Facebook and Twitter

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

Friday, February 28, 2014

Pharmacy Patient Bill of Rights

You have the right to choose your doctor.
You have the right to choose your pharmacy.
You have the right to switch pharmacies at any time.
You have the right to have your prescription filled.
You have the right to have it filled correctly.
You have the right to pay cash for any prescription your insurance denies for requiring prior authorization. (I am NOT refusing to fill it. Please, pay cash for it. You may. It's your RIGHT.)
You have the right to be counseled on any prescription we fill for you.
You have the right to HIPAA privacy.
You have the right to call in your refills.
You have the right to call your own doctor for refills. (Hey, they are YOUR prescriptions.)
You have the right to wait for your prescription.
You have the right to come back for your prescription.
You have the right to expect me to fix the errors your prescriber makes; to contact the office for clarification (to the best of our abilities); to screen for drug interactions; to ensure you receive the correct medication at the correct dosage in the correct form and in the correct amount.

You do NOT have the right to pay cash for and receive controlled substances early.
You do NOT have the right to have anything filled quickly.
You do NOT have the right to yell at or abuse any member of my staff.
You do NOT have the right to have us bill your insurance for you. (We do. It's a courtesy.)
You do NOT have the right to expect us to use a discount card.
You do NOT have the right to expect a price match.
You do NOT have the right to "just a few to get me through the weekend". (Try that at the bank.)
You do NOT have the right to expect me to automatically refill prescriptions for you.
You do NOT have the right to expect me to call/fax your doctor for your refills. (Most offices don't want us to do that anymore.)

I have the right to refuse to fill any prescription based on professional discretion. Keep that in mind.
I have the right to determine my own professional discretion. Keep that in mind.


Monday, February 24, 2014

My Sincerest Apologies

Someone told me I should apologize for their long wait in my pharmacy. Someone said I should apologize for taking too long to get a transfer from another pharmacy. Someone told me to apologize for their prescriber's office taking too long to get back to me when I called about an invalid e-script they sent. Someone told me I should apologize for being out of stock on a new medication that, for some reason, perhaps the $6,000 cost, no pharmacy within 25 miles had either. All of these someones got me thinking.

I apologize that I will not apologize to you. Sorry. That is how it has to be. I have a job to do. I am not concerned about your feelings. I am not concerned about your ice cream melting in your car even though it has not been above 2.6 degrees all day. I am not sorry you had to wait while I performed my job. I am not sorry your prescriber chose to send your prescription to mail order instead of to me. I am not sorry you have to wait while I call her back, after her 90 minute lunch break which started 15 minutes prematurely, to ask why she gave you Bactrim for your burning UTI when you have a documented Sulfa allergy.

Do prescribers apologize when you don't like their diagnosis? No. Do they apologize for continuously sending error-filled e-scripts? No. Do they apologize for being 3 hours behind every single day? No? Then I am not going to apologize for checking for drug interactions. For checking for allergies. For checking my state's PMP for control abuse. For checking the dose and directions on this prescription when it doesn't make sense. And you know what? I'm going to do this for every single prescription I fill today. And I am not sorry one bit. I don't care. It's my job and that's why I went to school. And that's why they pay me. So here's a dose of Shut The Hell Up and Have a Seat. Sip it slow because it'll burn all the way down. Sorry. But that's how I feel. No apologies needed.

All Apologies...
What else should I be? All Apologies.
What else should I say? Everyone is gay.
What else should I write? I don't have the right.
What else should I be? All Apologies.
I wish I was like you, easily amused.
Find my nest of salt. Everything is my fault.
I'll take all the blame...

Friday, February 21, 2014

Direct-To-Consumer Ads II

I hate them. Truly I do. Honest I do. As the Viagra ad says: "This is the age of knowing". Apparently you can learn a lot from a drug ad. Is it wrong that they tint the whole commercial blue when one of the side effects of Viagra is "...objects having a blue color tinge to them"? I think that's just cruel.

The most recent ad to grind my gears is the one for Eliquis. The one where the older gentleman is playing basketball and says: "I was taking warfarin but I wanted to up my game". WTF does that even mean? It's like a huge Madison Avenue non sequitur. It does not follow. How do you get from taking a blood thinner to the act of upping one's game by switching to another blood thinner? Perhaps the ad agency couldn't convince any of the ED drug manufacturers to use this commercial because it was too literal. It's simple advertising. It's a sales pitch. Few outside of the healthcare industry probably even noticed this.

Because telling your doctor what's right for you makes the most sense. You're supposed to tell him what's wrong with you. Not what you want. That's what the street dealer is for. Or the legal marijuana states. Do they have DTC ads for different products there? Those I'd like to see. Those make sense. Ask your budsman if Pineapple Express or Romulan Cotton Candy is right for you.

Wednesday, February 19, 2014

The Demands of the Public

First, Do no harm. Wait, that's physicians.
Pharmacist Oath says: "I will consider the welfare of humanity and relief of suffering my primary concerns." Apparently not important to these patients.

In the course of 5 days our pharmacy received two very different complaints.
The first was from an old bitty who likes to abuse our staff. She brings a cart full of groceries to the Rx counter and insists the pharmacy ring everything for her. When we point her to the front end, she proceeds to tell us she only brought one check with her. We tell her she can write for more than the amount up front and return with the cash for her prescriptions. She then complains to the manager and calls corporate who sends her gift cards. Then she returns next month with the same game and we are forced to ring her cart. Lesson learned? Absolutely.

The second complaint was a rambling email calling out every employee by name like Santa mushing his reindeer. She even named people who were on vacation and floaters who haven't been around in years. Anyway, her chief complaint was that our staff "offers to ring out everyone's groceries, regardless of the number of people in line and how long the line is". We don't. See first complaint.

When my boss called for resolution of these two issues I gave the simplest solution. Give each woman the other's phone number. Let them get bitchy with each other. Then call both of them down to the pharmacy to pick up prescriptions that aren't really there. Let them raise their hackles a bit then introduce them to each other. We can sit back and laugh and watch the fireworks without intervention. Perhaps call one of the local law enforcement officers to monitor from afar. Let him handle the fallout. After a couple arrests, no more problems. Customer Cage Match! Two bithchers enter, one bitcher leaves. Fun for all ages. I'd even offer to live tweet from the event and post the video here online. I think this could solve many of our problems.

Realistically however, the other customers would keep asking "what's taking so long?' and "why was theirs done first?" and saying "you told me 20 minutes!".  They'd just stand on the dead bodies so they could lean a little further in to the window to yell at us. You just can't win in retail pharmacy. Perhaps I'll repost my "Close the Pharmacy" piece. Or you could just search for it. It's worth it.

Tuesday, February 18, 2014

Weight Loss Drugs

Two new weight loss drugs were launched recently, Belviq and Qsymia. In order to be able to dispense Qsymia, pharmacists must complete an FDA-required Risk Evaluation and Mitigation Strategy (REMS) program.

As I am dutifully studying my program to serve my community, I notice something very important. It is the part that says "Qsymia can cause fetal harm" and that we should counsel on women not becoming pregnant while taking this and they should use birth control. Sage advice. I shall commit to this immediately.

For those of you still reading past the boring stuff, this is where the cynical part enters.
The funny part is how they chose to phrase this in the context of a weight loss drug lesson:

"Even females who believe they cannot become pregnant should use effective contraception while taking Qsymia due to the potential for increased fertility associated with weight loss."

This is how CP reads this: Now that you are starting to look hot, guys will become more interested in you and the odds of you getting lucky will increase exponentially so be careful or you'll get pregnant and fat again. You'll be looking to score with your new body and your long-neglected areas will be working overtime trying to satisfy your demand. It works for guys too. Now that you've lost your "dickie-do", the beer gut, the spare tire, ladies will be lining up to have your babies.

Since you have recently rediscovered your naughty bits, it's time to bring them out of the shed and put them to good use...

Your music quote today: Kudos to those that know this one.
"Thank God I'm pretty. The occasional free drink I never asked for. The occasional admission to a seedy little bar. Invitation to a stranger's car...Thank God I'm pretty."

Tuesday, February 11, 2014

But I am a Doctor!

Can I just say that I love this!? I wish I could just post a letter telling people all the ways I intend to shirk my responsibilities as a healthcare provider, and make everyone do my job for me. Fortunately for me, I am not this self-righteous. I may have a little ego problem, but this is a study in pompous grandiosity. I love to point out to people where someone is so full of himself that he misses the point entirely and ends up making an ass instead. Let's take a closer look at the message...

"...Your refill will be ready when you arrive at the pharmacy." Since when did you work in my pharmacy? I invite you for a visit. Please come to my pharmacy during one of your many hours NOT spent at your office and we will follow your plan to the letter.

"You should call your pharmacy for refills." Piss off. How about you actually see your patients in the office and, I don't know, write them prescriptions, like you had to do the very first time they visited?

"...If the office is closed..." Sweet. You get to leave before 5pm every week day, you go on vacations, you go to (pharma-sponsored) conferences, you get to leave the office and not tell us. Give me your itinerary and I'll try real hard to track you down. Better yet, you do what most people do when other businesses are closed-you wait until they reopen. How about that? Sometimes, a spoon is just a spoon. Who encourages their patients to be assholes? I see this office is accepting a limited number of new patients. Let's tell all of Texas they can get free appointments certain days and times. The office will only take the first 12 people waiting in line any given morning. If you are refused, call the State Medical Board and tell them you are being discriminated against. Yeah, that's it, that's the ticket. Where else do people think this is at all acceptable behaviour other than a prescriber's office?

...and finally...

*Winner for Best Prescriber Idea Ever in 2014*-- and I quote: "Call our office to get the number of the covering doctor, call the covering doctor's office, then hand the phone to the pharmacist." Abso-f*cking-lutely brilliant! I want to send flowers to this douchebag. Think about it...If I can be "lazy" and get the patient to call his own doctor for his own refill on my phone and he will give me the refill? Mission Accomplished! (During normal office hours--there's always a catch in fine print.) The end result is the same--patient does all the work, a real prescriber gives me the refill, and I get to fill it without any of the extra work. Call me lazy anytime. Please embarrass me like this. Thank you Herr Prescriber! I don't know what we pharmacists would do without a strong leader like you to show us the error of our ways and tell us how to perform our jobs. Hopefully the sequel to this will be "How to get others to do your work without actually being in an office" or "How I got my license on a beach in the Caribbean Islands and reading WebMD articles". Vis-a-vis Pinocchio, you can shout with pride "I'm a real doctor!".

Friday, February 7, 2014

Dear State Board of Pharmacy...

I would like to introduce myself. I Am The Cynical Pharmacist. I have had a blog for a couple years and moved it to Facebook a little over a year ago. I started with the tenet that everyone is out for themselves when it comes to pharmacy. A while later I discovered it is mostly true among patients, doctors, and corporate pharmacies. For now I would like to focus on my unofficial, but highly conclusive, results from my time on FB.

First, pharmacists need a "return to sender" button for electronic prescriptions. We receive more errors on these prescriptions and this results in a majority of wasted time trying to figure out what the doctor intended. From hold times with office staff to waiting for them to call us back, electronic prescribing is not the savior it was expected to be. I believe we as pharmacists should be allowed to charge the offices a fee for repetition of the same mistakes. Eventually one of these will not get caught and the pharmacist will get in trouble. The prescribers refuse to learn how to fix the problems on their end. (See FB post dated 10/7/13.)

Second, corporations do not care about prescription errors. Of course they have workflow designs in place to minimize them. What I am talking about is the additional work we are supposed to incorporate into our days while working with minimal tech support. Pharmacists need a study to be done to define a minimum pharmacist-to-technician ratio. Corporations should be required, by State Law, to obey these. There should be studies done for stores with drive-thrus, for those that perform MTMs, and during flu shot season. If you wish to run a pharmacy in our state, you must obey these rules.

Third, coupons or other incentives for pharmacy-to-pharmacy transfers should be immediately outlawed. Many states already do this and some even limit the number of times a prescription can be transferred to a single transfer. Inconvenience to the patient? I am sorry, but if this is what the law says, then that is the law. People will adapt. They'll get over it.

Fourth, I am tired of being told how to do my job by the AMA and prescribers. Many offices post signs or have outgoing messages that say "call your pharmacy and they will request refills on your behalf". Wrong. I never agreed to that. It used to be a courtesy. I want to know how and why we allowed ourselves to be taken advantage of in this manner.

If we truly care about our profession, it is about time we as a profession stand up and fight for our rights and our patients' rights. We are tired of getting yelled at by customers who turn around and cry to corporations who reward them with gift cards. This has to stop. We are tired of being the whipping post for prescribers and the AMA. We are tired of calling offices to verify error-filled prescriptions only to be told "it's a glitch, oh well" and being responsible for bailing out the prescriber when she picked the wrong drug/strength combination from the drop-down menu or she didn't erase the default directions only to have them act as if this happens all the time. Their flippant attitude could mean serious consequences if the pharmacy is not on the ball. The only way for us to ensure acuity is to minimize distractions. For this to happen we need a group to have a backbone to tell patients and prescribers and corporations "this is how it has to be!".

If you truly wish to see what a day-in-the-life is like for retail pharmacy, I invite you to check out my FB Page. I have over 66k people across the country and around the world who are all telling the same stories. We all know the issues. The chief complaint I receive is "nothing is going to change as long as we just sit here and complain". We need to act. We need to take our profession back. I am constantly asked when I am going to do something about it. Today. Today is the day I write to all of you and beg for a meeting, a conversation, a meeting of the minds to radically change the direction of pharmacy.


Tuesday, February 4, 2014

You Can't See Me

Truckers have important information printed on the backs of their trailers. It is a public service reminder about driving: "If you can't see my mirrors, I can't see you".
We should post a similar sign in the pharmacy. If you can't see me, I can't see you.

How many people have stood just far enough behind the counter as to be hidden by the post? Or the gate? Or the privacy divider?
They are the first to become agitated when you've managed to not see them for a what feels like an eternity, often 7-11 seconds.
While I do not encourage the fake cough, the throat clear, the key jangle, the counter slam, the key drop, the giant sniff, or the loud "HELLO!?", simply stepping forward or to the side may produce the desired result of being seen.