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Thursday, February 28, 2013

Unreachable Doctors

Doctors. If you are in a practice and you have multiple offices in multiple cities, please have a phone number for each location. I understand you have 3 offices and different schedules each day. Why do you have one phone number at just one office? I'm not talking about 1 number for all 3 offices that is answered wherever you happen to be. I'm talking about calling the number assigned to only office A, when the patient was seen in office B or C. Then your receptionist tells me the following:
1. Oh. They're not in this office today, but we can leave a message for him to call you back when they return later in the week or next week. OR
2. Sorry, we don't have a direct line to that office. We take all the calls here. They may call us later for their messages and you may hear back from them today. Otherwise it won't be until they get back here later this week or next week.

So how do I reach the doctor to inquire about the miswritten prescription he just wrote? I'll tell you what. Let me put the patient on speaker and you can repeat exactly what you told me. Or should I just tell her she has to drive all the way back to that office to have him fix it? Tell her it's the doctor's fault? Tell her she can ask the doctor for a complimentary coffee and Danish and tank of gas for her inconvenience?

Let's give the pharmacy scenario. In any town in this country, there is a street that has 3 or 4 of the same pharmacy chain on it. Suppose they only have 1 phone number for that pharmacy's 3 or 4 stores in that one city. Let's suppose Pharmacy A is the only store with a phone. Your patient is at Store B looking for an e-script and you swear you sent it. You call the only phone number you have, to store A and they tell you they can't look it up, but will be happy to leave a message in case store B tries to call them for something later. Looks like your patient is out of luck.

Seriously. It happens. It's hard enough to keep track of my own schedule, let alone where certain doctors are on certain days at certain times. I don't care about being a super sleuth. I am great at investigating all sorts of issues in the pharmacy world. I am, however, concerned about the inconvenience you are presenting to my patients. To your patients.

Wednesday, February 27, 2013

Pick One, Any One

I get paid to fill prescriptions. (Actually, we don't get paid until you actually pick them up and pay for them, but you're smart enough to understand that.)
I don't get paid if you don't pick up your prescriptions.
I don't get paid to return it to stock and reverse the claim from your insurance.
I don't get paid more if you come in after 2 weeks and decide now you want it after I reversed it.

I also don't get paid if you have me fill something, then decide you'd rather have it somewhere else. I also don't get paid to reverse this claim either.
I had a guy call to verify we had refilled his prescription. He asked about the copay, if it was ready, why he was taking it, asked a few more questions, then thanked me for my time and said he'd be down shortly to get it. Fifteen minutes later we get a call from a competitor. He wants it there. Why? It's the same copay. It's not already filled. It's not billed to his insurance. It's here. It's waiting for him. For us to reverse everything, transfer everything, then for them to fill everything for him is going to cost him more time. If you wanted it there in the first place, tell me that while you had me on the phone. I could have reversed it while I was talking to you. The other pharmacy could have transferred it from me. They could already have begun the filling process. You wouldn't have to wait for all of this. Yet I keep coming back to "it. was. already. filled. and. waiting. to. be. picked. up"!
It's like ordering a pizza from Domino's, calling back to make sure it was done, adding an order of boneless wings, then driving to the Pizza Hut next door and placing a carryout order at the counter. No logical reason for it.
I believe we should be able to bill for "services rendered". We filled it, billed it, and counseled on it. Then we reversed the claim and returned it to stock. The insurance is only paying one pharmacy (not mine) for the entire package.
The average cost to fill a prescription is $10. Now that is $10 WITHOUT any pills in the bottle. Never mind the cost of what we actually "dump" in there. It takes as much work to reverse everything. I suggest we bill the patients a $30 return-to-stock fee. That's $10 for the initial fill, $10 for the reversal process, and $10 for extra processes (answering the phone after the automated system called you to tell you why it called you, counseling you on medication you are not receiving, etc.)
Unless your doctor calls to tell us HE changed your medication, then let's post this sign:

"All prescriptions NOT picked up in 13 days will be subject to a $30 restocking fee. This fee will be charged directly to you and will not be reimbursed by your insurance company. Any prescriptions sent to us by your doctor that should have gone to another pharmacy will be charged the same fee (same amount of work)."

Tuesday, February 26, 2013

Prescriptions are Paper

So far, I am able to report I have found the one reason to recommend electronic prescriptions over paper versions.
Did you ever wonder? What happens to a paper prescription from the second it is handed across the airspace between the doctor and the patient, to the time it is proffered to our staff? I used to believe my way was normal. I would politely take the prescription, fold it, place it in my pocket, drive to the pharmacy and, presented none the worse for the wear except for the double crease, hand it to the friendly technician. That is, until I was on the receiving end of numerous prescriptions that required Haz Mat suits and tongs to handle.
The worst part is, there is no predictor for its state of decay based on age of the prescription. I have received prescriptions dated over 1 year ago that look better than some that were walked directly across a hallway 30 seconds after leaving a doctor's office.

I say, if a dentist is going to send all of his patients to my pharmacy and all of those prescriptions have blood on them, I am going to avoid that dentist.
If you vomit on your prescription, do not try to blot it off then hand it to me, unassuming, as if nothing was wrong. It's not a coffee stain and it smells. And it's still damp...
Unless that brown stain is a round ring, I'm not assuming it's coffee. Call your doctor, tell him you lost it, and to just call me with a new one.
It's not a napkin or placemat. Please do not eat on it or wipe your hands and mouth on it. I've been presented prescriptions with more food and grease on them than the fry cook sees when cleaning the fryer.
By the way, while I do appreciate you blocking your coughs and sneezes from entering my bubble, please don't use your prescriptions as a shield. Instead of hacking them directly on me, you're now handing them to me; with the chunky droplets attached. Yum.
Ladies. What happens in the purse must stay in the purse. Seriously. What goes on in there to explain the deteriorated state of the papers you just handed me? War-torn Republics have bombed out buildings that are in better shape than this.
These are all prescriptions I have seen that have been written the same day they were brought to me. I can't even imagine the tragedy that befalls a prescription someone haphazardly places on a kitchen table or dresser or one that gets to spend the night in any of these places. The horror, the horror.

Monday, February 25, 2013

I want it all together

(Another) Conversation with myself...
Me: I want all my medications filled at the same time.
CP: And I want the Olive Garden Never-Ending Pasta Bowl to be available as takeout.
Me: So you're saying you can't do it?
CP: No. I am saying I'm hungry and they should feed me whenever I feel like eating, for free.
Me: Again. What's this have to do with my monthly refills?
CP: Nada. But I will need a few concessions from you in order to fulfill that obligation.
Me: Can do.
CP: Repeat after me. "I...state your name..."
Me: "I...state your name..."
CP: Funny. Anyway...I promise to never ever miss a dose of any of my medications. I promise to never miss a doctor's appointment. I promise to never ever get sicker, or better for that matter, and necessitate a change in my medication regimen. I promise to always take my medication exactly as prescribed, including reading the labels before taking each dose. I promise to always call or visit my doctor when there are 7 pills remaining in my bottle. I promise to make my doctor always prescribe the same quantity for all of my medications so they will all come due at the same time. I promise to make sure he writes for the same number of refills on everything to ensure I only have to see him once for everything too. I promise if I expect this of you, I should expect the same of the person who actually writes them. I promise I will never hold you accountable for "loaning me a few to get me through the weekend" if catastrophic circumstances arise and I am unable to meet any of the above-mentioned obligations. I promise that all travel plans I make shall go through you and my travel agent simultaneously so I know when to get my refills to properly prepare for my trips. I promise to call my own insurance company to request any prior authorizations. I shall also make note of when these authorizations expire and proactively request them in time for next year's refills so I do not lapse in therapy. I am committed fully to my own health and well-being. I'm good enough. I'm smart enough. And doggone it, people like me.
Me: Amen. Anything else?
CP: You promise to give me 2 days to get them all ready for you. You promise to call to get a copay total so if something is unexpectedly high, you will call your insurance to sort it out before coming to get them. You promise to pick them up at off-peak hours.
Me: That it?
CP: I think so. I'm sure someone else will have an addition or two. But this is a good start...

Friday, February 22, 2013

New Lows

Words of advice I impart upon all new pharmacists/interns/pharmacy employees:
Just when you think you have seen it all, along will come someone to lower the bar significantly. It is when I get comfortable and complacent that a new nadir is reached. Not only was the bar lowered into an abyss that had previously not existed, someone jumped on it to drop it even further.

Doctor handed a patient a prescription sheet. The patient had been in and requested refills for his 3 medications by handing the doctor his bottles. The doctor simply wrote the patient's name, the 3 prescription numbers, "X3 each", then signed it. Yep. Pretty sure in no state is this legal. There is no drug name. No quantity. No strength. No directions. (Is X3 equal to 3 times total? or this plus 2 more?). No date. Nothing. Not even sure whose numbers they were. Surprised the doctor didn't just sign the bottle instead.

This was followed by a patient who visited her doctor. While the office is in the same plaza as my pharmacy, she felt a wee bit peckish and decided to stop home for a quick nosh. Feeling sated, she cast her shadow upon my counter, at which time I approached her.
Full Customer: I need to fill my prescription.
CP: Lovely. We do that here.
FC: I can't seem to find it.
CP: Well that is a bit of a problem then, innit?
FC: Not really. I left it on the kitchen table. Can you just call my doctor for it?
CP: Nope.
FC: Why not? I know what it is.
CP: And you know where it is.
FC: You mean I have to drive all the way back home to get it?
CP: Of course not. I did not imply that at all. Though it is one solution to your problem. Might I also suggest, since we are in close proximity to your doctor, actually getting in your car and driving to his office?

Thursday, February 21, 2013

All or Nothing

Prescription labels have a lot of information on them. As with all directions, you must obey the entire label, not just the parts you deem relevant.
In college, when friends would skip classes they'd ask for my notes. (I dated each lecture.) I'd hand them every other or every third page just to see if they were paying attention. They didn't.
Whether assembling a bike or installing a ceiling fan, failure to follow each step could prove catastrophic.
Why do people treat medications differently? Why do they stop reading where it is convenient?
Directions read "take 1 or 2 tablets by mouth 1 or 2 times a day as needed for pain". That's what it says. This allows for a maximum of 4 tablets to be taken in a day. Yet this conversation will occur...

Half-Reader: I'm out of medication.
CP: How?
HR: Took them all.
CP: How?
HR: By mouth.
CP: Obviously. I know it's big, but did you put them all in at once?
HR: No. It plainly says "as needed" on there so I took them as I needed them.
CP: But it also says 1 or 2 at a time. And then it says only 1 or 2 times a day.
HR: I don't read that part. All I know is it says "as needed" and I needed them. And now I need more.

Late Refiller: But it says I have 3 refills.
CP: It does say that. What else does it say?
LR: Quantity 30?
CP: Uh-huh. And after 3 refills?
LR: My doctor's name? Who's not really my doctor anymore because I...
CP: Follow along with the bouncing ball. Now read with me.
"3 refills..."
LR: "3 refills..."
CP: "Until..."
LR: "Until...January 31, 2013". Oh.
CP: Good job.
LR: So I can't get it then?
CP: Not since it is now February 2013.

Wednesday, February 20, 2013

No One Called Me...

It think it's proper courtesy to discuss the inclusion of someone in your plans with that particular someone. This is especially true if you are going to promote a relationship between parties where both must be active, willing participants. Instead, I am left with the feeling of "he doesn't love me. he only used me to get what he wanted. he never calls. he never writes..."
Of what do I speak? Simple. I was in a doctor's office a short while ago. While leisurely perusing the journals and other media they had to offer, I noticed the television in the room. It was promoting all the fine services this particular office had to offer. One of them came as a great shock to me. It read:
"Please contact your pharmacy when you need a refill. We have teamed up with them to fill your prescriptions electronically."
Really? YOU did all that? First, I don't remember being invited to the team meeting. I don't recall getting a jersey or uniform. (I guess that makes me the ball girl?) I guess on this "team" I'm not a star player. I can't get my own direct hotline number to contact anyone else on the team if there is an issue with these electronic prescriptions you keep sending me. We can't send back an electronic prescription to our teammates in the offices. That would be spectacular. And if YOU are sending them electronically to ME, why are the patients instructed to contact ME for a refill? It doesn't say anything about "they have teamed up with us to send in your refill requests and we promise to reply to them in 24-48 hours". That would be less one-sided.
Thanks to this message, the onus for the entire patient-doctor-pharmacy prescription triangle rests squarely on the pharmacist. The doctor is blatantly forcing us to shoulder the blame for all refill issues. Read it again "please contact your pharmacy...". It means quit calling the doctor's office. If it doesn't get requested? Pharmacist's fault. If it doesn't get returned to the pharmacy? Pharmacist's fault. Call and pester your pharmacist. Even though "we teamed up with them", call the pharmacist who will have to leave a message just like everyone else.

Tuesday, February 19, 2013

White Coat

The White Coat carries a certain cachet to it. It signifies our expertise and medical knowledge. It signifies us as a most trusted profession. But is it really necessary? Do we have to wear it to give advice and counseling? For people to know we are a licensed professional?

Good Idea: Walk on to the floor at work and counsel patients. Help them select over-the-counter items that are appropriate for them. Offer advice and counseling on these products. Question them about prescription medications they are taking that may affect your recommendations. Demonstrate your expertise and show why people trust you. You'll be labeled a hero and people will love you.

Bad Idea: Sans white coat, walk up to strangers in the OTC aisles of your local Target, Wal-Mart, grocery store (or a place that does not employ you). Start counseling them and offering advice about why that hemorrhoid cream is not the best choice for them. Ask personal questions to determine their best treatment options. You'll be labeled a creeper and people with straightjackets will visit you.

Friday, February 15, 2013


Selecting medications is not at all akin to choosing produce. There's no melon squeezing for one. We're not looking to avoid wilted or brown lettuce and we're not stealing small samples when we fill your prescriptions.
I understand, when buying OTC items, looking for the best date possible if it's an item you use only as needed or rather infrequently. Some people approach it like the Milk Lady in "Clerks", pulling out every bottle and placing them on the floor, hoping to find that one gallon that never expires. 
Prescription products are a bit different. Manufacturers make the products. They ship them to warehouses or wholesalers who rotate their inventory. They ship them to the pharmacy. If I order and receive a cream that expires in 9 months, I have to assume that's the best dating available. No, I will not call another pharmacy to check if their creams are fresher than mine. 
Itchy Lady: It's to treat an infection I have now. 
CP: So use it. 
IL: But I have recurring infections. Sometimes in the fall. Sometimes a year or two later. 
CP: Look, you're treating an active fungal infection that may or may not recur next fall. Let's focus on fixing that little problem right now. Instead of trying to find something that may be dated a month or two longer, how about you open up that tube and start using it now? We could also focus on figuring out what's causing it to recur and preventing it in the future. 
IL: But I don't want to have to pay again in a year or two. 
CP: And I don't want to shovel my driveway when it snows. My options are either to move (prevention) or shovel (active treatment) or do nothing (let it fester).

It's not just the creams that get people acting strange.
Had a customer ask us to fill her prescription while she watched. That meant grabbing the bottle off the shelf and counting the pills whilst in front of her. It's not as if we opened a bag of Doritos from the cupboard and pulled off the Chip Clip, risking them having gone stale. My top 100 drugs don't have enough time to get to know each other on shelf in a day, let alone to collect a mote of dust to dirty their labels.

Also had to keep a customer's eye drops and insulin in the coldest part of the fridge for her. She would place each bottle up to her cheek to ensure they were maintained at an appropriately cold enough temperature for her liking.

Nothing like that new prescription smell! 

Thursday, February 14, 2013

Close the Pharmacy

You did not misread that. You misinterpreted it. Pharmacies used to be hidden. Pharmacists were accessible if they walked out to you. Which we often did. And we were more valued as a result. You could no more stare at us over the tops of the shelves than you could hear us whispering on the phone in a corner. Times have changed. While the whole open floor plan concept works great in building a house, it does not suit the pharmacy. I say close it.
We are truly a few metal bars and a coin-operated food dispenser away from being animals in a zoo. People stare at us. They yell at us from anywhere in the store. They throw stuff at us (one bag with 3 boxes of Lovenox coming at my head is enough). They put their kids on our counters. I swear someone took my picture at my last store too. Seriously. What other profession allows its professionals to be treated as such?
I say close it. If the "centralized pharmacist" concept is going to work, make the rest of it happen behind the scenes. This way, when I have 3 techs each on a phone line and I am checking something, no one can smart off saying "there's 4 people back there not helping me". Piss off. Now you see me, now you don't.
I want the pharmacist to be the focal point. I want to perform my professional duties. You just don't need to know what else goes on. "Pay no attention to the man behind the curtain." I don't really want or need to see how my food is prepared in the kitchen (Hibachi is exempted from this) nor how my friends' colonoscopies are performed. I don't care. All I want is for my profession to be taken seriously again.
Close the pharmacy. Put up a wall. Put a pharmacist out front in a consultation room or at the counter, in a chair. Give her an iPad to assist patients while their medications are being filled. Slow down the whole process. Focus on the professional aspect of our jobs. Focus on our knowledge. Focus on why we spent so much time and money at school. If we stop trying to squeeze blood from a desiccated idea (profit margin on pills?) then we can look at new ways of highlighting our place in the health care world and getting paid for it.
Doctors live an insular experience, hiding behind layers of staff and walls. They visit with patients, one-on-one, privately going over medical history, diagnoses, and treatments. Pharmacy needs to examine this concept. I have an outline for this model.

Wednesday, February 13, 2013

Take a number

At my pharmacy in the phuture...
...Now calling Number 27. Number 27? 27? Anyone #27? No? Okay, Number 28. Number 28? 

I'm torn. We should either go full-out deli counter or lottery ticket luck for our wait times. 
1. Deli Counter/DMV-find the red ticket machine, take a number, sit down. When your number is called, come to the counter and drop off your prescription. We will process it right in front of you. This includes data entry and insurance billing only. Hold on to your ticket and have a seat. When the actual filling and checking process have been completed, we will recall you to the checkout station. 

2a. Lottery System: We will place random wait times in a hat. They will be weighted according to our approximate wait times and may fluctuate hourly. They will be represented as follows:
 2 tickets---10 minutes
 3 tickets---15 minutes
15 tickets---30 minutes
50 tickets---45 minutes
100 tickets--tomorrow

2b. Carnival!: We will have a dart board with balloons covering little tickets with times. Pay a fee, throw a dart, get your wait time. Here's your prize! Done. If successful, we could expand to a pond with little rubber duckies. Kids could play while you wait. Imagine how fast that 45 minute wait time will seem while your little darling is splashing around trying to win a goldfish. Ah, the joy! 

Since I'm a friendly pillar of the community and everyone loves me, there will obviously be a game for emergency waiters. If your prescription meets the criteria laid out clearly at the kiosk (*), you will have 2 choices for wait times: 6 minutes or 11 minutes. 
(*some restrictions apply--must be for a sick child, an antibiotic, from an ER or a hospital discharge, must be written the same day. Applicable exemptions may occur and final say rests solely with the carnival barker, um, pharmacist.)

Maybe we could employ all of these. Let's make the pharmacy a destination for the whole family. Young, old, well, infirm; bring them all. Watch as the pharmacist and staff juggle bottles and perform amazing tricks with their samurai spatulas and acerbic wit. 

Tuesday, February 12, 2013

The Subway Treatment

I say pharmacy should just go all out with their removal of the profession of pharmacy from the actual practice of pharmacy. Let's become even more marginalized and transparent. Let's become Subway.
At Subway, no one cares if the lines to order food snake out the door. They can clearly see and hear the entire process. In pharmacy, while they can view the whole process, it is from a distance which leads to a misinterpretation of what we are actually doing. No one is close enough to truly SEE the process. Let's change that. It'll work like this:

Place Order Here: Present your prescription to the first technician. He will input your "order" into the computer. He will grab an appropriate-sized vial and place it on a tray so you can identify with it as your own down the entire line.
Second Station: Second Technician will make any necessary changes to your order. He will call your doctor to clarify the incomplete or illegible order. He will do this right in front of you so you can hear them say "Oops. Must have been a computer error."
Third Station: Third technician will fix your insurance and billing information right here. She will call your insurance right in front of you so you can hear the complete conversation and understand why your copay is so high; why your deductible is so high; why this needs prior authorization.
Fill Station: This is where they will select the pills and count by fives right before your very eyes. Prepare to be dazzled as they deftly maneuver your little capsules with a shiny spatula on the tray before you.
Wrapping: You get to watch up close as the professional label slapper expertly rolls your freshly printed label clearly, neatly, and straightly around your circular bottle. (Tips and applause are welcome.)
Checkout: Pay up. Simple. No arguing, fussing, fighting, or cursing allowed. No whining that the Subway across town is independently owned and operated and they only charge blah blah blah...
Extras: Those a la carte, impulse buys of a bag of chips and a cookie can now be purchased. Here they are called Pharmacist Consult. As these items are not free, but do complete your meal, neither is her advice free. So make it a meal and have a chat. Enjoy your prescription and get to know your pharmacist here at Subway Pharmacy.

Thursday, February 7, 2013

The Bank Heist...

Drive-Thru Bank Teller: How may I help you today?
Lost Pharmacy Customer: I'm here to pick up my money.
DTBT: So you're making a withdrawal?
LPC: No. I'm here to pick up my money. I need to buy gas for my friend from yesterday's post. And post his bail.
DTBT: I don't have anything here for you.
LPC: Yes you do. My company sends it directly to you every Wednesday. Today is Friday. I gave you people 2 extra days and it's still not ready!? You lost my money?
DTBT: No sir.
LPC: You sent me an email telling me it was here and now it's not. What is going on there? All I want is my damn money. All you do is just slip it in the drawer or slap it in that tube. I come here every week and get the same thing. I've been out for over a week now and my family is going to starve and it's all your fault.
DTBT: We do get your direct deposit every week sir. In fact, we receive them from thousands of companies for thousands of employees all over our great nation. As we have informed you previously, you must actually make a request for a withdrawal. You can accomplish this through your online account or those little slips of paper designed to be completed by you and placed into my little drawer or tube. Perhaps the ATM attached to the wall immediately behind you could be more accommodating for you.
LPC: You people do this to me every time. It's your job to know how much money I get in my account each week and how much I want when I come here. I put enough money in here that I could own this bank by now.
DTBT: Technically not. You're not even close to paying off that pneumatic tube you're holding right there. Besides, you keep withdrawing it.
LPC: Then give me all my money so I can transfer to the bank across town.
DTBT: Fine sir. However you'll have to come inside for that transaction.
LPC: Can't...No shoes.
DTBT: I shall allow it this one time since no one is waiting in here.
LPC: Can't...No shirt.
DTBT: No worries sir. For a fine, upstanding gentleman such as yourself, I shall make another exception.
LPC: Um. Can't... Got no pants either.
DTBT: Do you do this at the pharmacy too? Arguing with someone but not listening to reason or fact? Maybe your doctor sent it. Maybe it needs a prior authorization. Maybe there was a delay, like your paycheck. Maybe you forgot to reorder it yourself, like your withdrawal. You could come inside to discuss this further, but please go home and add clothes.

"What would happen if a bank appeared at my pharmacy" or
"How banks would be treated if people thought they were pharmacies."

Maybe we should switch signs one day...

Wednesday, February 6, 2013

It's not the price of gas...

...the setting- a long, lonesome highway. East of Omaha. Along the route, miles back, in a quiet car dealership the phone rings, breaking the solitude of closing hour with its shrill announcement...

Irate Customer: I'm going to sue you.
CP: Go ahead sir, everyone else is doing it these days. You'll have to get in line behind the woman that died in yesterday's post. Why are you so special?
IC: Your car tried to kill me.
CP: Christine?
IC: Um, no.
CP: What happened?
IC: The gas ran out.
CP: It ran out. I see. And how is that my fault?
IC: No one told me it was going to happen. I've been sitting on the side of the road, without gas, for over 3 days now.
CP: Sir. There's a light. Did you see a light? And a "ding" sound. Did you hear a "ding"?
IC: Yes to both, but YOU didn't call me. I don't pay attention to those things.
CP: So despite a light that shows "Low Fuel" and an audible signal indicating you are running low on fuel, you kept driving? How many gas stations did you pass from the first signal until you actually ran out of gas?
IC: It doesn't matter. You should have called me or told me before I left here. It's not my job to know car things, that's your job. I'm going to use another dealer down the street.
CP: How can they help?
IC: They wash my car for free and they have a lady there who calls me when my tires need rotated and oil needs changed.
CP: We offer those services as well but she is not a real woman. You do know that, right? She's a computer.
IC: I'm also out of washer fluid.
CP: But how? We gave you a 6-month supply when you got the car.
IC: I used extra.
CP: Who told you you could use more?
IP: They said I could use whatever I needed whenever I needed it. The guy that reviewed everything about my new car with me when I bought it.
CP: I bet he also showed you where the gas tank and washer fluid reservoir were too?
IP: That's neither here nor there. The point is you should be held accountable for my car running out of vital fluids.
CP: I bet you drive your pharmacist nuts too. You're probably "that guy". The one that sits in his chair, every single day, taking his medications and somehow not noticing the bottles are getting empty. This, despite obvious visual (diminishing quantity) and audible (the bottle sounds emptier when you shake/pick it up) clues begging you to refill them. You probably "don't pay attention" to the labels either. You know, the ones that tell you "no refill" and how much you are allowed to use at a time.

Sorry, our service desk is closed right now. You'll have to call for a tow.
This has been "What would happen if people treated their cars as they do their prescriptions".
Or..."5pm at the pharmacy counter would have nothing on rush hour".

Tuesday, February 5, 2013

But her Refrigerator was still running...

<fade in> camera opens behind a young woman, seated at a kitchen table. Hands placed beside her plate. A fork in the left hand, knife in her right. Camera moves around the table, slowly panning up to show the gaunt, emaciated face staring back through hollow, lifeless eyes.
Enter Cynical Patrolmen...
First Responder: What happened?
Second Responder: She died.
FR: Obviously. How?
SR: Murder. Definitely murder. Yes. Murder by starvation.
FR: But how? She's just sitting here, peacefully.
SR: Precisely. Apparently she grew so accustomed to having everyone else take care of her that she didn't notice she wasn't eating.
FR: Who can we blame?
SR: No one. Perhaps the grocery store, her local market, everyone. Everyone else except her, I guess.
FR: But she died.
SR: As happens when people do not eat. It's sad, really. Notice her refrigerator is empty. Her cupboards are bare. No one called to tell her she was out of food. No one called the grocery store to place an order to refill her pantry. No one called to tell her any food was ready to be picked up at the store. No one billed any food to her credit card for her or ensured delivery of it to her house for her. She waited and waited for someone to tell her she was out of food and needed to eat to live. This poor woman suffered needlessly because no one had the decency to do their job. She waited until she just died.
FR: She must have been out of food nearly 2 weeks. Too bad she never thought to go to the market herself. All of this could have been avoided <starts to cry> if only...
SR: If only?
FR: If only she had taken initiative. Taken her life into her own hands. She was so young. She had a cell phone. A car. Money. She could have called the store. Visited it personally. Paid for food herself. Why did this have to happen? Why CP?
SR: People have become so accustomed to having everything done for them, they don't remember how to do anything for themselves. I bet if we check her medicine cabinet, all of her bottles will be empty too. They'll probably all have refills available, but since no one called her to remind her to fill them, to pick them up, or to actually put them in her mouth, she never took these either.

This has been a production of "If people took care of their kitchens like they take care of their health" or "What would happen if pharmacies stopped all of their compliance calls".

Monday, February 4, 2013

Where is it?

Two roads diverged in a wood and my, my script took the one less traveled...
By nature, I just have to know. I was the kid that observed and studied everything around me to figure out how it all works. I am still possessed of the need to know. I will always find the answer but I wish it were not so difficult some times.
Two family members were seen in the same office at the same time for the same reason.
Two family members arrived at my pharmacy looking for their e-scripts.
One e-script was in my queue.
One was not.
It was noon. Doctor was at lunch.
Patient returns just before 5pm.
I call the office to request a verbal order. And, as inquiring minds are wont to do, to ask what happened to the other e-script.
Nurse: It says it was sent.
CP: When?
Nurse: Same time as the other one.
CP: Funny.
Nurse: I get this all the time where the system says it was sent but the pharmacy calls and didn't receive it.
CP: Funny.
Nurse: What's that?
CP: It says "refill too soon. filled today". Can you tell me WHERE it was confirmed as sent?
Nurse: Oh. Somewhere else...
CP: Please walk back there and slap your doctor for me.

Friday, February 1, 2013

Pharmacy of Choice

You picked me. Thank you. I will do my best job for you. Thank you for selecting Cynical Pharmacist when there are so many other, rather vanilla options out there. Special services and hours aside, you really are picking a pharmaCIST not a pharmaCY.

...Some time later, the novelty wears off and another suitor enters the picture with promises of delivery, or in-home medication swallowing classes, or chocolate-dipped KCl 20mEq tabs...

As with all new relationships, some troubles lie ahead.
Everyone is perfect until you get to know them.

New suitor only has hours from 7:15am until 3:45pm. They deliver after they close until 3:59pm. They are closed all weekends and holidays, including non-government and non-U.S. ones (Boxing Day, Canadian Flag Day, Canberra Day, and in observance of the equinoxes).
Anyway, now you find yourself without medication for an unexpected long weekend. Who knew that May starts off with May Day, Constitution Day (Japan), Greenery Day (Japan), Cinco de Mayo, Bank Holiday (UK), and National Teacher Day and your new pharmacy observes them all? Now you call me...

Traitor Patient: Please, former favourite pharmacist, can you not help me this one time?
CP: You left me.
TP: I thought they were going to be better.
CP: Uh-huh.
TP: They promised me flowers with every prescription. Gift Cards galore. They said I'd have no side effects from THEIR generics
CP: And?
TP: Now they are closed and I am without. I will most certainly meet an unfavourable fate should you not find it in your heart to provide a few pills to save mine.
CP: Nae.
TP: Prithee, why not?
CP: You left. You broke the sacred bond and trust we had developed. I knew everything (that was wrong) about you. I was always there for you, not just when it was convenient.
TP: And it can be that way again.
CP: Alas, it cannot. It has to be a clean break. I can't have you crawling back to me every holiday or weekend or every night wanting me to be there for you.
TP: We were good once. You used to help me.
CP: And you turned to the Dark Side. You made your bed with them, you have to accept their failings. I'm not taking you back. It is for the best. Through this, you shall grow. Through this, you shall learn preparedness. It has to be this way.  "Don't want to be your fall-back crutch anymore."
TP: At first I was afraid. I was petrified.
CP: You will survive.