Working together for the greater good: MD vs. RPh

David StanleyIt started the way so many of these things do, with a phone call to get the ball rolling on a prior auth. “I’m not sure that’s the strength the doctor meant to prescribe,” the lady at the group medical practice said. “I’ll have to check and call you back.”

That was on Friday morning. On Saturday morning a friend of the patient - who was seriously ill and having trouble breathing - came in to get the prescription. No one from the group practice had called us back. You know exactly how this goes.

See also: The No. 1 priority and the public good

Step 1: The doctor is out

First, a test claim. The far-more-common strength of this nebulizer solution would go through the patient’s insurance just fine. Actually, it would also be easier to use; the only difference between what we were told “was probably wrong” and what was covered was that the paid-for med didn’t require predilution. The solution to this problem was in sight.

You can guess what happened next.

“Well that doctor’s not in today. If the patient’s really ill, they should go to the emergency room.” This, of course, was delivered after a lengthy hold. Evidently the concept of paging a physician was long forgotten at this practice, along with asking the doctor on duty for his opinion.

See also: The tiny alternative to the pharmacy megamerger

Step 2: My life on hold

One thing they can’t teach you in pharmacy school is when not to take no for an answer. Fortunately, I knew the doctor on duty this day had a good helping of common sense in his head. It took a while, and I had to sit through another lengthy session on hold - which I suspected the staff made longer than necessary to penalize me for being a pain in the neck - before the doctor got on the line. Our conversation went something like this:

Step 3: Work with me here

Me: “Can we do the commonsense thing here that everyone knows is best for the patient, and give her the easier-to-use, far-more-common strength of this nebulizer solution, which most likely was what was meant to be prescribed in the first place?”

Doctor: “Absolutely.”

The end was in sight. Just some quick phone counseling with the patient, who was at home and gasping with every word, to make sure that original prescription wasn’t what the original, unwilling-to-be-reached doctor really wanted.

Step 3: What machine?

“When they were going over how to use your nebulizer machine, did they say you would have to dilute this medicine first?”

 “What machine?”

They had sent this woman out the door with a prescription for medication to go in a nebulizer without ever mentioning that she would need a nebulizer.

Step 5: Calling around

Back to the phones to call around, until I located one at the independent drugstore in the next town. It was the best I could do, as I didn’t have a nebulizer in stock. I gave the friend directions to the store and came to grips with the fact that this was the best solution I could engineer. Not perfect I thought, but not all bad. Now it was on to the next crisis.

Mid-morning on Monday someone from the group medical practice called.

Step 6: Count to 10

“We just wanted to let you know the on-call doctor took care of that nebulizer prescription with the strength issue.”

They were probably lucky that my technician took that phone call instead of me.

Not that this was anything special. Things like this happen every day, in every pharmacy in every corner of the country.

Feel free to tear this page out and give it to the next person who says that pharmacists are soon destined to be replaced with machines.