Friday, October 30, 2009

You're Driving Your Pharmacist and I to Drink

Before an appointment ends I always ask patients if they need any refills or scripts written. It saves time later.

So yesterday I asked Mrs. Brainless if she needed any refills on her seizure medication, and she said no.

Last night, around 9:00, a pharmacist called me. Mrs. Brainless was there, needing a refill on her med. The same one I'd offered to refill earlier (for the record, she told the pharmacist it was "my seizure pill, whatever it's called". Fortunately, they know her there and could look it up).

I authorized the refill, then called her cell phone (1-800-BRAINLESS), and asked her why she'd told me she didn't need any refills a few hours earlier.

"I didn't then. I still had one pill left for my night dose. But I took it, and now I'm all out, so I'll need some for tomorrow morning".

30 comments:

Anonymous said...

After reading the exploits of your patients for many moons I have reached the conclusion that you really are operating an underground cerebrectomy clinic.
In light of the Halloween season, I commend you for your noble efforts.
Rock on, Igor!

Anonymous said...

I can't believe people this clueless are still alive. You'd have thought they'd have fallen down an elevator shaft or some such by now.

Anonymous said...

Does this prove that the theory of "Survival of the fittest" is NOT true at all???

Sue

Grumpy, M.D. said...

Sue- as time goes on I gravitate toward Aldous Huxley's idea in "Brave New World". The population is like an iceberg. Nine-tenths of it is below the water.

That nine-tenths, however, seems to have my phone number.

Anonymous said...

My favorites...people who don't understand why a refill needs to be authorized by the doc. "My doc told me I have to be on this for the rest of my life...I'm sure it's OK for you to just give me a refill."

You are right...that's why we drink!

Flavius said...

hmm.. that was a reasonable response. Speaks to half of my patients. Our other fun patient profile is the one who has been holding a script for nearly a month, but suddenly demands to wait for it and that 15 minutes is way too long (This is usually close to closing time as well... on a friday).

-Flavius

Anonymous said...

Flavius,

this IS the reason why I quit retail barely after a year and defected to the institution. I was convinced that I would either die of cerebral haemorrhage, a stroke or a massive AMI if I had lingered on in retail.

Sue

Anonymous said...

Dr. Grumpy, I think you'd be amazed at the preponderance of patients who request their refills at the pharmacy without giving the drug name or reference number on the bottle. For example, "I need my blood pressure and my water pills. But not my diabetes or heartburn medicine."

Grumpy, M.D. said...

No, I wouldn't be.

1. I have friends an patients who are pharmacists, and we exchange war stories.

2. I read TAP and other pharm blogs regularly.

HeatherLynn said...

you sure do have some doozies at your office...

while its comical, I have to tell you...I'm not entirely sure the movie "idiocracy" wasn't onto something.

Direct Quotes:

Doctor: [laughs] Right, kick @ss. Well, don't want to sound like a d*ck or nothin', but, ah... it says on your chart that you're f*cked up. Ah, you talk like a f@g, and your sh*t's all retarded. What I'd do, is just like... like... you know, like, you know what I mean, like...

Doctor: Don't worry, scrote. There are plenty of 'tards out there living really kick-@ss lives. My first wife was 'tarded. She's a pilot now.

If you've not seen it, it's worth checking out just for the concept.

~hl~

Anonymous said...

Good to know other people live my life!

Pharmacists are the fast food of the medical world. Sadly our corporate idiots feel I should be right out there in front so the public can easily distract me. But, I don't have to facilitate bad behavior on the part of the public nor do I need to reinforce it. I routinely tell pts that physicians will not take refill requests after hours or on weekends.

I would not have made that call to you. I'd have given her a few, told her she should have planned ahead (yeah - deaf ears I know!), but then made her come back a second time after receiving a fax OK from you (so all your staff could have a chuckle as well). My best offices state on their recordings (the one...if you are having an emergency, call 911 -etc) that refill requests will take 2 days. I make patients wait those 2 days before I make another attempt to contact. Otherwise, I make them call the office themselves. That way she has to tell not just you but the whole staff that she was irresponsible & not truthful at her last appointment. After all - the prescription is an agreement between the prescriber & the patient. My job is to fill it correctly & provide instruction - not babysit those who cannot take care of themselves.

That pt is playing you as well as the pharmacist. I'm betting she has an extra tube of toothpaste, roll of toilet paper & pound of sugar in her cabinets from Costco.

jesmerchek+kids=pure craziness said...

You are right, this is why we are driven to drink. The other night I had a diabetic patient needing his insulin at 9pm...when he had no refills and hadnt filled it for 3 months prior. But that night it was an emergency and he had the balls to yell at me while I called the doc on call. UGH!!

moppie said...

Your patients kill me. They don't seem normal at all.

CK Lunchbox said...

What? Is she like 5 or something? That's the kind of stuff my kids pull. I seriously could not do your job.

Grumpy, M.D. said...

CK- over 60. I don't see anyone under 18. So all my idiots are adult idiots.

Anonymous said...

Dr. Grumpy: Please change the pronoun in your title. Ouch!

Thanks.

rxBambi said...

My favorite is 'I need my little white pill'

Rose said...

Flav: Same here! I've had people stand there and ask if we're closed as we were finishing out the day. With the gates pulls shut. Or even as we're LOCKING up to leave.

Heather said...

LOL, such simple minded logic!

She is definately not a planner!

Drinking pharmacist said...

I take my scotch neat, thank you

Anonymous said...

Try kids with asthma: The parents tell you they are using the red inhaler. When you ask how they are using it they say "You know, the way you told me to". That's when you find the insurance company's note in the chart saying there has been no refill for an inhaled steroid for the last year. Then the kid pipes up and says he quit using the red one a long time ago because it never works.

Dr. Cranky, the pediatrician.

TranscriptionistTia said...

@Flavius

I used to do pharmacy, but quit to work at home (read: no visible patients) doing MT work.

When I was in the pharmacy and someone had a hissy about having to wait 15 minutes, I'd ask if they were more comfortable waiting 15 minutes for their prescription or waiting an hour for their photos to be developed.

I always hated that, almost as much as I hated the idiot who asked me couldn't I just go get a gallon of milk for them, delivered through the *outside* drive-thru lane, of course.

TranscriptionistTia said...

Check out this link...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1868354/

Obviously, Dr. G wasn't asked to participate, or stupid questions would have been at the top of the list!

I did LOL at how "do not know the medications that they are taking" was on the list. It seemed to fit so well with today's post!

Anonymous said...

On Sunday my wife was discharged from the hospital for a kidney infection. As we were leaving I put the prescription in my pocket.

When I got to the pharmacy it was gone. I lost it about 3 hours after we had gotten it.

I had to go home, tell my wife that the pharmacy was busy and wouldn't have it for another hour or so. Then I had to call the doc and ask him to call it in.

The doc seemed a little annoyed. I don't think it mattered that I felt bad. I don't normally lose things that quickly.

Once I had the drugs I told my wife what really happened. She just laughed at me but had she needed pain meds, I probably would've gotten yelled at.

Anonymous said...

How you don't dive head first into a wood chipper is beyond me. Though my BIL is just that damn stupid. We are all doomed.

LD50 Rat

PharmOhio said...

Great post! Summarizes the past 13 hours for me perfectly!

My favorite patients are the ones who don't understand a PA. Today I had a lady who couldn't understand it and wanted me to make sure that when we called her doctor, we would explain the process to him.

RxKerBer said...

every other RPh said...my work life in a nutshell.

My favorite was the woman who came in at 15 mins before closing wanting a refil on her diazepam that she just filled ONE day before because she "lost" them. Like I don't hear that 100 times a day. She said she must have thrown it away in our outside trash can when she threw away the receipt. Yeah, right . She actually asked me to get the garbage bag and look through it for the bottle. Anyway, to shut her up, I let her use my phone to page the MD office as I will not dispense controls early without MD knowledge and approval. The answering service refused to page the MD for this. YAY!!!! I told her she could go to the ER if she needed meds until tomorrow, but she'd need to find a 24 hour pharmacy as I was CLOSED. This is the best...she has no phone (for MD to call her back) or car ( to go to ER and another pharmacy). One more excuse after another. She whined to the answering service that they needed to force me to give her the meds. NOPE!!

The MD replaced the meds the next day at a smaller qty. Then she called for a refil 4 days later!!!! She will not be getting any more meds that MD withouth being seen and having a stern talking to.

I won't even tell you the havoc she raised about her kids med (which I got changed with the MD ASAP and she didn't pick up until the next day - day of diazepam BTW). And she was trying to steal cosmetics when I locked up the pharmacy and the cashier, mgr, and I were waiting for her to leave the store so we could leave.

Ok, enough rambling. I'm going to lower my BP now and enjoy the rest of my vacation.

Anonymous said...

Shouldn't she get a dementia
workup or something? She might
have suffered brain injury...

Fiz said...

The valium lady would get short shrift over here! You get a stated number to last a certain period of time and no re-fills till the next date they are due! Had to laugh at House last night(we're a week behind you)when they yelled for "Five milligrammes of diazepam, stat!" for a kid that was fitting. It wouldn't touch me! I take 15 mils a day. (Prescribed!)

Anonymous said...

"Can't you just fill whatever I'm out of? It'll be quicker that way...otherwise I would have to go home, look through the medicine cabinet, open all the bottles to see what I have left, and touch-tone the numbers in after I find it...and if I mess up I have to start all over and I don't have the time to do all of that."

...Seriously.

 
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