Alexa? Siri? Anyone?

In the (not-too)-distant phuture, I see the next evolution of healthcare.
Just this week I received the prescription posted that included these lines in the directions: "Instructions to pharmacist. Please clarify directions. They are not clear."
No shit they're not clear. For centuries our job has been to make it clear. Whether to keep patients from harming themselves or their prescribers from killing them, that has been our job.

Later in the week I received a note phrom a pharmacist where an office called asking how to prescribe a medication. They wanted to know how to use (why to prescribe it), how to administer it, and for what duration therapy should continue. When the office staff said she'd "just google how to use it", the pharmacist provided adequate support, but was surprised by the dearth of knowledge. If you do not know HOW to prescribe a medication, why are you prescribing it?

It the (not-too)-distant past, prescribers researched. They went to libraries and called Drug Information Services at hospitals. Now they are calling retail pharmacists about new drugs.
(Carefully, CP walks the line of "we are drug experts so people SHOULD call us" and "this is a new expectation an office staff member has because her prescriber said research it".) Should we know? Many things we do. But even the greatest among us do not know all there is to know about everything, especially when it comes to new, specialty medications. Can I research it for you? Sure. But it is going to take some time.

As phor that not-too-distant phuture prediction?

I see an Amazon Echo in every office and Echo Dots in every room.
Nurse: "Alexa, what's a good blood pressure?"
Dr. Zoffis: "Nurse, I want a Z-Pak. You finish inputting the prescription."
Nurse: "Alexa, What dose should I give? How long do I give a Z-Pak?"
Dr. Zoffis: "Alexa, when I don't know what's wrong, is it ok to just give a Z-Pak and Tamiflu?"
Nurse: "Alexa. . . If I'm out of Vitamin B-12, can I just give a double dose of B-6?"
Nurse: "Alexa, what does asystole sound like?"

Of course this is likely what would happen:
ALEXA: "I don't know. Google it."

Pharmacists vs. Doctors, IV

As more and more professionals are responsible for prescribing, more and more professionals are responsible for irritating me.
As more and more professionals delegate more authority in their offices, more and more items fall further and further down the priority line.
As rapidly as technology advances, it seems our ability to develop social mores regresses or fails to advance as quickly.
If you are going to use the technology, please understand how it works.
If you are going to employ different types of technology, be sure you are using them correctly and in the correct circumstances.

If I call you, I expect you to call me.
If you need to reach me right now, speak to me.
(Translation: Do not leave me a voicemail.)

If you send an email in error, what is the worst that could happen?
I suppose the recipient(s) could read the email.
But, what if your email alarmed the recipient(s) and they took actions that resulted in harm to themselves or others?
If you just "delete it" from your screen, does that make all trace of its existence disappear?
Does it "unsend" itself and automatically erase itself from the minds of those who have seen it?
What if you realised your error and wished to recall it?
How do you recall it?
Do you send another email?
What does it say?
"Sorry. JK. lol."?
Do you leave a voicemail?
Send a fax?
Smoke signals?

Sounds silly, right?
No way that could happen. (Who uses smoke signals anymore? And the final telegram was transmitted July 14th, 2013.)
Except that it does. All day, every day.
Where, you ask?
In your local pharmacy.
Prescribers love to send electronic prescriptions but they have a difficult time knowing what to do when they are sent mistakenly, incorrectly, in error. This is where the delegation issue comes into play. If it's wrong and you know it, call me. Now. (Translation: Ixnay on the OicemailVay, comprende?)

I cannot tell you the number of times I have had this conversation:
CP: I have a question phor you.
Dr. Zoffis: What now?
CP: Which strength/medication/directions did you want our patient to receive?
Dr. Zoffis: Why?
CP: Well, you sent me a prescription this morning, which the patient purchased, and now I have a new prescription that seems to contradict the first.
Dr. Zoffis:
     Answer A: We left a voicemail to cancel the first one an hour ago.
     Answer B: Well since we sent this one it must be the right one.
     Answer C: Yeah, the doctor canceled the first one in our system.
CP: Let me be clear: That's not how it works. Simple, yet somehow confusing to offices everywhere. If you were to have handwritten the prescription and chose to cancel it, how would you have handled it? Would you have mailed a new hard copy to the patient? That's effectively what you're doing here. The patient could already have filled and started taking the medication by the time the new order arrives. This is what happens when you choose to cancel electronic orders via any means other than a live chat with the pharmacist. No. Counseling does not always catch your mistake because, like today, the patient's niece's boyfriend's Uber driver came in to pick up the prescription and knew nothing about a change in therapy. Your note on the new prescription to "cancel previous" is rather vague and will now be attached to every single prescription you send for the next two years.
Dr. Zoffis: Well, it's canceled in our system.
CP: Ok. I know it's tough to understand how technology works when you simply stare at your phone to get cat videos and your friends' photos of the birthday parties they held for their pets but your patients' lives are at stake. You know what's funny? I take the time to thank prescribers and their staff who call me directly to cancel prescriptions in error. They are surprised to learn they are in the minority.
Dr. Zoffis: So, what do you want from us?
CP: In the immortal words of Blondie, "Call Me". And since your patient left with your initial, incorrect prescription, you get to call him and tell him.
Dr. Zoffis: Um, We don't do confrontation here.
CP: Phine. I will call him, give the copies of both prescriptions, the documentation phrom our conversation, and send him to your office. What time y'all close?

Why Are You Still Arguing With Me?

. . . Better yet, why am I still involved in this conversation?

CP: Thanks phor visiting CP's Pill Palace, How may I phrustrate you today?
Not Understanding This: I was here yesterday for my wife's medication.
CP: I remember. I mentioned that her eye drops were ready.
NUT: Yes. I am also looking phor a pill.
CP: Ok. They called it in yesterday.
NUT: Right. Where is it?
CP: It was too soon. I put it on file. We mentioned this yesterday.
NUT: Oh. What is it?
CP: Valtrex.
NUT: No. That's not it.
CP: Yes. Yes, it is. I typed it myself.
NUT: No. It's something else.
CP: Is it phrom the same prescriber who wrote the eye drops?
NUT: Yes.
CP: What are we treating?
NUT: Shingles on her face and eye.
CP: That explains the Valtrex. We just filled a month supply last week.
NUT: Well, I don't know what it is, but that's not it.
CP: Well, if you said it is phrom the same prescriber who wrote the eye drops and it is to treat her shingles, and you were expecting 2 medications, one of which is a drop and one is a pill, and you don't know what it is, then I don't know what other answer I can give you. Call the prescriber?
NUT: I did. They said they called it in.
CP: Did they mention the name? Or what is was phor?
NUT: I don't remember.
CP: <waves hand> These ARE the drugs you are looking phor.
NUT: These ARE the drugs I am looking phor.
CP: <waves hand> Have a nice day.
NUT: Have a nice day.
Uber-Intern: Why didn't you just use your Jedi mind trick earlier?
CP: I just wanted to see how long I could play this out until I got bored.
UI: We're not that slow today.
CP: But he's really nice so I was hoping he'd come around sooner.
UI: You must teach me the ways, Master CP.
CP: Much to learn, you have. Much to learn. . .

Pharmers Only

Pharmacies are constantly trying to come up with ways to make patients' visits more enjoyable. Instead of phocusing solely on prescriptions, they are offering new services. 

Introducing: "Pharmers Only", an in-store dating app that will provide matches while you wait.  

How does it work? 

Upon enrolling in the service, you will upload a list of your current medications and the desired medication profile of your potential partner. Every time you get a new prescription, an alert is sent to other patients who received medications on your "prepherred list". Both of you will be given similar pickup windows. It's called the "Kismet" pheature. 

What if I am already in the store? 

The app will ping you and a potential match alerting you there is a #PharmMatch nearby. It's the  matches-while-you-wait pheature. We expect it to be the most popular use of our app. 

What if I only take maintenance medications? 

This is the easiest use of our system. Simply review patients based solely on their medication profiles and our system will synchronize your refills with the match(es) you have selected for that month. 

Can I select certain medications to exclude matches? 
Yes. If your medications may produce an interaction with a potential match's profile, you can exclude those. 

What if I'm thinking a little more superficial? 
<sighs> Yes. You can exclude all profiles that have filled Valtrex, Denavir, or Zovirax in the past. Happy? 

Can I select certain profiles based on one medication? 
Dude. No. You cannot select "Birth Control" as the only criterion. 

Can you supply some of your lame pharmacy pickup lines to help break the ice? 
Of course. But you have to choose wisely. 

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

Beggars Can't Be Choosers

. . . unless they are pharmacy patients. Then all bets are off and you'd better phind a solution.

Even then. . . 

Backorders happen. 

Any number of things may cause them. From weather (see Hurricane Maria in Puerto Rico) to bombings of factories, from an interruption in the supply chain to a shortage of raw ingredients to greedy manufacturers, there have been many reasons for shortages in my #PharmLife. Yet no explanation has been able to mollify every member of the public. Phor some reason we, a most trusted profession, are either lying to them, hoarding it all phor ourselves, or really bad at ordering and should be phired. 

Then, once you have convinced them you have not been lying for the last 6 months and offer them an alternative, they get angrier. 

Sometimes, the customer is just an ass. 

CP: Thanks for calling CP's Drug Emporium. How may I phail to meet your unreasonable standards today? 

Getting Really Upset at My Pharmacy Yet Again: I was told to call ahead so you don't mess up my life-saving blood pressure prescription. 

CP: Cut right to the chase, do we? I like that. 

GRUMPY-A: I need a specific manufacturer of my medication. If you don't have it, I shall have to go somewhere else. I want to know before I call my doctor.  

CP: Of the 25mg tablets, I currently have Teva. 

GRUMPY-A: Of course. That is one of the ones I cannot take. 

CP: As you are fully aware, because you always ask phor me when calling, this medication has been on backorder phor the better part of 6 months. I am quite phortunate today to have even the phew phrom Teva on my shelf. 

GRUMPY-A: I guess I'll just have to call around and see who has it. No one else seems to have it either. 

CP: Well, backorders tend to phornicate with pharmacy inventories nationwide. It's not exclusive to our little hamlet. 

GRUMPY-A: What else can I do? 

CP: Can you take the Mylan brand? 

GRUMPY-A: That is the only one I can take. Why? 

CP: I have the Mylan brand in 50mg. They are scored, but you'd have to split them. 

GRUMPY-A: <flabbergasted and appalled> But then I'd have to CUT THEM!!!

CP: Good to know you're phollowing. It's now up to you to determine which is the less inconvenient option. Do you want to continue combing the desert phor the needle-in-the-haystack or do you want to split 15 tablets in half with a tablet cutter while dreaming up new ways to annoy me with all the phree time you'll have now that you're not calling around? 

GRUMPY-A: I'll have to think about it. 

CP: Of course. Can't be too hasty when it comes your "life-saving blood pressure medication". 

"Now I got the gun you got the brew
You got two choices of what you can do
It's not a tough decision as you can see
I can blow you away or you can ride with me"

Shift The Blame - If The Real World Worked. . .

I went to the grocery store.
I had a list.
I was supposed to buy coffee and creamer.
That's it. Two items.
I came home with the coffee and forgot the creamer.
If this were my pharmacy, I would call the grocery store, yell at the manager that they were responsible for my forgetting the 2nd item on my list, demand a gift card for my troubles, and ruin their day.
This is not the real world, but it is my pharmacy:

Forgetful Lady Yelling: I came down to the pharmacy to pick up two items and you gave me one.
CP: Shouldn't you have noticed when I handed you one item?
FLY: That's not the point.
CP: Okay. What are you missing?
FLY: How am I supposed to know?
CP: Well they are your prescriptions and as there were only supposed to be two of them . . .
FLY: I threw the bottles away as soon as I called them in to you.
CP: And the instant they hit the bottom of your waste receptacle, you forgot what you were taking? What you were taking every single day?
FLY: Yes.
CP: I really hope I can forget this conversation that quickly.
FLY: What's the point of calling them in to you if I have to remember what I take?
CP: Okay. Look at your bottles. Stare at them. Is there something missing?
FLY: Yes. My stomach pill.
CP: Okay. It looks like I . . .
FLY: . . . and my cholesterol one, and my memory one, and my one for memory, and my blood thinner.
CP: Okay. That's 4 more. You said you were missing one of the two you called in earlier.
FLY: Now that I look at it, I only have that one.
CP: Well I have to get all of these ready.
FLY: You mean I have to come back?
CP: You don't have to come back. No. There are plenty of options for people when they forget to call in or leave with all of their medications.
FLY: Such as?
CP: You could just stop taking everything. It is the most convenient option but I'd advise against that. You could transfer everything to another pharmacy and go there instead of coming back here. Maybe they won't forget you're forgetting something. You could send someone else in your stead? That way you could continue checking for any other medications we may have forgotten you were needing.

Why Do You Come Here?

Your money is your money. What you choose to do with it is entirely up to you. How you spend it, where you spend it, entirely up to you.
What is not up to you is expecting a business to conform to your rules for your convenience.
Can we special order items for you? Of course.
Will we match prices for you? Certainly.
What I will not do is waste my time calling multiple pharmacies around the area on a list of 6 medications to get you the best deal. Sometimes, if a pharmacy knows another pharmacy is calling, they will give an inflated price. (This happened regularly with me at a couple locations, including an independent.)
This makes it difficult to verify the price you are quoting me.
***This gets you mad at me for me trying to help you.***

If you want the convenience of picking up all your medications at one location, accept their prices. However, if I am the highest-priced pharmacy on all 6 medications, why do you come here? Am I the only pharmacist willing to match prices?
The other problem with matching prices is my acquisition cost may be quite different from that of the other pharmacies. If they got a kick ass deal on Mylan's version but I have Par's generic, I cannot sell it to you for less than my cost. That's bad business. Not every pharmacy uses the same manufacturer for every generic they stock.
Again, I do not mind matching prices. I encourage people to seek a better price if they have no insurance. I can and will adjust my prices where possible.
Just don't be like this guy:

Time Wasted Arguing That Prices Are Negotiable: You were supposed to match my prices.
CP: I'm sorry. When did you tell us this?
TWATPAN: Monday night. I brought in a list.
CP: It's Wednesday and we just received the prescriptions. I looked at the list but there are no prices on there.
TWATPAN: You were supposed to call them. I get Jantoven not Warfarin. That's wrong.
CP: You want Jantoven?
TWATPAN: Did I stutter?
CP: <calls competitor> Their Jantoven is more than we charge. Ours is cheaper.
TWATPAN: I said I take Warfarin.
CP: Apparently you did stutter. I specifically asked if it was Jantoven and you said "did I stutter?" Let's try this again. Here are the prices they are charging. Since your one medication is below my cost, I will charge you my cost while matching the other 5 prices.
TWATPAN: First you do away with your $4 list, now you won't match prices!
CP: We never had a $4 list and I did match your prices. Are you even paying attention? I think it's about time to knock the rust off my Klingon. Pretty sure no one would notice.

<2 hours later, TWATPAN returns>

TWATPAN: You gave me the wrong prices.
CP: Pretty sure you were standing there glaring at me while I called the other pharmacy and repeated the prices out loud and you were nodding your head in assent. Or it was someone else who looked like you and acted like a toddler who didn't get a sucker. Please tell me you don't have a twin.
TWATPAN: I called them and they gave me lower prices.
CP: Since I was not privy to that conversation, what, exactly, did they say?
TWATPAN: They said with their in-store discount card, my prices would be even lower.
CP: Of course they did. That's incentive for you to go there. I can't match special offers. The cash price is the cash price. If one tire location offers free mount and balance with purchase you have to buy the tires there. You can't bring your own tires purchased elsewhere and take advantage of the free mount and balance only.
TWATPAN: You're going to lose a lot of business.
CP: Really? So far you have monopolized nearly a solid hour of manpower today. You were here for 35 minutes earlier. You called us 3 times and now you're back for another round of arguing. I lost nearly $75.00 on your 6 medications plus an hour of payroll. If you went to the other pharmacy, I would actually come out ahead.
TWATPAN: One of these days I'm going to leave.
CP: I'd like to ask you a question that has been gnawing at me since your first visit.
TWATPAN: What?
CP: Why do you come here? It's not for the prices. It's not for the convenience. I didn't force you to do business with me. You are free to leave at any time. Please. Why. Do. You. Come. Here?
TWATPAN: <disgusted look. storms off>
CP: Must be my award-winning personality.

Pharmacist = Medication Mentor

The most common complaint people have against my posts is that normal people do not understand the inner workings of the pharmacy. Good Point. Just as I don't understand the inner workings of the restaurant business or working the line at GM or selling stocks, I don't expect everyone to have the level of knowledge I possess about my profession.

HOWEVER, I know how to learn more about the other trades. I research it. I ask questions of the people who know what they are talking about. THEN, after getting the answers I sought, I take my newfound knowledge and improve whatever I was trying to accomplish. 

In the pharmacy world, people prefer to take what I tell them, ignore it, argue with me about it, then complain about what I told them. 

Insurance information changed? I will tell you you have a deductible. 

You will argue with me because you believe you are correct. You're not. 

I understand that it is easy for people to develop preconceived ideas. I also understand it is increasingly difficult to change these preconceptions in spite of mountains of evidence to the contrary. But YOU asked ME for my professional advice. Accept it. Improve your life with it. Remember it for next time. 

A Pretty Hollow Aged Gentleman Ignoring Advice: My wife has high blood pressure. 

CP: Phrom putting up with you?
APHAGIA: What? No. She has lots of drainage and a cough. What should I get?
CP: Away phrom her.
APHAGIA: No. To treat her.
CP: Oh. I'd say chlorpheniramine. Works quicker than the 24 hour antihistamines and shouldn't make her drowsy like Benadryl.
APHAGIA: Her doctor said no antihistamines.
CP: Curious. Why would he say that?
APHAGIA: They can increase her blood pressure.
CP: That's backwards.
APHAGIA: How so?
CP: Sudafed, which is a decongestant, can increase her blood pressure. It's also not going to do anything for her cough or the fact she is leaking. Her other choices phrom the myriad possibilities out there (read: four ingredients) include Dextromethorphan, a cough suppressant that's not too good at its job and can cause nervousness, and Guaifenesin, an expectorant which she does not need if she has a dry, postnasal drip-induced cough. She has an acute condition and needs an appropriate medication.
APHAGIA: I'll just get her this Robitussin DM. It's for cough.
CP: Sure thing. Can you just sign this release phorm phor me, please?
APHAGIA: Sure. What is it?
CP: It's a standard in the pharmacy world now. It states: "I, the patient or the patient's representative who was sent to the store to ask appropriate questions and select the most appropriate therapy for my/their conditions, completely refused the expert professional's advice after a lengthy discussion and will not hold said pharmacist accountable when the medication does not work, my/their condition(s) worsen, and I am phorced to come back to the pharmacy phor the correct (original product suggested) or return to the pharmacy with prescriptions due to a worsening of initial symptoms that would have been thwarted had I listened to your expertise phrom the outset. This document serves to indemnify the pharmacist phrom all accountability due to ignorance of professional services provided here today.
APHAGIA: Wow. Seems wordy.
CP: I am witty with words and I read lots of medical studies and legal updates. It seeps in. Think of it as leaving the hospital AMA or leaving the doctor after your wife's visit for her HBP checkup and deciding not to phollow his advice on treating the HBP with medication and dietary changes. Would you do that?
APHAGIA: No.
CP: Still want this Robitussin DM?
APHAGIA: Yes.
CP: I was right and you lied to me.
APHAGIA About what?
CP: Your wife's high blood pressure. It is phrom putting up with you.