6. MD Errors
When I was two years out of pharmacy school, I allowed myself to be convinced by a local MD to dispense an adult dose of Compazine for a 13-year old-girl. I questioned the dose, but acceded to his argument that she was "adult sized."
I prepared the prescription but cautioned the parent not to exceed the dose and, perhaps try 1/2 suppository. They exceeded the dose based on verbal instructions from the MD and came back for a refill on a Sunday morning.
I phoned the doctor and, once more, he instructed me to fill that prescription. The child suffered a seizure which is a characteristic adverse reaction to that drug, was hospitalized but fully recovered. The parents sued the doctor and me.
After a week in court, I was found not liable. The doctor was liable, as were the parents. I learned that it's okay to refuse to fill a prescription when one knows that the dose is excessive, despite the protests of the doctor and the patient. I was lucky. In reality, I should have been liable as I failed to exercise the professional judgement. After the trial, I realized that a more capable attorney would have seized on that.
7. A Simple Sentence
The gravest mistake I made as a pharmacist, I think, was when I had prior knowledge that a patient/co-worker had undergone chemotherapy not long before she came to pick up an as-needed prescription for a Z-Pak, and I wasn't as firm enough as I could have been about checking with her physician despite description of ongoing upper respiratory symptoms.
Her sister was with her, and I think that I didn't want to alarm her, despite my private concerns about how long the patient, my co-worker, a nurse, might have left. For many years, I felt that I contributed to her demise.
Now, after the deaths of my own parents, and other friends and acquaintances, I realize that a simple sentence such as “I care about you, and you need to check with your doctor about picking up this prescription for a Z-pak” would've alleviated my feeling of guilt of inadequacy.
Since, then, I have tried to be more honest about patient questions of their therapies. Another co-worker patient had a new prescription for lithium, and despite a lack of knowledge about what it meant (i.e., possible bipolar disorder, mania, schizophrenia, etc.) I tried to emphasize that she keep contact with the physician because there were many monitoring considerations with this medication to result in favorable response.