How Not To Be Seen

ME: What's the greater infraction? People who drop their keys on the counter or the coughers?

MICE ELF:  Coughers. You didn't have it when you entered, and you're not DJ Kool. 

CP: Let me clear my throat!

ME: Next one - People who stand between drop off/ pick up/ or consultation windows like lost puppies looking for a good home? or people who stand next to a line and get mad because you keep skipping them? 

MICE ELF: Lost puppies, especially with the COVID/ social distancing tape on the floors. 

CP: Here's a better one. Why do patients always stand behind the one pole/support beam for our gates in the pharmacy? 

ME: Then get mad when you don't notice them. You pick up your head, thinking you heard someone but there is no visual evidence confirming your suspicions. 

MICE ELF: Like truckers; if you can't see my mirrors, I can't see you. 

CP: Exactly. If you can't see me, and cannot make eye contact with me, I cannot see you. Just because you're used to working the pole doesn't mean your affinity for them is warranted in my pharmacy. 

ME: Especially when they are going to get mad they had to wait so long. 

MICE ELF: Perhaps they're used to bigger tips. 

CP: Or they're trying to hide in plain sight. Like little kids. . . or they're practising their championship hide-and-seek skills. 

ME: Perhaps they are shy and don't want to be seen?
MICE ELF: You mean they made it all the way down here, extricated themselves from their vehicles, only to plant themselves behind the nearest pole at my pharmacy? 

CP: Maybe they think we are going to snipe them with our blow dart flu shots. 

ME: Duck season!

MICE ELF: Rabbit season!

CP: They also hide behind the window frame. 

ME: What's worse is when they try to speak to us through it. 

MICE ELF: Glass is a great medium for voice conduction. 

CP: But the pole. I still don't understand the whole pole hide-behind. 

ME: They want to complain no one waited on them. 

MICE ELF: Maybe they don't want to be known at the "key dropper'' or the "cougher".

CP: Well, they're going to forever be known as either Mrs. Nesbitt or BJ Smegma going forward.

Clearly Canceled

CP: CP's Playhouse. How may I help you?  

Miserable And Demanding Doctor Of Grumbling 2020: I am calling about my patient's Rx which she claims is not there but I clearly sent last night. 

CP: I was here last night and have no recall of her prescription. 

MADDOG2020: I sent it at 7:29 last night. 

CP: Well that is of no help. Perhaps, if you use eClinicalWorks as your software provider. . . 

MADDOG2020:I just sent it again. 

CP: Ok. Let me check. . . 

MADDOG2020: <clearly grandstanding and frustrated> You should have it now.

CP: I do see it. Let me look at it. . . Aha!

MADDOG2020: It's the same thing I sent last night. I don't know why you told her. . . 

CP: I DO remember this one! I even had both my techs look at it before I canceled and deleted it. 

MADDOG2020:Why would you do that!?

CP: Read the directions. 

MADDOG2020:<mumbles>

CP: Out loud. So those in the back can hear.

MADDOG2020:  "oral caps cancel this fill tid"

CP: Yep. It clearly said to cancel it, so I did. 

MADDOG2020: Oh, I just resent what my NP sent the last time. 

CP: Good strategy, Silly Boy. And I'm guessing we followed those directions and canceled her previous refills the last time, when this note was relevant. 

MADDOG2020:Well that's not what I wanted. 

CP: Yeah, that's why we encourage you to review what you send before you hit 'send'. It's also why I don't allow verbal corrections on e-scripts from anyone in your, or any prescribers' offices. If it's not fixed on your end, it will continually be automatically renewed the wrong way and may, eventually, be filled that way which could harm a patient. 

MADDOG2020: Looks like I'll have to retrain her. 

CP: May want to be "starting with the man in the mirror". 

MADDOG2020: <humbled> I'll talk to her next week. 

CP: "I'm asking him to change his ways."

MADDOG2020: Good-bye. 

CP: "Yeah, make that change!"

<click>

Don't Think Too Hard

CP: Since we constantly have this debate, and we like to involve our students to teach them how to think, we are going to play a game.
CPP: The Professional Judgement Game?
CP Yes.
CPP: My favourite! Is this because everyone likes to comment on your posts about how we should just call? Or how they wouldn't ever call? Or how a counsel with the patient would have cleared things? Or how a consul wouldn't have provided an answer?
CP: Like those cure-all natural oil remedies - essential-ly.
CPP: Nice. Let's see this test.

1. Amoxicillin 500mg - Take 1 tablet by mouth 3 times a day.
(Do we dispense tablets or capsules? Or does it matter on this particular Rx?)

2. Amoxicillin 500mg Tablets - Take 1 capsule by mouth 3 times a day.
(Do we dispense tablets or capsules? Or does it matter?)

3. Duloxetine 60mg Tablets - Take 1 capsule by mouth 2 times a day.
(How do you dispense this one? If you said tablets for either of the above based on the drug written, then you have to answer tablets here and you have to call the prescriber, right?)

4. Motrin 800mg Capsules - Take 1 tablet by mouth every 8 hours.
(Tablets? Capsules? Call prescriber? If you answered tablets to any of the previous 3, then this has to be tablets, rights? Or is it Capsules because it's in the name?)

5. Insulin Glargine
(Do you dispense Lantus or Basaglar? If you try Lantus and it requires a prior authorisation, can you just switch it?)

6. Levothyroxine Capsules - Take 1 tablet by mouth once a day."

(But the patient ALWAYS gets tablets. Med selection error? or did the prescriber want Caps?)

Answers:
1. It doesn't matter. Just because "tablets" is written in the directions does NOT mean the prescriber intended for tablets to be dispensed. Often it's a default sig. Or pre-printed. Either way, it does not matter.

2. Meh. Same answer. It does not matter. Maybe his drop down menu only had tablets; or it was listed first. Same with the directions. As long as the patient gets 500mg of Amoxicillin, it doesn't matter. But if you claim that #1 HAS TO BE tablets based solely on the sig, then you must abide by your rule and dispense capsules here. Otherwise, your "steadfast" rules conflict and have no basis in real e-prescribing/dispensing.

3. Capsules. It's the only way the product is available. This is to prove that just because the directions use one dose form and the drug name is selected as another, albeit unavailable dose form, does not mean we have to move heaven and earth and call the prescriber to fix this. . . unless of course you disagree with either of the first two answers. In that case, stop wasting time. You know you just dispense capsules, so use that logic on #1 and #2.

4. Tablets. Period. Even though I have seen this very same prescription multiple times, there is no way the prescriber(s) intended to give the patient 800mg ibuprofen capsules. Tablets all the way. Again, if you disagree with any of the previous answers, then you MUST call this prescriber and verify capsules was correct as submitted. Another waste of time.

5. Please tell me no one does this. If a patient asks for ibuprofen OTC you can give them Advil or Motrin. Same here. If Lantus is not covered, try the Basaglar. It's written for the generic name, NOT the brand. Had the Rx been sent over as "Lantus Solostar", then you'd have to call, per insurance pain-in-the-assitude. I hate floating to stores and my first doctor calls are about these exact scripts; fix it.

6. Patient gets tablets. Give tablets. New prescription and the patient never had any Levo previously? It doesn't matter. But be a good Pharmacist and, if you try the capsules (Tirosint) and they are ridiculously expensive, simply change it to the tablets and save them money. We'd rather they be compliant and take their medication than quibble over whether or not the prescriber chose the first option from the drop-down menu (which she did).

Every pharmacist has her own quirks and panty-bunching idiosyncrasies. Don't put your brain out to pasture by forgetting why you went to school: to learn HOW to think, not what.

CPP: Think everyone passed?
CP: Most likely. We have a great group of phollowers. I think we will catch shit from people justifying why they call (insurances and audits and on and on) but I stand by our answers. Even if I get audited on 1000 Amoxicillin Rx's over 5 years, I'm only out like $42.00.

It's So Obvious It's Confusing

UT: How difficult are the terms "drop off" and pick up" to comprehend?

CP: Generally they are self-explanatory. If you polled random people around the world 84% of them would be able to correctly identify which one meant drop off and which once meant pick up. Unless. . . UT: Unless you polled patrons of retail outlets.

CP: Well of course then. It goes without saying that the retail world operates in a Bermuda Triangle-like set of parameters. Nothing is ever as it seems.

UT: <Sees patient at pick up window with prescriptions in hand> Do you want to handle this one?

CP: Certainly.

<CP pops up from behind computer like a prairie dog>

CP: Hello. Are you dropping off today?

Misses Out On Signs Explaining Key Nuances Usually Comprehensively Known Leading Everywhere: No. I am picking up.

CP: Hence your reason for being under the sign clearly marked as "Pick Up Here".

MOOSE KNUCKLE: Correct.

CP: <searches computer for MOOSE KNUCKLE. . . > I have nothing ready for you.

MOOSE KNUCKLE: She said she sent it.

CP: Who is this mysterious "she" of whom you speak?

MOOSE KNUCKLE: My prescriber. I just left her office and she said she sent it.

CP: Did she say she "sent it"? or that she "sent you away with it"? as in "sent it with you"?

MOOSE KNUCKLE: Huh?

CP: What's that in your hand?

MOOSE KNUCKLE:I don't know.

CP: May I see it?
MOOSE KNUCKLE: <hands over papers in hand>

CP: As I suspected. This would be your prescription.
MOOSE KNUCKLE: Right. I need to pick it up.

CP: Right. After you drop it off.
MOOSE KNUCKLE: She said she sent it.

CP: She did. She sent it to me via your hand. You are the delivery person of your own prescription. You can't just walk into Five Guys Burgers, head to the pick up window, and grab the first order number you hear them shout. You need to place your order first.
MOOSE KNUCKLE: But I thought it was placed.

CP: No. Your mates wrote down the order for you to take to the counter and place it yourself. Had you used doordash, someone else would be here picking up your order, not you.

MOOSE KNUCKLE: Ok. So what do I do now?

CP: Now that I have your prescription, you may sit until I call you. Then you may return to the Pick Up window as I now know you are quite familiar with its location.

MOOSE KNUCKLE: Why did she say she sent it?

CP: As I am not her, and since you have to wait, why don't you use this time to call her and ask her? UT and I are both dying to know.

MOOSE KNUCKLE: I don't want to bother her; she's busy.

CP: Right. Yet here I am, doing my job, herding people into the correct locations at my counters because they don't understand words while answering questions that should be posed to other people. Nope, not busy here.

New Twist On A Classic

CPP: What's your favourite, or at least most popular, question asked of you?
CP: The alcohol one.
CPP: Can I drink with this?
CP: Exactly. People always treat it as if it's a negotiation.

 Pt: How much can I drink with this?
 CP: None.
 Pt: 3?
 CP: Nope.
 Pt: 2?
 CP: Fewer.
 Pt: 1?
 CP: Keep going.

CPP: I asked you this because I know you enjoy answering questions literally and thought you might have a quick quip for this.
CP: I do. Let's play.

Forcing Rx's Over Gums: Can I drink with this?
CP: Yes. Absolutely. In fact, I encourage drinking while taking this medication.
FROG: <excited> Really?
CP: Yes. A dry swallow is a difficult feat and will leave a bad taste in your mouth, or get stuck in your throat.
FROG: That's not what I meant.
CP: I encourage drinking. It is healthy to stay hydrated. It is a difficult task for a pharmacist, what with the "no drinks allowed on the bench" policies and the mandatory masks. Lemme tell ya, 12 hour days in these things really parches the ole gullet and they don't make them yet with straw holes.
FROG: I wanted to know if I can drink. . .
CP: I assume you CAN drink. Water would be the potable liquid of choice. As I said earlier, I solidly encourage drinking while taking this medication.

CPP: You know that's just cruel, right?
CP: Next time he will be more specific. Or get to the point faster.
CPP: Surely someone out there is going to think you're serious.
CP: I am serious. I would totally answer the first question this way. . . knowing my patients and the rapport I have with them, this answer would go over very well with the crowd. And don't call me Shirley.

Oy

Uber-Tech: Angry Tart on hold.
CP: Thanks for getting her all into a lather for me.
UT: No problem.
CP: What's her issue?
UT: She received a 90 days supply 57 days ago and wants a refill before she departs for a vacation. Somehow, she not only needs it early, but she only has enough for another week.
CP: Curious.
UT: Good luck.
CP: <cracks neck, knuckles, does deep-knee bends> Thank you for holding. This is CP, problem solver extraordinaire. How may I help you?
Old Yet Very Enraged Yeller: That girl told me I can't get my refill. <continues to repeat vacation plans, out of medication, doesn't take more than she should, etc, etc, etc>

CP: I heard that. Your insurance won't pay for. . . 

OYVEY: It's not like I can abuse them! I only take 1 a day. 

CP: And they won't pay. It's not a matter of abuse, it's. . . 

OYVEY: Where did they go? It says I can refill them before next week. I just want them before I leave. 

CP: Ok. Where are you going? 

OYVEY: That's none of your business. 

CP: Well, in most parts of the world, including "none of your business", there are pharmacies for the residents of those towns. You could transfer your. . . 

OYVEY: Not where we're going. 

CP: Roads? Where we're going we don't need roads. 

OYVEY:  Huh? It says one refill and I want it. 

CP: Listen, Veruca. My tech tried to help you. You yelled at her and asked for me. I have tried to help you and you have yelled at me. Let me explain it like this: You can argue with me and talk over me OR, you can ask for my help; but you absolutely cannot do both. If you had asked for my help, which I still attempted to provide in spite of your actions, I may have offered to process enough doses to last until you returned and processed a vacation override or at least used a discount card. Since you have been belligerent and demanding, I am less inclined to help you. You have chosen the dark path. May you find the light in The Land of None Of Your Business. 

OYVEY: scoffs <click>

UT: That went well. 

CP:I wonder where else people choose to ask for help then berate you for no good reason. 

UT: I'm sure that was an episode of Baywatch. Can't you just see Pamela Anderson rescuing some schmuck drowning, giving him mouth-to-mouth and him complaining about it? 

CP: You need to update your TV habits. 

UT: I never watched it. I was more of a 90210 girl. 

CP: Ditto. 

Move Along, Move Along

The next time someone visits your drive-thru and gives your technician a difficult time, remember that you are inside.
Person At Drive Thru Huffing And Irritated: <screaming unintelligibly>
CP: <picks up D-T microphone> Hello.
PADTHAI: WHAT!?
CP: Are you yelling at my technician? The employee trying to help you?
PADTHAI: YES! SO?!
CP: Are you in your car?
PADTHAI: YES!
CP: Good. Then you can drive your ass somewhere else.
<clicks>

CP: Welcome to the Drive-Thru. How can this end poorly?
PADTHAI: Can I get stuff from the front here?
CP: <whispers to self> that did answer my first question. <to patient> Within reason. What do you seek?
PADTHAI: Your store brand allergy medication.
CP: Generic for which brand?
PADTHAI: The 24 hour one.
CP: And which of those might you prefer?
PADTHAI: Your brand.
CP: Of which name brand.
PADTHAI: The once a day one.
CP: I've really got nothing better to do than continue this stand up routine with you. As you've asked me to help you, and I sillily acquiesced against my better judgement, I thought you could help me help you by helping me to help you.
PADTHAI: The green one.
CP: Green tablet or green box?
PADTHAI: Box.
CP: Zyrtec?
PADTHAI: Sure.
CP: How many?
PADTHAI: Doesn't matter.
CP: There are at least 3/4 dozen package sizes out there and as I've previously mentioned, I have nothing else to do except make decisions for you that will ultimately be incorrect so let's waste more of my time, shall we?
PADTHAI: The medium size.
CP: We have no packages shaped like spiritualists.
PADTHAI: Huh?
CP: NVM. BRB.
<CP returns triumphantly>
CP: I have a 100 count box for $30.00.
PADTHAI: Just for allergy medication?
CP: It's more than just allergy medication. It's 24-hr, once-a-day allergy medication! Generic, no less!
PADTHAI: Do you have a smaller one?
CP: I do. And larger ones. You asked if we sold OTC products through the Drive-Thru. I said we do, within reason. It is not my job to shop and make critical decisions for you. We have packages sizes of 300 tabs, 240 tabs, 120 tabs, 100 tabs, 90 tabs, 60 tabs, 36 tabs, 24 tabs, and 10 tabs. I chose the mean value for you. I could have selected the median value of 90, but. . . I opted to not.
PADTHAI: What are the prices for all the others?
CP: I didn't check. There's a reason they are out there and I am back here.
PADTHAI: Harrumph! Any ideas?
CP: I'm going to go with higher for the larger counts and less for the lower counts. You asked me to sell you a product, size of my choosing, through the drive thru. You did not give me a budget with which to make a more informed financial decision, nor did you provide constraints on the size selection. Therefore, you get what I pick or you can don a mask, walk inside, and choose for yourself. As I've mentioned twice now, I have all day to wait for you here at my drive thru. The one with the line of 9 cars in which you too waited for this opportunity; the opportunity you have spoiled.
PADTHAI: I think we should go elsewhere.
CP: Finally, a decision made by you. And what a glorious one it was. Good day.
Uber-Tech: Well that went poorly.
CP: As predicted.

This Is The United States Calling. . . Are We Reaching?

. . . he keeps hanging up.

CP: Thank you phor calling CP's Pill Paradise where we may not be the patient's pharmacy of choice, but we aim to lower their expectations all the same. How may I help you?
Patient's Insurance That Always Passes It Through: I have a patient on the line and I need you to resend a claim for her.
CP: Sure thing. Did she receive her medication?
PITAPIT: Yes, she did.
CP: Can confirm. I do see she picked it up 4 days ago.
PITAPIT: And she now needs reimbursed; her prior auth was approved.
CP: Was it?
PITAPIT: Yes. I ran a test claim and it's covered.
CP: You didn't, by some strange chance, happen to backdate that test claim to the day she actually retrieved her medication, did you?
PITAPIT: No. I ran the claim and it worked.
CP: Cool story, bro. But I'm not going to rerun the claim.
PITAPIT: <startled quaver in voice> Um, why not?
CP: Allow me to ask you a few questions, and paint a scenario. Are you married?
PITAPIT: Yes.
CP: Since when?
PITAPIT: 2010.
CP: Congratulations on 10 years. How long did you date before you got married?
PITAPIT: 4 years.
CP: I see. And did you know each other prior to dating?
PITAPIT: Yes. We were friends for a few years.
CP: How sweet. So you've been married for 17 years?
PITAPIT: No. As you said, it's 10 years, this month.
CP: I see. So you knew each other for 3 years, dated for 4 years, and have been married for 10 years. Got it. So this patient has had her new insurance for 3 months, picked up her non-covered prescription 4 days ago, and received approval for the prior auth today. Can she claim her medication has been covered since she started her insurance 3 months ago? Or since she picked it up from my pharmacy? Or only since today?
PITAPIT: I guess it would only be covered since today.
CP: Right. As you can only claim to have been married for 10 years, she can only claim to have this medication covered for a few hours. Unless you can get someone to backdate your marriage date to the day you two met, you can't claim 17 years of marriage. Phollow? The same rules apply here. Unless you backdate her claim to the date she paid for them, she cannot get reimbursed for her out-of-pocket expenses PRIOR to coverage being approved. Capeesh?
PITAPIT: What can we do?
CP: Well, you ARE the insurance company. And YOU are the ones who required the prior auth. And YOU are the ones who have the power to backdate the approval from the date the prescriber submitted it instead of leaving it as today. And only you can prevent phorest phires.
PITAPIT: Can you change the fill date?
CP: How did I know you would ask that? Well, as I explained before, YOU are the insurance and YOU are responsible for all of the patient's misery this past week. As I explained to her when I offered to find her a discount card to help lower the out-of-pocket cost for her very necessary medication, unless YOU, her insurance, backdated the claim, she would assume the risk that YOU, her insurance, would not reimburse her. ME? Helping. YOU? Not so much.
PITAPIT: Why won't you just change the date?
CP: You're phunny. It must be why you've been married for 17 years. First, this is a controlled medication. If I change the date, I alter her refill date AND the date on file with the State PDMP. But the greater question is, WHY. WON'T. YOU?
PITAPIT: <audibly shrugs> It's not in my script. Usually the pharmacy gives in.
CP: I shall capitulate to no insurance, nor anyone who expects me to do their job for them. I will, however, remind the patient that her insurance is the bad guy.
PITAPIT: Ok.
CP: Good luck explaining that to her. I already did for you. . . 4 days ago. Oh, and good luck on your next 17 years of marriage.