Pharmacists: Front and Center

It's been a long time since I paid any attention to APhA, but I would encourage fellow pharmacists to
take a look at (and sign) a petition started by our fellow blogger, the DrugMonkey.  For whatever reason, APhA has chosen to give an AWARD to a guy whose writings (and you will see a sample) defy anyone's perception of what a scientifically-oriented, advance-the-profession-of-pharmacy type of outfit should be all about.  Really quite stunning.  Take a look:


https://www.change.org/p/thomas-e-menighan-ceo-american-pharmacists-association-apha-end-your-endorsement-of-homophobic-pseudo-science?recruiter=8922511&utm_source=share_petition&utm_medium=copylink

or go to Change.org and search "APhA".

A quick question for fellow pharmacists

Is anyone else out there seeing prescriptions written for generic Revatio (sildenafil 20mg),
with directions to be used as Viagra?

What's It Worth to You?

It's a weird business we're in, this medicine stuff.  In my oft-repeated role as a highly-paid cashier, I am tasked with telling people how much their medicine purchase totals up to.  In any other retail situation, we approach the cashier with a pretty good idea of how much we're going to pay.  In pharmacy-- not so much, because there is usually a 3rd party payer involved who picks up some of the tab -- a lot or a little, thus leaving a lot or a little for us to CO-pay.

People's definition of what a "lot or a little" is can be surprising, to say the least.  This week I had a customer fork out $180 for a topical steroid product without batting an eye.  Later on I checked someone out with four prescriptions, including some moderately pricey stuff, and his copay was $6.00. "WOW!!" he exclaimed, in all seriousness.  "You guys are gonna BREAK me!"

I don't know where people got the idea that all medications should be cheap.  (and actually, a lot of them are.)  But something that is potentially life-saving, life changing, and keeps you out of the hospital (where $6.00 wouldn't even get you into the parking ramp?)  Don't make me feel like some kind of shyster for asking for your payment.

YOU can decide what it's worth to you.

View from behind the counter today was not pretty

We are desperately trying to close up and go home.  Everyone is tired, hungry and irritable after a long day.  But the electronic prescriptions keep pouring in, so we can't just hand the piece of paper back to the customer and say, "Sorry, if you need this tonight you'll have to go elsewhere. We are closed."
We finally finish up, and I realize that probably 50% of the prescriptions that kept me and my staff overtime were for things like Claritin, and Miralax, and Tylenol -- over the counter stuff.

OK, I know. This is a pet peeve of mine.  I used to think that as a pharmacist, I would be dealing primarily with prescription drugs.  Sure, I would give advice on over- the-counter products, but ultimately these would be customer self-selected.  Someone would come in thinking "I need something for my allergies" (or kid's diaper rash, or flaky skin, stuffy nose, constipation, sore shoulder, etc. etc.) They would go to the section marked "Cold and Allergy" (or some such designation),  peruse the products, read the labeling and make a decision -- and ask me or my staff a question or two if necessary.  I wonder if those people exist anymore.  I think everyone goes to the doctor for everything now, and the proliferation of the Doc-In-A-Box outlets probably makes it even worse.   Nobody can read labeling, or instructions for use, or precautions.  They refuse to take the time.  I just wish people could keep things in perspective, when others around the world are living in tents and scratching for food and dodging rockets and burying their dead.

Prescriptions that don't get picked up within a certain period of time have to be returned to stock.
I am astounded by the number of these we put back every week. Why were they never picked up? Remember when getting a prescription was kind of a big deal?  SOMEONE had to call in that refill. SOMEONE sat there in that doctor's office.  By never picking up that prescription you have wasted everyone's time, and lots and lots of money.   WHY???

I got a call from someone who said she hadn't been checking her blood sugars for several months, but decided she should start doing it again.  Therefore, I needed to call her doctor, get a new prescription for test strips, and then I needed to see that the strips were mailed to her.   Yeah, I know -- I'm supposed to act for the welfare of the patient and see that she gets her diabetes supplies so she can test her blood sugar and be well and all that.   Why do I feel like SHE should be doing this though?

Wastefulness and entitlement.  Sometimes you feel like you see nothing else. I sure wish we Americans could have some sort of revelation.  I wish we could lose some weight too.

A New Phase

Having spent the last few weeks dealing with the health issues of an aging parent,  I have a new found
sympathy for people who try to negotiate a health care system they don't understand, a bureaucracy that seems overwhelming and medications whose names appear to be written in Swahili.  Having worked in health care for a long time gave me a distinct advantage that I wish everyone had, but doing many of these things 'long distance' will present continuing challenges.

A few things I learned:
Thank goodness we had an Advance Medical Directive all signed and sealed.  If you don't have one of these for your parents or other family members, do it NOW.   It is needed not only for end-of-life decisions, but to allow medical staff to share ANYTHING with you about the person's condition.
Make a copy of it and store in on your smart phone, computer, iPad, or whatever.  You won't be sorry.

There are a lot of heroic people working in long term care.  It is unglamorous and thankless.  We spoke with a nurse who was on a 16-hour shift.  We had many others go above and beyond to help us with appointments, transportation, etc., and take time with us when they had none to spare.

Just one appointment with a doctor who looks at you and LISTENS.. psychologically can make all the difference in the world.  It was a long wait, but it was worth it.

I have a feeling I'll be getting more insights over the next few months, but you know what? I think it will make me better at my job, and that's a good thing.

Down Memory Lane

Maybe it was getting outside for a long walk after a winter's hibernation that did it, but I started reflecting over my years as a pharmacist, and thinking about the little incidents that stood out to me. Although I've worked in retail for quite a while, a lot of my memories go back to hospital pharmacy, where I also spent a lot of time.  Through the hundreds of med-cart checks, the thousands of orders and IV bags and crash carts and questions about "can I mix these two things in an IV?", it's interesting how certain moments stick with you forever.  My own list includes:

-- one of the first times (as a newbie) I was sent up to the bedside to talk to a patient about his potential discharge meds.  He had a tube in his throat and told me he really wasn't interested because his wife took care of all that stuff.  I didn't know what to say to him and I still wouldn't today. I felt pretty darn inadequate.

-- walking through a "Head and Neck" unit where the patients often had cancer and were sometimes terribly disfigured.  One poor guy basically had a hole where his nose should have been.  The head nurse there was an absolute angel and took care of those people like they were family.  Her name was Sandy.

-- staying several hours late after an evening shift waiting for the blood bank to deliver a bunch of gamma globulin so we could run it all into an IV bag for an emergency high-dose administration.  I had never done it before.  I walked it up to the nursing unit after we prepared it.   I still have nightmares about tripping and falling, and watching that IV bag burst and splatter all over the floor.

-- ditto with my first experience preparing a bag of high-dose methotrexate.  The oncologist was young and fairly new and I think even he was nervous to order it.  The patient was a 21-year old.

--after years of working in the basement, being transferred to a surgical satellite pharmacy on an upper floor.  I remember sitting there with the sun streaming through the window one day and feeling reborn.

--starting a new hospital job and sitting through new employee orientation, when a huge packet of "Benefits Information" would be slapped down in front of me.  I'd think Gawd, this is so borrring!
Little did we know that that kind of job (full-time! with benefits!) would become the ultimate in good fortune.

-- and finally, going on bedside rounds in a Nephrology unit.  We were visiting with an older woman -- sick, chronic, hirsute.   She said to the (very experienced and very kind) doctor, "I'm worried."  He looked at her and said simply, "I am too."   I'll never forget that one.

Monday Morning.. Quarterback?

I'm really glad to see that Nasacort is going OTC (the first topical steroid nasal spray to go over-the-counter in the U.S.).  This type of product is already OTC in other parts of the world.  I think these Rx-to-OTC switches are a good attempt to bring down costs and put more of the responsibility on the consumer (remember how much time you used to spend dispensing Allegra and Claritin?)  Of course we still spend way too much time on OTC prescriptions, but that's another story.  Gosh, if Flonase ever goes OTC I might actually get to eat lunch once in a while...

Here we go with 2 weeks of Olympics overload again.  How come somebody can always come up with billions of dollars for sporting events but not for housing, food, homelessness, health care, or any of the other problems that plague Russia or other host countries?   And I like watching NHL hockey games as much as the next guy but those players are professionals -- they get paid to play hockey full-time  --- and I have no idea how they fit into the original intent or spirit of the Olympics.  Allowing professionals into the Olympics (and the amateurs to do commercial endorsements, etc.)  ruined what little interest I had.  Beijing's Olympic Stadium now sits unused and falling into ruin, and I suspect most of the Russian venues will end up that way too.

I really enjoyed watching Philip Seymour Hoffman.  So why would this guy, who seemed highly intelligent and at the top of his game, with three small children, stick a needle in his arm?  It's really unsettling. I guess we're reminded that that's what addiction is.  I still remember a pharmacy school lecture where the instructor was explaining how to alleviate a cancer patient's fear of "addiction" to pain medication that they truly needed.  One of his points was that 'addiction' includes actively seeking out a substance and being compelled to use it, knowing full well that it's harmful.  It's an illness, and I can only rationalize his actions that way in my own mind.  They say that heroin is making a big comeback and that prescription drug abuse is a gateway to it.  And that doesn't make me feel too good either...