What to do after receiving a bad prescription?
October 13, 2024 10:05 PM Subscribe
My child was mis-prescribed at an urgent care facility, an error that was caught by her primary care doctor. What, if anything, should we do?
We took my child to urgent care last week for an ear infection and the doctor prescribed amoxicillin. The medicine wasn't working after a few days, and after contacting urgent care again, they suggested we see her primary care doctor. When we did, the primary care doctor discovered that the urgent care prescription was for half the appropriate dose that my child needs for her weight. For round numbers, let's say the appropriate dose as our primary care doctor calculated was 40ml/day, and our instructions from urgent care were for 20ml/day.
During the appointment, the primary care doctor also casually mentioned that this is the second time she's seen this happen to one of her patients with the urgent care we went to (part of the same hospital system as primary care). She said she'd write a note to the urgent care facility about the issue, but that doesn't feel like enough. She apparently wrote a note the last time, but that didn't solve the issue.
We're in Washington state. Is there someone we should contact to raise the issue about this? Some office within the hospital system? Some state regulator office? Anyone? An underdosing of amoxicillin isn't the end of the world, but to me it feels a little like a green m&m thing...what else are they missing or messing up? I don't want this to happen to our family again, or to others. And since our primary doctor says she's seen it happen before, it feels especially worthy of alerting someone about it.
At first I was just frustrated that we needed to have a second appointment (extra out-of-pocket cost and time, not to mention more time for my child to heal than this should have taken), change of medicine, and some additional precautions (probiotics) to make sure an extra amount of time on antibiotics doesn't cause other problems with her digestive system. But with a little more time to think about it, I'm more scared than anything. What if the wrong prescription was for something that's a bigger danger to my child's health? What if they prescribed an overdose on something more harmful?
Should we push back on billing for the urgent care appointment? I've never done that with a medical bill, but in this case it seems like we received bad service. My partner was recently laid-off, so we are more cost-conscious at the moment.
Lastly, how can we make sure this doesn't happen again? None of our family members have medical training, so it's not like we have an idea of what an appropriate dosage of any medicine should be. But our trust has been shaken.
We took my child to urgent care last week for an ear infection and the doctor prescribed amoxicillin. The medicine wasn't working after a few days, and after contacting urgent care again, they suggested we see her primary care doctor. When we did, the primary care doctor discovered that the urgent care prescription was for half the appropriate dose that my child needs for her weight. For round numbers, let's say the appropriate dose as our primary care doctor calculated was 40ml/day, and our instructions from urgent care were for 20ml/day.
During the appointment, the primary care doctor also casually mentioned that this is the second time she's seen this happen to one of her patients with the urgent care we went to (part of the same hospital system as primary care). She said she'd write a note to the urgent care facility about the issue, but that doesn't feel like enough. She apparently wrote a note the last time, but that didn't solve the issue.
We're in Washington state. Is there someone we should contact to raise the issue about this? Some office within the hospital system? Some state regulator office? Anyone? An underdosing of amoxicillin isn't the end of the world, but to me it feels a little like a green m&m thing...what else are they missing or messing up? I don't want this to happen to our family again, or to others. And since our primary doctor says she's seen it happen before, it feels especially worthy of alerting someone about it.
At first I was just frustrated that we needed to have a second appointment (extra out-of-pocket cost and time, not to mention more time for my child to heal than this should have taken), change of medicine, and some additional precautions (probiotics) to make sure an extra amount of time on antibiotics doesn't cause other problems with her digestive system. But with a little more time to think about it, I'm more scared than anything. What if the wrong prescription was for something that's a bigger danger to my child's health? What if they prescribed an overdose on something more harmful?
Should we push back on billing for the urgent care appointment? I've never done that with a medical bill, but in this case it seems like we received bad service. My partner was recently laid-off, so we are more cost-conscious at the moment.
Lastly, how can we make sure this doesn't happen again? None of our family members have medical training, so it's not like we have an idea of what an appropriate dosage of any medicine should be. But our trust has been shaken.
Have you looked at dosage guidelines to see whether what your child was prescribed is at all within the range of recommended dosages? I realize that that is not something you should necessarily have to do when you are prescribed something, but I would handle the situation differently if I were prescribed an amount below all of the guidelines vs being prescribed the amount for a mild infection rather than a severe infection.
posted by needs more cowbell at 3:51 AM on October 14 [4 favorites]
posted by needs more cowbell at 3:51 AM on October 14 [4 favorites]
If you want to file a complaint about a health care facility in Washington state you can do so here.
What people are saying above that it will need to be outside of the dosing guidelines is true so ideally you will look at the weight based dosing range for your child's current weight. There are philosophies of care which differ between doctors and some doctors like to use the minimum dose in the range while others prefer higher. Neither one of these are clinical malpractice, just different approaches to care. But if it is something that is malpractice go ahead and file that report. If you can't figure it out and you want to file the report anyway that is okay. The whole point of these reports is that they are clinically evaluated.
If you write a report be concise and clear. You won't need much in a case like this. But you will need the perscription dosages, and your child's weight, the name of the urgent care and ideally the name of the prescribing doctor. Also include you had to go to another doctor and get the perscription changed and it caused a delay in recovery from the ear infection.
posted by AlexiaSky at 5:46 AM on October 14 [6 favorites]
What people are saying above that it will need to be outside of the dosing guidelines is true so ideally you will look at the weight based dosing range for your child's current weight. There are philosophies of care which differ between doctors and some doctors like to use the minimum dose in the range while others prefer higher. Neither one of these are clinical malpractice, just different approaches to care. But if it is something that is malpractice go ahead and file that report. If you can't figure it out and you want to file the report anyway that is okay. The whole point of these reports is that they are clinically evaluated.
If you write a report be concise and clear. You won't need much in a case like this. But you will need the perscription dosages, and your child's weight, the name of the urgent care and ideally the name of the prescribing doctor. Also include you had to go to another doctor and get the perscription changed and it caused a delay in recovery from the ear infection.
posted by AlexiaSky at 5:46 AM on October 14 [6 favorites]
I don't know about Washington, but around here urgent care facilities are Generally Considered Inferior, they're fine if you need a band-aid on the weekend but that's about it. They misdiagnosed my mother's sprain as a fracture. And they even said as much, saying we'll give you a boot and meds now, but PLEASE see your regular doctor on Monday, he can diagnose the x ray better than we can. So yeah, just assume they won't be good and make a complaint through their formal channels--they won't get better unless pushed.
posted by Melismata at 6:20 AM on October 14
posted by Melismata at 6:20 AM on October 14
What if they prescribed an overdose on something more harmful?
Hopefully the pharmacist would catch it - that is part of their job. I have had a pharmacy notice that I was prescribed two meds with a potential interaction and contact my doctor to confirm that they should fill it anyway. In that case, one doctor prescribed both, was aware of the interaction, and felt it was the best option for me despite the risk - but I know pharmacies often catch interactions esp when multiple doctors are prescribing. This is a one reason its often recommended to use one pharmacy for all your meds.
I know this doesn't answer your question about what to do, but perhaps it provides some peace of mind that there are additional checks.
posted by maleficent at 9:06 AM on October 14 [2 favorites]
Hopefully the pharmacist would catch it - that is part of their job. I have had a pharmacy notice that I was prescribed two meds with a potential interaction and contact my doctor to confirm that they should fill it anyway. In that case, one doctor prescribed both, was aware of the interaction, and felt it was the best option for me despite the risk - but I know pharmacies often catch interactions esp when multiple doctors are prescribing. This is a one reason its often recommended to use one pharmacy for all your meds.
I know this doesn't answer your question about what to do, but perhaps it provides some peace of mind that there are additional checks.
posted by maleficent at 9:06 AM on October 14 [2 favorites]
Ultimately, this is within an acceptable range of human error and/or medical professional judgment.
If you would like to write an email to them, please do, but I would not pursue anything beyond that personally.
posted by samthemander at 9:29 AM on October 14 [7 favorites]
If you would like to write an email to them, please do, but I would not pursue anything beyond that personally.
posted by samthemander at 9:29 AM on October 14 [7 favorites]
I would also add: it’s totally normal that your trust has been shaken. I would argue that that is a GOOD thing. Doctors, nurses, pharmacists - they are all human beings, just doing their job to the best of their abilities, managing their kids’ pickup times and their bills and their grocery shopping and their elderly parents and their laundry and their lingering long-Covid symptoms, just like the rest of us.
It is GOOD that you enter future conversations with doctors with a small amount of “should I do a little bit of research too?” Perspective.
You wouldn’t hire a roofer and choose new shingles without doing at least a basic google search on the shingle materials. You wouldn’t travel to a vacation destination 2 hours from your home without briefly googling “[name of town] activities” or whatever. It’s normal and good to be an engaged and informed patient. It’s normal to expect your doctor to prescribe the correct amount of medicine! But, I do think it’s wise to do a small bit of reading on your side as well, in a “trust but verify” model of the doctor/patient relationship.
posted by samthemander at 11:41 AM on October 14 [1 favorite]
It is GOOD that you enter future conversations with doctors with a small amount of “should I do a little bit of research too?” Perspective.
You wouldn’t hire a roofer and choose new shingles without doing at least a basic google search on the shingle materials. You wouldn’t travel to a vacation destination 2 hours from your home without briefly googling “[name of town] activities” or whatever. It’s normal and good to be an engaged and informed patient. It’s normal to expect your doctor to prescribe the correct amount of medicine! But, I do think it’s wise to do a small bit of reading on your side as well, in a “trust but verify” model of the doctor/patient relationship.
posted by samthemander at 11:41 AM on October 14 [1 favorite]
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I don't know if it is what is going on here, but I've had doctors who varied greatly in their opinion of how much of a med should be prescribed. One example is an allergist who told me to break the OTC Claritin in half because that's all you need, and then seeing another one who said a single Claritin does nothing and to take 2.
Which is to say maybe (hopefully) it isn't an error just a clinical difference of opinion. It sounds like it would make you feel better to chat with this with the low-dose prescribing provider to see what they were thinking.
posted by nixxon at 10:32 PM on October 13 [8 favorites]