Maybe I jumped the gun, but I don’t see how either doctor was incompetent. In this case, the doctor was rude to the pharmacist, but not in a way that would raise many eyebrows. And it is a reality that many patients “allergic” to one drug can take a similar one safely, although I would not take that chance myself. In a previous thread, where the doctor did not want to prescribe the patient a medicine that had worked in the past, I saw nothing to suggest incompetence, though clearly his bedside manner needed work.
[QUOTE]
*Originally posted by
Muffin * . . . not have the qualities requisite for effective conduct. That is incompetence . . . .
Incompetence is not having the qualities requisite for effective conduct.
Were either of the doctors effective? No. Did they have the qualities requisite to being effective? No, or at least they certainly did not exhibit them. At the least, and without geting into whether or not a person was ever put at risk, you have identified that one doctor was rude to another professional, and the other doctor’s bedside manner needed improvement.
One would hope that a formal drawing of attention to their incompetence would encourage them to develop the requisite qualities.
Again leaving behind the issue of whether or not either of these doctors may have put a person at risk, and instead just looking at the conduct which you have identified, if you believe that extending professional courtesy and having a proper bedside manner are not requisite qualities for effective conduct by doctors, then by my definition these doctors were not incompetent.
However, I believe that extending professional courtesy and having a proper bedside manner are requisite qualities for effective conduct by doctors, and those that fail in this regard should develop competence where they are lacking.
Doctor 1 said ‘Don’t be stupid. Just give him the prescription’
Doctor 2 said ‘No’
OK, there may be mroe we don’t know (for instance, it sounds like it wasn’t actually doctor 1’s job, and he was in a hurry), but on the facts as given Doctor 1 sounds scary What’s with this ‘just rude’?
I can see how you and I differ as to what constitutes incompetence, for under the Health Professions Procedural Code (Ontario), the following applies: “52. (1) A panel shall find a member to be incompetent if the member’s professional care of a patient displayed a lack of knowledge, skill or judgment or disregard for the welfare of the patient of a nature or to an extent that demonstrates that the member is unfit to continue to practise or that the member’s practice should be restricted.” To me, that is too low a standard, for I would hope that something about remediation would be tacked on at the end.
kspharm, I feel your pain. I am a pharmacy technician. I have been one for almost 13 years now. I worked retail pharmacy for almost 9 years before gettting out. And there is one doctor in this town that is practically responsible for me quitting retail.
He wrote an Rx for an eleven month old patient. The baby apparently had a wicked cough, and the doctor chose to use Tussionex. Instead of calculating the dose for a patient (and IIRC Tussionex is not supposed to be used in patients under a certain age; I don’t remember all the details) that was only 11 months old, he just wrote any old directions down that he thought of, apparently.
He wrote the prescription for 1-2 teaspoons every 4-6 hours as needed. The regular adult dosage is 1 teaspoon every 12 hours. (again, IIRC) It is also recommended that you don’t take anything more than that, because of the side effects of this medication. So, I called him up, to ask him if he would like to change it to something else, and offered to fax him the information from the Facts and Comparisons book.
He told me that he was going to report me to the Board of Medical Review for “prescribing without a liscense”. He told me that I was acting as a physician, and that he would have my liscense yanked in a heartbeat. (Boy was he really miffed when I told him that techs don’t need a liscense in SC.) I tried to explain to him that I was trying to help him out, and that there was no way our pharmacist would fill this order, because the dosage was incorrect. He finally started screaming at me, telling me not to tell him how to do his job, so I just put him on hold and gave him to the pharmacist. She promptly picked up the phone and told him that what he wrote for the child was a potentially lethal dose, and that she was not going to fill it. He threatened to have her liscense, too.
So, there are some good doctors out there, who are at least willing to listen when you have a recommendation, and then there are some who just have their head so far up their asses they can’t see straight. Sorry you had such a bad experience.
Don’t let the frustration the first doctor generated dissuade you from doing the exact same thing again in the future should the need arise. We’re counting on you.
KSPharm… You have my empaty. Pharmacists have a difficult job. so do nurses, and doctors. We all have to double check ourselves and each other. Im a nurse, in a care facility, so we often have docs prescribe over the phone and never lay eyes on the patients. Sometimes we have to suggest medications… not prescribing… but suggesting what has worked on others. I had a doc jump to a a suggestion of zyprexa (which he’d never heard of… couldnt spell, and this is only last week!) but he didnt want to read the monograph…Ive had doctors order Sulpha for allegic people…Tylenol #3 with codine to codine allergic patients…
That said Ive had a pharmacist dispense Maalox instead of Milk of Magnesia (and she was still constipated, wonder why?) “lose” orders and dispense “Contin” (long acting non crushable drugs) to people who can’t swallow pills. Misreading handwriting. things happen.
Nurses have given Gravol instead of Benadryl because generic lables were misread…
Nobody’s perfect but three separate people sure help eliminate errors.
Congratulations for your good job. Sorry the doc had such a case of head in ass disease.
Perhaps, perhaps not. Codeine, hydromorphone, oxycodone are all metabolized into morphine in the body. The number of patients allergic to just some of these medicines (and take similar ones without any problem) has always astounded me. This number is very high indeed.
Allergies are funny little things and it is strange what ends up working. kspharm was certainly right to bring it to the doctor’s attention, and if I was the doctor I would have listened to him. That said, the claim he saved a life may be overstating the case.
And I would define incompetence in a medicolegal sense, as muffin did in his last post. Doctors should certainly aim for a higher standard, but I don’t think a doctor is incompetent if he is “rude” to a nurse by telling her brusquely to pass an instrument at a critical point in an operation, for example. I don’t think a doctor is incompetent for not doing what the patient wants.
I moved to a new place, and signed a contract to work there. I paid a lawyer to review it. He spent half his time working with a law clerk on the interpretation of one item, which in fact he misinterpreted – hence his advice regarding that issue was completely off base. Is this lawyer incompetent? Should the legal profession be held to the same high standards? What would it take to get a lawyer proven incompetent if he/she lost your case, hmmm?
In an ideal world, neither doctors nor lawyers would ever make mistakes. There are very few situations, however, in which a lawyer’s mistake would directly result in hospitalization or death, and in fact I can’t think of a single one where death would result within minutes. That’s what the appeals process is for. Plus lawyers (especially non-litigators like contract attorneys) hardly ever have to make split-second decisions; they can ponder all possible outcomes at their leisure.
So if anything, it’s far more important for doctors not to make mistakes. And hell yes, that doctor should be reported; let the appropriate medical/credentialling authorities decide whether he did the right thing in prescribing a drug with the potential to cause an allergic reaction. Why should he do it at all if there are safer alternatives? And if you’re saying the pharmacy tech isn’t a doctor and therefore shouldn’t be allowed to excercise discretion, then isn’t that what review boards are for?
If a lawyer screws up, then report the lawyer to his or her governing body (the LSUC in your case). If it is a trivial matter, probably nothing will come of it other than a note or call to the lawyer, but if the trivial matters pile up, the LSUC will try to work with the lawyer to get him or her to improve. At the low end, this might include therapy, further education, mentorship, or even supervision. For more serious matters, this might include sanctions ranging from fines to temporary suspensions to being tossed out of the profession.
If a lawyer provides advice that is totally off base, in addition to reporting the lawyer, demand a refund for both the fees paid for the bad work and full compensation from the lawyer for the the loss caused by the lawyer. If the lawyer (or the lawyer’s E&O insurers, or LSUC) does not pay out, then take it to court.
What would it take to win against a lawyer in a claim of negligence? Prove that the lawyer did not act as a reasonable lawyer would have.
Should lawyers be held to the same standard as doctors? Absolutely!
BTW, just as you are under the HPPC s.52, I’m under the Rules of Professional Conduct s.2.01:
If it’s any comfort, kspharm, doctors of this ilk express the same sort of attitude towards their patients.
“I was wondering if perhaps, since you recommend an anti-inflammatory, I wouldn’t be better off with a non cortical stearoid anti-inflammatory formula, since I’ve had problems with other cortical…”
“No, just take this. Works for all my patients. (Besides, the pharma reps always give me cute toys and treat me to a phenomenal lunch and even give me briefcases and stuff). Oh, and quit reading medical stuff on the internet, it’s all shit.”
Thank you for being one of the few who bother to pay attention and who give a damn.
My grandma obtained an additional 20 years in her own home because a pharmacist put his foot down and said half the prescriptions she was on were interfering or interacting with each other with fallout in the mental zone, and the other half were poorly considered prescriptions that attempted to address the mental side effects as if they were fundamental conditions. Cut her dailies from about 22 separate drugs to 6 and in less than a week she was making perfect sense and had us over for dinner that she cooked unassisted after shopping effectively (and, again, unassisted, including driving to and from) for the first time in years at the grocery store.
I love and trust my doctor, but I have never taken a prescription from him without first checking it out thoroughly with my pharmacist. Nineteen times out of twenty, the pharmacist agrees with him on my meds, but every now and then she thinks of something he didn’t, or that I didn’t think of… it was my pharmacist who remembered that I’d had a violent reaction to prednisone, and it was also she who noticed that two different doctors had prescribed conflicting meds for me another time. And twice she’s stopped me from paying beaucoup bucks for scrips by pointing out that there are some OTC meds that would work just as well. Fortunately, my doctor is terrific about her input, and has not once contradicted her advice.
A good pharmacist has saved my life before (well, maybe not my life, but certainly saved me from a nasty allergic reaction) and a bad pharmacist almost killed my husband (filled a prescription for a cardiac drug with the wrong dosage - but the bottle didn’t reflect that and the pills looked almost the same). I take pharmacists pretty seriously, and I’m grateful for the good ones like you.
How I wish a pharmacist had taken the same steps for my gramma. She spent most of my teenage years high on one thing or another. It took family insistence of a trip to the Mayo (and a similar cut in her medication) to make her give up her doc.
Dr_Paprika, if you looked at the title of my thread, it says I tried to save a life…. I did not claim that I saved a life. I was merely trying to allert the prescribing doc that there might be a problem. I know that allergies are funny things, as you said, and in my personal experience most patients that claim they have codeine allergies aren’t allergic. When I don’t have enough information, though, I try to follow up. I really did not appreciate the first doc in this case treating me like shit. There is no need to talk someone that way, no matter what the situation. And BTW, I fully support M.D.'s as far as malpractice insurance issues go (Pharmacists especially, as well as nurses, deal with the same thing). Peace
My doctor friends always say that you could replace every pharmacist with trained monkeys; same or better results.
You caught an idiot doctor who made a wrong and potentially deadly decision and use that as an argument that doctors in general require pharmicists to do their jobs right.
I wonder how many pharmacists have caused fatal and potential fatal situations. Let me use that anecdotal assumption as a reason for a rant that asks for pharmacist replacement by monkeys.
Better yet, replace them with robots/computers that have fail-safe build in (that’s what you are using as a reason for pharmacists to exist: second level check for erroneous prescriptions).
Hinten, do you take your smart in homeopathic doses?
Read the OP again, and I think you’ll find nothing of the sort. kspharm mentioned two docs; one was rude and stupid, and the other was intelligent and helpful. Nowhere does he draw a conclusion about doctors in general from that.
Sorry, kspharm, I realized the thread title only after submitting the reply. Again, you might very well have saved this man’s life, and you deserve kudos for contacting the doctor and doing a good job. The discussion of allergies was more directed to those who see this as a clear cut case of medical incompetence, where I just see an unprofessional asshole doctor who is begging for trouble down the road (not the same thing).
I probably get one or two calls a day from a pharmacist (often they don’t have a specific medicine in stock, question use of a high dose protocol of amoxicillin in otitis media, need a “limited use” form for the patient’s drug plan, question on why I lower the dose for elderly patients). Not uncommonly, they inform me of possible drug reactions (usually with erythromycin, which I prescribe commonly). They have saved my bacon several times, though, informing me of a possible allergy the patient neglected to mention, diplomatically suggesting the CORRECT dose, etc.
I always have time to talk to the pharmacist. They often know more about the medicines than I do. They are unfailingly polite and diplomatic, and if I don’t always agree with them, the discussion is important and unfailingly helpful. If I do disagree with a pharmacist who calls me, it damn well needs to be for a better reason than “I’m a doctor”. Must be hard to stay diplomatic as a pharmacist when a doctor sloughs off your good advice. Well, hats off to the lot of you.
