I suspected that while attempting to treat the patient's chronic pain, the prescriber was intentionally avoiding the use of opiates. When I telephoned the physician's office, I discovered that the prescriber was a mid-level practitioner. In my experience, mid-levels are often less receptive than experienced physicians to pharmacist interventions.
My experience to date has been that mid-levels (with some exceptions) are less receptive than experienced physicians to pharmacist interventions. As I was sitting on hold, I was mentally bracing for the conversation; I had an idea how it was going to go. But I had promised this woman that I would do everything I could to help her, even if it meant a Monday-morning wrangle with the prescriber.
As expected, as soon the NP picked up the phone, the sarcasm began. “My receptionist tells me that you have a problem with what I prescribed. What makes you think that you know something about my patient that I don't?”
“I know that she is in chronic pain and is not getting relief from her current regimen,” I replied.
“You are not in a position to make that call,” he said.
The pharmacy is so busy right now, I thought. It would be so easy to just back down right now. I reminded myself that opportunities to help people are why I got into the profession to begin with.
“I could refute that point, but that isn’t why I’m calling,” I said. “This patient came to me with complaints of disorientation, sleep deprivation, and severe pain in spite of being heavily medicated, and I want to do something about it.”
“I don't prescribe opiates,” he quickly replied.
“So you admit that you’re placing a self-imposed principle above what may be the best option for your patient,” I said.
“That's not what I am saying.”
“Then what should I tell the woman at my counter who thought she could rely on you to properly mange her pain?”
“Okay, okay, okay,” he said with vexation. “The supervising physician is rarely on-site, and I don't feel comfortable managing patients who take opiates on my own, so I avoid prescribing them.”
“Maybe you should have established that several months ago, when you put your patient on a cocktail of medications that you knew were not right for her,” I said angrily.