Monday, June 25, 2007

They Don't Teach Prescription Writing in Medical School

Before I get into the meat of this post, listen to this customer complaint today:

Customer: "I'm here to pick up 2 prescriptions my doctor phoned in."

Tech: (After checking the computer and asking me whether I had anything yet to be typed for her) "Your doctor hasn't called anything in for you yet."

Customer: (now angry) "Maybe I'll go to Walgreens to get my prescriptions."

Tech: (confused) "Did your doctor call in your prescriptions to Walgreens? Would you like me to call them?"

Customer: "No, I've never been to Walgreens, but maybe I'll start going there now."

The customer then stormed off. Apparently, it's our fault that her doctor did not phone in her brand new prescription to our pharmacy in a timely manner. Next time, I'll remember to break out my good old pharmacist clairvoyance and call this complete stranger's doctor before she gets a chance to show up.

On second thought... even if I had that power, I wouldn't do that. Fuck her.

Another thing that pissed me off today were the endless prescription problems. Why is it that the only profession that truly knows how to write a prescription properly is unable to prescribe??? Do they teach prescription writing in medical school? Hospital doctors are the absolute worst at this. They work in a place with a kabillion other doctors and practitioners who prescribe. The prescription blanks contain no information other than the hopital to which the doctor belongs. Sometimes the hospital's phone number isn't even on the blank!! Despite this, the fuckhead doctor thinks it's perfectly valid to scribble everything on the script in such a way that not even a CIA handwriting expert could decipher what it says or to whom the writing belongs.

This leads to the always fun task of calling the hospital. Those in the profession know exactly how exhilirating this can be. For those who've never had the pleasure of doing so, I'll paint you the average scenario:

Upon calling, the first person you'll talk to is someone from the hospital answering service who can do nothing but tell you the patient was, indeed, at the hospital on the day the script was written. Being otherwise useless, said receptionist will transfer you to her best guess as to the department the patient was seen when the script was written. Usually, they send you to the ER first. From there, someone will pick up the phone, have no idea what you're talking about, and place you on hold. 2 minutes later, a different ER person will pick up the phone, look through some computer and decide that the person was seen in wing 2, so she'll transfer you to that department. Someone from wing 2 picks up the phone, whereupon you'll have to recite the same spiel for the 4th time ("Hi, this is Mr. RPh from Busy Retail Pharmacy. I'm trying to clarify the directions and find out the doctor who wrote this prescription for Pain-in-the-ass Patient. What? Do I know which doctor wrote it? No, I'm sorry. I can't even make out a single letter in the signature. Can I hold? Sure, I'm now only about 20 scripts behind thanks to Doctor Fuckhead's inability to write more legible than a 2 year-old, but don't you worry... I'll hold.")

Anyway... after being transfered around a couple more times, you end up finding out that the script, even though written on a hospital blank, wasn't from the hospital, but instead was written at the clinic just down the road from the hospital. They can't transfer you, but they'll give you the number. Finally, you call the clinic and find out Doctor Fuckhead was actually Doctor Smith, and he didn't really mean to write the prescription for Tylox 5/325 (which doesn't exist). He actually meant Percocet 5/325, which has the same active ingredients, but the different dosing somehow qualifies them to be entirely different products. Technically, you can refuse to fill this script because doing so requires the pharmacist to make an alteration to the prescribed drug on a Narcotic script (a big no-no according to the DEA). However, you just don't feel like dealing with the stupid run around again, so you just mark it on the script and try to catch up with the work that piled up during your 20 minute transfer-fest.

The wave of the future is supposed to be this e-prescribing, where a doctor just punches a prescription into his PDA, and it gets beamed electronically to the pharmacy. It's supposed to cut down on prescription errors. In theory, it sounds great. Pharmacists won't have to guess at doctor's terrible handwriting. In practice, you gets scripts like this (actual prescription order):

Drug: Hydroxyurea 500mg
Dispense: 5 capsules (30 days)
Sig: 80mg/kg per day

This prescription is impossible to fill even if I knew the weight of the person to which it was prescribed. Your guess is as good as mine as to how the prescription got sent in that fashion. I assume the doctor chose the drug, and then messed up on some sort of preset dosing form, but who really knows???

You also get scripts with directions that read like this:

Lipitor 10 mg
Dispense: 30 tablets
Sig: 1 tablet with food by mouth daily by mouth at bedtime with food.

If you have a really lazy pharmacist, that's what the directions will end up saying on the patient's prescription bottle.

See... one of my coworker's theory is that the average brain can only contain so much information. Four years of premed, 4 years of medical school, 1 year internship, and 2 years of residency pretty much fill doctors' heads with so much medical information that common sense gets crowded out.

Personally, I think that most doctors aren't any smarter than anyone else. They're just big, overachieving nerds who spent all of their academic life doing nothing but studying all day. They're not brilliant. They just work a lot harder at it than the normal person, while not truly having superior intellect. Of course, from my experience in retail pharmacy, I've come to learn that the average person is a fucking moron. Hence, most doctors are morons that just work a lot harder than the average person at not looking so dumb.

I need food.


Natalie :) said...

Oh, I have been on that phone call to the hospital. It's like you were RIGHT THERE, dude, listening to my entire conversation.


Racquel said...

Everything you said is soooo true. Do you ever have issues with people buying sudafed. We call them "FED Heads" they're my favorite. "It's for my grandmother. I'll also need some syringes for her too. No, I'm not sure what size she needs. Yeah I'll take a pill crusher too." Classic!