Monday, July 21, 2014

View from behind the counter today was not pretty

We are desperately trying to close up and go home.  Everyone is tired, hungry and irritable after a long day.  But the electronic prescriptions keep pouring in, so we can't just hand the piece of paper back to the customer and say, "Sorry, if you need this tonight you'll have to go elsewhere. We are closed."
We finally finish up, and I realize that probably 50% of the prescriptions that kept me and my staff overtime were for things like Claritin, and Miralax, and Tylenol -- over the counter stuff.

OK, I know. This is a pet peeve of mine.  I used to think that as a pharmacist, I would be dealing primarily with prescription drugs.  Sure, I would give advice on over- the-counter products, but ultimately these would be customer self-selected.  Someone would come in thinking "I need something for my allergies" (or kid's diaper rash, or flaky skin, stuffy nose, constipation, sore shoulder, etc. etc.) They would go to the section marked "Cold and Allergy" (or some such designation),  peruse the products, read the labeling and make a decision -- and ask me or my staff a question or two if necessary.  I wonder if those people exist anymore.  I think everyone goes to the doctor for everything now, and the proliferation of the Doc-In-A-Box outlets probably makes it even worse.   Nobody can read labeling, or instructions for use, or precautions.  They refuse to take the time.  I just wish people could keep things in perspective, when others around the world are living in tents and scratching for food and dodging rockets and burying their dead.

Prescriptions that don't get picked up within a certain period of time have to be returned to stock.
I am astounded by the number of these we put back every week. Why were they never picked up? Remember when getting a prescription was kind of a big deal?  SOMEONE had to call in that refill. SOMEONE sat there in that doctor's office.  By never picking up that prescription you have wasted everyone's time, and lots and lots of money.   WHY???

I got a call from someone who said she hadn't been checking her blood sugars for several months, but decided she should start doing it again.  Therefore, I needed to call her doctor, get a new prescription for test strips, and then I needed to see that the strips were mailed to her.   Yeah, I know -- I'm supposed to act for the welfare of the patient and see that she gets her diabetes supplies so she can test her blood sugar and be well and all that.   Why do I feel like SHE should be doing this though?

Wastefulness and entitlement.  Sometimes you feel like you see nothing else. I sure wish we Americans could have some sort of revelation.  I wish we could lose some weight too.


Meghan said...

I didn't even know until recently that you could get a prescription for OTC drugs. I just assumed your doctor would recommend something, and then it was on you to go get it. Why do docs even write for OTC drugs? And why do insurance companies cover them?

barb tracer said...

They dont unless its Medicaid

bcmigal said...

We have a site and several apps that pts can use to manage their prescriptions. Add to that phone calls, voicemail, email. text messages all to inform them that the prescription is ready for pickup. Yet there are pts who do not pick up within the 14 day period then complain that we are at fault when they do not take their meds for a month. I give up!

kely bob said...


TheTracker said...

"Why do docs even write for OTC drugs?"

So, there are a number of reasons. One, as barb pointed out, is that Medicaid patients pay nothing for prescriptions. If you don't give them a script, they won't get the medicine.

Another reason, as the OP points out, is that people are dumb and careless and don't read the directions. I prescribe it in order to emphasize how I want the patient to take the medicine and to ensure -- sorry, PharmDs -- that they get further reinforcement of this from the pharmacist.

It's also a way to document for the benefit of the patient and the chart that I did SOMETHING for you, even if I didn't write the Dilaudid 4mg TID (#90) that you wanted. "Ibuprofen 800mg q8 PRN pain" sounds better to a patient than "Take your Advil like it says on the bottle."

When you send someone out with a plan for OTC treatment -- especially from the emergency room, which is where I work -- there's a great danger that they are going to feel that you are dismissing them and their complaint. Which makes people more angry than anything else you can do. Which in turn leads to emails from our chair.

So, I'm am sorry, really sorry, that it makes more work on the pharmacy side. If I'm being honest, though, I'm going to continue to do it.

Anonymous said...

A different perspective on those unclaimed prescriptions: I check how many refills I have left before seeing my rheumy. If there are fewer refills than there are number of months before my next follow-up appointment, I ask for a new paper script so that when my refills run out I can take in a new piece of paper. It works quite well and doesn't inconvenience anybody.

Unfortunately, it turns out that when my rheumy's office sold out to the hospital, they started sending escripts every time I ask for a piece of paper. I don't always need to fill it yet. For instance, the muscle relaxant is 1-2 pills a day with enough in the bottle for me to take 2 a day -- but if I've only taken 1 on some days, the rx doesn't need to be filled yet. I'd prefer to be the one to order my refills. I've tried telling the doctor's office to quit sending prescriptions and let me do it myself, but the hospital's computer system apparently doesn't allow that :(

KD said...

You need to get a prescription for OTC medicines in order to use FSA funds to pay for it.