Happy New Year! (Or Not…)

My first resolution this year is to do less.
I resolve to do less for other people...
but...I resolve to give people the knowledge and training to do things for themselves.
I resolve to not call your prescriber for your refills.
I resolve to not care about your prior authorization for an expensive acne cream from your dermatologist.
I resolve to not call your prescriber to fix his handwriting errors anymore.
I resolve to just say "NO" to your ridiculous expectations.
I resolve to throat punch you if you use the phrase "slap a label on it".

My second resolution is that I resolve to do more.
More talking with patients about their medications.
Taking more time to do the actual professional functions of my job…the ones that came with my college education and not the ones patients and corporations think are my job.
More fighting for my profession and my colleagues.
More putting the onus back where it belongs: on the patient, the prescriber, the insurance, the "man", or whoever may be responsible who is not me. (Because everyone thinks it's the pharmacist's phault.)

I resolve to post a sign about realistic expectations:
1. You must present your insurance card every time you drop off a prescription. I don't care if you have been here before, even if it was 167 minutes ago, I still expect you to hand it to me. (Your prescriber has this policy posted and you don't complain there.)
2. Your wait time will be based on the ever-fluctuating amount of work I have to do and CAN and WILL be adjusted to fit your attitude.
3. Copays are non-negotiable. There is no arguing with the pharmacy staff. Attempting to do so will result in longer wait times for you on all phuture drop offs for the rest of the year. (See #2.)
4. Prices are set by your insurance. I can point out their phone number on the back of your insurance card (because you obeyed Step #1) for you to call them directly. First, you must step out of line. Second, see #2.
5. You have the right to a consultation just like everyone else. Just because you opt to forgo this every time you are here does not mean others should be expected to do so as well. Their time is just as valuable as yours. If you complain, please see #2.
6. Just because everything went smoothly the last time you were here (no line, no wait, medication in stock, no insurance issues, etc.) does NOT mean this trend will continue. It's like the stock market: past results are not predictors of the phuture.
7. If you expect to have a good experience at my pharmacy, be a good patient. Be prepared. Obey #1. Know your insurance. If you expect your prescriber sent us a prescription, please call before coming to the pharmacy. Also, do not go directly to the pickup line. Stop by the consultation or drop off window and verify we received it and it has been processed. It could be in any stage of completion at this point and you needn't waste 20 minutes in the pickup line only to be told it's in the work queue or our stack of faxes/voicemails, etc. that have yet to be run and you have to get back in line when we are done. This also allows you to be compliant with Step #1…
8. If your prescription is waiting to be picked up and in my will call section, you are welcome to pay the price attached to it and leave with it. Asking me to add a discount card, try multiple manufacturer discounts, or change anything about the completed, ready prescription will result in you stepping out of line and increase your wait to that of the current wait time in my pharmacy. At this point I am not the person making you wait. YOU are. This will result in you being issued a business card with #2 printed on it…(Both the policy and a picture.) If you had read #7 and been a good patient, you would have called ahead and taken care of this before getting in the pickup line.
9. If you call me from the drive thru asking what is taking so long, my answer will be as follows: "It is taking longer than expected because I had it filled then all these people showed up, much like you, and wanted their prescriptions too. Imagine that. At a pharmacy, no less. In order to provide you with speedier service, I deleted your prescription and called over to the pharmacy across the street. They said it would be ready in 15 minutes so I transferred it there, along with your complete profile. I invoked #2 to the fullest extent. Thank you and good day."
10. Prices: It's not free here. It's not $4.00 here. It's not anything other than what I told you it was. Remember, YOU chose to do business with ME. I did not drag you off the street and force you to fill prescriptions here any more than Home Depot forced you to buy a fridge from them instead of Lowe's. It is a free country and I resolve to help you in many ways but begging you to be my patient is not on my to-do list.
11. Gift Cards: You want one, buy one.
12. I will only care about your health as much as you do. The less you care about it, the less I do.
13. Obeying all the pharmacy rules will not only expedite your service today and in the phuture, but will make the world a better place, one patient and unreasonable expectation at a time...

The 12 Days of Pharmacy

On the Twelfth Day of Pharmacy, a patient said to me…
...let me speak to your manager.
...it's a drive-thru, not a stop and park.
...what's the best thing you got?
...you were s'posed to match the price.
...didn't my insurance work?
…how do I get a gift card?
...15 minutes? Why so long?

...it's just a box!
...just slap a label on it.
…saw my doctor send it.
...all you do is count by 5's!
...I thought antibiotics were free.



A Doctor sent to me...
12 duplicate e-scripts,
11 faxed copies of it,
10 voicemail messages,
9 patients expecting $4 copays,
8 illegible prescriptions,
7 narcs with no dea#
6 refill request denials,
5 prior auth rejections,
4 people told "it'll be ready for you"
3 scripts missing signatures,
2 scripts meant for another pharmacy,
and a patient expecting everything to be free!

If the Real World Worked As People Believe the Pharmacy Does

Bank Teller: Thank you for coming into the bank. No one does anymore.
CP: And there are still just as few employees as there ever were.
BT: How may I help you?
CP: I should like to inquire as to the status of my payroll funds. They were to be direct deposited this morning.
BT: Do you have your account number?
CP: No. I have used other Bank of America locations before. Just look me up.
BT: But this is Chase.
CP: Aren't you all connected?
BT: No. No more than Walgreen's and Rite Aid share a computer.
CP: Oh. Well is my deposit here?
BT: I can't seem to locate it.
CP: What? They said it would be here. Can you check my friend's account? They sent our payroll at the same time.
BT: I show a deposit made today for that person, but nothing for you.
CP: What? I watched them send it. I put the direct deposit account info in myself and faxed it directly to payroll yesterday!
BT: It can take up to 2 weeks for it to get approved. Check your mailbox for a cheque.
CP: This is why I quit coming here to KeyBank.
BT: We are Chase.
CP: Can't you give me enough money to get through until my cheque arrives? I'm out. There's a great deal on Chia Pets at the local CVS and I need to stock up before they sell out.

Proof Pharmacy Exists Outside the Real World

CP: Good Morning and welcome to the first of the month where reality ceases to exist. How may I help you?
Dazed and Confused Mother: I need to fill this prescription for my son. He's never been here before.
CP: Welcome to you both. Let me get all your information.
DCM: I'm already in the system.
CP: Peachy. As you said, he is not. I shall need to enter him from scratch.
DCM: But I've been here before!
CP: And I've been to California before.
DCM: <Puzzled look>
CP: Do you have his insurance card?
DCM: No.
CP: I need it in order to process the prescription to it. Or I can charge you the exorbitant cash price of $5.00.
DCM: No way! He has insurance. It's Medicaid. <Looks at me expectantly>
CP: <Looks at her with matched expectancy>

hours pass…
DCM: Aren't you going to look it up?
CP: Question for you.
DCM: Okay.
CP: Did you have a good Thanksgiving?
DCM: Yes?
CP: Did you do some Black Friday shopping?
DCM: Of course.
CP: Get some good deals?
DCM: Yes. <explains a few purchases>
CP: How'd you pay?
DCM: Credit card.
CP: You knew you were going shopping, right?
DCM: Of course.
CP: You planned your trip? Which stores to hit? Who had the best deals? What to buy where? You made sure you had your purse and your wallet?
DCM: Yes.
CP: With your credit cards inside?
DCM: Duh!
CP: If you had made it all the way to the front of the line with your new 50" TV, XBox, and other purchases and realised you didn't have your credit card, would you have asked them to just look it up?
DCM: No. That's ridiculous.
CP: Do you think they would have called Visa simply because someone in your house had shopped there once before?
DCM: No.
CP: So you're expecting me to believe that you forgot your Welfare Credit Card, went to the doctor, received a prescription, knew you were coming to the pharmacy, and now you're expecting me to fix your problem for you? In what world are you living? Never mind the fact that you scoffed at $5 for this prescription but you just spent over $500 on new electronics last weekend.
DCM: So I should go home and get it?
CP: That would be ideal. Or you could return some items and scrape up the cash for the copay?
DCM: <Sends son to the car> He found it!
CP: Okay. That'll be 25 minutes to wait now.
DCM: What? Why so long?
CP: How long did you wait in line for all that crap you just bought? It's now 45 minutes.

Waiver Zone

I need a lawyer. Keeping in mind how much I love lawyers, this is a pretty big admission for me.
("If it wasn't for lawyers, we wouldn't need lawyers.")

It's not what you think, however.
I would like a lawyer to draft an exemption clause for me, for pharmacy, for those of us in the trenches. It will be an amnesty clause. Get out of jail free card.

Patients are so quick to blame the pharmacy for everything that stands between them and their medication. Building on the Disney Fast Pass Lane I want installed at my pharmacy, and adding to the $50.00 instant no-questions-asked flu shot fee, I want to add a special lane for "I'll Take My Chances".

The "I'll Take My Chances" (aka Russian Roulette) Lane will allow you to walk right over, sign a legal waiver absolving the pharmacy, pharmacist, and all its staff of any and all blame should any errors occur or fatal reactions ensue from a "Filled-Exactly-As-It-Was-Written" prescription. No questions asked. This will be more along the lines of "I Want It Right NOW" instead of "I Want It Right". Patients will accept full responsibility. I am sure we could have an attorney present at the table where these are signed to bear witness to the forfeiture of all future recriminations against anyone involved in filling these prescriptions.

Imagine the time we will save. No longer will our phone lines be tied up both ways (us calling prescribers for explanations and the patients calling us asking what is taking so long). No longer will we have to deal with the Charles Manson Stare Down as these patients will be placated in the knowledge their high-risk, high-reward prescriptions will be filled imminently. We can issue a 5 minute guarantee on this lane and have it staffed by one pharmacist and one technician at all times. There will of course be a surcharge imposed for this service but keep in mind, you are worth it!

We can even extend this to "one-and-done" on insurance billing. We will attempt to bill one, and only one, insurance for you. If it does not go through, requires prior authorization, or you are unsatisfied with the copay, your options become Take It OR Leave It. There will be no discussion, no pleas for what's behind Door #3. I am not Monty Hall. This is not a discussion. If you want fast service, know what you want and expect to pay for it. It will be like the Soup Nazi. No argument, no debate, no Rx for you. Next!

I'm Sorry.

Please allow me to apologise. I am sorry.
We hear this all the time. Some say it is human nature. Some will say it is conditioning. Some will say it is our parents' fault: always say "please and thank you "and apologise. I also think it is Corporate America's fault. If you say you are sorry, it will help defuse a situation. Maybe. My problem is that we offer apologies for everything today.

Your refill is too soon? I am sorry.
Your doctor didn't call in your prescriptions yet? I am sorry.
We told you to call us 2 days before you need your refill because it is a special order item and now you are out of it? I am sorry.
You think 20 minutes is too long to wait at 5pm on a Monday? I am sorry.
Your insurance changed and you left the card at home? I am sorry.
You planned a vacation and forgot to refill your medications until now…as you are en route to the airport? I am sorry.
Your prescriber wrote the prescriptions wrong and we had to call and he hasn't called back? Yep, Sorry...

Only I am NOT sorry. I am tired of that being our immediate, conditioned, pre-programmed response to people. I'm not sorry. Is that wrong? There are better ways to empathize with our patients. That's what we are trying to do-empathize with them. But it's erroneous. It's not MY fault so why am I the one who is saying I AM sorry?

Instead of "I'm sorry", let's try something else.

Mad Hatter: What do you mean he didn't send it? I was right there when he did it!
CP: Wow. That sucks dude. I feel your pain. Call them back and give them a swift kick in the ass. Next!

Mad Hatter: I am flying to London right now and need this filled ASAP!
CP: Well ASAP would be about 25 minutes. Thanks for giving me some time. I was afraid you wanted it, like yesterday.
MH: I do want it yesterday.
CP: Well, in the immortal words of Chad and Jeremy: "Yesterday's Gone". Safe travels. Next!

Mad Hatter: Why is this so expensive? Didn't you bill my insurance?
CP: Yes.
MH: That's it? Yes?!
CP: Yes, sir? Yes it is expensive. Yes we did bill your insurance. Yes they seem to suck at paying for really expensive things. It is the harsh reality of the world in which we live. Things cost money. I'd love to pay $1138 for a new Ferrari but it's not going to happen. You have the right to pay for it. You also have the right to leave it here and not pay for it. Please decide quickly as there are others behind who are waiting to make this difficult decision. Next!

Mad Hatter: I wish to register a complaint.
CP: Next!

Mad Hatter: I'm sorry that last guy was a twatscrew.
CP: No worries. And don't apologise for him or his behaviour. He's a big boy. Besides, always being right means never having to say you're sorry. (My apologies to Ali Mcgraw).

An Open Letter: Dear State Board of Pharmacy-Transfers

Dear YOUR State Board of Pharmacy,

My name is The Cynical Pharmacist and I am a licensed, practicing pharmacist in YOUR STATE. It is my mission today to ask you to outlaw prescription transfer incentives. While I understand the YOUR STATE Board is not in the business of regulating company practices, they are in the business of protecting their State's citizens.

Pharmacy is a profession. We expect to be treated as healthcare professionals. We expect to be respected as professionals. If we allow our services to be bartered for gallons of gas and free gift cards, we are nothing more than cheap hookers, a profession which does not require a license.

We pharmacists are not in the position to make these changes to our state laws. You are. You give us our licenses. You take them away. You write the laws that govern how pharmacy should be practiced in your state. We listen to you. It is time you listen to us.

There are several states that have already outlawed the incentivizing of prescription transfers. This list includes New York, New Jersey, Oregon, Alabama, Mississippi, New Hampshire, and Arkansas. Simply put, prescriptions are not commodities to be traded on the retail market. These are life-altering medications that make a huge impact on a patient's life.

My concern with continued acceptance of this practice in YOUR STATE goes deeper than transfer errors. It goes deeper than the possibility of mistakes. It goes deeper than missing interactions and therapeutic duplications. It is about perception. We are the most accessible professional in all of healthcare. We gladly give away all of our professional services for free. The problem isn't companies attempting to buy patient loyalty. Studies have shown less than a 20% retention rate on patients who use coupons and incentives. The problem is lack of respect that arrives as a side effect with these programs. If we do not respect ourselves, we simply cannot expect our patients, and even other healthcare professionals, to respect us. I am starting a campaign to take my profession back. It starts with your help.

I have broached this subject directly with my State Board in the past. I have spoken with other pharmacists who have also contacted their State Boards and had similar results. The Boards' refusals to enter this discussion often boil down to the following argument: The Board does not exist to regulate company policy. I have mentioned each of the following situations before and received the equivalent of a shoulder shrug from those with whom I spoke. According to these members, the following are simply anecdotal and they have no proof that these can happen, do happen, and even if they did, the frequency with which they actually occur.

1. The risk for errors increases each time a prescription is transferred. The more times you fill it, delete it, call it in to another pharmacy, and give a verbal order to someone else, the risk increases. (Think of the telephone game in kindergarten.)

2. Time is wasted on transfers for coupons that could be spent on any other professional task. Each time I have to step away to get a transfer or give a transfer for a patient, I am at risk of speeding through something to catch up. I may miss a drug interaction. I may dispense an incorrectly filled prescription. The risk that I may make an error increases.

3. Patients complain about not being able to shop around or "going South" for the winter. There are states that only allow single transfers. Simple. If the rules exist, patients will adjust to them. They will get two prescriptions: one for home and one for their desert oasis. (Think about how well everyone adjusted to no refills on Hydrocodone-containing products recently.) Also, with most insurance plans, the patients' copays are the same at nearly every pharmacy. They shouldn't need to shop it around.

4. Grown adults use their elderly parents' medications to make money. This is true. I have seen it firsthand. Do the parents know? Is that their right? We have people who will carry folders with their parents' prescription receipts from all the local pharmacies. Every week they will drive from pharmacy to pharmacy, transferring CVS to Target, Target to Walgreen's, Walgreen's to Rite Aid, Rite Aid to Wal-Mart. Next week, they repeat the process. This should not be allowed to happen. If an error occurs, who will get in trouble? The pharmacies. Who will pay the price? The elderly parent. Your job as State Board involves looking out for the health and wellbeing of your citizens. 

Patients will complain states are taking away their rights. I believe they are taking advantage of a system that never should have existed in the first place. We need to make our profession more professional. It starts with you. It starts with this law change. It has to start now. I want my profession back. Please.

I would be happy to attend a Board meeting to discuss my proposal further.

Thank you for your time and consideration.

Sincerely,

I have included a link to Alabama’s law, a state that changed most recently.

“A pharmacist and a pharmacy should never offer or participate in the offering a financial award or benefit, not related to competitive retail pricing of any drug, to induce or encourage any individual to transfer a prescription from one pharmacy to another.”

Author:

Statutory Authority:

History:

effective June 13, 2011. Amended: December 16, 2011; effective January 20, 2012.

Herb Bobo, R.Ph. Secretary

Code of Alabama 1975; §34-23-92.

Original rule filed: May 30, 1990; Effective July 30, 1991; Amended: May 9,

http://albop.com/act205%20-%20MAY%202014%20sf.pdf

Here is the verbiage currently proposed in Virginia.

http://townhall.virginia.gov/L/ViewAction.cfm?actionid=4186

Displays

If you want to sell a product, people need to know you have it available to sell.

Think about product placement. It's all marketing and psychology. 

Companies pay top dollar to have their products placed in strategic locations, whether it be end caps or eye level on store shelves. 

Remember the old department stores that had huge window displays? 

Think about car dealers. Chevy has the newest, shiniest Corvette sitting prominently in the showroom. You can see it from the street. You are invited to look at these products. You cannot help yourself. 

(CP, what the hell does this have to do with pharmacy?)

Many pharmacies have a window, glass wall, barrier, something between the pharmacy staff counter and the general population strolling around out front. Most pharmacies keep their fastest movers on this ledge...or maybe just their Amoxicillin, Percocet and Norco because they are the biggest frequent flyers. In every pharmacy I have worked, we have had a variation of this. I always find it a little amusing when the Powers That Be saunter through our department and chastise us for having these items in a prominent location. It's bullet resistant glass. It's nice to know you are more worried about an open bottle of Norco behind a window than you are about my safety behind open counters. 

To me, this is marketing at its finest. 

Remember not too long ago when the Hydrocodone products were on backorder? (Except at my store where we anticipated the shortage.) I figured proper product placement in the window was the perfect way to show people we had what they sought.

As people would walk by they would espy the pretty bottles of 512's and Norcos in the window. They'd begin to drool at the mere sight. Pavlovian response underway, they'd call all their friends and say: "Hey, guess what? We found that Norco you were looking for. It's right here in the window display under the Christmas tree with the turkey ornaments and menorahs. Come quick before they sell out!"

When corporate would ask why our numbers were up double digits in prescription sales we'd laugh and tell them about our Jolly Multi-Holiday C-II display…then they'd complain because the decorations weren't approved, we didn't suggestive sell flu shots to all of them and we only advertised low profit margin generics.

Seriously, though. What is the difference between having a bottle 8 inches in front of me, on a ledge, versus 3 feet behind me? Patients can see my entire pharmacy inventory as they walk by. Thanks to the open-concept floor plan, the only thing that doesn't flow through my pharmacy is the front end aisle. Listen to me Oh Great and Powerful Powers That Be: You cannot insist I close my door and keep select products under lock-and-key if you are going to leave 30 linear feet of waist-high counter open to the general public. You CLEARLY are not concerned about the safety and wellbeing of your employees. You are plainly telling me that the few dollars invested in a couple bottles is worth more to you than our lives. (No. It is not a safety issue. Someone doesn't just walk by, see some controls on a ledge and decide to rob the pharmacy.) For you, it is all about the inventory…which still makes no sense. It's like leaving your garage door up at night with the lights on and the door to the house ajar, but locking your bathroom door during your middle of the night micturition trip. 

A(nother) Debate with Myself

Me: Why are you here?
CP: Existentially, philosophically, or?
Me: Professionally.
CP: I am a pharmacist.
Me: But why retail? You so hate your job.
CP: No I don't.
Me: But all your posts are so negative and mean. You must really hate people.
CP: I don't know half of them half as well as I should like; and I like less than half of them half as well as they deserve.
Me: Okay. But is it because that's where the money is?
CP: Nope.
Me: Then what is it? And don't say "to help people".
CP: Why not?
Me: Because that is the worst interview answer ever.
CP: Okay. How about this?: To foster and promote an environment where a healthy dialogue and transaction can take place enabling patients to get a better understanding of what it means to take better care of themselves and to enable them to reach these goals on their own.
Me: Verbose. Explain. Succinctly.
CP: I still believe people are good. I still believe they come to us for their healthcare needs, now more than ever with the other services we provide. This will continue to grow. We are the face of healthcare. We are the easiest professionals to reach directly. People like us.
Me: But you always complain they hate you.
CP: They do and they don't. Hate the game. Love the player. Many people understand that. Someone once asked me in an interview what my favourite thing about my job was. I quickly answered: My patients. I love them. I love getting to know them and their families. I love knowing what they are taking so I can help them with any questions they have. I love they feel comfortable enough to ask me questions and just talk with me whenever they need it.
Me: Aw. How sweet.
CP: Then I was asked about my least favourite thing about my job.
Me: Go on.
CP: I answered: The patients. The whiny, I-need-everything-now, slap-a-label-on-it, yelling, screaming, entitled, I'm-going-to-call-corporate-on-you, hurry-up-what's-taking-so-damn-long, stare-me-down IMpatients that we all deal with every day.
Me: Nice. Did you get the job?
CP: Of course I did.
Me: Back to the question: Why ARE you here?
CP: I serve a bigger purpose than myself. I believe I can do my best work in retail. I have the knack for patient service. I'm good enough, I'm smart enough, and doggone it, people like me. It's like bedside manners for prescribers. Those who are great at it are often lacking in other areas. Those who suck at it are often brilliant practitioners. There are few who can find the happy medium. I am somewhere on that Bell Curve. Another area of practice would have fit in with my brain a little better but I am a talker and love to engage people in conversation.
Me: But you complain a lot.
CP: Sure. Look at where it's brought me. I am bringing to light many problems facing our profession today. Retail seems to be looked down upon by other professions and other professionals within the practice of pharmacy even though we represent the majority of practicing pharmacists employed today. We have a job to do. It is evolving. It has moved away from its "helping patients" credo and become "dollar grabber extraordinaire" with all its ancillary, a la carte services.
Me: What do you wish to do about it?
CP: I want my profession back.
Me: And how will you accomplish that?
CP: Stay Tuned...With this page. I have a few ideas in the works, but I need input from all my followers. Hence the Participation Polls I am conducting. Some assembly required. It's like class participation. The more you participate, the better the class does.

Help(less) Techs

We live and die by our technicians. Without them, we are nothing. It's like the scene in Full Metal Jacket.
This is my rifle. There are many like it, but this one is mine...Without it, I am nothing.

Great techs make great pharmacists. However, there are always those ones that annoy the crap out of you. Every job, every profession has them.

We all know the type:
1. hears all the gossip any customer or fellow employee whispers but manages to be deaf to the sounds of the phone or the drive-thru bell;
2. is ready to go on break the second it's time and arrives for work at the last possible second to be considered on-time;
3. knows how to do most things, but would rather (play dumb) delegate the "hard stuff" like looking up insurances, rebills, and adding discount cards;
4. can't make eye contact or acknowledge anyone is at the counter or if they notice, will always say "someone will be right with you" while also asking the other person to get the phone;
5. takes the refills out of the queue but ignores the lone, difficult e-script that's been looming for 2 hours now;
6. manages to turn a 15 minute break into a half-day episode of Where's Waldo?;
7. suddenly can't reach any medications that are "too high" or "too low";
8. complains about where things are placed on the shelf, but doesn't alphabetize anything after the second letter in the name;
9. has never met a full trash receptacle he/she can't completely walk past and ignore;
10. will stop counting in the middle of a prescription because it's break time;
11. strategically knows when to call off certain days of the week/month;

The problem here is it's a double-edged sword. If we pick up their slack because they don't do it, they are encouraged to continue this behaviour. If we refuse to do their work for them, we get further behind and have to work that much harder the rest of the day to make up for their ineptitude.

(Short of firing them, which in many places is not an option, what is the answer?)

Happiness in Slavery

Today is not Valentine's Day. I will not be your bitch. But I will be happy to treat you like one.

Every once in a while there comes along an opening, an opportunity for an educational moment. A teaching moment, if you will. When the tech shouts "guy bitching about a price match and he doesn't  know the W's", I rub my hands together in anticipation. This will be good.

CP: <picks up phone> Thank you for holding. This is CP's pharmacy where you get a dose of medicine to go along with your medication if you abuse my techs, pharmacist speaking, how may I help you?
Dumb and Dumber Solo: You didn't match my price.
CP: Did you tell us to match your price?
DDS: No. That's your job.
CP: No it isn't.
DDS: Yes it is.
CP: Print me my job description and highlight that area in green for me please.
DDS: What?
CP: Okay. Here's an easy one. WHO are we matching?
DDS: I don't know.
CP: WHAT price are we matching?
DDS: I don't know.
CP: WHEN did you get this price from "them"?
DDS: I don't know. You always do it.
CP: Last one: WHERE is this mystical matching pharmacy?
DDS: I don't know. You always handle it and I'm pissed!
CP: If you do not ask me to price match, HOW am I supposed to know?
DDS: That's not my problem.
CP: Hmm. Perhaps you should not entrust us with such an important mission in the phuture. It would behoove you to have this information ready on all subsequent visits.
DDS: That's not my job.
CP: And until you bring me my job description, I am going to have to tell you it is NOT MY JOB either. YOU want me to match A price but YOU don't know WHO, WHAT, WHERE, or WHEN? That's like telling an English student to solve for the square root of purple. Throw me a frickin' bone here buddy. Prices change. Pharmacies add, but mostly remove, items from their lists all them time. My job is not to stay current on them for one crabby patient who can't be bothered to take care of his own lone prescription.  I have over 400 I am going to do today. I don't have time to worry about your price. The fact that I am going to lose money on it doesn't really make me want to exert any extra effort on my part. You obviously don't come here for our friendly staff and customer service. You come here because we will match a price. Our corporate policy dictates that you have all of the relevant info ready as we cannot match willy-nilly. I'd be willing to bet you don't wish to drive in traffic to the other side of town where this pharmacy is located, right? If you can't be bothered, then neither can I. The next time you try to pull this crap on me, I will simply transfer your prescription to them. You'll already be aware of the price.

It's Not Supposed to be Like This

Why?
Where do people get their irrational expectations?
Why do people believe what they have come to believe?
Why is it MY fault that what YOU believe is so damn wrong?

Why can I not go to the gas station and trade a live chicken and some eggs for a couple gallons of gas?
Why does a new Xbox 360 not cost $11.29?
Why is the Earth not flat? (Yes, some people still believe it is...)

One of my favourite words to use at work is "baffle", in its many forms.
People baffle me. I am baffled by their questions. Certain situations are baffling.
Yesterday presented another of these baffling conversations. In this case, it was with a pet owner.

(Side note: many many many medications are currently undergoing the whole go-on-backorder-for-a-month-then-return-with-a-six-hundred-percent-price-markup. Many of these used to be pretty cheap and are often prescribed by veterinarians. This is one of those cases.)

Lost Her "Marbles": Why does this cost so much?
CP: Because it's not cheap.
LHM: Last time I got this I paid like $10.00 or something.
CP: Very precise. Can you tell me when this was?
LHM: Last time. I know it was.
CP: Uh-huh. The last time we filled this, prior to today, was August, 2013. That's over one year ago. I know there was a huge spike in the cost of this over that time. Do you give this to Lady Marbles all the time.
LHM: Oh yes. Every single day. We never miss a dose. She has to have it.
CP: Ok. So where have you been filling this?
LHM: Here. Always here.
CP: And you made 90 tablets last 450 days?
LHM: She has to have it.
CP: Then today it will cost you $35.00
LHM: "It's not supposed to be this way. It's supposed to be cheap."
CP: According to whom? Who said it was cheap? Because it is for a cat? Because "that's what you've always paid"? Gas cost less than $1.00 per gallon when I was in high school. Does that mean I'm grandfathered in to that price for the rest of my life? I do not understand your complaint of "It's supposed to be cheap". Please explain.
LHM: She has to have it.
CP: Yes, Poor Pussy. You have yet to answer any of my questions so far. You dodge them as well as a seasoned politician running for reelection. Prices go up. Caring for pets is not cheap. Would it help if I explained this is a 180 day supply? It works out to less than $6.00 per month. I could charge you $10.00 if you'd like...but I will only be able to give you 6 weeks of medication.
LHM: No. I guess I'll get this. I just don't understand why it costs so much. This isn't how it's supposed to be.

(The whole time I kept picturing Switch's death in The Matrix: "Not like this. Not like this.")

Check Baby Check Baby 1, 2, 3, 4...

...okay, one is all I need.
I checked my cheque-book for cheques the other day before I went shopping. This was a trip to a retailer that accepts only cash or cheque so I wanted to make sure I was prepared. I noticed I was down to my last cheque. Briefly I considered walking out the door with my single cheque in hand. It occurred to me I might make a mistake. I could lose the cheque. I could make it out to the wrong place or for the wrong amount. A need may arise where I find myself going back into the store to purchase something I had forgotten or that I broke in the parking lot. The point is that I wanted to be prepared for any possible outcome whereby one cheque may not suffice.

...and then I thought of my pharmacy. It happens all too often, but we do have this one Vicious Twat who seeks out ways to get under our skin. She comes to the pharmacy at 8:58 with multiple refills and expects to wait when she knows we close in 2 minutes. She complains if we attempt to scold her for any of her misbehaving. Her greatest coup so far has got to be the "I only have one cheque" routine. She employs it with every visit. You all know it. It goes like this:

VT: Can you ring all my other crap here too?
CP: Nope. Too much crap. Take it up front. That's their job.
VT: But I only brought one cheque.
CP: Then you can go up front, ask them to allow you to overwrite the cheque for the exact amount of your prescriptions, which in this case is $53.00, and then you can bring that cash to me, we will call your debt settled, and you can go on your merry way.
VT: That's too much work and I'd have to go all the way up front then walk back here with my groceries.
CP: Or you could take them to your car, then come back.
VT: That's even more walking.
CP: You could get a scooter from up front and drive with malicious intent through the aisles on your way back here.
VT: But you're closing now.
CP: Correction. We already closed and thanks to you and your shenanigans, again, there are still 4 people in line waiting their turn. It would be different if you didn't do this to us every time you visit. It would be different if you hadn't filed a complaint against the nicest, quietest tech in my entire pharmacy because she politely mentioned the above scenario as an option to you and you had the nerve to get offended. It would be different if I didn't have somewhere to be at 9pm tonight. It would be different if if I could get The Powers That Be to kick your ass out of my store. As it stands, we are at quite the impasse. Here is how this will work. I will not accept your single cheque theory. In fact, I'd like to look in your cheque-book and verify there truly is only one cheque remaining. Besides, who tears out one single cheque? I will wait on every other patient behind you until my line ends. If by that time you have not come up with some other form of payment, I will close and lock my last gate for the night. At this point you will be faced with the following situation. You will be forced to take your own groceries up front, pay for them with your last, lonely cheque and go home. You must then return tomorrow with another cheque, or some other form of payment, and pick up your prescriptions which will still cost you $53.00. I shall leave it up to you but please move over so I can attend to all of the smiling faces behind you who also think you're being a rather snooty bitch.

Do You Wanna Get a Flu Shot?

Why do people still schedule appointments with their prescriber's office for flu shots?
(Unless your insurance mandates this, which few do anymore, this is a good question.)

Funny observation from my recent office visit:
The guy in front of me arrived at 1:02 for a scheduled 1:15 flu shot. He brought his 18yo daughter for her shot appointment at 1:25.
The guy behind me arrived at 1:03 for a 1:15 flu shot as well.
They checked in and were give a clipboard with the routine questionnaire attached for them to complete while they waited.

The process looked a little surreal to me.
Here, in a prescriber's office, people walked up to a counter and quietly, patiently waited in line to check in. They quietly and patiently sat while completing their paperwork. They waited quietly until they were beckoned to the back by Lady Stabber. They proceeded to checkout and quietly paid their copay. They left without making a sound, a fuss, a commotion. They did not cause a ruckus, create a scene, remonstrate with the staff, or exhibit any of the character traits associated with the Pharmacy Phlu Shot encounter.

Father and daughter were there over half an hour.
I would have processed, billed, administered, and checked out both of them on any day in 20 minutes. They could have come before work, after work, at lunch, on the weekend, and the result would have been the same. Why do people continue to make appointments at their offices solely for a flu shot? To me, that is not convenient. One of my patients, when I asked her about getting her flu shot, told me she didn't know we gave them (see marketing people! you are failing here) and instead went to a competitor she happened to be driving by simply because they had a sign out front.

Note: You can call ahead and let us process your prescription on your insurance before you arrive. This way, as with the office above, all that is now required of you is to complete the paperwork.

My two questions I will leave you with today:
1. Why do people continue to make flu shot appointments with their prescribers (solely for that purpose)?
2. Why do people act so much differently in these offices when their wait is longer?
3. (Bonus Question) Why are they so HAPPY to wait longer in the office for a flu shot?

It was the Fever

Some excuses are not acceptable for certain situations.

I took a voicemail for Bentyl 10mg capsules. Listened to it twice, as always. Definitely Bentyl.

Next day, as I am talking to my partner, I am informed that the patient complained he received the wrong medication. Here is how my partner explained it to me:

CP's Partner: Make sure you write this down for your little page.
CP: Curiosity is piqued. Do tell.
CPP: Had this conversation with a nurse this morning after the patient called to inquire as to why his medication looked really really different.
CP: Okay.
CPP: I talked with him then called the office. Turns out I was able to get transferred to the actual Voicemail Nurse who phoned in the actual prescription!
CP: No way!
CPP: Way! I asked her if she remembered calling in the prescription.

----
CPP: Do you remember calling in the prescription?
VN: Yeah. That was me.
CPP: The patient said it was supposed to be for Reglan 10mg tablets.
VN: "Yeah. I had a fever that day so I'm not really sure what I said." (actual quote)
----

CP: She actually said that?
CPP: Yep.
CP: As if that's in any way an acceptable excuse?
CPP: Yep.
CP: I think the only time "I have a fever" is acceptable is when it comes from Christopher Walken and he wants more cowbell.
CPP: Maybe we can use that from now on in our pharmacy.
CP: Why is the wait 15 minutes?
CPP: I have a fever.
CP: Why did you miss your sales and script count goals?
CPP: Fevers.
CP: Tech Budget?
CPP: Fever.
CP: Why did you short me 27 Oxycodone?
CPP: We didn't. We count by fives. We never miss by an odd number. Are you febrile?

CP: So basically she blamed a fever for her error? An error which could have, though not likely in this case, been detrimental to a patient's health had he not been so vigilant?
CPP: Correct.
CP: I don't suppose they are one of our frequent e-script offenders too?
CPP: It wouldn't surprise me.
CP: Did you document her words?
CPP: Verbatim.
CP: This whole thing gave me a fever. Make sure we add that office to our "do-not-ever-let-this-doctor-take-care-of-me-or-my-family" list.
CPP: Definitely...once my fever goes away.

Find the Error

Okay, class. Pay attention. Welcome to the first day of school. My name is CP and I will be your instructor through these lessons. We are gathered here today to learn about this thing called Electronic Prescribing.

(oohs and ahhs from the crowd.)

When I was in school, our prophessors would show us examples of error-filled prescriptions. We had to identify what was missing, added, incorrect, or illegal and correct it. Here is my plan going forward. 

We are going to collect all of the error-filled prescriptions throughout the day. At the end of the day, we will remove all patient-identifying information from these prescriptions. We will then attach a fax cover sheet to each of these that reads: 

"Our Pharmacy received this error-plagued electronic prescription from you or one of your colleagues today. Please take the time to examine the mistakes that were made. We circled the number of errors so you would know how many to find. Bonus points if you can find all of them. In order for us to not send your error-filled prescriptions to the State Boards, please correctly remedy your colleagues' prescriptions. For every one that you fix correctly, we will remove one of yours from the Boards' pile.  Also, please feel free to contact your colleague and make phun of him or her for their gross ineptitude. 

We will then fax this, along with the prescriptions to all the local prescriber offices. The prescribers who send back the fewest corrected prescriptions each month will be placed onto the naughty list along with the prescribers who made the most errors during the month. It will be quite interesting to see how many corrected ones we get back. At the end of each month, we will forward both of these lists to the State Medical and Pharmacy Boards.  

After a while, you will learn you do NOT want to be on our list. 

Perhaps we could give kudos to those offices that mend their ways. We could ask them to post one of those "XX Days without being made fun of by CP" boards in their offices. 

Check out the Monty Python Blackmail sketch here...

Monty Python Blackmail

or for the shorter, more relevant version, click here...

http://youtu.be/xrRZVCg31fE?t=1m24s

Plan Ahead

It helps to plan ahead.
It helps to prepare.
While sometimes it is okay to just wing it, this is not always the case.
Be prepared.
Save yourself some time.
Save me some time.
More importantly, save everyone else some time.

Sunday, 11am, a man approaches the counter.

Strange Little Man: I need to have this filled.
CP: Hooray! One more and I get a cookie! Do you wish to wait?
SLM: No. I am going to go home and try to find a discount card for this.
CP: Okay. Sounds like time well spent.
SLM: It is. I get this every month and always find a card to save me money off my copay.
CP: Great. May I pester you for a moment over this whole scenario?
SLM: Sure.
CP: I notice here that this prescription was written 10 days ago.
SLM: That is correct.
CP: You say you get this every month.
SLM: Yes.
CP: You say you bring me a new discount card every month.
SLM: Correct.
CP: May I ask why it is then that you would hold onto this for 10 days, grab it off your kitchen table, drive it down here, leave it for me to fill, THEN drive back home to do some research online to find a coupon which you will bring back to me later which I will have to spend twice as long trying rebill as I needed to initially fill it, all the while backing up my pick up process and making everyone behind wait even longer for their prescriptions than is necessary?
SLM: I wanted you to get started on it.
CP: And at no point in the last 10 days, or this morning, did you think to research this coupon you bring me every month? Shouldn't you have it bookmarked or favorited somewhere?

Fast forward to 4:15 pm, after the football game and just as pickup time is peaking because we close at 5pm and SLM enters...

SLM: Here is the coupon I found.
CP: It took 5 hours to research this?
SLM: And watch the game.
CP: Okay. You do realise that I have to put all this information in the computer, reprocess it, and call them because what you gave me isn't working, right?
SLM: No. I know this happens every time though.
CP: Then perhaps you should print this BEFORE you bring me the prescription so I have plenty of time to fix it. There are now 11 people behind you in line, all of whom also watched the game and now wish to pick up their prescriptions before I close. You should apologise to them, and buy each of them a soda with the huge savings you are expecting with this coupon card.
SLM: Golly, that sounds swell!
CP: I know. Makes me pine for the days when we had soda fountains...

Walking With a Limp

I was once told by some HR prick that my mouth would get me in trouble. He may have been right as I seem to have #NoFilter when it comes to my customer interactions. Mind you, these are not your typical, run-of-the-mill interactions. These are the ones where I defend my honour and that of my technicians...and try to one-up the belligerent arse standing across from me. One of my most important rules in my pharmacies has always been defending my technicians. They don't get paid enough to put up with the bullish!t spewing across the counter and no one is allowed to treat them worse than I do.

Which brings me to today's witty tete-a-tete.
Uber-Tech: Mr. Limp Bizkit over there would like to use this coupon for his 3 free tablets.
CP: Okay. Tell him to hold on a bit longer and I shall try to work my magic.

(mere minutes pass...)
CP: Please tell MLB that he already used the 3 free coupon and has to use the other one for a discounted copay.
MLB: What? I wanted all of them! Why is this taking so damn long? That's not what I told her!
CP: Wow. I counted 3 exclamation points there. You need help.
MLB: I asked her for all of them.
CP: And just how many would that be, exactly?
MLB: I. SAID. ALL!
CP: Well let's see. Your prescription was written for 10. Your insurance pays for 6 per fill. Your coupon discounts only 3 at a time. So which "ALL" do you want? The ALL 10 originally prescribed? Or...
MLB: How hard is it?
CP: Apparently not very...
MLB: Jesus Christ!
CP: He won't help you...and he also doesn't need this. He was able to rise from the dead with no help. Beat that!
MLB: There is no reason I should have to wait over 2 hours here for this.
CP: You are correct. There is no reason. So why are you?
MLB: What?
CP: Why are you waiting? Just take your stuff and go. We filled it exactly 2 hours ago...right when your doctor sent it to us. It was ready to go...2 hours ago. All you had to do was pay for it instead of giving my tech a hard, sorry, difficult, time. YOU asked ME to change the billing. YOU asked ME to change the quantity. YOU are keeping YOU here waiting for all of this when all you have to do is PAY and LEAVE.
MLB: This is ridiculous. You people don't know what you're doing.
CP: By the way, the cost for ALL 10 of them will be $300.
MLB: Just give me my damn blood pressure medication.
CP: Yes. You definitely need that.
MLB: (mumbles under breath as he storms off...)
CP: Have a good night, sir!

(MLB returned a short while later and started in on another of my techs...)
MLB: Why didn't you give me my 3 free tablets?
CP: Because it is a once-per-lifetime offer.
MLB: And I used this 2 years ago!
CP: Did you die and come back to life sometime in the last 2 years?
MLB: No. That's ridiculous and you're an ass.
CP: Thank you. And if you hadn't worried about interrupting me every time I went to explain the rules, you would have had your answers, not had to come back, and probably be an hour closer to "action time".
MLB: Your problem is you think you know everything.
CP: And your problem is that you don't realise I do know everything. Now go away or I shall taunt you a third time.
MLB: Ass.
CP: Have a good night!

Discount Card Cheerleaders

Discount Cards are swell. They promise big but always come up short. The only thing missing from the magazine and mail promotions is Billy Mays. These discount cards practically scream at you that they will save you tons of money off your prescriptions. While it is true that the insurance-less folk out there will save a few dollars off retail prices, the promised savings ranges are rarely, if ever, truly realised. As with all advertisements, people fall for the bold print and BIG type and focus on the "up to 90% OFF" and ignore the little asterisk explaining the only way to receive UP TO 90% off would be to only purchase 10% of a prescription.

Patients expect something that is mailed to them, for free, to provide them with unlimited savings. Where else does this really happen? Are these the people that click every link in their spam folder expecting enhancements?
When patients come up to the counter with these decks of cards I think they expect Monty Hall and a group of cheerleaders with pompoms to suddenly appear in a shower of confetti and start cheering: "Take it off! Take it off! How low can you go?"

*Please note: This is specific to general discount cards and NOT manufacturer-/medication-specific copay cards. That's another rant...

One Prescription Equals One Prescription

How long does it take to fill one prescription? From start to finish?
How long does it take to process it?
To type it and bill the insurance?
How long does it take to count it?
To label it?
How long to check it?

Assuming nothing is wrong with it that needs fixed, how long does it take for one lousy prescription?

I know there are companies out there that, if a technician is not allowed to count the prescription (CIIs), then these are not included in the totals used for tech budgets. I call shenanigans.

The big problem I have is not including prescriptions put on file.
They still need scanned.
They still need typed.
They still need checked.
They often still get billed to insurances (often e-scripts sent that may be a few days too soon or that the patient had filled at mail order or any of the myriad reasons for us to try to process the claim). These often take longer because we have to process them, get a rejection, research it, call on it, or send a prior auth for it. Either way, at least as much work goes into one of these as a regular, filled Rx for which we receive credit.
They still need checked by the pharmacist.
The only real difference is the missing step of "just putting pills in a bottle".

One day recently, we filled over 400 prescriptions. On the same day, because I counted them, we processed over 40 prescriptions that were put on hold. This means my numbers would have been improved by 10% for my staffing if these prescriptions, which require just as much effort to process, had been included in my totals.

While I realise we do not get any payment from anyone for prescriptions not actually filled and picked up, it does not change the amount of work that we the people need to perform.

We want people to get shingles shots.
They want to know how much it is.
We process their prescription. We bill their insurance. We get a label. We tell them it is $50.00. They balk at the price because next year they are switching Medicare D plans and it will be free. They don't want it. Now you back out the claim and put it on file. How long did it take? How much did you make? Do you get credit for the time it took away from processing something else?
No. You get nothing.
It IS your job to process these. We have a lot of prescribers in our area who send e-scripts for an entire patient's profile with the note: "Please hold. Do not fill until patient requests." This is great. It means we do not waste our time filling them only to have to return them in 13 days. However, I still have to do most of the same work just to file them.

When corporate bosses ask why your numbers are down, you cannot point to all the scripts you filed and almost filled. (I understand we will get credit when we actually fill them in the phuture.)
If you are going to base my pharmacist and technician hours on the amount of prescriptions we DO it should include the ones we PROCESS and NOT just the ones we fill.
Just because WE don't COUNT doesn't me THEY shouldn't count.

Hercules! Hercules!

I had a new experience yesterday while administering flu shots. They say expect the unexpected. I saw a fine couple in their early sixties at the counter paying for their shots. I overheard someone mention "we have a cryer over here". I saw the gentleman in the T-Shirt pictured and figured it couldn't be him.

As I enter the room, Mr. Big Guns was slunk down in his chair, hand over his eyes. After finishing his wife's shot, I moved in for the kill shot. One thing I have practiced with my technique is to talk while I approach with my needle. The second thing I have developed is the "pump fake". This really came in handy as he flinched so much I thought he might have turned to stone. Once he thought it was over and relaxed, I went in for the kill. The entire time he spent blubbering and sniveling.

Phew, flu shot over...
...aaaaand he's getting Pneumovax too. Here we go again...

Policies and Procedures

I wish corporate would just stop making new policies and procedures. Our pharmacy is beginning to look like this:

Corporate Hypocrisy

Dear CP,
Here's a little story I've got to tell...
I thought you might find this relevant to your site.
Over the last several months, we have been instructed by The Powers That Be (TPTB) to reduce our inventory. Always a good idea, right? It would be better if they'd quit changing manufacturers on us, but that's another rant you can explore later.

Here is what happened. (Just as I predicted and yet somehow, TPTB didn't see it coming.)
We were told to reduce inventory. We spent months working on this. Eventually the congratulatory emails arrived from TPTB patting us all on the back for the work we've done and how much money we saved them and yadda yadda yadda more TPTB blather. We were heroes in their eyes.
And then...
We noticed that we were owing more and more people more and more items every day. We used to only have to owe, on average, 3 people per day. Now that total is just under 20 per day. That is only within the last 4 weeks.
And then...
TPTB sent emails out to us in the trenches that went like this: We have seen a large spike in customer service calls that point to not having products in stock as the number one issue.
Seriously. TPTB cannot be surprised by this. We knew it would happen. It would not have been so bad if they hadn't continued with the whole "surprised act" when they said: Make sure you call CUSTOMERS to tell them you are out of stock.

Yes! Because that is the reason they are pissed at us. It's not because we didn't have it in the first place, it's because we neglected to tell them that. See, if I were a PATIENT of a certain purveyor of health, and this particular place never had my health in stock, I'd be pissed at them for that. I don't care if they always called me. I'd see their name on my phone and think to myself "gee, they must not have my medication in stock...again".

I realize there is a balance. I realize we cannot control manufacturer backorders. I know as well as you do that we cannot stock lots of everything for everybody. That is reasonable. What is not reasonable is owing people basic medications. I ask you, O Wise One, have others experienced the same type of hypocrisy when it comes to inventory and stupid customer service metrics?

Dear Anonymous,
You must bring balance to the Force. No decisions ever made by corporate make sense. It's a little like God making the platypus. Sometimes you just have to say WTF? and move on. We truly are a damned if you do, damned if you don't profession.
Inventory too high? Your fault.
Inventory too low? Your fault.
People unhappy about stocking issues? Your fault.
Increased complaints about inventory from patients? Your fault.

I do find your story hilarious that they expect complaints to disappear simply because you call the patients. We call them too but it's a huge inconvenience for people to wait a full day for something they may need to start right away. Another issue I see with your comment is that your boss didn't take into account people who are waiting. You could tell them right to their face they have to come back for it. It's not going to make them any less pissed, but it will likely still generate a complaint. You did your due diligence and were proactive but it doesn't change the fact that you are out of the medication and the patient has to return. If they can figure out that we are going to give 1138 flu shots this year, they should be able to project how much Omeprazole and Ondansetron we are going to use.

Working with the Public

When did it become acceptable for those working with the public to just have to take it? Was it corporations deciding to focus on "customer service metrics"? Why is it that with nearly every post I write lamenting the state of retail, people comment that that's how retail is supposed to be?
I say that's bullshit. Why do we allow EVERY retail worker to be treated like crap? Is it just because "it's the public"? Since when is that an excuse to act like an intolerable git? I never walk into a retail outlet and say "today I'm going to throw a tantrum and hold my breath and swear at and belittle the clerks until I get my way". Never! But we as Americans willingly accept this as "acceptable public behaviour". Why?
I hate when people throw "whatever happened to 'the customer is always right?'" in my face as if that's some sort of argument ender. There are two flaws with that statement. First, you are not a customer, you are a patient. Second, you are not leaving with a product, you are leaving with your health. Hardly quantifiable.
People talk about how bad things would be if, one morning, some group decided to stop working. Could you imagine a day with no retail outlet open? We are no longer a manufacturing country. We are a retail country. We sell stuff. Lots of it. Let's empower everyone to fight back. Let's all walk out one day.

With National Pharmacist Month upon us in October, people have been asking me to start a campaign to get pharmacists organized in a Walk Out Day. Great idea...expect we pharmacists are all talk and no action.
Many would agree to do it, but then chicken out at the last second when they hear whispers that all who participate would be terminated for "job abandonment".
Many young pharmacists have too much debt to walk away.
Many pharmacists would say "it's not my fight. I have my patients to take care of and I have to put their needs first."
The problem is that THESE are exactly the pharmacists who need to join us. Wherever there is someone else who will "just do it", we have no collective voice. We have no unity. This is precisely why a union will not work. This is why a day of work boycotting will not accomplish anything other than job creation for new grads.
Another issue that surfaced recently was from a technician who was followed to her car by a patient whose CII was not fillable. It had been postdated by 2 days. The DEA is clear that you canNOT change the date of issuance of a CII prescription. Instead of the pharmacist making this clear to the patient, ambiguity ensued as he offered to call the physician, whose office had just closed. WE can NOT change the date. Why offer? Because we are trying to do the right thing? How about the legal thing instead? Sending this patient on his way would not have endangered his technician. WE are making OUR lives harder.

Fast Cash

Thanks to Corporate Greed, what should have been viewed as a worthwhile service, an important function of our jobs, has been relegated to the "you want fries with that?" suggestive sell.
Flu shots are important.
Getting one is important.
Waiting for 15 to 20 minutes to get one? Not so much...

I came up with a plan to deal with this scenario I had over the weekend.

Impatient Lady: I want a flu shot.
CP: Certainly. That will help me reach my quota. Please simply fill out this important, required questionnaire and I will process it for you.
IL: How long?
CP: About 20 minutes from start to stick.
IL: <throws paper and pen back> What? I want it now! Why do I have to wait? I'm going somewhere else.
CP: Okay, Veruca Salt. You do realize that the next closest pharmacy is a 20 minute drive, right? Plus you have to storm out of here, walk to your car, drive there, park there, go in there, wait in line there AND be told it'll be 20 minutes, right? Just making sure you have thoroughly thought through your hasty decision.
IL: <storms off>

It was then that I decided to revisit my Disney FastPass post from last year.
What if we offered "instant flu shots"? No waiting?
I don't mean a flu clinic where people still have to wait in line. (We used to have clinics where people would ask how long. I averaged 3 minutes per shot if all the paperwork was completed. Sorry, but the 20th person in line? He has an hour wait.)

I mean instant, shoot-em-up now flu shots.

IL: I want a flu shot.
CP: Certainly.
IL: How long?
CP: 20 minutes.
IL: What?! I can't wait that long. I have ice cream in the car with my baby who is on his way to the airport to fly to a dentist appointment for which he needs an antibiotic filled at another pharmacy one hour beforehand and the appointment is in 30 minutes.
CP: Wow. Well in that case, I have an alternative for you.
IL: What's that?
CP: Instant flu shot.
IL: Yes. Yes. I'll take it! How's it work?
CP: I walk with you into that little room over there, grab my syringe I pre filled this morning, and as I am helping you fill out the questionnaire, I am prepping you for the shot. I do all the hard work so you don't have to wait.
IL: I like this. Let's go.
CP: One catch.
IL: What's that?
CP: It costs $60.00
IL: What? All pharmacies are charging less than $30.00 for their flu shots.
CP: I know. But they are also making you wait...and wait...and wait...and fill out your own paperwork. Then they are billing your insurance. I am offering you a reasonable solution to your self-inflicted problem of poor time management. Your choice is simple: Wait 20 minutes or pay for the expedited, Platinum Club service. Maybe I'll even let you pick out your own BandAid...for free!

Phone Menus

Having to dial different pharmacies, insurance companies, prescriber offices, and takeout places can make one a so-called expert on phone menus. I like the ones that tell you "please listen to the message in its entirety: our options have changed".
When was the last time you updated that message? Your options haven't changed in years.
I think if you're going to change them, change them frequently. Also, make the options erratic and senseless. People will have to actually listen to them instead of getting menu fatigue. Change the options every week. If patients had to press 369 to request refills at your office, change it to 17 the next week and make 369 an automatic disconnect.
Will they call the pharmacy? Absolutely!
Will the ask us to call the office for them? Of course.

If you are from a prescriber's office, press 9999999999999999999999999999999999999.
If you wish to speak to a member of our pharmacy staff, press the square root of 4, cubed.
If you wish to call in a refill and have your rx#, press 1138.
If you wish to call in a refill and do NOT have your rx#, please hang up, go find your bottle, and call back.
If you are not sure what pharmacy you dialed, please press "end" on your phone and call back to listen to the greeting again.

A Letter to Corporate

Dear Corporate Pharmacy,

I would like to thank you for my gainful employment and the paychecks that come with it. It has been a great career so far and I have seen many changes that have improved our profession. Along with these positive changes, I have also witnessed the ruination of the profession I love. I lay the blame squarely at your feet, corporate rulers.
It is unfortunate that you seem so out of touch with what our profession represents. It is time you rethink your policies and procedures and hiring practices. It is time to take off your suits, walk into our stores, put on a lab coat, and do the job you wish to destroy; the job you think you know. While you are there, you can take a few pharmacists and technicians and move them into corporate offices so they can write the new P&P manuals. They can dictate how a pharmacy should work. More importantly, you need to STOP making policies and procedures and just let us do our jobs without interference.

Let me provide you an example.
Most pharmacies have two cash registers and many have a drive-thru. If I have one technician for the register and one to perform data entry, then no one is counting. If a line builds, people will wait and become irritated. They will complain. We at the store will get docked for poor customer service because we are not quick enough. However, we are working within the budget sent to us by corporate. Imagine a Superstore with 30 checkout lanes...after Thanksgiving. What is the best impression for customer service? A. Customers walk in and see 30 open lanes with 30 cashiers and only 5 people in each lane, or B. Customers see 30 open lanes, only 1 cashier working, and 150 people waiting in that one lane? This is what you have done to pharmacy.

I have always been in favour of pharmacists providing immunizations. I am on board with MTMs. What I have a problem with is continuing to add tasks to our daily responsibilities while not adding compensation or support for the increased workload. Have you read Animal Farm? You have made us Boxer ("I will work harder"), while you have become the pigs.

We Just Can't Win

I realise it has only been 9 short months since the changes were made to all Hydrocodone/APAP products that limited them to containing no more than 325mg of Acetaminophen.
I realise doctors can't learn anything new such as drug/strength combinations that have been around for a long time. (This is actually OUR fault. We always call and fix it for them. But I digress...)

Doctor wrote a prescription for Vicodin 5/325. Since we are not allowed to assume which part is correct, we are required to call.
CP: Which did you want? The VICODIN name which is 5/300 or the NORCO which is 5/325?
Dr. I Can't Know New Things: I wanted the 5/300.
CP: Super-dee-duper. Thank you kindly.

As I process it, the insurance rejects as a non-formulary, non-preferred drug. Great.

CP: I need to get this changed to the 5/325.
DICKN'T: Why didn't you tell me that before?
CP: I don't know formularies and copays until I run it. Since I did not, at the time of my initial phone call, have a valid Rx to run to the insurance, I was not privy to that information. Besides, who are you to talk? You didn't even know the correct drug/strength combination you prescribed. After 9 months you should have been able to figure that out by now. Women grow and birth babies in less time than it takes you to learn how to write a prescription...which is your actual job.

One Bottle Does Not Equal One Bottle

I know this will seem far-fetched but I got into an argument with a doctor over an error on her e-rx.
If she had only taken my phone call instead of relying on the phone tree to answer my question this would have been an easy fix. Instead I had to resort to telling the secretary who yelled, often incorrectly, to the nurse in the background who yelled to the doctor who yelled back to the nurse, back to the receptionist then into my ear.

Here was the problem: Rx was written for Zyrtec Syrup. Dispense one bottle.
Great. We get this in pints because Medicaid covers it. I'm pretty sure she did not want to give the patient a pint. I asked for clarification on the definition of "one bottle".

Doctor Obvious: I wrote for one bottle. Just give them one bottle.
CP: Bottles come in different sizes. We get pints. This bottle would last for 96 days at your current directions. Is this really what you want?
DO: I want just one bottle.
CP: I can give the patient anywhere from a 1 oz bottle up to a 16 ounce bottle. You have to pick one.
DO: Why are you making this so difficult? Just give one bottle.
CP: Why can't you figure out how to use your e-script software and select a quantity? If you wrote for Hydrochlorothiazide 25mg tablets to dispense "one bottle" would you expect me to just give them my 1000 count stock bottle?
DO: That's different. (actual quote)
CP: HOW? How is that any different?
DO: We've had problems with you before.
CP: Go ahead and say it. I know it's coming...
DO: (and CP, in head) You're the only pharmacist that ever calls on this, blah, blah, blah.
CP: Yep. I guess I like my license. Tell you what. Figure out how to use your software or the next e-rx that comes over like this will just get sent to the Medical and Pharmacy Boards.
DO: 4 ounces! <click>

Yet in everyone's eyes, I was being the asshole. All she had to do was give me a quantity. That would be the same as her writing an Antibiotic Rx for 10ml twice a day, dispense QS without the duration. I would still have to call...and she would probably tell me "one bottle!" without understanding what she did wrong.
It is our job to fix your problems.
It is our job to fix your errors.
It is our job to save your ass.
I'm not asking for a "thank you".
Just don't go all "Vicious Twat" on me.

It Says Consultation

Sign, sign, everywhere a sign...do this, don't do that, can't you read the sign?

No. People cannot read them. If they can, they choose not to read them. It is far easier to interrupt someone than to look for something on your own. With that being said, it is quite obvious there is no patience anymore. We are a harried, hurried lot. Protocols and decorum are not meant to be followed.
Lines at businesses are just a suggestion. If you wish to push your way ahead of other people for what you feel is a simple question, then you march your ass right to the front and ask away.

Most pharmacies have designated points, yes, marked with signs, that guide people to:
A. Drop-off,
B. Pick-up,
C. Consultation.

I believe the most common design flaw with this is that the Consultation Window is often too near the pharmacist or another workstation. This invites the Everyday Patient to stroll on up to the window, lean across the counter, and bellow "I just have  a question".
I am certain you do. That is the point of this point of access. Questions. Consultations. However, it does not mean stick your head in my window or sit on my counter and start talking to me as if I am Santa and the counter is my lap. I am on the phone. I am checking prescriptions. If it were your phone call or your prescriptions, would you not want me to be focused solely on you?

It's like walking into a bank, seeing a line of customers, then strolling to the front right next to the first person and saying "I just have a question". That's not how it works.

I think we need to redesign these areas. My first thought is that they need to be on a separate wall of the pharmacy, a wall which a pharmacist will need to move to in order to provide counseling. My second thought is that we should have a glass partition with a speaker. We could set it up like a movie theatre ticket booth or a prison visitation centre. The pharmacist would have to turn on the microphone, or pick up the phone and the patient would talk into the speaker or the phone on his side. Brilliant!

#WhyYouGottaBeSoRude

I Was on Hold For...

All professions are not created equal. We each have our own expectations for ourselves and for the other professions with which we deal. Sometimes those expectations are rather unrealistic.

Uber-Tech: Thank you for calling CP's Pharmacy. How may I help you.
Irrational Rx Expectation Deliverer: I need to call in a prescription.
UT: Can you hold, please? CP is on the other line.
IRED: Sure.
(some time later...seconds, minutes, hours, days...)

UT: Thank you for calling...
IRED: I need to speak with the pharmacist. I just called and was left on hold forever.
UT: Apparently it was not forever as here we are. You are rather impatient if you think a few minutes is an eternity. Please hold and I will tell CP you are on the line.

CP: Thank you for holding. This is CP. How may I help you?
IRED: I need to phone in a prescription.
CP: Wunderbar! We love prescriptions.
IRED: I was on hold forever.
CP: And I was busy the whole time. I still am, but, here I am, talking to you. Now what is so important that you needed to call me, hang up, and call back again? It must be life-threatening. Is it Epi-Pens?
IRED: I need to call in Augmentin 875mg bid for 10 days.
CP: Seriously? Augmentin? AND you're calling from an office 45 minutes away? What makes this more important than the other 500 prescriptions I will fill today?
IRED: Um.
CP: You do know we have voicemail, right? It's the first option available after you select the "doctor's office" option. You called me twice so you should have heard it. Let me ask you a question...When I call your office and ask to speak to the nurse, what happens? I get put through to voicemail. I don't even get the chance to ask my question which is usually about an error on an e-script you sent over. The beauty of voicemail is the convenience of it. YOU get to leave your prescription at YOUR convenience and I get to retrieve it at MY convenience. I also get to rewind and replay it since you give prescriptions like the Micro Machines guy sells cars.
IRED: Um.
CP: The next time I call your office, I expect my call to be answered immediately by a nurse or the prescriber. I don't care if you're in a room. I don't care if you're drawing blood or giving shots or taking rectal temps with your thumb. If you can't be bothered to wait, or to use voicemail or your e-script software for that matter, while I am counseling a patient, administering shots, performing an MTM, taking prescriptions, retrieving voicemail, checking prescriptions, or any of the other tasks I need to do then you can extend me the same, common courtesy. I will just keep calling, hanging up, and calling back until you answer. Is that acceptable?

Dear Doctor

...I would like to invite you to visit my pharmacy. I would like to take you on a tour. I have been to your office before. I have seen how it is run. I know how long your wait times are. I know how long you spend with patients. I know how your staff treats their patients, and pharmacists who call them. I wish for you to know the same about me.

The main reason I would like you to visit is to show you how we receive prescriptions from your office, and all the other offices in the area.

It was very nice of you yesterday to see a hurried patient.
It was very nice of you to tell her you would encourage us to quickly fill her prescriptions.
The only problem is the method in which you chose to deliver your message: The Notes Section of an E-Script.
That is SO not the way to deliver an important message to the pharmacy.

(For the record, the message read: "Patient is leaving the office now and would like to pick this up in 30 minutes.")

I didn't see it.
When I check my work queue, I don't see messages. I see names. Patient names and drug names.
If you wish to convey a message with a sense of urgency, please choose a more appropriate, expeditious method. I would go so far as to suggest, and this is only a suggestion, that you personally walk to the phone and call in the prescription to me. I know, it seems ludicrous to think that prescribers can use phones and actually call pharmacies but hear me out on this.
Back in the way way back, this is how it used to work. Short of a patient bringing us a handwritten prescription, offices used the telephone to transmit orders. Guess what? That antiquated technology STILL WORKS! All you had to do was call me, add a sense of urgency to the order, and I would have put her among my waiters.

Instead, your order got lost among the other 35 e-scripts that dropped from 4-4:30pm on a busy Thursday and, get this, the patient got mad...AT ME!

From now on, when patients ask me to send refill requests to your office, I am going to have them stand at my counter and watch me. I am going to send their requests via telegraph. I will input every order in Morse Code and tell them their office will be writing them new prescriptions that will be ready at the front desk when they arrive and they should go now.

Refill Request. Stop. Your Patient. Stop. On Way Now. Stop.

Inventory Reduction

In pharmacy we must always be mindful of our inventory. We must improve our turns, keep inventory low, and order profit-friendly NDCs.
Manufacturers have these same issues.
When you market a "new" medication, you want it to be a game changer. You expect to sell it by the bushel. What if that doesn't happen?
You get this quick, witty conversation at work.

CP's Partner: Why did you run this through for the 30 count NDC?
CP: Because the Rx was written for 30 tablets and I don't think we'll use it again.
CPP: Great minds think alike.
CP: Indeed.
CPP: Only one problem.
CP: What's that?
CPP: They quit making the 30-count NDC.
CP: Of course.
CPP: We can only order the 90-count NDC now.
CP: Right. Well when you have a groundbreaking drug such as this you want to sell as much as you can.
CPP: Did you just call Gralise a "groundbreaking drug".
CP: I did.
CPP: Your cynicism just made me spit out my coffee.
CP: Thanks. Think about it. They took plain old Gabapentin, made an extended-release form of it and charged triple. No one prescribes it because it's rarely covered and the generic is much cheaper. Now how does a company with a failed brand get rid of their inventory? They package all their slow-moving product in larger bottles forcing pharmacies to order sizes they don't need. This puts the burden on the pharmacies to get rid of the inventory. Manufacturer's warehouses are emptier, product has been sold and paid for, profits improve. Pharmacies are stuck with partial bottles waiting to expire. Think of all those Duexis prescriptions we received.
CPP: Another fine groundbreaking drug.
CP: Indeed...Right you are, Ken...

Just Stop...

Change can be good. It can be difficult to accept at first. People are often resistant to new ways of thinking. Sometimes this is because they are accustomed to and comfortable with the old way. Sometimes they fight because they cannot see how the new way will be better than the old. The definition of insanity is doing the same thing over and over and over expecting a different result. What if we gave people no choice but to accept the "new normal"? Would civilization as we know it end? Would the markets crash? Would the world stop revolving? No. Life would go on as it always has after these Earth-shattering events. Now, how does this relate to pharmacy?

I was told by a corporate pharmacy suit that "as long as everyone else is doing it, we need to as well". He went on to say that "as long as we have a chip in the game we can sit at the table". Brilliant. This is the thinking that has advanced our profession backwards over the last couple decades.

Ideas: Stop all coupons. Stop all transfer incentives. Stop all gift cards. Stop all Perks programs. Stop using my profession to generate FE business. Better yet; get out of the FE business altogether. If you give a group of children 7 choices of flavors on anything, they cannot make a decision. Give them one option, or perhaps two, and they will make it quicker. Same with pharmacy. Remember when they took away all analog TV? People fought it, cried about it, government legislated on it and there were constant battles about it. Guess what happened? The day came, the switch was thrown, and nothing happened. It's a tough decision to get rid of one's security blankie, their lifesaver, teddy bear, or crutch. At some point, they have to learn to grow up and walk/survive without them. It's time for pharmacy corporations to man up and just not do it anymore. People complained, people got upset, people were revolting (some still are-wink wink). But they survived. I like it. I went shopping today and everyone was trying to figure out how to use coupons at the 3 places I visited. Some coupons weren't valid on certain products, at certain hours, on certain sizes, in combination with other offers, whatever. The point is, I spent more time waiting for people to use their coupons and figure out sales ads today than I did actually shopping for what I needed. Make it stop. The Profession of Pharmacy needs to go back to when it was respected as just that, a Profession.

If they want to focus on healthcare and the profession, I am all for ways to do it. I have no problems with immunizations, MTMs, clinics, etc in my pharmacies. Just focus the money from advertising and gift cards on adding support to facilitate these programs. I could do all of these more efficiently if you gave me extra help. We have no adaptability or flexibility. Our corporations are strictly dollars-and-cents types. First cuts are to labor. In the next breath it's improve your customer service. It's like telling a kid to keep clapping after cutting off one of his arms; cruel, yet somehow expected to work or he'll be put in timeout.

Seriously consider charging for everything. Doctors expect us to fax them refill requests? Charge for them. Patients expect us to call or fax for refill requests? Charge them. Prior Authorizations need faxed? That's a charge too. You need a few pills or you'll die over the weekend? There's a fee for that. I have a great post dedicated to nickel-and-diming doctors and patients over error-filled prescriptions. Time to revolutionize the industry. Get everyone on board. Change the game. The players will adapt. If everyone signs on, there will be no "well Wal-Mart doesn't do that so I'll go there". Make it the new pharmacy professional standard.

If Patients Treated Their Prescribers' Offices as They Treat Us...

... and I am certain they do. It is something we share. A common bond. Like a school shares germs and a lice outbreak. I would be interested in hearing how the conversations I have at the pharmacy sound at the office...

1.Just call in whatever you called in for me last time.
2. Just call it in wherever you sent it last time.
(I'll just go wherever I think that is anyway and yell at them.)
3. I don't know what it is. It's right there in my chart. Can't you just look it up?
4. What do you mean the pharmacy didn't fax you?! I was right there when she clicked "fax". She said she sent it. I watched her.
5. What do you mean I have to call my own pharmacy and have them request a refill? I'm standing right here!
6. I need everything refilled I've had prescribed over the last year. Yes. Of course I mean the yeast infection cream from last January! I said everything, didn't I? No. Not the inhaler stupid.
7. It's my pre-med! I need it now! My dentist appointment is right now and I was supposed to take this a half hour ago but you people didn't open until now so it's all your fault if I have to reschedule!
8. I've been on this for years. What do you mean "no refills until I come in for an appointment!"? He said I'd be on this until I die.
(Apparently he is trying to hasten my demise.)
9. What do you mean I have a $20 copay? Did you bill my insurance? Why the hell do I pay so much to have premium insurance if you're going to charge me $20 every time.
10. Well the other doctor I go to across town doesn't charge me anything.
11. My pharmacy said my office visit would be $4.
12. They said this exam was on your "Free" list.
13. What do you mean I have to wait for my appointment? There's no one here in this waiting room.
14. All you have to do is put me in a room and squeeze that little bulb thingy.
15. Wow. You guys must be slow today. There's no one here.
16. How long is this going to take? I just picked up ice cream from the grocery store and it's melting in my car.
17. I need the little white one, the oblong white one, the roundish off-white one, and some green or blue tablet or capsule or something plus my cream or ointment...or maybe the gel. <click>
18. No I do not have my insurance card with me. I've been coming here since before you were born.
19. No, I've never been seen but my husband has. It's all the same information.
20. Why do you need my date of birth? I'm not telling you that. That's private. You're going to steal my identity.


Receptionist: How may I help you?
Every Patient: I need to speak to the doctor.
Receptionist: Is there something I can help you with?
EP: No. I just need to speak to the doctor.
Dr. Zoffis: How may I help you?
EP: I need to schedule an appointment...


Receptionist: Ma'am, why are you ripping pages out of all our magazines?
Proactive Patient: I'm taking out all the drug ads so I know what to tell the doctor I need today.

Receptionist: <picks up phone> Hello?
PP: What's taking so long?
Receptionist: Are you calling me from the waiting room?
PP: Yes.