https://opmed.doximity.com/what-pharmacists-want-physicians-to-know-b52de53c09dd
Having worked as a retail pharmacist for 17 years, I have learned many tips that can help ease communication between doctor’s offices and pharmacies. Pharmacists are overworked and almost never have enough help, so when we call you, it’s not because we want to annoy you or waste your time. Here are some tips that will help you become every pharmacist’s favorite doctor.
Think Before You Prescribe That Opioid
With the opioid epidemic at crisis level, all healthcare professionals need to be more vigilant. Is the patient suffering with cancer pain, or is the patient coming back month after month for a prescription of a too-high dose of oxycodone that was originally given for a surgery one year ago? If that opioid is being prescribed in conjunction with a benzodiazepine, it’s time to start tapering. According to the FDA, combining these drugs comes with risks of “extreme sleepiness, respiratory depression, coma and death”
Insurance companies are starting to realize this and beginning to reject prescriptions, not only for the combination of benzodiazepine plus opioid, but often for high dose or quantity. Pharmacists and physicians need to work together to help these patients. Not only are patient’s lives at risk, our licenses are as well. Before you mindlessly send off another prescription, think — is this really needed? Can we start tapering? Does this patient exhibit signs of substance use disorder, and if so, what are the next steps? Have those difficult conversations with your patients.
It is also important to pay attention to the date on the prescription. Pharmacies are enforcing strict policies on filling/refilling of controlled/narcotic prescriptions. For example, if a patient fills a 30-day supply of oxycodone on June 1, the next due date would be July 1. Most pharmacies have policies to only fill these prescriptions a maximum of one or two days early. Filling a prescription 3 days early every month would supply the patient with an entire extra month of medication after just ten months. It is helpful when the doctor writes on the prescription (or in the comments of the electronic prescription) “Please fill on or after June 29,” as well as communicates this to the patient.
Also, please include a diagnosis code, especially with the larger quantities/dosages. ALWAYS write out the quantity. Once, I had a patient change #10 to #60. I asked, “Did you change the number?” and he admitted it. It is best when you write the number in parenthesis too, i.e., #60 (SIXTY). And never forget to sign and date the prescription, and be sure your DEA and NPI are on the prescription.
Always Check Allergies
I can’t even tell you the number of times a patient comes in with a prescription for an antibiotic they are allergic too. In fact, I have even had the same patient with a penicillin allergy come in with a prescription for amoxicillin three different times in one year, and each time I had to call and have it changed. Not only does it tie up the pharmacist and inconvenience the doctor, but the patient who is feeling sick is the one who has to wait. A quick question (and updating the electronic record), before prescribing an antibiotic will save everyone a lot of time!
Be Dedicated to the Pharmacy
My favorite doctor’s office has an extremely efficient nurse, Julie. She knows that the doctor will not reply to electronic refill requests in a timely manner, so she asks pharmacies to change the preferred contact method to fax, where she is able to quickly return our faxes. You can check here get better faxing solutions.
Figure out the best way to address prescription refills. Have a staff member assigned to taking care of refills by phone, fax, voicemail. We like to take care of our patients and keep them happy and taking days to reply to a request for a maintenance medication is frustrating for the patient and pharmacy.
Also, train your staff to always check with you on pharmacy questions. Sometimes electronic prescriptions come over with crazy directions such as “Take 25 tablets daily.” The most annoying thing is when we call to clarify, and the person answering the phone says, “Well, that’s what the doctor said, so it’s correct.” No, it’s not.
Also, on the topic of electronic prescriptions, never tell a patient, “I sent it over, it will be ready when you get there.” Sometimes, especially during busy hours, prescriptions can take up to an hour to arrive. Pharmacies are processing many other prescriptions at the same time, and someone who doesn’t work at the pharmacy is not equipped to tell the patient when their prescription will be ready (although we will be glad to tell the patients that they don’t have to wait when they come to your office, ha-ha!)
Also, please do not tell the patient how much a prescription will cost. You don’t know, we don’t even know until we process the prescription with the insurance card.
Speaking of insurance, pharmacists also do not like prior authorizations. We don’t send them to annoy you, as some doctors think we do. So, when you get a prior authorization request, have that dedicated staff person (better yet, if you have a busy office and the budget to do so, hire a part time pharmacist to handle your prior authorizations!) either take care of it in a timely manner, or consult with you about changing the medication to something that is covered. Whatever you do, we just want the patient to get the medication that they need, in a reasonable amount of time.
Use the Comment Section
On electronic prescriptions, we love when doctors use the comment section to clarify something that may raise a question. For example, say your patient went from atorvastatin 10 mg to atorvastatin 80 mg. Since it wasn’t a small increase to the next dose, most pharmacists would probably call the doctor’s office to see if it was an intentional increase or an error. If you make a dosage adjustment it always helps to make a short note in the comments: “note- dosage increase from 10 to 80”
Or, say you’re aware of a drug interaction but you have already discussed it with the patient — if you put a note in the comments such as “patient will hold warfarin while on fluconazole” this will save us all a lot of time.
Be Friendly!
Being friendly doesn’t cost anything. We are all swamped in our respective professions and dealing with different challenges. And feel free to ask our recommendations on anything pharmacy related, that’s what we are here for.
Karen Berger, PharmD, graduated from the University of Pittsburgh School of Pharmacy in 2001. After working many years in chain pharmacies, she currently enjoys working as a pharmacist at an independent pharmacy.
The paragraphs gives a good insight into the minds of some pharmacists working in community pharmacy… pt taking a opiate a year after surgery… should be tapered.. I guess that this pharmacist has never hear of failed back surgery – where the pt’s pain is worse after the surgery than before… never heard of a pt having a nerve severed during surgery and the pt becomes a chronic pain pt.
START TAPERING if the pt has been taking a opiate and benzo together… apparently some pharmacists believe that when the FDA states that the combination of the two MAY COME WITH SOME RISKS… does not mean that every pt is going to experience ..extreme sleepiness, respiratory depression, coma and death… the word MAY… SHOULD NOT BE INTERPRETED as WILL… Should you taper pts that have been taking these two in combination for some time without any serious side effects when only a few pts could experiences these side effects.. OF COURSE NOT… a “good pharmacist” will have a conversation with the pt about the side effects – they may experience if a new pt – or talk to the pt that has been on them for a while to see if they noticed any side effects and you make notes in their medical records in the pharmacy computer system.. the pharmacist license is seldom at risk if they do proper counseling and documenting in the pt’s notes.
Here is the simple math question you could have gotten in grade school.. if a pt gets 3 extra days every month …how many months does it take for them to have a extra month’s supply ? Of course, you must assume that the prescriber knows exactly the intensity of the pt’s pain every day of every month and prescribe an amount to take care of that potentially highly variable intensity that all chronic pain pts experience.
Those ICD10 codes can be troublesome… I consider myself a fairly healthy 71 y/o and I recently got paperwork after seeing my prescriber and included on the paperwork was all the ICD10 codes that apply to me – ALL THIRTY OF THEM… How many pts are comfortable with a pharmacists knowing all the ICD10 on their medical records ?… what if the prescriber picks 1-2 ICD10 codes and puts them on the Rx and the pharmacist is not “satisfied” with the ICD10 codes and the medication prescribed ?
Pharmacist need to start talking to pts.. have a “conversation”… quit practicing pharmacy “by the numbers” … and quit interpreting all “MAY HAPPEN” to “WILL HAPPEN” and making absolute decisions about appropriate therapy.
Pts who encounter those type of pharmacists …need to find themselves a new pharmacy and pharmacist… of course, my normal recommendation is a INDEPENDENT PHARMACY …
Filed under: General Problems
I couldn’t agree more, this whole Opoid thing has gotten totally out of Control it’s almost like a State and Federal Government feeding frenzy started much of it started by the Media as usual. I just emailed the Governor and one of our State Legislators about them passing and signing an Opiod bill that will punish the Chronic Pain patients in my State, and went on to congratulate them on passing and signing a bill for Sunday sales of Alcohol and informed them that 100,000 people die a year due to Alcohol related causes, far more than the number who die a year from Opioid overdoses. The sad thing about the whole situation is my State Representative is a retired Doctor his Rep contacted me earlier in the week to explain why he voted to pass the Opoid bill, I then brought up how our State could have set the Standard in the Country by separating the Chronic Pain patients from the people who chose to use them for reasons other than they were meant for, she informed me they could not write a bill for everyone in the state which obviously goes to show that she failed to listen to me to begin with. Someone somewhere has to stand up an stop this lunacy before it goes any further. I simply don’t know what I am going to do. My life is going to all but be ruined. Hopefully a class action lawsuit can get started at some point possibly by the ACLU.
I totally agree with Steve on this. These type pharmacist are dangerous to your health.
They must be getting this garbage Information from the DEA or been brainwashed by media.
I damn site don’t want them dictating to my Dr.
Just because a patient requires both
A benzo and pain med, they shouldn’t judge.
It doesn’t mean addict or abuse disorder. People actually have real life experiences, of all sorts.
It angers me to no end when I’m judged just because I need to take a benzo with pain medicine. How can they determine that if a patient needs a benzo then they must be tapered? I say BS!
They don’t make me tired all, just relaxes my.nerves.
That Pharmacist has no idea what a pain patients life is like. Especially if they live with a Veteran who has PTSD, is always negative and bitching about everything including money and everything Always negative. Let me tell you, thats stressful as hell.
So in order to Hold it together plus being a caregiver for someone else who is chronically ill, I need often need to take a xanax once or twice a day,” BIG Deal” to maintain my own sanity. It isnt easy now days for everyone.
I can’t stand a pharmacist like that know it all, who thinks he’s a Dr! He must not be living in the real world.
Great advice for not only Doctors but also the Patient, I am one of those patients who is prescribed a benzodiazepine and Opioid I have been taking them for over five years and thankfully have never had a problem.