Pharmacists and physicians

Pharmacists are increasingly becoming advocates of patients in this era of rising drug costs. On The Pharm suggests ways for a pharmacist to discuss treatment options with physicians.

However, I can say that there are some doctors who simply want the drug filled, and any “asynchronous communications” (i.e. faxes) are viewed as extra, burdensome paperwork.

Comments

RJS
“that there are some doctors who simply want the drug filled, and any “asynchronous communications” (i.e. faxes) are viewed as extra, burdensome paperwork.”
Mmm, I have no doubt. However… would you rather be interrupted by the telephone or respond to a piece of communication at your leisure? Perhaps during off hours or even at home…?
I know which I’d prefer.
Anonymous
Most of the time, when I receive a call or FAX from a pharmacist it is a request to switch to a geneic drug. There is a real conflict of interest here because the pharmacy makes a much greater profit on generics than branded drugs. I am not sure that the pharmacy is really a patient advocate at all, especially because some generics are not as effective as some branded drugs.
RJS
“Most of the time, when I receive a call or FAX from a pharmacist it is a request to switch to a geneic drug. There is a real conflict of interest here because the pharmacy makes a much greater profit on generics than branded drugs. I am not sure that the pharmacy is really a patient advocate at all, especially because some generics are not as effective as some branded drugs.”
Unless you’re dealing with independents, the pharmacist has no motive to switch to a generic, because they get no compensation for suggesting such a thing.
What the pharmacist does get is significantly less bitching from the patients who are unhappy about high copayments.
I think every doc should have to work in a retail pharmacy for a month during med school. To see what real world drug dispensing is like. Might change some misguided attitudes like this.
Anonymous
RJS: If you really want to hear alot of bitching about price (co-pays, non-covered tests or treatments, etc……)try working in a doctors office. We basically are dealing with a general public that has the Walmart attitude-cheaper is always better, especially if the insurance company won’t pay for it.
Anonymous
RJS, I am not speaking from experience, but if a company that a pharmacist works for makes a greater profit on generics then it is likely that a company directive or policy exists that stipulates that a pharmacist must suggest a generic alternative. If a pharmacist was losing my company money by not suggesting generic alternatives under the guise of “saving our customers money” it would definately adversly affect his/her advancement or pay scale.
mike
Anonymous
MAy I suggest RJS spend a little time in a doctor’s office so he can review some of his misguided views.
Anonymous
what i hated is when i was a resident. i would be driving home one day and get a page. it woudl be from a pharmacy with a question about some send home prescription i wrote…. i have no medical records with me. do you think i remember the details of every patient i send home? expecially if i wasnt following them very long.
they shouldnt page a resident with every detail.
Anonymous
To the resident above:
we won’t call you if you
1) write for strenghts that manufactures actually make (especially combo drugs) 2) don’t implement chicken scratch 3) write DEA number AND spell out your last name when writing for vicodin 4) don’t sign on the right side when there are generics available and patient has a crappy insurance plan
Anonymous
jI am glad for a pharmacist to call with a suggestion. I used to only get called when I had miswrote the prescription, or there was a reasonable question that I had done so.
About 12 years ago, it shifted so that most of the communications were requesting refill Rx that were inappropriate or unnecessary interuptions because the original Rx still had active refills but they didn’t bother to check, patient was out of meds because they were months or even years overdue for their follow-up (not pharmacies fault, but avoided under the old system whereby pharmacist told people to call their doctor for a refill), or just at a stupid off hours time for a prescription that is not an emergency or even out.
The problem went away like a fart in the wind when I began charging for refill auths.
RJS
“MAy I suggest RJS spend a little time in a doctor’s office so he can review some of his misguided views.”
I’d love to. In fact, I think it should be mandatory during pharmacy school to spend a month at a doc’s office to see the inner workings.
Anyway, while we’re on the subject, perhaps you could point out in my article some of the things that are “misguided.”
Or were you just trying to be witty?
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“it woudl be from a pharmacy with a question about some send home prescription i wrote…. i have no medical records with me. do you think i remember the details of every patient i send home? expecially if i wasnt following them very long.
they shouldnt page a resident with every detail.”
Who else would they page? Your name is on the prescription. Not the hospital’s.
Oh, and incidentally, I’ve noticed that some of the pharmacists I work with will page on every little thing. I won’t. No direction on Flonase? No problem. Same for Ambien. But some pharmacists will call. I think they’re doing the profession a disservice when they do so, because they know what the answer will be, and all they’re doing is being a pain in your ass.
Also what 7:19 said.
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“(not pharmacies fault, but avoided under the old system whereby pharmacist told people to call their doctor for a refill)”
This is a mixed bag, actually. We have many instances whereby doctors will not let patients call for refill auths. They want the pharmacy to send them a fax. It’s not optional. You use the pharmacy as a proxy, otherwise no refills. I think these are the offices that want paper records of everything, and a fax serves better than someone writing something down.
In general, however, I agree with your sentiments. Actually in the “old days” before there was something called “unlimited long distance calling” pharmacists would often have the patients call because all those phone calls add up very quickly. Or they’d charge the patient for the favor. This was in the days where every drug store was an independent, so the money was very real. Now everything’s fast food pharmacy… it’s different than it used to be. Less personal in many ways, unless you make the time.
Anyway, I’m sure you doctors have noticed an increase in the sense of entitlement in patients over the years. It’s expected now. You’re a bad pharmacy if you don’t do that refill request.
Oh, and you wouldn’t believe how often pharmacies are badgered about whether X has been called in “yet.” They’ll keep calling us, as though the more often they call us, the quicker the refill will arrive. Honestly, if you’re that desperate, call the doctor — they’re the ones with prescribing privileges.
“The problem went away like a fart in the wind when I began charging for refill auths.”
You must be in an area where doctors aren’t a dime a dozen.
Anonymous
I posted anon 8:16 above and want to add that in general, pharmacists have been my best partner in this profession and have, frankly saved my (patients) bacon a few times.
I recognize that, except for the part where the pharmacist calls without checking the old Rx, none of this is anything that they have driven, that some docs want the pharmacist to call for all reauths (I think they are boneheads, the patients never come in that way), and most is driven by patients coming to see all healthcare providers as a form of public utility instead of a cherished personal relationship.

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