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Seven Things Every Pharmacist Wants to Say to a Physician
Jason Poquette is the director for outpatient pharmacy services at Saint Vincent Hospital in Worcester, Mass., and an APPE preceptor for the Massachusetts College of Pharmacy. Contact him at Jason.pharmacist@gmail.com.
You've thought about telling a physician these things over the years, but those thoughts usually go unspoken.
I talk to doctors every day. Some I would even call my friends. Most are incredibly appreciative of the services that we pharmacists provide. We’re like the ebony and ivory on the grand piano of healthcare.
Still, there are situations where communication is … not so easy. We both have busy working conditions. We don’t share an administrative assistant who can coordinate our calendars and schedule regular 30-minute meetings to catch up. I really can’t speak for EVERY pharmacist, and my own experience with local physicians has, overall, been fantastic. But if I could get just 10 minutes of uninterrupted time on a conference call with all my local physicians, here are the seven things I would tell them.
1. Thank you.
Listen Doc, I want you to know that I appreciate the care you give to our patients. Seriously. I know you sometimes work very late hours. I know you have a ridiculous amount of paperwork to do when you would rather just be seeing patients and treating them.
Don’t let it go to your head, but you do great work. I hear the compliments you get from patients who think you are the greatest gift to mankind. You might be. Not only as a pharmacist, but as a patient myself, and father of four children, I’m definitely grateful for the physicians in my life.
2. Call me sometimes.
Some of you call me all the time. You ask me about patient refill patterns, about drug interactions and about drug coverage information. But some of you never call me at all. Heck, I’ll give you my cell phone if you want a direct line. We’re partners in this community, and I want you to know my name and pick up that phone from time to time if you have a question or a concern. You can text or email me if you prefer. Some of you already do this too! But I want you all to know that’s what I’m here for.
3. Check in with your office staff about how refill requests are managed.
In my experience, most doctors are brilliant clinicians, but are sometimes a little bit weak on office management. To supplement this, you hire amazing office managers who typically run a tight ship.
But you should check the ship from time to time. A few of your ships are sinking. Are refills getting managed in an organized way so you can review and respond in a timely manner? Some of you are replying within one day to all requests. That is great. Some of you it takes multiple requests and many days to get a reply. Just monitor your process. Thanks.
4. Print clearly!
Okay, this is becoming less problematic in the days of printed and electronic prescriptions, but it still applies to some. I know you are busy. But so is my staff and your staff. It slows us both down if my team has to call your team to clarify a messy order.
And this isn’t just true of hand-written orders. Some electronically sent prescriptions have directions or dosages that make no sense. I recommend scheduling 30 minutes next month to just read and review orders that leave your practice electronically. Do they demonstrate the quality you expect? If not, discuss with your peeps.
5. Prevent a call-back with a clarifying note.
Are you going to write an unusually high dose or mix two medications that can sometimes interact? I know that drug therapy isn’t always black and white. Sometimes the benefits outweigh the risks. Maybe you thought about this. But maybe you didn’t. Save us and your staff a lot of time by indicating your understanding of this on the prescription.
Also, speaking of clarifying, it wouldn’t hurt to add a diagnosis code to help us understand the dosing you wrote for.
6. Optimize your prescription software for maximum safety and clarity.
If you are printing prescriptions from your office computer, you can probably improve some of the features to minimize an error. For example, don’t prescribe by the generic name only. This is especially true for combination HIV therapy or other combination drugs.
Writing for Hydroxyzine? Which one? Starting a patient on bupropion? There are various formulations for the same strength. Never write for insulins by generic name only. You can help us prevent errors this way. Also, make sure your prescriptions clearly have the patient name and DOB printed as well.
7. Finally, be more careful with opioids than ever before.
If I have a few moments to speak to a group of doctors today, I cannot ignore the opportunity to talk about opioids. We’ve got a problem on our hands as a nation. We can’t turn back time and remove narcotics from the market. Nor should we. But we don’t need to prescribe so much!
Most of you have caught on, and have greatly reduced your volume. Others appear to be either indifferent, defiant, or clueless. Stop it! I implore you to make your patients sign a contract that includes no doctor-shopping, ER-shopping, pharmacy-shopping, or early refills. Use the PMP. Also, insiston and conduct drug-screenings and random pill counts. I’ll even do the pill count for you.