A patient’s struggle to fill an Adderall prescription taught this doctor a lesson

A patient of our practice recently went to a pharmacy to pick up her prescription for Adderall, which she takes for adult attention deficit hyperactivity disorder (ADHD). She has taken this medicine for years, and it has helped her a great deal.

When she arrived at the pharmacy counter, she was told that she could not fill her prescription.

“Why?” she recalled asking, annoyed but curious.

She was told the pharmacy’s rules would not allow her to receive the medicine, because records indicated that she had not seen her primary care doctor in three months for a check that it was safe for her to keep taking. It is important to monitor for harmful side effects such as high blood pressure, rapid heart rate, or loss of appetite.

What followed was a flurry of anxious calls and exchanges with our office, culminating — hours later — in a phone conversation between the patient’s primary care doctor and the pharmacist. The doctor explained that an appointment had been cancelled by our office and rescheduled for later in the month.

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After a long period of stressful interactions between patient, doctor, office staff, and pharmacist, the patient finally received her medication refill. I wish I could say that this was a rare occurrence, but I have seen this happen far too often. Perhaps you have had this disruptive experience yourself.

Such rules vary by pharmacy, but the broader issues at play remind me of a saying credited to the author and playwright Oscar Wilde: “It is always with the best intentions that the worst work is done.” This patient’s story certainly supports that contention. And we can do better.

Doctors, including myself, are often not well informed about the pharmacist’s role, training, and perspective. I admit that in my medical schooling, I was led to believe that pharmacists were obligated to simply fill prescriptions as written (before electronic records, I imagined this included cryptanalysis expertise to decipher my handwriting), identify potential mistakes in dosing and overlooked interactions or allergies. In fact, pharmacists are highly trained and skilled professionals who often have their own meaningful relationships with patients.

Similarly, pharmacists may not be aware of the specific policies and procedures in place at medical offices, which are often more nuanced than a data inventory of office visits and diagnostic tests. Misunderstanding and poor communication between doctors, office staff, and pharmacists may leave patients frustrated, untreated, and at risk.

Both doctors and pharmacists share a responsibility to oversee safe medication prescribing, especially around higher risk and regulated drugs like Adderall. We should also be thoughtful and humane.

This requires understanding of each other’s roles and challenges. Patients depend on us to work collaboratively on their behalf, following safeguards and avoiding negative assumptions about their behavior and motivations.

If you are a patient taking a controlled medication such as an opioid, ADHD or anti-anxiety medicine, you can advocate for yourself and ask your doctor about the medical office’s process for connecting with local pharmacists if a prescribing concern arises.

As busy professionals working under time constraints, doctors and pharmacists must communicate effectively to share observations and concerns, and clear up any worries about unsafe medication use, abuse, or diversion.

Care providers like us also have a duty to follow established prescribing and dispensing guidelines, understanding that they are just that — guidelines, not rigid commandments.

Our patients deserve to be viewed first and foremost as suffering humans who need our complementary skills to help them heal.

Jeffrey Millstein is an internist and regional medical director for Penn Primary Care.