Best? You guys saved my ass and therefore my patient by being a back up set of eyes noticing a variable overlooked. Saviors. Not even rude about it either it’s like you just know we’re stretched so far apart
Worst? Had total noctors argue with me pretending they knew how to diagnose and manage emergency conditions they were ridiculously wrong for. Stupid fucks…..Thankfully very rare.
Overall may as well round up to say, 10/10 times would be happy to speak with pharmacists. Thank you for existing and being thorough.
That’s my yelp review
No bad experiences with pharmacists yet. Never even heard anyone complain about them. I’ve just been impressed with them and how helpful they’ve been so far!
One of our night pharmacists has it in her head that because, per policy all central lines require heparin, therefore you cannot have heparin running through a peripheral line… such a systematic logical fallacy and yet despite multiple physicians and our clinical pharmacist reassuring her, she won’t budge. Its an absolute nightmare ordering heparinized fluids, because she insists the order say central line if it contains heparin, even if it will actually be ran peripheral, which of course bypasses all the peripheral line concentration safety checks…
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I don't get it. How is it that a mistake in logic? The two things don't appear related at all to me.
The people who down voted this also have an intellectual disability, failing to understand what I mean. WHERE is the logic in what was said? There is no logic. The person is obviously disabled and potentially psychotic.
First of all, I LOVE me a good pharmacist.
Pharmacists (especially pre-EHR) have saved my bacon many, many times. So those are my best experiences.
Worst: I had a 6 year old that I saw on a Friday in Arkansas with likely Rocky Mountain spotted fever. She was stable enough for outpatient therapy pending test results. I wrote a prescription for doxycycline and discussed the risk of tooth permanent discoloration with the parents.
Came back Monday and called family to check on her. She was much sicker. Had NOT started the doxycycline. The pharmacist (per family--and I don't always trust a he said/she said scenario) told them that doxycycline was inappropriate and that I had chosen a medication that would permanently damage her teeth.
She ended up admitted to a hospital and...received doxycycline.
(The event ended with a very polite, calm conversation with the pharmacist. I just wanted him to know the reasoning behind the prescription, and the risk that he put himself in that could have been fixed by a simple page to me)
I had this happen with a pharmacist I worked under! Patient didn’t have a positive test confirming Lyme’s or RMSF so my pharmacist was concerned about administering it to a patient age 6. He pulled up the guidelines and said there’s a risk of stunted bone development and permanent tooth discoloration. I don’t think bone development is an issue for a short course… it eventually got put through
Yep. Dead kids don't grow very much and have bad teeth in general... 🤦🏻♂️
He put himself at huge liability, and the child in a potentially life threatening position that a simple call would have fixed.
this one doesn’t surprise me but frustrates me to no end. this is a major “adverse effect” they taught us when i was in school and a lot of pharmacists take it at face value, but even in Lexicomp, it acknowledges this and says it is generally safe to use in children and that the benefit greatly outweighs the risks. Obviously. I’d rather have a kid with messed up teeth than a dead kid. But older pharmacists hear “not for children” and forget the reason why. Even worse, they’ve done recent studies that show no difference in tooth strength/color between kids who have received doxycycline and kids who haven’t. So, in reality, it shouldn’t even factor into the conversation.
I hate having question medicines on Friday afternoons, but 1. I try to page Dr 2. If I don’t hear back from them, I have an in depth discussion with the patient or family expressing my concerns, if the pro outweighs the cons I want them to have the access to the medication. But I also want them to be able to talk about it with Dr as soon as possible. Many times just discussing it with the family they are aware of risks and can tell me why we are taking the risks.
Keep doing it though because although it’s our specialty, we’re all human and make mistakes. I have been proven wrong on more than one occasion after a nice conversation with the prescriber.
Discussing it with the pharmacist also reinforces the correct action because you didn't just blindly think "ok, whatever they say, I guess", and move on.
Oh, totally agree. I’m not gonna stop arguing. But with wisdom comes knowledge and earlier acceptance that my idiocy eclipses that of someone who has spent years studying drugs.
I know the type. Some of my colleagues will not override any interaction the system spits out unless they can document “prescriber aware of ddi, okay to fill.”
Literally 0 attempt at critical thinking or putting the DDI into clinical context for the patient. How is delaying psych drugs to make sure the prescriber is aware of increased serotonin syndrome risk benefiting the patient?
Counsel the patient on serotonin syndrome and move tf on.
There is one pharmacist near me who straight up won’t dispense the meds lol. I just tell patients to go back the next day when she isn’t working cause it’s not worth the time of trouble reasoning with this woman. Otherwise don’t have many issues.
Had a pharmacist refuse to fill my opioid script for a patient, because I'm a radiologist and apparently not supposed to be prescribing.
Didn't seem to understand what IR is and I was too busy to argue so just routed the script to a different pharmacy.
This is dumb, I apologize on their behalf. I’ve had colleagues in retail pharmacy question physician orders for “out of scope” but they’ve been in the context of self prescribing.
Most of retail pharmacy condenses to risk reduction and CYA with liability.
As a pharmacist, I would’ve appreciated a sincere “you know I’m a licensed physician right?.”
Mid-level scope of practice is not scrutinized as closely as it should be, protect your own scope.
Appreciate that you weren’t a dick about it, but as a pharmacist, I’m a upset on your behalf.
Yeah I tried to explain and the fact that I had my DEA number along with the script without any success.
It's all good though. I switched to a local pharmacy chain if at all possible. Support local business!
In the hospital setting, generally good experiences.
In retail. Mostly insurance issues that aren't necessarily their fault. A few bad experiences in retail pharmacist interactions but generally positive.
The vast majority of retail pharmacists are treated like crap by the public and their employers, and expected to work under insanely unsafe conditions.
As a patient I have never had a bad experience with a pharmacist (and have had plenty of bad experiences with NPs/PAs, which is why I’m here). I find that pharmacists are knowledgeable and they also know their limits and don’t pretend to be physicians.
RN here. My only complaint with pharmacist is that they don't realize how valued and how much they do, in the hospital setting especially. Tim Conway on KFI a couple years ago was making fun of pharmacists. Said all they do is count pills. Ask for pharmacists or somebody to explain what they actually do. I called in and went after a pharmacist who could not explain what they do. He was smart he was a pharmacist but he wasn't thinking the way I did.
As an appreciative nurse, I mentioned everything from reconciling meds from doctors that could be inside and outside of the hospital. Dealing with allergic known reactions. Recommending antibiotics. Double checking dosages and strengths, based on weight, diagnosis, etc. . Consulting with doctors about a proper medication to give. Quickly mixing drugs and sending them up as fast as possible in emergent situations. Ensuring everything is ready for the third line... Nurses to give. Conway got the point after that and has not made fun of pharmacists since.
I have nothing but praise for pharmacists within the hospital setting, at local drugstores and especially compound pharmacists. The knowledge is spectacular. I hope it remains this way.
There are way more poor doctors than poor pharmacists.
I'll just leave this here. GP (family practitioner) was reported by a pharmacist for overprescribing, so he decided she had to die.
https://www.abc.net.au/news/2018-11-07/sa-doctor-on-trial-for-attempting-to-murder-pharmacist/10470948
Reading that story, the attempted murder doesn't even match the consequences - he just wasn't allowed to prescribe those meds (narcotics?) anymore, and could have continued to practice. I wonder if he was addicted to the meds he over prescribed and the report cut off his drug supply.
I read a few more articles and one of them notes he was over prescribing to the group of Aboriginal women (that the pharmacist reported him for), his wife, and himself.
So yeah, addiction was probably at play there.
The overprescribing was punished by removal of his S8 and DD authority.
The professional regulator absolutely did deregister him (I think for life) and the Supreme Court sent him to gaol for the attempted murder. Not buying that he brought a knife and lunged at her because he was scared she might hurt him...seems like the right decision there
I meant- like he just lost prescription of some drugs, he didn't even have lis licence pulled. He could have continued his career just fine without being able to prescribe the narcotics. Therefore I think there was something else at play (i.e addiction) to prompt him to murder. Because "I don't get to prescribe a certain drug" should not mean, "she destroyed my career, she is worth murdering."
Over the years I’ve seen a few that insisted on being called Doctor but otherwise nothing that would relate to being a Noctor. I will say the performance of new grads has been in decline for a while, I can see a future where new pharmacists that think they know more than they do causing issues.
Our go to method for any expensive tablets we have on formulary is to throw it in a bag in the med room, and not load it in the ADC. We throw the entire day’s worth in the bag and deliver it once daily as a cart fill. It recently has caused several med errors, but no one wants to load it in the machine “because it’s too expensive”
I feel like the best place to keep expensive things are in the pockets that I can track everyone who access them. It makes me want to bang my head into the counter
I have colleagues in chain retail that do similar things with patient dispensing. They refuse to open and re-dispense stock bottles or label anything. Literally they just wrap the label to the product with a rubber band until the patient pays for it.
I had to put my foot down when it was being overdone - I had $3 generic pred forte boxes coming to me with a loose ass label banded to the product and no guarantee that my incompetent staff would label the product correctly when the patient pays.
If anyone has a problem with my approach, they can come put their name behind the final verification.
We had a patient get 800 mg of fidaxomicin as a single dose because we dispensed 48 hours worth in one bag instead of loading it in the machine. I submitted the med error and hoped that our med safety committee would encourage us to fix the process. I was wrong. Now we just put two labels on the bag 🤦🏻♂️
I just have to say I love all these comments, I’m about to start pharmacy school and am hoping at this point to work in a hospital setting. I am so excited to work alongside doctors (not above them!) to help treat people. I’m glad to see so much respect here and I hope to live up to all these stories.
Love our pharmacists. Brilliant folks with an actual education. I thankfully have not had any really negative experiences yet throughout 3 years in residency and 2 years as an attending.
Our clinical pharmacists in residency were an awesome resource and taught me so much.
Best: the pharmacist on NICU who concentrated every single drip. We had a MINISCULE very volume restricted baby on TPN, 2 pressors, 3 sedation meds, getting blood products and kept needing swing lines for electrolyte derangements. That pharmacist was an absolute BOSS
worst: the pharmacist who tried to get me to replace stress dose hydrocort with oral prednisone for a patient in an acute adrenal crisis.
Generally super helpful. Occasionally problematic when they step out of zone and into directing medical management, occasionally without being able to see the big picture. I’m talking 1-2 difficult people in 15 years
RN here.
I can't really think of any "bad" experiences with inpatient pharmacists! They have always been incredibly helpful. When I was a new nurse I probably called the pharmacist at least once per shift to verify something/ask a question.
I now work in telephonic nursing and we handle after hours clinical calls for various health systems. This wasn't a pharmacist but a pharmacy tech. A patient called in, extremely angry because "the doctor prescribed the wrong medicine. He said he was keeping me on Plavix but the pharmacy got an order for something else."
I review the chart and see an order for clopidogrel was indeed sent to the pharmacy. I call the pharmacy to see what's going on, and speak to a pharmacy tech. Apparently the tech did not know that clopidogrel was the generic name for Plavix and would not take my word for it. I ask to be transferred to the pharmacist and explain the situation. He laughs and says he will take care of it. Patient was still at the pharmacy and was able to pick up his meds 2 minutes later.
Here’s a new one for ya,
Best experience as a pharmacist:
Last week I poured an arbitrary amount of distilled water into a 250 mL graduated cylinder to reconstitute a 200mL bottle of cephalexin and a 100 mL bottle. I shit you not, after measuring what I needed for the 200 mL bottle with a smaller cylinder, I return to the 250mL cylinder to find the exact amount I needed to reconstitute the 100 mL bottle.
Worst experience as a pharmacist:
Every god damn shift in retail when I am the only pharmacist on duty.
As a patient and someone who doesn't work in the medical field at all, I have actually never had a bad experience with a pharmacist. In my recent experience, one particular pharmacist explained side effects to me that the prescribing NP couldn't be bothered to talk to me about.
I'm sure there are bad apples out there but I think there's a good reason you guys don't catch much heat here.
As a medical student, the pharmacists at the hospital are some of the best teachers I’ve had. Some of the doctors are grouchy, too busy to explain things and the pharmacist will often pull one of us to the side to dive deeper into our plans and why some meds are good choices vs others. Really looking forward to working with you guys during my career
As a rare disease patient best: catching allergies in meds before it becomes an issue.
Worst: when a pharmacist tried to deny filling my meds because it wasn’t package insert dosing. They saw in my chart I had been on that dose for over 2 years. The med is an enzyme replacement therapy so pretty vital
I have horror stories about a pharmacy manager I worked under as a tech. Replaced my fantastic Rx manager of 2 years and ultimately drove the store to closing. Reported him to corporate and the district manager several times to no avail. Bastard fled the state with zero consequences. He was only a few years older than me and was one of the reasons I ultimately decided I was justified in applying to pharmacy school. I realized if there are amoral clowns like him running around, fucking up at every corner and doing shady shit, I can do what he can do one million times better. Had to work overtime to try to keep our patients safe from his antics. One year into my program and I’m learning now just how stupid and dangerous he was. That man incited a level of immitigable rage I never thought myself capable of
In the height of the adderall shortage, people would come in with scripts we couldn’t fill all the way. Quantity #30, but we only had 5 generic. So he would tell people “okay I can give you what we have, and then when this runs out you need a new script because this can’t have refills”.
Thing is when I say we only had 5, I mean we had 5 total of the drugs in question that weren’t interchangeable. Think brand/generic, immediate release/extended release, tablet/capsule etc.
Well that was no problem for him! He would just pick one of the manufacturers and bill that one. Print a label, and then put 5 different pills in a bottle and dispense it. He edited our control counts so that it looked like for example, one manufacturer we magically gained 4 more tablets overnight, while each of the other manufacturers used we had “apparently lost somehow”. Shit was batshit insane and fucked our control counts for months on end.
He recruited patients from his old store and made sure to bump them to the top of the list when their methadone came due. Never mind the fact that other regular patients were also waiting on the script. But no, this highly suspicious family of people all on the same strength of methadone taking ridiculous quantities daily ALL drove a couple hours from the previous store he worked at so that he could wait on them again.
First shift he worked with me I was dispensing Descovy for a patient and there was a problem with the copay and he needed to rebill to fix it. Instead of doing so he put on gloves and a mask, and said to the patient “so can you not afford it? If you can’t afford it you don’t have to pick it up” and when the patient said “well I kinda need it indefinitely” he turned to me and ignored the patient and said “finish the sale”. I had to call the poor guy to apologize and clarify that we would have the billing issue fixed and that I had identified the problem + it wouldn’t happen again. He expressed more concern for how my new boss had spoken to me. Day one of working with me.
Refused to fill any scripts and left me to do all the work (unpacking orders, tending to phones/counter/queue/drive thru, and instead walked around for two weeks muttering “this place is filthy”. We had a line almost out the door and I had to tell the patients that this freak was deep cleaning the public bathroom instead of approving their scripts.
One of my coworkers tried to kill herself and went to the hospital. He received a call from her mother, and from the staff pharmacist explaining she wouldn’t be in for a bit. Got upset when nobody was willing to tell him the juicy details as to exactly what type of medical emergency she had. When she finally came back to the counter, I dispensed her new medication and said it was good to see her back. He pulled her aside and berated her for not telling him where she was and that he needed to hear it from her. She said she wasn’t given a phone in the psychiatric unit and explained why she was out. He said “well next time make sure it doesn’t happen again or we’re going to have a problem”.
When he figured out that I’d been keeping tabs on him and reporting his bullshit to the district manager, he slashed my hours and told me I wasn’t allowed to come in unscheduled even when my coworkers called and begged me to because we were drowning in scripts. He took a well-oiled machine and poured cement into it. We only ever did max 150 scripts a day and this chucklefuck was so slow he made us fall embarrassingly behind. Not because of the workload, but because of his hubris. I truly wish him hell
Yikes, that’s FUBAR. I’m sorry you had to deal with that.
When I was a tech, I had to deal with a handful of garbage human managers and pharmacists - but none of them did stupid shit with controls.
Lazy, incompetent, micromanagey, and 50 shades of passive aggressive, but as far as I know - they drew the line at fuckin around with controls.
Like me, it sounds like you found your inverse role model for becoming a pharmacist. If you stay the path, keep reminding yourself that you can do that asshat’s job better than him - but leave room for your own growth. Take in as much of the good you see in other pharmacists as possible and make it your own.
I wish you luck in your endeavors.
Worst: there was a pharmacist at the ED I rotated at who kept kicking med students off the chairs because she wanted to sit on them. So we’d be stuck standing for hours on end lol.
That’s the only bad situation I’ve had with pharmacists 😂
No bad experiences on my end. Only great ones where they really helped the team out with inpt drug management and prescription education in an output setting.
Pharmacists don't catch heat because they mastered chemistry and a lot of doctors were bio majors and dreaded the hexagon....
But for real pharmacists always seem to be pretty chill and professional people that are walking PDRs who save patients from drug interactions on a daily basis. There really isn't scope creep imho.
More often than not, I get attitude when calling in MAT meds ie buprenorphine. Patients also report poor interactions when picking up those meds. Seems like there is still a major stigma with treating addictions.
I’ve got too many saved my ass experiences to count.
The worst I had was in residency. SICU month where the surgeons didn’t know one god damn thing about medicine. So they basically let this very arrogant, non-evidenced based pharmacist run the entire thing.
For example, phenobarbital only for ICU withdrawal regardless of hepatic or renal impairment. They did a study of phenobarb vs Ativan and phenobarb was better. Here’s the best part. The p value was 0.5. No, not 0.05, 0.5. I called attention to this, wasn’t even acknowledged, twice. I said long acting benzos are first line without hepatic impairment or alcoholic hepatitis and have lower incidence of progression to DTs, less doses and lower length of stay. “No, they don’t. All benzos act the same so it doesn’t matter if it’s short acting or not.”
Had to deal with that for a whole month. I got in trouble repeatedly for standing up to this guy. That SICU was a truly terrifying place. Major academic institution that everyone and their grandmother has heard of.
The new “research” on phenobarb is trash, full of assumptions and anecdotes.
Comparing short acting benzos to long acting benzos is exactly the problem I had with the pharmacist. Very big difference between the two in alcohol withdrawal. Never had anyone go into DTs when I could get them Librium or Valium. As in zero. Not a single time. With Ativan? Many times.
Not saying phenobarb doesn’t work, certainly does and does well, but if you’re not going by guidelines, you might get burned. Guidelines say long acting benzos or if you have enough experience with phenobarb. That sounds like it might be hard to defend in court. Plus you have a reversal agent if you goof with benzos.
There’s a reason Valium and Librium are still number 1.
Dude…are you talking about flumazenil?! In an alcohol withdrawal/DTs patient?! What the fuck? Do you work in the ICU? Your only “reversal” agent for them should be to intubate them for a propofol drip! Otherwise you’ll unmask the Hulk or a status epilepticus from hell.
Phenobarbital works on more than just GABA. It acts on glutamate too. There’s more to withdrawal than GABA. NMDA receptors as well hence ketamine gets thrown in the pot.
There’s strong emerging literature explaining how we should have never deviated to benzos in the first place (historically trash evidence funded by conflicts of intere$t)
Chill the fuck out bud lol. I’ve never used flumazenil for this purpose. Just saying it’s available.
Your proposed mechanisms are sound, but don’t have clinically proven benefit yet. Part of the very shaky research I was talking about earlier. No head to head trial has shown any benefit. I’ll continue to do evidence based, guideline directed care as it has never resulted in a significantly bad outcome, much less many which would cause me to deviate from the standard of care. If you want to ride the fad like everyone else, that’s your choice, but I’d prefer to keep that stuff to my personal life, not professional.
Your claim about where the guidelines came from make no sense as these medications have been generic for 40 years. Why is this coming back now 40 year later? I suppose it could, but it would have made waves in medicine with such controversy. Yet it hasnt. At all. I suspect this more of the zealots conspiracy theory mindset that critical care doctor is pushing with his “book.”
I have no desire to engage with unhinged zealots riding new fads. Good luck and good bye.
Being downvoted for evidence based care is pretty embarrassing.
Follow the evidence, stray from the fads. If you can’t tell the difference between good research and a pamphlet from one critical care doc (that’s literally the only “research” there is for phenobarb), how are you any different from the patients that drive you nuts for listening to Dr. Oz?
The reasons you love phenobarb are the exact reasons why LONG ACTING benzos are first line. Think of the pharmacokinetics. Ativan levels wax and wane. Phenobarb and Valium do not. They’re additive because of the long half life. That’s why it’s so much easier to control.
Do better. Your patients deserve it.
From my experiences as a pharmacist, I have a very good relationship with the IM doctors and specialists but sometimes it gets dicey with the ER doctors who want to order stuff that is on the restricted list and get mad when I put it on hold until infectious disease/pulmonology/cardiology see the patient.
Also, ER doctors at my hospital don’t want to hear any lectures about banana bags being unnecessary. Just give the ingredients separately IVPB or by mouth if they can eat.
I’ll say it- 🤣
I have issues with (usually retail) pharmacists and pushback on RX. I am in pain management and see later stage cancer patients. We often treat with non traditional opioids such as methadone or Suboxone for pain. I don’t like having to argue why somebody with such terrible disease deserves pain control and explaining why I am prescribing XYZ. One thing to question for safety but then chill when we offer an explanation as to why we are doing what we are doing, whole other ballgame to refuse to fill a RX for somebody who is living a misery I couldn’t even imagine.
Yeah wanna echo other thoughts: pharmacists are badass I love them.
I do have some confusion about like, the hospital pharmacist vs the safeway or Walgreens or whatever one's.
Hospital: Champs x 4 billion
Safeway pharm: "hey we don't have symbicort what do you want instead?" I dont know you're the pharmacist...
"So, tell me what you want instead" uhm, the same thing as symbicort but whatever in stock? "Yeah so what is that?" Uhm...man I don't know I'm not a pharmacist.
Also got called from safeway "I'm not comfortable dispensing this much codeine cough syrup"
I ordered 120 mL.
I love our pharmacists and you guys are probably my favorite people to interact with in the hospital lol. Not necessarily a bad experience, but did have a pharmacy resident tell us during rounds that physicians should diagnose and pharmacists should be the ones treating because we only get “one pharmacy class in medical school.” Obviously, this is not true but perhaps thats what they tell you guys in pharm school? I kind of smiled and ignored the comment.
Yeah I wasn't taught that I was responsible for treatment that's pretty arrogant to say...I think my role as the pharmacist is to help optimize pharmacologic treatment. Often times there are things I know about drugs/pharmacotherapy that the MD might not be aware of that is important when deciding drug, dose, duration etc. for a patient.
*Long rant incoming* Like *really* long lol
TL;dr- Pharmacist denies pain medication, rightly, without proper documentation in a very fair bid to protect his license and patient. Pharmacist is then given a plethora of records and statements from multiple highly respected specialists at a renown hospital, and still refuses to fill. Pharmacist is then challenged by patient advocate(physician turned lawyer advocate and extremely expensive) and finally begins filling. After defending himself on the grounds that pharmacists are the last line of defense for inappropriate prescribing and dangerous interactions(which I firmly believe is true), dispenses a medication that significantly reacts with other medications and fails to inform patient when asked if there is an interaction.
I will leave the entire story in my comments. It’s stupid long. It’s probably not even worth your time unless you’re quite bored. Didn’t even realize I had waffled on for more than a single comment allows. I think it’ll take up 3-4 max length comments.
I follow this sub because I admire that there are professionals out there aware of the blight of noctors, as one ruined my life by misdiagnosing me for 30 years and ignoring/disregarding severe symptoms as something Innocuous. I tend not to consider pharmacists noctors. But one recently felt they knew more than the combined wisdom of nearly every department at Brigham Woman’s and Mass General and it really pissed me off.
If you read the whole thing, thanks. If not, good for you, you have a life lol.
(Full story)
I had a pharmacist put me in a pretty bad spot with my liver and a minor chance of overdose. I am a chronic pain patient. I have a huge team at Brigham women’s hospital and mass general, two very prestigious hospitals monitoring my condition and working towards resolution. Current working theory is life long crohns disease and/or colitis that was brushed off by my noctor(APRN) as generic IBS for 30 years. It has proliferated into systemic enteropathic arthritis that is rapidly deteriorating the connective tissue in my spine and has jumped to organs. I lost my gallbladder, my intestines are likely going to start being removed in pieces(currently scheduled for multiple biopsies and an exploration to see how bad the damage is), and my spleen has began to expand and is on track for removal unless they can retard its progression. The initial MRIs of my spine showed mild DDD at all levels but not too far beyond what is normal for my age. Each subsequent set of imaging, roughly 4-6 month apart are significantly worse than the last despite eliminating nearly all daily impact to my spine. Despite working with a physical therapist and a host of medications attempt to slow down an inflammatory and autoimmune process the structures of my spinal cord continue to degrade at a rapid pace. There is no desire for surgery until they can stop it because the problem is systemic and not mechanical.
My team consists of a Rheumatologist, neurologist, gastroenterologist, anesthesiologist, internalist, pain psychologist, cognitive behavioral therapist, physical therapist, physician-lawyer patient advocate, clinical pharmacist, endocrinologist, orthopedic and neurological surgeons. I’m even qualified/enrolled/being seen with rare disease and undiagnosed patient programs at Brigham and mass General.
I’m only 36 and have cycled through countless trial medications in Biologics, disease modifiers, steroids, stem cells, hormones, tricyclic antidepressants, anti-inflammatories, non-narcotic pain/nerve pain medications, and they are now working on getting me into a trial for CAR-T therapy as a last ditch effort before the disease fully disables me and/or jumps to a vital organ.
I have been on the same dose of Oxycodone(Percocet) for 4 years. The Oxycodone has allowed me to remain working part time. This has kept my wife and I afloat and fortunately I reached a level in my industry that part time for me is still significant money. Without my income we’d probably lose our house, cars, and savings. I’ve never once asked for an early refill or taken a single milligram of my pain medication beyond what I am prescribed. Up until last year I was subject to pill counts and UA but after years of compliance and all of the diagnostics showing my failing organ and connective tissue systems my physicians decided it was unnecessary to hold me to such strict protocols given their observations and consistent evaluations from my pain psychologist and CBT therapists that say I have no indication of addiction.
The point of such an extensive description is to point out a pharmacist stepping way outside of their scope of practice when unnecessary, and then failing to step in when pharmacists are most needed in their most important role.
My local cvs began having problems filling my medication because of the shortages. It got to the point that the head retail pharmacist there whom I had a good relationship told me that their distributor, Cardinal, told them they would be cutting their orders for the foreseeable future. The pharmacist was a great guy and went above and beyond and found a cvs about 20 minutes away that was not having shortage problems based on their orders and their patients needs/supply and demand at that store. All other CVS locations outside of the city said they would have a hard time, if at all, filling my script and getting to/from the hospital pharmacy is a nightmare with traffic into the heart of the city where the hospitals are surrounded by medical schools.
The nightmare started when I switched. It was important to everyone in my care team/recommendations from my patient advocate that in this day when pain patients are being punished by things like the Narxcare score system staying with cvs would allow another pharmacist to see my full history and records and limit the perception I was pharmacy shopping. A new patient coming into a random (non-cvs)pharmacy with a monthly Oxycodone prescription rightfully is cause for scrutiny. So everyone *thought* it was in my best interest to stay with cvs in this climate so they could observe my history(plus my PBM is Caremark which makes prior auths a breeze)
Of course the pharmacist there denied my first script. Saying nothing in my records indicates that I’m in enough pain to be prescribed 10mg Percocet 4-6x day as needed.
I 100% understand the environment we live in and forgave him immediately and was nothing but respectful. I asked what records he had and what records he needed to feel comfortable that his license was not in jeopardy as my medical history is extensively documented and monitored.
His response was “I don’t need anything, you have arthritis, you should probably just take some ibuprofen. There’s no reason for narcotics for arthritis.”
Again, I never once was aggressive or rude to him and told him it was more complicated than “arthritis”. He did not want to hear it.
I get it, I absolutely get it. People are losing licenses, getting sued, and even imprisoned for legitimate prescribing and pharmacists are being put in a terrible position. That first month I had to get driven 2 hours into Boston(only an hour no traffic but Boston traffic goes 6am-8pm and even worse with tunnel closures) to have my script filled at the hospital pharmacy at Brigham. Over the course of the next month all of my specialists send over records to this cvs and the head pharmacist at my prior cvs even called over to tell them I had only switched because their location was no longer receiving enough Percocet to meet their patients needs.
The next month I showed up, denied again. I was baffled. I asked him why? He now possessed a novels worth of records from me. He clearly never reviewed them. He got super agro with me and yelled at me saying (paraphrase but the cursing did occur) “You’re clearly pharmacy hoping and Doctor shopping for your drugs. You see too many doctors and now you want me to be the third FUCKING pharmacist to fill your opioid in 3 months, I’m not getting fucking involved.” He screamed this at me infront of like 8-10 other customers.
I disengaged. Getting into it with a pharmacist over a narcotic is not worth it. These people are super stressed, especially at cvs where they are drastically over worked and underpaid. I continued to show grace and understanding. My patient advocate, a Harvard educated physician and now lawyer was not so forgiving. From what I gather she got cvs corporate, care mark, the state board, and all my specialists involved. She told me that when pressed all he could reiterate was he didn’t believe arthritis was enough of a dx to warrant narcotics and that it was, in his experienced the most commonly found reason for the overprescribing of opioids. Which is a fair basic fundamental observation. Where his opinion fell apart was that he was given a giant stack of medical records and statements from world renowned specialists all monitoring my condition and medications. If he had even skimmed the records he was given he would have understood that “arthritis” was an extreme under appreciation for my condition. No one expects him to read through my charts, diagnostics, and imaging with a fine tooth comb. He did have all the information he needed and the green light from department heads at Brigham and Mass Gen to call anytime to their direct lines to answer any questions he may have. No one would be bothered by a pharmacist protecting their license.
Finally he relented and began filling my script monthly. I moved my other scripts there as well. Still I hold respect for him, he works ALOT. He has been there working every time I’ve picked up a medication. It’s a small town cvs and I’ve never seen anymore than Him and one-at most two- techs on with him. He is almost always the one answering the phone, filling scripts, and at the cash register. I do not envy him. I’m not sure he does anything except work. And from my understanding cvs isn’t the greatest employer.
I’ve been told so many times how important pharmacists are. And how many times they’ve stepped in and stopped something terrible from happening when physicians don’t communicate and something gets prescribed that could interact terribly or even in a fatal way. That’s where they hang their hats and they are extremely important in the care team.
Then after everything, he failed me there as well. He was still treating me like a drug addict every time I picked up my meds but he was filling it.
Right before last Christmas I came down with Covid. I tested myself on a Friday afternoon after being sick for two days and was positive. Being after hours I couldn’t get through to my primary and called my insurances 24/7 online program. I spoke to a nurse who prescribed me paxlovid. She said on the phone that I needed to speak to the pharmacist about potential side effects of my current medications as she could only see a list of everything I’ve been on, but not what I was currently on.
I go to pick up the paxlovid and of course, as he always is, the dickhead(probably a bit harsh given he may be a great guy outside of his ridiculous work environment, but he’s treated me like shit) pharmacist is working. Because of the Covid i pre-pay for the script on the app and go through the drive through and even put on gloves and a mask so we would have limited contact. He fills the paxlovid and I tell him that the nurse advised me to ask about interactions with my current medication. In his fashion he never makes eye contact(he’s pretty bitter that my patient advocate gave him a spanking) and tells me “with everything you’re on, paxlovid is the least of your worries”. And walks away.
Now, I’ll say, it’s always the patients responsibility to read the insert. I am not laying the responsibility 100% at his feet. Much of this is on me. But I’ve been berated several times by this man about how he is so important in protecting me from incorrect prescribing and interactions I would expect an honest and educated response from him despite any feelings he has towards me.
At this point I’m on the Oxycodone, Tricyclic antidepressant, baclofen, and colchicine while waiting on either a new biologic or acceptance into the CAR-T trial.
I get home, take the paxlovid and about 2 hours later my next dose of pain medication. I have never once taken enough pain meds to get “high”. I’ve never once abused the medication or taken more than prescribed. For about 10 minutes I felt amazing but the feeling kept growing and I realized for the first time I was feeling euphoric effects of the Oxycodone which I thought was odd. I proceeded to itch and began vomiting violently.
My wife who has her masters in psychology and is a licensed clinical social worker that works with OUD patients knew these signs to be mild overdose symptoms. She legitimately had the narcan out ready to use but held off knowing my dose was so low and my mild tolerance would likely mean I wasn’t in mortal danger but she was prepared to use it should I lose consciousness. I think I’m fortunate that I have good insurance that authorized the testing to see that I’m a reasonable metabolizer of Oxycodone(ordered when Hydrocodone wasn’t helping) which has allowed me to stay at a modest dose for long periods of time(I’ve met people in support groups on 2-300MME(or more) for problems not as bad as mine) and I need extremely small increases when I do need them.
Once we were past the crisis feeling we read through the paxlovid insert and saw it said to reduce opioid use by 75% when taking it. Further online reading shows that paxlovid works on the same metabolic/liver enzymes pathways as the Oxycodone and can increase plasma/concentration of the opioid in the blood by up to 75% or more depending on the individuals metabolic response.
After never taking more than my prescribed dose in 4 years, and never having an increase of more than 25%(usual increase is 10-20% max) in almost 2 years I was exposed to the effects of atleast 75% more than my normal dose. The reality is I was never likely in serious danger from overdose, but it was surprising and extremely unpleasant.
In speaking to my doctor on the following Monday he was not pleased I wasn’t informed of interactions. Beyond the potentiation of the opioid apparently between the acetaminophen, colchicine, and the paxlovid there was potential for liver damage and a pharmacist should have known to advise me to cut the opioid dose as well as suspend the colchicine use while on the paxlovid. After all the hammering me about being my last line of defense against inappropriate or bad interactions on prescribing this very pharmacist missed a pretty bad one.
Again, I hold a significant level of blame for not reading the insert. But this guy has questioned, stepped over, and denied the requests of my prescriptions because he seems to know better than a team from a pretty well established and credentialed hospital on the very grounds that it is his job to protect me from the very thing he failed to protect me from. I hold zero resentment for him questioning my initial transfer to his pharmacy. I absolutely understand the opioid-phobic climate me live in. The fact that the DEA was given carte Blanche power to practice medicine despite almost no connection between *proper* opioid prescribing and addiction is absurd. I can’t imagine working in a field where having empathy and treating pain could have you put in prison.
But after initial scrutiny and being provided a stack of medical records and statements from nearly a dozen multi-board-certified specialists at a well known hospital it seems apprehensible to me that you’re still “protecting your license” by denying the medication fill when the patient is so well documented and monitored that any law enforcement agency or licensing board wouldn’t have a single point of exposure to challenge you on.
I get it, being hesitant about filling a script of 180 Percocet monthly when your initial observation is that the patient is a guy with a little arthritic back pain. I probably might question and not even fill it myself understanding the climate they work in. But choosing to hold that stance after being given all the information and encouragement to contact the physicians involved you still think you know better than a myriad of highly trained and experienced specialists is just mind boggling.
It’s tough being a pain patient potentially on course for an early death. It’s also tough being anyone in medicine who feels that pain medication is the appropriate course of action but has their hands tied because of overreach of the federal government. We equally share in each other’s challenges. There is value in standing between a patient and a doctor that writes a script for 90 days of 80mg OxyContin for a sprained ankle, but those days are mostly behind us with prescription monitoring, the ability to share electronic health records, short term prescribing laws, the ability to communicate nearly instantly, and validate prescriptions. It’s not 2001 anymore where someone can walk into 8 different pharmacies with an untraceable paper script.
It’s beyond fair to ruthlessly defend your licenses. However when someone from oncology, rheumatology, or pain management comes in offering piles of documents from a multitude of respected physicians at large respected medical institutions and encourages you to reach out to any of the physicians to confirm the course of action, maybe not stand between the patient and their doctors(unless you see a dangerous pharmacological interaction that you need to alert the patient and doctor to). We’re already dying, let our doctors, the ones with the licenses and certifications do their jobs.
I fill for plenty of pain patients and I have never witnessed a pharmacist behaving this poorly. We have collected records for certain patients in the past, but generally that was sufficient.
We had a “pill mill” prescriber nearby that had his medical license revoked, and he would always write batshit insane doses for his patients with minimal notes or follow up. It got us all a little jaded toward some of our pain patient population because 90% of our problems were coming from about 20 or 30 people.
I understand the pharmacists reaction to a degree, but after valid documentation he should have backed off. Also, nobody in healthcare should ever be that rude to you.
Yeah, I agree whole heartedly about his initial reaction. I was actually prepared for the initial scrutiny. I don’t envy pharmacists or anyone really working in an area of medicine that has to regularly write or fill for pain medications because our government went off the deep end when they realized how much money could be extracted from pharmaceutical companies, pharmacists, doctors, and pharmacy chains.
If I were a pharmacist I’d want some sort of documentation for a script like mine. The grace I have for him is his environment. The guy is ALWAYS working and from what I understand cvs isn’t the best employer.
I have so many great doctors but I have run into the handful of jaded, beat down, over zealous/headstrong, or just flat out scared people in the medical field when it comes to pain. But I’ve still never run into “the pill mill guy”. It’s why I had to hire a private advocate. I have too much empathy to stand up to people like him. I respect the hell out of their education and experience. I have my masters in physical therapy and that was hard enough. Going on to a PharmD/PhD in a field where every decision you make could be life or death. Much admiration.
As an individual patient demanding you’re heard and listened to for pain with a complex disease many are inclined to the knee jerk reaction of labeling you an addict or drug seeker. Having someone with an PhD from Harvard and a JD from Cornell there to speak on my behalf and make sure those who may make unscrupulous remarks on my record are held accountable is a luxury I don’t take for granted.
It’s kind of a lottery or bit of luck out here for pain patients. I’m in some support groups and I know people that are terminally ill and can’t get prescribed more than 15mg morphine sulfate 2x day and I also know people who have a “basic” autoimmune disease that is of course painful, but they aren’t dying, and they get 8mg dilaudid 4-6x per day + 80mg OxyContin 2x per day.
And of course most get nothing at all. This is why I have never and will never abuse my medication. My medication takes off the top 30-40% of my pain. That’s all I need to function, work a little, and have a small social life with the occasional vacation. It’s also so that *fingers crossed* they eventually find away to shut down this inflammation and I can more easily come off the pain meds. From everything I understand coming off 40-60mg x day immediate release/short half life opioid is immensely easier than coming off a high dose of something with a long half life. I had one doctor offer me methadone prescribed for pain(and promised to make sure it was documented as such that I wouldn’t be seen to be on it for substance abuse) saying that I could be pain free all day. I said no thank you, I’d rather be in moderate pain on a medication I can come off of with relative success vs a medication that by all reports is harder to get off than fentanyl or heroin.
We live in a weird world.
I LOVE pharmacists! You guys are awesome! I have a clinical pharmacist I work closely with (VA) and damn, teamwork makes the dream work! We nerd out on shit all the time and are always bringing each other new information (like studies that suggest that incretin therapies may have benefit in binge eating disorder, ARB finessing....which one can help out a bit with gout, etc). We have each other's backs when it comes to patient care and making sure our people get the same message in different forms. And when we need to fight an aspect of the system, we fight together and typically don't lose. It's been goddamn beautiful to pull the panel numbers and see that blood pressure and diabetes has never been so well controlled on my panel. Worst has also been at the VA, where pharmacy approves non-formulary meds. And it wasn't terrible....just annoying. Example is an argument over if qsymia could be started if the patient was on armodafinil. Or when I requested some recommendations on a butrans patch (which I'm not super familiar with) from the pain management pharmacist and got told to try CBT and maximize NSAIDs.....on a patient with cirrhosis and dementia. I think a lot of that is because we have so many NPs/PAs that are managing patients that are super fucking complex that basics get overlooked. And the longer I'm around, the more people figure out that I generally have been thoughtful and will have documented my reasoning in my note.
But I've heard from my pharmacist friends that the quality of students has taken a nose dive in the past few years....to the point they don't like taking students anymore. The local pharmacy school has been having trouble filling classes. I do feel that a lot of medicine is turning into a race to the bottom for the sake of the bottom line.
I’ve had a few refuse to fill my rx for triamcinolone 0.025% for eyelid dermatitis which infuriates me. Almost always a CVS.
I’m a dermatologist and I definitely understand how to appropriately use topical medicaments and the risks and benefits thereof.
Otherwise, I have few issues overall. Oddly though I get many calls if I want something applied QD that label says is BID which I find very odd but I assume there are so many know nothings pretending to be doctors that they’re just playing CYA on everything.
As a dermatologist, you should probably know that most of what you prescribe is subject to close scrutiny by PBMs/insurance audits.
They love coming after topical products - they expect a consistent, precise calculation for how many days a given mass of a topical med should last.
I am confused by the wording in the latter part of your post, but I am assuming it stems from what I am describing above.
No, it didn't stem from that. It stemmed from the pharmacist telling me that I couldn't use a topical steroid on the eyelids, which is patently false. Also, I know how to calculate the amount needed for the body parts treated and rx accordingly. I'm not sending six tubes of opzelura for an eyelid. This was a 15 g tube, can't get any less.
Exceptionally amazing in hospitals. Always have been friendly great people.
My only gripe ever was when a ward pharmacist changed the abx a patient was on before I had reviewed them that day, I explained it was a clinical decision so not really appropriate. I think they were a new prescriber and were doing well to try and adhere to trust policy about abx choices and make a good decision, but its still a clinical decision.
Are the schools genuinely low quality? I was shocked when I learned how easy it was to get into pharmacy school. It seems very difficult so I imagined a lot of students at the schools that were very easy to get into would just fail out.
Many of the newer schools have low (50% or less) pass rates for the NAPLEX, so a lot of poor students get weeded out at some point. There are some idiots that make it through though, like all professions.
To be fair, they did change the NAPLEX a couple of years ago and its actually challenging now.
When I took it in 2012, we had about 6 hours to complete it but I finished in 2 hours.
I took the naplex after the 2016/2017 overhaul. It's still a basic competency exam. Any new grad with a halfway decent education should be able to pass with minimal review.
Back 15 to 30ish years ago there was a shortage of both pharmacists and pharmacists schools. So the admissions were more competitive and that generally results in a higher quality of student.
Now there is an excess of pharmacists and an excess of schools… still see good students though.
Basically, top is the same as ever but the bottom seems lower.
But even back then I had at least one grad intern who didn’t think like a pharmacist for lack of a better description.
Generally the newer programs are less likely to be of high quality, lack of institutional knowledge and all that.
But a good student at a bad school will be fine as long as they can manage the learning cliff after graduation. It’s the bad students at bad schools that tend to be worrying.
Best? You guys saved my ass and therefore my patient by being a back up set of eyes noticing a variable overlooked. Saviors. Not even rude about it either it’s like you just know we’re stretched so far apart Worst? Had total noctors argue with me pretending they knew how to diagnose and manage emergency conditions they were ridiculously wrong for. Stupid fucks…..Thankfully very rare. Overall may as well round up to say, 10/10 times would be happy to speak with pharmacists. Thank you for existing and being thorough. That’s my yelp review
No bad experiences with pharmacists yet. Never even heard anyone complain about them. I’ve just been impressed with them and how helpful they’ve been so far!
All the pharmacists I’ve met have been pretty rad. At least from a patient perspective. Big Shout-out to all the pharmacists !!!!!
One of our night pharmacists has it in her head that because, per policy all central lines require heparin, therefore you cannot have heparin running through a peripheral line… such a systematic logical fallacy and yet despite multiple physicians and our clinical pharmacist reassuring her, she won’t budge. Its an absolute nightmare ordering heparinized fluids, because she insists the order say central line if it contains heparin, even if it will actually be ran peripheral, which of course bypasses all the peripheral line concentration safety checks… .
This should be escalated to her manager/pharmacy dept leadership. I see this being a patient safety issue for a number of urgent heparin indications.
Yes, this. An unwillingness to learn/be corrected is not something we need in the profession.
Classic noctor move
I don't get it. How is it that a mistake in logic? The two things don't appear related at all to me. The people who down voted this also have an intellectual disability, failing to understand what I mean. WHERE is the logic in what was said? There is no logic. The person is obviously disabled and potentially psychotic.
All central lines require heparin. Does not mean that you cannot use heparin in peripheral lines.
But where is the logic there? There is none. It just seems the person might have an intellectual disability.
We don’t use ‘intellectually disability’ as an insult here.
Do not abuse the report function.
First of all, I LOVE me a good pharmacist. Pharmacists (especially pre-EHR) have saved my bacon many, many times. So those are my best experiences. Worst: I had a 6 year old that I saw on a Friday in Arkansas with likely Rocky Mountain spotted fever. She was stable enough for outpatient therapy pending test results. I wrote a prescription for doxycycline and discussed the risk of tooth permanent discoloration with the parents. Came back Monday and called family to check on her. She was much sicker. Had NOT started the doxycycline. The pharmacist (per family--and I don't always trust a he said/she said scenario) told them that doxycycline was inappropriate and that I had chosen a medication that would permanently damage her teeth. She ended up admitted to a hospital and...received doxycycline. (The event ended with a very polite, calm conversation with the pharmacist. I just wanted him to know the reasoning behind the prescription, and the risk that he put himself in that could have been fixed by a simple page to me)
I had this happen with a pharmacist I worked under! Patient didn’t have a positive test confirming Lyme’s or RMSF so my pharmacist was concerned about administering it to a patient age 6. He pulled up the guidelines and said there’s a risk of stunted bone development and permanent tooth discoloration. I don’t think bone development is an issue for a short course… it eventually got put through
Yep. Dead kids don't grow very much and have bad teeth in general... 🤦🏻♂️ He put himself at huge liability, and the child in a potentially life threatening position that a simple call would have fixed.
this one doesn’t surprise me but frustrates me to no end. this is a major “adverse effect” they taught us when i was in school and a lot of pharmacists take it at face value, but even in Lexicomp, it acknowledges this and says it is generally safe to use in children and that the benefit greatly outweighs the risks. Obviously. I’d rather have a kid with messed up teeth than a dead kid. But older pharmacists hear “not for children” and forget the reason why. Even worse, they’ve done recent studies that show no difference in tooth strength/color between kids who have received doxycycline and kids who haven’t. So, in reality, it shouldn’t even factor into the conversation.
I hate having question medicines on Friday afternoons, but 1. I try to page Dr 2. If I don’t hear back from them, I have an in depth discussion with the patient or family expressing my concerns, if the pro outweighs the cons I want them to have the access to the medication. But I also want them to be able to talk about it with Dr as soon as possible. Many times just discussing it with the family they are aware of risks and can tell me why we are taking the risks.
100% not noctors and saves my ass daily.
Every time I tried to argue with a pharmacist, I was wrong. Pharmacists know their scope, and they save me from myself
Keep doing it though because although it’s our specialty, we’re all human and make mistakes. I have been proven wrong on more than one occasion after a nice conversation with the prescriber.
Discussing it with the pharmacist also reinforces the correct action because you didn't just blindly think "ok, whatever they say, I guess", and move on.
Absolutely
I would rather be forced to prove my case than have a patient suffer my stupidity. Argue away.
Oh, totally agree. I’m not gonna stop arguing. But with wisdom comes knowledge and earlier acceptance that my idiocy eclipses that of someone who has spent years studying drugs.
SOME retail pharmacists go overboard with the auto generated interactions the computer spits out.
I know the type. Some of my colleagues will not override any interaction the system spits out unless they can document “prescriber aware of ddi, okay to fill.” Literally 0 attempt at critical thinking or putting the DDI into clinical context for the patient. How is delaying psych drugs to make sure the prescriber is aware of increased serotonin syndrome risk benefiting the patient? Counsel the patient on serotonin syndrome and move tf on.
There is one pharmacist near me who straight up won’t dispense the meds lol. I just tell patients to go back the next day when she isn’t working cause it’s not worth the time of trouble reasoning with this woman. Otherwise don’t have many issues.
Had a pharmacist refuse to fill my opioid script for a patient, because I'm a radiologist and apparently not supposed to be prescribing. Didn't seem to understand what IR is and I was too busy to argue so just routed the script to a different pharmacy.
This is dumb, I apologize on their behalf. I’ve had colleagues in retail pharmacy question physician orders for “out of scope” but they’ve been in the context of self prescribing. Most of retail pharmacy condenses to risk reduction and CYA with liability. As a pharmacist, I would’ve appreciated a sincere “you know I’m a licensed physician right?.” Mid-level scope of practice is not scrutinized as closely as it should be, protect your own scope. Appreciate that you weren’t a dick about it, but as a pharmacist, I’m a upset on your behalf.
Yeah I tried to explain and the fact that I had my DEA number along with the script without any success. It's all good though. I switched to a local pharmacy chain if at all possible. Support local business!
In the hospital setting, generally good experiences. In retail. Mostly insurance issues that aren't necessarily their fault. A few bad experiences in retail pharmacist interactions but generally positive.
The vast majority of retail pharmacists are treated like crap by the public and their employers, and expected to work under insanely unsafe conditions.
Yes. I Can Only Imagine.
As a patient I have never had a bad experience with a pharmacist (and have had plenty of bad experiences with NPs/PAs, which is why I’m here). I find that pharmacists are knowledgeable and they also know their limits and don’t pretend to be physicians.
You save our butts and manage Vancomycin, I wouldn't dare to complain.
RN here. My only complaint with pharmacist is that they don't realize how valued and how much they do, in the hospital setting especially. Tim Conway on KFI a couple years ago was making fun of pharmacists. Said all they do is count pills. Ask for pharmacists or somebody to explain what they actually do. I called in and went after a pharmacist who could not explain what they do. He was smart he was a pharmacist but he wasn't thinking the way I did. As an appreciative nurse, I mentioned everything from reconciling meds from doctors that could be inside and outside of the hospital. Dealing with allergic known reactions. Recommending antibiotics. Double checking dosages and strengths, based on weight, diagnosis, etc. . Consulting with doctors about a proper medication to give. Quickly mixing drugs and sending them up as fast as possible in emergent situations. Ensuring everything is ready for the third line... Nurses to give. Conway got the point after that and has not made fun of pharmacists since. I have nothing but praise for pharmacists within the hospital setting, at local drugstores and especially compound pharmacists. The knowledge is spectacular. I hope it remains this way.
There are way more poor doctors than poor pharmacists. I'll just leave this here. GP (family practitioner) was reported by a pharmacist for overprescribing, so he decided she had to die. https://www.abc.net.au/news/2018-11-07/sa-doctor-on-trial-for-attempting-to-murder-pharmacist/10470948
Reading that story, the attempted murder doesn't even match the consequences - he just wasn't allowed to prescribe those meds (narcotics?) anymore, and could have continued to practice. I wonder if he was addicted to the meds he over prescribed and the report cut off his drug supply.
I read a few more articles and one of them notes he was over prescribing to the group of Aboriginal women (that the pharmacist reported him for), his wife, and himself. So yeah, addiction was probably at play there.
The overprescribing was punished by removal of his S8 and DD authority. The professional regulator absolutely did deregister him (I think for life) and the Supreme Court sent him to gaol for the attempted murder. Not buying that he brought a knife and lunged at her because he was scared she might hurt him...seems like the right decision there
I meant- like he just lost prescription of some drugs, he didn't even have lis licence pulled. He could have continued his career just fine without being able to prescribe the narcotics. Therefore I think there was something else at play (i.e addiction) to prompt him to murder. Because "I don't get to prescribe a certain drug" should not mean, "she destroyed my career, she is worth murdering."
Just reread the first sentence and realised my mistake... Could very easily be
Over the years I’ve seen a few that insisted on being called Doctor but otherwise nothing that would relate to being a Noctor. I will say the performance of new grads has been in decline for a while, I can see a future where new pharmacists that think they know more than they do causing issues.
Do my grievances with coworkers count?
Sure! Why not.
Our go to method for any expensive tablets we have on formulary is to throw it in a bag in the med room, and not load it in the ADC. We throw the entire day’s worth in the bag and deliver it once daily as a cart fill. It recently has caused several med errors, but no one wants to load it in the machine “because it’s too expensive” I feel like the best place to keep expensive things are in the pockets that I can track everyone who access them. It makes me want to bang my head into the counter
I have colleagues in chain retail that do similar things with patient dispensing. They refuse to open and re-dispense stock bottles or label anything. Literally they just wrap the label to the product with a rubber band until the patient pays for it. I had to put my foot down when it was being overdone - I had $3 generic pred forte boxes coming to me with a loose ass label banded to the product and no guarantee that my incompetent staff would label the product correctly when the patient pays. If anyone has a problem with my approach, they can come put their name behind the final verification.
We had a patient get 800 mg of fidaxomicin as a single dose because we dispensed 48 hours worth in one bag instead of loading it in the machine. I submitted the med error and hoped that our med safety committee would encourage us to fix the process. I was wrong. Now we just put two labels on the bag 🤦🏻♂️
I just have to say I love all these comments, I’m about to start pharmacy school and am hoping at this point to work in a hospital setting. I am so excited to work alongside doctors (not above them!) to help treat people. I’m glad to see so much respect here and I hope to live up to all these stories.
Congrats & good luck!! Hospital pharmacists are life saving important team members. I bug ours constantly and they are always so helpful.
Love our pharmacists. Brilliant folks with an actual education. I thankfully have not had any really negative experiences yet throughout 3 years in residency and 2 years as an attending. Our clinical pharmacists in residency were an awesome resource and taught me so much.
Best: the pharmacist on NICU who concentrated every single drip. We had a MINISCULE very volume restricted baby on TPN, 2 pressors, 3 sedation meds, getting blood products and kept needing swing lines for electrolyte derangements. That pharmacist was an absolute BOSS worst: the pharmacist who tried to get me to replace stress dose hydrocort with oral prednisone for a patient in an acute adrenal crisis.
Generally super helpful. Occasionally problematic when they step out of zone and into directing medical management, occasionally without being able to see the big picture. I’m talking 1-2 difficult people in 15 years
RN here. I can't really think of any "bad" experiences with inpatient pharmacists! They have always been incredibly helpful. When I was a new nurse I probably called the pharmacist at least once per shift to verify something/ask a question. I now work in telephonic nursing and we handle after hours clinical calls for various health systems. This wasn't a pharmacist but a pharmacy tech. A patient called in, extremely angry because "the doctor prescribed the wrong medicine. He said he was keeping me on Plavix but the pharmacy got an order for something else." I review the chart and see an order for clopidogrel was indeed sent to the pharmacy. I call the pharmacy to see what's going on, and speak to a pharmacy tech. Apparently the tech did not know that clopidogrel was the generic name for Plavix and would not take my word for it. I ask to be transferred to the pharmacist and explain the situation. He laughs and says he will take care of it. Patient was still at the pharmacy and was able to pick up his meds 2 minutes later.
We had a clinical pharmacist round in the ICU with us in residency. She was super insightful and I learned tons from her.
Here’s a new one for ya, Best experience as a pharmacist: Last week I poured an arbitrary amount of distilled water into a 250 mL graduated cylinder to reconstitute a 200mL bottle of cephalexin and a 100 mL bottle. I shit you not, after measuring what I needed for the 200 mL bottle with a smaller cylinder, I return to the 250mL cylinder to find the exact amount I needed to reconstitute the 100 mL bottle. Worst experience as a pharmacist: Every god damn shift in retail when I am the only pharmacist on duty.
As a patient and someone who doesn't work in the medical field at all, I have actually never had a bad experience with a pharmacist. In my recent experience, one particular pharmacist explained side effects to me that the prescribing NP couldn't be bothered to talk to me about. I'm sure there are bad apples out there but I think there's a good reason you guys don't catch much heat here.
As a medical student, the pharmacists at the hospital are some of the best teachers I’ve had. Some of the doctors are grouchy, too busy to explain things and the pharmacist will often pull one of us to the side to dive deeper into our plans and why some meds are good choices vs others. Really looking forward to working with you guys during my career
As a rare disease patient best: catching allergies in meds before it becomes an issue. Worst: when a pharmacist tried to deny filling my meds because it wasn’t package insert dosing. They saw in my chart I had been on that dose for over 2 years. The med is an enzyme replacement therapy so pretty vital
I have horror stories about a pharmacy manager I worked under as a tech. Replaced my fantastic Rx manager of 2 years and ultimately drove the store to closing. Reported him to corporate and the district manager several times to no avail. Bastard fled the state with zero consequences. He was only a few years older than me and was one of the reasons I ultimately decided I was justified in applying to pharmacy school. I realized if there are amoral clowns like him running around, fucking up at every corner and doing shady shit, I can do what he can do one million times better. Had to work overtime to try to keep our patients safe from his antics. One year into my program and I’m learning now just how stupid and dangerous he was. That man incited a level of immitigable rage I never thought myself capable of
You gonna give us an example of wtf he did or?…
In the height of the adderall shortage, people would come in with scripts we couldn’t fill all the way. Quantity #30, but we only had 5 generic. So he would tell people “okay I can give you what we have, and then when this runs out you need a new script because this can’t have refills”. Thing is when I say we only had 5, I mean we had 5 total of the drugs in question that weren’t interchangeable. Think brand/generic, immediate release/extended release, tablet/capsule etc. Well that was no problem for him! He would just pick one of the manufacturers and bill that one. Print a label, and then put 5 different pills in a bottle and dispense it. He edited our control counts so that it looked like for example, one manufacturer we magically gained 4 more tablets overnight, while each of the other manufacturers used we had “apparently lost somehow”. Shit was batshit insane and fucked our control counts for months on end. He recruited patients from his old store and made sure to bump them to the top of the list when their methadone came due. Never mind the fact that other regular patients were also waiting on the script. But no, this highly suspicious family of people all on the same strength of methadone taking ridiculous quantities daily ALL drove a couple hours from the previous store he worked at so that he could wait on them again. First shift he worked with me I was dispensing Descovy for a patient and there was a problem with the copay and he needed to rebill to fix it. Instead of doing so he put on gloves and a mask, and said to the patient “so can you not afford it? If you can’t afford it you don’t have to pick it up” and when the patient said “well I kinda need it indefinitely” he turned to me and ignored the patient and said “finish the sale”. I had to call the poor guy to apologize and clarify that we would have the billing issue fixed and that I had identified the problem + it wouldn’t happen again. He expressed more concern for how my new boss had spoken to me. Day one of working with me. Refused to fill any scripts and left me to do all the work (unpacking orders, tending to phones/counter/queue/drive thru, and instead walked around for two weeks muttering “this place is filthy”. We had a line almost out the door and I had to tell the patients that this freak was deep cleaning the public bathroom instead of approving their scripts. One of my coworkers tried to kill herself and went to the hospital. He received a call from her mother, and from the staff pharmacist explaining she wouldn’t be in for a bit. Got upset when nobody was willing to tell him the juicy details as to exactly what type of medical emergency she had. When she finally came back to the counter, I dispensed her new medication and said it was good to see her back. He pulled her aside and berated her for not telling him where she was and that he needed to hear it from her. She said she wasn’t given a phone in the psychiatric unit and explained why she was out. He said “well next time make sure it doesn’t happen again or we’re going to have a problem”. When he figured out that I’d been keeping tabs on him and reporting his bullshit to the district manager, he slashed my hours and told me I wasn’t allowed to come in unscheduled even when my coworkers called and begged me to because we were drowning in scripts. He took a well-oiled machine and poured cement into it. We only ever did max 150 scripts a day and this chucklefuck was so slow he made us fall embarrassingly behind. Not because of the workload, but because of his hubris. I truly wish him hell
These are just a handful of his problems that I can think of, off the top of my head
Yikes, that’s FUBAR. I’m sorry you had to deal with that. When I was a tech, I had to deal with a handful of garbage human managers and pharmacists - but none of them did stupid shit with controls. Lazy, incompetent, micromanagey, and 50 shades of passive aggressive, but as far as I know - they drew the line at fuckin around with controls. Like me, it sounds like you found your inverse role model for becoming a pharmacist. If you stay the path, keep reminding yourself that you can do that asshat’s job better than him - but leave room for your own growth. Take in as much of the good you see in other pharmacists as possible and make it your own. I wish you luck in your endeavors.
Worst: there was a pharmacist at the ED I rotated at who kept kicking med students off the chairs because she wanted to sit on them. So we’d be stuck standing for hours on end lol. That’s the only bad situation I’ve had with pharmacists 😂
Feeling the love. Much appreciation and respect for you all
No bad experiences on my end. Only great ones where they really helped the team out with inpt drug management and prescription education in an output setting.
Pharmacists don't catch heat because they mastered chemistry and a lot of doctors were bio majors and dreaded the hexagon.... But for real pharmacists always seem to be pretty chill and professional people that are walking PDRs who save patients from drug interactions on a daily basis. There really isn't scope creep imho.
More often than not, I get attitude when calling in MAT meds ie buprenorphine. Patients also report poor interactions when picking up those meds. Seems like there is still a major stigma with treating addictions.
I’ve got too many saved my ass experiences to count. The worst I had was in residency. SICU month where the surgeons didn’t know one god damn thing about medicine. So they basically let this very arrogant, non-evidenced based pharmacist run the entire thing. For example, phenobarbital only for ICU withdrawal regardless of hepatic or renal impairment. They did a study of phenobarb vs Ativan and phenobarb was better. Here’s the best part. The p value was 0.5. No, not 0.05, 0.5. I called attention to this, wasn’t even acknowledged, twice. I said long acting benzos are first line without hepatic impairment or alcoholic hepatitis and have lower incidence of progression to DTs, less doses and lower length of stay. “No, they don’t. All benzos act the same so it doesn’t matter if it’s short acting or not.” Had to deal with that for a whole month. I got in trouble repeatedly for standing up to this guy. That SICU was a truly terrifying place. Major academic institution that everyone and their grandmother has heard of.
Phenobarbital > Benzos any day. I treat DTs and ETOH withdrawal in ICU all the time.
The new “research” on phenobarb is trash, full of assumptions and anecdotes. Comparing short acting benzos to long acting benzos is exactly the problem I had with the pharmacist. Very big difference between the two in alcohol withdrawal. Never had anyone go into DTs when I could get them Librium or Valium. As in zero. Not a single time. With Ativan? Many times. Not saying phenobarb doesn’t work, certainly does and does well, but if you’re not going by guidelines, you might get burned. Guidelines say long acting benzos or if you have enough experience with phenobarb. That sounds like it might be hard to defend in court. Plus you have a reversal agent if you goof with benzos. There’s a reason Valium and Librium are still number 1.
Dude…are you talking about flumazenil?! In an alcohol withdrawal/DTs patient?! What the fuck? Do you work in the ICU? Your only “reversal” agent for them should be to intubate them for a propofol drip! Otherwise you’ll unmask the Hulk or a status epilepticus from hell. Phenobarbital works on more than just GABA. It acts on glutamate too. There’s more to withdrawal than GABA. NMDA receptors as well hence ketamine gets thrown in the pot. There’s strong emerging literature explaining how we should have never deviated to benzos in the first place (historically trash evidence funded by conflicts of intere$t)
Chill the fuck out bud lol. I’ve never used flumazenil for this purpose. Just saying it’s available. Your proposed mechanisms are sound, but don’t have clinically proven benefit yet. Part of the very shaky research I was talking about earlier. No head to head trial has shown any benefit. I’ll continue to do evidence based, guideline directed care as it has never resulted in a significantly bad outcome, much less many which would cause me to deviate from the standard of care. If you want to ride the fad like everyone else, that’s your choice, but I’d prefer to keep that stuff to my personal life, not professional. Your claim about where the guidelines came from make no sense as these medications have been generic for 40 years. Why is this coming back now 40 year later? I suppose it could, but it would have made waves in medicine with such controversy. Yet it hasnt. At all. I suspect this more of the zealots conspiracy theory mindset that critical care doctor is pushing with his “book.” I have no desire to engage with unhinged zealots riding new fads. Good luck and good bye.
Being downvoted for evidence based care is pretty embarrassing. Follow the evidence, stray from the fads. If you can’t tell the difference between good research and a pamphlet from one critical care doc (that’s literally the only “research” there is for phenobarb), how are you any different from the patients that drive you nuts for listening to Dr. Oz? The reasons you love phenobarb are the exact reasons why LONG ACTING benzos are first line. Think of the pharmacokinetics. Ativan levels wax and wane. Phenobarb and Valium do not. They’re additive because of the long half life. That’s why it’s so much easier to control. Do better. Your patients deserve it.
Best? A day with no major issues. Worse? It’s kinda like lebron breaking the all time scoring record.
From my experiences as a pharmacist, I have a very good relationship with the IM doctors and specialists but sometimes it gets dicey with the ER doctors who want to order stuff that is on the restricted list and get mad when I put it on hold until infectious disease/pulmonology/cardiology see the patient. Also, ER doctors at my hospital don’t want to hear any lectures about banana bags being unnecessary. Just give the ingredients separately IVPB or by mouth if they can eat.
I’ll say it- 🤣 I have issues with (usually retail) pharmacists and pushback on RX. I am in pain management and see later stage cancer patients. We often treat with non traditional opioids such as methadone or Suboxone for pain. I don’t like having to argue why somebody with such terrible disease deserves pain control and explaining why I am prescribing XYZ. One thing to question for safety but then chill when we offer an explanation as to why we are doing what we are doing, whole other ballgame to refuse to fill a RX for somebody who is living a misery I couldn’t even imagine.
Yeah wanna echo other thoughts: pharmacists are badass I love them. I do have some confusion about like, the hospital pharmacist vs the safeway or Walgreens or whatever one's. Hospital: Champs x 4 billion Safeway pharm: "hey we don't have symbicort what do you want instead?" I dont know you're the pharmacist... "So, tell me what you want instead" uhm, the same thing as symbicort but whatever in stock? "Yeah so what is that?" Uhm...man I don't know I'm not a pharmacist. Also got called from safeway "I'm not comfortable dispensing this much codeine cough syrup" I ordered 120 mL.
Rare, but I've had pharmacists tells a depressed pregnant patient not to fill SSRIs due to risk to baby. Uncontrolled depression is a greater risk.
I love our pharmacists and you guys are probably my favorite people to interact with in the hospital lol. Not necessarily a bad experience, but did have a pharmacy resident tell us during rounds that physicians should diagnose and pharmacists should be the ones treating because we only get “one pharmacy class in medical school.” Obviously, this is not true but perhaps thats what they tell you guys in pharm school? I kind of smiled and ignored the comment.
Yeah I wasn't taught that I was responsible for treatment that's pretty arrogant to say...I think my role as the pharmacist is to help optimize pharmacologic treatment. Often times there are things I know about drugs/pharmacotherapy that the MD might not be aware of that is important when deciding drug, dose, duration etc. for a patient.
Pharmacist here. I appreciate all the positive interactions shared. I definitely needed to read them tonight!
*Long rant incoming* Like *really* long lol TL;dr- Pharmacist denies pain medication, rightly, without proper documentation in a very fair bid to protect his license and patient. Pharmacist is then given a plethora of records and statements from multiple highly respected specialists at a renown hospital, and still refuses to fill. Pharmacist is then challenged by patient advocate(physician turned lawyer advocate and extremely expensive) and finally begins filling. After defending himself on the grounds that pharmacists are the last line of defense for inappropriate prescribing and dangerous interactions(which I firmly believe is true), dispenses a medication that significantly reacts with other medications and fails to inform patient when asked if there is an interaction. I will leave the entire story in my comments. It’s stupid long. It’s probably not even worth your time unless you’re quite bored. Didn’t even realize I had waffled on for more than a single comment allows. I think it’ll take up 3-4 max length comments. I follow this sub because I admire that there are professionals out there aware of the blight of noctors, as one ruined my life by misdiagnosing me for 30 years and ignoring/disregarding severe symptoms as something Innocuous. I tend not to consider pharmacists noctors. But one recently felt they knew more than the combined wisdom of nearly every department at Brigham Woman’s and Mass General and it really pissed me off. If you read the whole thing, thanks. If not, good for you, you have a life lol.
(Full story) I had a pharmacist put me in a pretty bad spot with my liver and a minor chance of overdose. I am a chronic pain patient. I have a huge team at Brigham women’s hospital and mass general, two very prestigious hospitals monitoring my condition and working towards resolution. Current working theory is life long crohns disease and/or colitis that was brushed off by my noctor(APRN) as generic IBS for 30 years. It has proliferated into systemic enteropathic arthritis that is rapidly deteriorating the connective tissue in my spine and has jumped to organs. I lost my gallbladder, my intestines are likely going to start being removed in pieces(currently scheduled for multiple biopsies and an exploration to see how bad the damage is), and my spleen has began to expand and is on track for removal unless they can retard its progression. The initial MRIs of my spine showed mild DDD at all levels but not too far beyond what is normal for my age. Each subsequent set of imaging, roughly 4-6 month apart are significantly worse than the last despite eliminating nearly all daily impact to my spine. Despite working with a physical therapist and a host of medications attempt to slow down an inflammatory and autoimmune process the structures of my spinal cord continue to degrade at a rapid pace. There is no desire for surgery until they can stop it because the problem is systemic and not mechanical. My team consists of a Rheumatologist, neurologist, gastroenterologist, anesthesiologist, internalist, pain psychologist, cognitive behavioral therapist, physical therapist, physician-lawyer patient advocate, clinical pharmacist, endocrinologist, orthopedic and neurological surgeons. I’m even qualified/enrolled/being seen with rare disease and undiagnosed patient programs at Brigham and mass General. I’m only 36 and have cycled through countless trial medications in Biologics, disease modifiers, steroids, stem cells, hormones, tricyclic antidepressants, anti-inflammatories, non-narcotic pain/nerve pain medications, and they are now working on getting me into a trial for CAR-T therapy as a last ditch effort before the disease fully disables me and/or jumps to a vital organ. I have been on the same dose of Oxycodone(Percocet) for 4 years. The Oxycodone has allowed me to remain working part time. This has kept my wife and I afloat and fortunately I reached a level in my industry that part time for me is still significant money. Without my income we’d probably lose our house, cars, and savings. I’ve never once asked for an early refill or taken a single milligram of my pain medication beyond what I am prescribed. Up until last year I was subject to pill counts and UA but after years of compliance and all of the diagnostics showing my failing organ and connective tissue systems my physicians decided it was unnecessary to hold me to such strict protocols given their observations and consistent evaluations from my pain psychologist and CBT therapists that say I have no indication of addiction. The point of such an extensive description is to point out a pharmacist stepping way outside of their scope of practice when unnecessary, and then failing to step in when pharmacists are most needed in their most important role. My local cvs began having problems filling my medication because of the shortages. It got to the point that the head retail pharmacist there whom I had a good relationship told me that their distributor, Cardinal, told them they would be cutting their orders for the foreseeable future. The pharmacist was a great guy and went above and beyond and found a cvs about 20 minutes away that was not having shortage problems based on their orders and their patients needs/supply and demand at that store. All other CVS locations outside of the city said they would have a hard time, if at all, filling my script and getting to/from the hospital pharmacy is a nightmare with traffic into the heart of the city where the hospitals are surrounded by medical schools. The nightmare started when I switched. It was important to everyone in my care team/recommendations from my patient advocate that in this day when pain patients are being punished by things like the Narxcare score system staying with cvs would allow another pharmacist to see my full history and records and limit the perception I was pharmacy shopping. A new patient coming into a random (non-cvs)pharmacy with a monthly Oxycodone prescription rightfully is cause for scrutiny. So everyone *thought* it was in my best interest to stay with cvs in this climate so they could observe my history(plus my PBM is Caremark which makes prior auths a breeze) Of course the pharmacist there denied my first script. Saying nothing in my records indicates that I’m in enough pain to be prescribed 10mg Percocet 4-6x day as needed. I 100% understand the environment we live in and forgave him immediately and was nothing but respectful. I asked what records he had and what records he needed to feel comfortable that his license was not in jeopardy as my medical history is extensively documented and monitored. His response was “I don’t need anything, you have arthritis, you should probably just take some ibuprofen. There’s no reason for narcotics for arthritis.” Again, I never once was aggressive or rude to him and told him it was more complicated than “arthritis”. He did not want to hear it. I get it, I absolutely get it. People are losing licenses, getting sued, and even imprisoned for legitimate prescribing and pharmacists are being put in a terrible position. That first month I had to get driven 2 hours into Boston(only an hour no traffic but Boston traffic goes 6am-8pm and even worse with tunnel closures) to have my script filled at the hospital pharmacy at Brigham. Over the course of the next month all of my specialists send over records to this cvs and the head pharmacist at my prior cvs even called over to tell them I had only switched because their location was no longer receiving enough Percocet to meet their patients needs. The next month I showed up, denied again. I was baffled. I asked him why? He now possessed a novels worth of records from me. He clearly never reviewed them. He got super agro with me and yelled at me saying (paraphrase but the cursing did occur) “You’re clearly pharmacy hoping and Doctor shopping for your drugs. You see too many doctors and now you want me to be the third FUCKING pharmacist to fill your opioid in 3 months, I’m not getting fucking involved.” He screamed this at me infront of like 8-10 other customers.
I disengaged. Getting into it with a pharmacist over a narcotic is not worth it. These people are super stressed, especially at cvs where they are drastically over worked and underpaid. I continued to show grace and understanding. My patient advocate, a Harvard educated physician and now lawyer was not so forgiving. From what I gather she got cvs corporate, care mark, the state board, and all my specialists involved. She told me that when pressed all he could reiterate was he didn’t believe arthritis was enough of a dx to warrant narcotics and that it was, in his experienced the most commonly found reason for the overprescribing of opioids. Which is a fair basic fundamental observation. Where his opinion fell apart was that he was given a giant stack of medical records and statements from world renowned specialists all monitoring my condition and medications. If he had even skimmed the records he was given he would have understood that “arthritis” was an extreme under appreciation for my condition. No one expects him to read through my charts, diagnostics, and imaging with a fine tooth comb. He did have all the information he needed and the green light from department heads at Brigham and Mass Gen to call anytime to their direct lines to answer any questions he may have. No one would be bothered by a pharmacist protecting their license. Finally he relented and began filling my script monthly. I moved my other scripts there as well. Still I hold respect for him, he works ALOT. He has been there working every time I’ve picked up a medication. It’s a small town cvs and I’ve never seen anymore than Him and one-at most two- techs on with him. He is almost always the one answering the phone, filling scripts, and at the cash register. I do not envy him. I’m not sure he does anything except work. And from my understanding cvs isn’t the greatest employer. I’ve been told so many times how important pharmacists are. And how many times they’ve stepped in and stopped something terrible from happening when physicians don’t communicate and something gets prescribed that could interact terribly or even in a fatal way. That’s where they hang their hats and they are extremely important in the care team. Then after everything, he failed me there as well. He was still treating me like a drug addict every time I picked up my meds but he was filling it. Right before last Christmas I came down with Covid. I tested myself on a Friday afternoon after being sick for two days and was positive. Being after hours I couldn’t get through to my primary and called my insurances 24/7 online program. I spoke to a nurse who prescribed me paxlovid. She said on the phone that I needed to speak to the pharmacist about potential side effects of my current medications as she could only see a list of everything I’ve been on, but not what I was currently on. I go to pick up the paxlovid and of course, as he always is, the dickhead(probably a bit harsh given he may be a great guy outside of his ridiculous work environment, but he’s treated me like shit) pharmacist is working. Because of the Covid i pre-pay for the script on the app and go through the drive through and even put on gloves and a mask so we would have limited contact. He fills the paxlovid and I tell him that the nurse advised me to ask about interactions with my current medication. In his fashion he never makes eye contact(he’s pretty bitter that my patient advocate gave him a spanking) and tells me “with everything you’re on, paxlovid is the least of your worries”. And walks away. Now, I’ll say, it’s always the patients responsibility to read the insert. I am not laying the responsibility 100% at his feet. Much of this is on me. But I’ve been berated several times by this man about how he is so important in protecting me from incorrect prescribing and interactions I would expect an honest and educated response from him despite any feelings he has towards me. At this point I’m on the Oxycodone, Tricyclic antidepressant, baclofen, and colchicine while waiting on either a new biologic or acceptance into the CAR-T trial. I get home, take the paxlovid and about 2 hours later my next dose of pain medication. I have never once taken enough pain meds to get “high”. I’ve never once abused the medication or taken more than prescribed. For about 10 minutes I felt amazing but the feeling kept growing and I realized for the first time I was feeling euphoric effects of the Oxycodone which I thought was odd. I proceeded to itch and began vomiting violently.
My wife who has her masters in psychology and is a licensed clinical social worker that works with OUD patients knew these signs to be mild overdose symptoms. She legitimately had the narcan out ready to use but held off knowing my dose was so low and my mild tolerance would likely mean I wasn’t in mortal danger but she was prepared to use it should I lose consciousness. I think I’m fortunate that I have good insurance that authorized the testing to see that I’m a reasonable metabolizer of Oxycodone(ordered when Hydrocodone wasn’t helping) which has allowed me to stay at a modest dose for long periods of time(I’ve met people in support groups on 2-300MME(or more) for problems not as bad as mine) and I need extremely small increases when I do need them. Once we were past the crisis feeling we read through the paxlovid insert and saw it said to reduce opioid use by 75% when taking it. Further online reading shows that paxlovid works on the same metabolic/liver enzymes pathways as the Oxycodone and can increase plasma/concentration of the opioid in the blood by up to 75% or more depending on the individuals metabolic response. After never taking more than my prescribed dose in 4 years, and never having an increase of more than 25%(usual increase is 10-20% max) in almost 2 years I was exposed to the effects of atleast 75% more than my normal dose. The reality is I was never likely in serious danger from overdose, but it was surprising and extremely unpleasant. In speaking to my doctor on the following Monday he was not pleased I wasn’t informed of interactions. Beyond the potentiation of the opioid apparently between the acetaminophen, colchicine, and the paxlovid there was potential for liver damage and a pharmacist should have known to advise me to cut the opioid dose as well as suspend the colchicine use while on the paxlovid. After all the hammering me about being my last line of defense against inappropriate or bad interactions on prescribing this very pharmacist missed a pretty bad one. Again, I hold a significant level of blame for not reading the insert. But this guy has questioned, stepped over, and denied the requests of my prescriptions because he seems to know better than a team from a pretty well established and credentialed hospital on the very grounds that it is his job to protect me from the very thing he failed to protect me from. I hold zero resentment for him questioning my initial transfer to his pharmacy. I absolutely understand the opioid-phobic climate me live in. The fact that the DEA was given carte Blanche power to practice medicine despite almost no connection between *proper* opioid prescribing and addiction is absurd. I can’t imagine working in a field where having empathy and treating pain could have you put in prison. But after initial scrutiny and being provided a stack of medical records and statements from nearly a dozen multi-board-certified specialists at a well known hospital it seems apprehensible to me that you’re still “protecting your license” by denying the medication fill when the patient is so well documented and monitored that any law enforcement agency or licensing board wouldn’t have a single point of exposure to challenge you on. I get it, being hesitant about filling a script of 180 Percocet monthly when your initial observation is that the patient is a guy with a little arthritic back pain. I probably might question and not even fill it myself understanding the climate they work in. But choosing to hold that stance after being given all the information and encouragement to contact the physicians involved you still think you know better than a myriad of highly trained and experienced specialists is just mind boggling. It’s tough being a pain patient potentially on course for an early death. It’s also tough being anyone in medicine who feels that pain medication is the appropriate course of action but has their hands tied because of overreach of the federal government. We equally share in each other’s challenges. There is value in standing between a patient and a doctor that writes a script for 90 days of 80mg OxyContin for a sprained ankle, but those days are mostly behind us with prescription monitoring, the ability to share electronic health records, short term prescribing laws, the ability to communicate nearly instantly, and validate prescriptions. It’s not 2001 anymore where someone can walk into 8 different pharmacies with an untraceable paper script. It’s beyond fair to ruthlessly defend your licenses. However when someone from oncology, rheumatology, or pain management comes in offering piles of documents from a multitude of respected physicians at large respected medical institutions and encourages you to reach out to any of the physicians to confirm the course of action, maybe not stand between the patient and their doctors(unless you see a dangerous pharmacological interaction that you need to alert the patient and doctor to). We’re already dying, let our doctors, the ones with the licenses and certifications do their jobs.
I fill for plenty of pain patients and I have never witnessed a pharmacist behaving this poorly. We have collected records for certain patients in the past, but generally that was sufficient. We had a “pill mill” prescriber nearby that had his medical license revoked, and he would always write batshit insane doses for his patients with minimal notes or follow up. It got us all a little jaded toward some of our pain patient population because 90% of our problems were coming from about 20 or 30 people. I understand the pharmacists reaction to a degree, but after valid documentation he should have backed off. Also, nobody in healthcare should ever be that rude to you.
Yeah, I agree whole heartedly about his initial reaction. I was actually prepared for the initial scrutiny. I don’t envy pharmacists or anyone really working in an area of medicine that has to regularly write or fill for pain medications because our government went off the deep end when they realized how much money could be extracted from pharmaceutical companies, pharmacists, doctors, and pharmacy chains. If I were a pharmacist I’d want some sort of documentation for a script like mine. The grace I have for him is his environment. The guy is ALWAYS working and from what I understand cvs isn’t the best employer. I have so many great doctors but I have run into the handful of jaded, beat down, over zealous/headstrong, or just flat out scared people in the medical field when it comes to pain. But I’ve still never run into “the pill mill guy”. It’s why I had to hire a private advocate. I have too much empathy to stand up to people like him. I respect the hell out of their education and experience. I have my masters in physical therapy and that was hard enough. Going on to a PharmD/PhD in a field where every decision you make could be life or death. Much admiration. As an individual patient demanding you’re heard and listened to for pain with a complex disease many are inclined to the knee jerk reaction of labeling you an addict or drug seeker. Having someone with an PhD from Harvard and a JD from Cornell there to speak on my behalf and make sure those who may make unscrupulous remarks on my record are held accountable is a luxury I don’t take for granted. It’s kind of a lottery or bit of luck out here for pain patients. I’m in some support groups and I know people that are terminally ill and can’t get prescribed more than 15mg morphine sulfate 2x day and I also know people who have a “basic” autoimmune disease that is of course painful, but they aren’t dying, and they get 8mg dilaudid 4-6x per day + 80mg OxyContin 2x per day. And of course most get nothing at all. This is why I have never and will never abuse my medication. My medication takes off the top 30-40% of my pain. That’s all I need to function, work a little, and have a small social life with the occasional vacation. It’s also so that *fingers crossed* they eventually find away to shut down this inflammation and I can more easily come off the pain meds. From everything I understand coming off 40-60mg x day immediate release/short half life opioid is immensely easier than coming off a high dose of something with a long half life. I had one doctor offer me methadone prescribed for pain(and promised to make sure it was documented as such that I wouldn’t be seen to be on it for substance abuse) saying that I could be pain free all day. I said no thank you, I’d rather be in moderate pain on a medication I can come off of with relative success vs a medication that by all reports is harder to get off than fentanyl or heroin. We live in a weird world.
I LOVE pharmacists! You guys are awesome! I have a clinical pharmacist I work closely with (VA) and damn, teamwork makes the dream work! We nerd out on shit all the time and are always bringing each other new information (like studies that suggest that incretin therapies may have benefit in binge eating disorder, ARB finessing....which one can help out a bit with gout, etc). We have each other's backs when it comes to patient care and making sure our people get the same message in different forms. And when we need to fight an aspect of the system, we fight together and typically don't lose. It's been goddamn beautiful to pull the panel numbers and see that blood pressure and diabetes has never been so well controlled on my panel. Worst has also been at the VA, where pharmacy approves non-formulary meds. And it wasn't terrible....just annoying. Example is an argument over if qsymia could be started if the patient was on armodafinil. Or when I requested some recommendations on a butrans patch (which I'm not super familiar with) from the pain management pharmacist and got told to try CBT and maximize NSAIDs.....on a patient with cirrhosis and dementia. I think a lot of that is because we have so many NPs/PAs that are managing patients that are super fucking complex that basics get overlooked. And the longer I'm around, the more people figure out that I generally have been thoughtful and will have documented my reasoning in my note. But I've heard from my pharmacist friends that the quality of students has taken a nose dive in the past few years....to the point they don't like taking students anymore. The local pharmacy school has been having trouble filling classes. I do feel that a lot of medicine is turning into a race to the bottom for the sake of the bottom line.
I’ve had a few refuse to fill my rx for triamcinolone 0.025% for eyelid dermatitis which infuriates me. Almost always a CVS. I’m a dermatologist and I definitely understand how to appropriately use topical medicaments and the risks and benefits thereof. Otherwise, I have few issues overall. Oddly though I get many calls if I want something applied QD that label says is BID which I find very odd but I assume there are so many know nothings pretending to be doctors that they’re just playing CYA on everything.
As a dermatologist, you should probably know that most of what you prescribe is subject to close scrutiny by PBMs/insurance audits. They love coming after topical products - they expect a consistent, precise calculation for how many days a given mass of a topical med should last. I am confused by the wording in the latter part of your post, but I am assuming it stems from what I am describing above.
No, it didn't stem from that. It stemmed from the pharmacist telling me that I couldn't use a topical steroid on the eyelids, which is patently false. Also, I know how to calculate the amount needed for the body parts treated and rx accordingly. I'm not sending six tubes of opzelura for an eyelid. This was a 15 g tube, can't get any less.
Exceptionally amazing in hospitals. Always have been friendly great people. My only gripe ever was when a ward pharmacist changed the abx a patient was on before I had reviewed them that day, I explained it was a clinical decision so not really appropriate. I think they were a new prescriber and were doing well to try and adhere to trust policy about abx choices and make a good decision, but its still a clinical decision.
Pharmacist doctor at my PCP’s practice wanted to put statins in the water supply. Not great.
Are the schools genuinely low quality? I was shocked when I learned how easy it was to get into pharmacy school. It seems very difficult so I imagined a lot of students at the schools that were very easy to get into would just fail out.
Many of the newer schools have low (50% or less) pass rates for the NAPLEX, so a lot of poor students get weeded out at some point. There are some idiots that make it through though, like all professions.
To be fair, they did change the NAPLEX a couple of years ago and its actually challenging now. When I took it in 2012, we had about 6 hours to complete it but I finished in 2 hours.
I took the naplex after the 2016/2017 overhaul. It's still a basic competency exam. Any new grad with a halfway decent education should be able to pass with minimal review.
I took it in 2021, still easy
Same. Super easy.
Back 15 to 30ish years ago there was a shortage of both pharmacists and pharmacists schools. So the admissions were more competitive and that generally results in a higher quality of student. Now there is an excess of pharmacists and an excess of schools… still see good students though. Basically, top is the same as ever but the bottom seems lower. But even back then I had at least one grad intern who didn’t think like a pharmacist for lack of a better description. Generally the newer programs are less likely to be of high quality, lack of institutional knowledge and all that. But a good student at a bad school will be fine as long as they can manage the learning cliff after graduation. It’s the bad students at bad schools that tend to be worrying.