Shoe Update and Bye to 2008

A little while ago I wrote about my quest for a new pair of shoes that I could stand in comfortably for those long long days at the ol' pharmacy and I got some great suggestions (Merrell, SAS, Dansko, etc.) I filed them all away for future reference but I decided to try the Merrells this time (style: "Encore Groove"):
http://www.merrell.com/US/Product/NZGP/Womens-Casual-Footwear/Slip-Ons/Womens/Encore-Groove.aspx

I am REALLY liking them. Nice contoured footbed, great arch support, very lightweight. I always stayed away from slip-on or clog style because I didn't want my feet sliding around in them but these fit like a shoe and don't slip at all for me. Glad for all the tips on shoes.

Busy last day of 2008 today -- pretty much non-stop prescription action. At the end of the day one customer apparently got booted from his Part D plan with the reject "Coverage begins 1/1/09" -- of course he claimed not to have changed anything and we figured they probably re-enrolled him and forgot that he might need something on 12/31/08. I waited on hold for about 15 minutes with the insurance and had to give up -- pretty annoying.

Another person came in and wanted to look at our selection of blood glucose monitors. Not for herself, though -- she had money left on her flex spending account and thought she might buy one and 'give it to someone else.' Interesting thought (come to think of it, can you do that?) but it took a few minutes to get the whole story --I thought, maybe she's going to put it away for that day she becomes diabetic?

A Happy New Year to all fellow pharmacists in the trenches! We'll keep on doin' it in 2009 -- like we have a choice, right?!!

If I Were King........

Y'know, I'm not a manager -- I've always been a worker bee, and I 'supervise' technicians to the extent that we work together, and I'm the pharmacist. I try not to get sucked into petty bickering and workplace politics. I'll lend a sympathetic ear to whoever wants to talk to me. But I find the one thing that comes up over and over (and I'm sure this is true for other businesses) is this: If you're a manager, and you've decided to impose a rule or a standard that you expect your staff to follow, then EVERYONE has to follow it. There can be NO EXCEPTIONS. NONE. And the staff members who decide to blow you off while others attempt to obey the rules, need to be DEALT with. Not doing so creates unhappiness, morale problems, bickering, bad blood and outright hostility.

I'm just talking about simple standard stuff -- if you have imposed a dress code, for example. Or decided that employees are to answer the phone in a certain way. Rules about calling in sick, coming in late, or leaving early. I have seen over and over in my pharmacy career how certain employees are allowed to walk all over the rules, and I will never understand it, NEVER. You've got to treat everyone the same, and if there are extenuating circumstances, just explain it to everybody. This seems so simple to me -- am I missing something?

As you may have guessed, this issue has raised its ugly head again in my place of work. What a distraction....

Oh, the pamphlets you'll get !!

Since we often see customers as they are coming out of their doctor's appointment, I can't help but notice the materials they plunk down on the counter while fishing around for their insurance/credit card/prescription. Often it's a fistful of those pamphlets that the doctor's offices hand out --- "Understanding Hypertension", "Lower Back Pain", "Meet Your Sinuses" (0r something like that). Unfortunately I think these pamphlets are a poor substitute for actual patient education, but I realize the limitations placed on some young nurse practitioner to try and change someone's entire lifestyle in a 10-minute visit for a Vicodin renewal. I waited on a rather disheveled, cigarette-smoky-smelling man who, as he left with his pain meds, remarked sarcastically "Now all I have to do is quit smoking, lose 30 pounds and quit shovelling snow." I started to laugh at his little joke then I realized the look on his face was one of pissed-offedness. I guess having those suggestions thrown at you along with a bunch of pamphlets doesn't go over too well sometimes, but again I realize the daunting task some of the practitioners face -- to motivate someone to really take charge of their health is a special talent they probably don't teach enough in medical school.

I know that 'wellness' programs are the new thing now -- run by insurance companies who will give you a credit for participation. Of course, you have to have insurance first. But let's face it, even those of us in the health professions can resist the idea of being lectured to, even if we don't smoke or over eat. We shy away from the chirpy 'coach' who tells us to exercise more. These people make us feel guilty, and running away from guilt is the most basic human emotion.

The motivation always has to come from within. Will power is such a tough thing to maintain. Anyone who can figure out how to harness these things in patients like my crabby customer will deserve a Nobel Prize. Then, we can get rid of the pamphlets!

Layoffs and Loyalty

Our organization has been hit with some layoffs -- not the pharmacy department, but the health care organization/clinics where we are located have cut some support staff, including some pretty senior people. I know it's going on all over the country, but it sure sucks. One of the people I know who is laid off has a terminally ill family member. At Christmas, no less. The organization warned us it might be coming, but it's still kind of shocking. Even if you're not affected, you almost have a 'survivor's guilt.' You don't really know how to act.

I think of myself as a conscientious employee. I come to work to work -- not to stand around and chat, not to avoid the jobs I don't like, not to do the bare minimum until I can go home. I get angry at other people for doing those things. I try to be as helpful as possible to my customers and co-workers, whom I value and generally like very much. I have to be at death's door to call in sick. But when it comes to the 'company' or the 'organization' I have always kept them at arm's length, because I know when push comes to shove it's all about the bottom line. They won't go to bat for me. We get the philosophy lectures, the mission statements, the caring & sharing pamphlets -- all that stuff. I've seen it many times and I know it's just window dressing.
When I'm at work I do a good job not as a representative of the company, but of myself. I don't feel good about saying it, but you won't find me wearing a sweatshirt with my company's logo or volunteering at some company-run 'ask your pharmacist' event. I don't feel that kind of loyalty and unfortunately I know it's reciprocal.

I've always been able to get a lot of job satisfaction from pharmacy work. I don't need to work for the World's Best Company to get it. I'm glad to have job security and I truly wish everyone did.

I'm here to pick up prescriptions for (insert name here)

We had a rash of problems this week with people sending other people to pick up their prescription refills. You know the drill ---- boyfriend, girlfriend, spouse, neighbor, babysitter, caregiver, friend or family member comes in to pick up for their boyfriend, girlfriend, spouse, etc. and leaves with a sack of items that are filled and ready. Shortly, a phone call comes in from the customer who is angry because they didn't get 'everything.' A search of the pickup bins reveals another bag or two for that same customer which was separate from the other items.
There are lots of reasons for this -- prescriptions called in at different times, prescriptions waiting on doctor approval, prescriptions waiting for a supply of drug to come in --- these may all result in items being completed at different times and added to the bins. It's not always possible to keep everything together. And people can be pretty p.o'd that their errand person didn't come back with all of it (as in, "What do I do now because YOU guys screwed up??")

So, rule of thumb: when sending someone to pick up prescriptions for you, tell them HOW MANY they should be getting. Preferably, make an EXACT LIST. Check it twice. So you won't be naughty and we'll be nice.

One other random irritant: insurance companies who now cover only generic Imitrex -- but we can't get our hands on any, leaving us and our headache sufferers up the creek...

Because of the Economic Downturn, Do I have to Kiss Butt More than Ever?

It's starting to look that way. If numbers go down and people aren't going to the doctor, it's being suggested that we've got to take pains to bend over backwards for the customers.

Sure, normal customer service is expected. But I do not feel any more compelled to figure out someone's insurance plan who doesn't have the card and doesn't have a clue. I do not feel any more compelled to try and counsel a patient who is talking on his cell phone through the entire transaction and glares at me for the interruption. I do not feel any more compelled to tiptoe around a customer who I know to be getting his narcotics from several sources, and who has hopelessly duped his doctor.

Yes, they might go somewhere else. And with the number of copies I'm giving out lately maybe they are -- although I believe the gift cards are playing the biggest role there. But I'm not going to kiss butt to anyone who's being rude, sneaky or just downright lazy. And I'm going to feel the same whether the economy is up or down. Enough said.

Those cursed little rolls of labels

Most of the technicians I work with are accustomed to having different pharmacists come through from day to day, and some of those pharmacists like to do things different ways. I am impressed with the technicians who try to remember the preferences of each pharmacist, or who ask "How would you like me to do this?" if they haven't worked with you a lot. It can't be easy for them to keep track all the time. Some pharmacists like to receive the prescription for its final check in as 'finished' a form as possible (like me). Others seem to trust the technician only to count out or pour the medication -- the rest of the paraphernalia (receipts, patient info, med guides and other paperwork) gets dumped into the basket for the pharmacist to sort through and arrange in some presentable form. To me, this is a frustrating extra step especially when a patient's got multiple prescriptions and I'm up to my eyeballs in waiters.

One technician told me he worked with a pharmacist who didn't even want him to stick the label on the vials (!) and visions of a counter-full of unlabelled med vials gave me nightmares.

Anyways, we have one or two pharmacists who don't want the techs to put any auxiliary labels on the vials -- they only want certain ones and so they want to do it themselves. Now, everyone's computer software spits out some auxiliary labels that are not worth slapping on the vial ("Take exactly as directed"? --- I hope that was implied...). And we have a few in our system that I think are needlessly alarmist, like the statin prescriptions that say DO NOT drink any grapefruit juice EVER. But why would any pharmacist not allow a "Shake Well " label on an inhaler or antibiotic suspension, or a "May cause drowsiness" on just about any pain med?
My point is that I'm standing there fiddling with these silly things when I'm already way, way behind and I wish that other pharmacist would lighten up and let the techs do the obvious ones.

I know, we're lucky if the patient reads the label at all, much less these little extras. I remember in pharmacy school wet lab having to carefully note all the auxiliary labels that should be placed on my newly created medicine. I just can't shake the habit that my Rx's look naked without them.

Thanksgiving Week

We see a lot of humanity coming through a retail pharmacy, and I am always reminded at holiday times how there's a lot of people out there not exactly livin' the warm and fuzzy Walton Family kind of life. In fact, I kind of think the majority of them aren't. Don't get me wrong-- there's still a LOT of spoiled, self-centered, difficult people who I'd like to slap upside the head sometimes. But I look at some of our customers and I know they are not going to be celebrating the big classic family Thanksgiving. I don't exactly do it either, but I know I am very fortunate for what I have.

When it comes to regular customers you can get drawn into their lives, and boy does it get complicated. The mom with the houseful of behavioral-problem kids, the 13-year olds on antidepressants, the people looking after elderly parents, and the woman who calls her out-of-state ex-husband as she's standing at the register because the kid's insurance has expired.
We pharmacists have a front-row seat to a lot of these things whether we want to or not. Our own pharmacy staff and medical personnel aren't exempt either. You get a little window into people's lives, not because you're being nosy but because you've gotta check the prescription.
Of course I am legally bound to never violate anyone's confidence -- but for some reason I just think about this stuff at holiday time.

I hope at least some of the pharmacists out there have Thanksgiving off ! Enjoy, any way you want to do it!

I'd Like to Go Back to Being a Pharmacist

You know ---screen the prescriptions, dispense the drug, review the medication with the patient, answer some questions, help out the nurses and the docs, do the stuff I was trained to do.

I'd like to do that, but some days I don't do any of that. I am simply bogged down. I am on a wild goose chase. I have patients appear requesting refills on prescriptions they've already ordered someplace else. People ask me to request refills from their doctor and are mystified when it's denied. They then tell me the CORRECT doctor to call, after we've gone round and round on it for several days. They don't understand what the problem was. They only give me half the story. It's like putting together a jigsaw puzzle, and I can't help but feel that's just not my job.

And then the vacations. They're going out of town. They're out of refills. They need it early.
They're leaving today. They will be by in about an hour. I need to fix it for them.

People call wanting me to fill something for them. They don't know the name or the prescription number. We spend painful and precious minutes on the phone playing 20 questions, trying to guess what it is they want as chaos swirls all around. Turns out it was filled at a different pharmacy....but don't I have it in my records? Their doctor is in my clinic, after all.

Phone call after phone call -- all babysitting. Everyone's calling on a cell phone, and it keeps cutting out. I have to keep asking them to repeat things, and they get annoyed.

The insurance isn't working. The work comp isn't working. The doctor hasn't called back.

My head is spinning.

Tomorrow will be better.

Getting on "The Pot"

Several people have come in looking for Neti-Pots in the last few days -- these are the saline nasal irrigation systems which apparently became more sought after once they appeared on "Oprah." I guess some of our doctors or NP's are starting to suggest them to people. Once the customers take a look at at, they kind of stare at you like, "Seriously?" Yep, seriously --- you stand over the sink, pour the saline solution into one nostril with the little teapot-like device till it flows out the other nostril. We also have people looking for the "NeilMed" Sinus Rinse, which is a similar deal except it uses a squeeze bottle to flush the solution through. NeilMed says theirs is better as it flushes more gunk out --- kind of like a high pressure hose versus a watering can.

If I had the magic bullet for the whole sinus thing, I'd be a gazillionaire. Once the weather starts to turn cold, it's got to be the most common complaint we hear. "I'm stuffed up but it is/isn't in my chest." "I'm coughing at night because of post-nasal drip." "My nose is running but it's not stuffed up." "I'm coughing but it's a dry cough and it's all in my head." People are confronted with an array of cough/cold OTC medications and want to know which one's the "best." I know it's hard for most people to understand that they all contain one or more of the same basic ingredients. The FDA only approves a short list of these types of medications for OTC use, and all these products are just different versions of the same thing. It's surprising to me how many people, after a few questions-and-answers, will end up with generic Sudafed and be pleased as heck with their purchase.

I've heard a few people swear by the Neti-Pot. I wouldn't discourage anyone from trying it, I guess. I have a little trouble selling regular Mucinex though -- I think that one may be a very expensive placebo.

My Knees (Back, Feet) Hurt

There are plenty of good shoe companies out there that make "walking shoes." I bought a pair of these, thinking they would be good for work because I know that some day my old reliables are going to start looking too crappy. I need "standing shoes." My old reliables are a pair of Rockports that have a nice springy thing built into the sole, and provide some cushion -- kind of like those pads we have down on the floor. I've also outfitted them with a cushiony pair of arch supports. They're awesome, if dorky looking. But of course I can't find this exact style anymore.
The new walking shoes I bought have good support and everything but the bottom feels hard as a rock compared to my old ones. I can really tell the difference in my knees at the end of the day.
Standing ALL day -- the bane of our existence. If anyone reading has a good shoe recommendation -- I'll take it !!

Politics and Guesswork

Whew. Like a lot of us, I was following the election ups and downs pretty closely and this week kind of wore me out. I'll just say I was happy with the results of the presidential race but alas, disappointed with some of my state races. The tasks facing our incoming president are daunting but I am hopeful that with a new perspective we can turn things around. I found it really exciting to see the reactions around the world to our new president. There can never be a down side to having a president who's popular overseas.

Still, the people where I work generally avoid talking politics, which I think is probably a good thing. Some just don't pay a lot of attention. But the ones who pay attention realize that working in close quarters as we do, it's better to stay off the topic as it creates lots of strong emotions. Someone in another department who stops by the pharmacy frequently was obviously not an Obama supporter, and has taken to letting loose with sarcastic comments the minute she enters the area. It's already causing some problems and I can see it's going to lead to trouble if she isn't told to find something else to talk about, and soon.

As far as pharmacy work this week there was a lot of the 'guessing game' going on. Someone called and wanted refills on two tubes of creams he had in his hand. The labels were completely worn off so he could not identify them. I checked his profile and saw no tubes of cream. Were they filled at our pharmacy? I asked. Not sure. Do you know where they might have been filled? Not sure. Any clues as to what they are called? At this point, he became weary of my questions and asked, could you just fill them? ...... these are the types of things that drive your pharmacist crazy.

Another man was picking up his prescriptions. There were two ready. He stated there should be three. Which one is missing? we asked. He had no idea. So we begin the process of pulling up his profile and playing 20 questions, naming each medication, sometimes it's color, what it's for, and before long there are three people tied up in this process which drags out for several minutes. This irritates the bejeezus out of me. People MUST know the names of their medications --- ask your pharmacist, they'll print you a list that you can carry. It's not just for our convenience, it's for your own SAFETY. I've taken calls from women who don't know the name of their birth control pill. C'mon people... responsibility please!!

Your Pharmacist is your Firewall

Several of the other pharmacy blogs have addressed the question of what we pharmacists actually do --- that we're not just robo-counting-technicians who dispense anything that's put in front of us. I think most people are unaware of how many mistakes doctors actually make on prescriptions. To them, that prescription is a sacred document ---- "I've been seeing the same doctor for 15 years !! That's what he wrote! Why do you have to call? The doctor WROTE the prescription!"

We see it even in simple things like Tylenol dosing for young children. Tylenol can cause liver damage if given in excessive dosages, and in children it's dosed by weight. We've called doctor's offices many, many times for Tylenol dosages twice the recommended amount. We contact doctors routinely to ask about prescriptions for medications that patients are allergic to -- and sometimes the allergy is documented right ON the prescription! I saw a hospital order once for Pencillin 1 million units IV every 6 hours --- right underneath a red stamp that noted "Penicillin Allergy." This week we got a prescription for a patient we had not filled for in awhile -- it was for a HUGE dose of a very powerful narcotic. The technician is concerned about us having it in stock --- I'm concerned about it killing somebody. Since it is for a liquid concentrate, and the dose is written in milliliters, not milligrams, the red lights are flashing as this is a really common source of errors, and people have died from this sort of confusion. It almost made me nervous just looking at it. The point is, we checked it out -- we did not just fill it and assume it was correct.

Your pharmacist may not be able to answer every question off the top of their head, but remember they have probably seen thousands and thousands of prescriptions. Knowing when something doesn't look right is what it's all about.

TAXI !!

Woman approaches the counter and we determine that a prescription has been faxed for her from within the clinic. The woman speaks not a word of English. Not ONE word. We fill the prescription. Meanwhile, two other prescriptions show up for her. Through a series of grunts and hand gestures, it becomes apparent she has a taxi waiting and cannot wait for these. She wants them sent to Walgreens. We pull up a list of Walgreens addresses in the area, and she points to one. We call them and fax the prescriptions. I am absolutely sure she will show up at a different Walgreens and they will spend a lot of time trying to figure this one out. I think all their computers are connected so I'll hope for the best.

Next day, man walks in with eight prescriptions. He agrees to wait after a discussion about 'how long?' We're caught up so we start in on them, and he steps out to call a taxi. He returns in a few minutes and seems to expect them to be ready, and we tell him we've just started entering the third one. More time goes by while two technicians work diligently on his prescriptions. They're trying to go fast, so I catch a couple of mistakes. The taxi driver arrives. The customer steps up to the register and stares me down as I'm trying to check everything. I tell the clerk to start ringing him up while I finish. As she does, he asks "Do you need my insurance card?" Sigh.... He claims to be familiar with all the medications, which I doubt since a couple of them involve gradual dosage increases. But, he's gotta get that taxi, and the rest of us need to get out of the way. I sure didn't have a good feeling about that one.

Also had a customer who had been using his Pulmicort Flexhaler with the dosage counter at zero for (probably) several months. He seemed to think it was kind of funny. Yeah, no big deal --- it's just an inhaler. Really more of a plaything. Sigh........

Economics is Everything

"$25 gift card with transferred Rx" reads the sign at the local Big Chain pharmacy today. So much for encouraging people to fill all their prescriptions at one pharmacy with the hope that all potential dangerous drug interactions can be detected. I'll be bracing myself this week to see prescriptions bounced around like ping-pong balls. And next month, the customer will attempt to call in the refill back to my pharmacy using their Big Chain prescription number, sending me on a wild-goose chase to figure out what the heck they want me to fill for them. Or more likely, they just show up with Big Chain's bottle(s) and look stunned when the technician tells them we've got to call the other pharmacy and it may take a little longer.

It's always been an attractive gimmick and a sign of the economic times, I guess. Our company has already put out the word that we are to decrease waste. The first thing that comes to my mind is the paper, paper, paper -- not the least of which is the stuff we have to cram into each prescription bag that gets thrown away (sometimes on the customer's way out the door).
We also need to start charging a shipping fee for mailing prescriptions. You want the convenience, you need to pay a buck or two. We're often mailing prescriptions that cost less than the packaging material needed to send it, and they are paying pharmacy staff' to chase down credit card numbers and expiry dates.

We'll see what happens. Don't misunderstand, I'm glad I have a job.

A Salute to the People Who Know Their Stuff

In the pharmacy world we piss and moan about other people we encounter in our daily work --
bitchy nurses, dumbass doctors, and yes, other pharmacy personnel who we find lacking in competence. And heaven knows, there are plenty of them out there. But in the last couple of months I've found myself close to a couple of surgical procedures -- one as a patient, the other as a family member. And I've been truly impressed and appreciative of many of the people I've encountered as they do their daily work.

I'm a big believer in recognizing people who do a good job, especially when you know that it's totally routine for them, and they're probably sick and tired of giving the same post-op spiel 20 times a day, or explaining the blood pressure cuff, or soothing yet another person who's sweating out having an IV placed. You can always tell the people who are true professionals. They make you feel like you are the center of their world; they know exactly what you're going to feel before you do; they anticipate everything, they crack a few jokes, they smile, they ask "Are you OK?" over and over. You don't really appreciate these things till you're on the other side. And for these people, it's all in a day's work but they never act like it is. And when the procedure's over and the problem is fixed and you get to go home and live your life, you've got to remember to say a little thank you for those medical personnel whose everyday skills you relied on.

Of course I include many of my fellow pharmacists in this salute. But when you're nervously stuffing your clothes into a plastic bag in some pre-op holding room and the damn hospital gown
flaps open in the back revealing your least attractive feature --- well, I have a special feeling for the nurse who reaches over and gently closes it. I salute you.

0.07 ounces of pure gold?

I find Abreva helps shorten the duration of a cold sore if you start applying it really early. The price averages $15-16 bucks for a teeny tiny 2 gram tube, so when I saw a $3 coupon in the Walgreens ad I figured I would pick one up. Well, the price had been jacked up to $17.99, so with my 3 bucks off I was pretty much back at what used to be the regular price.

I should have stomped up to the pharmacy counter and asked when is it going generic ? (Wal-breva, anyone?) Now I know how my customers feel. I shouldn't even mess around with the stuff. Valtrex, 2gms twice a day for two doses, is the ticket. It's expensive too, but I know it's going to work.

I just needed to complain to someone!

A Few Random Do's and Don'ts

A pretty routine work week, but a few things kept repeating themselves... which leads me to offer this short reminder in the form of "do's and don'ts"......

For you prescribers out there:

DO pick up the phone and call me if you fax a prescription for your patient for antibiotic #1 and then change your mind and fax another one for antibiotic #2. It would be very courteous of you to inform me of your change of heart before the patient is out the door, requiring me to run out into the rain in a vain attempt to corral our patient back into the pharmacy. I'm sure you expected me to call YOU for clarification because I've got so much time on my hands, but in this case that's a non-starter.

DO take just a moment to proof-read the medication order you are about to bestow on your patient, and on me. A month's supply of medication X at one tablet per day is generally a quantity of 30 tablets --- not 15, and not 20. I don't have time to call you, even though I have to. The patient's not gonna be happy paying a full co-pay for a 1/2 month supply, and c'mon, this is the easy stuff!! Similarly, Augmentin 875mg BID for 10 days would be 20 tablets. If you write it for 28 tablets, did you mean 14 days? These are the eternal questions we all face, and legally I can't make the decision for you. When I call your office, please DO have someone pick up the phone.

For our valued customers:

DON'T toss your insurance card at me as I am ringing you up at the cash register. It is not a credit card. It needs to be processed as the prescription is being filled.

DO avoid conversations with me such as:
"Do you have your insurance card?"--- No.
"Have you filled prescriptions here before?"---- I 'm not sure.
"What kind of insurance do you have ?" ---- It's through my wife's work.

DO meet me halfway. Help me out here, and I'll be glad to get you on your way as quickly as possible.

This week was deja vu all over again!

Saturday Follies

Weekends in the pharmacy are often spent putting out fires --- dealing with issues that should have been dealt with during the weekdays when (a) the pharmacy was fully staffed, (b) doctors' offices are open, and (c) the daily drug order arrives to replenish our stock. A mistake that was made during the week will always rear its ugly head on Saturday. Some problem that no one followed through on will also take the form of a customer staring you down first thing on Saturday ("They told me they would order it and it would be ready.") When I worked in hospital pharmacy, people seemed to be more vigilant about making sure we were supplied for the weekend. Since there was always another shift following right after you, people passed on messages and FYIs a little more reliably. That seems to be lacking in my retail setting and it does bother me when I'm working alone on the weekend and really get dumped on.

Customers like to call in refills on Thursday that need their doctor's authorization, and show up Saturday morning, without CALLING FIRST, to find that it has not been approved yet. I break the bad news that they're probably looking at Monday or Tuesday. This is usually not well received. And no, I can't give you a few Ambien, or a Flonase, or (sorry) some Viagra to get you through the weekend.

Weekends also mean that the people we're dealing with down the medical food chain are more likely to be fill-ins, substitutes, or on-calls. To be honest, sometimes I don't mind a little challenge to my problem-solving skills and I feel good when I can work a solution for someone. Other times I really get mad at being stuck with the situation when it should have been taken care of in the Monday-to-Friday business.

This weekend I went above-and-beyond to solve a problem for someone whose doctor's office made a mistake -- it had nothing to do with the pharmacy whatsoever. It put me behind in checking prescriptions and the people waiting got pretty impatient, but there wasn't anyone else who could help this person. I could have turfed it off, but I tried to help -- and to all those impatient people waiting, your pharmacist trying to help someone may be another reason your prescription takes so damn long to fill.

Keep the Crap off my Counter

During really busy times our pharmacy counters are covered with stuff and the stock bottles really start to pile up. I've worked with other pharmacists who always seem to operate under a huge stack of bottles, loose paper and prescriptions that may or may not already be done and dealt with. I hate clutter and I get especially nervous when too many stock bottles are filling up the counter. It increases the chances that someone will grab the wrong one and a mistake will sneak through --- it happens to you once and you never forget it. I will go out of my way to get bottles reshelved and off the counter before moving on to the next bunch of prescriptions coming down the line. Also, once a piece of paper is dealt with, I say BE GONE --- to the trash, to the prescription file, to the call box, whatever --- off my counter.

I'm afraid I also get annoyed at working around people's water bottles, coffee cups, pop cans and half-eaten food. Everyone's told they're not supposed to have this stuff out but they do, especially if they've got a milquetoast manager. Once I have moved the same Coke can for the 15th time in a day, I start to think about throwing it across the room. And when that phone cord sweeps across the counter and almost knocks over an entire line of assorted beverages, it's time for everybody to just dry out for awhile.

Also, how is everybody drinking so much when we can't go to the bathroom?

P.S. I'm still interested in hearing anyone's comments about med guides (thanks to those who already have commented).

Special Orders

We frequently have customers coming in and looking for a specific OTC item that we don't carry. If they mention it's "really hard to find" I always offer to check our wholesaler's catalog and order it for them if it's available. This can be sort of an interruption and can take a few minutes, as sometimes finding the specific item is easier said than done. But I'm glad to do it, because I've wasted many a trip looking for hard-to-find items myself (I think every OTC med/hair/cosmetic/skin product I've ever really, really loved has gone from hard-to-find to discontinued right after I discover it.) If the customer asks me to order the item I do, and I advise them it will be in the next day. The next day it comes in and I carefully set it aside, sometimes with their name on it.

Which is why it kinda bugs me when they never come back and get it. It would be really easy for me to shrug my shoulders and say, "naw, we don't carry that". But I made the effort, so please, come back and get it cause I really have no use for it. We've had many of these oddball items sitting around for months collecting dust. Don't ask me to order it if you're not coming back --- I've got other stuff to do !!

One more post about Med Guides then I'll shut up

I dunno, it seems to me that this whole med guide thing would be a fairly big deal to the standard operating procedure of most pharmacies, but it's being pretty much ignored. Everyone knows about these FDA-mandated drug information sheets that are supposed to be supplied with EVERY new prescription AND refill for a whole host of commonly dispensed drugs -- antidepressants, NSAIDs, warfarin, ADD drugs (Adderall, Concerta) to name just a few. The regulations state that a pharmacy's own printout is NOT a substitute. They also state that a prescription dispensed without this required information can be considered to be 'misbranded.'
That's a pretty big deal. There are some products (eg, Advair inhalers) where the med guide is included in the box and you don't have to worry about it. But I can confidently state that the pharmacists I work with are NOT grabbing that tear-off pad and enclosing that med guide with every (or any) of the dozens and dozens of ibuprofens, Wellbutrins, Lexapros and Methylins that we verify every day. It's not that I'm dying to do it either --- it's a cumbersome regulation to add to all the cumbersome regulations we already have. But I can't help but worry about the liability issue, and I think it is the job of our head office people to help us devise a way to comply with this, as long as it's on the books -- good or bad. But they're not doing anything and nobody really seems to care too much about it. It's just kind of puzzling. Of course, we'll get all kinds of directives every week about the stupid stuff -- full page memos about how to key in some discount coupon, or the 400th revision of the dress code......

I'll shut up now.

I've got a question about Med Guides

How is everyone out there handling it? I'm sure some of the large chains have been able to incorporate the Med Guides into their own printed drug info that is generated with each prescription, but what about everyone else? Have you set up some kind of apparatus to store all the darn things so you can pull them easily as you're checking prescriptions? I'm really curious, as my employer has given us literally no guidance on this. I know some products have been able to incorporate it into their packaging... but, does everyone out there manage to throw one in with each antidepressant refill? I know it's kind of a dumb question, but every time I try to ask our head office about it, I get back a non-response (see previous post on e-mails).

Language Barriers

Today was one of those days when every customer interaction felt like a struggle to make myself understood. I attempt to explain how to take a Medrol Dosepak or a PrevPac or use an Advair inhaler and the person (of Asian, Hispanic, East African, etc., origin) nods and (sometimes) smiles. We complete the transaction and I walk away feeling very uneasy.

Sometimes it feels like the number of prescriptions and the complexity of the directions is inversely proportional to the recipient's ability to understand English. It especially worries me when a small child or baby is involved --- I point to the "1.5 mL" mark on the syringe and hope it's sinking in. Some pharmacies have the ability to print labels in other languages but I'm uneasy not being able to independently verify what the label says. And even if a translator or other family member is present, how do I know they are correctly translating what I'm saying?

I know, people should learn English when they come to this country. It takes time, though, and for some it may never happen, for whatever reason. I try to imagine if I had to learn Mandarin, or Thai, or Arabic, and was uneducated to begin with. Pretty tall order. I don't know what the solution is, other than trying to do the best you can under the time constraints. Come to think of it, we all know how frequently good old American English-speakers can screw things up --- I guess it can't be too much worse.

E-Mail Rules! (Sometimes)

PharmacistMike's comment on the last post regarding e-mail (how he always gets the e-mails on the lunch menu but not the important stuff) really had me nodding my head in agreement. I think e-mail is a great tool. Companies and organizations can communicate the same information to all their people with the touch of a keyboard -- it's so easy, DO IT! Of course you're assuming everyone checks their e-mail frequently, but assuming they do, it's far more efficient than phone calls or written memos. I almost always prefer e-mail as a communication method --- I don't get tied up on the phone, play phone tag, or end up babbling into an answering machine. I can state exactly what I want to say or ask a question simply and concisely and be done with it. It's there in black and white and the person on the other end (hopefully) is clear on the message.

It doesn't always go that way, though. How many times have you sent a somewhat lengthy e-mail with several questions in it and gotten back a one-line answer which in no way addresses your message? Or you are left wondering if the person got your message mixed up with someone else's, it's so totally unrelated to anything you said? Or the person answering you is simply unable to communicate with the written word and you're scratching your head trying to just understand it? That's when it can drive you nuts.

One thing's for sure though, the lunch menus will always come through!

I hit the communication gap

Neither my company nor my wholesaler could explain the Sandoz Azithromycin suspension recall yesterday. Is this the deal where Pfizer claims it is misbranded? Considering we go through the stuff like there's no tomorrow, I figured someone could give us the lowdown so I would know how to reassure the wide-eyed mom who thanked me for not giving her child a 'recalled medicine.' Our company has a great tool to communicate with all its pharmacists (it's called "e-mail" ) but apparently couldn't figure out how to do it. Frustrating.

Where were you on 9/11?

I had the day off. I got up a little late, turned on one of the morning shows and immediately saw the picture of smoke billowing from the Trade Center. I thought, oh man, a high-rise fire --- that looks really nasty. Of course the reality quickly became evident, and as more planes started to crash I had this weird idea that the terrorists were tampering with our air-traffic control system (I had read a really good suspense novel called "All Fall Down" with this theme).
I spent the entire day in front of the TV, like many others. I had to call into work to check my schedule, and I figured the people there knew what was going on but weren't seeing the images yet. I exchanged a few nervous comments with one of the staff ("Crazy, huh?") and went back to watching the horror.

Putting aside the shock and grief at the loss of life, it makes me so sad to think of the lost opportunities and all that has been squandered since that day. On 9/11 America needed a president who was astute, strong and possessed of great wisdom. We needed someone who, as he accepted the sympathy calls from other world leaders would say thanks a lot, but we will ALL meet in one week's time at a designated location and we will TOGETHER form a plan to erase the scourge of terrorism from this world FOREVER.

Unfortunately, the people we had in office weren't anywhere near up to the task. It's now well documented that within hours (hours!) of the attacks they were trying to find a link to Iraq.
We were quite justified in going into Afghanistan but it should have been with 140,000 troops, not a force smaller than the New York City police department. Fifteen of the nineteen hijackers were Saudi nationals --- anyone know of any repercussions to Saudi Arabia? On September 12, the United States could have declared that we were severely restricting or stopping oil imports from Saudi Arabia (and believe me, the Saudis need us to buy their oil ---- it is the sole basis of their economy -- they have no manufacturing, no tourism, no nothing !). Remember how incredibly angry and upset we all were after 9/11? If Americans had been called upon to sacrifice, to conserve gas and oil, I have no doubt they would have responded mightily.

But we know the rest of the story. Arrogance, politics and incredible incompetence in Iraq--not the troops, the people who sent them there. Read the book "Imperial Life in the Emerald City: Inside Iraq's Green Zone" and you won't know whether to laugh or cry at the sheer idiocy of the "Coalition Provisional Authority. " When the British suffered a terrorist attack in 2005 the police had all the perpetrators either killed or in jail within days. They didn't invade anybody, didn't set up secret prisons, they just went after the people who did it and got them.

Normally I enjoy watching historical retrospectives on TV, like the History Channel often runs.
I have never been able to watch one on 9/11 --- I just find it way too painful. I can't begin to
comprehend what the people in those planes and buildings must have felt. I look back on the last 7 years and I don't think we have done right by them. It was the luck of the draw; we just didn't have the right people in charge. It should have been so much different.

Just a reminder to myself

A day rarely goes by when I don't remind myself how lucky I am. I was able to go to college, get a professional degree and work continuously in my profession, even with all its frustrations. I have never had to worry about supporting myself or about finding a job. I make good money and I never take this for granted. But in my pharmacy career I've worked with many people who live paycheck to paycheck, and many of the technicians I've worked with have been single moms who just barely scrape by every week. I feel guilty when I hear them talk about not being able to buy things for their kids. These are some really good workers who I depend on to help me, and there's no way they would rather be receiving unemployment or welfare. They come in every day and work hard and know exactly when that paycheck will show up in their account.

A technician once told me that she and her son had used the food bank for a time, and it helped her get back on her feet. Another one told me that a pharmacist she worked with had loaned her several hundred dollars to get over a rough patch --- the pharmacist just said, "You need it, I've got it, just take it."

I don't want to get political, because (a) I'm not smart enough, and (b) if you get political these days, you will alienate 50% of the people in the room. But there are a lot of good people out there struggling, and I really hope things will get better for them. We are told that the gap between rich and poor is ever-widening in this country, and that's not America. I believe in personal responsibility and obeying the law. I also believe that if a Category 4 hurricane destroys your town it's not your fault, and that the richest country in the world should be able to lend you a hand. I wish kids didn't have to pay the penalty for their parents' stupidity, and I wish the parents were never stupid. We've got to get smart in this country --- no more sneering at the experts, no more cowboy-redneck stuff, no more smirking at someone who 'went to Harvard.'

I guess what started this was that one of my clerks told me she was looking for a second job and all she could find was a job working overnight in a convenience store, alone, for 7 dollars an hour.
It just bothered me and made me realize again how lucky I am, even as I whine and complain about the ups and downs of the crazy pharmacy biz.

What is it people don't get about insurance cards?

We asked for an insurance card from a customer this week. When the card didn't work, we asked if it was his most current card. He replied, "Well, it's the most current card I have ON ME." (Yeah, you're thinking what I'm thinking.) After some more unsuccessful efforts to get the claim through, we explained the situation and he proceeded to launch into some long explanation about primary and secondary insurance and something that had changed...... in other words, he presented this card knowing damn well it wouldn't work and stood there and watched us waste our time.

What do people think we are doing with these insurance cards? BRING THE CORRECT CARD.
It's a simple concept. We actually need the NUMBERS ON THAT CARD. It's not enough information to just say " I have Aetna (Caremark, Blue Cross etc etc)." We need the NUMBERS to bill your INDIVIDUAL PLAN. It's like trying to make a purchase with a credit card and telling the cashier, "Oh, I have Visa."

This customer finally ended up paying cash, and while tossing the bill on the counter made some remark about how this was 'always a hassle.' You got that right, bud.

Also, a heartfelt thank you to the out-of-state pharmacist who waited patiently while I tried to give him a copy, repeating his address and phone number twice, and waiting on me while I used the transfer function on the Worst Pharmacy Computer System in the World. You're a good egg.

Let's all do some CE.....

We pharmacists are required to complete continuing education to maintain our licenses, and I wish that Americans were required to do the same to maintain their citizenship. I'm worried about the 'low information' voters. In fact, I believed that before they received their economic stimulus check, all Americans of voting age should have been asked to complete a CE packet. This would include things like how Congress actually works to pass bills (explaining things like veto-proof majorities and filibusters), what the Patriot Act actually says --- heck, what the Constitution ACTUALLY says, in plain language, and what it doesn't say. That way, when politicians make assertive statements which are in fact misleading or outright lies, we Americans would know better. I think there is a shocking amount of ignorance out there, and our politicians don't hesitate to cater to that lowest common denominator.

It's been shown that more people know the names of the American Idol judges than know the names of their Congressman or Senator. I had a few days off last week and in flipping TV channels was treated to "cage" fighting (where two guys beat the crap out of each other while the crowd screams for blood), Jerry Springer (enough said), Maury Povich (the 'paternity' show guy who determines who's the daddy of some poor kid born to a bunch of losers who scream at each other and then parade THE KID out there too), and of course the endless cheaply-produced reality shows that put a bunch of self-obsessed spoiled brats into contrived situations and then zoom in for those icky close-ups while they ponder their boring lives. I know there are many people who pay no attention to this garbage, but I fear there are too many that do. I guess with the election coming up, this makes me discouraged and worried.

Fact checking --- priceless!

Personalities

A friend of mine is miserable in his job because of one person, his immediate supervisor. He likes his job, but just can't take it any more and is forced to look for another one in a not-too-friendly job market. We have a few float pharmacists in our system who no one wants to see coming. They are either rude and confrontational or hopelessly disorganized, and some of our techs get almost physically ill at the prospect of working a shift with one of them. In my pharmacy career so far I've witnessed several situations where one person has been allowed to wreak havoc on an entire department -- that one person makes everyone unhappy, and the gossip and the behind-the-scenes eye-rolling goes on day after day and creates a crummy work environment.
I marvel at how these people came to their position of 'power' -- to impact so many people just on the basis of their personality and yet remain untouched and oblivious. There never seems to be a solution, and supervisors are reluctant to listen to complaints that are really just 'personality issues.' We all gotta get along, but I wish some people could get with the program just a little more.

With that, I'm headed off for a few days vacation!

I know it's been said before, but........

We send a refill request for Lisinopril 10mg, 1 tablet daily.
We receive a faxed prescription back for Lisinopril 40mg, 1 tablet daily.
We send it back to question the change in dosage.
We receive another prescription for Lisinopril 10mg --- Yay! --- oh, wait a minute, it says 2 tablets daily.

I really resent having my time wasted this way. I want to call the Dr.'s office and say, C'mon guys, this is the EASY stuff. I shouldn't have to spend one more minute on this.

Just a crabby, crabby day today.

September's coming.......

.... and that means it's back to school, and that means the ADD meds come roaring back to life with a vengeance. We have a lot of pediatricians in the area who are big prescribers of these. I don't have any great insights into our over-medicated kids, but in performing the transactions I often feel it's the parents who need the meds more than their kids. For some, I know that these
medications can be a god-send --- the kids read better, get better grades and feel better about themselves. The parents may be anguished about using medication but want to try to help their kids any way they can. On the other end of the spectrum are the parents who are impatient, self-absorbed and a nightmare to deal with. You can easily see the type of chaotic environment the kids must live in and why they may have some trouble behavior-wise. My least favorite of these parents are the well-off suburbanites who you suspect don't have the time of day for their kids. They act terribly put-out by the whole pharmacy visit routine and may even complain loudly about the co-pay going up while the kid stands miserably in the background. I just hate that. And of course the whole idea of having to plan ahead for that next 'refill', which needs a signed prescription, is foreign to them.

Some parents really have it together -- they will call and set things up during the last week of August in anticipation of school starting. Others, not so much. It will be the Friday before Labor Day when they suddenly realize school starts Tuesday, and then it will be my fault that they can't pick up the prescription in an hour. Sigh. Oh well, somethings never change ...!

Please Mr. Postman

Our pharmacy will mail your prescription medications to you -- it's a service we offer, although we have to do it to stay competitive. We don't charge for the mailing or the postage, and we'll even attempt to contact you when the credit card number you've given us for your copay declines. It does create a lot of extra work. But please understand, no matter how many times you ask me, I CANNOT tell you exactly when your prescription will arrive. Once it leaves the pharmacy it is out of my control. If you call to order the refill at 2pm today, and then ask me "Do you think I will get that tomorrow?", my best guess would be no.

"But I really need it and I just took my last one." My guess is still no.

"I'm going out of town and I've got to have it."

Well, on your way out of town, why don't you swing by the pharmacy and pick up the damn thing. Otherwise you will have to wait. I verified your address. And if it doesn't arrive in a few days, it may be sitting erroneously in your neighbor's mailbox or stuck in some sorting machine at the post office, but I just don't know what to tell ya.

I'm not sure what a pharmacy's responsibility should be when it comes to mailed medications that don't reach their destination. Should we be stuck for it and replace it? Do we charge the patient a second time? I'd be interested to hear others' policies on this.

My favorite time of the day

Lunch time! Of course, a lot of pharmacists don't get lunch -- they either skip it entirely, thus ending the day dehydrated and ketotic, or they are forced to wolf down some sort of stale sandwich while perched on a stool in front of a computer or huddled in the back room next to the sharps containers. They return from their luxurious 7-minute meal break hopelessly behind and wondering whether it was worth it at all.

Sometimes, when working with a second pharmacist, I actually get a lunch break. I can leave the pharmacy and come back after 30 minutes or so. I've never been one to run errands at lunch. My main goal is to (1) sit down and (2) enjoy some peace and quiet where I don't have to answer a phone or talk to anybody or answer any questions. I don't want any social interaction -- I want to eat and read a book. Some of the people I've worked with will actually go out and sit in their cars, just to enjoy that little cocoon of quiet. It is actually rejuvenating.

This is pretty standard in the pharmacy world. I'm used to it, but I often fantasize about having a different career where I'm working in a big downtown office. I walk out of the building at noon for my lunch hour (!), perhaps with some co-workers and we go down the street to a restaurant where we sit and look at a menu. We eat and maybe get some dessert. That would be awesome. except I would probably weigh 300 pounds. But I can still dream......

Playing Policeman

The Pharmacy Chick had a post recently about how Schedule II prescriptions used to be relatively rare, but nowadays our C-II cupboards may as well come equipped with revolving doors. I realized how true this is. And not only do we seem to dispense C-II's frequently, but in larger and larger quantities. Lately I feel like we've had to play policeman more than usual (is it something about August?) ----- the early refills because "I'm leaving town", the meds that were "stolen," the claim that won't go through because it's already filled somewhere else but the person figured they could double-dip.

Strangely enough, it's not the C-II's lately --- it's the clonazepam, the Ambien, the tramadol, and of course always the Vicodin. I don't really take any satisfaction in thwarting these people's attempts to obtain more drugs. It's got to be a crappy life. But then I'm waiting on the guy with cancer who's almost apologetic about picking up his oxycodone and tries to ask me in a round-about way if he should worry about becoming 'addicted.' I guess it's something all we pharmacists just deal with.

Mystery Science Theater

No, unfortunately, it's not Gypsy, Tom Servo or Crow. It's the individual who loudly proclaims, "I'D LIKE AN OTC RECOMMENDATION FOR MY ALLERGIES." This individual then proceeds to tie up one of our pharmacists for a good 10 minutes. We strongly suspect this is one of the mystery shoppers our company employs to make sure we're all being good. However, this person puts forth a thousand questions, like, "Do these allergies have anything to do with my age?" and "Will I have this the rest of my life?" The pharmacist gamely tries to use his crystal ball and give some kind of answer, but mystery shopper just won't wrap it up.

I don't think these people are supposed to tie us up that long. They are supposed to fill a prescription, or ask a couple of questions, or see if the shelves look tidy, or maybe just make sure we don't snarl at them. Most of the time we score pretty well because we can spot them a mile off. But they shouldn't back us into a corner for so long that the 'real' customers are kept waiting.

Tumbling Dice

I've got my head down frantically trying to catch up from a semi-regular computer failure when I hear one of my least favorite sounds --- the rustle of a plastic bag followed by the sound of multiple empty prescription bottles hitting the counter.

It's Saturday. I'm the only pharmacist and we have 'weekend' staffing. I glance at this customer and think why, in the name of all that's holy, couldn't you have called ahead (say, yesterday) and ordered those refills? They would be ready. You wouldn't have to wait. I wouldn't have to look at you looking at me and waiting expectantly like you had just revealed my Christmas presents. When you come in on a Saturday and plop down those empties, chances are you are going to have a long wait. You are gambling that you have refills available and that I have all the drugs in stock. I must admit I take perverse pleasure when one of those situations arises. That'll learn ya.

Am I Missing Something Here?

Young woman and male friend approach the counter first thing on a Saturday morning. Young woman states she is using a birth control pill --- should she also use Plan B? She proceeds to answer "no" to the following questions from me:

Did you miss some doses?
Are you having irregular periods, spotting?
Are you on some other medications that could interfere with your birth control?
Is it your first cycle of birth control?

I'm stumped. I tell her that OC's are very effective if used correctly. She seems satisfied and leaves. I guess I'm glad she asked, but I hope she really wasn't going to take Plan B every time she had sex while on the pill. Just covering all the bases, I guess......

The Ultimate Question

Colleges of Pharmacy are very big on 'pharmaceutical care', 'medication therapy managment', or whatever else you want to call it. They preach it, teach it, practice it on each other, take videos of themselves doing it and then watch the videos. That's fine. But I think a lot of working pharmacists would agree that the #1 question we are asked in our usual workday is --- say it with me --- "How long will it take to fill these?"
Now, in my heart, I understand why people ask. They may have come to expect long waits at the pharmacy and they want to know what they're lookin' at. But when it's the FIRST thing that comes out of someone's mouth as they approach the counter -- before I have even seen what they have in their hand --- I just find it incredibly irritating. I can't help it. It's like they are saying to me, the ONLY thing I care about your service is how fast you can do it. Prescription medication or cheeseburger, it's all the same to me.

I wish I could come up with a polite, yet pointed response to the Ultimate Question. I'm still working on it.

How Urgent Is It?

One of the pharmacies I work at is next to the clinic Urgent Care, and it never ceases to amaze me how long people will wait for this service, only to finally emerge from the labyrinth of examining rooms with the word "Sudafed" scribbled on a piece of paper. I cannot fathom what urgent problem brought someone into the clinic for which a dollop of Triamcinolone Cream is the god-given cure. One of my favorite Urgent Care prescriptions is Patanol drops -- those itchy eyes that just won't wait one more day. These are not uninsured people --- quite the contrary. They are people who just can't be bothered to get established with a regular doctor or who can't get an appointment exactly when they want it, so they use the Urgent Care as a very expensive alternative and in my opinion, waste everyone's time. Save those seats in the waiting room for the mom who's been up all night with the screaming baby yanking at his ears -- please.

I did get a call from an Urgent Care doc once asking for some Lidocaine Jelly. His patient had a "device" stuck in his rectum. Now that's an emergency. Owwweeeeeeeee.

Hello Fellow Pharmacist Warriors

I'm new to blogging but felt I had to give it a try. I never knew pharmacy blogs existed until someone sent me a copy of the DrugMonkey's classic "Why Your Prescription Takes So Damn Long to Fill," and from then on I was hooked. I enjoy reading all the blogs on Pharm-Land and
I have laughed and learned a lot from my colleagues. I presently work in a clinic pharmacy and before that worked for a long time in hospital pharmacy. I've been in my present position about 8 years and still consider myself an amateur -- still not quite in the same league as pharmacists who've worked retail for 20+ years and seen it all. But I'm gettin' there! I'm not whip-smart like the DrugMonkey or a great writer, but I know I will find it therapeutic to post as often as possible and exchange comments with the pharmacy blogosphere. As Stephen Colbert would say, you guys are the heroes!