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Sunday, July 23, 2017

You Work In The Office?

Normally, we pharmacists are the ones initiating this conversation.
I laughed.
The nurse wasn't as amused as I.
That amused me more.

CP: Welcome to Alternate Reality Friday, how may Maester CP help you?
Nurse In Charge Of Nothing: I'm calling from Dr. Zoffis and was wondering if you could help us out with a patient.
CP: Certainly. It's sort of my thing.
NICON: She's here for her visit and she says she misplaced her bottle. We are trying to figure out what she needs refilled.
CP: This sounds eerily phamiliar. Do go on.
NICON: It's for her Losartan. Which strength did she fill last time?
CP: Silly question for you. Did you not prescribe it last time?
NICON: We did. That's the problem. We can't read Dr. Zoffis's handwriting. It's either a "5" or a "50". He wrote something then scratched it out, then wrote on top of that.
CP: Now I know why it sounds so phamiliar. We are usually the ones calling you because we can't read handwriting.
NICON: <clearly not amused> Can you tell me which one she got?
CP: I can.
NICON: So. . .?
CP: . . . a needle pulling thread. . .
NICON: Which strength was it?
CP: It was the 50mg.
NICON: <whispers to patient behind her "was it 50mg?> She says that sounds right.
CP: Of course it "sounds right". I've got it here in her profile. It's sorta kinda like a patient record thingy, akin to this thing called a chart that many a Dr. Zoffis will keep in their office. It's typically used for situations like these.
NICON: Phunny.
CP: That's my line. I have to ask the obvious.
NICON: Why not?
CP: I usually call the office and someone either knows the answer, researches it for me, or directly asks the prescriber what was written. Is there a reason you didn't just swivel your chair around and ask Dr. Zoffis directly?
NICON: He was in another room and I'm updating the patient's medical records in her room for her appointment.
CP: He couldn't be bothered.
NICON: He's busy.
CP: Yet he's coming into this very room in a matter of minutes.
CP: I'll send you my bill. I should at least receive a consulting fee or MTM credit or something for your shenanigans.
NICON: I'll bring you doughnuts.
CP: Only if you pronounce them "Duff Nuts".
CP: Dough as in "rhymes with tough"; although I'd accept Dough as in "rhymes with cough" too.
NICON: I wish my prescriber was as phun to work with as you.
CP: Come to the Dark Side.

Wednesday, July 19, 2017

FOR The Win!

Is it possible for a product to be used FOR a purpose while also, simultaneously, being used for its opposite purpose?
Just because of how my brain works, and the fact that I like to mess with my colleagues' heads, I often initiate conversations with my partner at work just to watch the brain squirm. So it is with this topic:

CP: What is the definition of "insomnia"?
CP's Partner: Insomnia is defined as "an inability to sleep".
CP: Precisely. Now, if I received two prescriptions for Ambien, and labeled them as follows, could they both be considered correct?
1. Take 1 tablet at bedtime for sleep.
2. Take 1 tablet at bedtime for insomnia.
CPP: Um.
CP: Another example would be any medication prescribed for blood pressure:
"Take 1 tablet once a day for blood pressure."
Does this mean that without this medication, the patient would have NO blood pressure?
CPP: Please stop. You know what they mean.
CP: Yes. They mean to treat High Blood Pressure. But that is not how the label reads. It simply says "FOR blood pressure."
CPP: Point conceded.
CP: I have another one for you.
CPP: Stop.
CP: Condoms.
CPP: What about condoms?
CP: Thinking about the Ambien examples, focus on these directions:
1. Use 1 condom for babies.
2. Use 1 condom for prevention of babies.
CPP: But . . .
CP: Yes?
CPP: That makes by head hurt. Please stop.
CP: Nope. I'm on a roll now. I have one more.
CPP: I feel sorry for your family. They have to live with you.
CP: Diarrhea.
CPP: Okay. Last one. Get it over with. What about diarrhea?
CP: If a patient asks for a medication for diarrhea, what do you recommend?
1. Take 1 tablet of Imodium for diarrhea. or
2. Take 1 bottle of Golytely for diarrhea.
One treats it and one causes it. They cannot both be correct, yet the products would be labeled correctly if I put "for diarrhea" on each.
CPP: Does your brain ever cramp? What do you feed the chipmunk running on the wheel in there? Red Bull and Starbuck's?

Thursday, July 13, 2017

The Death of Professional Judgement

In the immortal words of Korben Dallas, "I am a meat popsicle". This answer shall suffice in response to any question concerning a pharmacist's job responsibilities.
Pharmacy schools (apparently) no longer teach "professional judgement" or companies have basically policied it out of existence. The new mantra is: "Don't Think For Yourself!".

CP: Why can't I just use my professional judgement, that with which I was naturally blessed as well as professionally paid to have attuned, to make a decision?
ME: Because you're not allowed anymore.
CP: Why am I not?
ME: Policies. You are a meat popsicle. You are a button pusher. You do not get paid to think.
CP: In what dystopian novel did I just awake?
ME: None. It is the era of Big Brother. It is the era of micromanaging. It is the era of fear of lawsuits. It is a direct result of ISIS and terror threats.
CP: Huh? How can you associate my using my collegiately enhanced brain and years of experience to make a professional decision to that of terror threats?
ME: What are you trying to accomplish?
CP: I wish to change an e-script from Proair to Ventolin because this patient's State Medicaid plan changed and they have a new formulary.
ME: Not allowed. They are totally different.
CP: Okay. How about Amoxicillin or Doxycycline? The insurance only cover tablets as opposed to the capsules, or vice versa. I simply wish to change the dosage form and provide service to my patients.
ME: No can do. That's practising medicine. Prescribers are infallible and there must be a reason they selected the exact option they did on their e-script software.
CP: You mean the software that doesn't make them choose Doxy Mono or Doxy Hyclate?
ME: The same.
CP: You mean the prescribers that have become so irritated with whiny pharmacists wasting their time over the last 5 years that they have changed their prescribing habits on their electronic devices?
ME: How so?
CP: Now we receive what would pass as passive-aggressive threats on any social media.
"Doxycycline 100mg, don't care what salt form or if it's tabs or caps. I just want the patient to have what's covered. Don't call me unless all forms of Doxy are not covered and rather expensive. Again, I. Don't. Care! Stop calling me."

or . . .

"Albuterol inhaler. They're all the same. I don't care what the package inserts say. So the patient switched insurance. Fine. Then they can switch inhalers. Albuterol is Albuterol. I. Don't. Care! Just stop calling me!"

or . . .

"Amoxicillin 500mg tabs to take 1 capsule 3 times a day. Look, if I were to hand write this prescription, I'd not put tabs or caps anywhere on it. It's not my phault the software makes me pick one and for some reason the sig does not match. Unless the patient has a gelatin allergy, I don't care. And you'd probably know more about that than I."

or . . .

"Prednisone tapers. Look, I tried to quickly figure out how many I would need to prescribe but my math skills suck and they make us use the computers for everything. Just give the patients what they need and we can all be happy. I Love You! You are the most helpful, underrated profession and we need to thank you more for saving our asses."

ME: So what's the real problem?
CP: New(er) pharmacists are so worried about everything that they cannot think for themselves. (I had an e-rx for a cream with directions to "apply 1 tube twice a day" and another for FeSO4 325mg with directions to "take 1 milligram once a day". A real life pharmacist refused to approve them when I corrected them to "apply twice a day" and "take 1 tablet once a day", respectively.) I have offsite pharmacists, that's PHARMACISTS (people with licenses like mine), that refuse to check or approve prescriptions like this. I see comments from pharmacists on my posts every day that echo the fear factor present in our profession. Too many times have I read "I have to call" or "I'd call on that" instead of "My alma mater and past preceptors trained me to use my brain and make this decision all on my own. It's my license and I earned it and I am damn well going to use it".
(Obviously, there are instances where we HAVE to call. Our educated brains tell us to do so. But not for many of the more trifling, petty situations I see all too often.)
ME: So ...?
CP: So we bitch and moan about being treated as equals; as peers; as knowledgeable professionals all the while calling and asking stupid questions.
ME: But won't your stupid questions cause the prescribers to change their habits?
CP: Yes. They now write notes telling us not to call. Rather than solving the serious problems, we annoyed them with petty grievances and now they don't take us seriously.
ME: What do you want?
CP: I want my profession to grow back its spine. Document your actions and thoughts and calculations on the hard copy then fill it accordingly. We are so afraid of an error, an inspection, a policy violation, an audit that we forget how to actually do our job. You didn't go to college to live in fear. You went to be a respected professional. Now grow up and be one.
ME: Tough words.
CP: Tough Profession. We fight everyone else; it makes no sense to fight ourselves.
ME: I think I love you CP.
CP: I know.

Friday, June 30, 2017

No One Is Available To Take Your Call

Patient of Irrational Expectations: Why is my medication so expensive?
CP: Baby needs diapers.
PIE: What? You always do this to me.
CP: Do what?
PIE: Overcharge me. You're supposed to be matching my price.
CP: Did you tell me that when you called in your refill?
PIE: No. You should just know.
CP: Yes. As you are the only patient keeping my business afloat, I know yours is the one prescription on which we match prices. Whom are we matching?
PIE: It's that independent across the street.
CP: Ah yes. "We Be Druggists". We purchased them 4 years ago when their pharmacist retired. With a name like that, it's no wonder they went out of business.
PIE: And you're supposed to be matching their prices.
CP: But they went out of business. Four years ago. We bought them. We have their phone number too.
PIE: I just want you to match their price.
CP: Would you like me to call them?
PIE: Yes!
CP: <puts phone to ear and dials the old "We Be Druggists" phone number>
      It's ringing.
      <picks up other line and holds it to other ear>
   CP: Hello?
   CP: Hello?
   CP: I'd like to get a price quote.
   CP: Sure thing.
   CP: How much is this prescription?
   CP: $31.38
   CP: How much do you charge?
   CP: Wow. We charge $31.38 as well.
   CP: Wow. Miss PIE wanted us to match her price.
   CP: She's a little demanding, but she's sweet. Tell her I miss her.
   CP: Will do.
PIE: What did they say?
CP: He said to say "Hi!" and that he misses you and that the price is the same as what we're charging.
PIE: How can that be?
CP: Must be inflation or something. Apparently the cost of being closed has gone up over the last 4 years.
PIE: Fine. I'll pay it today. But you better check all my prices with them in the phuture.
CP: Yes, ma'am. Just remind me before you come down to pick up your prescriptions. They're not always this easy to reach.
PIE: Will do.

Commodious Quim?

Pt: I need a refill on my vaginal cream.
CP: Sure thing. Wait. It's too soon.
Pt: What do you mean?
CP: Well, for starters, your insurance denied it because we filled a 90 day supply 21 days ago.
Pt: What's that mean?
CP: According to the directions we have, this should have lasted you at least 80 more days. It says: "insert 1 gram vaginally 2 days a week". We dispensed a 30 gram tube. That's a 15 week supply, or 105 days, whichever you prefer.
Pt: But I'm out.
CP: Okay. How are you applying it?
With a paintbrush? Like Jackson Pollock?
With a caulk gun? (ha ha)
Until full? (How deep is your love, by the Bee Gees?)
You squeeze the tube from the middle, don't you? . . .


Thursday, June 22, 2017

But Metrics I Met

It's like they don't care bout nothing man.
Do another MTM yea (ooh ooh ooh).

La da da da da da, Da daaa.
La da da da, La da da da, La da da daaa

I was gonna fill your scripts, but metrics I met.
I was gonna count the pills and label them too but metrics I met.
Your script is not done yet and I know why (why man?) yea hey,
Metrics I met
Metrics I met
Metrics I met.

(La da da da da da da da da)

I was gonna counsel you till metrics I met.
Given you advice about side effects but metrics I met.
(La da da da da da da da da)
I couldn't spend enough time with you then and I know why (why man?) yea hey,
Metrics I met
Metrics I met
Metrics I met.

(La da da da da da da da da)

I shoulda been helping you, but metrics I met.
Find the TP out on the floor but metrics I met.
They don't measure that type of service and I know why (why man?) yea hey,
Metrics I met
Metrics I met
Metrics I met.

(La da da da da da da da da)

I was going to pick up the phone but metrics I met.
Answer your questions and talk to you but metrics I met.
Now I'm getting a customer complaint and I know why (why man?) yea hey,
Metrics I met
Metrics I met
Metrics I met.

(La da da da da da da da da)

I was going to take your script from you but metrics I met.
Figured I'd scan and type it too but metrics I met.
(La da da da da da da da da)
Now my times for my queue are blinking red and I know why (why man?) yea hey,
Metrics I met
Metrics I met
Metrics I met.

(La da da da da da da da da)

Now I don't get to go home until metrics I've met.
And I can't do any other work until metrics I've met.
Not getting a bonus this year and I know why (why man?) yea hey,
Metrics need met
Metrics need met
Metrics need met.

(La da da da da da da da da)

Monday, June 19, 2017

Lower Your Expectations

Explain your problem to me.
I will address the issue and attempt to phix it.
Once I have reached a conclusion, I will present it to you.
Whether or not it is satisfactory is not my problem.
It is, however, the answer, and continued arguing on your part will not change the results.
Think of it as yelling at your TV after the other team scores. Or yelling at the scientists because their science disproved your personal beliefs.

CP: How may I disappoint you today?
Dude Wants A ReFund: I have this discount card and I want a refund.
CP: Okay. Where and when did you get it?
DWARF: The Other Pharmacist at another store gave it to me. I'd been paying $500 a month for this because my insurance won't cover it. She told me the drug rep came in and left these cards. She was able to give me money back.
CP: Okay. I will try. We filled this only one time for you, in April. I'm not sure it will work.
DWARF: She said if you have a problem, just call her. All you have to do is change it to this card and give me a refund.
CP: That's all, huh? Did you activate the card?
DWARF: No. She took care of everything.
CP: Okay. <makes magic in the computer. pushes buttons. pulls levers. bells and whistles sound like it's a Willy Wonka computer system>
DWARF: That sounds promising.
CP: Unfortunately, the results were negative. We lost him, sir.
DWARF: What do you mean?
CP: She activated this card on 15th May. We filled your prescription 15th April. In other words, we filled the prescription before coverage was active.
DWARF: So I'm just out $100.00?
CP: Technically you've been out $500 for the last couple months. That would be like playing the lottery and when your numbers don't hit, complaining to the lottery commission that you're out the multi-million dollar jackpot. You didn't have to buy the lottery ticket any more than you had to buy the prescription.
DWARF: <stink eye> She said you'd be able to do it. She did it.
CP: She did because she activated the card on the day she filled your prescription. If you have new insurance that won't take effect until August, they won't retroactively pay for things before you were covered under their policy. If I have to purchase a new washer and dryer in August, I can't invoke the Memorial Day sale that Lowe's held just to get myself a discount. "But I didn't need to buy them when they were on sale. You need to give me that price today, three months later."
DWARF: You don't need to explain it to me.
CP: Usually people stop arguing with me by now. You're still standing here with a look of incredulity on your face and trying to get me to change the fact that the discount card denied the claim.
DWARF: This is why I don't come here.
CP: Actually it is because you live across town and we were the only pharmacy that had that strength in stock on the day you needed it. Sometimes, even @TheOtherPharmacist can be wrong.

Thursday, June 15, 2017

How Long ...

... is the wait?
CP: About 10 minutes. 
Pt: 10 minutes? 
CP: 10 minutes. 
Pt: You said 10 minutes? 
CP: Did I stutter? Is there another way to interpret "10 minutes" other than as "10 minutes"? Is there some metric conversion you are trying to perform so you keep repeating it aloud while mathing? 
Pt: You said 10 minutes. 
CP: I did. I was wrong. It's not 10 minutes. 
Pt: I knew it. 
CP: What I should have said was: Assuming all things go according to plan and we are not invaded, overrun, or otherwise turned into zombies or wights, and your insurance information is correct and they decide to cooperate and not deny your claim for any reason, and if the status quo remains as quotidian as the rest of my day so far and no one causes "scriptus interruptus" while working on your order then, and only then, shall my estimated wait time of approximately 10 minutes prove to be accurately precise. Or precisely accurate. Either way, the clock shall not drop until I have ceased speaking with you so you may continue to delay the onset of action or effectively move yourself aside so the countdown starts. The tension mounts ...
Pt: On with the body count?
CP: Ice-T! 
Pt: Lemonade!
CP: 10 minutes. 
Pt: Phine. 

Tuesday, June 6, 2017

Bored Today?

Did you ever wonder what some people must do with their days? When I am scheduled to work my plan is to go to work. When I am home, I make plans according to what needs done around the house or in my life. Based on some of the answers I receive from patients during conversations, I wonder ... that's it. I just openly wonder; mouth agape in awe at how life happens.

CP: You have a prescription to pick up.
Pt: What's it for?
CP: Why did you go to the doctor?
Pt: <shrugs shoulders>


CP: Let's play pretend again. I'll be the patient and you be the serious pharmacist.
CP's Partner: Okay. Definitely role playing.
CP: Let's do the "nothing better to do" sketch.
CPP: Got it. Ready?
CP: Ready. What are your plans today?
CPP: I'm going to Home Depot to find some plants for my garden.
CP: Sounds lovely.
CPP: What about you?
CP: Not sure. I think I'm going to the Walmart to people watch and pick up a few things, get an oil change, then I was thinking about swinging by my prescriber's office.
CPP: Why your prescriber's office?
CP: It's on the way and I want to see if anything is wrong with me. Maybe I could use a few tests, like a tuneup on my truck. Maybe I'm due for some refills or even some new prescriptions I haven't even taken before. You never know.
CPP: You can't just make an impromptu trip to your prescriber. It's not like going to the mall and window shopping. Or going to Home Depot to get inspiration for your yard.
CP: Why not? How do I know I don't need something if I don't have them rule out something to give me?
CPP: That makes my head hurt.
CP: How else do you explain so many people taking prescriptions for conditions they don't even know they don't have?
CPP: Stop it.
CP: You called to remind me to pick up my prescription. I asked what it was. You asked why I went to the prescriber. I don't know. I just randomly walked in off the street in between my oil change and getting a new iPhone and had the prescriber look at me. He uttered some medical mumbo jumbo, said he'd send prescriptions to a pharmacy, and here I am, hours later, expecting to retrieve them.
CPP: That's not how it works though.
CP: How not?
CPP: No one goes to the prescriber on a whim. Something is wrong, you go to the doctor. If it ain't broke, don't phix it.
CP: What about scheduled maintenance?
CPP: You're not a car. And that excuse is flimsier than what most patients would say in this scenario.
CP: I can't think of what they'd say. There seems to be no logical reason to why these people go their prescribers other than "we had nothing better to do".
CPP: This is why we lose every argument we have with them.
CP: They don't remember anything being prescribed for them. They don't remember having visited their prescriber in the last two weeks. They seem genuinely surprised when we call to tell them they have medications ready. Yet when we ask why they called or went to the office, all we get is "I don't know".
CPP: Must have been bored and had nothing better to do...

Monday, May 22, 2017

Mind Your Letters

Sometimes even the most mundane arguments, nay, discussions, with patients can provide us with a humorous bon mot.

Uber-Tech: <what the patients must hear> How may I help frustrate you today?
Pt: I need to get a prescription refilled.
UT: Certainly. Which one do you need?
Pt: I don't know the name, but it starts with a "P".
UT: All of your "P" medications are too soon to fill.
Pt: <Huffy> No they're not. I know I need it. It's for my stomach or something.
UT: Uh-huh. Protonix is too soon. We just filled it last week. Could it be some other medication?
Pt: <phully phrustrated> No. It starts with a "P". Just fill it.
UT: Ooooorrrrrr. You could go home, find the bottle that is in a state most empty and tell me the number so we may process the correct medication you actually need.
Pt: <mumbling> This is why I hate coming here. You never know what I need.

15 minutes later

CP: CP's Prescription Emporium, you irritate, we medicate. How may I help you?
Pt: I was just in there trying to get my refill.
CP: Yep. I remember. Gave UT a rather difficult time about your "P" medication refill.
Pt: Yeah. Sorry. About that ... I was wrong.
CP: No shit, Sherlock. The first step is admitting you have a problem. Did you find your bottle?
Pt: Yes. It turns out it's my "F" medication. Here's the number.
CP: I see it here: Finasteride. An area a little lower than your stomach.
Pt: Yeah. "I got my "P's" and "F's" confused.
CP: Well, like some people's minds, a "P" is just a closed "F". See you again soon.

Recounting the conversation

UT: What did he say?
CP: He got his "P's" and "F's" confused.
UT: And parts of the body. I always thought you were supposed to mind your "P's" and "Q's".
CP: Yeah. There's a big difference between telling someone to go "F" himself and to go "P" himself.
UT: <Falls on floor>

Friday, May 19, 2017

They Just Don't Get It

Retail is like a basketball game. As long as the other team keeps scoring, you will be behind.
My boss doesn't get it.
She is rather narrow-minded and heavily under the influence of corporate Kool Aid.
I love our conversations, however much they resemble an exercise in futility.

Can't Help Annoyingly Needling Every Location: <struts into pharmacy like a queen> Hello!
CP: <Stares daggers> To what do we owe the presence of her Royal Ladyship?
CHANEL: Just checking on my peons, I mean, my peasants, no, what did they tell me to say?, my drones? Worker bees?
CP: They get the point, Madam Superior.
CHANEL: Like the nun?
CP: Yes. Because you are Nun The Wiser.
CHANEL: Oh. I like that.
CP: Thanks for making my point. As you were saying?
CHANEL: It seems from all of my reports that you keep falling behind in production.
CP: Well, you did cut our hours.
CHANEL: No matter. Our system works majestically so long as you have the right people in all the right positions.
CP: This sounds like a royal fuc... orgy.
CHANEL: Pardon?
CP: Nothing. Keep going.
CHANEL: As I was saying, with our current system, you should be able to pump out 40 to 50 prescriptions per hour.
CP: But we currently have 50 to be typed and 50 to be checked.
CHANEL: Right. So, because Corporate is flawless and perfect and shits rainbows like my mouth, that means you will be caught up in 2 hours.
CP: Dafuq? How do you figure?
CHANEL: Simple math my good indentured servant. <waves like Glinda> That's 100 total prescriptions to be done. Divide that by the requisite 50 per hour and you get two! ah ah ah ah ah Two hours of work!
CP: Thanks Count Dooku. But there is a flaw in your system.
CHANEL: Hardly. Corporate are never wrong. Math is never wrong. Pray tell how you figure, blasphemer!
CP: Simple math You Royal ... Leader lady. I currently have 100 prescriptions in my queue. You are assuming that no more prescriptions will be added to my workload over the course of the next 2 hours. And that is where you fail as a leader. Retail pharmacy is like a basketball game. As long as the other team keeps scoring, you will be behind. When the Cavs get a lead of 20 + points, they don't just go sit on the bench and wait for their opponents to catch up and tie the score. The Cavs continue to score. They try to extend their lead. In the same way, prescribers don't just stop sending e-scripts; patients don't just stop bringing us work to do; patients don't just stop showing up to pick up prescriptions; the phones don't just stop ringing; the fax machine doesn't just get paused; the corporate requirements (vaccines, cycle counts, the order, cold calls, etc.) don't just evaporate.
CHANEL: Then you're doing it wrong.
CP: Oh. I forgot. You've also handicapped me by making me play a man down. It's more like 4v5 now thanks to your cuts.
CHANEL: Okay. <twitches> Well, you'll be caught up before you go home. Cheerio! Pip-Pip and all that.
Uber-Tech: WTF just happened?
CP: The corporate robots get twitchy when you confuse them with reality. We are like a glitch in the Matrix to them. We operate in the real world and they can't handle it when confronted with logic and reason.
UT: You mean "alternative facts".

Tuesday, May 16, 2017

Call Ahead Seating

This is what restaurants call it; or some variation that results in the patron using her smartphone to call the restaurant telling them she is on her way. This allows her to add her name to the waiting list now as opposed to when she arrives in 20 minutes.
Some restaurants call these reservations. 
Chain restaurants don't take reservations per se, but they accept and encourage people to use mobile technology to reserve, sorry, save, their place in line. (I understand. People will skip reservations without calling. Instead of reservations for next Friday that may not show, they accept "holds on seats" for 20 minutes into the future for people more likely to dine at their venue.)

Retail pharmacies have used and encouraged this for decades. It's called "call in your refill before you come to the pharmacy". A day or two early would be most appreciated. However, the non-adopters of this technology are also the ones to complain when a party that just walked in the door gets seated ahead of them.

Words of Advice: Call Ahead.
1. If you want to make sure we have it in stock, Call Ahead.
2. You just left the office and your prescriber sent it electronically? Call ahead. Call now. If we received it we can move it up in the queue. (Me love you long time for doing this.)
3. For the last 6 months I have personally told you we will not stock your $2500 medication and that you should call 1 or 2 days before you need it. Don't yell at me about not stocking it after I told you to Call Ahead.
4. You want to know why it takes so long to wait for a refill? Call Ahead.
5. I monitor my queue and make all antibiotics high priority or waiters. This minimizes wait times. Not everyone does this for her patients so ... Call Ahead.
6. People always ask if they can wait. Of course. I am not one to keep you from doing whatever you choose to do with your time. However, instead of standing around waiting at my counter, does it not make more sense to Call Ahead, perhaps a day or two or three early, and spend your time waiting ... elsewhere? Like home?

I had a gentleman last week walk in and hand me a bottle. I asked why he did not call in the refill.
Old Guy: I need this refilled.
CP: Why didn't you call this in over the phone so you wouldn't have to wait?
OG: Why would I call it in and have you guys tell me 2 hours, or tomorrow, when I could just bring it in and you'll tell me 20 minutes? I can shop during that time.
CP: True ... Or you could have called it in yesterday, walked in now, just as you are here to shop, and not have to wait 20 minutes because it would already be done.
OG: But I'm here now.
CP: Unfortunately your medication is not. We don't receive our order for another hour. Had you called it in yesterday, we may have had all of it. Or we could have told you to come down at a later time. You will still have to make another trip.
OG: This is why I hate coming here.
CP: Right. Because the lack of a simple phone call on your part somehow translates into bad service on my part. Sometimes you win #PharmacyRoulette and sometimes ...

Friday, May 12, 2017

Pleasure Doing Business With You

So many questions ...
1. Do I please her when she is ready, when I am ready, or when the prescription is ready?
2. Is she expecting to be pleased? Or is this going to come as quite the shock to her?
3. Can I send her away explaining "we do not have this item in stock" so another pharmacy may please her?
4. Can I ask her to call the 1-800 "customer pleasure", I mean "customer service" number beforehand? Y'know, just in case ...
5. Will she be happy with our usual (wait) time of 15-20 minutes?
6. What happens if she doesn't arrive for this until 8:55pm and we close in 5 minutes? Do I make her come again?
7. I see 2 refills on the prescription. Do I have to please her with each refill? What do I do in the case of a "refill too soon"? (Will she not be pleased?)
8. How (quickly and often) do we get more refills?
69. Does the inhaler come into play?

Thursday, May 11, 2017

Ask, And Ye Shall Receive ...

... exactly what you requested.
It's like the story of the djinn being really literal when granting wishes.
 -Wisher: I wish to be rich.
 -Djinn: Done. Your name is now "Rich".

CP: How may I help you today?
Sweet Little Old Woman: I need my sugar pills refilled.
CP: Which ones?
SLOW: My sugar pills.
CP: Thanks for the clarification. I'll be right back with them. Wait here.
<walks over to OTC shelf>
SLOW: What's this?
CP: Your sugar pills. Good Day!

SLOW: Well can you give me my husband's medication?
CP: I can give it a go. What's he need?
SLOW: His high blood pressure medication.
CP: Does he have a prescription for it?
SLOW: <bewildered look on face> He needs a prescription for it?
CP: Yes. All blood pressure medications require a prescription.
SLOW: Our last pharmacy did not.
CP: Perhaps you should call him to verify what he needs.
SLOW: <steps back from counter, makes call, back and forth yelling ensues, storms to shelf then turns her ire on me> You're an idiot!
CP: Thanks.
SLOW: <brandishing a box of Coricidin HBP like an argument-winning hand grenade> It's right here on your shelf. You don't need a prescription for it.
CP: Well it's an OTC cold product so there's that. It says "HBP" so gullible people will purchase a worthless product simply by following a marketing gimmick. It keeps you from asking a pharmacist any questions. But I'd guess discussions with you are a rather one-way highway.
SLOW: But it says High Blood Pressure right here!
CP: Right. Not to treat HBP, but to treat sinus symptoms without raising your HBP.
SLOW: It's for his HBP. It says so right here!
CP: Okay. Good luck with that. Want me to ring that out with your sugar pills?

I sometimes wish to go back to school and major in Sociology. I wouldn't even need to do field research. My pharmacy experiences would suffice as a study in human behaviour.

Monday, May 8, 2017

Your Refill Has Expired

... It's passed on. It has ceased to be. It is no more. It is bereft of life.

Death Of Prescriptions: I would like to have my prescription refilled. 
CP: Certainly. What is the number? 
DOP: 666
CP: Prophetic. Unfortunately, it appears there are no refills. 
DOP: But it says I have 6 more on the bottle. 
CP: Allow me to search further ... ah. Here it is. This prescription was written last year on 5/1/16. Since prescriptions are only valid for 1 year from the date they were written, this expired on 4/30/17. 
DOP: But it says I have 6 refills on the bottle. 
CP: Keep reading. 
DOP: ... until 4/30/17. What does that mean? I need this. 
CP: Do you have your wallet handy? 
DOP: Of course. 
CP: Do me a favour. Grab your driver's licence. 
DOP: Ok. I fail to see what this has to do with my prescription. 
CP: Somewhere on there is an expiration date. Have you found it? 
DOP: Yes. It expires on my birthday in 2018. 
CP: Good. Now imagine that your prescription is your licence, or vice versa. In 2019, your licence will still look the same. Your picture doesn't just disappear on the expiration date, thereby rendering it invalid. In much the same way, refills don't just vanish from your bottle once the expiration date passes. You may need to drive, but you still must visit the BMV every 4 years for a renewal. For prescriptions you must visit or, at least in some way, contact your prescribers to let them know you are still alive and requiring medication. 
DOP: But ...
CP: Let your licence lapse. Get pulled over. Argue with the officer that nothing has changed, your weight, height, address, picture, etc and see how quickly she lets you go. I'd be willing to bet she'd apologise for inconveniencing you. 
DOP: You're ...
CP: ... an ass. I know. Get over it. Here's one more for you. Take all of your bottles and "will" them to your children and phuture grandchildren or put them in a time capsule to be opened after your untimely demise. Even though the bottles will still indicate a number of refills on the bottle, they will not be valid. Unfortunately, we do not possess the magic required to remove words from bottles once they have left our possession. 

Thursday, May 4, 2017

Tempus Fugit

Even though Standard Time has existed since the mid- to late-1800's, some people still insist on ignoring its practicality. Railroads were the largest proponents, and first adopters, of the Standard time system. It made sense from a traveling perspective. Apparently people continue to use their own local "sun time" to make trips to the pharmacy.

Oxford Dictionary's Definitions (and the ones upon which most people agree.)

Morning: "The period of time between midnight and noon, especially sunrise to noon."
Afternoon: "The time from noon or lunchtime to evening."
Evening: "The period of time at the end of the day, usually from about 6pm to bedtime."
Night: The period from sunset to sunrise in each 24 hours."

Surely Understanding Nothing: I am calling in my refill.
CP: Jolly good. We serve to live.
SUN: I will pick it up later today.
CP: Lovely. Do you know an approximate time so I may prioritise it accordingly?
SUN: I will be in tonight.
CP: Thank you. As it is currently 2:13pm, we shall expect your arrival after 4pm.
SUN: What? No! I was thinking around 3:00pm.
CP: That's less than an hour from now. In no part of the world is 3pm considered "evening". I should have told you after 6pm as that is more in line with the true definition (see above).
SUN: Well I'll be there at 3pm.
CP: Next time, just tell me 3pm.

As a result of this conversation, we have instituted a policy in my pharmacy where all wait times are confirmed twice. First, we will ask if the patient is using EST, CST, MST, PST, ACST, (du) HAST, ORAT, or GMT. Then we must verify that a 20-minute wait in Standard Time is not expected to be ready next Friday, or in 7 minutes.
Maybe we should do the whole "synching of our timepieces" before patients leave the counter or we hang up with them.

Tuesday, May 2, 2017

It's Not Me, It's You

Early candidate for Quote of the Week:

This One's Outta Line: "Why didn't you call me to tell me you were putting it back?"

CP: How may I help you today?
TOOL: I'm here to pick up my prescription.
CP: I see. I see. What's the name?
CP: Got it. Giant TOOL. Now I know why I remember that name. We returned this to stock yesterday.
TOOL: What? Why? I need it right now!
CP: Of course you do. It's a bedtime medication and it's 10am and I know you don't work nights but allow me to research this.
TOOL: I need it right now! This is ridiculous.
CP: You took the words right out of my mouth.
TOOL: "Why didn't you call me to tell me you were putting it back?!"
CP: <pregnant pause with a slight inclination of the head and a sinister smirk> Hmm. You're phunny. We don't call patients to tell them we are putting medications back.
TOOL: Why the hell not?!
CP: Because we call patients to remind them to pick up their prescriptions. Somehow you must have missed the 7 voicemails, 6 texts, 4 letters, 2 emails, and the Stripper Gram we sent to the house over the last 13 days.
TOOL: No one ever called me.
CP: <Having already prepared for this, spins computer around> It shows right here that an actual human being answered the call and took our message on 3 of the occasions we rang your dwelling. Oh, and someone signed for the Stripper Gram so you'd better check out what TOOL Jr. has to say about it.
TOOL: How long now?
CP: Probably 3 to 7 minutes.
TOOL: I'll be back tonight.
CP: I thought you desperately needed this now.


Friday, April 28, 2017

Damned If You Do ...

... Damned If You Don't.

Let's face it, you're not going to make everyone happy.
Correction. In pharmacy, you're not going to make anyone happy.

That's better. As we all know, pharmacies make too many phone calls to patients; so many in fact, that patients can't keep them straight and decide to just call us for clarification. It's not their phault, but that of the "helpful compliance systems" developed by pharmacies. However, for every person complaining we call too often, there is someone equally sore we do not call enough. For this reason I say we are damned if we do and damned if we don't.

<Day 1>
Understandably Wants It Now: <at the counter> I need to have this filled.
CP: First, this prescription will require prior authorization. Second, we do not have it in stock as it is quite expensive. Third, we will not order it until the prior auth has been approved. Do you agree to these terms and conditions as I have explained them to you?
UWIN: I wholeheartedly understand and agree.

<Day 2>
CP: We are calling to inform you that your prior auth has been approved.
UWIN: Hooray. I'll be right down.
CP: We have to order it.
UWIN: But I brought it in yesterday.
CP: And the prior auth went through today. Now we will order it. It was all in the agreement you agreed to agreed with when you left your prescription with us. (Besides, I could have waited until tomorrow to call you and tell you it was approved at which time my order would have arrived and you'd've been none the wiser. Just sayin'.)
UWIN: This is ridiculous.
CP: No. Here is what is ridiculous.

If I order it, your prior auth won't go through and I'm stuck with it.
If I don't order it, you get mad because I don't have it for 1 more day.
If I order it AND the prior auth goes through, the co-pay is too high and now you don't want it.
If I don't order it and the prior auth is rejected, you get mad because you want to pay cash for it now.
If I order it, you decide to transfer it to a store closer to home because they have it in stock.
If I don't order it, you complain that we never have anything in stock even though this is new.
If I order it, you decide to call the prescriber and have her change the medication to something in stock, cheaper, or preferred on your insurance.

Whatever we do, it is wrong in someone's eyes. While just my appearance at work is often enough to make angels and technicians sing, for some, the pitchforks and flaming torches appear.

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?
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?
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.
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. 


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.


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.


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?
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!

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."


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


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..."