Meds and dealing with your pharmacist

leaf

Meds and dealing with your pharmacist

leaf

By request of Deidre, this topic is intended to share your problems, feelings, techniques, etc. dealing with your pharmacist.

I'm a pharmacist, but I work in a hospital, so almost all patients I see have been admitted into the hospital.  I actually see maybe 1 patient every few months (usually if the patient's chart is in the patient's room.)  In addition, I work the graveyard shift, so I rarely actually see patients.   99% of the time I am interacting with nurses.  I rarely even interact with doctors.

However, I'm happy to share my personal perspective.  I hope it will be a learning experience for all of us.

Hanna60978

.

mzmiller99

I call my favorite pharmacist Dr. Lori!  But, all the pharms at my local Rite Aid are very competent. 

 Even the one who recommended Valerian for my sleep problems.  He never told me how incredibly horrible they taste!!   I still love him, tho!

PhyllisCC

Leaf,

 I don't  interact very often with a pharmacist as most of my meds I get thru mail order.  But I've been fortunate to have very helpful, non-judgemental  ones when I've had to shop at my local pharmacy.   Wanted to let you know that I appreciate your offer to help us deal with issues we may have. Thank You.  Phyllis

leaf

Well, just like any other profession or group, there are better and worse pharmacists. Just like there are some people who are more 'grown up' than others.

It is fairly uncommon for the pharmacist to know your diagnosis.   They can make some educated guesses; if they get a prescription from an oncologist, they can logically guess you have cancer.  So if an onc prescribes large doses of pain meds, sedatives, antidepressants, then  you know it can be very reasonable.

As far as doses go,  you're looking to see if a med is prescribed in a dose that is 'out of the usual range'.  So if a drug is usually given at 5-25mg a day for disease A and 10-200 mg for disease B, it will be really hard for the pharmacist to catch it if an error was made to prescribe 100mg  for disease A.  

When my GP (who handles my sertraline prescription) accidently refilled it with 25mg instead of 100mg tablets, I knew the doc had probably made a mistake.  If the pharmacist was really with it, I think they could have caught that, because if they were tapering me off of the med, they would normally taper me off more slowly than that (sertraline comes in 50mg tablets.)

 Privacy:  Here's more on HIPAA. http://www.hhs.gov/ocr/privacy/hipaa/faq/index.html

That doesn't mean that patient confidentiality slips don't happen, of course.  Some people 'get it' and some people don't. 

I know some confidentiality issues from personal experience.  I did not appreciate it that while at work, on the night before my excision, I was told by a collegue that " <the male radiology clerk, who had looked at my face sheet that contains my LCIS diagnosis> wishes you well on the excision, and 'advises that you get  bilateral mastectomies', because he had a co-worker and that's what she did."

Now, a normal person may be able to laugh that off, but I couldn't.  I didn't know until a few months later that I had  longstanding PTSD. I'm sure that didn't help matters at all. 

As far as what your hospital pharmacist may remember about you - well, probably not a lot. I almost never see patients, so all I have to go on is what is in an order.   If a person has a very unusual diagnosis (if the doctor put the diagnosis on the order), or uses 4 times the usual amount of a drug, I may remember the fact that we had a patient with a diagnosis of X, or used 4 times the amount of a drug.  But at the end of the day, I probably won't remember the patient name.  The nurse is more likely to remember a patient name.  I fill at least several hundred orders a night, and am filling medications for the entire hospital.

mzmiller99

Leaf - thank you for all you do for us. 

 Pharmacists have kept a good eye on my elderly parents over the years, Lori, in particular, as she would question some of the combination of drugs that my parents were on.  Too many doctors and not enough oversight, except for Lori.  Other times, they have called my docs when I had problems with meds, to suggest a better one.

As a chemistry-phobe, I am in awe of anyone who works in any related field.

Susan

tami48

I always ask my Pharmacist about drug interactions, because I'm always so worried that something won't work well with my seizure medication. 

leaf

That's good to do.  There are waaaaaaaaay too many interactions for any mortal human to memorize. Interactions are not an all-or-nothing thing.  Most interactions do NOT occur in all people who take the two medications, and may or may not be significant. So there are usually at least some people who take the medication combination in question and do just fine.

Interactions are detected over time.  In other words, it may take time for the medical community to realize there may be an interaction between two meds.  Since not all people who take the 2 meds in question have the interaction, it often can take years before an interaction is discovered.

There is much LESS information about interactions with alternative medications.  One part of this problem is that alternative medications do not have to be standardized, and can contain ingredients not listed on the label.  They don't have to contain the ingredients listed on the label.

The significance of an interaction definitely can be a judgement call.  Interactions can affect things like how quickly a medication may work, how much is absorbed, and how quickly it is eliminated. This may or may not be important depending on the medication use.

Sphynx

Someone posted this web site some time ago where you can enter the meds you are taking and check for interactions. I've found it useful back when I was taking a boat-load of meds during chemo and just after. 

drug-interactions

I can relate to the albuteral problem.  My DH is having a hard time since they changed his asthma meds.  I'll have him ask about the nebulizer.  Thanks for the advice.

Jorf

I love my pharmacist. When I was going through treatment I'd see him monthly for my stack of meds and he always had the kindest demeanor. Also helped me out with insurance billing when I was going to be out of the country when I needed a refill on my tamoxifen.

That said, I've had some horrible interactions with pharmacists at the big chains (never had a problem with a small local pharmacy) as a prescriber. The stories that my patients tell me...the interactions I've had on patient's behalf. Ugh. As Leaf said, there are good ones and bad ones in every profession. Pharmacists in stores have a very busy job and sometimes they shortcut so we need to be really savvy consumers. Look at your pills before you take them home. You deserve to know why it doesn't look the same - you may have a reaction to a new generic and if you don't realize that's happened you can't tell anyone when they ask, "What's changed?" Also, be sure that your pharmacy will bill Medicare if that's what you have. In certain circumstances (blood glucose meter strips, for instance), they won't bill and people pay exorbitant amounts that they don't have to and are never told.

The other reason I go to small, local pharmacies is this: before I had insurance I would call around for prices when I had to fill a prescription. Invariably, the small, local pharmacies had the best or close to the best prices. (This was before Target, that other store that shall remain nameless, and some of the pharmacy chains had $5 lists). Target would be around the same. The chains were always considerably more expensive. No joke, there was one generic NSAID that was $29 at the local shop and $129 at Stop&Shop. Anyway, we need to support these businesses!!!

leaf

It is important to support good people.

In my state, it is not legal for a hospital pharmacy to compete with an outpatient pharmacy (except for certain very specific circumstances.)  That's because hospitals can often buy in bulk unlike a small, community pharmacy.

Likewise, the small, local pharmacy has trouble competing with a big chain.

I feel really sorry for people who have many problems traveling to the best pharmacy and are stuck with going to the pharmacy nearest to them.  I have found very big differences between different outpatient pharmacies.

Deirdre1

Leaf:  I'm so glad you created this post - thank you (and I apologize for not noticing it earlier - long story)! 

There are two pharmasists at the store I go to and one is wonderful, he is knowledgeable and helpful but the other guy just seems not to know the most basic of interaction and that scares me to death (no pun)..  So I try to schedule my interaction with the 1st pharmacists and most of the time I am lucky, but not always..  So when there was a local paper that reported our state will now have a full log of types of scripts I have (had some for anxiety) and that pain patients would also be tracked.  First of all I thought we were traced through the doc and pharmacists and now we are told there is a third body of people that have out names, address and all of the drugs we are taking.

Now I'm a bit paranoid when it comes to someone knowing what I am taking (and where I live!) because when I presented in an emergency ward I got a doc who only saw that I was on anxiety drugs and stopped listening to what I said and didn't do any of the normal test and I had pneumonia!  (and believe me I only present in ER's RARELY) My primary care doc was out of town and so I ended up being instructed to go back to the emergency room the next day and was dx'ed..  So that's were the paranoia comes from.. So I guess my question is do the pharmacists and the Board of Pharmacy take oaths like the doc's?  And where does the information sharing stop..  How safe IS our private information??

And again this is a wonderful thread and I hope it just keep on going!!!  Best

leaf

 I DON'T think the ER contacted the State Board of pharmacy or the place where you send your controlled prescriptions.

At least in my state, the Board of Pharmacy is VERY SLOW at investigating things. It can take them 2-3 years to want the evidence in a possible nurse theft of narcotics.

 Here's more about the HIPPA laws.

Who Can Look at and Receive Your Health Information

The law sets rules and limits on who can look at and receive your health information

To make sure that your health information is protected in a way that does not interfere with your health care, your information can be used and shared:

• For your treatment and care coordination
• To pay doctors and hospitals for your health care and to help run their businesses
• With your family, relatives, friends, or others you identify who are involved with your health care or your health care bills, unless you object
• To make sure doctors give good care and nursing homes are clean and safe
• To protect the public's health, such as by reporting when the flu is in your area
• To make required reports to the police, such as reporting gunshot wounds

Your health information cannot be used or shared without your written permission unless this law allows it. For example, without your authorization, your provider generally cannot:

• Give your information to your employer
• Use or share your information for marketing or advertising purposes
• Share private notes about your health care
• http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

So, the 'bad news' is yes, your GP can share information with the ER doc, and they can share information with the State Board.  But they are both covered by HIPPA.

Now sometimes information can get out - these are the people who are NOT required to follow HIPPA.

"

Who Is Not Required to Follow This Law

Many organizations that have health information about you do not have to follow this law. 

Examples of organizations that do not have to follow the Privacy Rule include:

• life insurers,
• employers,
• workers compensation carriers,
• many schools and school districts,
• many state agencies like child protective service agencies,
• many law enforcement agencies,
• many municipal offices."http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

From what I can see of the Emergency room, and I could be wrong about this, there is NO WAY they would have enough time or resources to ask the state board what prescriptions have been filled by a patient.  You were probably brushed off because of the immense patient load. (Not that I'm excusing what the doc did.) Particularly if you were only on anxiety meds. As far as I know, they don't investigate legally anyone who has a cocaine overdose and goes up to ICU with a stroke, or overdose of PRESCRIBED *or* UNPRESCRIBED narcotics.

I am NOT trying to excuse the doctor here.  But what MAY have happened is this.  He saw you were on antianxiety meds.  One symptom of anxiety can be hyperventilation (you breathe too fast due to anxiety.)  If that was one of your symptoms, then (s)he may have assumed that was what was going on, and didn't look any farther.  I'm not trying to excuse the doctor. 

The workload of the ER is IMMENSE.  You probably got a feeling for that as you waited to see the ER doc.  Some people spend more than 16 hours waiting in the ER.  They wouldn't have time to contact state officials.

Deirdre1

Thanks Leaf:  In the particular case I was referring to and I was shocked by this as well - there was NO ONE but me in the ER and the ER and Hospital closed about 18 months later, so perhaps this particular hospital was on a skelton crew and perhaps weren't interested in having the best doc's on board at the time..  I had never been in an ER with so few (one) individual in it!

So perhaps their is room in the "making sure your doc is giving good care" for creating another data base.. because as you said there doesn't seem to be any concern about overdoses with prescribed or unprescribed narcotics..

Oh and I don't see you as trying to excuse the doc, but I had a fever of 102 degrees at the time too and that's what took me in.. so I think, as is possible in all professions, I just got a really bad doc - or uninterested or perhaps he had just lost someone.. anyway, I do appreciate you information.  Thanks

And thanks again for this thread!!  Best

leaf

Yes, I think you had a Really Bad doc, or something was really going on bad that day.  Who wouldn't want to investigate a temp of 102!!!!

My hospital has about 200 beds (not including babies) - its not a rural area. I've never worked in a rural area where they could ever have just one person in the ER.

You have a completely legitimate reason to be on anti-anxiety meds with a diagnosis of cancer.  Of course, they should not have brushed you off.  We have plenty of people who are admitted to the ICU and CCU and medical units who have MUCH more serious psychiatric medical issues than you have, and they get treated medically appropriately.  If appropriate, they get ventilated, surgery, antibiotics, etc.

It is very common for people to be admitted with anti-anxiety meds.  Nurses are routinely asking for anti-anxiety meds in the oncology and intensive care units, and it is not at all unusual in the medical-surgical unit.  You would be crazy if you weren't concerned about the condition for which you were admitted to the hospital.

So if you have a diagnosis of anxiety, that should NOT be a barrier, of course, to proper medical treatment.

Of course, some people just can't get over a stigma of psychiatric problems.We all have psych problems.  Our brains are connected to our bodies.  

I love one person's signature here that says something like 'Be kind to everyone you meet, because you don't know what burdens they are carrying.'

I'm glad your GP was with in enough to get you the care you needed. I wouldn't want that ER doc to handle my case.

Deirdre1

<chuckling>.  Well it will surprise you to hear that there are 1million people in our city - I guess the fact that the ER was empty should have made me run in the opposite direction!!!    Thanks Again!

leaf

Oh my.  I thought you often don't get a choice.  I'm so glad you got diagnosed properly the next day.  Maybe your GP knew something about the ER situation.

Mary22

Just found this post. I get my Rx's by mail order, to save money. However my son is ADHD and I have to go to the pharmacy for his rx's and have a great relationship with almost all the Rph's. I worked as Pharmacy tech and I have worked with great Rph's who will go out of their way to help a customer and others who could careless.

leaf

Yes, as in every profession, there are people who care, and people who don't care.  Often I wish there was a 'Care-o-meter' test at licensing exams. But life does teach some people more.  Not all, but some.

DragonladyTina

I have always said if you need medication advice seek out a pharmacist, doctors are great at prescribing but don't always know about the meds they are handing out. A pharmacist is your best bet.

Tina

leaf

There are so many medications out there, that its impossible to know all about them.  So some pharmacists know more about one group of medications than another. 

A doctor is sometimes expected to know all about all aspects of diagnosis and treatment, which is clearly not possible. Pharmacists are usually not very good at things like evaluating symptoms. In a hospital setting, nurses should be better at that.  A knowledgeable nurse and  knowledgeable pharmacist can make a pretty good team in a hospital setting.