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

 

Seeing Is Not Believing

<patient approacheth drop off window>

CP: Greetings. Are you dropping off today? 

Another Customer Exhibiting One's Failure Bout Appreciating Simple Signs: No. Picking up. 

CP: <looks up> Clearly. I shall help you down there. <points to pickup>

ACE OF BASS: Yeah. I saw the sign. 

CP: <looks up at Drop Off sign under which patient now stands> Did you though? Did it open up your eyes? When you saw the sign?

ACE OF BASS: Yes. I saw it. 

CP: But did you comprehend it? Life is demanding without understanding. 

ACE OF BASS: I saw the sign.

CP: No one's gonna drag you up to get into the light where you belong, but where do you belong?

ACE OF BASS: At pickup?

CP: Precisely. 

 

UT: How do you know so many song lyrics? 

CP: It's a gift. 

UT: Seriously though. Everything I say or patients say at work somehow leads you to a song lyric right off the top of your head. 

CP: I think in movie quotes and song lyrics. 

UT: No one is going to believe you had this conversation with someone and knew these lyrics. 

CP: That's why you're here; my witness. 

UT: Now witness the firepower of this fully armed and operational battle station.

CP: Nice.

Not Your Messenger

CP: Thank you phor calling CP's Cellar of Physic. How may I assist thee?

Female Rapidly Using My Patience: Did my prescriber call in my refill yet?

CP: We are indeed in receipt of your medication. 120 tablets for 30 days. 

FRUMP: It's supposed to be 240 tablets. I take 2 tablets at a time. 

CP: They sent us 120 at 1 tablet per dose. Perhaps you should call them. 

FRUMP: I always take 2 tablets. I've been taking 2 tablets forever. 

CP: Apparently, your streak comes to an end today. If you're expecting something different, you should call. Maybe she is weaning you off the medication? Or making a change?

FRUMP: No. She didn't say anything to me. You need to get the correct prescription. 

Uber-Tech: Thoughts?

CP: Bets?

UT: Prescriber changed it?

CP: That's my guess. Let's call. 

Nurse On Phone Exasperated: Dr. Zoffis, How may I help you?

CP: CP phrom Cellar of Physic calling to verify an e-script I received phor a patient. 

NOPE: Sure. 

CP: It came across as "1 qid" but the patient states she was expecting it to be "2 qid" as she previously received. Did the prescriber change her dosing?

NOPE: Let me check <mumbles the notes as she reads> Yes. 

CP: Ok. That's what we thought. Can you call her and explain that to her? She's called thrice this morning and yelled at us that we aren't filling it correctly and somehow, we can't read it correctly or interpret it correctly and one should be two. 

UT: When two become one?

CP: "Come a little bit closer, baby, Get it on, get it on 'Cause tonight is the night when two become one."

NOPE: Huh. 

CP: Nothing. Can you call?

NOPE: Nope. She was notified 30 days ago at her appointment. 

CP: Well apparently it didn't sink in. Can you call her again so she stops harassing us?

NOPE: Phine. 

UT: Think it'll sink in this time?

CP: Nope. She won't be happy that two became one. 

UT: She'll probably still take two anyway.

This Is The Reason. . .

 . . . You Can't Just Write What You Want And The Pharmacist Won't Just Fill It

CP: How often have we said "If you're a prescriber and you don't know how to prescribe a medication, perhaps you shouldn't be prescribing it"?

CPP: in aeternum. I don't mind if they call for some help, but I also don't want to prescribe the medication for them.

CP: Yeah, we should get a consulting fee on some of these. I do appreciate them leveraging us but choosing the medication and telling them how to write it is a bit much. 

CPP: Especially when they send it to another pharmacy. Or completely ignore our advice.

CP: Exactly. 

CPP: What spurred this topic today?

CP: A recent conversation with a prescriber and his nurse.

CP: Hello, Nurse!

Nurse Obviously Clueless Like U Expect: Hey, CP. Did you receive the e-script we sent?

CP: I did. Except there's a problem; the Oxycontin isn't available as 50mg. 

NO CLUE: It's not? Doctor wasn't sure. He stepped the patient up from 20mg to 40mg and wanted to go to 50mg now. 

CP: The next increase is 60mg. 

NO CLUE: Well he wants 50mg.

CP: The only way to achieve that would be to prescribe 40mg plus 10mg (or 20mg plus 30mg) but I'd advise against it. It will be quite difficult to get both strengths approved. Especially with how quickly he moved the patient from 20mg to 40mg, I'd go with 60mg. I have 10, 20, 30, 40, 60 in stock. 

NO CLUE:  How about 25mg? 

CP: No. The only ones they make I am missing are 15mg and 80mg.

NO CLUE: So there's no other way to get 50mg?

CP: I'm still recommending against it based on the patient's history but no, there is not.  

NO CLUE: Okay. I'll check with him. 

 

<1 hour later>

CP: So I see we received Rx's for 10mg and 40mg Oxycontin.

NO CLUE: That's what he wanted.

CP: Ok. Did you start the prior auth?

NO CLUE: Yes. 

 

<3 days later>

CP: So I see we received a new prescription for 60mg Oxycontin. 

NO CLUE:  Yeah. The 50mg just wasn't enough and it was confusing for the patient to remember to take one of each twice a day. 

CP: You don't say. Did you start the prior auth yet?

NO CLUE: This needs one too? I thought you said it wouldn't?

CP: If you had prescribed that first, it wouldn't have. Now that the patient has all kinds of tablets hanging around, the insurance needs an explanation. 

 

CPP: I like being asked how to make my job easier, then being ignored, then being provided the exact opposite then being forced to explain how to fix the problem I tried talking them out of making which makes more work for me because I have time to fix mistakes I preemptively fixed in the first place. 

CP: You can give a man an education but you can't make him take it.