Commentary: Just part of the job

March 15, 2010

Patients could learn a thing or two from pharmacists - and so could doctors.

The patient started to argue with me. I repeated, "I will not fill this prescription until I talk with your doctor, and I'm not going to discuss it with you."

"Disss-cuss it with me? You refuse to disss-cuss it with me?" He was trying to mock me, and it was irritating.

"What's your name?" He demanded loudly.

I sighed and walked over to the counter. I told him my name and, of course, Plagakis stopped him. I wrote it out for him even before he asked. I don't know why I put up with this the way I do.

My call was the correct one. This very-drugstore-savvy guy knew what buttons to push to see whether he could cause me trouble. Look at all the changes that this job has put us through.

By the time Al Green got to "Take me to the river and wash me down" I was talking with a physician assistant on the telephone. He was ordering temazepam 30 mg for an 83-year-old woman who lived alone. She had told me earlier that zolpidem did not work unless she had a couple glasses of wine with it.

"Temazepam is not a good choice for Maggie," I said. "It is too long-acting. She'll wake up with a hangover every morning."

"But she'll sleep," he said, with an officious tone in his voice that telegraphed his unspoken thought. Who does this pharmacist think he is?

I went on, "When she gets up in the middle of the night to use the bathroom, she's liable to bounce off the walls and very likely will fall one night. There is no one there to hear her call for help. I don't think that temazepam is a good choice for a 40-year-old. Maggie is 83."

"My doctor's protocol default is temazepam when nothing else works."

I so wanted to say, That's a lazy man's default, but I behaved myself. "I'm not taking a chance on Maggie's daughter hiring an attorney when Maggie falls and breaks her hip - not when both of us now know the dangers of temazepam."

After a silence, "What do you suggest?"

I mentioned that nightmares are better than a fall. He agreed to try trazodone. Nothing is perfect for Maggie.

"Hold me, love me, please me, tease me till I can't, till I can't take no more."