Sponsorships

When will pharmacies look to new revenue streams that exist outside insurance company reimbursements? In a capitalistic society, we exist to make money. Pharmacies already utilise ads on receipts and patient leaflets. When are they going to think bigger?
Soccer has team sponsorships on all their jerseys.
Baseball includes ads within the game: "That stolen base was brought to you by Biff's Bail Bondsmen."
Basketball has sponsored timeouts.
Football has everything sponsored, from the coin toss to the two-minute warning.

What about Pharmacy?
1. I'm thinking we need to get sponsors for our white coats. Find a local dry cleaner or national company to sponsor them.
"These white coats kept clean with the power of OxiClean!" I'm not saying we need to go all NASCAR and have clothing that is made up entirely of patches stitched together, but a tasteful patch on the shoulder or chest would look swell.

2. My favourite idea is to team up with an insurance company (not pharmacy related) and some celebrity to sponsor DURs. Every time we complete a Drug Utilization Review, a message would print on the patient's receipt: "This DUR Double Check brought to you by State Farm", with a picture of Aaron Rodgers.

3. Any State Prescription Drug Monitoring Reports that result in the successful arrest of a patient, or even prevention of the filling of a prescription, could be sponsored by Crime Stoppers. Better yet, we could even get McGruff the Crime Dog to pop up on our screens!

4. MTMs could be sponsored by attorneys.
"This consult brought to you by the law firm of Dewey, Screwem, and Howe."

5. Immunizations need love too. Why not a cross-promotion with other companies?
"Today's shot brought to you by Jameson."
or...
"Since you care about your health protection as much as we do about your personal protection, today's vaccination was brought to you by Smith & Wesson".

Vitamin Bingo

You know it's been one of those days when you've been waiting since Monday for a refill for a patient and it's now Friday and the phone finally rings and this happens:

A Lapsed Nurse: Hi. This is ALN calling from Random On Call Prescribers Network.
CP: Good evening. Welcome to Pee Wee's Playhouse.
ALN: Um...I'd like to call in a prescription.
CP: And I'd like to take one from you. I'd call that kismet...or fate. Or would you prefer destiny?
ALN: Um...Apparently one of our patients was supposed to have a prescription called in earlier this week.
CP: Yes. Captain Jack. Poor lad. Been waiting since Monday.
ALN: Okay. I'm a nurse and I'm going to phone in this prescription on behalf of Dr. Zoffis.
CP: For Cyanocobalamin?
ALN: Huh?
CP: Cyanocobalamin.
ALN: <crickets>
CP: Okay. What is the prescription?
ALN: B12 injection.
CP: So...cyanocobalamin, then?
ALN: Um...<whispers as she reads> there it is. Yes. I guess that is what it says.
CP: Okay. And?
ALN: One injection per week with 11 refills.
CP: So I should give 4 injections for a month with 11 refills?
ALN: Wait. Four? <counts weeks in a month in her head> Yes. 4 shots for one month.
CP: Thanks. I see now why you're semi-retired.

You're the Only One...

Even though we ALL, as a profession, seem to care about our licenses and jobs, there appear to be more and more of us who get questioned about our professionalism. When we call prescribers and their offices, we are accustomed to hearing:
"You're the only pharmacy that gives us a hard time about this".
"No other pharmacy has a problem with how we write these."
"Why is your pharmacy the only one that calls us on this?"
"You're the first pharmacy to tell us this."

This is true across the country. Pharmacists in all cities and all states have shared stories about how they are the "only pharmacy that calls or complains" about a particular office. It's time we reciprocate, in kind.

1. You are the only office that refuses to give us CTP numbers for non-doctor prescribers on phone-ins.
2. Why does your office give us such a hard time when we call and tell you that you cannot sign a fax using an electronic signature?
3. You're the only office that tells me stamped signatures are totally legal in the state (they're not).
4. Why is your office the only one that doesn't accept faxed refill requests?
5. Why is your office the only one that makes the pharmacist fax for patients' refills instead of the patient calling?
6. Why is your office the only one that loses e-scripts they supposedly sent to my pharmacy?
7. Yours is the only office that takes our prior authorization forms and trashes them without reading them and blames us when the patients' medications aren't approved...because you don't take faxes from pharmacies.
8. Why is your office the only one that writes "not our patient" on the faxed refill request, when I am looking at the previous prescription handwritten by the prescriber in the office?
9. Your office is the only one that can't figure out how to approve e-script refill requests and instead denies them, only to send an approval later in the day.
10. Why is your office the only one that knows there is a problem with their e-script software, as you told me 3 pharmacies have called so far today, and you shrug it off as inconsequential?

Inconceivable

Compare and contrast. I always hated those words when I was school. As we get older and our experiences broaden, we are more able to understand how to argue points.
At least I thought that to be true. Until yesterday...

Pretty Sure It's Comparing Oranges: Will this new medication work for me?
CP: Possibly. It's designed to give you relief all day as opposed to just 4-6 hours at a time.
PSICO: I have a whole collection of expensive medications that didn't do shit.
CP: Well, shit happens. So hopefully these will do shit. See you in 15 minutes.

<PSICO strolls down to pickup>
Uber-Tech: Any questions for the pharmacist today?
PSICO: Are these going to help?
UT: I heard you talking to the pharmacist. Stop back by the counsel window on your way.
PSICO: Why are these so cheap?
UT: Not sure. Ask CP.
<PSICO pulls in at Consultation Station>

CP: Hello.
PSICO: Hello, it's me. I was wondering...
CP: Stop it.
PSICO: I already know these aren't going to work.
CP: Okay. I'll bite. Why are these not going to work?
PSICO: The Gabapentin I picked up last time cost me $35.79.
CP: Okay.
PSICO: The Morphine you just sold me only cost $19.96.
CP: Okay. That's good. It cost less.
PSICO: No. It's inferior.
CP: Sorry?
PSICO: Haven't you ever bought something in a store and knew it was different from the top-of-the-line stuff? Like Ragu.
CP: Ragu is top-of-the-line?
PSICO: Yes. And then you buy the stuff next to it that's not as expensive and it's all watered down and nowhere near the same quality. This isn't going to work because it's cheap and watered down.
CP: Seriously? That has got to be the weirdest theory I have ever heard.
PSICO: It's true.
CP: No. No it's not. It's not even close. It's like comparing Taco Kits with Tampons; Skateboards with String Cheese; Star Wars with Gone With The Wind.
PSICO: Well I'll try it but it's not going to work.
CP: Positive thinking may. If you think it won't work, it won't. If you think generic Ragu sucks, it does.

No Respect

CP: Thank you for calling the Dangerfield Drug Depot, this is CP. How may I help you?
Implacable Little Lady: Why was this so expensive?
CP: Your insurance has this in its highest tier. It's listed on your card that way.
ILL: But why? My doctor told me it wasn't expensive. He said he picked a cheap medication.
CP: Well, he was wrong.
ILL: But he said.
CP: Well, from now on, tell him the CP  told you all your office visits are free. He can't charge you.
ILL: That's not nice of you at all.
CP: How is it not?
ILL: It's not professional.
CP: Neither is your doctor. He's rather overstepping his bounds. As a doctor, especially a specialist in the ophthalmology field, he should know that he is prescribing a brand name drug. If not, he should do more research before he tells people the ins and outs of my job.
ILL: Well he has every right!
CP: I'm sorry? He has every right to do what?
ILL: To tell me if it's expensive.
CP: Why?
ILL: I am within my right to ask him and it's within his right to answer me.
CP: But not with incorrect information. It IS within his right to do research. Even though your most trusted prescriber gave you WRONG information, you are going to vehemently defend his right to provide said information?
ILL: I asked him. It's his right.
CP: No. Not really. It is not within his right to give blatantly wrong information under the guise of professional trust. A better question here would be: If you have such blind faith in professionals, why does his word trump mine? I mean, it's not as if I'm the pharmacist and I have the knowledge about medications and I do this all day.

Vampires

Fairly Average Patient Purporting Extensive Research: What is a good recommendation for phlu prevention this time of year, my good chemist?
CP: First, thank you for asking. Tis kind of you to put so much faith in your local pharmacist. I am humbled by your respect.
FAPPER: You are the go-to source for all things medication related.
CP: I'm blushing...To answer your question, there are a number of things you can do. Start with your annual phlu shot, continue with good hygiene habits, (wash hands, cough into your arm, try not to breathe around people), stay home when you are sick, and rest when your body needs it.
FAPPER: Sounds pretty easy.
CP: Basic stuff, in fact.
FAPPER: What about natural OTC remedies?
CP: Such as?
FAPPER: Oscillococcinum?
CP: It works as well as my other favourite recommendation.
FAPPER: What's that?
CP: Well, before I go to bed each night, I make myself a VPL. I take phresh cloves of garlic, drill holes through them, then string them together to make a necklace. I wear it to bed each night. When I wake I am rephreshed, and, more importantly, alive.
FAPPER: Sorry? VPL?
CP: Vampire Protection Lei. It wards off the vampires so I don't wake in the morning with holes in my neck, pale from exsanguination.
FAPPER: Vampires don't exist.
CP: How do you know?
FAPPER: I just do.
CP: How can you prove they don't?
FAPPER: I just know.
CP: Ah. Well, I believe in them. My faith in their existence is further proven by the fact that I awake each morning having not been drained by them.
FAPPER: That makes no sense.
CP: It is as logical as your belief in Oscillococcinum.

More of the Same

CP: Hello! This is CP. Is this Lady Who Sees Bad Prescriber?
LWSBP: Yes. This is She.
CP: Were you aware your prescriber was calling in a new medication today. And that she was requesting DAW for you to get brand?
LWSBP: She was supposed to call in a new prescription, but for the same medication I've always had.
CP: I see. Well this is for Corgard.
LWSBP: I've always taken Propranolol.
CP: Yes. Which is Inderal. Which is why I am calling. I tried to call the office but they are gone.
LWSBP: She looked it up in her little book and said they were the same thing.
CP: Who did?
LWSBP: The Nurse Practitioner.
CP: Your NP researched your medication you have been taking for years, the generic name of which you and she knew, and managed to come up with the wrong answer?
LWSBP: She said it was the same as Inderal. She said Propranolol.
CP: Well this is why I called. I will have to agree with her: they are the same in that they are both beta-blockers. However, that is where the sameness ends. For example, let us suppose you are putting together a fruit tray and you are asked to bring bananas. Going to the store and substituting tomatoes, because they are a fruit, for the bananas is not going to be the same.
LWSBP: So what do we do?
CP: I will call your prescriber and get you your Propranolol.
LWSBP: No tomatoes?
CP: No tomatoes.

My Dr. Visits

These are my visits to 3 separate offices in 3 different cities over the last couple months. And people complain about their pharmacies...

Office opens at 8am.
My appt. time is 8:50 (please arrive 15 minutes early-checked in at 8:35)
Office specialist calls me up at 8:45 to get my ID, insurance, and signature to allow treatment.
Nurse takes me back at 8:55.
Nurse leaves office at 9:17 and says doctor will be right with you.
Doctor walks in at 9:48 and we chat. He leaves at 9:57.
Checkout lady takes me around to schedule follow up testing and I leave the office at 10:24.

Second Office scenario: Appt. time is 8:30 (please arrive at 8am for paperwork, ID, background check, whatever). No one else in the waiting room.
Nurse takes me back at 8:31, checks vitals, says doctor will be in "as soon as he arrives" and offers me coffee.
Doctor arrives at 9:21 and we chat. He shows me to the front desk (9:30) where I wait for my prescriptions, a review of our discussion, and further instructions from the nurse. Leave office at 9:36.

Third Office visited: Packed waiting room for appt. time of 10:30 (arrive early as is customary).
Taken back to room at 10:32. Hear doctors talking about their Fantasy Football Results/Upcoming Games. Doctor enters the room at 11:21. We leave office at 11:29. He shows me to checkout and leaves. I have blood drawn and receive prescription orders. Walk out of office at 11:39.

Whatever. The obvious point is this: They have all these different stations and my entire 9 minute appointment actually took 109 minutes (8:35 to 10:24), then 96 minutes, then 75 minutes. For what? No one in the waiting area complained. No one huffed. No one threatened to go across the street. Everyone could see other people waiting. Everyone just accepted they were busy. How is this acceptable?
Is it because most of the wait time was spent in the actual room, closed off from the rest of society?
Yes, the billing is done at the beginning.
Yes, my copay is collected at the beginning.
Yes, the nurse checks the BP and vitals and says wait for the doctor.
Yes, the doctor is averaging 9 minutes per visit in each of these offices. That's ~6 people per hour he can visit and 50 people per day, allowing for a light lunch.
Why do we wait so long?
In pharmacy, people can watch as we ready their prescriptions. "Ooh. Ooh. I see mine! There it is. I see it!"

It's Still Illegal

The set up: Pharmacies see the same errors from the same offices all the time. 

Pharmacies call. 

Pharmacies get grief from the Phone Whisperer. 

Offices never change. 

Cycle Repeats...

Local Office Screening Each Request: Thanks for calling the office of Dewey, Screwem, and Howe. Sup?

CP: You can't do this. 

LOSER: Sez who? 

CP: CP. The great and powerful. 

LOSER: Hmm. What makes your word gospel?

CP: Unlike prescribers who think they are Above the Law, or that it does not pertain to them, or they can ignore it, pharmacists' licenses depend upon their compliance with it. 

(To which LOSERs will respond with either or both of the following:)

1. But we've always done it this way. 

2. You're the first/only pharmacist that troubles us over this. 

CP: I see. I see. So, your argument here is that, since you've always broken the law, you are allowed to continue doing so?

LOSER: Yes. I mean, no. I mean, I didn't say that. 

CP: You kinda did. 

LOSER: No I didn't. 

CP: Let me put in context for you. The next time you get pulled over for speeding, try this dialogue with the officer who saunters up to your vehicle: "Well, officer, you see it's like this. I ALWAYS set my cruise at 7MPH above the posted Speed Limit on the Interstate." 

Cynical Highway Patrol: That's not legal. 

LOSER: It's okay. I always do it. 

CHiP: That's not how it works. 

LOSER: Sure it does. I've always done it this way. It works this way at work too. 

CHiP: No. No. No. No. No. Here's a ticket.
LOSER: Okay. I'll just put it in my glove box and ignore it.
CHiP: You can't do that either.
LOSER: Why not? I always do it this way. 

Why is it so?

CP: Your copay is $123.45
Have A Little Faith: Why is it that?
CP: That's what the copay is.
HALF: But why?
CP: Why not?
HALF: But I have insurance.
CP: Yes. Yes you do. This is your copay.
HALF: But if I have insurance, why is it so much?
CP: With insurances today, there could be many reasons.
HALF: Such as?
CP: It's expensive? You have bad insurance? You are in the Hole of Donuts?
HALF: But they're just eye drops.
CP: Yes. Eye drops with no generic. Using the qualifier "just" does not just magically make something cheaper or easier to accomplish. That's like telling me I "just" put pills in a bottle.
HALF: Well that doesn't make sense to me.
CP: Lots of things make no sense to me. Particle physics, for example. Yet we have experts on this subject and I have to trust them. You've got to have faith in those who know.
HALF: Well I don't like it.
CP: You don't have to like it. You just have to accept it.
Water's wet and the sky is blue.
The earth is round and global warming's true.
Your insurance pays while you pay too.
Whatever happens, we all get screwed.

Dress Code

There must be some sartorial standard patients everywhere just seem to understand. I've never seen an official dress code anywhere, but maybe I'm not on the right mailing list or I don't belong to the right groups. I know I shouldn't be, but I still get surprised at the way people dress when they know they are coming to the pharmacy for flu shots. It's not as if they were in the checkout line, reading the covers of the magazines, and the impulse to buy a pack of gum, batteries, and a flu shot struck them. These are people who planned on coming in for a flu shot.

Women over 60yo--Sweatshirt. Period. Bra optional.
"Sorry. Guess I'm going to have to take it off."

Women 20s to 40s--Under Armour, long sleeve running shirt, skin tight. Vest.
<slides the sleeve up to expose her wrist tattoo> "Is this far enough?"

Men 20s to 50s--Long Sleeve or Business Dress Shirts.
<rolls up sleeve to elbow> "Is this far enough?"

Winter Weather Waiters--Long sleeve T-shirt. Long sleeve top. Sweatshirt. Jacket. Vest. Scarf.
<stretches down neck of tops to expose 1/4" of collarbone> "Will this work?" (Only for a vampire.)


Look, I'm going to have to stick my needle in you. There's only one place it can go. This is like getting ready to have sex by only taking off one sock.

#IfICantSeeItICantStickIt

GoPro or Go Home

I believe a new method of rating pharmacy staff is overdue. Where unions make it impossible to get rid of crappy personnel and the chains' frequent managerial turnovers make consistent appraisals unlikely, it's time to take matters into our own hands.

You've likely heard my rants about the need for retesting. I'm in favour of anyone over 65 years old having to retake their driver's test. Look, it makes sense. We could get uber to sponsor it so they could have a legion of retired drivers out there looking for people to drive around. Makes sense.

Back to pharmacy land. I believe we need to retest our techs. My design for this is simple. I will pull one hundred drugs from the shelves and dump them into one giant tote. Each technician, and pharmacist, will be awarded points for accuracy and speed. If you cannot alphabetise, you are a danger. We rely on medications being put away correctly. At the end of the tests, the staff person with the lowest score is voted off the island, or relegated to cashier only.

I hear you. You're absolutely right. Maybe we should make this our first interview task. For companies that like to hold group interviews, this would be a wise way to separate the chaff. "Sorry. Your scores on the Shelf Stuffer Relay were rather dismal. You've been sacked."

Another way to work this in to standard protocol would be to have all staff wear GoPro cameras. This way, when that one technician, and you know who she is, says "wasn't me" when you know damn well it was, you can go to the video that shows her own hand placing the Mirtazapine 7.5mg behind the Meloxicam 7.5 mg bottle because they both have green labels, and fire her.

(This would not be phunny if not for the phollowing: On many days, I will help put away the order. Just for phun, on slower days, I will leave a few items in the totes that I know certain techs will carelessly shelve. For whatever reason, these seasoned vets will prove me right and put each one in the wrong spot. Maybe it's because they look like another product. Maybe they like to put Rectal Rockets in Gen Pop as opposed to the correct location of Rectal/Vag. Either way it just proves that the reckless disregard for such a seemingly mundane task reflects on their approach to the rest of their jobs.)

Flu Shot Phun

1. Wear a Kevlar cutting glove on your non-shooting hand. Tell the patient it's to protect your hand because the last time someone came in with arms this small, you had a through-and-through and stabbed yourself. (Yes, I know you can stab through these. They won't know that.)

2. Tell your students, especially those who've not yet experienced hitting bone, that when they do, they need to request a curved needle so they can go around this weird obstruction they found. 

3. When you hit bone, pull out a little, redirect your aim, hit it again, then tell the patient: "There's something in here. I can't get the needle around it. What's wrong with your arm?"

4. Attach a mini laser pointer to your syringe. When the patient asks what it is, tell them it's your laser sight.

5. Attach dart flights to your syringes. Grab a red Sharpie and draw circles on the patient's arm. Have the patient stand against the wall. 

Anagrams

My brain works in mysterious ways. It works faster than the rest of me. It works on the next task before I've managed to get the prior one completed. It sees things differently. It tries to organise and find patterns. This is why I excel at Boggle, Scrabble, and Words With Friends and why people hate playing me. This is also how I came up with today's challenge.

We all know drug companies spend lots of money on research for marketable names and there is a science to it. This is why so many medications have Zs and Xs. Great words for the Scrabble board. Not so great to make other words.

Come up with your own Drug Name Anagrams.
Here are 6 to get you started:

Benicar=Carbine
Breo=Robe
Klonopin=Pink Loon
Levsin=Snivel
Neoral=Loaner
Xarelto=Tax Lore

Now if I could just get Zynga to create a Pharmacy WWF games...

More Pharmacy Phun With Words

As I've oft written, I rarely miss an opportunity to have some phun with my staff, phamily, or patients. This is especially true with regards to questions and grammar. A previous lesson involved the questions of time.
Do you know what time it is? is a Yes/No question. Note, I did not ask for the time. I may have simply been nosy inquiring if you knew. I may also have espied you checking your watch and wanted to test your recall. Either way, the correct answer is either Yes or No.

For today's example, I draw upon the conversation I had earlier this week.
CP: Top O' the Morning to You!
Telephone Inquirer Making Exaggerated Requests: And Good Day to you.
CP: How may I help you on this brilliant day?
TIMER: I was hoping to get a phlu shot today.
CP: Most definitely. No better way to spend an autumn day than getting shot.
TIMER: That's what I was thinking.
CP: When would you like to visit our establishment?
TIMER: Well, that's the reason I am calling. I'd hate to be a bother during your busy day.
CP: No worries. We are always busy but we are also quite accommodating.
TIMER: "When are you the least busy?" (The real question)
CP: "When we are closed." (The real answer)
TIMER: Phunny.
CP: I thought so. Did you want to know times when we are less busy?
TIMER: I suppose that would make more sense. Rather difficult to get prescriptions and shots while you are closed, eh?
CP: Indeed.

Magic Mouthwash

Sounds more amazing than it is. In some pharmacies, this is the only item they will ever be asked to "compound" for patients. However, as straightforward as this prescription appears to be, there remains a great deal of ambiguity around its formula. The problem is, there really exists no single recipe for it. There are as many possible ways to assemble this as there are prescribers to write for it. Each believes his or her own to be the one true king. As a result, conversations like this will ensue:

Clueless Office Staff Person Lamely Answering You: Dr. Zoffis. How may I help you?
CP: I am CP.
COSPLAY: OMG! The great CP is calling my office? What did we do?
CP: Well, you are not a local office to my pharmacy. You're over an hour away and as such, I am unfamiliar with your local customs.
COSPLAY: Ok. What is it you need?
CP: Magic Mouthwash.
COSPLAY: Yes. She writes it all the time.
CP: Apparently the pharmacies near you are used to this from her. Round these parts, we ask our prescribers to write ingredients and directions on their prescriptions.
COSPLAY: She writes this all the time.
CP: I heard you. Now please extend the same courtesy and hear me. She simply wrote "Magic Mouthwash". There is no amount to dispense. There are no directions for mixing. There are no ingredients. Does she want a 1:1:1 ratio of Maalox, Benadryl, and Lidocaine? Does she like the fancier version with Nystatin? Or Dexamethasone? Or Doxycycline?
COSPLAY: I don't know that. She writes it all the time.
CP: Then you should know what she uses. Does she have a recipe somewhere in the office?
COSPLAY: I've never seen one.
CP: Would it be possible to trouble her for the answers I seek?
COSPLAY: She's in a procedure right now.
CP: Of course.
COSPLAY: Can't you just give her the usual?
CP: That's like me flying to Saskatchewan, walking into a random bar I've never visited and asking the bartender to give me "my usual".
COSPLAY: Well she writes it all the time.
CP: I'm guessing you were hired to answer phones and the only qualifications asked of you were: "can you say 'Hello?' in a sweet voice?" and "can you make appointments in the computer?".
COSPLAY: She writes it all the time. Just give her the usual.
CP: Okay. Here's what we're going to do. I'm going to tell you what I'm going to write on the prescription. I'm going to put your name on it as the person who approved it. Then I'm going to fill it and give it to the patient. Verstehen?
COSPLAY: Okay. I'm not going to end up on one of your posts...am I?
CP: Sorry. I'm mentally writing as we are concluding our business.

For What it's Worth

Everyone has a price point. There is a point at which the value of the item is exceeded by its cost. Some people spend an extraordinary amount of money on their pets. Fine. Good for them. Others spend money on baubles and trinkets and collectibles. To each his own and all that. At what point do you care less about your health than anything else?

Very Anxious Geriatric In Need of Application: Did my doctor call in my prescription? 

CP: Yes. Yes, she did. 

VAGINA: How much is it? 

CP: $286.57. 

VAGINA: Really? 

CP: Yes. 

VAGINA: Why so much? 

CP: You have $233.00 applied to your deductible. After that, your copay will be $53.57 henceforth. 

VAGINA: That's a lot for a cream. 

CP: Yes, ma'am. But if it works...

VAGINA: I've tried other things in the past but this is so expensive. What's this one called?

CP: Estrace. Vaginal Cream. 

VAGINA: Okay. Does it work? 

CP: Haven't tried it. 

VAGINA: And it's how much? 

CP: $286.57 today. $53.57 going forward now that your deductible has been reached. 

VAGINA: Okay. Let me think about it. I'll probably be down later. 

CP: (to uber-tech) How much is your vagina worth to you? 

UT: What? 

CP: Is it worth more than $200.00? 

UT: Yes. 

CP: Ok. Just checking. 

UT: I'm surprised you didn't ask her that. 

CP: Thought about it. Was afraid of the answer she'd give me. I didn't need to hear about The Tin Man and his Oil Can. 

UT: Ew. 

I'm on Vacation

I hear everything. I have to be on high alert. It's just how my brain works. It helps if I need to jump in on an interaction with a belligerent patient at pickup. It also helps when my technicians may be asked questions to which I know the answers, like if we have something in stock. Anyway, on this particular occasion, I was lurking behind the wall, cramming a donut into my maw while simultaneously thumbing through my fantasy football lineups. I overheard a patient, Runs-With-Scissors, asking my technician if we would sell syringes to her over the counter. I was obliged to help this poor, unfortunate soul until I rounded the corner and walked into the conversation.

RWS: I am trying to buy syringes for my insulin.
CP: Okay. What brings you here today?
RWS: I'm on vacation from Iowa.
CP: Uh-huh.
(aside to my tech: "she does realise we are currently in Iowa, right?")
Uber-Tech: (whispers to CP: "I don't think so.")
CP: Where do you usually fill your prescriptions?
RWS: Hometown Pharmacy.
CP: Which insulin do you use?
RWS: (smiling, like she was waiting for this question, she proudly answers) PORK!
CP: Okay. Well, they haven't made that insulin since 2006 but there is a Hometown Pharmacy just down the tracks a bit. Perhaps they could look up your information from your home in faraway Iowa. RWS: So you can't help me?
CP: No. I believe that to be an impossible task at the present time.

Dumpers

I was tooling around Costco the other day looking at all the mega-size bottles for sale and I had an epiphany. First I thought "who can use this much Honey?" when I saw a 3 pack of litre bottles shrink-wrapped together. Then it hit me. People take these big bottles and dump them into smaller bottles at home, just like we do with medications at the pharmacy. It was at this point that I started talking to myself. Hey, it happens. 

Myself: <laughing>

CP: What's so funny? 

Myself: Remember the post you did last week about the 3D printer? 

CP: Yeah. What about it? 

Myself: Remember how the one guy asked if he could just have the "ones you dump from the bigger bottles into the smaller ones"? 

CP: Of course. Where you going with this? 

Myself: I have an analogy for you. Since I know you love little literary devices. 

CP: Intrigued.  

Myself: You're always looking for a comeback or some way to put someone in his place for belittling you and your job. 

CP: Okay. 

Myself: This time it's waitresses. 

CP: Go on. 

Myself: Saying that all we do is pour pills from big bottles into little vials is like saying that all a waitress does is pour ketchup and salt & pepper from big bottles in the back into small bottles on your table. 

CP: No one's going to catch the similarity. 

Myself: Sure they will. They greet you when you sit at their table. They take an order from you. They hand the order off to be prepared and deliver it to your table. Afterward, they send you to the cash register where you are asked if everything with your meal was to your satisfaction. The only part you saw was when she refilled your drinks from the big pitcher, or your condiment containers from the big bottles, and when she took your order, then delivered it, along with the bill. You didn't see all the other work she did in the kitchen. You didn't see her waiting other tables in the other room or outside. You didn't see her ringing register while the hostess was on break. You didn't see her taking phone orders for curbside pickup. 

CP: So now you're saying we're just glorified waitresses? 

Myself: No. I'm saying we are kindred spirits. We are compadres. We are forced to smile at people while they denigrate us and our work to our faces while we are trying to do our job FOR them. 

CP: Got it. You're a strange little person. 

Myself: I know. 

CP: Deep Thoughts. 

Myself: Know what's phunny? 

CP: You changing all your "F's" to "PH's" in everything you write? 

Myself: Haha. No. This post was supposed to be one line, short enough for a twitter post. 

CP: Okay. Which line? 

Myself: I'd intended it to only be about where I said "saying pharmacists only put pills from big bottles into smaller ones is like telling a waitress her only job is filling ketchup, S&P, and drinks on your table from bigger vessels in the back". 

CP: Phunny. 

Myself. Don't you start...

How to be a Better Patient

How to be a Better Patient...

1. If your prescriber sends your prescriptions electronically, either
a. call before you come to the pharmacy to verify we received them and make sure we have your information, or
b. come to the drop off window to verify the same.
This way you won't have to wait in a long pickup line only to discover we've not yet received or even started filling your prescriptions. It helps us prioritize and helps you manage your time. 

2. Read Your Insurance's Explanation of Benefits. At least give it a cursory glance on the key points: copays, deductibles, preferred pharmacies, mail order requirements, and formulary restrictions. I'm like the general practitioner of insurance: I know a little about a lot. You are the specialist, the one who knows a lot about a little, when it comes to YOUR insurance. Help Me to Help You. 

3. Read Your Labels.
They tell you how and when to take your medication. If your prescriber changed anything, it will be on your newest label. Read it. Even if we counsel you on the changes, by the time you get home, it is difficult to remember everything you heard in a whirlwind morning of office and pharmacy visits. 

4. Refills. Now that you've read your labels, note the refills. Also, call them in 3 to 5 days early. This will ensure the prescription refills are valid and allow the pharmacy time to process any refill requests, insurance issues including prior authorizations, and order the medication if it is out of stock. You don't have to pick it up right away since you still have medication remaining so thank you in advance for giving us time to make sure everything is correct for you. 

5. Pick Up Your Prescriptions...Now!
I know. I just said call them in early and wait a couple days. This is for the patients who sign up for the refill service and, despite 3 phone calls, texts, emails, and skywriting campaigns, still do not pick up their medications within 13 days. It wastes our time to fill prescriptions you do not need. It wastes resources to keep them filled and continue trying to contact you. It phrustrates you when you come in, the day after we return them to stock, expecting them to be there and now we have to scramble to get them ready for you post haste. Please come get them. They are lonely without you. They miss you. Maybe we could send snapshots of unadopted prescriptions like the local pound does with puppies and kittens...

6. Know what you're taking and, more importantly, WHY! and Ask Questions!
After reading the labels, call us. Or review everything with us at pickup. We are not as imposing as your prescriber. We don't have other appointments that are running behind. We are here for you. The more medications you take the harder it can be to remember what you are treating. My favourite question people are reluctant to ask is: "Did my medication change? It looks different from last time". I love this and tell all my patients who ask the same thing. This. Is. Awesome. It means you are actually paying attention to what you are putting in your mouth. 

7. Your Pharmacist is a well-educated Professional. She is a valuable resource for health information. Just because her work environment may seem like Chuck E. Cheese's does not give you the right to yell and scream like a toddler when you don't get your way.
Your prescription is just as important to her as the one before it and the one after it. So is your time. Maybe this time you don't have a question. Maybe another patient does. Maybe next time that person will be you. 

8. Patients need Patience.
Prior Authorizations happen. Out-of-stocks happen. Wait Times happen. Phone Calls Happen. Consultations Happen. Why is the pharmacy busy? People like us. We're popular. Just like you, other people are unwell as well. Just like you're not alone in this world, you're not the only person who is sick today. Not surprisingly, you're not the only person who felt now was the perfect time to get a flu shot. You're not the only person who decided to go shopping the day after Thanksgiving either. As I've said in a previous post: If it is at all possible, avoid peak times at the pharmacy. This basically means all Mondays, Weekdays from 11-1 and 4-6, and days immediately before/after holidays. 

Silly Stuff People Say...

1. "They called and said my prescriptions are ready to pick up and I can't come in until tomorrow."
CP: Okay. And who might you be? Because you're our only patient. Anyway, I'm busy tomorrow. Can you make it the day after the day before tomorrow instead?

2. "I'm having a drug test tomorrow. I hope I pass."
CP: Did you study?
(This was from a person who had never used illicit substances but truly was afraid of not passing.)

3. "I'll be back sometime before you close."
CP: Good, because after we close makes no sense...unless you're planning on robbing us. That's a good time for that.

4. "I need a refill on my white capsule. It's 100 megatons."
CP: That's heavy, Doc.

3D

Pharmacy Phun with Patients. The next time someone asks "what's taking so long?" or is dull enough to utter "all you do is put pills in a bottle", surprise them with this witty tete a tete.

Irascible Dude Getting All Fervid: What's taking so long?
CP: Your prescription.
IDGAF: Why?
CP: Printer Problems.
IDGAF: I don't care about that.
CP: Well, you did ask. I assumed you were being empathetic.
IDGAF: I watched my doctor send it over an hour ago.
CP: And?
IDGAF: I assumed when he hit "send" it just came out done.
CP: Oh. Like hitting "start" on your microwave instantly cooks your bag of popcorn?
IDGAF: Yeah. I mean, no. But I saw him send it.
CP: I'm sure you did. Ever send an email?
IDGAF: Of course.
CP: Ever see what happens to it after you hit "send"?
IDGAF. No. I'm not there.
CP: And neither were you here. As for our printer problem, more importantly the one that directly affects your prescription, it's a little slow. It's the newest printer you can get.
IDGAF: It should be faster then!
CP: Not exactly. It's a 3D printer. It prints out each individual dose, one-at-a-time. Your doctor ordered 180 capsules. It's going to be a while.
IDGAF: Can't I just get one of those you just slap a label on?
CP: Nope. Not what your doctor ordered. My technician is busy sitting in front of the printer, holding a vial, waiting for each capsule to be completed so she can grab it off the printer and place it in the vial. It's a very labor-intensive endeavour. Not sure how long it's going to take to even get to the label slapping part.
IDGAF: What about the ones where you just takes pills from a big bottle and put them in a smaller bottle?
CP: We're out of those.
IDGAF: What are all those bottles behind you?
CP: Antique displays.
IDGAF: What?
CP: Ever been in a pharmacy where they have cute little decorative urns and mortars and pestles, and glass bottles of many colours?
IDGAF: Yes.
CP: Throwbacks to the days when we were apothecaries and actually made your medications. Now we use those as pharmacy decorations. Same with these stock bottles. We need something to take up all this shelf space. Wouldn't want patients thinking we didn't have anything in stock.
IDGAF: This is absurd.
CP: No. It's cynical. Now go sit down, pull out your phone, and play Candy Mania until we call you.
IDGAF: Fine.
CP: Wait. Almost forgot... (singing) Do you wanna get a flu shot? What else you gonna do? You have a lot of time to kill. It's such a thrill. Just let me please shoot you!

Drug Combos

In an effort to fully embrace our fast food mentality and expedite workflow, we need to learn from the restaurant business. We need to have catchy names for some of the most common prescription combinations. This way our data entry technicians, or those in charge of the drop off window, can shout: "Ordering! One Whiz-Bang* and a Dental Double**" to the line cook, er, filling station technician.

*Whiz-Bang=Cipro 500 and Flagyl 500

**Dental Double=Amoxil 500 and Norco 5mg

Steeler Special=Macrobid and Pyridium
Johnny-on-the-pot=Golytely and Dulcolax
Jump Around=Z-Pak and Medrol Dosepak (pack it up, pack it in...)

How to Complain

People complain.

Pharmacy patients complain a lot. At least it seems that way. 

Companies don't like complaints. Instead of using them as a tool to make positive changes in their business, they chastise the pharmacy team for not meeting the ridiculous expectations placed upon them. On my day off I ran into a former patient of mine. She was fired up and wanted to complain about the pharmacy she was currently using. As I listened to her, I realised we in pharmacy should guide our complaints. I could have told her not to complain but that wouldn't help. I could have told her to just call the 1-800# and allow the pharmacy to get in trouble. Instead, I opted for the third option: tell her how to complain. 

When patients complain, it is often a knee-jerk reaction to a perceived slight or overreaction to something that, had they taken time to breathe, may not have resulted in a complaint. In order to garner the appropriate response from the powers-that-be, we need to encourage the use of buzzwords. Without these, the corporate suits won't pay attention. Simply mentioning "metrics", "quotas", "HIPAA", or "privacy violation" will prick the ears of even the most inattentive corporate lackeys. 

Dear Pharmacy Gurus, 

It is with a solemn heart that I must call today for I wish to register a complaint. While the store where I shopped is the offender, I wish no repercussions to come to the staff there. They are only doing what is expected of them and therein lies the problem. First, you as company overlords are forcing them to meet quotas for vaccines. As a result, my pharmacy felt it necessary to run vaccine prescriptions through my insurance while filling my other prescriptions. While I am certain they intended to tell me what was and was not covered at the checkout window, this did not occur. It was not until I got home that I noticed the notes from my insurance company rejecting the flu shot, pneumonia shot, and shingles shot. If you did not place quotas or mandatory requirements on these pharmacies, this would not have happened. They also would have had the time to talk with me as I paid for my prescriptions. It is a sloppy, unprofessional way to drive business and I believe, unethical, which leads to my second complaint. 

If your pharmacies are engaging in this type of behaviour simply to meet your targets, is my privacy at risk? I believe that submitting a claim to my insurance without my permission is a HIPAA violation. Why? How? I haven't authorised you to bill them. I haven't okayed any claims other than the original reason for my visit today. I am disgusted with how you have taken this trusted interaction with healthcare professionals and turned it into a "do-you-want-fries-with-that?", cheap money-making ploy. Please remove quotas and metrics from your staff so they can get back to what they are supposed to be doing: providing me quality healthcare.
p.s. I think I'll follow up on that HIPAA thing. 

Ratings System

Retailers offer customers the option to write product reviews on their websites.

I like to research these before I buy something so I know what to expect. The ones that amuse me the most are the negative reviews. Obviously, if a product has many negative reviews, there must be a reason; it's likely an inferior product. What about the 1 or 2 negative reviews adrift in a sea of positives? 

Some common ones I found this weekend:

"I gave this a 1 because I couldn't figure out how to assemble it. I had to return it to the store." 

"The colour didn't match when I got it home." 

I think we need a system like this for pharmacies. Remove the fake, forced "Customer Service Reviews" and offer online reviews of your experience. This would apply not only to the pharmacy itself, but to the medications dispensed. 

"I gave this pharmacy a 1 because I had to wait in line behind 3 other people picking up their prescriptions and no one gave me a gift card."

"The drive-thru wasn't fast enough. I should be able to order and pay at 1 window then pick it up immediately at the second window like I do with my breakfast, lunch, and dinner every day."

"The blue ones worked better and they gave me white ones."

"The pharmacist was so busy helping someone find something out front that I had to wait an extra 2 minutes to get my prescription checked. The customer service is horrible."

Perhaps we could set up a website dedicated to Pharmacy reviews?
We could offer a drop-down menu of all pharmacies in the country and sort by store number or address.  This would allow patients to go online and rate their service. Instead of a phony "On a scale of 1 to 5, How was your service?" we could see that the patient was unhappy with the fact that we stapled her bag shut. It happens. We shouldn't get dinged on "satisfaction results" simply because she gave us a "1" for a staple. It's all about context. This way we can hand the patients the address at pickup, or text them a link, then find our own store on the list.

Maybe we could include a corporate link too?

Anyone want to start this with me? We can link it to my page.
"Pharmacy Patient Reviews"?

English is Funny

We Americans have a way with words. We can take anything another country or another part of our country has and twist it, chew it up, and spit it into a new, bastardized creation. It's our specialty.

From the South to New England, from the inner city to open country, it can be difficult to understand other fellow Americans. 

Birth Control Language Barrier: 

BeYaz or Not Be Yaz, that is the question...

Female That Wants Birth Control: I need my pills refilled. 

CP: Okay. Which ones? 

FTWBC: The birth control. 

CP: Do you know the name? 

FTWBC: It BeYaz

CP: Okay. Um. Is it YAZ? or is it BEyaz? 

FTWBC: I said it Be Yaz

CP: Okay. Let's try it this way. Be it Yaz or Be it Beyaz? 

FTWBC: Right. 

CP: What's right? 

FTWBC: Be Yaz. 

CP: It is for BEYaz? 

FTWBC: That's what I said. 

CP: <looks in computer. it's Yaz.> 

Now just imagine this not as a patient calling in for a refill but as a representative of the prescriber's office calling in a new prescription.  

Set up for Failure

What are your company's expectations? "Unrealistic" should be the answer no matter what number you give. Let's examine flu shot goals, um targets, I mean quotas, er, plans. Math is good here.
Here is an example of averages in statistics: On average, 55-60% of the US population votes in presidential elections. The numbers vary little from elections after 1920 going as low as 49% to a high of 63%. It is fairly accurate to say voter turnout is ~57% every year since 1920.

As it regards pharmacy, let's assume the following:

On average, 40% of the US population receives a flu shot each year. The numbers vary little year to year. This is, for all intents and purposes, a finite number. (And the number of the counting shall be 40%. No more. No less.)
Your company expects an increase of 20-60% in the number of flu shots administered by your store.
Where will we get these shots?
Ten years ago when I first started immunizing, it was easy to show growth. I was the only person in town giving shots. It stayed that way for 4 years. Then everyone got in the game. Now you can receive a flu shot from your prescriber, an urgent care clinic, in hospital, during an ER visit, from the fire department, at the county health department, any pharmacy on any corner in any town, or during any vaccination clinic provided by any of these groups.

Another number to add to the equation: Prescription Growth. Each year we are given metrics, um targets to reach as it pertains to prescription growth. I have yet to work in an existing (not new construction) store that had a goal of 20-60% growth in prescriptions. Usually these goals are single digits, but always much less than 20%.

As I understand it, corporate people want us to grow one segment of the business by 40% in a saturated market where growth is stagnant and our overall prescription increase, the bulk of our business, is only expected to grow by <10%?

Where do we get the flu shot business? We are expected to steal, pilfer, and swipe it from competitors. Guess what? They have the same unrealistic, unattainable goals as we have. While we may not lose business over this, we are certainly not going to gain 40% either.

NPR

Pharmacies have no control over the prices of prescriptions where patients use their insurance. Period.

(For the NPR article I am referencing, click here: http://www.npr.org/sections/health-shots/2015/09/16/440612238/how-to-save-money-on-prescription-drugs-insured-or-not?utm_source=facebook.com&utm_medium=social&utm_campaign=npr&utm_term=nprnews&utm_content=20150916 )

A pharmacy cannot charge more than its Usual and Customary Charge to a patient on insurance. This means that if the cash (no insurance) paying patient is charged $45, the pharmacy cannot charge her $900 on her insurance. Many pharmacies when quoting prices, are only able to give straight cash prices and not prices on insurance without first billing the prescription to the insurance. Some companies are able to provide these prices but you must make sure what price you are receiving. A better solution would be for the patient to call her insurance and ask them. They are the ones that set the prices.

Lesson 1. Pharmacies want to build loyalty. We are a most-trusted profession. The correct response to pricing issues would be build a relationship with your PHARMACIST first. Second, READ YOUR INSURANCE EXPLANATION OF BENEFITS. If your insurance selected a preferred pharmacy, go there. If you like your pharmacist and she does not work there, pay more for her knowledge and trust. If it is cheaper to purchase 90 days at a time, ask your prescriber to write new prescriptions that way the next time you see her. (NPR got this a little wrong. You won't be avoiding copays. You'll have to pay more initially. If your copay is $30.00 for one month, it's usually $90.00 for 3 months. Generally, the only way to save copays is to use mail order which often fills 3 months for 2 copays.)
Again, trust your pharmacist. Ask her what alternatives are available. Go home and check your EOB or your insurance's online formulary (or call them) and research which of these alternatives is preferred. Call your prescriber and ask her to change it.

Lesson 2. Appeal. Good idea. But the problem is this relies on the patient actually taking control of her own healthcare. It is easier to have the pharmacy and prescriber's office do all the work than to take some responsibility.

Lesson 3. Look for Financial Assistance. Another good idea. Another problem with patients taking responsibility. The patient would have to do the research.

Lesson 4. Bad idea. This requires no effort on the part of the patient which is why it's the easiest and least effective.
Discount Cards are NOT helpful. They cannot be combined with commercial insurance.
They are a data collection scam. People who complain about privacy violations seem all too willing to let these companies have access to their personal information in exchange for an average of 10-20% off the cost of their prescriptions. If these patients are truly cash paying customers, then, and only then, should they work to find a lower cash price. Call other pharmacies for prices. Ask about their in-house discount cards. Ask if your regular pharmacy matches competitor prices. This is especially relevant when purchasing medications for pets.
(Chain pharmacies often do not have access to Acquisition Cost which is the price actually paid for the medication. Independents do. They will be better able to give you a better deal because they can see how much they need to charge to cover their costs. Chains generally only see Average Wholesale Price which can be hundreds of dollars more than the AC.)
Example: The anti nausea medication Ondansetron has an AWP of ~$700 but an AC of closer to $4.00.

Manufacturer Cards (Note: These are different from Discount Cards.) They are distributed directly by the manufacturer and are specific to their medications. They are for brand name medications as a way to reduce copays but, as correctly stated by NPR, they cannot be combined with Medicare plans or government-funded plans. Unfortunately, prescribers continue to hand these cards out to these patients.

Lesson 5. Great idea. We have been saying this for years. The only problem is it requires research by the patient. It is difficult to understand, especially for older patients on Medicare who take multiple medications, often many brands and generics. Ask your pharmacist for help before making a final decision. She can help.

Unfortunately, NPR set this up so the pharmacist looks like the bad girl. The easiest lessons are the ones over which we have no control and are the ones the patients would rather do. Because the best ideas require the most work from the patients themselves and are the most effective, few will opt for this route. We will still get yelled at and patients won't listen as we offer them alternatives.
C'est la vie...

Apple

After spending some quality time this past weekend at my local Apple store, I realized what an amazing concept they have for their retail outlets. I think I want to work with them on designing a pharmacy.
A technician will greet you as you enter the store. She will ask the reason for your visit today then direct you to the appropriate person/area of the store while entering your personal and insurance information on an iDevice and alerting that person to your needs.

Second person will instantly know why you are here-to pick up a prescription, to drop off a prescription, to have us check your insurance, to get a flu shot, for counseling, etc. She will guide you to the appropriate table/counter/area where a technician will answer all your questions and assist you with your needs that day. The pharmacists will be behind a counter/wall checking your prescriptions as the orders appear but will walk them out and review them with you. A technician/cashier with another iDevice will scan your credit card for payment and have you sign, with your finger, right on this device and your transaction will be complete.

Vaccines

Arguments to not get a flu shot (or any vaccine).
1. I've never had a flu shot and I've never gotten the flu so I'm not going to start now.
(Have you ever been in a car accident? No? Better cancel your car insurance. What a waste of money.  Ever had a homeowner's claim? No? Cancel that policy as well.)

2. The flu shot gives me the flu.
NOPE. You may have experienced flu-like symptoms, but you certainly did not suffer from the flu. You'd know it if you did. Let's put this in perspective. Riding your bicycle into the back of your own parked vehicle, in your own garage is not a car accident any more than 24 hours of runny nose, diarrhea, or headache is "THE FLU". Getting hit by a semi while riding your bicycle down the middle of the street? Now that's the flu. It will take you weeks to recover or, if you're really old or very young, there's a good chance you're dead.

3. Big Pharma!
What? That's it? Then I shall make sure to not fill your Prozac and Antibiotics and Synthroid anymore. I never knew you felt so strongly about prescription medications.

4. It's not 100% effective. They're just guessing.
Yet you keep taking your paycheck and dumping it in the Instant Lotto machine at the front of my store every week.

5. It's government population control!
Agreed. The more people rail against vaccines, the less people will get them. The fewer people that get them, the more people will die from vaccine-preventable illnesses. It's just a really, really long-term plan.

Rules for Offices

1. If a pharmacist is calling, you can bet it is for a valid reason. Treat it as such and listen to her.
2. Do not send an e-rx to cancel an e-rx.
3. Do not leave a voicemail to cancel an e-rx.
4. Not all faxes are refill requests. Read them before trashing them or sending them back with a signature.
5. Identify yourself. Name, rank, serial number. That way I know how to escalate my call to the proper party if required.
6. Enunciation. It has 5 syllables. You must be able to say that word so I can understand it before calling in any prescriptions to me. If I can't understand it, I didn't receive it.
7. Proofread. It's most likely the prescriber who entered the e-rx. Do him the proper courtesy of a read through before hitting "send". You'll make him look good and me love you long time.
8. Don't tell people prices and don't let your prescribers tell people prices.
9. Don't tell people "it will be there when you get to the pharmacy". People will hear that as "it will be READY" and get mad at us when it isn't.
10. When I say there is a problem with the electronic prescription I just received, do not read it to me. It didn't come across blurry. It wasn't hard to read. If I wanted it read to me, I'd call Morgan Freeman because that man can narrate. I want the incomprehensible mumbo jumbo you entered to become a coherent, intelligible script so get me the person who can fix it.
11. Talk to your prescribers. Tell them what mistakes they are making. If they don't know we are calling asking you to fix their mistakes, they will continue making the same mistakes. This means I have to keep calling you. This becomes frustrating for us both.
12. Don't leave me a voicemail when I had to leave you a voicemail because I needed clarification. More often than not you will not completely answer my question, necessitating further calls from me to you. This becomes frustrating for us both.
13. When we call on the same mistake each month, fix it in the system. Your prescribers are lazy and simply approve what the patient had last time. Too bad we called and no one fixed it. Don't know who is more at fault, you for not fixing it or the prescriber for blindly approving error-filled fills month after month. This becomes frustrating for us both.
14. Whatever you are chewing, sucking, or masticating, spit it out before talking to me. I'm not going to play the "guess what I have in my mouth" game with you.
15. If I ask you for information, believe that I need it. Just because your prescribers do not know or understand the rules and laws that apply to them and did not properly train you, their staff, on them, does not mean that I don't need a DEA#, CTP#, or NPI#. Which leads me to...
16. Do not tell me I am the only pharmacy/pharmacist that "bothers" you with these trivial nuisances. Pretty certain I am not the only pharmacist in the country who worked hard for a license and would like to retain it for its awesome money-earning potential.
17. Finally...if I tell you it isn't here, if I tell you I didn't receive it, if I tell you it's not on my voicemail, it's not on my fax machine (yes, I checked the paper tray), it's not in my e-script queue, it's not yet been received anywhere in my system, keep in mind we have a patient waiting. Give me the prescription now. Give it as a verbal or resend the e-script. I don't care. We can argue later about where it went and why your screen confirms it was sent. I have you on the phone right now with a patient waiting. Give it to me, then research it. I'll probably have to call another pharmacy to have them reverse it anyway.

But I'm a Prescriber

There are no more powerful words in the English Language than these.

It is the fix-it-all answer for any situation. 

CP: There's a problem with this prescription you wrote. 

Good Ole Doctor: But I'm a prescriber. 

CP: Your car ran out of gas. 

GOD: But I'm a prescriber. 

CP: You have a small penis. 

GOD: But I'm a prescriber. 

CP: I'm trying to explain why you're wrong. 

GOD: But I'm a prescriber. 

You get the picture. This would not be so bad if the following events had not taken place. 

CP: You can only get one inhaler. 

GOD: But I'm a prescriber. I write it like this all the time. 

CP: Good. So you understand that just because you write it like that does not mean they actually get it filled like that. 

GOD: But we need one for home and one for school. 

CP: And the insurance only allows one at a time. Picture this. Let's pretend that you're a prescriber...

GOD: But I'm a Prescriber. 

CP: Good. So stay with me. As a prescriber you know that you can write for whatever you want, let's say 90 days of HCTZ 25mg. The insurance...

GOD: But I'm a prescriber. I know what you're trying to say and I get it. 

CP: I don't think you do because you keep interrupting me. As I was saying...

GOD: But I'm a prescriber and we need one for home and one for school. 

CP: Okay. Let's try this. Let's pretend it's NOT the first day of school. Your insurance only pays for one inhaler because, per the directions, this one inhaler is a 25 day supply. This means you can only get one filled per month...You can refill it...

GOD: But I'm a prescriber. I know this. Just tell me when I can get another one. 

CP: As I was saying...most likely, you can get it in 17 days. 

GOD: And it will be free, right? 

CP: Wait what? Why free? 

GOD: Because it's the rest of what was written. I shouldn't have to pay another copay because you can't fill the whole thing today. 

CP: How does that even begin to make sense? 

GOD: But I'm a prescriber. I know these things. 

CP: Obviously not a good one and obviously you don't. Back to the 90 day thing. You can write for whatever you want. It does not mean the insurance has to pay for it. If they limit you to 30 days, you don't come back and get the next 2 months for free. 

GOD: But I'm a prescriber. Of course what you are saying makes no sense to me. You are the fool. Just tell me what I need to do to get my child's inhalers filled. 

CP: I tried but you kept interrupting me. 

GOD: I'll just call my coworker and have her send a new one for two inhalers. 

CP: Fine. As long as it meets the criteria for payment from the insurance or we will be back to the top of this dialogue and I don't think you want to try this again. It will end poorly for you. 

GOD: But I'm a prescriber. 

Open at the Close

Signs are only helpful if two requirements are met:
1. You must be looking for them.
2. You must read them.
There are other factors that enter into it of course but without these two, the rest of them are moot.
(You must be able to interpret them. You must pay attention to them. You must heed them...etc.)

We have our hours conspicuously posted:
a. on the front doors
b. on the pharmacy counters
c. on the wall of the pharmacy
d. in the waiting area
e. drive-thru windows

The problem with arriving early to work is people can see you. Even if you have shutters instead of a gate, people see the lights on and know someone is home. They'll just bang on the shutters shouting "I know you're in there. I just have a question!" until your blood boils.

Here is last week's verbal sparring joust:
<We are early. It's a Saturday. Unpacking the crew's donuts and coffee. Sunny. 78 degrees...inside and out...>

Early Ass Talker Making Exclamations: What time do you open?
CP: We open at 9am, kind sir. About 20 minutes.
EATME: It's 14 minutes.
CP: What?
EATME: It's 14 minutes.
CP: Well my clock says it is 8:43 so that's 17 minutes. (Which is also "ABOUT 20 minutes".)
EATME: Mine says 14 minutes.
CP: Glad I don't use your clock to open, then, huh? Perhaps you should sync your watch with my clock. This way you will always know when we are open and never be too early.
EATME: Smart Ass.
CP: Smart Ass who fills your prescriptions when we open at 9am. Which is now 16 minutes away. Provided I open on time. Sometimes people talk to me and keep me from getting my work done and I lose track of time. Glad you're here though so I won't forget.
EATME: I'll be back.
CP: In 15 minutes...give or take.
EATME: Can you take my prescriptions now?
CP: Are we open?
EATME: You're in there.
CP: And you're out there. What conversation would you be having right now were I not in here? Had I not decided to arrive early? What if I had been that pharmacist who believes in only working the exact 10 hours, 600 minutes since you're counting, and not a second more than scheduled?
EATME: Piss off.
CP: I don't get to do that in a 10 hour shift. See you in, hey! look! it's now 14 minutes.

Disney's 3:00 Parade Question

Little Old Lady: My doctor gave me these patches. Which side do I use?
CP: The sticky one.

Every business should work to discover what their "What time is the 3:00 Parade?" question is. From this, they should teach their employees to learn what the inquirer meant to ask instead of giving them the straightforward, "you're an idiot" answer. For the Disney example, the takeaway is that people are actually asking "What time will the parade pass by here?" or "When will it enter Frontierland?" since that is where they are heading next.

I thought of this as my intern dutifully told me about LOL's question and I was about to answer her call.
What was she trying to ask?
She obviously had never used transdermal patches before.
What did the patches look like?
Was she going to ask where to put them?
Was she concerned about side effects?
Did she read the package insert?
Why, when she was at the counter and offered counseling, did she not ask then and there so I could open the box and show her?
How do I answer this over the phone?

LOL: Which side do I use?
CP: Which side is sticky?
LOL: There isn't one. There is a silver side and a clear plastic side. There's also this tape cover thingy in case I think it won't stick. Do I tape it on with that?
CP: No. Since I can't look at one right now, let me ask you: Does the clear side look as if it peels off?
LOL: It does.
CP: Good. Lay the patch flat on the counter, slowly peel the backing from one corner to keep it from curling, then once it's removed, place it in the desired location on your body. Press the patch into place starting in the center then working out to the edges to make sure it is completely stuck in place. If you're worried about showers or swimming with the patch in place, you may use the cover. Always remember to remove the old patch before placing another patch anywhere on your body.
LOL: That makes more sense now. I read all the directions but they didn't say which side to use.
CP: That's why we are here. To help. Remember, there are no stupid questions, only stupid directions.

Cost

No one knows the value of a prescription medicine. If we want to improve healthcare, we need to revisit our approach to pricing.
Everyone knows how much a gallon of milk is worth. And a gallon of gas. The harder something is to produce, or the harder to find, the more expensive it becomes. Think lobster (outside of Maine), caviar, truffles, Kobe Beef, Lamborghinis, etc.
Thanks to insurances, no one can appreciate the true value of a prescription medication. Let's develop a chart and pricing scheme for illnesses. The more common your disease and the easier to treat, the cheaper your medication.
We could introduce tiers to each classification.
Infections: A. General, B. Complicated, C. Lethal
Heart Disease: A. Basic, B. Complicated, C: Imminent Death
Diabetes: A. Madonna (Borderline), B. Illegal Immigrant (Over the borderline)

I think we need to publish a list of costs...Acquisition Costs (AC).
American Healthcare (weigh in if your country is different) needs to use a better pricing scheme than Average Wholesaler Price (AWP) when looking at costs of medications.
Why do some companies consider Generic Zofran (Ondansetron) to be a specialty drug? Cost.
AWP is listed around $700.00 while AC (the cost the pharmacy paid for it) is closer to $4.00 for a bottle of 30 tablets.
Insurances require prior authorizations on this due to cost.
Make healthcare more affordable. Charge $20.00. That's $10.00 for the basic cost to fill a prescription with NO drug in it, plus the price you paid, plus a $6.00 dispensing fee.

Better to Give Than to Receive

...or so the saying goes. In the pharmacy world, this is often accurate.
Sometimes it is for insurance reasons.
Sometimes it's a relocation.
Sometimes it's because I'm an asshole.
Sometimes it's because the patient is an asshole.
Either way, the initial optimism and joy and thinking to yourself "boom! script growth, baby!" is quickly met with the harsh reality of the pain those scripts will cause you.

Just Another Cynical Pharmacist Openly Thrilled: This is the pharmacist. May I help you?
CP: CP calling for some transfers. You really busy?
JACPOT: Time is relative, my friend. Sounds like more than a few.
CP: I have 8 for you. All for one person.
JACPOT: Any chance you were given numbers?
CP: Any chance Sunderland win the EPL this season?
JACPOT: Right. Who we got?
CP: Last name Baggins. First name Douche.
JACPOT: What? Really?
CP: Um. Yes.
JACPOT: (loudly announcing to rest of staff, rather muffled) ...seriously! she's transferring. Yeah, no shit! Oh this is news most welcome. Hooray!
CP: So I take it...
JACPOT: ...Phew. Hey everyone. I'm buying tonight!
CP: Well she sounds like an old sailor, port to port. How long did it take you to get rid of her?
JACPOT: About 3 months of pure hell.
CP: Well once I have these 8 copies, you can start the clock on me.
JACPOT: Good luck! (and somewhere in the background, I could swear I heard Munchkins singing...ding dong the witch is dead.)

Anniversaries

Something about the celebratory nature of an anniversary that makes one reminisce about the good ole days. There are gifts to buy, cards to send, hugs and kisses to be shared by all.
Somehow, the annual expiration of one's prescription does not qualify for this sort of fete.

Why, then, do people complain we did not call them when their prescriptions expired?
Should we have an obituary section in the local paper, or perhaps on our website mourning the passing of these refills into the land of insignificance? Should they appear on the eve of their demise?
We already know people do not pay attention to...anything really.
Silence your cell phone alerts during movies? They're talking to YOU. Yes, you on the phone right now, oh never mind.
Medication Pickup Reminders? Patients complain they never got the 7 calls we made in the last week.
Refill Reminders? Patients complain they didn't listen to the message or they weren't out when we called the first 4 times.
Text alerts? Patients ignore them.
Email Reminders? Must have been lost in their spam folders.

It's not as if we don't put an expiration date on the bottle itself. You know, the bottle the patient has to physically touch each time they wish to take a dose of said medication. (oh wait, what? we do do that? never mind.)
Remember, you can give a person an education, you just can't make him take it.

It Matters Not

Cat, dog, beaver, monkey, rat, snake. It does not matter to me. I have filled prescriptions for these and many more animals. People love their pets. They are quite passionate about their non-human friends. This tends to make some of them a little more out of touch than one might expect, say, a normal parent to be. Bear with me.

I had this conversation multiple times my last weekend so it's not an isolated occurrence, as most of you will be able to attest. (...and I had another last night.)

Fiercely Enraged Learning It's Now Expensive: I am here to pick up the prescription for My Precious. 

CP: Peachy. That'll be $46.99

FELINE: (Incredulously) WHAT? IT'S FOR A CAT!
CP: And?
FELINE: It's for a cat!
CP: You keep saying that as if you think you are a JEDI. I am a retail pharmacist. Mind tricks don't work on me.
FELINE: (More indignantly now) But it's for a CAT!

CP: I don't care. 

FELINE: What do you mean? 

CP: Should it cost less because it's for a cat? You are at a human pharmacy picking up a human medication that will be used on a cat. Its use does not dictate its price. If that were the case, different indications for different medications would warrant a pricing flow chart. 

FELINE: So I have to pay the same? 

CP: If you were taking this medication and, like your unemployed cat had no insurance, I would charge you the same price to take it as well. The medication does not know who or what is taking it. I don't get charged less to purchase chicken wire because I'm using it to make little prisons for my mini-voodoo doll collection of pharmacy CEOs instead of making chicken coops.

Deal(er) With It

I wonder if people treat their Street Dealers with the same courtesies as they do their professional, legal dealers.

1. Did you make this batch of Meth in an old Mt. Dew bottle? I can't take the batches made in Coke or RC bottles.
2. What brand of baby powder did you use to cut my coke? It better not be that store-brand stuff. I want the real Johnson's.
3. My marijuana buds had little hairs on them last time. Can I get the ones without the little hairs? They creep me out. I think I'm smoking little furry spiders.
4. My crack rocks are different sizes this time. Are you sure you gave me crack and not crystal meth?
5. Can I get the Ecstasy with the pictures of leprechauns on them? The ones with Hello Kitty made me too thirsty.
6. Is this one of those bad batches of heroin that's going around? I had that the last time and it damn near killed. It must be generic. I think I'm allergic to it.
7. Where were these drugs made? I don't want any from Colombia. I heard they use drug mules and my last batch tasted like shit. I only want drugs that are made in America!
SD: Technically, they are Made in America. Colombia is in America, albeit SOUTH America. If you want to show 'Murican Pride, perhaps you should insist on "Made in the USA".

It's Revolutionary!

The punchline to today's joke is: ...and that's how you get a dermatologist turned on.

I was watching the telly, minding my own, when suddenly I saw balloons. 

I like balloons. But not these. 

These were no ordinary red spheres of helium. 

No. They were metaphorical orbs of latex. 

I watched with interest trying to determine into which new prescription drug advert I may have inadvertently stumbled. 

Would it be something life-altering? A real game-changer? Something revolutionary? Something to better the human race? 

Hopes quickly faded as the balloons in my mind burst like the teenager's acne they were representing onscreen. 

#Onexton was the medication; another "me-too" in the arsenal of dermatologists' acne treatments. Their cache already includes Benzaclin, Duac, and Acanya so why not one more? 

I'll tell you. Brand Names and Patents. 

Want to woo the local dermatologist? Make an appointment as a drug rep. Walk into her office with flashy discount cards and while she's listening to your sales pitch, sidle up behind her, put your lips next to her ear so they brush ever so delicately against her skin and whisper: "Brand. Name. Only." and "Discount Card".

...and that's how you get a dermatologist turned on.

Don't Leave a Message After the Beep

The whole reason for the existence of an answering machine is to accept phone calls and gather messages when you can't be there to answer them in person. The whole point of voicemail is the same. It's like mail, only a verbal version, like audio books. If the reason for their being is to provide you with a message, should you not heed it? Should you not at least listen to it?

Calling a pharmacy after receiving a voicemail without actually listening to the voicemail, is the same as calling the person who sent you an email, without having actually read the email, and asking, "What's up? I see you emailed me. What did you need?".

Apparently, the only way to get through to people, is to leave them multiple messages.
"Hi. This is CP's Pharmacy calling. Listen to the next message we are going to leave."
"Hi. Here's the message. Don't come down here! We don't have your medication in stock. Come tomorrow!"
"Hi. CP again. Make sure you listen to the other messages. Very important."
"Hi. Don't call us. Don't come down here. Wait until tomorrow. Don't waste our time."
"Hi. We've left you 5 messages now. I'd better not see you until tomorrow, or else."

Maybe we could treat them as they treat us. When patients call in, or stop by in person, we can just ignore everything they say. Maybe pretend to have an absence seizure and blink off into space before saying: "Sorry. I was too busy doing other things. I didn't listen to a single word you just said. Why are you here? Why are you calling me?"

Better yet...
CP: Hey, I see we have 36 refills in our queue this morning. They all came after we closed. Let's call each person and ask what they need refilled, when they need it, and what else they may have wanted.
UberTech: I like it. Ooh. Let's role play. You be the patient.
CP: Hello?
UT: Yes, Is this Mr. Gozinya?
CP: Call me Peter.
UT: Okay, Peter. I see you called in a refill last night.
CP: Uh-huh.
UT: Okay. What did you need refilled?
CP: I left it on the computer. I typed it on the phone.
UT: Oh. I saw your name on our list but didn't actually look at the drug or prescription number. Can you give it to me again?
CP: No. I threw away the old bottle as soon as I called it to you.
UT: I see. I see. Would your wife know what it was? Maybe one of your kids there? Or one of the dogs I hear in the background? Ooh! The parrot I hear squawking?
CP: No. Isn't that the point of me leaving it on your computer? So I don't have to worry about it anymore?
UT: You would think so, but never underestimate the power of laziness and stupidity to lower the bar on themselves.

The Struggle is Real

These conversations must happen everywhere. They just must. Otherwise, crying and drinking and rocking myself to sleep is not consolation enough...

CP: How may I help you?
Thorn In My Side: I am calling to check on my profile.
CP: Ok. What, may I ask, is your specific inquiry?
TIMS: There was this TV show on the other night and I want to know what it was.
CP: Did you watch it?
TIMS: Yes.
CP: What was it?
TIMS: I don't know.
CP: Was it last night?
TIMS: No. It was a few weeks ago.
CP: Ok. What channel?
TIMS: Not sure.
CP: So you want me to tell you what show you watched and you can't remember anything about it?
TIMS: Yes. I need to continue the series since my friend said I need to keep watching it and you need to tell me what it was and how I can find it.
CP: Can't you call your friend?
TIMS: No! You're the cable company. That's your job!

Just Put It In Your Mouth

When people tell me they don't know what medications they take or why they take them, I imagine the following scenario. It has to be true. I can think of no other logical answer...

CP: Here. Drink this. 

Random Obedient One From Earth: What is it?

CP: Some cocktail I just made for you. 

ROOF-E: Ok. 

CP: Now, eat this. 

ROOF-E: What's in it? 

CP: Does it matter? 

ROOF-E: Not really. Thanks. 

CP: Okay. Take these. 

ROOF-E: What are they? 

CP: Prescription medications. 

ROOF-E: Do I need them? 

CP: Trust me. I'm your doctor. 

ROOF-E: Okay. Sounds legit. 

More Pizza Analogies

This has to happen. It's the only thing that allows the sleep to come and the nightmares to dissolve...

Pie Guy: Welcome to Wicked Slice. Are you picking up or placing an order?
CP: I am picking up.
PG: The name under which your pie may be found?
CP: CP.
PG: I am sorry but I see no order under that name.
CP: I didn't order it yet. It's not delivery. I am picking it up once it's ready.

For those times when you just can't convince patients that their prescription is so expensive, cutting down the quantity does not change their minimum copay at all. (This is, of course, talking only about a set copay for a 1-month supply. It is obviously less to go from 90 days down to 30 days. For this example, let us assume for 10 tabs of Crestor, it will still cost the same as 30 tabs. Capiche?)

PG: How many slices would you like today?
CP: I got a medium, right?
PG: Yep. I can cut it into 6 or 8 for you.
CP: I don't think I can eat 8 and I don't want to pay extra, so just make it 6 slices.
PG: It's still the same price for a medium, regardless of the number of slices.
CP: That's okay. I'm not that hungry and my family may change their minds when I bring it home. Can I bring back the rest if you cut it into 8?
PG: No. No you may not.

Just fill everything...

PG: How may I help you?
CP: I'd like one pizza with everything on it.
PG: Everything?
CP: Yes, everything! What are you deaf?

Option #1:
CP: WTF is this? I didn't want anchovies or black olives!
PG: But you said "everything".
CP: You should know I'm allergic to mushrooms. It's on your file.

Option #2:
CP: WTF is this?
PG: You said everything.
CP: Can you take the bacon off? And the green peppers?
PG: No. You said everything. You can take them off when you get home.

Option #3:
PG: Which items do you want?
CP: All of them!
PG: I am sorry, but we do not put "all of them" on unless we go through them each individually.
CP: What?! I've been buying pie from you since before you opened! Just fill everything.
PG: That's not how we do it here. Do you want Ham?
CP: Yes.
PG: Banana Peppers?
CP: Hell no! That's too hot for me.
PG: Okay. Pineapple?
CP: What? I don't want no damn fruit on my pizza.
PG: Mushrooms? Sausage?...

They Came for Their Flu Shots

...sounds like a horror movie.
Coming this fall. From the producers of Zostavax Zombies and the writers of MTM Mayhem, comes this twisted tale of Phear in the Pharmacy.
Just when you thought it was safe to relax and enjoy your summer in the pharmacy, the idyllic atmosphere is slowly chipped away with news that flu shot season is coming. First, the emails about ordering supplies, followed with reminders about cold calling for clinics. This will lead to the new quotas...ahem (goals for the season) being established and the collective gasp of a retail industry will be heard from all corners as we choke on the new, unrealistic, unattainable "targets".

The countdown has started. Today is when the new "They Came For Their Flu Shots" trailer will be posted and the countdown begins. Only ~21 days to go until the new season arrives.
Tickets on sale now. Book online or through our new Pharmacy App.
Free Alcohol Wipe and Bandage offered to the first 100 registrants.

It's Your Phault

Did you ever notice that people are only compliant the day after they run out of medication?
Did you ever notice that their sudden perfection, this angelic quality, is destined to be destroyed by you, the big Devil?

Let's take a look at a recent example.
First, some quick math.
Patient takes 2 tablets every day (according to the directions).
Prescription filled on 4/7 for 60 tablets for 30 days.
Prescription REfilled on 5/22 for 60 tablets for 30 days.
Today is 7/8 and the patient is...obviously out of medication.

The conversation:
Snow White: I need my medication today.
CP: Okay. It appears to have expired and there are no more refills.
SW: You were out of stock. You were supposed to order it.
CP: We did. It did not arrive today. Manufacturer supply issue. I found another manufacturer so we reordered it for tomorrow.
SW: I'm going to go into AFib over this. I have to have it!
CP: Okay. We will have it tomorrow. You still need a new prescription.
SW: I'll miss tonight and now tomorrow morning. You're putting me at risk!
CP: Are you still taking one tablet two times a day?
SW: Of course!
CP: Are you Jesus?
SW: Excuse me?
CP: Is your name Anne Sullivan?
SW: NO! What is your problem?
CP: Just curious as to which Miracle Worker is remonstrating with me today.
SW: What?
CP: Well, Jesus turned water into wine and Anne...
SW: I just need my medication today!
CP: Then call your doctor and get a new prescription. I shall have the tablets tomorrow morning. You received a total of 60 days of medication from 4/7. Somehow, assuming you took your first doses on that day, you made 60 days' worth of medication last you 93 days, yet you complain to me that you will only miss tonight's dose and that will throw you into AFib.

Maybe it has something to do with Netflix and binge watching TV series. You start GOT or TWD and complete them in a few days or weeks and suddenly you can proclaim yourself a series-long phan and expert.

Pizza! Pizza!

Pharmacies have done a great job of copying other retail establishments in an effort to become more customer friendly. I am surprised this has not worked in reverse. Imagine all the things businesses could learn from the pharmacy world. Today I'd like to focus on one of those: Automatic Refills.
Why don't pizza joints offer this service? Customers could sign up for a daily, weekly, or monthly pie.  During football season you'd get your pizza delivered every Sunday at 1pm. Imagine all possibilities with this service. The Pizza Parlour calls you and tells you when you need to eat. They phill your phood order phast and have it delivered before you realise you are even hungry.

Problems with this service:
1. Customers would call asking why they had been out of pizza for 5 days and were starving. They'd been standing at the door withering away and no pizza had arrived.
2. They would complain that they changed their order from half-pepperoni, half-mushroom, and extra cheese to bacon and green olives because they just found out mushrooms are a fungus, yet the pizza keeps getting delivered as originally ordered.
3. They would complain that they needed more pizza during their Netflix and LOTR marathons and the computer should just know to send more.
4. They'd be upset that their team plays Monday Night Football this week and their pizza arrived early on Sunday.
5. They keep getting text alerts that their pizza order is due, but they don't read them and end up calling the wrong pizza place because they get pizzas from multiple places on different days.
6. You forgot to discontinue the service now that you're on a diet or gave up pizza for Lent, yet they still call you and try to deliver pizza to your door. Stop. Calling. Me!

If customers are not signed up for delivery, pizza places would have a stockpile of hot pizzas and wasted ingredients that they cannot return to stock. They'd waste so much time cooking the pizzas and making phone calls to come pick up the orders and then throwing away the pizzas for these automatic refills that they'd be so far behind on walk-in and phone-in orders which would lead to longer wait times. They'd have to cut employee hours and staffing and drop delivery service as a result. Wait, what? That doesn't make sense...Oh, maybe that's why other places haven't adopted pharmacy practices. Think I'll just go back to my marathon of OITNB.

Check Please

Why do people call the pharmacy to complain about a missing prescription before searching for it? I suppose it's the equivalent of "where are my sunglasses?" (on your head) or "where is my cellphone?" (you're talking on it).

CP: How many I help you?
Grumpy Foreskin: I got home and one of my prescriptions was missing.
CP: Ok. What do you mean it was missing?
GF: I am holding an empty bottle. What are you going to do about it?
CP: Well sir, it was in the bag when it left here. I checked our on hand quantities and we are spot on with our inventory.
GF: This is outrageous!

(cue dogs barking and a wife nattering on in the background for atmosphere...muffled sounds of struggle...)

Grumpy Foreskin's Wife: This is ridiculous! You keep doing this to him! I am an RN and I want to talk to someone who can fix this NOW!

(puts call on long, interminable, #PunishmentHold)

CP: As I tried to explain to your husband, our on hand quantities are correct. Perhaps you could check around the house. I noticed you picked up this prescription 3 weeks ago, not a few hours ago, as you made me believe.
GFW: FINE!

(two hours later)
CP: How may I help you?
GFW: I found them.
CP: No shit? Ok. I need to know. Where were they?
GFW: In the glove box of his car.
CP: Thanks for wasting my time and being such an understanding, patient person. You bring nothing but warmth and tenderness to your profession. You are an exemplary RN and I am happy to call you a professional colleague.

The Best

A most common request from patients is the recommendation of an OTC product. Included with that request is the plea for "The BEST" product to treat what ails them.
Why?
Why does everyone want the best?
Just because something is the best does not guarantee it is the most effective choice for you.

If you have opportunity, I'd encourage you to engage in the following witty repartee.

Advice Seeker: I need a recommendation for sunburn.
CP: Avoidance.
AS: What?
CP: I recommend avoidance. If you do not get a sunburn, you will not have to treat one.
AS: What's the best thing I can get?
CP: Sunscreen. And a hat. And a long sleeve shirt. Pants. These will all help. So will staying indoors.
AS: No. What's the best thing once I get a sunburn?
CP: Obviously it's too late by then.
AS: How do I treat it?
CP: Carefully. You really want the best thing?
AS: Yes.
CP: I don't think you can handle the best thing. You've already proven that. I can start you with the third-best, or maybe the second-best, but let's not be hasty and jump right up to #1.
AS: I can handle it. I just need to get rid of this sunburn.
CP: MIASMA.
AS: Huh?
CP: Motrin, Ice, Aloe, Solarcaine, Menthol, Avoidance.
AS: Sounds complicated.
CP: You asked for "THE BEST", not "The easiest and least complicated".

Social Media and the Pharmacy

The big fear in movies is the weaponization of something that was developed to be helpful to humankind. Social Media and Pharmacy are no different. Corporate Pharmacy wants to embrace the technology for its customers to spend more time thinking about them. They develop apps to place prescription orders, to refill prescriptions, to remember to refill prescriptions, to shop online, to receive text and twitter alerts when prescriptions are filled, etc.

However, not one of these companies likes to be viewed negatively on any social media. Customer logs a complaint on twitter or Facebook? Company can research it and call the store to have them apologize to the customer.

But...should an employee air any negativity regarding her employer, employee risks termination of employment.

One thing I already knew before starting this page has been confirmed and fully reinforced every single day since: All retail pharmacy corporations are the same. They are all equal opportunity offenders. I used to tell people pharmacy was the same wherever you went. To this day, everyone can relate to these posts because their pharmacy is just like all of mine have been. If everyone on this page thinks I work for her company, then what does that tell you?

Someone on my FB page apparently got made at me after trading barbs with a few followers and posted this note for me: "You do realize that your entire page is against policy and you could be fired for breaching company policy."

I asked which company but did not receive an answer...

I ask you the following questions:
1. Does your company have a specific, defined social media policy in place?
2. Can an employee be fired for a policy violaion if the company has absolutely no written, formal policy in place?

If you have a copy of your company's Social Media Policy, please message it to me. I'm curious to know which employers have them and how extensive they are.