The Public, the Providers, and the Plodding

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

The "Public" Factor:

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

The Providers:

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

The Plodding:

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

Yup, this is gonna be interesting.

Advancements in Pharmaceuticals for the Good of Humankind

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

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

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

DON"T !!

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

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

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

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

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

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

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

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

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

Let the Games....Continue

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

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

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

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

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

Knock it Off!

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

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

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

Many Americans do a Glucose Tolerance Test Every Day

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

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

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

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

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

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

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

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

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

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