We've Come A Long Way, Baybeeeee!!

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

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

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

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

What's Happening

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

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

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

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

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

Say What?

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

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

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

Hey, Remember ME??

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

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

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

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

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

Working, and OK With It

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

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

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

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

Who's not Listening here?

"Pharmacist! Phone Call!"

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

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

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

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

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

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

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

"Well, her eyes aren't red."

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

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

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

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

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

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

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

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

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

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

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

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

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