Monday, March 10, 2014

Down Memory Lane

Maybe it was getting outside for a long walk after a winter's hibernation that did it, but I started reflecting over my years as a pharmacist, and thinking about the little incidents that stood out to me. Although I've worked in retail for quite a while, a lot of my memories go back to hospital pharmacy, where I also spent a lot of time.  Through the hundreds of med-cart checks, the thousands of orders and IV bags and crash carts and questions about "can I mix these two things in an IV?", it's interesting how certain moments stick with you forever.  My own list includes:

-- one of the first times (as a newbie) I was sent up to the bedside to talk to a patient about his potential discharge meds.  He had a tube in his throat and told me he really wasn't interested because his wife took care of all that stuff.  I didn't know what to say to him and I still wouldn't today. I felt pretty darn inadequate.

-- walking through a "Head and Neck" unit where the patients often had cancer and were sometimes terribly disfigured.  One poor guy basically had a hole where his nose should have been.  The head nurse there was an absolute angel and took care of those people like they were family.  Her name was Sandy.

-- staying several hours late after an evening shift waiting for the blood bank to deliver a bunch of gamma globulin so we could run it all into an IV bag for an emergency high-dose administration.  I had never done it before.  I walked it up to the nursing unit after we prepared it.   I still have nightmares about tripping and falling, and watching that IV bag burst and splatter all over the floor.

-- ditto with my first experience preparing a bag of high-dose methotrexate.  The oncologist was young and fairly new and I think even he was nervous to order it.  The patient was a 21-year old.

--after years of working in the basement, being transferred to a surgical satellite pharmacy on an upper floor.  I remember sitting there with the sun streaming through the window one day and feeling reborn.

--starting a new hospital job and sitting through new employee orientation, when a huge packet of "Benefits Information" would be slapped down in front of me.  I'd think Gawd, this is so borrring!
Little did we know that that kind of job (full-time! with benefits!) would become the ultimate in good fortune.

-- and finally, going on bedside rounds in a Nephrology unit.  We were visiting with an older woman -- sick, chronic, hirsute.   She said to the (very experienced and very kind) doctor, "I'm worried."  He looked at her and said simply, "I am too."   I'll never forget that one.

Monday, February 3, 2014

Monday Morning.. Quarterback?

I'm really glad to see that Nasacort is going OTC (the first topical steroid nasal spray to go over-the-counter in the U.S.).  This type of product is already OTC in other parts of the world.  I think these Rx-to-OTC switches are a good attempt to bring down costs and put more of the responsibility on the consumer (remember how much time you used to spend dispensing Allegra and Claritin?)  Of course we still spend way too much time on OTC prescriptions, but that's another story.  Gosh, if Flonase ever goes OTC I might actually get to eat lunch once in a while...

Here we go with 2 weeks of Olympics overload again.  How come somebody can always come up with billions of dollars for sporting events but not for housing, food, homelessness, health care, or any of the other problems that plague Russia or other host countries?   And I like watching NHL hockey games as much as the next guy but those players are professionals -- they get paid to play hockey full-time  --- and I have no idea how they fit into the original intent or spirit of the Olympics.  Allowing professionals into the Olympics (and the amateurs to do commercial endorsements, etc.)  ruined what little interest I had.  Beijing's Olympic Stadium now sits unused and falling into ruin, and I suspect most of the Russian venues will end up that way too.

I really enjoyed watching Philip Seymour Hoffman.  So why would this guy, who seemed highly intelligent and at the top of his game, with three small children, stick a needle in his arm?  It's really unsettling. I guess we're reminded that that's what addiction is.  I still remember a pharmacy school lecture where the instructor was explaining how to alleviate a cancer patient's fear of "addiction" to pain medication that they truly needed.  One of his points was that 'addiction' includes actively seeking out a substance and being compelled to use it, knowing full well that it's harmful.  It's an illness, and I can only rationalize his actions that way in my own mind.  They say that heroin is making a big comeback and that prescription drug abuse is a gateway to it.  And that doesn't make me feel too good either...

Sunday, January 26, 2014

Reading Rainbow

OK, well we're almost through with January, the dreaded "new insurance" month.  I don't think we're out of the woods yet.  All those people who got 90-day supplies of meds at the end of 2013 haven't returned for refills yet.  I'm guessing the hammer will really drop around mid-March.  This is when folks will discover all the things they "didn't know" about the new insurance.

Y'know, after a tough day with pharmacy customers I think about the meaning of "education."
Everybody talks about how important education is to the citizens of a country.  To me, it doesn't mean how many people will become rocket scientists, because most of us will not.  It simply means training someone to read, comprehend, and apply information.  That's really all it is.  Sitting down to read something (longer than a tweet, anyway) is becoming a lost art. People won't read their insurance policies, they won't read the drug information that comes with a prescription.... heck, they won't even read the label.  I had a guy complain furiously that the tablets he was given in unit-dose packaging would crumble and break up when he pushed them through the foil.  This is why, I pointed out, that on each and every tablet unit was the UPPER CASE warning DO NOT PUSH.   A wide-eyed look of disbelief is shot at me when a bottle that prominently says NO REFILLS is presented for a refill.
And it's not limited to the customers --- my fellow staff members are asked to read a new policy or procedure and show up the next day clueless ("So, how am I supposed to do this?")

Electronic prescriptions are sent with nonsensical directions that no one bothered to double check.
Refill requests are denied ("we just sent you a new prescription on January 8th"--- Me: "Yeah, that was January 8th, TWO THOUSAND AND THIRTEEN.")   I don't know why this bothers me so much. It's such a waste of time. This is supposed to be the easy stuff.

Anyways, I truly appreciate my technicians who are battling, and often winning, the insurance wars.
We shall persevere.

Friday, December 13, 2013

All I Want for Christmasssssss....

Yup, I don't know where 2013 has that I've got that out of the way, here it is Christmas time again.  I feel like I just took the tree down.  I was never a big "all excited about the holidays" person, and my feelings haven't changed much over the years.   I guess the thing I most look forward to is having an extra day or two off work (and not all pharmacists are so lucky),  having an excuse to slow down a bit, cook and eat unhealthy stuff, light the fireplace, watch some goofy movies and generally go off the grid for a bit.   I actually do enjoy buying gifts for the people I care about, but I'm overwhelmed by all the crap in the stores and the urge to buy stuff I (and they) don't need just because it's there.
There are always attempts to have Christmas parties at work --- to go out for dinner or have a gathering somewhere, but everyone's schedule is so busy and quite honestly I think people feel they already spend enough time with their co-workers, and well ------ let's just skip the extracurriculars. No offense.

I hate hearing sad stuff at Christmas -- people getting killed in car accidents or shootings.  We're surrounded by images of big gatherings of friends and family, but I'm acutely aware that it's not like that for many people.  I see a bleak holiday season for many of my customers who are poor or disabled, and I'm so impressed by the ones who take the time to sincerely wish me happy holidays.  Even the folks who are financially well-off are often splintered by family feuds, divorces and custody battles. Christmas can be a cruel season, and I guess that's a consequence of our modern times.

Not to sound totally down on it, cause I'm really not.  I do salute all the people who work on Christmas Day.  I did a few of those myself.  Next year will be interesting --- health care changes and some merges and reorganizing with my employer.  I'm going to look past the rude and demanding customers, the people on their cell phones, the lazy and the entitled.  My philosophy is still this:  show me just a tiny bit of respect, and I'll go to the wall for you.

 I'm still really, really lucky, and I plan to be there.

Tuesday, October 15, 2013

Mom's boyfriend.

Followers of the NFL heard about Minnesota Vikings' running back Adrian Peterson losing his 2 year old son last week.  The child was beaten to death by his mother's boyfriend.  There isn't a lot of detail about how involved the multi-millionaire football player was with this child -- obviously he wasn't married to the mother and somehow this child became another sad statistic;  losing his tiny, young life at the hands of "mom's boyfriend." How many times do we hear that phrase?   Indeed, there's a lot to be debated about wealthy pro athletes spawning kids all over the place and then apparently having little to do with their well-being.  Of course, lots of people who aren't pro athletes are guilty of the same thing.

It goes without saying that we all feel physically ill at the idea of child abuse. I once worked in an in-patient pediatric health care setting and I couldn't imagine being a physician or a nurse who had to treat those patients and somehow keep it together.    I REALLY want to see a big-name professional athlete (or several of them)  come out and blanket the airwaves with public-service announcements on child abuse prevention.  I want to see those ads run during NFL and NBA and NHL games.   The only pro athlete I'm aware of who has done these types of ads is Mark McGwire, and that's because I saw him on a poster in a doctor's office once.  Think anyone else will step up to the plate?

Monday, October 7, 2013

I'll keep at it if you meet me halfway

I'm not computer-savvy enough to link to YouTube videos but if you get a chance, go to YouTube and search for "Louis C.K. hates cell phones". Then watch the video of the comedian Louis C.K. on Conan explaining why he doesn't want to get cell phones for his kids.  It's great -- funny, sad, and true.  As someone who watches people all day with their nose in their cell phones, I realize that the loss of eye contact caused by technology (and other kinds of personal contact) has really been a bad thing for our society.  It also makes it increasingly hard for anyone in the service industry to do their job.  I lament this and I refuse to give in to the zombie-like behavior of those I am supposed to be helping.  And it's not just the customers.  I work with pharmacists who see themselves as paragons of professionalism but apparently have no problem whatsoever being distracted by stupid texts and stupid Facebook crap on their personal cell phones. All day long.  While they are checking your prescriptions.   I don't accept that.  I love my iPhone, but it has no place in my workspace when I am doing my job.

I understand that the airlines are contemplating allowing people to use their devices all the time, including during takeoff and landing.  I am totally against this. Make people turn the goddamn things off for 10 minutes and listen to what's going on around them.  No, your iPad cannot be used as a flotation device.

I didn't participate in the recent Pharmacist Tweet-A-Thon.  I just wasn't in the mood.  My first customer of the day handed me a letter that said his $300 prescription had received prior approval from the insurance company.  He spoke not one word of English.  When the prescription was filled and I prepared to collect a $3.00 copay, he looked at me quizzically and shrugged in the universal "no money" gesture.  Another person haughtily informed me that she did not have $1.00 for her copay. When I indicated I was not going to just hand it over, she reached into her purse and pulled out a dollar.
Someone else told me I was "full of shit" when I tried to explain the rules regarding quantities of diabetic test strips when covered by Medicare.

I have a few tips for everyone who is entering the health care market under the new legislation (and I'm truly glad you are getting health care, by the way):

1.  READ.YOUR. POLICY. You, and only you, are responsible for understanding it.

2. Understand that everything is not going to be free. Being 'covered' by insurance also means that you might have to pay $3 ( or $100) out of a $300 prescription.  This is nothing new.  Even my long time customers with good jobs and good insurance have trouble grasping this.  The payer makes the rules.

3. You have to be able to communicate. Please learn the language or bring someone who speaks it.

4.  Be patient.  Be courteous and respectful of people in health care.  We are human too. I will move heaven and earth for someone who gives me an ounce of respect and practices common courtesy.
And please don't walk up to me with your face in your cell phone.

Monday, September 2, 2013

And how will you be paying for that?

CrazyRx Man recently posted "Why it takes TIME to get your Rx filled" and it was a great summary of all the potential obstacles, safety steps and other assorted procedures your pharmacist must perform before handing you those pills in a bottle.   It made me want to elaborate a little more on the step which involves submitting the claim electronically to your insurance, because people sometimes just don't get it that this is the PAYMENT step.  And just like any other retail transaction, we can't let you walk out with the goods until they are paid for.

Most people pay for stuff nowadays with a credit or debit card.  As long as you swipe your card and it is not 'declined' you are on your way.  Now imagine if there were conditions put on that card (like an insurance plan would do) which involved more than just having money on it.   To use my favorite analogy, let's say you are buying a new couch at a furniture store.  You swipe your card at the sales desk and any one of these messages pops up on the screen:

1. Too soon!  You bought another similar piece of furniture 3 months ago. There's no way that could be worn out yet.  You're gonna have to call us and explain yourself.

2. Prior authorization required!  That is a very expensive leather sofa.  We need to know why you can't get something cheaper.

3. Plan limitations exceeded! We'll only let you buy one with 2 cushions, not 3.

4.  Plan limitations exceeded! We prefer you to buy Sofa World brands, not Sofas 'R Us.

5.  Invalid days' supply!  You need to estimate how long this couch will last you.  We think it should be 12 years, not whatever you put in.

6.  Step therapy required! We need you to try a loveseat before you can move up to the full-fledged couch.

7.  (And if none of those get you...)  Card number not found! The number on your card is NOT the same number that we need to process this purchase.  You need some other numbers which we're not going to tell you until you have been on hold with us for at least 10 minutes.

No wonder I need some couch time when I get home from work.