A pharmacist struggled with medical ethics after he mentioned the brand name for a drug prescription to an elderly customer, who was getting refills for her husband.
The customer inquired about what sildenafil was, and the pharmacist said: "Viagara."
Though sildenafil is an ingredient typically used to treat erectile dysfunction, it was prescribed for the customer's husband for his pulmonary hypertension.
Viagara is the name brand of sildenafil, as Cialis is the brand name for tadalafil – also used to treat similar symptoms and are Phosphodiesterase-5 (PDE5) inhibitors.
But did the pharmacist reveal too much in one word?
Redditor "DumpsterPuff" talked about his pharmaceutical misstep in the "Today I F*d Up" SubReddit and insisted he did not violate the Health Insurance Portability and Accountability Act (HIPAA) because he did not disclose what the husband was using the drug for.
The OP wrote:
"I work in a pharmacy and patients will pick up or refill prescriptions for their family members all the time."
"Unless we have it documented otherwise, if they give us a name and a date of birth, we can fill the medication (within reason, of course. It something looks sketchy I'll always alert the patient just in case)."
"My pharmacy in particular mostly does nursing homes, but we have a few people who live in these homes who need minimal assisted living and are in charge of their own meds, or their power of attorney does it for them instead of a nurse."
"We have a couple where the wife will usually call in medications for her husband. She has no idea what the drugs are or what they're for, just that he needs them when they're empty."
"So oftentimes it's a conversation over the phone of 'the big white pill... no the one for diabetes I think...' so I kinda have to figure it out."
"Today she called and was going over a whole bunch of new meds that were prescribed within the last few months and she was even less sure of what everything was now. I was kinda starting to lose my patience and I said:"
"Okay, so he was prescribed x, y, z, and sildenifil. I would assume all four would need to be refilled pretty much now?"
"Lady: 'What's the little blue one? The really tiny blue one? He dropped a few of those.'"
"Me: 'Sildenafil.'"
"Lady: What is it?"
"Me: 'Sildenafil. Also called Viagra.'"
"Lady: silence"
"Me: "hello...?'"
And with that, the line went dead.
"Now normally that would be concerning but my phone line in particular is kind of screwed up and it's not uncommon for me to have a dropped call, so I think nothing of it, fill all the meds and move on."
"About an hour later I get a message from one of my pharmacists."
"RPH: 'Hey did you talk to [patient] earlier about her husband?'"
"Me: 'Yeah, why?'"
"RPH: 'I just got off the phone with her, it took my 20 god damn minutes to explain to her that what [patient] was taking was not for what she thought it was.'"
"Me: 'I didnt even tell her what it was for. I told her Sildenafil and she kept asking what it was so I she her the brand name.'"
As it turns out, the husband was taking sildenafil for pulmonary arterial hypertension – a type of high blood pressure in the blood vessels leading to the lungs.
PDE-5 inhibitors – like sildenafil – were approved for pulmonary hypertension treatment by the Food and Drug Administration (FDA) in 2005.
But the wife drew her own conclusion about what her hubby was up to when she heard the word: Viagara.
"RPH: 'Right, so apparently she thought he husband with mild alzheimers was cheating on her in the nursing home. and I had to explain to her that the med is being used for pulmonary hypertension and not for ED.'"
"Me: 'Sh*t... sorry bro.'"
In an update, the OP maintained his innocence about breaking pharma rules:
"No, I did not break HIPAA with this, apparently some people didnt read the first paragraph. In pharmacy, it is perfectly acceptable to answer basic questions like what the brand name of a drug is, hence telling her it was viagra was okay to do, but telling her what it'susedfor could be a violation/medical advice which I CANNOT do."
"So what I said is perfectly in bounds with the law--if it wasnt I would have been in prison years ago, along with all of your pharmacy technicians and pharmacists."
"If you think this is a HIPAA violation, you most likely havent worked in a pharmacy or medical setting that involves dispensing drugs."
"That's just how it generally works. We obviously can't go around telling strangers about what a random person takes, but family members who have other family members fill/pick up their meds is a different story, and is WAY different than being in a doctor's office."
Redditors found the humor in the wife's foregone conclusion.
"I'm really, really sorry, but this got me laughing a lot lol" – BlaBlaBlaWhiskas
"It surely was! lol"
"But think on the bright side: now she won't think her husband is a pervert when getting random erections! So win/win situation."
"PS: I would die to see your colleague explaining this to the pissed off lady hahaha it must have been hilarious xD" – BlaBlaBlaWhiskas
This user heard a story about a wife trying to beat the system so that she can afford to use Viagara for her heart condition.
"I remember one story where the wife was taking viagra for heart issues, and it was super expensive because it was off label and insurance wouldn't cover it."
"So, the doctor kept asking the husband if he had any problems with erectile dysfunction, and the guy never picked up the hint and always denied having any issues."
"The hint, for any who may not get it, was that the husband's insurance would cover viagra for ED, so the doctor was trying to write the husband a script so he could give it to his wife, but obviously couldn't straight up say that." – Binsky89
People advised for the wife to be apprised of all of her husband's medications and treatment, given his mental illness.
"I feel like she needs to be a little more aware of what he's taking and how much and probably what it's for."
"My dad ended up in the hospital and my mom couldn't remember any of his medications when the ER staff were asking what he had taken recently and when the pharmacist came to confirm medications. I had to take care of all that and it was a little frustrating." – WrecklessMagpie
"We have my 95 year old grandfather keep a list of his meds and dosage (and I think my grandmother's, as well, since she usually doesn't have a purse or anything on her) in his wallet for exactly this reason...I have mine in the emergency section of my phone (JIC I'm incapacitated, because there's no way in hell my husband knows what I take)" – amoreetutto
This Redditor assured the OP he was in the clear.
"Firstly, indeed there is no breach of HIPAA and secondly the lines of HIPAA are a bit blurred when there is a spouse involved that in this case also has Alzheimers."
"Unless the man specifically mentions not to relay medical information about himself, usually it is assumed that you can share some medical info. Clearly the man in question is not fully able to refill prescriptions, hence it is the job of the wife."
"OP isn't in the wrong here and he only relayed information anyone could have looked up him or herself." – ThePhantomPear
Still, the mere mention of "Viagara" seems to make make people's blood boil.
"Yeah I think this is common enough that I'd often been told it's common to avoid using the brand name Viagra because it's 'common knowledge' that it's only used for ED."
"Even if it's actually used for ED I've heard it's recommended to call it Sildenafil anyway to avoid any kind of situation arising."
"I've also heard stories of people getting straight offended by staff who would dare even suggest they would take 'Viagra' even though they are taking it for cardiac issues." – DataReborn
No judgement here.