Canadian Physicians? Not As Arrogant As American Physicians!

Today was Friday the 13th. Thank the pharmacy Gods its over! Patients where crazy today arguing and losing it over every little thing! Of course tons of abusers came in too. Ironically enough the minute I put in the order for C-II medications into the system 8 prescriptions for Percocet magically showed up in 30 minutes! Again, glad today is behind me.

One thing that I thought was very different today was the two drastically different experiences I had with two physicians. One was originally from and trained in Canada (she told me this) and the other was a typical American trained physician. Both physicians worked at the same institution, both are residents and since there is only one medical school in town that pretty much supplies all the residents to the hospitals in the area I assume they are both enrolled or affiliated with that university.

The first physician actually called me to make sure that her patient had a prior authorization taken care of for his prescription. This about floored me that a physician would actually call to make sure a prescription was covered for their patient before being prompted by a pharmacist or patient. She was very polite and explained that being from Canada she did not fully understand the American insurance system. WHOA! A physician admitting they don't know everything? They exist? I then checked and sure enough she was right, this patient needed a prior authorization for their Diovan. I explained what they wanted to use (a generic ACE inhibitor over and ARB) and what I would substitute for it based on what I saw in the patients profile. She explained to me that apparently the patient had a ACE-I induced cough issues several years back, which was never filled by my pharmacy. I then explained to her how to go about getting a prior authorization for the patient. The physician thanked me. Let me repeat that... THE PHYSICIAN THANKED ME! One of the few times a month this actually happens and was definitely sincere.

A few hours later the same physician personally called back to tell me it went the prior authorization went through and it indeed had. She then asked me to explain some things about American insurance to her. I explained it pretty quickly but basically they do everything they can to keep costs down and therefore increasing their profits. I went in more detail but don't want to drag on here. She was glad that I was the first pharmacist she had a good experience with and took the time to listen to her and explain a little about how I see things. I was hands down amazed at how passionate and genuine this physician was. Definitely one of the best physicians I have EVER come across.

A few hours later...

A patient came in with 5 prescriptions all for very expensive medications relating to HIV. The physician who wrote the prescriptions was a resident which in itself isn't too big of a problem considering the prescriptions actually made sense. It is very common for residents to write for medications that doses are either A. Made up, B. Way out of normal range or C. Don't make any sense to what they are treating the patient for. The one problem that occurred was that this resident was not on file and did not have an NPI number (which is quite essential these days to bill most medications to insurance companies). I called and had the doctor paged to get his NPI number since I could not find it with a few websites online.

20 minutes later...

The paged physician calls me, on his way home of all things, and tells me that he has an NPI number. I then ask him what it is. His response was, "Look it up." I explain that I tried and that nothing came up. He then spelled his name to me slowly like I was in middle school. I then told him that was exactly how I had it spelled and still nothing. The physician then said, "Well I know I have one! The paperwork has been mailed in and I got something back it just isn't on me at the moment. It HAS to be online SOMEWHERE!" How about this "doc", since you have it and I don't (and neither does the whole freaking internet!) why don't you look for it and when you find it give me a call? He agrees to this and hangs up.

An hour later...

The fairly grumpy physician calls back and repeats to me his NPI. He also gave me a website to look up his NPI and said he knew it was there. This was the same website I had previously used and explained it to him. He then decided that while he had me on the phone he was going to look it up to prove me wrong. He looked it up. Nothing. Just like I has said. The physician then said, "Well it should be there I don't know what's wrong with this site!" I decided to cut my losses and close the discussion since I had proven to him that he was indeed wrong and that I was a competent pharmacist. No need in causing more hostilities amongst our professions.

These two very different experiences made me wonder. Is the arrogance of most doctors a result of the American system and the pedestal that physicians are placed on? Is it an Americanized attitude? Are Canadians raised that much differently in how they interact and work together with other healthcare professionals? I am not a fan of the Canadian healthcare system but this physician has left me scratching my head a little. Would it actually be better for the patient to change to a system like this? I must say that despite all the craziness of Friday the 13th, this was quite a comparison of how physicians act and has really got me thinking. I wonder if there is a way for more physicians to act like the Canadian while still maintaining some of the benefits of the American health system.