Phaxes Phrom Pharmacies - A Debate

CP: Remember when offices used to write prescriptions phor patients at their office visits and the patients would bring those hard copies to the pharmacies to phill?

ME: Of course; it's where our story began. 

MICE ELF: Natch. 

CP: I realise times have changed and pine phor those days. 

ME: Pining phor the fjords?

MICE ELF: Not pining. Those days are dead. 

CP: And I miss them greatly. I dislike our new options so much but I was thinking the other day how, with the advancement of technology and e-scripts and online charts, etc, we seem to have regressed with side effects of all of these. 

ME: Side effects?

MICE ELF: Of e-scripts? 

ME & MICE ELF:  <sardonically> Say it ain't so!

CP: Prescribers have essentially broken themselves into two basic camps today: those who mandate the pharmacy request patient refills via phax/e-script, and those who mandate the patient request their own refills, not accepting contact via pharmacy. 

ME & MICE ELF: <nodding> uh-huh, and?

CP: And I ask which of these is actually better, or arguably worse, phor the patient?

ME: Prescribers who rely on the pharmacy!

MICE ELF: Prescribers who rely on the patient!

CP: If I send the requests, I know the dates and times I electronically submitted my request(s). I can explain to the patient the office is ignoring me and set the upset patient on the office. "Sic 'em! Sic balls, Chopper!"

ME: Nice. All it takes is a patient phoning in their refill for the system to automatically send the request. We aren't even involved. Easy. 

CP: And we can make an emergency script if needed showing how the office ignored us. 

MICE ELF: But I think the patient should be responsible for their own medications. 

CP: Good point. We have argued that many times. My issue is how many offices are difficult to reach, even phor the pharmacies. Imagine how much trouble it is phor the patients. 

MICE ELF: They can wait on hold. Or they have e-chart access. 

CP: Easy to understand for those under 60yo, or those with smartphones and internet access. What about the situation where the patient has been ringing the office for 7 days and the prescriber hasn't sent in the Rx? What happens? Now the pharmacy has to make an emergency Rx with no record of how long the patient has actually been trying for a refill. The patient comes to us in a panic and they need our help. 

ME: Wouldn't prescribing rights help this?

CP: It would, but that's not the issue. If prescribers are going to require patients to contact the office for refills, they should be responsible about sending refills and contacting the patients in a reasonable time. 

As much as I loathe the "please contact your pharmacy phor refills", I do prefer it over offices that don't respond to their patients. 

MICE ELF: Well e-script requests get ignored often as well. 

ME: I didn't realise patients' requests were often delayed. 

CP: That's the problem. Neither of these is perfect; phar phrom it. Instead of accepting refills phrom only one source, perhaps they should accept requests phrom both. 

ME: Do you know how many offices will hate that? Conjugal Visits w/Satan notoriously is responsible for inundating offices with multiple requests phor the same patients, same medications, and even old, discontinued meds. 

MICE ELF: How about we go old school?

CP: Either in person at the visit or via MyChart? Covers all ages.

ME: No calls, no phaxes, no responsibility on our part. 

MICE ELF: But I have to have these or I'll die. 

CP: Should've asked at the last visit or learned to use that iPhone your grandkids got you for Christmas. 

ME: Ouch. 

MICE ELF:

Which of the phollowing is more annoying:

1. Offices that require pharmacies to submit all patient refill requests?

2. Offices that require patients to call phor their own refill requests (and phorget to actually send them)?

Special Trip

CP: What do you pack phor a special trip?

CPP: I suppose that depends on the definition of "special".

CP: I suppose it does. Does a trip to the pharmacy qualify as "special"?

CPP: No. I'm thinking of ones where you pack a little suitcase for a weekend away or where you get all gussied up. Why?

CP: The number of people who complain about "not wanting to make a special trip" to the pharmacy. 

CPP: Ah. Let's hear it. 

Lady At Pickup Is Sulking: Picking up. 

CP: Joy. Name?

LAPIS: Lazuli. 

CP: Ah. That is arriving in our order today. 

LAPIS: I know. 

CP: Uh-huh. Says we called you yesterday and told you it'd be here after 13:13. 

LAPIS: Uh-huh. 

CP: Yet here you are at 9:03am. It's mathematically and physically not here yet.

LAPIS: "Well I'm not making a special trip for it."

CP: Well you don't have to get all dressed up to come back. The Walmart pajama attirewill be just as fine when you return as it is now. Nothing special about it. In fact, had you checked a clock before you left, you really needn't've made this trip in the first place. I'd call this the special trip, honestly. 

LAPIS: Harrumph. 

CPP: She actually "harrumphed"?

CP: She did. 

CPP: I'm guessing there's another story?

CP: Same store; same day. 

Please Allow Ninety Days Always: Picking up. 

CP: It appears I have 5 medications ready phor you. 

PANDA: I should have more. 

CP: I see a couple that are in my queue for 97 minutes phrom now. I've not yet gotten to them as it's still <checks watch> 97 minutes away. 

PANDA: Are they all for 90 days?

CP: Some are. Others are not. 

PANDA: "We live over an hour away and I don't like making special trips here."

CP: With an hour drive to visit your pharmacy, I find it difficult to believe that EACH trip here isn't special. In the phuture, I'd check my watch to verify the promise time and, maybe, just maybe, call ahead to make sure everything is filled today. I see some things phor you aren't due until 1, 3, 6, and 9 days phrom now. You could really cut down on these special trips. 

PANDA: But we like coming here. 

CP: Then make sure your provider writes for 90 days at a time since he didn't do that on the last round. While I appreciate you visiting us, you can't tell me you love me on in one breath while complaining about the inconvenience in the next. 

Ok. Sure. Thanks Phor The Warning?

CP: Good Morning. CP's Draughts and Drachms. How will you make me crazy today?

Lady: Yeah. I just called. 

CP: No you didn't.

Lady: I did. 

CP: Called what?

Lady: Called you. 

CP: No you didn't. 

Lady: I most certainly did. 

CP: Didn't.

Lady: Did. 

CP: Why?

Lady: To get a refill. 

CP: Ok. But you didn't talk to me. 

Lady: Right. 

CP: Ok. What do you need this time?

Lady: I just called in my refills and that machine lady told me it would be ready at 13:13. I 'll be there at noon. 

CP: Ok. We will see you at noon. Your prescription still won't be ready until 13:13, but I appreciate you coming early to check out our work. Are you bringing cookies?

Lady: What? No. I want my prescription when I get there; not when it's ready.

CP: Then come later, when it's ready then it'll be ready when you get here. 

Lady: Listen. I have had just about enough of this. 

CP: But you're not completely full up on me yet? I suppose there is always room for Jello. 

Lady: What ever are you on about now?

CP: See ya when I see ya. 

Lady: My Rx had better be ready when I get there. 

CP: Then I suggest you coordinate your schedule accordingly. Tschuss. 

#QuoteOfTheWeek

Do Not Self-Edit II

CP: I really didn't think I'd make a sequel to this post, well, ever, let alone a week later, but here we are. 

ME: Just when you think you've heard everything. 

MICE ELF: I heard a rumour. . . 

ME: Phunny, Allison. 

MICE ELF: Sorry. As you were venting?

CP: It's not a lack of the ability to read; it's not a lack of comprehension per se, so what is it?

ME: What is what, boss?

MICE ELF: Is it a duck?

ME: I think MICE ELF needs a vacation. 

CP: Agreed. You know how we've had patients not be able to read their refills on their bottles?

ME: As when they say "but my bottle says 3 refills"! and we try to lead them to finishing the line with "UNTIL. . . ?" 

MICE ELF: And they keep repeating "3 refills"?

ME: You can give a person an education but you can't make them think.

CP: Precisely. This was a first and I had no words. 

ME: Do tell. 

CP: CP's Draughts and Drachms. How may I help you?

Bad Readers Unite Here: I need to know if I can double my medication to catch up. 

CP: Ordinarily, in most cases, I'm going to say not. But I want to hear the rest of this story. 

BRUH: I missed half of my doses for the last 4 days. 

CP: Bruh! What the hell? Sorry. Explain yourself. Did you forget? Leave them at home? Stolen by chipmunks?

BRUH: I didn't know I was supposed to take them. 

CP: Uh-huh. When we asked if you had any questions, you said. . . ?

BRUH: Nah. I'm good. It's on the label. 

CP: Uh-huh. And then what happened? 

BRUH: I read the label and it said "'Take 2 tablets by mouth' . . . and that's where I quit reading". 

CP: Quit. . . Reading. . . Uh-huh. So you missed the part where it said ". . . twice a day", I take it?

BRUH: Uh-yup. So can I take like a 5th or 6th one for the next couple days to catch up? 

CP: Can we go back to you only reading half of the directions? There were 8 words on that label and you stopped reading after the first 5. That's either some serious ADD or awful impatience. You probably stop the microwave with 0:01 left too. When cooking, do you make it past the part where the recipe says "preheat oven to 350"? 

MICE ELF: There are no words. 

ME: Oh, there are words; he's just not reading them.

Never Prepared

CP: I'm either over-prepared or under-stupid. 

CPP: I think you're just stupid enough. 

CP: Haha. Tessalon Taker.* Seriously, though. Many of the people we see on the daily make me question

my every social interaction. 

CPP: First example?

Medicare Insurance Lady Doesn't Envisage Why: I need to fill these prescriptions. 

CP: What a joy! Please allow me to phacilitate the philling of these phine medications. 

MILDEW: I shall wait for them. 

CP: While you're waiting, could I trouble you phor your insurance card?

MILDEW: It's in the system. 

CP: Indeed it is. However, it is telling me I need your Medicare Part B card. Might you possess it presently?

MILDEW: "I don't know. Nobody's ever asked me for it before."

CP: I think whether or not someone has asked you phor it before is immaterial to our present situation. I asked if you had it. It's either "yes" or "no". Nobody's asked me phor my car insurance or my Junior Zookeeper of the Month Card, but I know I have both of them in my wallet at all times, just in case. Here. <shows Zookeeper card>

MILDEW: You are a strange human. 

CP: Thanks. I also have a picture of the star I adopted. 

CPP: Did she have her card?

CP: She did. Still not sure why she responded as she did. It's as if I asked her opinion on whether she enjoyed the company of snails or axolotls. At least there she could have responded with "I don't know. I've never been asked or thought about it before". 

CPP: What's your next issue?

Automatic Information Download Isn't A Thing?: I'm here for my prescriptions. 

CP: Here you go. I just need to verify your information. What we have on phile does not match what the prescriber sent over on your e-script. 

AIDIAT: That's not correct. You don't have my right address. 

CP: Again, that's why we are checking. 

AIDIAT: I haven't lived there in years. 

CP: And whose phault is that? If no one tells us, we don't know to update every time you move. 

AIDIAT: That's like 3 places ago. 

CP: Again, we don't have a tracker on you. I'm just trying to update your information so it's correct. If you could just stay with me phor a few more seconds I can verify everything is current. 

AIDIAT: And my phone number is wrong. 

CP: Okay. I need you to step away phor a minute or two, collect your thoughts, and reapproach when you are capable of answering the questions I ask of you. 

CPP: Did you phix his profile? 

CP: Of course. And guess what?

CPP: What? 

CP: The information sent over on the e-script was also incorrect. 

CPP: Think we should tell him?

CP: Nah. Let's let the office get the same enjoyment we did phrom their oversight of not knowing he moved and changed numbers. 

CPP: There should be a way phor people to communicate that to the businesses they patronize. 

CP: Yeah, like, telling them or something. 

CPP: Or something apparently. 

*What's the diagnosis for taking Tessalon?

Phuh Cough.

Maybe It's A You Problem

CP: CP's Draughts and Drachms, Is this I Can't Always Remember Usual Stuff? 

ICARUS: It is. 

CP: I am calling today to let you know that your courtesy refill is due this week and we have to order enough to fulfill your insurance's new requirement to fill a 90 days supply. It will be in tomorrow. 

ICARUS: I have plenty because you guys always fill them a few weeks early anyway. 

CP: A few weeks early? 

ICARUS: Yes. 

CP: On a 30 days supply? 

ICARUS: Yes. 

CP: Hmm. Sounds implausible. May I put phorth a second theory phor why you have an excess?

ICARUS: Yeah. You keep filling them too early. 

CP: Hunh. We phill your refills based on the dates when you actually pick up your medication phrom us. I proffer, now hear me out, that maybe, just maybe, potentially, you are not so compliant; missing doses, skipping doses, giving doses the cold shoulder. It's a theory. We could test it. 

ICARUS: Yeah. You fill them too soon and call me to come pick them up, which I have to do so you'll stop calling me. 

CP: Yes, it could be that, or, again, hear me out on this: we have filled these roughly every 37 days since Halloween. You've been picking them up about 3-7 days later, on average. This means you should have been out of medication long before you received them. Therefore, your stockpile is of your own making. I rest my case.

ICARUS: Your honour! May I rebut? 

CPP: You may not. The math checks out and you could not be more of a but so to rebut would be redundant. Case dismissed. 

CPP: Now do the lady with the 90 days supply.

CP: CP's Draughts and Drachms. Is this Can't Remember Any Way Drugs Are Dosed? 

CRAWDAD: It is. 

CP: I was calling to let you know that your 90 days refill is due and is on order phor tomorrow. 

CRAWDAD: Oh I don't need it. You keep philling it too early. 

CP: According to my calculations, you are due in two days. 

CRAWDAD: Well I have about 80 left. 

CP: That's a pretty sizable estimate. Seeing as how we filled your previous prescription 87 days ago, you should have maybe a dose for today plus the next two days, not 80-odd doses remaining. 

CRAWDAD: It's cuz y'all keep filling them so damn early. 

CP: Ooooorrrrr, just maybe, you aren't taking them correctly? Maybe they changed your dose? Frequency? You were in hospital? Sabbatical? Hajj? 

CRAWDAD: Nope. I never miss a dose. I phill my pill packs every week.

CP: <whispers> yeah you phill them, but do you empty them? 

CRAWDAD: What's that?

CP: I agree. You're right. You never miss a dose. I shall wait to hear phrom you until we next phill your refills. 

CRAWDAD: <sounding sceptical> Why the attitude change?

CP: Oh. I realised you were correct; you never miss A dose. You miss A LOT of doses. Therefore, since we can't predict when you will need a refill again, we are leaving your healthcare up to you. Good day!

Do Not Edit

CP: Have you heard of selective reading?

CPP: I'm going to guess it's what's people do on the internet when "researching"?

CP: Yes. But along with that, they only provide you details they deem essential. 

CPP: Exactly like "researching it for themselves" on the internet. 

CP: Precisely. 

CPP: In what context are you raising this query?

CP: Remember last week when we discussed patients providing us superfluous information when requesting refills or prescriptions or just talking to us?

CPP: Yes. 

CP: Today we have the people who don't provide enough information, or rather, self-edited information. 

CPP: Do tell. 

CP: CP's Draughts and Drachms, how may I help you?

Please Read All Your Words On There: We are going out of town. 

CP: We are? 

PRAY WOT: My husband and I. 

CP: Good on you, love. Am I needed for this conversation? Is my bit coming round soon?

PRAY WOT: He has enough calcium to last until the day we come back and we don't want to run out while we are gone. 

CP: <knowing full well she means Atorvastatin> Well your insurance will pay for your refills a few weeks early since you last filled a 90 days supply. We can fill that today for you if you like. 

PRAY WOT: Oh really? I know it's just calcium but I don't want him to miss it.

CP: Do you have the bottle at hand? 

PRAY WOT: I do. I know it's not important.

CP: Stay with me here. What is the rest of the drug name?

PRAY WOT: I see calcium. 

CP: Do you also see Atorvastatin?

PRAY WOT: Yes. 

CP: That means it's his Lipitor; it's for his cholesterol. This makes it a little more important. 

PRAY WOT: Oh. I looked at the label and I only saw the calcium part of it. 

CP: Make sure when you read names, especially names of medications, that you read the entire name. You don't get to choose which parts are important. It changes the meaning considerably. I know "calcium" is recognizable, but it's not the important part of the name here.

PRAY WOT: Gotcha. Thank you. 

CPP: That's like reading only parts of a number; like the cents on a check and omitting the dollars. 

CP: Or giving directions to "Carolina", "Dakota", "Diego", "Los", etc.

CPP: I had this same conversation last night. 

CP: No way!

CPP: Way!

CP: Dude!

CPP: Sweet!

CP: Do tell. 

CPP: Patient said she was only allowed to take her blood pressure medication before her surgery. I looked at her chart and told her it was the Losartan. She asked about the Calcium. I told her Atorvastatin was not for blood pressure and she said "I thought it was when I saw the calcium". I explained that no, ATORVASTATIN was her cholesterol medication and she replied "I guess that makes sense because of the calcium in it". 

CP: It's a-TOR-VA-statin. The calcium don't enter into it. 

CPP: It's bleeding demised. 

Smells Like. . . Diuresis

BP is high, you think you'll die

there are some drugs that you can try

fluid volume may be a lot

diuretics are worth a shot 

how low, how low, how low, to go 

how low, how low, how low, to go 

 

It's Aldactone, spironolactone

there's hygroton, chlorthalidone

thiazide drugs, these include both 

hydrochloro- and the chloro-

furosemide, bumetanide, ethacrynate, and torsemide

loop, hey!

 

Full up on salt, your fluid's much

Edema could be dangerous 

Heart failure, it's hard to breathe

diuretics can help relieve

how low, how low, how low to go 

how low, how low, how low to go 

 

It's Aldactone, spironolactone

there's hygroton, chlorthalidone

thiazide drugs, these include both 

hydrochloro- and the chloro-

furosemide, bumetanide, ethacrynate, and torsemide

loops, hey!

 

we have Lozol, indapamide, 

and Midamor, amiloride

metolazone, zaroxolyn, 

inspra which is epleronone

how low, how low, how low to go 

how low, how low, how low to go

 

It's Aldactone, spironolactone

there's hygroton, chlorthalidone

thiazide drugs, these include both 

hydrochloro- and the chloro-

furosemide, bumetanide, ethacrynate, and torsemide

loops, hey!

 

We have Loop ones, and thiazides, 

Potassium sparing ones too 

there are others but they don't rhyme

they're not major, just nevermind

like mannitol, like mannitol, like mannitol, like mannitol

and caffeine y'all, and caffeine y'all, and caffeine y'all, and caffeine y'all