Long story short: Trying to clarify the old "use as directed" for Coumadin 5 mg, #60. Called the office twice during the day to no avail. They can't pull this off. It's not in the chart, written on the wall, on crib sheets in the doctor's pocket, in the bloodwork history, on the roof or anywhere. Nobody at the office can tell me this guy's dose. Meanwhile, if I try to be the "good guy," I will have not 1, but 2 insurances (medicaid secondary) fucking me in audits in years to come. What's a boy to do? I know. I'll page the "doctor on call."
Let's just say I've had better ideas. These better ideas include:
- reading a pamphlet in high school about the rewards of a pharmacy career
- riding a bike while utterly intoxicated
- punching myself in the face
- heckling grizzly bears
- taunting badgers
- kissing a possum
- answering the phone at work
- giving policemen driving the opposite way the middle finger
The "on call" "doctor" then tells me she has no idea what the dose is. First, she says to talk to the patient's Mom. I told her this was not a very good practice; letting the Mom prescribe Coumadin, that is. After bantering back and forth she then capitulates and says: "well, just give him 1 pill daily.....30 pills." Well that is some sound and thoughtful advice, "doctor." So, Mom is now the MD, is she? What. The. Fuck. You know what I did? I called Mom.
I went with Mom's dosing, it actually made more sense. I notated the prescription: 2 daily, per Mom. Come get me insurances, I don't care.
The next lady was a patient on Lipitor. She was on 40mg, a usual dose, but the "Physician's Assistant" wanted to jack her up to 60mg. This is not a usual dose. Why? Let's get schooled, shall we? There is a "rule of 6s" with statin drugs - for every doubling of the dose, there is a 6 percent response (roughly). So zippy the "PA" is going to deduct a whopping 3% from this lady's LDL. Nice work Sherlock. Oh, did I mention the patient thinks she's a doctor? According to her, the dose of 60 mg is too high. I think she said:
"Now, tell me, really, this Lipitor, this 60 mg, tell me, that's a high dose, 60 is too much?"
First, that's not a question, it's just a feeble attempt to put words in my mouth. My opinion must count for something, because people are always trying to form it for me. I can hear them now, "my pharmacist says that smoking crack is just fine when you're pregnant." Look, if 60 was too much, I'd tell you. Stop trying to trick me into saying it is. It's not. It's retarded, but not too high.
"Well, I'm going to stay on the 40mg. I can do that, can't I?"
I told her that it was a free country and up to her doctor and her.
"I can't get through to my doctor, just this physician's assistant."
I told her the last time I got through to a doctor that she said to do what the patient's Mom thought was best. I guess getting the doctor is not always a winner.
Good luck out there. Let us RPHs handle the drugs. Please? Pretty Please?
