Under the order for Lovenox it was written. It was written very clearly, and even though the prescription was faxed, it was still easy to read. That alone put the prescription in the upper 80th percentile of competence.
"Patient will be holding Coumadin." it said, and I stared at the prescription and smiled. I almost wanted to take a picture. I almost cried tears of joy. I almost wanted to find this doctor and wrap him in a big bear hug until I remembered I wasn't gay.
Those of you not in the professions probably don't know that Lovenox and Coumadin are both anti-coagulants. What this doctor was doing, you see, was going out of his way to let me know he knew the patient was on an anti-coagulant from another doctor and he was on top of the situation. Taking a few seconds to make sure everything would go smoothly for everyone involved.
"A simple step" those of you not in the professions might be saying to yourselves, and you would be right. You also probably don't know it's a simple step that never happens outside the theoretical fantasy world of pharmacy school. This is how drug interaction work usually goes my friends:
You drop off a prescription for drug X from Dr. Smith and I notice you're taking drug Y from Dr. Jones. There is a chance that drugs X and Y can be taken by an individual with your particular medical problems. There is also a one percent chance the combination of X and Y will set your liver on fire. Did Dr. Smith know what Dr. Jones was up to when he wrote the prescription and explain the risks to you before he sent you on your way? Or is your liver going to catch fire and your malpractice lawyer say I was negligent? Who knows? You are nowhere to be found, having left to go have your hair done. I call Dr. Smith's office and reach the 19 year old receptionist after navigating through the voicemail forest and spending five minutes on hold. I sense the fear in her voice as soon as I say I have a question about one of Dr. Smith's prescriptions.
I explain the situation and she confidently says "It says in the chart two times a day," which is an answer to a question I did not ask. I say I better talk to Dr. Smith directly about this and she says he's busy at the moment and she'll have him call me back. She goes to hang up and I ask if she has my number. She realizes she doesn't.
Ten prescriptions and two phone calls have backed up while I was doing this. The first caller asks if we carry the blue wart stuff she saw on TV last night. You come back and I explain the liver incineration issue.
"So it's not ready?" is all you say. Your new hairdo looks terrible.
I catch a break and you agree to let me call you if and when Dr. Smith gets back to me. An hour passes and I hear nothing. I call Smith's office again and get the after hours answering service, who patches me through to Dr. Johnson, who is covering for Dr. Smith that evening.
"It's usually given twice a day, right?" is what Johnson has to say, and I wonder what part of "liver fire" sounds like "label directions." I try again.
"Ohhhhhhhhhh....says Johnson. You know, I never prescribe this........" Then 10 seconds of silence. Like the problem has been solved. When I refuse to go away it is agreed that maybe Smith himself should give me a call.
"Yes, I'm well aware of this!!!" Smith says half an hour later, extremely annoyed to be taken away from his dinner. "The thermoeosnophillic scan we did on the 5th indicated a low probability of liver fire and the alternative has a higher possibility of eyeball explosion." If I would have had access to your complete medical record I would have known this. But I don't. So I didn't. So a 5-second problem becomes an all-day affair. That's how these things usually go. And at the end of the day all you remember is that it took forever to fill your prescription and Wal-Mart never seems to take so long.
That's because the pharmacist at Wal-Mart decided to take a gamble and not check. Because he's only charging you $4 and has to keep the prescriptions moving if he's gonna keep his corporate bean counters happy.
Which is why those five words made me so goddamn happy. I kept repeating them to myself over and over as I filled the prescription, "patient will be holding Coumadin.......patient will be holding Coumadin...." I almost didn't want to let this prescription go.
The computer flagged the next one for Voltaren because the patient was taking methotrexate.
Two different doctors.
Sigh.
