Has Your Child's Doctor Ever....

Updated on April 13, 2012
P.E. asks from Fitchburg, MA
24 answers

Prescribed the wrong medicine? Is this a forgivable offense? We were in the office yesterday and my baby has thrush along with diaper yeast infection. The doctor told me to get lotrimin for his rash and that he would prescribe something for the thrush in his mouth. It was oral nystatin. Well, I picked up the prescription and luckily I read everything over and over and it was the nystatin ointment for skin. So he prescribed the right medicine but the wrong form...I just keep thinking what if I was someone who didn't double, triple check everything and just put the ointment in his mouth and he got sick...ugh. I called right away and left a message and the nurse called me back saing obviously it was the wrong stuff and she'd speak to the doctor and find out what he meant to do. Well two hours later the doctor called back and left a message saying he was sorry yadi yadi yada and he will call in the right stuff. Im just so annoyed right now....What to do.

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So What Happened?

It was definitely the doctor, he said so himself...He also offered to reimburse me for the cost of the ointment.

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answers from Washington DC on

I once picked up a prescip. for Z-pack for strep. Got home. Went to take it at 10p to realize the pharmacy had given me a pack of birth control pills! I called them up and said I don't think this is right. Oh my they said.

So I drove back and they gave me the correct medicine at no charge. I just hope the lady that got my z-pack wasn't a first timer and realized there was a problem too.

2 moms found this helpful


answers from New York on

This sounds like the kind of human error every single human makes. And doctors are human. If it happens more than once, switch doctors. If the results are truly life-threatening, sue. If it happens once and only once, forgive and let it go.

1 mom found this helpful

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answers from San Francisco on

Are you certain the mistake was what he wrote down, perhaps they made a mistake at the pharmacy? I had a pharmacist mess up an antibiotic order, which was powder mixed in the wrong ratio with water so it was foul and chunky and intense and made my daughter sicker! Terrible.

But people are human and make mistakes, and you figured it out and got it fixed. I understand being annoyed but I would try to let it go this time. If you continue to have issues with your doctor, start shopping around for a new one. But one mistake, that was corrected and apologized for, is not grounds for a new doctor yet.

6 moms found this helpful


answers from St. Louis on

Two things could have happened and you will probably never know where the error lied so forgive. One part of being a parent is checking what we are giving our kids and reading the directions. Clearly if it was oral it would say by mouth and ointment on the effected area. Why gives meds without reading the instructions, right?

So far as the error, he could have wrote nystatin and forgot a letter behind it or put the wrong letter, the pharmacy may have guessed and guess wrong or he may have called it in and the pharmacy wrote it down wrong.

Again that is why we read instructions before taking meds. :)

6 moms found this helpful


answers from Dallas on

I think you have demonstrated why we all need to be our own patient advocats. Re-read every prescription back to the doctor, make sure you understand what you are going to receive and how to administer (even if a liquid med) then do the same thing with the pharmacist.

More and more I believe everyone is triple checking for things like this.
I guess if you are so annoyed and this is a pattern, you can leave the practice and find another. If this is one incident, let it go and just re-read everything in front of him from now on. . .

3 moms found this helpful


answers from Milwaukee on

I would forgive. He is human. I would be concerned if it happens a lot.

3 moms found this helpful


answers from Los Angeles on

A quack murdered my mom with the wrong dosage on a perscription. But lawyers and doctors being what they are, nothing was ever done and I buried the results of her doctor's mistake. (I couldn't get a lawyer to take the case without a $100,000 up front fee and I couldn't get a doctor to testify under oath what they told me "off the record".)

Yes, I always check the perscription and the dosage.

Good luck to you and yours.

2 moms found this helpful


answers from Jacksonville on

Is it possible that the mistake was made by the pharmacist who filled the prescription?

2 moms found this helpful


answers from Dallas on

Are you sure it was the Dr? Cause I'd be less likely to trust the pharmacist than my Dr. And yanno their handwriting is ATROCIOUS.

Just trying to give you another perspective.

Good on ya for being quick to get it corrected.

Sending good thoughts your way.

2 moms found this helpful


answers from Shreveport on

My husband almost died with blood clots and he was diagnosed with diabetes. We found this out after he almost dies one morning in our home. He was in icu for a few days and the hospital for a few more. So, he had different doctors. We went to our family doctor whom I LOVE, they did some blood work and monitored his meds. Well, she has a pa and we rarely se her. I called in a refill and they said he needed to come in for a 3 month lab check up. We made the appointment and they refilled the meds. He started feeling bad 3 days later and we found out the PA gave him the wrong doasge and type(same name, but a time release) I called the nurse and she tried to tell me it was our fault for not coming in to get a check up? Really? I was livid and we no longer see that practice, and it is sad bc we loved the doctor we saw! At least your doctor took responsibilty.

2 moms found this helpful


answers from Minneapolis on

Yes, I've had some close calls with medication issues. I think the world of medical providers, but we all need to be our own advocates. They are human and make mistakes. This sounds like an easy mistake to make.

When my then toddler was in the ER with a fever of 105 that wouldn't come down despite meds and other measures taken at home I almost had two separate nurses overdose him on meds. One came in to give him something after another had just been there giving him the same thing. I questioned her and she said, "Oops."

My mom was in a well respected trauma hospital with a life-threatening injury. She has an underlying very serious autoimmune disease that complicated her situation. We had numerous issues coordinating her meds between her rheumatologist and her treating trauma doctors. I don't remember the details, but I caught one problem that could have been significant. After that I kept a notebook on her bedside table for us to jot down notes, ask questions, monitor things, etc. We had a family member there every day keeping tabs on things. Oh, my dad had to advocate to get a feeding tube when the doctors weren't sure it was necessary. It did end up being necessary and might have been a big turning point for her recovery.

I would give the doctor a second chance on this one and just remember to be your son's advocate. It's good you caught it, but I think this is a forgivable offense.

2 moms found this helpful


answers from Chicago on

Forgive, move on and be glad that this is the only thing you have to complain about thus far. He is a human, we all make mistakes, that is why we double check right? If it happens again, then I would be concerned.

2 moms found this helpful


answers from Cincinnati on

The nurse practitioner at my family doctor's office has prescribed the wrong dose for my kids twice. Both times, three of them were taking the same antibiotic for the same thing (strep) and she mixed up the names and dosages. I always double check the dosages when I have more than one kid on an antibiotic. However, its usually pretty obvious as there is a fairly big discrepancy in their weights which affects the dose. I did have the same doctor (doctor, not the nurse practitioner) prescribe the wrong dose of an antibiotic to my first son when he was under a year old. Luckily, the pharmacist caught it- so ever since, I have been careful about reading everything before I start giving it to my kids (and the only side effect would have been upset stomach and diarrhea). I consider it a forgiveable offense. I have had two other pediatricians (started with the family doc, went to a couple other practices, and ended up back at the family doc) and ended up leaving for less forgiveable things. I just consider it part of my job as a parent to double check others when it comes to my babies. Doctors are human beings and they do make mistakes. I would say as long as it doesn't happen very frequently, I would give him another chance.

2 moms found this helpful


answers from New York on

If this is the first mistake he makes with your child, and since you are very good at checking (thank God for that), I would give him another chance. We all make mistakes although we are talking about the safety of your child. But since you are a great mother who checks what she is getting, I wouldn't push it. But if you have another issue with him and you don't feel comfortable anymore, then look for someone else.

1 mom found this helpful


answers from Denver on

Doctors are human too. They "practice" medicine.
Happy that you checked and found the error. That is awesome because I think we all usually take for granted that the pharmacy and doc do not make mistakes but just from your post I will now remember to check any perscriptions we may get.
Actually, I would be a bit annoyed about the mistake but try not to be to hard on whom ever made it unless this is a reaccurring issue.
Hope the baby gets better soon! Happy friday....btw, when my baby had thrush I used something called gentian violet, it was messy but cleaned it right up without prescription meds.

1 mom found this helpful


answers from Charlotte on

Are you sure it was the doctor, or was it the phaamacist? Double check that, just to be sure. It happened to me once (eye versus ear) and it was the pharmacist's fault. The jerk wouldn't even say he was sorry...


1 mom found this helpful


answers from Tallahassee on

The doctor didn't, but one of his nurses did.

DD has a history of getting urinary tract infections and we were seeing a urologist for the problem right around the time she turned 3. This all started when DD started preschool and was expected to be more independent in the bathroom. I was not happy when I found out that they were making a 2/3 year old, who was newly potty trained wipe herself after a bowel movement, but that's another story.

Anyway, whenever I suspected DD had a UTI I would take a urine sample in for them to test. Well, one of the times that it came back positive was on a Friday afternoon and they called to tell me the results and that they sent a prescription to our pharmacy and I needed to get DD started on it right away. DD was napping at the time so I waited until she woke up and then we went to go get the prescription. By this time, the Target pharmacist was very familiar with us because we were always picking up a prescription for something. (She would even stop me and talk to me if she saw me in the store shopping and not getting prescriptions.) She informed us that the prescription that was sent over for DD, who had just turned 3 a week or two earlier, was for Cipro pills. These are giant horse pills that are only approved for adults. The pharmacist informed me that Cipro is not a drug that a small child should be taking. She was so nice and called the urologists office for me and handed me the phone. It was late afternoon and all of the nurses had left for the day/weekend and I ended up talking to the doctor's assistant who told me to just crush up the pills and give them to my daughter. I asked the pharmacist about doing this and she said absolutely not. Cipro is not approved for small children and even if it were, the medicine would lose efficacy if we had to crush it up. The assistant then told me, as my daughter was crying and screaming in the background because she was in pain, that we would just have to wait for Monday because the nurses and doctors had all left. All of this after I was told to get her started on the medicine right away. I was so angry and that's when the pharmacist took the phone and told the assistant that she needed to get in contact with a nurse or doctor right then to get the prescription changed. The assistant ended up calling a nurse and we finally got an acceptable liquid antibiotic but I was furious by the time it was all said and done.

There was also one time when I ran out of antibiotics for my daughter before she was supposed to finish it. When I calculated the amount that came in the bottle with the amount that she was supposed to take per day for the amount of days she was supposed to take it it was off. I think we were about two days short. I had to call the pharmacy and they saw their error and gave me some additional medicine and a gift card since I had to go out of my way to go back and get more.

1 mom found this helpful


answers from San Antonio on

I had a pharmacy mess up my medication once...it was in college and I was given an antibiotic (I knew what it looked like as I ended up on it a couple times of year). Anyways, when I picked up the rx, I opened it right there in the pharmacy and looked at the pills...they didn't look right so I looked at the label it for some other medication...I went back to the pharmacy and asked about it showing them the pills. The pharmacy tech snatched the bottle out of my hands so fast I thought my head would spin. She would fix it she explained...

I looked up the other drug later at home and it was for schizophrenia...can you imagine if my young eighteen year old self had just taken it. I learned a lesson in that moment...always always check your medication at the pharmacy before you leave.

I have had doctors prescribe really expensive medications that we didn't really need because an OTC would do and have pharmacists help me figure out if we needed to pay $275 dollars for a nasal spray that we could at least try an over the counter one first.

People make mistakes...keep double checking...

1 mom found this helpful


answers from Boston on

I worked on an investigative news piece on this while interning at a news station in college. The *reported* error rate for pharmacies is 1-2% of prescriptions are filled incorrectly. That's just the mistakes that actually get reported, so it's probably a little higher. That means that for a busy pharmacy that fills 100-200 prescriptions a day, 1-4 of them are wrong. Sometimes it's the wrong dose (that was the most common error), sometimes it's the wrong form of a medicine (liquid vs. pill vs. topical), and sometimes it's the completely wrong medication. Luckily, most mix ups are fairly harmless. The story that prompted our report was of a woman whose infant was prescribed an antibiotic at many times the correct dosage (it was supposed to be something like 1/2 tsp 2x a day and was printed as 2 tsp 2x a day) - the baby was fine, just quite sick to her stomach.

Doctors can make the same errors, they're only human. I think your story is a great reminder that there are several points of possible failure in the chain - it starts with the doctor, then goes to the pharmacy, then the patient or parent. All it takes is for one of those 3 people to be double-checking to prevent and error. Of course we want things to be error-free, and electronic prescriptions have helped out a lot, but none of us is perfect every minute of every day. That's why at the patient or parent, the responsibility is on us to ask for write down the name of what the doctor prescribes, what it looks like and the dose. Then when you get the medicine, check everything (name, dose, that the description on the container matches the contents) before giving or taking it. We're only looking at one new prescription at a time while the doctors and pharmacies are processing dozens a day.

I really only know to do this from what I learned on that news story. I did get a medication for one of my kids once that was not what I expected - the pills were different name, color and dose. I called the pharmacy and then the pediatrician's office. It turned out that my insurance company didn't cover the first medication, so the doctor substituted something else so the prescription was correct. The nurse who took my call though did remark that they do this regularly and I was the first parent to ever call in and verify that the switch was intentional.

Good thing that you had the sense to check! I wouldn't really do anything about it - it was a mistake, I'm sure he feels bad, but they happen. Just use this to validate your own vigilance and make sure that you continue to be diligent about check each prescription carefully!



answers from Victoria on

Yes we did get the wrong meds. It was actually a np that perscribed a medication to our 10 month old son for ear infections. We went to a ent doctor that caught the mistake. Luckly we only gave him the min amounts a few times the ent said that medication the np was only intended for those 17 years and older. He is truly fine. But the effects of giving him that med were his joints and everytime his leg is hurt or his arm I freak out. He is four years old now and I am feeling much better. But still worry about him like only a mother bear would. We only take him to our pedi now. He rarely prescribes meds which I love and will often perscribe otc meds. Very hard lesson to learn. The np in our city are treated as if they are doctors and prescribe meds with one head doctor "in charge" . This way that head doctor is allowed to charge the money of seeing a doctor. The np we saw was free provided by my husbands work. None of us go to that np as she prescribes bad meds/extream meds for others as well. Its enough to make me want to go hippy and use all natural...which i do if i can.



answers from Seattle on

Oh sure. When you're on as many meds as my son has been, the law of averages creeps up. It's been no big deal, as the meds have always been caught be someone in the process (other doctors, nurses, pharm, or myself).

Part of why my husband is calling me a control freak is that I keep a running diary of meds, doses, and times. But it's just what EVERY parent of a chrinically/longterm sick child does. We're part of the treatment team in the hospital, and out of it, we're not only 'primary', but in the event of needing to be in the ER we need a list of what meds, how much, and when... And it needs to be accurate.

Mistakes happen, so we (parents & med team) plan for that.

Funny story... Being the granddaughter of a surgeon, pre surgery, I always sharpie 'NOT this _______" (arm, leg, eyc.) pre surgery. They usually do that themselves once you're under, then wash it off, so I save them a step / it's just good practice. But it also let's anyone who sees it know a) wrong leg, and b) that I'm in medicine. Plan for mistakes and circumvent as often as possible. ANYHOW last time I was under I woke up to a note on my 'wrong' shoulder under my own. 'Okay, okay no BOGO.' Goofball.



answers from New York on

well, tuesday evening i took my 7 year old to see the pediatrician. she was diagnosed with ear infection, and the doctor said she would call a prescription with my pharmacy. i go to pick up the antibiotic and it didn't seem right, the dosage i mean. i asked the pharmacist if this was correct and he said that is what was called in. i give my daughter the first two doses in the course of 12 hrs. i was still in doubt. i finally emailed the office wednesday night to ask whether the dosage was correct. another doctor replied and said no it's not and that i should call the office first thing thursday. mind this, it's 3 days now with my daughter in pain and fever. called the office explained the situation and they said they need to verify with the doctor who emailed me. half an hour later i get a call and an apology. not only was the dosage incorrect, but so was the antibiotic as well. i was fuming. yes, i question everything because that's in my nature but what about someone who trusts the doctors blindly? so i pick up the new antibiotic, call the office again and said i need to file a formal complaint against the doctor who prescribed the wrong antibiotic. they understood. it's awful and i am still mad about it.



answers from Louisville on

Had a doctor that would have prescribed me the wrong meds once - and he had my chart in his hand at the time!! Luckily he was telling me what he was writing so I was able to tell him, um, think you need to change that to something else as I'm allergic to amox! (craxy thing is, it was during the time I was in this office - 2-3 years - that the allergic reaction happened!)


answers from Hartford on

I think I've had nearly every doctor I've ever had for myself or my children Rx the wrong medication at some point. It's often a situation exactly like you described: the wrong form of the medication or the regular medication rather than the extended release or the liquid instead of the pill. I always have the Rx's written out so that I can take them the pharmacy I want at my own leisure and don't have to wait for the doctor to call it in, and I always look the written script over right there in the office. But honestly, most mistakes have happened on the pharmacy end in our case. I know how to read a script from working with nurses, and I know when the pharmacy messed up and entered the info incorrectly. They always try to pass it off like it was the doctor and they have to call the doctor's office to "fix" the mistake.

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