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Wednesday, September 16, 2009

or not to err, that is the question.

Lately I've noticed interesting reactions from patients when something unusual is noticed with their prescription. Let's say someone receives a prescription for a quantity that they did not expect. Joe Schmoe gets some Zantac 150mg, and takes it twice a day. He looks at the bottle before he leaves and sees that it is for sixty tablets. He points out, none too courteously, I might add, that we've made a mistake. He had asked for a ninety day supply. We should have given him a quantity of #180.

Note: We've made a mistake. Us. The pharmacy team. The druggist. The stoopnagle with the white jacket who can't count. You know the guy, the one who can't read the prescriptions with the silly handwriting on them.

Except that guy didn't make that mistake. Didn't make too many others either. This is the guy whose job it is to catch mistakes. That's right. The job of a pharmacist is to catch the mistakes of others. It is not—principally—to dispense medication. That really is secondary. His first job, and this is really what he gets paid for (because the drugs are sold at a loss or close to it, believe it or not), is to act as a gatekeeper of sorts. He—or she—watches for errors in the prescription process. It used to be that many errors were the result of bad handwriting. This was especially tricky to catch if the pharmacist was new to the area and unfamiliar with a particular doctor's script. Now it is even worse, I'm afraid, due to the increasing percentage of prescriptions sent to pharmacies via electronic software, e-scripts as they are called.

E-scripts are tricky because you never know if a doctor (or nurse or secretary or physician's assistant or the pet dog) merely clicked on the wrong line. For instance—and this is only one of a myriad examples, some much more subtle—did a doctor mean to write for Lisinopril+Hydrochlorothiazide 20/25? Or did he click the wrong drug? Let's say that the patient has been on plain Lisinopril 20mg for years. But the patient's blood pressure might have recently changed causing the doctor to add another drug to the regimen. Well? Do you call the office? Sure, you say. Just call. But know this: you are filling a prescription every minute for twelve straight hours. You also know you won't be able to talk to anyone. You'll get a voicemail message (after navigating through some stupid voice prompt: push "1" if this is an emergency; push "2" for the office manager; push "3" for the dog warden…") and likely won't hear back until hours later or even tomorrow. Or ever. In the end I usually just jot a note to ask the patient if there was a change meant. Sometimes they know. Sometimes they don't have a clue. Ah, well, another day at the pharmacy.

Oh, and when I show Joe Schmoe the original prescription for #60 Zantac, proving that it was his precious perfect physician's assistant who wrote the wrong quantity he treats it as nothing wrong. He even still insinuates that the error happened in the pharmacy. Nice. It seems doctors don't make errors, only pharmacists. Even when they catch them.

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