Rules for Physicians
In the New York Times health blog, Tara Parker-Pope draws attention to a blog by Dr. Robert Lamberts, an Augusta, Georgia primary care physician. The blog (http://www.musings.org) is usually informative, often funny, and occasionally infuriating. Dr. Lamberts has created lists of rules for physicians and for patients (how to be a better patient.) In his honor, here are some rules for physicians dealing with pharmacists:
1) Write either legibly or illegibly, not in-between: http://www.musing.org,legible prescriptions are best, but if it’s completely illegible, then I’ll call. Too many prescriptions are semi-legible, look like one thing, but were supposed to be another. That’s how mistakes get made. The extra few saved by scribbling aren’t worth it.
2) Come to the telephone: telephone communications are supposed to be between physician and pharmacist, but too often, the physicians assign these calls to their office staff. In many states, telephone prescriptions dictated by anyone but a licensed prescriber are illegal. What’s particularly annoying is when we call to alert the physician to a prescribing error, and they still won’t speak to us directly.
3) Don’t say “I’ll take responsibility”: The pharmacist is an independent professional, and filling a prescription is effectively a collaboration between two colleagues. Our responsibility is to the patient, not to the prescriber. If we feel that a drug or a dose is unsafe, we can’t fob off responsibility and liability if something goes wrong. Part of the problem is that we can refuse to fill a prescription if there’s enough evidence to convince us that it’s dangerous, but we can’t counterprescribe. So, if the physician orders penicillin for a patient with a penicillin allergy, the pharmacist has an obligation not to dispense the drug, but that leaves the patient with an infection that’s not being treated.
4) Talk to your patients: This is a serious problem, and it’s built into the system. Physicians and pharmacists are both pressed for time, and what gets cut out may be the most important part – the counseling. Maybe physicians assume the pharmacist will do it, and pharmacists assume the physician will do it, and too often the patient never gets counseled. Neither one should rely on the other.
There are more rules, but these would be a good start.