Tuesday, April 27, 2010

I'm Sorry........ What?

This past week I can't count the number of people I waited on who had a cell phone pressed to their ear. Now, this isn't going to be another cell phone rant (although I'll say it AGAIN; if you don't terminate that call immediately, you have given the person on the other end of that call permission to hear EVERYTHING I'm going to say about your prescription. And I'm not going to wait one SECOND for you.)

In waiting on multitudes of people all day, I just can't get over how DISTRACTED everyone is.

We're supposed to counsel people on their prescriptions and believe me, I keep it as short and simple as I possibly can. I figure we should talk about the prescription at least briefly, but in addition to competing with the aformentioned cell phone, I've got people more concerned with trying to corral and discipline their kids, juggling their numerous bags and purses stuffed with everything imaginable, digging into those bags for money, credit cards, check books --- writing that check (which is a whole 'nother process in itself -- asking me the date & who they make it out to and then proceeding to balance that ledger), gathering up the other crap they have decided to buy and asking me if I've got it in any other flavors/colors/sizes, questioning the copay on the prescription before anything else and making it clear to me that actually using this medication has long since ceased to be anywhere on their radar screen.

With all the talk about the importance of 'education' in our country my biggest beef has always been that people don't take the time to READ, and if they do read they don't COMPREHEND. "Listening" is another skill that is similarly deficient. I told someone last week to get two doses of their antibiotic in on that day ---" take one capsule NOW, and another one TONIGHT." He calls me up 30 minutes later and says he took 2 capsules at once and is anything bad going to happen? .... And this is the easy stuff, folks.

With all the patient information and med guides we are required to stuff into every prescription bag, I'm honestly kind of surprised we don't get more questions from people.
I'd love to know how many people actually sit down and read through the instructions on that Spiriva or Asmanex or Maxair inhaler before they use it. People don't seem to know how to read and understand things that are right in front of them.

It's unfortunate that most of the children's cough/cold medications had to be pulled off the market recently -- not because they are inherently unsafe, but because too many parents couldn't read the damn directions and give their kid the correct dosage.

I find this worrisome. We can't live our lives in text messages and e-mails and Twitter feeds... but no one seems to have the time or the focus anymore.

Tuesday, April 20, 2010

The $20 Bottle of Acetaminophen

Fellow pharmacy blogger "Fries with That" recently had a post entitled "OTC products on Medicaid" (http://fastfoodpharmacy.blogspot.com/2010/04/otc-products-on-medicaid.html),
voicing frustration with the time and effort spent having to process prescriptions for cheap OTC medications that are covered under states' Medical Assistance programs.

It's true; the time and labor spent on these things costs way more than the prescription itself is worth -- but they have to be inputted into the computer, filled, counted, poured, labeled and checked just like an Rx-only drug. One of the pharmacies I cover does stacks of these. We'll get entire families of several kids getting Tylenol, Motrin, hydrocortisone cream, petroleum jelly (yes, it's covered)... adults and kids getting generic Claritin in all its forms, Benadryl, assorted topical lotions, vitamin products... you name it. I get really frustrated being buried under piles of these, and having to get them corrected and re-processed for NDC number, or directions, or number of refills, or bottle size, etc..... seems like a complete waste of valuable time.

I say, Medicaid plans should set up an OTC charge. With a couple of keystrokes, we bill them one charge -- and I know, we'll have to fight about how much that will be --- then we pick the product(s) off the shelf and hand them to the customer. Done. Time saved, resources saved. I am more convinced than ever that cutting health care costs is going to involve the little things that reduce people's TIME, and cut out the middle man. We don't always need to cut the service, we just need to do it smarter.

Sitting in the dentist's waiting room I am perusing "Rolling Stone" magazine. I've long since lost track of what 'the kids today' listen to, but apparently one of the most popular college-played bands is "Ted Leo and the Pharmacists." Whaaa??? I listened to a couple of songs online --- they're not bad! I don't think they write songs about pharmacy though... no "My Vicodin was Stolen from my Boyfriend's Car" or "What? My Copay's Always Been Zero."

Monday, April 12, 2010

Random Thoughts While Waiting for the Cable Guy

So we're getting more OTC proton-pump inhibitors on the shelves, and I know people will be confronting me with boxes of Prilosec OTC, Prevacid 24HR and now Zegerid OTC, and asking "Which one is better?" I don't blame them for asking, but I don't look forward to giving my usual mealy-mouthed answer which is, "There's probably no real difference." Then they kind of look at you like... yeahh.....rightttt..........thanks a lot........
By the way, Zegerid OTC (which is Prilosec + sodium bicarbonate) says it contains a "special ingredient" (that's the sodium bicarb, the medical term is "baking soda") that "protects the powerful medicine from acid in your stomach so it can be quickly absorbed." However, there's a little asterisk after that last line: *Speed of absorption does not imply onset of symptom relief." Whaaaa??? I guess the selling point is not really.... a selling point after all.
What the hell, maybe that bicarb will help your heartburn.

I got totally bogged down in a Sudafed transaction last week. Scan the driver's license.... won't scan for some reason...call someone over to help me.... fill out logbook, get signatures, etc. etc. and babysit customer while you walk them through all this. I've concluded that since there's no central database that pharmacies share anyway, our lawmakers should have just done the following:
1. Sudafed products go behind the counter.
2. You can buy ONE package of any available size. No screwing around with logbooks.
3. If you want more, get a prescription.

And if you come back too many times, we'll recognize you. This would accomplish pretty much the same thing as the system does now, while giving me a few precious minutes back.

Someone handed me a prescription for Robitussin 200mg/5mL syrup. Every Robitussin product (brand or generic) I could locate is 100mg/5mL. There used to be an "Extra Strength Robitussin" but I could find no evidence it still exists. This was a computer-generated prescription. Could we puh-leeze purge that system of products that no longer exist? Again, the customer looked at me a little strangely.....

I know what I'm doing back here, honest.

Tuesday, April 6, 2010

If You Feed Your Toilet Paper UNDER the Roll, Please Seek Care Elsewhere

Dr. Grumpy had a recent post (http://drgrumpyinthehouse.blogspot.com/2010/04/sunday-seriousness.html) about the Florida urologist who posted a sign outside his practice reading "If you voted for Obama... seek urologic care elsewhere." Dr. Grumpy's take was:

"I don't discuss politics with patients. They ask me what I think of the new health care bill, and I give them a generic "We'll see what happens." Divisive discussions aren't good for a doctor-patient relationship."

That's it. That's the only way, plain and simple. Most of the commenters agreed but a few seemed to be on the fence, saying this guy has a right to run his business the way he wants, even though they may not agree with him.

Now, putting aside the fact that this urologist seems woefully misinformed --- like claiming that hospice care will be "cut" but being unable to supply any evidence of that ("I can't tell you exactly what the deal is" he says, when asked) --- I don't buy the suggestion that there's any excuse for this guy at all. Maybe it's not illegal but it is unethical, irresponsible and 100% unprofessional.

In the course of a day we occasionally have patients make comments about the news, current events or whatever, in the course of small talk or conversation. You smile and nod and make some benign remark. It's very wise to stay away from touchy subjects. If someone were to come into my pharmacy and want to engage in loud pontificating about a political viewpoint I did not agree with I would grit my teeth, shut my trap and probably get them out of there as soon as possible, but I would still do my JOB, and I certainly wouldn't tell them not to come back (my employer would take a dim view of that.) It seems to me it's kind of a sacred principle of medicine that people should be able to get medical help from a doctor no matter what their situation. You go to a doctor's office with perhaps some very embarrassing condition and you get non-judgmental HELP. The majority of medical professionals live up to that -- that's what the word 'professional' means. It's the foundation of medicine, isn't it? This Florida guy is just showing himself to be one of the 'bad' doctors if he can't do that.

It's like the cop who deals with a belligerent, abusive drunk and calls him 'sir' the whole time. I admire the hell out of that. It's his job, and he'll do it that way because he respects himself and his profession.

I will never forget when I was a new graduate and was working in the Cardiac Care unit of a hospital, doing chart and med checks. This patient had been admitted who was well known to us --- one of society's cast-offs. He was homeless, obese, had multiple medical problems and was not exactly the most attractive human being you've ever seen, if you get my drift. The med students and residents were tired of him, and here he was back again with some new problem. I sat down and looked at his admission note. The admitting cardiologist had HAND written the most elegant, thorough, organized and complete 5-page note I've ever seen, before or since. I remember thinking, this is the doctor I want. This is the doctor I want advocating for ME. He's going to do his best for this patient, no matter what. Mr. Florida Urologist couldn't even pack this guy's lunch.

In our blog world we often complain and vent about the quirks and weirdness of our jobs and our patients. It's an outlet that everyone needs. But in the end I think most of take it very seriously that we do our jobs for them the same as for anyone else. The day I stop doing that is the day I KNOW I'm finished.

I only hope another urologist arrives in the area and posts a sign on his door that says "I'm a doctor, come and see me."