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Tuesday, March 12, 2019


CP: I don't mind helping. I simply ask that you help me to help you help me.
ME: You really need a new partner at work.
MYSELF: We're tired of being your go-to phriends for these conversations.
CP: No one understands me like you do. Besides, you offer good counterpoints from time to time so I can see both sides.
ME: Right. Which, as we've discussed recently, too few people are willing to do.
MYSELF: If you are able to see what the other side is going to argue, it will either reinforce your beliefs or allow you to change them in light of new evidence.
ME: Now that everyone is asleep, can we progress to today's lesson?
MYSELF: <yawns> Please?
CP: I love thinking for myself, but I don't like having to think for others as well.
ME: Yes you do.
MYSELF: What happened?

<fades into a recent conversation, phone rings, 4pm>
CP: Happy Phriday! CP, Pauper of Pills, How may I assist thee today?
Nurse At Pain Management In Need of Defending Early Refill: Yes, I'd like to let you know we approved an early fill.
CP: Thanks. I didn't ask for your approval, not that I need it of course, but. . .
NAPMINDER: For your patient.
CP: Well that's different. Why did you approve it?
NAPMINDER: He is taking a vacation.
CP: Nice. When is he leaving?
NAPMINDER: Tomorrow morning.
CP: Wow. Excellent. Thanks for giving me lots of time to get the okay from his insurance since they're likely to be the ones to put the kibosh on the early fill.
NAPMINDER: The prescriber just okayed it and the patient only just called this morning.
CP: Right. They planned for a vacation, bought tickets months ago yet somehow it sneaked up on them and they remembered the medication they take 4 times a day is the last thing on their minds. Got it. Quick question for you.
CP: When do they return?
NAPMINDER: I don't know. I didn't ask.
CP: You should have. It's a rather important question, don't you think?
CP: The patient called and said he is going on vacation and needs an early refill and you approved it without asking when he'd return?
NAPMINDER: Yes. That's how we always do it.
CP: What if he's coming back Monday? Or Tuesday? Or, I don't know, any day before his medication would run out?
NAPMINDER: I don't know.
CP: Then you'd be giving him a month supply of medication when he really doesn't need it yet. Or maybe he only needs a day or two.

<patient calls 5 minutes later; or maybe he was already on hold while I was finishing>
Needs Early Refill for Vacation Outside United States: Did my prescriber approve my vacation override?
CP: Yep.
NERVOUS: Great! When can I come down for it?
CP: When are you leaving?
NERVOUS: Tomorrow. We have an early flight.
CP: And when do you return?
NERVOUS: We come back next Saturday.
CP: Okay. I will have your prescription ready for you next Sunday.
NERVOUS: But my doctor approved it.
CP: And I filled it for you 21 days ago, which was a day early. If you started taking them on the day you picked them up from me (which you should not have done since that fill was one day early) you would have enough medication to last you through next Sunday, the day after you return.
NERVOUS: But they said it's okay.
CP: Unfortunately, they do not get final say. Since I would have to call your insurance and explain the reason for the early refill, I will have to answer these questions and plead your case. Since you will not only NOT run out of medication but will have enough for a day after your return, I cannot defend the early refill.
NERVOUS: But. . .
CP: Have a nice trip. Relax. Take your prn meds as needed and we will see you in a week.

ME: What if they were diabetes or BP meds? 
CP: Wouldn't matter. 
ME: Why?
MYSELF: Because he had enough to last? 
CP: Yes. That and I don't have to report those fills to a PDMP. Also, there are laws regarding early fills on controls that don't exist for other medications. 
ME: Perhaps they're planning on losing some.
MYSELF: Let it go.
CP: Wouldn't you rather they lost the last day or 2 of medication than their new supply for the next month? Try explaining that one.
ME: So you're not being a giant douche, flexing your muscle and keeping people in pain?
MYSELF: Sadistic little. . . 
CP: No. I have a job to do. While people may not, or choose not to understand, or may not like or agree with my responsibilities, it does not change the fact that I still have a professional obligation to meet. 

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