Comments on: Idiots and e-Prescribing

By: Rob

Rob — Mon, 10 Aug 2009 14:22:56 +0000

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.

By: bloodyhell

bloodyhell — Mon, 10 Aug 2009 06:01:10 +0000

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.

By: WarmSocks

WarmSocks — Thu, 16 Jul 2009 14:23:31 +0000

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.

By: Linda

Linda — Tue, 14 Jul 2009 15:26:42 +0000

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!

By: Jeff

Jeff — Fri, 10 Jul 2009 04:11:16 +0000

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.

By: Abbi

Abbi — Fri, 10 Jul 2009 01:39:05 +0000

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.

By: nanarcr

nanarcr — Thu, 09 Jul 2009 23:43:44 +0000

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.

By: Rob

Rob — Thu, 09 Jul 2009 22:19:32 +0000

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.

By: Rob

Rob — Thu, 09 Jul 2009 22:15:49 +0000

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.

By: Aviva

Aviva — Thu, 09 Jul 2009 22:13:07 +0000

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.