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Monday, December 12, 2016

No, I Do Not Feel Bad For You

Pharmacies have spent the better part of their history trying to do what is right for their patients. What were once considered professional courtesies have now become the expected norms. There comes a point when these courtesies are held against you and you need to fight back.
Offices that have messages instructing their patients to call the pharmacy so we can submit refill requests are probably the most loathsome of the bunch. But the story from my weekend adds an ever-growing-in-popularity wrinkle.

I Deserve Another New One: I called my doctor and they said to call you.
CP: Wonderful. Now that you have completed following instructions I shall bid you Good Day!
IDA-NO: Wait. They told me to ask you to give me a few tablets to get me till my appointment; or at least until they open Monday.
CP: I see. So you actually spoke with the office?
IDA-NO: Yes.
CP: Uh-huh. Why did they not just approve the refill? I have many offices that approve e-script requests on weekends.
IDA-NO: They have a No-Refills-On-Weekends policy.
CP: Phunny. I have a "Don't Fill Prescriptions From Stupid Doctors" Policy. If they don't care enough about you to approve refills when you actually speak with them, then perhaps it's time to find a new prescriber?
IDA-NO: But they said you'd give me some.
CP: No. They told you to call and ask. You spoke with them and they denied your request and passed the buck to me. Now I am expected to shoulder the blame. If I say "No" they can blame me. My direct deposit was late due to the Holiday last month. I asked the bank to hand me $50.00 so I could buy pies to take to dinner. For some reason, they laughed at me. I told them it works like this at the pharmacy. They told me to go to the pharmacy then.

Look, I understand the "no refills on the weekends" policy and could even defend them. However, with more offices requiring pharmacies to send electronic requests and many offices approving refills on weekends this way, healthcare is no longer a M-F 8:30-5pm office job. But I absolutely will not be your bitch if you try to make me the whipping post for your policy.

Thursday, December 1, 2016

New Symptoms

A little #PharmacyPhun from the weekend...

CP: What is your chief complaint?
Little Old Lady: "I have a horny cough."
CP: Um...
LOL: What do you have for my "horny cough"?
CP: Um...

(thoughts in head)
I can give you something to suck on...(cough drops, perverts!)
I have something that will slide right down and coat your throat (stop it!)

After Uber-Intern and I collected ourselves we decided it would be more phun to ask everyone for their input.

What suggestions do you have for treating Horny Cough?

Tuesday, November 29, 2016

I'm Revoking Your Privileges

Computers are supposed to make everything easier. 
E-scripts are supposed to make everything easier...and error-free. 
What both of these statements forget is that humans are required to make use of them. 
Humans are the X factor. 
Humans (read: prescribers) tend to make things more difficult. 
Other humans (read: pharmacists) are, fortunately, there to clean up the mess and make sense of it. 

Prescription received electronically by the pharmacy: "Entercourts 9mg"
Okay. First read, it's obviously Entocort. 
But...Entocort is only available as 3mg. 
Hmm. Second glance, maybe it's Intercourse? You know, just a little dose. 
Perhaps a permission slip for a lawyer?

Of course it's the weekend. 
Of course the prescriber must be paged. 
Of course he calls right back. 

CP: Hiya. 
Adopter of New Technology Means Admission of Nothing: Howdy. What seems to be the trouble? 
CP: This new-fangled technology seems to have taken what you entered, shredded it, reassembled it, then shot it onto my computer like a study hall spitball to the chalkboard. 
ANTMAN: What was it? 
CP: It came across as "EnterCourts". 
ANTMAN: That's what I typed. 
CP: Oh. Then you're the spitwad. 
ANTMAN: "I didn't really know how to spell it. I was going off of someone else's notes." 
CP: I see. "How did the computer allow you to type something that doesn't exist?" Better yet, "why are you prescribing something you don't know how to prescribe?" 
ANTMAN: Well I knew what I wanted and assumed it was close and you'd figure it out for me. 
CP: I appreciate your (totally warranted) faith in me but I still had to waste my time tracking you down...on a weekend. How about next time you just use the phone? Last I checked, prescribers' phones allowed outgoing calls. There's also this, albeit primitive, invention called pen-and-paper. It wouldn't help the issue here, but at least you could write "Budesonide 9mg or WTF" and I'd understand you want Uceris. 


Thursday, November 17, 2016

Overstepping Their Bounds

I know how to do my job.
You know how to do your job.
I won't tell you how to do yours if you won't tell me how to do mine.
Better yet, I won't tell other people what your job is if you won't tell other people what my job is.
Agreed?

Same Shit Every Weekend: I am out of my medication and I really need it.
CP: Ok.
SSEW: What should I do?
CP: Call the office.
SSDW: I did.
CP: Good job. What happened?
SSDW: The answering service said you'd give me 2 or 3 to get me through the weekend.
CP: Really? She said that huh? Okay. Call her back and tell her she will page the prescriber. Tell her it's okay, the pharmacist told you she would do it for you. It doesn't matter that this office has a "no refills, never page the prescriber" policy on weekends.
SSDW: Okay.
CP: In the meantime, I'll fax him for you. For some reason, it seems the prescribers at this office like to sit around and watch football and send e-scripts. You'd be surprised how many we receive on weekends.

<20 minutes later>
CP: I got your prescription.
SSDW: I know. I got another person at the answering service and she put me through.
CP: I just love problems that resolve themselves.

Wednesday, November 16, 2016

Ask the Question You Want Answered

My sixth grade teacher impressed upon me the correct way to ask a question. It was a habit of 12 year olds to ask "Can I go to the bathroom?" and he would properly respond with "I don't know. Can you?" We, of course, would reply "May we?" and he would say "I love French".

Anyway, it helped develop my way of looking at things and the importance of word choice. My other favourite question is: "Do you know what time it is?" The correct answer to this is either "yes" or "no". The person did not actually ask for the time.

This brings me to my favourite counseling question:

"Can I drink on this medication?"
Of course you can drink on it. You'd die in about 3 days without water. Don't be silly.

"Can I drink alcohol while taking this medication?"
Better, but not perfect. Certainly you CAN drink alcohol while taking this. I'm assuming you're able to drink water and other beverages so alcohol, in its fluidity, should easily be drinkable for you.

"Should I drink while taking this medication?"
Yes. This can dehydrate you so it is important to replenish your fluids.

Ugh! "Might it be permissible to imbibe while taking this medication?"
Hell no! What are you, crazy?

Friday, November 11, 2016

I Have A Syncing Feeling

Did you ever have the feeling some people prefer to argue or complain simply for the satisfaction they get from being miserable? They're not looking for a resolution, rather they seek to make others share their misery.

CP: Welcome, to Jurassic Park.
Frequently Unsatisfied Customer: Jurassic Park?
CP: Trying out new names for the pharmacy. We're not getting any younger.
FUC: You're weird.
CP: So I've been told. How may I help you today?
FUC: I have a few prescriptions to pick up.
CP: Just for you?
FUC: Yes.
CP: Today I have three of them ready.
FUC: "Yeah. I take a few other ones. I really wish there was some way I could get them all on the same trip. I really hate having to make multiple visits here during the month."
CP: It sure is inconvenient. It's not as if you're here every other day shopping for other items throughout the store. Must just be the pharmacy where the stars don't align. I wish everything in my fridge and cabinets would run out at the same time too but, I digress. You were whining?
FUC: I take a whole bunch of medication and want to get them all in one trip.
CP: Got it. Well today is your lucky day, seƱor FUC. We happen to have this remarkable program that does the thinking for you. It takes all your prescriptions and sets them to fill on the same day each month. It will even adjust the fills for the next month so they will all be due together. It's truly amazing. It takes the thinking right out of it, something that seems right up your alley. "Should I go ahead and sign you up for this syncing program?"
FUC: "Nah. Not today. But thanks."
CP: Of course not. Well, I look forward to having this conversation again next week. Provided I'm still here. Since I now won't make my goal of enrollments.

(Yes, this was inspired by a true conversation.)

Wednesday, November 9, 2016

You Are Allowed

How about just saying what you really mean? "I am an asshole." Period. It is simpler that way and patients understand.
Wait. Allow me to back up a moment.

Twice this week, we faxed Dr. Zoffis prior authorization requests.
Twice this week, Dr. Zoffis replied with a fax that said: "patient is allowed to purchase this medication without insurance".
Well no shit, Dr. Obvious. The point of the prior authorization fax is to let you know the insurance won't cover the medication you prescribed, not to ask your permission for the patient to pay hundreds of dollars for it. They really don't need your approval to do that.

Here is the brief debate that ensued at my pharmacy:
CP: I don't like prescribers that do this. If you don't want to do prior authorizations, simply say that. but PLEASE make sure that your patients know you will not help them.
CPP: I don't have a problem with it. I see this as patients today walking in to the office and requesting to be placed on the medication they want.
CP: Okay. I will grant you that. Remember last week with the prescriber who refused to do the prior auth for a medication they prescribed after they had been giving samples to the patient?
CPP: Yes.
CP: The prescriber chose the medication. He gave the patient samples. Now that the patient's insurance won't pay, the prescriber tells him "too bad, so sad because I don't do prior auths"?
CPP: I see your point in this scenario.
CP: How is he servicing his patients if he won't be bothered to prescribe an alternate treatment? Just because he picked this particular medication, and it's not covered, he won't prescribe anything else?

It's one thing to have a policy against wasting time and resources on prior authorizations that may not improve patient outcomes or end up with you chasing your tail. It is quite another to offer the patient no other options for treatment. They came to you seeking help. You are their healthcare provider.

Friday, November 4, 2016

Your Logic Astounds Me

Or ... Really?

Wednesday, the day. 10am, the time.
Bitchy Lady Assuming My Eager Deference: I was calling with a question?
CP: Okay. Then what happened?
BLAMED: Huh?
CP: You WERE calling, then what happened?
BLAMED: Um...I have a question?
CP: Sure. Go for it.
BLAMED: My doctor assured me that you would fill my prescription on Friday.
CP: Really? That's rather presumptive of him. I can't recall the last time your doctor called me to discuss any of our mutual patients.
BLAMED: He told me you'd fill it and I just wanted to make sure it would be okay.
CP: Well, according to my records, you will be too soon on Friday so I will not be able to fill it.
BLAMED: But he told me...
CP: Yes. Yes he did. As you've made abundantly clear. However, the important part is that he did not tell me. You know, the pharmacist charged with filling it.
BLAMED: I have a trip planned and I leave Friday.
CP: Well, seeing as how today is Wednesday, you have plenty of time to take the necessary steps. Simply ring your prescriber, have him call me and once we have discussed your prescription, I should be able to fill it.
BLAMED: Now I can't go on my trip! It's all your phault. I won't get to visit my new grand baby and ...
CP: Hello? I made this really simple for you. It's 10am on Wednesday. Call your doctor and have him call me. You have 3 days.
BLAMED: You personally ruined my trip. I'm going to transfer my prescriptions out and never come back.
CP: Sounds pretty extreme and I'll miss conversations like this one but be bold and do not cower in the face of your convictions. In the meantime, I would suggest calling your doctor so he can approve your early refill with the pharmacy you choose to have fill your prescription.
BLAMED: He's Pain Management. I can't find him. He's in a different office every day.
CP: And you have 3 days. Call all the offices. Leave messages. Hell, drive to each location, knock on the door, and ask if the doctor is in.
BLAMED: I can't believe you're going to make me miss my trip.
CP: You realise I'm only stalling because I want to see how long you choose to keep arguing with me.  I should have hung up a long time ago but I feel as I'm really making progress, slowly chipping away at the thick layers of your skull. For the last time: Call your doctor. Tell him to call me. You have 3 DAYS.

<fast forward a whopping 22 minutes>
Pretty Honest Office Nurse Ejaculating: So...BLAMED tells me you're refusing to fill her prescription.
CP: Is that what she said?
PHONE: Yep. Pretty sure that's not the whole story.
CP: Yep. It's too soon and she told me the doctor "assured her the pharmacist would fill it" early.
PHONE: Phunny. I told her we'd probably have to talk to the pharmacist.
CP: I just wanted to make sure we were both on the same page.
PHONE: The patient brought in plane tickets and her reservation. Otherwise, the doctor would have absolutely said no. We will make the adjustment on the dates for next month accordingly.
CP: Perfect! Too bad she skipped telling me all that. Next time, just have Dr. Zoffis write a note explaining why he approved the early fill (checked itinerary) and I will fill it. Of course, it would have helped if she had brought me the prescription first, as I requested.
PHONE: At least you didn't ruin her trip.
CP: No. Just her morning. But she made mine. At this rate, I'll be held responsible for the outcome of the election.

#MyFaultIsBiggerThanSanAndreas
#OwnYourStupid

Friday, October 28, 2016

I Wouldn't Believe It If I Hadn't Been In Pharmacy

Just a typical week in the #Pharmacy. Full of to-be-continued stories. It's the longest-running soap opera. We need our own channel.

CP: CP's Pharmacy, How may I grovel for your business today?
DUDE: I have a question.
CP: I have an answer. That's a go for CP.
DUDE: What medication did you refuse to fill for me?
CP: We didn't refuse to fill anything for you.
DUDE: Yeah huh! It was my blood pressure.
CP: You mean the one you presented over the weekend?
DUDE: Yeah.
CP: The one that needs prior authorization?
DUDE: Yep.
CP: The one that was written over 2 weeks ago and you managed to bring in on a Saturday now that you've been out and are blaming me for destroying your blood pressure?
DUDE: That's the one.
CP: The one that I offered to fill as CASH for you?
DUDE: Uh-huh.
CP: The one you refused to pay $200.00 to take?
DUDE: That's the one.
CP: Okay. Now I remember. Why do you need the name? I faxed the office for the prior authorization that day. It's now Friday. Shouldn't they have done it by now?
DUDE: I called to ask for samples and they said I need the name.
CP: Hold on. What?
DUDE: They said I had to call you to find out the name of the samples they gave me so they could give me more.
CP: This is either the phunniest thing I've heard or the saddest testament to healthcare today. Let me make sure I understand you. Your prescriber, the one who actually wrote you a prescription for a medication, needs you to call me so I can tell you the name so you can call them and tell them what they wrote for you so you can get more samples of something they've been giving you for months? (Never mind that you don't know what you've been choking down every morning.)
DUDE: Pretty much.
CP: Are they working on the prior auth?
DUDE: Not sure.
CP: So confused right now. Your prescriber chose the most expensive, brand-only medication in this class and won't change it. Doesn't know what it is. Doesn't know what he's been sampling to you. Apparently doesn't have a charting system in the office. Didn't communicate if they're going to do the prior auth. And you're okay with this?
DUDE: Yes?
CP: Here's a secret. Pharmacists have lists. The lists have certain prescribers on them. Your prescriber is now on my list. Hopefully you choose your President better than you've chosen your healthcare provider. From this, I'm guessing you're going to vote for

Monday, October 24, 2016

No Good Deed...

One day, out of the goodness of my heart, I decided to help my neighbour. It was nothing major, just a simple, random act of kindness. She was on vacation and I took the time, while mowing my lawn, to cut her grass too. (This could also apply to shoveling her driveway and sidewalk during the winter months since she is older and may slip on the icy drive.) Anyway, I did this for her one time. The next time her grass needed mowed, or walk needed shoveled, I saw her on her front porch. I was busy taking care of my own yard maintenance and smiled at Friendly Neighbour when she suddenly turned  abrasive towards me. We've occasionally shared a morning coffee and the random bit of gossip together so this turn of events was quite surprising.
FN: Why aren't you doing my yard?
CP: Sorry?
FN: Why are you not working in my yard?
CP: Because it's your yard. I have my own yard to tend.
FN: You took care of mine once for me.
CP: Yes. As a courtesy.
FN: Well now I expect it every time.
CP: I guess you'll just have to learn to take care of yourself again.
FN: What? I guess I'll just slip on the ice, break a hip, and die then.
CP: Well there's that. Or you could use your tractor with the plow attachment and, you know, do it yourself like you used to do. I bet your pharmacist once called your prescriber to obtain refills for you, as a simple courtesy, and now you just expect her to do it for you every time. I'll even wager that you go days without medication because you figure someone else is going to take care of your responsibilities for you. Parents wipe the asses of their children until they outgrow their diapers. I'm surprised I've not walked into more public restrooms and heard: "Mom! come wipe my butt!" from twenty-somethings. I mean, mom still calls in their birth control for them. So, no. You can mow your own grass or shovel your own walk ad infinitum.

Thursday, October 13, 2016

Winning At Customer Service

When it comes to healthcare, people only care about one thing. Speed. And cost. Okay two things. The two things people care about when it comes to their healthcare are speed and cost. And convenience. Okay. The three things people care about are speed, cost, and convenience. Apparently, pharmacy has fully embraced this concept and based its rewards system on these three tenets of healthcare.

I like to play games. 
I hate to play corporate games. 
I like to play games with corporate. 
Corporate hates when I play their games better than they do. 

Here is my proposal: Remember the other week when I said "suck at your job"? The second part of that is to wait until corporate starts a contest. Since you intentionally failed miserably at their quotas/metrics, you know how to meet them. Now that there is extra incentive for you, excel at your job. Reverse course and, instead of fighting against the flow, go with it. You won't have to do anything and you will be Most Improved! 

But I don't want to stop there. No way. I say go Balls Out to beat them at their own game. 
Corporate says to give gift cards. 
Corporate says to remind patients to call the 1-800-I-HATE-YOU number. 
Corporate says to increase Customer Service Scores.  

The solution: Become Oprah. 
Give EVERYONE a $10.00 Gift Card. 
a. 20 minutes too long to wait? Gift Card to sit quietly. 
b. On the fence about a flu shot? Gift Card to help my numbers. 
c. I need more Zostavax, Pneumo, or Tdap shots this week. Gift Cards for each one you get. 
d. Out of stock on your new e-script? Gift Card for you. 
e. Gift Card if you call the 1-800# from our waiting room. 
f. Just walking past the pharmacy? You get a Gift Card too! 
You get a gift card!
Everybody gets a Gift Card!

If "they" want us to give gift cards to reward negative behaviour, we should be able to buy a few positive votes as well, right? It is election season after all.

 I wonder how long it'll be before they decide to rethink the whole negative-reinforcement-buy-them-off-with-gift-cards concept...

Tuesday, October 11, 2016

Ways To Improve

Stores are often tasked with designing ways to improve their performance. Whether it is increasing script count, customer satisfaction calls, flu shot totals, or the atmosphere of their pharmacy, for some reason the stores are responsible. Even though we have District Managers and a Corporate Marketing Team, for some reason, underperforming stores must get creative ... in addition to all their other duties, like actually filling prescriptions.
The next time corporate asks for suggestions, keep these in mind.
To increase flu shots:

1. Snipers. Snipers with blow darts.
2. Impregnate the handles of the shopping carts/baskets.
3. Needles on the chairs in the waiting room.
(Note: They did not say we had to collect copays, only that we had to increase the number of flu shots administered.)
4. Mascots. You know the Liberty Tax locations that dress an employee as a Statue of Liberty during tax season? She's out of work right now so get her a Giant Syringe costume and stick her on the corner. Perfect for Halloween season too.
5. Play Hide-And-Get-Shot with the kiddos while they wait with their parents.
6. Hold their prescriptions hostage.

Little Old Lady: I'm here to pick up my prescriptions.
CP: Have you had your flu shot yet?
LOL: No. I get it at my doctor's office.
CP: I see. Would you like one today? No appointment necessary.
LOL: No, thank you. I just need my heart medication.
CP: Ok. That'll be $20.00 for the 4 of them...and a flu shot.
LOL: What?
CP: How bad do you want your heart medication?
LOL: I need it to live.
CP: A flu shot will help too.
LOL: I just need my medication.
CP: I cannot sell these to you until you agree to a flu shot.
LOL: But I'm getting one next week.
CP: I don't know that. Believe me, it's for your own good.
LOL: I'm going to have a panic attack.
CP: I guess you'd like the Xanax in your bag too then, huh? Agree to a flu shot...
LOL: But...
CP: It's just a quick prick...
LOL: But...
CP: It'll be over before you know it.
LOL: This is a shakedown.
CP: Corporate said to increase the number of flu shots we administer. They did not rule out extortion.

Monday, October 3, 2016

Grandparents Are The Spoilers

As parents we want what is best for our children. It is our obligation to be diligent when it comes to the welfare of our children. This is what we agreed to do when we signed on to become parents. We knew full well there would be trials and tribulations along the way. There would be ups and downs. What we often didn't expect however, was the grandparents. Grandparents have a unique way of undermining our best efforts as parents. Somehow they raised us and we turned out okay. At least we think so. But we want our children to be better. We want to do better for them.

As times change, each successive generation believes they have it harder than the previous one. At the same time, the previous generation believes the newer one has it better. As each generation doesn't understand the others' music, neither do they understand what it's like to be a parent in that age. 

As parents, we are in charge of disciplining our own children. We give them rules to obey in our house. When we take them out in public, we have rules there too. But at grandma's house? The same rules don't apply. Why? Because no one disciplines the nana. I've even seen that saying on cute little signs: "No one spanks the Nana." In today's family dynamic, there's the chorus of: "We can at grandma's!". While that has most often been the case, it takes on a different meaning today.

While most certainly there are grandparents who are strict with their grandchildren there are always exceptions. Another fond saying is: "Grandchildren are God's reward for not killing your own children". Some grandparents will spoil their grandchildren rotten while others want no part of dealing with the mini question fountains.

How many grandparents hand out candy like it's, well, candy? Despite our strictest rules, grandparents are often there to curry favour and spoil the little buggers. Fill them up with love and attention and all things mom doesn't allow in her house, then send them back there to their insufferable, soda-free existence. Ultimately, it is about balance. You must obey mom's and dad's rules except at nana's house where the rules don't exist and because no one spanks the nana.

...and this is what is wrong with American healthcare today.
The Parents are the Pharmacists.
The Grandparents are the Prescribers.
The Children are the Patients.
The Candy is the, well, still it's "candy".

Reread it with these characters in mind.
Despite the best efforts of the parents (pharmacists), there will continue to be grandparents (prescribers) getting away with handing out "candy" to the children (patients) because no one spanks the nana (prescribers).


Friday, September 30, 2016

Things You Don't Want to Hear From Patients During Shots

1. (moans)
2. Deeper!
3. Is it in yet?
4. It's smaller than I thought.
5. Awwwww.
6. Can I touch it?
7. Get that thing away from me.
8. Where are you going to stick that?
9. I didn't know they came in different sizes.
10. Yes! Yes! Yes!
11. My last pharmacist had a bigger needle.
12. Again!
13. Let's cuddle!
14. Of course I'll call you.
15. Just the tip, right?
16. Well that was quick.

#YouWontFeelAThing

Thursday, September 22, 2016

How To Succeed With Corporate Without Really Trying

If you want to get noticed, if you want to get recognised, if you want to be successful, remember this: do the opposite. When you read about why people leave jobs they love, one of the reasons is lack of recognition. Awards go to the Most Improved, NOT the Most Consistent. If you do your job, and do it well, you are not the type of employee corporate values. If you suck at your job then respond with marked improvement, you are a valuable asset, worthy of recognition and promotion. Seems a little backwards, eh?

Here is what I propose. Suck at your job. (Bear with me here.) 
When a new metric is introduced, suck at it. Do the worst. Strive for sub-mediocrity. Learn how to achieve the goals, but also how to NOT meet them. This will allow you to hit them harder and faster than everyone else. When the time is right, and the same few stores have excelled at hitting their targets, step in and not only meet but exceed your goals. You will receive all the praise and glory while your colleagues will be asking themselves "WTF did I do wrong here?" when they get nothing for doing their job correctly. 

It seems to have worked for a lot of colleagues and DMs I have met over my career.

Suck at your job. Just not at everything all at once. You don't want to become a DM...Then you'd be forced to host those weekly conference calls instead of blocking them out on the speakerphone.

Monday, September 19, 2016

Why Words Are Important

We all know that there are people out there for whom we need to spell out everything. This is especially true in pharmacy with regards to our labels. Hence, we have the following:
"Unwrap then insert" on suppositories.
"Uncap then inhale" on metered dose inhalers.
"Take by mouth" on liquid antibiotics for patients with ear infections.

The following conversation may or may not have actually occurred:
CP: How may I help you?
Dumb Old Guy: You filled a prescription for my dog and I don't think it's working.
CP: Okay. What seems to be the problem? Are you giving it to her according to the directions?
DOG: Well, there's the problem. It says "TAKE ONE..." on the label so I took them. I wondered how she would get better with me taking them, but that's what it said.
CP: Do you have kids?
DOG: No. Just me and my Rottweiler, Fluffy.
CP: Well that's good news. Let's keep it that way, shall we? You do have a refill on here. Let me get that ready for you and I'll make sure the label instructs you to "GIVE" it to Fluffy.
DOG: Thanks, doc.


Friday, September 16, 2016

A Little Knowledge is a Bad Thing

Today's cast will include: CP, L'Intern D'Grande, A Supplicating Student, His GF, and a Dog.
Location: a pharmacy located near an institution of higher learning.

Some days I like to torture myself by getting out of my normal stores and visiting folks across the tracks. Okay, I like getting paid for OT, but I still am selective about where I work. On this day, I traveled almost an hour away to visit a college town pharmacy where my old intern had transferred. We had volleyed quite a bit of the usual banter back and forth like old times when the story of the day unfolded right before our eyes. We were in mild disbelief as we listened to the story.

LIDG: How may I help you?
ASS: My GF is visiting from out of town.
LIDG: Good for you. Not sure how you want me to help with that, but I get off work at 10 if you want to send her over.
ASS: Um...No. She left her antibiotics at home.
LIDG: Then definitely don't send her over.
ASS: Anyway, she lives a couple hours away and will have to go the weekend without them.
LIDG: Okay. And...?
ASS: Can't you give her a few to get her through the weekend?
LIDG: No. Unless...
ASS: Yes?
LIDG: ...unless you have a new prescription for them?
ASS: No.
LIDG: Then no.
ASS: So you're going to make her go all weekend without them?
LIDG: No. It kinda sounds like you are though.
ASS: "You realise you're responsible for promoting antibiotic resistance in her now, right?"
LIDG: Uh...No. She lives 2 hours away. It's Friday night. Drive there tomorrow. Drive back tomorrow. Problem solved. You should probably pick up her birth control while you're there.
ASS: She remembered that.
LIDG: Of course she did. Quick question before you sulk away.
ASS: What?
LIDG: What are you studying?
ASS: "I'm a 3rd year Med Student."
LIDG: Well that certainly explains everything. Remember to sign up for the class on how pharmacies and prescriptions work. I'm sure it's an elective, but you really need it.
CP: Impressive. Most impressive. Obi-Wan has taught you well.
LIDG: Poor little Husky is now a whipped puppy.
CP: Going to be a long, blue weekend for him.
LIDG: We can only hope that our life lesson today has taught him something he can't and won't learn in the classroom.
<laughter erupts and lasts until close>
CP: Good one!

Wednesday, September 14, 2016

Hear Me Now And Listen To Me Later

Sans Checking Any Messages: You guys called me and I don't know why? 
CP: Did we leave a message? 
SCAM: Yes. But I didn't listen to it. You've called me 3 times. 
CP: Professional tip: I'm going to hang up now. You go back, listen to the messages and, if there is any confusion about the reason for our calls, you may then call me back. 
SCAM: Do you have prescriptions there for me? 
CP: We do. One really expensive medication. We left you 3 messages. It required prior authorization which your prescriber worked diligently to obtain. We then had to special order the item for you. 
SCAM: Why do you have it? 
CP: Your prescriber sent it to us. 
SCAM: I told them I wanted it at your other location. 
CP: Oh. See, here's what really happens. We compete with each other. If we finish all our own work, we start searching other stores' files for prescriptions they haven't yet filled. Our modus operandi at this store is to select the most expensive items from other stores so we can hit our sales goals without doing too much work; in other words, fewer prescriptions. Once we steal it, they can't fill it. That's why we called you. Sure it's called incestuous cannibalism, but we're keeping it in the phamily. It's a new way to stimulate competition for meeting metrics among the stores. 
SCAM: But I want it there. 
CP: Well, since I ordered this for you, after your prescriber and I exchanged numerous phone calls since last Friday, and left you almost as many messages, I'm going to have to ask you to pick it up here. Yeah. So if you could just swing on by and remove this from my inventory, that'd be great. 

Monday, September 12, 2016

We Are Not That Kind of Pharmacy

Always remember that it is important to ask the question you want answered. 

CP: Good day, ma'am. How may I help you? 
Little Old Lady: "I'm looking for jock itch."
CP: I am truly sorry, but we are phresh out of jock itch. However, I can point you in the direction of some lovely topical applications to treat jock itch once you find it. 

#QuoteOfTheWeek

Friday, September 9, 2016

Backup

There are snobs in every profession and business. I'm not talking about the businesses themselves, mind you. I'm talking about the customers patronizing the businesses. Coffee snobs come readily to mind. Are there really pharmacy snobs? I'm not talking about people preferring the CaVS to the Wu-tAnG Clan. That's like comparing McDonald's to Wendy's. I'm talking about preferring mail order to your average retail location. Most patients with whom I discuss mail order hate it. It's mostly the idea that they are forced to use a non-local pharmacy and may have to wait weeks for their refills. What I really hate most about the whole situation is being a #BackupBitch. I'm not good enough for you to leave your wife so I'm only good when it's convenient for you. I don't think so. Treat me like a side piece and I'll treat you the same way.

What started this rant, CP? 
Years of experience, followed by this woman. 

Mail Order Sister Sassing That We Are Terrible: I'm here to pick up my prescription. 
CP: I see that we received a phone in from your prescriber about 30 minutes ago. 
MOSS TWAT: That's right. 
CP: There was a problem with it because mail order just filled it yesterday. We had to call the insurance to get the override so they would pay for it. We just finished that call and actually left you a message at home. 
MOSS TWAT: I'm not at home. 
CP: I can see that. The message we left was to tell you that we do not have your medication in stock. 
MOSS TWAT: Why the hell not? This is a pharmacy, right? 
CP: Pretty sure. I'd have to walk out front and read the sign to be certain but, judging by the drugs behind me, I'd surmise we are, indeed, in some type of dispensary. Yes. 
MOSS TWAT: This is why I don't use this pharmacy. You never have what I need. 
CP: Are you out of medication? 
MOSS TWAT: Duh! That's why I'm here. 
CP: Okay. For the phans playing along at home who don't know how this works, can I take a second to sum this up for them? 
MOSS TWAT: Will it fill my prescription faster? 
CP: No. But they'll understand that my phrustrations with you are justified. Anyway, you ran out of medication. You use mail order pharmacy exclusively, as you've iterated a few times already. You called in your refill too late and now, since it will take days to get here, I have been selected to be your fallback plan. Not only that, but you have not been to our pharmacy in over 3 years. If you were one of my regular patients, I would carry your medication. However, as the only person I've ever seen receive this medication and strength in the Tri-County area over my career, it is unlikely you will find this sooner than my promise time of tomorrow morning. Not only that, but my promise time of TOMORROW is still weeks faster than your mail order's promise time. Sound about right? 
MOSS TWAT: This is ridiculous. I have this problem every time I come here. 
CP: And I thank you for your frequent business of once every 45 months. You do realise how insanely bitchy you are being, right? I am your backup plan. I am not your first choice. You choose to not do regular business with me, yet you expect me to cater to you all while accepting your verbal abuse and loud tirades against my pharmacy? I would rather "forget" to order your medication, have you file a pissed off complaint against me tomorrow and never ever set foot in my pharmacy again, then bend over and help you out of your self-induced situation, you thankless twat. It's like getting mad at your boyfriend because your husband asked for a divorce because you're cheating on him.
MOSS TWAT: So you said this will be here tomorrow?
CP: Thanks for paying attention. I did say that.
MOSS TWAT: Good. I'll be here tomorrow.
CP: Hopefully you lose a few pounds between now and then.
MOSS TWAT: What?
CP: That giant chip on your shoulder. Maybe not being under its weight will allow you to thank me for being nice and helping you.
#DontPhuckWithYourPillPusher

Monday, August 29, 2016

Va-Giant!

I received the following prescription, along with the accompanying old joke, from a pharmacist last week.



I got a kick out of this Rx yesterday. One gallon?? What is that, 128 tubes?? Kind of reminds me of the old joke where the patient is having an exam by her GYN. Patient: How does it look Doc? GYN: WOW, that is the largest vagina I have ever seen,,,WOW, that is the largest vagina I have ever seen,,, Patient: Well, you did not have to say it twice. GYN: I didn't.

As a phan of alliteration, I felt it was up to me and L'Intern d'Grande to develop new euphemisms for the vagina that could hold a gallon.

We started with the obvious: Cavernous Choach, Gargantuan Garage, Conception Canyon, and Voluminous Vagina but decided that 3 words might best fit the task at hand. And it got worse...
Behemoth Baby Baker?
Humungous Human Heaver?
Spacious Sapiens Shooter?

Wednesday, August 24, 2016

Stupid is as Stupid Does

Ever have one of those coworkers that just couldn't figure out how wrong they were? Even when you showed them they were making mistakes, they refused to believe you? I don't tolerate stupidity very well, especially when I have to do more work to correct you.

CP: You forgot to do this. Again.
Twit Of The Day: "Well, if you're not making mistakes, you're not learning anything."
CP: Then you should be the smartest person in the pharmacy.

Corporate Is Smarter Than You!

A(nother) Conversation With Myself...

CP: Hello? Self?
SELF: Yes. It is I. What troubles you?
CP: It's been...many years since I last sought your counsel.
SELF: I know. Get on with it. People are waiting to see if this will be phunny or not.
CP: Got it. We need to stock more Epipens.
SELF: Why?
CP: It is peak season.
SELF: I see. End of summer combined with back-to-school.
CP: Exactly. So you understand my phrustration?
SELF: Not exactly. Corporate says "no". When corporate wisdom says "no" they are to be obeyed for their omniscience shall ne'er be question'd.
CP: Why does corporate say "nae"?
SELF: The very complex computer algorithm thingy shows a history of using only 2 packs per week.
CP: But it's peak time. The averages don't work now.
SELF: That's just what they tell us.
CP: But we need them, just in case.
SELF: But, according to corporate, you probably won't use them.
CP: Kinda like the patient, amiright?
SELF: Now you're catching on.
CP: I'm glad you're willing to take the risk for the patient. We wouldn't want them to pay for something that has become prohibitively expensive that they're just not going to use anyway.

CP: But seriously. Why does corporate insist on using rolling 13 week averages (just one of many options they have for programming their inventory control) to select inventory? The gas company anticipates I shall use an amount of gas similar to last September during this September. My June demand will not be the same as my February or my October demand. Antibiotics and lice treatments will be all the rage here in one to two weeks while ear drops and allergy medications will have to wait until their numbers are called again next May to enjoy prominence on our shelves. I know this. You know this. The public knows this (for they tell us all the time when we are out of stock) but corporate does not.

The next time your pharmacy is out of Medrol Dose Paks, Ciprodex Ear Drops, Epipens, it's not (always) their phault. You know those items that the big retailers advertise in their weekly sale ads? Very popular that week and likely to sell through.

Friday, August 19, 2016

What (Not) To Say During Flu Shot Season

1. CP: How'd it go? 
    CPP: I boned the flu shot lady. 
    CP: You did what? 
    CPP: That sounded bad. I hit bone.

2. Don't tense up while I pull out. 
3. I didn't expect to get so deep. 
4. Just relax, it goes in easy. 
5. Oh God! Is it in? 

6. Pt: Well that was quick. I didn't feel a thing. 
    CP: That's what she always says. 

7. Time to play a little of the in-out, in-out.  
8. CP: Ok. You're going to feel a little prick. 
    Pt: That's what my last boyfriend said too. 

9. Just stick around for about 15 minutes ... I'll make you breakfast. 


Thursday, August 18, 2016

Euphemism

A mild or indirect word or expression substituted for one considered to be too harsh or blunt when referring to something unpleasant or embarrassing:

CP: How may I help you today, kind sir?
Creepy Old Dude Giving Ejaculatory Responses: I need your help.
CP: In what capacity?
CODGER: I need a little pick-me-up.
CP: You're depressed?
CODGER: No.
CP: Narcoleptic? Always dozing at the bingo hall?
CODGER: No. I need a lift.
CP: You...want me to call a cab?
CODGER: No. It's not hard!
CP: Actually it is. You could just come right out with it.
CODGER: That's the problem. It won't come out.
CP: What?
CODGER: My pencil.
CP: And you're at the pharmacy for...?
CODGER: I need lead in my pencil.
CP: Oh. Okay. I think I got it now. Follow me.
<walks out to the back-to-school section>
Here you go.
CODGER: What's this?
CP: Lead. For your mechanical pencil. Do you need the 0.5mm or the 0.7mm?
CODGER: I need an erection.
CP: Oh. Why didn't you just say so? Here.
CODGER: What's this, now?
CP: Since we're in the school aisle, I thought it convenient to hand you duct tape and some tongue depressors. Think splint. Anything else I can help you find?
CODGER: Headache medicine.
CP: Isn't your wife supposed to give you that excuse?

Monday, August 15, 2016

But...how?

Drop-off window.
A patient.
A prescription. 
A basket. 
A question.

Prioritization is key. Some people excel at it. Others, not so much. (Think about dropping off your prescription BEFORE putting ice cream in your cart. Just saying.)

Basket Lady Presenting Rx: I am here to drop off this prescription. 
CP: Swell. Would you like us to fill it too? 
BLPR: That would be most ideal. 
CP: Will you be waiting for us to fill it? I noticed you have a basket and it is empty. 
BLPR: As it is empty, your observation is most correct for I do intend to shop while you prepare it. 
CP: Lovely. 
BLPR: For my reference, how long will it take? 
CP: Approximately 11 minutes. 
BLPR: Delightful. 
CP: Oh. While we were talking, it appears they have already managed to bill your insurance for it. 
BLPR: Oh my. That was fast. 
CP: <That's what she said> Yes. We are on the ball today. It will be yours for the low low price of two whole dollars!
BLPR: Oh. Really? 
CP: Yes. I can make it more if you like. 
BLPR: No. It's not that. I will have to come back. I don't have $2.00. 
CP: But you're going shopping. You have a basket. It is empty. You said you were going to buy stuff. You're not on Medicaid so you can't be using a SNAP card. How, pray tell, do you intend to pay for the sundries?
BLPR: Never you mind. Just know I shall return.
CP: Of that I have no doubt. 

Friday, August 12, 2016

A Little Pharmacy Phun

Guy In Search Of Memory: Do you have Prevagen?
CP: I do not believe we carry that. Let me check. 
GISOM: It's for memory. 
CP: Oh. We do not carry it. 
GISOM: You don't? 
CP: I told you once. 
GISOM: No you didn't. 
CP: I most certainly did...
GISOM: But you didn't even check.
CP: I did.
GISOM: Didn't.
CP: Did.
GISOM: You did?
CP: I did.
GISOM: Wow. I really need to find that.

Friday, August 5, 2016

Pharmacy Phantasy

It's that time of year, the time when everyone starts researching players for their Fantasy Football Drafts. As I prepare my own teams, it occurred to me that we are missing an in-store opportunity here.
What about Phantasy Pharmacy? 
What about drafting patients? 
Each store would be its own league made up of pharmacists, interns, and technicians. 

Points would be awarded in the following categories: 

1. Phone Calls  = 1
2. In-Store Visits  = 2
3. New Prescriptions Filled
    1 Rx = 1
    2 Rx = 2
    3 Rx = 3
    4 Rx = 4
    5 Rx = 5
    6 Rx = 7
    +2 for each Rx filled thereafter

4. Prescriptions Refilled = 1
5. Prescriptions Returned to Stock = -1 / Rx up to 5 then points reduced per New Rx Filled scale
6. Personal Calls (from patients requesting a specific employee) = 2
7. Complaints to the 1-800# (negative points) = -3
8. Compliments to the 1-800# (positive points) = 3
9. Insurance Changes = 2
10. Manufacturer/Discount Cards presented = 2
     (positive for presentation at drop-off, negative for presentation at pick up)
11. Vaccines Received (bonus points if more than 2 administered in one visit)
     Flu=1, Pneumo=1, Shingles=2, Hep A or B=3, TDaP=3, MMR=4, Meningococcal=5, HPV=5
12. Enrolled in your Med Sync Program = 10
13. Removed from your Med Sync Program = -10 
14. Transfers In = 1.5 / Rx
15. Transfers Out = -1.5 / Rx

Obviously, some weeks you would do better with certain patients. The first of the month is a good time for the high volume refillers. A month with 5 Mondays or Fridays or weekends would help in some categories as well. 

We could play the game head-to-head one week at a time for a full season or we could draft every month or two and have a winner-take-all at the end of the year. 

We would make available each patient's statistics and post them to the mock draft board. 
Jane Smith leads the store in phone calls per day while only filling two prescriptions regularly. However, she is seeing a new prescriber. 
John Smith is never happy when he visits and he only calls when he needs his Viagra refilled. However, he must have found a new girlfriend because he is in our store 3 times a week buying one tablet at a time and he always calls first. 
Jacqueline Smith leads the store in 1-800# complaints and gift cards received. She also finished last season third in the company and is seeking to move up to a CC1 (Chief Complainer #1). 

Tuesday, August 2, 2016

(Un)Educated Question

We deal with many questions. Patients want to know about their diagnosis, their treatment, where to find batteries, what their rash is, etc. It's no surprise we have to answer so many, what we consider to be, "weird ones" with the ordinary. I impress upon my students that to the inquirer, their question is important to them...
...unless, of course, the asker prefaces it with "I know this is stupid, but..." then it is okay to mock them later.

<Phone rings>
CP: Allo? CP's Emporium of Drugs.
Overly Dramatic Dame: I know this is stupid, but I have a question for you.
CP: It's not stupid to have a question. Lots of people have questions.
ODD: Good point. Let me try again. I have, what I perceive to be, a stupid question.
CP: There are no stupid questions, only stupid people.
ODD: Right. Um...
CP: That's why I like working retail. You never know what you're going to hear on the other end of the phone.
ODD: Good way to look at it.
CP: Ask away!
ODD: Oh. Right. So I was just there buying ice cream.
CP: Oxygen Potassium...
ODD: And the lady in front of me was buying stuff for lice.
CP: Uh-huh. So you two bought L-ICE Cream together?  How Cute.
ODD: Well, she told the cashier she had head lice. "Did I get it?"
CP: Lice?
ODD: Yes.
CP: Did you hug her?
ODD: No.
CP: Did you have a sleepover with her?
ODD: Odd question, but, no.
CP: Did you slow dance together in line? Cheek to cheek? Put your head on my shoulder kind of 60's groove?
ODD: Um. No.
CP: Okay. Then you should be in the clear.
ODD: Really? I wasn't sure.
CP: Which is why you asked. I appreciate that. Note that I used levity to ease your mind, not make you feel too stupid about your question, and still answer in a way that left you wanting more from me.
ODD: That's great. I feel so smart now.
CP: Want another simile?
ODD: Sure! Your writing and true, daily conversations are so invigorating and honest. I can't get enough.
CP: Thinking you can get lice by standing in line behind someone at the grocer is like thinking you may have become pregnant by standing in line behind the guy buying condoms because, to your knowledge, he wasn't wearing one at the time.
ODD: You have a rather warped brain.
CP: I know. My staff tell me that all the time.


Counseling and Labeling 101

Okay: Take this medication as directed prior to colonoscopy.
Not Okay: Juice the sluice and let 'er loose.

Monday, August 1, 2016

Patient Logic

Patient and, for that matter, general public logic seem rather irrational. There is no way to explain what happens inside the brain of an individual patient or an hysterical group of fanatics (see the people who managed to get Trump AND Clinton to the POTUS Finals...)
But I digress.

CP: Welcome to Pee Wee's Playhouse. How may we help you today?
Always Complaining Never Ebullient: I need to know if you have this medication in stock.
CP: I am certain we do but shall check it doubly.
ACNE: Mmm-hmm.
CP: My brain, like the North, remembers. We do have it.
ACNE: Good. I shall wait for it.
CP: Okay. It'll be about 7 to 11 minutes.
ACNE: Wow. That quick?
CP: We are quite efficient here.
ACNE: I was just at your other location. I don't know why I keep going there. This is the seventh month in a row they haven't had my medication in stock. And they told me it'd be 45 minutes to get it ready. When I got back up to the counter, they told me they didn't even have it.
CP: Which brings you here. Welcome! We always stock this particular medication and strength for we have many people on it.
ACNE: They said it wasn't that common.
CP: Well it isn't if you don't stock it. We happen to always have it which may be why it is more common to us. Though it is surprising with them only 6 minutes down yonder to not see it nearly as frequently. Have you considered transferring here?
ACNE: What? No. I live halfway between the stores but they're so much more convenient.
CP: Uh-huh. I don't follow.
ACNE: They have a drive-thru so I can drop off without putting on pants to go inside.
CP: Lucky ladies.
ACNE: Then I can swing back by and pick it up without getting out of my car.
CP: Very convenient.
ACNE: Plus their pharmacy is on the side and not in the back so when I do decide to go inside, I don't have to walk as far.
CP: With pants...Sounds like a well-planned location. Everything seems perfect and convenient except one thing.
ACNE: What's that?
CP: They don't ever have your medication in stock. You have to drive to that pharmacy, drop off your prescription, then discover they are out of it. THEN you leave there, drive past your house in the opposite direction "to the Chelsea drug store to get your prescription filled" because we do have it. Sound about right?
ACNE: Yes. But I don't like coming here.
CP: Praytell...
ACNE: You're not convenient.
CP: You keep using that word. I do not think it means what you think it means. Try this definition: "Fitting in well with a person's needs, activities, and plans".
ACNE: See, right there, this is why I don't come here.
CP: Other than every month to get this prescription only we carry.
ACNE: Right. What?
CP: Don't let your incredulity keep you from calling our 1-800# and telling them how awesome we are. In-stock issues are actually a measurable metric for our bonuses. But make sure you tell them the other store is always out of stock.
ACNE: Nah. I don't call on those. Unless they give me something, I'd rather complain to you about it.
CP: I see. Yet here we are, just a boy, staring at a pharmacist, hoping to get the other store to like him and carry what he needs.
ACNE: You're weird and I couldn't even keep up with your references today.
CP: Thanks. But your prescription is now ready. See you next month.


Patient Logic

Patient and, for that matter, general public logic seem rather irrational. There is no way to explain what happens inside the brain of an individual patient or an hysterical group of fanatics (see the people who managed to get Trump AND Clinton to the POTUS Finals...)
But I digress.

CP: Welcome to Pee Wee's Playhouse. How may we help you today?
Always Complaining Never Ebullient: I need to know if you have this medication in stock.
CP: I am certain we do but shall check it doubly.
ACNE: Mmm-hmm.
CP: My brain, like the North, remembers. We do have it.
ACNE: Good. I shall wait for it.
CP: Okay. It'll be about 7 to 11 minutes.
ACNE: Wow. That quick?
CP: We are quite efficient here.
ACNE: I was just at your other location. I don't know why I keep going there. This is the seventh month in a row they haven't had my medication in stock. And they told me it'd be 45 minutes to get it ready. When I got back up to the counter, they told me they didn't even have it.
CP: Which brings you here. Welcome! We always stock this particular medication and strength for we have many people on it.
ACNE: They said it wasn't that common.
CP: Well it isn't if you don't stock it. We happen to always have it which may be why it is more common to us. Though it is surprising with them only 6 minutes down yonder to not see it nearly as frequently. Have you considered transferring here?
ACNE: What? No. I live halfway between the stores but they're so much more convenient.
CP: Uh-huh. I don't follow.
ACNE: They have a drive-thru so I can drop off without putting on pants to go inside.
CP: Lucky ladies.
ACNE: Then I can swing back by and pick it up without getting out of my car.
CP: Very convenient.
ACNE: Plus their pharmacy is on the side and not in the back so when I do decide to go inside, I don't have to walk as far.
CP: With pants...Sounds like a well-planned location. Everything seems perfect and convenient except one thing.
ACNE: What's that?
CP: They don't ever have your medication in stock. You have to drive to that pharmacy, drop off your prescription, then discover they are out of it. THEN you leave there, drive past your house in the opposite direction "to the Chelsea drug store to get your prescription filled" because we do have it. Sound about right?
ACNE: Yes. But I don't like coming here.
CP: Praytell...
ACNE: You're not convenient.
CP: You keep using that word. I do not think it means what you think it means. Try this definition: "Fitting in well with a person's needs, activities, and plans".
ACNE: See, right there, this is why I don't come here.
CP: Other than every month to get this prescription only we carry.
ACNE: Right. What?
CP: Don't let your incredulity keep you from calling our 1-800# and telling them how awesome we are. In-stock issues are actually a measurable metric for our bonuses. But make sure you tell them the other store is always out of stock.
ACNE: Nah. I don't call on those. Unless they give me something, I'd rather complain to you about it.
CP: I see. Yet here we are, just a boy, staring at a pharmacist, hoping to get the other store to like him and carry what he needs.
ACNE: You're weird and I couldn't even keep up with your references today.
CP: Thanks. But your prescription is now ready. See you next month.


Saturday, July 30, 2016

(Not) In This Moment

The inanity of it all induces infarcts in my cranium.

CP: Halloa! May I speak to COWING, please?
Confused On Why I Need Gel: Speaking.
CP: This is CP, the great and powerful, all knowing, yet humble pharmacist calling to tell you we are filling prescriptions for you.
COWING: Yes. Good. My doctor said he was sending prescriptions over for me.
CP: Indeed he did. The only trouble is the ointment he prescribed.
COWING: Yes?
CP: We are currently out of stock and must needs order it for tomorrow.
COWING: I see. That is okay. May I ask a question?
CP: I'll give you that one for free but feel free to ask another.
COWING: Why did he give it to me?
CP: Pardon?
COWING: I don't remember ever having a cream before.
CP: Okay. I see this is a new prescription.
COWING: Did he tell you where I'm supposed to apply it?
CP: Hopefully in your house. But on the label, he only told us to write "affected area twice a day".
COWING: Hmm.
CP: Hmm, indeed. You did see your doctor today, non?
COWING: Oui.
CP: And you indicated some type of issue to him?
COWING: I guess.
CP: You guess? What did you say was wrong with you?
COWING: I'm not sure.
CP: Ah, there's the rub.
COWING: Phunny.
CP: Good doctor. He can prescribe something to fix something when someone doesn't tell him there is anything wrong. Perhaps you should call him in the morning and find out why he gave this to you. Wouldn't want to act too rashly.
COWING: Good idea.
CP: Thanks. Be sure to let me know too when you come in to pick it up. I'm curious as to how this ends. #ILoveYouForAlwaysDrivingMeInsane

Thursday, July 28, 2016

It's Not Open For Discussion

There are truths. There are facts. There are laws. 
When it comes to these things, there can be no debate about their existence or validity. 
And yet...

CP: CP's pharmacy where we obey all the laws. How may I help you? 
Nurse Is Not Nice Yet: I'm calling in a prescription. 
CP: Phantastic. Let er rip. 
NINNY: <completes verbal assault on my ears> Anything else? 
CP: Yes. You said the prescriber is a CNP. 
NINNY: Sorry. She's a PA. 
CP: Okay. I just need her CTP#. 
NINNY: I have her DEA#. 
CP: Which is neither spelled nor pronounced CTP#. Try again. 
NINNY: NPI#. 
CP: It's her Certificate To Prescribe Number; hence CTP#. 
NINNY: I don't have it. I have always called in prescriptions this way and we have never had a problem with any other pharmacy...until you. 
CP: Phunny. When I've politely asked for information, I've never had a problem with an office providing it to me without drama...until you. 
NINNY: Well we don't have it. 
CP: In order to write a prescription, all non-doctor prescribers MUST have a CTP#. This number MUST appear on all written and electronic scripts and MUST be provided when phoning in the prescription. 
NINNY: I don't have it and we've never done it this way. 
CP: Would you like me to fax the State Law to you? 
NINNY: YES! <rattles off fax number>
CP: Then you will call back with the CTP# and an apology? 
NINNY: <Click> 

<15 minutes later> 
CP: You're a go for CP. 
NINNY: <politely> I have the CTP# you requested. 
CP: Thanks. Was that so hard? 
NINNY: <grumbles> 
CP: Sucks being wrong, huh? Next time, learn something instead of being a vicious twat. It's my job to know the laws I have to obey. Perhaps your office manager could use an update and send a memo. 

Friday, July 22, 2016

Overreacting

CP: Ma'am, we are calling to let you know that your prescription is too soon to refill until 3 days from now.
Over Dramatic Dame: "I guess I'll have to go without, then."
CP: Are you completely out?
ODD: No. I have about a week left.
CP: Well this is due only 3 days from now.
ODD: Oh. Okay. Then I should be fine.
CP: Depends on your definition of fine...


Thursday, July 21, 2016

Train(wreck) of Thinking

The following conversation recently took place. 
There once was a girl from Albuquerque whose brother happened to live near me. This is their story. 

CP: Thanks for calling CP's Pharmacy where we dispense doses of reality. How may I help you? 
Someone Expecting A Lot: I was calling to see about paying for prescriptions over the phone. My brother lives up there and I wanted to pay using my credit card. 
CP: I must apologise, but we are not allowed to accept credit card payments over the phone. 
SEAL: Why the hell not?  
CP: Our mutual protection.
SEAL: If my brother walks in there with cash, can he pick it up? 
CP: Of course. Cash, amazingly enough, is like cash. It's rather universally accepted as a standard form of payment. Cash is always welcome.
SEAL: "So you're telling me if I drove all the way up there, walked in and paid cash, I couldn't pick it up?"
CP: Not sure where you live, but that's quite a leap in a logical train of thought. I simply said I couldn't take your credit card information over the phone. 
SEAL: But I have cash. 
CP: Which I can't take over the phone either. Not quite sure how you even expect that to work. 
SEAL: But I want to pay for it there so you can show my account as paid then he can pick it up at another store. 
CP: Wait. What? If I follow, you are telling me: You are hours away from me. Your brother lives near me. You want to pay me for something he is going to pick up at another location. And to speed the story along, the prescription is for your dad? 
SEAL: Yes. I don't see the problem. 
CP: Oh. That IS the problem. Have you tried that with Starbuck's? Maybe had your brother place an order in Des Moines, called the Starbuck's in Decatur to pay for it, then sent someone else to pick up the order in Detroit? 
SEAL: No, that's stupid. 
CP: Precisely. 
SEAL: We don't live there.
CP: <beats head into counter>

Wednesday, July 20, 2016

Teaching Moment

Today we are going to learn what words mean. (or not...)

CP: Are you ready, class?
Practically Every Retrieval Person: YES!
CP: Okay. Repeat after me... "I..."
PERP: I...!
CP: State your name.
PERP: State your name.
CP: <whispers, "too easy"> ...do solemnly swear...
PERP: ...do solemnly swear...
CP: ...that I will repeat and understand...
PERP: ...that I will repeat and understand...
CP: ...everything Professor CP teaches today.
PERP: ...everything Professor CP teaches today.
CP: Good.
PERP: Good.
CP: Here we go.
PERP: Here we go.
CP: Your insurance will NOT pay for your prescription today.
PERP: You are refusing to fill my prescription today.
CP: Wait. Back up. Stay with me here. Your insurance...
PERP: My insurance...
CP: ...Won't pay...
PERP: ...Says you won't fill...
CP: ...Your prescription...
PERP: ...My prescription...
CP: ...Without a prior authorization.
PERP: ...Because you're an asshole.
CP: I would be all too happy...
PERP: You are all too happy...
CP: ...to charge you cash and take your money...
PERP: ...to take my money and refuse to fill my necessary medication...
CP: ...but your insurance will not pay for it.
PERP: ...and blame my insurance for not covering it.
CP: You should go somewhere else.
PERP: I'm going somewhere else that knows how to bill my insurance.
CP: See you tomorrow.
PERP: See you tomorrow.

Saturday, July 16, 2016

I Can't Answer...

...Anything that starts with:
1. Why did my doctor...?
2. When will my doctor...?
3. When will the insurance...?
4. Is it cheaper at...?
5. Does another pharmacy...?

Thursday, July 14, 2016

Subliminal Utterings

Ever have one of those great moments when your lousy day improves remarkably because of one little interaction?
Me neither. But this helped.

CP: <entering prescriptions at drop off> Do you have your insurance card? 
Drug Using Mama's Boy: Yes. 
CP: Thanks. <enters information, clicks on the wrong screen and whispers...> Dummy. 
DUMB: <acting insulted> Excuse ME?
CP: Sorry? 
DUMB: Did you just call me a dummy? 
CP: What? No. Sorry. I said "Dumb Me". I clicked on the wrong thing. 
DUMB: Oh. Okay. 
CP: <Whispers as he walks away> Dummy.

Wednesday, July 13, 2016

Answers Are Hard

I ask, you reply.
The more succinct the answer, the better.
The more accurate, the better.
However, just make sure the succinct answer is accurate.
Unlike this guy.

Too Short: I have this refill to drop off.
CP: When did you want to pick it up?
TS: She needs it. (actual response)

With such an open-ended answer, Super Intern and I decided we needed to work out our responses.

"She needs it..."
1. So, when?
2. I can see that from the empty bottle.
3. I'd love to give it to her, but she's your wife.
4. Okay. Go home and give it to her. By the time you finish and get back, the prescription will be ready.

See what happens when you don't say "I'd like to wait for it"?


Tuesday, July 12, 2016

If The Real World Worked...

These conversations must take place elsewhere.
They must. It's the only thought that keeps me sane.
Here is my vision after yesterday's all-too-typical conversation.

CP: Thank you for calling CP Pharmacy where all your dreams come true. How may I help you?
DUDE: You shorted me.
CP: <doesn't offer meaningless apology for something which may not be our fault> Let me research that for you.
DUDE: I was supposed to get 90 and you only gave me 30. You shorted me. It's quite obvious.
CP: Aaaaaand...Nope.
DUDE: Um, yep.
CP: How about nope? Your prescriber only wrote for 30 tablets.
DUDE: But I take 3 a day. That's only 10 days.
CP: With refills no less.
DUDE: But I should get 90.
CP: Why?
DUDE: Because I take 3 a day.
CP: Why not ask for 270? Why stop at 90? Maybe she only wanted you to receive 30 at a time.
DUDE: I still say you shorted me.
CP: Okay. Here's an experiment for you. Call your bank.Tell them they shorted you. Tell them you wanted a check for $20,000 but the one payroll direct deposited was only for $1,000 and you deserve more. Even though you have refills (one check per week for the term of your employment) you feel you deserve more. I'm sure they will call your employer's payroll department and get this little oversight remedied for you.

Thursday, July 7, 2016

Sound Effects

One amusing thing about daily radio shows has always been the use of sound effects boards for comedic effect. It elicits an almost Vaudevillian nostalgia. I feel we need this in the pharmacy for the benefit of "Good Customer Service".
Example from last week:

Patient Expecting Some Type of Extra Response: I just called?
CP: Okay. And now you've called again.
PESTER: She hung up on me.
CP: Who did?
PESTER: That lady I was just talking to.
CP: I see. <checks around to ask what happened>
Okay. I seem to have found the problem. Let me put you on hold while I deal with it.
PESTER: She hung up on me!
CP: Got it. No hold then. <sets down phone. queues up sound effect board>
(Sounds of whips cracking, chains rattling, women screaming)
I shall repeat until you say Mercy!
PESTER: Do you mean me?
CP: Yes. I shall flog this vile wench until you say "Mercy". Since you are the person she doth wronged, you shall be responsible for the amount of punishment meted out.
PESTER: What? That's inhumane!
CP: Well what did you expect? You kept repeating "She hung on me" as if you wanted some sort of repercussions for her transgression. This is the solution upon which I alighted.
PESTER: Gods, No! Mercy.
CP: Are you sure? Usually people tell me to just let the hate flow through me.
PESTER: Perhaps a walk of atonement may better serve this situation?
CP: No. It's a small space back here. No room to walk. Anyway, what was the reason for your initial call?
PESTER: I needed a refill and couldn't figure out how to type in the numbers on the phone fast enough.
CP: That's it? A refill?
PESTER: Yes.
CP: Would you like to try our new delivery service?
PESTER: Sounds great! What do I have to do?
CP: Nothing. Just wait at home for us to drop by. I'll be sending my tech with our whips and chains.


Wednesday, July 6, 2016

Somebody's Watching Me

People love to watch us work. After last week's interaction however, I am convinced they watch but do not see. Today's winner in observation is brought to you by Mr. Magoo.
#WhyYourPharmacistHatesYou

I saw you.
You saw me.
You arrived in line behind 3 other people.
You were 4th in line on Friday, July 1st.
A Holiday weekend.
You stood in line behind 3 people at Drop Off.
You watched 3 people each drop off 3 prescriptions.
You heard 3 people, with 3 Rx's, say they would wait.
You heard my tech give out wait times to each person.
Still you stood.
Still you moved forward in the queue.
The wait times increased accordingly:
25 minutes,
30 minutes,
35 minutes...
Friday at noon on a Holiday weekend...
Then you hear "40 minutes" for your wait time.
You are surprised,
Confused,
Miffed,
Insulted,
Incensed,
Nonplussed, even!
Your reply?
"I'm going somewhere else where they can do it faster!"

Good! And Good Luck! It's a 10 minute drive to the next closest pharmacy. Where you'll have a 30 minute wait.
On Friday.
Of a Holiday weekend.
At noon.

Wednesday, June 29, 2016

Preparations

I've long said that there are two classes prescribers are not required to take: Writing 101 and Math.

Quote of the week: "I'm going to allow you to do that math."

When I was a teen, I was allowed to borrow the car.
When I turned 21, I was allowed to purchase alcohol.
When I passed the boards, I was allowed to practice pharmacy.

However, I've never been in a situation where it was necessary to receive permission to do math. So it was with the voicemail I received.

Mary-At-The-Hospital-Lets-Everyone-Solve-Summations: Prescriber wants 12.5 ml twice a day for 10 days and..."I'm going to allow you to do that math".

I really wanted to call back MATHLESS and thank her for permitting me to do calculations, especially those required to complete her prescription. To me it shows a lack of preparedness.
YOU are the one phoning in the prescription.
YOU are the one holding all the information.
YOU are the one that knew you were going to call me.
Be Prepared!

It's like going to the grocery without a list.
Or ordering a pizza for 10 people without asking their preferences before calling.

I don't know what I would have done had I not received her permission to do the math.
CP: I am sorry ma'am, but I am not allowed to calculate a quantity on your daughter's prescription and the prescriber was unavailable to verify it for me.
Mom: But it's really easy. It's 250ml.
CP: I believe you. But the prescriber did not expressly permit me to do the math.

Nah. #WeArePharmacy. We specialise in fixing prescribers' errors. Here you go!
#MathIsHard


Thursday, June 23, 2016

If the Real World Worked...

Let's focus this story solely at a pickup location, the terminus of all transactions. Whether it's the pharmacy or a pizza place, once something is ready, you cannot change the order without consequences. In this case, the result is a longer wait. You have altered the terms of our interaction. Sometimes I feel like Lando facing Vader. "I am altering the deal. Pray I don't alter it any further."

Picking Up Something-Extra: I am here to pick up my pizza.
CP: Name?
PUS-E: PUS-E
CP: Got it. I have 2 large pepperonis, an order of BBQ Wings, and a 2-litre. Is that correct?
PUS-E: Yes. Yes it is. It's exactly what I ordered.
CP: Okay. The total is $22.49.
PUS-E: What about the garlic bread?
CP: What garlic bread?
PUS-E: I was supposed to have garlic bread. It's part of your meal deal coupon. I have it here.
CP: Did you tell us you had a coupon for a meal deal?
PUS-E: No.
CP: Did you ask for the meal deal?
PUS-E: No.
CP: Did you ask for garlic bread?
PUS-E: No.
CP: When I read you the order mere seconds ago, and you said "exactly", were you being facetious or just dim?
PUS-E: Huh? I want garlic bread and to use my coupon.
CP: Okay. We will fire up some garlic bread for you. It'll be another 15 minutes to get it ready.
PUS-E: But the game starts in 5 minutes.
CP: I know. I was hoping to listen to it on the radio. We've had orders coming in all night. Just ask all the people behind you who also wish to make it home in time for kickoff.
PUS-E: Your machine told me my order would be ready at 7:45. It's 7:47 and now I have to wait another 15 minutes? This is ridiculous.
CP: It was ready at 7:45. You've been arguing with me for 2 minutes trying to change your order. You are welcome to take your already-completed order, minus the bread of garlic, and hie thee home, tarrying not.
PUS-E: What about my breaded garlic?
CP: Your original order, as originally placed, is complete and ready, in its entirety, for you to take home and slam down your gullet whilst cheering on your favourite club. This transaction could have been completed minutes ago had you not altered the terms of our deal.
PUS-E: Well how much longer now?
CP: It's still 15 minutes.
PUS-E: What? Why?
CP: You've been arguing with me for 5 minutes now. I've had no time to walk away and place your order; an order you've yet to assent to me making.
PUS-E: I'll wait for it. But it's all your fault if I miss kickoff and if my food is cold and...
CP: Yeah yeah yeah. I get it. Next!

Wednesday, June 1, 2016

A Conversation About Nothing

Irritating Male Patient Adds Lots Extra: Did my doctor call in my prescription? 
CP: Yes. 
IMPALE: Was it Amlodipine? 
CP: Yes. 
IMPALE: Is it ready? 
CP: Yes. 
IMPALE: How much is it? 
CP: $0.00. 
-----------------------------
Now, this should have been the end of the conversation. All of the finer, important points had been established and there is nothing else I can provide. As you can guess, there is much much more to this story, unfortunately...
-----------------------------
IMPALE: Here's what happened: My doctor, well, really, my nurse practitioner, took a sabbatical and isn't in the office and my old mail order company closed so I needed a new prescription and someone else in the office had to send it in on his behalf to the new company and they sent my other 3 prescriptions there but somehow forgot this one and since the company changed I was afraid I'd run out with the holiday and all so I had them call it in to you. 
CP: Ok. You do know you can get it for the same $0 copay here without dealing with holiday issues such as this, right? 
IMPALE: Yeah, but I prefer mail order. They've always been so convenient for me. 
CP: Except today, on the Holiday weekend. 
IMPALE: Well...
CP: Today is Saturday and we are open until 7 tonight. When would you like to come in for your ever-such-an-emergency prescription that has been here since Friday? 
IMPALE: Oh, I should be there some time on Tuesday. 
CP: Thank you for using mail order. 

Tuesday, May 24, 2016

How Pharmacy is Like the Movies

Dirty Harry-Do you feel lucky, punk? Well, do you?
Keep rushing me and I'll give you exactly what the prescriber ordered, errors and all.

Seven-What's in the box?
All we do is slap a label on it. Who cares what's actually in it. Here you go.

or

Forrest Gump- Life is like a box of chocolates.
We'll just grab it (something random) off the shelf and hand it over. You never know what you're going to get.

Poltergeist-They're here.
Opening time, and first of the month, and Mondays.

Minions- Reading a prescription is like trying to decipher their dialogue.

Saw-Want to play a game.

Thursday, May 19, 2016

Best/Worst Pharmacy Pickup Lines

1. They call me Zyrtec because my D lasts for 12 hours and keeps you up all night.
2. Pharmacists always carefully follow directions. We take the time to unwrap before we insert. 
3. They call me Nystatin because you have to swish before you swallow. 
4. You're so sexy they had to name a birth control after you ... Camilla (insert pretty much any name here: Heather, Yasmin, Errin.)

You must be a box of pen needles, because you are ultra-fine. 
And don't forget the comeback: I may be Ultra-Fine, but you didn't tell me you too were like a box of pen needles, Mr. Nano (or Mr. Micro-Fine). 


Tuesday, May 17, 2016

Choices

"In this day and age, a man has to have choices. A man has to have a little bit of variety."
"What are you talking about 'variety'? Hostages?"

No. Not hostages. But we do have a lot of options today. We all make hundreds of decisions every day. Most of them are minor, but some have a significant impact on our life. Such as which pharmacy to patronize. Last I checked, we all have free will in this country. I can choose to eat or not eat at certain restaurants. I can choose where to spend my hard-earned dollars. I can be loyal to whomever I choose.

The problem with free will is that people often forget to exercise it. I know many don't exercise anything, but the freedom of choice really doesn't require that much work. If you love a business, shop there frequently. If you hate it, why do you continue to go there?

"Of all the gin joints, in all the towns, in all the world, she walks into mine."

When your doctor asks (and on electronic prescriptions, it says) "Patient's Pharmacy of Choice", remember that YOU picked ME.  It says Patient's Choice.  I did not force you to come to my pharmacy. You made the decision to turn into my parking lot, exit your vehicle, and enter my store. It's not like a dinner choice.  Hey, I'm in the mood for Thai tonight. Your selection, and repeat business, is not just a whim.

With that in mind, I am done with you.  If you are unhappy, leave. When people threaten to go somewhere else, I'll tell them "Go Ahead".  I will even ask where they want me to transfer their profile so it's waiting for them when they get there.

I'm tired of being held hostage by people who don't understand and refuse to understand how the whole refill/insurance/plan ahead thing works.  I'm tired of people thinking they can get something by complaining simply because of their own stupidity.

I am taking the Twitter approach to dealing with these people. Twitter is about choice.  You actually have to choose to follow someone.  If you do not like what they have say, you have the simple choice to "unfollow".  I'd like people to apply that to pharmacy choice as well.  I only wish we could "block" people too.

Benadryl

Drowsy:

    • sleepy and lethargic; half asleep:the wine had made her drowsy
    • causing sleepiness:the drowsy heat of the meadows
    • (of a place) peaceful and quiet:a drowsy suburb called Surrey Hills
    • Sleepy:

      needing or ready for sleep:the wine had made her sleepy
    • showing the effects of sleep:she rubbed her sleepy eyes
    • inducing sleep; soporific:the sleepy heat of the afternoon
    • (of a place) without much activity:he turned off the road into a sleepy little town
    • (of a business or organization) lacking the ability or will to respond to change; not dynamic:the one-time sleepy world of pensions


Here's one for you from yesterday....

Guy comes up to my consultation window at the pharmacy yesterday with a bottle of store brand generic liquid sleep-aid (diphenhydramine). 

He asks: "Can this be used to help you sleep?" 
Me: "absolutely"
His next question: (wait for it.....) "but it won't make me drowsy will it?" 
Me: ....I stare blankly at him for a moment.... "Um, yes. That's kind of the point of it. To make you drowsy... so you can sleep..."
He just says: "oh" and walks off.

I used to believe people didn't understand the definitions of "drowsy" and "sleepy". I'm not "bashful" about it making me "happy" to think of them as "dopey" when they call me "doc" and I tell them not to be "grumpy" with me. They'll no longer be "sneezy" either.