Happy New Year!

For those of us who work today, keep one thing in mind. Today is the last day you get to hear "Just fill everything I have a refill on that's in my profile whether or not I've taken it or am still on it from last January" for the next year.
For tonight ushers in a new beginning. A new set of favorite quotes, if you will, starting tomorrow.
"What do you mean my insurance changed?"
"What do you mean I have a deductible?"
"What do you mean my copays went up a whole dollar?"
"Why don't you accept my insurance anymore?" (We do, but just because your copays went up, doesn't mean we don't accept it...)
"I didn't pay that much here last month!"
"Why isn't my prescription covered here anymore? It was last year!"
"It was covered when I went to ABC pharmacy last year."
"No, they didn't send me a new card."
"A new card? Oh. It looked the same so I left it on my kitchen table."

Customers may forget what happened a year ago when the insurance clocks reset. Pharmacists never do. Patients may hate the hassle of dealing with their one insurance. Pharmacists have to deal with thousands of different ones, weekly. We are all in the same boat and all have a common goal-figuring it out so we know what to expect the next time we see this particular card and figuring it out so we can explain it to you so you understand it going forward. It's what we do. Patients receive Explanations of Benefits usually around December. Few read them. Fewer understand them. Simply put: New Year, New Rules. Everything changes January 1st.
Remember the "Warning-Peak Times Ahead" Post from last week? This is where we need the digital board that reminds everyone "New Insurances Ahead. Expect Delays".

Good Luck this holiday and Happy New Year!

Different Rules

Pharmacy...The scene...Patients line up outside the pharmacy gates before we open. Cars queue up at the drive-thru before we open. It's anticipation. Better make sure we open exactly at 9am. (They watch us with a "we see you in there so just help me now!" look in their vacuous stares.

Doctors...The scene...Patients wait outside before they open. Maybe they open the doors at 8:05. Maybe later. Patients are okay with that. They know they have a scheduled appointment time and lots of magazines and TV shows to watch until someone decides, rather ambiguously, to call them back much later than that scheduled time. Lunchtime is usually from 12-1pm. Phones go off at...maybe 11:45 today. Maybe 11:52. Who knows? People are okay with that. Phones come back on at 1pm? Never. 1:07? 1:11? 1:19? Who knows. We get the answering service who is mad at us for calling and they tell us "they should be back. But try later." Patients call us and tell us to call. Right. I have the same number to reach them that you do.

Pharmacists...Lunchtime arrives. For us, that's just the hours between 12 and 4pm. No significance other than we can't reach doctors from 11-something to 1-something. Grab a handful of Cheetos and wipe my hands on my off-white smock. Oops. Chug a Mountain Dew. Keep trying to decipher the e-scripts and voicemails I got after your doctor shut off their phones for lunch.

Doctors...4-5pm. Switch off phones at some point before they say they are closed. Hurriedly leave a dozen voicemail messages in a speed contest against the other office lady sitting next to you so the pharmacy can't possibly call you back on them. Patients know they are closed and don't rush the staff for last minute appointments as the staff is walking out the door. Which is good because the doctor left hours ago, but the staff is just finishing the calls.

Pharmacists...5-9pm. Explain to customers the doctor switched off their phones early. Patients say "that's okay. They work long days. But you bastards need to give me my meds now. I'll be waiting." After a 12 hour day at 9pm we lock the gates, close the door and start to our cars. Multiple people run up to us and coerce us to open the pharmacy because they have to have their stuff tonight because they've been out for 6 days, are going to now die without them, and they've been waiting to be picked up for 8 days even though they were written 3 months ago.

Pharmacies have posted open and close times. Doctors use some rather amorphous scheduling when they decide to open and close and switch their phones to the answering service.
Over generalized? Sure. True for many offices with which we deal? Definitely. Every day in the life of your pharmacist? Absolutely.

Your dog ate what?

I don't know where to store this. I imagine if I ever had one, I'd keep it in a nightstand like a lot of people. It would probably occupy the same space as the other stuff used for those special occasions. I'd try to make sure that access was quite limited as well. I'd probably make sure to put it away in its safe place when done so it doesn't get in the wrong hands. Still, I am always surprised when I get questions about how to replace one. Or how quickly can it be replaced? Then I'm surprised that people think this is their only option. I can think of at least 8 other options, but that's just me. Seriously, how do people let these fall into the wrong hands?

Over the years I have heard:
My dog ate my diaphragm.
My kid chewed my diaphragm.
My son wore it as a yarmulke.

Okay. These examples likely mean you left it out. I'm sure the kids could riffle through your drawers but by the time you have kids, you should probably move the other stuff in that drawer as well.

Everything's Free

Get your FREE stuff at the pharmacy.
People love to get free shit. Always. Doesn't matter if they need it, could use it, or even know what it is, as long as it's FREE, they gotta have it. If everyone else is going to get free shit, sign me up for mine too or life just isn't fair.
New stores open and give out free samples as enticements. It's usually coffee or ice cream or baked goods. I've never thought of going to a pharmacy for free shit just because it's free.
"Free Antibiotics!" "Free Diabetes medications!" advertised all over the country.
"Free Advair (*with prescription)" and many other manufacturer gimmicks abound, all with that "*" restriction.

Look, the rules still apply. You still need a prescription for anything you normally need a prescription to receive. You can't get a FREE oil change if you don't have a car. I am still amazed, though I really shouldn't be, by the number of people who walk in to the store, or lazily glide into the drive-thru, and expect us to just hand them free shit.
Lazy Douche: "It says free diabetes medications?"
Me: Yes. You can read. And?
LD: I want some of it.
Me: Do you have a prescription?
LD: Doesn't say nothing about that.
Me: It does, actually. And I retract my first statement. Do you have diabetes?
LD: No. It just says "free" and I want some while I can get it.

I wonder if people are shopping online for Christmas presents and when they see "Free Shipping", I wonder if they just order that. Without buying anything else?

Customer: Now how do I just order the free shipping? That'll be just perfect to put in her stocking. I'll also sign her up for a free estimate on new windows. Best Christmas yet if I can get her the Metformins too.

Grammar Lesson-Pronouns

Pronoun: Pronouns are used in place of a noun that has already been mentioned or that is already known, often to avoid repeating the noun.
Focus on the "already been mentioned" part of that...
While it is quite common for people to abuse the English language, the biggest issue I have, today anyway, is the mysterious pronoun people. There is a great song by Jem called "They". In it, she asks "Who are they? Where are they?" Did you ever wonder who they really are? Especially when patients come in with all of their "they" stories:

1.They told me it would be here.
2.She said she sent it.
3.He said it was ready.
4.They told me it was only $4.
5.They said I could go to any pharmacy.
6.She told me to come here and pick it up.
7.She said they negotiated the price down.

Again, I ask, who are "they, he, she, and it"?

Let's try:
1.My doctor said my prescription would be here.
2.The nurse at the office this morning said she sent my prescription electronically.
3.I spoke with the tech this morning and he told me my prescription was ready.
4.My insurance told me I could go to any pharmacy.
5.The doctor's office told me this medication was on your $4 list.
6.My wife just told me I was supposed to come here to pick up her prescription.
7.(I still have no idea what the last guy was talking about with a negotiated price.)

It's a little like jumping into the middle of a movie, with the characters and plot already established, and trying to figure out why he hates her and they are trying to chase after them while they are also being tracked by them for seeing it happen while she still loves him but he's now with her and it's going to happen again if someone doesn't stop them from doing something, except the TV isn't working so you can only hear the movie, and the movie keeps starting at different points all day long and the characters keep changing and you can't mute or rewind it and it doesn't end until you get in your car and it's a cliffhanger that you know will continue tomorrow like the old Saturday matinees except no one has figured out how to it's going to end. Please make it stop. 

Can you teach a Doctor?

Doctors. What are we going to do with them? We need them, but can they be taught? I believe they can be trained, but they really need reprogrammed. Examples: (Yes by doctors, not just their staff.)
This will be ready when you get to the pharmacy.
It's pretty cheap. Usually under $10.
You don't need a new prescription if you have refills left. Just triple your dose and tell the pharmacy I said it's OK and they'll just fill it.

1. Your doctor does not work in my pharmacy. Never has.
2. I don't work in his office. Never have.

I don't tell him how to run his office, he shouldn't tell you what I do in my pharmacy.
No matter how many times we call offices and tell patients to remind their doctors, the doctors will still send patients in for refills on medications where they changed the dose/strength/frequency and the patient is now too soon. Do they not remember the point of a prescription is to tell me what to tell the patient? Do doctors not know we bill insurances? Do they not know how to do math? (No, hence all the q.s. quantities.) Do they not know a new prescription is required every time they give you something new? Like new directions? New strength?
You're right. I said they don't work in my pharmacy. How could they know this? Perhaps taught in school? Prescription writing 101? (Obviously taught with penmanship-they skipped those classes.) Perhaps experience? Pharmacists call and request a new prescription because he changed something. Pharmacists tell the doctor we need to know the correct information so we can perform our jobs too. Pharmacists call and call and call. I guess the answer to my somewhat rhetorical question is, no?

Either Way...

Damned if you do, damned if you don't...This is an either/or post. Pick one side.
Patients receive too many phone calls.
Patients receive too few phone calls.
Pharmacies make too many phone calls.
Pharmacies make too few phone calls.

So we call:
Either/Or Patient: Why did you call me?
Me: You have no refills on your prescription. We were calling to let you know so you could save a trip until we hear from your doctor and that you may want to call him yourself.
EOP: I know that. That's why I called. So you could fax him. You're stupid.

So we don't call...
EOP: Why didn't you call me and tell me I had no refills?
Me: True, there were no refills. We faxed your doctor and were waiting for a call back. Your bottle says no refills. The machine told you no refills and we would fax the doctor.
EOP: Now I wasted a trip. You're stupid.

So we call...
EOP: Why did you call me?
Me: Because your refill is due. The automated system wanted to let you know it was ready to be filled and to ask if you wanted us to get it ready.
EOP: No it's not. I still have plenty of pills left. You're stupid.

So we don't call...
EOP: Why didn't you call to tell me my bottle was empty? I've been out for over a week now waiting for your phone call. You're stupid.

So we call...
EOP: Why did you call me?
Me: The computer called to let you know your prescription has been down here waiting to be picked up for 3 days, 7 days, 9 days, 10 days, whatever...
EOP: She didn't tell me what it was. I don't know why the doctor called that in. I don't need it. I don't take it anymore. You people just fill anything, huh? You're stupid.

So we don't call...
EOP: Where is my medication? It was supposed to be here last week.
Me: It was. Your doctor called it in but you never came in for it so we put it back.
EOP: Why didn't anyone call me? I obviously need it. My doctor sent it here didn't he? Must mean he wants me to have it then. Boy, you're stupid.

Others:
Why do you people keep calling me? If I needed it, I'd call it in myself. This is harassment. I'm going to sue you and go somewhere else.
Why don't you people call and tell me when I'm supposed to take my medication. Isn't that your job?
Why didn't you call to tell me my insurance changed? Now I am here and I left the card sitting on my kitchen table. It's all your stupid fault.
Why did you call me to tell me my insurance changed. I know that. I have the card right here.

I could go on...

Little (Pharmacy) Drummer Boy

Come, they told me, to your pharmacy.
E-Scripts would be ready, or so they told me.
I do not understand what's taking so long.
I just left their office and now I am here, waiting for you, give me my drugs.

Sir, sit down right there, we'll have it ready, when it is done.

Have you been here? we asked him knowing.
I have before, he said, his temper growing.
Insurance cards I need? Oh what do you mean?
They told me four dollars and one should be free, aren't your drugs free, won't you help me?

Prior Auth we need, your doctor we'll call, will you wait?

Office was called, and now we can fill
The meds for you kind sir, staring at me still.
We did our best for you, thankful you should be.
Home to your wife now run, for holiday fun, my job here's done, thanks now I'm done.

Then he smiled at me, the nice little man, Cialis in hand.

Insurance Cards-The Bad

The flip side to patients not having their insurance cards is patients having too many insurance cards. Please, at some point, go through your billfold and chuck the old cards. Seriously. You only need to keep the most current card. If they issue you a new card, like most insurances do at the beginning of the year, it is meant to replace the old one, the now obsolete one. To replace means to remove the old one, throw it away, and place the new one in its predecessor's warm comfy home.
How many do we carry now just for ourselves? We have a medical card, prescription card, dental card, vision card, then the same ones for the spouse and each of the children. Throw in a few discount cards just for fun while you're at it. Keep the cards for the last 5 years and you could play Pinochle with them. The worst part is when they dump a casino's daily supply of cards on your counter and say "here you go. you figure out which is correct". How about "NO"? I am not employed by the show "Hoarders" to help you organize your wallet. It's your insurance. You figure it out.
It's December. New cards are arriving this month. Don't ignore them because they are not Christmas cards. Take this opportunity to clean house. If a new card arrives, hold it, caress it, love it and squeeze it and call it George. But please put it in your wallet only after clearing out the debris from the Clinton administration. This way, when we ask if you have new insurance, you can stand up proud, chest thrust out, and in a loud, booming voice for all to hear, proclaim "why yes! Yes I do!"

E-rxs, Lost in Transit

I see a lot of complaints about the he said/she said that goes on regarding lost e-scripts. Aside from accidentally deleting one, it's pretty difficult for us to lose an e-script. With patients standing at my counter, huffing and puffing, or on the phone with their doctor, I have a procedure that has yet to fail me. Or prove me wrong.
Huffy Patient: My doctor said he sent it hours ago.
Me: Ok. Where did he send it?
HP: Here, of course. This is where I told him to send it. You people do this to me all the time.
Me: Did you ask him what fax number he used? (This is for missing faxes that usually go elsewhere.)
HP: No. That's your job.
Me: But you just had him on the phone. How can you be certain he sent it to me?
HP: He said he did.
Me: Fine. Allow me to call him.

Office Lady: What now?
Me: HP says you sent his prescription over via fax or e-escript.
OL: We did. At 11:17 this morning. It says so right here.
Me: Where did you send it?
   Option #1
OL: We told him we sent it to ABC Drug.
Me: Awesome. You do know that I am XYZ Pharmacy, right?
   Option #2
OL: We sent it to you. You are XYZ Pharmacy, right?
Me: I am. Now can you verify my information as to where you sent it? Since I obviously do not have it, there must be a problem on my end. I get tons of e-scripts and faxes from other offices all day and would like to figure out if I have to call my people to fix it.
OL: Let me check this next screen. Wait. Oh. It says right here "FAILED". I guess that's why you didn't get it. Let me resend it.
Me: Just give me a verbal. I can't trust you now.

Why are there two screens? Why does the first always say it was sent, but the second screen is the one that tells them "failed"? So far, I am batting 100% when I ask them to check the confirmation screen after they tell patients they sent it. They even give them an exact time it was sent. Great. Your office may have hit "enter", but it does not mean it "sent".

No Means No

How many licks does it take to get to the center of a Tootsie Pop?
How many "NO's" does it take to get someone to understand No Means No?

Impatient Patient: Did my doctor call anything in for me yet?
CP: No.
IP: Nothing?
CP: No.
IP: Not for my blood pressure?
CP: No.
IP: I called him this morning. Nothing, huh?
CP: No.
IP: Yesterday, perhaps?
CP: No.
IP: Not my antibiotic either?
CP: No.
IP: Maybe last week then?
CP: No.
IP: Are you sure?
CP: No. I want to see how long we can keep this going. Ask me if he faxed anything.
IP: Ok. Did he fax anything for me?
CP: No.
IP: But you said...
CP: And you listened. Now try voicemail or e-scripts, or email, or secret courier.
IP: Did he e-scribe it?
CP: No.
IP: Email?
CP: No.
IP: Is it on voicemail?
CP: No.
IP: Did it magically arrive via secret courier?
CP: Um, No. But I like the way you think.
IP: Well what else is there?
CP: Morse Code?
IP: Is it worth it?
CP: Not really. But I'm amused. Of course by this time, I now have to check my fax machine, my e-scripts, my voicemail, my email, my Pony Express satchel, and Top Secret pneumatic tube all over since it's taken me so long to get you to understand no means no.
IP: <optimistically> How about now?
CP: No.
IP: Ok. I'll wait around for it.
CP: Of course you will...

Do You Have any Medication Allergies?

Stupid is as stupid does.
We always ask for any allergies to medications when patients drop off prescriptions. Why? Just to annoy them and take longer to fill their prescriptions? As a sort of pop quiz? Just to watch them squirm and get that far-off, deep-in-thought look in their eyes? Of course!
The responses we get are either "they're on file" or "I can't remember" followed by "why do you always ask me?". Well, last time you were here, you got a new medication. Perhaps you developed an allergy to it. Perhaps you made an ER visit where they administered something to which you were allergic. I don't know. All I know is I need to have the most current information on file to do my job. The only person who can supply that, is you. Therefore...the reason we ask every day.
Does your doctor ask for current insurance information at each visit? And do you whine about it?
Does your doctor ask for your current med list with each visit? And do you bitch about it?
Does your doctor verify your address? Or pharmacy of choice with each visit? (If not, they should.)
Why complain about what people are required to do in order to do their jobs?
The other reason, is to verify what someone else may have mistakenly added to your chart.
An office, that specializes in pain and its management, uses a prescription program that lists the patient's allergies on each prescription. This is distracting, but is also helpful...Unless they don't make sense. The allergies listed, by the doctor's office, for one patient were: ANCETS, ENDOSYN, and PERIDYIM. I know what they should be. Shouldn't someone in that office be responsible for ensuring accuracy? What use is an allergy list if not one of those is spelled correctly? What use is it if it makes no sense? We asked the patient (due diligence) and were given almost the same list, verbatim. We verified the specific medications and reactions and updated our file. Remember, the information is only as good as what is entered. Garbage in equals garbage out, right? This goes along with the office staff that call in nonsensical gibberish as drug names and respond with "well that's what the patient said she was taking or that's how she spelled it to me". How about your own due diligence? Ask a follow up question, check the chart, know what you are calling in, know what you are adding to the chart. It's not as if a severe allergic reaction could kill a patient or anything, right?

Obey the Law

Rules, as they say, is rules.
I believe we have to live by them. All of us, by the same ones. Why do doctors always act as though we are just being a pain in the ass when we call them on something? For years, since I was an intern even, it has been illegal in my state to use a rubber stamp or other mechanical means for a doctor to sign a prescription. Yet somehow, I still see one occasionally. What happens when I call the doctor to alert them to this? (Mind you, all I am seeking to do is inform them it is illegal and to take it down now as a verbal order. Simple, right?)
Me: Is your office using a stamp for the doctor's signature?
Phone Lady: Yes.
Me: Did you know it is not a legal signature?
The responses generally come out as one of these:
PL: Why not? It's just...Amoxicillin, or It's just a Z-Pak, or It's just a Bowel Prep, or The doctor is out of the office today.
Me: I don't care what "it's just". The law states that a doctor must manually sign a prescription in the manner in which he would sign a check or legal document. That means with a pen. There are no exceptions for cases where "it's just amoxicillin" is acceptable.
This is usually followed by PL telling me I am the only pharmacy or pharmacist that calls them on this, that they have been doing this for years. Right. I am the only pharmacist who cares about my license. Apparently, all the other times I called, you ignored me. I even had people tell me their doctor told them not to come to my pharmacy because I don't accept their prescriptions. Wrong. I don't accept invalid prescriptions from offices that are too stubborn to obey the laws. Seriously, is it really that difficult for a doctor to scrawl a line on the bottom of every prescription that he writes? Usually, the offenders are writing for medications for procedures and the prescriptions are often preprinted for him. It's not as if they are prolific scribes penning the next War and Peace and they risk their hands getting fatigued.

Did you ever Wonder?

I am pretty good at math. Always have been. I can do most pharmacy calculations in my head rather quickly. If you need a calculator to double-check, please grab one. I mention this because I always wondered why people would prefer to argue with me, when I am obviously right, rather than acquiesce. I present two cases today:
1. Birth Control: There are 365 days in a year. In order to give someone a year's supply, most doctor's offices will give patients 12 packs (usually 1 pack with 11 refills). This is not enough. How many months have 28 days in them? (All of them actually, but most have 30 or 31...) This is where the problem lies. If they are scheduling patients to return in 1 year, 12 packs will last 336 days, 13 packs will last 364 days. She will still need a 14th pack. I called a nurse out on this when she called in 1 pack with 11 refills.
Combative Nurse: That's 1 pack with 11 refills. Her appointment is next year.
Me: Ok. But she'll need 14 packs to get her through until then.
CN: No. There are only 12 months in a year. She will be back in 12 months. Therefore she needs 12 packs.
Me: But there are only 28 tablets in each pack. You are only giving her enough for 336 days. There are 365 days in a year.
CN: That's how we always do it.
Me: Ok. Then you always do it wrong. Grab a doctor and a calculator and call me back.
(Yes, most gynecology offices know better. Yes, they sometimes give patients free starter packs. The point is, outside of that being true, this conversation happens. It is not legal, here, to put "refill x1yr" so that is not an option.)

2. Pain Meds (and others as well): Everyone has a rule about how early we fill controlled substances. Usually it is 1 or 2 days early. Ever wonder what happens to those cumulative refill quantities? If someone fills his prescription 2 days early every single month, assuming a 30-day supply, at the end of the year, he will have an extra 29 days of medication somewhere! Where do they go? If we are so concerned about early refills and abuse potential (obviously legitimate patients are not being discussed here), then how do we deal with this issue? Some insurance companies will stop refills on heart or cholesterol medication if the cumulative refills amount to too much over a certain period of time. Has anyone ever really looked at these "repetitive creep" amounts? I know we can research these fills through some states' Prescription Monitoring Programs and alert doctors but what else can we do? I've had the "cumulative refills are too soon" conversation with a number of patients and doctors. Most of them have been quite receptive but some are argumentative. I am not talking about shirking our duties of having the conversation with the patient and doctor about how much they are actually taking, dosing increases, strength changes, status changes (pre-op vs. post-op vs. accident, etc). This is simply about the woman who presents a prescription early for Vicodin 5/500 written for 4 times a day for 120 tablets and always shows up saying she is out or needs them right now, every single month.
Where did they go?

Staff Auto-Correct

In a fast-paced, noisy environment, it is our duty to ensure accuracy. This means even when others will not cooperate with us.
How do we ensure accuracy when taking verbal orders from a practitioner's staff over the phone? The easy answer is to repeat back to the nice caller, all of the prescription information they gave us. I like to take it a bit further and clarify what I heard since enunciation is often overlooked for the sake of speed when phoning prescriptions into a pharmacy.
Office Person: Calling in a prescription.
Me: Go for it.
OP: Tramadol 50mg BID for a month.
Me: Okay. So that's take one tablet two times a day?
OP: No. He wrote BID.
Me: So twice a day?
OP: No. It just says BID.
Me: Yes. BID is archaic Latin for Twice a Day. I'd like to clarify this since you mumbled and I couldn't tell if you said BID or TID. Besides, if you're in charge of phoning in prescriptions, you should have some idea as to what the secret codes are.

I also have the issue where I repeat something and then get corrected for pronouncing it correctly. If I'm trying to clarify what I heard, don't just mumble over me again. This is especially true of medications that sound alike.
OP: **sinopril 20mg.
Me: So that's LI-sinopril 20mg?
OP: No. It's ***inopril 20mg.
Me: So, FO-sinopril 20mg?

OP: That's Omeprazole 20mg.
Me: Ok. Generic for Prilosec 20mg?
OP: No. He wrote Omeprazole.
Me: Omeprazole is the generic for Prilosec. I'd like to verify this too since some prescribers like to use the generic names exclusively, regardless of if they are available in the marketplace because that's how they were taught in school and it can be confused with Esomeprazole, generic name for Nexium.

I'm not trying to correct you. I am trying to get the correct information for the patient. If you don't know the answer, please turn around and ask the doctor or another staff member for it. Then learn from it so every other pharmacist in town can benefit from our little chat today. If it is your job to call pharmacies, take the time to learn a little about what you are doing. It is a big responsibility and many of the staff with whom we interact on a daily basis are fantastic. However, there are the people outlined above I still talk to years after I became a pharmacist that have not learned anything...

Address Change

The US Postal Service offers "I'm Moving" cards for people to use to notify others that their address is changing. Doctors should use these...
We get lots of prescriptions from lots of offices. While it is ultimately up to us to try to maintain accurate records in our computers, some things may get missed. The problems arise with:
1. Doctors whose names are listed at multiple (10-20?) locations, each with its own address, phone number, fax number, etc...Are you seriously still at all of these?
2. Doctors who work at multiple hospitals during their rotations before settling down in an office outside that city...You graduated? Great. Now where are you officially practicing.
3. Doctors who leave or change practices...Didn't get along with the old partners? Bummer. Where are you now?
4. Doctors who retire or die without having the decency to tell us...The nerve!

All of these present problems for the pharmacies. When these doctors require that "the patient must contact their pharmacy to fax us a refill request" and we do not have the correct office, it can be difficult. We had faxed a refill for a patient and the office had politely scrawled "NOT AT THIS OFFICE!!!!!!!!!!!! MOVED!!!!!!NO LONGER HERE!!WASTING OUR TIME!!!!" on the fax.
Sorry. I believe a simple phone call alerting us to his change in practice would have cleared things up rather nicely. If we do not see anything from an office for a while, or the patient has not been in for over a year (lots of 90 day supplies will do that) and the doctor moved a year ago, it may still go to the old office.  Most often, the further away a doctor is from one of our stores, the less likely we are to run across many of her patients. Ergo, we are not as familiar with and less likely to be notified of any changes. Besides, we all know plenty of offices that will continue to use very old prescription blanks just because they are too cheap to destroy them and order new ones. Not helpful here.
I am sure the offices get tired of the errant faxes and e-refill requests that inundate them all day. So do we. It's no picnic calling every one of the 3 to 7 numbers we have on file to figure out where the patient was seen 3 months ago. Or who that on-call doctor, who moonlighted at the ER for 6 hours, was who saw him that one night  and no one knows where he came from originally or went after. However, most pharmacies do not move. Ever. The pharmacists may, as may the doctors, but the patients usually stay at the pharmacies. The patients come to the pharmACY, not to the pharmACIST,  but they see a DOCTOR, not an office. (Yes, some patients see whichever doctor is available--not the issue here.) When the doctor moves, we need to know.  Since you require it, if I can't find you, I can't fax you...

Unasked Questions

I love unasked questions. They are what make our days entertaining. I often wondered how many unasked questions someone could spit out before finally giving up and asking the questions they want answered.

<Please say this in your head with a bit of a Canadian accent. You know? The kind where every statement sounds like a question?> Love my Canadian neighbors BTW!

My doctor was calling in a prescription for me?
He said to check after 5:00?
It should be for an infection?
I was in the office around 2:00 today?
He was sending it electronically?
Or he was faxing it?
Or he said he was making a paper airplane out of it and flying it to you?
I have cold sores?
Maybe it was herpes?
I'm supposed to have something there from the other day too?
I think maybe someone called me?
It may have been you guys?
Or the doctor?
I think I'm supposed to pick it up by yesterday?
Maybe today?
I don't know?
I'd like to see if it's there?

I had this dialogue last week:
Her: I have a question for you?
Me: Ok...
Her: I need a refill on some medications?
Me: Ok...
Her: I don't have my bottles or my numbers?
Me: Ok...Still waiting for the question...<Yes, we all know the question, but it's like listening to something in German-you have to wait for the verb to know what to do.>
(Ok. Those are statements with an inflection at the end to make them sound like questions...)

Offices and other pharmacies (perhaps myself, said sheepishly...) are guilty as well:
I was calling in a prescription?
For a patient?
I was calling for a transfer?
I was calling for a med verification from the local jail?

You were? Then what happened? I picked up the phone?

Retail Holidays

Why have people been calling all week to ask what our hours will be on Thanksgiving? If you're planning on needing something, come in today. If you're planning on making everyone sick with your dinner, order takeout.
I accept that we should get calls from doctors, ERs, hospitals, other pharmacies and providers so they know where to send people on the holidays. I expect that. I do not expect my customers to be planning their holiday around a trip to the pharmacy. I realize there are people who do not celebrate some/many/all holidays and these are great days to beat the crowds. Over my years of practice I have also realized that people will look at their pill bottles when they wake up and tell themselves "today is refill day", regardless of what the calendar says. I have had people walk to my store in a blizzard and drive through a Level 3 snow emergency (roads are closed to non-emergency personnel). It was not out of an emergency need. These were people picking up prescriptions that had been filled for days, were bringing me new prescriptions dated one day/week/month ago that didn't need them today, or people who had 1 or 2 pills left but it was "refill day". Why?
 If it's a holiday and I do not have to work, I am staying home. I am enjoying time with my family. I only come to work because people come to where I work. (I realize hospitals and ERs are open and people need to fill emergency prescriptions somewhere. That is not the argument here.)  My question is why are regular patients calling to find out my holiday hours? Stay home. Enjoy the day off from work. Enjoy the holiday. Let me and my employees enjoy our day too.
A special shout to all retail brethren as they face the Black Friday crowds late on Thanksgiving. Enjoy your holiday early. You certainly don't deserve the abuse inflicted upon you by your companies and the retail customers you have to face that day. It's become a whole lot worse this year with companies starting as early as 8pm Thanksgiving night.

Happy Thanksgiving all...

More "Do Not Do This" Items

They always say "kids, don't try this at home". I say, people, don't do this at my store.
Don't:
-leave your bottles or prescriptions on my counter and walk away. This is not a newspaper stand where people just pick up a paper, drop a few quarters down and walk away.
-push ahead of someone and say "I'm just going to leave these here".
    Haha--me too!
    (I once had a guy push past 4 people in line dropping off. He slammed them on the counter and said "Fill these, I can't wait anymore" So I taped them to the counter where he found them when he returned later to pick them up. Yes. They are still waiting for you. They're a little lonely. Please pick them up and hold them.)
-call and ask "Is it okay if I did this?" when you should have called earlier and asked "Can I do this?"
-put prescriptions or refills in the drive-thru tube and then drive away. Would you sign your paycheck and do the same thing at the bank? If so, please put it in my tube and the refills in the bank's next time. If you do this, then please don't get mad when you are not in my computer, I had no way to contact you because you didn't leave a phone number, and you forgot the new insurance or there were no refills. Basically, you skipped all of my required steps to fill your prescriptions so I'm skipping filling it.
-get mad at me when I ask for your driver's license to prove who you are. You requested that we ID you when picking up your prescriptions. It is not my fault you lost your license. Perhaps your first stop should have been the BMV next door.
-get mad when you forgot a prescription at my store. We get orders all day from a number of sources for hundreds of patients. This is why we ask "How many are you picking up today?" If you tell us 2 and we have 2, I will quit looking. If it is supposed to be 7, you should have said 7.
-tell me grandma is sick and needs her insulin shots because she is visiting from out of town for the holidays and you're the best damn grandchild who always takes care of her and you need to buy just a bag of syringes to get her through so she doesn't have to spend Thanksgiving in a strange hospital because it may be her last holiday with everyone all together around the feast and she can't enjoy the sweet potatoes and pie without her insulin so can you just have one bag, please?

Retail Rocks!

I love my job. Most pharmacists do. Whether we work hospital, community, mail order, managed care, or any other position, we love our jobs. When I started this page, my goal was to share my frustrations with our profession while hoping to gain understanding from the people we serve. So far, the most common negative comment I have received on here has been "If you don't like retail, just shut up and quit!". While such a well-articulated, succinct profundity cannot be ignored, it obviously highlights the fact that non-retail and non-pharmacy people just don't get it. I shall try to explain. Just this once. Here is today's post:
I am not complaining about my job. I am complaining about people. I am complaining about the whore my profession has become when dealing with people. The problems we face are a retail problem. America has evolved over the last several decades from a manufacturing economy to a retail economy. We no longer make stuff, we sell stuff. This means an increase in the number of retail outlets and worker/customer interactions every day. Combine short attention spans, laziness, the I-want-it-now mentality, and entitlement with all of this and there will be issues. As I have stated several times (go back and reread them all before judging), and many people have stated in my defense, there is not a single person working a retail job in this country who deserves to be treated the way many of us are. This is especially true of the profession of pharmacy. Got that? It is a profession! Are you listening corporate pharmacy leaders?
Simply saying "quit retail" or "find another line of work" is not only unintelligent, but sophomoric. A person works in a sewage treatment plant. It smells awful. You tell him to quit, right? Based on this line of thinking, that is the correct choice, right? If he quits, two things will happen: the smell will stay and someone else will still have to do the job. His quitting does not make either thing better.
A public defender has to defend people accused of crimes. If he quits his job, does crime suddenly go away? Do we then no longer need public defenders? No. In retail, if everyone quits, the jobs would still need done and the customers who are rude, ignorant, demanding, impatient, condescending, lazy, apathetic, or angry will continue to be that way. Our society (and the retail community focused on stupid Customer Service Metrics) not only encourages (it is a tacit approval) but rewards this behaviour.  People shop in their pajamas, in sweat pants, in no pants, talk on their cell phones at the counters, text and talk during movies and otherwise indulge their me-first attitudes everywhere they can. Why? Because no one wants to get a bad customer service call. Everyone is afraid to say anything for fear. The smell cannot change. The criminals will not go away. The jobs still need to be done. But people do not have to be assholes.

We Are Here For You

Accessibility: (of a person, especially one in a position of authority) friendly and easy to talk to; approachable.
Why are pharmacists the most trusted professionals?
Why do people call us with most of their medication questions?
Why do we get yelled at more than any other professional? 
Why are we held to a different standard than other professionals?
Why do people think we hold all the cards when it comes to their healthcare?

Accessibility. We are the most accessible healthcare profession available. We are the most accessible point of contact for all healthcare questions/concerns/complaints. People can't call their insurance companies and get immediate feedback. Pharmacies provide that. Even though we have nothing to do with the issue you are having, you can immediately vent to us. Your insurance company is locked away somewhere but I am here, face-to-face with you and your ire. Someone commented, a doctor I think, who was a little off base, on yesterday's post with this witticism: How many prompts does it take to talk to a pharmacist? Now, had he phrased his question better, I could have granted him a single point. However, the answer to his question is, simply, one. Press "0" on most any pharmacy menu and you'll get someone to answer the phone. The fun part about pharmacy is this: Ask to speak to a pharmacist. I can guarantee you will speak to a pharmacist. Period. Now, let me try that at a doctor's office.
Press 1 if you are another doctor
Press 2 if you'd like to make an appt.
Press 3 for prior authorization
Press 4 for billing
Press 5 if you are a patient needing a refill
Press 6 for questions for a nurse
Fine. Pharmacy menus can be long too and we have to have ads for flu shots. I won't argue that and I have to call other pharmacies too, but who waits? Press the button. And when I call a doctor and ask to speak to a doctor, will I ever get a doctor? (Not including ER doctors who just saw a patient. They're usually pretty good when it comes to talking to us.) No. I get a receptionist; perhaps a nurse. Someone will call me back. Who? A receptionist; perhaps a nurse. A doctor? Never. At any given hour of business (usually 9-9, unlike doctors) a pharmacist will be available to speak to someone about his medication. A pharmacist may even answer the phone herself! We can't hide behind a wall of receptionists and nurses who screen calls and take messages and who make our calls for us. 
I ask you to read those first two questions again. 
We are accessible. We are here for our customers. We are available. You can call my phone number and speak to me directly. All you have to say is "May I speak to the pharmacist please?" Seriously. It is that simple. I think I'm going to try that with the doctor's offices I call tomorrow. "May I speak to Dr. Zoffis, please?" 

Calling Doctors...

What is easier? Making 2 phone calls or making 3 of them? I always thought 2 was fewer than 3 and therefore simpler. Why do some doctors' offices require the pharmacy call them for prescriptions? The way it is supposed to work is the patient visits the doctor. The doctor prescribes something. Someone at the office either writes it, faxes it, electronically sends it, phones it, or teleports it over to the pharmacy. The pharmacy then fills it. I can't spend all day tracking down prescriptions for patients because doctors won't call pharmacies. If the patient calls the doctor then the doctor calls us, that is 2 calls. If the patient calls the doctor, then calls us, then we call the doctor, that is 3 calls. What reasons have I been given by the offices?
1. You're long distance and you work for a big corporation. They can afford the bill. (I guess no one near you uses an independent then, huh?)
2. We always have to wait on hold for such a long time with pharmacies. (Fantastic. I guess you never heard of this thing called voicemail. Revolutionary concept, this. You call. You talk. It records. Done!)
3. We only have one person who can call in prescriptions here. (And I only have one person who can take prescriptions here. That doesn't stop the other dozens of offices from calling me all day.)

It was an especially awesome and frustrating Saturday when this unfolded at 9:15 am:
Impatient Patient: My doctor wants you to call him at home.
Me: WTF? Why?
IP: I just called his cell phone and talked to him. He wants to prescribe me something but you have to call him. He said you have to call him at home right now because he's leaving.
Me: Wouldn't it have saved time if he would have just hung up with you and called me? He could have left a voicemail by now and I could be working on it. I am going to do over 400 prescriptions today, by myself. I don't have time to track down your doctor immediately. (I take the number from him...)
IP: <less than 3 minutes later> Did you call yet? I have his cell number.
Me: <I call the cell number. It was incorrect. I call the house number I was originally given. The doctor's wife answers and gets all bitchy with me because she is put out that I am calling. She gives me his correct cell number and I get his damn voicemail.>  Listen, if your husband is going to request people call him, take it up with him. I'm just doing what he told me to do. I'm not happy about it either because his lazy, self-important ass could have called me at 9:15 and this would have been over. Instead, I have to make multiple calls and track him down on a Saturday and waste 2 & 1/2 hours of my time for one lousy prescription. <Doctor finally called back...at 11:45. After I got 6 more phone calls from IP>

It's all in the Planning

I like to plan my day. I like to know when I am going to do certain things. I like to be able to tell people when they can expect me. Many pharmacies employ some type of timing system when it comes to filling prescriptions. They either use little clocks on their computers for each order, times on patients' bags, or stopwatches clipped to baskets, to keep track of when something is due for pickup. How do we arrive at these times, you ask? Simple-we ask people questions:
When do you want to come back for this?
Did you want to wait or come back for this?
When would you like to pick this up?
Usually this conversation ensues...(it has many forms)
Me: Will you be waiting or did you want to come back?
Every Single Customer Ever: Well, how long will it take?
Me: Our wait time is about 20 minutes right now.
ESCE: Hmmm. I'll probably come back.
Me: What time did you want to come back?
ESCE: You said about 20 minutes? I'll be back in 15-20 minutes.
Me: So I should say you're waiting?
ESCE: No. I can't wait that long. I'll be back then.
This one isn't too bad. It usually ends with a head shake and a 20 minute wait time on it.

The ones I really love are these:
Me: Okay. And when did you want to come in for it?
Phone Customer: This afternoon some time.
Me: Ok. I'll put an hour on it an we'll see you after then.
PC: But if I'm not there, it'll be tomorrow some time.
Me: So I should put tomorrow instead?
PC: Well, if not today or tomorrow, then it'll be some time on Saturday.
Me: Great. Thanks for helping me plan my day and prioritize. When everyone else's orders get behind, I'll blame you.

The times are there so we know when to expect you. If you're going to tell me Saturday, I expect to not see you before Saturday. It's like a date. If we are going to make reservations for dinner for Friday at 7pm, we are not going to tell the maitre d' "Unless we decide 8:17 works better. Maybe we'll just wait until Saturday instead. Even better, how about we just show up unannounced at around 5:29?"
Worse yet are these:
Drive-Thru Guy: Here to pick up a prescription.
Me: Ok. What's the name and date of birth?
DTG: Here you go.
Me: I don't have anything ready for you. When did we tell you it would be ready?
DTG: I told them I would be back after 7:30 tonight. I dropped it off this morning.
Me: I see. Here it is. You dropped it off at 11:34 this morning. You told us you'd be here after 7:30 tonight. It is currently 12:17pm. It's not quite ready yet.
DTG: Why the hell not?
Me: Um. Do you own a watch? Perhaps have a sundial on your dashboard? Some means of telling time? I know in my world that I can't confuse 43 minutes with 8 hours on my worst days but you seriously have to get a grasp on this thing called "time". I bet you order your pizzas from the parking lot and walk in 10 seconds later expecting those 30 minutes to have magically melted away like my brain from this conversation.

Ask the Question

I have always been a believer in asking the question that you want answered. What do you ask of someone when you want to know the time? What do you ask of someone when you want to know about their allergies or if they need counseled?

Time Guy: Do you know what time it is?
Me: No.
TG: But you're wearing a watch.
Me: I am. And it has the time on it.
TG: What does it say?
Me: It doesn't talk.
TG: Can you tell me what time it is?
Me: I can.
TG: Will you?
Me: No.
TG: Why not?
Me: I'd have to look at my watch first.
TG: Can you look at it?
Me: I can. But I don't want to. I know what it looks like.
TG: Sir, what time is it?
Me: Time for the next question...

Any Tech: Do you have any drug allergies?
Funny Customer: Well, weed makes me a little funny?
AT: Um...
FC: Oh, and Ecstasy makes me really thirsty.
AT: Um...
FC: Meth makes my teeth fall out.
AT: Any allergies to any medications?
FC: Oh. No. I guess those were side effects, not actual allergies anyway.

Any Tech: Any questions today?
Every Customer: What are the winning lottery numbers?
AT: Um, for the pharmacist?
EC: Is she single?
AT: Um, do you have any questions for the pharmacist regarding your prescriptions today?
EC: That's better.

I also like the people who walk up and say "Can I ask you a question?" Hmmm. Didn't give me a lot of choice on that one. My answers have ranged from:
"Besides that one?" to "You just did." (said as I walk away).

If McDonald's was like your Pharmacy

People always act as if pharmacies are fast food joints. We do have drive-thrus. We also have a dollar menu (okay, it's more of a free, $4, $10 menu but you get the gist). To help people understand the differences, however subtle, I have written the following guide:   If Mcdonald's was my Pharmacy...

-You would need to visit a doctor to make sure you need the meal you are here to purchase.

-Your doctor would write you a prescription for the exact meal and quantities you need today (no ordering a la carte or upsizing without prior authorization).

-Your order, after being entered into the touchscreen, would generate individual receipts (read:labels) for each item on your order (fries, apple pie, quarter pounder, Coke). This is provided, of course, that he can read the doctor's directions. Even though the doctor only had to circle a picture of the sandwich he wanted, he managed to circle two pictures (one from the dollar menu and one from the regular menu). Now she will have to call the doctor for clarification. 

-One person would then take these receipts (labels) to fill your order. He would pour a pile of fries on a tray and count them to get you the prescribed amount. He would use a graduated cylinder to pour you the correct volume of your beverage and count out the ice cubes for each cup. The quarter pounder would be weighed out on a scale or balance to ensure accuracy. Each of these would then have its own receipt (label) attached to it.

-The manager would receive the tray from the filling station. She would scan the receipt to bring up an image of the food product you ordered and make sure it matches what is in her hand. She would check the order, one item at a time, to make sure it exactly matches what the doctor ordered (wouldn't want to forget an order of hash browns first thing in the morning) and to make sure they can all be eaten at the same time (no interactions). She would also check to make sure you didn't forge any refills on the Coke or change the small fry to a large fry--you know, to prevent abuse. Then your history would pop up on the screen. She could see if you always get this order or if your doctor changed something since your last visit. She would also check your medical history to make sure you are healthy enough to receive today's meal. (Heart problems?-No Big Mac for you. Diabetes?-No Diet Coke. High Cholesterol?-No fries with that!) She would also check with other chains to make sure you are not getting these meals prescribed by another doctor and using two different fast food chains for the same thing. She wouldn't want you to accidentally overdose on cheeseburgers because they're called something else at Burger King and you didn't tell her you just filled an order there. If you are healthy enough, your food moves down the line. If not, we have to call your doctor to ask why he prescribed this particular meal for you. In some cases, he may tell us you need the large fries and a milkshake, but she will tell him it needs prior authorization through your insurance. Once he calls for the prior authorization and the insurance calls him back (usually 24-72 hours later--long wait for lunch!) either to approve the large fries or change the prescription to apple slices, your order will move on.

-Now your order proceeds to checkout. We give you a cash total. It's the first of the month/year and your insurance has changed but you didn't provide it immediately. The cashier takes the new information and hands it off to someone else for correction and an update to your file. She hands the tray back to the checkout person who tells you the new copay, collects the copay from you, then smiles and says "Have a nice day!".

-Refills on beverages will not be authorized without a new order from your physician.

-Medicaid patients will have copays and the formulary will only include items on the $4 and $10 menus board. This means no milkshakes, no medium or large sized portions, and no sundaes. 

-All the while, every person involved in your order in the back- the person cooking, dropping a basket of fries, wrapping the sandwiches, pouring drinks, waiting on drive-thru-is also answering the phone that is ringing off the hook. At this McDonald's, doctors are phoning/faxing/electronically sending in orders for other hungry diners. There are hungry diners sitting at home calling in orders they want to pick up later or checking to see if their doctor called in their orders yet, or calling for our hours. The manager is also out administering espresso shots to those who have prescriptions for caffeine because she is required to do so. She is also walking out to help people find the bathroom, the condiments, the napkins, the trash can, and a place to sit all in the name of good customer service. (She's not allowed to just point to the stand behind the customers and say "everything is right there.")

-Drive-Thrus. Remember, drive-thrus are about convenience, not speed! What takes so long, then? It can actually take longer because managers are required to do counseling if someone asks and if they ask at the drive-thru the wait can seem interminable. When this happens, the manager patiently, expertly demonstrates how to open a straw, insert it into the "X" cut into the plastic lid, and use it to deliver himself a mouthful of ice cold beverage. He then demonstrates how to properly open a packet of ketchup and apply it to your burger as well as the proper method to dip fries into it. Next, he'll answer a question about the appropriate number of bites to take for this particular sandwich and how much mastication is required for each bite. 

-When the fries look different, the patient may be confused. It is up to the manager to patiently explain that this is McDonald's, not Wendy's, so there is not skin on the fries here. He will also have to explain why the wrapper looks different (different burger joints use different wrappers) or why they may have changed colors (the new Christmas cups are in at McDonald's).

Everybody got it? Please remember this the next time you visit either of our establishments and maybe it will change your perception.   

The Golden Rule of Pharmacy

We were always taught to obey the Golden Rule-treat others as you would have them treat you. Great for kids, bad for business.  The Pharmacy Interpretation should be-Treat others the way they want to be treated. Business books agree with this, and I adopted it in my pharmacies without realizing how relevant it truly was. In fact, I was practicing it before I read its witticisms.
We all deal with the same customers every day. I have worked inner-city, affluent suburb, blue-collar, college, and every other town in which there is a pharmacy. In every one of these, the customers are the same: quiet ones who cause no problems; loud, boisterous ones who want you to know they are there; dedicated ones who love their pharmacy staff; fickle ones looking for an excuse to leave you; and the whimsies-those who shop wherever they happen to be at the moment they decide they need a refill.
I am truly focused only on the ones who make our life hell at work. Why do people find it necessary to yell and argue with pharmacy staff? I am very good at conflict resolution and solving problems. I often find that most perceived problems are misunderstandings that we have not been allowed to explain. At my most recent store, I was warned of a number of customers who cause problems every time they call or visit. My staff always find it necessary to tell me so-and-so is on the phone, or here, and that he always causes a problem. Why do my staff feel threatened or intimidated by these people? Because this is the situation the customers have fostered and the staff have felt powerless to change it. (To that I say, Thank You Corporate 1-800 Customer Service Calls! Thank You for making my staff feel powerless to stop abuse from customers.)
ATypical (True) Interaction: Lady complains that she had to wait for something until the next day and was gracious enough to bring it in the night before to give us plenty of time to work on it. (Nice, but her doctor put a Do Not Dispense date on it until the next day so she wasn't exactly trying to help us.) She arrived earlier than we told her it would be ready and she complained. I was already warned of her history so I was prepared. She kindly explained how she went out of her way to bring it in early, how we're her only pharmacy, but she's considering changing after this, blah, blah, blah. I offered her an apology and a $5 Gift Card for the inconvenience of having to wait an extra 10 minutes-though she was early. She ignored that and told me how, every time the other 3 pharmacies she uses make a mistake, they give her something without her even asking. How they buy her off just to shut her up, apparently. Not backing down, I apologized again. Now, 19 minutes into this conversation I had had enough. I interrupted her and asked "What do you want?" Taken aback, she said "Excuse me?" I told her "Listen. You have had me on the phone for 20 minutes now. I offered an apology and $5. You are not happy with that. In my experience there are only 2 types of people who call 1-800 numbers:         1.) Those who like a place and want it to improve and found something a little off during a recent visit.  2.) Those who want something.  This is you. Now. What. Do. You. Want? She told me she wanted a gift card. I told her I already offered that and she could pick up with her next refill, but not to yell at me or my staff again.  She has been back a number of times and no longer strikes fear in the hearts of my staff.  All it took was someone to stand up to her and call her out on her attitude.

Grouchy Guy refused to give my tech his wife's date of birth. He threw the Rx at her and told to fill it, he'd be around. I paged him back to the pharmacy and asked him why he was so mean. He said my job was just to fill it and he walked away. I shouted back to him to come back here, stuck out my arm with his script and said "Here. Take this. We're not filling this for you. There are plenty of pharmacies around and I don't need your business if you're going to treat my staff that way." Dumbfounded, he took it back and left. The funny follow-up is that his wife brought it back later and ignored the issue from earlier. Her husband has been back a few times and is always a model customer. Why did it take all of that to arrive at an amicable situation?

Why do we let customers abuse us? I love my technicians, for without them, I am nothing. At all of my stores, I have taken it upon myself to run interference between them and problem customers. My reasoning is simple and I have told many techs and customers this: They have a job to do. They don't get paid enough to get yelled at by you. Neither do I, but I can refuse to fill your prescription if I choose.  The only person who can yell at my techs is me.  I don't understand why other pharmacists won't stand up for their techs and themselves in these situations. We are still a profession. Doctors can discharge patients with a letter if they don't want them anymore. We have to do it face-to-face. What other profession gets yelled at as much as we do? What other profession rewards customers with the opportunity to call a 1-800 number for feedback that could impact that professional's career?
I elect to take a stand. I have a job to do. It does not involve getting yelled at for things that are way beyond my control. If you want to treat me that way, expect me to think that's how you prefer to be handled and I'll give it right back.

I believe...

This is the post where I lay it all out there.  It is titled "I Believe...A Cynical Pharmacist's Manifesto".

I Believe...

• in no more 3-day holdover supplies for patients.  You knew your bottle was getting empty. Learn some responsibility. If you filled a 30-day supply more than 30 days ago, too bad. Your car tells you when it's almost out of gas and you listen. Your bottle says "only 1 tablet left" so listen. 
• the State Board of Pharmacy should serve their pharmacists, not the public. They should not be out to get us, but should listen to our input.
• if you ever use more than one transfer coupon, you give up all right to sue if an error is made. Period.
• retail pharmacies need to get rid of 1-800 customer service numbers.  If I can't complain about a bad doctor or horrible patients, they can't complain about me and impact my bonus for doing my job.
• we need 1-800 customer service numbers to complain about doctors and patients.
• if doctors expect us to do their jobs (fax refill requests, look up profiles, run narcotic usage reports, remind patients of their appointments) then I should be able to bill the office and get paid as their employee.
• if doctors are going to tell patients how much something costs in my pharmacy, they should pay the difference every time they are wrong.
• if the FDA is truly worried about Acetaminophen toxicity and overdose, they would immediately stop all production of combination OTC products. (not change the packaging on Children's and Infant's Tylenol.)
• if look-alike, sound-alike names are so error-prone, the FDA would NOT allow generic names to be so similar, differentiated only by salt form (metoprolol, anyone?). They also would come to some agreement on the stupid letters: CD, LA, SR, XL, ER. (How am I supposed to fill this Rx, again "Buproprion 150mg 1qd"?  or Bupropion XR 150mg? 
• Pharmacy is way under-represented in our legislature. We cannot have a health care conversation without pharmacy.  The AMA and PBMs carry more weight than we do and dictate what we do. This should not be so. 
• the 6-month exclusivity on new generics is OK, as long as we call it what it really is: Patent Extension. The brand company owns the generic that gets those rights (i.e. Actos) and they don't even change the tablets.  It saves customers money, but it's a lie.
• the "customer is always right" is a terrible philosophy in pharmacy.  It would be akin to arguing a diagnosis with your doctor.
• awesome technicians make pharmacists awesome. Without them, we are nothing.
• manufacturer copay coupons are misprinted lies! They are more work for my techs, and misleading for customers who will immediately yell at us, not the manufacturer.
• with a new diet pill on the horizon, that trying to lose weight by taking a pill is like trying to get pregnant by just watching porn.
• in pharmacists as immunizers. But I also believe in at-will participation.
• if my Medicaid customer comes to my drive-thru with a better car, or to my counter on an iPhone, smokes, or appears to have more money than I do, she should be arrested, forced to hand over those possessions, and immediately removed from the welfare rolls, along with anyone who shares her blood.
• all Medicaid prescriptions should have copays. 
• the children are our future.  Teach them well and let them lead the way.

Predictive Refill Programs

I have never been a fan of the predictive refill programs that have taken over our profession.  Correction: The original concept was nice, but we have, as always, let the programs run away from us and now have to fight to get it right.  My problems are these: No one is happy even if they voluntarily enroll in the program and no one program is perfect.

If we call patients to tell them their refills are ready, they are bothered because they are not out of medication yet.  If we do not call a patient, they are bothered because they ran out and no one told them they were going to run out.

I believe the best fix for these programs is to employ the early refill narcotic patients as mentors.  These patients know the exact hour we can fill each of their narcotic prescriptions and usually call us daily and hourly for weeks up to the due date.  If we could simply embed a narcotic taker with a blood pressure taker, then everyone would know precisely when to pick up their prescriptions.  In fact, I would be willing to bet that the diabetics would become even more compliant with their own daily regimens and actually take/use their medications correctly.

No longer would we have to suffer the ignoramus who comes to our counter after 6pm on Friday and complains that his bottles of insulin are empty and he's been without it for 3 days and he's going to die if we don't just give him Lantus and Humalog right now.  Sorry.  If you're willing to bet your life on the first 3 days, I'm willing to bet your life over the weekend.  Let me introduce you to Mr. Percocets.  He's always prompt when his medication runs out.  He's your new flatmate until you can learn to accept personal responsibility for your own health and wellness.

The other issue with these programs is the amount of work involved. I actually believe we had fewer customer complaints prior to implementing these programs.  Under the early refill system, we fill prescriptions we're not even sure they're still taking.  Not only that, but the entire concept is based on strict patient compliance.  It assumes they are taking the medication exactly as prescribed, not missing doses, and keeping appointments.  We all know what happens next: Our computer calls the patient on days 3, 5, 7, 9, 11 (or according to some patients, never) and they don't come in for it.  On the 13th day, per insurance regulations, we put the medication back in stock.  Now we have to label this bottle with a lot # and expiration date because the State Board says we can't dump it back in the stock bottle and then we have to hope we can use it in the next 90 days (Ohio's law).  Then, on day 14 (or mere hours after we pulled the bag, reversed the claim, and returned it to stock) the patient comes in and wants to know why it isn't ready and why they have to wait another 20 minutes when it should have been done last week.  This is usually followed with "I got a call that said I had until yesterday to pick it up. Why isn't it done?"  I guess you ignored the first 4 phone calls you got, huh?  Now we have to put them back in line, pushing back the other people whose prescriptions we should be filling, and do everything for them a second time.  This one person made us do triple work, but we only get paid once.  Never mind the other costs that go into filling the script.  How is this more efficient?

What about the automatic doctor refill requests? Wasn't that part of the original plan too? The refills would pop into our system early, see the patient was out of refills, fax the doctor, the doctor would get back to us, the refill would be filled, the patient would come in having no idea all the work that went on behind the scenes, and walk out, happy and ignorant as a clam. Brilliant! Except it never works that way. The patient wanted it somewhere else, switched to mail order, hasn't been to the doctor in over two years so they deny the refill, then the patient's phone number is disconnected.

(Full disclosure: The only reason I have to favor the refill system is for out-of-stock or special order drugs.  I don't have to keep these items in stock or I get at least a day's notice I need to order extra of something just for you.)

It's become a stupid, busywork generating system that promised to save us time but seems to only create  more work. We even have to dedicate 1-2 tech hours a day solely on dealing with these old refills. I understand the need to generate more prescriptions as much as any pharmacist today, however, how much time are we really saving?

And The People's Choice Winner Is...

"Of all the gin joints, in all the towns, in all the world, she walks into mine."

When your doctor asks (and on electronic prescriptions, it says) "Patient's Pharmacy of Choice", remember that YOU picked me.  It says Patient's Choice.  I did not force you to come to my pharmacy. It's not like a dinner choice.  Hey, I'm in the mood for Thai tonight. Your selection, and repeat business, is not just a whim.

With that in mind, I am done with you.  If you are unhappy, leave. When people threaten to go somewhere else, I'll tell them "Go Ahead".  I will even ask where they want me to transfer their profile so it's waiting for them when they get there.

A fine gentleman was leaving for vacation.  Of course, his refills were too early but he neglected to provide us with this information when he left them.  As I was going to explain this, he said he'd just transfer pharmacies if it was going to be a hassle.
Nope.  No hassle. If you leave, no hassle at all.  So go.  Now! See ya.

I'm tired of being held hostage by people who don't understand and refuse to understand how the whole refill/insurance/plan ahead thing works.  I'm tired of people thinking they can get something by complaining simply because of their own stupidity.

I am taking the Twitter approach to dealing with these people.  Ricky Gervais is wonderful to follow.  Twitter is about choice.  You actually have to choose to follow someone.  If you do not like what they have say, you have the simple choice to "unfollow".  I'd like people to apply that to pharmacy choice as well.  I only wish we could "block" people too.


Following someone on Twitter and complaining about what they tweet about is like phoning someone to tell them you don't want to talk to them

http://twitter.com/rickygervais

Customer Complaints=Money!

Why do people always act as if they are entitled to something?  Why do people always feel wronged and that they should be compensated for it? Is it the 1-800-WE-SUE-YOU ads on TV? Here are my favourite, recurring issues concerning customer service.
Only in Retail Pharmacy could we allow a profession to be subject to 1-800 complaint calls.  We can't complain about doctors or lawyers or accountants or other real professionals when they make us mad.  Ever had to wait more than a couple hours to see a doctor? Can't complain to anyone.  Had to wait more than 15 minutes for your prescription? Here's a free coffee, a $20 gift card, and the pharmacist won't get a bonus and will personally kiss your ass on the counter next time you're in.

Customer #1: Called to complain that she graciously gave us a full day to fill her prescriptions (dropped them off last night, but doctor wrote "do not fill until today" on them) and they weren't ready.  I apologized, explained we were busy, that we try to have them all done by 11 am, etc, etc.  She interrupted me and politely pointed out that when she goes to ABC Drugs, they always give her a gift card.  I apologized again and she said that XYZ Pharmacy always gives her free stuff when they are wrong too.  Aha!  I figured her out and proceeded to call her on it.
     ME: Okay.  Again, I am sorry.  In my career in retail, I have realized there are two types of people who call 1-800 complaint lines: those who are looking to continue coming to your establishment and have always had a great time and want just this one little problem fixed so they can continue to happily enjoy your services.
     LADY: Yes, That's me!
     ME: And the other type would be those who are looking for a handout.  Those who want something for some perceived slight against them. Those who figure they can bully a company or a manager into giving them a gift card or free crap to make them shut up and go away.  Every time you interrupted me, you mentioned the word "compensated".  That means you are looking to get something from me and all the other places you do business.  What will it take to make you go away?
     LADY: What?
     ME: I already offered an apology and a $5 gift card and you have kept me on the phone for over 20 minutes now, talking about compensation and how ABC and XYZ are so much better at handouts.  What will it take to make you go away?
     LADY: What?
     ME: I will have a $5 gift card waiting for you when you next come in for a refill.  Anything else?
     LADY: No.

I have heard nothing from her since.  Apparently, she was notorious for customer complaints prior to my arrival and no one stood up to her.  But why do we let people take advantage of our profession like this?

Customer #2: Comes back through the drive-thru and just now presents his insurance card. As we explain that he will have to come back after we rebill his prescriptions, his automatic response is :"Are you going to pay for my gas?"
     ME: No.  Why would I?
     HERR DOUCHE: Because I have to come back.
     ME: It's not my fault you didn't have your insurance card the first time. Or that you're 30 minutes earlier than we told you to come back. Or that your doctor didn't send the e-Rx over yet.
    HD: But I should be compensated for you wasting my gas.
     ME: Why? Does Best Buy pay you for gas when they issue a raincheck for the 72" TV they're out of? Does McDonald's give you a gas card when they make you pull up and wait for the fresh, hot fries they just dropped? Here's an idea. Park your car and walk your lazy butt into my store.  Shop around a bit.  It'll take you so long to get back here, since your only exercise is 12-ounce curls, that I can have it gift wrapped for you.  Pay for your gas?!

Since when did anyone deserve to be so entitled? These people are the product of parents who held their hand and did everything for them.  They were continually told they were better than everyone else and they didn't have to take it anymore.  It's a culture that retail pharmacy has not only encouraged, but strongly embraced.  Our bonus is tied to great customer service.  How about we focus on the professional aspects of our jobs, the reason we went to school.  We just need someone to tell these people "being a customer does not entitle you to anything. We appreciate your business, but I am not going to pay you for the privilege of shopping here."

I am NOT Your Doctor's Bitch

I know I have said this before (see Pharmacist vs. Doctor) but it bears repeating after this week's phone call.
I retrieved my voicemail to hear the following message from a doctor's representative:
"This is Dr. Zoffis calling.  We received a call from patient Lazy Ass.  He told us he was out of refills.  Dr. Zoffis requires that all requests be faxed from your pharmacy so we can give them to him when he has time and then send them back to you. Please make note of our fax number in your system so you can fax us on all refill requests.  The patient needs a refill on his HCTZ so fax it so we can get his refill back to you."

Wow.  What a bitch.  Is it just me or could this long-winded soliloquy not have been shortened to:
"Please refill Lazy Ass' HCTZ 3 times.  Thanks"???

Assuming we had actually faxed you correctly in the first place, I am certain we would have had either (or both) of the following outcomes:
     1. My doctor demands you fax him and he says you didn't yet and now I've been out of meds for over a week!
     2. My doctor said he faxed your refill request back on Monday, Tuesday, Wednesday, and twice on Thursday but you didn't fill it.  You lost it and now I've been out of meds for over a week.

Seriously?  Let me see if I understand this.  In the really old days, your doctor would write a prescription and you'd hand-deliver it to me.  In the olden days, a speedy-tongued girl would directly deliver a verbal order.  If she forgot to call or you forgot to give it to me, not my fault.  If you took it to the wrong pharmacy or she called it there, not my fault.  Now the onus is on us for every possible thing that could go wrong?  If they don't get the refill request? My fault.  If they forget to send it? Send it to the wrong pharmacy? My fault and my fault? If the e-script service verifies it was delivered but I can't find it? My fault?
I am sorry, but my obligation ends when I hit "SEND" on the refill request.  I cannot fill prescriptions I do not have and I only get paid for prescriptions I fill.  Therefore it is in my best interest to fill your prescription and not waste time tracking down a lost-in-transit, phantom script.

Obviously, there is a breakdown somewhere.  Why though, is the blame falling squarely on the pharmacist? The patients accept zero personal responsibility for their own healthcare.  They expect us to fill the refill before it's due, call them when it's filled, remind later in the week it's still here, call the doctor when the refills expire, then refill it when it's due; lather rinse repeat.  The only service we are not providing is actually going to the doctor for them.  Wait for it.  I'm sure some corporate pharmacy suit is crunching those numbers and figuring out the logistics of where to incorporate that between flu shots, MTM, and actual filling of prescriptions.

Everyone expects us to do everything for them.  I think I'll try the "my fax machine can only receive" trick and see what the offices' responses are.  Why, too, do doctors argue and scoff when you ask them to resend a script or to authorize a verbal order? Really? Just read it to me, like you used to do. Oh well, it's not like they're telling patients my pharmacy has a certain drug in generic or that they're free or $4, right?  They'd never do that.

How to Sound Stupid to your Pharmacist

Overheard recently (daily) at your local RxDrug Counter:

"I needs my Percs filled. Are they ready?"
"I forgot when my husband could get his Ativans. They due yet?"
"You got any OC's in stock?"
"I want the old Opanas.  You all have them?"

Rule #1: Do not pluralize your drugs.  It makes you sound stupid and an awful lot like a stereotype.  Therefore, I shall henceforth treat you as such.

Rule #2: Be careful of the stories you tell because I will talk to my techs and your doctor.  If your stuff was stolen, file a police report and we'll talk.  However, the important thing to remember is to tell the officer WHAT was stolen so he can list it on the line that says "Items Missing..." If you tell me someone entered your house while you were gone and they took your "Vikes", okay.  However, if the police report you handed me reads "Items Missing...Not sure. Man says someone entered his house, went through his drawers and didn't notice anything missing but would call if he did", THEN I'm not going to believe you even a little bit.  Especially if the doctor calls in to approve the early refill and I ask them what story they got and they tell me: "his wife called and said he got the crap beat out of him and they took all his Vicodins".  Strange because the report says windows were broken and you weren't home.  And don't pluralize your drugs.

Rule #3: Don't give me the stolen Rx story today then the "left them on vacation" story the next month, especially if you already used the "going on vacation" story in between.  No way did you leave them in the hotel.  You would have driven back and slapped the manager around to get back in there if it's possible you even let them out of your sight for even a shower.

Rule #4: Do not call me more than once a day.  Do not call me again once I have given you a date when your RX may be filled.  If I tell you the 13th, it will not change between now and the 13th.  Buy a calendar and put a shiny red heart on it so you know it's "Drug Day"!  Then call me on the 13th.  But only once. After 10am.

Rule #5: If for some reason I say "NO" to your narcotic refill request, you may ask for an explanation.  There may be a very legitimate reason you cannot get it and you may be a legitimate person asking for it legitimately.  For the rest of you, do not scream, curse, throw a temper tantrum, mumble things about sex with dead animals, or otherwise "lose it" in any theatrical way in front of my pharmacy.  You look like the stereotype mentioned in #1.

I do not assume everyone abuses their prescription medication. I do not stereotype based on looks or the Rx presented to me.  I do, however, have a job to do that while performing may lead to unexpected questions being raised.  It is these good people that are the recipients of my humble rants and raves here.

The truth is easy to remember; the lie is easy to forget.