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Tuesday, December 31, 2013

Peak Season

It would be like Valentine's Day with no chocolate or flowers.
It would be like the start of the NFL season with no Wilson Footballs.
It would be like the Fourth of July with no Fireworks.

Could you imagine if, at the busiest time of year for each of these products, the manufacturers suddenly experienced a shortage? That they actually could not anticipate the need for their services? There would be rioting in the streets. Okay, less rioting and more whining, but you get the picture.

You have one job. You have one product to make. You have one time of year when that product will be prescribed. You have ads on TV promoting your product. Why is it that, one week after filling my first prescription for Tamiflu, it is on manufacturer backorder? It is unavailable? Manufacturer is limiting supply?

Tamiflu is prescribed for the flu. Flu season in North America runs anywhere from October to April but usually starts late December and peaks around February. This is the third consecutive year with a shortage this early. Never mind that for a few years before that we had to compound the suspension because they couldn't figure out the demand there either.

If you don't make your product you can't sell it. If you don't sell your product you can't make money. You suck #tamiflu and I hate you...but I need you...

Monday, December 30, 2013

How the Pharmacy World Differs from the Real World

What do you do when you receive a new credit card in the mail?
You call to activate it, sign it, then put it in your wallet.

What do you do when you are handed a new Customer Loyalty card from your favourite shopping location?
You immediately put one part on your key ring and the big card in your wallet.

What do you do when you receive your new license?
Yep. Right in the wallet.

Why? Because all of these items are important and you will be asked to present them frequently.

What do people do when they receive new insurance cards?
If they even open the envelope that arrives in December, they toss it in a drawer or under a pile of bills and miscellaneous mail they won't deal with until after the first of the year. If they even looked at it, they'd say "looks the same to me" before casting it aside in order to open, read, and hang the Christmas card with the lengthy, verbose letter from some distant relative bragging about their world travels and their smart 18-month old grandchild who can memorize Little Einsteins songs.
They also refuse to read the Explanation of Benefits (EOB) that comes with the new card. This would be the helpful paper that explains copays, deductibles, formularies, prior authorizations, etc. You know, all the things we tell everybody they refuse to believe.

Despite the pharmacy asking everyone to present their new insurance cards, we will undoubtedly hear any or all of the following ad nauseum:
1. I didn't get new insurance cards.
2. My information didn't change.
3. It's still the same insurance.
4. My company has had the same insurance for the last 42 years I've worked there.
5. Can't you just look it up?
6. I never have this problem at any other pharmacy.
7. What do you mean I have a deductible? I didn't pay anything last month for this.
8. I never had a copay before.
9. This was covered last month.
10. And, of course, when March rolls around..."What do you mean I have to use mail order? I've had this filled here the last 2 months and NOW you tell me this? I'm out of medication!"

Friday, December 20, 2013

Pharmacy Pre-Holiday Checklist

For my Christmas preparations, or any holiday for that matter, I try to make sure I have everything I need so I do not have to go out at the last minute. The same holds true for storms. If we are experiencing a major snowstorm, a hurricane, or swarm of locusts, my goal is to not venture outside. I can raid my pantry of the food that got lost in the back and the items buried on the bottom of my freezer to make a few meals to get me through until civilization returns. I've usually received enough warning that the weather phenomena or the Holidays are coming. Holidays are rather predictable in that they occur roughly the same time every year. Pretty sure Christmas has been December, 25th for as long as I've been alive and New Year's Day occurs January, 1st...every year now.
In the pharmacy world however, people seem to plan shopping trips during/around these events. Level 1 snow emergency where the roads are closed? Busiest days in the pharmacy and for hospital visitors.
It already started last week.

Holiday Shopper: What are your hours on Christmas Eve?
CP: Why?
HS: I need to know how late the pharmacy will be open.
CP: Why? Are you planning on making your family sick with dinner? Take them out for Chinese then. Are you planning a visit to the ER? By definition that's not how that works. What could you possibly need 4 days from now that you cannot purchase today? We are open right now.  

It happened around Thanksgiving and it will happen until New Year's Day. I understand the need to be open and that people need our services when they need them. My point, my question, is why do people PLAN to pick up prescriptions on these days? (No, they're not ALL non-holiday observing folk and they're not expecting us to be slow and they're not all post-ER visits.)

If shopping on Holidays were a crime, this would be premeditation.

Wednesday, December 18, 2013

No Valid Rx Received

Doctors hate our phone calls. They hate that we call to clarify everything.
Doctors love that we call them to clarify everything. If we did not, their prescriptions wouldn't make sense and we save their asses and the patients have no idea we deserve all the credit. By virtue of us calling on all their mistakes, we are actually enabling them to not learn from them. They are like toddlers. Let the child put a fork in the outlet one time. Next time, he won't do it. He learned.
In order to practice tough love on the prescribers who refuse to learn their systems, I have decided to implement the following practice at my pharmacy.
Simple. Delete the electronic prescription. Print it first. Fax it to the doctor asking for corrections then delete it. Retain the confirmation fax with the hard copy and delete the electronic copy. If the new one is not corrected, repeat the process. When the patients arrive, politely tell them:

"I am sorry. We have not received any VALID prescriptions for you today. Here are the copies of the communications to your prescriber. I will let you use my phone if you wish to call and berate him yourself for his ineptitude. Perhaps you can get him to answer his messages and double check his prescriptions prior to sending them."

When the office calls and starts to yell at you with "We sent this over 11 times. I have confirmation right here it went out at 11:02, 11:27,..." you can politely interrupt her and explain that yes, you did in fact receive something from them at those times, but you did not receive any VALID prescriptions. All you got were incomplete messages you tried to validate but nothing quite resembling an actual prescription. "However, since I finally have you on the phone, could I trouble you for a verbal order?" I get the patient to work on his prescription and the office to call me...the way nature intended.  

I am your whore.
Let me tell you something, baby.
You love me for everything you hate me for.

I say no more.

Tuesday, December 17, 2013

Ways to Spend Your Off Day

Whenever the lottery reaches outrageous jackpots, hysteria ensues and people lose the ability to think rationally. Offices pool money to buy tickets and employees dream of the what-ifs. Of course we were asked if we would continue working if we won a few hundred million dollars. Since it was a busy Monday and my entire staff was in rare, hyper-cynical form, operating as the well-oiled machine we are, my thoughts strayed and I had a couple good ideas of what I want to do with my time; either for fun on an off day, or should I ever be able to retire.
Yes, I would continue to work. Someone has to keep telling these stories.
Then the thought occurred to me. I should go to my local Wal-Mart and become a greeter. I know they no longer have them, which is why it would work. I'd grab a blue smock someone haphazardly tossed aside for a break, or steal one from Lowe's. I'd stand in the vestibule and comment on all the people entering.
"Nice Pajamas. Is that your Sunday best? They go well with the fuzzy bunny slippers."
"Cute brats. You must be headed to the pharmacy for some Adderall."
"Can I help you find anything today? Like soap?"

Oh the fun I could have. After being kicked out of every Wal-Mart in the area, I'd switch to Plan B: my money-making scheme. It goes like this...
Since Corporate America is so concerned about customer service above actual service and they believe in positive reinforcement for negative behaviour, I am going to visit every pharmacy I can. With no prescription, I am going to wait until there is a line at the pharmacy counter, get in it, then start yelling...

"What's taking so long?"
"I've been here over an hour!"
"All you do is slap a label on it!"
"My doctor said he sent it 4 hours ago. I was there. I watched him hit 'enter' on the computer."
"Hurry up. I have ice cream in my car I bought before I got in line which sounds stupid but everyone else does it."
"I always have this problem when I come here."
"You people don't know what you're doing."
"Can I drink with this?"
"Where's the Preparation H? Can I put it on the bags under my eyes?"

When they ask who I'm picking up for, I'm going to make up a name and date of birth.
"What do you mean you can't find me? My sister's aunt always gets her prescriptions filled at the CVS in Portland, OR. What do you mean this is Walgreen's in Portland, ME? Aren't you all linked? I want to speak with your manager."

I figure if I do this enough, I can collect enough gift cards to make a comfortable living.
As The Cranberries asked, "Everybody else is doing it, so why can't we?"

Monday, December 16, 2013

You Can't Get There From Here

Did you ever wonder how some people get through a day? Just how some people get from point A to point B all by themselves? I've noticed different types of habits among people who enter a store in search of a certain product. There are people who look and look and look but never ask anyone for help and will even leave the store empty-handed rather than draw up the courage to ask. There are the other extreme, though. These people walk looking straight ahead, focused on finding not the product, but a person to ask where the product is. These are the ones that amaze me. Despite the pharmacy department's location in the back corner of many stores and having to navigate a warren of aisles to get there, they come to us first. My answer? Look up! There are signs everywhere.

How did you get here? Did you stop outside my front door and ask random passersby for the location of my store? How did you navigate the streets?
It's not even that it may be easier, and quicker, to ask someone. This may be true. The fact that people walk from one end of a store to the complete opposite end just to ask the pharmacy is insane. The odds are quite good they've passed the item they seek.

I once had a lady walk in the front door, make a right turn into the store, pass a giant display of newspapers, walk past the cash registers, turn left along the coolers and follow it all the way to the back corner, turn left in front of my windows, walk to my counter, and ask me where the newspapers were.

Since when did we become "Customer Service"? (Since corporations started tracking it!) Or the "Information" kiosk like they have at the mall? We are not the all-knowing inventory/stocking gurus you perceive us to be. Ask me about flu shots. I have a button, glowing like Rudolph's Nose on my sharp, starched, pressed, white straightjacket. Or about medications. Seriously, ask me about them. I went to school to learn about them. Maybe I should have a button that says that! I shall adorn my vestments with pieces of flair that truly reflect the reason for my existence.

"Ask Me About Medications"
"Ask me about Other Vaccinations, for once, please?"
"I Don't Practice Santeria"
"I will NOT call your doctor for a refill"
"I will NOT give you a few for the weekend"
"I don't want to be your fall-back crutch"
"If you ask, you must take my recommendations and advice. Period"
"Despite all my rage I am still just a rat in a cage"
"Despite my cage, I am not an animal. I am a Pharmacist!"
"I know why the caged bird sings...or plays Pandora all day"
"Please Feed the Animals...Please!"

But Corporate wouldn't allow it. One, because it was not their idea. Two, because it stinks of revolution...like Katniss and the berries. 

Friday, December 13, 2013

Younger Marketing

I'm tired of the Blue-Hued ads for Viagra with the line "it's the age of knowing".
I'm tired of seeing old folks in bathtubs watching sunsets.

It's time to market to a younger audience. We need something edgy, something to lay claim to these drugs as our own. I'm thinking Pfizer, with another 7 years on their patent, needs to tap into the next generation to turn 30. It's never to early to develop a target audience. Start them young, then by the time the generic is launched, the next blockbuster is on the market and you've got the 30 year olds turning 40 and forever loyal to you. Manufacturers are great at this. Just ask dermatologists who only prescribe the "next big thing".

I wanna make some babies.
I wanna get it on.
I wanna make you horny but I can't get it up.
I wanna make some money, but I don't want no job.
I wanna make you horny, but I can't get it up.
Get it up, get it up, get it up...

LEVitra eLEVates your love life...

Thursday, December 12, 2013

I Need Some Clarity

Prescription: (noun) An instruction written by a medical practitioner that authorizes a patient to be issued with a medicine or treatment.

It says instruction. Its sole job is to tell me what the prescriber wants. It exists to convey the thoughts in the prescriber's head to my fingers to enter the instructions in the computer so I may properly explain to the patient what they are taking and how to take it.
Back in the days before e-prescribing, prescriptions were illegible so we called to verify them and the errors were those of omission. In today's electronic world, the errors are those of commission, but at least they are legible.
Since prescribers won't take the time to sit and actually learn how to use their programs, we get conversations like this one:
Slacking Ass Doctor: Why do you pharmacists keep calling me?
CP: Because your directions aren't clear.
SAD: Yes they are.
CP: No, they're not. You have 2 sets of directions on here. The first one, which I assume is the default, says "once a day", but at the end of the line it says "twice a day".
SAD: Didn't you read the whole thing?
CP: Yes. Clear as mud, which is why we pharmacists continue to harass you over this petty discrepancy.
SAD: "If I type something in the comments then that's obviously what I want. Ignore the first set of instructions. You should just know that." (actual quote)
CP: That's the whole point of the prescription: to communicate to me your exact intentions, not to convey ambiguity. If you'd learn how to use the program correctly, you'd cut down on the number of phone calls from the pharmacies. You might actually start to like us and thank us for saving your ass.
You must unlearn what you have learned about us. We do not exist simply to do thy bidding, master.

Monday, December 9, 2013

It's So Obvious...Except When It Isn't

Part of a pharmacist's job is to interpret. We take what the prescriber has written and translate it into English for the layperson. However, we are also there to explain. If a prescriber writes "BID" as the only direction, it is up to us to make a readily understandable label for anyone to follow. We like verbs in the pharmacy world. Words such as "take", "apply", "inhale", etc. What usually gets me are the oversimplified directions we have to put on the labels. Years of practice will teach you that you must make your labels understandable to the lowest common denominator. Simply put: Use small words and make it so simple that any kindergardener just learning to read could tell his mother how to use it. Prescribers usually aren't so careful in explaining how to use/take their prescriptions. That is our job.

This brings me to the following list. It includes directions we shouldn't have to type, but do.

1. Unwrap and Insert Rectally/Vaginally (on any suppository...because people don't. Ouch. OR they swallow them.)
2. Remove old patch (yes, people go to the ER with dozens of patches all over their bodies.)
3. Chew AND swallow. (Because someone would spit.)
4. Apply to AFFECTED area. (Because it's not obvious which part of the body has the issue. You did point it out to the prescriber for her diagnosis, right?)
5. Remove old ring (it only takes 1 ring to rule them all and in the darkness bind them. You're not building a vaginal slinky.)

Wednesday, December 4, 2013

(That's Not?) What You Heard

Sometimes I feel as though I am jumping in to the middle of a story. It's as if the patient has been talking before you picked up the phone and you just happened to catch the end of it. You have no idea of the plot so you're a little confused by what you hear. As you wait patiently for an explanation or a question, or something to alert you it's your turn to talk, there is an uncomfortable silence while you try to process the limited information you were provided.

To wit:
Quirky Caller: "My dog ate my box and he's looking at me like he didn't do anything."
CP: Um. Bad dog?

<thoughts in head>
1. Why are you telling me about your box and that you let your dog eat it?
2. Which box is it?
3. Is it birth control? Patches?
4. Do you need me to refill something?
5. Is there more to this story?
6. Diaphragm?
7. I hate when that happens?
8. Good Dog?

CP: Okay. And how may I help you today?
QC: I need a new one.
CP: Okay. I'll look that up and fill it for you. Anything else today?
QC: Nope. That's all I need filled.

Monday, December 2, 2013

Like Sands through the Hourglass...

It is often the perception, or rather, misperception, of something that leads to trouble. Many a war, fight, spat, or hurt feeling have been caused by some perceived slight. Why? Someone's perception is often far different from the truth.
Take time for example. When you are on hold with a company or business, the wait seems interminable. For the actual employee, the time seems to fly by and feels as though it were only seconds. Physically waiting in a line however, one should expect a truer estimate of time. Most people have a watch, a phone, or some other means (watching other people flow through the queue) to gauge the passage of time. It does not matter. The wait time in the pharmacy is an hour. Just ask this guy.

Patient Tech:Your prescription is ready.
This Guy: It's about time. I've been waiting over an hour for it!
<He pays, then leaves in a huff.>

This occurred as I walked in for the start of my shift. I actually walked past the counter as the interaction was commencing.

My shift started at 10am.
I walked in at 9:48am.
We opened at 9am.
His Rx was sent electronically at 9:31am.
We started to process it at 9:32am.
The other pharmacist checked it at 9:47am.
TG was rung out at 9:48am.

As I said: Perception.
Does the waiting time really count if you arrive before a business opens? No. Just because you lined up outside a Best Buy in October for Black Friday sales does not mean you can yell at the business for the wait or the conditions of your wait. Even if the prescription had been waiting when we opened and it took the same 15 minutes to process, he would have complained about the wait.

It is funny that PT walked over to me after I hung up my coat and said "Glad you didn't hear what TG just said". She knew he would not have been able to get away with that had I heard him.

Tuesday, November 26, 2013

Policy Impasse

What do you do if your policy conflicts with another party's policy?
Throw a fit? Cry like a baby? Send capital-letter faxes, essentially shouting at someone?
Most pharmacies have the policy where they "fax your doctor for your refill request". It's a courtesy, but most places offer this.
Many prescribers require pharmacies to only fax requests (e-requests go automatically, but that's different.)
What do you do when you receive a fax telling you you won a trip to the Bahamas? Or your information is wanted for the next Who's Who publication? Trash it. Throw it away. Discard it. To the rubbish heap with it, post haste!
But what if you are a prescriber? What if your policy is to not accept faxed requests? You do this:

"Attention. We are no longer accepting faxed refill requests. Please have patient call the office for refills."

Hmm. I just sent you a fax alerting you to a patient of yours who is out of medication and needs it from you. Would it not be prudent to contact said patient yourself to schedule their appointment with your office? It seems rather circuitous to fax me to have me call the patient to tell them to call you, don't you think?

Also, I assume you have this posted conspicuously in multiple places around your office? I assume you sent letters to all your patients notifying them of this policy change? I assume you are not relying solely on me and my competitor colleagues to spread the word for you?

Do you have a trash can in your office? Perhaps a HIPAA-delegated receptacle? Use it. Rather than wasting my time, and yours, faxing this back to me, devote your energy to dropping it into this bin. Gravity will actually do most of your work for you.

But since I'm making points here, wouldn't it be just as easy to sign the fax I gave you, and instead of sending me a letter telling me you no longer accept faxed refill requests, you could have faxed me that refill request? Simple. Fast. No phone calls. No extra work. Everyone is happy.

I know. Silly, right?

Friday, November 22, 2013

Look Before You Call...

If I've lost or misplaced something, I shall attempt to find it on my own, retracing my steps, until calling someone to waste their time bringing them into my search.
Why do people not look before they call? Why do people instantly get their feathers ruffled before I even pick up the phone to help them solve their problem? I never thought of the pharmacy as a place that was out to get people. Why the accusatory tone when calling me? I have way more instances where I "found" people's cards/rx's/bottles/etc. in their houses and cars than I do cases where we forgot to give it to them.

Average Customer: Hey, you didn't give me one of my prescriptions. I paid for it and everything. I drove all the home, a whole 1.5 miles, and now I have to come back!
CP: Yes sir it is still down here. Fortunately for you a fine upstanding citizen took it out of the shopping cart/basket you left it in and brought it to our counter. We were just about to call you.
AC: Somehow it's still your fault!
CP: And yet you still have to come here to retrieve it. I'll be waiting for you to slink back for that, along with your dignity...

True Story: I just left there and can't find one of my bottles.
CP: We sold you 3 bottles. They were in the bag before I stapled it shut.
TS: Well I opened the bag to take one and I jammed on the brakes and they went flying. Maybe it's in my car.
CP: Sure, I can wait all day while you check that.
TS: Yep. Here they are. Under the passenger seat.
CP: You realize I have to bill you for this? It's the new Consulting/Finder's Fee. If attorneys can do it...

Old Lady: Happy Monday. I just left my doctor and he gave me 2 eye drop prescriptions. I ran out.
CP: I tried to fill them but they are too soon. Do you get them from mail order?
OL: No. My one bottle is empty and the other is still good. But I need these today.
CP: Have you ever used another pharmacy?
OL: No. I come here all the time. Try them again.
CP: Sorry, they are still too soon. Do you get prescriptions anywhere else?
OL: No. But I send away for them though.
CP: <smh> Um. Silly question. Do they "mail" your drops to you?
OL: Yes.
CP: Okay. That's mail order. Have you recently received any eye drops from them?
OL: Well I got 2 packages from the company delivered to me on Friday but I haven't opened them yet to see what's inside.
CP: Okay. That'll be $25 for the wasted billing time.

Every Customer: You forgot to give me my insurance card back.
CP: I handed it back to you after I scanned it into our computer while I was rebilling it. I watched you put it in your wallet.
EC: Oh. I didn't look there...Yep. Here it is. <click>

Thursday, November 21, 2013

A little information goes a long way...

...or does it?
A little knowledge is a bad thing. Think about those people you know who know just enough to make them dangerous. They're called general practitioners...(Just kidding. I meant Nurse Practitioners. JK, again...) They are your friends, or FB friends, who know a little about everything and are always the first to tell you how much they know.
Pharmacists know a lot. We do. Just look at the faith our patients have in us.
Real questions from real patients (NOT actors...)
1. "I read that red wine is good for my heart. What kind do you recommend?"
(Sorry, I've watched the awesome movies Som and Bottle Shock and I consider myself an oenophile only by the fact that I drink wine annually in Niagara, but I am far from qualified to help your heart.)

2. "I heard that ladies find bushy eyebrows to be attractive. Do you think I could use Rogaine above my eyes to thicken them? Can you research that in your spare time?"
(Yep. My spare time. So you can be a hit with the ladies at bingo night. Tell them you just took your Viagra 45 minutes ago and their motors will be revving.)

3. "I have to wait for my prescription and I need to know how long it'll take, but I want to know if I'll be okay. The signs out front said 'No Parking' and I figure I'm okay since I parked between the 2 signs. What do you think?"
(I think I'm going to call the cops. You'd better move your car. Don't worry. The prescription won't be ready for about 20 minutes so you've got time.)

Sometimes, to prove my earlier point, a little knowledge is definitely a dangerous thing. I would not have believed this one had I not been there to bear full witness...

4. Lovely Elderly Couple: Do you have this OTC product?
CP's Partner: What's it called?
LEC: Not sure.
CPP: What's it for?
LEC: Diverticulitis.
CPP: Anything else you can tell me?
LEC: It's either a capsule or a liquid.
CPP: Please allow me to show you what we carry that may fit the bill.
LEC: Nah. That's not it. You don't know what we're talking about. We're going to "Place That Knows Gibberish"
CPP: Good Luck!
LEC: Nyah!
CPP: They were pleasant.
CP: As I always say, a little knowledge is dangerous. Especially for us...

Wednesday, November 20, 2013


I realize there are out-of-stock issues. They happen. Sometimes it's a manufacturing problem. Sometimes it's an ordering problem. Sometimes, it's a popularity thing. I cannot predict that all my patients who used to get 30 days of their medications will all come in today with new prescriptions for 90 days. It happens. We have to adjust our order points. Inventory is fluid, especially subject to change with the seasons (Pharmacy Winter, Flu Season, and Pharmacy Summer).

CP: I'm sorry but we do not have enough to fill this today. We will have the rest in tomorrow. I can give you a few today to get started or you can come back tomorrow and receive the full prescription in one trip.
Miffed Father: You mean I gotta come back?
CP: Unfortunately, yes. We've had quite the run on this today.
MF: But I always get this here.
CP: And you always got 30 days. This new prescription is for 90 days. We have enough to cover 30 days.
MF: So you don't know how to order?
CP: I do...For you to get 30 days. Besides, you've had this prescription for more than 2 months. Why did you wait until now?
MF: I didn't need it then.
CP: I may have had it then.
MF: Probably not.
CP: You're right. But I don't have it now either so there you go. You should have waited one more day.
MF: Would you have had it then?
CP: Probably not. But we'll never know, will we? Let's play pretend. I'll pretend you dropped this off with the intention of picking it up tomorrow.
MF: And what do I do?
CP: You come back tomorrow. Guess what will happen?
MF: What?
CP: Your prescription will be ready with the full 90 day quantity inside. I'll even bump up my inventory to accommodate your future refills. Better yet, we will sign you up for our SERF program.
MF: SERF? Like the feudal laborer?
CP: That's the basis for the acronym: Super Easy Rx Filling, SERF. It works for you. You are the lord of your own refills. Simply sign up and the system fills your prescriptions, calls your doctor for refills, calls you to remind you to come get them, and in phuture upgrades, will eventually take your medications for you. This way we can ensure we will always be in stock.
MF: You're kidding, right?
CP: Only a little. But it's up to you to figure it out. See you tomorrow...

Tuesday, November 19, 2013

Where is it?

Why do people carry wallets and purses? Men and women keep their money, license, credit cards, insurance cards, etc. in their wallets. Women have purses to carry their overstuffed wallets and just about anything any other person would need in the case of an emergency. For what reason should you ever be without your insurance card? (Okay, forgetting to put it IN your wallet, but there I go expecting logic and reason out of the general public...)

How do people manage to shop a store for an hour only to get in line and realize "I forgot my wallet"?

Do people get pulled over for speeding and tell the officer "I left my ID at home"?

Very rare are the instances when I would get in my car and not need something that would be housed in my wallet.
Why do pharmacies not require that a photo ID AND insurance card be presented with all prescriptions when they are dropped off to us? (It is harder with e-scripts, phone-ins and faxes. I get that.) My doctor's office left a message confirming my appointment and 4 times during the 30-second reminder call, they said "you must bring your ID and insurance card with you or you will not be seen".

Pharmacies need to implement this policy. In a prescriber's office, there is no "I'll bring it back with me when I come to pick it up" because you're not actually leaving. Besides, we do all the billing BEFORE finalizing your prescription. It doesn't go into the will call bag/drawer/bin without a copay on it.

I was kept 15 minutes late Sunday night and still lost a prescription due to Herr Douchebag's ineptitude. First he forgot the insurance when he dropped off the prescription at 10:37 (saying he would return around noon). Then he forgot his wallet with his credit card, but had the insurance, when he returned at 4:07. Then he returned at 4:58 only to get to the front of the line at 5:07 (we close at 5pm) with an expired credit card. When we told him we could not take his new credit card over the phone from someone on the other end of his cell (the cell he was on every time he was in our store), he asked for the prescription back so he could take it to a competitor who was open later. Prescription was written last month.
End result: I filled a prescription, had to rebill a prescription, had to waste time for his 3 trips through my pickup line, then had to cancel the filled prescription so he could take it elsewhere. I need to be able to bill him for this...

Monday, November 18, 2013

Pick a Name

Pick a name. Any name. But be consistent. If your given name is Richard Douglas and you prefer to go by Dick, please make everyone aware. This includes your doctor and your pharmacy. If your doctor has you listed as Ricky and the pharmacy has you listed as Dougie, do not blame us if we can never find you in the computer.
Women are by far the worst. "My name is Cynthia with a C, but I go by Sindy with an S around my friends and at businesses that have a silent P in them. Also, my last name is hyphenated. It's Jones-Smith-Watson. I've had my doctor since I was single so he only knows me as Jones. Professionally I go by Watson, but the pharmacy has to have all 3 since that's what my insurance has on file and the IRS needs them all too."

Seriously. Do not get mad at me because you cannot commit to a name. If you don't know who you are, then I shouldn't be expected to know either. We have enough trouble matching dates of birth with insurance companies and deciphering the hieroglyphics that doctors pass off as prescriptions without worrying if we have the correct patient.

Also, do not get mad at me if i don't know how to pronounce your name.
CP: What's the name?
Angry Customer: Smith
CP: I have one here for "Kate" Smith?
AC: It's pronounced "Yolanda"!
CP: What? It's spelled Kate. Should rhyme with Gate.
AC: My mom gave me this beautiful name and you people can't get it right. I hate you. I want a gift card for this heinous insult. You can't even pronounce a simple name.
CP: Please go away. Your mother was a hamster and your father smelt of elderberries.

(Yes. All of these cases happened. Names have been changed because, well, even if they weren't no one would know the difference.)

Friday, November 15, 2013

Irrational Entitlement Issues

Back in the day when there were more independents, many customers asked and expected corporations to match their prices. That was fine. Then the independents sold out to the MAN and in order to retain their customers and make them happy, pharmacies honored the price matching for them. However, it's been eleven years since they closed. I'm sorry but I can no longer match a price to a place that is now a parking lot. (Actually happened last year.) I'm sure if they were still in business, their prices would have climbed as well. Generic Percocet 7.5/325 from Mallinckrodt raised their price by over 300% recently. I'm not going to eat that.

Why do people insist on getting something they really have no right to receive? Here is my most recent, finest example:
A pharmacy was offering free antibiotics and other incentives to buy, sorry, "generate", customer traffic and patients for its pharmacy. I got into a discussion with a lady about their program after it ended.

CP: How may I help you?
Entitled Lady: I'd like this prescription filled.
CP: Ok.
EL: It's free, right?
CP: No.
EL: It says antibiotics are free.
CP: Not here. And over there, the program ended a few months ago.
EL: Well that's not fair. Pharmacies advertise them as free and I want them free.
CP: Again, not here. You are welcome to ask them, but as I already stated, the scam, sorry, "welcome offer", ended some time ago.
EL: I don't care. I wasn't sick at all when they had that and I didn't get to take advantage of it. Now I'm sick and I want free antibiotics!
CP: I feel your pain. It's just my luck I didn't start driving while gas cost less than $0.50 a gallon. I wonder if BP would allow me to take advantage of that now? I'll accuse them of ageism if they don't accede to my demands. I wish I could get coffee for less than $0.50 a pound, milk for less than $0.50 a gallon, and eggs for less than $0.40 a dozen like this is the 1920's. I wish the Black Friday deals were offered every day since I have to work and can't take advantage of the sales. Alas, such is life in 2013: where people are rude and expect everything to be given to them and prescriptions cost money and gas prices hover around $3. "Gobble gobble goo and gobble gobble gickel. I wish turkey only cost a nickel."

Monday, November 11, 2013


If you want to know where a person's priorities lie, ask if they have pets. If they do, stalk them on Facebook and you'll see lots of awesome memes, videos, pictures, and stories about their furry little babies. This is not about pets, pet lovers in general, or anything to do with animals at all. The reason I draw your attention to people with animals is to illustrate a problem. I am about to ask you two questions. Pharmacists, especially, will know where I am going with this before they read the second question. My point today, while slightly humorous, is intended to get everyone to think a little differently. To prioritize a little differently. Again, this is simply an example to help people understand where priorities often are placed.

My first question today, to all the pet people, is "Where are your pets' vaccination records?" Everyone will be able to tell you exactly where they are and often have them committed to memory.
(This works just about as well for those with children, but it is more poignant with pets. See question #2.)

My second question today, to everyone, is "Where are YOUR vaccination records?"

When I taught immunization classes, this was a favourite example of mine to illustrate how poorly we take care of our own health. This example is the perfect complement to the questions and statements we hear every day:

No. I don't know what it's for. I just take it every morning.
I know it's the blue one for something and the yellow for something else.
My doctor said I'd be on this until I die but I don't know why I am taking it.
It's not my job to know my insurance, that's your job.
What do you mean you can't just hand me a bottle of Lantus to get me through the holiday weekend when I have no refills and my doctor is also on vacation?

Friday, November 8, 2013


the unjust or prejudicial treatment of different categories of people, especially on the grounds of race, age, or sex

Had a new one recently...If a company advertises a 3-month supply as $10, is it $10 regardless of quantity? If not, is it a discriminatory practice to charge more?

Without an asterisk to explain *typical 90-day supply, this is misleading. If someone takes a medication once a day and another patient takes 4 tablets a day, the quantities are quite different, yet the day supply is the same.

It is no different than explaining the car companies are not discriminating against you because you bought a truck with a 20 gallon tank and the little economy car only has a 12 gallon tank. Sure, it takes more gas to fill, but it's not discrimination. You're not sicker because you need a higher dose. 

A guy pulled out his phone and wanted to record our conversation. He was accusing me of discrimination on the grounds that he was "sicker" and needed a higher dose than the average person. He threatened to sue me and my employer. Medications come in different strengths, dosage forms, durations of action, etc because not everyone responds to the same medication the same way. 

Do bigger clothes require more material and are they more expensive?
Bigger turkeys weigh more and cost more. If you're feeding a family of 20 for Thanksgiving, is it discrimination because you require more food to feed them than a family of 4? 

I'm not sure if the novelty of his argument surprised me or just pissed me off for the insane logic behind it. 

Doctor Don't Tell Me What to Do!

Take this to your doctor...
Dear Doctor,

Why? If you know something will not be covered, why prescribe it?
When did it become MY responsibility to call you?
If you are going to hand this to a patient, it had better have your home phone number on it so we can call you. If the patient comes to my pharmacy at 7:15 pm, the night before the procedure you better make damn sure you can fix his prescription. In what illogical, backwards world do you live where you think this is how the healthcare world works? Tell you what we're going to do. I will call and find the alternative. I will tell you exactly what to prescribe. I will then bill you the full cost of the first prescription you wrote; you know, to cover my costs. Every time I see one of these letters, you get a bill. Each minute I spend on the phone on hold with the insurance or a member of your staff, will be billed my hourly rate.
Seriously...where in the world do you think this is at all acceptable? You better be certain you answer the phone when I call. Better yet, print your home address on these so I can send the pissed off patients to your house for the new prescription. I didn't go to school to be your bitch.

Thursday, November 7, 2013


Hello Mr. Krinkle. How are you today?
Pharmacies now require their staff to answer the phones with such a long script, it's amazing we have time to fill any prescriptions.
"Thank you for calling CP Pharmacy where we offer all kinds of vaccines like Zostavax and the Flu Shot and the Tetanus shot, and we have a convenient drive thru and a $4 list and free antibiotics and we give gift cards if you complain at all and sometimes we even fill prescriptions when there is time and my name is Cornholio and I need TP for my bunghole and I am a pharmacist and how may I help you today?" (deep breath)...

I think it's stupid. We as a "profession" advertise the hell out of our services. I almost feel like those lawyers who prostitute themselves all over TV with ads that say "we'll make them pay". They give lawyers a bad name. Same here. If someone doesn't know we offer vaccines and have free antibiotics and $4 lists then I say "good!". Ignorance is bliss and I want them as my patient. It means they have no expectations and I can win them over because they just want a prescription filled by a friendly, caring pharmacist and they chose me for that reason.
The saturation of advertising our "professional" services is horrible. Everyone thinks my pharmacy has a drive thru, offers $4 generics, has free antibiotics, and offers other "perks" when I have none of these. It doesn't matter because everyone else's ads make it appear every pharmacy is The Money Hungry Whore pharmacy. While we all would like to make a profit, we're not all the same slut.
If they would take all the money they focus on advertising, from the little phone scripts (time wasted is money) to the little buttons the staff is forced to wear (pieces of flair), to the skywriting planes and robocalls, they may be able to hire staff that would actually be able to focus on filling prescriptions. Word-of-mouth is still a great way to build a business. Short wait times, friendly staff, and variety of services will be easier to achieve if the pharmacy isn't so focused on advertising/posturing who they wish they were. To the corporations I say, Shut Up and Put Up. Shut up your promotions and gimmicks. Put Up your best staff and focus on filling prescriptions. Show me a company that wants this to be a real profession again.
The next thing you know corporate will send some lackey in to stand behind us with a stopwatch and time every step of our filling process and dock us for typing too slow, or too fast, or not checking voicemail every 49.7 seconds, or...wait. Sorry. They already do that. If only they worried about getting them filled correctly instead of quickly...

Wednesday, November 6, 2013


CP: Do you have your new insurance with you?
Proud Patient: Indeed I do!
CP: You're kidding, right?
PP: Nope. They said everything you need is on this card. Why are you so stupid? I use this same card at every other pharmacy and just used it at my doctor this morning. You're an idiot and I want a gift card and a free Duck Dynasty Chia Head or I'm going to hold my breath and...

<CP pushes button that drops PP into the Rancor pit.>


To be a pharmacist, one must be good at chemistry. Check. And Math. Check. Really really good at math. Okay, check. To anyone else in the healthcare professions, math is an annoying conspiracy created by pharmacists to give themselves something to feel good about doing when they're not whining about how hard it is to count by fives. Huh?
Computers calculate doses now. Simply enter the weight and preferred product into the computer and poof! out comes a magical dose. No matter that it is impossible for a mother to administer this to her child. That's the pharmacist's problem and the mother's.

My finest examples come from these recent experiences:
1. "Give 1/10 tablet to your pet." Yep. 0.1 of a tablet. If it were the size of a personal pan pizza, perhaps this would be plausible. Tipping the scales at just over 3/16" around, means it is more likely one would get 10 irregular-shaped pieces and a bunch of dust. It would be easier to cut the tablet, grind it into a powder, get a mirror and razor blade, and make 10 lines for the dog to snort, than it would be to cut this into 10ths.

2. "Give your child 3.87 ml twice a day." Correct, 3.87 ml. We have devices that measure in 10ths, but not in 100ths. She can give 3.8 or 3.9, but seriously? What's wrong with 4ml. (After recalculating the dose with the weight mom provided while I was on hold with the office, 4ml was well within the appropriate dosage range.)

It goes back to reliance on computers to do all the work. Prescribers were told how incredible these systems were and how there would be no mistakes and "everything will be wonderful someday". Wrong. We not only see MORE errors with e-scripts, we see errors that never would have occurred with the old ink-and-pen method of prescribing.  As it is with all other aspects of the healthcare world, the bastard stepchildren, pharmacists, will play clean up and thank you for the opportunity to fix their mistakes and ask for more. Doctors still believe their job only involves the diagnosis and treatment selection.

Monday, November 4, 2013

The Double Standard

I had an appointment. I was late. I missed it. I called them and told them my test at the hospital took longer than expected. (When I arrived they told me they were already behind 30 minutes. I still had a window of opportunity to make my appointment on time.) As I said before, I called my doctor as I was leaving the hospital and explained what happened. This is what followed:

Office Lady: I just sent you a letter.
CP: Huh?
OL: You no-showed your appointment so I just put a letter in the mail.
CP: I'm not even 40 minutes past the appointment time. You mean to tell me that you typed, signed, enveloped, stamped, and mailed me a warning letter about no-showing my appointment? Already?
OL: Yes. But you called so you can ignore it. I can reschedule your follow up for tomorrow.
CP: Okay. I'm going to hold my doctor to the same standards tomorrow.
OL: Huh?

<Fast forward to tomorrow when I arrive 5 minutes before my scheduled appointment time.>
I set my timer and stopped it at the 23 minute mark when the nurse took me to the room.
After her 3 minute vital check and Q&A session, I restarted my timer.
I stopped it again at the 23 minute mark when the doctor entered the room.

CP: You do realize that by now I would have a letter with my name on it threatening to kick me out of your practice for being 40 minutes late? You are 49 minutes late. What's your excuse?
Dr. Zoffis: Sick people, longer appointments, scheduling, blah blah blah.
CP: Whatever. Don't threaten me again. I have yet to be seen within 20 minutes of my scheduled appointment time since I've been coming to this office and your staff has the temerity to send me a letter within 40 minutes of a no-show? When you scheduled me for a test at the hospital and the follow up here? You'll be getting my letter next month discharging you as my doctor. It will include the new office to which you will send my files.

Thursday, October 31, 2013

Houston, We Have a Problem

Is it ironic that Led Zeppelin's Communication Breakdown was playing on my XM radio when I got in my car to drive home after work? Here's the story.
Phone rings and Super-Tech answers it.
ST: CP Pharmacy, how may I help you?
Flustered Patient: Did my doctor call in yet?
ST: No, ma'am. Not yet.
FP: They said they faxed you all morning and have been trying to call.
ST: I am sorry but we have nothing.
FP: Ok. I shall try them again.

<a couple hours later>
FP: I just had them on the line. They say that when they send the fax, it comes back to them as an error and it won't go through.
ST: I just checked our fax machine. It has plenty of paper in it and we have been receiving a pretty steady stream since we opened this morning. Perhaps it's user error?
FP: They also said they have been calling you all day and the line just keeps ringing.
ST: Silly question. Are we talking right now?
FP: Of course.
ST: Good. Then it is safe for me to assume that my phone is receiving calls and working. Phew. One problem down.
FP: I just had them on a 3-way call when they tried to reach you and I heard it ringing.
ST: Silly question #2. Did you hear what number they dialed?
FP: Of course not. Can you please call them and ask for Wonderful Nurse?
ST: I shall put my pharmacist on it post haste!

CP: <gets the phone menu with no option for WN>
(I called back for a total of 3 calls and left messages under each mailbox since there were no options for "Live Human Being".)
This is CP calling for FP. I was told you were having issues reaching us today. If I can call you just fine, and the patient can call me just fine, it must be something on your end. But that is neither here nor there. Since it appears this is of great import to the patient, it is Friday at 5:01 pm after all, I hope you get this message. My suggestion to you would be to have someone in the office use her cell phone to call me. This way, the patient's needs are met and we all can have a happy weekend.

<10 minutes later my voicemail alerts me to a message>
WN: Hi. This is WN calling in for FP. Apparently we haven't been able to reach you all day. I had to grab her information and I'm calling from my cell phone as I drive home.

CP: <calling FP> I don't know why they didn't think of this first, but apparently someone heard my message and called from her cell phone so I received your prescription and it's filled and ready for you to pick up this evening.
FP: You are fantastic. Thank you so much for all your effort. I don't know what their problem was and why they were so difficult.
CP: It was our relentless teamwork, and a little bit of charm.

Tuesday, October 29, 2013

Technology is Too Slow for Me

First we talked. People moved away and then we shouted. Eventually telephones were discovered and we could call (though some still shouted). Then came the answering machine. A delightful device that took the worry out of leaving the earshot of one's telephone. Never again would you wonder if you missed an important call because you had to go to the store. Now a blinking light would assure you that the message had been captured. Cordless telephones were nice because you wouldn't have to miss a call or message while spending some quality time in the bathroom. Then came call waiting. The fear used to be that someone was trying to call you while you were trifled with some other call. We used to rush people off the phone saying "I'm waiting for a very important call". Caller ID was huge. Now instead of having to answer that annoying call while waiting for the important call, you could politely ignore, okay, screen your phone calls. The future really hit with the creation of the cellular telephone. With this device, an annoying person could carry on an annoying conversation at an annoying decibel at any location without fear of, well, loss of self-respect. No more would you have to miss a call. You could accept (and many people forget, decline) a phone call anywhere. It took the best creations, call waiting, caller ID and put them all in your pocket. (Eventually in your pocket. Have you ever seen the first cell phones?) There exists on these devices a program of some sort that actually records messages. It is like the answering machine's badass rebel grandchild. It is called voicemail. Amazing creation, this.  If you somehow choose to ignore or miss a call, people can talk to this recorder and then you can retrieve it, play it back, and even call them back right there if you want!
But why the history lesson today, CP? It's the end of Pharmacy Month.
Because every day I get this conversation, excerpted from last week:

CP: Thank you for calling CP...
Really Interested Person: Hi. My name is RIP and someone from there just called my house?
CP: That's a question. Are you telling me someone called your house?
RIP: Yes.
CP: And?
RIP: Is there something you need?
CP: I don't know. Did we leave you a message?
RIP: I don't know. I didn't check them. Let me listen to them and call you back.
CP: Okay. Because doing that first would have answered your question before you had one. Best you took the time to call me first, wait through my phone menus, ask for the pharmacist, wait on hold, then waste my time when all you had to do was play your voicemail.

Remember, you can give someone an education, but you can't make them take it.

Wednesday, October 23, 2013

Turning the Tables...

As pharmacy staff, we are used to prioritizing. We are used to reshuffling our work. It's a stretch, but let's call it ER triage. People who just arrived and whose e-rxs haven't been processed yet get a bump and those with sick kids do as well.
Your doctor's office? Not so much. In fact, never. I don't just mean in the waiting room carefully designed like a casino with lots of magazines and TVs to distract you but no clocks to be found.

It's one thing to be like this with your patients but it is quite another to be like this with the pharmacy. I loathe that most offices do not have a phone option for "If you are a pharmacist with an immediate question about a prescription we wrote or sent electronically, Press #3". Instead, we get this...

CP: I have a very important question about an e-rx you just sent me. I literally just got it and noticed the problem. The patient just walked in and really needs it and...
Office Rep: Yeah, you have to call the refill line.
CP: But why do I have to leave a message? It's not a refill.
OR: I'll transfer you.
CP: Wait. It's important! We need the answer now.
OR: No one can answer your call right now.
CP: Can I hold?
OR: No. Transferring...

It took them an hour to get back to me. I politely explained that I had an urgent matter with Patient A.lready H.ere's prescription and it needed addressed immediately. I also mentioned that they needed to get a protocol in place for pharmacists to have their questions answered. I believe they likely laughed at me when they played that for all in the office to hear. Anyway...

Doctors' Offices tend to not respond to us. They brush us off like an early refill narcotic patient. Here is what I propose:
Whenever the phone rings into the pharmacy and it is a prescriber's office, the conversation will go like this:
Uber-Tech: Thank you calling CP Pharmacy where we are just plain awesome. How may I help you?
OR/RN/MD/APN: Calling from Dr. Zoffis with a question and to phone in a couple prescriptions.
UT: Ok. I'm sorry but we no longer accept phone calls from offices. Period. There is nothing you have to say to anyone here that you can't say to our voicemail. Our pharmacists have decided to take care of their own patients right now. We found that by not wasting our time actually talking to you, we can save hours a day and increase our flu shots and MTMs. It was a liberating epiphany. You can call back and press #666 for the prescriber voicemail. This way the pharmacist can play and repeat the message as needed. Please do speak clearly as unintelligible messages will be deleted and disavowed and we will make no effort to contact you since you don't answer our calls. Thank you and remember what a vital role we all play in the healthcare of our patients.

Tuesday, October 22, 2013

How Do I Love Thee?

How does a person pick the pharmacy where they choose to do business? A little over 2 decades ago, it used to be due mostly to the pharmacist. Next on the list was location. People tended to stay local. Now that has changed considerably. With often multiple chains on the same corner with the same conveniences, what truly separates us? Oddly enough it's the pharmacists. But that's not why you've assembled here today.
Let's suppose for today's example that we are in small town USA with only one little pharmacy. Neighboring town USA has a few options, including a link in the chain of Small Town's pharmacy. It is an idyllic day in this peaceful waterfront community.
Being the go-getter, uber-effervescent individual I am known to be, I bounce up to the counter to assist, unbeknownst at the time, Mr. Grumple-Foreskin.
CP: <Chipper> How may I help you today?
GF: <Knocking aside the chipper> They never have this. <flings Rx at me>
CP: Ok.
GF: But you always do.
CP: Well that seems like an easy decision to me.
GF: It's not. They have a drive-thru. And here I have to walk all the way to the back of the store. I hate it here.
CP: I have to walk to the back too, you know. At least it's scenic, past some lovely shrubbery.
Uber-Tech: NI!
GF: That's not funny. I hate this place.
CP: Forgive me for playing the role of ObviousCP, but, why are you here?
GF: Because you carry what I need and the idiots over there need fired for not knowing how to order.
CP: Forgive me for asking. Have you thought for a second they DON'T want to order this? See, you come in and ask for it, knowing they are out of it. You get all grumpy on your ride over here and I have to deal with you because I actually carry this for my patients. Seems as though they've outsmarted you, Mr. GF.  Perhaps next month these will remain on manufacturer backorder at my store. I'd suggest you call before you make the long drive in from Neighboring town. There are plenty more pharmacies with drive-thrus around. Why don't you keep driving around until you find them? All of them...

Friday, October 18, 2013

Do you have any questions?

Uber-Tech: Do you have any questions for the pharmacist today regarding your prescriptions?
Every Single Customer: I've been taking it forever.
UT: Wonderful. It hasn't been around that long, though you do look pretty old. Let's try this again: Any questions regarding your prescriptions?
ESC: I just said I have been taking this all my life.
UT: That is not an answer to the question that was asked. This would have involved something along the lines of "yes" or "no" since that was the type of question presented to you.
ESC: I've been on this forever! How many times can I say that?
UT: I don't know. My guess is that no matter how many times I ask you my question, you're going to try to beat your old record.
ESC: You're starting to annoy me.
UT: Good. Maybe logic will sink in sooner rather than later. While we wait, let's try to explain why your answer is insanely short-sighted...Your argument is this: Since you have been taking the same medication for an eternity, there is absolutely nothing you can learn about it. There is nothing that could change about it. There are no reactions you could develop and there are no changes that could occur. There are no interactions with any medications you are adding and there are no new side effects you could ever possibly have.
ESC: Essentially.
UT: Good. Then you are an expert and could probably teach my colleagues a few things. Even though body chemistry changes and medications react differently in people as they age and even though allergies can develop years after starting a medication, you factually know you shall never experience this. Is that correct?
ESC: I've been taking it forever with no issues, so it must be true.
UT: Jolly Good, sir! You have stuck to your guns and continued saying that. Then may I ask you to kindly sign this waiver?
ESC: What is it?
UT: A simple form absolving all pharmacy staff here of any liability should you ever have a question or experience you need to share with us about your medications. It waives our legally mandated offer to counsel you. It allows us to never annoy you with the pesky "Do you have any questions..." spiel we always pester pester pester you with every time you visit our boutique. Basically, we shall never again ask intrusive questions about your "medication you've been on all your life". Satisfied?
ESC: But what if something happens?
UT: You have assured me it shall not. Good day, sir!
ESC: But.
UT: I said Good Day!

ESC's Wife: Next time just say "No". You always fall for this and you always lose. Well-played UT. Well played.

Thursday, October 17, 2013

Good Deed

Every once in a while there comes a moment; a memorable moment that lets you question your cynicism. Did that really just happen? You want to look around and ask someone to pinch you, just in case you're dreaming. When you do realize that yes, it indeed just happened, you must swiftly act upon it and bring recognition to its existence.
"CP, whatever is this life-altering event of which you speak?"

It was a dreary day, like all the others, when I heard it: the voicemail. It called me. Knowing I could not ignore its existence any longer I wearily dialed the code to retrieve its contents. It was a moment that changed me forever. Upon hearing the first dulcet tones of her lilting voice I knew this was a message like no other. She said she was calling in prescriptions for a patient about to be discharged from her facility and wanted us to have the time to get them ready. That day she left 10 prescriptions on my voicemail. But it was her pacing that was the game changer. She spoke with such a rhythmic cadence that I did not need to rewind or replay any part of the message. Her pace perfectly matched my writing. It was as if I were thinking the words as my pen spewed them forth upon the paper.
Upon completion of the call, as a lone tear streamed down my cheek, I knew what I had to do. Knowing it was nearing 5pm I knew I had to act quickly. I immediately called her back. She initially thought she had forgotten something.

CP: I just wanted to tell you that you left the most perfect voicemail I have ever received. You were perfectly paced, organized, didn't miss any information and didn't pause to look for anything. I had to thank you because I'm pretty sure no one ever calls to say they appreciate your messages. If only every other person who left me messages could learn from you, my days would be so much better.

Awesome Nurse: Thank you. I'm always concerned I go too fast or sound stupid. You just made my whole weekend.
CP: You are quite welcome.  Praise for a good job comes all too infrequently and you definitely deserve it today.

Wednesday, October 16, 2013

To Drink or Not to Drink?

If I were to give you a drug name and ask you to tell me one thing about it, what would you say?
Would you give me a side effect? An allergy precaution? What it treats? It's main indication? What it looks like? Smells like? What would you say?
Suppose I amend my statement to: If you were given exactly 3 words to counsel about a medication, what would you say?
I present this to you today based on one customer interaction I had recently. We had put a bright shiny sticker on the patient's bag alerting her to a potential, serious reaction. I heard the patient ask my technician a question. My ears perked up and quivered and I slowly started to walk to the counter.

Quizzical Patient: Can I drink with this medication?
CP: No. Absolutely not.
QP: But my doctor said it's okay.
CP: Really? That's bizarre. Did you ask him directly or did he just tell you it'd be safe if you decided to join Dionysus for some wine?
QP: I specifically asked him. I told him we are having our monthly "spirit" walk and I would be imbibing most of this weekend.
CP: To which he replied?
QP: It's totally safe. Have fun.
CP: Unless he really didn't like you or was intending to be facetious, I don't think "have fun" is what's going to happen if you mix alcohol with this medication.
QP: Are you sure?
CP: Let me explain it like this. If you were to ask me to tell you one important thing about this medication, and gave me 3 words to do it, my answer would be "Absolutely No Alcohol!" We have even warned patients not to mix OTC cough medications that contain alcohol.
QP: Well that damn doctor just screwed up my weekend.
CP: I think you should call him and invite him to join you this weekend. You can share some of your medication with him while he gets spirited and see what happens.
QP: Do you have any suggestions for what I can do?
CP: Depending on your priorities, if you can stand to be miserable for a few more days from what this treats, then you could wait until after the weekend to start it. Judging by the look on your face, make it a Shirley Temple this weekend.
QP: Thank you for saving me from an almost certainly miserable weekend.
CP: You are welcome. My name is CP and that is my job.
(And this is one of those times where you wish you could force a customer comment card into their hands and ask them to tell the Powers-That-Be how wonderful we are. But we don't. Why don't we? Because it's our job. This is what we do. I don't need a corporate pat on the shoulder for validation, even though it would even out a complaint about not knowing why we don't stock the powder of some vitamin, only the gelcaps.)

Monday, October 14, 2013

What is thy bidding, my Master?

In response to this letter...

Please take this note to your doctor...
Dear Prescriber,
First, if you want me to call you and do your job, you had better expect a bill in the mail. Each letter I receive will result in a charge to you of $75.00 plus whatever amount you receive from the patient's insurance. If you know a product will not be covered, then prescribe an alternative. Write on the prescription Besivance OR..."first alternative". Do the same for the Lotemax Gel. Give me an either/or option here. You are either lazy, incompetent, or both. It is not the pharmacist's job to call the insurance for alternatives. The patient gave you his insurance card. Use it. Before Besivance and Lotemax came around, what did you formerly prescribe? Go with that.

Second, restricting the hours I can reach you is absurd. In the real world, patients come to pharmacies after 6pm and on weekends. If you want me to reach you, give me your cell phone and home address. You can bet that when the patient comes to my pharmacy at 7:45pm on a Friday night and has surgery scheduled for 8am Monday and needs his prescription right now even though you wrote it 3 months ago, he is going to blame me. In order to appease him, I will personally drive him to your house so you can experience the full fury of the pharmacy patient. If you choose to put the onus on me, you'd better expect to be held accountable and play by my rules. I will not roll over and let you dictate how I will run my pharmacy.

Finally, grammar. It's "Fridays", plural, not "Friday's" possessive. If you're going to try to communicate with another professional, the least you could do is appear intelligent. Failing to do that furthers the opinion that you don't have to be smart to be a doctor...

I am not your Bitch

Friday, October 11, 2013

A Tale of Two E-Scripts

It was the best of times, it was the worst of times. There I was, at the data entry terminal, minding my own business, working ahead on the e-rxs when it appeared. First came the Omeprazole 40mg, 1 capsule twice a day, #60 prescription. As I finished processing it I noticed a second e-rx had appeared. This one was for Nexium 40mg, 1 capsule once a day #30. Hmmm. (I made my pensive face.) What to do? Was there a message from the doctor? Did he really want this patient on both PPIs? If only I could read his thoughts through my computer. If only there were notes attached to the e-scripts. If only the office would call me...After 35 minutes of staring intently at the phone, begging it to ring, I realized I should call the office myself. Dutifully I called and it went like this...

Office Girl: Hold <click>
CP: <thinking to self> Wow, I'd get dinged on my customer satisfaction scores for doing that. Too bad offices aren't graded too...
OG: How may I help you?
CP: Pharmacist calling with an important question about two e-scripts you just sent to me. It's very important.
OG: Okay. I'll transfer you to the prescription refill line.
<message left on refill line went like this> CP calling with an important question that cannot wait. I suggest the next time I call you teach your staff to NOT transfer me to the refill line as I am questioning e-scripts you just sent to me. If there are errors on your prescriptions you need to have a protocol in place to have them immediately addressed. I look forward to hearing back from you as soon as you determine it is important enough for you to call me back.

<Exactly 54 minutes later>
RN: RN calling. Someone called and left a message about a question on an e-script but didn't leave the question.
CP: That was me. Thanks for taking my call. First time caller, long time e-script filler. Did you really intend to put this patient on two PPIs?
RN: Huh?
CP: Pull up what you sent me.
RN: The Omeprazole was canceled back in September. He was supposed to start Nexium last month.
CP: So you sent me a prescription for a canceled Rx, then sent me another for Nexium, which he already is getting from another doctor?
RN: Yes.
CP: Why, may I ask, would your office send me a canceled Rx AND a new Rx? Am I supposed to guess that is what happened? Why did no one call me? What would have happened had we filled the Omeprazole and the patient took it? He would have been pissed at me and blamed me and yelled at me. How about next time I say "it's important" your OG lets me talk to you straight away. It took you an hour to call me back. Glad it wasn't anything serious like an anaphylactic allergy. So I'm canceling the Omeprazole but what about the Nexium?
RN: Just cancel that too if he has refills from another prescriber.
CP: Ok. Thanks for wasting my time.

Thursday, October 10, 2013

But My Doctor Said He Sent It!

...But I watched him send it...
There are no more terrifying words in the world of retail pharmacy. (Ok, "can you look at this rash?" is a close second.) In the world of electronic prescribing, where perfect prescribers prepare perfect prescriptions, everything is wonderful. "Please don't tell me everything is wonderful now..." In the Utopian world that was sold to us healthcare professionals by the e-script services, there would be no errors. According to prescribers, who apparently received a different, additional memo, the prescriptions are not only transmitted to the pharmacy in nanoseconds, but are filled instantaneously there as well.
As you are all well aware, I'm here to tell you that this world only exists in prescribers' heads; and they are never to blame.
Yesterday was a day like all the rest. Birds singing on my shoulder and helping me put on my smock, mice singing as they tie my new Under Armour shoes. Yes, it was a Disney type of morning...until the phone rang.
Impatient Lady: Is my prescriptions there yet? My doctor said he sent it.
CP: No. We are all caught up on our prescriptions. It's not on voicemail, e-scripts, fax, or pneumatic tube.
IL: He said he sent it. I was there in the room with him. I WATCHED HIM SEND IT!
CP: Oh, in that case it must be here. Let me check my other inboxes...nope, not in the Pony Express satchel, it's not on the teletype, no Morse Code or telegrams, and the smoke signals have been down all morning but I'm pretty sure it's not there.
IL: I'll call back later.
CP: Yes, I know you will.

<Later (17 minutes)>
IL: Is it there yet?
CP: Nope. Not even via candygram.
IL: Are you sure?
CP: What is this, a deodorant commercial? Yes, I'll raise my hand if I'm sure if that'll help.

<Later (23 minutes)>
IL: How about now?
CP: Nada.
IL: But I watched him send it.
CP: You keep saying that. Let me ask you this: Did you see WHAT he typed?
IL: No.
CP: Did you see WHERE he sent it?
IL: No.
CP: Did you ask them, any of the last 3 calls you made to them, WHERE THEY SENT IT?
IL: No.

<Later (4 minutes)>
Office Lady: Calling in a prescription for IL.
CP: What happened to the one she saw him send?
OL: Oh, he sent it to the wrong pharmacy.
CP: And you could not have figured that out sooner? A simple little, "Yes we sent it at 12:56pm to Little Big Horn Pharmacy and got a confirmation that it was received" would have helped straighten that out since I am CP Pharmacy. Simply telling the patient "yeah, we sent it" is not good enough. Do you have any idea how much of my time was wasted talking to this lady because your office can't get their act together? How many people in your office talked to her without tracking this down for her? Instead of simply resending it to me, you had to call me, take me away from another task, to give me a prescription that, had it been done correctly any time in the last hour, would have already been filled and waiting for her. Oh, I don't suppose you told her you sent it to the wrong pharmacy, did you? Or are you going to leave me hanging out to dry as the inept one in this debacle?
OL: You can tell her that if you like.
CP: I shall, but she likely won't believe me. She didn't believe me when I told we didn't have it, what makes you think I'm getting off the hook that easy? Prescribers are always Teflon Dons...

Tuesday, October 8, 2013


I never knew America was on the barter system. Years ago in a Greek Agora it was common practice to barter and haggle for products sold on the street. In many countries this is still the way it is. I wish America worked like this for everything. Apparently pharmacy customers have long held this belief and I was oblivious to the role I was supposed to play.
I feel like shouting "inconceivable!" vis a vis Vizzini...but I digress.

Next time I am at a department store, I am going to haggle over the printed price on the tag.
CP: $300? For a sweater?
Department Lady: But it's Cashmere!
CP: I don't care if Led Zeppelin signed the sweater, it's not worth $300. Does it have mini heaters in it? It's just a bunch of fibers all sewn together. I'll give you $20 and not a penny more.

How about at the movie theatre?
Ticket Seller: That'll be $15 for your 3-D Gravity ticket.
CP: I can get this at Redbox for like $2.00 in a couple weeks. How about you settle for $5.00?
TS: How about I stuff your nostrils with those Sno Caps?

Gas Station Attendant: That's $3.29 a gallon.
CP: <waving hand across the counter> That's not the price I was looking for.
GSA: That's not the price I was looking for.
CP: <waving hand> I want to charge you $1.79 a gallon.
GSA: I want to charge you $1.79 a gallon.
CP: ...and grab a free Mountain Dew...

I know people who have complained about their cable bills and received a discount/promotion/bonus for signing another contract, but that's the way the cable companies want it and they're not shy about telling you that. Argue and they'll give you free HBO. They like it when you argue. Eschewing masochism, pharmacy should not be a place for negotiations. In fact, the negotiations already took place, and they were short. Your copays were established long ago; so long ago in fact, that they're printed on your card or your EOB. That's the price you have to pay. No, we don't put Nuvarings on sale. (This is excepting those places that do free antibiotics during the pharmacy winter and $1.99 or $4.00 generics. Those are geared towards CASH-paying customers. We already established they only make up less than 20% of our patient base.)

I feel like this whenever people wish to 'aggle...

I have always believed that the price was the price. Whether it's a can of soup or a blender, a soccer ball or a steak at restaurant, I always pay the price listed. Can't you just picture some of our favourite pharmacy patrons in a 4-star restaurant arguing over the price of the filet? We have prices on price tags for a reason: so you know what to pay and we know what to charge you. It's a business, not a garage sale. For the eleventieth time pharmacists do not set your prices. Quit arguing with me. Pay up.

Monday, October 7, 2013

There's a Glitch...

"Dave. What are you doing, Dave?
Whether it's HAL from 2001, A Space Odyssey or Ash from Alien, the computer is always to blame for man's demise. However, man continues to forget that man programmed the computers. Man has to do the double check for safety reasons. Pharmacists don't have the luxury of blaming the computer. Doctors however can be absolved of blame simply by invoking the "Computer Glitch" defense.

CP: Hi. This is CP calling to verify a prescription that was sent electronically.
Glitchy Office: Go ahead.
CP: It says here to take 1 tablet by mouth with the first main meal of the day, twice a day.
GO: Uh-huh.
CP: Is the patient a Hobbit?
GO: Sorry?
CP: You know, Second Breakfast?
GO: No. That's a glitch. Our system defaults to that.
CP: So you know it's a problem and your answer is "It's a glitch"?
GO: Yeah. You guys usually call us and our doctors are really busy. They figure you'll catch it.
CP: I wish you didn't have so much faith in me. I'd like to have a little faith in the prescribers but they continually erode that every day with every prescription they send me. I find it funny that the AMA considers pharmacists calling to verify prescriptions a nuisance. Apparently your office considers it "backup".
GO: What's your point?
CP: How about you call the AMA and tell them that you can't figure out your software and you're too damn cheap or lazy to call out the tech to teach you how to use it properly? Then you can ask them to pay the bill I'll send you for each prescription I have to call to verify. Better yet, how about next time I don't call? How about I just fill it and document the Rx with "office says it's a glitch and just fill it like it is because we don't have time to check our work"? I sure wish I could use that excuse as a Healthcare professional. I didn't realise "glitch" was a legal defense in this country.
Sorry, it was a glitch that caused us to dispense 10 mg of Coumadin when your doctor ordered 1mg. Oops. Damn glitches.
Sorry the patient died due to the doctor's incompetence in using his software. Sorry no one double-checked the information before it was sent to the pharmacy.
GO: Isn't that why you're there?
CP: It is. I also expect the prescribers to actually know how to prescribe. We've gone from an era of errors we couldn't read to the age of legible errors. Now we know exactly what's wrong with it. If you're going to request us to call or fax you for your patients' refill requests, then I'm going to request that all your prescriptions make sense.

Thursday, October 3, 2013

Everything's My Fault

"I wish I was like you, easily amused...I'll take all the blame..."

A lady comes in after 5pm, peak pickup hour on the banks of the pharmacy. (The time I tell everyone to avoid the pharmacy.) She is already fired up because her insurance has changed. She has the new medical insurance card, but there is no prescription information on it.

After getting a little louder with each syllable to the point where I can now hear her from a few rows deep in my holding cell, I decide to step in and rescue my tech. (Besides, a crowd was starting to grow and you know how much I love playing to the crowd.)
(Keep in mind, this has already been billed to an insurance. When it originally rejected, they gave us the new number to call. We have the correct one but she doesn't believe us because the copay is nearly $300...)
Super Annoyed Person: <Just handed the "new" card to tech> I don't see what the problem is. I gave you the card. Everything is on there.
CP: Yes. Everything except for the pharmacy information.
SAP: I know it's there. You just have to call that number on the back.
CP: Which one? The one that says "customer service"? That would be for you to call as I am a provider and that number is not listed. It also says to call "between 7:30 am and 4:30pm" and here you are at 5:15 pm.
SAP: I don't see the problem. You are just an idiot. I could do your job better than you and faster too.
CP: Okay. Prove it. We are currently accepting applications and, as you can see, we are a little shorthanded at the moment. In fact, let me open the door for you right now. Since you are the expert, I invite you back to fill your prescription yourself. Come in.
SAP: You people couldn't handle me back there. Everyone would quit because I'd actually make them do work and light a fire under some asses back there. You wouldn't know what hit you.
CP: Again, I say prove it. You are welcome to apply on your way out. Have a pleasant night.
SAP: Oh I will. You better damn well believe it.

<Flash Forward 5 days where SAP has called and verified the information we told her last week.>
SAP: I'm here to pick up my prescription.
CP: The one with the new insurance? Turns out what we had was correct, huh?
SAP: You people are too damn expensive. I'm transferring all my stuff out of here. You don't know what you're doing.
CP: Bummer. I was so looking forward to more verbal sparring with you. You do realize, of course, that your copays are the same regardless of where they are filled, right? Anyway, I'll make sure when the other store calls for the transfers that I tell them you are looking for a job and they should give you an application. I will put in a good recommendation for you and tell them how experienced you are. I will give you credit. You did call your insurance. You did get the information for processing the claim. Too bad I did it faster than you and without the chippy attitude. I know, it sucks to be wrong. It especially sucks after the animated, demonstrative display you put on for everyone last week. Just tuck your little tail between your legs, lick your wounds, and heal up for your battles with your new pharmacy. With your history, There Will Be Blood...

Monday, September 30, 2013

A Spoon! A Spoon! My Kingdom for a Spoon!

It has finally come to this. I've had customer complaints about poor service, perceived slights, and long waits. Last week was a new low in the retail pharmacy world.
It is after close. A darkened pharmacy lurks in the shadows of the back corner of the store. An eerie stillness permeates the air. A fog rolls in. A dog barks. As I slowly wend my way among the warren of aisles to my front door, a hobgoblin jumps out and approaches me...
HobGoblin: Where do you think you're going?
CP: Home.
HG: Not until I get what I need.
CP: Sorry, but the pharmacy is closed. I stayed until 9:15 after having arrived early at 8:20 this morning. Time to enjoy some sustenance and a long pee. I bid you good night.
HG: Just you wait a minute. You didn't give me what I need with my prescription.
CP: You got your prescription?
HG: Yes.
CP: Then whatever could you now require?
HG: A spoon!
CP: Sorry?
HG: A spoon! No one back there offered me a damn spoon. How the hell am I going to give this to my child without a freaking spoon?!
CP: Seriously? This is why I'm still held captive here? A spoon? First, we don't have to offer you anything. It is a courtesy that we provide where we hand them out with liquid prescriptions. Second, had you not come in at 8:59 screaming that your child had to have her antibiotics tonight, even though you dropped off the prescription at 10:17 this morning, perhaps we would not have felt so rushed that we may have remembered to offer you a dosing utensil. Third, most people have accumulated so many cups, spoons, and syringes they could open their own dispensary, that we don't always remember to offer them. When you buy soup or pudding, does the grocery store have to offer you a spoon? Lastly, you could have asked for one. Seriously. Instead of keeping your pie hole busy hurling invectives at us about making sure we stay open, how about you say thank you for sticking around long enough and then asking for a measuring device?
HG: Well I never!
CP: I know. And you never will. Next time you choose to go off on someone, make sure it's not CP, it's not after hours after a 13 hour day, and you bring a serious complaint to me. By the way, there is an entire section of spoons, droppers, cups, syringes, applicators and dosing aids conveniently located directly across the aisle from the pharmacy. Go buy one. I am not going to unlock my pharmacy and wait for the alarm company to call me just to give you a free spoon.

...Now someone in corporate America will get the brilliant idea that all pharmacy employees be required to, at all times, keep a spoon and a syringe on them when wandering the store. Whether it's on their way to the bathroom or their way in and out of the store, it will be required. FE managers will be required to do random checks on pharmacy personnel. Maybe we will even be expected to wander the aisles and offer spoons to all store customers who appear to be buying anything in a liquid. If this idea works, maybe they front end will have to offer forks and knives in the meat department...

Join me next time for Star Tech-The Search for Spork

Friday, September 27, 2013

Mitch Hedberg

Realistic Expectations, as explained by Mitch Hedberg...

I walked by a dry cleaner at 3am. The sign said "sorry, we're closed". You don't have to be sorry. It's 3am and you're a dry cleaner. It would be ridiculous for me to expect you to be open. I'm not going to walk in at 10am and say "hey, I walked by at 3 and you guys were closed. Somebody owes me an apology. This jacket would be halfway done."

If only they employed the little gnomes that everyone believes work in the pharmacy...

Wednesday, September 25, 2013

15 Minutes? What's this mean?

The first quarter of a football game (involving only 4 minutes of really playing anything).
The first half of your favourite sitcom (about 12 minutes of the actual show).
How long it takes to save 15% with Geico.

Think of all the things that take 15 minutes. Why does the pharmacy wait time seem so long when the wait is 15-20 minutes? Are we really asking for that much of your time?

It is perception. You know you can wait in line at the traffic lights during rush hour for the shortest distance to your destination and it will take you 15 minutes to get to work. You also know you can drive side streets and avoid the congestion and lights but it's a little out of the way and will take 20 minutes. The difference is actively driving versus actively sitting. Personally I will take the scenic, meandering drive every time over the congested sit-and-sit-some-more rush hour scene.

It is this perception of time and its passage that confuse retail patients. Watching a show or a game will seem to move time at a quicker pace than standing at the counter staring at me as I fill your prescription. They say "a watched pot never boils". (Though if you keep staring at me and looking at your watch, I may boil...) Move along to some other task. As you walk away to while away the woefully interminable wait, please ask yourself why it was so easy to wait at the doctor's office. Why could you wait in Gen Pop (the main waiting area) then wait again in solitary (a room) and not complain?

I think we should rise up against our prescribers. Shout to the rafters "we're not going to take it anymore!" and march around the office complaining. At the pharmacy you are rewarded for such insolence through gift cards and fruit baskets. I wonder if we could push for free MRIs and vouchers for PAP smears and Prostate exams?
I think the next time I have to wait at the ER I will call the main hospital line and say:
"what's taking so long?"
"why did people who arrived after me get taken back first?"
"what are you going to do to compensate me for my wait time?"
"can I get free X-rays for life?"
"I don't care if he has 6 gunshot wounds, my stuffy nose is really inconvenient and I need some antibiotics right now so I can take my prescription to the pharmacy in a couple weeks right before they close and annoy the piss out of them too."

Tuesday, September 24, 2013

New Twist on an Old Classic

Stop me if you've heard this before...
Random Patient: I have to go out of town for a funeral so I need an early refill.
(Now let's suppose, for this exercise, there are no narcotics involved. Seriously, that was not the case.)

The new twist comes from what happened later. Apparently this patient did not have the foresight, or perhaps the time, to stop by his local pharmacy to alert them to his hastily scheduled travel plans. (Funerals do tend to sneak up on you.) Instead, we got to be on the other end of his out-of-town conversation...

<Sunday. 4:57pm. 3 minutes until closing...>

RP: I am out of town for a funeral and I left my medication at home.
CP: Do you happen to use one of our stores in your hometown?
RP: I certainly do.
CP: Then let us see if we can fill it for you. Oh, I am sorry. It appears your refill is too soon for the insurance to cover it. I can charge you for a few to last you until you get home.
RP: But I'm on Medicaid. I don't have to pay for them. You need to give them to me.
CP: You're so cute, coming in at closing and demanding I give you something for free. Go ahead. Ask for something else. I like to be entertained.
RP: You don't understand. I have to have this or...
CP: ...or you'll die. Right. If I may ask, exactly how far have you travelled for this solemn occasion?
RP: I drove all the way from (city in the neighboring county).
CP: Really? My parents live there. That's about a 30 minute drive. You mean to tell me your definition of "out of town" is less than 30 miles? Either you don't get out much or you're just really lazy if you can't drive home and back to pick up your medication. Your choices are to pay cash for a few or spend the gas and time to make the 1 hour round trip. Either way, the cost will be the same. But hurry up, because I'm going home as soon as these gates hit the counter.
RP: Fine. I'll pay for them.
CP: Thank you for shopping with us today. Oh, I almost forgot. Would you like a flu shot?