Mind Over Miller: Pharmacy philosophy

Dr. Miller reflects on the way prescription writing used to be.
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Jul 01, 2014

I do not recall any of the veterinarians I worked for during my college days, or the colleagues I worked for during my first two postgraduate years, ever writing a prescription. Instead, they all did a lot of dispensing.

I learned prescription writing, of course, in my pharmacology courses. So when I opened my own practice in 1958, one of the first things I did was order a prescription pad. I did a house call practice for the first few years. It was mixed practice, about 50% beef cattle in the beginning, in an area that had never had a local practitioner.

Although the human population back then was quite small, the animal population was enormous. But all veterinary services came into the valley from elsewhere.

My small-animal practice required about five house calls a week at first. I even spayed dogs on ironing boards—wearing a cap, gown, and gloves, which was not conventional at the time, although we were trained that way in school.

Because my dispensary was limited to a trunk in my station wagon, I wrote a lot of prescriptions. The response was interesting:

Q: "Where do I fill this?"
A: "Any pharmacy." (We had two in the valley, but no M.D.)
A common response would be: "You mean just like a people doctor?" But more often, "Oh, you mean like for adults?"

This last comment made me aware of the child surrogate role pets so often hold.

Occasionally, people would say: "You can write prescriptions like a real doctor?"

Keep in mind that while large-animal clients were usually aware of the intensity of a veterinary education, most small-animal clients were not, especially in a community that had never had a practitioner. Their awe at my being able to legally write a prescription educated them. Prescription writing enhanced my professional image. After the first couple of years, fewer people were addressing me as "Mr. Miller" and more people were asking if I planned to "open a 'shop.'"

The two local pharmacists, of course, were fully aware that I was qualified to prescribe and gladly filled the prescriptions.

In one of the two pharmacies, one entire wall was devoted to veterinary products, mostly large animal but also small animal. Two years after I opened my practice, I walked into the pharmacy and was surprised to see the entire veterinary display gone.

"Lou," I said to the pharmacist, "What happened to your veterinary section?"

"Oh," he responded, "The ranches are starting to subdivide, and in a few years, there won't be as much need for it. Besides," he winked,"I'm making more money from your prescriptions than I ever did from that display."

After I opened my first office, I continued to write many prescriptions, despite having a well-stocked dispensary. I continued to do so throughout my career. The pharmacists loved me and recommended me. It lessened the inventory of products I had to have on hand. Above all, it was professional, and as long as I practiced, I worked hard to build and enhance that professional image.

It was what I called "ethical advertising," because our code of ethics at the time prohibited any form of advertising or merchandising.

Was it effective? When I retired, my practice had grown into a 12-doctor group, still adhering to the ethical code of the '50s. "Medicine and surgery" … period!

What would I do today? If I had a hospital now, I would have a separate room with a separate counter and a sign that says "Pharmacy." Then I would write a prescription for every possible drug that merited a prescription, give it to the client and say, "You may fill this prescription right here in our hospital pharmacy, or if you prefer, at any regular pharmacy."

If the product was not available at a regular pharmacy, I would say, "My prescriptions can usually be filled at any pharmacy, but this one is a veterinary product not ordinarily available at regular pharmacies. You can have it filled, however, right here in our hospital pharmacy."

This approach leaves the client impressed and appreciative.

Robert M. Miller, DVM, is an author and a cartoonist, speaker and Veterinary Medicine Practitioner Advisory Board member. His thoughts in "Mind Over Miller" are drawn from 32 years as a mixed-animal practitioner. Visit his website at robertmmiller.com.