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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.
NICON: Yes.
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".
NICON: Why?
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.
Why?
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.