Sunday, August 30, 2009

Small Victories

For people who deal with the public, cell phones are the bane of our existence. Just when you think you've seen the height of rudeness with those things, someone goes one better ---- even with all the talk about cell phone etiquette, I'm standing in line to pay for a clothing purchase the other day and watched while everyone in line AND the sales clerk stood and waited while the woman at the counter took a cell phone call.

That's why I cherish the small victories so much. It's a little strategy game I like to play.
A woman brings a couple of prescriptions in yesterday and wants no interaction with us other than "How long will it TAKE??" She sits down and starts yapping loudly on her cell phone, recounting every detail of her day so far as well as details of the doctor's appointment that we would rather not hear. In other words, unimportant blabbing. This is NOT a vital conversation, and SHE initiated it.

So her prescriptions are ready and I call her name. She looks right at me, and gives me the one-finger "hold on a minute I-can't-come-up-there-cause-I'm-on-the-phone" salute.

No. This is a non-starter, of course. I put her stuff down and walk away to continue my very busy pile of work. Just then a little old lady comes in to pick up some prescriptions, and to my total delight, settles in to ask about a thousand questions and recount a litany of problems that she had last month with some hip surgery. I was delighted because Miss Cell Phone has now finished her call and is shifting her weight impatiently and looking sour-pussed behind my little old lady, who I take LOTS of extra time with, move just a little slower with, ask if she's got ANY more questions, and chat a little about the weather and what she's doing on the weekend.

You lost your place in line, Miss Cell Phone, and I'm gonna take my SWEET time gettin' back to ya !!

That'll teach you ----- oh, who am I kidding, of course it won't.....

Tuesday, August 25, 2009

Let's Save Some Money!

I was struggling to open a bottle the other day and ripped off the quadrillion-folded glued-on little package insert that came stuck to it, as I often do. A while back I remember reading that the cost to the drug company of printing, processing and attaching these little manufacturers' drug information inserts to each bottle is phenomenal ---- I don't remember the exact figure but I was really amazed by it. I also thought there was talk of discontinuing these things to the tune of millions in savings, since all this information is accessible on-line, on handheld devices or yes, -- the ol' PDR.

I'm not sure if this is still in the works, but it seems like a great way to save money and decrease waste. How often does anyone look at these things? I can't say I've never painstakingly unfolded one, put on the 18x magnifying lenses and searched whether or not it contains red dye #2, but whenever I do it's kind of a last resort. My main concern is that the patient has the instructions for use, as for an inhaler, or (if I'm really on top of things) a Med Guide --- but these things are usually separate anyway.

I bet if the drug companies did away with those things AND direct-to-consumer advertising, they might just be able to lower the prices on a few of their products.

And while we're at it, I don't need the bottle of tablets to come inside a little box, too. I bet those little boxes cost money to make...

Wednesday, August 19, 2009

Side by Side Effects

I have actually had people pick up prescriptions and say, "Now, this doesn't have any side effects, right?" Where the heck would someone get that idea? Obviously, anything one puts down the gullet has the potential for side effects, I tell them, although I try not to be too harsh about it because they were so bright-eyed and hopeful......

People often ask about side effects from their prescriptions. Usually they call on the phone when we are extremely busy and want to to launch into a fairly long description/ timeline of what they're having and when they have it. To me, it doesn't matter if the side effect shows up anywhere in the fine print of the package insert, Micromedex, or anywhere else --- my rule of thumb is 'proximity'.

So if someone calls and says, "I just started atenolol 4 days ago. Today I feel like the end of my nose is burning and my toenails are all of a sudden growing really fast. Is that a side effect of atenolol?" My response pretty much has to be, "Well, if there have been no other changes in your medications, diet, lifestyle, laundry detergent or general environment, I guess we can't rule it out."

And really we can't, even though I could never produce a shred of documentation to support it. It goes under "anecdotal."

I think about this as we're asked to make sure the latest FDA warning goes on all our prescriptions, either on the bottle or in the patient leaflet:

"Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088."

Boy, they may want to re-think that. Or hire some more FDA operators darn quick.

Saturday, August 15, 2009

Pharmacy Graffiti 4 Ever

On my way to work I drive past an old mill with a large warehouse and usually some boxcars sitting along side it. It's a place that's ripe for the graffiti artists. The other day I noticed spray-painted high up on one of the buildings "I Love Xanax".

I'm waiting for someone to come along and add "DAW."

Wednesday, August 12, 2009

Pharmacy Funnies

Thanks to the commenter who sent me this link to his web series pilot called "Hard to Swallow".
It's a 6-minute video about life at "Sunland Pharmacy". Funny! Check it out at:

Tuesday, August 11, 2009

Bursting the Bubble

We spend so much time in the pharmacy 'bubble' that it helps to be reminded we're not alone. While waiting in the optometrist's office today I overheard all of the following going on at the reception desk:

-- People without their insurance cards
-- People who were 1/2 hour late for their appointment and wanting to "still get in."
-- People who were completely OUT of contacts and needed the receptionist to come up
with some for them.
-- People bitching about prices.
-- People bitching about their insurance.
-- People who needed everyone to hurry up for them because they were on the way to

Ahh, healthcare. It's everywhere you wanna be.

Friday, August 7, 2009

The Perils of Slowness

We had about a day and a half this week that was super slow --- summer time, vacations, whatever the reason. In all my time in pharmacy I've always found it funny that some of the same staff who complain about being stressed out and swamped all the time will turn around on a dime and complain bitterly when it's suddenly too slow. I can certainly handle a slow day -- heck, take advantage of it, cause you know it isn't going to last. If nothing else, I feel we can use the time to clean up the pigsty around us.

But pharmacy workers are hard-wired to be running like crazy. The good ones can be kind of a restless bunch. It's a strange phenomenon on a slow day to watch some of your co-workers become disoriented and sluggish. It's like everyone loses their edge, or gets out of the rhythm, or something. And I find more errors than normal on the few prescriptions I do check.

The final indignity after a slow day is coming in the next morning and finding that no one sent the drug order.

Sheesshhh...... it's like we're all on crack and somebody took the pipe away for a day!

Saturday, August 1, 2009

Sometimes It's Just Not Worth Arguing

We filled an Albuterol HFA inhaler today and we had to select one brand (Proair HFA) over another because the patient's insurance only covered that one. While being rung up she protested that she didn't want Proair, she specifically wanted Ventolin HFA because she has a gluten allergy and needed to get away from all gluten-containing products. The Proair apparently caused some sort of facial swelling or other reaction of some sort.

Now, I'm no expert in this area but my inspection of the package insert revealed that the inhaler contains albuterol, propellant and "no other excipients". I seriously don't think there could be anything gluten related in there. But this customer was so insistent and so positive this reaction was connected, she wanted us to request a prior auth. for the Ventolin. And observing a long line of impatient people forming behind her I thought sure, go for it.....

Reminded me of the guy who wanted a refund on his Erythromycin after one dose because it upset his stomach. After our negative response to that, he declared he was going to call his insurance company to get that copay back. Sure, go for it!

Sometimes, you just have to punt.