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Monday, September 25, 2017

Shhh. Listen

I have long been convinced that people blank out when they are waiting for someone to answer the phone. They seem to experience an absence seizure from when the phone starts to ring to when the person answers. I am also fairly certain that businesses could answer the phone with any script or name they desire and the people calling will have no idea. Maybe it's simply that people are expecting a result and, as such, pay no attention to the actual result they get.

Phrom the weekend:
CP: Thank you phor calling CP's Pharmacy. This is CP THE Pharmacist. How may I help you?
Lack Of Listening: Yes. May I speak to the pharmacist please?
CP: Sure. Please hold.
<1 minute later>
CP: Thanks for holding, this is CP THE Pharmacist. How may I help you?
LOL: Is this the pharmacist?
CP: No ma'am. Please hold for the pharmacist.
<2 minutes later>
CP: Thank you for holding, this is the Pharmacist.
LOL: Is this the pharmacist?
CP: Does it really matter?
LOL: You said you're the pharmacist?
CP: A phew times now. How can I help?
LOL: I need a refill.
CP: You need a tech. Please hold.


Wednesday, September 20, 2017

Time To Celebrate

A(nother Conversation With Myself)
ME: CP, what is one of the most phrustrating situations you face every day? 
CP: I'd say the Q&A that happens with every drop off. It's phrustrating because it's the simplest encounter we have all day, and we have it hundreds of time each day, yet it seems to be the most difficult for patients. 
ME: Okay. What scenario is so troubling? 
CP: When I ask for your personal information, I'm not trying to get to know you. 
It's not a date. 
I'm trying to make sure I have the correct profile for you. 
This means that your Name, Date of Birth, Address, Allergies, and Phone Number form a portrait of you in my computer. Additional conditions and your insurance may help complete the picture but I need the basics. 
I ask, you answer. 
The sooner you answer, the sooner I get work. 
The sooner I get to work, the sooner you get to leave. 
ME: Sounds pretty straightforward to me. How can it get complicated? 
CP: People point to their DOB on the prescription and say "It's on there." 
ME: So? 
CP: The DOB can often be wrong. Or the patient name can be wrong or a mismatch. I had a grandfather who took his grandson to the office visit. The pediatrician put grandpa's DOB on the Rx. I had an office select the correct DOB, but the wrong patient. Oops. I don't care about the information for a second longer than I need it to do my job but shouldn't you care about your health for more than one second? 
ME: Point made. Okay, I know you started this post with the intent to go another direction but you felt an intro was necessary, so what was the original intent of this post? 
CP: Odd answers to my questions. 
ME: Okay. Give me one example that stands out in your memory. 
CP: Sure. 

CP: Welcome to CP's Renaissance Faire where verbal jousting is always a main event. How may I spar with you today? 
JW: I have come to fill a prescription today. 
CP: Jolly good! Have you filled prescriptions with us before? 
JW: Never. This is my first time. 
CP: Mine too. I just need some information from you to create a profile in my system. Name? 
JW: JW. 
CP: Address? 
JW: No. A suit. 
CP: Witty. Date of Birth? 
JW: We don't celebrate birthdays. 
CP: Pardon? 
JW: Jehovah's Witnesses do not celebrate birthdays. 
CP: Nor any holidays for that matter. That's fine. I'm not planning on sending you a card or hosting a surprise party. I just need the date. 
JW: We don't celebrate them. 
CP: But you were born, correct? 
JW: Yes. 
CP: Fine. While you may not attribute any significance to any particular day of the year, I need you to choose one for me to enter into the system. 
JW: I don't know what to pick.
CP: Like cheap American beer, everyone has a Born On date. Any idea when yours may have been?
JW: Nope.
CP: Any favourite numbers?
JW: I like seven.
CP: How about 7/7/1977? Easy to remember?
JW: Sounds good.
CP: Just remember it when you get to the register. And I promise not to commemorate our first date with a card or anything cheesy in a year...or on your "birthday". 

Tuesday, September 19, 2017

Your Student = Your Responsibility

According to the State Board of Pharmacy, the one that gives me my license to play pharmacist, I am allowed to have an apprentice. Intern. I am responsible for her training. I am responsible for everything she does. My license is on the line as I am the one signing off on her. 

Apparently, the rules are different when it comes to prescribers. 
As if hospitals were not impossibly organised, let's add practising prescribers to prescribers who practise. Never mind trying to reach the actual prescriber of the patient's discharge medication. Sometimes I think it's some random person in a lengthy white coat that happened by as the patient wanted to leave. 

Here's the problem and #WhyYourPrescriptionTakesSoLong. 
CP: We have to call the person who wrote this prescription. 
Pt: Why? 
CP: Well, you're on Medicaid and for some reason, hospitals have yet to learn to register all their new students with the State. Either that or they leave it up to the individual students themselves which is terrible policy. Either way, we need another prescriber to okay this medication or you have to pay. 
Pt: Well, you know I'm not paying so get on it. 
CP: Right. 
<rings hospital>
CP: I am trying to reach Dr. Zoffis. He wrote a prescription for this patient on 4H. 
Hospital Answer Lady 9000: Let me page him for you. 
CP: Thanks. 
HAL9000: No answer. He's a new resident so he may not be receiving pages. I can call his attending. 
CP: Go for it.
HAL9000: I paged him. 
CP: Okay. Should I hang up? 
HAL9000: No. Please hold. 
CP: <sings entirety of Aenema while on hold>
HAL9000: Still there? 
CP: Wouldn't behoove me to cut communications at this point. 
HAL9000: He didn't answer so I will try again. 
CP: Can't you just take my number and have him call me back? 
HAL9000: Definitely not. Hospital policy mandates that we attempt to page the prescriber 3 times before taking a message. 
CP: So I have to sit on hold for 7 minutes per attempt so you can page a prescriber who could be in the ER, in surgery, or dropping the kids off at the pool because of some stupid policy? 
HAL9000: Correct. Please hold. 
CP: <sings Break Stuff and starts Hangman's Body Count>
HAL9000: Hello? 
CP: Just go with Round 3 so I can get off hold. 
HAL9001: Oh, you've already been through twice? 
CP: Yes. 
HAL9001: Give me your information and I'll have him call you. 
CP: Thanks. 

<1 hour later>
Herr Dr.: I received a page? 
CP: You did. No question about it. I need you to sign off on this prescription one of your students wrote. They are not licensed with Medicaid and the patient won't pay the full cost. 
HD: I'm not going to do that. 
CP: Huh? 
HD: I remember the patient's name but that's it. I'm not signing off on it. 
CP: Is Dr. Zoffis one of your students? 
HD: Yes. I met him once. 
CP: Then who can I get to authorise this prescription? 
HD: I don't know. Maybe try the Endo specialist group. 

<calls Endo Group>
CP: Can you help with this? 
EG: We don't even know who that patient is. 
CP: Is this one of your students, Dr. Zoffis? 
EG: Maybe. We get so many I never learn their names or faces. 
CP: Helpful.

Pt: Did they phix it?
CP: Nope. Apparently no one cares about you once you leave the facility.
Pt: So what do I do now?
CP: I just put the attending's name on it.
Pt: Who was it?
CP: Douche Baggins.
Pt: I remember him. Thanks!

Monday, September 11, 2017


When: Interrogative Adverb.
At what time; how soon

Soon: Adverb.
In or after a short time; early

Shortly: Adverb
In a short time; soon

Now: Adverb
At the present time or moment

Anon: Adverb
Soon, shortly

When we ask the question "When would you like to come in for your prescription?", we are trying to plan our day in the most efficient manner in order to ensure your prescription is ready by your intended arrival time. It really makes no sense for me to work on your prescription right now if you intend to wait until tomorrow, or the weekend, to retrieve it. This allows me to dedicate my time and energy to high priority prescriptions such as antibiotics and ER/post-surgery medications and, well, flu shots. When you have a prescription that requires urgent attention, you can appreciate all the other patients communicating honest pickup times with us.

In the question "WHEN?", we are asking for a time. It can be exact or a ballpark estimate. The correct answer to "At what time would you like to pick up your prescription?" is NOT "later"; nor is it "soon", "shortly", or "today". Those are not times on my clock.

If you choose to give me vague answers, I shall try to out-vague you.

Pt: (on the phone) Did you receive my prescription(s) from my prescriber?
CP: We did. They just arrived in my queue but we have yet to process them. "When (at what time) did you want to come in for them?"
Pt: As soon as they're ready.
CP: Okay. We will see you then.
Pt: Wait. When will they be ready?
CP: Oh. Anon. <click>


CP: When did you want to come in for them?
Pt: Later.
CP: Okay. See you later, alligator.
Pt: How much later?
CP: After a while, crocodile. <click>

Yes. This is an endless debate.
How do we phix it?
As I stated, we get the patients to commit to a time.
When they are vague, we give them longer-than-necessary estimates. However, this rarely works because, regardless of the time (15 minutes from now or 4 hours from now) there will always be the incredulous "That LONG!?" response. Look, if you had pinpointed a time as I had offered, I could begin work on your prescription and it may be done quicker. Since you left the time entirely up to my discretion, I made a decision based on my needs at the moment. Accept it and move on.

When people are in the store, I give them exact times if they choose to wait. In this way, there can be no ambiguity surrounding the Time Of Promise Pickup:
"If you're waiting, that'll be 22 minutes which puts us at 3:57. See you then." It helps, especially since our perception of 22 minutes differs greatly from that of the people on the other side of the counter.

Friday, September 8, 2017

Last One Called Gets All The Yelling!

It's a game.
Make the patient make as many phone calls as possible without actually helping him until he reaches the end of the line . . . and his rope, and begins erupting far away from you. 
Unfortunately, this usually means the pharmacist bears the burden. 

CP: Thank you for calling CP's Pharmacy. Please tell me in what manner you are going to request the impossible so I may disappoint you today. 
Richard Better Use Retail Next Script: I am without my medication. 
CP: That sucks. You should totally get it refilled. Problem solved. Next!
DickBURNS: Wait. I'm waiting on my mail order to arrive. 
CP: Ok. Since you don't use my pharmacy, I fail to see how I can help you. Did you just need someone to talk to while you wait? 
DickBURNS: No. They've been trying to fill my prescription for 2 weeks now. 
CP: It usually takes me about 15 minutes. Two weeks seems like an awful long time to "try" to do anything. 
DickBURNS: Well they say they contacted my doctor and he hasn't responded. They have called him 3 times and I have called him every day for 2 weeks. He still hasn't responded to either of us and now it's the weekend and I am out of medication. 
CP: Boy that's a toughie. First I'd suggest finding a new prescriber. Second, since it's only Thursday, I'd suggest driving to his office and requesting a prescription in person. 
DickBURNS: When I called my mail order pharmacy they told me to come to my local pharmacy and you'd give me my medication. 
CP: <laughs> I love when people tell everyone what my job is and how I do it and believe I can wave a magic wand and damn all the laws I have to phollow. What is this medication? 
DickBURNS: I need Trazodone for sleep. 
CP: Well, upon checking your profile, you have filled exactly 3 prescriptions since 2014 with our pharmacy. Not one of those is for Trazodone. Since your mail order has no prescription, I cannot transfer one from them. Since I have never filled it, I cannot invoke my State's emergency fill exemption so I am unable to help you today. 
DickBURNS: So you're refusing to help me? What am I supposed to do now? They said you'd help me! I need my medication. 
CP: First, you're not my patient. Second, mail order can't tell you what I will do in my pharmacy or my state. Third, I gave you options that included visiting your prescriber. Fourth, there are no options available for you from me other than me giving you other options that do not include me. 
DickBURNS: You're not very helpful. 
CP: Wrong. I was quite helpful. You believe me to be unhelpful because I did not give you the answer you sought when you first rang. There is a difference between your interpretation of helpfulness and the truth. I realise you're phrustrated but your ire is misplaced with me. It instead belongs with your prescriber. Had he done his job, we would not be having this conversation. I stand by my original suggestion, find a new prescriber. Besides, if my state allows me to fill an emergency prescription shouldn't mail order be expected to offer the same service? They are a pharmacy, right?
DickBURNS: But they said you'd do it.
CP: Right. Not cost effective for them. Good luck. Sleep tight. Er . . .

Friday, September 1, 2017

The More You Say It, The Phunnier It Gets

Sometimes, okay, quite often in my pharmacy, a conversation, or a phrase, or even a single word inspires an entire post. The strength of it is directly proportional to the acceptance by my colleagues  of the twist-of-phrase.

It's always inspiring to me that floaters choose to come to my store; mostly due to them knowing they are not in for a drab, boring day. I like to think it's me, but I know better. 

Why is it that patients always say the same thing? It's not just every patient reciting the same line; I'm talking about every patient repeating the same line each time he visits the pharmacy. 

CP: What is your date of birth? 
Pt: I come here all the time. 
CP: Then you know I ask for it every time. You really should be better prepared next time. 

CP: Do you have your insurance card with you? 
Pt: It's in the computer. I come here all the time. 
CP: I think you have a serious problem. Insurances should not be that stimulating. 

CP: Any changes to your personal information?
Pt: I come here all the time. 
CP: I realise corporate pharmacy has prostituted our profession, but you really need to stop doing that. We are not literal prostitutes and since only the pharmacists are Blood and OPIM (Other Potentially Infectious Materials) trained, we're tired of cleaning up your "accidents". 

CP: Do you have any allergies? 
Pt: I come here all the time. 
CP: I'm glad we excite you that much, but you should really try to wait until you get home. They make medication for that. 
Pt: Really? What medications treat that? 
CP: SSRI's are one class. 
Pt: SSRI's? 
CP: Yes. And to help you remember, when you write it down, it actually looks as if the acronym is trying to say "So Sorry". 

Tuesday, August 29, 2017

I Forgot.

It's like riding a bike.
Okay, more like falling off a bike.
We go to school and we learn things.
We go through life and we practice things.
They are as easy as breathing; as driving; as eating.
Until one day . . .
We stop doing them. Idle hands may do the Devil's work, but idle brains wither and die.

Imagine a world where you learn to write and speak your name. You do this before tests and on all paperwork through your adult life. Now imagine that the world changes and you only need to present a biometric ID or retina display to gain access to classes, apply for a mortgage, or complete forms at the BMV or your prescriber's office. No more talking or writing expected.

Will you still remember how to communicate the old way?
Will you remember your name?
How to pronounce it?
How to spell it?
Will there be secret, underground societies comprised of humans who prefer the old, verbal method of greeting one another?

Alas, poor Yorick.

CPP: CP, where are you going with this?
CP: Sometimes events occur in multiples and you wonder if it's a sign of the Apocalypse or a series of unrelated anomalies.
CPP: And last week was?
CP: A number of offices called us with the same issue and their answers were all eerily similar in their stupidity.
CPP: Blamed the eclipse?
CP: Worse. The software.
CPP: Okay. Tell me what happened.
CP: Prescribers go to school, right?
CPP: Most of them. Others, I'm not so sure.
CP: But they learn how to write prescriptions, right?
CPP: What with electronic records, it's become an antiquated practise.
CP: Indeed. But the majority of prescribers out there had to hand write prescriptions at some point, non?
CPP: Oui.
CP: Then why did we receive multiple calls from (and make multiple calls to) offices whose electronic prescribing systems were "giving them fits" and they "forgot how to write prescriptions"? I can understand certain traits of a civilisation eroding over a generation, but within a few years of practise?
CPP: I see what you mean.
CP: We had a control prescription where the prescriber forgot to write his DEA#, spell the quantity, and date the prescription.
CPP: Outrageous! Of course you called the office.
CP: Of course, at which point I received the obligatory "the system was down" excuse from the phone answerer person.
CPP: Remember our math teachers in school always telling us we won't always have a calculator?
CP: I repeat that often. It's why I still do all my calculations on the backs of the prescriptions after doing them in head. I check myself.
CPP: Before you wreck yourself?
CP: The point is, we can still do this. We don't get flummoxed. We don't get upset. There is no perturbation. We can think for ourselves and adapt and do what's right and necessary.
CPP: You really need to do a post about having the ability to think for oneself. Something along the lines of learning HOW to think as opposed to being taught WHAT to think.
CP: Like the one I wrote last week?
CPP: Precisely. 

Wednesday, August 23, 2017

This Is Only A Test. Had This Been An Actual Emergency. . .

CP: Sometimes, all you can do is throw your hands in the air . . .
CP's Partner: . . . and wave them like you just don't care?
CP: . . . and pray for the human race.
CPP: What now?
CP: You know how we're allowed to authorise a refill in an emergency for a patient?
CPP: Yes. We have discussed this at length.
CP: Remind me, and enlighten our phellow phollowers, as to what criteria must be met for this to occur.
CPP: Gladly. First, it must be an emergency.
CP: Defined as?
CPP: The patient must be out of (a life-saving) medication. They must be unable to reach their prescriber. The prescriber's office must be closed. We are permitted to fill enough for the patient up to 1 month, but generally only enough to last the emergency period.
CP: Because if they were open, then they would logically be able to reach the prescriber and he/she would be able to fulfill the obligation of approving a new prescription refill.
CPP: Exactly.
CP: And they could reach the prescriber the next day since it's only Tuesday?
CPP: Yes. Why the rephresher?
CP: That phone call I just took.
CPP: Excellent. More role-playing. I'll be the plucky pharmacist.
CP: And I'll be the patient.

CPP: Hello, this is CP <snickers> How may I be of service?
CP <as the patient> I am out of refills.
CPPasCP: I am terribly sorry to hear this. Again, how may I be of service?
CPasPt: I just got off the phone with my office. They told me that I should call you, tell you when my appointment is and that you will give me enough medication to get me through to my appointment.
CPPasCP: That seems kinda backwards, does it not?
CPasPt: I didn't think that sounded right but thought I'd call since I have a great relationship with y'all.
CPPasCP: You were wise to come to us. Here is what I want you to do. Call back to the office and tell them you spoke with us. Tell them we made you an emergency appointment for 8:45 tomorrow morning so that you wouldn't have to wait 2 weeks to see them since that is ridiculous for such an urgent matter. Since they have bestowed so much power upon us, tell them their faith has been rewarded and you shall see them soon.
CPasPt: I like where you're going with this.
CPPasCP: And when they reply with "that's not how this works", kindly remind them that that's exactly what the pharmacists (both of them) said when you explained that we are supposed to use the emergency clause just because they don't want to be bothered to obey the state laws and call in a refill for you.
CPasPt: Will do. Thanks!

CPP: Such an awesome patient. You do realise we couldn't get away with that with all of our patients.
CP: I do. But just wait until you hear what office this was.
CPP: Really? I've explained this to them for 2 years now. They can't invoke "emergency fill" during normal business hours. It's not an emergency if they are actually IN the office and reachable.
CP: Right? As if we don't already do enough work for them . . . Hey, check the queue.
CPP: Seriously? That was quick.
CP: Must have gotten through to them a lot faster than we anticipated. And look! They wrote it wrong so we have to call them to phix it anyway.
CPP: Guess we should have written our own in the first place.
CP: Nah. Where's the #PharmacyPhun in that?

Another all-too-real-life story brought to you by CP; with special guest appearance by CPP.

Tuesday, August 22, 2017

Do Not Go-Lytely...

Do not Go-lytely into that good night,
The tongue should burn and cry at the first taste;
Rage, rage against the dying of the light.

The fire coming out the end is fright,
Doctor's orders did not prep for haste
Do not Go-lytely into that good night.

Insides, in panic cry, screaming not right
This unwelcome guest that now clears this space,
Rage, rage against the dying of the light.

Four hours to drink with no end in sight
And now, a glass, to assault yet more waste,
Do not Go-Lytely into that good night.

The cramps, in gut, are spasming tight
In knots it turns like anxious days we've faced,
Rage, rage against the dying of the light.

Again, once more, on the seat I alight
Pray this, the end, of my bowels have been chased.
Do not Go-lytely into that good night.
Rage, rage against the dying of the light.

Monday, August 21, 2017

What's Your Birthday?

I learned a long time ago that "First Name" somehow sounds a lot like "Birth Day" to people standing  at a pharmacy counter. As a result I modified my approach to asking for a patient's "Date of Birth". It doesn't mean we still don't receive the wrong answer from time to time. but this image always comes to mind when it does.

No, no, no, no, no, no
No shorty what's your birthday?
I said I need to know what is your birthday?
I needa have all your info what's your birthday?

Wednesday, August 9, 2017

Lice Lice Baby

Yo, R. I. D., let's kick it.

Lice Lice Baby, Lice Lice Baby

All right stop, irritate and scratchin'
Lice is back and it needs some attention
Nits are stuck on the hair so tightly
Can't go to school the nits are unsightly
Will the itching' stop? Damn, I hope so
Stay away from the mayo.
Rakin' the scalp with an itch I can't handle
Gas and a match will burn parasites like a candle

Fwoomp! Shoulda used clippers instead.
Bear can't hide in the trees if there ain't no wood.
Pickin', so hard I broke the comb's handle
Nits attachin' to my roots like a vandal
Head-to-head contact, it's just frowned upon
Parents don't want us kids to get along

Just for this problem Nix will solve it
If that don't work maybe Rid may resolve it.

Lice Lice Baby, Time for Head Lice Lice Baby, Time for Head
Lice Lice Baby, Time for Head Lice Lice Baby, Time for Head

Now the parasites are lurkin'
Resistance is growing and OTC's not workin'
Get to the doctor, to the doctor, for savin'
Scripts are good for lice that's misbehavin'
Treating patients with malathion
Natroba is newer to rely on
Used to use Lindane or a product called Kwell
Robi-comb and LiceMD are new, that's swell
Smilin' for school photos
The girlies sharing combs, teachers screamin' "Hell No!"
Did they stop? No, kept brushin' tho.
Helmets and hats we say don't share 'em
Now they're planning sleepovers and we say forget 'em
Keep lice from spreadin'
So we continue to use coco-nut oil.

Killing all the eggs off is a challenge
Ovicidal meds they just can't manage
Seven days to repeat doses
Pediculicide's no better
Mom's got the comb and Dad's got the razor
Aiming for bugs starting to crawl
Parents freakin' out they got 4 more kids in the hall
Wailing poured out like a banshee
Kids off running, never knew man she
Broke all the windows neighbours heard
Cursing comin' out my mouth real loud
Drew the police, then a small crowd
Parents and children, thankful it's not them
Of scratching and itching now dealing with this problem
Mention lice in passing, everyone scratchin'
Hands to their heads in reflexive action.

Just for this problem Nix will solve it
If that don't work maybe Rid may resolve it.

Lice Lice Baby, Time for Head Lice Lice Baby, Time for Head
Lice Lice Baby, Time for Head Lice Lice Baby, Time for Head
Lice Lice Baby.

Tuesday, August 1, 2017

We're All Busy

If you don't want to argue with me, then don't argue. Prefacing your argument with "I don't want to argue" does not absolve you of the penalty for arguing. In this case, instead of arguing, you could learn a thing or two if you would just listen, then process what I'm saying, then acknowledge that you understand. Of course you could argue, but that will end poorly . . . for you.

I Don't Want To Argue But Here I Am Arguing: I would like to have this filled.
CP: I would like to fill this for you. 
IDWTABHIAA: We usually use another of your phine establishments. 
CP: I see that. I also see that this is too soon to fill by 3 days. 
IDWTABHIAA: Why is that? 
CP: We fill all control medications exactly one day early here. Since it was filled last 26 days ago, it is 4 days too soon. As we fill everything 1 day early, you have 3 more days. 
IDWTABHIAA: It's just for Ritalin. 
CP: You should read my post about the word "just" from last week. Anyway, it's just too soon. 
IDWTABHIAA: <Taps finger on prescription> But the doctor wrote the date on there. 
CP: Yes. She wrote "A" date on there. It's called the <taps finger on prescription> "earliest fill date" which means that is the earliest date on which I CAN fill it. It's like a Speed Limit sign. You can drive UP TO the posted speed, but over that is bad. I can fill it any day ON OR AFTER the date written, but before that is bad. And, like a speed limit sign, it's more of a suggestion. 
IDWTABHIAA: So you're refusing to fill it even with that date on there? 
CP: Pretty much. Yeah. 
CP: I already told you. We fill all controls exactly one day early (there are always exceptions) and this is 4 days early. The date she wrote on the prescription is irrelevant. This prescription was written a couple months ago. Since you did not fill the other prescriptions in a timely manner, the due date of this one has become delayed. 
IDWTABHIAA: Your job is to fill it with that date on there. 
CP: No. The date is immaterial. Your doctor can write anything she wants on the prescription. It is not a direct order from Jean-Luc Picard, "Make it so", that I have to obey. There are laws and governing bodies to which I owe my allegiance. 
IDWTABHIAA: Now I have to make two trips. 
CP: Actually, you only have to make 1 more. 
IDWTABHIAA: I barely have time to make even one trip. 
CP: Yeah. We're all busy. 

Monday, July 31, 2017

How Pharmacy Prepares You Phor Parenting

1. Cold food.
2. Someone who thinks they know more than you is arguing with you. 
3. Someone is always crying. 
4. Something is getting thrown at you.
5. Someone tells you she has to pee just a mile after passing the last rest area. (Someone is out of refills just after the office has closed.)
6. Just wait until your father gets home is the equivalent of calling the prescriber after running a PDMP report.
7. Can't spank your patients but you can put them in timeout [go to your (waiting) room].
8. Weekends in the pharmacy are the equal to the night before a school project, that someone hasn't started, is due.
9. What do you need refilled? is the same as "what do you want for dinner"? They don't know and will just shrug their shoulders and say "whatever you want".
10. Teaching a child to read is like walking a patient through the refills on their bottle:
CP: 2 refills,
Pt: 2 refills,
CP: Until,
Pt: Until . . .
CP: Until what?
Pt: Until 6/25.
CP: And today is . . . ?
Pt: 7/30.
CP: So it's expired.
Pt: So it's expired.
CP: Good!
11. You are fluent with 111 ways of saying "NO", but no one understands or listens to you anyway.
12. You endlessly repeat yourself. 

Thursday, July 27, 2017

Not My Job, Not My Blame

The last thing I heard her say before she slammed down the phone was: "You need an attitude adjustment".

Quick Background: Prescriber sent an e-rx for 60 tablets of Tramadol. The directions were clear (it's an e-script after all) that the patient was to "Take one(1) tablet by mouth UP TO 3 times a day as needed". The prescriber also indicated this was to be a 30 days supply.
All of this is totally normal for a pain clinic. The patient's previous Rx, also electronic, was for 60 tablets as a 30 days supply to be taken "one(1) tablet twice a day as needed".
Many pain clinics want their patients to stick to "as needed".
Again, normal behaviour.

Woman Is Thus Calling Herself: I am calling from Dr. Zoffis about the Tramadol Rx.
CP: Yes?
WITCH: I wanted to make sure you were going to fill the extra 30 tablets we sent over today.
CP: I will.
WITCH: Good.
CP: In 6 days.
CP: It's too soon until then.
WITCH: We wrote the wrong quantity on the Rx. It should have been for 90 tablets to last a month.
CP: But you didn't. Unless the directions change, the insurance won't pay for it for 6 more days. Since I also have to report it to my state's PDMP program, I have to wait until it is due.
WITCH: Why didn't you call?
CP: Excuse me? You wrote a completely valid prescription and now you're telling me it's my phault the patient is out of medication because you can't do math?
WITCH: I've had pharmacists call on this all the time.
CP: You really need to go back and read my post on "Professional Judgement" from last week. Too many people calling on stupid stuff means you don't fix the big stuff. If they're calling you, maybe there's a reason . . .
WITCH: You should have called.
CP: And you should have proofread the prescription. It's a totally valid, normal, understandable prescription we see all the time from pain clinics. Do not try to blame me for your mistake. "It's bad enough you screw up regular prescriptions and I have to call, now you want me to call on ones without errors to make sure there are no errors?"
WITCH: How can the patient get her prescription?
CP: She can wait 6 days or she can pay cash for it today and I will document our discussion.
WITCH:  What if the patient is unwilling to pay cash?
CP: Then I will send her to your office and tell her to ask you for a check to cover her copay, since it was your mistake.
WITCH: That's not very professional.
CP: Neither is blaming the pharmacy for your mistake, which I'm sure is how you presented it to the patient.
WITCH: You need an attitude adjustment.
CP: Yep. I'm no one's bitch and people don't like that.

Wednesday, July 26, 2017

Time = (Their) Money

I've recently made a new discovery. While insurance companies have oft been the least-looked-forward-to phone calls of my day, they have breathed new life into the game.
Typically, we have to call insurance companies for some reason every day.
Whether it's due to a duplicate fill spurred by a timing issue in the system or a vacation override, or an interaction override, we have to call them.
After navigating their phone tree, which is like trying to determine the lineage of all the bastards on Game of Thrones, we finally succeed in speaking to a real, live human person.

Aetna Insurance Dude: How may I help you?
CP: Are you real?
AID: I'm a real boy!
CP: Thanks Pinocchio. I need help with a vacation override.
AID: I will be more than happy to feign attempts at providing assistance all whilst successfully ruining your happy thoughts and making you curse me over drinks tonight. How may I accomplish this for you?
CP: First, use a word that means "more than happy". Tell me you'd be elated, ecstatic, overjoyed, delighted, euphoric, or even pleased as punch. "More than happy" is lame and overused. One could say it's become hackneyed, trite, banal, or even platitudinous. Second, I have a gentleman here visiting from Nebraska and he ran out of his insulin. Can we get a vacation override for him?
AID: Allow me to diligently check my files. Why does he need a refill?
CP: He is out. As I stated.
AID: I see. Well, we just filled a 90-day supply for him last month. He should have enough.
CP: He does. In Nebraska. He was due to return a few days ago but his plans unfortunately changed and he needs to spend a few more days here.
AID: The patient can call himself and request an override, but he has to do it at least 5 days before traveling.
CP: Do you hear yourself when you speak or is there some kind of philter they put on your headset that makes sense of the words you read verbatim from the "Book of Approved Phrases to Piss Off Pharmacists"?
AID: Is he out of medication?
CP: There you go again. Let me put you on hold and I'll check with him.

<This was the part that was #PhunkyPhresh to me>

AID: "Ok. But I am only allowed to hold for 2 minutes each time."
CP: Que?
AID: "I am only allowed to hold for 2 minutes each time."
CP: So first I have to navigate a lengthy phone tree, then wait on hold until you pick up and spend forever on the phone, but if I have to put you on hold, you can't be inconvenienced to wait more than 2 minutes? I guess that makes sense. What else am I going to do? Hang up? Start the whole process again? It's my time I'll be wasting. Now I know why you check on something, come back after 1:59 and tell me you're still searching, put me back on hold, then repeat the process. You'd save more time if you quit coming back until it was phixed.
AID: I am sorry but unless the patient calls 5 days ahead of his vacation, we cannot help him.
CP: I know you're just the mouthpiece for these policies, but that's a new level of #Phuckery.

From now on, just put the insurance on hold every 1:55 and keep coming back. See how many holds we can get before we lose them.
AID: What's the ID#?
CP: Please hold <1:55> MB . . . please hold <1:55> . . .

I know I'd be wasting my time, but it would be so much more phun.

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.