Pharmacist Behaving Badly

 

 

I had another encounter with a rogue medical professional. June, my Health Services Manager for my office practice, called to tell me a pharmacist needed to speak to me. She said he rudely asked how long I intended to prescribe Suboxone for the patient for whom he was filling a prescription, and said he needed to verify that I had really written the prescription.

I didn’t like the sound of what she was saying. Pharmacists don’t ask doctors how long they intend to prescribe medications. I sensed I was dealing with a medication-assisted treatment-hater. I girded my metaphysical loins for a contentious conversation. I vowed to remain calm and pleasant no matter what. My resolve didn’t last long.

I called the pharmacy and after a long wait, the pharmacist came to the phone. I’ll call him “Mr. X” to protect his identity even though he doesn’t deserve it. Here’s the conversation as I remember it, and I did write down as much of what he was saying as possible, thinking it would make a great blog entry.

“Hello, my name in Dr. Jana Burson and I was told I needed to speak with you about my patient, Mr. “Y.”

“First of all, your employee was very rude.” He didn’t waste any time going on the offensive. “And I have all these numbers and it’s hard to contact you.”

I have an office number where people can leave a message, an answering service for calls 24/7, and June’s cell number, which she carries with her at all time. And June has the patience of a saint, having worked in mental health for many years.

“It’s my understanding that you called June yesterday but didn’t leave your name. When she called back, no one at the pharmacy knew who had called her. And today she answered your call after a few rings.” This wasn’t starting out well.

“Well anyway, this patient has been on Suboxone for three years, and I just need to know what the plan is for him. The DEA comes around and asks us information and I need to be able to tell them what’s happening with this patient.”

This was an utter lie. The DEA does not have permission, not to mention the time and energy, to look at Suboxone patients’ prescriptions, unless they are part of a criminal investigation. This is protected health information. Rather than confront this pharmacist with his lie, I continued.

“What information, exactly, do you need?” I asked sweetly.

“What the plan is for him, since he’s been on this medication for over three years!” he said, emphasizing the last part.

Suddenly I felt the need to provoke him a little further.  Lazily I said, “Oh…let’s see…it’s actually been longer than three years. He was on it for two years in another state before he saw me.”

“Just how long do you intend to let this go on??”

“Allow what to go on?” I knew what he was getting at, but sometimes it’s fun to goad haters.

“How long do you intend to prescribe this Suboxone for him?”

“My plan is to prescribe it until… he no longer benefits from the medication. And he’s doing very well, so I have no intention of stopping it.”

At that point he blasted off on a tirade. Part of me was hoping her would, to be honest. On my better days I try gently to educate and inform, but this guy was so hostile from the beginning that I guess I stopped caring.

To summarize, he made veiled threats about what the DEA would do when they discovered how long I had prescribed Suboxone for this patient. I laughed and said “What in the world can you tell them that they would care or be concerned about?” He said “Use your imagination.”

Weirdly, he also ranted that I was only in my office one day a week, as if that showed I had nefarious intent. I felt like saying it’s because I can only have one hundred Suboxone patients, but it was none of his business.

I said “What is your problem? Opioid addiction is a disease, and this is an approved medication to treat this disease. Studies show better success rates and lower death rates for patients who stay on Suboxone. As a pharmacist, you should know better than to…”

“Tell your patient not to come back here because I’m not filling his prescription!” And the little vermin hung up on me, but not before I shouted into the phone, “I’m calling your supervisor!”

I didn’t want my patient exposed to this pharmacist’s attitude, so I called June and asked her to call Mr. “Y” to tell him to fill the prescription somewhere else. She did, and discovered that he’d filled the prescription two days earlier, the day after I’d written it. I was puzzled, and now my patient was mad, too. June told him why we were calling to warn him to fill his prescription at another pharmacy, not the CVS in South Charlotte that he had used for many months without problems.

My skin has grown thicker, and my exchange with this pharmacist was not going to darken my day. However, I felt I owed it to patients everywhere to talk to someone about the need for training for pharmacists. And yes, I was mad. I called the pharmacy chain’s district manager and related the whole episode to him. I told him I thought my exchange with his pharmacist indicated the need for their pharmacists to get more education. Then the district manager mentioned my patient, now extremely angry, had just called as well, and the manager already got an earful from him. I felt proud of my patient. He hadn’t let a judgmental pharmacist intimidate him into silence.

This pharmacist’s reactions and perceptions were so unreasonable that I believe he has issues of his own. When I encounter such vehement, unreasonable opposition to my patients, I really wonder if they have had addiction in their family, or even themselves. Sometimes healthcare professionals, like all other humans, bring their baggage to work with them. If so, measures should be taken to address it on a level that does not harm the patients they say they want to help.

I don’t know if the pharmacy chain will take measures to make sure their pharmacists are better educated and screened, but I hope so. In the meantime, I tell my patients who encounter rude behavior from pharmacies to vote with their feet, and go where they are treated well.

About these ads

7 responses to this post.

  1. Posted by dbc910281927681 on September 22, 2012 at 4:56 pm

    That is a shameful story. I hope other doctors learn from your experience, as there are plenty of pharmacists like this, and if you think they treat doctors bad, imagine how they treat patients.

    Reply

  2. Posted by Dave M> on September 22, 2012 at 8:31 pm

    That story made my heart sink. It made me glance at the Pharmacist code of ethics hanging on the wall of my pharmacy:

    1. A pharmacist respects the covenantal relationship
    between the patient and pharmacist. (At my school of pharmacy, we were taught we were not to interfere in the patient-doctor relationship too.)
    2. A pharmacist promotes the good of every patient in
    a caring, compassionate, and confidential manner.
    3.A pharmacist respects the autonomy and dignity of
    each patient.
    4. A pharmacist acts with honesty and integrity in
    professional relationships.
    5. A pharmacist maintains professional competence
    6. A pharmacist respects the values and abilities of
    colleagues and other health professionals.
    7. A pharmacist serves individual, community, and
    societal needs
    8. A pharmacist seeks justice in the distribution of
    health resources.

    The pharmacist you characterize needs to read and re-read the code of ethics a few times!

    http://www.ashp.org/DocLibrary/BestPractices/EthicsEndCode.aspx

    BTW, I have been visited by the DEA twice in the last year and a half. Both were quick visits, looking to see if authorized Suboxone prescribers were putting their correct “X” based DEA number on the face of the prescription and were looking to see if a pain patient who was treated with plain buprenorphine 8’s had the words “for pain” printed on the face of the prescription. Not ever in my career have they looked for a patient who was treated too long on something. I hope this helps your readers. There are many pharmacists out there who will treat you and your patients with respect.

    If a pharmacist wants to learn about medication-assisted treatment, it has to be self-taught mostly. With this new-fangled internet thing, it’s amazing what you can learn!

    Reply

    • Posted by dbc910281927681 on September 22, 2012 at 9:26 pm

      Thank you for your response, reminding us not to stereotype – and also informing us about the DEA’s actions. They are, I’m guessing, continuing to wage a battle against ‘pill mill’ doctors – a battle they are winning in most states.

      Reply

      • Posted by dbc910281927681 on September 22, 2012 at 9:28 pm

        (as a side note, unfortunately the effect of this war on pill mills is that good and legitimate doctors must second guess themselves and/or be overly cautious or conservative) .. anyway, really, it sounds like they were more just doing regular check-ins on Suboxone. They always intended to monitor it closely. I also find it very hard to believe that they, or anyone, would question a patient’s duration of use. It was known from the start that some may end up on it for their life.

  3. I’m learning to never expect justice but always try & give justice. Ignorance & intolerance is very frustrating. Thanks so much for looking out for the addict!

    Reply

  4. Hey doc! I was referred to your blog by a reader of mine– suboxonetalkzone.com . Send me an email if you care to– we appear to share many thoughts. I would also appreciate it if you would consider putting in a plug for my forum, suboxforum.com; I get no funding from RB, so I can say whatever I want! BTW…. Suboxone is best considered a long-term treatment for a long-term disease– why is that so complicated for some people?!
    JJ

    Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 470 other followers

%d bloggers like this: