Negative interactions with doctors' offices can have serious consequences, so play nice.
Most of us know the feeling: You call the doctor’s office to tell them nicely that the directions do not make sense, the quantity does not match the directions, or even worse, that the drug combination that they wrote could hospitalize or even kill the patient. You say you want to “clarify the prescription.” You are not allowed to speak to the doctor directly on the phone and instead get an assistant who asks you to spell Zocor when you are explaining the problem. She takes a message and returns your call, for example, by saying that “the doctor said it is OK. The patient can continue taking the Norvasc 10 mg and Zocor 80 mg.” This is when things get interesting.
Still being polite, you attempt to inform the doctor through the assistant that the FDA has issued warnings not to use Zocor in doses above 20 mg for patients taking Norvasc, and you even offer to fax the package insert. The medical assistant does not understand why you as the pharmacist are not “just filling the prescription.” You are planning on using your authority to refuse to fill the prescription but do not say that yet, instead asking again if you can speak to the doctor directly. Now the assistant gets rude, saying that the doctor is busy seeing patients and does not have time to talk to you, so you inform her then that you will be unable to fill the combination as prescribed. “Hang on, I’ll get her for you if I can catch her between patients.” You are on hold for another 5 to 10 minutes, now putting the total time dealing with this prescription at 20 to 30 minutes, all while prescriptions and immunizations are backing up and other patients are starting to get upset. When the doctor finally picks up, she starts the conversation with, “I told you it was OK! What is the problem?” You are ready to lash back. She is angry because you interrupted her day while she is trying to see patients and deal with all the time-consuming administration and billing at the doctor’s office, and you are angry because you are trying to resolve this interaction and get back to your hectic day of filling prescriptions, dealing with insurance, and administering vaccines.
Unfortunately, this type of interaction is not only common, it can do a lot more than just erode the relationship with a doctor’s office. It could actually harm or even kill patients. In one experiment, experienced neonatal intensive care unit staff members were divided into several groups. All groups had to perform a task to diagnose and treat a patient in a hypothetical life-threatening situation, but experimental groups were exposed to rude comments from someone they were told was an outside expert in the field of critical-care medicine. Their performance was then judged by experts who were not aware of the rude comments that were made. What they found was that the teams exposed to the rude comments were not nearly as capable of communicating with each other, functioning as a team, or effectively treating the patient. In short, the rude comments could have created a situation where a patient died instead of lived.
This has serious implications for practice, especially considering how common it is for health care professionals to treat each other with disrespect. Although we all have our pride and might have opinions and even facts about how a patient should be treated, the way we present that information to others can mean the difference between life and death. Think, for example, if this doctor in the previous example was not willing to change the Zocor prescription. What would you do? The only real options are refusing to fill the prescription and letting the patient know why, risking the patient going elsewhere and getting it filled, or filling the prescription and noting that the doctor approved it in an attempt to pass blame and potential liability. Neither of these are good options, and neither is what we would want to happen to our loved one or ourselves.
Changing the culture of health care starts with 1 person at a time. Keep that in mind as you go about your day. Being aware of the way our actions affect others can help us start to make progress on this insidious and rarely spoken about problem that can cause harm.
McKnight, Travis. Rudeness in hospitals could kill patients. The Cut. thecut.com/2015/10/rudeness-in-hospitals-could-kill-patients.html. Published October 26, 2015. Accessed December 14, 2017.