Let the Games....Continue

I had a prescription ready at the counter and called the customer's name.  She walked up to the counter with her nose in her phone.  Of course, that's not unusual.  She reached the counter and still didn't look up.  I waited a few seconds.... still no eye contact.  Normally I would walk away, but I decided to play a little game and see how long it would take her to look up while I stood there waiting.  I waited, and waited, and with only about 3 feet between us it probably took her a good 45 seconds to allow me a moment of her time -- and only a moment.   Yes, we've got a sign asking people to turn off their cell phones.  What a joke that is.   It often occurs to me that there is a whole generation of toddlers and pre-schoolers who, when they think of their parents, will picture them staring at their cell phone.  Until the kids get old enough for their own phone, that is.

Every once in a while you get an elderly customer who is a breath of fresh air.  They are polite and respectful.  They don't have cell phones.  When you talk to them they listen, and are appreciative.  They come from a generation who didn't run to the doctor with every minor ailment.  A trip to the doctor's office was a responsibility they took on to maintain a good state of health, or it was because they had a medical concern or condition that they felt required a doctor's attention -- in which case it was probably pretty significant to them.   A prescription is a big deal and they look at a pharmacist as someone providing a professional service.  I love those folks, and I will spend ANY amount of time with them, no matter how busy it is.

What is it about standing in line that makes people behave like first-graders? When we have a bunch of people lined up, some picking up refills and some waiting for new prescriptions, we've got to be fair.
The people who have been waiting for new prescriptions for 20 minutes may get called up ahead of someone who just walked in to pick up a refill.  We'll get to everyone, people.  I can't count the number of times I've felt as though I'm in a schoolyard.... and by the way, just because you're a regular customer who comes in ALL the time does not put you at the head of the line.

I feel vaguely guilty selling people Mucinex.  Expensive placebo? I always tell them to drink lots of water with it.  In fact, just drink the water, skip the Mucinex.

I still do a slow burn when someone walks up, slaps down 2 or 3 prescriptions, and the FIRST words they speak are "how long will it take to fill these?"   I always wonder if the first thing they say to the doctor when he/she walks into the examining room is, "How long will this take?"  Or when they check into the lab, or X-ray, or lay down on the gurney in pre-op --- are they asking this same question?
I wish I knew of a response that might convey a reminder that this a professional service, and not a sub shop.   Or at least a response that wouldn't get me fired.

Knock it Off!

OK, knock it off with the calls for Phenergan with Codeine.  I've taken a slew of inquiries lately -- Do we have it?  What flavor is it?  Do you have the purple one?

This, of course, is one of the latest drugs of abuse -- mixed with soda or alcohol and apparently called the Purple Drank, among other names.   Really guys, we're not stupid.  We can tell from the questions you're asking that you're not suffering from any, um, cough today.  And of course you're making it a heck of a lot harder for those folks who may legitimately need it.  I've told several callers I don't have it (as I'm staring at the bottle on the shelf.)  I've also faced disappointed customers who discover it's not the 'purple' one that they're getting.  Yup, and then they want the prescription back.  What a damn waste of my time.

 There are still prescribers out there who need to be aware that people who ask specifically for this product may not be using it in the 'prescribed manner.'  Just say no.  There ya go.

Many Americans do a Glucose Tolerance Test Every Day

A neighbor of mine, who is pregnant, is going to the doctor soon for her Glucose Tolerance Test --
(this is a test given to detect gestational diabetes --  a sugar solution is given to drink and then blood sugar testing is done to make sure the body is handling the glucose load and clearing it appropriately from the blood.)  It can be kind of a yucky solution -- it's concentrated and you have to drink it fairly quickly -- and typically contains 75gm of glucose.  

It occurred to me that you could get about the same dose by chugging 2 to 2 1/2 cans of a typical
non-diet soda.  Not a problem for many folks -- in fact, skip the cans and go right for the 16 or 20 oz. container.   This helps me understand the attention being paid to 'sugary sodas' and the attempt to limit portion size in some restaurant outlets (aka the New York "Bloomberg soda ban.")  And by the way, the maximum allowed size under this 'ban' (16oz.) is still a pretty damn big cup of soda.

Whether you think this will have any effect at all, or is even worth doing, is up to you.... but it irritates the crap out of me to see a certain conservative starlet waving a Big Gulp at her recent speech and labeling this effort an assault on her freedoms.

Americans are free to kill themselves any way they want.  They are free to live the most unhealthy lifestyle they can come up with --  sit on the couch, drink a couple cases of Mountain Dew and smoke a carton of cigarettes a day -- whatever.    But ask any pharmacist or physician what proportion of their patients' multiple health problems can be linked to simple obesity and you'll see some pretty significant numbers.  I'm so used to seeing people struggle up to the counter in various states of obesity that I really don't  notice it anymore unless I stop to think about it.   The COST of all this treatment  -- drugs, insulin, diabetic testing supplies, diabetic teaching, doctor appointments, lab visits, -- is really staggering.

I know losing weight is tough, and it gets harder the older you get.  Even if the 'soda ban' doesn't hold up at least people may become aware, little by little, of the destructive effects of many of the things we consume.

Disclaimer:  I truly enjoy an ice cold Coca-Cola (NON-diet) every once in awhile.

I Think if I See One More Prescription for Tylenol, I'm Gonna Lose it

More and more, I feel like I am spending a TON of time filling prescriptions for over-the-counter medications. (For the non-pharmacist reader, many of these are covered under medical assistance plans -- and as such, need to be processed just like a prescription medication, with all the same procedures, record-keeping, etc.)    Now, this is not going to be a swipe against the "moochers" -- and believe me, I struggle with this, because I believe that the majority of people on assistance do NOT abuse it.   But even fellow pharmacists who've been doing this a long time are beginning to wonder how long we can keep it up.  Additionally, many of our customers on state assistance are immigrants (some might even say refugees) from other countries.   Now, if a child enters this country and immediately comes down with leukemia, I'd like to think we're not going to stand there and let him die.  We are better than that.  But how obligated are we are to cover prescriptions for (and to stock people's medicine cabinets with) things like Tylenol?   And hydrocortisone cream,  and every form of vitamin, Miralax, Compound W, Colace, saline nasal spray, simethicone,  Sudafed, Claritin, Eucerin, ibuprofen, calcium, iron, aspirin, Benadryl, Maalox, Milk of Magnesia,  Lotrimin cream,  Robitussin, artificial tears,  and many MANY others -- all things that most of us purchase on our own.

Inexpensive products..... BIG EXPENSIVE HEALTH CARE machinery behind them.  I think about it now every time I wade through those quality-assurance double checks of my saline nasal spray prescriptions.

We routinely have people bring us prescriptions for OTC's from a hospital emergency room.  We all know the cost of an emergency room visit,  and this is utter INSANITY.    There needs to be a way for people to get advice on minor health issues, (ask your pharmacist, maybe?)  and then be given a recommendation on what to go out and BUY for it.  To be sure, there are lots of very expensive drugs and medical procedures out there that the average person cannot afford on their own.   Tums is not one of them.

The Prescription Abuse Game

I've only worked about half my career in retail pharmacy (started in hospital) so I always thought of myself as a neophyte when it came to fake prescriptions, phony call-ins and other forms of drug diversion.  I'm sure I've been fooled more than once.  I'm not sure how many occurrences most pharmacists would say they have in a typical week, but I seem to have encountered a cluster.

We had one guy come in -- never filled with us before and wanted to pay cash for his Percocet prescription ( I wasn't too familiar with the doctor, either.)  Of course even for me this was a red flag
and a check of the state's monitoring website revealed a long string of Percocet prescriptions, some filled literally right on top of each other.  The most recent was 4 days earlier for an even larger quantity.
Sent him away and he was not a happy camper.  I don't really care what he's doing with it,  probably selling it, but it's irritating as hell and a waste of my time.  I contacted the doctor's office, sent them a copy of the State information, and never heard anything back.

I've also encountered a string of 'lost' prescriptions claims -- 'lost' on vacation, 'accidentally' threw it away, lost my purse, etc. etc. etc.   I wish every prescriber would make it clear from the outset that they will not replace lost or stolen prescriptions without a police report.  I can't believe how accommodating some of these doctors are.

Also recently became aware of someone calling in her own prescriptions -- she was pretty good but it never sounded completely right to me and I am mad at myself and the rest of our staff that no one thought to take the time to verify it.

I guess it's just irritating to be played for a fool.  We're hammered with the principles of customer service and being nice to everyone and I feel like these drug seekers are probably laughing all the way out the door.  I know this isn't news to any experienced retail pharmacist out there, but just had to get it off my chest.

Pharmacy PRO

There's a commercial on TV for National Car Rental that features the "Business Pro" -- the frequent and experienced business traveler who can breeze through the airport -- going "shoeless and metal-free in seconds."  In the endless procession of people we wait on at the pharmacy every day, I have come to truly appreciate the Pharmacy Pro.  I'll give people a pass for their first couple of visits (maybe) but after that, well ----  these are the true marks of you,  the Pharmacy Pro:

1. You hand me your prescription insurance card with the prescription, or in the case of an e-prescription, when you check in.  Each and every time.  Even if you've been to the pharmacy 40,000 times before.  It's the newest and most current card. It's not your dental or medical card.  If the prescription's for a family member, you give me their card, not yours. I already love you for that.

2. You are acutely aware of your surroundings.  If the place is going crazy and there are lots of people waiting, you say "I'll stop back later."  If you know you have multiple prescriptions, you do the same regardless.  I love you for that.

3.  You are aware, at least generally, of what your doctor has sent us.  If there are things you don't need filled, but just kept on file, you tell me up front.  I love you for that.

4.  If you want a refill of something, as well as having your new prescription filled, you tell me immediately.  You do not wait until we are ringing up the prescription before saying, "Oh, and I also need some test strips" and expect to just stand there and wait.

5.  While waiting for your prescription, if you are paying by check, you have your checkbook out and you have already filled out the entire check except for the amount.  I love you for that.

6.  You are an active participant in this process.  You look over what you are receiving and verify that what is there is what you're after.  Not when you get to your car, not when you get home, not 3 days later when you tell me you 'never got' something.


Here's to you, Pharmacy Pro.

Random Stuff I've been jotting down

Ohh, where did the time go?  Thanksgiving, Christmas, and now January (normally "hell month" because of insurance changes and most people's neglect of carrying that new insurance card and general cluelessness about their own insurance coverage.)  Yeah... remember that "high-deductible" plan you signed up for?  Yeah, that is why your prescriptions are not SIX DOLLARS anymore.  I know they USED to be, but they are NOT NOW.   And apparently it's me, the sweaty, wild-eyed, hungry, tired and full-bladdered pharmacist that has to explain that to you.   And by the way, please don't cough on me.

I was attempting to read some sort of Medication Safety Newsletter the other day, full of breathless phrases like, "learners attend sessions on patient safety, pharmacy processes, human factors, and identifying potential hazards in a patient’s environment of care. They gain hands-on experience by following a medication from order entry to administration and identifying vulnerable points and possible solutions."  and......."The 90-member team is a network of physicians, nurses, respiratory therapists, and other healthcare professionals who serve as ‘lifeguards’ for providers traumatized by an unanticipated event or error. "    It had been a particularly hellacious day at my job as a retail pharmacist, and it just struck me whether the people writing these things have any idea at all about the working conditions that most pharmacists on the front lines (ie, community) endure.  Um, yeah, I think we could all identify a few of those 'vulnerable points' --- as in, well.....  (see any pharmacy blog).

I saw my first pre-stamped prescription for Vicodin 5/300.  This is the new lower-strength- acetaminophen Vicodin which is not interchangeable with the generic 5/325, which is the only thing anybody stocks.  So time was wasted calling the dentist's office in question, where someone (probably the receptionist) brightly assured me that the generic would be fine!  I can only hope that after the 500th pharmacy call that this dentist's office will get rid of those pre-stamped prescriptions.

I waited on a customer whose main complaint appeared to be a stuffy nose.  She had 5, count-em, FIVE prescriptions, including saline spray, Flonase spray, Sudafed, Mucinex and of course, amoxicillin.  All covered.   Seemed like a bit of overkill to me. (See previous blog post about excess time spent screwing around with OTC prescriptions.)

Spent a lot of time with an elderly lady who had initially been given samples of a very expensive patch,  found they worked well, got a prescription, and was now discovering they were not covered by her insurance.  Oh, the hazards of samples... and somehow it's up to me to fix it. 

Does anyone out there show up at grocery store 5 minutes before closing with a 2-page shopping list and dozens and dozens of questions for the staff who are trying to go home?  I wish people wouldn't do that at the pharmacy.  It's just inconsiderate and not right, especially when it's something that could and should have been dealt with earlier, or called in ahead of time.

New Year's resolution -- find more time for blog posts.... it's therapeutic!