Counsel Me

REEEE--- JECTED !!

2012-01-23T10:19:00.000-08:00

OK, the end of January is approaching and I can't get over the feeling of just spinnin' my wheels.
Work has been an endless parade of insurance rejects...." patient not covered....ask patient for new ID card..... non-matched cardholder.....refill too soon......we are rejecting this claim because it's a day with an 'r' in it, ha ha !!.....and a million other reasons that I've never even seen before. People who have completely changed insurance plans, did not bring the card, and expect me to figure it out for them. I ask people POINT BLANK when they drop off their prescription, "HAVE YOU CHANGED INSURANCE IN 2012?" They reply, "no, nothing has changed." Fifteen minutes later we finally get to their prescription, it rejects, we ask them about it and they say, "yeah, I have a new card." Honestly, I feel like I'm being punked in a reality show or something. And of course the person's next question is, "Is it ready yet?" Things never change.

The prescription transfers are still plentiful. As usual, people don't understand that this takes extra time. I feel bad about calling the same pharmacies multiple times a day, but what else can I do...

Anyway, the other things on my mind are:

--Staffing. Why do we never have the right amount of people when we need them? One of the busiest times in retail pharmacy is between 4pm and about 6:30 pm, when people are picking up prescriptions on their way home from work. Working people, as well, tend to want to schedule doctor's appointments at the end of the work day so they don't have to miss too much time.
Day after day we get slammed at the same time, we don't have the proper staffing, we rack up overtime and get our hands slapped for it, like we are incompetent or something.

-- Security. I never thought about it much before, but I'm becoming more aware of security lapses in the pharmacy and no one else seems to care. It costs money to beef up security, so it's not something I can do without the company's help. I really don't want us to learn the hard way.
I'm trying to figure out how to approach this without stepping on anyone's toes or sounding alarmist. But I'm going to keep at it.

-- Getting fired. It actually happens! We've had two support staff members get fired in the last couple of months. You would think people want to hang onto their jobs right now, but apparently the mere threat of firing wasn't enough for these two. I'm glad someone in the company actually has the balls to do it, but there are still other people who inexplicably get a pass.

Onward.

Happy New Yea------- Oh, wait.

2012-01-08T18:34:00.000-08:00

Aw yuck. What a hellish "new year's week" it was.

It included a major software change in the way we submit on-line claims to insurances. The end result, in a nutshell, is that there are approximately 1,000 new and different ways for a claim to reject, and I think we saw every one of them.

It included the usual insurance plan changes for customers, with the associated freak-out when
their new copays were revealed to them at the cash register. "But I've always paid (X) dollars!!"
was #1 on the week's hit parade. #2 was, "I don't have a deductible!!" followed by a grumbling
return later in the day, after they had called their insurance company.

It included one of the major corporations in town switching to a new pharmacy benefits card.
I don't even work for them, and I knew about it months in advance. These employees are educated, white-collar workers -- some are even health care professionals. Do you think even ONE of them had the card with them when they came in? Do you think the majority even understood that the benefits they signed up for during open enrollment screamed "CHANGE" ? Alas, no.

And of course it included the transfers out of Walgreens for Express Scripts customers. Most of the Walgreens I called had a message asking me to leave the information for the transfer and they would fax it to me. However, since no one plans ahead and many people wanted it while they waited, I had to ask to speak to someone right away. To my surprise, all the Walgreens pharmacists I talked to seemed pretty darn nice about it. I can't imagine how they are dealing with all that.

It also included assorted other computer glitches I don't even want to get into.

One of my co-workers said she felt like crying. Me, I had to fire up the ol' cocktail shaker
at the end of the week. Simple, yet effective.

We shall steel ourselves for the week to come.

The Ball Drops......

2011-12-31T20:02:00.000-08:00

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?

2011-12-12T13:56:00.000-08:00

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?

2011-12-01T18:56:00.001-08:00

--- 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?

2011-11-14T14:46:00.000-08:00

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)

2011-11-07T09:55:00.000-08:00

"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?

2011-10-26T13:27:00.000-07:00

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

2011-10-22T16:21:00.000-07:00

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.

2011-10-16T10:30:00.001-07:00

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

2011-10-08T16:09:00.000-07:00

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

2011-09-25T14:49:00.000-07:00

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

2011-09-09T20:54:00.000-07:00

.....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

2011-08-28T18:55:00.000-07:00

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

2011-08-14T12:24:00.000-07:00

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

2011-08-03T14:45:00.000-07:00

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

2011-07-26T14:40:00.000-07:00

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

2011-07-12T18:07:00.000-07:00

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

2011-07-12T08:07:00.000-07:00

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?

2011-07-06T14:40:00.000-07:00

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)

2011-07-05T14:06:00.000-07:00

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

2011-06-28T14:55:00.000-07:00

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

2011-06-05T17:38:00.000-07:00

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

2011-05-20T20:39:00.001-07:00

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

2011-05-16T15:22:00.000-07:00

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......

2011-05-09T15:16:00.001-07:00

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!!

2011-04-26T15:07:00.001-07:00

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

2011-04-25T15:28:00.000-07:00

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?

2011-04-12T14:00:00.000-07:00

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??

2011-03-30T14:13:00.000-07:00

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

2011-03-22T15:19:00.000-07:00

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?

2011-03-18T20:29:00.000-07:00

"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

2011-03-06T20:47:00.000-08:00

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

2011-02-23T18:27:00.000-08:00

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

2011-02-16T14:06:00.000-08:00

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

2011-02-14T14:10:00.000-08:00

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

2011-02-09T11:43:00.000-08:00

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!

2011-02-01T15:17:00.000-08:00

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.

2011-01-24T09:12:00.000-08:00

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

2011-01-11T13:29:00.000-08:00

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

2011-01-04T14:45:00.000-08:00

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

2011-01-01T20:28:00.000-08:00

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.

Dazed and Confused

2010-12-31T20:24:00.000-08:00

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

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

Crickets. We all just stood there.

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

Silence. Crickets.

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

Silence. Crickets.

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

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

There's those crickets again.

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

Christmas Potpourri

2010-12-24T13:16:00.000-08:00

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

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

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

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

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

In Search of the Perfect C.E.

2010-12-15T13:03:00.000-08:00

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

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

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

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

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

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

Yup, got that.

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

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

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

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

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

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

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

The Wretched Question

2010-12-13T15:51:00.000-08:00

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

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

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

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

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

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

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

Well, you get the idea.

Turkey Talk

2010-11-29T19:12:00.000-08:00

I worked Thanksgiving in close proximity to a "Quick-Check-Urgent Care" walk-in clinic type of place ---- surprisingly, most of the patients pretty much needed to be there. Lots of antibiotics were flowing. Not too many people wandered in on Thanksgiving Day to have that rash checked that they've had for 3 weeks, or to get a handle on that blood sugar that's been out of control since last Thanksgiving. So that was a pleasant surprise.

I did get several people who wanted me to 'guarantee' that their prescription would work.
Like, the person getting a Z-Pack (I know, who doesn't get a Z-Pack?) who said in reference to their ailment, "And this will TAKE CARE OF IT, RIGHT?" Or the woman who demanded to know if the phenazopyridine would work IMMEDIATELY for her UTI. As I opened my mouth to answer, she said NO, I MEAN IMMEDIATELY !!!

I can't guarantee that prescriptions are going to work. Prescribing is as much an art as a science. Every so often someone tries to return something because it "didn't work" or they just didn't like it and we have to explain that legally we can't take the medication back and re-sell it again. I had to explain to a customer once that "you wouldn't want me to dispense medication to you that had already been taken home by someone else, right?"

On Black Friday afternoon a customer brought in a prescription for an anti-nausea med for pre-treatment of chemo. The (naturally) expensive medication wasn't covered. We asked when the chemo treatment was scheduled.... "Monday morning." Date of the prescription: 1 week ago. Doctor's phone goes to voice mail. Possibility of getting a prior authorization on Friday afternoon? Slim to none. Moral of the story: bring those prescriptions into the pharmacy ahead of time. I sure hope they figured something out on Monday.....

The Drink

2010-11-22T10:44:00.000-08:00

We have a customer, a relatively young individual, who's been through a succession of reflux medications and got rather agitated when his new PPI prescription wasn't covered.
I spoke directly to the prescriber, a younger female physician who actually sounded kind of scared of the guy. "What he really needs to do is put away the vodka," she informed me.

Obviously many of our pharmacy customers have conditions that they have no control over, but others can attribute a lot of their medical problems to things like obesity, smoking, and alcohol. I recently read a small news item in Newsweek magazine that stated,

British researchers find that alcohol is more destructive to individuals
and society than any other drug, including heroin and crack.

Pretty eye-catching statement, but I think it's true. I'm thankful that my parents were only social drinkers -- it was an occasional thing, holidays and special occasions, and no one ever got drunk. I am the same way. I wasn't aware of it as a kid, but I realize now that I have numerous extended family members who are approaching middle age looking back at a legacy of broken relationships, estranged children, shaky financial status and general poor health as a result of the erratic and unpredictable behavior that comes with alcohol dependence.

I work with people who talk about 'going to the bar' like it's a destination in itself. That's their weekend activity. They leave their kids in the care of others so they can hit the bars.
Their kids eventually catch on to this and recycle the behavior later themselves. People describe something to me that happens at home with their (haha) 'plastered' spouse and I think to myself, YOUR HUSBAND IS AN ALCOHOLIC. Why can't you see that? I'm not talking about college students here; these are full-grown adults.

Think about the percentage of police calls that are related in some way to alcohol. (Watch an episode of "Cops".) It's phenomenal. I once heard someone say that beer is the most underrated drug in America.

Unfortunately, smarter people than me don't know what can be done about it. Alcohol is never going to be illegal. Humans are social animals and alcohol is associated with that. We've created a stressful society where people are looking for ways to take the edge off. I believe some people are genetically predisposed to 'addictions' while others will never come close to any kind of problem. But the impact of alcohol on our society really is very dramatic, when you think about it.

Just another observation from behind the counter.....

The Incredible Missing Prescriptions

2010-11-08T12:55:00.000-08:00

I know some folks out there who work for big chains perhaps aren't directly involved in the mailing-out of prescriptions. Everybody has to do it now (for free) to remain competitive. But what is your company's policy when the patient tells you they didn't receive it (and it's documented as being mailed, the address is correct, etc.?) People seem to feel it's our responsibility to simply replace it, at no cost to them, and that is regardless of whether we can bill insurance again. We are getting burned on this big-time. I'm curious to know how it's handled elsewhere.... Thanks!

Theater of the Absurd

2010-11-02T11:41:00.001-07:00

Prescription medication for customer is being increased from 40mg per day to 60mg per day. Thus, the prescription is written as 40mg tabs, take 1 and 1/2 daily, because there is no 60 mg tablet. Easy -- peezy !!!

Insurance company says no, we will only pay for one 40mg tablet daily. We advise the customer that this medication is inexpensive, and he can buy a month's supply for cash at under $14.00.

Customer says NO WAY and wants it covered under his insurance. Since we're all about the customer service, we send it off to the doctor's office for a Prior Authorization.

A few days pass. A nurse actually calls (!) and says the prior auth is approved. I run the prescription again -- it rejects. I call the insurance company and sit on hold for about 10 minutes. Finally the person on the other end tells me it is approved, but the customer must take three 20mg tablets instead of 1 and 1/2 of the 40mg strength.

OK. I run that through, and the copay is MORE than if the customer had just paid cash for the month's supply of the DAMN 40mg.

Customer comes in later, and when given the two options elects to pay cash price for the 40mg. Customer also is pissy and registers his unhappiness that the insurance company is telling him 'what to do.'

I wish I could total up the salaried time that everyone involved spent on this. Sometimes you just have to laugh in this job. And again, I am reminded of (a) why healthcare is so expensive in this country, and (b) why your prescriptions take so long to fill.

On another note........ we all hate it when management dictates we have to give a spiel to the customer at checkout, whether it be upselling or telling them about a special or asking for a donation to something. I was reminded how much I hate this myself when I attempted to buy a cheap paperback book the other day at Barnes and Noble.

Check out lady: Are you a member with us?
Me: No.
C-O-L: Do you know about the program?
Me: Yes, and no thanks.
C-O-L: Would you like to donate a book to our book drive?
Me: Not at this time, thanks.
C-O-L (now typing into the computer): What is your e-mail address?
Me (silently): CAN I PLEASE JUST PAY FOR THIS GODDAMN LOUSY BOOK AND GET OUT OF HERE ???? AAAAAAAGGGGGGGGGGGGHHHHHHH !!!!!
Me (out loud): I don't use e-mail.

By the way, I TOTALLY lied cause I do use e-mail!!

Can't wait for the Christmas shopping season.

All Tied Up Over Tylenol

2010-10-20T12:26:00.000-07:00

Overdosage with Tylenol is the most common cause of acute liver failure, and attempts have recently been made to educate the public that Tylenol (or acetaminophen, or APAP) is not an innocuous drug. People may not be aware that acetaminophen is present in many products other than "Tylenol" leading to doubling-up and inadvertent overdose, and there can be confusion over strengths of different products -- regular strength tabs, extra-strength tabs, chewable tabs, infant drops which are 100mg/ 1ml, and children's liquid which is 160mg per 5ml. For adults, 4000mg per day is the maximum dosage, or 8 tablets of 'extra strength' Tylenol equivalent, and there is talk of lowering that recommendation.

Anyway, the thing that worries me most is the kids, because of the aforementioned strength differences and the lack of faith I have in many of the caregivers who give the doses. You remember when they pulled all those OTC pediatric cough/cold products off the market not long ago? It wasn't because the medications were inherently unsafe, it was because there were too damn many dosage errors to justify leaving them out there. Every time I sold one of those things I attempted to make sure the parent knew how much to give, but they rarely initiated the question themselves.

Getting back to Tylenol, we get a lot of prescriptions for it because it is covered by state assistance for those who are eligible. Pediatric dose, as we all know: 10 to 15 mg per kg every 4-6 hours, maximum 5 doses daily. But after checking the child's weight, we consistently get doses that are written too high. Usually they creep up into the 16-17-18 mg/kg range, sometimes more. Okay, maybe a couple of doses isn't a big deal, but legally as far as that labeling is concerned it's OK for that child to get that dose every 4 hours for the next... well, indefinitely. I'm often nervous about assuming that a non-English speaking parent even remembers what 1.2 mL looks like on that dropper. We always have this conundrum --- should we call and bug the doctors/nurse about it EVERY time and hold up the prescription till they call back? Should we go ahead and change it to a more correct dosage and initiate a phone call or fax back to the office and hope it gets changed in their medical record? Or do we decide we've called them enough times and just tell the parent the correct dose and make sure they know how to give it? Is it worth all the time spent? It happens virtually every day. Are we just getting too wound up about the whole thing?

I'm curious as to how other folks handle prescriptions for OTC items like this.

For the record, I never use those dosing charts that give a weight 'range' and assign a dose for it. I calculate 12mg/kg (right smack in the middle) and then round up or down to the next logical dosage unit (1/2 - 1 - 1 & 1/2 teaspoon, dropperful, etc.) Done.

The Generic-Go-Round

2010-10-10T20:03:00.000-07:00

I'm still surprised by how often customers don't understand what 'generic' means. The ones that do understand are the 'prescription pros' whose eyes actually light up when you tell them their medication is now available as a generic, because they anticipate the price coming down. But many people still look very skeptically at you and ask, "But it's the same thing, right?" I feel as though they think I'm trying to put something over on them.

I've tried out a few different ways of explaining 'generic.' Some of them are:

1. It's the same active ingredient as the brand name drug, it just looks different and is made by a different company. (This one doesn't go over that well. It sounds kind of fishy.)

2. It's exactly the same medication as Zocor, they just can't call it Zocor because that's a
protected trade name. (Sometimes this is met with a nod of understanding.)

3. You know when you buy Del Monte Canned Pears and right next to it on the shelf there is a can of "Great Value" Canned Pears? They're both canned pears. One just has a fancier label. (This one is only used when I'm hitting rock bottom.)

People get funny ideas about generics. We all have the customer who swears, "the generic doesn't work for me," (even though there is no earthly reason why it shouldn't) or "I'm allergic to the generic." I don't dismiss these people out of hand. Generic products can contain different inactive ingredients (colors, flavors, fillers) that theoretically someone could have an allergy to. The lack of effectiveness is a little harder to buy, although again, theoretically a person could absorb the generic product somewhat differently which might affect its action. I recently had a customer beg me for a few tablets of Cardura because since he was switched to the generic, "I can't pee." ( I gave him a few and started the prior auth. procedure -- he did look really uncomfortable).

Other times I think people get it in their head that the generic is not going to work and then proceed to enable that very thing by sheer willpower. I took a call from an exasperated nurse who needed to start a prior auth for Duac Gel because the patient would not use its two --- cheaper---- components separately (Clindamycin gel and Benzoyl Peroxide gel) because she claimed that did NOT work. I'd have a tough time with that. I'm glad to see that occasionally docs will refuse to do prior auths for some of this stuff.

Then there's the flip side of the coin, when someone is presented with a higher-than-expected copay for what is a very pricey brand name drug, and their first question is "Isn't there a GENERIC??" I have to answer, "No, not for this one."

And I get that skeptical look, AGAIN............

The Truth Goes Marching On

2010-10-05T14:06:00.000-07:00

OK, so the makers of the delicious Sun Chips recently started packaging their product in a compostable bag made of plant-based materials. Better for the environment and a good idea, right?

Wrong. They have decided go back to the old packaging for all but one flavor. Why?
According to news reports:

"But that which makes them compostable also makes them loud. The bags have a different molecular structure from the original packaging, and they're stiffer. So people complained about the noise. Groups on Facebook abound with names such as "I wanted SunChips but my roommate was sleeping..." and "Nothing is louder than a SunChips bag."

Spokeswoman Aurora Gonzalez said the company received complaints about the noise from the bags, although it also received thanks from customers who liked being able to recycle them.

So the decision was made to remove the bulk of the biodegradable line."

Sigh. Some times I worry about this blessed land of ours. Yeah, the environment's important and all, but DO NOT, I REPEAT DO NOT, mess with our salty snacks and our ability to partake of them when the roomie is asleep. There are certain things that are sacred.

Why is this pharmacy-related? It isn't really, except that I often throw a handful of Sun Chips into the pitiful lunch I wolf down back in the stock room. It was a noble try, guys.

I Have Seen the Enemy and It is Me

2010-10-03T19:19:00.000-07:00

There are some days (I repeat, some) when I feel like I can really kick ass in this job. Multitask like crazy. Juggle about 15 balls in the air at once. Make snap decisions. Keep things moving. Everything is humming along pretty well and staying in its groove. I've got notes and pieces of paper everywhere but I know where everything is and what's going on with it.

Then, it happens -- that one interruption, phone call or yelled question that somehow upsets the boat. Someone hands me a prescription and asks me to put it on file for them. A few minutes later I realize I don't know what I did with it.

What the HELL did I DO with it? I JUST HAD it in my HAND. Damn it, where IS IT?, I screech.

God, I hate that. Everyone else looks sympathetic but is really too busy to offer more than meek suggestions ("maybe you left it by the register?") I start to empty the garbage cans. I look under every piece of paper, every computer terminal. I am completely thrown off. I get behind and other things start to pile up. The whole rhythm of the universe has completely gone to hell. I fear that my co-workers are secretly snickering and wondering if I am, y'know, losing it.

It's kind of upsetting when your whole workday can turn bad over one misplaced piece of paper. I never did find the damn thing. I'm still stewing.

A Workplace Topic of Conversation Today

2010-09-27T20:50:00.000-07:00

There was a news story recently about a mother in Michigan who complained to her daughter's school about the appropriateness of a cheerleading routine that the 6-year old was practicing. It included the words,

"Our backs ache, our skirts are too tight, we shake our booties from left to right."

That's right, SIX year olds. I didn't know they started 'em that young. I guess it's no surprise that in the cut-throat world of cheerleading the end result was that the cheer stayed and the kid left the team.

One of my co-workers was commenting that his very young, school-age daughter and her friends liked to gleefully sing the "California Gurls" song that was popular this summer, including the lyrics "sex on the beach." These are second-graders.

I don't have a daughter, and I'm kind of glad. I'm not sure I could handle it. I'm not trying to sound like the Church Lady here, cause I'm not --- but the messages that girls get about the 'booty', starting at a very young age, has got to be something that is really difficult to navigate. Our kids are totally surrounded by sexual images. We can control what they see and hear to a certain extent, but we can't shield them forever unless we lock them in a closet. I remember an article once pointing out that the U.S.A. has a very schizophrenic attitude towards all this. There's a huge uproar when Janet Jackson has a wardrobe malfunction and flashes a breast on TV, and yet I can't pay for my groceries without an issue of Cosmo screaming "orgasm" in my face or watch any sporting event on TV without the Viagra/Cialis/Levitra hit parade.

I sometimes think that being a pre-teen girl nowadays might be the depth of misery. I see them come through the pharmacy sometimes, and walking to school around my house. Most of them don't look anything like Katy Perry. I know I didn't. I guess those of us behind the pharmacy counter (and in the doc's office) often get to see the consequences of the --uh,-- 'booty', a little too often. Believe me, I bristle at the thought of any Morals Police looking over my shoulder, but sometimes I wish we could just dial it back a little. For the girls, and for the boys.

Same As It Ever Was

2010-09-13T13:02:00.000-07:00

This customer comes up to the counter to collect a Z-pack and some codeine-containing cough syrup for what appears to be a respiratory ailment. He seems thoroughly pissed off and grumbles to me, "Why do I get this every month? Why is it when I ask the doctor why I keep getting this, he just says 'I dunno'??"

Well, sir (ran my inner monologue) it might be related to your being about 150 pounds overweight. I don't sense a lot of physical activity here. I sense a general state of unhealthiness exacerbated by a lack of some good air moving in and out of those lungs on a regular basis --- like the ol' cough-and-deep-breathe they make you do in the hospital when you're bedridden so you don't get pneumonia and things like that.

But boy, was he mad at that doctor.

My second thought today has to do with the dreaded Hospital/Nursing Home/Rehab Center DISCHARGE. No pharmacy wants to see this horrendous fax coming because it usually means mass confusion, multiple questions and unanswered phone calls, a long, long list of medications both new and old that need to be filled and a thoroughly hysterical patient or family who don't know what the hell is going on (and are completely OUT of medication). I'm sure there are many places that try to do their best in sending the patient out the door with a clear set of instructions. Most of the time, it doesn't seem to work very well. The medications have usually been copied down by someone who doesn't know what they are writing. Most of the stuff wasn't even meant to be continued after discharge. Doses or medications have been changed from what the person is used to taking, and they don't know why. Some people get really upset by this and when they are elderly or confused to begin with, it's never good.

The companies that provide pharmacy services to long-term care facilities, as well as every hospital pharmacy, should have a Discharge Specialist. Some hospital pharmacists do discharge counseling on a regular basis --- that's good. They sit down with the patient or family, go through that list of medications, weed out the unnecessary stuff and clearly show them THIS is what you were taking before, and THIS is what you're going to start taking NOW.
They also set up a mechanism for them to get those medications filled and deal with the 'refill too soon' because the nursing home has already billed for them. Wouldn't that be great??

"Retreat hell! We just got here!"

2010-09-01T14:39:00.000-07:00

It's end of summer/back to school time which means many things for pharmacies (stock up on the lice stuff). Between various friends and family who work at different types of jobs I feel like I've heard a lot about 'retreats' lately -- you know, where a bunch of people from a company or department go off somewhere for a day and talk about their goals, their mission, their overall plan for the upcoming year, whatever.

Everybody hates these things with a passion. Usually they are boring as hell and considered to be a total waste of time. When I worked hospital all of the staff had to endure a bunch of meetings during the 're-engineering' of our department. Giant binders full of glossy flow charts and lists of stuff were generated by some out-of-state consulting firm that just modified the same recipe for whatever company they were hired to torment. People saw their job descriptions literally change overnight and there was a mass exodus of personnel (the economy was better back then so nobody worried about getting another job.) Gawd, it was horrible.

Thankfully, as a mere worker bee I am spared this in my current retail setting, but the pharmacy managers are required to attend gatherings like this and generate a rather fuzzy list of goals and objectives, which mostly just involves changing the order of the sentences from the previous year. They have no problem with WHAT they would like to do, it's the HOW that never really gets addressed.

I don't have anything against group meetings like this, but I'll never understand in a million years why they don't get all the people who DO THE JOB together once in a while to brainstorm on how to make things better, easier and more efficient. None of this ethereal 'goals and objectives' crap. Actual nuts-and-bolts ideas. I work with a lot of people who have some great ideas, but it almost seems like the people who run the place are afraid of us --- they never ask, they never give feedback on a suggestion, and people just keep bitching about the same problems day in and day out. I'll just never understand it. Somebody comes up with a simple idea, like moving a computer terminal, and it takes an Act of Congress to make it happen, if it ever does. This has been such a consistent theme through my entire work life so far, and it still drives me nuts.

OK then, back to school. My mission will be to tread lightly through the Nix and the ADD meds. Oh, and anybody know how I order more paper towels?

What's MY Delta Tau Chi Name?

2010-08-18T18:08:00.000-07:00

Congratulations Mom, your son/daughter's in college. I've spoken to many of you in the last few days who need to have their prescriptions filled and mailed to their college address.
No problem -- you simply give me the complete information on where to send it, and it will be done. Invariably though, these conversations usually include the words, "He/she just told me that they are completely out." And, I can clearly sense when I'm talking to a helicopter mom who wants me to work a miracle and get that prescription in to their kid's hands by midnight. It's especially interesting when it's a C-2, y'know, like Adderall.

Now, we all want to help our kids out; be their advocate, give them the tools to be successful. Here's a teachable moment. If you're going to do the ordering for them, they must tell you when they are down to a week's supply. They can put a reminder on their computer calendar, into the iPhone, onto their Facebook status --- I don't care. Better yet, you might want to teach them to call the pharmacy number themselves (it's on the bottle!) and simply tell us what they need and where it is to be sent. And if the kid runs out of Adderall and bombs a test or something --- well, it's a lesson learned and it will probably help them remember the next time, or maybe it will take a few times. We all learn this way.

It's all part of the college experience. Now go make that Dean's List!! TOH-GAHHHHHH !!!

Control-Alt-Delete Me

2010-08-11T16:16:00.000-07:00

The pharmacy computer system we have right now has been plagued with glitches and problems from the get-go. In fact, all our technology seems inherently unstable. When it does something weird like kick you off without saving any information, everyone just shrugs, says 'whatever' and starts over.

It just infuriates me that we have the same problems over and over again. I don't know how many people out there regularly have to call their company's computer "help" department, but the fact that these people can't diagnose the SAME PROBLEM we had a few days ago just aggravates me. And of course, the person you are talking to on the other end of the phone isn't even in your own state. I spend the first 15 minutes explaining where I am, who I am and what system I am calling about, and the person I'm talking to seems to be looking at it for the very first time themselves ("Wow, would you look at that screen, huh?") Then they want to give me a reference number and call me back in 15-20 minutes. Yeah, that'll work. Meanwhile, my entire work flow has ground to a halt and I've got a line-up of customers glaring at me and looking like they're about to burn me at the stake.

We are totally dependent on our technology. Believe me, I'm grateful for it even though I am whining here. There's just got to be people out there who can quickly diagnose and then permanently fix these problems, especially the ones that repeat themselves again and again. The face-to-face interactions with our computer people are no better -- they always seem mildly amused by my predicament and start asking me questions about my hardware and my servers until I want to scream HOW THE HELL DO I KNOW? THAT'S YOUR JOB !!!! YOU PEOPLE INSTALLED IT!!

I'm not opening any weird attachments. I'm not deleting programs, pulling any plugs or doing anything I'm not supposed to be doing. Just tryin' to do my job.

Thank you for allowing me to vent. Maybe the heat is getting to me.

This time it's not about the customers' cell phones

2010-07-26T16:00:00.000-07:00

So I'm sitting in the tiny 'back room' of the pharmacy eating lunch, surrounded by other employees' purses, backpacks, etc. and several times while I'm sitting there people's cell phones are going off. They can't hear them, so they ring multiple times and go unanswered.

Putting aside the question of why people will call other people's cell phones when they KNOW they are at WORK (??), I at least give these employees credit for leaving their cell phones in the 'back.' That's where I leave mine, and once in a while I might go back and check it, but it stays there.

I've got to believe most pharmacy workplaces have strict policies on cell phones, don't they? Mine apparently does not. Some of our managers are really lax about it, and I'm seeing more and more people working while carrying their cell phone in a pocket or (more often) just leaving it on the counter. Granted, it's generally out of view of the customers, but when I ask somebody a question and realize they are not answering me because they are deep in text-messaging concentration, I do a slow burn. Never mind talking on the damn thing in the middle of the pharmacy.

Is this a problem for anyone else or do I just work in an incredibly lax place? I'm debating whether to ask "upper" management to tighten things up a little and make it a rule that cell phones stay out of the general work area. They'll definitely do it, because they probably don't realize it's going on....but then again I'll be the bad guy if someone finds out.

At Least It's Friday..

2010-07-16T21:17:00.000-07:00

After finishing a long session with someone whose expensive, sustained release pain medication was too soon to fill because he had been taking approximately 4 times the dose that was prescribed and didn't discuss this with his doctor so there was no way I was going to tell an insurance company that we confirmed that he HAD consulted with his doctor when in fact he had NOT.... (and this is the kind of thing I love to get on a Friday afternoon)..... I turned to the next prescription.

A beautifully laser-printed, signed document with just the essential information. We'll bang this one out in 45 seconds, I thought, until the technician brings it back and says, "what should I put for the directions?"

Here's exactly what it said:
"1 each 2 times a day 1 tab po qam orally." (quantity, 30).

This was one of those psychotropic meds that could be taken 100 different ways.

A call to the office phone number on the prescription revealed a fortress-like phone triage system finally ending in a voice mail.

This is why your pharmacist is kind of cranky sometimes.

I'm Lovin' It??

2010-07-12T16:15:00.001-07:00

Customer drops off Vicodin prescription and says he'll be back in a few minutes. I get 'refill too soon' reject. Hasn't filled the prescription with us recently and the reject doesn't tell me anything else. I get the distinct feeling this customer's going to protest the resulting situation (that being, no Vicodin for you today) and I log onto the new Prescription Drug Monitoring website so I can be armed with the reason. He filled the same prescription (120 tablets!) four days earlier at a CVS in the city. Busted.

He pretends to not quite understand what I'm telling him but very quickly gives it up.

Wow. Something that worked that way it was supposed to . Who knew?

Survey Says........

2010-07-09T19:02:00.000-07:00

I admit it, I bury my nose in Vanity Fair magazine every month. The last page is always devoted to the Proust Questionnaire, a 'personality' questionnaire usually given to a celebrity or other famous person. The answers can be serious, creative, funny, or a combination of all. I think my favorite answer was Conan O'Brien's, when asked, "What is your idea of perfect happiness?" he answered, "A walk on the beach with my Israeli bodyguards."

Anyway, I always wanted to try it -- it's a little harder than you think, but kind of fun.
Give it a whirl.

The Proust Questionnaire

What is your idea of perfect happiness?
( Nerd alert! ---)
Being in the middle of a really, really good book that I can't wait to pick up every night.

What is your greatest fear?
What isn't?..... but let's start with making a mistake at work that hurts somebody.

Which historical figure do you most identify with?
Rosie the Riveter.

Which living person do you most admire?
Tough choice. One pair that comes to mind is Bill and Melinda Gates, for using their great wealth the way it ought to be used -- to save lives and try to change the world.

What is the trait you most deplore in yourself?
Reticence.

What is the trait you most deplore in others?
An overblown sense of their own importance.

What is your greatest extravagance?
Expensive food treats.

On what occasion do you lie?
To protect the weak.

What do you dislike most about your appearance?
At the moment?..My upper arms.

When and where were you happiest?
Right after becoming licensed as a pharmacist -- I had a full-time job, my own car and my own apartment... everything I had worked for, and I was happier than a pig in shit.

If you could change one thing about yourself what would it be?
More confidence.

If you could change one thing about your family what would it be?
Make it larger.

What do you consider your greatest achievement?
Being (I hope) a productive member of society.

If you died and came back as a person or thing what do you think it would be?
A career girl, like in a Doris Day movie, in late 1950's Manhattan.

What is your most treasured possession?
My home.

What do you regard as the lowest depth of misery?
Watching a child leave the pharmacy with an openly harsh and uncaring parent.

Who are your heroes in real life?
People who face aging and illness with dignity and humor.

What is it that you most dislike?
Those who celebrate, and propagate, ignorance.

How would you like to die?
Fast asleep. On second thought, scratch that ---- like Thelma & Louise.

What is your motto?
Be responsible for your own happiness.

A Footnote to the Last Post

2010-07-02T20:11:00.000-07:00

A couple of comments to the last post made me want to add just a few thoughts. The point I was trying to make (and it's a source of tremendous frustration to pharmacists) is how much time I have to spend some days doing guesswork. I don't mean answering questions or offering advice; I mean trying to get basic information from people whose responsibility it is to provide that information TO ME so I can do my job (and no, I don't think it's the worst job in the world at all). I'm a pretty experienced pharmacist and I can work with some pretty small shreds of information, but there comes a time when I simply can't guess anymore.

There's a subset of otherwise capable people, for example, who will NOT learn the names of their medications. Now, I don't expect them to be able to spell it or even pronounce it that well, but I do expect someone to have a basic idea of the medication's name and what it is for. If you want a written list, please ASK ME. I'd be glad to provide it --- in fact, that IS part of my job, as opposed to the insurance agent/postal clerk/coupon detective/phone operator stuff which is not. I also think people should have an idea of when they need to replenish the supply of that medication (how about when those last few tablets are rattling around in the bottle?) Call the phone number on the label and read me the prescription number. That's it. I will do the rest.

However, if you don't have the bottle you'll need to provide me with a little more information. When I worked in hospital pharmacy we had seriously ill people admitted who had NO CLUE what medications they were taking. Not ONE clue. It was left to someone else (the overworked resident, brand new RN or overwhelmed night pharmacist) to figure out. People who use prescription medication need to know what medication they take. This is not JUST FOR MY CONVENIENCE. IT IS FOR YOUR OWN SAFETY.

And my main point was that we accept this lack of responsibility because it's 'medicine',

it's being sick, it's health care, it's "I'm the patient", it's 'what are they giving me'---- and yet we would laugh at someone who walked into a furniture store and couldn't articulate if they wanted a chair or a coffee table. And the wrong prescription medication has a lot worse consequences.

To the commenter who was frustrated with trying to pick up 6 prescriptions every month ---

I really do sympathize with you. Pharmacy is an over-regulated, very labor intensive business where the human factor takes a front row seat. Most pharmacists I know dislike the 'auto refill' process because it rarely works well for anyone. My advice would be to find a smaller pharmacy with people who will work with you and give you a little more personal assistance. Give them time to work on it and hopefully it will save your sanity.

Thanks for all the great comments!

When Will Other Businesses get their act together and run like a pharmacy?

2010-07-01T20:45:00.000-07:00

When you think about it, retail pharmacy is sort of a unique undertaking, and after a long day filled with customers' inattentiveness, strange requests, weird questions, lack of information, non-English speaking interactions, half-believable stories and total guesswork as to what THE HELL they really want I keep wondering what other retail businesses would do if faced with our average day.

For instance, I tried to imagine, the......

TOP TEN THINGS OVERHEARD IN A FURNITURE STORE THAT RUNS LIKE A PHARMACY

1. "I need to get a dining room chair -- well, maybe more of a bar stool or a recliner.... I got one a while ago, it may have been blue or green, but it's some sort thing you sit on, anyway, made by company starting with 'S' or "W".....could you check your computer to see if I've ever bought anything like that before and can I get another one? Go ahead, read me the list and I'll see if anything rings a bell."

2. I talked to someone in your Chicago store who said they would figure out what it was and then call you and have you put it aside for me. I don't know who I talked to . Can you call them?

3. if I describe my dining room to you can you tell me what I might need or what's missing? -- and then how much it (whatever it is) will cost?

4. I have a discount coupon for some kind of chair or table but I didn't bring it with me. Can you look me up on your mailing list to prove that I did get one in the mail so you can give me the discount price? Or, can you call my wife/husband at home and they will read it to you? How long will that take?

5. My neighbor's' going to pay for it. You'll have to call him to get his credit card number.

6. I think I bought a sleeper sofa back in 1989 that was only $200. Why is it more now? It's always been $200.... or maybe it was a desk......anyways I know I bought it here.

7. I'm having company tonight -- can you give me a couple of chairs to get me through the weekend and I'll (maybe) come back next week and get the rest.

8. I need six of them, but once you get it loaded in my car and the paperwork is totally complete I'll probably change my mind and only decide to take three.

9. I lost that lamp I bought 2 days ago... is there some way I can get another one without paying for it again?

10. You know what? ---maybe it's actually a rug I'm looking for......

And remember, furniture can't kill you. I think the average furniture store employee would walk away from this pretty fast, but in pharmacy it's just another day.

And Another Thing........

2010-06-24T18:33:00.000-07:00

I remember some years ago picking up a magazine at work that was primarily aimed at family practice physicians. There was an article called "Dealing with the Difficult Patient" and to illustrate the article there was a picture of a guy in a hospital gown sitting on an office exam table glaring into the camera with his arms crossed and looking thoroughly pissed off. The kind of picture that makes anyone want to turn around and run far, far away.

I know there are some people who feel they've always got to be a squeaky wheel to get the results they want, especially if they are fighting some faceless bureaucracy or rude desk jockey who's clearly not doing his/her job. I can understand that... but what bugs the crap out of me are the ones who DON'T PLAY BY THE RULES but get what they want simply because they are such well-known A-holes that no one wants to deal with them.

Like the guy who came in expecting to pick up a refill and was told by us that it was denied. He stared us down and kept saying "that's not acceptable." We went round and round and explained it was the doctor's decision and we're just passing along the information at this point. He finally stomps off to the doctor's office (who is in our building) and 15 minutes later comes back WITH A prescription.

That just bugs the crap out of me. We talked to the nurse later who indicated they had eventually buckled and gave him one month because the guy was always so difficult and put up such a stink. Something along the lines of "we've gotta keep him happy."

I really hate that. And the next time he's just gonna do it again. (Why not? it worked.) He ought to have been told, "Them's the rules, if you don't like it, go somewhere else." Jerk.

The Call-Back

2010-06-17T19:10:00.000-07:00

So this customer calls and needs to talk to a pharmacist. She then proceeds to rattle off a boatload of medications that she needs to pick up THIS morning, before she goes to work in the afternoon. I tell her there are many orders ahead of her, and I'm not sure we'll be able to have all of hers ready in time. She pisses and moans, and then asks if we can call her when they are ready. I agree, but then she says, "Well, there's really only one thing I absolutely need today -- I MUST have it, I am completely out."

OK, I tell her, we will definitely have that one item ready for you to pick up when you come in. I can't promise the other things, but we'll prioritize the one item you need and you can pick it up.

Now, imagine for a moment you are this customer. Which of the following do you proceed to do.... DO YOU:

a.) Stop in at the pharmacy on your way to work to pick up the item you desperately need and be glad you were able to get it on short notice.

b.) Call me back at about 4pm that afternoon, from work (and therefore now unable to pick up the prescription before we close) and shrilly demand why NO ONE CALLED YOU to tell you your prescription was ready? When I remind you of our previous conversation (which everyone else in the pharmacy can attest to) you remain pissed off, as it's all MY fault, refuse any alternative I propose (such as transferring the prescription elsewhere) and hang up on me.

I'm sure you can guess which option this customer chose. It's just like those phone calls we get where the customer says, "Why didn't anyone call me to tell me my prescription was ready??? I've had NO medication for 4 days!"

Really? You forgot how to use that telephone, huh? There's really no obligation on your part to take the bull by the horns and give us a call? Huh. I mean for crying out loud, every 6 year old has a cell phone nowadays.

I see Walgreens is now advertising 'texting' people when their orders are ready. Great. We don't quite have that technology just yet, and probably won't any time soon.

If people ask for a call back, we make a note of it and do it. And by the way, if I get no answer, or an answering machine with no identification on it, then the ball is pretty much back in the customer's court. I've got to move on.

But please people, take just SOME responsibility for obtaining that medication you absolutely MUST have today. Since you decided to wait until you were completely out, it would be nice if you didn't blame me for that too.

Drama on Both Sides of the Counter

2010-06-13T10:26:00.000-07:00

When you're working long hours in close quarters you learn things about your co-workers in the course of normal conversation and chit-chat. I enjoy these conversations for the most part, although I'm not much of a chatter because I generally can't do that and concentrate on what I'm doing. I don't mind if people want to share stuff with me but I've never been one of those people who shares every intimate detail of my life with the people I work with. I guess I just prefer to keep some separation there -- that's just me.

I've mentioned before how filling prescriptions gives you a bit of a 'window' into people's lives. It's happened to me several times --- I've been working with someone and am impressed (maybe even a little envious) of how 'together' they are --- attractive, smart, personable --- then, I have the occasion to check one of their prescription refills, and I'm looking at a whoppin' dose of Prozac along with a healthy helping of Xanax or lorazepam on the side. Don't get me wrong -- it doesn't change how I think of them and I would NEVER comment in any way on someone's prescription --- but it reminds me that life often isn't as smooth as it appears.

I guess where I'm going with this is that the lives of some of my co-workers seem to be imploding --- divorces, child custody and financial issues being the primary issues. I just read an article entitled "Growing Up is Taking Longer, Economically and Socially." I think it's true. When I hear of someone getting married in their early 20's, I know that the chances of that marriage lasting are not good at all. It particularly bothers me when there are young children involved -- I SO wish people wouldn't have kids when their lives are unstable; I wish they wouldn't think having a baby is like getting a puppy --- but I digress.
I just feel like I'm surrounded by stories of people behaving badly and irresponsibly. People who just don't have a mature foundation and who want to walk away from their responsibilities with no consequences. Everyone encounters some misfortune in their life, but these kinds of things are "eyes wide open" situations that I think could have been averted.

It just bothers me, I guess. I've got the advantage of a few years over them. I'm a pretty practical person to begin with. All I can really do is offer sympathy and listen. I come home from work unsettled, though. Kind of a squishy post here, but it's something I've been thinking about for awhile.

I Lost My Mojo

2010-06-07T12:31:00.000-07:00

Jeez, I'm out of practice. Granted, it's been awhile since I took 10+ days vacation, but after being back a few days my knees are screaming, my eyeballs are throbbing and I am totally wiped. I did a lot of walking on the trip, but apparently that means the body is now unaccustomed to just standing all day and staring at computer screens and assorted pieces of paper. I gotta get back into fightin' pharmacist form -- this is ridiculous.

In pre-pharmacy (and I'm sure pre-med, pre-dental, pre-podiatry, etc.) we all have to take stuff like calculus -- get through it, and never think of it again. I couldn't solve a differential equation now to save my life, but I think simple addition and subtraction is perhaps a skill they should emphasize more. We had one course in pharmacy school where we were allowed no calculators -- we had to solve those pharmacy 'math' problems the old-fashioned way, and BOY did people struggle with that course. Even if they knew how to solve the problem they would always make some dumb math error (and there was no partial credit). I bring this up because one of our narcotic counts was way off the other day. Still trying to get my mojo back, I stared at the log, re-counted tablets and rifled through old prescriptions before realizing that someone had received a new bottle of 100 tablets, added it to the 230 already in stock, and come up with a new balance of 490. Sigh. There's 20 minutes I'll never get back.....hopefully I'll get the groove back this week.

Me: 1 Volcanic Ash: 0

2010-06-02T15:15:00.000-07:00

I was creating every possible scenario of what could go wrong on my recent trip (as I always do) and of course none of it happened and it was a successful and fun time. That pretty much does it for me as far as summer vacation (till the very end of August anyway) but I figure I miss the biggest crowds this way.

"Across the pond" I am struck by how much people do rely on public transportation -- trains and subways in particular. It seems like there is always a crush of people and the strain on the system has got to be relentless. There's always some sort of maintenance work going on and disruptions in service are an ever-present possibility. Not that we had any problems, but after a few days of being on the move things can get nerve-jangling.

In several of the train stations, as well as at the airport, I took note of occasional signs which read "Abuse of Staff will not be Tolerated", followed by a warning about said abuse and what penalties could be incurred. My first thought was that it's unfortunate such signs are necessary. My second thought was, where can I get hold of one of those signs?.... you know, for those special days in the pharmacy. Yelling at me because your doctor hasn't authorized a refill has about the same result as yelling at a ticket agent to get the trains running on time.

Ultimately, we just have to abide by that other phrase they use over there: "Keep Calm and Carry On."

Back in a Few

2010-05-16T11:26:00.000-07:00

Probably taking about a 2 week break here. Having a few virus issues with the computer, plus I've actually got some vacation time! Going out of the country, and again being the nerdy pharmacist I am, looking forward to snooping in the pharmacies to see what they got that we ain't got! (Sad, isn't it?)

Anyways, will return soon!

The Paper Chase

2010-05-08T15:02:00.000-07:00

E-prescribing, faxing, and electronic transmission of prescriptions to pharmacies can be ultimately more efficient, and I suppose it's an advancement in patient care, BUT...... sometimes I just can't shake the thought that it's yet another way to relieve people of their own damn responsibility in this going-to-the-doctor thing.

Guy walks in and plops a bottle of prescription lotion on the counter. There is no prescription label on it. He wants a refill.

OK, everybody out there knows the drill, right? --- the detective work now begins (for which I have NO time and even less interest.) Making a very long story short here, he got it when he got out of the hospital in another part of the state. We did not fill it. He can only give us a vague approximation of the doctor's name. We look at his profile and make a crude guess as to who the doctor is from some of his other prescriptions (luckily, there's kind of a "sound alike" name on his profile.) Guy insists we call right then and there. Person on the other end says please fax a refill request. We do, and convince the guy to check back with us later. All other people waiting in line behind him are now very cranky.

Doctor's office calls back a couple hours later...."he was handed a prescription for that with refills. Please ask him for it." OK, fair enough, but we all know what comes next.

We call the guy..... he claims he does not have the prescription (at least, that's the gist of a phone call that again lasts WAY too long.) We fax the doctor's office back again. Later, guy calls back, apparently rifling through a stack of prescriptions he has now found. After keeping my tech on the phone even longer and asking her to tell him what each one is for, he now apparently discovers the prescription. The whole idea that he would need to BRING that IN to the pharmacy seems to irritate and puzzle him.

Total time spent on this entire odyssey: WAY WAY WAY too much.

It makes me furious when I find out that someone was given a prescription and that same person sends me on a wild goose chase because they don't get the whole "you bring THAT to your pharmacy and they fill it" idea.

Is this, like, a totally outdated thing now??

The End of the Day

2010-05-03T16:13:00.000-07:00

I was locking up the pharmacy and leaving the medical building one day last week. I think I was probably the last person out. A group of cleaners comes in to the building at the end of the day and works during the evening -- they come in and do some light cleaning in the pharmacy itself before we close. Like a lot of people doing this type of work, they are all Hispanic. They smile and say hello but most of them speak only broken English.

As I was leaving the deserted building I saw one of these young men working in the trash receptacle room. He had some music playing -- it was very lively Spanish / Mexican style music. What I mean is, it wasn't rap or hip-hop or Lady Gaga or country & western or any one of our American mainstays.

It was, I'm thinking, his music from 'home.'

It made me kind of sad. I guess I felt kind of lonely for the guy. I find myself wondering about the path that led this young man from his place of birth to a job in the Midwest cleaning up the detritus from a busy medical clinic (and there's a lot of it, believe me.) Could they find an "American" to do this job? Maybe, especially with the current economy -- but it would be a 'high turnover' kind of job. It's not very attractive work.

I like where I live. It's hard for me to imagine having to pick up and go somewhere else, anywhere else, to make a living. Immigration reform is going to be the next big screaming match, but it's really about time we stopped talking about it and did something. I'm a law-and-order person but there's got to be a civilized way we can provide some opportunities to people who are willing to empty our trash and refill the paper towels and scrub down the exam room floors and work late into the evening after they watch us walk out the door. I'm not saying I can offer up a perfect solution, but I would like to see us work on one.

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

2010-04-27T16:05:00.000-07:00

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

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

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

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

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

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

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

The $20 Bottle of Acetaminophen

2010-04-20T15:08:00.001-07:00

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

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

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

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

Random Thoughts While Waiting for the Cable Guy

2010-04-12T13:40:00.000-07:00

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

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

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

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

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

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

2010-04-06T10:19:00.000-07:00

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

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

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

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

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

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

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

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

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

Are We a Pharmacy Today or Not?

2010-03-30T13:50:00.000-07:00

One of the pharmacies I work at is a small store with a pharmacist-in-charge who is very stingy with inventory. You'd think the purchasing money was coming out of his own pocket. Part of this is probably a personality quirk but I'm sure he gets a pat on the back from the head honchos for keeping inventory costs low.

Of course, he's not there on the days I work, and one of my biggest frustrations right now is not having drugs in stock & having to constantly fill partial prescriptions and 'owe' people the rest. I feel bad enough that I usually offer to mail it to the customer (IF it's an item that can be mailed) --- so, we get hit for mailing costs anyway. Seems it would be cheaper to just have enough in stock. I can almost tell just by looking at a prescription when it's handed in that we're unlikely to have enough (TWO bottles of Peridex??? -- ha, you wish). And yes, we've got the computerized inventory system which is supposed to replace what is used, but when he's got the par levels set ridiculously low it doesn't work so well. Plus, as we all know, you cannot rely on people to call in the day before to order their refills. We lost that battle a long time ago.

People get annoyed when this happens constantly. They're coming in every month for the same damn thing and we're always short. I'm mailing one tablet here and two tablets there. People claim they didn't get the balance of their prescription, or dispute the amount they were owed. What a headache !! Just KEEP SOME DRUGS on the shelf !!!!!!

Oh, and by the way, maybe the 4th or 5th time somebody asks for an OTC product we don't carry, maybe we could, y'know.....CARRY IT. I have no business training at all, but this seems like a swell idea to me.

Oh, Baby

2010-03-22T14:37:00.000-07:00

This couple came into the pharmacy last week with a newborn baby. Now, I think it's safe to assume that they were the parents, and I swear the Dad looked about 15 years old.
Mom didn't look much older. I've got professional co-workers in their 30's who just had babies and are overwhelmed and exhausted. I can only imagine how these kids are feeling.

I also worked with a technician recently who I was meeting for the first time. She was telling me how she had been admitted to a very competitive college program a few years back, but didn't like it and dropped out. I'm not sure what happened in the interim, but today she has a school-age child and infant TWINS. She is a single mom, and drawing some state assistance.

I'm sure the kids are all real cute, but I'm a practical person. I can't help but think of the struggles ahead for people like these. I can't quite figure out how people find themselves in these situations. Life can be messy, I know, but........??

In my view, birth control is an essential part of public health (and public economic health, too). I get really irritated with old-guy politicians and other morally-superior folks who want to make birth control sound like merely an excuse for wild women everywhere to have promiscuous sex. And the issue of pharmacists who won't dispense birth control because of a moral objection has always exasperated me. I most certainly understand the differing views on dispensing something that interferes with an established pregnancy, but that's clearly not what we're talking about here.

If a pharmacist has a problem with the idea of birth control, they cannot work in a retail/community setting. There's just no way around it. They can work in other areas where they will never need to come in contact with birth control, if that's their issue --- hospital, pediatric, long term care pharmacy, industry, academia --- and they will suffer no loss in income, prestige, or opportunity for advancement -- so there's no need to cry discrimination.

I must admit I don't get it -- how someone can go through all the training that pharmacists must endure without understanding that birth control is part of public health. When women control their own fertility it has a demonstrable effect on poverty rates, the workforce, and the economy. I'm not saying don't have kids, I'm saying have them when it's the right time in your life.

I know it's a complicated issue. But WOW, did that baby's daddy look young.

Feeling Sorry for Myself.. Waaaaaa

2010-03-17T14:38:00.001-07:00

I'm trying to focus enough to write today, cause I am totally incapacitated by allergies!
What the heck is doing this to me I don't know. I'm going to start sounding like one of those customers that gives the litany of disgusting symptoms I don't want to hear about -- post nasal drip that causes a sore throat and that tingly, itchy sensation in your nose and on the roof of your mouth. My usually reliable Allegra isn't working. Zyrtec isn't working. I take Benadryl at night and in the morning I feel like I had 12 martinis. I'm now going to move into the hard-core cold medications and keep piling on till something works.

Cripes, I'm actually woozy. Okay all you allergy customers, I'll join you (just for today) on the WAHHHH--mbulance........

Waste Not, Want Not

2010-03-10T13:37:00.000-08:00

I am glad to see "waste, fraud and abuse" being talked about in the debate on health care reform and I think addressing it is something everyone can agree on. I certainly know there are vast amounts of prescription drugs wasted every day by people who don't use them or don't use them properly. Pharmacy staff are all too familiar with the customers who believe that if their copay is $10 then that must be what the drug costs. We also know lots of people will take a few doses of something, decide it doesn't work, and never touch it again. I was reminded of this the other day when I watched a 3-month supply of a prescription leave the pharmacy --- cost, over $800, copay, $3.

A few months ago I saw a "60 Minutes" segment on Medicare fraud --- a guy talking about stealing millions from Medicare by submitting fraudulent claims for wheelchairs, artificial limbs, etc., through a fake company. He said it was like taking candy from a baby. Estimates of Medicare fraud go up as high as 70+ billion dollars a year (that's BILLion). And of course fake 'pharmacies' are right in there too. The report mentioned certain areas of the country, like south Florida, where it's a huge problem.

I think our government should make it the highest priority to go after this stuff. Talk about creating jobs, too --- lets get armies of field inspectors out there! They would pay for themselves in one day. They wouldn't even need a whole lot of training; in fact, people could work out of their homes, couldn't they? They could screen suspicious claims or concentrate on certain areas of the country. They could call up the person on whose behalf the claim was submitted...."Say, did you in fact receive that $7000 customized wheelchair from FakeIt Medical Supply?" If they say no, well ---- boom, that's money straight back in to the Treasury. We're talking about saving billions here. Am I oversimplifying this? I think it would be a blast!

And Then He Jumped Off the Couch, and................

2010-03-03T15:33:00.000-08:00

I've indicated before that I'm not a very good conversationalist when I am working. I have to concentrate... that's just me. When there's nothing going on of course, I am happy to do the chit-chat. Either way, there are some people that insist on keeping up a steady stream of conversation even when they MUST know I CAN'T listen to what they are saying.

Lately I feel like I've been bombarded with people who want to tell me stories about something their pet did. Long, detailed stories, just as if the animal is a person. Now, I like animals just fine. Listening to stories about someone's 2-year old kid can get pretty grim, but listening to the 15th accounting of that darn cat's antics is really putting my teeth on edge.

Kind of crabby, I know. It's been a long winter.

I Hate Being Forced to Sell Crap

2010-03-01T14:24:00.000-08:00

There are still a lot of snake-oil remedies out there in the big-box chain pharmacies. In my job I don't usually have to deal with people asking if the Chaser hangover remedy really works, or if they should use some weird de-toxifying thing that is prominently displayed on our shelves. I can vouch for most of the OTC items we carry. Sure, there are some that I don't think are very good, like the sub-therapeutic-dose multi-symptom cold products, but for the most part I wouldn't tell someone "it's useless, don't throw your money away."

I don't have any real training in marketing or business, but I do know there is a sucker born every minute. The same people who loudly protest a $25 copay will gladly fork over that much and more for a 'natural, homeopathic' remedy. I take a dim view of that stuff. Sorry, but the placebo effect is very strong, and these are some really expensive placebos.

Unfortunately, some of these products are starting to creep into our inventory. Some non-pharmacy, remotely-situated retailing geniuses apparently think they will be a moneymaker (and they probably will.) We don't have a 'front-store' and a 'back-store' --- it's all one store, which means not only will I have to ring the stuff up, I will get asked what I think of it.

I'm going to be honest. But even if I nicely suggest another product with some true pharmaceutical evidence behind it, the customer is left wondering why we carry the first item at all. I hate being put in this position. I 'm not going to pretend I am happy to sell this stuff. But if I say what I am really thinking ("somebody who I've never even met has decided we need to carry this junk") I come across as .... well, a disgruntled employee?
I need a way around this...... know what I mean?

My Phone Avatar

2010-02-15T14:20:00.000-08:00

There are many times when I pick up the phone during a really busy day and instantly regret it. I wish I could time-travel back 10 seconds and not pick it up. I wish I could instantly change places with a virtual representation of myself, who had plenty of time to take the call -- an avatar, if you will. I want my avatar to handle the following calls:

The historian. Someone who wants to give me a long, leisurely story about anything that pops into their head -- long-ago prescriptions, surgeries, doctor visits, family issues, etc. etc. leading up to ( I assume) a question, if they would ever just get to it.

The number reader. Someone who just wants to give me a list of prescription numbers to refill, perhaps with a little extra information about each ("You'll have to call the doctor on that one") in case I am unable to figure that out for myself. They don't want to use the automated refill line, which was created specifically so I would have time to actually fill those lists of prescriptions and not have to be on the phone all the time.

The non-English speaker. After about 10 minutes of back-and-forth on the line, I've been able to ascertain your name and date of birth. Now we're gettin' somewhere.

The salespeople. This one really gets me. What in God's name makes you think I have time to listen to you?? Without identifying themselves, they ask to speak to the 'owner.' When was the last time you worked in a pharmacy with an owner ??? For me, I think I was in pharmacy school and did a rotation in the last independent pharmacy left in the state. Then, they ask to speak to the administrative assistant (??) or whoever does the buying. Strike three, buddy, can't help you. Or it's some drug company rep wanting to give you a long scripted spiel 'just to let you know' about some product and what tier it's on with such-and-such insurance and would I feel comfortable now recommending it? I hate being rude to these callers, but have any of them been in a pharmacy lately? Do we look like we can deal with these calls?

Please hold for my avatar.

Groundhog Day, Again

2010-02-10T14:16:00.000-08:00

I know there are people way worse off than me right now, but I'm gonna complain about stuff anyway. It helps to get it off my chest. Maybe it's just the cabin fever talking.

1. PIGSTY PHARMACIES. Half eaten food, water bottles, pop cans, dirty dishes. Make it go away.
2. ENDLESS CHIT-CHAT. Worked with someone last week who wouldn't stop talking. Stop it! I can't think. I can't concentrate. No problem, I'll just do all the work while you are chatting. Why are you here again?
3. FAILING TECHNOLOGY. The computer system is slow. The computer system is down. The register is down. Why don't we just hang a sign on the door: Go Away, We Don't Want Your Business. How's that for a business model?
4. FOREIGN NAMES. I'm sorry, but you're going to have to spell it. Rattling it off and staring at me defiantly isn't going to get us anywhere.
5. GIVE ME YOUR NAME. Speaking of staring, announcing you're here to pick up a prescription and then staring at me silently isn't getting us anywhere either. I'm gonna need your name. Think about it, you'll catch on.
6. FLEX SPENDING CARDS. What a pain in the ass these are, and I know they make them that way on purpose.
7. ASKING ME HOW LONG IT'S GOING TO TAKE. Did you ask the nurse that question? Did you ask the doctor that question? Did you tell the doctor to hurry up because you have to get back to work? And when I give you my best-guess answer, don't argue or try to bargain with me. Believe me, this is no fun for me either.
8. AND OTHER THINGS THAT JUST IRRITATE ME RIGHT NOW. The main selling point for a pregnancy test is that it's the "easiest to read." What a great start in life for the kid who's mother is too dumb to read the test....
9. THE WINTER OLYMPICS (and the summer olympics) cost too much money. The Beijing Olympic stadium is sitting in disuse and rotting. What a waste.

I can't wait till spring.

The Meaning of an Expiration Date

2010-02-02T14:15:00.000-08:00

We get a lot of calls from people asking if some prescription they had filled a couple of years ago is 'still good'. I guess I can understand that question, but why does somebody call and ask if they can still use their bottle of vitamins that expired in March of 2007? I've had a string of these types of calls lately.

The fact that they have even looked at the expiration date indicates they have some idea of its significance. So I'm not sure what kind of answer they are expecting from me. Back in good ol' pharmacy school we were taught that for most pharmaceuticals under proper conditions, the expiration date is when they may have lost 10% of their potency. I know there were some studies recently that found many pharmaceuticals maintain potency well past the expiry date, especially if the packaging is unopened.

So yeah, if someone's in a really tight spot and they need to use a product, depending on what it is of course, I might say go ahead. But I get the impression some of these people just don't want to be bothered to buy another bottle, so they'll wait 10 minutes on hold for me until I can finally come to the phone and say, "Naw, I would probably discard it."

Just another puzzlement in the world of retail pharmacy......

Me Want Cookie

2010-01-26T14:53:00.000-08:00

The neon sign on my local "Pharmacy America Trusts" reads "Dr. Siegal's Cookie Diet $59.99."

Say what? They sure have some wacky products in those WAG stores, don't they? Apparently on this diet you eat 6 of these cookies during the day, and then you're allowed to have, y'know, a 'sensible' dinner. I imagine anyone who could actually stick to this would indeed lose weight. That 59.99 price buys one week worth of cookies. Seems a little pricey to me.

I bet they're selling like crazy -- that's why it's up in lights.

By All Means, Move at a Glacial Pace

2010-01-24T10:10:00.000-08:00

On a day last week at one of our smaller pharmacies (one pharmacist, 1 & 1/2 techs) we seemed extremely busy all day. Between the phone, cash register, new scripts and continuing January insurance issues there was no time to spare. At the end of the day, I look at the prescription totals, and I can't believe it --- you know, it says 110 prescriptions and if feels like 500.

What's frustrating is that the people at corporate look at JUST that number when allocating staffing and resources. You can't explain to them that it's not a true representation of how 'busy' you are. One of my 1 & 1/2 techs is lost to me on the cash register much of the time.
Endless phone calls are taken and made (mostly to insurances) and this eats up SO much time. We are bogged down in ordering procedures and the labor-intensive process of preparing mail-out prescriptions and calling people when their credit cards decline, etc... stuff that has nothing to do with filling prescriptions.

I can handle all that, but I can't change a staff member who is just inherently SLOW. This, I've realized, is probably our biggest problem. Somehow a simple, run-of-the-mill Vicodin script takes 10 minutes to produce in a finished form. I've got other techs who can enter/count/fill/label it in literally 90 seconds. In pharmacy, that's the way it has to be. You've got to be able to MOVE faster. And I mean physically, too. There are some people that just saunter around at the same pace all the time, completely oblivious to the situation crashing down around them. There are times when I want to holler, Come on, LET'S GO !!!!!! WHAT ARE YOU WAITING FOR ??????

Believe me, I don't believe we all have to run around like little jack-rabbits all the time.
But have you ever been waiting on a bank teller, or a receptionist, or a sales clerk who's moving at a glacial pace right in front of you? Just makes me a little crazy.

I Like Simplicity

2010-01-18T11:15:00.000-08:00

Little hiatus there...... some family obligations over the holidays and then attempted to go someplace warm for a week. It was NOT warm. I'm actually glad to be back to the normal routine..

Anyways, the other day I was faced with working at a pharmacy where most of the 'regular staff' were off for the day. Even though I know the place fairly well, I absolutely DREAD this.

It never turns out well. Invariably, something comes up that only one of the 'regulars' knows about. Or we really need to find something and no one knows where it is. The fill-in staff will 'kind of' know some of the procedures but there are some serious gaps, or they just don't know how it's done at that particular store. I can't help them, because I never do those tasks -- it's always done by the regular technician and I am rarely involved in any way. Now all of a sudden all those people are off, and everything is supposed to run smoothly? Never. It's always a disaster. Even if the prescription volume is totally normal, everything is a struggle.

On a day like this, you can count on some customer coming in to follow up on a conversation they had with an (absent) staff member 3 weeks ago, and expecting all of us to be instantly familiar with what they are talking about.

"He said he would order that soap for me and put it aside. I always get it here."
"She was going to call my insurance and then run everything through."
"He was getting a vacation override for me and mailing my meds, but I didn't get them yet."

I find this incredibly irritating because I just don't have time to figure out what someone else might or might not have done. And maybe the person actually DID do what they were supposed to, but they don't leave a paper trail, a note in the computer, ANYTHING. They special order something for a customer and leave it in the LAST place I would ever think of looking. Or they don't bother calling a customer and saying, "All those meds you ordered are too soon to refill, so DON'T COME IN."

A customer will come in claiming they are owed a big refund after an insurance re-bill. We waste 15 minutes scouring the pharmacy for evidence of this and finally find a barely legible 2 X 2 post-it note stuck to the side of the pick up bin. There's GOTTA be a better way.

But it's not always the staff's fault. Some of our procedures have become so freakkin'
complicated (drug order, closing the register out, various 'logs', etc) that unless you do it EVERY single day you are literally pulling out the Manual and starting at square one.... if you have a manual, that is, and it's not written in total gibberish.

I desperately wish we could simplify things and keep procedures uniform across all our pharmacies. I wish people would do things knowing that someone else has got to be able to understand what they did. If there's some weird thing with a customer's insurance or some other crazy thing that only one staff member knows about, for God's sake put a note in the computer! It will save us so much time and aggravation. There's a lot of automation in pharmacy now, but so much of it is still human-being labor-intensive, and the human beings keep a-changing.

January: Wash, Rinse & Repeat

2010-01-06T13:22:00.000-08:00

"I want to get some prescriptions refilled and I have new insurance."

Me: OK, what is the insurance?

"It's BigBoyHMO but I don't have a card yet."

Me: Well, I would probably just need your I.D. number.

"Well, they haven't sent me a card yet and I need to refill these now, because I didn't refill them last month because I didn't have insurance."

Me: To bill them to insurance I will probably at least need your I.D. number. We can get them filled and you can bring the information when you come and get them.

" I need to know the prices though. I think generics are $5 but I need to know what the brand name copays are."

Me: (reaching for my Harry Potter divining hat to ascertain her copays): Stop this merry-go-round, I'm getting nauseous.

Prescripton Drug Ad: Book One, Chapter One

2009-12-30T13:01:00.000-08:00

I was thumbing through my copy of Newsweek recently. The magazine seems to have gotten less interesting and the 'look' of it has become stark and kind of bland, in my opinion. So, there wasn't much goin' on, but in the middle of this slender package of print was a SIX page ad for Seroquel XR. Four of those pages were fine-print, package insert stuff.

Holy crap, I just stared at this monstrosity. Of course, there are many ads in Newsweek for prescription drugs, but this was ridiculous. I'm guessing it's not cheap to run a 6-page ad in any magazine. This is certainly reflected in the price of Seroquel XR, your extended-release version of the already expensive Seroquel that's out there now.

I'm conflicted about direct-to-consumer advertising. I don't think prescription drugs should be a black hole of mystery to people. There may be times when one of these ads gets someone to actually go to the doctor for help, or to have their cholesterol checked, or whatever. We Americans watch our media, you gotta say that. But of course the argument is that if the drug companies weren't paying for this advertising, maybe they could lower their prices. Somehow I don't have a lot of faith in that either.

I do think that every drug ad should be required to state the price of the drug. In a big red box, right at the top of the ad --- the average, cash-paying American customer price. Then maybe people won't look wide-eyed at their Advair/Lipitor/Plavix/Seroquel XR receipt, next to the copay price, and say "Wow, is that how much it REALLY is?"

It sure is, Pharmacy Customer, it suuuurrrre is.

Merry Christmas

2009-12-25T12:29:00.000-08:00

Merry Christmas Pharmacy (and Medical) Folk!

May your patients behave,
Your claims be paid,
Your printers unjammed,
Your bladders expand....

Hope springs eternal!

Counsel Me

2009-12-20T18:42:00.000-08:00

The law requires that a pharmacist be available to 'counsel' patients on all prescriptions, new and refill. All of us in Pharmacy Reality World know that this is practiced somewhat loosely. It may take the form of a technician asking, "do you have any questions for the pharmacist?" Customer glances at it, says no, and is out the door. In a pharmacy that's filling, say, 600 scripts a day with 2 pharmacists, there is no possible way the pharmacist can babysit every new prescription going out. It's just not physically possible. I have picked up prescriptions for myself and had no interaction whatsoever with anyone except the cashier telling me the price.

I'm realistic about this. I do, as best I can, try to at least perform a "show and tell" (as our State Board calls it.) "This is amoxicillin, you'll be taking one capsule 3 times a day for 10 days". In many cases, that's enough. Most importantly, it gives the customer a chance to say "Wait a minute, I thought I was getting (insert name of totally different drug here.)" Yikes. OK, then either we made a mistake, or the doctor did, or the person's confused. Once in awhile, disaster is averted, it's true.

Or, the customer may say, "but I thought I was supposed to take it six times a day," and then I can do my awesome pharmacist intervention and set them straight, because apparently they have no plan to read the label. ( By the way, don't you love it when someone says "does it say that on there somewhere?" after you have told them the directions?) Uh, yeah, that's why we put that silly little label on there.

Anyways, I do hate it when I reinforce some directions to a patient and they tell me that the doctor told them to do something different than the prescription says. We see this fairly often with e-prescriptions, because the prescriber either doesn't know how to change the directions or can't be bothered. Sure, if it says Celexa 20mg tab once a day but the doctor told them to start with 1/2 tablet for the first week -- that's not inappropriate, I get that.

But last week a customer said they had been given verbal directions which did not match their prescription. This was a drug which most assuredly was NOT usually given in the way the patient was 'verbally' told. Now, I know medicine is not black and white and there might have been a reason. I need to clarify this. It's Friday. The doctor is unavailable and everyone has left the office. In fact, the pharmacy is about to close too. We're not supposed to pull any overtime. I'm sweating bullets because I really don't want this person to kill themselves over the weekend.

I strongly suggest they follow the prescription as written until we can follow up on it but they are argumentative. It's going to be a nightmare to find someone who can clarify this -- the doctor on call can't do much -- there probably won't even be a note transcribed in the patient's chart till Monday or Tuesday.

Long story short, it bugs me all night and I call the patient at home the next day. I explain why I'm worried about it and he agrees to do what I ask, and even thanks me.

Well, it doesn't have a fancy name like "medication therapy management", but for most of us pharmacists it's the best we can do, and sometimes it even works.

Thinking about gifts

2009-12-15T15:36:00.000-08:00

Well, the Christmas shopping is almost complete. Now is the time I usually remember I've got to buy some gifts for my technicians. I float a little bit so I don't feel obligated to buy for everybody, but there are some regular technicians that I've worked with for quite a while and I do like to get something for them. In fact, there are a few of them who are REALLY good, and at Christmas I really want to show my appreciation for them helping me out so consistently. And obviously, I know they don't make the salary that I do. Sometimes you work in a place where you know one or two techs really well, and the others not so much. It's a little awkward but sometimes I have to slip them a gift out of sight of the others.

I usually go with gift cards. If I know they like to shop at a certain place or eat lunch at some favorite spot, I get those. Failing that, I figure everyone can use a Target or a Wal-Mart card. It's not too imaginative, but I feel weird about just giving someone money. You chat with people all year long but unless they have some over-riding passion that you identify with them, it's sometimes hard to remember (what was that restaurant she said she really liked??) I hope it's not too much of a cop-out. I just want to give them something they can use.

Any technicians out there who got a gift they really liked?

Following the Bouncing Check

2009-12-08T13:54:00.000-08:00

I've always been really meticulous (OK, kind of anal) about recording all the checks I write and balancing my checkbook with my bank statement. I never write a check without knowing there's enough money in the account. We just got another alert from the head honchos about one of our customers bouncing checks, and it disturbs me when this happens with our regular customers (ie, not the criminal element one-timers who we will never see again.) And usually they have written at least a couple of checks before we catch up with them --- I mean, how do you come in and write that second check when you know darn well the first one was no good? And you KNOW you'll be back again... like, what's the deal? We know you by name, for God's sake (and frankly, you can be a bit of a pain in the arse.) I've had people ask me to hold their check for a day or two, and we can work with them on stuff like that.

Seems to me it's just not worth the hassle -- I mean, they gotta pay attention. We're now put in the position of telling them we won't accept their personal checks any more. I know it's not my fault, but I still feel bad. We have one husband/wife regular pair who now have to come in and pay cash right out of their ATM envelope. I think I would feel kind of embarrassed. I just wouldn't let it happen.

I'm Mad at Centrum

2009-12-02T15:16:00.000-08:00

(I had a crappy Thanksgiving so maybe bitching about some trivial thing will be therapeutic....)

As a consumer, I hate seeing the word "NEW!" on my long-standing favorite products. DON"T mess with mah PRODUCTS !! Like the shampoo I've always used -- all of a sudden it's got a 'new' formulation and my head feels like a complete greaseball. My 'new' deodorant that doesn't work anymore. My new and improved moisturizer that smells funny and makes me break out. It never fails --- when I get really attached to something, they change it.

I've always taken a multivitamin/mineral supplement every day. There's always controversy about whether they are really needed, but I believe they do contribute to better overall health. This is especially true when I'm subsisting on coffee, granola bars, and luxuriating in half a pack of Life Savers for lunch. I've used Centrum for a long time --- just stuck with it; it's a good brand, doesn't cause me any GI side effects, and so on.

So recently the bottle says "New! Smaller Tablet Size Formula." Uh-Oh. Well, inspecting the label I find they dropped the folic acid from 500 mcg to 400mcg, and dropped the lutein and lycopene altogether. ( Gee, those seemed like a big deal when they first added them --- eye health and all that.) I kind of liked having those in there, although I admit they probably weren't present in large enough amounts to do anything. These changes alone resulted in a smaller tablet? Why couldn't they take out the boron? the vanadium? the nickel?? Or dammit, even the tin?

Well, I don't mind checking out some of the other formulations. Centrum Ultra Women's bumped up the calcium to 500 mg -- well, sometimes that gives me, uh, problems, and I don't want to be stuck with a bottle of 100 if it does. Centrum Silver has lutein and lycopene but NO iron. NO iron?? I still need that. Centrum Silver Ultra Women's has too much calcium and not enough iron, although I do like the 800 units of Vitamin D.

Anyway, long story short --- the porridge was neither too hot nor too cold. It was juuuuusttttt right. Why'd they have to change it??

Swallowing Forum

2009-11-22T10:31:00.000-08:00

We had to prepare (what felt like) a half-gallon of amoxicillin suspension the other day. It was a prescription for a teenager. Yes, Mom said, she "can't swallow pills."

Come on now. Sometimes I have a hard time --er--- swallowing that story. I am just somewhat disbelieving of these teens and adults who claim the total inability to swallow a tablet or capsule. I'm not talking about people who are handicapped or developmentally disabled or have some anatomical defect or injury. I'm talking about the normal folks who, somewhere in their past, gagged on a dry tablet or had something go down the wrong way and are now totally convinced it's beyond their capability. Sometimes they don't tell you until the prescription is all ready -- they look at you wide-eyed and say, "oh, I can't swallow THOSE !!" Well, what the heck did you think you were going to get after coming in for a doctor's appointment, receiving a prescription and waiting for it at the pharmacy --- a smoothie, a Big Gulp, what? They act kind of outraged that you would even present them with this daunting task.

The suggestions I give for this problem --- wetting the tablet or capsule and using a straw to drink the liquid needed to swallow it --- are sometimes accepted and sometimes not. Sometimes you can crush the tablet or open the capsule, but not always. But if a person has convinced themselves they can't swallow a tablet or capsule at the age of 15 it will be a difficult pharmaceutical road ahead, for sure.

Anyone have any favorite tips for our non-swallowers? I need some.

This Week's Snapshots, Pharmacy Style

2009-11-14T11:27:00.000-08:00

1. Flu Paranoia?--- Naaahhh.....

I'm standing in line at the bank and it's pretty busy. A woman is sitting off to the side in one of the chairs waiting for someone, and starts coughing loudly. The place goes quiet and EVERYONE standing in line turns to look at her. She smiles, laughs, and announces "Don't worry, it's just smoker's cough!" Well, thank goodness.

2. Things that make me go WHAT THE.....????

A woman calls the pharmacy to check on whether one of her meds is safe in pregnancy.

Not because she is pregnant, but just in case. She tells me, "ya know, I don't use birth control but I AM sexually active. " Well, that's what we like to hear.

3. Just plain aggravating...

A guy who's out of refills on his glyburide and who hasn't filled it since JULY is annoyed because we won't 'spot' him a few tablets. I mean, if you haven't been too concerned about your blood sugar for the past 3 months, what's the big emergency all of a sudden?

4. When in doubt, dispense a placebo....

A woman calls and says the new generic brand of acyclovir we gave her does NOT work.

She says she wants the other ones, and implies we have given her some sort of bogus fake acyclovir. I don't even try to argue because there are some battles you're just not going to win. We give her the last few tablets we have of the old brand and wish her happy shopping to find any more. I wish I knew of a better way to deal with this type of thing.

5. Laugh to keep from crying.....

Working with a very slow and kind of unpleasant technician this week who's been given every chance to get up to speed. Waiting for her to crank out a simple Vicodin script that the other techs would have done in about 30 seconds. The other (dryly humorous) pharmacist I'm working with mutters, "What the hell is she doing, harvesting the opium poppies or something?"

A Bit O' the Ugly

2009-11-09T14:40:00.000-08:00

We have a customer who comes in every few weeks -- nice squeaky-voiced little elderly lady, early 80's, who seems really sweet. She refills a prescription which is used for possible Alzheimer's symptoms or at least early signs of confusion/dementia, but she comes in unassisted and neatly writes a big fat check for this medication.

The other day I heard her asking the technician about some lab results she had been mailed from her doctor's office. I went over to see if I could help with the question and looked at the letter she had in her hand. There was a serum creatinine result and also an estimated GFR, so these were obviously kidney function tests. There were two results for the GFR, however, and one was labelled "Afr-Amer" or something like that. I don't deal with this a whole lot, but I told her I thought it was because a correction factor is applied if the person is African-American -- there's a different 'normal' range, and the lab printouts show this as a matter of routine so the correct result can be applied. These printouts can be confusing for anyone to read, no doubt, and I figured she just didn't know what the heck any of it meant.

Well, I quickly realized it wasn't the numbers that she was questioning, it was the "Afr-Amer" part. This little mouse of a lady, always pleasant small talk, usually in and out in a minute or two, got kind of upset. She got this hard edge to her voice I never heard before, and said "Why is THAT on there? Are those even my results? I just don't think THAT should be on there!" and repeated these comments several times. We finally offered to call the lab and have them explain it to her. "YES, I would like to do that," she said firmly.

Wow. After she left we all looked at each other, kind of taken aback. One of the techs ventured a comment about "people from a certain era and age group" . It was just weird to see this little bit of ugliness coming out of this (presumed) nice little old lady.

Just another interesting observation from another day at the pharmacy.

My Love Affair with Canadian pharmacies

2009-11-06T20:30:00.000-08:00

I have some ties to Canada (specifically, Ontario) and just got back from a trip across the border. Why do I enjoy my occasional visits so much? Is it the unfailing politeness and intangible feeling of civility I encounter there? The lower prescription prices? The health care system that is equally accessible to both the minimum wage-earners and the CEOs? The notices smartly posted in the banks and other public buildings about protecting yourself from the flu?

Yes, all those things, but as a pharmacist I really enjoy snooping around in the Canadian pharmacies.

First of all, there are a number of items that are over-the-counter in Canada that we still need a prescription for in the U.S. -- things like Allegra, Clarinex (although it's called something else) & scopolamine patches, to name a few. I stock up on those for my allergies and airplane flights. Sudafed products are still out on the shelves in Canada. They even have "extra strength" Advil (400 mg per tablet -- sweet!) I don't know what the meth situation is in Canada, although the pharmacy I visited did have two large signs in the front window stating that "narcotics such as Oxycontin are available by special order only." I wouldn't have a problem with that at all.

Then I proceed to the checkout where the candy is, and this is the part I really like.

The uniquely Canadian candy bars like Coffee Crisp, Aero (the bubbly chocolate), Smarties (cousin to M & M's), and the tooth-rottingly delicious Crunchie Bar (sponge toffee coated in chocolate). The clerk must have thought I was loading up for the trick-or-treaters but no, it's all for me to take home and hoard.

Instead of "Dancing with the Stars" they have "Battle of the Blades". It's a show where skating pairs compete, and the male half is an ex-NHL hockey player! You gotta love it.

Oh, and the ubiquitous Tim Horton's coffee and donut shops ---- heaven.

I know I should be thinking about larger issues than these, but not today. I'll take a large coffee and a honey-glazed, and all's right with the world in the arms of our neighbor to the north.