Tuesday, April 26, 2011


Sometimes a company stops making a drug, or runs behind, or has a production stoppage for whatever reason.

When this happens I typically get a fax or call from the pharmacy, telling me about the manufacturer's problem, and asking me to change to another product.

I'd like to thank my reader Jenny. When a similar fax showed up at her office, she sent it on to me:

(click to enlarge)


Grumpy PharmD said...

Dropperful is a no more a non-existent word than Teaspoonful.
Definition of DROPPER

: a short glass tube fitted with a rubber bulb and used to measure liquids by drops—called also eyedropper, medicine dropper

From: http://mw2.merriam-webster.com/medical/dropperful

Literary usage of Dropperful

1. Clinical Hematology: A Practical Guide to the Examination of the Blood with by John C. DaCosta (1901)
"After the first dropperful of diluent has been added to the contents of the tube, the latter are mixed by inverting the tube a number of times with the ..."

2. The Laryngoscope by American Laryngological, Rhinological, and Otological Society (1901)
"Further enquiry revealed that one-half dropperful of "ear-drops" had been put into the' ear hourly from \ pm to 8 pm The mother informed me that the "drops" ..."

3. Hand-book of modern treatment and medical formulary by William B.. Campbell (1914)
"Kig: One-half a dropperful warmed, to be instilled into the ear, for adults; less for a child. Indication : Useful in earache. ..."

4. The Prevention of Disease: A Popular Treatise by Kenelm Winslow (1916)
"This consists, first, in thorough washing of the sexual organs with soap and water, dropping into the urinary passage a medicine-dropperful of a freshly ..."

5. Every-day Diseases of Children and Their Rational Treatment by George Henry Candler (1914)
"... with a dropperful or two of plain boiled (cool) water to insure its arrival in the stomach. This same combination will be of marked service in any case ..."

From: http://www.lexic.us/definition-of/dropperful

Grumpy PharmD

Kara said...

I think "dropperful" is a fine word.

Grumpy, M.D. said...

I stand corrected. What about "mufacture"?

Anonymous said...

There really should be some kind of spell-check mechanism before you fax it out (think it's called a dictionary). Our pharmacy prefers the "Would you like to" game and have the Dr. check the box of the preferred option & fax it back to us. Too bad there isn't a "sig-check" application out there to use ( use a dropperful for a nasal spray? really???)

Pharm.Tech. RDC'06

Steph said...

Dropperful is old school, but still okay for drugs that actually use a dropper - but I have to agree with Anonymous. A nasal spray? Seriously?

But I hadn't even noticed that, as I guess I was distracted by the huge spelling error.

Kat's Kats said...

Now now, give them a break. There wasn't room on the fax to notate that the sender's entire supply of diet coke was viciously stolen by the night shift and the cruel & evile pepsi-drinking supervisor wouldn't let them restock same.

lumbiesi - occurs when someone has no diet coke; a zombie-like condition wherein the patient exhibits slurred speech, drooping eyelids, shuffling gait and cognitive difficulty to the extent that those surrounding them may assume they have had a stroke.

Anonymous said...

Nasohist is an oral medication, not a nasal spray.

Grumpy, M.D. said...

I removed my question about "dropperful", and appreciate all who chimed in to correct me.

Anonymous said...

So, mufacture? Really?

Truth be told, cannot is one word-not two and I personally think it's a little insulting when someone underlines a word like that twice.

I sort of wish I had been up earlier to see the question about dropperful.....

Old MD Girl said...

Maybe they produce cows?

Frantic Pharmacist said...

Looks like the Wal-Mart pharmacy had the manager's 8-year old helping out that day. Seriously, I am quite embarrassed by some of the faxes I see being sent off to docs' offices sometimes. Well, at least the message on this one is crude, but clear?

Anonymous said...

Mufacture: Made in Mu, formerly a part of Pangaiea (now Wisconsin).

WV: psimicri, making fun of imaginary objects

Grumpy PharmD said...

Reply to murgatr:

1) Neither Trigofen nor Nasahist is a nasal spray - both are liquids.
2) Some nasal sprays are administered as drops to babies, ex. Ayr Baby saline drops.

Grumpy PharmD

pharmacy chick said...

I think we have a problem houston.... "by mouth"??? And what the f is a mufacture?. Did the tech bring her kids to work that day.?

ERP said...

Maybe they have a cockney accent?

Anonymous said...

Way to go tech! Since when do 8 years olds help the pharmacist? The 8 year olds I tutor have more professional handwriting, and can spell manufacture. All that fax needs is a heart or smiley under the explanation point.


Packer said...

While all you medical types fought about droppers and manufacturers and nasal /oral typos and spelling the rest of the world(non anal retentive types) asks :Did the patient survive ?

TheStudent said...

I hate having to put "by mouth" in SIGs where the medication is clearly a liquid. Are people THAT stupid we have to tell them to put a liquid in your mouth, really?? I gotta say, I've seen some dr's handwriting (sorry dr grumpy lol) that looks lie they spell like that too!

Anonymous said...

Aside from the Mufacture nonsense...is it wrong that I want to force the fax sender to go back to elementary school and review what a contraction is?

Can + Not = Can't.

Such a simple thing shouldn't bother me. Maybe I learned artisinal grammar?

Anonymous said...

I think i like the curly-q on the letter "D". lol

Anonymous said...

To Grumpy Pharm.D:

Nasohist/Trigofen does not even exist north of the 49th parallel. There is not enough information for me to determine what the generic equivalent in Canada would be. So excuse my ignorance- this is why I'm a tech and you're not.

P.S: Get a grip - the emphasis of this post was on a different topic. Let's move on, shall we?

Pharm. Tech RDC'06

Unchained Pharmacist said...

I hope the person who wrote the message was not the pharmacist.

PharmGamerKid said...

On a side note, you know how many times I have sent a fax to a doctor's office with a message along the line of "Patient is allergic, please change" or and the fax comes back with "Ok x 3 refills."

Anonymous said...

As far as underlining goes. You would be amazed how many times a similar message is sent to a doctor's office and they send a auth for more refills back. It makes me wonder if they even read the messages we send.

Kat's Kats said...

@PharmGamerKid & Anon 1:23 - This is extremely scary!! It makes me glad that I rarely run into that kind of thing. Why yes, yes I do choose my medical team very carefully! And yes, yes I do report idiotic behavior like that to my insurance company!! Geez Louise!!

Will said...

I think this tech was trying to make a political comment. "Man"ufacture? Really? So only men can make things? Mufacture includes women and transgender. Much more PC.

Anyone buying it? Anyone?

GunDiva said...

Is mufacture a "mofo" manufacturer?

Anonymous said...

as a future pharmacist, i'm trying to come up with any reasonable explanation for this. sadly... i cannot. how embarrassing.

Grumpy PharmD said...

To murgatr:

One word - Google

Grumpy PharmD

Anonymous said...

After receiving the same fax back three times, with "Prn refills" or "yes" as a response to a question that does not have "yes" as a possible answer, I must admit to underlining and circling. And circling. And circling.
Also, after requesting refills and being yelled at by a nurse that they've called/faxed it in, only to have them realize that they gave the authorization to our competitor, I can actually live with the typos/errors as long as the response is appropriate!

Library-Gryffon said...

@SweetCheeks: in this case (with correct spelling and more mature handwriting...) I would definintely be using cannot. There are some times when the contraction just doesn't work, among other things it's too informal. Of course that could just be the end product of way too many years of college writing history papers, where couldn't and didn't just aren't the done thing.

Anonymous said...

dr would like to change, but it will take a long time and a lot of counselling.

ArkieRN said...

Either can not or cannot is correct. And in this context, I support the writer's use of can not. Using the two word style provides more emphasis, which the writer was clearly trying to do.

moomag said...

The Doctor can only change if he wants to change...perhaps Pharmaceuticals Anonymous may have a support group to help him.

Anonymous said...

Really: thestudent. Yes! You need to put "by mouth" on the obvious. Last week after counseling a mom on amoxicillin susp for her toddler's ear infection, she asked if the 5 MLS went in the ear. Oh man....in the mouth! So glad she asked (& Tess it was a genuine question). Remember the by mouth part helps protect your precious hard earned license!

Anonymous said...

Faxes like this make me so proud to work for this chain

Charles said...

Actually, I do not find it that bad - yes, it looks like it was done in haste. BUT, it is still LEGIBLE!

That's something that cannot be said about many doctor's handwriting. (Not that YOU have bad handwriting, right, doc?)

Also, for some of the other commenters, while I prefer cannot over can not; I think it is better to spell it out rather than use the contraction - can't. This is done by fax and they don't know how it will print out on your end. There is also a shortage of space on that form. (I think I see a lot of white space which as been whitened out for this post!?)

Could they have done better? Sure, but the meaning is clear; this isn't a published paper; and time was perhaps more important than spelling or being "perfect."

As long as they are perfect in the medicine that they do fill, then I'm okay with this.

P.S., I commenting after you have removed part of the post; so perhaps this wasn't such a big deal to you afterall.

TheStudent said...

@ anonymous 10:08 4/26
I know, trust me I do write it every time! I guess I was just commenting on the fact that; can people really be this clueless about where a liquid goes?? And the answer is always, as any medical professional knows, an emphatic (and head smacking) YES!

Anonymous said...

So of a sidenote I get a funny phone call today from an ancient man who says "ya hhhmmm i have a question I used to get Dilantin brand name, which is a good all American tablet, where is this generic phenytoe-in(phenytoin) tablet made? It ain't made in China is it?" I go to bottle and look and think ooh boy and promptly announce "uh no sir they are made i isreal." He starts howling ...."jewish tablets huh. Well those have to be better than Chinese ones." I hang up giggling and think to myself get your self together Rph it wasn't that funny. Was it?


txpharmguy said...

Some state medicaids require, for high dollar rxs, that the prescriber write out the rx in his/her own handwriting, instead of say a computer-generated fax. One particular request and response from this MD was priceless. The rx was for Nexium and the tech sent a fax over requesting that the rx be in the own physician's hand (instead of handWRITING). So, the MD, traced his hand onto the fax request and wrote "Nexium 40 mg #60 one BID" inside the outline of his hand. Gotta love a doc with a good sense of humor.

MDB said...

I've gotten faxes from the doctors offices for scripts for drugs no longer on the market. I've had the discussion with one office that cisapride is no longer available about 6 times now in the past couple of months. It is not like it just recently go pulled, it has been off the market for over 10 years. I also hate when I fax over a note for the office to either do a prior auth or change the medication and in response I get an e-script or fax of the same Rx the insurance wants a PA for.

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