Friday, December 31, 2010

Dazed and Confused

There are some days when people say things that are so puzzling, so..... jaw-droppingly dumb, that you are literally struck speechless. It's the kind of thing where the "crickets chirping" sound effect really comes to mind. What's even more irritating is that the person saying these things to you starts to get agitated like you are the idiot.

Today a woman had the entire pharmacy staff searching for prescriptions that her doctor 'should have called in.' She was getting quite annoyed. Finally, after several minutes of multiple people scrambling around, I asked her if the doctor's office may have handed her the written prescriptions. She exhaled loudly, sniped "well yes they DID, but I left them at HOME."

Crickets. We all just stood there.

Another person wanted us to transfer a prescription to another pharmacy. He did not, however, know the name or phone number of said pharmacy.

Silence. Crickets.

Another person needed a refill, and was told the prescription had expired and would need doctor authorization. "It has NOT expired," she screeched. "The label says, refill as needed until 12/29/2010 !!!!"

Silence. Crickets.

Two other recurring events today:
1. People who were given new prescriptions for all their chronic meds at a doctor's appointment. Some time later they call in and ask me to call the doctor for refills, because "I don't know what I did with the prescriptions."
This is THE biggest freakin' waste of everyone's time, ever, in my opinion. Once again, it is people taking no responsibility for anything. Burns me up.

2. People who allow us to fill multiple prescriptions, bring them to the counter, explain them, package them up, ring them up, and then (and ONLY then) inform us that "I didn't bring any money today."

There's those crickets again.

And the band plays on into 2011. Happy New Year, I guess!

Friday, December 24, 2010

Christmas Potpourri

I've received a couple of calls in the last few days from people asking me to identify some tablet that they found in their kid's room. I can definitely understand the parent's concern but it still makes me a little uncomfortable and I wonder if I am courting any HIPAA violations by doing so -- but I figure if it's a loose tablet and not in a labeled bottle then anyone should be able to pick it up and inquire as to its identity. In one case it turned out to be an Endocet. I don't try to get the parent too worked up ('you don't know who it belongs to or even if it belonged to the previous owner of your house/apartment' etc.) but of course I am not naive enough to suspect there won't be a bit of a confrontation. If it was my kid I would want to know.

People don't seem to be totally in the Christmas spirit this year. For the usual reasons, I suppose -- the economy, stress, fear of what's ahead. I sort of feel it too. Yesterday a customer was very pissed off at his insurance company who apparently told him he was active -- however, when we called them they found no record of him anywhere. As he huffed out I noticed he was wearing a large pin that said "I Celebrate CHRISTMAS." Great..... something else to be angry about.

Another guy was sitting waiting for his prescription and yelling into his cell phone (presumably to one of his employees), 'NOW GO MAKE ME SOME MONEY."
Another guy was signing for his prescription and picked up a stray pen on the counter that said (inexplicably) "The New York Times." Gee, he sneered, "people still read PRINT?"
Rather than assure him that people still did, I let it go.

Finally, a customer called and told us he was out of his narcotic pain medication and needed a refill. He had one tablet left. Oh, and he had NO way to get into the pharmacy to pick it up. There was NO one he could send to pick it up. Did we deliver? Well, no we don't. (Now, at this point we don't even have a refill request in to the doctor, much less a signed prescription ready to go.) Even if we get the prescription immediately and mail it, we're looking at several days, and it's a holiday weekend. WHY oh WHY do people do this? We try to help them out as much as possible, but there's just not a lot we can do in this situation. Add it to the stack of problems. I have no clue how it turned out.

Anyways, Merry Christmas everyone!!! -- hope you get some time off AND enjoy it!!

Wednesday, December 15, 2010

In Search of the Perfect C.E.

When I first graduated as a pharmacist I joined the organizations, subscribed to the magazines and made every effort to plow through them and keep current with continuing education. Obviously, it is very important -- and not just because CE is required to stay licensed, but to do our job responsibly. I went to the day-long CE events in the hotel ballrooms and convention centers, and the dinners, and the luncheons, and all that.

Gradually I lost interest in a lot of those things --- not because I don't want to learn anything, but because I began to realize how little I was getting out of them. I would plod through some long article and an hour later not remember a single thing I had read. Nothing was relevant to those of us who work not in academia, not in research, but on the front lines of pharmacy. I would sign up to attend a lecture on, say, "Recent Advances in the Treatment of Asthma." I would think great! --- I need to get a little refresher on some of the new inhaled medications and what distinguishes them from each other in practical terms. But alas, what I got was someone who spent 45 minutes reviewing the causes and epidemiology of asthma, which by now we've all heard a hundred times. Then the speaker would realize they were running out of time and hurriedly throw up a slide listing all the classes of asthma drugs, their brand names and refer me to some handout which was no more helpful than any textbook, and bye-bye I'm out of here. Well, I didn't need to waste a Saturday on this.

I can't tell you how disappointing most of these things are to me. No prescriber has ever called and asked me to explain what causes asthma. What they want to know is, "Can you suggest something for my patient who has failed on this-this and this?" or "Which product do you think is easiest to use?" Or, "we need help figuring out some devices to get this recalcitrant 4-year old to use an inhaler."

I know the problem with most of these CE lessons is they have to be objective and not exhibit commercial 'bias.' That's too bad, because I think some kind of bias is what we need. I truly appreciate it when a speaker can relay their own practical experience to me.
Of course I can evaluate it in the scope of my own experience. But the things I remember most are when, say, a pediatrician says "New Liquid Medication X works great and is low-cost, but I NEVER prescribe it because my patients simply won't take it -- it tastes that bad." Now, that helps me. That's something I can USE. I am always desperate for those tips, insider experience, or 'pearls' as we used to call them.

What made me write this post was deciding to give it another shot yesterday and read an article in one of those pharmacy magazines. It didn't go well. One of the articles was on Medication Therapy Management (which used to be called patient counseling, then profile review, then pharmaceutical care -- but that's another story). Another article was on the well-worn topic, "Selecting A Blood Glucose Meter." OK, great, I'm always looking for tips there. It turned out to be a pretty short article:

"A blood glucose meter is an essential tool.... patient should use....blah blah.

Yup, got that.

"Pharmacists play an essential role... selection of meter... key features.. blah blah.

Yup, that's why I'm reading this. Please continue.

"Key features that may be considered.... sample size....alternate testing sites....portability..... memory options.... blah blah.

OK, we're getting closer. Let's get down to brass tacks. Names, specifics please.

"After a meter has been selected, it is important that the patient understand...."

WAIT A MINUTE, THAT'S IT?? WE'RE DONE?? Didn't we skip over the whole 'selection' part? Oh, I see you've ended by providing me with a nice list of all the names of blood glucose meters. Well gee, so that's what all those crazy things are on my pharmacy shelves. Thanks a whole lot.

Well, I'm still searching for the ultimate CE .... good ol' Pharmacists Letter will have to be my lifeline for awhile longer. And no way am I picking up one of those magazines, unless I'm on the cover.

Monday, December 13, 2010

The Wretched Question

Pharmacists often complain that when someone hands us a prescription their first and only question is, "How long will this take?" Sometimes they don't even hand it to us first. Sometimes they themselves have already decided how long it should take (as in, "It's just some cough syrup", or, "how long would it take to just refill an inhaler?") I've gotten used to it, but there are just some days when I hear it over and over again, and it REALLY gets on my nerves. In fact, it discourages and depresses the hell out of me, especially when it is super busy and I am working my butt off to try and take care of people as best I can in a professional manner. Even the customers who don't speak a word of English know how to say "HOW LONG?" And no matter what you tell them, they're back hovering at the counter 5 minutes later. I can't think of anyone else in the health-care chain who gets asked immediately and consistently, "how long will this take?"

It's really impossible to explain to people that putting the pills in the bottle is the least of our worries. The required record-keeping, regulations, requirements of the insurance companies and error-proofing procedures are formidable even without the unintelligible and nonsensical prescriptions that often come our way. And of course there's the simple factor of volume, which is inversely related to the number of staff working. No need to go over all of that again.

Anyways, as part of my 'bucket list' one day I am going to turn the tables.

Patient: I have some questions about these prescriptions.
Me: Sure. How long will this take?

Patient: I have no idea how to use this inhaler. Can you go over it?
Me: Sure. How long will this take?

Patient: Can you recommend something for this gunky cough I have and also something for my kids' acne?
Me: Uh, how long will this take?

Patient: Can you call my doctor and get me something for my migraines and then call me when it's approved and then mail it to my home and then call me when my credit card declines?
Me: OK. How lo-----

Well, you get the idea.