I'm Revoking Your Privileges

Computers are supposed to make everything easier. 

E-scripts are supposed to make everything easier...and error-free. 

What both of these statements forget is that humans are required to make use of them. 

Humans are the X factor. 

Humans (read: prescribers) tend to make things more difficult. 

Other humans (read: pharmacists) are, fortunately, there to clean up the mess and make sense of it. 

Prescription received electronically by the pharmacy: "Entercourts 9mg"

Okay. First read, it's obviously Entocort. 

But...Entocort is only available as 3mg. 

Hmm. Second glance, maybe it's Intercourse? You know, just a little dose. 

Perhaps a permission slip for a lawyer?

Of course it's the weekend. 

Of course the prescriber must be paged. 

Of course he calls right back. 

CP: Hiya. 

Adopter of New Technology Means Admission of Nothing: Howdy. What seems to be the trouble? 

CP: This new-fangled technology seems to have taken what you entered, shredded it, reassembled it, then shot it onto my computer like a study hall spitball to the chalkboard. 

ANTMAN: What was it? 

CP: It came across as "EnterCourts". 

ANTMAN: That's what I typed. 

CP: Oh. Then you're the spitwad. 

ANTMAN: "I didn't really know how to spell it. I was going off of someone else's notes." 

CP: I see. "How did the computer allow you to type something that doesn't exist?" Better yet, "why are you prescribing something you don't know how to prescribe?" 

ANTMAN: Well I knew what I wanted and assumed it was close and you'd figure it out for me. 

CP: I appreciate your (totally warranted) faith in me but I still had to waste my time tracking you down...on a weekend. How about next time you just use the phone? Last I checked, prescribers' phones allowed outgoing calls. There's also this, albeit primitive, invention called pen-and-paper. It wouldn't help the issue here, but at least you could write "Budesonide 9mg or WTF" and I'd understand you want Uceris. 

Overstepping Their Bounds

I know how to do my job.
You know how to do your job.
I won't tell you how to do yours if you won't tell me how to do mine.
Better yet, I won't tell other people what your job is if you won't tell other people what my job is.
Agreed?

Same Shit Every Weekend: I am out of my medication and I really need it.
CP: Ok.
SSEW: What should I do?
CP: Call the office.
SSDW: I did.
CP: Good job. What happened?
SSDW: The answering service said you'd give me 2 or 3 to get me through the weekend.
CP: Really? She said that huh? Okay. Call her back and tell her she will page the prescriber. Tell her it's okay, the pharmacist told you she would do it for you. It doesn't matter that this office has a "no refills, never page the prescriber" policy on weekends.
SSDW: Okay.
CP: In the meantime, I'll fax him for you. For some reason, it seems the prescribers at this office like to sit around and watch football and send e-scripts. You'd be surprised how many we receive on weekends.

<20 minutes later>
CP: I got your prescription.
SSDW: I know. I got another person at the answering service and she put me through.
CP: I just love problems that resolve themselves.

Overstepping Their Bounds

I know how to do my job.
You know how to do your job.
I won't tell you how to do yours if you won't tell me how to do mine.
Better yet, I won't tell other people what your job is if you won't tell other people what my job is.
Agreed?

Same Shit Every Weekend: I am out of my medication and I really need it.
CP: Ok.
SSEW: What should I do?
CP: Call the office.
SSDW: I did.
CP: Good job. What happened?
SSDW: The answering service said you'd give me 2 or 3 to get me through the weekend.
CP: Really? She said that huh? Okay. Call her back and tell her she will page the prescriber. Tell her it's okay, the pharmacist told you she would do it for you. It doesn't matter that this office has a "no refills, never page the prescriber" policy on weekends.
SSDW: Okay.
CP: In the meantime, I'll fax him for you. For some reason, it seems the prescribers at this office like to sit around and watch football and send e-scripts. You'd be surprised how many we receive on weekends.

<20 minutes later>
CP: I got your prescription.
SSDW: I know. I got another person at the answering service and she put me through.
CP: I just love problems that resolve themselves.

Ask the Question You Want Answered

My sixth grade teacher impressed upon me the correct way to ask a question. It was a habit of 12 year olds to ask "Can I go to the bathroom?" and he would properly respond with "I don't know. Can you?" We, of course, would reply "May we?" and he would say "I love French".

Anyway, it helped develop my way of looking at things and the importance of word choice. My other favourite question is: "Do you know what time it is?" The correct answer to this is either "yes" or "no". The person did not actually ask for the time.

This brings me to my favourite counseling question:

"Can I drink on this medication?"
Of course you can drink on it. You'd die in about 3 days without water. Don't be silly.

"Can I drink alcohol while taking this medication?"
Better, but not perfect. Certainly you CAN drink alcohol while taking this. I'm assuming you're able to drink water and other beverages so alcohol, in its fluidity, should easily be drinkable for you.

"Should I drink while taking this medication?"
Yes. This can dehydrate you so it is important to replenish your fluids.

Ugh! "Might it be permissible to imbibe while taking this medication?"
Hell no! What are you, crazy?

Ask the Question You Want Answered

My sixth grade teacher impressed upon me the correct way to ask a question. It was a habit of 12 year olds to ask "Can I go to the bathroom?" and he would properly respond with "I don't know. Can you?" We, of course, would reply "May we?" and he would say "I love French".

Anyway, it helped develop my way of looking at things and the importance of word choice. My other favourite question is: "Do you know what time it is?" The correct answer to this is either "yes" or "no". The person did not actually ask for the time.

This brings me to my favourite counseling question:

"Can I drink on this medication?"
Of course you can drink on it. You'd die in about 3 days without water. Don't be silly.

"Can I drink alcohol while taking this medication?"
Better, but not perfect. Certainly you CAN drink alcohol while taking this. I'm assuming you're able to drink water and other beverages so alcohol, in its fluidity, should easily be drinkable for you.

"Should I drink while taking this medication?"
Yes. This can dehydrate you so it is important to replenish your fluids.

Ugh! "Might it be permissible to imbibe while taking this medication?"
Hell no! What are you, crazy?

I Have A Syncing Feeling

Did you ever have the feeling some people prefer to argue or complain simply for the satisfaction they get from being miserable? They're not looking for a resolution, rather they seek to make others share their misery.

CP: Welcome, to Jurassic Park.
Frequently Unsatisfied Customer: Jurassic Park?
CP: Trying out new names for the pharmacy. We're not getting any younger.
FUC: You're weird.
CP: So I've been told. How may I help you today?
FUC: I have a few prescriptions to pick up.
CP: Just for you?
FUC: Yes.
CP: Today I have three of them ready.
FUC: "Yeah. I take a few other ones. I really wish there was some way I could get them all on the same trip. I really hate having to make multiple visits here during the month."
CP: It sure is inconvenient. It's not as if you're here every other day shopping for other items throughout the store. Must just be the pharmacy where the stars don't align. I wish everything in my fridge and cabinets would run out at the same time too but, I digress. You were whining?
FUC: I take a whole bunch of medication and want to get them all in one trip.
CP: Got it. Well today is your lucky day, señor FUC. We happen to have this remarkable program that does the thinking for you. It takes all your prescriptions and sets them to fill on the same day each month. It will even adjust the fills for the next month so they will all be due together. It's truly amazing. It takes the thinking right out of it, something that seems right up your alley. "Should I go ahead and sign you up for this syncing program?"
FUC: "Nah. Not today. But thanks."
CP: Of course not. Well, I look forward to having this conversation again next week. Provided I'm still here. Since I now won't make my goal of enrollments.

(Yes, this was inspired by a true conversation.)

You Are Allowed

How about just saying what you really mean? "I am an asshole." Period. It is simpler that way and patients understand.
Wait. Allow me to back up a moment.

Twice this week, we faxed Dr. Zoffis prior authorization requests.
Twice this week, Dr. Zoffis replied with a fax that said: "patient is allowed to purchase this medication without insurance".
Well no shit, Dr. Obvious. The point of the prior authorization fax is to let you know the insurance won't cover the medication you prescribed, not to ask your permission for the patient to pay hundreds of dollars for it. They really don't need your approval to do that.

Here is the brief debate that ensued at my pharmacy:
CP: I don't like prescribers that do this. If you don't want to do prior authorizations, simply say that. but PLEASE make sure that your patients know you will not help them.
CPP: I don't have a problem with it. I see this as patients today walking in to the office and requesting to be placed on the medication they want.
CP: Okay. I will grant you that. Remember last week with the prescriber who refused to do the prior auth for a medication they prescribed after they had been giving samples to the patient?
CPP: Yes.
CP: The prescriber chose the medication. He gave the patient samples. Now that the patient's insurance won't pay, the prescriber tells him "too bad, so sad because I don't do prior auths"?
CPP: I see your point in this scenario.
CP: How is he servicing his patients if he won't be bothered to prescribe an alternate treatment? Just because he picked this particular medication, and it's not covered, he won't prescribe anything else?

It's one thing to have a policy against wasting time and resources on prior authorizations that may not improve patient outcomes or end up with you chasing your tail. It is quite another to offer the patient no other options for treatment. They came to you seeking help. You are their healthcare provider.

Your Logic Astounds Me

Or ... Really?

Wednesday, the day. 10am, the time.
Bitchy Lady Assuming My Eager Deference: I was calling with a question?
CP: Okay. Then what happened?
BLAMED: Huh?
CP: You WERE calling, then what happened?
BLAMED: Um...I have a question?
CP: Sure. Go for it.
BLAMED: My doctor assured me that you would fill my prescription on Friday.
CP: Really? That's rather presumptive of him. I can't recall the last time your doctor called me to discuss any of our mutual patients.
BLAMED: He told me you'd fill it and I just wanted to make sure it would be okay.
CP: Well, according to my records, you will be too soon on Friday so I will not be able to fill it.
BLAMED: But he told me...
CP: Yes. Yes he did. As you've made abundantly clear. However, the important part is that he did not tell me. You know, the pharmacist charged with filling it.
BLAMED: I have a trip planned and I leave Friday.
CP: Well, seeing as how today is Wednesday, you have plenty of time to take the necessary steps. Simply ring your prescriber, have him call me and once we have discussed your prescription, I should be able to fill it.
BLAMED: Now I can't go on my trip! It's all your phault. I won't get to visit my new grand baby and ...
CP: Hello? I made this really simple for you. It's 10am on Wednesday. Call your doctor and have him call me. You have 3 days.
BLAMED: You personally ruined my trip. I'm going to transfer my prescriptions out and never come back.
CP: Sounds pretty extreme and I'll miss conversations like this one but be bold and do not cower in the face of your convictions. In the meantime, I would suggest calling your doctor so he can approve your early refill with the pharmacy you choose to have fill your prescription.
BLAMED: He's Pain Management. I can't find him. He's in a different office every day.
CP: And you have 3 days. Call all the offices. Leave messages. Hell, drive to each location, knock on the door, and ask if the doctor is in.
BLAMED: I can't believe you're going to make me miss my trip.
CP: You realise I'm only stalling because I want to see how long you choose to keep arguing with me.  I should have hung up a long time ago but I feel as I'm really making progress, slowly chipping away at the thick layers of your skull. For the last time: Call your doctor. Tell him to call me. You have 3 DAYS.

<fast forward a whopping 22 minutes>
Pretty Honest Office Nurse Ejaculating: So...BLAMED tells me you're refusing to fill her prescription.
CP: Is that what she said?
PHONE: Yep. Pretty sure that's not the whole story.
CP: Yep. It's too soon and she told me the doctor "assured her the pharmacist would fill it" early.
PHONE: Phunny. I told her we'd probably have to talk to the pharmacist.
CP: I just wanted to make sure we were both on the same page.
PHONE: The patient brought in plane tickets and her reservation. Otherwise, the doctor would have absolutely said no. We will make the adjustment on the dates for next month accordingly.
CP: Perfect! Too bad she skipped telling me all that. Next time, just have Dr. Zoffis write a note explaining why he approved the early fill (checked itinerary) and I will fill it. Of course, it would have helped if she had brought me the prescription first, as I requested.
PHONE: At least you didn't ruin her trip.
CP: No. Just her morning. But she made mine. At this rate, I'll be held responsible for the outcome of the election.

#MyFaultIsBiggerThanSanAndreas
#OwnYourStupid