Pharmacy Training

It is important to train your patients. Train them to check in at drop off whenever they are bringing in new prescriptions, new insurance, or are inquiring about the status of their prescriptions. Many patients will learn the rules and expectations; others, not so much. Thrice in the past week I had the following conversation:

CP: Sorry we are out of your medication. This is a special order item. It costs $5000 for this bottle. This strength has been on backorder off and on for a few months now. 

But I'm Out Now I Could Die: But I'm out now. I could die. 

CP: You won't die. 

BIONIC-D: This happens every month. 

CP: It does. For the last 4 months, at least. 

BIONIC-D: "Can I call in 3 days early?"

CP: Yes. Yes! That's the point. We've been trying to tell you that for nigh on a year. If you call in before your bottle is empty, it gives us time to locate the medication. We can call other stores, distribution centers, competitors, etc to find this. Waiting until the bottle is empty and yelling at us when we've told you to call early is like waiting until you car runs out of gas, pushing it to the station and yelling at the attendant there that you don't want to push it in again so you're going to listen to the chime alerting you you're almost out of fuel. 

BIONIC-D: Okay. I just don't want to die without my medication. 

CP: Funny how you only think of that when you're actually OUT of medication. You could learn something from all the Apocalyptic Storm Stockpilers (ASS's) out there. Whenever the media whisper potential for a severe weather event such as snowstorms, locusts, or a Cane Toad invasion, people run to the pharmacy and grocery to stock up on essentials. You'd think that without an extra loaf of bread, gallon of milk, and case of bottled water these people would be found in their houses, emaciated and on death's door after the roads reopen in 12 hours. 

The Ruination of Pharmacy

People have become accustomed to getting what they want. Manufacturers bombard the public with drug ads and Pharmacies compete with each other by selling free antibiotics and promoting $4 medications. This conversation exemplifies all that is wrong with retail pharmacy today. 

CP: Thank you for calling "Whores R Us" Pharmacy. How may I help you? 

Mother of the Year: I was calling about a prescription antibiotic for my son. 

CP: We received one yesterday. It is ready. 

MOTY: Is it free? 

CP: No. We do not have a free list. Nor do we have a $4 list. 

MOTY: The doctor was supposed to call this morning to change it to something on the free list. 

CP: Who's free list? As we do not have such a list, he cannot call in a prescription from it. 

MOTY: I just want what's free. 

CP: Fine. Pretending for a moment that we have a free list, the only thing on it is Amoxicillin. 

MOTY: But he's deathly allergic to Amoxicillin. Can you call the doctor and tell them what else you have on the list and get them to prescribe that? 

CP: I could. But I won't. 

MOTY: Why not? 

CP: Professionally, it's a bad idea. 

MOTY: How about tablets that are free so I can crush them?

CP: Again. No. 

MOTY: Don't you care about your patients? 

CP: I do. That is why I am not calling. Let me explain. The infection your son has will not respond to treatment with any company's free antibiotics, except Amoxicillin. Since he is deathly allergic to this, it would not be in his interest to take that. By giving an antibiotic that won't help him he risks many things. He may begin to feel better but the infection will not go away (it kills the really weak bacteria but the strong survive). He will remain miserable for the next week to 10 days at which time you will have to take him back to the doctor to get the original antibiotic he should have been prescribed today. As a parent, would you not want your child to feel better sooner rather than later and know that you as the responsible adult did what you were supposed to do for him? Or would you rather he suffer needlessly for the couple weeks because you were too cheap to buy him the right medication at the time he needed it? Just because it's free doesn't mean it's appropriate. 

MOTY: I'm going to call the office and have them call you. 

CP: Go for it. 

<later that day>

MOTY: Picking up my son's antibiotic. 

CP: We have it. Let me mix it. 

MOTY: Did they change it? 

CP: No. They agreed with me. They'd rather prescribe something that is going to work. If you want something for free that is not going to work, we agreed to suggest just doing nothing. 

MOTY: Oh. Ok. 

You Know Your Friend is a Prescriber When...

Drunk texts are a bad idea. E-scripts often read like drunk texts.
The only idea worse than this is texting people by First Name as they are listed in your phone.
I have received a number of texts not intended for me. Sometimes I get a follow up text saying: "Sorry, wrong Chris".
Sometimes I play along and act as if I am their intended to see how long it takes them to discover their error.

Prescribers' friends must receive a lot of these miscommunications if they text the way they send electronic prescriptions. How many times have we received e-scripts for a medication that we knew was wrong? When we researched it a little, just to be sure, we noticed it was the first product listed on an EMR dropdown menu. Just for phun, we call the office anyway and ask what the prescriber was thinking. This is usually how the conversation transpires.
CP: Hi.
Prescriber's Office Of Fat Fingers: Hi.
CP: How are you?
POOFF: I am well. How are you?
CP: Baffled and Confused.
POOFF: Why ever so?
CP: It's this e-script Dr. Zoffis sent me.
POOFF: <reads it to me> Okay. What seems to be so baffling?
CP: First, the fact that you think I can't read. Second, that Dr. Zoffis selected Lovastatin ER from the menu.
POOFF: That's what the patient always gets.
CP: Keep reading the patient profile.
POOFF: Uh-huh. It says Lovastatin 40mg right here.
CP: Okay. Now scroll all the way across the e-script the good doctor sent to me today.
POOFF: <mumble mumble> ...40mg ER.
CP: Ja. ER. Does Der Doctor require Die ER?
POOFF: Nein.
CP: I did not think so. Is he seeing other patients?
POOFF: Yes.
CP: Do any of them take Lovastatin 40mg ER?
POOFF: No.
CP: I wonder how many of them have received the same drunk text. Next time I'm just going to play along if for no other reason than to see how far I can take it. "Ja. I am Inge from Sweden."

No Cure For Dependency

These are days to remember. 

Remember when math was done with an abacus? Then a calculator? 

Remember all the other times we were taught to use paper and pencil and show our work? 

Remember calendars and the little song "30 days hath September, April, June, and November"? 

With technology today, you can forget everything. Period. Everything can be forgotten because there's an app or a website or something to help you. Yes. This happened. 

CP: Thank you for calling. This is The Cynical P-Harmacist. How may I help you?

HIM: My name is Hard Is Math. I am a Nurse Practitioner and I received a message to call you back. 

CP: Yes. Thank you for returning my call. 

HIM: In school, they told us that if a pharmacist calls, something is wrong and we need to fix it. 

CP: Wisdom for all. Here is the problem. You wrote 3 prescriptions for Ritalin for a patient at his last visit. 

HIM: Correct. They come every 3 months and I know I am allowed to do that. Go on. 

CP: You wrote: "Fill 30 days after first Rx was filled" on the second one. 

HIM: Right. 

CP: Unfortunately, the DEA is quite clear that you have to specify "the earliest DATE" upon which that prescription may be filled. Else wise, there is naught to prevent someone from taking all 3 prescriptions to multiple pharmacies to be filled on the same day. No one will know when the first was filled. 

HIM: I see. You are quite correct. You have shown me the error of my ways and I shall amend them. 

CP: Lovely. I am happy to have helped. 

HIM: I have another question. 

CP: Go on. 

HIM: What website do you use for the calculations? (actual quote)

CP: My brain. I take the current day and add 30. It's quite easy as I've practiced using a calendar and math my whole life. 

HIM: Isn't there an easier way? 

CP: No. I do these date checks dozens of times a day. It's almost as easy as breathing to me. You wrote the prescription on December 22nd. Since December has 31 days, you simply subtract 1 from the same day next month giving you January 21st. Simple. Even simpler is writing the prescription in a month with only 30 days. Here's a secret, the date is the same. April 20th becomes May 20th. 

HIM: "Is there a website you use to calculate dates?" (true quote)

CP: No. As I mentioned earlier, I do them in my head. If this does not work for you, simply looking at a calendar would be quite efficient as well. 

HIM: "Is there an app or something I can use? (true follow up quote)

CP: No. This has probably got to be the easiest calculation I perform all day. The only thing harder is 28 day supplies. It adds an extra step of subtraction. 

HIM: Okay. "Well I know those websites and apps exist so I'll find one on my own." (again, true)

CP: You go right ahead. I'd rather the math be right. However, it will most likely take you a whole lot longer to stop what you're doing, open the website, enter the date and days, wait for the answer, and write it down than it will to just follow my helpful guidelines. 

HIM: Thanks. 

<CP recounting story to Uber-Tech>

 UT: She said that? 

CP: Verbatim. 

UT: I bet she takes online pregnancy tests too. 

It's Not Me...It's You

CP: Thank you for calling CP's Pharmacy.
Some Mom: Am I down with CPP?
CP: Yeah you know me. How may I help?
SM: I called Other People's Pharmacy.
CP: OPP?
SM: OPP!
CP: And?
SM: And I remember filling a prescription with you for my daughter last year for dreamwine then transferring it to OPP.
CP: And then?
SM: Well they can't find it.
CP: Did they ever fill it?
SM: I don't think so. Anyway, they can't find it. Can you call them?
CP: Why? I checked the record. We transferred that back in September. We spoke with the intern Arya and the pharmacist was Jaqen H'ghar.
SM: Well they don't have it.
CP: How is my calling going to help? I cannot look in their computer for them.
SM: It is for Daenerys Targaryen.
CP: I know that. I found her in my system.
SM: Wait. I have the bottle from OPP. Do you think that would help?
CP: Wait. What?
SM: I have the bottle.
CP: You have the bottle? You mean this entire conversation could have been avoided? You mean all you had to do was call OPP and give them the prescription number? What, pray tell, is the name on the bottle?
SM: Oh. They put her first name as "Dany".
CP: Bring me the bottle.
SM: Why?
CP: No reason. I want you to meet my intern, Vargo Hoat.

Overreacting

We are so accustomed to throwing around terms of which we no longer understand the definition. Today's example is the use of the term: "ER". Back in the good ole days, this was an abbreviation for the words "Emergency Room".
Emergency is defined as: A serious, unexpected, and often dangerous situation often requiring immediate action: a medical condition requiring immediate treatment.
Problems fitting this description were taken to a special area of the hospital known conveniently as the "Emergency Room". Pretty self-explanatory, right?

Woefully Overwrought Woman: I need to find this product now!
CP: What seems to be the problem?
WOW: My son has this infection and the doctor told me I could buy it over the counter. They wouldn't even give me a prescription for it.
CP: Okay. Let me come out to show you what you need.
WOW: They said to get some type of cream, but did not tell me which one.
CP: Fine. What are we treating?
WOW: Ringworm.
CP: Uh-huh. Well I like Lamisil because the treatment period is shorter and the box is pretty shades of blue. How old is your son?
WOW: He's in his twenties.
CP: Got it. Well this is safe for a boy of his age. You may bring this to my register if you desire.
WOW: No. He needs it right now. Looks like we wasted an ER trip last night for nothing.
CP: You took him to the ER for this?
WOW: Yes! He said it really bothered him.
CP: When did this sudden, emergency infection afflict him?
WOW: He said he's had it for about 3 months now.
CP: I see. I see. Definitely a good thing to take him to the ER last night. I'm sure he couldn't have waited another 6 hours to be seen in his doctor's office. I really hope no real emergencies came through the EMERGENCY ROOM while he was occupying a bed with his horrible case of ringworm.
WOW: Well I never!
CP: Oh but you should have. A long time ago.

This...

This is why...
I had counseled a woman a few weeks back on how to taper/adjust her new medication to avoid side effects and find the lowest effective dose for her. She returned over the weekend to ask a few more questions and tell me she was feeling better.
Awesome Lady: Thank you so much for helping me. I have a few more questions.
CP: Wonderful. Here are your answers.
AL: Thanks again. I really appreciate your help.
CP: You are welcome. It's what I do.
<she walks away>

AL: Wait.
<does a 180 and returns>
CP: Yes?
AL: I almost forgot.
CP: You did. But you remembered.
AL: I had an appointment with my doctor and told him everything you told me to do.
CP: <GULP> Really?
AL: Yes! He said that was the best thing I could have done. He said your advice was perfect and I should follow it all the time. He was really impressed with your advice and said I was lucky to have you as my pharmacist.
CP: Well, thank you. That is high praise indeed.
AL: I always knew to trust you more than my doctors, but it was nice to hear him praise you as well. Just thought you'd like to know.
CP: Again, thank you. That made my day.

OPP

Why is it going to take so long?
OPP!
What?
OPP!
What?

OPP how can I explain this
Listen hard so you don't miss
To understand the day of your pharmacist
O is for Other, P is for People now that's simple,
The last P, well, here's an example
It's a paper that your doctor gives that tells me what to fill
I use it then to label bottles of pills
You bring it to the pharmacy if it's written out for you at leavin'
It seems I gotta start to explainin'
Trust it
You ever get all sick and know you need a medicine
You see your doc and get a slip and now you think that you're all in
You head down to the drug store knowing that it just can't wait
Then you see a line and now it looks like you'll be running late
S to the C to the R to the I to the P to the T
The rest of town is sick now too (oh no what a pity)
It's OPP,  time to grab a chair and sit in it
Won't help you by complaining none so come back to get it

You down with OPP?
Yeah you know me!
You down with OPP?
Yeah you know me.
Who's down with OPP?
All the pharmies!