Tips for improving physician pharmacist communication
Dear Pharmacy Doctor
I am a family practice doctor and saw a patient who was recently discharged from the hospital for a muscle abscess. He underwent a 7-day course of IV piperacillin/ tazobactam and levofloxacin in the hospital. After he was discharged, the final wound culture grew out vancomycin-resistant enterococcus (VRE). The wound was not healing and despite IV antibiotics via PICC line, I discontinued the antibiotics. The microbiologist suggested oral linezolid based on the sensitivities. I agreed. The next day, a pharmacist from a pharmacy benefit manager (PBM) called to inform me that linezolid was not covered and I needed to order an alternative. I asked, "What can I order instead?" The pharmacist was left dumbfounded. He paused for a bit and began fumbling through some books. After ten minutes on hold and being accidentally disconnected, he called back to recommend IV levofloxacin. I explained that the patient did not respond to the fluoroquinolone and asked for an alternative. He could not provide an answer. I was so upset that he wasted my time. Is it wrong for me to expect pharmacists to be adequately prepared before they call me?
Dear Frustrated Doctor
You are right; pharmacists and other healthcare professionals should respect your time and vice versa. It is unfortunate that you had a poor encounter with a pharmacist. Their role in pharmacy benefit management is difficult. Their job is to ensure that medications are properly prescribed and dispensed to the patients. If they deny a treatment based on their guidelines, then they should be prepared to offer an alternative. After all, we still have to treat the patient.
Being unprepared is definitely not professional behavior. To the physician, you appear lost and confused. Your credibility as a viable information source quickly declines. Physicians never expect the pharmacist to be the “know-it-all”. They expect that you will provide the best treatment options available based on your research.
Do your research, compile two or three treatment options, frame and rehearse your response before calling the physician (see How to Communicate with the Medical Team).
Physicians respond best when they are presented with the case and problem in the SOAP format. For example, the pharmacist can say, “Hello Doctor. Do you have a moment? (Pause) You have a 74-year old patient, Mr. Wilkes in ICU. (Pause) He has an order for oral linezolid 600 mg BID for his wound culture with VRE. Would you consider changing it to Cubicin 200 mg IV daily?” You provided all of the pertinent information, you were brief and to the point and most importantly, you offered a viable alternative. Whether or not the physician agrees to your recommendation, he or she will regard you as a valuable member of the team. In addition, you will feel more job satisfaction and less anxiety and stress. And that's the best way to build a strong physician-pharmacist relationship.
About the Author
Dr. Karine Wong has a 10 year history of working in hospital management and 2 years as a hospital pharmacist and outpatient pharmacist. She recently published a children's book called Don't Sit On Her.
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