Facebook and Twitter

and follow my blog on Twitter @pharmacynic to receive notifications on new posts.

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?

Friday, September 20, 2013

NuvaGlo--Part 2

You may remember a couple months back a post I did about the NuvaGlo; a lighted version of the Nuvaring. It would come in different colours. As technology improves, so does the ability to improve the original product and get a new patent. All great manufacturers are great at patent extensions. They market the crap out of their products and, with a little twist, can continue raking in profits hand-over-fist for decades. With that in mind, I propose an extension to the lighted Nuvarings (NuvaGlo).
Today we will introduce The NuvaShine, NuvaVibe and NuvaSavers.

NuvaShine: It's like the Flashlight app for your phone. Super bright. Wear a skirt and it's easy to find your seats walking down the aisle of a darkened movie theater.

NuvaVibe: It will be a vibrating vaginal ring. Keep it in for 3 weeks, then take a week off. For those of you who like to skip periods altogether, put another one in after the 3 weeks. The convenience here is it stops vibrating after 3 weeks so you know when it's time to change. (Perhaps a remote control upgrade in the future? I'm thinking Katherine Heigl in "The Ugly Truth".)

NuvaSavers: (Inspired by LifeSavers) these rings will come in a variety of flavours to meet your tastes.
Luscious Lemon, Tangy Tangerine, Sweet Berry, and of course Regular and Black Cherry...
...or Rainbow Sherbet (pictured below).


Thursday, September 19, 2013

One Month Supply

Doctors don't like math. It's okay, they're not really that great at it anyway. Their e-scribing software usually does the hard work, but for those who like the old ink-and-paper method, they still have to use their brains a little.
That's where we as pharmacists come in. Historically, it has pretty much always been our job to be the math gurus. We need to double-check the doctors' calculations; on dosing, quantities, and day supplies, etc. It is a surprisingly not-so-infrequent occurrence that the supply and directions do not match (take 1 tablet 2 times a day for 10 days--dispense 14 tablets). Do we call? Nope. We get to exercise Professional Judgement. By the powers vested in me by the State License under which I practice, I can make that change all on my own. Do we double-check antibiotic dosing for children? Yep. The maximum amount of acetaminophen per day? Sure do. Let's not even get in to the amount of calculations my brethren in the hospital world have to do.

Doctors frequently take the easy way out and write to dispense a "One Month Supply".
As Pharmacists, we always take that to mean 30 days. (For once a day dosing we'd dispense 30 tablets. For twice a day, 60 tablets, and so forth...)
But why do we always pick 30 days?
Is it because it works out to an even 360 tablets in a year?

As a Cynical Pharmacist, I obviously see things differently. The next time the doctor actually writes "month supply" or "1 month" or something similar, I am going to say "February". That's the month supply I am going to use. February. (Side question: How many months have 28 days?  All of them have 28 days, the rest all have 30 days, and 7 of them have 31...But I digress...)

What's really funny is, if we use the 28-day method, patients can fill prescriptions 13 times which equates to a 364 day supply. It is actually a better way to fill. However, as with all things new, two groups would not go for it:
1. Doctors. They'd never be able to figure out how to prescribe 1 month plus 12 refills.
2. Patients: They'd never be able to figure out how we gave them 13 months of medication in a 12 month period. AND they'd complain about the extra one copay per year and extra trips to the pharmacy.

Besides, what else is good about February? It should be the new standard month...

Tuesday, September 17, 2013


Our pharmacy had the fire alarm go off in the back room around 7pm a while back. Most people, most normal, rational people, would see and smell smoke and opt for the closest exit. Neigh, Neigh! I say. For we are dealing with the "Retail Pharmacy Patient". It played out like this...

Hyper Manager: The sky is falling! The sky is falling!
CP: Pull yourself together. It's only the fire alarm. We heard it, but figured it was a drill. 
HM: It isn't. We have to evacuate now! Get everyone out of the store. 

Put Out Patient #1: But I need my medication. I've been waiting in this pick up line for an hour and a half. 
Put Out Patient #2: Yeah. It's just a fire. I can't even see the flames. I have to be somewhere in 5 minutes. I can't go outside and come back. 

HM: It is my job to ensure the safety of our employees and customers. For that reason you have to close the pharmacy and evacuate. Now!

POP#1: I'm going to sue you for not giving me my medication. 
POP#2: I'm going to call your corporate office and file a complaint about how inconvenienced I was by all this and score some free gift cards. It's all your fault I'm missing my son's soccer game that started 15 minutes ago, even though I just got here as the alarms started sounding. 

I realize it's a little being next in line when the movie sells out. Or when the roller coaster breaks down. Or when the bathroom gets the "closed for cleaning" sign put up right in front of you. But It's A Fire! I really wish these people were in line when my pharmacy was robbed. Couldn't you just see them bitching to the death the guy with the gun? 

POP#1: Oh no you don't. I was here first. They closed this place down for a fire last week and I couldn't get my medication for a whole 3 hours!

POP#2. I'm going to complain that this robbery was all your pharmacy's fault and score me some gift cards. This always happens when I come here...

Friday, September 13, 2013

Dick and Jane

See Jane. She is a pharmacist.
See Dick. Dick is a patient.

Jane: How can I help you today?
Dick: I need a refill.
Jane: Do you have the prescription number?
Dick: No. But it's in your computer.

Don't be a Dick.

See Jane. She is a pharmacist.
See Dick. Dick is a patient.

Jane: How may I help you today?
Dick: Can you tell me the price of this before I have it filled?
Jane: Do you have insurance?
Dick: I do.
Jane: Then I cannot tell you. I can give you a cash copay, but I must process the prescription to your insurance so they can tell me what I am to charge you.
Dick: But every other pharmacy I ever used can always do that.
Jane: Alas, they cannot. Do you know if you have set copays for brands and generics?
Dick: No. That's not my job.
Jane: Actually it is, for it is your insurance.

Don't be a Dick.

See Jane. She is a pharmacist.
See Dick. He is a patient.

Jane: How may I help you today?
Dick: I need a refill.
Jane: I am sorry sir, you are out of refills. As it's been over a year since this was written you need to call your doctor to have it refilled.
Dick: I ain't got time for that. You do it!
Jane: As I cannot do that, since your doctor requires an annual visit and does not like us to fax him, it appears we are at an impasse.
Dick: I'll just die then.
Jane: Or you could go to the doctor...

Don't be a Dick.
See Jane: She is a pharmacist.
See Dick: He is a patient.

Jane: How may I help you today?
Dick: This was run through as cash. Why didn't you tell me? I have insurance! Shouldn't you pay attention?
Jane: Some people have 1 insurance. Some have 2. Some prefer to pay cash and submit for reimbursement. Some use discount cards. Had you filled with us before, we may have had your information on file. Shouldn't you pay attention to what you are buying BEFORE you fork over the credit card?

Don't be a Dick.

See Jane: She is a pharmacist.
See Dick: He is a non-pharmacist District Manager.
Jane: Good to see you today, sir!
Dick: Thanks. How are things going? Lots of shots administered? Script counts up?
Jane: Of course. We are the best store in the district.
Dick: Oh. I see you have a customer.
Jane: You mean a patient? Here in pharmacy-land, we have patients.
Dick: Patient. Customer. Whatever. As long as they spend money, right?

Don't be a Dick.

Tuesday, September 10, 2013

I Have the Power!

I was not blessed with the benefit of foresight. I, unfortunately, was only given hindsight. Prescience is not one of my skills. This does not stop people from thinking I have this magical power. With the number of predictions I am routinely asked to make, you would think otherwise.

What time will my doctor call you?
What will my insurance copay be?
When will the prior authorization go through?
How long will I have to wait...if I come in after 6 tonight?
Who will win the EPL this year?

I decided to take a sublime approach to answering these questions. I am going to get a sound effects board for my computer. The next time someone asks this question I will announce "Sublime Time" and the whole pharmacy, a la Coyote Ugly, will jump up on the counter, join arms, do a kick line and sing:

"I don't practice Santeria. I ain't got no crystal ball."

Friday, September 6, 2013

Pharmacy Analogies II

Calling the store from the drive-thru when you can clearly see 9 cars in front of you is like calling Disney World from the back of the line and asking why the wait for Toy Story or Space Mountain is so long...except there you have big signs telling you the wait time before you get in line.

Asking if any of your prescriptions (i.e. METHylprednisolone or METHotrexate) have METH in them is like asking if POTatotes have POT in them. (Spelling-wise oui! Drug-wise non...)

YOU calling ME to ask if YOUR insurance will cover a certain prescription is like ME calling YOU to ask if MY insurance will cover MY prescription.

Asking if we will be busy when you come in "in a few hours" is like jumping into the monkey cage at the zoo...not sure what's going to happen then, but it'll be fun to watch.

Complaining to me that the front of the store is out of an advertised sale item is like complaining that every retailer is out of this year's "IT" Christmas item...on Christmas Eve. (Everybody else wants the deal too...)

Whining that you are out of medication, out of refills, and have to make an appointment to get more is like complaining you have to stop for a red light and wait for a green light. (That's the way the system is supposed to work.)

Doctors telling patients how much their prescriptions will cost at my pharmacy is like me guessing the winning lottery numbers.

Asking your doctor how much a prescription will be at my pharmacy is like calling me from your doctor's waiting room and asking when he will see you.

Telling me to call your insurance for your ID number is like telling Starbucks to call the bank to look up your debit card number.

Wednesday, September 4, 2013

For Hire...

"I wish I was a neutron bomb, for once I could go off."
And I wish we could be allowed a HIPAA exemption a day. Here is why...

CP: <at drop-off window> How may I help you today?
Know-It-All: Obviously I'd like to fill a prescription.
CP: Thank you, but my name is not obviously. I see you have papers there, and I understand you are at "drop-off" but many people come to ask questions with shopping lists in their hands. Not so obvious...
KIT: Fine. How long will it take to fill these?
CP: Have we filled prescriptions for you before?
KIT: Obviously, that's why I come here.
CP: There you go with calling me obviously again. I expect it to take between 17 and 23 minutes.
KIT: What? Why so long? All you do is (pick one: 1. put pills in a bottle, 2. slap a label on it, 3. grab it off the shelf from right behind you there.)

<And this is where the exemption comes into play.>

CP: Oh! You're experienced! Why didn't you say so? I happen to have an application right here. Just fill this out while you wait. Better yet. Come on back. I will let you fill your own prescriptions today. I sure am glad you came along when you did. We are short-staffed this week, what with budget cuts and the addition of flu shot quotas and all. I actually have to go give a shot right now so let me let you in to get started on your prescriptions. I'll only be about 3 minutes so I expect you'll have everything ready for me to check upon my return. Again, I can't tell you how excited I am that you happened to walk in just as I was crying in the corner, praying that the Gods would send me someone to ease my suffering during these long pharmacy winter days. Pharmacy Gods be praised! They like me. They really like me!

KIT: <to Super-tech> What just happened?
ST: CP happened. CP owned you. Now go have a seat in the waiting area. We shall call you in about 27-33 minutes.
KIT: It was just 20 minutes like a minute ago.
ST: First, you spent so long arguing with CP that more prescriptions got in front of you. Second, it's a time penalty for arguing with the pharmacist. Any more questions?
KIT: No.
ST: Don't forget your application...

Tuesday, September 3, 2013


It has always been my policy to have my employees verify the copay price with patients BEFORE actually ringing the sale. I hear there are some companies that mandate this as well. That makes me pretty smart. My reasons were always to make sure the patient was AWARE of the price so we would not have to reverse a sale. This ensured that a really high-priced item would trigger the obligatory "but I have insurance!" or "didn't my insurance cover it?" or "WHAT?!" exclamations from patients. These were usually handled delicately with a quick explanation that their high-priced insurance actually did cover it and we'd quote some lofty Usual and Customary (U&C) price to them to prove how expensive this could have been.
However, this would not be funny, or cynical, without an outlier, a nonconformer, a person that just doesn't quite get it. They laugh in the face of, well, themselves in the mirror probably. They are smarter than you and I. They own us. They have us played. It is a chess game to them. They are card playing professionals.
At the penultimate moment before the sale, as the wick is about to be snuffed by its own waxy cocoon, the player tries to trump us...

Awesomest Tech At Things: How may I help you today?
Bret Maverick: I am here to pick up a prescription.
AT-AT: Lovely. We do those here. Name, date of birth, next of kin, blood type, and the first 314 digits of pi?
BM: <cooly complying> Anything else?
AT-AT: No sir. Are you aware of the price of this medication?
BM: I am. I have purchased this before, many times.
AT-AT: Wonderful, then if you'd like to hand me payment we can be all....

<as if in slow motion, and played like the titular character's final hand (FYI that's Maverick)
A card is slowly removed from its hand, then slowly, carefully flung upon the counter, where it rattles,  clacking around, until coming to rest, face-up, to be revealed as the Ace of Spades! Straight Flush! Winner!>

AT-AT: Yes?
BM: Bam!
AT-AT: Bam what sir?
BM: That's my card. My insurance.
AT-AT: It is indeed yours sir. But nonchalantly flicking it upon my counter like you just won a WSP event is rather overdramatic and ineffectual.
BM: So this doesn't help?
AT-AT: It already helped sir. Of this you were most certainly aware, as you stated earlier. However, the theatrics were quite nice. I can't quite figure out how you managed the whole slow-motion video of your deal to me, but it looked really impressive. Now I just need a credit card. And this time, you can just hand it to me, thank you.