A pharmacist’s recommendation can be life saving, I’ve seen them. Pharmacist recommendations can be aggravating and borderline enfuriating to some providers. I’ve seen those as well. Writing good recommendations takes time and effeort, as well as significant experience. Here’s a couple examples.

Example 1:

• Jane is a 79 year old female. NSAID use is discouraged in the elderly, consider changing to alternative therapy.

Horrible.  You should never write a recommendation like this.  There certainly is some truth to NSAIDs not being the safest medication in the elderly, but stating facts is not going to win you any points with providers.  First, no options are presented.  If you are going to write a recommendation to improve or change medication management, you have to provide a solution or alternative option.  Second, this recommendation has no patient specifics.  If you can apply your recommendation to any random patient, you should think about rewriting it.

Example 2:

• Jane is a 55 year old female with diabetes and had a heart attack about 3 years ago.  Consider addition of aspirin.

In this scenario, the aspirin recommendation is certainly warranted, but in an obvious situation like this where the patient should be on aspirin, I would be very careful and make sure to ask the patient and/or provider if they have tried aspirin in the past.  In this scenario, I’m not saying you should not write a recommendation, but just recognize that this patient has probably tried aspirin or someone has asked them numerous times why they aren’t on aspirin.  Still, I’d label this as a poor recommendation without more history provided in the recommendation.  Adding that Jane has never been on aspirin (if she hasn’t) as well as recommending potentially checking labs like hemoglobin and aspirin to ensure safety would be appropriate to add to this recommendation.

Example 3:

• Jane is a 68 year old female reporting mild fatigue with a history of anemia (latest hemoglobin = 10.9) and GI bleed, She is currently receiving aspirin 81 mg daily and naproxen 500 mg BID for rheumatoid arthritis.  She states that naproxen has been the only thing that has been effective for her rheumatoid arthritis and doesn’t want to change.  Given past GI history and current medications, consider addition of omeprazole 20 mg daily for GI prophylaxis?

This is a much better example.  I hope you can see the difference. There is always a fine line between oversharing versus providing enough information to give your recommendation a strong chance of being accepted.  Lots more patient specifics in this example, and recognition that the patient will be unlikely to change the higher risk medication (NSAID) given her GI history and use in rheumatoid arthritis.

Interested in more pearls like this on writing recommendations?  Check out my “practice changing” webinar on medication recommendations!