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Idiots and e-Prescribing

by Rob on July 9, 2009 · Comments

in Rants

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I just got off of the phone with a local pharmacy. This is my second irate call to them regarding e-prescribing. I was not nice.
The problem stems from the refill request process, which is initiated now through the pharmacies. The patient calls for a refill and the pharmacist sends us a request that goes directly into our EMR for my reply. The theory looks good, but the reality is not quite ready for prime-time – especially when pharmacies seem to hire trained chimps. Perhaps I am being a little harsh…on chimps. Here is how my first call went:

“Hello, this is Dr. Rob and I am calling regarding your requests for refills using e-prescribing. I am not sure if you realize it, but someone at your pharmacy is a complete idiot. We get multiple requests for the same medication from your pharmacy. It happens again and again, and it is making me angry. I don’t know why your pharmacy is the only one that doesn’t seem to get it, as the other pharmacies in town seem to understand this process. Don’t blame anyone else; you are at fault because your pharmacy is the only one that doesn’t seem to understand this process. As of now I am going to recommend my patients go elsewhere for their prescriptions.

Have a nice day.”

My staff was startled. I almost never lose my temper, but these people have absolutely no penalty for their stupidity and I felt that I needed to remedy this. They can request away, making me do more work and filling up the patient’s chart with duplicate refill requests; I am the one who pays the price of their ineptitude.

One of my managers spoke with the manager of that pharmacy a few days after my rant; they assured him that they “are not idiots” and will fix the problem. This morning I got the 4th request in 4 days for the same medication on a patient. Yes, it was from the famed pharmacy of imbeciles. I wasn’t as mean on this phone call, but I did use the word “pathetic.”

e-Prescribing has its good side, but until there is a pill to cure stupidity, there will be a price to pay. Unfortunately I am paying it in this case.

But I can say with pride that I did not use these words at all in either of these phone calls: fool, ass, halfwit, dunce, dolt, ignoramus, cretin, moron, imbecile, simpleton, dope, ninny, nincompoop, chump, dimwit, dumbo, dummy, dum-dum, loon, dork,sap, jackass, blockhead, jughead, bonehead, knucklehead, fathead, numbskull, numbnuts, dumb-ass, doofus, clod, dunderhead, ditz,lummox, dipstick, thickhead, meathead, meatball, woodenhead, airhead, pinhead, lamebrain, peabrain, birdbrain, jerk, nerd, donkey, nitwit, twit, boob, twerp, schmuck, bozo, turkey, chowderhead, or dingbat.

I am reserving them for future calls.

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  • Automatic refills are more than a convenience for the consumer - they are a huge moneymaking racket for the pharmacies. I had one pharmacy chase down my local doc at his (other) academic practice in the fourth attempt to refill a discontinued nebulized medication - after I had discontinued automatic refills.

    I have discontinued all automatic refills with the 3 major chain pharmacies I deal with (and need the 3 because some don't stock what is prescribed.)

    This is one problem for which the patients are directly accountable. I suggest physicians inform their patients that they will only honor a refill request directly from the patient, not the pharmacy. This will improve patient safety, save countless dollars from overprescribing due to automatic refilling, and take less physician and staff time in the long run.
  • My doctor's office instructed me to go to the pharmacy for refills, so that the pharmacy can fax them the request. It isn't an automatic refill -- I have to remember to do it every month. Most of the time this works fine.

    It doesn't work when the doctor's office doesn't respond to the pharmacy, which has been happening to me more and more lately.
  • Rob, You forgot putz, nudnik, and mishuganah
  • Our office quite using e-scribe for this very reason. ALLLLLL the pharmacies in our area are {insert insult here} and we got sick of it, so until it's mandatory, we no longer do it.

    Our office opened in November 2007, and we use EMR completely. No paper charts here! I LOVE IT!!!
  • Rob
    I knew what you meant. It is amazing how bad these pharmacies are in this. I do think the government mandate came significantly before the system was designed to make it work. As always, those blazing the trail are the ones who pay the biggest price.
  • Just saw my typing error.... I meant quit not quite.... long day of Type A Flu coming back around...
  • I smell a contest -- suggest an impressive yet not coarse word for Dr. Rob to use when describing the People and Procedures of the Pathetic Pharmacy!!!
  • Rob
    Hey! You already have a llama. I just copied the thesaurus on this one, but I am definitely open to more suggestions. I already got scolded in one email for being "angry" so I'll probably just leave the rant here. I did like Gary's additional suggestions. The thesaurus obviously doesn't speak Yiddish.
  • Um, so, Dr. Rob, had you approved the refill the first day and they kept sending more requests? Or were they nagging you because they thought you should have responded faster?

    All my doctors here in PDX require me to have the pharmacy request the refill. I'm told by their staff that it's more efficient for them and cuts down on errors. As a patient, it's a draw for me. I like the convenience of being able to request the refill from my pharmacy by phone or online no matter what day/time it is.

    But there's a frustration in that my insurance will only approve a refill 5 days in advance of me running out of meds, but I have some doctors (specialists) who don't respond promptly, which causes me a great deal of anxiety and sometimes to run out of certain meds that I'm not supposed to suddenly stop taking. My pharmacy will send a reminder to the doctor if they don't respond within three days and after that, they throw their hands up and tell me to call myself and nag. (My solution is usually to beg my PCP to take over the prescribing, which she's sometimes leery of, because I know she's reliable about getting my refills approved. I'm blessed with a fabulous PCP.)

    Anyways, you sound so efficient and on top of things that I'm sure it was the pharmacy's error, but I thought I'd throw out there a different perspective.
  • Aviva,

    We had this same exact issue in our office, where the pharmacy would continually send the refill request, even after we approved it. And with our program, there was no way we could miss a refill request because basically a pop-up would come up when we would start up our EMR program.
  • Oh, and in reply to nanarcr: How exactly is it a money-maker for the pharmacies to harass the physicians? If you aren't taking the medicine any more, it's just going to sit on their shelf, not picked up and purchased. It's a waste of staff time and a waste of shelf space for them, which at least at my pharmacy is in high demand for Rxs that are actually sought after.
  • Rob
    Yes, I always double-check before denying. Then when I deny, I say "duplicate request" as the reason for denial. Now I have started using the word "doofus" in the mix at times.
  • Doc Rob, I learned a great word in Mishnah class : am haaretz (ahm hah are etz). Roughly translated as an ignorant (uneducated, uneducable) person. I use it frequently. :-)
  • Jeff
    Doctor Rob,
    As a pharmacy educator, I hate stupid pharmacies also. I do wonder though, as I know every pharmacy I have worked in would not allow you to send duplicate requests if a request had been answered, if there is not an issue with the system. In addition, you receive daily requests from the pharmacy, as the patient is calling the pharmacy 5 times per day since your receptionist is telling her to call the pharmacy for the refill.
    One suggestion I would make is to ensure when you type in the rx, you provide the patient with enough refills to last the patient for at least 1 month after their next appt (in case either of you have to change the appt.) The physician residents that I work with get a flag (go EMR) when I see that they have a 3 month Rx and a RTC date of 6 months or longer. Love the blog and hopefully my residents will be as passionate about medicine as you are.
  • Linda
    I am a pharmacist and I could go on and on and on about the ridiculous rx orders sent to us via EMR. But, I won't because that is disrespectful - just as this discussion is disrespectful to my profession.

    Perhaps you were ranting to some technician who doesn't know how the system works, but it is generated by the PATIENT! When a patient puts in an rx number, day or night, a refill requested gets automatically sent to the physician - no person is involved. However, the patient hears there are no refills. So, that same patient has 3 other bottles of lorazepam & he/she will try those. Yep - each one of those generates an automatic refill request during the night to the physician. So, no human ever runs interferance on these. I come in the morning and see Ms Anxiety just sent 4 refill requests to her Dr for lorazepam.

    The funniest part is I might get refill OKs for at least 3 of these!!!!! Now, do I dump them (yes, occasionally will) or will I just let the "system" handle it & hold 2 out of the 3, yet have the pt request it all over again next month. Yep - I let you sweat just becasue you didn't READ the refill request which has the rx numbers (all different) and the dates of fill (all different).

    Now - a bit more respect is due, particularly when I save your ass when you send me an 3-rx for Diovan 160 and the pt has been stable on 80mg, the pt has no knowledge of dose increase & when I call your office, you just say - "oh, I must have chosen the wrong strength..."

    Get off your high horse and work WITH us - not against us!
  • My doctor doesn't do phone/fax refills - and has signs in every room stating this policy. When my prescription says "2 refills" and my doctor says to follow up in three months, I make that follow-up appointment before leaving the office and know that I'm not getting any more meds unless I keep that appointment.
  • bloodyhell
    I'm a pharmacy tech and we don't have automatic refills yet...I really wish that patients had to call the doc for their refills instead of us, I hate being the middleman, the messenger. Why it took you 4 days to get back to the pharmacy, we don't yet know, but sometimes it takes doctors a week or two, and the patients are calling us 5x a day asking if you called us yet. It's great fun when I walk in at 4pm for my night shift and the first customer in a line 10 people long asks "Has Dr. Smith called yet?" and they look at me expectantly, offering no further info. The patient thinks we run a crappy pharmacy when after 5 minutes of trying to figure out what the hell they're talking about, we tell them we are still waiting to hear from you. "Well can you call him?" they demand...making us piss you off further. I also think e-scripts suck- I read on another blog that the pharmacy has to pay like 30 cents for each one you send, and the systems don't exactly communicate very well yet as far as denials. It's far from a moneymaker. Just call the shit in. And when you do, don't tell your pt that "it's generic, so it won't be more than $4" (not ALL generics are on out nice little $4 list) or that "they'll have it ready when you get there"...we fill call-ins for some people who neve actually come pick them up, yes even for diflucan and nitrofurantoin, so we never know if someone is on their way or not, and even if they are, we probably have 8 people ahead of them with 4 scripts each who "just got out of the hospital"... some doctors irritate us. Probably not you. A lot of patients are just demanding and horrible communicators. Love your site- keep it up.
  • Rob
    I do see how your situation is difficult. This post was a rant - I was really frustrated at the time I wrote it. The problem for us is that 99% of the pharmacies in the area don't have a problem like this one does. I respond on the first day, usually, and we still get more requests - that is what is frustrating.

    You state the bottom-line here: e-scripts suck. The idea is sound, but the infrastructure and execution are horrible still. All ends suffer.
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