The Ball Drops......

It's the last (week)day of 2011. Things are chugging along fairly smoothly in the ol' pharmacy, until about 4:20 pm. And at that point things go completely, totally to hell. The phone starts ringing nonstop, because the whole world has discovered that:

a) they still have money in their flex spending accounts that needs to be used up before the new year, or

b) having met their deductible and having no copays, they really really want to squeeze in one more refill of their medications before the copays kick in again on January 1st.

Now, I'm not blaming anyone for wanting to save some money, but I do blame them for waiting until the VERY LAST minute to cheerily advise me that they'll be stopping by in 15 minutes. God, it's frustrating. And if they have no refills remaining (as is often the case) then they're stunned that I can't snap my fingers and make it happen. True, perhaps they haven't filled that prescription since 2009, but what's the big deal "I'm sure my doctor will OK it." And damned if some of them don't get on the horn to the doctor's office (apparently), because I start getting calls from exasperated nurses telling me to go ahead and fill so-and-so's acne medication one more time. The doctor's offices must be as sick of this as I am.

Also had one customer, getting on an overseas flight that afternoon, plop down a bunch of empty bottles and then proceed to get restless once 10 minutes had passed and we weren't finished. Only had a few tablets of one of his meds in stock -- it was a 'nonessential' so had no problems telling him he was SOL. In fact, even if it was an essential medication, I guess he would have been SOL.

The end result was standing-room-only in the pharmacy well past closing time. The Overtime Gods will not be happy.

HAPPY NEW YEAR.....!

Holy Crap, It's December?

I haven't been keeping up too well on blog posts lately, not because I've lost interest but I just can't freakin' believe where the time goes. Amazing how this leaving home at 7:30am and coming back at 7:00 pm cuts into one's free time.

I can't really get into Christmas this year. Each year I find myself less and less enthusiastic. The stores are full of the same crap and every sad news story reminds me that it's really just another day for a lot of people. Forgive me, but I don't really look forward to Christmas 'get-togethers' with co-workers either. Nothing against them at all, I just associate work with a different mind-set and it's hard for me to put it away when I'm looking at the same faces outside of work. When that gate comes down, I just want to get out of there. I suspect a lot of people feel the same way but are good sports about it anyway.

Seems like December 1st brought about some formulary changes for a lot of customers. I get the impression a lot of people are changing insurance plans in the new year and there's going to be a lot of confusion -- more than usual, maybe? People have been asking about generic Lipitor for weeks now, even delaying their refills till it came out. They thought the price was going to plunge immediately and wanted to know what their insurance would charge them for it. (Completely unknown to us!) We've had to caution them that they may or may not see a difference right away, and that has been borne out.

I've struggled mightily with more and more customers who speak little or no English. In fact I've become quite discouraged at what I see is a waste of money and resources in the polypharmacy for these folks. How much of a chance is there that they're going to use the
Pulmicort Turbuhaler or the Medrol Dose-pak correctly, and therefore benefit from it? I'm not saying they don't deserve the appropriate treatments, but they can't read the label (I can see them trying to 'memorize' the directions for each bottle) and I have no idea how well they understand my game of 'charades' as I try to demonstrate with hand gestures, because that's all I can do. (Plus, I've got these ridiculous SureScripts prescriptions that print directions even I can't decipher half the time.) I've watched people go out the door with bags of very expensive medications that I have no real hope are going to be used correctly. I don't know what the solution is, if the person doesn't bring someone along who can translate. We can't keep written materials in every language and for every question. I also suspect that it's a cultural thing for some folks to decline to ask questions, particularly of a female pharmacist.

I dunno, man.... it's just been on my mind. Hey, I'm gonna watch "National Lampoon's Christmas Vacation" -- that will get me in the spirit!

Ours is not to question why..... but why?

--- I put together a multi-prescription order for someone a couple of weeks ago -- several refills (had to order one thing specially), a transfer from another pharmacy, and two prescriptions that needed doctor approval. I remember the guy dumped it all on me over the phone and wanted to know how long it would take. We called him as soon as it was all ready. Then WHY, two weeks later, is it still sitting in the pickup bin --- UN-picked up?

--- a guy brings in several bottles, and complains that the generic brand of Ambien we filled for him does not work nearly as well as the one he got from Big Box down the street (he has that bottle too.) We do the usual back-and-forth until my technician notices that the Big Box bottle has his wife's name on it. We ask him, um --- is that prescription supposed to be for your wife? He seems completely mystified as to why we would question that, and continues to be confrontational about the brand that he got. Well, I'm still not sure how that conversation was supposed to end. WHY would anyone EVER take someone else's prescription medication? .....ha ha, I know, I know ... dumb question. But the whole thing was still our fault.

--- a customer gasps at the 10 dollar copay on her sedative prescription and tells me she does not have the money, nor does she have a credit card. While telling me this, she sets her tablet computer on the counter. She says accusingly, "Well I guess I won't be sleeping tonight." WHY..... don't I feel very bad about this?

--- I keep having customers telling me their medications were 'stolen.' It's almost always the controlled substances. Enough already. OK, even if it's halfway true.... if you don't have enough brains to safeguard your prescription medications from the neighbors, or your kid's friends, or your kids, the painters, the movers, your brother-in-law, the landlord, or any one of dozens of people who apparently go through your possessions and sift out the prescription for which they recognize the generic name as something they might enjoy.... then I can't
help you. And as far as leaving your entire prescription in your purse, or car........ WHY?

Pharmacy Gets A Mention?

Billy Crystal is going to be hosting the upcoming Oscars. I like him on the show and I think he's funny (although I hear he's a raging egomaniac -- but who isn't in show biz.) I couldn't help but notice this in the news article:

Crystal, who has hosted the widely-watched Hollywood telecast eight times previously, announced his new job on Twitter with a post: "Am doing the Oscars so the young woman in the pharmacy will stop asking my name when I pick up prescriptions. Looking forward to the show."

It's a funny line, but I would like to personally congratulate that 'young woman in the pharmacy' for doing her job. People don't understand the catastrophes that have resulted when names aren't verified in the pharmacy -- even if we're supposed to know who you are. Give us a break, Billy --- but I'm looking forward to the show too.

Talking About Waste (Again)

"The Drug Enforcement Administration says people turned in more than 188.5 tons of unwanted or expired prescription medications in the agency’s third National Prescription Drug Take-Back Day on Oct. 29."

This kind of bothers me. What a waste! There are a lot people around the world who have little or no access to quality pharmaceuticals and you wonder how much of this stuff might have helped someone.

Sure, there are a lot of reasons why prescriptions are wasted or not completed. A patient starts a new medication and can't tolerate it; they start an antibiotic and it has to be changed later because of lab results; a patient is prescribed 30 tablets of pain medication for a minor procedure and needs only one or two. But there are a lot of situations where I feel like I'm looking waste right in the face, like:

-- a person starting a brand new medication, and is prescribed a 90-day supply right off the bat...

-- a tiny little baby prescribed voluminous quantities of a topical product (the jar of ointment is almost bigger than the kid)...

-- OTC products that are prescribed in multiple packages at a time (this is especially unsettling when the recipient of the prescription seems completely clueless on what they're supposed to do with it)

-- a gigantic bottle of some horrific-tasting liquid medication, for a kid who I can tell you right now ain't having none of it after that first dose....

-- boxes and boxes and boxes of expensive nebulized medications, inhalers, aerochambers going out the door ---especially for anyone who can't look up from their cell phone long enough to even answer me, when I ask if they know how to use the stuff.

When someone complains that they can't get more than a 30-day supply with their insurance, or that they can't get an 'early' refill, I'm kind of sympathetic but I understand what the point of that is --- it's to try and keep the waste to a minimum. I don't feel like a lot of people have the respect for prescription medication that it warrants. And sorry, but I see NO reason why any prescription should be 'lost.' Things happen, but I really grit my teeth when someone airily tells me they misplaced their $200 inhaler like it was a bag of M & Ms.

And of course, don't even try to figure out why you fill all those prescriptions that never get picked up----

That's my little rant for today.

What Up, Walgreens?

Why has this happened to me more than once? A patient calls and says they need to transfer their prescription from me TO a Walgreens. They have contacted the Walgreens, as they should, but the Walgreens tells them I have to call THEM (Walgreens) to give them the prescriptions. (For the non-pharmacy folk, this is not the way it's done. The pharmacy that will be filling the prescriptions calls the other pharmacy for the information). I hate to put the patient in the middle of this, but they are adamant that the Walgreens refuses to call me, as they are supposed to. Sure I could call them and happily give away my business, but it's the principle of the thing.

When this happened the other day, I held my ground and told the customer to call the Walgreens back. They know better, I told him. I know it wasn't the patient's fault, but why does this keep happening?

E-Prescribing can be E-vil

The prevalence of electronic prescribing and faxing of prescription orders has generally made things more convenient for customers and probably decreases wait time as well, but as all pharmacists know it is a mixed blessing. The attempts to plug in a 'personalized' prescription into a computer program can lead to some pretty interesting prescriptions, like "Apply 9999 applications topically ", or my personal favorite from this week, a prescription for Plan B, quantity 60 tablets, with 11 refills. Customer then arrives and is totally taken aback that it's not 'ready yet,' either because we have received no prescription or the one we did receive is completely nonsensical. Heaven help me, there are days when I really miss the old fashioned exercise of someone visiting their doctor, being handed a prescription, and then being responsible for choosing a pharmacy and bringing that prescription TO IT. Y'know, kind of like having a little responsibility all their very own self.

So now we not only have the responsibility to fill your prescription correctly, with all the usual challenges associated with that, but we seem to be charged with hunting down that prescription and obtaining it for you as well. If we didn't get it, then it's up to us to seek it out, right? Clear the decks, folks, I'm about to spend 20 minutes on the phone trying to track down one prescription from Giganto Orthopedic Surgery Group and by the way, it's lunch time and please leave a message.

The problem is even worse when, like me, you work in a medical building/clinic when we seem to be held accountable for any prescription written by any doctor in the building whether the patient fills it with us or not. It doesn't matter how many times you tell me "THEY TOLD ME THEY SENT YOU MY PRESCRIPTION" --- I can't fill a prescription that I don't freakkin HAVE. Really, I wouldn't lie to you. We actually had a customer claim her doctor had faxed us
her prescription, watched us tear apart the pharmacy looking for it, acted like a complete bitch and finally rolled her eyes and said, "Well, I've got it out in my car -- do you want me to go get it?" I said, yeah that would be swell. Then I went in back and looked for a sharp object to do myself in with.

And then there are the people who want to 'read' you their prescription over the phone because they didn't want to be bothered stopping at the pharmacy, nor do they want to wait while it's being filled. Sigh.

When it comes to electronic prescribing I know there's no going back, but some days I feel there are just as many errors, just as many problems to clarify, AND the added bonus of leaving people with the notion that everything's going to be done for them. It's the fast-food, drive-through-ability of everything. We'll find the prescription, we'll figure out what your insurance is, we'll wrap it up and tie a bow on it and do it in 10 minutes. Dang, it's frustrating.

What Can You Say.

From the New York Times, Oct 14th:

A 13-month-old boy died after he apparently swallowed pills from a bottle of prescription drugs that his parents had given him to play with as a rattle, the authorities said on Friday.

The boy, Edwin Perocier Jr., was put in his crib in his parents’ apartment, on Southern Boulevard near 156th Street, in the Bronx, about 9 p.m. on Thursday, a law enforcement official said.

One or both of the parents, Edwin Perocier, 44, and Zoraiva Santiago, 22, gave the child a bottle of Suboxone that belonged to Mr. Perocier, the official said. The medication is used to treat people who are addicted to illegal or prescription opioid drugs.

A short time later, Ms. Santiago went to check on Edwin and found the bottle open. Some of the pills had fallen out and one of them was wet. Ms. Santiago took the pills away, gave the child a bottle of milk, and went to sleep, a law enforcement official said.

At 7:45 a.m. Friday, the parents awoke and found Edwin unconscious in his crib. They called 911, and Edwin was taken to Lincoln Medical and Mental Health Center, where he was pronounced dead on arrival.

No charges had been filed as of Friday night, a police official said.

Ms. Santiago’s 4-year-old daughter was taken into custody by the Administration for Children’s Services, according to a law enforcement official.

Adderall and the Gift of Function

Back in March of this year I wrote a post called "The Supply Chain, Adderall, and Flying by the Seat of your Pants" and it has been very interesting and informative for me that I am still getting comments on it 7 months later. It looks like the supply of generic Adderall and Adderall XR are going to continue to be spotty for at least the rest of 2011.

I continue to find it worrisome that we fill so many prescriptions for ADD meds for children and adolescents, however I do recognize that it's a godsend for many of them in conjunction with other forms of therapy. No argument there. Is there lots of inappropriate use? --- Probably. But again, the folks who really benefit from it are penalized by the abusers, just like with other controlled substances.

I have gained a lot of sympathy from the comments by adult patients. I appreciate the fact that they are not blaming me for the shortage situation -- I personally try to help people figure out alternatives, make some phone calls for them, and I certainly don't look down on them for just trying to fill their prescription. However, as I said in the post, frustration sets in when a few people's sense of entitlement overshadows the reality that we're all 'in the same boat' here.

I especially sympathize with people who unquestionably need the medication to function --- to hold down a job, to go to school, to interact socially. Let's face it, without these basics it's a very tough road. These needs go to the root of a successful and happy life, and a mental disorder that interferes with them certainly is terribly burdensome. Then, when someone finds a medication that actually helps and allows them to function, I can see how being told that medication is unavailable indefinitely can cause utter panic.

One commenter said their doctor will no longer prescribe Adderall tablets --- maybe this is because his office got tired of phone calls from patients and pharmacies saying they couldn't get it. If I get a phone call asking me if we have it in stock, I have no problem giving a yes or no answer. Unfortunately though, I can't "reserve" it for anyone. If I hear of another pharmacy that has stock, I'll pass that on. I'll check the other pharmacies in my organization. I would hope most pharmacists would try to offer some assistance, as long as people realize we may not be able to drop everything and deal with it right away. It's another part of the job that we didn't ask for -- so if your pharmacist finds your medication somewhere else for you...... show 'em some luv.

Dear Diary

I wrote a blog post back in July about my frustration with the constant "how long is it going to take to fill my prescriptions" battle that we fight every day, and I'm afraid I have to write another one today, if only to give myself some self-therapy. Maybe I'm just late to the party, but this is something I really think is going to cause me a meltdown one of these days. Before this I guess I just took it for granted that being speedy was supposed to go with the job. Forget about counseling, profile review, MTM or whatever you want to call it now -- it's ALL about the customer convenience, and that means be FAST. Nothing else matters.

I made a minor error this week while trying to check a bucketload of prescriptions for someone who kept asking how much longer it would be. Nothing really significant, but it required a phone call and it made me very angry because I knew exactly why it happened. I was trying to hurry. I tried to glance at it too fast -- there was no other reason. I was so, so mad at myself for allowing this.

Another customer brought 3 prescriptions and actually got snotty when we told her it would be about 15 minutes. Yep, and she even asked if we could 'call them to another pharmacy' (we did not). You see, the idea that she would have to sit and wait, even if it's just 15 minutes, is intolerable. But if we 'call' the prescriptions elsewhere then they will magically be ready when she gets there, and so technically she doesn't have to actually 'wait.' Just stop for a minute and imagine this scenario in any other business on the planet. W...T...F.

And then, a customer brings in a prescription... there's a couple of people ahead of him. Probably about 10 minutes passes, and we discover the prescription is not covered, and needs a prior authorization. I explain the situation to him, and since he just came from the doctor's office I offer to call them and see if they could prescribe something else that is covered. And his question to me is, "Well, how long will THAT take?"

So, I'm trying to HELP you, and all you can ask is how long it will take. Well, damn it , forget it then. I'm going to send you away with no medication and tell you the doctor needs to do the Prior Auth. Buh-bye. I will then fax the form to the doctor's office where it will linger in the Prior Authorization Black Hole for a few days. You will call several times and ask me if your prescription is ready. I'll say no, I haven't heard that it's been authorized, and why don't you call your doctor. Then I'll get a call from the doctor's office telling me they never got any fax. I'll send it again (when I have 2 minutes to spare). Your doctor will be out for the day and the nurse will call me back when she doesn't have your prescription insurance information and doesn't know how or what to send them. Days will pass, probably more phone calls back and forth until someone takes the bull by the horns and either gets word back on the prior auth., or changes the prescription. Meanwhile, you will recount this to everyone you know and bitch about how screwed up the health care system is.

So, looking back, it probably wasn't such a bad idea for you to wait another few minutes for me to make that phone call, huh?

Help me. I'm afraid I may hurt someone.

Sorry for the Sour Tone Here, but I'm Tired

.....and so in the spirit of Jimmy Fallon's "thank-you" notes, here are a few of mine:

Thank you...... Walgreens, for handing your pharmacists the responsibility for 'walk-in' flu shots. I know it's a big money maker and all, but when I call them for a copy on a waiting customer's prescription and get told to call back later because the pharmacist is 'giving flu shots right now,' it's a little frustrating.

Thank you..... pharmacist who worked yesterday, for not ordering the drugs that I need to fill prescriptions today. Yes, there were things about the prescription that needed to be clarified. But now that everything has been straightened out, it's Friday and I don't have the drug, and now won't have it till Monday. Would it have killed you to order it in, inventory be damned, knowing the prescription was pending and was eventually going to be dispensed??? Now the customer is probably going to take it elsewhere, after we did all the legwork, and I don't blame them.

Thank you...... manager for whom I am filling in today, for establishing a nice lax and borderline unprofessional atmosphere in your pharmacy. The staff loves you for it, but I sure don't. Staff seem to show up when they feel like it, come and go as they please, and pretty much operate in a bubble of their own entertainment, into which neither the customers nor I am invited. I am truly embarrassed at times. In addition, because you're such a social animal everyone else in the medical building seems to have chosen the pharmacy as their hang-out spot to come in and shoot the breeze. GET OUT OF MY WORKSPACE AND GET OUT OF MY PHARMACY. My services are devalued enough without you coming in here and assuming that what I'm doing requires no concentration at all. There's gonna be a showdown here, mark my words.

The Category: Potpourri

I've fallen behind on the blog writing for a couple of weeks. I've taken on a slightly different work schedule which has left me kind of wiped out. August has been surprisingly busy, though. Anyway, here are some of the totally random things that have broken through my foggy mind lately....

1. When someone is discharged from any sort of health care facility they usually have a bunch of discharge instructions and crap thrown at them. In fact, the more elderly the person, the greater the volume of overwhelming crap. One of the things people invariably get is a "medication list." They bring it to the pharmacy, thinking it's a prescription. It's not. By the way, I maintain that anybody who wants to get involved with MTM should be looking at hospital/long term care discharges before anything else. Most medical errors occur during 'transitions' in care, and maybe an added bonus would be simplifying things for everyone involved. Figure out what the person has been taking, what they need and don't need, what they need to continue or discontinue, and generate prescriptions that are pharmacy-ready for the doc to sign. What doctor/on-call person/first-year resident wouldn't like that?

2. A woman brought in a single pill (yes, just one tablet) and said she wanted a refill on 'that.' Quickly relieved of the notion that she might know the name of it, or what it was for, I finally got to use my Epocrates Pill ID function on my smartphone. Man, that is slick!

3. Thank you, someone at Big University Clinic, for giving my customer a prescription for Percocet. The signature is illegible, the 'printed name' is illegible, the DEA number I might be able to guess at (but all possible guesses match no one in my system), and of course there's no NPI. The customer is bellowing at me because it's taking so long. The recording on the other end of the phone number on the prescription says you are 'unavailable to take my call.' This makes me very, very grumpy.

4. It's back to school time and the ADD prescriptions are flowing like water after a hurricane. And naturally, the wholesaler's running out of Adderall. Again.

5. I can't get over the number of highly educated and otherwise very competent people who can't spell. My current pet peeve is two words: "LOOSE" is the opposite of "tight" , while "LOSE" is the opposite of "win." So for instance, when I read that someone is about to 'loose' their insurance, I wonder why it was so tight in the first place. It's just a thing with me....

Rolling the Dice Every Day

This was a weird, long week. Things are slower, as they often are in August, but the situations that do come up seem to be just ---- strange. It was a full moon, however, so that explains a lot.

I actually got to feeling good this week, because I had TWO people tell me "I feel better after talking to you." Both were phone conversations followed up by a face-to-face meeting at the pharmacy later in the day. They were both upset for different reasons, but because we were not too busy I was able to sit down, stay on the phone, let them vent a little and then offer some sympathy and understanding as best I could. One person came in later and shook my hand, and the other one actually apologized for her loss of temper.

What bothers me, though, is that more often than not I cannot do this. Most of the time I'm overwhelmed with work and have many people waiting on me. It is really hard to spend that much time on the phone with someone and think clearly about the best way to handle the situation. There are many times when I've had to be somewhat abrupt and in a hurry to end the conversation because I just can't let it go on and on. I don't feel good about it, but it simply isn't humanly possible when all people care about is how long their prescription is going to take.

I don't like confrontations with upset people, and I have never received any training on how to deal with it -- it's mostly on-the-job training and observing how other people handle it. If someone is being rude and snippy to me I find it VERY difficult to keep a pleasant tone, even though that's what we are supposed to do. And believe me, there are plenty of people who really piss me off with their lack of responsibility, entitlement issues, and lack of respect for the service I am attempting to provide. That's why I found these two situations ultimately so rewarding. I know it was because I was able to take the time and talk to them for awhile. I'm also totally aware that it's a complete crapshoot as to how often I'll be able to do that.

Perspective

In spite of all the pissing and moaning we may do on our blogs, I for one never let a day go by without realizing how fortunate I am. Seeing the pictures coming out of the refugee camps in Kenya--- where literally millions are at risk for starvation -- makes me unsettled, scared and heartbroken. I can't help but think about the accident of birth that let me grow up in a land of plenty while others face doom from their first day of life. Why is it them and not me?

In the pharmacy where I fill in some shifts, there are a lot of customers who are African immigrants. We treat them with the same courtesies that everyone else gets. As I've mentioned before, in spite of the lack of English-speaking skills they tend to learn one phrase quickly, which is "How long?" Just yesterday a man approached the counter and protested that he had been waiting 'TWENTY MINUTES!!'

One of our cashiers is also of African origin. He's been in the USA for quite awhile and shakes his head at this sort of thing. He has family back in Africa and related to us what he saw happen when someone in the village gets seriously ill. If that person is really lucky, four people will be available to carry him to the next village to find some medical help. That's the BEST-case scenario.

So, all of a sudden that 20-minute wait doesn't seem so bad. And that's true no matter what country you came from.

Perspective, people.

This One's for the Girlfriends

In my job we're allowed to dress fairly casually under the lab coat or jacket, or whatever we choose to wear as the 'white' layer on top of the street clothes. If I'm going to be running around for 9 or 10 hours like a maniac, then I am bloody well going to be comfortable. I never want to look like a slob of course, but in the summer we're talking semi-dress pants or khakis, and a blouse or polo shirt -- nothing binding or restrictive.... pretty basic stuff.

I have grown to hate shopping for clothes. I 'catalog' a lot of it, but there are some things you just have to try on. I hate wasting a precious day off trudging around some mall looking for something which should be easy to find, but somehow isn't. And I have my limits on price --- I'm not gonna wear anything expensive to work and end up sending it to the dry cleaners in order to remove the amoxicillin stains/printer cartridge ink/pen ink/Sharpie marks/spilled lunch/spilled coffee stains etc. etc....

Anyways, after today's shopping outing I have confirmed a couple of things:

1. Just when you're feeling pretty good because you've toned up and lost a couple of pounds, it
is not a good idea to stand in front of a department store dressing-room mirror. It can be a
soul-crushing experience. Also, it allows you to crush your soul from several different
angles.

2. You find a GREAT fitting pair of pants. They not only fit well, but they don't shrink in
the wash or come out looking like a used Kleenex. You head back to the store to get
another pair, perhaps in a different color. Even if they are no longer sale-priced, you are
excited at your find and will definitely buy more no matter what. We know what happens, though. The different color doesn't fit 'quite' the same. What do they do, change the pattern when they change the color?

Am I right or am I right? Maybe scrubs are the way to go, after all.

Just Gotta Get it off my Chest

Sorry. This topic has been covered by me before, but I really feel the need to vent. I am shopping at Walgreens this morning, perusing the 2-for-1 vitamin sale, in earshot of the prescription counter. My ears perked up when I heard the technician say to a waiting customer something about "putting a rush on it". The customer then says, as if speaking to a small child, "Now, I'm going to run ONE ERRAND. When I come back, it SHOULD BE READY."

I've been getting a lot of this lately. I call it "The Challenge." The customer decides for ME
how long it should take to render this professional service. They give me a time limit and throw down the gauntlet.

"I'm going to make an appointment, then I'll be RIGHT BACK." Or, as they slap the prescriptions down, they state, "TEN MINUTES?"

They come back, badger the technician, who (I know) is trying to be nice and who assures, "It's almost ready", or "the pharmacist just has to check it."

I am SO goddamm SICK of this. Actually no, it's not almost ready. When I am satisfied that the prescription is correct and safely ready to go down your gullet, THEN it will be ready.

I continued my shopping trip at Home Depot. They have an area where they mix paint colors for people. Unlike a prescription, no one dies or is injured from the wrong color paint.
Yet, people seemed quite OK with the fact that it will take AS LONG AS IT TAKES to get the right damn paint color mixed.

I came to retail pharmacy after a number of years in hospital, and I was probably guilty of allowing customers to run me around like a little rabbit for a long time. One of the things I came to appreciate from fellow bloggers is how upside down that is and how completely brainwashed we can get. At work recently we had to submit some professional 'goals' as part of our evaluation, and one of mine was that I am going to take the time I need to safely render my service. And when there are interruptions, and people gabbing, and phones ringing and distractions everywhere, that is when I'm going to protect MYSELF and my license, and I don't give a crap how long anyone thinks it should take. Probably not the kind of 'goals' they had in mind.

Again, I am just venting here. We're all familiar with the many factors that have allowed pharmacy services to be so devalued.

I don't know why this is grating on me so much lately, but... it is. Must be the heat or something.

It Speaks for Itself

Another reason to ban cell phones in the pharmacy?

MANSFIELD, Massachusetts (AP) — A judge on Monday increased bail for a rock band bassist accused of stealing prescription painkillers from a pharmacy just hours before a show.

Attleboro police said Coheed and Cambria bassist Michael Todd showed a Walgreens pharmacist a note on his smartphone Sunday afternoon, saying he had a bomb and demanding prescription drugs.

The 30-year-old Todd of Anaheim, California, fled with six bottles of Oxycontin, taking a cab that dropped him at the tour bus at the Comcast Center in Mansfield, where his band was to open for Soundgarden that night, police said. He was arrested before the show, and the band played without him.

Really. A note on his smart phone. Any maybe it's time to take OxyContin out of retail pharmacies, too.

Subliminal Advertising?

So I saw a commercial last night for CVS, with the friendly CVS pharmacist (forget her name) standing in front of the requisite shelf full of drug bottles at the pharmacy. There, at eye level, are what I'm SURE are four 500-count bottles of Mallinckrodt's generic Vicodin.

Just sayin'.

Driven to Distraction (Re-Visited)

I, and others, have written about the cell-phone curse --- trying to communicate with customers who are in the midst of cell-phone conversations or texting and regard us as a minor annoyance that is interrupting their important communications with the rest of the world. It is something that everyone hates, and everyone in the public arena has to deal with this.

I recently returned from a trip to a big east coast city. (Really BIG.) Now, I'm not exactly from Podunk-ville, but I was floored by the number of people walking the street with their noses in their cell phones -- in fact, the majority aren't even talking on them, but rather texting or tweeting or just reading stuff. I saw cops looking at their phones. I saw security guards and doormen looking at their phones. I saw a TSA agent talking on his cell phone as we lined up in front of him, and the conversation, which I could hear clearly, didn't sound work-related. The taxi driver was on his cell phone. The guy behind the counter at the bank was glancing at his cell phone, the guy selling us tickets... and on it went.

Maybe some of these people do have to use a cell phone for work-related communications, I don't know. Or, maybe they're actually breaking the rules of their job. But I was really blown away by this level of absorption in these devices. How are you an effective security guard when you're reading your phone half the time? A high-school kid I know works in a fast food restaurant and they are absolutely FORBIDDEN to have their cell phones with them while working. If it's good enough for the hamburger joint why isn't it good enough for the TSA?

I've written before about my problem with pharmacy employees being distracted by their cell phones. I work with people who regularly make and take cell phone calls from home while working, and it really bugs me. Remember the good old days, when if someone needed to reach you they called your work number? --- better yet, you called them on your lunch break?

Disturbed and Disheartened

Been away from the blog 'post' for a few weeks -- visitors, a little traveling (more on that later) and just general 'time getting away from me.' Anyways, back now --- and I know there have been several posts about the Long Island pharmacy murders on Father's Day, where a pharmacist, clerk and two customers were shot execution style by a guy who then made off with a backpack full of narcotics. They put up no resistance but were killed anyway. Like everyone else, I am totally sickened by this. I hate the fact that we are swimming in controlled drugs half the time and shoveling them out by the bucketful. I hate arguing with people about early refills, then calling the doctor and seeing them give in over and over again. I hate the fact that we are forced to keep way more stock than we should. I hate the fact that our pharmacy 'fishbowls', which are supposed to provide "accessibility" to our patients, also scream "c'mon in and rob me." I hate the fact that only one pharmacy I currently work in even has a 'panic button' to call for help. This was probably a wake-up call for a lot of us, and I intend to make some noise with my employer about it.

I hope that this guy who has been charged with these murders (and his accomplice wife) have themselves a good ol' drug problem--- because now I hope they are going to sit in prison lookin' at some major COLD TURKEY withdrawal -- and hopefully that's only the beginning. Never see the light of day again.

The Scenario Keeps Repeating Itself

Customer: "I'm picking up a prescription."

Then what follows is.......silence. Stare.... More silence. I wait for it....... I know it's coming.... they're going to give me the name --- the name, I need a name, gimme a name.......... any minute now, c'mon...................aw, hell, I guess not. I'm gonna have to ask the question.

Me: "OK, who is the prescription for?"

Customer: "Me."

Silence. Longer stare. More silence.
I'm on the verge of laughing, or crying. This is my life.

This scenario, in various forms, repeated itself several times this week. I find myself puzzling over it. I'm trying to rationalize it. Maybe it has to do with prescriptions being sent electronically. Do people think maybe a photo or physical description accompanies the prescription, so we just know who they are? Maybe I can match up the prescription with their outward symptoms? (sniffling, red eyes, coughing, rash?) Yes folks, in this depersonalized, bar-coded, anonymous world we live in, we still need your name. Please.

Spring Mini-Vacation

I'm headed out for a few days to visit Canada and re-kindle my love affair with Canadian pharmacies (see post of November 6, 2009). It's been too long.

Tim Horton's, here I come !! And after the snarlingly unpleasant set of customers I had today, that honey-glazed is gonna go real good.

Just Another Day at the Salt Mines

Guy come in and plops down 4 med bottles from a mail-order pharmacy, and wants to transfer prescriptions to my pharmacy. Wants to wait for them --- doesn't want to stop back, because apparently he doesn't live close but his doctor is here. I already see that one of the prescriptions is for 480 tablets of something I don't have, because I've got no one on it.

I take a deep breath and try to keep an eye on everything else that's going on, because the phone call to the mail-order pharmacy is going to be at best, a 15-20 minute ordeal IF all goes well.

Oh yeah, and he's got new insurance. He's going out of town, leaving on the weekend. When does he choose to present me with this little project? Three o'clock on a Friday afternoon. (GOD, I'll never understand this.)

The call to the mail-order pharmacy goes surprisingly well, but still takes about 15 minutes to reach the appropriate person and do the transfers. While I'm on hold, I manage to check a few other prescriptions that are waiting. Amazingly, the mail-order customer's prescriptions still have refills available. We run the first one with the new insurance.... it's not covered.

I explain that there are some generic alternatives available and those will probably be covered. He doesn't understand why I can't just call up the doctor and get that prescription right now. His other 90-day prescriptions are covered, but with pretty high copays. I don't have enough of another medication to fill the whole thing.

The guy's been waiting awhile now, and starts to get a little pissy about the prices, and about the one med not being covered. I'd like to get a little pissy with him too and in my silent soliloquy say the following:

1. Don't get irritated with me, sir. In case you hadn't noticed, I'm trying to juggle half a dozen other customers here.
2. Why in the HELL did you wait to fill these 3-month prescriptions, with NEW insurance, on a Friday afternoon, just before you are leaving town?
3. I don't set the prices. You're on some expensive stuff. I can't write you new prescriptions. We both know who has to do that.

And most importantly,
4. PICK UP THE PHONE AND CALL AHEAD. If you had called me yesterday we could have had ALL of this straightened out and ready to go. The doctor could have been contacted, the drugs ordered, and you would be in and out.

And to the other customers, this is yet another example of why your prescription takes so damn long to fill.

Lie to Me, Go Ahead and Lie to Meeeee......

You know that song by Jonny Lang? If the pharmacy had Muzak (and thank God it does not), this would have been great background music for one entire morning last week.

(I've changed a few minor details here to protect the untruthful)...
#1 was a regular customer and a nice guy. He gets a prescription for codeine-like pain medication, and for as long as I can remember the prescriber has specified it "must last 30 days." He came in to pick up his refills and we told him that one was 4 days early, and we would be glad to fill it on day #30, which was after the weekend. He looked somewhat perplexed, like this had never happened before (it kinda had, I'd let it go if it was one day early), and then said he was going out of town and would need it.....then said something like, "well, maybe I'll have to change my plans till I can get it filled," and left without further protest.

Later that day, doctor's office calls in and says not only to go ahead and fill it, but gives it more refills. The nurse says, "He's flying to Hawaii, and needs to get it before he goes."

Whoa. Nobody said anything about flying to HAWAII. I mean, I could have worked with him on that --- true or not, I would never know the difference I guess. And y'know, this doesn't sound like the kind of travel plan you could just postpone for a couple of days. So, are we just trying to get it today, or are we flying to Hawaii?

I don't know which is the real story. Like I say, I don't think this particular customer is a bad person or anything. No previous bad interactions at all. In fact, I think he would have told me about his trip to Hawaii if he was actually going there. Why you gotta lie to me?

#2 was a person whose purse was stolen. As we all know, when a purse is stolen it invariably contains someone's ENTIRE prescription of a controlled drug, as though it's a good idea to carry around a bottle of 240 Percocet (or similar med) in your purse. We had received a new prescription, insurance rejects it as too soon, and customer phones in to check on it. She assures us she talked to her insurance, and they will cover a stolen med. So, do people think we're not going to know when that's not true?

We call the insurance, they say nope, not for a controlled substance. Customer calls back and is aghast ( "Well, they covered it LAST TIME!!")

Oy.

Lie to me, and tell me everything's aw-rightttt....................

We've Come A Long Way, Baybeeeee!!

There's a TV commerical for Alli running here right now (that's the OTC weight loss drug that blocks some of your dietary fat from being absorbed -- at the risk of some, um, "bowel-related changes"). The spokesperson is identified as a Registered Pharmacist, and although she is not shown in a work-like setting she states, "As a pharmacist, I know Alli is safe because it is FDA approved", and "blocks 25% of the fat from being absorbed" and as part of a weight-loss program helps me lose weight etc., etc....and so on.

The commercial cuts away to something else for a second, and then comes back to her as she declares in a final statement, "My husband is a doctor, and if HE didn't think Alli was safe, he WOULDN'T let me use it!!!"

Now, I loves me my doctors (especially the Grumpy ones) but..... what the deuce is that all about? Apparently the makers of Alli didn't think that this woman's training as a pharmacist was quite enough for her to testify to the safety or effectiveness of this product without the doctor hubby's blessing.

Every time I see it, it just sticks in my craw.

What's Happening

As we come out the other side of the second flu 'wave' and other assorted crud, and still struggle with various drug back-orders, the pharmacy biz goes on. I've been a little more preoccupied lately with the lives of my co-workers, instead of the customers (for once.)

One of them recently experienced a personal tragedy and left everyone struggling to maintain normalcy. It's one of those things where being crazy busy can actually be a good thing. Anyways, at the end of the day I was again filled with admiration for the people who deal with these things on a daily basis --- the physicians, nurses, clergy and funeral home staff who are unfailingly professional and compassionate and know just what to do when everyone else is at their worst. Hats off to them.

Okay, so the gas prices are really high. I see on the news that people are 'angry' --- well, if they are angry at the oil companies raking in billions in profits, then I get that. But c'mon folks, we've been through this before and the solutions are usually the same. I know there are businesses that are hurt by high fuel prices, but again I am looking at the people around me who drive to work in Suburbia USA in a Ford F-150. Sorry, I don't want to hear what it cost you to fill up.

I'm also a little weary of co-workers who are in continuous drama because of a spouse who can't find a job. Now PLEASE understand I'm talking ONLY about my own metropolitan area here, which is not as depressed as many others in the country. There actually are 'Now Hiring' signs, and they're not real hard to find. If I found myself unemployed, I'm one of those people who would be out there filling out applications wherever I saw those signs. Chances are it's not going to be a dream job, but it's income while I wait for a better opportunity. I feel bad for a couple of my co-workers whose spouses, I suspect, just don't want to work. It's a tremendous strain on them. I don't think I could handle it for very long.

And finally, just an aside -- I went to pick up some glasses the other day. At the counter next to me, a little girl about 5 years old was being fitted with new glasses and from what I could tell, her first pair. The technician was explaining the fit, asking her if she could see better, and explaining how she might need a little time to get used to them, etc. The mom was standing behind her.... listening? encouraging? complimenting?. No. Mom was texting on her phone the entire. freakkin. time. Didn't look up once. Do you think they'd have called Security if I walked over and slapped her?

Say What?

With Allegra switching to over-the-counter status recently we've had to inform people of the change as the insurance plans drop it from coverage. I use Allegra and I am more than happy to see it go OTC --- totally simplifies my life. I just walk in and buy it. But one customer the other day was not happy about having to purchase it -- the price being more than her usual copay -- and chirped, "Well, I'll just ask the doctor for something else!"

Uh, no. That's not really the idea. Having the medication go OTC means that we no longer have to involve the doctor --- or the appointment scheduler, or the nurse, or the transcription person, or the pharmacist, or the pharmacy technician, or the insurance company, or the myriad of other people who, in one small way or another, play a role in generating a prescription for a person.

All of those things cost a HECK of a lot more than a box of Allegra. But yeah, try telling that to someone who had an $8 copay and believes that was all it cost.

Hey, Remember ME??

What's the deal with people who come into the pharmacy and treat you like you're so much gum on the bottom of their shoe, then return later in the day and act like nothing happened?

This woman comes in with a narcotic prescription that clearly states, "Do not fill before xx/xx/xxxx" --- the date being 2 days before today. We were not rude to her, and simply informed her that we could not fill the prescription due to these instructions, and of course she flips out, raises her voice and gives us all the usual reasons why we HAVE to fill it right NOW. She slams her hand on the counter and talks to me and my technicians like we are the scum of the earth. She then gets on her cell phone, paces around and liberally emits the "F" word. Finally, she stomps away.

Naturally, I'm sure she calls her doctor and a little while later the office calls and gives us permission to fill it early (surprised?). An hour later she returns with the prescription, and not only says not a WORD about the prior interaction but wants l'il old me to help her find some lotion and some kind of cleanser for her very dry skin.

W.T.F.? I swear if it was me, I would hand the prescription over, skulk over to a waiting chair and hide my head under a magazine till my name was called. In fact, I would never make that kind of a scene in the first place.

I understand people can be under a lot of stress. The grown-up ones are those who can say, "Sorry I was upset before. I'm having a bad day and I realize you are just doing your job."

Working, and OK With It

The Redheaded Pharmacist had a post entitled "More Than A Paycheck" which I really could identify with, because in spite of all the venting and bellyaching I may do (and there will be more, believe me) pharmacy has actually been very good to me too. In my various jobs I have seen a lot of employees come and go, and it does bug me to see people who disrespect their own profession and therefore, mine. I worked with a fairly recent graduate not long ago who showed up unshaven, wearing a filthy lab coat, and acted like the job was little more than a distraction from playing with his iPhone. Get out of here, dude. Not so long ago pharmacists were in short supply, and all you needed to get hired was a pulse. People would come in with the attitude, "you're lucky to have me." Anybody with that attitude now is going to be in trouble.

I think back to when I worked hospital pharmacy... all the doses I checked, all the IV solutions, all the parenteral nutrition solutions ---- they easily must number in the tens of thousands. For me, it's just another IV bag, but to the person into whose veins it will be running it's a whole lot more than that. They'll never know my name, but my job is to stand between them and potential disaster. One of the differences between me and the technician who makes the IV bag is that I am required to know when something doesn't look right --- I'll never forget once stopping a technician who was told (per the instructions) to add 5mL of insulin to a TPN bag, and of course it was supposed to be 0.5mL. She shrugged and said "OK!" and changed it. And I will always wonder about what might have happened.

The other day, in my current retail pharmacy job, my technician (who's great btw) was having a bad day and making a lot of errors. Some of them were clerical errors, some were right drug/wrong strength, and one was potentially hazardous (hydroxyzine for hydralazine). It is days like that when I am reminded why I am there. Yes, most of it is repetitive and unglamorous, but to the person on the other side of the counter it's a pretty big deal. All in all, I get a lot of satisfaction at the end of the day because I got through it and did it right. The paycheck is good too, but it's nice to have both.

And now, I will proceed to complain some more!
So.... this guy comes in the other day............................................ to be continued.............

Who's not Listening here?

"Pharmacist! Phone Call!"

(Keep in mind that this conversation occurred AFTER the doctor's appointment, AFTER the prescription had been written, waited for, filled, paid for, and taken home.)

"Yeah, I just had a prescription filled for some eye drops for my daughter, and I had some questions."

Me: OK. (not recalling this person, but wishing she had perhaps asked them while she was here).

"Well, the doctor said that pink eye is probably due to a virus, so why did he prescribe an antibiotic eye drop for it? That doesn't work for viruses anyway, right?"

Me: Well.... he may have done that to guard against an underlying bacterial infection or....ummm......
(Now, what I'm thinking here is, why didn't you ask him that question as you sat there while he wrote the prescription? I wasn't in the room with you. Most likely he gave it to you just to do 'something' for a basically self-limiting condition. Most likely, you demanded that he give you something. I can't really tell you for sure.)

"How long am I supposed to use the drops? It doesn't say on the bottle."

Me: It varies... sometimes they recommend 5-7 days, sometimes they have you treat until the redness is gone, and then a day or two beyond that just to make sure that things are cleared up.
(I had to repeat this a couple of times)

"Well, her eyes aren't red."

Me: OK.... why did they think she had pink eye?

"Well, she has some drainage.... some discharge."

Me: O-- kay..... maybe there is some suspicion of bacterial infection, then?

Caller (sounding unconvinced): "should I call the doctor's office?"

Me: Please do. (OK, I didn't say it that way, but yes. What we had here clearly was a failure to communicate. Whether the doctor didn't communicate or the patient didn't listen I do not know, but I am not the one who's responsible for figuring that out.)

This kind of thing drives me nuts. Not for my sake, but because I think of this as wasted time -- an unsatisfactorily conducted doctor visit that costs everyone money, a prescription that costs everyone money, and now there's going to be more time spent leaving messages with the doctor's office for someone to eventually return a call to this person.
In a world filled with disaster images, it's so out of proportion, and silly.

The Supply Chain, Adderall, and Flying by the seat of your Pants

There are so many drug products on back-order or limited supply right now that working in a pharmacy can feel like a scavenger hunt, especially when we're asked to keep inventories down and don't have a lot of 'cushion' to work with. I hate having to bounce people around on different generic manufacturers of the same drug because the one they got before is unavailable. If all forms of the drug are totally unavailable we have to track down the prescriber for an alternate --- but if the person doesn't want an alternate ("Midrin generic is the ONLY thing that works for my headaches -- would anyone else have it?") --- well, I'll make a couple of calls but after the second or third "no" I've got to give the prescription back and send them out to continue the search on their own. I swear I'm spending so much time trying to find a solution to these problems -- calling other stores, scouring the wholesaler's listings for SOMETHING --- it almost requires a full-time person right now. And it's not just prescription drugs; a lot of OTC's are affected too (PanOxyl soap?? -- really??).

We can't get the 5mg tablets ---- but hey, I can instruct the customer to split the 10mg tablets, right? Problem solved. Uhhhh..... not so fast. Customer calls the next day and swears that those half-tablets made her deathly ill. Every fiber of my being wants to protest --- "but, there's NO reason in the WORLD why that should happen !! It's the same thing !!! It's the............." ------------- oh, never mind. As Charlie Brown would say, AAUUUUGHHH.
I've got enough problems without this.

One that has hit us hard is the generic Adderall shortage --- unfortunately this medication is HUGE in one area where I work. The XR capsules have been unavailable for awhile and now the regular generic tablets are starting to go too. We can get brand name Adderall XR but of course people are charged the brand name copay (which they love) if we can get it to go through at all. Or, the insurance lets us fill the brand name but doesn't reimburse us for it.

Just as an aside here, the stuff is way overprescribed. There, I said it. I know there are kids who have seen their school and reading performance greatly improve because of it, and that is good, but I cannot believe that all the kids and adults we have on this drug truly have attention deficit disorder. Apparently it's quite popular amongst the college set if you need to pull an all-nighter. People become so casual about it. Parents call in because their kid has run out, knowing full well the prescription is not technically refillable, and the doctor needs to write and sign a new one each time. I am of the opinion that Adderall is not an emergency. I even had one parent say "yeah, I know it's a controlled substance and blah-blah-blah." (YES, she actually SAID "blah-blah-blah"). Sorry to inconvenience you with these pesky DEA rules, ma'am.

But I digress. I know we shouldn't whine too much, because here in the USA we are lucky to have access to pharmaceuticals, and if we can't get one there are usually plenty of suitable alternates. If you come down with pneumonia, or kidney stones, or a migraine, or gout --- well, in many other parts of the world you're just SOL.

But damn, I hope that generic Adderall is back soon... so I can concentrate (!?) on the more relevant parts of my job again.

Caller, Identify Thyself

Even though most people have caller I.D. these days, when I call a customer's home from the pharmacy the FIRST thing I do when they answer is identify myself -- who I am, and where I'm calling from. THEN, I ask if I can speak to the person I'm looking for. I figure this is common phone etiquette and they know up front that I am not a telemarketer or some other nuisance call. I got a phone call the other day at home that went:

Me (not recognizing the number but answering anyway): Hello?
Caller: Is Mrs. McGillicuddy there?
Me (pretty sure this is no one I wish to speak to but still don't know who it is): No, she's not.
Can I take a message?
Caller: Well...uh... is Mr. McGillicuddy there?

Okay, at this point I feel under no obligation to answer any more questions till the caller identifies THEMSELF. I find this really obnoxious. People will call the pharmacy and ask for a certain person. When told they are not there, they'll ask for another person. When they are not there either, they'll say "Well, who is there today?" I STILL have no idea who I'm talking to and now I have to give them a rundown of the entire staff? Nuh-uh.

Or sometimes it will go:

Me: Frantic Pharmacy, this is Lucy speaking.
Caller: "WHAT IS YOUR FAX NUMBER?" (or, "DO YOU CARRY OXYCONTIN 60MG?" or, "DID YOU GET A PRESCRIPTION FOR ETHEL MERTZ TODAY?")

Am I not justified in asking ...... WHO ARE YOU ????


(..... sorry about all the CAPITALS.)

90-Day Nonsensical

In my Sunday paper's Walgreens flyer there was a little boxed-off section which read:

Get your 3-FILL; 3 months supply
.. it's 3 refills in one
..and for 3 months, you're done.
Ask your pharmacist about a 90-day prescription today.

That was it. That's all it said. NO disclaimers whatsoever!!! Easy as pie, right?

Now I do not work for Walgreens, but if I did this kind of stuff would drive me CRAZY. What a totally misleading ad, and what a headache it must create for their pharmacies. I'm sure they have people coming in 'asking their pharmacist' why they can't get a 3-month prescription of Percocet or Oxycontin. I'm sure they have people coming in asking why they can't get a 3-month prescription and pay the same as they do for 1 month. And of course the big thing they left out here is that your ability to get a 3-month prescription of anything (even if your doctor wrote it that way) is dictated by your INSURANCE plan, and unless you are on a dirt cheap generic you're going to need a plan that covers 3 months (with the appropriate increased copay), otherwise you'll be sticking with the one-month, thank you very much. Or, if your plan does cover 3 months they'll likely require you to use mail-order, which has nothing to do with Walgreens anyway. But strangely, the ad didn't mention any of that.

They would prefer you come in and 'ask' your pharmacist for the details on this, and God knows they've got all kinds of time to explain it.

For 3 months, you're done!!!

I Don't Get It

1. When there's a huge computer, phone, or other technology screw-up that impacts our customer service and puts us a half-day behind, why is there never any accountability? If I messed up so royally in my job on such a regular basis, I'd be in serious trouble. But all we get from these fiascos is, "sorry for the inconvenience, thanks for being patient." These people want us to believe that these glitches are unexplainable, and we just have to hang in there. I'm NOT BUYING that CRAP anymore.

2. When someone is fully aware that their prescription needs a doctor approval, or a prior authorization, or some other Act of God before it can be filled, and simply shows up without calling first and watches in amusement as I frantically search for something that just ain't gonna be there, no way, no how.

3. When I e-mail someone in management with a legitimate question or concern, why can't they simply hit the 'reply' button and send me a one-line, simple response?.... even if it's only to say, "I got your message and I'll get back to you."

4. When a customer sends me on a long, time-consuming wild goose chase to get their cheap prescription changed to something that will be covered without a copay, because they inexplicably came to the pharmacy with no money. However, said customer is adorned with piercings, tattoos, jewelry, exotic nails and a smart phone.

5. In these days of high unemployment, when a pharmacy employee can't condescend to do their freakin' job. Show up on time, not 15 minutes later. And get up and go wait on that customer who, whether you like it or not, provides the revenue to keep you employed here.

6. Cameron Diaz. She's apparently one of Hollywood's highest paid actresses. When was the last time she was in a movie that anyone wanted to see?

It's An Error

There's another prescription error in the news -- in Colorado, a woman was given someone else's prescription (the person had a "similar sounding" name) and she took it home and took a dose. She realized soon after that a different name was on the bottle. Unfortunately the drug was methotrexate and the woman is in her first trimester of pregnancy, so now she must await the possibility of miscarriage or birth defects.

This is awful of course, and according to one news report, the woman said the pharmacist (and we'll assume it actually was the pharmacist and not other support staff) knew that the drug was methotrexate and even helped her pick out some prenatal vitamins.

Obviously there was a breakdown here --- the pharmacy says their policy is to double-check the name and address when handing out a prescription. In addition, the offer of counseling or at least the quick 'show and tell' wasn't done. I'm sure the pharmacist couldn't feel worse. Reading about this kind of thing is a good wake-up call for all of us not to let ourselves slide into any shortcuts because of the pressure of doing things 'fast.' (Yeah, I know.... all the forces are still against us on that...... See: every pharmacist's chief complaint..)

Believe me I'm not blaming the patient for any of this, but it's also a good reminder to folks who are picking up prescriptions--
1. Please don't get visibly irritated when we ask (again!) to verify your name, date of birth or address.
2. Look carefully at your medication bottle and receipt before you take any of it.
3. Look at the patient information leaflet that is provided with your prescription. If this patient had done so, she would have immediately realized this medication was NOT for her.

Another reminder of the human factor today. For all the venting we do on our pharmacy blogs, none of us wants to see this happen.

First of the Month -- Schedule 2 Count Time!

For the non-pharmacy folk: Schedule 2 drugs are the heavy hitters (Oxycontin, Percocet, Ritalin and many others with high abuse potential) that pharmacies are required to keep an exact count of. Every month we are required to count our inventory and make sure it reconciles exactly with the record of prescriptions dispensed, which are individually logged throughout the month.) Other bloggers have lamented how a Schedule 2 prescription used to be a rarity --- now, we shovel them out in buckets.

One of the pharmacies I cover occasionally has constant trouble with these counts. Some are over the expected amount and some are under. There's no real pattern to either the amounts or the drugs affected. Now, ordinarily this is how many a pharmacy employee has been caught stealing, but this is a small staff --- no turnover, long-term capable employees and honestly there's really no suspicion of diversion here (I know it sounds naive, but trust me on this.) In addition, most of these discrepancies are solved and found to be the result of error --- miscounts, addition or subtraction errors in the log, brand-name/generic mix-ups, prescriptions dispensed but not logged, new inventory received but not logged in correctly, etc. The mistakes appear to caused primarily by people in a hurry, as is the usual state of pharmacy.

There are a few that are never solved, though. It takes so much time, effort and teeth-gnashing to figure out the discrepancies -- there's always a little nervousness and finger-pointing and frustration involved, because it is a big deal and no one wants any cloud of suspicion hanging over them.

And then it came to me to ask out in the blogosphere if anyone out there has a good system going that keeps those Schedule 2 counts pristine? Other than counting the damn things on a daily basis?

Complaint Dept.

I don't know what it is, but the last couple of weeks at work I feel like I could jump out of my skin. The same obstacles keep popping up every day and easy stuff finds a way to be difficult. It'll get better, but for now I would like to blow off steam about a few things.

1. Managers who give permission for technicians to leave early on days that the manager is NOT working, and I AM. I think it would be common courtesy for the manager or technician to ask ME if it's OK beforehand, since I am the one who is going to cover for the absence by being a highly-paid cashier for the rest of the day. I am sick and tired of seeing people walk out the door early because someone who's not there told them it was OK.

2. I understand it is sometimes necessary to use your lunch break to run errands. But that is still your lunch break. Don't come back to the pharmacy, plop yourself down and proceed to take another half hour to actually eat. You had your lunch break. It is now over.

3. Please, for the love of God, cut back the personal phone calls. Ignoring customers while you talk loudly on the phone to your 'whoever' is --- well, I shouldn't even have to get into it.
What makes people think that personal conversations take priority over doing their damn job?

4. OK, insurance companies --- you've sent me a letter advising me that all generics of a certain drug are back-ordered and will be for many weeks. Only the brand name is available. So how about giving people a little break on that jacked-up brand name copay, since it's really not their fault that they can't get the generic, huh? And you know they can't get it --- you just told me, right?

5. I really don't like telling people that the advice they've been given is baloney. I try to be nice about it and not undermine anyone too much, no matter how stupid it is. My customer was told by a dietitian to take "super-potent" Vitamin C supplements to help his back heal after surgery. I told him to save his money. He agreed with me.

And that concludes my pissing and moaning for now.

A Little Cluster of Inattentiveness

A couple of encounters with pharmacy on the 'customer' side of things for me lately....
subsequent to the ER visit mentioned in my last post, we were given a prescription for 9 tablets of generic Zofran for nausea. I usually get prescriptions filled at the pharmacy where I work, but circumstances required me to go to a nearby chain store ( shall remain nameless, rhymes with Schmalgreens). They weren't too busy. I was out of there in 10 minutes.

Got home, opened the bag and observed that the prescription was labeled for 9 tablets, billed for 9 tablets, and filled with 30 tablets (ie, the label was placed on a box of 30 and I got all of them). Also observed that the patient address on the label was over 10 years old and had not been updated with the address shown on the prescription.

A few days later, a neighbor of mine (senior citizen) was telling me about getting a prescription from his local grocery store pharmacy. It was for a topical gel. They called him the next day and asked him to bring the prescription back, as they had discovered on their QA audit that they gave him the wrong strength. He did, they apologized profusely, filled the correct one and (to their credit) they refunded his $200+ copay.

True, none of these things would have killed anybody. It just caused me the tiniest bit of discouragement. And I don't even use pharmacies that often!

The Waiting is the Hardest Part

I have been fortunate in my life to stay out of the emergency room (at least as a patient). Made an unexpected visit there last night with a family member, after a clinic doctor recommended we go there for some IV re-hydration. The IV was placed right away, but then we started the long, long wait to get back in a room with a doctor, to check lab work and finish the assessment. It was a long evening, ending back home about 2 am.

The ER was, of course, very busy. As we waited we had a chance to observe many others come in. Nobody looked near-death, but a lot of people looked pretty uncomfortable especially after sitting and waiting for several hours. The guy across from us decided he wanted to call it quits and leave -- he was kind of pissed --- and a nurse came over and very politely and gently talked him out of it. I was really impressed with the attitude of the staff. They just kept plowing ahead, dealing with all kinds of people, issues and problems.

Two other things I observed: a LOT of very overweight folks.... probably not taking very good care of themselves. The other thing -- people wear funny clothes when they come to the ER. One adult male was in Tweety Bird pajama pants. Well, it was something to look at anyway.

I recently wrote about customers bugging us about how long their prescription is going to take. Quite honestly, the wait in the ER was excruciating -- almost 4 hours. But once we got 'roomed' and the process began, the staff was attentive, thorough and nice as all get-out. They followed every step and addressed every issue. They didn't rush us or give it the quick once-over and boot us out the door. Nothing was too trivial. My family member was feeling better by that time and was quite hungry -- the nurse went and got a handful of snack crackers and some juice to tide him over. The doctor, who was apparently at the end of his shift, was unhurried, approachable and just darn nice.

I left that place really tired but really appreciative that everything was OK and that we were lucky enough to have access to this medical care. A lot of people don't. Yes, it was a long wait, and the thought crosses your mind to just bag it and go home. I'm glad we didn't.

And I guess what I think about as far as pharmacy work is give us time to do our jobs.
That's all the ER staff was asking for. I know it isn't always easy, but something to keep in mind.

The OTC Jungle, Revisited

New regulations in 2011 will no longer allow people to purchase over the counter medications with their health care flex-spending debit cards, unless their physician has written them a prescription for that OTC product. Even then, the rules for reimbursement will vary among insurance plans --- my own plan, for instance, still requires a different method of payment and for me to manually submit items, including a copy of the prescription, to them.

It's going to be interesting to see how this plays out. First of all, we need people to know how their own plan handles this, and we all know how splendidly it works out when we ask people to understand their own insurance. (Not.) There are going to be lots of people who will be asking US to get those prescriptions FOR them, as in "Can you call my doctor and get a prescription for Robitussin DM and how-long-will-that-take and when-can-I-pick-it-up," etc. And even though we are using technician and pharmacist time to process these as prescriptions, we have been told that ultimately we will still charge only the OTC price, because that is what other pharmacies are doing (....true?) So the time we spend fiddling around with this will be free.

We have a good proportion of customers who use these FSA debit cards, and I feel sure that none of them will know about this change. I seldom claim for OTC's myself --- I don't buy that many and I tend to throw out the receipt without thinking. Is it worth the trouble? Get the generics, clip the coupons, and ask your friendly pharmacist if it's worth the price. If they wanted to change the rule, maybe it should have been no more OTC claims, with or without a 'prescription.' Save the paperwork. We've got enough already.