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.