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Thursday, April 13, 2017

Tickets! Get Your Tickets!

I already did a post on adapting Disney's FastPass to the pharmacy for prioritization during normal hours. After navigating the Rings of Hell known as Ticketmaster to procure my TOOL tickets the other week, I had a new thought: Preferred line treatment.

We can sell passes to be the first in line on your narcotic due date. They will be VIP passes good for one date at a time. We can also hold a lottery to distribute a limited number of tickets for each day. I suggest an auction for the most prized day, Friday! Instead of being told to come back the next day after 10am or 11am, we will guarantee your prescription will be ready by 8:05 or 9:05am (5 minutes after the Rising of The Gates in your store) on the promised date. We will number the chairs in the waiting room 1-5 and you will claim your prized seat that morning. Busier stores may adapt this idea to accommodate the number of chairs in their waiting area, or greediness of their staff.

CP: Your prescription cannot be filled until next Tuesday.
Pt: What time will it be ready?
CP: Since we do not open until 8am, we need everyone to give us until 10am to finish the morning's work that awaits us upon entry to the Hallowed Halls of Hygeia.
Pt: Can I not get it any quicker?
CP: Your prescription, as well as the others we promised for that day and the ones entered into our system overnight, all get the same treatment and take equally as long. Let's not forget about all of the new prescriptions people will be bringing to us they also need that morning.
Pt: Isn't there anything you can do?
CP: We did just start a new pilot program. We are selling seats in our waiting area. The first 5 patients to purchase seats will have their prescription guaranteed to be ready for pickup by 5 minutes after we open.
Pt: Go on.
CP: However, patients must remain in their seats until their names are called. If they are found to be lurking, standing, malingering, or otherwise impatiently hovering, their ticket becomes void and non-refundable and their prescription enters the general queue. Might this interest you?
Pt: Yes. How much does it cost?
CP: Each seat license is $25.00 for priority seating if purchased before closing the night before your fill is due. Any remaining seats that have not been purchased go on sale on a first-come, first-serve basis or a lottery the morning of filling. There is no discount for waiting until Filling Day.
Pt: Any other restrictions?
CP: As of right now, Fridays are the most popular days for narcotic pickups. For this reason, tickets will be auctioned off every Wednesday at 9pm.

This will check many of corporate's boxes: great customer service and guaranteed repeat business along with a little extra cash flow.

Friday, April 7, 2017

Are We Speaking The Same Language?

CP: Good Day Madam I'm Adam.
What The What: You're a palindrome? 
CP: Something like that. 
WTW: Why are you calling me? 
CP: We processed your refill and the insurance will not pay for it. 
WTW: I called my insurance last week and they told me they do pay for it. 
CP: As of today, they do not. 
WTW: Yes they do. 
CP: It needs a prior authorization. 
WTW: No it doesn't. I called them. 
CP: They may pay for it AFTER the prescriber submits the prior auth. 
WTW: No. I called them and they told me it's covered. You must be doing something wrong. 
CP: Of course. I shall bear the blame for this. If I could take on any more burden I'll need 80's shoulder pads under my clothes. Here's how the "you must be doing something wrong" part of your argument crumbles: I enter your insurance information. I enter your prescription information. I hit "enter" on my keyboard. I wait. Your insurance responds with "paid" or "denied". The only thing I could be "doing wrong" is hitting "enter" incorrectly. Unless...
WTW: Unless what? 
CP: Nah. It couldn't be that. 
WTW: Be what? 
CP: The only thing that could be wrong would be if you provided me with incorrect information. But that wouldn't happen, would it? 
WTW: No! I called my insurance before I brought you that prescription. 
CP: Okay. Just for phun, I have to ask. Whom? 
WTW: What? 
CP: Whom did you call? 
WTW: My new insurance. 
CP: What new insurance? 
WTW: The one that starts the first of next month. 
CP: You do realise this is March, right? 
WTW: Yes. 
CP: And that April is still 2 weeks away? 
WTW: Yes. 
CP: And the new insurance starts in April...in 2 weeks...which is not today? 
WTW: Yes. 
CP: So when I explained to you it wasn't working and you told me I must be "doing something wrong", you know now that it was YOU "doing something wrong"? I cannot process prescriptions for phuture dates if the insurance is not in effect. 
WTW: Oh. I didn't think about that. 
CP: Obviously. See you next month. 

Wednesday, April 5, 2017

No. No It Is Not

People will believe what they want to believe no matter the evidence in front of them or what learned professionals may tell them.
[The Earth is round. (Why is this even a thing?)]

CP: How may I help you today? 
Ordinary Citizen Raging And Pestering: I have a question about this product. 
CP: Go for it. I shall have an answer for you. 
OCRAP: Is this the same as Rexall? 
CP: Say again? 
OCRAP: Is this the same as Rexall? 
CP: Rexall? 
OCRAP: Yes. 
CP: Rexall is a pharmacy. Not a product. 
OCRAP: Well my wife has a bottle of Rexall and wants this to replace it. 
CP: Rexall is a pharmacy. It's also a line of products. They make all kinds of items. 
OCRAP: So is this the same thing as Rexall? 
CP: As Rexall what? That's like going to CVS and asking simply for "Equate".
OCRAP: I don't know. She has a bottle that says "Rexall" on it. I just want to know is this the same thing?
CP: Okay. Sorry for my less-than-valiant attempt at answering your question. Please allow me one last go. Hold the bottle closer to me. Closer ... Closer ... Right there. <I touch the bottle> Now, close your eyes. Listen to the mellifluous tone of my voice speaking these words. Picture the bottle your wife has. Focus on it. Are you focusing?
OCRAP: Yes.
CP: Where is it?
OCRAP: On her dresser.
CP: Focus harder. Concentrate. See only the bottle. Wait. I got it. I see it.
OCRAP: You do?
CP: Yes. This is most definitely the same thing as Rexall.
OCRAP: How'd you do that?
CP: Part of my skill set as a pharmacist.
OCRAP: You are amazing!
CP: I know.
OCRAP: Thank you so much.
CP: No worries. It's what I do. Before you go?
OCRAP: Yes?
CP: She needs a refill on her KY too. Your vision was unfocused at the beginning and I saw it there too.
OCRAP: She's not supposed to be home. 

Tuesday, April 4, 2017

Help Equals Assistance ...

... It Is Not The Same As Me Doing Everything For You.

(A real conversation from a real pharmacy.)

The Oxford English Dictionary defines Assistance as: noun - "the action of helping someone by sharing work".

Every day we bemoan the issue of patients no longer helping themselves. My interest in their health is directly proportionate to the amount of interest they have in it.

CP: How may I help you today?
Where's My Mommy: I called in for my refill?
CP: That's a question.
WMM: I need to pick it up?
CP: Still a question. But let's roll with it. What's the name?
WMM: My name?
CP: You just can't help yourself, can you? Yes. Your name. If the prescription is for you.
WMM: WMM.
CP: Finally, a statement! I do not have anything here ready for pickup.
WMM: Um. I called it in the other day.
CP: Allow me to research. I see here that you did phone on Thursday last at which time we told you there were no refills. We faxed and rang the prescriber that day, Monday, and Wednesday. So far she has not responded to our requests for refills. As of this morning we deleted the requests after leaving you a message that you should attempt to call her yourself.
WMM: What should I do now?
CP: Perrrrrrrrhaps you should call her yourself.
WMM: Would it help if you sent it again?
CP: Back to questions again. No. It would not help. We contact the office every other day for a total of 3 attempts. If those are unsuccessful, we put the ball back in your court. After a week of trying to reach her ourselves, I can say that no, it would not be helpful for us to contact them. It would, however, help if you called them.
WMM: Okay. Can you resend it?
CP: I can. I won't, but I can. Someone needs a swift kick out of the nest.
WMM: Oh. Ok.
CP: You fly back to school now little Starling. Fly, fly, fly. Fly, fly, fly.

Monday, March 27, 2017

Time ...

... is on my side.
... is of the essence.
... flies when you're having fun.
... and tide wait for no man.
... has come today.

Don't waste mine and I won't waste yours.

The time, 09:53.
The place, Pharmacy.
The day, hard and cold like nipples on Hoth.

CP: Morning!
Irascible Dame Getting All Flustered: What's good about it?
CP: Nothing. I was simply stating it was morning. Note I did not preface my morning with good. Go back and reread it.
IDGAF: Whatever. I need to call in a refill.
CP: Certainly. Refills keep us in business. Gotta love the repeat business they provide. And looking forward to follow up encounters with those who fill them.
IDGAF: I need it today. I tried the machine but it told me it wouldn't be ready until tomorrow.
CP: I can do that today for you. When would you like to come in for it?
IDGAF: It doesn't matter to me. As long as it's today.
CP: No problem-o. It shall be done today. Give me until 12 noon and it will be ready for you.
IDGAF: Really? That long?
CP: First, you did tell me "it doesn't matter" what time. Second, noon works for me since it's only 2 hours away and I have lots of other prescriptions that are waiting and my next tech comes in at 11. So, in short, yes, really.
IDGAF: I was coming down to buy stuff for lunch shortly.
CP: Okay. I'll play along. Why didn't you just say "I'll be at the store in 30 minutes for some shopping. Would it be possible to have it ready by then?" to which I would have replied "most likely, as long as you pick this up after your basket is full and not as soon as you enter the building". Besides, I eat lunch at 3pm so 12 noon seems like a logical time for me to think about food.
IDGAF: Whatever.
CP: Let's try this again. When would you like to come for your prescription?
IDGAF: Dunno.
CP: Really? I'll make it easy for you. See you after 10:29.
IDGAF: Fine.
CP: Yes, I ... Forgot It's Never Enough

Thursday, March 23, 2017

It's Magic ...

... or Just Doin' my Job, Ma'am.

Remember playing -peek-a-boo with a baby? 
Remember how the baby is all excited that you managed to disappear behind your hands, then magically reappear? 
Babies are fascinated by your magical skills. 
They giggle. They laugh. They love you. 

I was reminded of this last week when a prescriber called me to question a dose she prescribed for her pediatric patient. (Let's ignore the fact that she waited until 6 hours after sending the e-script to call, by which time the patient's mom already picked up and administered a dose.)

CP: Thank you for calling CP's pharmacy where you currently have the privilege of speaking to the infamous, self-deprecating CP. How may I help you? 
Following Through on Writing: I was calling to double-check the dosing on a prescription I sent over for Little Tyke earlier. 
CP: I recall. Is that the one for Amoxicillin 250mg/5ml? 
FTW: It is. I usually calculate my own doses but I let the computer calculate it for me and I didn't double-check. It doesn't round and I entered the patient's weight and just went with what it said. It seems a little high now that I think about it. 
CP: I remember this one. Mom already came and got it and we talked to her about it. 
FTW: Really? 
CP: Yes, but do not worry. We calculated the dose several times. We have students on rotation and one of the doses I make them memorise is the max of Amoxicillin. This worked out well because I had them do the calculation. 
FTW: But I didn't put the weight on the prescription. 
CP: I know. We don't need it. In any equation, as long as you have 2 of the 3 numbers, you can solve for the 3rd. We knew the max dose per day and we knew the dose you prescribed. Using these numbers we could find the patient's weight. We put a note on the patient's prescription at pickup. We asked mom to verify that LT weighed at least 70lbs and was being treated for strep. 
FTW: How'd you do that? That's amazing. LT was diagnosed with strep and weighs 73 lbs. Really? You did all that? 
CP: It's what we do here. The dose appeared high so we double-checked it. It was a great exercise for my students and for me. As Bon Jovi sang, "It's my license". 
FTW: "It's my life"? 
CP: You get me! Anyway, I know not all 12 year olds weigh the same. I make my students memorise other max doses as well so they can quickly calculate doses on the most commonly prescribed or recommended products for parents and their children. (Benadryl, Ibuprofen, and Acetaminophen especially.) Besides, if the dose seems off or if mom didn't answer the questions at pickup correctly, we would certainly have called you before it left the pharmacy. 
FTW: I'm so impressed! I never knew you guys did that. Thank you so much for looking out for us and our patients. 
CP: We all have the same goals in mind. You and I share the same patients and we're both busy. We are the last line of defence from a bad day. I know medications. I know doses. I know how to quickly calculate doses in my head. It's what I do. 

#WhyYouLoveYourPharmacist

Tuesday, March 21, 2017

An Insurance Paradox

Herr S: I wish to obtain my prescription.
CP: Certainly. You may pay the cash price or you may present us with insurance.
HS: I have insurance.
CP: Wunderbar! Please present it.
HS: You have it on file.
CP: I do not.
HS: You most certainly do. I come here all the time.
CP: I do not care where you come, only where you purchase prescriptions.
HS: I come here for prescriptions.
CP: We only accept cash or insurance, not come.
HS: There's something wrong with you.
CP: Yes, but you keep coming back...
HS: Anyway my insurance is, has been, and always will be, on file.
CP: Right. Unless it changes.
HS: Nothing has changed.
CP: Are you sure?
HS: Absolutely.
CP: Care to wager on it?
HS: Well maybe the group number changed.
CP: Maybe?
HS: Yes. Maybe. A little.
CP: Is it "yes" or "maybe"? It can't be both. You can't be "a little pregnant" or "maybe dead".
HS: Try this.  <presents card info>
CP: Wow. That worked.
HS: I preferred knowing and not knowing.
CP: Is that like going and not going?
HS: Something like that.
CP: Have a lovely day, Mr. Schrodinger. Come again.

Monday, March 20, 2017

You Know Nothing!

I walked into work the other day to witness a lady holding court with 2 of her friends. She was, how do I put it, "educating" her friends about OTC allergy medications.

Lady: That Cetirizine you're holding? It's like $0.98 at the dollar store down the street. The one they sell is better than this one. I've taken all of these OTC ones and the only ones that work are Xyzal and Cetirizine. (Never mind that Xyzal didn't arrive on store shelves yet.)

Friend Unbeliever: But this is once a day. I think the Cetirizine works better. What's the difference in them?

Lady: This one here, in your hand, has HCL in it. See, mine didn't. It's that extra HCL that makes it more expensive. It's probably why they don't sell it at the dollar store. It doesn't matter because the HCL ones don't work. You need it without the HCL.

Friend The Second: <silently nods in agreement>

Lady: I don't know what that HCL is, but it makes it not work. You're better off going to get the other stuff from the dollar store. This is like 4 times as expensive just for that HCL.

FU: I need it now, so I 'm just going to get this one.

Lady: Okay. But it doesn't work for me.

Now imagine this conversation is taking place among a group of students. A group of medical or nursing students. Because that's what happened.
Reminds me of the day I was with a phriend in a prescriber's office and we met with a CNP who instructed us that antihistamines were for sinus congestion and Sudafed, a decongestant, was for drainage. That was the last time my phriend ever went to that office.

#ALittleEducationIsADangerousThing

Friday, March 17, 2017

Prescriptions Take Time

Like a good wine, prescriptions take time. You cannot rush the process.
CP: Hello kind sir. How may I help you?
GS: I am here to pick up my prescription.
CP: I apologise but I have nothing ready for you.
GS: I am out.
CP: Okay. Was your prescriber to call us? Was it a refill you ordered?
GS: I called my doctor and told them I needed a refill.
CP: That's a good start. When did you ring them?
GS: This morning.
CP: It is currently 10:15am. When did you phone?
GS: About half an hour ago. I need it now.
CP: I see. Thirty minutes is the perfect amount of time to wait for a pizza. Ten to fifteen is perfect for Chinese food. But prescriptions ... need a little time to mature.
GS: What am I going to do?
CP: Did you have your dose today?
GS: Yes. But winter is coming.
CP: Indeed it has come. Spring is actually next on the calendar but there is a day of snow in the forecast.
GS: Can't you just give me some?
CP: Well, seeing as how it's Tuesday AND you contacted the office AND it's only 10:20am AND the office is open AND you've taken your dose for the day ... I cannot. These are all the boxes I must check as "NO" before invoking the emergency powers issued me by the state to write and dispense medication to you. I am sure if you check back later we may have something. Perhaps call before you leave the house?
GS: I guess he just wants me to stop taking my medication for a few days.
CP: Not sure how you can infer that about your prescriber. I am fairly certain you are not his only patient much like you are not mine. Either way, there is a good likelihood he shall send something over before they close. We are open until 10pm so there is still plenty of time. We can call when we receive it.
GS: Fine. I guess I will stop taking them for a few days and see what happens.
CP: Pretty sure that's not what I said. Are you and I even having the same conversation?

Friday, March 10, 2017

Pharmacy Posse

If our professional organizations won't take care of us, then we owe it to ourselves to take matters into our own hands.





My proposal is this: We need to gang up. Not unionize, but gang up. We will form posses. Each band of droogs will be comprised of all the pharmacies in the neighboring town. Our mission will be to harass the harassers. I will go to your store and you will go to mine. Think of us as the next generation of secret shoppers.

We will intimidate the intimidators. Hate the haters. Love the lovers.
We will just mill about the pharmacy waiting, drop off, and pick up areas. If we notice patients giving a hard time to any of the employees, our professional brethren, we will step in as casual customers, and put them in their place.

"Hey, I want them to take their time and not make any mistakes on my prescription. STFU and leave them alone!"
"Do you always treat the people who take care of you with such venom? I bet you yell at the wait staff serving your food. I wonder how many times people have spit in your entree."
"Where do you work? When we get done here, we're phollowing you back to your office to stare and yell at you."
Maybe we could stand uncomfortably close to them. Make eye contact while slowly inhaling the perfume off the back of their necks, then whisper "your hair smells lovely".

Armed only with our wit and CP 5000 Kitana spatulas, we will come to the defence and run interference for our pharmacy phriends in need.

But CP, what about the good ones?
Customer service surveys. Indeed, we all need these to maximize our bonuses. It is the only true measure of a good pharmacy staff. Never mind that stuff about not making mistakes and being the best professional we can be. The only way to know if a pharmacy member is worth her salt is through the totally worthless metrics. This is where we step in.

CP's Army: Excuse me. Did you receive the correct prescription?
Pt: Yes.
CPA: Did the pharmacist review it with you?
Pt: Yes.
CPA: And you are happy with their job performance today?
Pt: Yes.
CPA: She made sure your prescriber didn't kill you. She even called to change the dose on that antibiotic for your baby.
Pt: She did?
CPA: She did. And she didn't even seek credit for it because it's her job.
Pt: I didn't know she did all that.
CPA: You're going to call the 1-800 and give her all positive marks?
Pt: No. I never do those.
CPA: Let me rephrase. (Best Jedi impression): You ARE going to call and give her positive marks.
Pt: I am indeed!
CPA: Good. Feel the Phorce Phlow through you. G'Day!

Of course Option #2 will be to have the patient make the phone call directly from the waiting area.
CPA: Your pharmacist is calling right now to phix your prescriber's phailures in prescribing.
Pt: She is?
CPA: You should call the 1-800 number and thank corporate for employing such an attentive, detail-oriented professional to take care of you. Here, use one of my phones.

Option #3 will go like this:
CPA: You're going to call, right?
Pt: Nope. Piss off.
CPA: Okay. In that case, you got two choices of what you can do. It's not a tough decision as you can see. I can blow you away or you can hand your receipt to me.
Pt: <hands over receipt>
CPA: Thank you. Your positive 1-800 call is on its way. I bet you don't tip your wait staff very well either.

#PharmacyPhuckery


Wednesday, March 1, 2017

If The Real World Worked...

...no one would be responsible for his own actions. Oh, wait...

Remember driving to the video store to rent a DVD? What happened when they were out of the most popular title on Friday night?
Remember standing in line for Black Friday sales and you finally get inside and they are already out of the item you wanted?
Remember heading to the grocery to find they are out of something you need for a recipe?

What did you do?
What recourse did you have?
What actions did you take to receive compensation?
Anything?
No.
In most cases you likely rented another picture, bought an alternative product, and drove to another store or purchased a substitution.

If the real world worked the way people believe pharmacy does, there would have been hell to pay. See, the pharmacy world operates just outside of normal. If there were a rural suburb of normal, this is where Pharmacy World would be located. We'd even have one of those signs that gives the population...and a kid sitting by to change it.

The expectations in this Twin Peaks-esque World are quite skewed. In each of the above scenarios, the outcome would have been the same had they occurred in Pharmacy World, but different than in Normal Town.

CP: I apologise, but we are currently out of this medication.
Can't Comprehend Current Conversation: But why?
CP: We've had quite the run on this today? We never stock it because it costs $1 bajillion? It's brand new and we haven't had call for it yet? Pick one.
CCCC: Don't you know how to stock?
CP: Yes. I order something. It comes in tomorrow. Much like you and your prescriber. She ordered something and now it has to come in tomorrow. As I said, it is quite expensive and no one has prescribed it before. (Or everyone has been writing for it but supplies are limited.)
CCCC: So I have to come back tomorrow?
CP: As I stated, yes.
CCCC: I spent all this time in the drive-thru lane and now I have to do it all over again tomorrow?
CP: Well, you could come inside for a bit of a change of pace and scenery.
CCCC: Who's going to pay for my gas?
CP: Sorry?
CCCC: My gas! All that I wasted while sitting in this interminable line and that I am going to have to use to come back tomorrow!
CP: Hmm. Let me think. That would be you.
CCCC: <incredulity permanently tattooed to her face> Excuse me?
CP: You could have called before you came down. You could have come inside. We attempted to ring you but you mustn't have heard the message.
CCCC: I deserve compensation for wasting my time and gas.
CP: I didn't realise gas was such a sought-after commodity and Pharmacy Town was in the middle of it. Did the apocalypse happen while I was stuck in here and now we're in the middle of Max Max? Let's think about this for a moment because no one ever does the math. Your vehicle averages about 20 MPG. It's 4 miles to your house. Since you were coming here anyway, let's start the math from now. That's 4 miles home, 4 miles back. Add in 15 minutes of idling and that's less than 0.1 gallon each time. Right now we are at 8 miles and 0.2 gal used. At 8/20th of a gallon you are using 0.4 gallons driving. Add the idling 0.2 to this and you used a total of 0.6 gallons. With the cost of gas right now at $2.00 per gallon, your wasted fuel costs amount to $1.20. Even when gas was $4.00, you'd only be out $2.40.
CCCC: Well I deserve something.
CP: You got it. A math lesson and a history lesson.
CCCC: What history lesson?
CP: Next time you'll call ahead ... and listen to your voicemail.

Monday, February 27, 2017

The Debate

1. "Take one tablet by mouth every day."
2. "Take one tablet by mouth once a day."

Both directions say the same thing...or do they? According to some pharmacists, they are not entirely the same in their instructiveness. Let us examine a little closer.
CP's Partner and I conducted a very scientific poll. We asked our Phamilies, Phriends, Kids of Phriends, Random Strangers, and our Bartender to explain to us how they would take medication if they were given Option 1 or Option 2 on their bottles.

Conversation #1:
CP: How many tablets would you take if I told you to "take 1 tablet every day"?
People We Polled: <incredulous looks on faces> One.
CPP: And on how many days would you take one?
PWP: <still looking dumbfounded> Every day.

Conversation #2:
CP: How many tablets would you take if I told you to "take 1 tablet once a day"?
PWP: Seriously?
CP: Yes.
PWP: One.
CPP: Okay. Now the tricky question: On how many days would you take one?
PWP: Every day.
CPP: But it doesn't say "every day". It says "once A day". Couldn't this be interpreted to mean you get to select "A" day on which to take it?
PWP: You're arguing semantics with me.
CPP: Precisely!

Summary:
PWP: Why are you asking me this, again?
CP: We were having a debate. At work, we noticed a number of prescriptions, prescriptions we personally typed, getting sent back for correction.
CPP: We wondered why until we noticed that the same pharmacists were sending them back for the same reason...
CP: ...The two directions listed above. I believe that both are a fine option. Personally, I prefer Option #1.
CPP: Personally, I don't care, but Option #1 works fine for me. I just wanted to try to learn why some pharmacists were stuck on Option #2 being the ONLY correct option. Hence, my reply in Conversation #2.
CP: Unless they are insisting that the medication be taken at "the same time once a day"?
CPP: Okay, but they are still taking only one tablet every day. If they were really that hung up on "at the same time" then could they not amend Option #1 to "at the same time every day"?
CP: True.
PWP: You are both really weird.
CP: But we yearn to know. To understand our fellow colleagues. To boldly go where no one has gone before. To...
CPP: They get it.

*For the record, we know "ONCE' means "eleven" in Spanish and that can be confusing but that is not the gist of this debate.
*Second, there is a HUGE difference between "Take 2 tablets once a day" and "Take 2 tablets every day". While the patient will take a total of 2 tablets either way, the timing is different. It's either 2 at the same time, or 2 throughout the day which could be taken 19 minutes or 16 hours and 11 minutes apart.
*By adding a simple "prn" or "as needed" to either of these changes them as well. Again, not the point.


What say you?


Tuesday, February 21, 2017

Demo Time

The next time someone asks why it takes so long to fill your prescription, I'm going to send over one of my highly trained, cynical representatives to perform a demonstration.
We will have a demo cart set up with the following items: empty vials, safety lids, non-safety lids, a blank label, a completed "test" label, random tabs/caps we found under the counter (or M&M's), a counting tray, a spatula, and the most illegible, poorly written or typed prescription we have seen in our pharmacy. 
Then, in our tone most snarky, we shall commence the lesson.

See this blank label? Uh-huh. This is the before. Yep. See this completed one, the one with all the writing on it? Yep. We put that on there. But how does it get there? First you have to read the prescription. See this one? I can't give you XXXXXXXXXXX the way that it is written. It would either kill you, or it doesn't exist. See, your prescriber is just making it up as he goes along. Must have been the 5pm special, scribbling as he and his colleagues exeunt. Now we have to call the prescriber...

Fast forward to receiving a new, clean prescription. This could take seconds to weeks, depending on your office. Now we type it all in the computer. What we type in here (motions to computer) comes out there (waves hand over completed label). This is how we know what, and what quantity, to count. Now we have a big bottle of medication. Somehow, we have to make sure it is the right one. Uh-huh. Yeah. We can't just grab random medication off the shelf. That would be bad, m'kay? So we pull it. Then we scan it. THEN we count it. Let me demonstrate it for you.

<exhibits flawless, machine-like skills while wielding a CP 5000 model spatula and effortlessly sliding the chosen little doses across the smooth surface of the tray>

Then we have to select the appropriate size vessel for your medication. Easy with tablets as there is a graduated marking system on the side here <waves hand over the tray demonstrably>, but less easy with capsules. It takes experience and know-how to gauge the size. We then bust a cap on it. THEN, and this is every patients' favourite part, we professionally apply a label to the bottle, delicately rolling it so as not to impart creases or wrinkles (okay, we slap that bitch on there, but it's lovingly applied to appear straight and elegant). THEN...

...we hand it off to the pharmacist. Her job is to verify that what I put in there is what is supposed to be in there. I performed this demonstration for you in an aseptic, controlled environment. Normally, I would perform this task under duress; I would be answering phones, taking your drop off, fielding questions about the location of cotton balls, the bathrooms, and the sale item of the week and slinging pills like a short-order cook slinging hash. The pharmacist, once she is satisfied I didn't mislabel or misfill your bottle, will bag your order so you can go wait in line to retrieve it.
[Note: I skipped the part about the drug interactions, profile check, etc because that is the pharmacist's advance class (#WhyYouPrescriptionTakesSoLong II) which is available only on weekends and evenings for a nominal fee.]
Assuming no one in front of you decides to present a new insurance or discount card, it is quite likely you can proceed through checkout in a matter of minutes.

Hello? Sir? Wake up. Your prescription is ready. Sir? 

Monday, February 20, 2017

Patient Know-It-Alls

Don't you just hate it when someone is so convinced they are correct and you know they are wrong but can't change their belief? It's like every post on Facebook this past election season. Or going down the rabbit hole of Flat-Earthers thanks to Kyrie Irving...Or an average day at work in the pharmacy.

Just Convinced He's Right In Some Thinking: I need my diabetes medication refilled.
CP: Okay. <scanning profile> I see we have Metformin on your profile. Would you like me to...
JCHRIST: Nope. That's not it. It's for something else.
CP: It is for diabetes.
JCHRIST: No. No, It's not. I said it's something else.
CP: O...kay. Any idea what it...?
JCHRIST: What about my blood pressure medication?
CP: You mean the one to lower it?
JCHRIST: Of course to lower it! What a stupid question.
CP: Just making sure. <scanning...scanning...> Aha. I see Lisinopril.
JCHRIST: Nope. Wrong again.
CP: Well, it IS for High Blood Pressure. The way this conversation is going, I suggest you at least fill that.
JCHRIST: Did that replace my Lipitor?
CP: No. That would be for cholesterol.
JCHRIST: No it isn't.
CP: Um...Yes. Yes, it is! It's right there in the name "lipid".
JCHRIST: No. It isn't. Don't they teach you about drugs in school?
CP: In fact, they do. I'm just curious where you obtained your education.
JCHRIST: School of hard knocks. I've been taking these for years. That's why, when your people ask if I "have any questions for the pharmacist", I always answer "Nope. Been taking them since before you were born".

...That moment when you realise you are arguing with an idiot...which makes you an idiot...which makes you wonder who is the bigger idiot...

CP: I see. Well, since my advice is always free, let me offer this to you. You can give a man an education, but you can't make him take it. Since you are so convinced you are taking the correct medications for the correct conditions, there is nothing I can do to help you. The next time you pick up your medications, I will have a new waiver for you to sign:

"I, the undersigned, have refused the most valiant attempts at counseling by my pharmacist. Even though she is trained in the ways of the phorce, and I am but a patient, I prefer to put all my faith in my uninformed alternative facts. Nothing she can tell me shall persuade me otherwise and I shall live and die by my own ignorance, exculpating the pharmacist from any blame."

#ThereAreNoneSoBlindAsThoseWhoWillNotSee

Thursday, February 16, 2017

A CP Guide to OTC Products

In any pharmacy or grocery store or place that sells oral cough and cold products, there are rows and rows and shelves upon shelves with products "begging for your filthy dirty dollar. Shut up and buy!" How does one decide what product is correct for their particular symptom(s)? Simple, ask the pharmacist...Then ignore her advice and go with your friend's sister's hairdresser's customer's second cousin's recommendation.
The next time you are overwhelmed, simply break down the aisle into these categories:

1. Pain Reliever/Fever Reducer. Almost always Acetaminophen (Tylenol) but sometimes Ibuprofen (Advil or Motrin--same thing and you can't argue one works better than the other.)
2. Antihistamine: Usually diphenhydramine (Benadryl), sometimes chlorpheniramine or brompheniramine.
3. Nasal Decongestant: always phenylephrine if you don't see the Rx staff for it. Pretty worthless.
4. Cough Suppressant: Always Dextromethorphan.
5. Mucolytic: Always Guaifenesin.

That's it. Nothing more to it. The only reason there are so many products is that there are so many manufacturers and brands marketing themselves to you. Basically, the only thing you need to look at is will the product you buy alleviate the symptoms you have? If you remove the pain reliever from the equation, then the job is easier. Most people have either or both of these at home.

Forget the "Sinus", "Allergy", "Cold", or "Flu" designations placed on the boxes. They are as worthless as they box on which they are printed. "Words are wind."

Do I have pain? A headache? Then a pain reliever is right for you.

Do I have a runny nose? Itchy, watery eyes? Drainage? A cough? (Basically, if it's leaking and it shouldn't, you want an antihistamine.)

Is my nose stuffy? My head congested? (Basically if it's not running and it should, you want the good stuff-the pseudoephedrine from behind the pharmacy counter.)

Am I coughing? Is it dry? Seriously, get an antihistamine. Forget the DM. Doesn't work.

Am I coughing up bits from my lungs? Get the Guaifenesin. Best bet is Plain Mucinex. Blue Box. And drink lots of water.

In all seriousness, buy individual products where able. Combination products will almost always have you taking something you don't need for a symptom you don't have. Worse yet, you could be taking a combination that does not include a medication to treat the symptom you DO have. It is easier (I did not say more convenient) to add or subtract single ingredients as symptoms come or go than it is to take multiple combination ingredients that won't work.

When in doubt, ask your pharmacist.
Then take her advice.

I thinking we should make a survey sheet of symptoms.
These could be available at the pharmacy counter or online.
The patient could check the box or circle the symptoms of each family member when they get to the pharmacy or from home (especially before sending their husband or kids).
The pharmacy staff would then hand the appropriate product(s) to the patient after reviewing the list.
Someone should make this for me so I can post it.

Tuesday, February 14, 2017

Lame Pharmacy Pickup Lines

1.  "I'm easily administered, like Lactulose. I can be take orally or rectally."
2.  "Single this Valentine's Day? Come to the pharmacy where we can treat your VD ... blues."
3.  "Call me Proair because you can use me every 4 hours as needed."
4.  "You must be a 5-alpha reductase inhibitor because that is one Finasteride."
5.  "You can always get it over the counter at the pharmacy. Just ask."
6.  "Pharmacists come in prescribed doses."
7.  "Are you here to pick up a bottle of insulin because you are extra sweet."
8.  "I need to keep Amiodarone on hand because every time I see you, my heart skips a beat."
9.  "A pharmacist's love is like Nystatin Suspension-you have to swish before you swallow."
10. "If you're looking for a short-term fling, I've got just this thing. Call me Medrol and I'll be all over you the first day before slowly slipping away."

Monday, February 13, 2017

Adopt-A-Phriend

Welcome to CP's Pharmacy where we are always at the phorephront oph phun and ephphiciency. Today's discussion is "Bring a Phriend to the Pharmacy".
Always looking at ways to revolutionize the practice of pharmacy and stay one step ahead of the competitors out there, CP has once again developed a growth strategy that will be a real game-changer. We will initially celebrate with a monthly program with the goal of this becoming a weekly, or even daily, program in certain markets. 

Bring A Phriend To The Pharmacy is a simple concept.
Chains have invested a lot of time and money into med synchronization programs that simply don't work. The idea is that the patient will be contacted when her refills are automatically filled on a predetermined schedule. The problem with this idea is the patient herself. It's the human factor. (Patients often forget to take their medications as prescribed; forget to pick up the refills; or otherwise miss doses or generate stockpiles of certain prescriptions.)

As I got to thinking about this and how we could improve the idea I asked myself, "CP, who are the most compliant patients in the pharmacy world?". After about 3 milliseconds of brainwork, I responded with "Controlled Substance Patients (CSP)". That's when it hit me. If we partnered the MOST compliant patients (CSP) with the lesser compliant patients, Other Disease-State Patients (ODSP), we could really affect compliance. Think about it...

Controlled Substance Patients
-are always on time (even early).
-never miss an appointment.
-know exactly when their refills are due.
-know exactly when their next dose is due.
-never miss doses (and sometimes take an extra, just in case).
-take even "as needed" medications on a strict schedule.
-know the hours of operation of every pharmacy.

CP, what does this have to do with "Bring A Phriend To The Pharmacy"?
I'm getting to that. Patience. I mean, Patients.

This program will join a CSP with an ODSP. It will be like a life coach knocking on your door every morning at 5am for your workout ... except, we'd encourage the ODSP to drive.

CSP: Time to pick me up!
ODSP: It's 5am.
CSP: It's Refill Day!!
ODSP: But they don't open for 4 more hours.
CSP: We have to be first in line.
ODSP: The pharmacist said our prescriptions wouldn't be ready until 10am. They don't actually work on them until they open.
CSP: Right. But they hate it when we stare at them. Makes them feel pressured and they just want to get rid of us. They speed ours through and we can have them by 9:30.
ODSP: <click>
<<10 minutes later>>
ODSP: Hello?
CSP: Where. ARE. You? Let's go.
ODSP: Ugh. Being healthy is tiring.

Eventually we can expand the program to pair up patients who are on a similar dosing schedule. This way, the patients will always take their meds together, thereby increasing compliance. I'm working on the name, but "Let's Do Drugs Together" will be the working title.




Wednesday, January 18, 2017

Private Parts...

...or #WhyYourPharmacistIsPhrustrated

January is a chaotic time, especially in the pharmacy. The post-Holiday high has evaporated and the new reality of winter blues and insurance changes settles across the land like a blanket, suffocating any hope of patience or kindness hinted at last month. There are many stories out there. This is but one of them.

Optimistic Wife: Here is our new insurance card.
CP: You are amazing. He is lucky to have you.
OW: We know how you suffer for your trade and wish to make things easier.
CP: Your graciousness does not go unnoticed ... Oh dear.
OW: What seems to be the trouble?
CP: It appears something is wrong with this new insurance. I received a non-matched DOB rejection from them. Please tell me again what his DOB is.
OW: <slightly irritated> I should know what it is. We just celebrated it yesterday.
CP: Thank you. Just wanted to make sure, before I called the insurance, that it was not I who mistyped the information.

<calls insurance>
Helpless In Seattle: What is the reason for your call today?
CP: I am getting a non-matched DOB reject. I was hoping you could provide me with what you have so we may send this patient on his way this weekend.
HIS: Okay. Let me get all the information from you.
CP: <provides patient's name, address, family members, phone number, blood type, favourite movies and TV shows, and employer> Phew. How's that?
HIS: Fine. Thank you. Yes. It does appear that his DOB does not match.
CP: Right. As I told you 10 minutes ago before you started your interrogation. May I have the correct one so I can get the patient's wife on her way to easing her husband's suffering?
HIS: No.
CP: And why, pray tell, not?
HIS: "It is a HIPAA violation."
CP: Actually it isn't. HIPAA is between the patient and his healthcare providers of which I am one. It involves the Patient, the Prescriber, and the PHARMACY. So go ahead and provide it to me and we'll be on our way.
HIS: Is the patient there? I can tell him.
CP: No. He is at home. Convalescing after his stint in hospital. His wife is here.
HIS: Okay. I can tell her.
CP: What? NO! No you cannot. THAT is the very definition of a HIPAA violation. You may need to reread the script you're following. This is why I hate insurance companies. <click>

<calls to get another representative>
<goes through the whole spiel again>
More Forthcoming at Each Opportunity: Yes. I see that what we have differs slightly.
CP: May I have it please?
MFEO: Sure. Just make sure they get it corrected soon.
CP: Will do. We have a place to submit the incorrect DOB so it matches what you have. You know, two wrongs make a right when it comes to insurances.

OW: What happened?
CP: They're dyslexic. They had the year as '65 instead of '56. At least they made him a younger man for you.
OW: Thanks for your trouble.
CP: It would have been easier if the first call hadn't invoked HIPAA as a reason to not provide me with the correct information. She must think she's the insurance version of Negan. "I will shut that shit down!"
OW: Phunny.
CP: Thanks.

Tuesday, January 17, 2017

Celebrity-Voiced Labels

We need audio labels. For patients you have trouble seeing/reading their labels, we need to offer labels that will read the directions to them.
I think we can offset the initial cost by getting celebrities to volunteer to record their voices, similar to GPS devices. 

Every time I read: "Take 1 tablet by mouth twice a day 'with or without food'", I think of U2's "With or Without You".

Peter Schilling (Major Tom) does Prednisone tapers: "4, 3, 2, 1..."

Fred Durst: "So you can take that suppository and stick it up your yeah! Stick it up your yeah!"

The Violent Femmes could start any label:
"Take one, one, one cause you left me and two, two, two for my family and three, three, three for my heartache and four, four, four for my headaches..."