Friday, October 10, 2008

Don't lost trust in your doctor

At CPhT's pharmacy, we are experiencing a problem.

Terry (surprise surprise!!) is basically telling people they don't agree with what the doctor is prescribing, and what they would have prescribed. There are a few issues there. I'll list them out.

1) Terry does not have a doctorate of medicine/CRNP license/prescriptive authority/ANYTHING, so no matter what he thinks, the doctors' opinion is the one that matters.

And yeah, the doctors are wrong on occasion. There are times that Mr. Smith is getting x drug from Dr. Stupid and Dr. Worse tries to hand him drug y, which is a Level 1 Interaction. But, we're talking about average patients here, getting average medications for illnesses. It's not usually chronic patients whose doctors are having their medications questioned. Although, it has happened with chronic patients.

2) Terry does know a lot about the drugs, but Terry does NOT know WHY the doctor selected the chosen drug.

Maybe the patient has neglected to tell us of their penicillin allergy, therefore rendering Terry's choice of Augmentin useless. Maybe a few weeks ago, they went to XYZCHEAP Pharmacy with their $4 generics, and got a bottle of cephalexin, and it just didn't work as well as the doctor had hoped, and they are choosing something else.

... Sorry, I ran out of steam/am running out of time before I have to get ready to leave for work, so I'm going to cut to the main story.

Go back a few weeks ago. We had a child come in with bronchitis. The nurse practicioner did pick a suboptimal drug regimen (a drug not technically indicated for bronchitis), and Terry told the parents that the drug was not a good one. Terry called back, and they told Terry that they'd really chosen another family member. That drug had some issues, according to Terry, so they called the office AGAIN, who said it was REALLY supposed to be drug #1 called in. Following so far? Drug #1 called in, then they said no, it was #2, then they said, no, it was really #1.

As I could imagine, the mother of the child was getting pretty upset at this point. They had some of drug #1 at home, and Terry said to use that, and in the meantime, Terry would try the doctor again, and if they refused to see it as Terry thought it should be, the mother could have her cousin's sister's dogwalkers' fiance (herein known as C/S/D/F) call us, and Terry would tell the C/S/D/F what to prescribe. Terry did not receive a call back from the doctors' office, nor the C/S/D/F, and the mother calls, after Terry leaves. It's me, my favorite pharmacy, and my 6th year intern who's filling in while she's on her off block on her rotation. Terry did not leave a note, and I was helping a customer elsewhere, when I hear Meg (pharmacist) and Diana (intern) freaking out. I caught a few snippets of the talk, and I finished with my customer, and rushed over. I told them the story, as far as I knew, and Diana related what I told her to the patient's mother. She was still PISSED (don't blame her) that nothing has been resolved, but she doesn't know if she can get the C/S/D/F to call at this point. I had to go call Terry and ask what the dose of Terry's favorite drug would be, and I had to call the pediatrician back. The nurse checked the chart and told me that drug #1 is what they ordered and wanted. She also told me that the doctor that was in that night was going to call the mom as soon as he was done with his visits, because the mom flat-out refused to speak to any practitioners ever again. I then proceeded to tell her what Terry had done, because it wasn't fair for them not to know why this mom was making crazy demands and freaking out. I think I was right to do that, because I wanted the doctor to have the full knowledge that their knowledge was being questioned. Basically, they picked a dose, and went with it, of drug #1. A few days later, they did the max. adult level for drug #1. For an 8 year old.

Fast-forward to yesterday. The 8 year old's sister has now caught the bronchitis. The doctor wisely selected a drug that is indicated for bronchitis. However, the patient has developed enough airway constriction that they decided that the OTC meds mom & dad were giving her is just not cutting it, and they needed to give her a corticosteroid. The patient's mom wanted to talk to Terry, but she wasn't home, so she had to call back. The dad decided not to pick up the corticosteroid because they just weren't comfortable with it. Finally, when Mom called Terry back, she was convinced enough (I believe) to pick it up.

Our intern and I were debating when Terry was not yet in yesterday (Terry had a half-day for a doctors' appointment) what kind of parenting it takes to stop trusting the doctor. I know Terry did not instill anything positive about the doctors' office and staff to these parents, but when your kid can't BREATHE?? You're just going to let them go?? Seriously?? I'd almost go as far to call that negligent parenting. The drug is safe, the doctor even prescribed a little below the dose for mg/kg/day as they wrote it out on the script for the parent, and yet, mom & dad don't trust it, because Terry doesn't trust their office. At some point, you have to trust the doctor and just bite the bullet. We told Dad it was a safe dose for that patient's age, and everything that we could to alleviate fears. But no, daughter is going to suffer until Mom can discuss the pros & cons of the corticosteroid. Just suck it up and be a good parent.

Was it wrong of Terry to do this? We all think yes. I don't think that it's exaggeration to say that none of us are happy about the way Terry is going on. At the rate Terry is questioning prescriptions from doctors, soon enough, NONE of them are going to want to deal with us.

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