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    Working together for the greater good: MD vs. RPh


    David StanleyDavid StanleyIt started the way so many of these things do, with a phone call to get the ball rolling on a prior auth. “I’m not sure that’s the strength the doctor meant to prescribe,” the lady at the group medical practice said. “I’ll have to check and call you back.”

    That was on Friday morning. On Saturday morning a friend of the patient — who was seriously ill and having trouble breathing — came in to get the prescription. No one from the group practice had called us back. You know exactly how this goes.

    See also: The No. 1 priority and the public good

    Step 1: The doctor is out

    First, a test claim. The far-more-common strength of this nebulizer solution would go through the patient’s insurance just fine. Actually, it would also be easier to use; the only difference between what we were told “was probably wrong” and what was covered was that the paid-for med didn’t require predilution. The solution to this problem was in sight.

    You can guess what happened next.

    “Well that doctor’s not in today. If the patient’s really ill, they should go to the emergency room.” This, of course, was delivered after a lengthy hold. Evidently the concept of paging a physician was long forgotten at this practice, along with asking the doctor on duty for his opinion.

    See also: The tiny alternative to the pharmacy megamerger

    Step 2: My life on hold

    One thing they can’t teach you in pharmacy school is when not to take no for an answer. Fortunately, I knew the doctor on duty this day had a good helping of common sense in his head. It took a while, and I had to sit through another lengthy session on hold — which I suspected the staff made longer than necessary to penalize me for being a pain in the neck — before the doctor got on the line. Our conversation went something like this:

    Step 3: Work with me here

    Me: “Can we do the commonsense thing here that everyone knows is best for the patient, and give her the easier-to-use, far-more-common strength of this nebulizer solution, which most likely was what was meant to be prescribed in the first place?”

    Doctor: “Absolutely.”

    The end was in sight. Just some quick phone counseling with the patient, who was at home and gasping with every word, to make sure that original prescription wasn’t what the original, unwilling-to-be-reached doctor really wanted.

    Step 3: What machine?

    “When they were going over how to use your nebulizer machine, did they say you would have to dilute this medicine first?”

     “What machine?”

    They had sent this woman out the door with a prescription for medication to go in a nebulizer without ever mentioning that she would need a nebulizer.

    David Stanley, RPh
    David Stanley is a pharmacy owner, blogger, and professional writer in northern California. Contact him at [email protected]

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    • Anonymous
      OK, I'll add my all time favorite: Pt. w/Bell's Palsy (often an immediate predecessor to a diagnosis of diabetes) and right sided paralysis gets discharged with an RX for insulin pens, which at the time were very new and not stocked routinely. Also, no dose was given on D/C orders. Naturally your trusty pharmacist phoned the office of this very "prestigious" endocrinologist to find out what the dose was (since no-one at the hospital could access the info for me, this being the days of paper charting). After 4 hours still no call back. Trusty pharmacist went to patient's house (knowing he'd have to draw up some doses until pens arrived from wholesaler) and waited another 3 hours (hearing much of the patient's life story) before the final clarifying call came from the endocrinologist: "just give her what I ordered [you puny little pharmacist]!" He deserved my response...