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Tuesday, December 31, 2013

Peak Season

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

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

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

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

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

Monday, December 30, 2013

How the Pharmacy World Differs from the Real World

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

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

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

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

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

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

Friday, December 20, 2013

Pharmacy Pre-Holiday Checklist

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

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

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

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

Wednesday, December 18, 2013

No Valid Rx Received

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

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

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

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

I say no more.

Tuesday, December 17, 2013

Ways to Spend Your Off Day

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

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

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

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

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

Monday, December 16, 2013

You Can't Get There From Here

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

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

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

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

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

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

Friday, December 13, 2013

Younger Marketing

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

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

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

LEVitra eLEVates your love life...

Thursday, December 12, 2013

I Need Some Clarity

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

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

Monday, December 9, 2013

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

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

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

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

Wednesday, December 4, 2013

(That's Not?) What You Heard

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

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

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

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

Monday, December 2, 2013

Like Sands through the Hourglass...

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

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

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

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

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

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