r/medicine•
IVF-MD

Pharmacist being careful or overstepping her position?

I'm a MD specializing in fertility. Today, a patient undergoing fertility treatment also had a URI with a lot of coughing and asked if I could call in a prescription for symptomatic relief. My nurse called in Cheratussin (with Codeine). The pharmacist refused, saying that a medication with codeine can't be called in. So I hand-wrote and signed a prescription on my pad and when she went to pick it up, my patient was told by the pharmacist that they can't fill it because I am a fertility doctor and this should be written by a PCP, as it is outside my "scope of practice". That was a direct quote from her when my nurse called and asked for clarification as to why they are rejecting the prescription. For 20 years, in addition to a lot of fertility medications, I've also been been regularly prescribing anitbacterials for UTI's, Diflucan for candida. And every single patient gets Valium prior to their embryo transfer. So I write for that over 100x per year. And today, some pharmacist is telling my nurse that "Cough medicines shouldn't be prescribed by a fertility doctor. It should be prescribed by a primary care doctor or PA". Anyway, it's the end of a busy day and I thought I would vent. It doesn't affect me. It just inconveniences my poor patient who is already dealing with the stresses of infertility treatment and it amuses me because it came as quite a surprise.

Update: I was almost looking forward to having a professional discussion with this pharmacist, but my NP took care of it. The pharmacist (who my NP said sounded kind of uptight) decided to fill the prescription "just this one time" but "Don't do it again. Next time have the patient go to their PCP", they told us. That was my entertainment for the day. :)

UPDATE: I respect most pharmacists and have gotten useful information from them when I proactively asked them for their help. In this case, I didn't ask for help. After piecing together the events, I conclude that this pharmacist was not malicious. I really think she was just a scared corporate employee who stuck by the "I must follow orders" mentality, as some of you have suggested. The fact that healthcare has gradually drifted towards that type of mentality is a much bigger problem and a whole other conversation. Thanks for all the comments. I learned a lot.

Posted Dec 6, 2018, 1:14 AM UTC · edited

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