The only thing I agree with this pharmacist is that no one can force a pharmacist to fill a prescription… but we have a very serious surplus of pharmacists and if an employer doesn’t agree with how their employee pharmacist is exercising – or abusing – their “clinical decisions” all the chains have hard drives full of pharmacist willing to take that pharmacist position.
I often wonder what part of their clinical decision making process makes them “not comfortable”. So this pharmacist makes clinical decisions without having access to all of the pt’s medical record other than what is on the store’s computer system or the PDMP report that has been pulled. Not comfortable is an emotional opinion… which doesn’t take much if any clinical experience and typically lacks mostly clinical facts as a real reason to refuse to fill.
I have refused to fill prescriptions before… sometimes because of the pt’s allergy to a new med, sometimes because of a serious level one interaction, a few times that was because what I considered a lethal dose of a opiate and in every incident such as that… the prescriber was very grateful that I refused to fill that particular prescription and they replaced it with an appropriate dose.
I never gave back a prescription that I had concerns about without trying to reach the prescriber and I typically started the conversation- can you help me understand why I should not have a problem with this Rx with the pt’s other meds, medical history, allergies – whatever was appropriate.. If the prescriber was adamant about filling it as written… I would document the conversation on the back of the Rx and fill it as written along with my concerns. I would typically tell the pt what my concerns were and what side effects that they may encounter and what they needed to do if they experienced them… I was never sued, so … either the pt was cautious and experienced the side effects and acted appropriately and nothing seriously happened to the pt.
I have had a gun pointed at me… but my own independent pharmacy was NEVER ROBBED IN TWENTY YEARS… maybe because it was common knowledge that I had a conceal permit and could probably be armed. In fact, in our small town of 35,000 population… I had the city record for having the most people attempting to pass a forgery arrested and the record for filling the least number of forged/altered prescriptions. One particular occasion a person impersonated a prescriber office and phoned in a Hydrocodone/Acetaminophen Rx… and wanted it delivered .. .so I call my friend who was the head of the county narcs and he offered to deliver the Rx to the pt for me and arrested the woman at her front door after she accepted the delivery. Every time that I had someone arrested, No one tried to pass another forged Rx for 12-18 months.
I remember one young man that handed me a folded Rx … .that was obviously a forged… I did not feel like wasting my time and calling the cops and having him taken care of …. so I wrote on the back of the Rx “THIS IS A FORGERY and handed back the folded Rx … and gave him an excuse that I could not fill it for some reason…
I find it interesting that this pharmacist besides not giving a shit about what the prescriber wrote for… she quickly proceeded about she is perfectly fine about pharmacists lying to pts about having inventory and/or being robbed. IMO, most of these chains are being robbed because the Rx dept is fairly OPEN with lower counters that bad guys can quickly jump over and many of these 24 hr chain pharmacies are 15,000 – 20,000 sq ft and over night shift is one pharmacist in the pharmacy and one person at the front register.
These chain stores don’t want to the Rx dept to look “too unfriendly” to the pt. Stolen meds are replaceable as are most Rx dept employees.
This pharmacist said that her Mother was a pharmacist and had been robbed… so she should have had some idea of what she was getting into becoming a pharmacist and she went right straight ahead to become a pharmacist… When you know the danger and you head straight into the danger… you should not be surprised when you have to personally deal with the danger. You should not take it out on the pts that you are committed to serve, but these seems to be the place pts find themselves. I just wonder what the ratio of refusal to fill Rxs for chronic health issues is controlled substances to all other chronic meds… with controlled substances Rxs are normally abt 15% to 20%… my money is on that the percentage of denied controlled Rxs is much larger than the 15%-20% of the total.
I have copied this video down to my hard drive… so it is not going to “disappear” from the web.
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