Sunday, December 20, 2009

Counsel Me

The law requires that a pharmacist be available to 'counsel' patients on all prescriptions, new and refill. All of us in Pharmacy Reality World know that this is practiced somewhat loosely. It may take the form of a technician asking, "do you have any questions for the pharmacist?" Customer glances at it, says no, and is out the door. In a pharmacy that's filling, say, 600 scripts a day with 2 pharmacists, there is no possible way the pharmacist can babysit every new prescription going out. It's just not physically possible. I have picked up prescriptions for myself and had no interaction whatsoever with anyone except the cashier telling me the price.

I'm realistic about this. I do, as best I can, try to at least perform a "show and tell" (as our State Board calls it.) "This is amoxicillin, you'll be taking one capsule 3 times a day for 10 days". In many cases, that's enough. Most importantly, it gives the customer a chance to say "Wait a minute, I thought I was getting (insert name of totally different drug here.)" Yikes. OK, then either we made a mistake, or the doctor did, or the person's confused. Once in awhile, disaster is averted, it's true.

Or, the customer may say, "but I thought I was supposed to take it six times a day," and then I can do my awesome pharmacist intervention and set them straight, because apparently they have no plan to read the label. ( By the way, don't you love it when someone says "does it say that on there somewhere?" after you have told them the directions?) Uh, yeah, that's why we put that silly little label on there.

Anyways, I do hate it when I reinforce some directions to a patient and they tell me that the doctor told them to do something different than the prescription says. We see this fairly often with e-prescriptions, because the prescriber either doesn't know how to change the directions or can't be bothered. Sure, if it says Celexa 20mg tab once a day but the doctor told them to start with 1/2 tablet for the first week -- that's not inappropriate, I get that.

But last week a customer said they had been given verbal directions which did not match their prescription. This was a drug which most assuredly was NOT usually given in the way the patient was 'verbally' told. Now, I know medicine is not black and white and there might have been a reason. I need to clarify this. It's Friday. The doctor is unavailable and everyone has left the office. In fact, the pharmacy is about to close too. We're not supposed to pull any overtime. I'm sweating bullets because I really don't want this person to kill themselves over the weekend.

I strongly suggest they follow the prescription as written until we can follow up on it but they are argumentative. It's going to be a nightmare to find someone who can clarify this -- the doctor on call can't do much -- there probably won't even be a note transcribed in the patient's chart till Monday or Tuesday.

Long story short, it bugs me all night and I call the patient at home the next day. I explain why I'm worried about it and he agrees to do what I ask, and even thanks me.

Well, it doesn't have a fancy name like "medication therapy management", but for most of us pharmacists it's the best we can do, and sometimes it even works.


Lipstick said...

Excellent post.

Grumpy, M.D. said...

Ya done good, Frantic.

If it didn't bug you, then you shouldn't be working in the field.

I have the same stuff. Cases that bug me, and I call the patient the next day with "I know we decided to do this, but after thinking about it I think we should do something else."

And generally, they are happy to know you are actually trying to care for them.

Brother Frankie said...

good post.

here is what has happened to me.
(the following is a fictional scenario)
i am a chronic pain patient. i have to mail order due to ins rules. i am allowed to fill a 15 day script at a local big chain pharm. my dr knows this and will double dosage on the script and vebally tell me what to take and when. i am a long time patient and a trust has been establiched.

just saying sometimes it may be legit... illegal, but legit..

then again, this is fictional and my doc would never do anything like this..

The Redheaded Pharmacist said...

Usually patients will ask one of three things:

1.Why is that my copay?
2.Can I drink alcohol with that?
3.Do I need to eat first?

Honorable mention goes to the question about if this medication affects birth control pills.

If you can answer those questions you have taken care of 99% of patient counseling interactions I ususally see at work!