Judgement or Judgemental?

[Pharmacist.steve]

This thread would be funny if the people posting did not believe that they were IN THE RIGHT !

This will give you some insight into some Pharmacist's mindset where they - IMO - are confused about making Judgement based on facts and being Judgemental based on some person bias.. WITHOUT ALL THE FACTS ...


thepharmacy********.com/forum/showthread.php?t=405

insert the word a-l-l-i-a-n-c-e where the **** are apparently the system believes that this is a "dirty word"

[Boxerlover]

Geez, I got so immersed in reading it I forgot to leave for an appointment!!

I'd bet my life I've had that pharmacist at one time! LOL

All I can say is I'm so glad you are on our side. It's scary and so sad to see that this is the way they feel and choose to treat us. He (she) wants to make sure he/she can speak directly to my doc to make sure that I am not trying to get anything over on the doc!? Are you kidding me!! And they say doctors have God complexes.

The original thread is why we move heaven and earth to work our vacation around my pm appointments so if it is at all possible I will not need a refill while we are away because I know what I am going to face. My insurance used to fill any script early 2 times a year for vacations but that has now changed on the schedule II's. I found that out last year when we had to go at a certain time because of my husband's work schedule(which is how it should be) and was now in a bind.

Our other issue is that my family has a cottage in PA and we have talked about me staying up there for a few months over the summer, but our concern will be presenting out of state scripts.

As for Mr. High and Mighty I am so grateful he is not in my state and I feel very sorry for the pain patient who ends up getting him.

Melissa

[Mark N]

I have one I know like this that often questions doctors decisions and choices of meds. Of course they come from a family that is very judgmental so I guess it is no wonder they are like this. It is too bad if you are a person they find a dislike to but if you are favored then life is good.

[slipnslide]

I was sooooo thoroughly disgusted to read some of those posts by so called "professionals". I can understand them wanting to protect their license, but....

1. To lie to a customer about a drug being "out of stock" simply because they weren't sure of the validity of a customer or a prescription, and not even make an attempt to verify the RX with the doctor/clinic that wrote it?:mad:

2. To play doctor and pretend to know who has "true pain" and the extent of the pain of those who walk through their Pharmacy doors is beyond ignorance and arrogance.:mad:

3. To avoid getting involved by "calling the police" because of fear of reprisal and using the excuse that they are tired of "playing cop"...They are simply not doing their job, nor are they doing "the right thing". What a disgrace!:mad: IMHO, they should do customers a favor and find a new profession where they can display a sense of pride and receive satisfaction from a job well done.:p

4. To say "I make the JUDGEMENT as to what is an excessive amount. I make the JUDGEMENT about whether a pain clinic is writing rx's for people that don't need pain meds or are abusing drugs. I make the JUDGEMENT as to whether to fill a rx or not... PERIOD." and for that Pharmacist to actually believe they are justified in their thinking scares the heck out of me and I feel they are a danger to their customers.:mad: God forbid you wind up being one of the people they feel are unworthy of pain meds!:eek:

I could go on and on, but I best just stop there;).

God bless you Steve, at least someone has some common sense!:)

Kim

[lobelsteve]

Let me paste some quotes from the thread...

1. I'm not sure of the exact details, except this involved a pain clinic in FL.

I ran into a similarly questionable situation a few months back. I was temping at a retail/long term pharmacy and someone had a script called in for a huge amount of Vicodin HP from a doctor out of state.. It was left on voice mail, so immediately I know I have to verify this. I call the number left and get a "call center" which is odd, they give me the DEA and address in Florida. Still not completely satisfied and stilll requiring the NPI, I do a search online and discover the doctor has an address in Texas, huh?! So I go to the Florida state license search and find the doctor has no license in Florida. So I call the "call center" back for an explanation.

"Where was the pt seen?"
Response: "Florida"

"This doctor does not have a license to practice in Florida. So how do you explain that?"
Response: "We have offices in Texas and Florida, and handle calls for both practices."

"OK, but how can the pt be under the care of a MD with no licensed to practice in Florida, who was seen and written a script in Florida????"

At this point I was given another phone number in Texas, which was just a voice mail line. Left a message, but of course no one ever called back. It was the same number on the doctor's Texas NPI business listing.


So, I handed all the info over to the pharmacy director and said, "this is fishy. I don't want to run off your customers, but I would not be filling this prescription. You might want to look at the patients profile. All her pain meds are from doctors in Florida, but never the same doctor."

The director launched an investigation with the DEA and such. I never heard what happened if anything, but as a temp I didn't want to just blow off the customer without telling the director. She could have her regualr pharmacist fill it if they want, but I didn't feel comfortable doing it.

2. The original post indicated that the pharmacist agreed to fill one script and let the patient find a local doctor. I assume this was to also buy some time to look into the matter. So the patient was not left in a predicament.

But you are correct that good judgement must be used in these situations. In this case, I was not there, did not see the patient (maybe she had slurred speech, stumbling or the shakes), don't know if it was after hours and a multitude of other factors that may have influenced the pharmacist to make her decision. But it does not sound as if she was trying to deny the patient medication. Only the extraordinary amount was in question. I agree with you that follow-up should have been made on the spot at the first available opportunity to contact the doctor's office.

But lets not be naive here as well. We all have interacted with "pain" clinics that are nothing more that legitimate drug parlors. I think any pharmacist practicing has to do their due diligence in protecting their license, reputation, the health of the patient, AND the society in general, if these drugs eventually end up on the street.

Pharmacy is more than simply following written prescriptions, and the courts have said so as well.

What is needed is a national network, so that pharmacists will have addition access to a patient's filling history. We now have one in Tennessee and it Works!
__________________


3. Yet, here in Tennessee, pain center generally means trouble. Sorry to say it but they are staffed with part time physicians that sometimes have a clouded history and the bulk of patients are not routinely seen by the physician. Sometimes all one has to do is pay a fee and the counter clerk writes the script. How these things continue to operate is beyond me.

My procedure was to call on every script and make them give me a diagnosis, which I documented. That way when or if someone OD'd or the drugs were confiscated in a bust, and labeled from my pharmacy, I was covered. But, even the diagnoses were suspect. Always vague.

It is a sad situation made worse by unscrupulous doctors. I have seen too much pain endured because of a reluctance by good doctors to appear as overprescribers. There is certainly a group of people that need our assistance and sympathy, but realistically, that number is far less that the actual number of people being treated. Again, pharmacist in the middle. Hydrocodone is the number one prescribed drug in Tennessee. Go figure. I am not a fool. I have worked in small towns all around Tennessee and know exactly where a good portion of the drugs dispensed (in good faith) wind up.

So, I do everything I can to ASSURE that a truely needy person gets everything they need. But I do everything I can to ASSURE those that are playing the system do not incriminate me in the process.
I picked some of the btter posts showing that the pharmacists were trying to protect their licenses and that the patients getting denied Rx's filled were highly likely to be addicts or diverters.

Legitimate pain patients (the folks with my Rx in hand) have filled in Florida, Texas, and who knows where else while on vacation or visiting sick relatives. I encourage their pharmacist to call my office when filling out of state to verify the Rx and validate the patient. I do this by writing on the Rx to please call my office before filling.

[jtroy]

Very interesting....I have been unfortunate enough to have dealt with my own cp now for way too long. I've lived in two different states through it all. Initially I was living in a very large metropolitan area and since I have great ins was able to get referred to a very prestigous pain clinic that staffed several full time boarded docs. This clinic was well known to the pharmacists in the area and there was never once ever a questionable issue with any of the docs (i.e., no discipline from boards, etc.) which is why I wanted to become a patient there....I didn't want to be a pharmaceutical dump if there were alternative ways to handle my pain....and....they were extremely rigid and this was the first time I had ever encountered a "pain contract" which I freely signed and felt even more comfortable there because of it. I was then prescribed Oxycontin and OxyIR.....then when I took it to a Walgreens to fill naturally it took a few hours for them to verify it and what not...and at that point that particular Walgreens become the one and only pharmacy I filled everything at.

It was at that time I first was exposed to this bias/stigma/whatever pharmacists have regarding CII's. Even though I was getting a prescription from the same doc within a very well know pain clinic I was actually asked questions like, "well, why is it that you are having to use your OxyIR more this month?"...."you realize that if you use the OxyIR every 4 hours you'll become addicted...it's written PRN that doesn't mean you are supposed to use it every 4 hours." Honestly...these questions were posed every month by different pharmacists there. Now, I began to become frustrated because it was as if they were practicing medicine and I'd never encountered this. Heck...I didn't have as much of an issue personally when I as a veterinarian scripted CII's for dogs or Diazepam for certain behavioral issues. I guess I just never realized how judgemental some of them could be.

Anyway...as a veterinarian we, for the most part, are both the doc and the pharmacist. Luckily we have so many outlets for pharmacies to do our compounding now but I remember doing alot of that when I'd work at a clinic on my off time during vet school. A long while ago physicians used to also have to "make" or provide medications as well....doc and pharmacist all in one.

What about the concept of putting them together? I know that perhaps this is a radical concept...Dr. Lobel is probably gonna' kill me for even throwing that idea out there....but, honestly....I can see how perhaps putting the medical clinic and the pharmacy practice together. Then...if a script for a super high dosage of insulin came to the pharmacist it would be a simple jog across the hall to visit with the doc.

No matter how medicine in this country progresses, this concept of a "professional" getting a script and then using their "gut" to determine validity is unprofessional at the least, and practicing medicine at the worst. If the script is legit but the pharmacist chooses not to fill it because they have determined that the patient is an addict by consulting with their "gut" and without 'facts' as Steve pointed out they have no business being a pharmacist and shouldn't be allowed to "practice" pharmacy. I think that what Steve was trying to point out (and was missed by many) is that the art of practice, whether pharmacy or medicine, must be firmly based in FACT not GUT. You know, those "professionals" who "practice" pharmacy that way should count their stars that we don't revert back to the days of old, where doctors dispense medications, and simply take their profession away leaving them to find another career.

We have to have a pharmacy in the equation. But we don't have to have pharmacists like that around. What they cannot understand is that there are soo soo soo many patients out their who, when confronted with this type of pharmacist, have that stigma that is already present within society regarding pain management reinforced----this is DANGEROUS!!! I've seen so many people ultimately have their lives and families destroyed because this was reinforced to a point where they feel like they are just another "junkie" and either deal with the pain and destroy their life or live one that is basically horrific....or just simply kill themselves.

[1ammodog01]

I suffer from chronic pain, doctors say it's skeletor problem I forgot the term, they also said fibemielga. I can exercise or due stuff outside, but the next day It's hard for me to get around they tell me stretch and exercise, I due that I just got back from Iraq last year around this time, so I was in pretty good shape, but since I have been back my body is having problems, what is causeing this? doctors don't want to say.

[Stetson]

Of,course they don't they don't want to have to pay you for the rest of your life for
lost wages and health benefits. Expect a long tough battle at each step.Good luck to you sir.

[Pharmacist.steve]

What about the concept of putting them together? I know that perhaps this is a radical concept...Dr. Lobel is probably gonna' kill me for even throwing that idea out there....but, honestly....I can see how perhaps putting the medical clinic and the pharmacy practice together. Then...if a script for a super high dosage of insulin came to the pharmacist it would be a simple jog across the hall to visit with the doc.


There is a outfit that puts pharmacies in pain clinics... I searched but could not find their name one the web... but they are mostly on the west coast and the last time that I did find their website .. they had < 10 clinics FYI

[zax44]

An interesting thread. I have been a cp'er for a long time and go thru the VA - they have rules, they drug test me randomly, but all in all, a good deal. I also known pharmacists on a personal basis, and the bias i found,(I never disclose my status) was incredible. If someone looked wrong, if they were not polite, long hair, you get the picture. Nedless to say, these people are no longer in my social group. Legitimate pain should be treated , by a doctor. If the Pharmacist has doubts, it does not take long, and this can be delagated, to call the prescribing doctor. God luck to us all.
Zax44

[lobelsteve]

What about the concept of putting them together? I know that perhaps this is a radical concept...Dr. Lobel is probably gonna' kill me for even throwing that idea out there....but, honestly....I can see how perhaps putting the medical clinic and the pharmacy practice together. Then...if a script for a super high dosage of insulin came to the pharmacist it would be a simple jog across the hall to visit with the doc.



This has been done in a lot of pain clinics but purely for profit reasons. It then biases the docs prescribing habits to write for more profitable medications for the practice while not necessarily writing for the best medication for the patient. Profit margins on Darvocet and Soma are huge. Same for Neurontin and Lorcet. Name brand drugs were loss leaders and if the patient did not get some drugs that made a profit for the pharmacy at the same time, it was bad for business and bad for patients.

[jtroy]

Hey Doc:

I know, I know. I suppose when I think of a concept like that I'm dreaming that we all live in a utopia....but we don't, for sure. Anyway, when I first started vet school I remember it was during the whole Clinton era and socialized medicine and boy was I against that. I'm starting to look carefully at what is going on in Europe and some of their concepts may be what we need over here. Who knows. Boil this thread down...really it's about pharmacists who discriminate based on their "gut" or some other personal issue...which is wrong. As Steve the pharmacist says things should be based in fact.

Regards,

Troy