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Monday, March 31, 2014

Nothing Good Comes After...

Words are wonderful. They are how we communicate. When put in a certain order, words can ask, answer, elate, hurt, calm, soothe, comfort, enrage, or simply terrorize. In today's case, nothing scares us more than these phrases, alone or, in the scariest situations, in some unholy arrangement that will leave us sleepless for weeks. I believe that a little knowledge can be a good thing. However, a little information can be a bad thing.

"I have this rash..."
"Can you look at this for me?"
"Do you have any questions for the pharmacist...?"
 (We should ask "germane to your prescription".)
"I looked it up on WebMD and they said..."
"Can you identify this?" (asked while holding an apparently clear bag.)
"I saw this on Dr. Oz..." or rather anything that starts with or includes "Dr. Oz..."
Same goes for anything that includes "...ObamaCare..."

"I think I might have this rash and I saw this product on Dr. Oz and I need you to look at it and identify it and is it covered under Obamacare? because WebMD tells me it's cancer."

Friday, March 28, 2014


Or a sign that I worked too many days...
Typical day in the pharmacy. Let's call her Lady Typical.
Thursday 9:30am, LT calls and asks if prescriber called yet.
CP: No.
Thursday 12:30pm LT calls..."Anything?"
CP: No.
Thursday 3:14pm "Now?"
CP: No.
Thursday 8:52pm "Maybe?"
CP: Not

Friday everything repeats. I manage to get all her calls.
Saturday is Groundhog Day.
Sunday is deja vu all over again.

Monday, Monday, can't trust that day.
It is early and I open, but I've finished my coffee and no phone calls yet. Curious.
Afternoon dawns and...nothing.
But Hark! What script through yonder e-scribe do I see?
Do mine eyes deceive me?
It is indeed the long-awaited, much-anticipated Rx for LT!
It is barely 4pm and though she has not yet called, the habits of the past 4 days portend the imminence and predictability of her pattern. She shall call.

Fast forward to Wednesday for I had the luxury of an off day Tuesday.
Phone rings at 8:31pm and I decide to answer...
LT: This is LT, did my prescriber call in that replacement Rx yet?
CP: WTF? Seriously? You hounded me day and night for 4 days, including over a weekend and despite me telling you they'd most likely call Monday, you wait until Wednesday night to call?! It was important enough to have wasted my time all those days but you didn't even call yesterday either?

Yes. This does occur with amazing frequency. I have worked 4, 5, 6, 7 days in a row, gone on vacation and had someone call about something on the day I return that I had fixed 10 days earlier. Never fails.

(And before someone else says it...Could we have called LT? Yes. On a busy Monday, after the patient herself had proven that she was predictable in calling us nearly every 3 hours, Why? Were it that important to her, truly that important, she would have called earlier. She also would have asked us to call. We offer. Some do not "want to bother us".)

Tuesday, March 25, 2014

I See You...

I saw you, and him. Walking in the rain.
I see you, baby, shaking that ass.

Okay, more like you were just standing there.
But I saw you.
You stood there.
I watched you from afar.
I kept looking up at you.
You were reading a book.
A magazine.
The Swimsuit Issue?
Your basket was on the floor.
Which is where I keep my dignity and sense of humour.
Because I knew.
I knew before you did.
I knew before my techs did.
We placed bets.
I watched the clock.
You watched the patients come and go.
The register rang.
Still you stood.
And still you read.
And still I stared.
Scripts filed? Check.
Reports signed?
Is she still perusing the free public library?
4:58, 4:59, 5:00 Gates!
I run them down and lock them all.
Slam. Slam. Slam.
Tech-meister dims the lights to a more "we are closed" level.
Darkness prevails.
And you look up. You raise an eyebrow.
Our crew natters away.
We walk towards the door.
You approach the gate.
Your lips part, as the question forms.
Slow-motion it comes.
But I know.
And the answer was foretold when I first saw you.
For I knew.
As you ask:
"Are you closed?"
And I open the door,
And walk out.
"No" is my reply.

Next time I shall deliver this...

"The pharmacy is still open.
Everything is shut tight.
The meds need their rest.
So bid them 'goodnight'.
The elves will soon rise.
Disturb them you can't.
Asking stupid questions,
Begets silly rants..."

Monday, March 24, 2014

If the Real World Operated Like This...

If only the Real World functioned according to the laws of the Pharmacy World, everything would be better...as a customer. Of course in this alternate universe, Pharmacists would be the Brown Coats...

Let us create the following scenario. Picture your bank. It's not as if you actually walk into one anymore, but this is where your money gets direct deposited. You have your mortgage here. You are loyal to them. We shall call them ABC Bank. All the other banks around have many locations too. They offer the same services and have fancy ATMs and exciting offers.

Today's lesson is about expectations.

Average Joe: I am here to close my account.
CP: I cannot find you in our system.
AJ: Impossible. I come here all the time.
CP: I am sorry but I cannot locate you in our computer. Do you have your account number?
AJ: No. Why would I have that. It's all in your system. My employer deposits my money here every week through email or magic or satellite or something.
CP: I am sorry, sir. Perhaps a more thorough search will find something?
AJ: This happens every time I come here. This is why I use your ATMs instead of walking inside.
CP: Sorry?
AJ: You have convenient ATMs. I like them. I use them all the time.
CP: Which bank do you think this is?
AJ: Bank of XXX?
CP: No. That is across town.
AJ: You mean you aren't all connected? I can go to any ATM anywhere and withdraw money.
CP: Yes. But you have to select one for your employer's paycheck deposits. You picked Bank of XXX. You also have to pay a user fee for using a non-preferred ATM. Ever wonder what those charges were on your bank statement?
AJ: I never look at that. As long as money comes out when I put my card in, I don't care. Now where's my free iPad for transferring?

Friday, March 21, 2014

Above the Law

Steven Seagal references aside, I am often amazed at how prescribers believe the laws do not apply to them. Laws that have been on the books for decades always seem to surprise people. I love being the first pharmacist EVER to have a problem with something...or so I'm always told.

Phone Nurse: Calling in a prescription for Xanax
CP: Okay, now I just need the DEA #.
PN: It's ok. They gave me permission to call it in.
CP: It's okay. I'll wait for it.
PN: You don't need his DEA.
CP: You're not Obi-Wan, and I DO need his DEA.
PN: I've never had to have it before.
CP: Lady, for as long as I've been a pharmacist, and for as long I've been in this game, the DEA has always been required when phoning in controls. Period.
PN: Well this is the first time I've ever been asked for it.
CP: Either I am wrong, which would be quite rare, or every other pharmacist with whom you have ever spoken has opted to ignore the law, or you are just plain lying to me. Just because your doctor chooses not to follow the law does not mean I choose to ignore it. Ignorance is not a defense. Try that on the State Highway Patrol when you get pulled over for speeding. Just tell her "no one else ever pulled me over. No one else ever said speeding was wrong. You're the first."...and I'm sure she'll apologize and let you off the hook.

Wednesday, March 19, 2014


There once was a boy with a script
The price was so high that he flipped
His insurance did suck
He's shit out of luck
He need watch where his wick is dipped.

She asked could she have a refill please
We told her none remain on these
Then what to do now for control of birth
She wondered aloud and I said with mirth
Simply place the empty pack betwixt thine knees.

In the toilet, the sink, the well, your pills fell
You have the worst luck, how can you not tell?
Norco, and Xanax, and Soma, all lost at sea
Your BP and sugar pills are fine though you see
Methinks you are lying, your story doth smell.

My bottle is empty you must fill it now
The weekend's upon us I'm having a cow.
More meds I'll not give
You'll continue to live
You missed many doses and still breathe somehow.

I need these right now how long is the wait?
Twenty minutes? too long for I shall be late
An hour before, these meds I'm to take
My appointment is now, 'tis your fault I won't make
Perhaps better planning is needed, Dear Ingrate...

Tuesday, March 18, 2014


Dependence takes on many forms at the pharmacy, and in retail in general.
There is dependence on drugs, of course, but also dependence on technology. I'm not saying we are smarter than our computers, but there are many people out there whose computers are they smarter than they are...while they are turned off...still in the box...in fact the box is smarter simply by having the computer packed inside of it.

It was a typically busy Monday. Temperatures were still cold, my first day back from vacation a rather unassuming start to the third week of the month. (Usually the least busy week in the retail pharmacy business.) Anyway, that's when the call had to be made. A patient brought in a prescription. Not just any prescription; one for Augmentin. Uber-Tech did her due diligence and obtained the patient's allergies: "Penicillin", he said.
Uber-Tech thought "uh-oh" and proceeded to inquire as to the severity of this allergy...
Allergic Patient: "rash, hives, trouble breathing, anaphylaxis...I really cannot even read the word 'penicillin' or I break out."

Uber-Tech hands this off to CP who calls the prescriber. CP, of course, has to leave a message on the refill line for something as important as a patient waiting for his antibiotic but is deathly allergic to the one prescribed.

<some time later, in a galaxy, far, far...ahem...the phone rings>

CP: Allo? El Pharmacisto.
Doctor Death: You called about a prescription for AP?
CP: I did. Patient reported a severe allergy to penicillin. You wrote for Cipro, then scratched it out and changed it to Augmentin.
DD: Okay?
CP: No. Not okay. He reported rash, hives, itching, ER visits, etcetera with Penicillin. This could kill him.
DD: "Oh. Well our EMR was down for system maintenance so we couldn't check allergies." (yes, actual quote.)
CP: Um. Could the patient talk? Was he able to tell you his symptoms and why he was visiting your fine establishment in the first place?
DD: Yes. For that is how we diagnosed him.
CP: Uh-huh. So did it never occur to you to, oh I don't know, perhaps look across the room while you had your little Rx pad on your lap and, um, maybe like actually, um, ASK THE PATIENT if he had any allergies? You hand-wrote the Rx but relied on EMR for an allergy check?
DD: Your overconfidence is your weakness.
CP: Your faith in your technology is yours.

Monday, March 17, 2014

We Tried, Really We Did

I believe in asking the question you want answered. Regular followers know that about me.
"Do you know what time it is?" is a yes-or-no question. I did not ask for the time so don't give it to me unless I ask for it.

Same goes with patients. When I ask a question, please answer what was asked and answer it correctly to prevent this daily scenario:

Any Caller: Did my doctor call anything in for me yet?
CP: Would that have been today?
AC: I believe so. Yes.
CP: I checked all systems and found nothing for you today.
AC: Okay. I will call them.

<30 minutes later>
AC's Nurse: I'm calling about AC.
CP: Yes?
ACN: Did you not receive the 3 prescriptions we sent...on 1/11/2014?
CP: <checking profile> Yes. They are on hold. They were too soon to fill since he'd received a 90 day supply a week earlier.
ACN: So they are there?
CP: Most definitely. Too bad he asked if we had received anything today. And I verified he was expecting something today. Had he bothered to ask if we had received anything in the last 75 days, I would have known he meant January.
ACN: Same thing happens here.

Monday, March 3, 2014

Rules of Acknowledgement

Every patient interaction begins with acknowledgment. Where it goes after that is often unpredictable, but always entertaining.
Average Patient approacheth. CP inclines head slightly, gently nods, and says "we shall be right with you." So far, relatively normal. However, this is where things take their turn.

AP: I just have a quick question.
CP: As I am certain it is, someone shall be with you momentarily.
AP: Where do you all keep the Tylenol?
CP: You're right. That was quick. Someone will still be right with you.
AP: Can't you just tell me?
CP: I could. Can't you just wait?
AP: No. I'm in a hurry.
CP: And I am with another patient/on the phone/checking a prescription/slapping labels around right now. You shall have to wait. You interrupted me with "just a quick question" and I made no guarantees of a quick answer.
AP: You could have told me by now.
CP: And you could have turned around and noticed them on the shelf behind you by now. Instead, you chose to combat me with words and you lost. Next time you shall wait as instructed or I shall taunt you a second time.


AP: <crickets>
CP: We will be right with you.
AP: <silence>
CP: (whispering to tech) can someone grab the counter?
Uber Tech: Sure. How may I help you?
AP: <nothing>
UT: May I help you?
AP: <just sitting there reading a magazine> Nope. I'm good.
UT: Okay.

90 seconds later...
CP: We acknowledged you and asked if you needed help and you told us "no". How were we supposed to...
AP: I am a physician and I deserve respect!
CP: You're psycho and you need medication. Here's a script pad. Please write something for yourself. Then go sell crazy someplace else. We're all stocked up here.