In retail pharmacy, we toe a very dangerous line every day. We often get a prescription that doesn't fit the standard or maybe doesn't fit our assessment of the patient. When this happens, we have to assume one of two things:
- A) There is something I don't know that makes this situation unique.
- B) The physician made a mistake.
Around 99% of the time, it's option A, and we know this. But it's dangerous, because if it was actually option B, things could go wrong and I could find myself in a courtroom within the year. Working in pharmacy demands that we have confidence in the prescribers around us, otherwise the healthcare engine would grind to a halt.
So believe me, when we pharmacists get you on the phone, we're not saying you're incompetent, or even suggesting that you made a mistake. We already know that you took into consideration our concerns, because they were your concerns too. We know that you already weighed the risks and benefits and made the call, and it's probably documented in the chart. We trust you, but we want to verify.
I was handed a Rx recently that was a new start for both Metoprolol 50mg BID and Lasix. The patient had recently experienced some symptoms of decompensation (no cardiac hx though), which made them decide to go to the hospital, where they were admitted for an overnight stay. In my head, I'm thinking that as far as I'm aware, if there's any indication of HF, beta blockers need to be initiated on a Start Low, Go Slow protocol. Obviously, with the wrong person, initiating at 50mg BID could get real bad, real quick.
It's always a tough call on whether to pick up the phone in the moment, but for stupid reasons. If I decide to contact the physician to verify, I'll probably get an annoyed patient, I'll have to call and get redirected through 5 different lines, hear a "just fill it" from the doc, who I know is already busy, and then get an "I told you so" from a doubly annoyed patient.
In this case, it happened to be a weekend and I had to be redirected to the personal phone of the cardiologist, who was off work. But I had a very nice cordial chat with the physician, despite being out with the kids in the background. They had done some kind of tolerance test that I am still not aware of, and apparently the metoprolol would play some rate control function as well and they wanted it under control quite quickly (patient never mentioned any kind of arrhythmia). I still don't completely understand the situation or the decision, but that doesn't matter, I just needed to know that it was carefully thought out and it wasn't a mistake. Patient was super understanding too.
Anyway, that's the only time I've ever spoken to a cardiologist on the phone, and probably the nicest conversation I've had with one outside of the GP who works next door. So thank you docs for not minding us asking you to basically repeat your chart notes to us. We know that's what we're asking you to do.
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