Thursday, February 17, 2011

I have a sore throat. Can you write me a script?


Things are still slow at the office, and it is really tight around here. I decided that I had to take away some benefits (not life-changing) to try to maintain the health of the practice long-term; that kind of went over like a turd in a punch bowl.

I mean, the staff is being pinched in all directions. There are fewer of them. There hasn't been a bonus in a couple of years. Medical is costing everyone tons of money (and it is going to get worse), and now I am taking away some of their vacation time.

But what am I to do? It sucks being the heavy. When everyone is making money this job is so easy. You are the bomb. But when it is tight, you are a jerk.

I saw a couple of movies last week. Repo Men was a futuristic movie. The premise is that organs are now made by a bio tech company so everyone that needs a transplant can get one. One problem, they are very expensive. So if you get behind on your payment, the repo men come and get back their property. Oh yeah. I thought it was good but they over did the gore way too much.

Then I saw The Secret in Their Eyes - a foreign film with subtitles. It was okay, but I had a headache after the movie from reading for two hours.

Noah had a beaut the other night. At the dinner, table we somehow got on the subject of being particular about people touching us. And then we asked who is the biggest germ-o-phobe in our family. Noah says, "I am."

He then made a disclaimer. "I am not a German-o-phobe. I am a germ-o-phobe." He wanted to make it perfectly clear that he didn't have a problem with Germans. Don't forget he, is 7. I didn't even know that he knew that there are more countries out there.

Today, I want to talk about something that we ALL have to deal with: people asking us to write scripts for them.

When you first get out of school, you think it is cool, so you write a script or two for your high school friends that have colds and sore throats. I mean, for crying out loud, it is just antibiotics. I know that these people are going to go to the doctor and they are just going to write them a script anyway.

But inevitably, this thing starts to snowball. Now your friends have friends and so on and so on. Then you have people you don't even know asking you for scripts. How about your staff? They have been battling a wicked sore throat for about a week. They are threatening missing work. You know that it is either viral and they are about to get better or it is strep. You know that if you give them a Z-pack or Augmentin they are going to be 100% in a couple of days. Then it is your friends from church. And then that angle starts to snowball.

First it is antibiotics, but every once in a while, someone will ask you for a pain killer. Then someone will ask you for a sleeping agent. How about a friend's pregnant wife? How about scripts for your wife? Or your kids? How about scripts for yourself?

Are you guys wrapped up in this vortex? Are you comfortable being people's physician? I am not. I did this for awhile and it became increasingly uncomfortable for me. I made it very clear early on in my career that this was not going to fly.

Listen, if someone is sick they should do to the DOCTOR. No if, ands, or buts about it. I know you are super important and you have a really busy schedule and all that, but GO TO THE DOCTOR. I know that money is tight, but I am not your doctor.
Now with the advent of "Minute Clinics" in our grocery stores or CentraCares or After Hour Pediatrics, there are no excuses.

For about 5 years now, I have had trouble sleeping. I am not a big sleeper anyway, I am thrilled with 7 hours. When I hit the pillow and I realize I am only going to get 6 hours it is not a problem. The problem is when my alarm is set at 5:45am and I get up at 3:45am, up again at 4:25am then up again at 5:15am, then I hear the alarm.

A week of this, and I am a son of a bitch to be around. Then after a couple of weeks of this I start to physically feel worn down and then I get sick. I know not sleeping is not healthy.

So I went to my doctor (what a concept) and he gave me some sleeping pills. Dude, have any of you tried this? It is the BEST stuff. I heard someone say once, "You don't even remember falling asleep." You wake up 9 hours later feeling like a million bucks. The only caveat is that you have to be able to sleep at least 8 hours - don't take it at midnight and set your alarm for 6am.

Now for me, I can't take it during the week because I know I am not going to get 8 hours. I can't take it on Saturday mornings because I run and get up at some crazy hours. So I will occasionally take it on Saturday night; a bottle of 25 might last me over 2 years.

A couple of years ago I was having sleeping problems. So I did the right thing and told my new doctor about this. I gave her the rundown and she was hesitant to write up a script (maybe because she heard of the people on sleeping pills getting in their cars in middle of the night and having wicked accidents and waking up after the accident, never knowing what happened). So, first she told me to meditate before I went to bed. I said, rolling my eyes, "I will give it try." After six months, I went back and told her again and she begrudgingly gave me sleeping pills. I took one regular pill and I went to bed fine, but I still woke up through the night. So, they didn't help.

I knew I was in a bind. She had a problem writing me a script for the regular pills; what is it going to look like when I come back 3 weeks later (even though I had only taken one pill) asking for a controlled-release version.

I run with three people with script pads, so I asked one of them if he could write me a script for the controlled-release version. He said it wouldn't be a problem because I am in his office's system (I'm in the system for my vasectomy, just in case you are wondering).

A couple months later, I asked the other guy in the running group (who is from the same office), and he looked like he had a problem with this. You know, like he was uncomfortable with it. Then I realized something: I am that guy - the guy asking for a script. He said he would do it, but don't tell anyone. I wasn't going to tell him that the other guy said he would do it, no problem. I just took it and ran (and felt a little dirty).

I have let everyone know that I am not writing scripts anymore. My brothers and sisters call and ask me and I usually turn them down (unless I see blood). My friends don't ask me anymore. My staff doesn't ask me anymore (if they do, they come to me saying they have a toothache and it is making their throat hurt). The stream of people has almost stopped.

I am always so careful about giving scripts out. I know the local pharmacist fills a tons of scripts, and I wonder if they see what is going on. I wonder if they see my write a script for my dad and make a mental note. Or see me writing Augmentin for my mom, knowing that there is not much in dentistry for which Augmentin should be written.

You know how I feel about my reputation. It is almost an unhealthy need to be respected around town. And a pharmacist is definitely someone that you want liking you.

So... Am I wrong? Does anyone know a pharmacist? What do they say? Do you write scripts for everyone? (I don't care if you do. I want you to comment and tell me what your thought process is). Have you ever thought about it before? Are you now rethinking your script-writing? Have you cut everyone off? Tell me, tell me.

Have a great weekend,


Anonymous said...

I think it can be incredibly dangerous not for you but for the other person. Most people don't know the side effects or reactions that can occur when taking multiple medicines. I would guess they aren't sharing with you all of the meds and vitamins they are taking. It takes someone very knowledgeable about drug to drug interactions to make sound decisions in giving out proper medicines. Also giving out antibiotics just because someone "needs" one can be dangerous. Taking antibiotics like candy leads to resistance and if not taken properly can possibly lead to bigger medical problems.

Anonymous said...

I'd do standard analgesics (paracetamol, maybe some ibuprofen) for general use because it's cheaper than OTC. That's about the limits of what I'd prescribe.

I did make an exception for a good friend whom I know to be generally fit and healthy, who got terribly ill and could not get in with a doctor for at least 2 weeks. I prescribed some Amoxycillin 500mg QID and he improved immensely over the next couple of days (made sure he finished them though!)

Anonymous said...

I just don't do it. If the script is for a condition out of my "scope of practice" then it's just not worth the risk. When friends ask they have to be patients of record and the issue has to be dental.

Defensive Dentistry said...

Pharmacists definitely know and remember. They have minds like steel traps and they forget nothing. They have to be wired that way to make it through school. Trust me, they are on to you. Pharmacy students are taught that dentists are the worst about writing inappropriate prescriptions, especially for antibiotics. They might cringe when they fill them, knowing that there is the potential for setting the patient up for MRSA, C. diff or MDR pseudomonas. If it were me I would think twice before putting pen to Rx pad.


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