Saturday, October 24, 2009

The flavor of flu

Geez, and it's only October. We are compounding a lot of Tamiflu suspension these days because of the shortage of the commercial product. It takes a little longer but I feel pressured to speed it up just to get the sick person out of the pharmacy. For myself, I alternate between soap and water, hand sanitizer and the foamy stuff (which is kind of wet and sticky but more fun to use). It's probably going on 2 years since I've had even a cold --- I'm thankful for that but it makes me nervous that I'm overdue for something nasty.

This guy is waiting for prescriptions for himself and his kid. We're busy and going as fast as we can. He comes up to the counter TWICE and loudly asks if it's ready yet. I really don't appreciate that especially when he's sitting there watching us run around like maniacs. We told you we would call you up as SOON as it's ready. It's not just a matter of pulling the next cheeseburger off the grill, you know what I mean? Finally I go to ring him up. All of a sudden he's asking about adding flavoring for the kid's antibiotic liquid. Oh really? NOW you're gonna tell me you want it flavored, huh? Well guess what, it comes already flavored. Whatever it is, your kid's gonna love it. Mr. In-a-Hurry-and-it's-taking-too-long. Now YOUR time is up. I don't know why this irritates me so, but damn, it really does.

By the way, that Tamiflu suspension I have to compound? ---- No, it's not available in banana, watermelon or bubble gum flavor. There are 2 vehicles that the manufacturer tells us we can use --- cherry flavor, no substitutions. For crying out loud, if my kid really needed Tamiflu I would be glad it's available to me and I would get it into my child no matter what flavor it was....

In a similar vein, I'm annoyed when I hear news reports about the government's 'sputtering' response to the production of H1N1 vaccine. Growing virus to make a vaccine is not something we can do in our kitchen sinks. I'm thankful to live in a country that has the capability and scientific know-how to produce MILLIONS of doses of a vaccine in a few months' time. The people at high risk are getting it first, and the rest of us will follow.

There are an awful lot of places around the world where, if a pandemic breaks out, the people are pretty much on their own. I think we take it for granted sometimes.

Tuesday, October 20, 2009

Let's Talk Trash

Most days I am bowled over by the amount of trash we produce during one workday in the pharmacy. We have multiple receptacles and by the end of the day they are all overflowing. A lot of it is packaging material and empty bottles, but the majority is just paper. Every prescription that is processed results in some form of discarded paper. There is always some unused portion of the label or receipt as well as backing from labels that gets peeled off and thrown away. The patient information leaflet is often discarded (my diabetic customer who's been coming in for 10 years doesn't need or want the patient info sheet on the 1000th refill of his One Touch Ultra Test Strips. ) But the computer system prints it anyway, and theoretically I'm supposed to provide it, but that's another story. Anyway, I've had people at the cash register pull the medication vial out of the bag and hand everything else back to me and tell me to toss it. If I decide I need to reprint JUST a label for some reason, my crappy computer system reprints everything else too --- receipt, patient leaflet --- which goes right into the trash.

We are supposed to separate 'confidential' stuff (anything with a person's name on it) from other trash but compliance with that is pretty spotty. When you have people filling in at your store who don't normally work there, they don't pay attention to it. And when I see the trash collected at the end of the day I don't see the various containers handled any differently. It all seems to go into the same big bin. I find this worrisome, but to be honest, having a protocol for this is the job of someone with a more important title than me.

Then when I got home today I picked up my own mail from the mailbox. I looked through it, and EVERYTHING went into the recycle bin. There were a couple of credit card applications, some grocery leaflets, some investment prospectus(?) or something, a free magazine that I don't even look at, and a subscription renewal reminder that I already sent in. Some days I just hate all this waste.

If we had a better computer system at work it might help, but don't even get me started on that.

Saturday, October 17, 2009

Naughty and Nice

One of our long-term Oxycontin/Vicodin regulars, who we've long suspected of some funny business (early refills, lots of 'trips out of town', insurance rejects cause it's filled somewhere else, etc.) gets his refills denied by the doctor. Apparently they learned he had been supplementing his prescriptions with some alternate source, or in the words of someone at the doctor's office, "He's been naughty."

"Naughty?" Really. That's a funny way to put it. I really don't understand why some prescribers are so slow to put the hammer down. They accept excuse after excuse from these people. The pharmacy howls and they don't want to hear it. It's not being 'naughty.'
It's WASTING the time of the people who are trying to treat you. It's lying. It's breaking a contract. Maybe I'm not able to look at it from the viewpoint of the medical practitioner, but I don't think 'naughty' is quite the right word. I think "no more prescriptions, buh-bye" at the first sign of trouble, is the way to go. And without guilt, too --- these people want to get it, they'll find a way.

And then there are the 'nice' people. Friday afternoon is full of last-minute calls. A customer calls and asks me to look up some medications he got in the past for excessive sweating. I find Drysol and generic Robinul in his file. He sounds really happy and excited and tells me he has an interview next week and would like to refill them. I tell him the Robinul is out of refills and I can request more from the doctor, if it's still a few days from the interview. He apologizes for the last-minute request, says he'd rather start it right away --- but don't bother, he'll work something out and check to see if he may have some left somewhere. The guy was so nice about it and if he had really pushed I probably would have told him to come in and get a few tablets.

I hope he gets the job, I truly do.

Tuesday, October 13, 2009

Open Enrollment -- That Most Wonderful Time of the Year

My guess is that when open enrollment for benefits rolls around soon, people will be taking an especially close look at their health insurance premiums. This new 'report' paid for by AHIP ("America's Health Insurance Plans" -- totally impartial, I'm sure) warns that insurance rates will skyrocket if the current health reform bill gains momentum. My first thought was, so what else is new? My premiums go up EVERY year. As for prescriptions, my non-formulary copay will be going from $30 to $50. Does anyone look at their premiums for the next year and find they have gone DOWN? Ever??

Now we have both pundits and high government officials on TV constantly throwing numbers around --- for example, Senator Kyl's "We could save 100 billion to 200 billion dollars a year with malpractice tort reform." The individual interviewing that person should have two questions:

1. Which is it, 100 billion or 200 billion? ( That's a fairly big spread there, cowboy.)
and, 2. Quote me your EXACT SOURCE on those numbers.

ANYONE who goes on TV and throws numbers around should be required to specifically quote their source, or just outright admit they made it up. The Daily Show did a brilliant piece on their Oct 12th show on just this topic, and on the lack of diligence by the news media (and CNN in particular) to make people "show their work." Check it out at their website -- I thought it was great.

Saturday, October 3, 2009

Somebody Missed the Memo

Our clinic system is bracing for the big flu outbreak. We are beseiged with memos and e-mails with flu news. We've had tons of people coming in for flu shots. Employee absenteeism has not materialized yet, though. Some areas seem to be heavily into the Tamiflu dispensing and others are not --- when they do get a rush of scripts they are usually for an entire household at a time.

I've been trying to keep my hands washed and foamed and Purell-ed. A lot of the customers use our hand sanitizer, and everyone seems acutely aware of the hygeine issues --- well, almost.

This guy brings a bottle of Tylenol to the register, tells me it's for his wife who is at home with "confirmed" H1N1. He then proceeds to let loose with a rip-roarin' sneeze, and not into his sleeve either. I ducked. I sure hope I was fast enough. Thanks a whole HELL of a lot.