Lack of Comprehension

"Do you understand the words that are coming out of my mouth?"

CP: Welcome to Jurassic Park.
Silly Moppet: What?
CP: Trying out new names for my phuture pharmacy.
SM: I have recently relocated to your area and wish to do business with your fine establishment.
CP: Wunderbar! Let me take all your information, including that insurance card you are holding.
SM: It's really nice to have such a wonderful pharmacist helping me.
CP: Glad to be of assistance. I know no other way. Hmmmm.
SM: What's wrong?
CP: As I was entering your prescription, your insurance rejected the claim. It appears it needs updated.
SM: Why?
CP: I don't really know. They are telling me this expired or you've updated to a new card since last month.
SM: Okay. Well thanks for trying. I'll just take my prescription and go all the way back across town to my last pharmacy. We've been there before.
CP: Okay. You realise that won't really work, right?
SM: Yes it will. We've been there before. Last month.
CP: Yes. You told me that. Let's assume you go shopping at Kohl's after you leave here. As you are checking out, the cashier tells you that your Visa has been declined. Would you tell her: "That's okay. I'll just go back across town to Target. I used it there last month."? No. Same situation here. I would encourage you to call your insurance company while on your short little trek across town. When my bosses ask why my prescription counts are down, I'm going to give them this example.

#everyday

Closed Circuit Cameras

Popular places are busy.

Places no one likes are slow. 

If you go to popular places, there will be other people. Constantly. 

If you did back to school shopping in the last 2 weeks, lots of people. 

If you see a highly anticipated movie on opening night, lots of people. 

If you have tickets to Wicked or Jersey Boys, lots of people. 

If you don't like crowds and people, avoid popular places and busy times. 

I previously posted about avoiding the pharmacy at peak times. 

How can patients know their pharmacy is busy when all they want to do is pick up or drop off? 

Live feeds. 

Let's install cameras in front of our pharmacies that show our drop off and pickup lines and waiting areas. We can have the feed available on the companies' apps. 

Patients can check on any store at any time and see if there is a line. "Let's not go there right now. They look busy."

OR

"Get in the car, quick! The pharmacy has only 1 person in line! I know we live 20 minutes away, but it's not going to get any better on a Monday."

Maybe we could borrow from Disney. They are the Masters of Line Movement. We could put a little card in every 10th order as we process it and see how long it takes to get completed. This data could update on the Company App, along with real time lobby video to give a more complete picture of how long the actual wait will be. Just like at Disney, you can see that one ride, or pharmacy, has a much shorter line so you can go there instead. 

Helping you with Time Management. Because We Care about your busy schedule, not your health. 

Closed Door Policy

I wrote a post I titled "Close the Pharmacy". It was pretty awesome.
Perhaps my boss read it but I think may have misinterpreted it.
We were paid a visit by Loyal Leader and something was noticed: Our door was ajar.
Since we are constantly forced (um, encouraged) to show people where items are on the shelves, we are constantly leaving the pharmacy. This results in someone being taken away from his or her duties to help the patient AND another to help the wandering soul upon his/her return to the pharmacy. We may occasionally leave the door slightly, (read "wide the fu@k") open.
So Loyal Leader got a twisted kilt about this.
And I laughed.
Seriously. I laughed while having this discussion about keeping the door closed:

LL: Do you always keep your door open?
CP: <Shaking head side to side> No.
LL: (after the third time witnessing the door being kept open) Really?
CP: Not all the time.
LL: It's a safety issue to have it open.
CP: <laughs> Oh. You're serious?
LL: Yes. <shuts door...again>
CP: Okay. We will keep it closed while you are here if it makes you feel safer.
LL: That's not what I meant!
CP: It isn't?
LL: No. The Prevention of Loss Organization says it must remain closed and locked during all business hours.
CP: <whispering> But how are we supposed to go in and out?
LL: You open it.
CP: Kind of throws a wrench in your PLO order of "closed and locked", huh?
LL: You know what I mean.
CP: I am certain I do not. Perhaps you should read the CP's post "Close the Pharmacy".
LL: Why?
CP: It is quite insightful. Shall I point out the obvious flaw in your PLO's logic?
LL: Please.
CP: Our door is 36 inches wide. Very solid. Good craftsmanship. Sturdy. Definitely will keep robbers and random passersby from taking a self-guided tour of the facilities.
LL: That's the idea.
CP: I have a big but...
LL: What?
CP: BUT! As in capital letters. BUT! The PLO does not concern itself with the greater safety issue present in my pharmacy.
LL: What's that?
CP: The 20 linear FEET of open counter space that is a mere 36 inches in height but runs the entire length of my pharmacy. When I was robbed, the guy did not knock on my door like a rumrunner trying to gain access to my speakeasy....nay nay. He. Jumped. The. Counter! Why does the PLO think a 36 inch wide metal door will protect the $500,000 in inventory back here and all our lives when any person can jump or slide over any part of my counter? Locking the door during normal business hours with wide the fu@k open counters is like locking the doors to a convertible and leaving the top down...with the keys in it.

Tramadol Supply

Why could we get no Tramadol early this week?
It's not as if anything changed other than its classification as a controlled substance, right?
The NDC didn't change...order numbers should not have changed. I mean, IT'S THE EXACT SAME DRUG IN THE EXACT SAME BOTTLE! Nothing Happened!
So I ask again, Why was it unavailable on its (Re)Christening Day?

Apparently we had to wait for the new bottles with the CIV designation on them. Look closely at the bottle. Look at the sticker that shows "CIV". Got it? IT'S A STICKER!

Apparently we were all waiting for someone to put the stickers on the bottles. It took 3 days to do it. It's not as if the company didn't know this change was occurring on 8/18/14. It's not as if they didn't have fair warning (45 days) to make bottles with the CIV actually printed on the labels.

Why do I bring this up today?
With the news that ALL HYDROCODONE products will be reclassified as CIIs beginning 10/6/14, guess what will happen with the current supply? Yep, pharmacists and pharmacies will start stocking up...squirreling a little away just in case this happens again in 6 weeks.

Seriously though...we went through over 2000 Tramadol on Thursday, the first day we could get more, because of the interruption in supply caused by the need for a fu@king sticker!

Do You Wanna Get a Flu Shot

(Yes, this is quite obviously sung to that song from Frozen)

Do you wanna get a flu shot?
Come on it's really fun,
Pull up your sleeve stick out your arm,
It's quickly done,
And you'll be on your way.
You used to be so healthy
Right now you're not
I know just the reason why!-
Do you wanna get a flu shot?
It doesn't have to be a flu shot.

Go away, CP!
Okay, bye...

Do you wanna get a flu shot?
Any other shot will do too
Tdap, Hep B, or pneumovax
I'm losing track
Of quotas for this fall-
(Seven Prevnar?)
It gets a little scary
All of these vaccines
Just watching you all walk by
(Shot-shot, shot-shot, shot-shot, shot-shot, )

Elsa,
Please I know you're out there,
My bosses asking where've you been
They say increase your numbers and I'm trying to
I've a needle right for you, just let me know
I really need to shoot you
It's either me or you
What do you wanna do?

Do you wanna get a flu shot?
It doesn't have to be a flu shot...

A(nother) Letter to Corporate

Dear Corporate,
You cannot sell what people do not want to buy.
It is simple economics. No Demand Equals No Sales. Easy.
Then why does it fall on me to increase the harassment of my patients by pushing vaccinations on them?
Fine. Don't call it a quota. If I don't have a mandatory goal to meet, then why is my bonus negatively impacted if I miss the numbers you assign? (Sorry, some companies call it a "budgeted amount" of shots to be administered. Semantics.)

I am not talking about seasonal flu shots. Now that every pharmacy gives them, the competition is watered down and the playing field is level. People will get flu shots wherever they happen to be when the mood to get pricked strikes them.

I am talking about Zostavax and the others. (It depends on your state laws.)
We have pestered our patients for the past few years. Those who want them have received them. Those who need them, got them. Those who have said "no" will continue to say "no".
This is not a "suggestive sell" item you can just place at the checkout counter like a pack of gum or a clearance item or a roll of tape.

CP: Is this all you need today?
Customer Randomly Asking for Prescriptions: Yes. Just that.
CP: Ok.
CRAP: And maybe some Tic Tacs and...how about one of those vaccines y'all are offerin'
CP: Oh? Perhaps a Shingles Shot? Or TDaP? Maybe a little MMR with some Hep A and Hep B?
CRAP: Sure. Hit me with the lot.

Requiring me to give more shots to people who don't want them is like mandating that Ford dealers in 1959 sell more Edsels.
It's also reminiscent of the "upsell" at the register of electronics stores. "Would you like to purchase the optional extended warranty we are offering today?" I know they make the company money. Few people want them. Fewer people purchase them.

Merck is launching a new advertising campaign promoting Zostavax. I wonder if corporate adjusted my "budgeted amount" of shots to account for the expected surge. I will still get asked why my numbers aren't improving. I can hear them now: "There have been plenty of ads made to promote awareness, and we budgeted you for more so why aren't you giving more shots?"

Can't we just focus on providing better service to our patients?
Can't we focus on taking our time filling prescriptions accurately?
This would be like asking a collision repair garage to increase the number of repairs it does. It would be like a snow plow service being forced to explain why their numbers are down...during the summer.
We are not salespeople. The reason we work for a corporation is so you can handle the business and promotion side of things.
I am a pharmacist. I have a professional job to do and a license to worry about.
You are a corporate suit who works in an air conditioned building, sits at a desk, and gets to eat lunch. Our jobs are different.
Now go do your job and leave me alone to do mine.

Tramadol Is Federally Controlled Today!

...And there was much rejoicing...hooray...whatever...

Let's look at what happens when laws change.
Your state outlaws smoking in public places. If you light up in a bar, you get fined/arrested/whatever.

Your state changes the speed limit from 70mph down to 55mph. If you are speeding, you are expected to pay the fine because all the new signs are posted, it has been in the paper and the Highway Patrol Lady will not buy the "I didn't know" excuse. She also won't fall for "That's today?".

The point is, when laws change, we are all expected to abide by them. Even if we change states, we are expected to adopt the new laws as soon as we move.

Prescribers seem to be immune to this legal fact of life.
A controlled substance has many restrictions. Prescribers learn how to prescribe controlled substances and non-controlled substances. The fact that a medication changes from one designation to the other should mean a simple adjustment in prescribing habits. It is not as if this is new territory for the prescriber. However, today we are reminded that prescribers are above the law. Hear me out on this...

On Day Zero, the day a switch in classification occurs, pharmacies must conduct a DEA audit. We must change the refills remaining and the expiration date to no greater than 6 months from when the prescription was originally written. In my state, the quantity must be numerically written AND spelled to be valid. I must have the DEA# on the hard copy. I am not allowed to accept electronic prescriptions for this anymore (yet...), and faxed authorizations must have a wet ink signature, not an electronic one. Sorry, some state's laws are antiquated and rarely change.

On Day Zero, PRESCRIBERS can forget the law has changed. Why? Because pharmacists will call. We will remind them. WE need to document the change on the hard copy. WE need to comply with the law on the day it changes. WE need to be vigilant and catch THEIR mistakes so the State Board doesn't fine US. They would fine US because prescribers are allowed to "forget" the law has changed but WE have to comply NOW. It is now 8 months after the removal of Vicodin 5/500 from the market. We continue to see prescriptions written for it. Why? You cannot retrain prescribers from their habits...and they rely so heavily on the pharmacists they don't even realize how much we do for them. We need to change that.

People will just say "deal with it" or "that's your job" or "don't put the patient in the middle of your pissing contest". You do realize that this just perpetuates the problem, right? RIGHT? WE ignore the problem. WE fix the prescriber's mistakes. Why? Because our professional obligation conflicts with the "customer service metrics" of our companies.
Give the prescribers a one month grace period. Fax them the note I posted about this change. After that, start faxing the invalid prescriptions back or send them back with the patient. It is our professional duty to change with the laws. Prescribers should be forced to comply immediately as well.
Perhaps if they started receiving fines and cuts in their staff budgets, they might notice...Probably not...

A Letter to Corporate

Thank you for employing me. I appreciate the paycheck. I have given a lot of myself to the Corporate Pharmacy World and thoroughly enjoy my job.
I am, however, concerned about your changing expectations of those of us behind the bench. Today I am specifically going to address Customer Satisfaction Surveys; in particular, the abuse, threatening, and extortion you expect us to perform to force patients, not customers, to participate in voluntary surveys.

Everywhere I have worked, and places I have not, seem to have a magic number of required responses to these surveys. Corporate requires 20 or 30 or 45 customer responses per month. Has corporate learned nothing from their years of operating in the pharmacy world? (Of course not. That was rhetorical.) Let me explain. No. There is too much, let me sum up.

We offer compliance calls to "encourage" and "remind" patients to pick up their prescriptions. They do not.
We offer predictive refills that call patients when their refills are due.
We offer text alerts and emails and online monitoring of your healthcare.
We offer advertisements, mailers, in-store banners and cheerleaders and bag stuffers, and personal reminders at checkout about our services including flu shots and shingles shots and people still manage to miss this all and call and ask if something is available or ready or offered.

Any edict from corporate that includes: "As part of your job you must increase your rate of response on customer surveys. Ways to help include circling the phone number with a Sharpie, highlighting it with lipstick, and ripping the patient's cell phone from her hands and directly dialing the survey number for her." should be immediately removed and the person responsible should be sacked.
When are you going to learn that you cannot force the general public to do anything?
We can't make them come in and pick up their prescriptions.
We can't make them take their medications as prescribed.
We can't make them be responsible for their own healthcare.
We can't do any of this any more than we can wheedle, cajole, urge, encourage, strong arm, or force them to give us their opinion on a survey by making a phone call.

You can lead a horse to water, but you can't make him drink.
You can give a person an education but you can't make him think.

Your efforts are misguided. Since you have obviously figured out how to make automated compliance calls to patients, why not try soliciting a 5 question survey about their recent visit? Or an email to the patients? Or a text questionnaire? Or a Twitter survey? People are so inundated with requests for satisfaction surveys they have turned a blind eye and a deaf ear to them. You have to engage them where they live: online.

Please do not ask me to do your begging for you. At the end of the day I still have an important job to do. At the end of the day, if I haven't made a mistake, I am happy. That should be all that you need to worry about from my end. I'll take care of my patients. YOU take care of the business end with all your paper pushing and policies and procedures and workflow designs and promotions and dreaming up new ways to make a buck for yourself.

I can give you this insight into the Profession of Pharmacy, but I can't make you read it or understand it or do anything about it. Just keep on keeping on in your ivory tower, Corporate Pharmacy. Hopefully someone will call and tell you what a great job I'm doing for you and that you should pay me more or give me more hours...but it's just a number on a random spreadsheet, right?

Pronunciation

Did you ever think yours was the right way to pronounce certain medication names? Ever think you were always right? Ever hear someone else pronounce a drug name and go "WTF? How did you come up with that?"
Ever think your coworkers or colleagues were absolutely crazy because they think their way sounds normal? Like yours is right but theirs is SO wrong?

I had a nurse phone in Levaquin for a patient. She pronounced it Lev-a-kwin. When I repeated the prescription back to her, I pronounced it, correctly I might add, as LEEV-a-kwin. She then corrected with her incorrect version. Sorry lady, I know my way is correct. Do not correct me.

That little line on top of the "e" is called a "Macron". It is used to indicate a long vowel sound. In this case we would pronounce it as "E" instead of "Eh".

I Came Here for an Argument

Why do people argue with me? I know my job. I know the laws. I know these things better than you do and better than your prescriber does. I ask again, why argue with me?
Why can you not just take my word as Gospel and move on?
If you seek a lawyer's advice, would you argue with her if she tells you the law is quite clear on this issue? (Okay, after the following encounter, I'm pretty sure you would...)

Completely Over-Confident Knucklehead: I am here to fill my new prescription for Opium Tincture.
CP: Okay. We have it in stock. Will you continue to get this so I know if I should reorder it.
COCK: Yes. In fact my doctor put 6 refills on it.
CP: Wow. Ever a gracious host, he is. I am sorry but he simply cannot do that.
COCK: Yes he can.
CP: No. He cannot. This is a Schedule II medication and the DEA is quite clear that medications in this class, including Percocet and Adderall, are forbidden from being prescribed refills.
COCK: But he wrote them on there. He obviously wants me to have them.
CP: And he obviously doesn't know the laws. I'd be more concerned about seeing a prescriber who doesn't know how to prescribe than about winning at this conversation. You are not going to be able to get them.
COCK: Why?
CP: Refills are not allowed. If he attempts to put them on there, they are void. Not legal. You cannot get them. They are dead to me. Bereft of life. Verstehen?
COCK: So you're not going to give them to me? This is an outrage! My doctor wants me to have these! I need this medication and you're the only people that carry it. I can't keep going back to my doctor for this. He knows what I need.
CP: Then he needs to know how to write for what you need. Ask if he is willing to write you 3 prescriptions per visit. He can put a "Do Not Until..." date on each one. Try that. That is legal.
COCK: Well he told me he wasn't sure if he could put refills on it anyway but thought he'd try.
CP: You mean to tell me that your prescriber knew full well he had no clue how to prescribe this and you stood here arguing with me for the last 20 minutes trying to make your case with nothing but an assumption and your dick in your hand?
COCK: Well he said to try.
CP: Get away from me. Don't talk to me. You're dead to me. GTFO!

It's Not MY Insurance

All information is only as current as what we are given when it is presented. If you drop your land line and only have a cell phone number now, it would behoove you to tell us that instead of complaining you are not receiving any calls. And don't get all huffy and say: "Dafuq is wrong with you people? I haven't had that number in like 3 years". Not our fault.
The information that tends to change most often is insurance information. People change jobs and insurances more than phone numbers, addresses, and in some cases, underwear.
We try to expire old insurance information...if we are certain it is expired.
Some patients have multiple insurances where they carry their own coverage and are covered by their spouse's plan. It is NOT MY insurance. It is YOURS. It is YOUR job to stay up to date on YOUR insurance. I am responsible for mine.

Painfully Irritating Insurance Lady: You billed the wrong insurance.
CP: We billed the one that worked.
PIIL: Well that's not the right one. You people do this to me every time.
CP: Perhaps you should find another, more competent pharmacy.
PIIL: What?
CP: Or perhaps the problem is with you and your insurance. We only bill what we have on file. The one you are asking me to bill is not working. It rejected, directly from the insurance company, as: Member not active on date of service. Coverage Expired. In short, it no worky.
PIIL: Then what is your problem?
CP: That you keep yelling at me as if I have some Wiccan Powers to bend the insurance universe to my Almighty will. Call YOUR insurance company. Ask them to explain the problem. Yell at them. Tell them to fix it.
PIIL: Why did you bill the wrong one in the first place?
CP: It is the only one that worked. Let's play pretend. You are so frustrated with your pharmacy for messing up your insurance that you have to go on a binge shopping therapy trip to the local outlets. At the first store, your American Express is declined. What do you do? Yell at the clerk? No. You pull out the Discover Card and tell her to run that. Declined. Do you yell at her yet? Nope. Pull out the Master Card. Denied. (Because you keep your cards alphabetically in your wallet...) Visa? Success! It worked! Now you can continue shopping with reckless abandon and spend away your frustrations at your pharmacist. Same thing with your insurance here. Primary denies so we try secondary. It works. Success! Got it?
PIIL: I'll just call my insurance.
CP: And your credit card companies too.

(15 minutes later)
PIIL: Try it now.
CP: It worked. What happened?
PIIL: I don't know. They said they had to fix something.
CP: You're welcome. And I won't hold my breath for the apology I feel is not imminent. And while I wait for that I shall bite my tongue and eat the "I told you so". Deal?
PIIL: <click>

Friday Special

With another weekend upon us, it is time for the Friday Special Requests we all love to get. Here are the questions, with a few real-life scenarios, to show the inanity of their requests...

1. I'm all out of my medication. If I don't get it I'm going to die!
2. Can't you just give me a few to get me through until I see my doctor some time next year?
3. It's insulin! I have to have it or I can't eat. (Actual quote.)
4. I've been out of it for over a week now and you're not going to refill it for me?
Just because they expired?
Just because my doctor needs an appointment?
Just because I filled a 1 month supply last September and magically ran out yesterday?

Let's equate this with other areas of life....
1. I'm all out of gas. If you don't give me some, I'm going to die!
2. My paycheck hasn't deposited yet? Just give me some money to last until it does.
3. It's my cable! You can't turn it off. I have to be able to watch Dr. Oz to get all my healthy living advice...
4. My cupboards have been empty for over a week! Why didn't you call to tell me I needed food? I've been sitting at my kitchen table with a fork and knife and an empty plate starving.

...and let's not forget to take into account that today is the first of the month.
5. What do you mean my insurance doesn't work anymore? It worked yesterday.
What do you mean my driver's license/tags expired? They weren't expired yesterday.

I don't remember so many people majoring in drama during my formative years in school. I must have lead a sheltered life growing up. I listen to these people all weekend long, beginning at 5:02pm Friday and I wonder: How do these people get through life? How do they make it through each day? How do they manage to set an alarm, wake up, put on clothes, eat breakfast, get in their cars, navigate the streets safely, get to work, perform a job, drive their cars back home, cook dinner, raise children, go to bed and do it all again the next day without accidentally hurting themselves or someone else? Without the help of the pharmacy? They rely on us for so much, it's scary.
If only this were not the reality...
Where are you Charles Darwin?