Can office staff write and CHANGE prescription for dr?

[crescentcitygal]

I have not posted here in a while because things have been pretty stable with DS12's meds for the past couple of years. We went to see the doctor yesterday (a child/adolescent/adult psychiatrist) about increasing his Daytrana patch from 10 to 15 mg (he has been on 10 mg since he started about 4 years ago). Saw the new physician's assistant, and he agreed that increasing to 15 mg was reasonable. Now, in this practice, the doctor or PA writes the rx for refillable meds (like the Tenex my DS takes), but for controlled substances like Daytrana, they always write the order for the med in his chart, hand it to one of the front office assistants, and that assistant writes the actual prescription on an rx form (which I guess is pre-signed by the doctor), then makes copies and does whatever other paperwork is required. I don't know if this is common practice or not, but I have just never questioned it. I do not know if these office workers are simply clerical people, or if they have some kind of medical assistant training, but they sit in the reception area and answer phones, make appointments, take copayments, and do other paperwork for the doctor.

So yesterday I was checking out with one of these "assistants" (who is fairly new there...maybe less than a year). While reading the rx order from the PA, she mumbled something like, "oh, we have to make this 20," and scratched something out on his chart. I said, "excuse me?", and she said, "oh nothing...I was just thinking aloud." I asked her, "Is there a problem with my son's prescription?" She said, "you can't get this prescription in 15 mg, so we have to make it 20." I stared at her in shock for a few seconds and then told her that I know for a fact Daytrana comes in 15 mg, and that was the next step up for him, and that was what the PA wrote the order for. I did NOT want to make the jump to 20 mg since my son is very sensitive to increases in dosage. She then said, "well, many people have told me that they have had trouble finding a pharmacy that keeps the 15 mg dose in stock since it is not a common strength." I told her that I was not leaving the office without the prescription for 15 mg as we requested and the PA ordered, and that I would deal directly with the pharmacy if they did not carry that strength. Another lady walked in from the back office and told her that the pharmacies could order the 15 mg patch if they don't have it in stock. Office assistant #1 looked confused, said, "oh okay," and handed me the prescription.

Then she read the order for his 5 mg generic methylphenidate pill (which my son takes in the morning as a booster). She looked in some book and told me that it did not come in 5 mg, that she would have to change it to 10 mg and I would have to cut it in half. I told her that he has been taking the 5 mg booster for over 2 years. She pointed to a line in this book and said, "see...10 is the lowest." She was pointing to Metadate CD. I pointed out her error, and she said, "I'm so sorry...I worked for a general practitioner for 14 years and didn't have to know this stuff." WHAT??

Do any of your doctors have their office staff write prescriptions like this? Is it even legal? Certainly it can't be legal or ethical for them to change what the doctor has ordered, right? I wonder if she thinks it is her job to know all about psychiatric medications and make her own decisions like that, or even if the doctor has given her the authority to do that? I should have asked to speak to the doctor at that point, but I was so shocked by the conversation we were having, and my 13 month-old was crying and ready to leave, so I wasn't thinking clearly. And since I am not knowledgeable about the different types of medical professionals and who has the authority to do what, I just didn't know if she was acting legally on behalf of the doctor or not. I didn't even know what a physician's assistant was until last year when the doctor hired one.

What would you do at this point? My husband is so angry and wants me to call today and complain about her. But I know that if I call, no one is going to put me through to the actual doctor. I will have to leave a message (probably with this same lady), and I doubt that she will forward a complaint about herself to him. I have an appointment next month with the PA who we saw yesterday, and I was thinking of waiting until then so I can talk to him face-to-face and cut her out of the loop.

[crescentcitygal]

Forgot to add that after we drove off, I stopped at a red light to check the prescriptions. She had given me the rx for Daytrana 20 mg instead of 15! I drove back and had to knock on the door to be let in (it was 5:05 and they were locking up) to get her to give me the correct rx! I drove straight to the pharmacy and asked them if they had the 15 mg strength in stock, and they did. No problems getting it filled.

[healthy11]

I've had positive experiences with the physician's assistant in my son's doctor's office, but the administrative/office staff who answer the phones are different, less knowledgeable people. I'm not clear if the person you were dealing with was a trained physician's assistant, or a nurse, or just a receptionist, or ?? In any case, I don't believe your experience with the new employee is typical. It sounds to me like the woman needs more mentoring/supervision because she's operating based on how things used to be in her former general practitioner's office, which isn't the same as a mental health provider's office. Honestly, I would write a letter to the doctor, stating what you already posted here, while politely suggesting that his assistants could benefit from additional training. You could mention that while you consider yourself to be a knowledgeable parent, you worry about other parents who might not catch the mistakes, and the impact it could have on the children who are his patients. You might ask him to call you to let you know what steps will be taken to ensure it won't happen again. (It will also let you confirm he's received your letter.)

[crescentcitygal]

Writing a letter sounds like a good idea. But do you think it would go straight to the doctor? Do they open their own mail? I just wonder if it would be "screened" by the office staff, and thus by the employee that I am complaining about.

I wonder, too, what her actual training and title are, but I don't know a polite way to ask. I really doubt that she is any kind of nurse or medical professional. She makes sloppy mistakes and doesn't seem very knowledgeable. In January, I went there to pick up an rx for my son's Daytrana patch, and she did not want to give it to me because I had not had it filled since November. I told her that my son does not wear the patch on most weekends and holidays, so between Christmas and Thanksgiving breaks we had more than enough to last a couple of months. I had to wait about 15 minutes until someone was available for her to ask if it was okay to give it to me.

[healthy11]

The reason I suggested you end your letter with a request for the doctor to call, was to be sure he received it. While there are no guarantees, in general, if you address a letter as "personal," most office staff respects it. You could address the outside of the envelope as:

PRIVATE AND CONFIDENTIAL
Dr.John Smith
987 Main Street, Suite 6
Anytown, NJ 12345

www.effective-business-letters.com/Private-and-Confidential.html

[crescentcitygal]

Thanks, Healthy, for the input. I have cooled off a bit and will think about what I am going to do.

[dwolen]

This is ridiculous. Don't feel any hesitation about complaining. Leave a message for the doctor to call you or get the doctor's e mail address? It sounds like the woman was a clerk. Generally, a PA or nurse would know the dosages or be cautious enough to say, "I need to look up the dosage or ask the PA, doctor or another nurse." Licensed health care workers know they have a license to protect, so most are much more cautious.
This clerk really should not be working there. If she is new, this is not the right job for her. It is perfectly ok to ask, "are you a secretary, nurse, or medical assistant." You are PAYING for a service (or you are paying via your insurance) so you do have a right to know the qualifications of the staff whom are interacting/intervening/interfering with your son's care.