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Tuesday, March 29, 2011

The Hardest Questions

It is a simple Q&A that goes down in our pharmacies.  The simplest transactions and face-to-face interactions between our staff and customers.  How is it then that the most rudimentary questions are the most difficult and often give us the largest headaches and stress of our day?  To wit:
#1.  "When do you want to come back for this?" is often followed by "when will it be ready?"  Reasonable, but wrong.  If we reply "20 minutes if you'd like to wait" and you intend to wait, then tell me you'll wait and I'll tell you 20 minutes.  If you intend to return at 6pm, tell me 6pm.  My favorite answer is "well, how long til it's ready?" and we say 20 minutes and you proceed to tell me you weren't coming back til after 7pm, something like 6 or 7 hours later or even the next day!  Just tell me "I'll be back tomorrow"!
#2.  "Have you/Has so-and-so ever filled prescriptions with us before?" we ask with all new prescriptions.  "Yes, we come here all the time." Thanks.  We appreciate the business.  I shop at Target and Wal-Mart all the time too, but I've never filled a prescription there.  It will invariably follow that your entire family is in the computer but, alas, you are not.  If you used another of our stores in another town or state, great, that will help too, just please tell us.  Now, onto the subsequent #3...
"Do you have your insurance card?"  See, everyone's insurance used to predictably change the first of the year but now we are all on a different schedule.  This means it is hard enough for me to keep my own insurance crap straight, let alone being responsible for yours and the 10,000 customers I see every month.  My favorite answer is "Of course, you have it on file because we always shop here."  Okay...I shop all the time at Best Buy, but I still need to show my credit card to walk out with my new 58" plasma.  Oh, and my wife shops all the time at Kohl's, but they don't know who the hell I am.  I still need a credit card to pay there as well.
Perhaps all of this is our fault, as a profession.  We always ask "is it on file?"  At doctor's offices and hospitals everywhere, signs are overtly placed telling you to "have insurance card ready" or "please present your new card" or there's always a box to check on some form for "new insurance?".  Now this is not idiot-proof because because we ask you to be responsible enough to read and understand.  Simply put, we need to make it mandatory that insurance and all information be in the store the same time you are.  When was the last time you went to an office or retail outlet, received your services, then said "I'll bring my card (credit or insurance) when I come back"?  Only in retail pharmacy do we allow this to happen.  This usually leads to the uproar over long waits, but that's another (already covered) topic.
We need to simply require it all the time.  Period.  It is better to have it and not need it than the alternative, right?  This way, if you don't have it you can understand why you have to wait for us to redo everything.  At least you'll know our policy.  With our profession looking like any other quick-stop retail outlet (see gas station and fast-food) we help to propagate this opinion while also asking to be taken seriously and selling out from the other side of our faces.  We need to act professionally in order to get our profession back.  There is more to it than just a few simple questions, and most will be discussed at length in other posts, but sometimes, it really is the simplest questions where we start going wrong.

Thursday, March 17, 2011

Patient Responsibility

I have long believed that a lawyer would sue Mother Nature, if he could get Her into court, for every day She didn't make the sun shine on his rear end.  I started off this year telling people that I believed my New Year's resolution was to act like the general public and lay blame on everyone I could, absolving myself of any in the process.  The media is full of stories of stupid people trying to get compensated by big companies for the dumb things they do: (hot coffee from McD's is actually HOT, pickles on the burger were too hot, I'm too fat because I ate all my meals through drive throughs).  It is also responsible for some of the dumbest warning labels we have on products today: WARNING- Remove baby before collapsing stroller.  Seriously.  It is this type of sue-first, admit no culpability attitude that leads me to the conversations I have every day that I am no longer in the mood to have.

INSURANCE-Look, you get an explanation of benefits (EOB) at the beginning of every year, just as I do.  By definition, this Explains YOUR Benefits to YOU.  Read it.  Commit it to memory.  Use this knowledge to advance yourself in human society.  Now you may ask "But O Wise One, how can I use this information in my daily life?"  Allow me to answer, my friend.  When you bring a prescription to my pharmacy you will not have to ask "what will this cost?" for it will be known to you.  If you need to know if it is brand or available as a generic, with this I can help.  No longer will this conversation take place: You-"how much will this cost?" Me-"I don't know" You-"Why not? Isn't that your job?" Me-"No, my job is to know what MY insurance copays are so I don't act like an idiot when I go to my doctor or pharmacy, not to know YOUR copays.  Do you know what my copays are?"
You will also know that with set copays, the price will be the same whether you are filling your Rx at Wal-Mart in Tuscaloosa or Yukon Cornelius's Discount Drugs in Anchorage.  Please do not try to tell me you paid $5 for 90 days of Lipitor at Walgreen's and I am fleecing you by asking for $30 for the same thing here.  If you have not filled something since last year, and this is a new year, and you have read your EOB, you will know that deductibles have restarted (usually $100 per member or family up to thousands of dollars) and that your first copays will be higher.  You will also be aware of increases in your copays since your employer is paying less for your benefits and you are responsible for more of it.  As I tell my customers every January, all bets are off once the first of the year arrives.  Do not assume everything will be as it was.  

PRESCRIPTIONS-Let us examine the initial process that brought you to me, the first time we ever met. You were unwell, scheduled an appointment with your doctor, visited said doctor, gave him your list of complaints, he diagnosed your condition, wrote your prescription(s), then either handed them to you to bring to me, faxed them to me or sent them electronically (much-preferred).  At the end of this process, you found yourself in my pharmacy waiting to pick up your medication(s).  Understand the process so far?  Good.  Now let's jump forward a few months to when your refills have run out and you need more.
Here is what actually happens and is expected: You call my refill line with your RX#, punch it in on my phone or through our website, you are alerted there are no refills and that we will contact your doctor for you, our computer then faxes or e-requests your doctor for the refill or we may phone them for you, then we wait.  We wait for the doctor, YOUR doctor to call US back.  We have done our part, met our promise.  Now it's a few days later and you are out of medication so you call US and ask "where are my refills?" and we kindly explain that we faxed, called, Pony Expressed a request to Herr Doctor and he has not called us back.  Then you always ask "well when will he do it?  I have been out of my medication for 3 days now and it's all your fault!"  Okay, well let's examine this for you, shall we.  First, in case you didn't notice, I am your pharmacist.  I do not work in your doctor's office, nor would I ever.  He does not pay me to put up with you, though I think he needs to adjust your meds right about now.  Second, please read the first 3 sentences of this paragraph again.  These are YOUR prescriptions from YOUR doctor that you brought to me.  The process starts with you talking to your doctor and ends with you bringing the RX to me.  If your doctor is one of those who only takes refill requests from the pharmacy and I have done my job, you still need to call him to find out what is going on over there because, say it with me "I do NOT work there!".  I cannot control what goes on over there any more than I can stop people talking on cell phones while driving.
I understand it is all about convenience, but keep in mind, I will fill thousands of prescriptions just like yours every month.  There are doctors who refill only through pharmacy requests, doctors who refill only through patient requests, and doctors who charge per request made outside of an office visit.  Not only am I expected to keep these straight, but I have to make follow-up calls every day for refills and for prior authorizations for drugs you need but your insurance doesn't want to pay for you to have.  If I had nothing else to do but call doctors all day, I could get you your refills.  However, I work 12 hour days at my job filling everyone's expectations that are the same as yours.  What are you doing that you can't do some of the legwork yourself?  Which leads me to:

WEEKEND OUT OF PILLS-This could also be known as "Going on Vacation".  Most prescriptions are taken once a day, every day.  As I peer into my bottle every day, I notice a dwindling supply.  As it approaches single digits, I start to say to myself "self, better think about calling in your refill".  My question becomes, how the hell do people not notice their bottles are empty until the weekend?  It never fails that my weekend starts at 5:01pm Friday and lasts through Sunday.  During this time, I will be inundated with the following requests either separately or some combination thereof: "I ran out last week and I really need this or I'm going to die.  Can you just give me a few pills til I can see my doctor Monday?", "My doctor never called so now I need them", "it's your fault I don't have any so you owe them to me", "I'm going out of town and need a few to last til I get back.  I have an appointment next week, honest", "I lost them?".  Now the burden falls on me to be the bad guy.  How did you NOT know your bottle fell empty on Monday?  Did your planned vacation to Texas just sneak up on you?  You didn't know you stopped your mail, packed your bags, got your tickets and needed pills?
Please make it stop!  Please accept some responsibility for your own healthcare.  Please don't make me be the bad guy.  I have long been served well by the following quote and have issued on rare occasions when customers have not asked but demanded something that is not urgent:
"Lack of planning on your part does not constitute an emergency on mine."

Tuesday, March 15, 2011


The Drive-Thru is the bane of my existence.  It was the worst addition to the profession of pharmacy in the last century.  We are a Healthcare profession!, not a quick-service food delivery system for a fat, lazy, American society that wants everything right now.  Seriously!  This is about your health, not about waiting on an order of fries to stuff your face while you drive and talk at the same time, usually while sitting at my window.
Here's what pisses me off:
1.  People on their damn phones while at my window and my techs are trying to offer counseling or just ask how many prescriptions they are trying to get.  Don't call me back complaining because we forgot a bag or didn't tell you about something important because you were too busy making your nail appointment to focus on me, the person actually standing in front of you, physically, trying to talk to you.
2.  People who call my store from IN the drive-thru line asking what is taking so long.  WTF?  Get your lazy ass the hell out of your car and come inside where I have fewer people.  Everyone gets the right to ask questions and have them answered, including you, so shut the hell up and wait your turn like everyone else.
3.  Sitting at my Drive-Thru like a spoiled 3 year old throwing a temper tantrum.  Well I am sorry that when you dropped off your scripts and we asked if you had insurance, you either gave me no card or the wrong card; or you now only want a 30-day supply because 90 days of something is too expensive or you didn't bring enough cash.  Whatever it is, it is going to take a few minutes to redo something we could have done right the first time with a little help from you.  This usually results in the 3-year old parking his/her car at my window, rolling up her window after saying "go ahead, call the cops. I'm not fucking moving and everyone else can wait like I had to so nyah!"  Really mature and usually caused by number one above and resulting in number two above.
4.  Treating the drive-thru like it's "Billy Bob's Brew-Thru".  No, I cannot go into the store and get you beer, cigarettes, lottery tickets, diapers, pseudoephedrine, or anything else.  Again, walk your lazy ass into the store.  My sign explicitly reads "Prescription Pick-Up" at the Drive-Thru.

The drive-thru was created for convenience in dropping off a prescription (mom with sick kids in the car, people who will pick up later on their way home from an appointment, or others who may not be physically able to walk all the way to the back of my store without suffering a heart attack) and returning at a later time to retrieve said prescription.  Thanks to our fast-food mentality, it is a commonly-held belief that if I drop off something at the first window it will be ready by the time I get to the second window after a lap around the building.  In case you missed it, the steps I have to perform include: typing your RX into my computer, billing your insurance, counting your drug(s), checking the accuracy of your doctor and my staff and your med history, and finally labeling and bagging that pretty bottle with the nice label for you to read.  If I forget something at a fast-food restaurant, your suffering will be limited to one fewer bag of fries, hamburger or mega-bladder-filling diet beverage which may actually be healthier for you.  If the same occurs at my pharmacy, the error could be much more life-threatening.  Shouldn't we want our healthcare to be more important than a $0.99 bag of fries?
In our gotta-have-it-now society, we don't even have the time to treat our healthcare professionals as such.  Apparently when I graduated from pharmacy school, I missed them handing out the paper hats.  I know you just wasted half your day in the doctor's waiting room reading 2 year old magazines and you are in a hurry to catch up on your important tasks for your day, but can you not have the patience to wait and act civilly when you come to my pharmacy?  Please?  It will keep both of us off high blood pressure meds a lot longer if you do.

Saturday, March 12, 2011

Expectation vs. Reality

          If the real world worked as people believe Pharmacy does, we'd be either the most efficient and productive country in the world or the rudest, slowest most incapable idiots to run a superpower.  If I were to place an online order at Best Buy for in-store pickup (or ordered a pizza for that matter) and was told a specific time to arrive, would I expect my order to be there if I placed it from the parking lot? As I was entering the store?  Not hardly, but that is the reality of retail pharmacy today.  I'm not making you a pizza or unloading a Blu-Ray player dumbass.  The steps in every other retail outlet are simple: walk in, pick out a prepackaged product from the shelf, put it in a cart, walk it to the teenaged checkout girl who scans it, slides your credit card, you sign a receipt and walk away.  Simple, right?  What about the magical process at a pharmacy? the one shrouded in mystery since all we do is "put a bunch of pills in a bottle", right?
          I take your prescription, and assuming it's the only one I take all day, I begin work on yours immediately.  We have to enter into our computer your name, your doctor, the drug, the strength, the directions, the quantity, the refills, the date your doctor wrote it, and your insurance information.  Now we send it to your insurance and if by some small miracle you gave us the correct card and it works correctly, we get a label and receipt (which has your copay on it from your insurance).  Now we have to pull the drug, then count the pills, then, wait for it, put them in a little bottle!  Then this gets handed to the pharmacist who will now check all of this critical information against your original prescription to make sure it is correct, that the drug in the bottle is correct, that there are no drug interactions with all the other crap you're taking you don't get at our pharmacy because you like to use coupons to pick a pharmacy.  Then we give it to our techs who call your name and charge you your copay, from your insurance, that you will complain about because "that's not what I pay at my other pharmacy" or "that's not what I paid last time" or "my copay is always $5.00 even though this is new insurance", or "I have this other card, would it help?", whatever.  This will cause us to have to redo your prescription causing a delay in processing everyone else's stuff because you are too lazy to read the explanation of benefits that comes with your insurance card every damn year that clearly explains what YOUR copays are, dumbass!  After all of this, with a smile on our face, we still take it in stride as you walk away and mutter "I'm thinking about changing pharmacies, this is some bullshit right here".