Methinks I don't have the right attitude for this profession

[AccountingDrone]

Who was that pharmacist to question the doctor? He was the man who prevented me from having a possible heart attack in my teens.

.

Pharmacists are to ask questions, many people go to more than one doctor.

And freaking insurance companies who are neither doctors or pharmacists can die in a fire.

I take clonidine .2 mg AND clonidine .3 mg. They do not make a clonidine in .5 mg.

Try getting that little pair pf scrips past the freaking insurance company.

[AccountingDrone]

My pharmasist questioned my meds and dosage for a few months before finally accepting that yes, I was on the BP med level of a giraffe with a coke habit.

LOL Clonidine, amlodipine, atenolol and losartan. I would kill to go on fewer meds ... unfortunately unmedicated I pop 210/190. Remove the clonidine, and I run XXX/170. Remove any of the other 3 and I run anywhere from 140-210/70. *sigh* Drives my cardiologist nuts. We went through 6 months of playing with meds with the taper up and off to change stuff out.

I still say it was directly due to a combination of avandia and the severe head exploding migraine and dehydration preoperatively combining to screw with whatever part of my poor brain that has the sliders for my BP.

[Lyse]

Every several months, the pharmacist at the retail pharmacy will question my ketorolac prescription from my neurologist. A minor irritant since it is documented that I've been counseled. However, several years back, a pharmacist at this chain prevented me from taking an antibiotic that I am allergic to. Yeah - somehow that got by the doctor. A second set of eyes is always a good thing.

[PepperElf]

I WANT my pharmacists to question my doctors! For some things, I'll go to a pharmacist BEFORE going to a doctor! The pharmacist is supposed to be the specialist in drugs and drug interactions, the family-doctor/front-line doctor is supposed to be a diagnostician and patient-management specialist.

Exactly. The pharmacists specialize in this. Doctor's... not so much.

Even my Mom's awesome doctor (he's intelligent AND he's early!) sometimes forgets to put "DAW" on her 'scripts. Mom tends to use the in-house pharmacist though so it's usually easy to clear that up quickly

[wolfie]

We had another retail pharmacy lab yesterday and one of my "prescriptions" was for 33 pills. I thought that was an odd number and asked one of the teachers about it.

Of course it's an odd number - if it had been for 32, or 34, pills, it would have been an even number.

Seriously, that was a BAD MOVE by the teacher. Pharmacy staff are the last line of defense to keep contra-indicated drugs out of the patient's hands. The teacher should have used this as a learning opportunity to point out an "exception" case - by "tearing you a new one", she was training the class to NOT question a possible error ("error" in this case including interaction with a different drug prescribed by another doctor - something the doctor writing the prescription would not have known about) by the doctor.

For example, let's say that a particular opiod pain reliever is available in time-release pills with dosages of 10, 20, and 30 milligrams (release over 6 hours), and each of these also contains 300 milligrams of acetominaphin (sp?). The high-dosage pills are likely to be harder to obtain (fewer pharmacies carrying them due to fewer prescriptions, or because they are a more attractive target for theft, or doctor doesn't want to be "red-flagged" for prescribing higher dosages). Doctor initially prescribes 10mg 4x per day. Patient's pain (let's assume it's a legitimate case, such as terminal cancer) "breaks through", doctor ups dosage to 2x10mg 4x per day. Doctor is basing prescription on opiod content, treating remainder of the pill as "filler".

A pharmacist, being more familiar with ALL aspects of medication than a doctor, sees that in addition to the opiod, the patient is now being prescribed 2400 mg of acetominaphin per day instead of 1200. Even on a "DAW" prescription, the pharmacist would be well within his rights (in fact, it's his duty) to contact the doctor and remind him that, while not questioning the dosage of opiod, the doctor may not realize that he's also prescribing a toxic dose of acetominaphin, and suggest changing the prescription to 20mg 4x per day (same dose of opiod, half the acetominaphin).

If the doctor refuses to make the change, I'd support the pharmacist stamping the prescription (assuming it's a paper prescription) with the pharmacy stamp, and writing in red "refused to fill - as written, contains a toxic dose of acetominaphin" (as a warning to other pharmacists who might not be quite as sharp) before returning it to the patient.

[Seshat]

Overdosing on acetominephin/paracetemol is especially nasty: one of the worst ways to die. It wrecks your liver, leading to you dying of the poisons the liver usually filters out.

Depending on how bad the liver damage is before you get to the hospital, they may be able to save you: there are antidotes. But you're still in for days or weeks of hell.

But yeah: paracetemol/acetowhateverephin is in a lot of meds as an additional component. Cold and flu meds, opiate/opiod painkillers, etc. It's a useful and - usually - safe analgesic.

Just be watchful, and don't take two meds that both have it without a pharmacist's advice!

[kpzra]

Better to question someone than "do as you're told" and end up having someone die. We were taught that in Paramedic training when it came to drugs.

[Pixilated]

Of course it's an odd number - if it had been for 32, or 34, pills, it would have been an even number.

Seriously, that was a BAD MOVE by the teacher. Pharmacy staff are the last line of defense to keep contra-indicated drugs out of the patient's hands. The teacher should have used this as a learning opportunity to point out an "exception" case - by "tearing you a new one", she was training the class to NOT question a possible error ("error" in this case including interaction with a different drug prescribed by another doctor - something the doctor writing the prescription would not have known about) by the doctor.
*snip*

Absolutely! If there are any opportunities to mention it when we do the 'class assessment' (many schools now use Scantron sheets with little or no room for actual comments ... hmmmm ...) I do plan to mention it. And I have a pretty tough hide, so am not likely to let it intimidate me when I get to my placement and/or work ... but not all of my fellow classmates are like that.

I'm also hearing from more than one fellow student (all of whom say they are talking to actual, working pharmacy techs) that a lot of the "stuff" we are learning is not material we will ever use (doctors do not, for example, send you a prescription with the child's weight in pounds, the strength of the medicine in milligrams per kilogram, and the the dosage they wish the child to have every six hours ... )

I find myself cynically thinking that a lot of what we're doing is "busy work" to justify the tuition costs.

[Rapscallion]

LOL Clonidine, amlodipine, atenolol and losartan. I would kill to go on fewer meds ... unfortunately unmedicated I pop 210/190. Remove the clonidine, and I run XXX/170. Remove any of the other 3 and I run anywhere from 140-210/70. *sigh* Drives my cardiologist nuts. We went through 6 months of playing with meds with the taper up and off to change stuff out.

Bloody hell. I thought mine of /98 or /96 at best was bad. They're at the point of keeping an eye on me.

Rapscallion

[BookstoreEscapee]

However, several years back, a pharmacist at this chain prevented me from taking an antibiotic that I am allergic to. Yeah - somehow that got by the doctor. A second set of eyes is always a good thing.

I had the flu a couple years ago, and by the next week I was developing pneumonia (saw the nurse practitioner and she said it was "borderline"). The NP gave me an antibiotic and an inhaler, one of the brand name ones that is two drugs in one (comes in a purple disk-shaped dispenser). My mom dropped me off at their house and went to the pharmacy. While she was out I looked up the drugs online and saw under the antibiotic was listed specifically this brand of inhaler was not to be mixed with it because one of the drugs interacts with the antibiotic. When my mom got home she had a plain albuterol inhaler because the pharmacist had caught it and called the doctor's office...gave me much faith in my pharmacy.

If I have a question about a drug, do I ask a diagnostician, or a drug specialist? Yeah, I thought so.

When I had a few days left on the antibiotic, I went back to the NP just to get a check up, just to be sure and because I was still wheezing a bit, and she gave me 5 days of another antibiotic; it was one a day so she just gave me 5 samples they had in the office, so I didn't have to go to the pharmacy. I went over there anyway, gave both antibiotics and the inhaler to the pharmacist, and asked if there was any issue with taking them together. (Luckily she said it was fine.) After the first time I wasn't going to take any chances.

[Ironclad Alibi]

"Who are you to question the doctor?"

The answer to that question is: "Their patient."

The video I get to watch in the doctor's waiting frequently has a bit about asking the doctor about anything you don't understand. Too many people visit the doctor and never ask anything. If only they would act that way in the store.

[Lyse]

My doctor just finds it amusing when I pull out my piece if notebook paper that has any questions I want to ask on it. I tend to blank while I'm actually there, so I started writing down things between visits. Huge help, for both of us.

[Pixilated]

My family physician in Toronto has told me I will never be off her list of patients unless I specifically request it (or until she retires, LOL), for which I'm very thankful -- although at the moment going to visit her would involve a four-hour train ride! But she was an excellent doctor. Years ago I had to get some tests and she told me they'd give me the results in a sealed envelope, which was, in her words, just plain stupid, since I'd have to find out the test results at some point anyway. She said I could open the envelope and read the test results myself if I wished; if not, I could bring them to her and we'd go over them together. She set the bar awfully high for any future doctors I may be dealing with.

And yes, I did rip open the envelope and read the test results on the subway. Didn't understand word one but it was the principle of the thing.

[AccountingDrone]

Bloody hell. I thought mine of /98 or /96 at best was bad. They're at the point of keeping an eye on me.

Rapscallion

fully medicated and not missing any dose by more than 10 minutes manage to stay at 115-135 / 75-85. If I miss a dose, or do any caffeine all bets are off.

My phone alarms at 5 am, 1 pm, 5 pm and 9 pm, for the pills of various types and again at 10 pm for insulin. My phone is always in my possession, as are my pills, and if I am planning to be away from the house, at least 3 days worth of pills, and my lantus pen, alcohol swabs and needles are in my purse with me. I wear a medicalert USB bracelet and a military issue medical dogtag. When on a road trip, my entire black bag travels with me, it has my 3 month issue of medication in it and a spare set of prescriptions travels in my wallet so all I need to do is hit the nearest pharmacy for a months supply of everything.

[depechemodefan]

The video I get to watch in the doctor's waiting frequently has a bit about asking the doctor about anything you don't understand. Too many people visit the doctor and never ask anything. If only they would act that way in the store.

At the library we get a lot of phone calls from older people asking us to explain the diagnosis the doctor gave them. Sometimes I do ask the person why didn't they ask the doctor but they say, "the doctor didn't explain it to me." I know doctors's time are limited, but when my mom was sick we did ask questions until we understood (luckily we went to doctors who dumbed it down enough, like "if you stop going to dialysis you will die because toxins will accumilate in you, besides your blood pressure will go up and your heart will work harder). So reading something on Medlineplus is one thing, but we can't interpret this stuff, so if you don't understand what we are reading, we can't tell you, "well, I understand it's a skin condition," because it might not be a skin condition. The customer could have said the wrong thing or spelled the diagnosis wrong, or the med says it treats skin conditions but the doctor didn't prescribe it for a skin condition it's for something else whic hthe drug can treat. We tell people to talk to the doctor or the pharmacist, but most don't want to. Arg!
I worked in a pharmacy as a pharm tech and lot of pharmacists let me know doctors only get 1 semester (of only one class) of pharm. So I trust the person who has the five year degree in pharm.