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Friday, June 6, 2014


Doctors are dumb.
The only problem is they don't know it.
The problem with doctors, and the ever-growing number of others with prescriptive authority who aren't pharmacists is they think they know everything about everything. This includes how a pharmacy works and everything about medications.
Never mind they tell patients how my pharmacy operates when most of them have never spoken with a pharmacist let alone stepped foot inside one.

A new twist on the all-knowing prescriber overstepping his knowledge:

CP: How may I help you?
Patient of Silly Doctor: I need this filled.
CP: Fabulous. We are in the script-filling business after all.
POSD: Can I get that in brand?
CP: Most definitely. However, I must warn you that the cost could be exorbitant if your insurance chooses to be quite the prick.
POSD: I have to have it though.
CP: May I ask why the brand is so important with this particular medication? (No, it is not a NTI drug and it is a new prescription for this patient.)
POSD: "My doctor told me to get the brand because the generic will give me side effects." (Yep, actual quote.)
CP: Ok. I'll let that one go for a minute but she actually needs to tell me that since, you know, I am the one actually filling it. A DAW from a doctor could mean the difference between a small copay and the debt of Detroit.
POSD: Okay, I'll speak with her. Why would she say that?
CP: No clue. It's like someone telling me Motrin works better than Advil. If you've never tried this, how can you know the generic will cause side effects? It is a rather asinine comment and I will add the doctor to my Do-Not-See-If-My-Life-Depended-On-It List.


  1. I am a VA patient. The only brands I usually get are the Anti-Psychotics. That is before they become generics, then I get the generics! I have never had a problem. Sometimes I will get different generics when they find it cheaper. It is a crap shoot when I get a new rx.

  2. I'd be informing Silly MD and patient if they're going to be wanting brand, Silly MD is going to have to file a Prior Authorization providing documentation to insurance why brand is needed. Otherwise Silly MD is going to have to OK patient getting generic regardless of his feelings because we all know insurance is going to reject. In the most recent years, I haven't come across an insurance that automatically approves brand at higher copay without wanting the PA done first.

  3. I feel this post. I am a medical coder, and the EMR has given doctors the false impression that he or she knows anything about coding. Case in point:

    Doctor Smart sends over charges for an established patient visit. The charge is for a consult. I inform Doctor Smart that she can't charge a consult code on a patient that is already under her care. She proceeds to argue that she was asked by the surgeon to give the patient pre-op clearance so that is a consult. I begged to differ. This went back and forth for much longer than necessary. I won.

    She may have MD after her name, but I have CPC-H after mine. Deal with it.You don't know everything.

  4. We're all dumb outside our area of expertise.

    We have one particular pharmacist in my ED who is awful that way. Ask for her help and she will always find an excuse why it isn't her job. When it comes to clinical decisions about which she knows nothing, however, you can't shut her up.

    I had an agitated head injury patient who had to be intubated for CTs and other management. Multiple doses of Ativan and Haldol had failed to calm her, and it was time for RSI. Rather than prepare the drugs I asked for, she recommended given an IM antipsychotic that she had "seen work in this situation."

    Yep. She wanted to try an off-label use of an antipsychotic with minimal sedative properties and a slow onset on a head injured patient who was agitated and confused. That was stupid. She's not stupid, she just doesn't know what she doesn't know.

    Nor are pharmacists as a group dumb. I certainly wouldn't make a generalization like that on the basis of a few bad experiences. Because that would be dumb.