Judging by many of the new prescriptions (Rxs) I see every day, I believe doctors and other prescribers do not write many of the prescriptions that get to the pharmacy. If you are a patient, I hope this encourages a little sympathy and patience.
We get Rxs delivered by hand, sent electronically, faxed, and phoned. Quite often these orders are a mess of malarkey. Much of the problem stems from the use of computers in medicine. Government reimbursement for medical services is higher for those offices using electronic records and ordering, so thousands of doctors across the country are trying rapidly learn new, complex software. Often they must learn more than one, in their own office, at one or more hospitals they see patients at, as well as variations of navigation depending on what device is being used.
The most egregious errors we see are in drug selection. Most medical software have one of those little bars with a triangle at the end which “drops down” and list from the first few letters typed or when the little triangle is clicked. Another click selects the drug that will appear in the Rx. Too many times, every day, there is a mis-click and we get the line above or below the intended target, or the entire description is not read and the first easy target is selected. Another type of error seems to occur when the doctor gives a verbal order to an office personnel and they make an (ahem) educated guess.
I saw this today as I was processing four electronic Rxs (e-Rx) that included 2 antibiotics, omeprazole, and bismuth subgallate. Now here the 2 antibiotics plus generic Prilosec gets me thinking h. Pylori therapy for an ulcer or GERD. The standard regimen calls for Pepto Bismol (aka a suspension of bismuth subsalicylate) NOT bismuth subgallate. Bismuth subgallate is give given to ostomy patients to reduce odor in the collection bag. A phone call corrected the problem fairly quickly in this case. I was not told if it was a mis-click, an incomplete reading of the description, or a mis-selection by an inadequately trained personnel.
Another troublesome time-suck comes from poorly trained staff calling in verbal Rxs and leaving them on voice mail because they “can’t wait on hold.” So they opt into voice mail, speak as fast as a coked up carnival huckster, mispronounce names of people and drugs and omit required information. My wife had a young lady leave an order for Alpha Zolam today. Of course, my wife had to then call the doctor’s office, wait on hold, and try to get clarification, only to have a snotty response that it was an order for Alprazolam. I once talked to a person who insisted the order was for Mr. Clean. Finally has to get her to spell it to learn it was for Mysteclin and my fault for not understanding in the first place. Hurry, hurry, hurry and somehow respect and common courtesy evaporate.
We also love the eRxs that come for bizarre quantities, multiple sets of instructions (sigs), cryptic messages in the notes field, and just plain non-existent products.
Oh sure, we still get plenty of indecipherable hand written ones too!
I am hopeful that this will all get better. Of course, I’ll be spending my days on a beach by then.