Shots!

I love them. I love administering them. I loved teaching the APhA certification program to other pharmacists. I love the idea of pharmacists being visible and approachable and trusted.

I hate companies. I hate corporate pharmacy. I hate quotas. I hate not being personally reimbursed for something that I willingly opted to do the first year my state allowed it. I hate that when I used to give most or all of the shots in my stores, the other immunizers who refused got paid the same as I. I hate that pharmacists are forced to administer vaccines. Some are shooters. Some are not.

I do believe it is a positive evolution for our profession. The flaw with the Pharmacists-as-Immunizers concept lies in corporate greed. 

Stay with me on this: Pharmacists see their patients much more frequently than doctors see their patients. We know what medications they take. We know what conditions they are treating. We can more readily identify who needs what immunizations. We talk to them more than their own doctors. This is truly a perfect example of why we need to be on the front lines ensuring OUR patients get not only maintenance care, but preventive care as well. It should be our job to help with this but it should be at our discretion; not forced upon us. As I have said, I love to administer vaccinations. I love to answer vaccination questions. But that is not necessarily for everyone.  

Corporate greed, however stepped in and usurped this idea.  With its quotas and mandatory 100% pharmacist compliance it became less about preventive care than making money. It's all about the money. No pharmacy company in this country can claim otherwise. (There's math involved, but that's another post...) 

If you love to immunize and love to spend the time with your patients that we as pharmacists so loudly proclaim that we do (and need to get back to doing) then enjoy it, like I do. 

Funny Idea, but you didn't get this from me...If you want to meet the quotas, simply turn away the same number of prescriptions per day as vaccinations you are required to administer. Just make sure you do it with cheap, low-profit margin prescriptions. (Start with those free and $4 meds...)  

I also believe the corporate suits owe us the administration fee they are charging. See, they don't actually administer the vaccines. WE DO...

Professional Complaint

Professional Complaint. As a pharmacist, you should be sympathetic to your own ilk. As this page has continued to prove, there are many like us and we are not alone. We all understand what each of us goes through day in and day out. (For those non-pharmacy fans, thank you for tuning in and learning about the other side of the counter.)

My rant consists of this: Why do some pharmacists feel the need to treat other pharmacists like any of the other people they deal with on any given day? I understand the loathing we feel towards transfers and coupons. If there were no coupons the transfer thing would be a footnote in our days. I hate them as much as anyone (I received 14 last night from 5 different people in less than 1 hour and had to call 7 separate pharmacies so I get it). That was only from 6-7pm. It does not mean I have to hear you complain about how they're ruining your life. Your company either promotes coupons or it does not. The fact is your job requires you to do transfers. Just like flu shots, just like filling prescriptions, just like counseling patients, it's part of your day-to-day routine. Don't take it out on me.
I try to get to the transfer line a little quicker because I know there is a pharmacist waiting to talk to me. She deserves my attention and I have a fellow professional with whom to converse. I'm not complaining about a little professional kidding. That is quite different. The people I don't understand are the ones who are treating my call as if I just asked them to administer an additional 50 flu shots tonight or they couldn't go home. Again, just like it's not every customer that is a problem, not every RPh is a problem.
I had a pharmacist tell a patient that he would match a price on a prescription for him. I told the patient we have to verify the price. He told me the other pharmacist told him he automatically inflates all of his prices by $10 if he knows a pharmacy is calling. Why? Because you're an independent? I don't care if that's truly the case. I find it unprofessional, especially being so open and flippant about it.
Again, I remind you that this page has served to prove we are not alone. We were a strong fraternity or sorority in college. We are still today. We should figure out how to harness this on a national level and bring about the change we are all clamoring for in the retail world. Even our non-retail brethren would benefit.

Whose Problem Is It?

I take responsibility for my actions. I take responsibility for my work. I take pride in who I am. I take pride in what I do. I help people, outside my job, when I can. I offer assistance when possible...
However, a customer proved to me this week that I do not know the lengths to which I should really be going. I did not know I should stick my nose into other people's business, literal business, and throw myself into their problems.

CP: How may I help you today?
A Total Twit: Your phone isn't working.
CP: Then how are we speaking on it? Yes, I know. We have one of our lines that has been down since Saturday. For whatever reason, today being Monday, the phone company has decided to take its sweet time and said they'll fix us soon.
ATT: Did you call the phone company?
CP: No. As a corporate entity we are required to call corporate office. They call the phone company who then sends a repair guy. Pretty standard. Usually it's fixed the next day, but with it being a weekend and all...
ATT: I don't care about that. Where is your corporate office? I'm going to call them and tell them they need to fix this now.
CP: Um...
ATT: And then I'm going to call the phone company. This is ridiculous! I had to wait on hold for over 25 minutes listening to your stupid hold music only to find out the line wasn't working.
CP: Hm. Knowing that we answer pretty quickly, I'd never wait on hold that long for any business. I'd call back. But then again, I'm not sitting here on the phone, after spending "half my day" did you say? trying to get through, just to tell me how to fix my phones. Why did you wish to speak to me in the first place.
ATT: For a refill. Here's the number. <click>

~2 hours later, in store...

ATT: Did you call the phone company yet?
CP: No. Did you? Or our corporate office?
ATT: Yeah. They said they're working on it.
CP: So your special powers you thought you possessed were discovered to be not-so-special? You did not have any pull that expedited a resolution to our telecommunications situation? Bummer. I was excited at the prospect that you, a patient here with no connection to my company or the phone company, could some how cajole Mama Bell into cowering at your feet and fixing one of the nine phone lines in our store that doesn't work.
But your prescription is ready. Have a nice day!

Pharmacy Analogies/Similes

Yelling at me because you ran out of medication is like yelling at BP because you ran out of gas.

Yelling at me when your doctor has not yet phoned in your prescription is like yelling at UPS when Amazon hasn't yet processed your order.
or
Driving directly to my pharmacy from the office and not finding a prescription here or ready is like placing an Amazon order from your laptop then running to the door and getting pissed at FedEx.

Asking me when your doctor is going to call is like asking me when you're going to die.
(the answer is the same: hopefully before the end of the day.).....ah, boo

Be prepared. If you know you are going to call me with a refill request, please know what you want. It's like calling for a pizza delivery, getting them on the phone, then shouting to everyone "Okay, who wants what?" 

You complaining to me about your insurance copay is like me complaining to you about my electric rates. 

When asked if you have any questions for the pharmacist and you answer "no", that is the end of the conversation. Asking a question as I walk away is a violation of the "end of conversation etiquette rules" and I have the right to ignore you. It's like answering "are you sure?" with a "yes" when making a purchase then immediately changing your mind. Too late. No changes, no take backs, no regrets. 

Do people call the grocery store to complain when their milk carton is empty...and has been for 3 days?

Asking for "a few pills until I see my doctor this week and he writes me a new prescription" is like asking the bank "for a few dollars until I start my new job this week and get a paycheck".
("But I've been taking it my whole life" is like "But I've been making money my whole life".)

Manufacturing a cough when at the counter to purchase Sudafed is like doing the pee-pee dance at the counter to buy Sudafed. (Wrong symptom/product combination.)

Every Time

You must learn from your mistakes. However, an education is like the "leading a horse to water" concept. You can GIVE someone an education, but you can't make it stick.

Every Month: I need a refill
CP: Do you have the number? (under breath "no, why would I have that?)
EM: No. Why would I have that?
CP: Optimistic me. What's the date of birth then?
EM: For me?
CP: Am I filling the refill for you?
EM: No. It's for my daughter.
CP: Then I shall require her date of birth. I fail to see how you think your DOB would have been helpful. Carry on.
EM: I don't know it. It's like a month with an "A" in it.
CP: Lovely. That narrows it down quite a bit. Thoughts on a particular day? Or year even?
EM: Don't know. Why are you being so difficult?
CP: Sorry, as the parental unit I had the slimmest hope you may actually know your own daughter's birthdate. Let's try this. On what date do you give her presents?
EM: Christmas?
CP: If she's lucky...Any other times?
EM: No. She's a foster child I've had for 5 years now and you people always do this to me.
CP: What's that, ma'am?
EM: Ask for her birthdate.
CP: Yes?
EM: Can't you find her any other way?
CP: Not with 100% accuracy. There happen to be a lot of Toulouse Lautrec's at the Moulin Rouge Pharmacy. We need to know the date of birth so we can pick the best one. Eenie-Meenie-Miney-Moe doesn't quite work anymore.
EM: Well I don't understand why this has to be so hard.
CP: Neither do I, ma'am. Neither do I. You say we do this to you every month?
EM: Yes.
CP: So you know, each time you call us, you will be asked for the date of birth of the person for whom we are filling, correct?
EM: Yes. But I fail to see...
CP: Yes. You fail to see that you are the problem. Either you are incapable of learning from past mistakes, you are incapable of preparing in advance for a phone conversation, or you just like to piss with the pharmacy staff because you're bored and have nothing else to do. Either way, unless you know something about your daughter and her refill, I cannot, at this time, prepare any prescriptions for pickup per your pestering.
EM: Would the number on the bottle help?
CP: <phone meets forehead>

Pharmacist Diet

With "pharmacy winter" now upon us, I wanted to give everyone insight as to what our diet involves. It is not enough to simply say, for most of us, that we do not get a lunch break. (Wah, I know. Poor salaried, well-compensated people bitching about lack of a lunch break.) Sorry, for whatever reason patients tend to forget we are lowly human beings who must still take in nourishment to remain...alive.
Anyway, my analogy for today is: Baleen Whales. Seriously.
How does a baleen whale feed? Two of the three ways are:
1. It opens its mouth and strains the sea as it swims or
2. It gulps in large quantities of food.

Both of these readily apply to the pharmacy staff. Most pharmacies I know have feeding stations set up at strategic points. This means there is an open bag of Cheetos near the fax machine, a bag of SourPatch Kids by the drop off window, and some trail mix or nuts by the sink, unless someone made me brownies. I love brownies. Also along the circuit are beverage stations. You'll likely find open bottles of pop/soda, water, and coffee mugs. It's pretty much a free-for-all when it comes to food. The skimming approach is apropos because as we walk the circuit picking up faxes and medications and waiting on customers, we skim handfuls from each open bag and swig mouthfuls from the beverage stations.

Some employees believe in the "gulping large quantities" method. They will walk to the back, cram in a full Smucker's PB&J and carry it in their mouth, chewing it to nothingness as they retrieve faxes, voicemails, and restock the shelves. There are advantages to both methods and most pharmacy staff have adapted to the one that best suits them.
Please be warned, if you manage to espy pharmacy employees engaging in this behaviour, do not attempt to speak to them or distract them. Feeding time is a very short, rare occurrence in the pharmacy and you'll likely only get grunts, especially fromm the "gulpers". Also, please look around and see if you can identify any of these stations. Usually they are well hidden and woefully understocked. If you do not see them and you are a patient, unlike at the zoo, you are encouraged to feed the animals in the cages.

Just Say Yuck

There is no amount of training one can do to prepare a new hire for what he or she will experience during the real daily grind of dealing with patients. Conversation overheard by one of my newbies:

Innocent Newbie: Thank you for calling. How may I help you?
Funky Taco: I was calling to see if my prescription was there?
IN: We just received the e-script. It should be ready in about 35 minutes.
FT: Can't it be any faster? I really need it.
IN: I'm sorry. Our wait time in the store is currently 25-30 minutes. We will put yours behind those in line, but 35 minutes will get it done.
FT: I can't wait that long! It's itching so bad. I'm crawling on the carpet like a baby and I can see it on the stairs behind me.

<awkward silence follows>

FT: I guess you didn't find that funny, huh?
IN: Um.
FT: Well it's your fault I'm in this much misery. You just fill it and I'll be down to get it. You better hope you don't have to go through anything like this.
IN: Um.

<click>

IN: <to CP> Some lady just described her yeast infection to me. She told me she was crawling around on the carpet and I just pictured a little cat scooting its butt down the stairs. Then she got an attitude with me because I didn't find it funny. How do you respond to that comment?
CP: First, that's just gross. Second, you politely say "thank you for that haunting visual. As I now have to bleach my brain, your prescription will take 45 minutes to finish. Oh, and make sure you wear clean underwear."
IN: <Puzzled Look>
CP: Sorry. Guess you don't yet know with whom you work. It's been a while since I've had a detailed description of Twat Rot quite like this one. Honestly, since this is retail pharmacy, you simply pretend you're a penguin from Madagascar: Just smile and wave. Just smile and wave...

Maybe I'm Amazed...

I like to get a name first. Anytime you do any business with anyone, it's nice to get a name. It's especially nice for those personal, intimate encounters in which one might engage.
I'm talking about doctor's visits.

Super-Tech: Hey CP, which doctor do you think this patient saw? Forgot the DEA on this control.
CP: I'm going with Dr. Zoffis. But ask the patient. Hopefully he knows.
ST: You think? My, you're optimistic today.
CP: Nope. Just waiting to have my faith in humanity crushed like my dreams of working in the circus.

ST: <to patient> Which prescriber did you see?
Oblivious Patient: Not sure.
CP: You're not sure?
OP: Nope. They have lots of doctors there.
CP: You don't know the name of your prescriber?
OP: No. Didn't catch it.
CP: How do you know whom to call to make follow up visits?
OP: I just call and they schedule me with whoever.
CP: They don't tell you who you are seeing?
OP: I guess not.
CP: Isn't that kind of like a one-night stand? You just go into a room with someone you don't know and come out with a narcotic prescription?
OP: Well, when you put it like that.
CP: Slut.

Truth and Questions

Sometimes, just for fun, and based on the read I get from the patient, I will answer their questions with as much truth and honesty as I think they can handle.

What if An Honest Apothecary Answered your questions honestly...?

What is the best thing for poison ivy?
Avoidance.

What is the best thing for lice?
Clippers.

What is the best thing for crabs?
Clippers and a new boyfriend.

What's the best thing to help me pass a drug test?
Stop doing drugs.

What's the best way to quit smoking?
Quit buying cigarettes.

We're Not Really in Here/ You Can't See Me Yet...

Have you ever wandered around a mall before all the stores open? It's a little like visiting a prison; or a zoo. Employees milling about in little cages. All the stores have gates down, some are open about a foot so employees can crawl under, but they all seem to have turned on their lights. Knowing full well they do not open for some time, what is the appropriate way to behave in this environment?

a. keep walking around enjoying your coffee until the shops open?
b. bang the crap out of the gates until someone addresses your presence?
c. yell at the employees about how they should wait on you since they're already in there and all they have to do is let you in because you just need to return something and you're in a hurry because you have to get to work and the 30-day return policy ends today?
d. try to throw whatever you're dropping off through the gates so when the employees walk over they know you were here first and deserve to be prioritized as such?

My question is, What would these people do if employees were not there early? What if they were union members who arrived promptly five minutes late (but well within the negotiated window to not be truly late)? What then? Like the rest of the law-abiding, rule obeying public, they'd have to wait until the store actually opened before dropping off their prescriptions and berating us for not being open early. My name is CP and here is my story:

8:54 am (Gates open in 6 minutes) A woman has been shuffling papers for 3 minutes outside our gates where we are gathered, setting up the first refills for the morning, logging on our registers, and clearing voicemail.
In Her Own Little World: I'm just going to push these under your gate.
CP: No you're not.
IHOLW: They won't fit.
CP: I know, hence my answer of "no you're not".
IHOLW: Can I try to push them through the gate?
CP: I'm going to say no, but I know you will anyway.
IHOLW: <pushing them through the gate> There. <walks away>
CP: You do realize we are not yet open, right?
IHOLW: But you're in there.
CP: And? Had I not been here, would I have walked into a pile of 17 prescriptions you shoved through my gate before my arrival? Or would you have forced them into my hand as I walked past you in the aisle? Or would you have been that person who leaves them up front with the manager saying "give these to the pharmacy when they open?
You'd better wait because I need your information...
IHOLW: Everything is on there. <hurriedly skedaddles>
CP: <quietly, under breath in hushed whispering tones> date of birth? address? allergies? insurance? okay, and when would you like to come back for all of these? Tomorrow? Okay, we'll see you after noon tomorrow. Thanks for giving us plenty of time to fill these. We appreciate your business.

<Fast forward to 5pm>
IHOLW: I said I'd be back between 5 and 6 tonight.
CP: First, you did not give us a time because I am the pharmacist who witnessed your shenanigans earlier. Second, I specifically asked if tomorrow was okay and you agreed; albeit tacitly with your rapid departure.
<knowing there was nothing to be said, she quietly verified tomorrow's pickup time and walked away. CP win.>

Maturity

They say "with age comes wisdom". I don't necessarily believe that. I believe you must first have a foundation on which to build.
I also believe that High School never ends.
Did you ever notice that many times our most argumentative patients act like spoiled brats? Can't you just picture them as your high school bully? Or the leader of the popular clique? Did you ever play the "what group were you in in high school" game? Hey, here comes Johnny Quarterback.

I bring this up because it is this mentality that keeps these people from maturing. It is this attitude that frustrates the pharmacy people in retail. I think these people act like spoiled brats for the attention. These are the patients who like to complain, then run to the front end manager and tell on you like a 5 year old. "I'm telling mom on you!"
Can't you just see them charging up front, then standing behind the manager while the manager berates you for poor customer service? All the while the customer makes faces at you like a younger sibling taunting you. They stick out their tongue at you, then act all upset when the manager turns back around and hands them a gift card, politely, quietly thanking him for correcting the behaviour of a rogue pharmacist.
I had this interaction over the weekend that made me realize this is all so true.

My technician and I were discussing a patient and her profile while the patient was on the phone. The patient had a concern and we were trying to address it. In the middle of our conversation, an impatient dude walks up and shouts "anybody here?" even though he walked right past us.
ID: Hello?
CP: We'll be right with you, sir.
ID: Well I ain't got all day.
CP: Well we're busy helping someone else. We will be with you as soon as we are done.
ID: Wow. You're a sarcastic bunch back there.
CP: Really? How was that sarcastic?
ID: <mumble mumble mumble>

The whole time my tech is ringing him out, he stared at me. Did he think I was going to do tricks? Sure, maybe I whistled the theme from "Bridge on the River Kwai" while pulling hydrocortisone cream with my back to him. Then he walked by and stared me down the whole way past my window. It was as if he walked in slow motion. I politely stared back, gave him a little wink, then said "Have a Nice Day, sir!".
Now that's sarcastic.

Diamond in the Rough

Sometimes, a person comes along that changes how you view everything. How you view the public. Sometimes it changes your opinion of your fellow man and woman. Sometimes, even a professional cynic can be awed at the display a single person presents when his healthcare is at stake. I was at a loss for words. (As you well know, that is a near impossibility, as rare as a welfare person paying for her child's non-covered medicines.) Anyway, this day started as do so many others. Unlike the rest, a ray of sunshine would permeate our souls and allow us to smile, a serious, honest smile that would brighten the days of all others we would see that day.
What could be so profound? What could have happened to be so impactful? It was a quote that he downplayed as natural, as normal, as expected. He played it off as if everyone took responsibility for his own healthcare and should be as forward thinking as he. In the normal flow of our daily conversation, my trusty technician asked if he had any allergies. I'm almost weeping as I recount the details. (sniff) And he said, (sniffle), he said, (snort), and I quote :

"If I have an allergy, I need to be proactive. I don't expect you guys to remember everything. Thank you."

It was a monumental occasion. We thought about taking his picture and hanging it on the wall of fame. (His would have been the first.) We thought about asking him to train all other customers in the ways of the patient. But, as with all good patients, we had to let him walk away, for we cannot keep him. Besides, that's kidnapping, and we don't have time for that.
Thank you kind sir for reminding us that not everyone is a complete dunce when it comes to taking care of his health.