of the prescription that you did counsel the patient/prescriber.
- Joined
- May 16, 2007
- Messages
- 4,499
- Reaction score
- 1,689
You would be incorrect. His license is as a physician. His specialty is ophthalmology. If his license limited him to only ophthalmology you would have a leg to stand on. As it is your logic is a double amputee. You don't have a leg to stand on. As long as retired physicians are allowed to prescribe in your state, you should dispense.
I don't think it means what you think it means. Of course, a physician is licensed to prescribed anything he wants. The term "scope of practice" is used to assign liability to pharmacists. The doctor can write for whatever he wants; the pharmacist has a duty to not dispense it.
Last edited:
- Joined
- Dec 18, 2012
- Messages
- 1,335
- Reaction score
- 1,045
No; this is completely state-dependent. Some state boards of pharmacy have made proclamations that medical doctors are not limited in scope of practice by their practice area.
I'd probably dispense this one, especially if he said he'd used it before under a different doctor's prescription. That said, since this isn't his specialty area, I would likely ask him during counsel if he's been seen for the condition by a dermatologist, as proper follow up with somebody other than himself is likely necessary.
Again, i don't think you understand. OP is not questioning the doctor's prescriptive authority. The doctor can write for whatever he wants. The question is should we, as pharmacists, dispense whatever is on the blank. This doctor is also licensed to prescribe chemo. Would I dispense it? No.
Last edited:
- Joined
- Aug 6, 2011
- Messages
- 1,368
- Reaction score
- 1,004
The license lets him prescribe what he wants, but that doesn't mean me or another pharmacist has to approve it and use their license to dispense it. Pharmacy boards (and professional liability) expect us to make attempts to make sure meds dispensed under their pharmacist license are used safely and appropriately. Just because a surgeon is an MD and has a medical license doesn't mean I'm going to fill scripts he wrights for friends to treat chronic conditions for which I know they are not appropriately being monitored for (which happens). There are instances where one may let 1 fill slide for a month to get someone by like with an inhaled corticosteroid for asthma a patient has been on for a while, but I wouldn't fill one with x12 refills for an asthmatic patient written by a surgeon who wasn't trained to treat asthma and likely isn't properly following the patient. In my judgement that medication isn't being prescribed appropriately or ethically. Pharmacists are held liable for what they dispense, if you know something is being used beyond the physician's training or have reason to believe they aren't being monitored, or won't be monitored appropriately, it's their duty to contact the prescriber and deny the prescription if it's deemed that it isn't being used safely or appropriately. It doesn't matter to me if an MD has a license to practice in the state I work in, if I see prescriptions I'm not professionally comfortable with filling I won't do it, I won't use my future license like that. Just because a general practitioner or surgeon can technically legally use their medical license to put in chemotherapy orders for an onc patient doesn't mean I would use my license to approve of that or dispense it. I'm not going to assume that liability and professionally I'd have reason to believe it's not being used appropriately or safely. I know that's an extreme (and not realistic) example, but it shows that just because a license enables one to do something doesn't mean they should be allowed to do it when we have a checks and balances system. The pharmacist also has their own license on the line for which they are liable for. Increasingly we see lawsuits where pharmacists are sued and held liable for things like opiod prescribing resulting in addiction. It was "legal" for the MD/DO to prescribe that, but they weren't doing so ethically and were technically not monitoring appropriately and feeding an addiction and the pharmacist dispensing that was also held liable and had to payout a sum too. I believe this was a recent case in West Virginia.
Last edited:
Wow...even a student here gets it. I couldn't have put it better myself.
- Joined
- Dec 18, 2012
- Messages
- 1,335
- Reaction score
- 1,045
No; I get it. I just clearly draw my line in the sand at a different point than you do. I don't dispense just whatever physicians write for, but this particular example isn't such a big problem for me if it's confirmed during counsel how he is actually using this and it's safe. Of course I would document our conversation, but if he's using it for a reasonable purpose, actually making it with a reasonable dilution of some type of lotion, and has follow up care, I wouldn't completely put the kibosh on it.
- Joined
- Dec 18, 2012
- Messages
- 1,335
- Reaction score
- 1,045
As a follow up, I find most physicians are pretty reasonable and intelligent people and generally make good choices with self prescribing or family prescribing. Occasionally I get the weird ones trying to prescribe medicine for their animals (or their friends' animals), but mostly it's just chronic eyedrops, blood pressure meds for mom when she couldn't get to the doctor, etc.
- Joined
- Nov 24, 2007
- Messages
- 8,446
- Reaction score
- 9,762
The examples of prescribing a years worth of asthma medication or high dose opiates or cancer chemotherapy are pretty extreme and don't really apply. I suspect if he simply ordered the standard cream or ointment this thread wouldn't exist. His insurance likely won't cover that arguably cosmetic use and that's why he ordered the IV form. One could argue that could be viewed as fraud which I would think would be reasonable to question his prescription. At the end of the day, this isn't for cancer chemotherapy or long term opiates, it's just to get rid of some unattractive AKs, that any physician can correctly diagnose, to look better at the club or not catch annoyingly on his sleeve. I don't really see the risk or crisis of conscience with this prescription, or why a retired ophthalmologist would be that cheap.
Last edited:
- Joined
- Oct 30, 2005
- Messages
- 1,174
- Reaction score
- 776
Just say you can't order IV products. Boom. Done.
- Joined
- Jun 29, 2011
- Messages
- 2,892
- Reaction score
- 1,863
Absolutely not. Scope of practice is a legitimate issue in pharmacy. You are sadly mistaken if you assume a medical issue that arises from your out of scope prescribing cannot extend to the pharmacist.
Wrong. Physicians have a scope of practice that must be followed. Can this physician show me the patient's chart? Can he show me the H&P performed? If not, it's not a valid prescription in my state. If you want to break the law that's up to you.
- Joined
- Nov 24, 2007
- Messages
- 8,446
- Reaction score
- 9,762
As I said, there's nothing stopping me from opening my own cosmetic shop and doing minor cosmetic procedures and prescribing 5FU for AKs, etc.
At least I'm a physician, most of these places have "technicians" doing dangerous procedures, seeing the patients, etc. The clients don't even understand the risks. They're lucky to see a physician for 5 minutes to update their acne drugs and rubber stamp a 6 mo rx.
But if you want to bust some Physicians balls and make him pay a $50 copayment to see a dermatology NP for his Actinic Keratoses cream, go for it. Maybe he won't get treated at all and end up with a squamous cell carcinoma.
At least I'm a physician, most of these places have "technicians" doing dangerous procedures, seeing the patients, etc. The clients don't even understand the risks. They're lucky to see a physician for 5 minutes to update their acne drugs and rubber stamp a 6 mo rx.
But if you want to bust some Physicians balls and make him pay a $50 copayment to see a dermatology NP for his Actinic Keratoses cream, go for it. Maybe he won't get treated at all and end up with a squamous cell carcinoma.
- Joined
- Jun 29, 2011
- Messages
- 2,892
- Reaction score
- 1,863
Or maybe I do what you told me to do and I get sued because his carelessness caused him to lose the nerve fibers in his skin. This is really a non-issue. That prescription should be denied without hesitation by any pharmacist with a brain.
There's also nothing stopping him from opening an illegal clinic in his home and treating his relatives and friends. So when **** goes down, there's a paper trail that leads back to the pharmacy that dispensed it. Again, it's not about you. It's about us doing our job and our own liability. You of all people should know this very well.
Or he could go get treated by a specialist and not be so unprofessional about it. It's this kind of frivolous attitude and abuse of prescriptive authority that has led to the current limitations and criticisms with opioid prescriptions. You're a professional. Act professionally.
Last edited:
Here's the other problem with this prescription: it is a hazardous drug product and it is concentrated. If he IS compounding it at home, he certainly isn't using proper precautions and could easily be exposing himself and anyone else who lives with him to repeated chemotherapy exposure. We also have no idea if he is using a safe concentration or if he is mixing it incorrectly resulting in an unsafely high concentration. If he isn't, that's even more likely to cause exposure. To me, that is very high risk in regards to dispensing liability. I have compounded several chemotherapy topical or oral products and would never do it outside of a vertical flow hood with chemotherapy precautions. Would you? There is a reason we do it that way, and it is because of safety.
- Joined
- May 16, 2007
- Messages
- 4,499
- Reaction score
- 1,689
You are wrong. Legally, morally or any other way. ALL MD's are created equal Once you graduate from medical school and get a license in a particular state, you DO NOT lose privileges because you decide to get more training and specialize. You are argument is illogical, and illegal. Unless your state has a law that indicates otherwise, and licensed physician can prescribe what he wants. You may decide not to fill something because you feel the therapy is not appropriate and you have the right do so. Scope of practice is not argument you can use in this case.
- Joined
- Jun 29, 2011
- Messages
- 2,892
- Reaction score
- 1,863
I am 100% right and the fact that you think otherwise is a sad reflection on how you view your license. MDs specialize for a reason. Why is it appropriate for an eye doctor to prescribe his wife or himself some fluorouracil for topical use? Why is it appropriate for a podiatrist to prescribe ketorolac ophthalmic susp? Why it is appropriate for a dentist to prescribe birth control? Answer: it's not appropriate. There is not a moral, legal, or "any other way" against following the law. Because YOU chose to treat your license like it was printed on construction paper is your choice. But don't come here and lecture us about scope of practice not being a valid argument. You are wrong. End of story.
So you would fill a cytarabine injection script written by this opthamologist if he presented you with a script for it? If you answer no, then you will have agreed that all MDs are not created equal and scope of practice is a valid argument. If you answer yes, then that's your call and you have every right to put your own license at risk for liability. I mean this pretty basic, and it's scary that there are pharmacists here that think this way.
Last edited:
I am sure you are wrong. The examples you picked proved that. Podiatrist and dentist have limited scope of practice whereas the md does not
I think some nonsense arguments are being made here. When you guys receive a speciality drug electronically do you go check to make sure it is written by specialist? In the signature you only see the md, not the speciality.
I once had an argument with a rph who believed a gynecologyst cant write pain pills
I once had an argument with a rph who believed a gynecologyst cant write pain pills
Last edited:
So would you dispense a cytarabine script written by this opthamologist if it was presented to you?
Last edited:
Sure, you cannot know everything at all times. You have to do your due diligence/clinical judgement and this is a case you have to make should you need to defend yourself. Just because something is sent over electronically doesn't mean it that voids you of mutual liability. In OP's case, he will have knowingly dispensed a medication outside scope of practice.
Also, I would leave anecdotal examples (your argument with this "other rph") out of debates because of all this he said/she said stuff that no one can really verify.
Last edited:
Dont have it. Cant order it.
lol. I didn't ask if you could order it. I asked if you would dispense it. I'm going to stock your pharmacy for you. Would you dispense it? Answer the question. it's a yes or no.
I work in retail bro. We dont dispense this
Bro...it's a yes or no question. Why you gotta lie like that. I work in retail too. You can surely order this. If you have to lie to avoid dispensing the medication then your whole argument has no merit. What a joke.
Well i would not order it. Dont feel comfortable to fill it even for the oncologist
I didn't ask if you can or cannot order it. I asked if you would dispense it.
If you have to lie to avoid dispensing the medication then your whole argument has no merit. What a joke.
But in OP's situation, the fluorouracil injection is okay right? I mean you would totally give it to him because he told you he's gonna use it topically. LOL.
I said of course after consulting with the md. There is a study that says its topicsl use is safe.
ancienbon said:
But you wouldn't dispense a cytrabine injection rx from him. So there is a difference between MDs: you are discriminating scripts. According to your argument, he should be able to write for anything and you would dispense it.
He is a licensed physician . He can prescribe it. Of course you have the right to refuse it.
- Joined
- May 16, 2007
- Messages
- 4,499
- Reaction score
- 1,689
Listen. you never learned how to argue. You don't know the rules. You have refused to answer my question. You pull out straw man arguments that you know down to prove your point. The problem is there are not analogous.
Dentist prescribing birth control = out of scope of practice
Podiatrist prescribing eye drops = out of scope of practice.
Ophthalmologist prescribing any drug he wants is not out of the scope of his practice. He is an MD. Specialization as added training. He does not lose any privilege under the law just because he had more training. Any time he wants he can open a family practice office and write for anything. he has an M.D. That is all you need to know about scope of practice. There is no law or regulation that says only oncologists can write for 5FU and only dermatologists can write for some other drug and only cardiologists can write for heart drugs.
Show me your state law that says M.D.'s have limited prescribing based on their specialty. Like I said, you can fill as not a appropriate therapy, not not because of scope of practice.
Then you are agreeing with everyone here then. That's all that has been argued. No one is arguing that the MD doesn't have the authority to write for it. We know he does. As pharmacists, you can refuse it because you feel that it will not be safely used since the doctor is written for something outside of his scope of practice. This term is to assign liability to the pharmacist; it's not used to define an MD's prescriptive authority. It's good you're going for breakeven in your debates. I like the change in tone.
Last edited:
That wasn't his argument; that's not even what's been argued here. LOL. Scope of practice isn't a term used to define an MD's prescriptive authority. It's used to assign liability to the pharmacist. I don't think you're understanding any of this. You're just quick to jumping the gun because you want to be right.
Not appropriate to therapy? You're not trained to diagnose...how do you know it's not appropriate therapy? That'll open up some lawsuits...I hope you're not going around telling doctors it's not appropriate therapy. You're not trained enough nor involved enough in the patient's treatment to even make that call.
Last edited:
Well you have the right to refuse any prescriptions in my state. I refuse to fill pain pills all the time.
Thank you . You summarized it all. It is ridiculous that they compare ophtalmologist with dentist and podiatrists. They are so out of touch
No one is arguing that the MD doesn't have the authority to write for it. We know he does. He can write for anything he wants, but should you dispense anything on the blank. As pharmacists, you can refuse it because you feel that it will not be safely used since the doctor is writting for something outside of his scope of practice. This term is to assign liability to the pharmacist; it's not used to define an MD's prescriptive authority. You and oldtimer are confusing the two.
How about methotrexate injection? Surely that is available at your store. Or how about Humira? You're okay with dispensing those from an ophthalmologist?
Brah, he's just gonna lie about his wholesaler not having it and weasel himself out of making a decision.
- Joined
- Dec 18, 2012
- Messages
- 1,335
- Reaction score
- 1,045
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991444/
Also, if a general practice NP can write for either of these, why can't an ophthalmologist?
Do you even read; stop jumping into threads without reading everything. No one is saying they can't write for it. They can write for anything. The debate is should we dispense it. That's OP's question. Scroll up and read. OP is asking if he should dispense it. He's not asking if the doctor has the authority to write for it. OP says hes uncomfortable with dispensing it. Many of us agree. There are a couple here who's given him beef for possibly refusing it because they feel he shouldn't be refusing a legitimate script, or any script, from an MD with authority to write for it.
Last edited:
