In which I vent spleen

I apologize in advance for writing a frothing rant that nobody will care about but me.  This will make me feel better.  Thank you in advance for your patience.


Attention, local pharmacists!  Please be advised I know perfectly well that a certain percentage of patients who are allergic to penicillin are also allergic to cephalosporins.  I understand that there are chemical similarities between the two classes of antibiotics, and that there is some potential for cross-reactivity.  I promise on whatever holy book you care to proffer that these facts are included in my considerations when choosing to prescribe a cephalosporin to a penicillin-allergic patient.

I did, after all, attend a fucking medical school.

Stop calling me to confirm if I’m goddamn sure I want to prescribe what I’ve prescribed!  If your liability-prevention rules dictate that you must call me to make sure I’m sure, then when I tell you to dispense what I’ve prescribed don’t ask me again if I’m sure!  Don’t say something like “even with a 10% cross-reactivity rate?”, because:

1) That leaves 90% of patients who can take cephalosporins safely and I don’t want to eliminate an entire class of antibiotics for them out of hand, and

2)  Oops, you’re wrong!

Yes, I am sure I wanted to prescribe what I prescribed.  The fact that the patient is penicillin-allergic is the reason I chose the other antibiotic in the first place!

Stop!  Calling!

Thank you.  I feel better.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. Hey, that dinner I proposed, the one with you and yours and me and mine? Given that my wife is a pharmacist on the other end of this, let’s talk about something else.

    • I know lots of pharmacists. One of my favorite mothers in the practice is a pharmacist. I have innumerable perfectly lovely conversations with pharmacists over the course of the week, either because they need to confirm a dose or switch to a different formulation of something I’ve prescribed or what have you. I have no beef with pharmacists.

      What I have a beef with is when I say “Yes, I know the patient is penicillin-allergic. Please dispense the medication anyway” and am then treated to a schoolmarmish follow-up question that clearly implies that the asker thinks I’m a frigging moron and is (for giggles) also premised on wrong information.

  2. …am then treated to a schoolmarmish follow-up question that clearly implies that the asker thinks I’m a frigging moron…

    In fairness to your interlocuters, you do spend winters in New England (voluntarily, even!)….

  3. All spleen ventage must be disposed of in an environmentally sound manner. Bonus points for recycling.

  4. I was sitting here thinking about this (because it’s raining outside), and I believe I have discovered that practically any word whatsoever can be made into an American slang term by adding the word “out” right after it.
    So, I’m going to say . . .

    Spleen out, bro.

  5. If it makes you feel any better, Doctor, they are even more “schoolmarmish” when talking to nurses.

  6. When it’s in, it’s a spleen, but when it comes out, it’s a splenectomy. What happens to the other “e”?

  7. Maybe these guys are reading from a script and have boxes to check? Like when you call tech support.

    If so, you’re boned. They will continue. 🙂

    Besides, never assume common sense comes intelligence.

      • It’s probably done with liability in mind. *shrug*.

        Thinking about it, though, given the numbers in America — if even as few as 1 in a 1000 prescriptions were a mistake, it’s probably worth the hassle.

        Especially with the growing prevelance of things like Minute Clinics and the like, with minimal patient histories.

        • I have no doubt it’s done with liability in mind. That said, when I have made my decision like unto crystal in its clarity, further inquiries about the certainty of my thinking will merely effect a rapid change from “polite” to “incredibly testy.”

          • As a lesson from one who has suffered both ends of PC Support, let me assure you — repeating it is necessary for a surprisingly large number of people, of all variants of intelligence, to make them stop and think.

            As dreadfully insulting as it might be to you personally, and as much as I disdain the “Are you sure it’s on?” statement after the “Is it plugged in” question, statistically speaking — people will reflexively assume many things, and prodding them in such a fashion gets a surprising number to actually stop and think.

            Your only solace — as is mine, when I grit my teeth through the painful process of moving onto Tier 2 support wherein someone who can do more than read from a script can answer my questions — is that it’s not aimed at you. It’s not personal.

            It’s just that, well, many people don’t really pay much attention to things, especially habitual actions, unless you make them.

          • The exchange that prompted my little tirade went something along these lines —


            Me: Yes?

            Front desk: The pharmacy is on line 2 about that prescription you wrote for Clytemnestra Philpott. [Ed: not her real name.]

            Me: *sighing, presses button for line 2* This is Dr. Saunders.

            Pharmacist: I’m calling about the prescription for patient Clytemnestra Philpott? She’s penicillin-allergic? But you prescribed a cephalosporin.

            Me: Yes. I know. I know she is penicillin-allergic. I prescribed that medication as an alternative to penicillin. Please dispense it.

            Pharmacist: Really? Are you aware of the risk of cross-reactivity?

            Me: *voice taking on a slightly clenched tone* Yes. Yes, I am quite aware of that. I want you to dispense the medication anyway.

            Pharmacist: Even with the 10% risk?

            Me: *voice taking on a rather more strangled timbre* Yes! Yes, even with that reported risk! I specifically chose that antibiotic as an alternative to penicillin. I prescribe it routinely as an alternative to penicillin. PLEASE DISPENSE IT.

            Pharmacist: If you’re sure. And I’m speaking to Dr. Saunders?

            Me: Yes. Yes, you are. Please dispense what I wrote. Thank you.

            *hangs up phone*

            *clicks ‘New Post’ on blog toolbar*

            *commences typing*

          • Ah man, not even a rote script? That’s just painful.

            It’s at least tolerable when you know they’re just reading questions off a flow-chart.

          • Due to an experience that I had today (three times), I got to thinking that maybe a phone menu might be a good way of dealing with this.
            Wait until at least 7 until they hear:
            If you are a pharmacist calling about a prescription, please press . . .
            From there on out, make them listen to a three-minute message before they get to press another key.
            And make sure that they have to go through at least 5 such menus.
            It’s not going to win you a place in The Lives of the Saints book, but maybe they’ll get the notion to consolidate calls.

          • From now on you should tell your patients to avoid pharmacies that call you. Make dark insinuations about their competence!

  8. A few questions/comments, and these are going to sound more confrontational than I want them to be, especially since you’re just venting spleen:

    Is it the pharmacist his/herself who is asking the questions, or does he/she have their assistant do it, and say to their assistant, “make sure we really get it on record that the doctor is clear he understands the risk”?

    Another question/comment: the “really” might be, er, really annoying, but maybe they are required to verify two times, in a similar way that my customer service jobs sometimes required us to “cross sell” products by asking each customer the same question, at least 3 times.

    Finally (and maybe along the lines of what Morat was asking), what’s the general relationship between doctors and pharmacists (or pharmacists’ assistants)? I can imagine that PHARMACISTS as a category have to deal with DOCTORS as a category in a lot of different ways and that some (probably a very small number) in the latter category are borderline incompetent, which means that those in the former category are required to say painfully obvious things, and repeat the question (and then resort to the inelegant “really?”).

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