You are a pharmacist or pharmacy technician, working at a large hospital. You receive an order for Fukitol, which says "Give patient Fukitol, 1 tablet upon waking each morning and one at noon".
You interpret this to mean:
A: Give twice a day, 1 pill when the patient wakes up and 1 pill at noon.
B: Give one 1 pill each day ONLY if the patient wakes up at noon.
If you answered B, thank you for taking the time to argue with me on the phone this morning. I really appreciated it when you said "maybe you should go back to school".
42 comments:
Your instructions are unambiguous but there is always somebody around to misinterpret a straightforward request!
We always have problems with aciclovir doses. "One five times a day, does that mean I take five together every day.."
I think it was pretty obvious. I don't like to bother other HCP's if I don't have to and I am always very nice but man do people flip you an attitude at the drop of a hat. Seriously-no need to talk to one another like that. The worse people are female nurses, esp. NP's. Sorry-it is true. They think they are MD's, RPh's, PA's, etc. and they are so much busier than anyone else. I spend more time correcting NP's errors than anyone else's. Sigh.
I was under the impression that the hospital staff woke up inpatients to give them morning doses of medication. That is how it has been when I was hospitalized. If I were the pharmacist, I would have sent a morning dose (I imagine there is some protocol about what "morning" means in the hospital) and then sent up a dose for noon. Whether the patient takes the medication seems to me the responsibility of the floor staff. Now, if the patient called me and said: "I just woke up and I was supposed to take 2 of these drugs today, upon awakening and at noon. What do I do?" It would depend largely on the drug. I would discourage a person from waiting to take a second dose of a diuretic until later in the day. That is really subjective advise based on drug and dose.
I think it is in poor form for anybody to tell anybody to "go back to school". Shame on the pharmacist. He or She should learn some respect/etiquette.
I think the pharmacist must have looked at the orders and said "Fukitol, rather than write as scripted I think I'll call in to see if I can Fukw/grumpy instead"!
I'm sure they teach pharms to call the doctor for verification if the orders don't appear clear....I think they are pretty clear myself. Why are people such assholes? Seriously....
Depends if in hospital, on discharge from said hospital, or not in hospital at all.
It would've been a little more clear had the sig been; 'take one tablet twice daily; once on arising in the morning, and once at noon'. Chances are with two or three things going on at the same time, writing that type of prescription might have resulted in leaving out a punctuation mark and then the patient getting a QID sig, or if a night shift worker wondering if they should take it whenever they got up to go to work, and then either in the middle of their day or at 12noon.
On the other hand, a possible scenario that the pharmacist envisioned was to make sure the tablet given on arising was at noon only, and to stay in bed until then.
However, first, let me state unequivocally, I would never have quibbled about the schooling issue, unless I knew for sure a lack of schooling was involved, and even then, it'd be rude to mention it in a direct conversation. I mean it's called 'com'munication for a reason, not one-way word flow.
There's one neurologist I know that always, always mispells agitation i.e. 'aggitation' and I will never tell him how superior I feel about that, knowing I would then have to admit that I mispelled elixir for 10 years unknowingly. (Not unlike some people I know that sometimes get lemon pudding mixed up with a vast desolate geographic location in Outer Mongolia.
Did they miss that day in Med Terms?
You are completely correct in that the pharmacist was very rude and inappropriate. However, when we call the doctor about a bad, obvious mistake, and they say, "Thats what I wrote and thats what I want, and if you don't like it, go back to medical school. You're just a pharmacist", it also sticks in our craw. Obviously this is not ALL doctors, or even most of them. It really has to be a team approach, and all sides (including nurses) deserve respect until they prove otherwise. Someone just pissed in his wheaties that morning, or maybe the machine outside the pharmacy was out of Diet Coke.
Your instructions were obvious, but unfortunately there are idiots that make it through pharmacy school. I have plenty of classmates right now that I would never in a million years want checking my prescription.
How many tablets was it written for? They didn't figure it out based on the quantity?
Sure is great how so many of my fellow pharmacists can turn off most of their brain function and seemingly work through the day on autopilot. Makes us look really professional.
Who *are* these people???
I mean seriously. That is insanely rude.
Stephanie- there was no quantity. It was a hospital inpatient order.
So what if he wakes up at 1:00 PM?
Filet-O-B...may I agree with you...even if I am "only" an RN half way through her MSN (to be an educator, not an NP, thank-you-very-much!)
I may get ridden out of Nursetown on a rail, but most NP's seem to be idiots who got precriptive authority from some online podunct program and an overinflated sense of their own knowledge. Maybe OK if they stick to the most BASIC of basic care, but they never do, do they??
I just can't see myself running around with a 'script pad and being safe, and because of some previous life experience I KNOW I have more education than some of these gals. If my two summa degrees, soon to be three leave me feeling adrift at the thought of writing for drugs, I can't beleive they allow someone with a "C" from the online University of Banglador to have this authority.
Let the flames begin.
Pattie, RN
Anon 12:05:
Is it mispell or misspell? Mea culpa?
There's good and bad in all professions...I mean someone had to graduate in the bottom 50% of the class. :)
Pharmacists like these make the rest of us look bad. That pharmacist was rude, and ignorant. Sometimes (more than sometimes) hospital staff pharmacists (not clinical pharmacists - there's a difference) are... a bit different...
However, I will say that when I call physicans on a daily basis for verification, approximately 90% of them have some sort of snide comment "I know what I wrote, now do your job and fill it!" even if there's a documented allergy, the dose is incorrect based on renal function, there's a known drug interaction, etc. I get yelled at all the time because, instead of trying to work together for the best outcome for the patient, the physician thinks I'm stepping on his toes and calling him stupid (when in fact, I'm not... just trying to let him save face in front of the patient and try to save his ass).
And of course, if the patient takes that first pill upon waking in the morning, then decides to take a nap and doesn't wake up...ever...this wouldn't be a problem.
>:p
When I worked at the hospital, I had a fellow pharmacist call a doctor and argue with him that he had exceeded the max daily dose of morphine for an end-stage cancer patient. I tried to keep him from calling, but he insisted. He didn't last very long with us. Don't forget, even the person who graduates last in the class can still get their license.
This is an old joke and yes, it is about doctors, but for some reason, it seems to be able to be applied to pharmacists (and other medical professionals) as well:
"What do you call a person who graduated last in medical school?"
"Doctor."
Oh good Lord, how could someone possibly misinterpret that? There's no shortage of idiots anywhere.
heehee I like what frantic said =)
Maybe the rph has a crush on you, was trying to piss you off so you'd come down to yell at her and she'll bat her eyes at you and flash you a little sumpin'
No? Well then I guess she's (or he's) just an effin idiot =)
Too funny. These types of things occur in all sorts of situations. I remember being at the pharmacy and when I went to the register, I told her in English (will make sense in a second) that I would like to ring the two orders up separately as I needed two receipts. She acknowledged in English and then proceed to speak to me in Spanish. I don't speak a word of Spanish so I replied in Arabic (I just happen to speak Arabic). She looked at me and then said in English "I thought you were bilingual." I replied in English "I am bilingual." Honest to goodness, she argued with me and denied that I am bilingual. I told her that bilingual meant being able to speak two languages. She denied that and informed me that it meant speaking English and Spanish. I paid for the purchases and left. OY!
Seems clear to me. 2 tabs/day, but they need to be taken by 12 noon.
If the patient doesn't awaken until noon, then they'd only get one pill that day, right?
Sounds like the dosing schedule for Provigil....
Anon @12:05----dude, you got wayyyy too technical.
Dr. G--I totally read that as 1 in the am, and 1 at noon. Not sure what the problem was, I'm thinking a lack of schooling on the pharm's part, certainly not yours!!!!
Being the devil's advocate...
Depends on the handwriting...I'm just saying. Handwriting can make things look so different, not that Dr G has bad handwriting
Word Verification: worries (now that is just funny)
I thought pharmacists did know everything though doc? I mean shoot, that is why they dispense the medicine and you just write words on a pad with numbers but it is them who hand the medicine over - even if it is with a leery eye and second/third/fourth/etc judgements on the doctors work - so they are an integral part in patient care. Blah blah blah.
Um....1 tab at ~ 8am, the other at noon. Not sure what's confusing about this. You came across a moron, and a conceited one at that. Sorry about that, they exist in all professions.
The cause is obvious. The pharmacist had too much blood circulating in their caffeine.
I don't know. The order seemed pretty clear to me. But who am I to say? I'm just a lowly RPh finishing my nontraditional PharmD program.
Just remember: you can't fix stupid.
there are a few in every profession....ugh...what a dumb@$$....
Just wanted to drop you a note to say thanks for the laughs! I lead a crazy stressful life (don't we all?) But I manage to stop in once a day and you always make me laugh... it a great 2 minute break each day.
BTW my word verification is unwart lol
As a SR. CPHT I have gotten a few weird prescriptions. Some of which got past a floater pharmacist and I had to question. However, I did completly understand that order. Yes RPh's do call the doctor back if the order is unclear.
The original directions seem very clear, could this be a handwriting problem????? Too bad the pharmacist was so rude - you run into people like that in every walk of life. Dr G - I love your site and your insight! read you every day!l
"But when I wake up in the morning I'm at home, not at the friggin hospital, so how can I give the friggin patient his friggin pill??? Jeez, don't you understand ANYTHING??? Maybe YOU didn't learn the difference between a house and a hospital in the tenth grade, but ***I*** did! Maybe you should go back to school!!!"
@dan -- the pharmacist in question may have been a jerk, but don't diss the profession. I'm an RN & would be lost without the pharmacy staff. If I have questions about a medication, I ALWAYS call the pharmacist. Likewise, I catch potential errors all the time because I'm with the patient and make note of the whole picture (labs, VS, etc.).
Punctuation saves lives....Let's eat Grandma vs Let's eat, Grandma!
Sorry, just seems relevant somehow. *^_^*
Did you ask him what would your going back to school do with him reading the order wrong?
There is nothing worse than unsolicited advice, particularly when it's wrong headed, unnecessary and delivered aggressively.
I'm currently in the US for a week being normally based in the UK. One of the first things i do is go to a pharmacy and stock up on all the over the counter meds i can't get in the UK. Things like generic versions of Vick's inhalers that actually work, melatonin and topical antibiotic creams. I also usually get one or two things I could buy over the counter in the UK, put not without unwanted public interrogation by a counter assistant about my medical and medication history. The Joy of just presenting a basket of over the counter meds to a checkout assistant at a pharmacy, paying and walking out almost justifies 8 hours in cattle class across the pond in itself.
Ah, ambiguity. Well, not really.
Just out of curiosity, was there any hostility on your part? Not accusing you of anything, but sometimes we pharmacists get it from doctors for no reason either. If you were respectful, then I apologize on behalf of that pharmacist. Arrogance makes us all look bad.
I don't think there was, and the nurse sitting next to me didn't, either.
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