All I Want for Christmasssssss....

Yup, I don't know where 2013 has gone....now that I've got that out of the way, here it is Christmas time again.  I feel like I just took the tree down.  I was never a big "all excited about the holidays" person, and my feelings haven't changed much over the years.   I guess the thing I most look forward to is having an extra day or two off work (and not all pharmacists are so lucky),  having an excuse to slow down a bit, cook and eat unhealthy stuff, light the fireplace, watch some goofy movies and generally go off the grid for a bit.   I actually do enjoy buying gifts for the people I care about, but I'm overwhelmed by all the crap in the stores and the urge to buy stuff I (and they) don't need just because it's there.
There are always attempts to have Christmas parties at work --- to go out for dinner or have a gathering somewhere, but everyone's schedule is so busy and quite honestly I think people feel they already spend enough time with their co-workers, and well ------ let's just skip the extracurriculars. No offense.

I hate hearing sad stuff at Christmas -- people getting killed in car accidents or shootings.  We're surrounded by images of big gatherings of friends and family, but I'm acutely aware that it's not like that for many people.  I see a bleak holiday season for many of my customers who are poor or disabled, and I'm so impressed by the ones who take the time to sincerely wish me happy holidays.  Even the folks who are financially well-off are often splintered by family feuds, divorces and custody battles. Christmas can be a cruel season, and I guess that's a consequence of our modern times.

Not to sound totally down on it, cause I'm really not.  I do salute all the people who work on Christmas Day.  I did a few of those myself.  Next year will be interesting --- health care changes and some merges and reorganizing with my employer.  I'm going to look past the rude and demanding customers, the people on their cell phones, the lazy and the entitled.  My philosophy is still this:  show me just a tiny bit of respect, and I'll go to the wall for you.

 I'm still really, really lucky, and I plan to be there.

Mom's boyfriend.

Followers of the NFL heard about Minnesota Vikings' running back Adrian Peterson losing his 2 year old son last week.  The child was beaten to death by his mother's boyfriend.  There isn't a lot of detail about how involved the multi-millionaire football player was with this child -- obviously he wasn't married to the mother and somehow this child became another sad statistic;  losing his tiny, young life at the hands of "mom's boyfriend." How many times do we hear that phrase?   Indeed, there's a lot to be debated about wealthy pro athletes spawning kids all over the place and then apparently having little to do with their well-being.  Of course, lots of people who aren't pro athletes are guilty of the same thing.

It goes without saying that we all feel physically ill at the idea of child abuse. I once worked in an in-patient pediatric health care setting and I couldn't imagine being a physician or a nurse who had to treat those patients and somehow keep it together.    I REALLY want to see a big-name professional athlete (or several of them)  come out and blanket the airwaves with public-service announcements on child abuse prevention.  I want to see those ads run during NFL and NBA and NHL games.   The only pro athlete I'm aware of who has done these types of ads is Mark McGwire, and that's because I saw him on a poster in a doctor's office once.  Think anyone else will step up to the plate?

I'll keep at it if you meet me halfway

I'm not computer-savvy enough to link to YouTube videos but if you get a chance, go to YouTube and search for "Louis C.K. hates cell phones". Then watch the video of the comedian Louis C.K. on Conan explaining why he doesn't want to get cell phones for his kids.  It's great -- funny, sad, and true.  As someone who watches people all day with their nose in their cell phones, I realize that the loss of eye contact caused by technology (and other kinds of personal contact) has really been a bad thing for our society.  It also makes it increasingly hard for anyone in the service industry to do their job.  I lament this and I refuse to give in to the zombie-like behavior of those I am supposed to be helping.  And it's not just the customers.  I work with pharmacists who see themselves as paragons of professionalism but apparently have no problem whatsoever being distracted by stupid texts and stupid Facebook crap on their personal cell phones. All day long.  While they are checking your prescriptions.   I don't accept that.  I love my iPhone, but it has no place in my workspace when I am doing my job.

I understand that the airlines are contemplating allowing people to use their devices all the time, including during takeoff and landing.  I am totally against this. Make people turn the goddamn things off for 10 minutes and listen to what's going on around them.  No, your iPad cannot be used as a flotation device.

I didn't participate in the recent Pharmacist Tweet-A-Thon.  I just wasn't in the mood.  My first customer of the day handed me a letter that said his $300 prescription had received prior approval from the insurance company.  He spoke not one word of English.  When the prescription was filled and I prepared to collect a $3.00 copay, he looked at me quizzically and shrugged in the universal "no money" gesture.  Another person haughtily informed me that she did not have $1.00 for her copay. When I indicated I was not going to just hand it over, she reached into her purse and pulled out a dollar.
Someone else told me I was "full of shit" when I tried to explain the rules regarding quantities of diabetic test strips when covered by Medicare.

I have a few tips for everyone who is entering the health care market under the new legislation (and I'm truly glad you are getting health care, by the way):

1.  READ.YOUR. POLICY. You, and only you, are responsible for understanding it.

2. Understand that everything is not going to be free. Being 'covered' by insurance also means that you might have to pay $3 ( or $100) out of a $300 prescription.  This is nothing new.  Even my long time customers with good jobs and good insurance have trouble grasping this.  The payer makes the rules.

3. You have to be able to communicate. Please learn the language or bring someone who speaks it.

4.  Be patient.  Be courteous and respectful of people in health care.  We are human too. I will move heaven and earth for someone who gives me an ounce of respect and practices common courtesy.
And please don't walk up to me with your face in your cell phone.

And how will you be paying for that?

CrazyRx Man recently posted "Why it takes TIME to get your Rx filled" and it was a great summary of all the potential obstacles, safety steps and other assorted procedures your pharmacist must perform before handing you those pills in a bottle.   It made me want to elaborate a little more on the step which involves submitting the claim electronically to your insurance, because people sometimes just don't get it that this is the PAYMENT step.  And just like any other retail transaction, we can't let you walk out with the goods until they are paid for.

Most people pay for stuff nowadays with a credit or debit card.  As long as you swipe your card and it is not 'declined' you are on your way.  Now imagine if there were conditions put on that card (like an insurance plan would do) which involved more than just having money on it.   To use my favorite analogy, let's say you are buying a new couch at a furniture store.  You swipe your card at the sales desk and any one of these messages pops up on the screen:

1. Too soon!  You bought another similar piece of furniture 3 months ago. There's no way that could be worn out yet.  You're gonna have to call us and explain yourself.

2. Prior authorization required!  That is a very expensive leather sofa.  We need to know why you can't get something cheaper.

3. Plan limitations exceeded! We'll only let you buy one with 2 cushions, not 3.

4.  Plan limitations exceeded! We prefer you to buy Sofa World brands, not Sofas 'R Us.

5.  Invalid days' supply!  You need to estimate how long this couch will last you.  We think it should be 12 years, not whatever you put in.

6.  Step therapy required! We need you to try a loveseat before you can move up to the full-fledged couch.

7.  (And if none of those get you...)  Card number not found! The number on your card is NOT the same number that we need to process this purchase.  You need some other numbers which we're not going to tell you until you have been on hold with us for at least 10 minutes.


No wonder I need some couch time when I get home from work.

Wait, Wait.... I know the Answer

A physician called the other day with a question and I drew a complete blank.  To be honest, it wasn't a question that was strictly in my area, but certainly something we covered back in pharmacy school.
The caller I spoke with before that was someone who had an e-prescription sent to our pharmacy, but wanted to pick it up at a different store in our system.  She wanted it transferred to the "24 hour pharmacy" at the hospital where she 'went before.'   I debated back and forth with her for several minutes, explaining that that was the HOSPITAL pharmacy and they would not fill an regular outpatient prescription (she wasn't buyin' it.)  I gave her a nearby alternate pharmacy and she wanted specific instructions on how to get there.  Then she decided she'd fill it at a chain pharmacy and wanted me to look up their phone number for her.  Then she hung up on me.

Which brings me back to the physician question.  I hate feeling like my pharmacy knowledge is slipping away.  Some days it really hits home how much of my time is spent screwing around with e-prescription problems and trying to figure out people's insurance coverage.  I am awash in prescriptions for over-the-counter products, trying to put them through insurance, trying to explain to people that they're not covered, or if they are covered, why there's a copay and why it is what it is.   Attempting to generate an e-prescription for any medication that requires ANY personalized directions is like putting a square peg in a round hole.   And arguing with people about WHERE their prescription should be filled....  I've said it before, I kind of miss the days when people brought you a piece of paper and that was that.

So Doctor, I'm sorry I had to put you on hold and scramble to find that information for you.   My life is full of argumentative customers and prescriptions for insulin syringes that say "Take one 3 times a day."
Have mercy on me.

Sum-Sum-Summertime

Well, most of the allergies are taking a break till fall, the hacking coughs seem to be at a minimum, and the ADHD prescriptions await the start of school.  Things are perhaps a little slower right now for some of us.  Our regulars, the core patients, continue to visit us though.  When I hear statistics describing how a small percentage of people account for a disproportionately large percentage of health care expenditures --- well, I sure believe it.   Don't get me wrong, I know most of them would rather not be in that group, but there's always the few who are demanding, entitled and have no concept of how much money is being spent every time they walk in the door.  I wish they knew.

My other summer observations, in no particular order:

If your insurance won't pay for your dose of gonorrhea medication because you've exceeded the maximum of once every 30 days -- maybe it's time to change your lifestyle.

I hate to harp on this, but I really am sick and tired of Vitamin D prescriptions. We could save billions of health care dollars by putting a big barrel of the stuff at the pharmacy entrance with one of those scoops in it, like the bulk section of the grocery store.  Help yourself.  All ages.

People are STILL stunned by this whole prescription coverage thing.  Again, just because your doctor writes the prescription, doesn't mean your INSURANCE has to cover it.  It also doesn't mean they have to cover it at little or no cost to YOU.   This is nothing new.  People still have a hard time getting this.

I get it, it's summer -- you're going out of town tomorrow, and need everything refilled NOW.  You wouldn't have thought of taking care of this yesterday, or the day before.  The insurance company is not going to pay for it early, so I'll drop everything and call them for you while you stand there with a quizzical look on your face.  What do you say we take this little task away from the pharmacist and give it back to the vacationer?

I don't lecture people on good eating habits or unhealthy lifestyles -- I get rather bored with that stuff myself.  But I would swear that some of my co-workers eat a fast food meal EVERY day.  Guys, that's not good for you.   I guess I get discouraged when I see people making bad lifestyle choices of all different descriptions, and it never seems to get better.

I guess I'll see you at the pharmacy in about 20 years..... every week or two, regular as clockwork....

The Public, the Providers, and the Plodding

As the routine daily tasks of pharmacy continue on these days,  I find myself thinking about the general state of our health care system and how uncertain/hopeful/apprehensive I can feel all in one day.  I'm thinking of three components..........

The "Public" Factor:

I just returned from a trip to a large, very busy city -- surrounded by people jammed in the streets, mostly looking at their cell phones, lost in that cell-phone world of whatever the heck they are looking at that can't wait until they have fully crossed the street.  Additionally,  I'm always stunned by the inability of large numbers of people to follow simple directions ("Turn off all electronic devices now."
"Order here."  "Pick up here."  "No parking." "Retain your ticket stub."  etc. etc.)    I always think it does not bode well for something like health-care reform, which is going to require people to 'do the reading', comprehend, and apply what they've learned.   People who have health insurance right now generally do a poor job of understanding it and reading the fine print.   It's only gonna get worse, and they are going to blame everyone but themselves. And they're still going to make a full-out $150 doctor's appointment and come out of it with a tube of $3 hydrocortisone cream.   I'm not hopeful at all.

The Providers:

 A physician is retiring from a medical office nearby, and I asked his nurse one day if they were going to replace him.  She said they hoped to, but  "it is very difficult to find a male M.D."   I found that interesting, and worrisome.   We have seen the trend of alternate prescribers (physican's assistants, nurse practitioners) take hold in the last few years,  and in many cases they are a great alternative for those minor ailments.  But they are probably going to be asked to do more and more that is outside the scope of their practice.  I have gotten phone calls from these folks asking me some prescribing questions that I would consider pretty 'basic,' and that's a little scary.  I had a nurse-midwife send a prescription for Seroquel the other day.  We needed some clarification on the dose and after calling her she realized that she didn't mean to write Seroquel at all, but something else.  Yikes.   And when you've got Americans consuming 80% of the world's prescription painkillers, you know that there are not enough M.D.'s (male or female)  anywhere to keep up with those scripts.

The Plodding:

On my recent trip I was surrounded by technology.  Buy something, and they e-mail you the receipt in seconds.  Wave a card in front of your hotel room door and it opens.  Your airline boarding pass is sent to your smartphone.  iPads are everywhere, for crying out loud......  I feel like the airport lounge has better technology than my pharmacy.  We are so FAR behind.  We are still fumbling with insurance cards (when we're lucky enough to be presented with one.)  We're still running out of drugs because our damn inventory system doesn't work properly.   I'm still getting electronic prescriptions that say "Take 1 tablet daily  Take 2 tablets daily."  (yes, an actual script from last week, that resulted in about a 48-hour delay and many phone calls until someone called us back. )  And of course, I'm still spending 15 minutes on the phone to find and retrieve a prescription, e-scripted to the wrong pharmacy, for frikkin' over-the-counter VITAMIN D.  And the customer is screeching "How LONG IS IT GONNA TAKE?"

Yup, this is gonna be interesting.

Advancements in Pharmaceuticals for the Good of Humankind

Hey, there's a "new" drug out for morning sickness! It's called "Diclegis" and it costs about $570 per 100 tablets.  Each tablet is a combination of 10mg pyridoxine (Vitamin B6) and 10 mg doxylamine.
The cost of these two medications, if purchased over-the-counter separately -- a few DOLLARS. (Doxylamine is "Unisom", in a 25mg tablet --- hint: break it in half!)

The DrugMonkey has covered this kind of stuff thoroughly in his newest book, "The Pharmacy Rip Off List", but wow, this one took my breath away.  Maybe because even the Pharmacists Letter felt that it deserved a mention (although they did put the quotation marks around the word "new.")

We waste so much money and resources on this kind of silliness.  I can't believe we're still seeing it.

DON"T !!

I generally stay out of the personal lives of my co-workers. Over the course of a long work day in an enclosed space like a pharmacy,  the conversation can drift many different ways.  I'll listen, I'll offer benign advice, but I don't lecture or impose any of my viewpoints on anyone else.  Sometimes I am listening to two other people talk, but staying out of the conversation myself.  However,  I REALLY hate to see people making stupid decisions, and it's hard to keep my mouth shut sometimes.

A short list of my advice, if I were to offer it:

1.  Thinking of lending your boyfriend of 2 months a bunch of money so he can buy a car?  DON'T.

2. Thinking of making a personal style statement by getting a big ugly-ass tattoo that creeps down your arm and you will look at for the rest of your natural life?  DON'T.

3. Thinking of continuing your visits to the tanning booth when you've already had two cancerous lesions removed because you just 'feel better' when you tan?   DON'T.

4. Thinking of taking on a ridiculous amount of debt because you've just gotta have that gi-normous
pick up truck to drive yourself to work every day?  DON'T.

5.  Thinking of having another child even though you are in no way financially stable and your husband/boyfriend seems to spend most of his time drinking?   DON'T.

6. Thinking of quitting your job (with nothing else lined up)  because someone pissed you off and you want to make a statement, even though you know damn well that no one is irreplaceable?  DON'T.

I'm still not gonna say anything, though.  I don't think it would matter anyway.

Let the Games....Continue

I had a prescription ready at the counter and called the customer's name.  She walked up to the counter with her nose in her phone.  Of course, that's not unusual.  She reached the counter and still didn't look up.  I waited a few seconds.... still no eye contact.  Normally I would walk away, but I decided to play a little game and see how long it would take her to look up while I stood there waiting.  I waited, and waited, and with only about 3 feet between us it probably took her a good 45 seconds to allow me a moment of her time -- and only a moment.   Yes, we've got a sign asking people to turn off their cell phones.  What a joke that is.   It often occurs to me that there is a whole generation of toddlers and pre-schoolers who, when they think of their parents, will picture them staring at their cell phone.  Until the kids get old enough for their own phone, that is.

Every once in a while you get an elderly customer who is a breath of fresh air.  They are polite and respectful.  They don't have cell phones.  When you talk to them they listen, and are appreciative.  They come from a generation who didn't run to the doctor with every minor ailment.  A trip to the doctor's office was a responsibility they took on to maintain a good state of health, or it was because they had a medical concern or condition that they felt required a doctor's attention -- in which case it was probably pretty significant to them.   A prescription is a big deal and they look at a pharmacist as someone providing a professional service.  I love those folks, and I will spend ANY amount of time with them, no matter how busy it is.

What is it about standing in line that makes people behave like first-graders? When we have a bunch of people lined up, some picking up refills and some waiting for new prescriptions, we've got to be fair.
The people who have been waiting for new prescriptions for 20 minutes may get called up ahead of someone who just walked in to pick up a refill.  We'll get to everyone, people.  I can't count the number of times I've felt as though I'm in a schoolyard.... and by the way, just because you're a regular customer who comes in ALL the time does not put you at the head of the line.

I feel vaguely guilty selling people Mucinex.  Expensive placebo? I always tell them to drink lots of water with it.  In fact, just drink the water, skip the Mucinex.

I still do a slow burn when someone walks up, slaps down 2 or 3 prescriptions, and the FIRST words they speak are "how long will it take to fill these?"   I always wonder if the first thing they say to the doctor when he/she walks into the examining room is, "How long will this take?"  Or when they check into the lab, or X-ray, or lay down on the gurney in pre-op --- are they asking this same question?
I wish I knew of a response that might convey a reminder that this a professional service, and not a sub shop.   Or at least a response that wouldn't get me fired.

Knock it Off!

OK, knock it off with the calls for Phenergan with Codeine.  I've taken a slew of inquiries lately -- Do we have it?  What flavor is it?  Do you have the purple one?

This, of course, is one of the latest drugs of abuse -- mixed with soda or alcohol and apparently called the Purple Drank, among other names.   Really guys, we're not stupid.  We can tell from the questions you're asking that you're not suffering from any, um, cough today.  And of course you're making it a heck of a lot harder for those folks who may legitimately need it.  I've told several callers I don't have it (as I'm staring at the bottle on the shelf.)  I've also faced disappointed customers who discover it's not the 'purple' one that they're getting.  Yup, and then they want the prescription back.  What a damn waste of my time.

 There are still prescribers out there who need to be aware that people who ask specifically for this product may not be using it in the 'prescribed manner.'  Just say no.  There ya go.

Many Americans do a Glucose Tolerance Test Every Day

A neighbor of mine, who is pregnant, is going to the doctor soon for her Glucose Tolerance Test --
(this is a test given to detect gestational diabetes --  a sugar solution is given to drink and then blood sugar testing is done to make sure the body is handling the glucose load and clearing it appropriately from the blood.)  It can be kind of a yucky solution -- it's concentrated and you have to drink it fairly quickly -- and typically contains 75gm of glucose.  

It occurred to me that you could get about the same dose by chugging 2 to 2 1/2 cans of a typical
non-diet soda.  Not a problem for many folks -- in fact, skip the cans and go right for the 16 or 20 oz. container.   This helps me understand the attention being paid to 'sugary sodas' and the attempt to limit portion size in some restaurant outlets (aka the New York "Bloomberg soda ban.")  And by the way, the maximum allowed size under this 'ban' (16oz.) is still a pretty damn big cup of soda.

Whether you think this will have any effect at all, or is even worth doing, is up to you.... but it irritates the crap out of me to see a certain conservative starlet waving a Big Gulp at her recent speech and labeling this effort an assault on her freedoms.

Americans are free to kill themselves any way they want.  They are free to live the most unhealthy lifestyle they can come up with --  sit on the couch, drink a couple cases of Mountain Dew and smoke a carton of cigarettes a day -- whatever.    But ask any pharmacist or physician what proportion of their patients' multiple health problems can be linked to simple obesity and you'll see some pretty significant numbers.  I'm so used to seeing people struggle up to the counter in various states of obesity that I really don't  notice it anymore unless I stop to think about it.   The COST of all this treatment  -- drugs, insulin, diabetic testing supplies, diabetic teaching, doctor appointments, lab visits, -- is really staggering.

I know losing weight is tough, and it gets harder the older you get.  Even if the 'soda ban' doesn't hold up at least people may become aware, little by little, of the destructive effects of many of the things we consume.

Disclaimer:  I truly enjoy an ice cold Coca-Cola (NON-diet) every once in awhile.

I Think if I See One More Prescription for Tylenol, I'm Gonna Lose it

More and more, I feel like I am spending a TON of time filling prescriptions for over-the-counter medications. (For the non-pharmacist reader, many of these are covered under medical assistance plans -- and as such, need to be processed just like a prescription medication, with all the same procedures, record-keeping, etc.)    Now, this is not going to be a swipe against the "moochers" -- and believe me, I struggle with this, because I believe that the majority of people on assistance do NOT abuse it.   But even fellow pharmacists who've been doing this a long time are beginning to wonder how long we can keep it up.  Additionally, many of our customers on state assistance are immigrants (some might even say refugees) from other countries.   Now, if a child enters this country and immediately comes down with leukemia, I'd like to think we're not going to stand there and let him die.  We are better than that.  But how obligated are we are to cover prescriptions for (and to stock people's medicine cabinets with) things like Tylenol?   And hydrocortisone cream,  and every form of vitamin, Miralax, Compound W, Colace, saline nasal spray, simethicone,  Sudafed, Claritin, Eucerin, ibuprofen, calcium, iron, aspirin, Benadryl, Maalox, Milk of Magnesia,  Lotrimin cream,  Robitussin, artificial tears,  and many MANY others -- all things that most of us purchase on our own.

Inexpensive products..... BIG EXPENSIVE HEALTH CARE machinery behind them.  I think about it now every time I wade through those quality-assurance double checks of my saline nasal spray prescriptions.

We routinely have people bring us prescriptions for OTC's from a hospital emergency room.  We all know the cost of an emergency room visit,  and this is utter INSANITY.    There needs to be a way for people to get advice on minor health issues, (ask your pharmacist, maybe?)  and then be given a recommendation on what to go out and BUY for it.  To be sure, there are lots of very expensive drugs and medical procedures out there that the average person cannot afford on their own.   Tums is not one of them.

The Prescription Abuse Game

I've only worked about half my career in retail pharmacy (started in hospital) so I always thought of myself as a neophyte when it came to fake prescriptions, phony call-ins and other forms of drug diversion.  I'm sure I've been fooled more than once.  I'm not sure how many occurrences most pharmacists would say they have in a typical week, but I seem to have encountered a cluster.

We had one guy come in -- never filled with us before and wanted to pay cash for his Percocet prescription ( I wasn't too familiar with the doctor, either.)  Of course even for me this was a red flag
and a check of the state's monitoring website revealed a long string of Percocet prescriptions, some filled literally right on top of each other.  The most recent was 4 days earlier for an even larger quantity.
Sent him away and he was not a happy camper.  I don't really care what he's doing with it,  probably selling it, but it's irritating as hell and a waste of my time.  I contacted the doctor's office, sent them a copy of the State information, and never heard anything back.

I've also encountered a string of 'lost' prescriptions claims -- 'lost' on vacation, 'accidentally' threw it away, lost my purse, etc. etc. etc.   I wish every prescriber would make it clear from the outset that they will not replace lost or stolen prescriptions without a police report.  I can't believe how accommodating some of these doctors are.

Also recently became aware of someone calling in her own prescriptions -- she was pretty good but it never sounded completely right to me and I am mad at myself and the rest of our staff that no one thought to take the time to verify it.

I guess it's just irritating to be played for a fool.  We're hammered with the principles of customer service and being nice to everyone and I feel like these drug seekers are probably laughing all the way out the door.  I know this isn't news to any experienced retail pharmacist out there, but just had to get it off my chest.

Pharmacy PRO

There's a commercial on TV for National Car Rental that features the "Business Pro" -- the frequent and experienced business traveler who can breeze through the airport -- going "shoeless and metal-free in seconds."  In the endless procession of people we wait on at the pharmacy every day, I have come to truly appreciate the Pharmacy Pro.  I'll give people a pass for their first couple of visits (maybe) but after that, well ----  these are the true marks of you,  the Pharmacy Pro:

1. You hand me your prescription insurance card with the prescription, or in the case of an e-prescription, when you check in.  Each and every time.  Even if you've been to the pharmacy 40,000 times before.  It's the newest and most current card. It's not your dental or medical card.  If the prescription's for a family member, you give me their card, not yours. I already love you for that.

2. You are acutely aware of your surroundings.  If the place is going crazy and there are lots of people waiting, you say "I'll stop back later."  If you know you have multiple prescriptions, you do the same regardless.  I love you for that.

3.  You are aware, at least generally, of what your doctor has sent us.  If there are things you don't need filled, but just kept on file, you tell me up front.  I love you for that.

4.  If you want a refill of something, as well as having your new prescription filled, you tell me immediately.  You do not wait until we are ringing up the prescription before saying, "Oh, and I also need some test strips" and expect to just stand there and wait.

5.  While waiting for your prescription, if you are paying by check, you have your checkbook out and you have already filled out the entire check except for the amount.  I love you for that.

6.  You are an active participant in this process.  You look over what you are receiving and verify that what is there is what you're after.  Not when you get to your car, not when you get home, not 3 days later when you tell me you 'never got' something.


Here's to you, Pharmacy Pro.

Random Stuff I've been jotting down

Ohh, where did the time go?  Thanksgiving, Christmas, and now January (normally "hell month" because of insurance changes and most people's neglect of carrying that new insurance card and general cluelessness about their own insurance coverage.)  Yeah... remember that "high-deductible" plan you signed up for?  Yeah, that is why your prescriptions are not SIX DOLLARS anymore.  I know they USED to be, but they are NOT NOW.   And apparently it's me, the sweaty, wild-eyed, hungry, tired and full-bladdered pharmacist that has to explain that to you.   And by the way, please don't cough on me.

I was attempting to read some sort of Medication Safety Newsletter the other day, full of breathless phrases like, "learners attend sessions on patient safety, pharmacy processes, human factors, and identifying potential hazards in a patient’s environment of care. They gain hands-on experience by following a medication from order entry to administration and identifying vulnerable points and possible solutions."  and......."The 90-member team is a network of physicians, nurses, respiratory therapists, and other healthcare professionals who serve as ‘lifeguards’ for providers traumatized by an unanticipated event or error. "    It had been a particularly hellacious day at my job as a retail pharmacist, and it just struck me whether the people writing these things have any idea at all about the working conditions that most pharmacists on the front lines (ie, community) endure.  Um, yeah, I think we could all identify a few of those 'vulnerable points' --- as in, well.....  (see any pharmacy blog).

I saw my first pre-stamped prescription for Vicodin 5/300.  This is the new lower-strength- acetaminophen Vicodin which is not interchangeable with the generic 5/325, which is the only thing anybody stocks.  So time was wasted calling the dentist's office in question, where someone (probably the receptionist) brightly assured me that the generic would be fine!  I can only hope that after the 500th pharmacy call that this dentist's office will get rid of those pre-stamped prescriptions.

I waited on a customer whose main complaint appeared to be a stuffy nose.  She had 5, count-em, FIVE prescriptions, including saline spray, Flonase spray, Sudafed, Mucinex and of course, amoxicillin.  All covered.   Seemed like a bit of overkill to me. (See previous blog post about excess time spent screwing around with OTC prescriptions.)

Spent a lot of time with an elderly lady who had initially been given samples of a very expensive patch,  found they worked well, got a prescription, and was now discovering they were not covered by her insurance.  Oh, the hazards of samples... and somehow it's up to me to fix it. 

Does anyone out there show up at grocery store 5 minutes before closing with a 2-page shopping list and dozens and dozens of questions for the staff who are trying to go home?  I wish people wouldn't do that at the pharmacy.  It's just inconsiderate and not right, especially when it's something that could and should have been dealt with earlier, or called in ahead of time.

New Year's resolution -- find more time for blog posts.... it's therapeutic!