It progressed the way these things usually do. "Mr. Smith, has your doctor told you how he wanted you to take this stomach medicine he prescribed?"
Couldn't talk to the doctor. One of the benefits of working the late shift. I was gonna have to milk Mr. Smith for a little info.
"Oh he just wrote that on there because he said it might be covered by my insurance if he did. I've been taking the over the counter Pepcid for a couple months now"
I almost fainted. I tried to keep up outward appearances. "So.... did your doctor tell you to start taking the Pepcid OTC?"
"Oh no, I just take it a couple times a week when the heartburn acts up."
My outward appearance effort must have slipped. "Why, is there a problem?"
Yes. There was a problem. The other prescription was for Reyataz. Some of you might have just now almost fainted. For those of you who didn't, I'll tell you Reyataz is used to treat HIV, and I'll let the drug interaction checker at drugstore.com give you an idea of the problem. Drugstore.com ought to be good for something:
PEPCID (FAMOTIDINE) and REYATAZ (ATAZANAVIR SULFATE)
Severity: Major
Description: Taking both an H2 blocker and atazanavir may cause your atazanavir to not work as well for you.
Using atazanavir together with a H2 blocker such as cimetidine, famotidine, nizatidine, or ranitidine is usually not recommended but may be required in some cases. Using both drugs may decrease how well atazanavir works.
That's the version you get. Here's what I see:
Atazanavir solubility decreases as gastric pH increases. The coadministration of atazanavir (400mg once daily) with famotidine (40mg twice daily) resulted in substantially decreased atazanavir plasma concentrations. Significant reductions in atazanavir serum concentrations may lead to therapeutic failure and the development of HIV resistance.
It goes on to say if you really, really, have to, you can combine these meds, but you have to be very careful, and it's a pain in the ass. Telling your doctor you take it a couple times a week when the heartburn acts up and the good doctor telling you he'll put in on your prescription blank to see if it's covered isn't being careful. There was a chance I was looking at a dead man. And I had to think of a way to tell him. Now.
I did the best I could. I probably sounded as bland as drugstore.com and I wanted to cry. He looked like a pretty decent man. The next lady in line demanded to know where we kept firewood. Welcome to my world.
I have no idea what happened next. The man got most of his meds from mail order and had only come to me in the first place because something got screwed up in the delivery process. I did the best I could, and really, I don't think I did anything wrong, but this whole thing really bugs me. It's been awhile since it happened but I haven't been able to write about it until now. If it weren't for the little blog garden I probably would never mention it anywhere. You know Mr. Smith wasn't his real name, but I have no idea what happened to Mr. Smith.
I do know for sure that lady found her firewood.
I really, really, hate this job sometimes.
11 comments:
*hug*
*tighter hug*
that is so sad. =( My goal was to graduate and serve my community in retail pharmacy. Things like this are making me doubt it.
Oh boy, I feel your pain. I don't work in a pharmacy but tampered with the idea a bit until I got a job working in a medical practice for a Doctor who has "pain management" contracts with every kook in the State of New Jersey.
Just to run down what a typical day is like for me: Patient X calls to cancel her appointment at the last minute, but makes sure that she tells us that she's running out of Oxycontin. I tell the Doctor what's going on, and instead of insisting that she either reschedule her appointment or even just show up for five effing minutes to pick up her prescription, he not only writes her a new prescription, he faxes it to her pharmacy and then mails them the hard copy! Meanwhile, I'm gritting my teeth because he doesn't even make her reschedule her appointment at all.
Next hour, Patient Y - who isn't even one of our patients, BTW, she's some other Doctor's patient that is on vacation. Since the Doctor I work for is a colleague of his at a local hospital he has privileges at, he agrees to authorize a refill for Vicodin for her at Wal Mart.
Here comes the fun part - an hour later I get a phone call from Wal Mart and find out that she's never even used their pharmacy before, she usually goes to a retail chain store like Rite Aid or something to that effect. They refused to fill it, naturally, and she's screaming bloody murder at me on the phone about how much pain she's in and how rude I'm supposedly being to her, because in my mind, I'm definitely thinking that she's got multiple scripts at every pharmacy in South Jersey. What did the doctor do, you ask? He freaking actually wrote her a new prescription and let her daughter come to the office to pick it up! AND SHE'S NOT EVEN OUR PATIENT!!
I'm telling you, these pain management people are a pain in my ass. I have a permanent back injury and degenerative disc disease and the strongest thing I take for my pain is frigging Motrin. I mean yeah, we have some patients who really are in a lot of legitimate pain, but I'd have to say that at least 60% to 75% of these people are just drug addicts. So I know a few things about idiot Doctors.
Great blog, BTW. Longtime reader, first time commenter.
Oh, God. I see shit like this all the time on home medication histories. The patients tell the intake nurse all the meds they take, and the nurse duly writes them down, sometimes even with correct doses and frequencies, and leaves it for the doctor who happily checks the "Yes, continue!" box like he's trying to make chads dangle from it. I would wager said docs don't even LOOK that hard at the list. So when I have to call to warn about a drug interaction, like, oh say, famotidine and atazanavir, what I get from the doc is "Well, he takes it that way at home, and he's really not my patient anyway, why don't you call his PCP?" And my husband wonders why I drink.
Come over to Hospital Pharmacy. You can actually do some good!!! :)
Nice post. Way to go on the drug interaction too.
Sorry I hit "publish comment" too soon....I feel sick for you. Sometimes work really sucks.
There's no shortage of idiocy in the hospital practice environment. Bonus: You can enjoy being called a Pharmacy Nazi to your face instead of having it shouted down the phone at you. Actually it was said behind my back, but I let him know I heard him.
I feel for ya. We had a doctor tell someone to cut a fentanyl patch and put it on their skin. The only thing that saved them was my dad asking if the doctor told them anything about it.
I'm really curious...why do you work in retail? It amazes me that you put up with this instead of getting another job. Actually, I can't understand why any pharmacist wants to work retail...
...please where can I buy a unicorn?
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