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Friday, March 2, 2018

Pharmacists vs. Doctors, IV

As more and more professionals are responsible for prescribing, more and more professionals are responsible for irritating me.
As more and more professionals delegate more authority in their offices, more and more items fall further and further down the priority line.
As rapidly as technology advances, it seems our ability to develop social mores regresses or fails to advance as quickly.
If you are going to use the technology, please understand how it works.
If you are going to employ different types of technology, be sure you are using them correctly and in the correct circumstances.

If I call you, I expect you to call me.
If you need to reach me right now, speak to me.
(Translation: Do not leave me a voicemail.)

If you send an email in error, what is the worst that could happen?
I suppose the recipient(s) could read the email.
But, what if your email alarmed the recipient(s) and they took actions that resulted in harm to themselves or others?
If you just "delete it" from your screen, does that make all trace of its existence disappear?
Does it "unsend" itself and automatically erase itself from the minds of those who have seen it?
What if you realised your error and wished to recall it?
How do you recall it?
Do you send another email?
What does it say?
"Sorry. JK. lol."?
Do you leave a voicemail?
Send a fax?
Smoke signals?

Sounds silly, right?
No way that could happen. (Who uses smoke signals anymore? And the final telegram was transmitted July 14th, 2013.)
Except that it does. All day, every day.
Where, you ask?
In your local pharmacy.
Prescribers love to send electronic prescriptions but they have a difficult time knowing what to do when they are sent mistakenly, incorrectly, in error. This is where the delegation issue comes into play. If it's wrong and you know it, call me. Now. (Translation: Ixnay on the OicemailVay, comprende?)

I cannot tell you the number of times I have had this conversation:
CP: I have a question phor you.
Dr. Zoffis: What now?
CP: Which strength/medication/directions did you want our patient to receive?
Dr. Zoffis: Why?
CP: Well, you sent me a prescription this morning, which the patient purchased, and now I have a new prescription that seems to contradict the first.
Dr. Zoffis:
     Answer A: We left a voicemail to cancel the first one an hour ago.
     Answer B: Well since we sent this one it must be the right one.
     Answer C: Yeah, the doctor canceled the first one in our system.
CP: Let me be clear: That's not how it works. Simple, yet somehow confusing to offices everywhere. If you were to have handwritten the prescription and chose to cancel it, how would you have handled it? Would you have mailed a new hard copy to the patient? That's effectively what you're doing here. The patient could already have filled and started taking the medication by the time the new order arrives. This is what happens when you choose to cancel electronic orders via any means other than a live chat with the pharmacist. No. Counseling does not always catch your mistake because, like today, the patient's niece's boyfriend's Uber driver came in to pick up the prescription and knew nothing about a change in therapy. Your note on the new prescription to "cancel previous" is rather vague and will now be attached to every single prescription you send for the next two years.
Dr. Zoffis: Well, it's canceled in our system.
CP: Ok. I know it's tough to understand how technology works when you simply stare at your phone to get cat videos and your friends' photos of the birthday parties they held for their pets but your patients' lives are at stake. You know what's funny? I take the time to thank prescribers and their staff who call me directly to cancel prescriptions in error. They are surprised to learn they are in the minority.
Dr. Zoffis: So, what do you want from us?
CP: In the immortal words of Blondie, "Call Me". And since your patient left with your initial, incorrect prescription, you get to call him and tell him.
Dr. Zoffis: Um, We don't do confrontation here.
CP: Phine. I will call him, give the copies of both prescriptions, the documentation phrom our conversation, and send him to your office. What time y'all close?

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