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What does a Pharmacist actually do?
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ort888
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Jan 27, 2008, 11:35 PM
 
Please fill in the blanks for me.

1. I bring my prescription and Insurance Card to the drop off desk. I answer a few basic questions as I am already in the computer system.
2.
3. I get a bag with my drugs and pay for them.

What happens at step 2?

Does it involve a guy going and getting a box off the shelf, putting it in a bag, entering it in a computer and putting it in the out bin? Or is there more to it?

What if the drug in question comes in a pre-packaged box with the exact amount in it?

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Jan 27, 2008, 11:38 PM
 
Step 2 is label making. A very important step. Not everything is a suppository.
     
Lateralus
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Jan 27, 2008, 11:38 PM
 
I believe your steps are out of order; 1 should be 2. And the actual number 1 is the part where the prescription is actually filled by the pharmacists/techs.
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Jan 27, 2008, 11:40 PM
 
Originally Posted by Lateralus View Post
I believe your steps are out of order; 1 should be 2. And the actual number 1 is the part where the prescription is actually filled by the pharmacists/techs.
How do they fill the prescription without the actual prescription written on a sheet of paper?

OP: #2 has always concerned me as well. I think machines can pretty much do all that work now. It should be a vending machine situation if you ask me.
     
ort888  (op)
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Jan 27, 2008, 11:55 PM
 
Seriously. I mean, the most intense thing they might have to do is count some pills right?

Find the correct container. Count out pills. Put them in a bottle. Label them. Enter it in a computer.

I'm just really pissed right now because I just got done waiting an hour and a half for a pre-packaged box in a bag.

The dumbass kid told me it would be 20 minutes.

I wondered around Walgreens for about 45 minutes before I went back and asked. they said soon so I sat down. Went back up and asked about 30 minutes later, somewhat agitated and they said soon and it still took another 15 minutes.

For a pre-packaged box with a sticker on it.
( Last edited by ort888; Jan 28, 2008 at 12:20 AM. )

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MacNNUK
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Jan 28, 2008, 02:55 AM
 
You're forgetting the all important knowledge, and the many years spent at University gaining that knowledge, and the many years learning how to deal with stupid customets.

Drug interactions, advice etc.....

It may also be a policy of Walgreens (not the Pharmacists) to get you to wander around the store.

The Pharmacist may have been on lunch, they are not allowed to dispense drugs without the Pharmacists presence.

Plus, other customers before you who had much larger orders, and people are dealt with in the order they arrive with prescription, not in the order they pick them up.

Who knows what other problems there were whilst you were wandering around the store .

Perhaps you were just obnoxious and they decided to make you wait, so that you would go elsewhere in the future ?

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Jan 28, 2008, 02:58 AM
 
Originally Posted by MacNNUK View Post
You're forgetting the all important knowledge, and the many years spent at University gaining that knowledge, and the many years learning how to deal with stupid customets.

Drug interactions, advice etc.....
Yeah, but all that could be kept in some database.

The time it took to get your prescription, could it have something to do with getting approval from your insurance?
     
ghporter
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Jan 28, 2008, 09:02 AM
 
Doctor writes prescription. Patient takes prescription to pharmacy. Pharmacy tech checks physician's creds with a variety of tools, including (if applicable) the doc's DEA listing. Once validated, the tech reads the scrip, enters it into the computer and draws it up while the label prints. After it's packaged and the label printed, the whole thing goes to the actual pharmacist who does some serious QC on the whole thing-is it indeed a valid scrip? Did the tech read the scrip correctly? Did the tech actually fill the bottle with the correct medication, of the correct dosage and number? Usually the pharmacist will also make sure that the tech has bumped the new med up against the computer's records of what other meds that customer already had.

A good pharmacist will be able to synthesize the difference between "potential side effects" and "potential interactions" based on the patient, the meds involved, the patient's diagnoses, patient age, preexisting conditions, etc. That's not something a database can do-it takes what we call "professional reasoning and judgment." On top of that, the pharmacist is trained to explain the very complex issues involving the use of and mechanisms of action of various drugs to patients whatever their level of preexisting knowledge.

If you are dealing with a "compounding pharmacist," the pharmacist actually formulates prescribed materials that do not come prepared. That's the whole mortar and pestle thing...

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Jan 28, 2008, 09:10 AM
 
I think times have changed, 25 or 50 years ago the Pharmacist used to mix some chemicals together to create the pills, filled capsules.

Now they read the prescription, look online and see if there's any interactions, count the pills out and give to the customer. Heck, most of the work is done by those pharmacy helpers, the pharmacist seems to do very little, at least for what I've observed.

I'm sure he needs to have a lot of knowledge and training but so far I've not seem him needing to exercise that knowledge. As I mentioned in days past, he needed to have a good knowledge of chemistry and help create the medicine in large part. Today, he even has a machine that counts the pills for him.
     
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Jan 28, 2008, 09:59 AM
 
There's actually quite a few preparations that are mixed as required.

And pill counters don't work with blister packed pills !!!

Which for some reason quite often don't come neatly in 28's

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Jan 28, 2008, 10:08 AM
 
My pharm checks everything and gives the prerequisite warnings.

But there is that weird lapse at step 2 where it takes 20 minutes to throw 5 pills into a bottle and cross check a computer record.
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vmarks
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Jan 28, 2008, 10:22 AM
 
Originally Posted by osiris View Post
My pharm checks everything and gives the prerequisite warnings.

But there is that weird lapse at step 2 where it takes 20 minutes to throw 5 pills into a bottle and cross check a computer record.
Step 2's time lapse is where they're throwing the 5 pills into the bottles belonging to the customers ahead of you. No one in the store? The doctor's office calls in scrips, faxes in scrips, and emails in scrips. The Pharmacy is always busy even when no one is present in the store.
     
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Jan 28, 2008, 10:29 AM
 
They count the pills and put it in a bottle in the USA? Don't you get the manufacturer's packaging? And the leaflet?
     
osiris
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Jan 28, 2008, 10:33 AM
 
Originally Posted by TETENAL View Post
They count the pills and put it in a bottle in the USA? Don't you get the manufacturer's packaging? And the leaflet?
It's usually a plastic bottle with dose/warnings and a paper bag with your name and more warnings.

What packaging, what leaflet? I suppose you get candy and frequent flyer miles too?
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Mrjinglesusa
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Jan 28, 2008, 10:39 AM
 
Pharmacists

You wouldn't need a higher education if all you did was put pills in a bottle.

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Jan 28, 2008, 10:42 AM
 
Step 2 - Profit!
     
torsoboy
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Jan 28, 2008, 10:59 AM
 
Step 2 is: take the prescription, find the bottle on the shelf, count the pills, print a label. I think ghporter's "serious QC" is pretty much limited to looking at the bottle and making sure it matches the prescriptions. They also call insurance agencies quite a bit, so I guess that would be in step 2 as well.

Mrjinglesusa: It does seem like they should do more considering their education, but from observation they don't do too much more than that.

I HATE waiting for prescriptions. It should take only a minute or two and you are done. I don't care if there are five people ahead of you, that should be 10 minutes tops and you're out of there. But like ort888 experienced they normally take a LOT longer than that to get you yours. At some pharmacies around here they don't even look up or acknowledge when a new person comes to the counter... 5 minutes later they come over and ask what you need. It is ridiculous.
     
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Jan 28, 2008, 11:19 AM
 
Originally Posted by vmarks View Post
Step 2's time lapse is where they're throwing the 5 pills into the bottles belonging to the customers ahead of you. No one in the store? The doctor's office calls in scrips, faxes in scrips, and emails in scrips. The Pharmacy is always busy even when no one is present in the store.
Yeah, real busy. The pharmacists at my store file their nails, check their makeup, and chat on the phone. No email/fax prescriptions - state sealed originals only.
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Jan 28, 2008, 01:00 PM
 
Originally Posted by TETENAL View Post
They count the pills and put it in a bottle in the USA? Don't you get the manufacturer's packaging? And the leaflet?
Most of the pills come from the manufacturer in stock bottles of 1000 or more pills, which the pharmacists (and techs) use to fill individual prescriptions. Sometimes the companies will package their own "30 day" bottles, which the pharmacy can slap their label on. Then the pharmacy generates the "leaflets" which are printed out and included with the bottles.

If you get samples from the doctor's office, they're usually in a little blister pack and include a leaflet from the manufacturer.

Very different from Europe. Also, it seems to me that in some places in Europe, the pharmacists will disregard the warning printed on the box that says "Available only by prescription."

I've been to German pharmacies to get stuff that we consider "over the counter" and available without a prescription here in the U.S., and gotten it, but it didn't say "available only by prescription." But twice now in Greece I've gone in, again for things that are available without prescriptions in the U.S. and gotten them, but some of them said, "available only by prescription."

For example, I got a cold in Greece in 2005. I went to the pharmacy, and asked for a non-nasal spray for decongestion. They had something called "Neurofen CF," which was ibuprofen and pseudoephedrine together. They just gave it to me. Box said, "To be dispensed with doctor's prescription only."

Then in 2007, I developed a rash, and went looking for "hydrocortisone cream" which is a weak steroid cream available over the counter here. They didn't have that. All they had was some very high potency stuff that one should never put on their face or neck. They sold it to me and said it was fine to put on my face. Good thing I was a doctor and knew better about it. (It was fine to use on my legs and cleared the rash up right away). The box again said "only with prescription."

I myself have never tried it in Greece with things that are prescription drugs here in the U.S. but my father routinely gets a few things from the pharmacy there that are "prescription only," (like his cholesterol and blood pressure medicines) in both countries. But he's never had to get a prescription.
     
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Jan 28, 2008, 01:48 PM
 
Here in Germany all tablets are individually sealed in a packaging by the manufacturer. I wouldn't like them thrown into a bottle. Who knows who touched those pills before? And if I'm sick I don't like touching the other ones as well when I pick out one. Who knows how long they are good if not sealed? Who knows whether nobody made a mistake and they are even the correct ones? If there is a problem with those pills, who knows the production charge of those pills?
The packaging also comes with a leaflet with instructions, contraindications and side-effects. I consider this quite important.
And Person Man, I can guarantee you that in Germany you will not get a prescription drug without an actual prescription in a pharmacy. Also, there is no wait in pharmacies. You get your medicaments immediately.
     
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Jan 28, 2008, 02:44 PM
 
Originally Posted by TETENAL View Post
Here in Germany all tablets are individually sealed in a packaging by the manufacturer. I wouldn't like them thrown into a bottle.
I hate that ind. seal packaging crap. The only med I have that is individually sealed is my migraine med and the last thing I want to deal with is the tiny hard to open packages when I am in tremendous pain. Seems the only meds that go in individual packages is the most expensive meds.
Originally Posted by TETENAL View Post
Who knows who touched those pills before?
All of the pharmacies I go to have open areas and you can see them filling the bottles. They never touch them and use disposable tools to dispense them.
Originally Posted by TETENAL View Post
And if I'm sick I don't like touching the other ones as well when I pick out one.
I flick one out and never touch them. Not a problem.
Originally Posted by TETENAL View Post
Who knows how long they are good if not sealed?
How long are you hanging onto medicine?!?! I rarely have a prescription around longer than 90 days. Older than that and I throw it out.
Originally Posted by TETENAL View Post
Who knows whether nobody made a mistake and they are even the correct ones?
The same thing could happen at the factory.
Originally Posted by TETENAL View Post
If there is a problem with those pills, who knows the production charge of those pills?
This is all kept at the pharmacy.
Originally Posted by TETENAL View Post
The packaging also comes with a leaflet with instructions, contraindications and side-effects. I consider this quite important.
I always end up with pages of printouts that describe the medicine and instructions. It's better than the teeny print included in the boxed, individually packaged meds.
Originally Posted by TETENAL View Post
And Person Man, I can guarantee you that in Germany you will not get a prescription drug without an actual prescription in a pharmacy.
The same here in the USA. I don't know what he's talking about. There's even some over the counter meds that you need to get directly from the pharmacist.
Originally Posted by TETENAL View Post
Also, there is no wait in pharmacies. You get your medicaments immediately.
Now this is a VERY good thing™.
     
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Jan 28, 2008, 02:57 PM
 
Nurse! Get this man 2000 CCs of, uh, adrenaline!
But... doctor?!
Damn your buts, I said 2000 CCs of adrenaline!
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Jan 28, 2008, 03:18 PM
 
Originally Posted by Railroader View Post
The same here in the USA. I don't know what he's talking about. There's even some over the counter meds that you need to get directly from the pharmacist.
Please read my post carefully. The incidents I described happened in GREECE. Not Germany, and not the USA. I asked Tetenal if the pharmacies in Germany were so lax as to dispense prescription medicines without a prescription like they do in Greece.

I am happy to hear that if a medicine is available in Germany only by prescription that you have to have a prescription in order to get it. Apparently in Greece (at least the pharmacies I and my father have been to) they ignore that little detail, which could lead to dangerous consequences. I should not be able to walk into a pharmacy and ask for Lipitor and walk out with it, unless it was specifically prescribed to me by a doctor.

Also, in Europe, just about every non-prescription medicine has to be obtained directly from the pharmacist. There's no "over the counter" for anything. For example, you even need to get Aspirin from the pharmacist in Europe, just as you need to get Sudafed from the pharmacist here.
     
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Jan 28, 2008, 03:33 PM
 
Originally Posted by Person Man View Post
Please read my post carefully. The incidents I described happened in GREECE. Not Germany, and not the USA. I asked Tetenal if the pharmacies in Germany were so lax as to dispense prescription medicines without a prescription like they do in Greece.

I am happy to hear that if a medicine is available in Germany only by prescription that you have to have a prescription in order to get it. Apparently in Greece (at least the pharmacies I and my father have been to) they ignore that little detail, which could lead to dangerous consequences. I should not be able to walk into a pharmacy and ask for Lipitor and walk out with it, unless it was specifically prescribed to me by a doctor.

Also, in Europe, just about every non-prescription medicine has to be obtained directly from the pharmacist. There's no "over the counter" for anything. For example, you even need to get Aspirin from the pharmacist in Europe, just as you need to get Sudafed from the pharmacist here.
Sorry, I totally misunderstood your post.
     
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Jan 28, 2008, 04:23 PM
 
My experience in Germany was kind of funny.

First of all, forget 24 hour pharmacies. The places close at like 6 PM so you have to sprint from work. And pharmacies do not generally have huge amounts of beauty products, chewing gum, chips, greeting cards, small electronics, etc. Most everything in Germany is behind SOME counter, even if you don't need a prescription, you still have to speak with a pharmacist about it. Even when I was having trouble adjusting to the food and had some, um, gas... I had to explain it to the pharmacist (in my limited German) to get anything. I'll never forget the word for constipation: Verstopfung. It's feminine.

Here in the US, Prilosec is now over-the-counter, while Nexium is Rx only. Anyways, I ran out of Nexium but figured Prilosec, being very similar, would be good enough. Prilosec is (or at least was) still Rx only in Germany and the pharmacy would not give it to me without a script, so my mother tried to mail me a refill from home. The German mail held it up and sent me a notice and I had to go to some warehouse in the middle of NOWHERE only to be told that it was illegal to send medication and I could send it back home for 10 euros or something, which I agreed to.

In Germany they seem to frequently, and rather conveniently, have doctors right above pharmacies, so I just went upstairs one day and explained the situation. The receptionist apologized and informed me that because I did not have insurance in Germany, I would have to pay for the visit outright. Wincing, I asked how much it would be. 12 euros. 12 euros!!! That's cheaper than my $25 co-payment at home! The visit was quick and easy. The Nexium itself was only like 10 euros without insurance, and, no waiting or even checking the script at all. In the US, it probably would have been about 200 dollars without insurance. What. The. Hell. I hate health insurance in the US.

To top it off, the German mail made a mistake in returning my drugs to the US. They didn't label it correctly, so the post returned them to sender, who was now me! I got them a week later. If you ever need to smuggle something into Germany, just ask deutsche Post!

One day I'll relay my experience with GYMS in Germany... oy.
( Last edited by maxintosh; Jan 28, 2008 at 04:34 PM. )
     
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Jan 28, 2008, 06:04 PM
 
Originally Posted by maxintosh View Post
My experience in Germany was kind of funny.
One of my patients' daughter was on vacation in Greece and had a miscarriage while there. She was 12 weeks pregnant. She was in Athens at the time (thank goodness, or she'd have had a bad experience-- rural health care in Greece isn't the best), and had to have a surgical procedure. It was an outpatient procedure. I got involved because her doctor in the United States needed the pathology report from the surgery, and the pathology report was in Greek, so I translated it.

I looked at all of her bills. The doctor's bill for the procedure was 500 euros. The hospital facility fee (for the operating room) was 50 euros. The pathologist's fee was 67.50 euros. The antibiotic given to her afterwards was 11.50 euros. (Granted, the antibiotic was one that's available here in generic form for around $10). All in all, the whole thing cost € 629.

That same procedure here would have been billed at $10,000 minimum. It's nuts.

Oh, and the pathology report? It was two full pages. Two FULL pages! That same report over here would have been like 5 lines. Granted, those five lines would have said the same stuff, because the doctor is interested in what the slides mean, and not what they looked like. (i.e. the pathologist described everything in excrutiating detail, whereas one here would have put down just the summary of what he thought it was).
     
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Jan 28, 2008, 06:20 PM
 
Originally Posted by torsoboy View Post
Step 2 is: take the prescription, find the bottle on the shelf, count the pills, print a label. I think ghporter's "serious QC" is pretty much limited to looking at the bottle and making sure it matches the prescriptions.
Ever tried to read a physician's handwriting? With a mixture of latin-ish and abbreviations? Good luck. THAT is a huge part of the QC-making sure that the tech was even close is a tough call in some cases, and the pharmacist is responsible by law so he is often the one that talks to the physician when he can't read the scribble. We ARE talking about someone with a doctorate degree here, not someone with some 2 year vocational degree.
Originally Posted by osiris View Post
Yeah, real busy. The pharmacists at my store file their nails, check their makeup, and chat on the phone. No email/fax prescriptions - state sealed originals only.
Those are the TECHS. The (singular in almost all cases) pharmacist is the one that stays busy through lunch researching meds and calling doctors' offices.

Geeze guys! You are making me feel that nobody appreciates how much work it takes to get into a health care profession. I'm about 15 months shy of a professional health care degree, and I'm afraid the best thing I'll hear from most people is "You're an occupational therapist? But I don't need a new job, I need to be able to button my shirt by myself!"

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Jan 28, 2008, 06:26 PM
 
Originally Posted by ghporter View Post
Ever tried to read a physician's handwriting? With a mixture of latin-ish and abbreviations? Good luck.
Which is why I print my handwritten prescriptions and orders. Good old printing (the kind you learn in school before cursive).

I was at the pharmacy the other day to fill a prescription (given to me by another doctor), and the pharmacist recognized my name and thanked me for the legible prescriptions I write. Unfortunately you don't hear that all that often.
     
ort888  (op)
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Jan 28, 2008, 06:48 PM
 
Let me clear up a few things.

I'm not trying to bag on Pharmacists, I was just very frustrated.

What I was the victim of was simply very poor customer service. I just got annoyed when the woman behind the counter was trying to make a bunch of excuses about why my order took an hour and a half.

I was the second person in line, and the pharmacy got pretty busy. The woman in front of me got her order filled about 20 minutes before me, so she had to wait a ridiculously long amount of time as well.

And again, it would not have been a big deal if the first kid had not told me it would only be 20 minutes. If it's going to take a long time, just tell me. I would have simply gone home and come back. No big deal.

And these people were not taking a long time because I'm rude. I'm polite to a fault with retail workers because I know where they are coming from. I worked retail for about 6 years. The flip side of that is that I also understand what it means to provide good customer service, because I took pride in doing a good job when I was in their shoes. So I know it's not impossible.

Anywho, I did tell the woman who checked me out how irritated I was at having to wait for so long after being told it was going to be 20 minutes. She was apologetic but full of excuses.

It was on the way home, when I opened the bag. and saw my prescription was nothing but a pre-packaged sealed box, with the exact amount of pills required, that I became especially annoyed.

I was just very frustrated because I had spent my entire Sunday in the emergency room with my wife, and she was at home, alone, and waiting for me.

It was the perfect end to a bad day.

EDIT: Oh yeah, and my prescription was printed on hospital stationary, and was not for any sort of abused substance or something they would have to get verified as a controlled substance.

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ghporter
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Jan 28, 2008, 09:09 PM
 
Originally Posted by Person Man View Post
Which is why I print my handwritten prescriptions and orders. Good old printing (the kind you learn in school before cursive).

I was at the pharmacy the other day to fill a prescription (given to me by another doctor), and the pharmacist recognized my name and thanked me for the legible prescriptions I write. Unfortunately you don't hear that all that often.
It's an open secret that many of us believe a lot of doctors intentionally write illegibly to limit their liability in certain circumstances. This is the same sort of mindset that resists computer charting-if you can't definitively read the note you can't definitively say the doc screwed up. However, I know a number of physicians (note the different terminology here) including a few in training, who are adamant that they WILL be understood whenever they write anything. I salute you for being of that latter group.

I've read a lot of charts while in my own training, and I can say I don't have the neatest handwriting myself. But NOBODY has worse handwriting (as a group) than people who put "M.D." after their names. That any physician gets noticed for his legibility is an indication of how truly awful doctors' writing really is. I could get into a real rant on this as one symptom of "doctor attitude" but that's off topic. Suffice to say that when I mention prescriptions, I'm not only talking about orders for pharmaceuticals. An OT needs a formal scrip to treat a patient. One major reason PTs are fighting hard for a doctorate entry level is to be independent enough not to depend on physicians for initial referrals-they need a written scrip to start too. I feel for pharmacists whose job is tricky and complex, and made orders of magnitude worse by the vast majority of people who write the scrips in the first place.

Not bad for "not a rant," huh?

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Jan 29, 2008, 01:10 PM
 
Originally Posted by ghporter View Post
It's an open secret that many of us believe a lot of doctors intentionally write illegibly to limit their liability in certain circumstances. This is the same sort of mindset that resists computer charting-if you can't definitively read the note you can't definitively say the doc screwed up.
You are right, but the reality of the situation is that illegible handwriting usually hurts a doctor's case more than legible handwriting does. For example, let's say a minor error was made by the doctor. The error had no consequences for the patient and may not have an impact on what the doctor is being sued for. If the chart is legible, that error may be overlooked, but if the entry is illegible it may count against him... especially if the case is weak to begin with and the attorney is searching for any little thing to help the case.

However, I know a number of physicians (note the different terminology here) including a few in training, who are adamant that they WILL be understood whenever they write anything. I salute you for being of that latter group.
Heh, thanks.

I've read a lot of charts while in my own training, and I can say I don't have the neatest handwriting myself.
My printed handwriting is far from neat. But it doesn't have to be neat. It has to be legible. I had a classmate in high school who used to write in very tiny letters. His handwriting was very neat. But it was so tiny it was illegible without a magnifying glass. I remember the teacher made a point to that student once when she wrote the grade and her comments in the same style. He complained that he couldn't read it.

But NOBODY has worse handwriting (as a group) than people who put "M.D." after their names. That any physician gets noticed for his legibility is an indication of how truly awful doctors' writing really is.
Don't forget the D.O.'s (of which I am one). They've got just as bad handwriting. I often joke that I failed "Bad Handwriting 101" in medical school.
     
finboy
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Jan 29, 2008, 01:48 PM
 
Originally Posted by Person Man View Post

That same procedure here would have been billed at $10,000 minimum. It's nuts.
Same procedure HERE (Houston) cost about $1,200 (as billed) in 2006 (or around 600 euros). Strange. Maybe being closer to Mexico lowers our healthcare costs (NOT).
     
Judge_Fire
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Jan 29, 2008, 03:39 PM
 
Around here, at my local pharmacy (24h) they tend to roam around the huge self-service area, answering questions and discussing product differences. Probably the best customer service in this country tends to be at these places, weird.
     
Oisín
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Jan 29, 2008, 03:59 PM
 
Originally Posted by finboy View Post
Same procedure HERE (Houston) cost about $1,200 (as billed) in 2006 (or around 600 euros). Strange. Maybe being closer to Mexico lowers our healthcare costs (NOT).
For a foreigner with insurance? Not a chance.

I’ve received and checked countless final invoices from American hospitals for outpatient procedures, quite a lot of which have actually been for miscarriages, and I’ve never seen one so low. Anywhere between $7,000 and $15,000 is the average I’ve experienced.

P.S.: World in general—please send 24-hour pharmacies, Denmark sorely needs them.
     
Person Man
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Jan 29, 2008, 06:18 PM
 
Originally Posted by finboy View Post
Same procedure HERE (Houston) cost about $1,200 (as billed) in 2006 (or around 600 euros). Strange. Maybe being closer to Mexico lowers our healthcare costs (NOT).
Perhaps the procedure itself, but by the time you add in the hospital's charges for the operating room, the pathology services, etc, you'd reach $10,000.
     
maxintosh
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Jan 29, 2008, 10:02 PM
 
Originally Posted by Oisín View Post
For a foreigner with insurance? Not a chance.

I’ve received and checked countless final invoices from American hospitals for outpatient procedures, quite a lot of which have actually been for miscarriages, and I’ve never seen one so low. Anywhere between $7,000 and $15,000 is the average I’ve experienced.

P.S.: World in general—please send 24-hour pharmacies, Denmark sorely needs them.
I can tell you when I got my nose put back in place (well, more or less) by the doctor when I broke it, they billed my insurance $5000. The procedure took about 30 seconds and involved shoving what looked precisely like a letter opener up my nostril and pressing until it cracked, then the doctor using his thumb and pressing on the bridge until it, too, cracked. No anesthesia or anything... hurt like a mother.
     
Oisín
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Jan 29, 2008, 10:37 PM
 
^ & ^^ Exactly.

Worst case I’ve ever seen:

A woman is walking barefoot on the beach in Santa Monica. Some idiots have had one of those spheric grill thingies standing directly on the sand while making hot dogs or whatever they’ve been making, but now they’ve gone home, taking the grill with them.

Woman accidentally steps on very hot sand where grill was placed a few minutes before and gets some pretty bad burns on the sole of her foot—second degree, though, not third.

She goes to some specialist clinic (possibly plastic surgeon specialty, can’t remember) and they give her some kind of liquid gel treatment and some other stuff, and plaster her foot up and give her crutches.

Couple of weeks later, the hospital bill arrives. It’s about $130,000. That made me do a triple-take or four (same with our ‘billing doctor’). I don’t know how much of that we eventually managed to get cut off the price, but if she hadn’t had insurance, she would probably never have been charged more than $3–4,000 at the most.
     
maxintosh
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Jan 30, 2008, 12:18 AM
 
What's interesting though, is they billed my insurance 5K and my insurance company sent me a notice they'd only pay $4,500 of it and the rest was my responsibility. However, I never, ever, saw a bill, and this was 5 months ago. I *think* they just wanted to see how much money they could get out of my insurance without ever intending to bill me for services. Seems kind of demented to me.
     
Oisín
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Jan 30, 2008, 09:22 AM
 
Five months? You may yet receive bills. Some US hospitals only seem to go through unsettled accounts about once a year, and then they send out letters threatening the patients with debt collection agencies almost a year after the treatment.

And if they send you a bill for something your insurance has already paid for (or something you’re not sure whether they’ve already paid for), send the bill on to your insurance company—again, some US hospitals have the attitude that, “If it works, it works”, and sending out double bills might just get some extra cash in. They frequently discover that there was an ‘error in accounting’ that led the patient to be billed an amount the insurance company has already paid.
     
maxintosh
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Jan 30, 2008, 02:03 PM
 
Well, it was a private practice and I've already gotten the bills for the visits themselves.
     
Oisín
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Jan 30, 2008, 04:27 PM
 
Then I’d say you’re likely safe. Must be your rugged good looks or something.

(Oh, hang on—you’re not Bill Gates?)
     
finboy
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Jan 30, 2008, 05:04 PM
 
Originally Posted by Person Man View Post
Perhaps the procedure itself, but by the time you add in the hospital's charges for the operating room, the pathology services, etc, you'd reach $10,000.
Nope, I'm quoting all-in. Doctor services, hospital outpatient charges, everything. A full D & C.

I mentioned this to a friend of mine today, who helped us through it (and ended up going through it last year herself). It was a few hundred more in '07.

ANYHOW: Back to the topic.

The Pharmacist used to have a different role, but nowadays they're limited because of liability exposure. They can't practice without a license, although that's what the pharms in most small towns here did for the past century.
     
Oisín
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Jan 30, 2008, 05:08 PM
 
Originally Posted by finboy View Post
Nope, I'm quoting all-in. Doctor services, hospital outpatient charges, everything. A full D & C.

I mentioned this to a friend of mine today, who helped us through it (and ended up going through it last year herself). It was a few hundred more in '07.
Then either a) you’ve been to some kind of partially funded hospital, b) you paid directly, without involving your insurance company, c) you’re talking about the amount that you paid, after the insurance company paid their bit, or d) you’re Bill Gates, too, and they liked your rugged good looks.
     
kovacs
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Jan 31, 2008, 05:42 AM
 
Hi guys, I work as a pharmacist in Belgium.

Most drugs in Belgium are only available in pre-pakaged boxes from the supplier so I don't have to count them. I still have to make some drugs myself everyday, combinations of drugs that are not commercially available or doses that are not available. I also have an insurance for me and my assistent for any medical errors I or she may make. We have a computer system that checks for drug interactions but I don't have it turned on on my computer, my assistent uses this system and has to ask my advice when the system detects a serious interaction. I am responsible for any mistake she may make. The system however doesn't detect errors made by the doctor, and they make plenty believe me, most of the time I correct these mistakes without the patient knowing anything about it. Some mistakes however require a call to the doctor or a new prescription. I also try to give the patient advice and information about the drugs that are prescribed, how should they be taken, what side effects can be expected and what they can do about it, ... I know most patients very well, so I know what medication they use and can give advice when they need an over the counter drug ( aspirin, ... ). Normally no drug is available without asking a pharmacist for it, they can not take the drugs themselves nor can they buy any in a supermarket. They also don't have to wait for it, if I don't have the product they require I can order it and have it within a few hours, we get five deliveries a day !
I usually do not give medication that is only available with a prescription to patients without a valid prescription, most drugs like Lipitor are way too expensive without a valid prescription anyway, so they don't even ask. In most cases it's much cheaper to pay for a doctors visit plus the price of the medication with prescription than pay the full price for the medication. With a prescription most drugs are very cheap or free and normally everybody in Belgium has free healthcare insurance.
     
SeSawaya
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Jan 31, 2008, 11:55 AM
 
Drug sampling slows things down a bit.
     
medicineman
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Feb 25, 2008, 10:22 PM
 
hmm. What do we do all day? Let's see your Rx. The insurance card you gave me was for doctors and major medical, not the one for prescriptions. Perhaps the online error message will give me a clue. Okay we figured out what card you need, but of course you don't have it. We'll call your insurance company, if we can get through 4 or 5 levels of automation.

The doctor neglected to put his DEA number on the prescription because it was not a controlled drug. Well, 9 out of 10 insurance companies will reject the Rx, because since the inception of online adjudication, the DEA was the physician identifier. Now being replaced by the NPI (because we don't have enough identifying numbers). If we can get through to the doctor, it usually winds up with, "I don't give out my DEA for children's vitamins!". Let's check the NPI registry and see if the info is online.

And sometimes things like this: http://www.sparagus.com/members/rich/img022.jpg
or: http://www.sparagus.com/members/rich/img023.jpg
or: http://www.sparagus.com/members/rich/img024.jpg
or: http://www.sparagus.com/members/rich/img025.jpg
might take a few minutes.

This all might be punctuated by: "hey doc, can you give me 5 of these pills, my mail order pharmacy is slow?"

Typical conversation, "Do you have a good burn cream?"


Smile and get to know your pharmacist. His name even, because he's supposed to remember yours and all the meds you take.
     
medicineman
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Feb 25, 2008, 10:28 PM
 
oops. I messed up the conversation:
"Do you have a good burn cream?"
"Is the skin red, blistered or open?"
"Why?"
"Because the treatments are different."
"It's red."
"You don't want to put a cream on a burn. The burn is caused by heat. Ointments retain heat. You want to remove heat. Use cold running water or ice."
"Okay. What kind of cream do you have?"
     
cjrivera
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Feb 25, 2008, 11:07 PM
 
I can actually make out most of that.... which is really sad.
"It's weird the way 'finger puppets' sounds ok as a noun..."
     
ghporter
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Feb 26, 2008, 08:33 AM
 
Originally Posted by cjrivera View Post
I can actually make out most of that.... which is really sad.
Indeed. It shows you've had lots of experience reading other physicians scratchings.

The thing is that these things are so illegible because the doc is in a hurry to just bang 'em out. They're often that way with orders in inpatient charts-but that backfires on them. With current JCAHO guidelines, (along with self-preservation, of course), nurses need to be 100% sure of what the heck the doctor ordered, so the docs get paged, tracked down, even run down in the hallway to decipher what they wrote on paper charts. "There's never time to do it right, but always time to do it over" really shouldn't be their mantra...

I'd like permission to use those scrip images in class. Some of my OT classmates have never really seen how horrible doctorscript can be.

Glenn -----OTR/L, MOT, Tx
     
Oisín
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Feb 26, 2008, 11:14 AM
 
US doctors make their prescriptions by hand?!?

I don’t know exactly how it works over here, but when my doctor gives me a prescription, she enters it into her system (note: enters, not types—she’s choosing from pre-existing values of some sort). The prescription is printed on a piece of paper then. It also has a unique identification number (and a barcode version of it), which is scanned at the pharmacy, and they can immediately see all the details of the prescription, including doctor’s details, detailed descriptions of the drug(s) prescribed, and (I think—it looks like it, at least, the way they use it) alternative retail drugs with identical active agents, if the doctor has prescribed a brand rather than just a drug.

Takes them about five seconds to read and process the prescription itself.

And of course, there’s no insurance bother involved, since it all goes to the same ‘insurance’ box (aka socialism).
     
 
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