Tuesday, February 24, 2009

It Usually Isn't a Customer That Sets Me Off

When it comes to dealing with customers, I have near endless patience. For one, whether or not it's a good thing, I automatically assume that everyone I meet is stupid until they prove otherwise. It's not a lack of respect on my part. I figure the odds are simply in my favor. Most people are stupid. Some are amazingly stupid. In fact, you meet a hell of a lot more amazingly stupid people than amazingly smart people. Therefore, I just assume that customers are going to have a hard time understanding what I tell them. I assume they will not call in a refill well in advance of running out of medication. I assume they will complain about their high copay even when it's been the same for the last 6 months.

The other reason I'm very patient with customers is simply because they don't know any better. Most of our customers don't work in a pharmacy. They don't work in a doctor's office. They don't work for insurance companies. They really have no idea what actually goes into filling that prescription for Celebrex that requires prior authorization. All they understand is that they won't be able to pick up that prescription right away.

On the other hand, if you work for a doctor's office, you better damn well know what the hell you are doing, or I will get pissed off. I've been known to make snippy remarks to medical assistants and nurses after they do something exceedingly stupid. Some call it unprofessional. I don't really care. I simply cannot tolerate stupidity coming from the people who are supposed to be telling me what to dispense to patients.

Here's an example:

For the past 2 weeks, I've been trying to get a prescription for lancets for a patient. She has Medicare, which means that we need one of those nice written prescriptions faxed to us with a diagnosis code, specific quantity, and specific directions. Well, the first thing I did was send a fax over to the doctor's office that had a cover page outlining ALL the prescription requirements for Medicare. If they simply read the cover page, it would have been abundantly clear what needs to be on the script. The doctor faxed back a script saying nothing but "Lancets with 12 refills."

Not good enough. So, I sent the fax back to the office and CIRCLED the part where it mentions needing a specific quantity and directions. Two days go by, and we don't get a response, so I call them to find out what the hell is taking so long. They couldn't find a record of the doctor ever prescribing lancets to her. Since I had a prescription right in front of me (albeit not medicare compliant), I assured the medical assistant that the doctor did, indeed, prescribe them.

"Ok.. So what are the requirements again?" she asked. I gave her my whole spiel about Medicare compliant scripts.

"Well, how are we supposed to know how often she tests her blood???" she asked confused.

"Well," I began. "I think the whole idea is that you are the doctor's office and therefore, you should be telling HER how many times she tests. That's generally the way this works."

After a little more convincing, she said she'd get a script right over to us. Ten minutes later, a perfectly legible, Medicare compliant prescription came over to us.... FOR TEST STRIPS!!!

My blood was boiling. I'd spent far too long trying to get this one freaking LANCETS prescription. Someone was getting a piece of my mind. I got a nurse on the phone this time. Now, she tells me that she has no idea why the office would ever prescribe a glucometer to her in the first place since they're primarily a pulmonary group. She told me I should check with her primary physician.

"OK," I said. "Do you know who that might be?"

After looking through her chart, "Well, it seems Doctor Retard IS her primary physician, but she usually doesn't prescribe this."

That was it. "Look... On [such and such date] Dr. Retard wrote a prescription for a diabetic glucometer for this patient. I have the script right in front of me. It is from Dr. Retard. Dr. Retard has also given her prescriptions for test strips in the past. Now, the patient is asking for Lancets. You know? Lancets, the things that prick your finger and get the blood out in order to put on the TEST STRIPS that go into the GLUCOMETER. She's not going to get much use out of the glucometer and test strips without lancets. Obviously Dr. Retard wanted her to use this glucometer because she wrote a prescription for it. What good is the glucometer without the lancets?"

"Furthermore," I continued. Dr. Retard has already written a prescription for the Lancets, but she completely ignored our fax about how it needs to be Medicare compliant. The prescription has already been authorized. It should be charted somewhere. I just need it to be written so I can bill the stupid thing to her insurance. When I asked the second time for the LANCETS, you guys sent me a script for TEST STRIPS. This is getting ridiculous. It's wasting my time and the patient's time."

I never got that script. I'm waiting for the patient to come in, so I can tell her that the people in her doctor's office are idiots.

It's that kind of shit that gets me going. I hate that kind of incompetence. I hate laziness too. Man, do I hate laziness! Like when you send over a refill request form to the office that has a nice place for them to write in the quantity and number of refills, and the office simply faxes back the same form to you with nothing but the doctor's signature. Is it approved? Does the doctor want the same quantity? Refills? A signature tells me absolutely nothing. Therefore, I send it back with a note on it in big lettering "WHAT DOES THIS MEAN?"

Here's a situation that's a combination of laziness and incompetence: I get a prescription called in for Toprol XL 100mg twice daily. Toprol XL is usually prescribed once daily. The patient has never gotten that prescription at our pharmacy, so I call the office to double check the directions. The nurse puts me on hold for a moment to check the chart. When she comes back, she says, "Yes that's how the doctor wrote it down."

"I didn't ask you to check how the doctor wrote it down. I asked you to check if the doctor actually INTENDED to dose it twice daily as it is usually a once daily drug," I remarked.

That's another major pet peeve of mine. When I call the office to verify a prescription dose or tell them about a drug interaction, I'm not questioning what was written into the chart. I'm questioning the intent. Prescribers make mistakes. They miss interactions. Rereading what was written down does not answer my question. I fully expect the prescriber to be asked directly, and in a relatively timely manner. If I call about an interaction or an incorrect prescription, I shouldn't have to wait a day to get a response. The response should be within 20 minutes (at the most).

I've mentioned this in a previous post, but I'll bring it up again: Can you imagine if it worked that way with the pharmacist? A patient calls the pharmacy saying that they think we made a mistake filling their prescription only to have a technician tell them that the pharmacist is busy and it may take us up to 24 hours to check the prescription and return the call. How well do you think that would go over? Not very well, I'd say. How is it any different when the doctor's office does it? Why do they get away with this shit?

I'll stop now. I had a frustrating day at work, and I just had to vent.


Erra said...

At least you care.

My ex pharmacist didn't do these things, and handed over a new drug with interactions (which my Dr had missed because my specialist prescribed the other drug). Pharmacist didn't even bother to counsel me on the new medication. Fortunately I read the leaflet, and the interaction was listed, so I contacted my doctor (oops, no, don't start on that - I forgot you were taking X). But how many people actually read the patient information leaflet anyway?

I go to a different (much more competent) pharmacist now.

Anonymous said...

Some doctors will let any idiot off the street call in scripts for their patients.

Frantic Pharmacist said...

I hear you loud and clear. We have taken to writing, circling and highlighting our refills/PA requests in large BLOCK letters as though we are sending it to a 6-year old. And they still don't get it right. Absolute waste of time and totally infuriating.

Anonymous said...

“Everything that irritates us about others can lead us to an understanding of ourselves.” – Carl Jung

Anonymous said...

'Zactly' I get an order for Prolixin decanoate 125 mg I.M. Wheww! I'm not that familiar with a dose that high so I call the nurse...can you tell me if the patient had that before, or where the patient picks up her prescriptions usually, or is there a note in the record of intent? Nope, the sweetie pie says..."I have an order for Prolixin decanoate 125 mg I.M. and it says such and such x 1 repeated one time by nurse so and so." ('Hey', my silent scream, 'I can read the damn order just as well as you can', may you please look at the chart or ask the patient where they had this order filled last time or what he's had before, please?)

Anonymous said...

Doctors get away with it because nothing impacts on them. if we "correctly" give out a script that is dangerous, we get punished, nothing happens to the surgery as it is our job to check. If we catch the error, and call the surgery, it is us that gets it in the neck from the patient as the doctor/god could not possibly have made a mistake.

I wish so hard that there was more sanctions on GP's and especially their reception staff to do their job right. I have had a reception staff tell a patient to "pop round the corner" and sign an unsigned morphine script, she got a slight ticking off for what is essentialy encouraging a criminal offence.

Anonymous said...

Oh yeah? Well what about the pharmacist who gave my psych patient hydrochlorthizide (a diuretic) 25 mg QID prn rather than hydroxyzine (an anxiety med) 25 mg QID. It bought her a nice 3 day visit to the hospital! Or my patient who got Prozac for a month rather than Prilosec. That green and white pill sure looks like that purple pill! If you and I (board certified internal medicine) could do the jobs we were trained to do rather than have it dictated by beaurocrats, and it will only get worse, 99% of the error inducing hassle factor would go away!