Prescribing privileges! A terrifying but fantastic voyage.
My peers and I have just received our prescribing privileges. We did some learning about safe prescribing and completed a short exam to ensure that we would survive in the real world. I have been writing orders, including those for some serious medications in the hospital setting, for 2.5 years. When I first heard of ‘writing orders,’ I was offended that we were meant to ‘order’ around the nursing staff. I’ve gotten used to the idea of being responsible for making serious decisions and am starting to come to terms with consequences; I’m fortunate to find myself often working within a team; pharmacists, nurses, and other physicians are often part of the system of checks and balances.
Still, it’s kind of frightening to hold the mighty pen that can write a life or death prescription. Usually it’s not that exciting, but adverse reactions, side effects, and other negative outcomes do happen. On the other hand, I feel great about being able to do a complete visit with almost any patient and not having to run around the clinic looking for someone to sign a ‘script. Freedom! It makes me more efficient, but I also waffle a little more about decision-making since I know only the pharmacist will be the only one to make sure I didn’t do anything crazy.
Our prescribing rights came with a duplicate pad; this is a magical and dangerous tool, used to write narcotic prescriptions such as those for morphine. In palliative care, it is as handy as a hammer to a carpenter; a necessary tool for the job. In addictions medicine, it can be like a rusty nail embedded in your foot.
So, now, I can order almost any medication under the sun; methadone, which I’ll write about shortly, is one exception. It’s exciting but terrifying! I’m evolving towards being a ‘real doctor’ in the same way that Pinoccio craved to be a real boy. I’m glad none of my body parts succumb to elephantiasis when I make a mistake or am not confident. (or is it Dumbo I’m thinking of?!)