Conversation #3

CP: Thanks for calling Cynical Pharmacy, this is the Cynical Pharmacist speaking. I am a Pharmacist. How may I help you?
Any Caller: May I speak to the pharmacist please?
CP: No.
AC: Why not?
CP: Not if you're going to act like that.
AC: Like what?
CP: I think you know.
AC: I most certainly do not know.
CP: You're not even listening to me. Are you listening to me?
AC: Of course I am and it's making me mad.
CP: Do you even know who you're talking to?
AC: The pharmacy?
CP: No. I am not a building. I am a person. I am a human being. I deserve to be loved and treated as such. I can't believe you didn't even know it was me all along even though I said Pharmacist twice in my intro spiel.
AC: Sorry.
CP: Furthermore, I can't believe you indulged me long enough to get this far. Now what did you want?
AC: Did my doctor call anything in for me?
CP: Hahahahahaha. See conversation #2...

Conversation #2

Any Caller: Did my doctor send you a prescription for me?
CP: Maybe...
AC: What do you mean maybe?
CP: Ok. Sorry. It depends?
AC: Depends? On what?
CP: It depends on who "me" is.
AC: I am me.
CP: I know this to be true as you and I, or as you put it "I and 'me'" are talking. However, "me" does not come up in my computer. If it did, I'd have a thousand of them and I would still need something like a first and last name and date of birth to separate you out from all the other "me's" who call me every hour with the same inquiry. Care to try again?
AC: No. I'll just call my doctor and ask him. Thanks though.
CP: Good idea. You're probably the only "me" he has. I'll be on the lookout for a call for "me". Want me to call you if I get one for "me"?

Conversation I'd Like to Have #1

Me: Thank you for calling my pharmacy, Cynical Pharmacist speaking, may I help you?
Average Patient: Did my doctor call anything in for me today?
Me: Yes.
AP: What?
Me: A prescription.
AP: What prescription?
Me: A small round, white one.
AP: What's it for?
Me: What's wrong with you?
AP: Nothing. What's wrong with you?
Me: Nothing. But I didn't need to see a doctor today.
AP: Neither did I.
Me: Then why did your doctor call in something?
AP: I don't know.
Me: Did you call him?
AP: Yes.
Me: Why, I ask, did you call your doctor?
AP: To get a prescription.
Me: Why did you tell him you needed a prescription?
AP: Because my head hurt.
Me: Great. So does mine now. I think I'll call your doctor and ask if he can give me what he gave you.

What's in a name?

A rose by any other name would smell as sweet...Very poetic.
A customer by any other name would be a guest...Not so poetic.
An associate by any other name is called a team member.
Their boss is called a team leader...

Is it just me, or does anyone else think of Star Wars when they hear a page for "Team Leader"? I find it especially true walking the aisles of Target. All I can picture, as I walk among the polo shirts, is Luke Skywalker and buddies saying "Red Team Leader, ready!" Do they call  Wal-Mart and ask for "Blue Team Leader"? Seriously. It's funny. Try not to think of this now whenever you visit these two stores or watch Star Wars. It's also sad. People complain there is no room for cynicism in the profession of pharmacy. Bullshit. There's plenty of room. We are not a profession anymore. I want it back. I want to be treated as such. When my profession starts being a profession again, I'll revisit my stance. Until then...

It is this idea of rebranding that helps the profession of pharmacy distance itself from being a profession. It marginalizes us. We are pharmacists. They are patients. If we continue to distance ourselves from who we are, the customers will also. If we don't take ourselves seriously, no one else will. That is why they treat us in the pharmacy the way they treat any cashier at any store in any town. It wasn't like this when I was a kid. It wasn't like this when I graduated. (It wasn't that long ago...at least in my mind.)

I want my profession back.

Stupid Insurances

Did you ever wonder how insurances come up with some of the formulary/dosing guidelines they use?
#1. Insurance rejects #30 Prevacid 30mg for a 30 day supply because they only allow for a max of a 21 day supply. When we reprocess this for 21 capsules, they reject the claim because "minimum day supply of 28 not met"...Now I think they're just playing with us.

2. Insurance kicks back a claim on Prenatal Vitamins with the DUR that says "Warning-carefully evaluate use in pregnancy"...So they're only useful before and after?

3. Maximum daily dose of Prozac 40mg capsules = 0.75 capsule per day? I called the insurance lady and she proceeded to ask if I had called the doctor to notify him of the high dose. High dose? I told the lady the doctor would laugh at me if I called and said the patient's insurance requires her to take only 3/4 of a capsule per day...I understand pill-splitting in some cases, but, really?

4. Insurance required insulin and pen needles be purchased together. Her Lantus and Novolog Pens each lasted 48 and 50 days, irrespectively. They would only allow her to get 100 needles at a time because she only used 3 shots a day, combined. Her needles were due every 33 days. We called and asked the insurance how we could bill them on the same day since the insulins would be 2 weeks too soon. They didn't know. Said we would have to call each time for an override. Right. Your rules are stupid so I have to do more work. Fantastic.

5. Mail order overrides--this is a post in itself, but...what about an unbreakable package? We call for the override to be told we have to reprocess for a 14 day supply and we have to change the dispensed quantity. Um, how do I take 16 inhalations out of a Spiriva or 32 from an Advair? Why should I have to even call for this? Give me override code for "unit-of-use" item. They have us running around like crazy fools. I think they secretly post cameras in our stores and watch us like some billionaires' pet reality show-like Rat Race where they're betting on whether or not we're going to lose it. Why not? They already record our calls "for convenience and training purposes".

We let the insurances make the rules for so long they are completely in charge. While they complain about tough times and how rising healthcare costs must be shouldered by more employers and employees, they continue to report record profits. Why are we paying more and more and getting less and less? Yesterday's news reported some states are seeing insurance costs rising by double-digits, some as high as 26%. For what? It's like big oil. You can't tell me rising costs are a burden to be shouldered by everyone else then report record profits as a company year after year.

Flu Shots and Urgency

#flushots usually don't come with a sense of urgency. They pretty much sell themselves in the fall. Get one, help prevent flu. Don't get one, run the risk of getting sick. We start offering them in August and peak shot season is October. I always wonder why people wait until January or February to get one; which is often peak flu season. There is nothing like a media frenzy to stir up interest. With the flu exploding now, everyone seems to want a flu shot who didn't get one months ago. Why? Because there is a lot of misunderstanding out there. True, if you haven't received one yet, you are still better off getting one now than not. However, keep in mind that it takes two weeks to reach full efficacy. If you have been exposed to the flu anywhere prior to its maximum effect, you can still get the flu. The symptoms may be less severe, but you can still get it. (Which is many times why people think they get the flu from the flu shot-which is quite impossible.) Many people expected the flu to arrive in a month or two. It didn't. It came early. There is no reason to wait as late as possible to get your flu shot. Next year, be the first in line in August.
Let's look at this another way. Waiting until now to get a flu shot, which has been offered for months, is like putting on a condom today, after having unprotected sex for the last 5 months. Sure, it will work going forward, but it doesn't offer protection against any previous exposures.

Stupid Insurances II

After a first-of-the-year apocalypse rant (new insurance cards and long wait times) last week, I thought I'd follow up with a thank you. Thank you to all of our patients who were prepared and had their new insurance cards ready when dropping off their prescriptions. Thank you to those customers who were extremely patient during longer than normal, and longer than expected, wait times. Thank you for helping us out by calling your insurance if numbers were missing or incorrect or your new cards did not arrive as expected. Thank you for not freaking out if I was the first to tell you you should have new insurance. All of this leads me to...
I hate insurance companies. Truly hate them. I have another post about their idiocy prepared, but I'm going with this today. Why? Last week was the first time in a number of years where a large number of new insurance cards patients presented, had the WRONG information on them. I'm not talking about a missing person code or misspelled patient name. I am talking about cards that had the wrong ID# AND wrong RXGRP # AND wrong PCN, on the same card. What's funny is when we processed them, the insurance started kicking them back with "resubmit with correct numbers..." and the reject would list them. This was fine except those numbers were wrong too. What's the point of sending out new cards with new information only to have it all be wrong?
It's like moving. You fill out a change of address form at the post office and put a house number to a street to a town to a state to a zip code that don't exist in any combination. Simply put, it's like me giving you a made up date of birth for myself. How am I supposed to make that work?
The cards are supposed to contain all the information I need to properly bill for the patients' prescriptions. If that information is wrong, what's the point? Just give me the 1-800 number I need to call to get everything for you. If insurances want to save money, kill the cards. That way I can justify employing one person to simply man the phones all day making calls tracking down whatever I need to bill them properly.
It's okay. As everyone plainly understood last week, we had nothing better to do than spend hours on hold, repeating our store information, that already comes up on their caller ID system, and being endlessly transferred, to get information that a correct card would have contained. It's not as if the insurances themselves hadn't made the cards and sent them out a month ago. It's not as if it's their billing information they're putting on their cards then sending to their customers. Idiots.

My Doctor Knows Everything...

We accidentally irritated a patient who had to wait forever for a prescription. It was our fault and I apologized. See, there was a pesky little drug interaction between something she was already taking and the antibiotic her doctor prescribed her this beautiful wintry morning. We diligently phoned her physician and explained to the patient why it was taking so long and that we had to wait to hear back from the doctor. It could save your life, we said. Patient continued to call us all day for it. I politely suggested she contact the office herself if it was such a great emergency. I explained the doctor may want to change it...then again, she may not.

Irritated Patient: "I don't know why you're keeping my medicine from me."
Me: "WE are not. WE are trying to prevent your untimely demise from a serious drug interaction."
IP: "I have been going to that doctor for over 10 years now. My doctor knows me and would certainly not give me anything I couldn't have!"
Me: "You would be surprised."
IP: "What is the medication she prescribed, then?"
Me: "She wrote for this antibiotic."
IP: "What? She knows I can't take that!"
Me: "As I said. You'd be surprised. Now can you have a seat and wait for her to call back with something else?"
IP: "I'm just going to call her again. She was in a hurry. I'm sure she just didn't notice it..."

Me: "Right. But we did. So you're welcome. Oh, and thanks for yelling at my staff all day. Thanks for calling us 14 times over the last 3 or 4 hours. Thanks for taking us away from helping other people. Perhaps other doctors were rushed and we needed to call them for other patients. Thanks for thinking your prescription is more important. Thanks for absolutely absolving your doctor of any blame in your irritated situation today. Thanks for laying it all squarely on us. Yep, your doctor did no wrong, but we made you wait by actually doing our jobs. Again, you are welcome. Come again.