What do you do??

[Fattoo]

I want your opinions as pharamcists from around the world;

If you give counselling for a patient and he tells you that the physician told him something different, what shall you do?

Do you tell the patient to follow the physiscian's instructions? What would you do if you contact the physician and he insisted on his opinion?

I face that condition alot.

Thanks.

[Raju]

Re: What do you do??

I want your opinions as pharamcists from around the world;

If you give counselling for a patient and he tells you that the physician told him something different, what shall you do?

Do you tell the patient to follow the physiscian's instructions? What would you do if you contact the physician and he insisted on his opinion?

I face that condition alot.

Thanks.

Such situations can be tough. It depends how serious it is. Usually, I would query it with the presciber once and see what they say. If there explanation seems OK, then go with it.

If there is still a disagreement, then you are within your right not to dispense the prescription or advise something else. Its happened a couple of times with me, especially with anti-diabetic medication aboved licensed doses (glibenclaide 30mg daily for an 80 year old man - which I wouldn't dispense no matter what the GP told me to do).

I had this situation once with Lamotrigine. A patient was started on it by a consultant 50mg bd, and then the next week to take 100mg bd - which is a VERY excessive dose to start on, due to the risk of skin s/e when started on too high a dose. (see table).



I told the consultant that I thought the starting dose was a bit high, and he said "let's just bang it in there and see what happens". I thought this was lousy and the patient was being subjected to an excessive risk. I told the patient (and her husband) that I am not happy to dispense the medicine as it is, and that they should feel free to try at another pharmacy.

But (understandably) they were worried and wanted me to sort something out. So I called the GP and expained the situation to him. Initially he was dismissive, saying that the consultant 's advise should always be followed. But I sent him some literature about it by e-mail and he agreed.

The doctor agreed and to issue an RX consisting of a slower and lower dose escalation of lamotrigine, which I wrote out, to build gradually to 100mg bd which was the consultant's eventual aim.

It was a very time consuming and tiring episode - as both the consultant and GP were hard to get through to on the phone, and the GP required repeated contacting to get him to agree.

If the GP had not agreed eventually it would have been even harder.