Fun at Work...

I believe in asking the question you want answered and answering the question that was asked. An exercise I like to use with my staff is the time.

CP: Tech, do you know what time it is?
Tech: It's 10:30.
CP: Wrong.
Tech: What? How is that wrong? I am quite certain the time is 10:30.
CP: The correct answer is either yes or no. I only asked if you knew the time. I am not actually interested in knowing it myself.

I use this to point out the customer interactions we have daily.
From now on, I am going to answer the question that was asked. And just for fun, it may not always be 100% correct...

Most Customers: Is my prescription ready?
CP: Yes. Yes it is.
MC: Ok. Thanks.

or...

MC: Did my doctor call anything in for me yet?
CP: Yep.
MC: Ok. Thanks.

or...

MC: Is it time for my refill yet?
CP: Nope.
MC: Ok. Thanks.

MC: Can I ask you a question?
CP: Answer A: Let's see...started with a question word, "can" and finished with a question mark, so I would have to say the answer to your question is "Yes. Yes you CAN ask a question." Next person please!

Answer B: You just did. Thanks for playing.

If you ask me a yes or no question, expect that answer. It should not be expected, however, that I will answer your question with a question to get to the question you really wanted to ask. If you want to know if a prescription is ready for a Smith, John then ask that. If you wish for the correct answer, ask the correct question.

Pharmacy Awards...

We all have our favourite office members who leave voicemails for us many times a day. From doctors to nurses to secretaries to family members of the practitioners, they are memorable for many reasons. I say we should reward them for their spectacular behaviour.
Let's have an annual awards ceremony for them. Here's how it would work. Each month, all local pharmacies would nominate one voicemail and one person in each category for a prize. At the end of the year, a winner would be chosen from this list of 12. We would send the person a letter of congratulations and a prize to acknowledge excellence in their category.

The Categories:
-Fastest Talker with No Errors
-Voicemail Missing the Most Information
-Best Supporting would be the Hardest Office to Track Down to Verify All Missing Information
-Most Articulate/Best Elocution
-Talker With the Most Food in the Mouth
-Most Messages Left Immediately Before Lunch and Closing Time
-Least Intelligible Message
-Least Prepared Caller (um, let me find that chart. it was just here, um, hold on, he forgot the strength and um...)
-Snootiest Messages Left (Yeah, we sent this last week and patient says it isn't there. <sigh> So here it is again)
-Most Messages Left to Cancel an E-Script (this should be a person-to-person call)

We could invite all the nominees to a contest luncheon. They would each try to transcribe the nominated messages. The overall winner would be the person who got the most correct on first playback or the person who restrained herself from slicing the jugular of one of her colleagues for her role in warranting this contest entirely.
Perhaps they'd learn something. Perhaps not. Perhaps they'd meet their competition and try to outdo them for next year's award.
Even better, we could have the local winners compete in State Regionals. The winners of those rounds would get to compete Nationally at APhA each Spring.

Bring Your ____ To Work Day

Some places have job sharing and cross training as part of their standard operations. There are some universities that have Medical and Pharmacy programs integrated, to a degree, so they can appreciate the other's profession (they share a few classes). As with all education, what-I-learned-in-school is nothing compared to "the real world" experience. To this end, I say let's have a "Bring A Professional to Work Day".
Doctors would have to have a pharmacist follow him all day and allow her to interact with the office staff. From this she would gain insight into how an office is run and what it's like to be on the receiving end of all of those pharmacies calling for petty annoyances like missing information on e-scripts, prior auths, refills, etc. And we'd get a lunch break!

Pharmacists would have prescribers following them around the pharmacy for a day. They would get to see what an e-script looks like after they hit "send". They would get to see that not all drugs are $4 and certainly not free at all pharmacies. They would get to see what it's like to deal with insurances in real time. We'd even "allow" them to call for an override or other insurance rejection. They may be lucky enough to have to phone their own office to request missing information or a prior auth. How spectacular if they got to phone a colleague to get his missing DEA#, or chastise him for not signing yet another prescription! The tour would not include the bathroom, since we never pee. And that lunch you enjoy?; it's called a Ziploc baggie of Cheetos stuffed in your pocket and a random handful of something edible someone left open on the counter that you just happened to walk by.

In all seriousness, it's not a bad idea. We could call it Adopt-A-Doc or Friend-A-Pharmacist Day.

Another Insurance Rant...

How to tell the insurance companies are just messing with us...
CP: Hi, CP calling regarding a rejection I am getting.
Insurance Gal: Ok. I can help you with that. And this call is being recorded for quality assurance and training purposes.
CP: Lovely. Hopefully someone will listen to this call.
IG: I'm sorry?
CP: Nothing. I have a lovely gent here who is trying to fill a prescription for Androgel and the rejection tells me it needs a prior auth.
IG: It does.
CP: Is there a preferred alternative?
IG: Maybe.
CP: Do I have to guess?
IG: Yes. I don't know any. I just read this little computer script.
CP: Ok. How about Axiron?
IG: Nope.
CP: Testim?
IG: Uh. Nope.
CP: Androderm?
IG: Huh-uh. All Testosterone products require prior auth.
CP: You could have said that first.
IG: It's not on the script.
CP: Ok. But will they be covered?
IG: <this is verbatim> "Yes. Absolutely. As soon as the doctor faxes us the prior auth form, it will be approved."
CP: So...If I have been paying attention and I have this right, let me explain. No, there is too much. Let me sum up...
I spent 2 minutes trying to fill this. Then 7 minutes dialing you, typing in prompts on the phone, entering, reentering and telling you my NCPDP number and name and first initial of last name, then 5 minutes talking with you to find out you will fax the doctor a request for a prior auth which he will fill out and fax to you so the drug that requires prior auth will immediately be covered?
IG: Sounds about right.
CP: And it doesn't matter which product he picks? Wouldn't it make more sense if, when I processed this the first time, I simply received a Paid Claim?
IG: Perhaps.
CP: But then you and I could not have engaged in this witty tete-a-tete.
IG: Indeed.
CP: And I'd have nothing to complain about next week and all of my customers would be less grumpy because their wait times would be less and the doctor may actually be able to remember to sign his prescriptions because he wasn't dragged away for some stupid prior auth form for a drug that you're going to automatically approve anyway.
IG: Correct. Is there anything else I can help you with today? I do have the time.
CP: Alas, I do not...
...Despite all my rage I am still just a rat in a cage...

Nuvaring Ideas

Did everyone see the NuvaBling commercial Saturday Night Live did a couple months ago? (If not, it's posted on here somewhere.) As we were discussing some of our best Nuvaring stories around the campfire at work, okay it's more of an oscillating fan, we hit upon a new idea for them to extend their patent life.
What if they made the Nuvarings out of the Neon DayGlo Bracelets and necklaces?
Imagine the possibilities with this:

Easy to find.
Fashion accessory when the 3 weeks are up (though some already wear them as jewelry.)
Different colors for the holidays.
Changes colors, like a mood ring. (From "Excited" to "Honey, not tonight".)
Changes colors when it's time to change.
How about ones that blink? NuvaBlink? Add a little custom trim job with an arrow or landing strip and you have a blinking runway guiding you home.

Of course, on top of remembering to take the stickers out of the box when filling these, we'd also have to remember the plastic connectors. So every 3 months you can connect them together into a necklace. Or after a year, a jumprope, or hula hoop...

L.aw E.nforcement A.ppreciation D.ay

In order to foster a more harmonious relationship between law enforcement and pharmacies, I've decided to have a Law Enforcement Appreciation Day (LEAD). For some reason, many stores continue to order large quantities of Sudafed for their pharmacies when the pharmacies do not or will not sell it. As a gesture of goodwill in the community, and a way to make large amounts of cash for our employers, let's have a day where all Sudafed products are on sale to everyone who asks. Forget the stereotyping. Forget the quantity limits. Forget the fact that their IDs are cracked, stolen, or expired. Let's let everyone buy as much product as they can carry out using only their two hands. Sudafed 24 hour and 96 count boxes of the "reds" for everyone!

How does this tie in to LEAD?
We will of course let all local law enforcement agencies know of our planned festivities. There will be a parade, of sorts, of happy customers leaving our location. Simply follow the vapor trail emanating from their vehicles and you've located all the meth labs in the county. I'm also thinking we could adopt some of the bankers' tactics. I like exploding dye packs in the boxes. You know, give them an extra box that has no Sudafed, just a dye pack. They get to the parking lot and "BOOM!", red dye, of course, al over the car. Or we could have little tracers in the security tags. Officers follow the signal to the motel or vacant house, or suburban neighborhood and bust the operation. In one day, we could wipe out the problem. This would be a win-win-win-win-win for all involved.

The agencies have empty cells to fill. Bam! New tenants for the bed-and-breakfast.
The stores have sales expectations to meet. All cash-paying customers=profit!
The stores have excess inventory! Not any more.
Invaluable relationship created between cops and pharmacies.
The scourge of meth in the community and the amount of time wasted in our stores on this will be gone.

(It's not funny, but with the requirements of MethCheck and all the other work expected of us to be the gatekeepers of Sudafed, we have better things to do with our time. Like calling your doctor for your refill because you can't figure out how the whole doctor-patient-pharmacy thing works.)

And it sucks as a regular customer to have to deal with feeling like a druggie just to buy Allegra-D for seasonal allergies. Now that stain is off you too and you can feel open and proud to ask for your favourite cold remedy.

"She Told me..."

We've all called an automated line at some point, right? Everyone knows it's a machine, right? Right? Then why do so many people call or come in to the pharmacy and yell and curse us out because "She told me it would be ready today?!"
Sir, you do realize "She" is not a real person, correct?
You are aware "She" is a computer?
Are you mad because "She" sounded too much like a real person?
Do you have flashbacks to that online date you made, with a computer?
It was different back in the day of the answering machines,  remember? Your stupid friends would have the message "Hello? I can't hear you. Speak up. Haha Gotcha. I'm not really here right now so leave a message..." Yeah. At least that sounded like someone you knew.

Instead, we get...
Joe Customer: She hung up on me.
CP: Wow. You must be real boring then for a computer to dump you.

JC: She promised me noon tomorrow.
CP: Did she also promise you we'd call your doctor? She's such a tease.

JC: I was giving her my number and then she transferred me to you.
CP: Yeah. I'm the "friend" who's in charge of letting you down slowly. She doesn't really want you to call her. Ever.

JC: She said I had no more refills, but my bottle says...
CP: First, your bottle can't talk. Second, you can't argue with her. She's a woman. And a computer. You don't stand a chance. Just tuck your tail between your legs and walk away. Then call your doctor for a refill.

Feel free to press "0" or whatever number gets you to speak to a real person. Please do not press the number for doctors. There's nothing I hate more than hearing that special chirp that signals a doctor is on the line, dropping everything I'm doing to scramble to find an Rx pad, only to find out it's a customer who wants to give me a refill number. There's an option for that. Use it. But remember...She's a computer, so talk nice to her and don't press her buttons.

Do Not Fill Until...

Pass the Buck. That's the motto. At least in the doctors' offices. I loathe the "Do Not Fill Until..." dates written on prescriptions. I especially do not like the ones on phoned-in prescriptions. You couldn't just file it away until next week?
Average Customer: But why? When they are so helpful and tell you when to fill it?

CP: First, patients will argue that the doctor can't do math. This is quite often the case where doctors can't figure out how many days are in a month and the onus is on me to get the doctor to change it while the patient stares me down. Second, if it's beyond a few days, like say, 2 months out, what happens to the Rx? Sure we can scan it into the computer and put it in the queue for that specific day. But what about those stores that cannot? How do they file it? Now the burden is on the pharmacy to remember when it is supposed to be filled. If we forget the exact date? Pharmacy is in trouble and gets yelled at. If it's not ready as soon as we open that day? Our fault. If it gets lost or is denied by the insurance? Our fault again. Why can't doctors just phone it in the day it's due? Or perhaps the day before?

AC: Good questions CP! Now teach me, O Wise One...

CP: For the same reasons I outlined above. They pass the buck. If they forget to phone it in, it's their fault. If they phone it in and someone loses it? Oh well. Not their problem. Perhaps the patient was in that day and the office is completing all of the work so they can file the chart. Perhaps.

Solution: I think I'm going to flip the tables on them. From now on, when I send refill requests to the offices, I'm going to add a "Do Not Refill Until..." date on all of them. This way, they will have to send them to me only on the dates I requested. I'll have a printed message that reads "Pharmacy requests that you do not approve and return the refill request until xx/xx/xxxx. If sent prior to this date, it will be destroyed and pharmacy reserves the right deny receipt of any and all refill requests and will instruct patient to contact their office directly for new prescriptions."
Sounds fair. Maybe I'll direct my outgoing phone message to say "Thank You for calling CP. We ask that all refill requests be e-scripted by your doctor. Please contact him directly and tell him to adopt this amazing new technology. We no longer accept written or phoned-in prescriptions. Your doctor has fully agreed to this as we are a healthcare team. Seriously. They agreed to it. My message says so..."

Samples

I think that if businesses that have pharmacy departments are going to have pharmacy departments, they should treat their pharmacy departments as they do their other departments. (Note--this means businesses where pharmacy does not account for the majority of the business; formerly known as loss-leader departments.)

Grocery Stores--there's always a lady with an apron and hairnet handing out samples of meatballs or trail mix along each department of the store. Embrace this with free samples at the pharmacy. We could mix up Golytely and offer little shooters. Jell-O Nulytely shots for all!  Followed by Imodium chasers? Once a month they could offer Lithium Lollipops or Haldol Hummus?

Wholesale Clubs--Penicillin and Ibuprofen, available by prescription, sold only in 500 and 1000 count bottles. Otherwise, what's the incentive? Gallons of Purple Drink for that nagging cough? Bulk benzodiazepines would be nice too.

Discount Stores--Make pharmacy a destination by including it in your holiday sales ads. I'm not talking about advertising Claritin-D or $4 generics; I'm talking about Door-Buster sales on Oxycontin and the 512's the day after Thanksgiving. Limited quantities and hours. We'd hand out vouchers to the first 50 people in line. Imagine the revenue!

Think about this. In all of these locations, what is the only department expected to remain professional and adhere to the Federal, State, and Local laws governing its practice all while trying to practice it amidst the circus environment that these settings promote?

Laws? We don't need no stinking laws! We've already pushed the boundaries of pharmacy so far outside of the profession, we can hardly get recognized as a healthcare field anymore. I say let's go balls out with this. These locations have done more to kill the respect of our profession than they have to further it. I think we need to differentiate between the multiple types of retail pharmacies: Those that are REAL pharmacies and those that are cheap knock-off destinations. There is certainly room for this in the American market, and I'm sure in the world, but let's let the people know what to expect when they walk in the front doors. Yes, the product is the same. Yes. the pharmacist is the same professional in a white coat, but the expectations for the environment are different.

Should've been a lawyer...

I sometimes feel as if I should have gone to Law school too. But then I'd be more Cynical trying to argue cases with seemingly intelligent people and realizing they're a different shade of crazy than the people in the pharmacy world.
I present this true case, modified slightly for dramatic effect.

Office Lady: (on voicemail) "We called this in last night. Husband was there and said you didn't have anything so I'm calling it in again. <sigh> They are not in your computer. They always use PDQ pharmacy but she is paying cash. Here we go. Again...."

CP: You say you called this in last night?
OL: Yes.
CP: You say the husband was here last night?
OL: Yes.
CP: You say the patient has NEVER been to our pharmacy?
OL: Yes.
CP: Did you tell us that last night on the first voicemail?
OL: No.
CP: Did you leave the phone number for the patient?
OL: No.
CP: Did you leave the address for the patient?
OL: No.
CP: Did the husband, who came in last night, mention that his wife had never filled at our pharmacy before?
OL: I don't know.
CP: He did not. He asked for a prescription for his wife. He gave us her name. He gave us her date of birth. Our computer showed no record of "His Wife" anywhere in the database. He left. He called you. He complained that we told him it wasn't here. Did it ever once occur to you that perhaps you were the whole problem?
OL: Of course not!
CP: Of course. Not once, in my entire career in this state, have you ever, ever! called and spoken to a pharmacist here. You always leave voicemails. Always at 11:59am and 4:59pm saying "we are here until 5 today if you have any questions". Even today, with the second, irritated phone call, you left a voicemail. How about calling to find out what happened? How about talking to a real person for a change? How about, instead of getting pissy because "the pharmacy doesn't know what they're doing", you actually take responsibility for your lack of information, your lack of ability in your job, and own up to the fact that it is YOUR fault.
OL: My fault?! I fail to see...
CP: Yes. You fail. Yes, your fault that this man could not pick up his wife's prescription. All you had to say on the very first voicemail was "this is a new patient who has never been to your pharmacy before. Here is her date of birth and phone number. This way you can call her and get her information so you can add her into your system. This way her prescription will be ready. This way I won't have to waste my time calling you tomorrow and acting all pissy toward you on the voicemail because I'm too afraid of real human interaction because no one hugged me as a child."

This plays out every day in every pharmacy in every town. The nurse calls, in this case fully aware the patient has not used this pharmacy, and leaves a message. The patient comes to look for it but gives incomplete information or neglects to say they are new and may not be in the system. What is the end result? The pharmacy looks like bumbling idiots, their doctor can do no wrong, and both the patient and office know why they use PDQ pharmacy and that's what you get for trying someplace new.

You Can't Make this up...

An average day dawns, as so many have before. The phone rings and we get an average refill for an Average Joe. Unfortunately, the medication is far from average and CP must call Average Joe to tell him it needs ordered. 

AJ: Hello?

CP: Sir? This is CP calling. We are out of stock on the medication you called in earlier to have refilled. 

AJ: Okay. 

CP: I was calling to let you know it won't be in tomorrow until after 3:11. 

AJ: Okay. 

CP: Can you wait until then? Or do you need it sooner?

AJ: I can wait. I have a few left. 

CP: Ok. Then we shall see you tomorrow after 3:11. 

AJ: Okay. 

A few hours later, on an average evening of what's continued being an average day, a customer rolls up to our counter in a motorized scooter. While I am occupied with a phone call, my bionic ear hears some grumbling directed at one of my technicians. I quickly end my call and begin my rescue march to the counter. Along the way, another of my technicians indicates this is none other than Average Joe, who is mad that his prescription is not ready. 

CP: Good day, sir. What seems to be the trouble?

AJ: My prescriptions is not here. 

CP: Are you, in fact, the patient known as Average Joe?

AJ: I am. 

CP: Well, sir, I do apologize but I spoke with you not 4 hours ago about this very prescription. I personally called to tell you we were out of stock. You told me you had a few pills to last. I mentioned I wanted to save you a trip down here and you thanked me and said you'd see me tomorrow. Do you not remember?

AJ: Wasn't me.

CP: Sorry? Your name is Joe, right? Average Joe?

AJ: Must have been my twin brother? 

CP: (Thinking uh-oh, HIPAA violation. Who'd I talk to?) Your twin? But I asked for Joe, Average Joe. And someone said "This is Joe, Average Joe". 

AJ: Yeah. Must've been him. I was sleeping. His name's Joe, Average Joe too. 

CP: Seriously? You and your twin are both named Average Joe?

AJ: Yes. It's okay. I'll come back tomorrow. 

CP: Ok. See you then. 

As I walk away with a seriously astounded look on my face, my technicians are all abuzz. Shaking my head as I walk past, they say "You know he doesn't have a twin, right? He's been coming here for years and always makes excuses, but that's the first time he ever made up a twin brother." Yes, a twin brother with the same name no less. 

FastPass

I think pharmacy should adopt the Disney approach to lines at our stores. Let's have people pick up a FastPass for expedited service at our counters.
If you've never used it, it is quite impressive. You rush to the park (pharmacy) first thing when the gates open. You go to the rides/attractions (pharmacy counter) you most wish to visit that day, and retrieve special passes that direct you when to return (they give you a time window). You can enjoy the rest of the park (shop around town, go to your doctor) at your leisure then return to the ride and get in the FastPass line. You get to bypass the regular line, with a wait time of 45 minutes to 3 hours, and jump into a line with about a 15 minute wait. At the pharmacy, you'd get to drop off your prescriptions at a special window where one designated technician would immediately input your order and fill it with a time of around 15 minutes, depending on number of prescriptions, regardless of how busy the rest of the pharmacy may be. Disney distributes a limited number of these per day and the pharmacy would be no different.
Maybe we could distribute a pass for each prescription you will bring us?
There would be a limit per family and per family member.
Just for fun, we'd exempt Medicare and Medicaid patients (we already discriminate against them, remember?)
In order to receive a FastPass, we'd have to have your most current insurance on file. In fact, you'd have to scan it into the ticket box first, before a Pass would be distributed. Yeah, that's it. That's the ticket!
Yes, some people complain this system is unfair. They are the ones who didn't get a FastPass because they didn't get there early enough or didn't know about the program. Better luck next time. Now you know. Same would hold true with pharmacy. People would complain it is unfair. Next time they would know about it and could take full advantage. It would be no different than a store that offers cheap generic prices versus a competitor that does not. It is a free market and you are not obligated to shop my pharmacy. Feel free to shop elsewhere (ride another ride).
Note: This is completely different than that sham of a program certain other so-called "pharmacies" offered as a 15-minute guarantee. If a program works at a place like Disney, then it can be applied anywhere.