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.