Complaint Dept.

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

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

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

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

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

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

And that concludes my pissing and moaning for now.

A Little Cluster of Inattentiveness

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

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

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

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

The Waiting is the Hardest Part

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

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

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

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

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

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

The OTC Jungle, Revisited

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

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

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

Dazed and Confused

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

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.

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.