Friday, April 24, 2009

E-Prescriptions: Great Advance or Big Ol' Crutch?

Computer-generated, flawlessly legible prescription for a topical steroid lotion ----
Rinse mouth twice daily.
Entered, prepared by my technician and presented to me for the final check. Of course, there's something wrong here. The doctor is called and seems flabbergasted: "But the directions just popped up like that! Can you get someone to fix that?"

Oh, no problem then... if the directions just "pop up" (which I seriously doubt) then that completely absolves you of any responsibility to actually READ what is on this prescription you are sending to the pharmacy.

Later, another e-prescription for Cefzil. Helpfully listed on one corner of the prescription are the patient's drug allergies/"adverse drug reactions": CEPHALOSPORINS.
Patient confirms this was an honest-to-goodness allergy, producing hives.
Again, the doctor wails, "Why didn't it (ie., a warning) pop up when I entered it?"

So apparently this prescriber's practice is governed by the "pop-up." I cannot convey my irritation at having to sit on the phone and track down someone, anyone, to clarify these prescriptions. COMPLETE waste of my time. I still wonder if these electronic prescriptions are worth it when prescribers don't check it for accuracy and don't know how to customize it or alter the directions so they make some kind of sense. Please, PLEASE read the thing. Just because it comes out of a computer doesn't mean it's perfect.

I really don't want to bring back those horrific hand-written prescriptions, but some days I just have to wonder.

Saturday, April 18, 2009

The Most Excellent Doctor's Appointment

In my work setting, a lot of the patients we see are coming right out of their doctor's appointment -- as in, across the hall right into the pharmacy, with their prescription in hand or having been transmitted to us electronically. As I am handing the prescriptions over and giving the appropriate spiel, I can tell immediately whether I can rate that doctor's appointment as a SUCCESS or as a FAILURE.

SUCCESS: The patient has a basic idea of what they are getting and why. They can confirm that what I am telling them matches what their doctor said. They know how long to take it for and when (or if) they need to see the doctor again. They may have a handwritten note from the doctor with some of these things jotted down. If the prescription is a device (like an inhaler or Epi-Pen) they may have even been shown how to use it or watched a video. Beautiful.

FAILURE: "What did he give me?" Total deer-in-the-headlights look. "Why did he give me X when I thought he was giving me Y?" "No, I don't know which of those 3 creams goes where." (and the prescriptions don't say either)... "No, they didn't say how long to keep using it." "What am I supposed to do if I don't feel better after 3 (7,10) days?"
"Am I supposed to keep taking my other blood pressure medicine with this one?" "Am I only supposed to use it if I need it, or all the time?" "He told me to get some Vitamin B52.... do you have that?" And so on.

I might be able to take a stab at some of these questions, but I really cannot answer (legally or practically) for the prescriber. What I would really like to do is tell the person to march back over to the office and have a 're-do' of the whole thing. But more often I am obligated to get on the phone and pull the doctor or nurse out and ask them what this person is supposed to DO who was just sitting in their office ACROSS from the doctor, not FIVE MINUTES AGO. Annoys the crap out of me when I am up to my eyeballs in prescriptions.

Now I know there are lots of people who are given perfectly good instructions who just don't listen. It goes in one ear and out the other -- they're nervous, preoccupied, whatever.
But I also think that some people do get the bum's rush out of the doctor's office and just aren't given clear instructions, and I have experienced it myself even though I know what questions to ask. And the doctor may be really nice and all, but sometimes they are TOO casual -- I mean, you really gotta spell it out. We pharmacists have to tell people the same things over and over and it's tedious and routine, but part of being a 'professional' is just doing it. It's like doing the same Broadway play for 9 performances a week.

My "Good Doctor" will:
1. Tell you what he thinks is wrong with you.
2. Tell you what he plans to do about it.
3. Tell you what will happen if it doesn't work and exactly when to come back.
4. Write it down if necessary.

That way I can concentrate on doing my part of the job. Excellent......!!

Tuesday, April 14, 2009

Sorry, but Appearance Matters

In pharmacy you have to be very detail-oriented. You've got to notice the small things. You've got to catch the one little out-of-whack thing that sticks out in a huge pile of repetitive, routine and otherwise unremarkable tasks. Anyone who works in a dispensing pharmacy has to accept this and be prepared for it -- there's no way around it.

How do you get someone to 'care' about their work?

By 'work', I don't mean correctness of the actual prescription - that's my responsibility to sign off on. But along the road to a finished prescription I sometimes get frustrated by the lack of attention to details that may not affect the final product but still indicate someone who just doesn't care enough to pay attention.

Like, for instance, the label that is slapped on cockeyed on the bottle. Okay, it won't kill anybody -- but it looks crappy and some of the more observant customers might wonder if the person preparing it took the right amount of time with everything else. Appearances matter -- to me anyway. Same if the customer's name is mispelled or their address is incomplete. I've checked prescriptions that are to be mailed out where the address labels have been mixed up between patients, or where the address is mis-typed and doesn't make sense -- but it's already passed through several pairs of eyes that just didn't look at that part. Misspelled words on labels bug me too --- I know, we're lucky if the patient even reads the label and there's probably a lot of them that wouldn't notice anyway -- but darn it, I just don't like letting that go (although I am forced to when things are really crashing around me).

Patient drug information sheets that are crumpled up and stuck inside the bag like trash. Bags that have been ripped open and re-stapled shut so they look like crap. Patients who are supposed to get easy-open caps and don't because nobody sees the indicator on the label. I don't ask the technicians to fix these things for me -- I usually do it myself. Should I feel embarassed at my pickiness? I don't think so. I think prescriptions should look professional even if the $4 crowd is determined to de-value them.

Another little pet peeve ---bad handwriting is not restricted to doctors. People will jot down catalog numbers of things we need to order and I can't READ it!! Okay, do we owe that person 106 tablets or 166? And you can be sure that the person who wrote the illegible note is long gone. Just a few extra seconds on their part would have saved me a whole lot of time.

I don't go complaining or chasing after the people who do these little things -- I think some people just 'care' and some don't and I'm not interested in nagging anyone. Some people do a job so mechanically that they forget other people will be looking at the results of that work in a different way. But it does bug me when the person doing the sloppy work doesn't have to deal with the consequences of their sloppy work.

I'm anal retentive, I guess, but that's what I get paid for.

Wednesday, April 8, 2009

The Full Moon Phenomenon

People acting weird, asking weird questions, coming up with weird problems. They seem restless, impatient and just goofy. At some point, someone on the pharmacy staff asks
(1) Did the Looney Tunes Bus just pull up?
and (2) Is it a full moon?

Pharmacists, ER workers, police -- they all swear by the full moon phenomenon even though there's no real science behind it. Some have said it's the tides, the gravitational pull, or even the ancient human instinct of preparing for the 'hunt'.

The full moon is tomorrow. When I told a customer his prescription would take about 15 minutes, he looked at me strangely and said, "My dog is in the car."

Must be getting ready for the hunt. Happy Full Moon!

Sunday, April 5, 2009


I, as a consumer (and just about everyone I've asked) really hate the process of "up-selling" --- when you are standing at the cash register, wallet open, credit card out, and the cashier or sales person attempts to sell you just one more thing by pointing out some discount, upgrade or add-on that you might just impulsively buy. Basically it's the "would you like fries with that?" question. "You can upgrade to the large size for only 50 cents." " Did you notice our scented candles are buy one, get one free today?" etc. etc. It's really irritating -- I'm standing here, ready to make my purchase, ready to leave. Don't put me on the spot by forcing me to say no over and over again. I'm DONE! I don't want to be on the e-mail list. I don't want to buy anything else. And why do you need my zip code/phone number? I guess there must be data somewhere showing that up-selling increases sales, but I don't think the customer alienation is worth it.

Our organization wants us to start this practice. They have literally given us a script to recite at the point of purchase, and all I can say to them is good luck with all that. If someone wants to try their hand at salesmanship, fine with me. But after explaining prescription medication to a customer and ringing up their (sometimes) substantial co-pays, I am NOT going to go down a checklist of annoying questions and make the obvious ploy to sell them just ONE more thing.
I think it is disrespectful. I am more than happy to answer questions initiated by the customer, and I'll point out items we stock that may fit their needs. The other day I searched the Web for coupons for prescription products for an uninsured customer. I'll gladly do that if necessary. But I figure if they want fries, they will ORDER the damn fries....!