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.