Larry David: Doctor… Pharmacist

I watched a Curb Your Enthusiasm rerun recently in which Larry David has some interesting interactions with a doctor and a pharmacist over a prescription for his father. As usual, there’s an interesting real-life observation in the midst of a lot of nonsense and screwing around.

To summarize:

  • Larry’s father’s doctor hands Larry a prescription for a blood thinner, which Larry is to fill for his dad
  • When Larry takes the prescription to the drug store, the pharmacist asks one question: “Is this for you?” and then tells Larry he recommends another product instead
  • Larry tells the pharmacist that the doctor must have liked the one he prescribed. The pharmacist says again that he likes an alternative
  • Larry then weighs their credibility out loud:”Doctor… Pharmacist… Doctor… Pharmacist…”
  • Eventually he decides to go with the pharmacist’s recommendation and the pharmacist writes down the recommended drug on a piece of paper
  • Larry takes the new prescription back to the doctor, who is offended and insists he is more knowledgeable than a pharmacist, but then relents and writes a new prescription

At the heart of the sketch there’s a sage observation: pharmacists are very knowledgeable about drugs. Much more so than many doctors. And doctors sometimes prescribe drugs without considering the full range of options and almost always without sharing that thought process with the patient (or caregiver).

Many details of the interaction were unrealistic, or set up to support the humorous point or the time limits of a TV show. But the most unrealistic part was the pharmacist being so assertive. Usually pharmacists don’t speak up at all, even when it would be helpful to the patient. That can be because they are too busy meeting their fill quota, they’re too shy to interact with the patient, they don’t want to offend their physician customers (and encourage patients to go elsewhere) or they don’t have the full clinical context.

In any case, this episode gives me a good chance to repost my Tips for pharma consumers from 3 years ago:

  • Physicians: When doctors write a prescription they usually whip out the pad, write out the scrip and hand it to you. Next time ask them to share a little bit of their thought process. Why did they choose that drug? What else did they consider? What would their second choice have been? A discussion can be useful: maybe there’s some other information you want to provide, maybe your doctor just prescribes whatever the drug rep recommends
  • Pharmacists: Pharmacists are the most underutilized health professionals. They go to school for six years and then mainly hide in the back of the pharmacy counting pills. But pharmacists generally know a lot more about drugs than doctors. Plus they’re available in convenient locations and at convenient times. You don’t need an appointment and don’t have to pay. Pharmacists are loathe to second guess doctors, but get to know one and you’ll find they are a great source of information and will even give you their professional opinion on whether you are on the right drug(s). Newer grads carry PDAs with advanced databases on them; every CVS, Walgreen’s and other chain pharmacist can call up a variety of drug information on their in-store terminal
June 12, 2010

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