Monday, November 13, 2017


Guy: "Local pharmacy. Can I help you?"

Dr. Grumpy: "Hi, this is Dr. Grumpy, returning a call about Mrs. Cranium's migraine medication."

Guy: "Yeah, you wrote a quantity of 12 pills on it, and her insurance says she's not allowed to have that many."

Dr. Grumpy: "Did that just change? She's been getting 12 every month for as long as I've been writing it."

Guy: "Well, they don't allow 12 pills in a day now, can you change it to another drug?"

Dr. Grumpy: "IN A DAY? No, she's not supposed to do that at all. That would probably kill you."

Guy: "Wait, you meant that to be 12 pills per month all along?"

Dr. Grumpy: "Absolutely. I'm looking at the script now. It doesn't say anything about 'per day'."

Guy: "That makes a lot more sense. I'll get this filled."


Old RPh said...

Sorry Dr G.
I'll read it a little more carefully next time.

Jono said...

I wonder if guy thinks all prescriptions are for one day only?

Legal Hospitalist said...

While the post is humorous, this is a health literacy issue. If the pharmacist or pharm tech cannot read it properly, I imagine that some patients cannot read it properly either.

Never assume the reader understands what we are writing.

Packer said...

I think the only 12 per day is in the opioid family, thus explaining the current crisis.

Anonymous said...

I have to ask if this was a triptan or butalbital. I can not image a licensed RPH would think she could have 12 in a day if it was a triptan!!! I suggest always writing, 12 tabs is considered a 30 day supply if that is what you intend...

Grumpy, M.D. said...


It was a triptan.

Yeah, that was my reaction, too.

Squarepantspharmd said...

Usually when something like this comes across an e-script system it will read the directions as "take 1 tablet by mouth..." and that's it. Nothing regarding times per day, nothing about an additional dose if necessary, nothing about a max per day, nothing about a days supply...just drugatrex Xmg 12 tabs with aforementioned yeah A LOT of those go back to the MD for clarification.

Loren Pechtel said...

This might not even be a literacy issue, but simply someone not paying attention.

Mail order script: The correct amount arrives, along with a note saying that is backordered.

Refill: Correct amount.

Refill: Doesn't show up. I call to find out what happened. Insurance denial, the quantity was too big. They didn't even bother to tell me and it doesn't make sense anyway--it filled twice. Turns out some moron fat-fingered an extra zero on the end of the quantity. The first two times someone saw the insanity and fixed it for that order without fixing the data in the computer, the third time they just blindly tried to fill an order for 2 1/2 years worth and of course it didn't go through.

Crazy RxMan said...

What a goofball. Even bad pharmacists know better than that. Jeez.

Anonymous said...

"Also, what's with all the turtle doves?"

Anonymous said...

Are pharmacists in the U.S. not required to have knowledge about, well, pharmacology?

Migraineur said...

I can't even imagine the "headdesk" this caused you. With most docs only wanting you to use three a week at MOST, I can even think of what a dozen a day would do to you.

I really hope that was a tech, and not the pharmacist.

Anonymous said...

There's an old saying that Quantity has a Quality of its own. I guess this is especially true in medicine and pharmacology.

stacey said...

And if you prescribe it to a native Spanish speaker "Once Per day",
'Once", is the Spanish word for eleven. So there's that.

Anonymous said...

When I fill a prescription for sumatriptan, the usual sig (instructions for the patient) are to take one dose and repeat after two hours if the headache doesn't go away, with no more than two doses in 24 hours. So, patients couldn't take a dozen tablets in a day, if they were reading the directions.

When I first practiced pharmacy, the pharmacist wasn't allowed to tell the patient what the medication was used for, but that changed about thirty years ago with mandated patient counseling by the pharmacist which used to be a good place to make the final check before the script was out the door.

That last counseling step used to be the final place where mistakes were caught, but now, it seems the insurance agent catches mistakes. Soon enough it will be an electric eye in a dispensing packet delivered by an Amazonian drone to the hall table just inside near your front door.

Anonymous said...

In some ways this conversation makes sense:

Imitrex (the most common triptan used in my area) can be repeated in 2 hours and most scripts specify that. 24 hours in a day/2 hour increments = 12 tablets in 1 day. There is a max daily dose, but that is only sent over as part of the script maybe 50% of the time, the other times I had to added it on the patient label for safety. With the lowest strength tablet, one could use up to 8 doses in 24 hours.

That being said, it is really common for insurance to allow 9 or 12 per month. We always used the minimum day supply unless otherwise specified on the prescription.

I'm betting it was an intern that called. New enough to pharmacy to not know the insurance trick.

I'm also really glad to not work retail anymore

Anonymous said...

Wow, pretty judge group of people. My doc once wrote me a script for methotrexate and screwed it up. Instead of x pills per week it was written for x pills per day. My pharmacist refused to fill it, saying it was enough to kill me and, yep, we confirmed with the doc's office that it was a mistake.

So, you know. Let's not forget the # of times pharmacists correct significant errors.

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