I thought I had seen it all...

So I got a phony phone-in prescription the other night. Not so unusual, right? What was it? Vicodin? Xanax? No...this chick was trying to call in her own prescription for...Diflucan! It went like this.

Ms. Itchycooch: "This is ER PA, agent of Private OBGYN, and I need to call in a prescription."

Me: "Ok..." I call shenanigans on this one at the first sentence, but I play along.

IC: "..."

M: "Yes?"

IC: "It's for Ms. Rotten Itchycooch."

M: "Ok, what are we giving her?"

IC: authoritative tone "Diflucan, one dose."

M: "What strength?"

IC: "The one dose pill."

M: "Ok, what strength?"

IC: "The one dose pill. I dunno, it's like 250mg or something like that?"

M: "It's 150mg."

IC: "Yes, yes, of course, it's the 150mg."

I collect the prescriber's phone number and thank the caller. A quick call to the ER, where ER PA works, and I confirm that this is a bullshit Rx.

Ms. Itchycooch walks up to the counter and I do something I have never done in all my 13 years in the pharmacy...I laugh in her face. Rude? Yes. Unprofessional? Absolutely. Wrong? Probably. I said, "I talked to the real ER PA, and she didn't phone in this Rx. You have got to be kidding me with this." She smirked and walked away.

What should I have done? Probably should have been a little nicer, and more helpful, and directed her to an OTC treatment for her issue. I actually feel like I let down a patient in need, but I just get so sick of the bullshit that patients try to pull every day in the pharmacy, and this was the first one that was so clear cut that I could say whatever I wanted to this girl and there was no way anyone could argue that I was wrong. So I guess I took it out on her. Yeah, I feel a little bad about that now.

Anyway, it must not have bothered her that much, because the very next day she showed up at my pharmacy with that same smirk on her face, and a prescription for Diflucan in her hand from the ER. Diflucan 100mg once daily for 10 days. I guess it must have been really bad...

Professional Judgement a.k.a. You Are Not A Robot!

I understand that a lot of drugs have dosages that vary according to various factors, such as weight. But can we please use some professional judgement and round some doses? I saw a Lovenox prescription today for... are you ready? 99.7mg. Yes, that was 99.7mg. For those of you not in the know, Lovenox is an injectable drug that comes in a variety of strengths in prefilled syringes, among those being 80mg, 100mg, and 120mg. Now if we calculate the dose based on weight and we come up with 99.7mg, can we please use our FREAKING BRAINS and round that dose up to 100mg? How the hell is someone going to measure 99.7mg?

Or how about those Amoxicillin doses...I have seen such craziness as 6.13mL. Are you freaking kidding me? I don't think a kid is going to die of an Amoxicillin overdosage if we round it up to 6.2mL, which is a volume that can actually be somewhat accurately measured. That "extra" 0.07mL isn't going to kill anyone.

Prescribers, you are not robots! Use your judgement and try to do things that make some damn sense!