Saturday, September 29, 2012

What could doctors do to make the pharmacist's life easier?

I was reading the comments over at The Angry Pharmacist's blog (not safe for work or the faint of heart) and there was one from a med student/resident/I don't really understand all the levels of training for MDs but I'm sure I will by the end of rotations asking how docs could make pharmacists' lives easier.  I figured I'd write that blog post since The Angry Pharmacist is a busy dude and I like procrastinating (big scary test x2 this week, one mostly a surprise, oh joy).

What I really want all doctors to know about working well with community pharmacists:

1. Your computer system only sends prescriptions to ours.  It doesn't send a message saying, "Oops! That was a mistake and I cancelled it here in the patient's chart."  You could call us, or you could make a note on a second e-prescription saying "this is correct, do not fill the other one."  Doing nothing but cancelling the order in the patient's chart just makes everyone frustrated that we have to call to clarify something.

2. Your computer system really ONLY sends prescriptions to ours.  We have no information on what you're treating or what dose change you may or may not have made (on purpose or by accident).  There are a couple easy solutions to this: add a diagnosis to your sigs (that's the part of the prescription that says "Take one tablet every day") by adding the words "for [hypertension or blood pressure or cholesterol or being crazy or mood]" to the end.  We like that. Patients love it.  Good idea.  Additional solution: make notes on the rx (that's shorthand for prescription, fyi) that say: "note dose increase to ___" or something.

3. Ask us.  We know stuff about medications and can help with just about any medication-related question.  We also have all the best resources for looking stuff up about medications, so let us do our jobs.  We see patients at all hours of the day so we have heard every stupid question ever (I promise).  Your question is not stupid, and you look infinitely smarter asking us before just deciding to write an rx without knowing what you're doing and having us call you to figure out what on Earth you were thinking.

4. Don't think we're calling you stupid if you make a mistake and we call to inquire about it.  Mistakes happen to people and doctors are still people, last I checked.  We just want to know what you actually meant so nobody gets hurt.

5. If you're doing something strange for some reason (unusual dosing for example or adjusting the dose for an organ transplant the patient just had and somehow didn't tell us about), and you aren't sure it will translate properly or your e-prescribing software is grouchy/making you angry or whatever, CALL US.  We are your colleagues.  We want to work together.  If you explain it on the phone to us, we'll get it right or ask you questions until we get it right.

6. We offer this thing called "medication therapy management" for patients who are having a bad time keeping their medications and/or health together.  Refer people to us and then call us or fax us to tell us you recommended it to them.  It's a great deal for everyone: we know lots about medications and can figure out what's going on and suggest changes to you, your patient gets someone to talk to about all the things they forget/are too scared to ask about when they see you, and the insurance company probably (most of the time) saves money in the long run.

7. We think working in teams with you is awesome and would love more clinical data access, and we could share with you if your patients are actually getting their prescriptions filled, and if it's on time or not each month.  Is your clinic hiring a pharmacist? We would love that job and could save you time by doing the grunt work "what medication should we give this patient?" part of visits and patients money by finding them a medication that's a good fit for them from the start.

8. ASK US.  We mean that.  We try when calling to suggest something instead if the patient is allergic or the insurance won't pay.  If you ask, we can tell you.

9. Pharmacists are largely PharmDs (or really wicked experienced and smart RPhs [registered pharmacists]).  We know our stuff.  Don't scoff at our recommendations.  We keep up on guidelines and literature too and we want to do what's in the patient's best interest.

10. Did I mention asking us questions and actually talking to us?  And that e-prescribing is 100% one way from your computer to ours?  Remember just those two things and you are set to be our new favorite MD (and we totally have favorites in the pharmacy, in case you didn't know).


  1. Oh, and don't forget that although we enjoy talking to your office staff, if you have a /real/ question or concern, ask to speak to us directly. Telling one of your front-end people to ask us just leads to frustration and poorly relayed messages.

  2. and add eprescriptions are electronic prescriptions sent over the internet from one computer to another computer or fax, that they are 'magic' they don't magically show up in the pick up bin the moment you send them. A team of techs and pharmacists still have to process and DUR check them, count them and check them physically again. Also there may be others in front of them, so please don't send the patient right down, or at least tell them when they get here it might not be ready yet.

    Also, see the first few lines of this comment and let your staff know that the only time a human actually is involved in the 'sending' part is at the beginning and that if a patient or pharmacy calls and says 'we didn't get a prescription' WE DIDN'T GET IT! We don't like wasting our time calling to harass you about prescriptions we already have in our possession. If I'm telling you I don't have it, its not to fight with you, its because I don't have it! I just want to know what the patient is supposed to get, just tell me, don't keep saying "well I sent it at 3pm or It says here that it sent." in a snotty tone. I'm not trying to say you messed up, just trying to say "I DON'T HAVE IT!"

  3. I'm not a pharmacist or a physician... I'm a counselor. I used to be a nurse, and plan on becoming an NP, so my post is more from the patient perspective.

    Personally, I enjoy when my DO works with the pharmacist. Having two bright people coming together to work with me to improve my health means there's a greater chance that my health will actually improve. Collaboration is a wonderful (seriously, wonderful) thing.

    I'd also like to have the same pharmacist. When I was young (and beautiful), I could go to a pharmacy and it was always one of three pharmacists. Now, it could be a monkey wearing a lab coat and I wouldn't know him from any of the others... they are all so impersonal. My pharmacist before knew my medical history, what surgeries I had, what medications I had taken, my allergies... now, the pharmacist barely knows my name.

    I support sharing clinical data with core pharmacy staff, IF those core staff are consistently present... three or four pharmacists is totally ok... twenty-nine is not. I'd like the pharmacist to know all the gooey details of my medical history and diagnoses - because there's a good chance that my PCP will not be thinking when she orders the antibiotic, and will end up ordering Avelox even though I already have a heart condition and musculoskeletal (tendon) issues. If I had a regular pharmacist, s/he would raise at least one question, contact my physician, and advocate for me.

    So, to the medical students, residents, and fellows, I would suggest that you establish a cordial working relationship with the pharmacists in your area. It's in the best interest of your patients to have somebody who understands their health and medication history, and it's in yours to have another meaningful pair of eyes reviewing the information to make sure that what you order is compatible with the person for whom you ordered it.