Pain

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Today was a bit busier than yesterday. We had quite the Sunday rush, and the front store was short a person thanks to the stomach bug that’s been going around. So, all in all, I guess I got what I was wishing for yesterday, haha.

The major theme I came across today was people’s reactions to pain. It amazes me how different people are when they’re in pain vs. when they’re not. They are almost a completely different person. I personally know a few people who suffer from chronic pain, so I have known about this phenomenon for a long time. But still, the reactions I see in the pharmacy sometimes surprise me because they’re so over-the-top.

There was one woman who came in today. She had just had major abdominal surgery done and was in a great deal of pain. She brings in a script for a narcotic pain medication. When it was run through her insurance, I received a rejection message stating it was too soon to be filled until the following day. I told her this, and she asked if she could just pay cash for it. I refused because of what the medication was. Had it been a non-controlled maintenance medication, then I would have let her pay out of pocket without any problems. But, seeing that it belonged to the most controlled class of medications, I politely told her no.

She immediately started screaming about how much pain she was in and that the doctor told her she could get it filled early because the directions were changed. Because she had gotten it at another pharmacy the previous time, I could not verify this without calling them, and they were closed. I told her if she got a hold of her doctor personally, and he authorized the fill over the phone to me, I would fill it, otherwise, my answer remained the same. She banged her fists on the counter and continued yelling. She couldn’t understand why it was her responsibility to call the doctor and not ours. At our pharmacy, when a person insists a narcotic is allowed to be filled early, the pharmacy personnel do not call on it. We have quite a number of people that have had past issues with prescription drug abuse, so we choose not to cater to them for safety issues.

To make this long story short, the physician did end up calling me and verifying that it was, indeed, allowed to be filled early. He stated that he gave her a very limited amount of pills for this very reason. I filled them for her, wanting to just get her out because her carrying on was making some of the other patients in the waiting area nervous. I went to the register to start ringing her out. That’s when it happened–the words, “I’m sorry,” escaped from her mouth. It’s very rare that we hear apologies from the people that have two year old inspired tantrums over their medications. I was shocked. She apologized for her behavior; she was just in a lot of pain. After some more apologizing, she left.

Other similar things happened today, all of which were due to the patient being in pain. But, that was probably the best story of the day.

 

Image courtesy of http://i834.photobucket.com/albums/zz268/Sticher/pain.jpg

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6 thoughts on “Pain

  1. Hard/cold rules with people who are on “subjective meds” (pain/anxiety/mental health) serves no one well.. Consider someone in chronic pain and runs out of their meds.. may not only have their pain come roaring back.. but.. thrown into withdrawal as well.. double or tripling their physical/mental problems. Some feel that such action by Pharmacists is a form of pt torture and pt/senior abuse. What would be the problem with giving/fronting her a day’s worth – keep the rx and fill it the next day… you have the inventory covered with the Rx.. If she doesn’t come back.. you fill it for the tabs/caps given and cancel the balance on the Rx. IMO.. too many RPH’s are more interested in “bean counting” than pt care… there is not always a way around a problem .. when a controlled substance is involved… but.. all too often.. a reason to say NO.. is often sought out first.

    • If she had gotten the med (or any med for that matter) at our pharmacy prior to this visit, I may have been a little more lenient. I work in an area where we have a lot of drug abuse, so caution is always needed with everyone (not just pain patients). As you read, I did end up dispensing it. If I was worried about the inventory (“bean counting”, as you rudely call it), I would have told her we were “out of stock” and sent her elsewhere like some pharmacists do. Instead, I took the proper measures to determine that it was legitimate. A couple extra pills may not sound like a big deal to people, but my license is on the line with every medication. Had she been abusing the drug, taken it home, and overdosed on it, and I hadn’t checked with the physician first, I would have been open to all kinds of liability. A person can easily overdose on certain medications with only a few pills. Not only would my license be taken away, but my conscience would never let me forget how I didn’t take the extra time to check into it. With noncontrolled meds, I do front people pills, especially seizure meds and blood thinners, as long as they have gotten the prescription at our pharmacy before. There are also a few circumstances in which I have fronted or allowed the early fill of controls (just not narcotics), like Ativan, because I don’t want the person going into withdrawal. I also use the honor system with noncontrolled meds if a patient says we shorted them.

      I treat every situation like this individually. There have been several times I have caught people “doctor shopping” and pharmacy hopping. But, there are many more that I have filled. I am not here to be mean. I am not here to be a softy or a pushover either, though. I am here to insure people stay safe. Drawing on a previous entry, if people are angry that I am taking too long double checking something to make sure it’s safe, I let them be angry. They are better off angry than dead.

  2. Since 40+ states have a PMP.. why didn’t you check her background on the PMP? Sure you took care of her… only after sending her off the “deep end”.. what if she would have thrown a stoke or cardiac right on the spot because of some black/white arbitrary rule.. would you have no liability?
    You state that you have known chronic pain pts.. but according to your statement.. you have never really RELATED to their pain.. because if you had.. you would clearly understand their “over the top” actions/reactions at times.
    Fronting a pt ONE DAY’s worth of opiates.. is not going to throw the globe off its axis nor put a tear in the time/space continuum and the probability of a chronic pain pt – or even a addict – taking one days worth of meds at one time…will cause no long term ill effects. Given my specialty is pain management, I have a pretty good background of experience to support that statement.

    • Unfortunately, our state only allows law enforcement officials to access PMP information. I wish it were otherwise because then this would have never happened. And, I didn’t push her over the deep end. She flew off the handle when I first declined to fill it. I was willing to fill it if she could contact her doctor, which she did. I know she was in pain, which is why I didn’t yell at her or treat her like an addict. The nurse she spoke to called me before the doctor did and was calling her names over the phone to me, saying she’s been a problem patient from day one. I thought her behavior, even though the patient couldn’t hear her, was highly unprofessional. This may have been a reason why the patient so easily launched into a rage. I told her the nurse I still wanted to speak with the physician. There are many out there that have no empathy whatsoever. Also, at my pharmacy, we are not allowed to partial any narcotics, no exceptions. If we do, the remainder of the script becomes null and void. I need to document every time the safe is accessed. If I don’t have an explanation, I get in trouble. If she had gone into cardiac arrest there, 911 would have been called, and I would have preformed proper CPR if necessary until paramedics arrived. Considering the situation, my license would not have been at stake. I was following the correct procedures and doing what I could to verify and fill the script.

      I am done justifying my actions to you. I did nothing wrong. I acted in the way I thought was appropriate. No harm was caused, and the patient was dispensed the medication. Patients get angry with pharmacists on a daily basis over medications. This type of situation isn’t unusual in a community setting. If you disagree with my actions, don’t read my blog. No one is forcing you.

      • If you put your thoughts/beliefs out there and too “thin skinned” to take criticism – constructive or otherwise – maybe its time to rethink what you say and where you publish it.

      • If I couldn’t take the criticism, I wouldn’t have approved your comments. I’m just saying, you don’t have to read my blog if you don’t like what I write. I don’t read the works of people that I don’t agree with. I have my opinions; you have yours. And, that is perfectly fine. I don’t care how you practice pharmacy. That’s your prerogative, and I’m sure you’re a great pharmacist and that your patients love you. I practice the way I was taught, both in the classroom and in a real life setting. I feel comfortable publishing these little blurbs of mine. They are a record of my experiences for others to read IF they want. I am keeping this mostly for my benefit, but I figured if others liked it, even better. I am not here asking for others’ advice.

        Now, let’s just agree to disagree and move on like adults. Carrying on like this is foolish because there would be no compromise between us.

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