Breathe Deep

CP: Thanks phor phoning CP's Emporium. How may I help you today? 

CANDY: I need a refill. 

CP: Certainly. Do you have the Rx number? 

CANDY: No. But I know the name. 

CP: That helps too. What's your name? 

CANDY: CANDY (Cees Are Not Dees Y'know). 

CP: Okay. And what do you need refilled? 

CANDY: My diaphragm.

CP: Oh. Okay. Take a deep breath. 

CANDY: <inhales> Okay. Now what? 

CP: You refilled your diaphragm. 

CANDY: No. My medication. It's called diaphragm. 

CP: Okay. Like the little trampoline for sperm? We do phill those upon occasion but rarely refill them. Usually they're not supposed to get full. 

CANDY: No. My medication. I take it by mouth. 

CP: That's not how diaphragms work. That's called a #DentalDam. 

CANDY: No. The medication I take phor depression. 

CP: Do you have the bottle? 

CANDY: Yes. 

CP: The one with the Rx# on it? 

CANDY: Uh-huh. 

CP: Which would have helped in the phirst place but would not have resulted in this phunny encounter? 

CANDY: Yes. 

CP: Spell the name phor me. 

CANDY: C-I-T-A-L-O-P-R-A-M. 

CP: You do know that "C" and "D" are not pronounced the same, right? Not sure how you got the rest of the letter salad that resulted in CITALOPRAM becoming DIAPHRAGM but you win the award phor #PharmacyQuoteOfTheWeek. 

Pills

Pills, all I really want is pills.
And in the morning it's pills.
Cause in the evening's still pills.

I learned the way that they work
And how all them need be took
And I know what you take them for
You see me when you need some more.

Ev-er-y day
I work with pills in many ways
I have to pour them on my tray
The little lip will make them stay
This keeps them from rolling away
With spatula I get to play
Counting pills is just one way
We fill prescriptions every day

Now don't you say, "You just pour pills upon that tray
Just slap a label on it, kay?"
It doesn't work in just that way
To the insurance Gods we pray
For your prescription they will pay
If not there will be some delay
Upon me blame I know you'll lay
But you'll come back another day

Pills - to treat infections
Pills - to get erections
Pills - to make you happy
Pills - and not so flabby
Pills, that's what I really love is pills
Five at a time I count pills
Into new bottles I place pills
All day is spent counting pills, pills, pills, pills, pills!

We Take All Complaints Seriously. . . Except

Mistakes happen. Depending on your source, they either happen more frequently or less frequently than reported.
Sometimes it's a simple mistake.
Sometimes it's an error so egregious, lives are at risk.
Over-reacting helps no one.
Please do not overreact.
"Happy, smile. Sad, frown. Use the corresponding face with the corresponding emotion."

OverReacting Woman Expecting Lots of Love: I am calling to complain.
CP: <checks caller ID> What seems to be the trouble today?
ORWELL: You shorted my husband 1 tablet on his medication.
CP: My apologies.
ORWELL: What are you going to do about it?
CP: Nothing.
ORWELL: What!? This is his life-saving blood pressure medication. He needs it.
CP: And he has it.
ORWELL: I think someone down there is stealing his medication.
CP: That's quite a leap.
ORWELL: You did this to us last time. He always gets a 90-day supply and we noticed he was 1 tablet short last month. Now you owe us 2 tablets.
CP: I don't owe you anything.
ORWELL: He could die without it.
CP: He could. But he's not going to miss any of it. Perhaps, as you say, he was short 1 tablet.
ORWELL: We sat together and very carefully counted his pills and we only got 179.
CP: Must have been a phun Saturday night at the ORWELL household. Let me audit my inventory.
<checks on-hand quantity, dispensings, who counted their prescriptions>
My inventory is spot on.
ORWELL: So. What does that mean?
CP: You are the only person to have received this particular NDC of this medication in the last 6 months. Twice we filled 180 tablets for you. We had 400 tablets to start. We counted to 180 each time. I currently have exactly 40 tablets on my shelf. I am not over, nor am I short.
ORWELL: Well where is his extra tablet?
CP: How do you know we shorted him last month?
ORWELL: He takes it twice a day and he only had enough for his morning dose on the last day.
CP: I see. Thereby proving, beyond a shadow of a doubt, that we shorted you 1 tablet. Not only that, but that one of my employees is stealing it. Case closed.
ORWELL: Right.
CP: Could it not also be possible that your husband missed even 1 dose throughout the last 90 days?
ORWELL: No. He is very religious about taking these. He knows he can't miss a dose.
CP: He also could have dropped one.
ORWELL: I doubt it.
CP: As much as I doubt we are to blame. I do have a solution for you.
ORWELL: Which is?
CP: Next time you are down here, I will give you a counting tray and a spatula and have you count the medication in front of me before you leave the pharmacy. If you are short, I will give you one. If you are over, you owe me one. If your count is correct, you can go home happy and continue playing checkers on the kitchen counter with your prescriptions.



I know what everyone is going to say, "why not just give her 1 tablet and be done with it? Why continue to argue to prove a point; to prove you're an asshole?". First, my inventory would be off by 1 tablet. I hate that more than anything. Second, the patient would expect it and I'd set a precedent. (I have given a single tablet to patients in cases like these where warranted. Not in cases where patients accused my staff of stealing a single ACEI.) Third, these "kindnesses" would become expectations along with faxing prescribers for refills, automatic refills, and loaning "just a few" to get through the weekend. Fourth, I had a woman argue with me every month that I shorted her. I added an extra tablet to her bottle, thereby giving her an odd number, and waited for the phone call. When she complained about the odd number, I told her to examine her bottle where I initialed the quantity. I told her I added an extra tablet and was not putting up with her phone calls anymore. She never complained again.

Mother, Mother. . .

Student At University Studying And Getting Educated: Hi. I was wondering if my prescription was ready?
CP: Not yet. We did receive it but we have not finished it. Give me 20 minutes and we shall have it ready for you.
SAUSAGE: Many thanks. I will be there then.
 <5 minutes later>
SAUSAGE's Mom: I was calling to see if my little SAUSAGE's medication was ready.
CP: Well, I just spoke with your little SAUSAGE and explained that 20 minutes was all I needed to complete the filling process.
SAUSAGE's Mom: Okay. I'm just trying to make sure it's taken care of. My little SAUSAGE goes to university out your way.
CP: I know. I heard.
<5 minutes later>
Store Local To SAUSAGE's Mom: I'm not sure why, but I'm calling to see why you're having trouble filling a prescription for a student of ours.
CP: Let me guess. You got a call from SAUSAGE's Mom?
SLTSM: Yep.
CP: <recounts how we spoke with both SAUSAGE AND SAUSAGE's mom> So why did she call you.
SLTSM: Not sure. But this is for a student? An adult student? A university student?
CP: Yes.
SLTSM: What is going on with parents today?
CP: This has me wondering who is going to chew up the medication for SAUSAGE and spit it into SAUSAGE's mouth like a mama bird. Not sure how SAUSAGE is going to be able to manage to coordinate the drinking of water and swallowing a whole tablet at the same time.
<other line rings>
Uber-Tech: Yes, ma'am. We are speaking with the other pharmacy right now. Yes. We are filling it right now. No. I am not sure what the problem is, <whispers> other than you.
CP: Again?
UT: Yes.
CP: What now?
UT: Just making sure everything is being taken care of for her little SAUSAGE.
CP: No wonder this kid flew so far from the nest to go to school.

"Hush now, baby, baby, don't you cry.
Mama's gonna make all of your nightmares come true.
Mama's gonna put all of her fears into you.
Mama's gonna keep you right here under her wing.
She won't let you fly, but she might let you sing.
Mama's gonna keep baby cozy and warm."

#OfCourseMamasGonnaHelpBuildTheWall

Just Because You Can . . .

I do not let people bully me. That's what it is, bullying.

People believe they can get away with anything when it comes to retail transactions. Partly it's due to our disconnected society. We don't have to interact with people face-to-face to complete most of today's transactions. We order everything online from Amazon. We receive automated reminders from the pharmacy, the dentist, the doctor. We receive tonight's dinner, ready to cook, from Blue Apron or Sun Basket. We text each other. We email. We stare at our phones while sharing dinner together. 

When we are called upon to actually converse and have a tete-a-tete, we don't know how to interact and exhibit socially agreeable behaviour. 

If a patient becomes confrontational, I shall intervene. I have no problem inviting them to never return. Go sell crazy some place else. 

It sounds as if this is not going to be phunny, but I love turning things around on my boss. 

I love looking at things from a standing-on-my-head perspective. 

CP's Boss (Her Royal Highness): I see you gathered another complaint. 

CP: <Proudly Puffs Out Chest> I did. I'm on a roll. 

HRH: You're not supposed to be collecting them. 

CP: Why not? Some people collect penguins. Some collect Star Wars memorabilia. I prefer to dabble in chaos. Complaints are my phriends. 

HRH: How so? They are a negative reflection on your attitude. 

CP: <whispers> Says the boss who doesn't deal with the public. 

HRH: What's that? 

CP: Nothing. Just admiring your dedication to keeping me on the straight-and-narrow even though you couldn't do my job which is why you got promoted. 

HRH: Just because you can do, or in this case, say something, doesn't mean you should. 

CP: Why not? People are too easily offended. Your perfume offends me. Your garish hairstyle offends me. Patients who yell and scream and throw temper tantrums like 2 year olds offend me. Unfortunately, I have to deal with all of them today on top of making sure I meet your quotas and that little professional expectation of not killing people. 

HRH: Complaints are not healthy. 

CP: Wrong. You have to know how to read them. Like news and studies on the internet or in journals, you have to know HOW to read and interpret them. They are not all the same. You paint me with a broad brush and believe I am a bitch based solely on my complaints. I will not allow any patient or boss or visitor to my store to belittle me or my staff. Period. I will stand up for everyone here. I do not have to take abuse. If I wanted that, I'd sign back up for that S&M class I dropped out of right after college. 

HRH: Um. . . This is why I only visit here for short periods of time on a rather infrequent basis. 

CP: Anything else before you shake babies and kiss hands and play your exit song on the way out the door? 

HRH: Cuts in hours will be coming soon. We will also reduce your overlap by half so be prepared to do more work with less help. 

CP: I'm thinking "no" on that one. 

HRH: <head swivels around violently, cracking> What did you say? 

CP: I. Said. No. To quote a phairly self-phamous person, "Just because I CAN does not mean I should". So, no. I will not be doing extra work just because you think I can.
HRH: How do you still have a job?
CP: Because people love me. I get everything done, despite your greatest efforts to thwart me, and I still do it all with a cryptic smile on my face.
HRH: Yeah. It's creepy. I've never been able to figure out how you do that.
CP: Practice. And despite the cynical attitude I have towards the profession, I love what I do. 

Opioid Epidemic Hurts Everyone

In The War On Opioids That Amasses No Gains (WOO TANG for short) another innocent victim has been discovered. Companies are quick to promote themselves as leaders in the WOO TANG.
CVS Caremark announced how they are limiting supplies through the pharmacies.
States have limited quantities that may be prescribed.
Insurances are blocking anything more than a 7 days supply for a prior auth.

These are all great steps. 

However, as with all great strides, a few missteps must occur. 

Unfortunately, the innocent suffer. 

Uber-Tech: I need your brain.
CP: Trust me, you don't want it.
UT: I need its view of this.
CP: It will be skewed.
UT: Look at this reject for this child.
CP: "Max of 4/day". Got it. What are the directions?
UT: Take 4ml by mouth every 6 hours as needed for pain.
CP: Well, that is 4 doses per day. I'm confused why there is a limit. Let's call.
UT: On it.

CLueless Insurance Talker: How may I (not) help you today?
UT: What?
CLIT: Nothing. Go ahead and start getting phrustrated. This will not end well for you.
UT: I'm trying to figure out why this claim will not go through. I tried rounding up in case the insurance didn't like the days supply but I still get a reject.
CLIT: I see all of your valiant attempts. You probably haven't been this rejected since high school.
UT: What's the magic number I need to submit to get a paid claim?
CLIT: <drags out a long> Fooooouuuuurrrrrr.
UT: For what?
CLIT: Just 4. As in "per day".
UT: Speak English.
CLIT: The insurance allows a maximum of four(4) ml per day. Period.
UT: Units would've helped there. There is a big difference between 4 ml, 4 doses, and 4 days.
CLIT: Ahem. And now phor my prepared statement: "Due to new opioid limits, the insurance restricts this medication to a total of 4 ml per day. Should the patient require an amount to exceed the total of 4 ml per day, the patient must contact his/her insurance directly to begin the process of a prior authorisation."
UT: Wait. What?
<UT repeats phor CP>
CP: Wait. WTF? Dosing of 4 ml 4 times a day is normal. He does realise this is NOT an opioid, correct?
UT: You do realise this is not an opioid, oui?
CLIT: It is part of the insurance's ongoing battle against the evil scourge, the plague of opioid addiction blanketing communities across this great land of ours.
CP: It's phor a child.
UT: It's phor a child.
CLIT: We have to stop them early. Before they become addicted or these medications reach the hands of innocents for whom they were not intended.
CP: Can we request an override? Begin the prior auth ourselves?
CLIT: No. Only the patient can begin the process by calling her own insurance. They will then contact the prescriber for an override.
UT: This is rather complicated phor a little pediatric patient to deal with on a Phriday night at 5pm. By the time they would have completed the medication, the prior auth would not have started.
CLIT: Not my problem. These are the rules. Get used to them. I'm sure we insurance companies and PBMs will come up with even more mind numbingly phrustrating blocks to patient care under the guise of "helping" in the near phuture. <click>

UT: What now?
CP: Now that everyone is on the hook, let's tell them the medication.
UT: So they can get really pissed?
CP: So they can see the extent to which we went phor this poor little guy to get his prescription philled on his insurance. Never mind it cost less than $5.00. I just had to know why, no HOW the insurance blocked him phrom receiving his post-surgical pain medication under the "Opioid" banner.
UT: It really is ridiculous, nay ludicrous that we had to spend so much time to get an answer. It wasn't about getting reimbursed. It wasn't about the patient not being able to pay. It's the principle. This was the first time we had seen this rejection and it made absolutely no sense.
CP: Seriously. How in the world could an insurance company lump IBUPROFEN 100mg/5ml Suspension in with an Opioid rejection? It's not possible. It had to be an error. There had to be an override for a post-op prescription for a child. This is sold OTC. You don't need a prescription.
UT: We cashed it out, gave them a syringe, explained how their insurance sucked, and wished him a speedy recovery.
CP: Before you ask, this all happened well within the promised wait time, while we were accomplishing a multitude of other tasks so we didn't actually waste time on it. However, now you don't need to call on this rejection because we did it phor you.
UT: You're welcome.
CP: I hate insurances.

Who? Me?

In #Pharmacy, it would be helpful if everyone would remember the phollowing mantra: "It's not me. It's you."
We didn't receive the e-script you sent? It's not me. It's you.
You are out of refills and I faxed your prescriber but he didn't respond yet and now you want to know what to do? It's not me, it's you.
Or, as phar as the blame game goes, let's try this one:

CP: Welcome to CP's 10 minute oil change. How may I help you?
Dad Overreacting Here: Oil? Change?
CP: I'm trying out new names. It's better than 10-minute Stick and Prick which is ultimately what we've become during October as it's Phlu Shot Season.
DOH: Got it. How long will it take to fill my child's prescription?
CP: Barring any unforeseen issues with your insurance or a Tusken Raider party marching through, I'd say about 15 minutes right now.
DOH: Ok. I'll wait.

<walks out to waiting area where DOH is checking his BP>
CP: Did you pass?
DOH: I have blood pressure.
CP: Good. Unfortunately, your insurance requires a prior authorisation on this medication.
DOH: What's that mean?
CP: The insurance won't pay for it. While I realise your son has taken this before, he switched medications from last month so the insurance needs the doctor to call before they will approve it.
DOH: "You mean my kid's gotta go without it?"
CP: No. I said your "insurance won't pay for it". See, I even quoted myself from the last line. However, you are welcome to pay for it yourself.
DOH: How much is it?
CP: Just shy of $200.00.
DOH: "What?! I'm not paying for it."
CP: Oh. So you mean your kid's gotta go without it? (See what I did there?)
DOH: Er. . .
CP: Wow. You were all too happy to blame me for keeping your child unmedicated. Now I get to blame you. Phunny how things work when you don't listen and just react. You have plenty of options to ensure your "kid doesn't gotta go without it" but "Insurance paying for it today" is the only one off the table.
DOH: I guess he can't go trick-or-treating tonight since all the candy will make him hyper.
CP: That's a fallacy. Besides, you could just, you know, restrict what he's allowed to eat.
DOH: Thanks for ruining his #Halloween.
CP: You're welcome. May I verify your address before you storm out, pouting like you proclaim your son will?
DOH: Why?
CP: I need to tell them where to send the "Dad Of The Year" Award.

On Time Is Early and Late Is On Time

In some countries it is considered rude to arrive early to a dinner invite. 

It is also considered rude to bring wine. Glad the wine thing's not customary round these parts. 

If I tell you a time, I expect you to be there at that time. While arriving a few minutes early for a job interview or date is acceptable, two hours is a little overeager. 

CP: How may I help you today and frustrate myself tomorrow? 

Lady In Waiting: I need to have this prescription refilled. 

CP: I see. Unfortunately we are currently out of this product. It is a special order item. We used it all today. There was a run on it. It's been on backorder. I don't carry it because their labels clash with my pharmacy decorations. Pick one. 

LIW: This happens every month. 

CP: Perhaps you should listen to me and plan ahead. Maybe call in a day or three ahead as I've asked, begged, implored? 

LIW: Phine. When should I arrive tomorrow? 

CP: You should arrive at 3pm. And the hour of the arrival shall be 3pm. No earlier. Thou shalt not arrive at 2pm unless thou shalt sit in thy car until 3pm. 1pm is right out. 

LIW: Until tomorrow then. 

CP: Until tomorrow. . .

<Tomorrow. Noon.>

CP: So much for me believing we had cleared up your pickup time. 

LIW: You did not expressly rule out anything before 1pm. 

CP: Make yourself comfortable. You've got 3 hours to kill. 

LIW: Why can't I get it now? 

CP: Because it's not ready now. When you head to your phamily's house for Thanksgiving dinner, do you eat before or after the turkey is done cooking? Do you just tell everyone "well, I'm here so it's time to eat" even though the bird has 3 more hours to go? You can arrive at the airport (an hour or two is always good practise), the theatre for a play, a concert, a movie, etc as early as you want, maybe even 3 hours like you are today. However, that does not mean your flight will leave or the show will start simply due to your presence. "Oh, I didn't know LIW had arrived. Let's get this party started. Flight schedules and movie times be damned!"

LIW: How much longer? 

CP: How long did that harangue take? 

LIW: You have a weird way of explaining things. 

CP: It's logical, methodical, and shows how people apply rules differently based on the situation in which they are present. I prefer to apply them similarly or at least as dictated by decorum. 

LIW: Is it ready now? 

CP: Is it 3pm now? 

LIW: No. 

CP: Thanks for answering your own question. 

LIW: I'll be back at 3. 

CP: Pleasure doing business with you. 

LIW: The pleasure was all yours. 

CP: It always is.

Why Your Pharmacist Is Phrustrated

Did you ever wonder what goes on in the restaurant's kitchen while you're enjoying the atmosphere and a bottle of Malbec in the dining room?
I'm sure lots of things happen we don't know about.
Perhaps they overcooked the steak.
Perhaps the risotto is phucking runny.
All that we, the diners, see is a beautiful meal that tastes good and doesn't kill us.
Unlike pharmacy, in a restaurant there is not a third party between you and the chef to phuck with your order.
Imagine someone grabbing the tickets phrom the wait staff then altering them based on their own made up "guidelines" before handing it off to the chefs phor preparation.

(Remove the "Oscar" phrom her steak. We're not paying for that up charge and she doesn't need the calories.)
(She needs a prior authorisation phor the Filet. She can start with sirloin or a T-Bone but that's it.)
(No calamari appetizer. Eat a salad.)

Then when you phinally receive your meal, it barely resembles your original order.
This is how the pharmacy does work.
We receive your order, enter it into the computer, cross our phingers that no one phucks with it and it gets stuck in the Reject Wasteland, then deliver it to your table, er hand.

Here is what went on behind the scenes last week at my pharmacy phor one patient:
(I'll phast phorward to the part AFTER I called the CNP to correct her on the dosing of this particular medication.)

CP: WTF?
Uber-Tech: What's up?
CP: Twenty-five years and my life is still, trying to get up that great big hill of hope, for a destination.
UT: Really?
CP: Sorry. You led me to it and it phelt apropos of the situation.  Just another in a long line of phrustrating rejections.
UT: Do go on.
CP: I have to call this insurance company for the dumbest reason ever.
UT: What's that?
CP: The prescriber wrote for "Zithromax 500mg tablets. Take all 4 tablets by mouth together as a single dose."
UT: Typical.
CP: Right? It's the normal, FDA-approved dosing for Gonococcal urethritis and cervicitis.
UT: I'll call phor you.
CP: Thanks.

<10 minutes later>

CP: Well?
UT: <ahem> "The insurance limits the dispensing of Azithromycin 500mg tablets to 3 tablets in a 30-day period." and before you ask, they also limit the 250mg tablets to 6 tabs dispensed in the same period so no, we cannot do what you're thinking.
CP: But it is a legitimate, FDA indication. A single, 2 Gram dose.
UT: They said you could request a prior auth.
CP: Right. I'm sure the practitioner wants to start that tonight since she already went home, it being 4:15pm on a Friday night. So the patient can pay out of pocket for a single tablet or wait until Monday in the hopes that her prescriber will begin the P/A process AND that her insurance will cover it.
UT: Pretty much.
CP: Too bad insurances weren't such assholes about paying phor opioid prescriptions. I guess they're not receiving kickbacks phrom the manufacturers on antibiotics.
UT: What are we going to do phor her?
CP: Same thing we do every night, Pinky. Take care of the patient and tell her her insurance sucks. I'm not above explaining #WhyYourPrescriptionTakesSoLong and rightly blaming the meddling middleman.
UT: Bill the 3 tabs on the insurance and then 1 tab as cash?
CP: You got it.
UT: Want to go phor sushi and saki after work?
CP: That is disturbing. And, yes.

Listen, Acknowledge, Understand, Deliberate, Agree, Naturally Utilise My Expertise

I can read it to you.
I can write it and spell it out phor you.
I can do an interpretive dance phor you.
I can use hand gestures (I mean, signals).
However, I cannot understand it phor you.

CP: Hey partner.
CPP: Howdy Pardner.
CP: Easy Cowboy.
CPP: Sorry.
CP: I understand. You're the only one back here with a country station on your Pandora.
CPP: It's only a couple songs. Honest.
CP: Phine. Here's your task phor the day. Look at this e-script I received over the weekend and call the prescriber.
CPP: Shore thang!
CP: <partner's gonna kill me for this dialogue> What are your thoughts?
CPP: Do they make this?
CP: Not that I am aware.
CPP: I see it. But I've never seen it. Were they just playing a pharmacy version of Cards Against Humanity? I'll take a drug name, a strength, and a dosage phorm and make a Franken-Drug on my e-script software. How does something like this even get through?
CP: As I've said before, they didn't ask us to design the software. But that's another post.
CPP: Did the patient come in phor this over the weekend?
CP: Certainly did.
CPP: What did you say?
CP: This product is not available as written. I realise this is phor your young child but I have no way to dispense you anything close to what is written here. I shall ring your office('s neck) on Monday and ask phor an alternative.
CPP: Sounds phair. Let me call.
CP: Well?
CPP: Had to leave a message. It went something like this. <Ahem> "Dearly beloved, we are gathered here today to get through this thing called life. I believe we can get by with a little help phrom our phriends at your office. The prescription you sent to us over the weekend for Sweet Child O'Mine is commercially unavailable. You shall either have to alter the strength, the dosage phorm, or the medication itself. Please call us and we may review the alternatives you choose to ensure we can get them if we do not have them in stock. Again, please call us with an alternative. Sincerely, The Revolution."
CP: Nice, professional, direct, to the point, yet simple and classy.
CPP: Thanks.
CP: I'm betting on voicemail as their return call.
CPP: Damn. You always guess voicemail.

<4 hours later>
CP: You need to listen to the voicemail.
CPP: Herr Dr. Zoffis?
CP: Jawohl.
CPP: <reciting the message> "The prescriber would like to cancel the prescription sent over the weekend. Since you cannot locate it, we will call the patient and instruct them to purchase it over the counter."
CP: Um. . .
CPP: Perhaps my message was TOO simple?
CP: No. It's not you. "If the instructions are not clear, if the orders are not obeyed, it is the fault of the general. But if the instructions ARE clear and the soldiers still do not obey, it is the fault of their officers."
CPP: You are wise beyond your years.
CP: Nope. Just recognizing that when the patient's mom returns, she will ask us to phind the product her prescriber told her was available OTC.
CPP: Ah yes. The Circle of Pharm Life.
CP: I wonder if anybody ever counts my references. This post is ridiculous.

Another reason #WhyYourPrescriptionTakesSoLong and #WhyYouShouldntAlwaysTrustYourPrescriber
#LetsGoCrazy

Real Conversations With Real People

Sometimes it falls upon your phriendly pharmacy staff to phone your insurance company. It is a necessary evil but one which we shall undertake to provide superior customer service. . . or at least get you your refill since Mail Order is the Devil Incarnate and . . . but I digress.
Now, phor your reading pleasure, I present. . . Tales Phrom The Pharm Side.

Uber-Tech: CP, we have a problem,
CP: Go phor CP.
UT: Apparently, Ms. Golightly's prescription is too soon.
CP: Dear Holly? How dreadful. I shall call for an override.
UT: That's why you're the best. Always looking out phor the little guy.
CP: I haven't even had Breakfast yet.
<pluckily dials insurance>
Practically Below Microbes: Thanks for calling Rejections R Us. How may I thwart your efforts and phrustrate you today?
CP: If only everyone was so honest.
PBM: Huh?
CP: Nothing. I was calling to get a mail order override for a lovely patient on her brand new medication that was processed by mail order today and not received yet from mail order since it was processed today by mail order.
PBM: Okay. And you are trying to bill it for what date?
CP: Today. 10/1/17.
PBM: Okay. I see that the patient's mail order processed a claim for a 90 days supply on 10/1/17.
CP: Correct. I can't quite figure out how they can bill a claim immediately but take 3 weeks to ship it to the patient. Baffling. Any who. . . I'd like an override so the patient may receive medication phrom me to begin therapy today.
PBM: Okay. Is the patient low or out of medication?
CP: As I stated earlier, before your teleprompter kicked in to gear, this is a new medication, so she can be neither low nor out since she never had any.
PBM: "We can only do an override if the patient has not received her mail order yet."
CP: Are you listening to yourself? Do you understand the words that are coming out of your mouth? I told you this was a new medication. Today. YOU told ME that mail order processed the claim . . . TODAY. Now how in the 7 layers of Pharmacy Hell can the patient have sent a prescription to mail order, had it filled, taken all of it, been out of it, and received a new prescription for me to fill all within nanoseconds? It bends the time-space continuum.
PBM: I have to enter a reason in order to process the override.
CP: Words are wind. I wonder why I waste so many of them being practical. I bet you tested really high on the parroting part of your interview. Say what.
PBM: What?
CP: Good dog. Now please process the request for my patient; who has no medication; because she never started it; because mail order billed it today but won't send it for weeks; but I need to do all this legwork to lose money; because I care.
PBM: Ok. So the patient is out of medication?
CP: Your parents wouldn't happen to be Cersei and Jamie by any chance?
PBM: Um. I don't think so.
CP: Yes. She is "out" in layman's insurance parlance.
PBM: Ok. I entered the override. Be sure to document on the hard copy the override I provided.
CP: GOT it.

UT: That sounded rough.
CP: We could save so much time if the conversation weren't so robotic. A simple, "Oh her mail-order didn't arrive and you need an override? Here's it is. G'Day!" would be amazing.
UT: As you always say, people today are being trained WHAT to think as opposed to HOW.
CP: You actually listen to me?
UT: You talk a lot. All phreaking day. Must be osmosis.

This Is Why We Can't Have Nice Things

People are assholes.
Period.
That could be my post every day.
Just a picture of a person, or No One, with the word "asshole" scribbled across it.
But there is more to life, and retail, than assholes.

Except for today.
Today is the asshole post.

We try to be nice to our patients.
We do a rather good job IMHO. (Despite the few whiny bitches on our customer scorecard; you know the ones who get their feathers ruffled for some perceived slight against their ego.)
When your patients keep coming back and say lovely things about you, that's all you need for validation, despite what corporate thinks.

To this end, we keep kibble for the K-9s at the drive-thru and stickers and suckers (when mom approves) for the children. (Make the kids happy and mom is happy. When mom is happy, everybody is happy.)

We do everything possible to provide nice things for people.
Until assholes happen.
Always keep in mind the assholes.

Don't demand pet treats at the drive-thru.
Sometimes we run out.
We buy these with our own money because corporate is too cheap to let us grab a box off the shelf out front.
It's a courtesy.
Say "thank you" and move on.
The next time you come back and we don't have them?
Oh, sorry. Some asshole complained we forgot to offer his spoiled bitch a treat so we had to do away with this customer friendly program. (His dog wanted a treat too . . .)
Here's the asshole's phone number.

Or you could have this guy we had last week:
CP: Have a nice day! (offering sucker to little rapscallion)
Rapscallion's Mom: You're so sweet. We love you!

There Was A Time People Once Cared Kids Enjoyed Things: Suckers?
CP: They are.
TWATPOCKET: Do I get one too?
CP: Were you a good little boy?
TWATPOCKET:  Huh?
CP: Sure. You may pick one.
TWATPOCKET: Can I have a bag for my medicine?
CP: Sure.
TWATPOCKET: <reaches in to barrel of Dum Dums and withdraws full contents>
CP: HEY!
TWATPOCKET: <befuddled look on face> What?
CP: One. You get one. Those are for kids.
TWATPOCKET: They're free, right?
CP: Not to assholes. You can buy yourself a bag of Dum Dums over in the next aisle. I suppose you're going to steal candy from the kids at Halloween next month too.
TWATPOCKET: That's not fair.
CP: Keep crying and you won't even get an Iron Man sticker to hold your bumper to the back of your truck.

"Counting all the assholes in room. Well I'm definitely not alone. Well I'm not alone.
You're a liar, you're a cheater, you're a fool."
#StillCounting

Shhh. Listen

I have long been convinced that people blank out when they are waiting for someone to answer the phone. They seem to experience an absence seizure from when the phone starts to ring to when the person answers. I am also fairly certain that businesses could answer the phone with any script or name they desire and the people calling will have no idea. Maybe it's simply that people are expecting a result and, as such, pay no attention to the actual result they get.

Phrom the weekend:
CP: Thank you phor calling CP's Pharmacy. This is CP THE Pharmacist. How may I help you?
Lack Of Listening: Yes. May I speak to the pharmacist please?
CP: Sure. Please hold.
<1 minute later>
CP: Thanks for holding, this is CP THE Pharmacist. How may I help you?
LOL: Is this the pharmacist?
CP: No ma'am. Please hold for the pharmacist.
<2 minutes later>
CP: Thank you for holding, this is the Pharmacist.
LOL: Is this the pharmacist?
CP: Does it really matter?
LOL: You said you're the pharmacist?
CP: A phew times now. How can I help?
LOL: I need a refill.
CP: You need a tech. Please hold.

#EveryDay

Time To Celebrate

A(nother Conversation With Myself)

ME: CP, what is one of the most phrustrating situations you face every day? 

CP: I'd say the Q&A that happens with every drop off. It's phrustrating because it's the simplest encounter we have all day, and we have it hundreds of time each day, yet it seems to be the most difficult for patients. 

ME: Okay. What scenario is so troubling? 

CP: When I ask for your personal information, I'm not trying to get to know you. 

It's not a date. 

I'm trying to make sure I have the correct profile for you. 

This means that your Name, Date of Birth, Address, Allergies, and Phone Number form a portrait of you in my computer. Additional conditions and your insurance may help complete the picture but I need the basics. 

I ask, you answer. 

The sooner you answer, the sooner I get work. 

The sooner I get to work, the sooner you get to leave. 

ME: Sounds pretty straightforward to me. How can it get complicated? 

CP: People point to their DOB on the prescription and say "It's on there." 

ME: So? 

CP: The DOB can often be wrong. Or the patient name can be wrong or a mismatch. I had a grandfather who took his grandson to the office visit. The pediatrician put grandpa's DOB on the Rx. I had an office select the correct DOB, but the wrong patient. Oops. I don't care about the information for a second longer than I need it to do my job but shouldn't you care about your health for more than one second? 

ME: Point made. Okay, I know you started this post with the intent to go another direction but you felt an intro was necessary, so what was the original intent of this post? 

CP: Odd answers to my questions. 

ME: Okay. Give me one example that stands out in your memory. 

CP: Sure. 

CP: Welcome to CP's Renaissance Faire where verbal jousting is always a main event. How may I spar with you today? 

JW: I have come to fill a prescription today. 

CP: Jolly good! Have you filled prescriptions with us before? 

JW: Never. This is my first time. 

CP: Mine too. I just need some information from you to create a profile in my system. Name? 

JW: JW. 

CP: Address? 

JW: No. A suit. 

CP: Witty. Date of Birth? 

JW: We don't celebrate birthdays. 

CP: Pardon? 

JW: Jehovah's Witnesses do not celebrate birthdays. 

CP: Nor any holidays for that matter. That's fine. I'm not planning on sending you a card or hosting a surprise party. I just need the date. 

JW: We don't celebrate them. 

CP: But you were born, correct? 

JW: Yes. 

CP: Fine. While you may not attribute any significance to any particular day of the year, I need you to choose one for me to enter into the system. 

JW: I don't know what to pick.
CP: Like cheap American beer, everyone has a Born On date. Any idea when yours may have been?
JW: Nope.
CP: Any favourite numbers?
JW: I like seven.
CP: How about 7/7/1977? Easy to remember?
JW: Sounds good.
CP: Just remember it when you get to the register. And I promise not to commemorate our first date with a card or anything cheesy in a year...or on your "birthday". 

Your Student = Your Responsibility

Simple.

According to the State Board of Pharmacy, the one that gives me my license to play pharmacist, I am allowed to have an apprentice. Intern. I am responsible for her training. I am responsible for everything she does. My license is on the line as I am the one signing off on her. 

Apparently, the rules are different when it comes to prescribers. 

As if hospitals were not impossibly organised, let's add practising prescribers to prescribers who practise. Never mind trying to reach the actual prescriber of the patient's discharge medication. Sometimes I think it's some random person in a lengthy white coat that happened by as the patient wanted to leave. 

Here's the problem and #WhyYourPrescriptionTakesSoLong. 

CP: We have to call the person who wrote this prescription. 

Pt: Why? 

CP: Well, you're on Medicaid and for some reason, hospitals have yet to learn to register all their new students with the State. Either that or they leave it up to the individual students themselves which is terrible policy. Either way, we need another prescriber to okay this medication or you have to pay. 

Pt: Well, you know I'm not paying so get on it. 

CP: Right. 

<rings hospital>

CP: I am trying to reach Dr. Zoffis. He wrote a prescription for this patient on 4H. 

Hospital Answer Lady 9000: Let me page him for you. 

CP: Thanks. 

HAL9000: No answer. He's a new resident so he may not be receiving pages. I can call his attending. 

CP: Go for it.

HAL9000: I paged him. 

CP: Okay. Should I hang up? 

HAL9000: No. Please hold. 

CP: <sings entirety of Aenema while on hold>

HAL9000: Still there? 

CP: Wouldn't behoove me to cut communications at this point. 

HAL9000: He didn't answer so I will try again. 

CP: Can't you just take my number and have him call me back? 

HAL9000: Definitely not. Hospital policy mandates that we attempt to page the prescriber 3 times before taking a message. 

CP: So I have to sit on hold for 7 minutes per attempt so you can page a prescriber who could be in the ER, in surgery, or dropping the kids off at the pool because of some stupid policy? 

HAL9000: Correct. Please hold. 

CP: <sings Break Stuff and starts Hangman's Body Count>

HAL9000: Hello? 

CP: Just go with Round 3 so I can get off hold. 

HAL9001: Oh, you've already been through twice? 

CP: Yes. 

HAL9001: Give me your information and I'll have him call you. 

CP: Thanks. 

<1 hour later>

Herr Dr.: I received a page? 

CP: You did. No question about it. I need you to sign off on this prescription one of your students wrote. They are not licensed with Medicaid and the patient won't pay the full cost. 

HD: I'm not going to do that. 

CP: Huh? 

HD: I remember the patient's name but that's it. I'm not signing off on it. 

CP: Is Dr. Zoffis one of your students? 

HD: Yes. I met him once. 

CP: Then who can I get to authorise this prescription? 

HD: I don't know. Maybe try the Endo specialist group. 

<calls Endo Group>

CP: Can you help with this? 

EG: We don't even know who that patient is. 

CP: Is this one of your students, Dr. Zoffis? 

EG: Maybe. We get so many I never learn their names or faces. 

CP: Helpful.

Pt: Did they phix it?
CP: Nope. Apparently no one cares about you once you leave the facility.
Pt: So what do I do now?
CP: I just put the attending's name on it.
Pt: Who was it?
CP: Douche Baggins.
Pt: I remember him. Thanks!

When?

When: Interrogative Adverb.
At what time; how soon

Soon: Adverb.
In or after a short time; early

Shortly: Adverb
In a short time; soon

Now: Adverb
At the present time or moment

Anon: Adverb
Soon, shortly

When we ask the question "When would you like to come in for your prescription?", we are trying to plan our day in the most efficient manner in order to ensure your prescription is ready by your intended arrival time. It really makes no sense for me to work on your prescription right now if you intend to wait until tomorrow, or the weekend, to retrieve it. This allows me to dedicate my time and energy to high priority prescriptions such as antibiotics and ER/post-surgery medications and, well, flu shots. When you have a prescription that requires urgent attention, you can appreciate all the other patients communicating honest pickup times with us.

In the question "WHEN?", we are asking for a time. It can be exact or a ballpark estimate. The correct answer to "At what time would you like to pick up your prescription?" is NOT "later"; nor is it "soon", "shortly", or "today". Those are not times on my clock.

If you choose to give me vague answers, I shall try to out-vague you.

Pt: (on the phone) Did you receive my prescription(s) from my prescriber?
CP: We did. They just arrived in my queue but we have yet to process them. "When (at what time) did you want to come in for them?"
Pt: As soon as they're ready.
CP: Okay. We will see you then.
Pt: Wait. When will they be ready?
CP: Oh. Anon. <click>

or

CP: When did you want to come in for them?
Pt: Later.
CP: Okay. See you later, alligator.
Pt: How much later?
CP: After a while, crocodile. <click>

Yes. This is an endless debate.
How do we phix it?
As I stated, we get the patients to commit to a time.
When they are vague, we give them longer-than-necessary estimates. However, this rarely works because, regardless of the time (15 minutes from now or 4 hours from now) there will always be the incredulous "That LONG!?" response. Look, if you had pinpointed a time as I had offered, I could begin work on your prescription and it may be done quicker. Since you left the time entirely up to my discretion, I made a decision based on my needs at the moment. Accept it and move on.

When people are in the store, I give them exact times if they choose to wait. In this way, there can be no ambiguity surrounding the Time Of Promise Pickup:
"If you're waiting, that'll be 22 minutes which puts us at 3:57. See you then." It helps, especially since our perception of 22 minutes differs greatly from that of the people on the other side of the counter.

Last One Called Gets All The Yelling!

It's a game.

Make the patient make as many phone calls as possible without actually helping him until he reaches the end of the line . . . and his rope, and begins erupting far away from you. 

Unfortunately, this usually means the pharmacist bears the burden. 

CP: Thank you for calling CP's Pharmacy. Please tell me in what manner you are going to request the impossible so I may disappoint you today. 

Richard Better Use Retail Next Script: I am without my medication. 

CP: That sucks. You should totally get it refilled. Problem solved. Next!

DickBURNS: Wait. I'm waiting on my mail order to arrive. 

CP: Ok. Since you don't use my pharmacy, I fail to see how I can help you. Did you just need someone to talk to while you wait? 

DickBURNS: No. They've been trying to fill my prescription for 2 weeks now. 

CP: It usually takes me about 15 minutes. Two weeks seems like an awful long time to "try" to do anything. 

DickBURNS: Well they say they contacted my doctor and he hasn't responded. They have called him 3 times and I have called him every day for 2 weeks. He still hasn't responded to either of us and now it's the weekend and I am out of medication. 

CP: Boy that's a toughie. First I'd suggest finding a new prescriber. Second, since it's only Thursday, I'd suggest driving to his office and requesting a prescription in person. 

DickBURNS: When I called my mail order pharmacy they told me to come to my local pharmacy and you'd give me my medication. 

CP: <laughs> I love when people tell everyone what my job is and how I do it and believe I can wave a magic wand and damn all the laws I have to phollow. What is this medication? 

DickBURNS: I need Trazodone for sleep. 

CP: Well, upon checking your profile, you have filled exactly 3 prescriptions since 2014 with our pharmacy. Not one of those is for Trazodone. Since your mail order has no prescription, I cannot transfer one from them. Since I have never filled it, I cannot invoke my State's emergency fill exemption so I am unable to help you today. 

DickBURNS: So you're refusing to help me? What am I supposed to do now? They said you'd help me! I need my medication. 

CP: First, you're not my patient. Second, mail order can't tell you what I will do in my pharmacy or my state. Third, I gave you options that included visiting your prescriber. Fourth, there are no options available for you from me other than me giving you other options that do not include me. 

DickBURNS: You're not very helpful. 

CP: Wrong. I was quite helpful. You believe me to be unhelpful because I did not give you the answer you sought when you first rang. There is a difference between your interpretation of helpfulness and the truth. I realise you're phrustrated but your ire is misplaced with me. It instead belongs with your prescriber. Had he done his job, we would not be having this conversation. I stand by my original suggestion, find a new prescriber. Besides, if my state allows me to fill an emergency prescription shouldn't mail order be expected to offer the same service? They are a pharmacy, right?
DickBURNS: But they said you'd do it.
CP: Right. Not cost effective for them. Good luck. Sleep tight. Er . . .

The More You Say It, The Phunnier It Gets

Sometimes, okay, quite often in my pharmacy, a conversation, or a phrase, or even a single word inspires an entire post. The strength of it is directly proportional to the acceptance by my colleagues  of the twist-of-phrase.

It's always inspiring to me that floaters choose to come to my store; mostly due to them knowing they are not in for a drab, boring day. I like to think it's me, but I know better. 

Why is it that patients always say the same thing? It's not just every patient reciting the same line; I'm talking about every patient repeating the same line each time he visits the pharmacy. 

CP: What is your date of birth? 

Pt: I come here all the time. 

CP: Then you know I ask for it every time. You really should be better prepared next time. 

CP: Do you have your insurance card with you? 

Pt: It's in the computer. I come here all the time. 

CP: I think you have a serious problem. Insurances should not be that stimulating. 

CP: Any changes to your personal information?

Pt: I come here all the time. 

CP: I realise corporate pharmacy has prostituted our profession, but you really need to stop doing that. We are not literal prostitutes and since only the pharmacists are Blood and OPIM (Other Potentially Infectious Materials) trained, we're tired of cleaning up your "accidents". 

CP: Do you have any allergies? 

Pt: I come here all the time. 

CP: I'm glad we excite you that much, but you should really try to wait until you get home. They make medication for that. 

Pt: Really? What medications treat that? 

CP: SSRI's are one class. 

Pt: SSRI's? 

CP: Yes. And to help you remember, when you write it down, it actually looks as if the acronym is trying to say "So Sorry". 

I Forgot.

It's like riding a bike.
Okay, more like falling off a bike.
We go to school and we learn things.
We go through life and we practice things.
They are as easy as breathing; as driving; as eating.
Until one day . . .
We stop doing them. Idle hands may do the Devil's work, but idle brains wither and die.

Imagine a world where you learn to write and speak your name. You do this before tests and on all paperwork through your adult life. Now imagine that the world changes and you only need to present a biometric ID or retina display to gain access to classes, apply for a mortgage, or complete forms at the BMV or your prescriber's office. No more talking or writing expected.

Will you still remember how to communicate the old way?
Will you remember your name?
How to pronounce it?
How to spell it?
Will there be secret, underground societies comprised of humans who prefer the old, verbal method of greeting one another?

Alas, poor Yorick.

CPP: CP, where are you going with this?
CP: Sometimes events occur in multiples and you wonder if it's a sign of the Apocalypse or a series of unrelated anomalies.
CPP: And last week was?
CP: A number of offices called us with the same issue and their answers were all eerily similar in their stupidity.
CPP: Blamed the eclipse?
CP: Worse. The software.
CPP: Okay. Tell me what happened.
CP: Prescribers go to school, right?
CPP: Most of them. Others, I'm not so sure.
CP: But they learn how to write prescriptions, right?
CPP: What with electronic records, it's become an antiquated practise.
CP: Indeed. But the majority of prescribers out there had to hand write prescriptions at some point, non?
CPP: Oui.
CP: Then why did we receive multiple calls from (and make multiple calls to) offices whose electronic prescribing systems were "giving them fits" and they "forgot how to write prescriptions"? I can understand certain traits of a civilisation eroding over a generation, but within a few years of practise?
CPP: I see what you mean.
CP: We had a control prescription where the prescriber forgot to write his DEA#, spell the quantity, and date the prescription.

CPP: Outrageous! Of course you called the office.
CP: Of course, at which point I received the obligatory "the system was down" excuse from the phone answerer person.
CPP: Remember our math teachers in school always telling us we won't always have a calculator?
CP: I repeat that often. It's why I still do all my calculations on the backs of the prescriptions after doing them in head. I check myself.
CPP: Before you wreck yourself?
CP: The point is, we can still do this. We don't get flummoxed. We don't get upset. There is no perturbation. We can think for ourselves and adapt and do what's right and necessary.
CPP: You really need to do a post about having the ability to think for oneself. Something along the lines of learning HOW to think as opposed to being taught WHAT to think.
CP: Like the one I wrote last week?
CPP: Precisely. 

This Is Only A Test. Had This Been An Actual Emergency. . .

CP: Sometimes, all you can do is throw your hands in the air . . .
CP's Partner: . . . and wave them like you just don't care?
CP: . . . and pray for the human race.
CPP: What now?
CP: You know how we're allowed to authorise a refill in an emergency for a patient?
CPP: Yes. We have discussed this at length.
CP: Remind me, and enlighten our phellow phollowers, as to what criteria must be met for this to occur.
CPP: Gladly. First, it must be an emergency.
CP: Defined as?
CPP: The patient must be out of (a life-saving) medication. They must be unable to reach their prescriber. The prescriber's office must be closed. We are permitted to fill enough for the patient up to 1 month, but generally only enough to last the emergency period.
CP: Because if they were open, then they would logically be able to reach the prescriber and he/she would be able to fulfill the obligation of approving a new prescription refill.
CPP: Exactly.
CP: And they could reach the prescriber the next day since it's only Tuesday?
CPP: Yes. Why the rephresher?
CP: That phone call I just took.
CPP: Excellent. More role-playing. I'll be the plucky pharmacist.
CP: And I'll be the patient.

CPP: Hello, this is CP <snickers> How may I be of service?
CP <as the patient> I am out of refills.
CPPasCP: I am terribly sorry to hear this. Again, how may I be of service?
CPasPt: I just got off the phone with my office. They told me that I should call you, tell you when my appointment is and that you will give me enough medication to get me through to my appointment.
CPPasCP: That seems kinda backwards, does it not?
CPasPt: I didn't think that sounded right but thought I'd call since I have a great relationship with y'all.
CPPasCP: You were wise to come to us. Here is what I want you to do. Call back to the office and tell them you spoke with us. Tell them we made you an emergency appointment for 8:45 tomorrow morning so that you wouldn't have to wait 2 weeks to see them since that is ridiculous for such an urgent matter. Since they have bestowed so much power upon us, tell them their faith has been rewarded and you shall see them soon.
CPasPt: I like where you're going with this.
CPPasCP: And when they reply with "that's not how this works", kindly remind them that that's exactly what the pharmacists (both of them) said when you explained that we are supposed to use the emergency clause just because they don't want to be bothered to obey the state laws and call in a refill for you.
CPasPt: Will do. Thanks!

CPP: Such an awesome patient. You do realise we couldn't get away with that with all of our patients.
CP: I do. But just wait until you hear what office this was.
CPP: Really? I've explained this to them for 2 years now. They can't invoke "emergency fill" during normal business hours. It's not an emergency if they are actually IN the office and reachable.
CP: Right? As if we don't already do enough work for them . . . Hey, check the queue.
CPP: Seriously? That was quick.
CP: Must have gotten through to them a lot faster than we anticipated. And look! They wrote it wrong so we have to call them to phix it anyway.
CPP: Guess we should have written our own in the first place.
CP: Nah. Where's the #PharmacyPhun in that?

Another all-too-real-life story brought to you by CP; with special guest appearance by CPP.

Do Not Go-Lytely...

Do not Go-lytely into that good night,
The tongue should burn and cry at the first taste;
Rage, rage against the dying of the light.

The fire coming out the end is fright,
Doctor's orders did not prep for haste
Do not Go-lytely into that good night.

Insides, in panic cry, screaming not right
This unwelcome guest that now clears this space,
Rage, rage against the dying of the light.

Four hours to drink with no end in sight
And now, a glass, to assault yet more waste,
Do not Go-Lytely into that good night.

The cramps, in gut, are spasming tight
In knots it turns like anxious days we've faced,
Rage, rage against the dying of the light.

Again, once more, on the seat I alight
Pray this, the end, of my bowels have been chased.
Do not Go-lytely into that good night.
Rage, rage against the dying of the light.

What's Your Birthday?

I learned a long time ago that "First Name" somehow sounds a lot like "Birth Day" to people standing  at a pharmacy counter. As a result I modified my approach to asking for a patient's "Date of Birth". It doesn't mean we still don't receive the wrong answer from time to time. but this image always comes to mind when it does.

No, no, no, no, no, no
No shorty what's your birthday?
I said I need to know what is your birthday?
I needa have all your info what's your birthday?

Lice Lice Baby

Yo, R. I. D., let's kick it.

Lice Lice Baby, Lice Lice Baby

All right stop, irritate and scratchin'
Lice is back and it needs some attention
Nits are stuck on the hair so tightly
Can't go to school the nits are unsightly
Will the itching' stop? Damn, I hope so
Stay away from the mayo.
Rakin' the scalp with an itch I can't handle
Gas and a match will burn parasites like a candle

Fwoomp! Shoulda used clippers instead.
Bear can't hide in the trees if there ain't no wood.
Pickin', so hard I broke the comb's handle
Nits attachin' to my roots like a vandal
Head-to-head contact, it's just frowned upon
Parents don't want us kids to get along

Just for this problem Nix will solve it
If that don't work maybe Rid may resolve it.

Lice Lice Baby, Time for Head Lice Lice Baby, Time for Head
Lice Lice Baby, Time for Head Lice Lice Baby, Time for Head

Now the parasites are lurkin'
Resistance is growing and OTC's not workin'
Get to the doctor, to the doctor, for savin'
Scripts are good for lice that's misbehavin'
Treating patients with malathion
Natroba is newer to rely on
Used to use Lindane or a product called Kwell
Robi-comb and LiceMD are new, that's swell
Smilin' for school photos
The girlies sharing combs, teachers screamin' "Hell No!"
Did they stop? No, kept brushin' tho.
Helmets and hats we say don't share 'em
Now they're planning sleepovers and we say forget 'em
Keep lice from spreadin'
So we continue to use coco-nut oil.

Killing all the eggs off is a challenge
Ovicidal meds they just can't manage
Seven days to repeat doses
Pediculicide's no better
Mom's got the comb and Dad's got the razor
Aiming for bugs starting to crawl
Parents freakin' out they got 4 more kids in the hall
Wailing poured out like a banshee
Kids off running, never knew man she
Broke all the windows neighbours heard
Cursing comin' out my mouth real loud
Drew the police, then a small crowd
Parents and children, thankful it's not them
Of scratching and itching now dealing with this problem
Mention lice in passing, everyone scratchin'
Hands to their heads in reflexive action.

Just for this problem Nix will solve it
If that don't work maybe Rid may resolve it.

Lice Lice Baby, Time for Head Lice Lice Baby, Time for Head
Lice Lice Baby, Time for Head Lice Lice Baby, Time for Head
Lice Lice Baby.

We're All Busy

If you don't want to argue with me, then don't argue. Prefacing your argument with "I don't want to argue" does not absolve you of the penalty for arguing. In this case, instead of arguing, you could learn a thing or two if you would just listen, then process what I'm saying, then acknowledge that you understand. Of course you could argue, but that will end poorly . . . for you.

I Don't Want To Argue But Here I Am Arguing: I would like to have this filled.

CP: I would like to fill this for you. 

IDWTABHIAA: We usually use another of your phine establishments. 

CP: I see that. I also see that this is too soon to fill by 3 days. 

IDWTABHIAA: Why is that? 

CP: We fill all control medications exactly one day early here. Since it was filled last 26 days ago, it is 4 days too soon. As we fill everything 1 day early, you have 3 more days. 

IDWTABHIAA: It's just for Ritalin. 

CP: You should read my post about the word "just" from last week. Anyway, it's just too soon. 

IDWTABHIAA: <Taps finger on prescription> But the doctor wrote the date on there. 

CP: Yes. She wrote "A" date on there. It's called the <taps finger on prescription> "earliest fill date" which means that is the earliest date on which I CAN fill it. It's like a Speed Limit sign. You can drive UP TO the posted speed, but over that is bad. I can fill it any day ON OR AFTER the date written, but before that is bad. And, like a speed limit sign, it's more of a suggestion. 

IDWTABHIAA: So you're refusing to fill it even with that date on there? 

CP: Pretty much. Yeah. 

IDWTABHIAA: Why? 

CP: I already told you. We fill all controls exactly one day early (there are always exceptions) and this is 4 days early. The date she wrote on the prescription is irrelevant. This prescription was written a couple months ago. Since you did not fill the other prescriptions in a timely manner, the due date of this one has become delayed. 

IDWTABHIAA: Your job is to fill it with that date on there. 

CP: No. The date is immaterial. Your doctor can write anything she wants on the prescription. It is not a direct order from Jean-Luc Picard, "Make it so", that I have to obey. There are laws and governing bodies to which I owe my allegiance. 

IDWTABHIAA: Now I have to make two trips. 

CP: Actually, you only have to make 1 more. 

IDWTABHIAA: I barely have time to make even one trip. 

CP: Yeah. We're all busy. 

How Pharmacy Prepares You Phor Parenting

1. Cold food.

2. Someone who thinks they know more than you is arguing with you. 

3. Someone is always crying. 

4. Something is getting thrown at you.
5. Someone tells you she has to pee just a mile after passing the last rest area. (Someone is out of refills just after the office has closed.)
6. Just wait until your father gets home is the equivalent of calling the prescriber after running a PDMP report.
7. Can't spank your patients but you can put them in timeout [go to your (waiting) room].
8. Weekends in the pharmacy are the equal to the night before a school project, that someone hasn't started, is due.
9. What do you need refilled? is the same as "what do you want for dinner"? They don't know and will just shrug their shoulders and say "whatever you want".
10. Teaching a child to read is like walking a patient through the refills on their bottle:
CP: 2 refills,
Pt: 2 refills,
CP: Until,
Pt: Until . . .
CP: Until what?
Pt: Until 6/25.
CP: And today is . . . ?
Pt: 7/30.
CP: So it's expired.
Pt: So it's expired.
CP: Good!
11. You are fluent with 111 ways of saying "NO", but no one understands or listens to you anyway.
12. You endlessly repeat yourself. 

Not My Job, Not My Blame

The last thing I heard her say before she slammed down the phone was: "You need an attitude adjustment".

Quick Background: Prescriber sent an e-rx for 60 tablets of Tramadol. The directions were clear (it's an e-script after all) that the patient was to "Take one(1) tablet by mouth UP TO 3 times a day as needed". The prescriber also indicated this was to be a 30 days supply.
All of this is totally normal for a pain clinic. The patient's previous Rx, also electronic, was for 60 tablets as a 30 days supply to be taken "one(1) tablet twice a day as needed".
Many pain clinics want their patients to stick to "as needed".
Again, normal behaviour.

Woman Is Thus Calling Herself: I am calling from Dr. Zoffis about the Tramadol Rx.
CP: Yes?
WITCH: I wanted to make sure you were going to fill the extra 30 tablets we sent over today.
CP: I will.
WITCH: Good.
CP: In 6 days.
WITCH: Why?
CP: It's too soon until then.
WITCH: We wrote the wrong quantity on the Rx. It should have been for 90 tablets to last a month.
CP: But you didn't. Unless the directions change, the insurance won't pay for it for 6 more days. Since I also have to report it to my state's PDMP program, I have to wait until it is due.
WITCH: Why didn't you call?
CP: Excuse me? You wrote a completely valid prescription and now you're telling me it's my phault the patient is out of medication because you can't do math?
WITCH: I've had pharmacists call on this all the time.
CP: You really need to go back and read my post on "Professional Judgement" from last week. Too many people calling on stupid stuff means you don't fix the big stuff. If they're calling you, maybe there's a reason . . .
WITCH: You should have called.
CP: And you should have proofread the prescription. It's a totally valid, normal, understandable prescription we see all the time from pain clinics. Do not try to blame me for your mistake. "It's bad enough you screw up regular prescriptions and I have to call, now you want me to call on ones without errors to make sure there are no errors?"
WITCH: How can the patient get her prescription?
CP: She can wait 6 days or she can pay cash for it today and I will document our discussion.
WITCH:  What if the patient is unwilling to pay cash?
CP: Then I will send her to your office and tell her to ask you for a check to cover her copay, since it was your mistake.
WITCH: That's not very professional.
CP: Neither is blaming the pharmacy for your mistake, which I'm sure is how you presented it to the patient.
WITCH: You need an attitude adjustment.
CP: Yep. I'm no one's bitch and people don't like that.

Time = (Their) Money

I've recently made a new discovery. While insurance companies have oft been the least-looked-forward-to phone calls of my day, they have breathed new life into the game.
Typically, we have to call insurance companies for some reason every day.
Whether it's due to a duplicate fill spurred by a timing issue in the system or a vacation override, or an interaction override, we have to call them.
After navigating their phone tree, which is like trying to determine the lineage of all the bastards on Game of Thrones, we finally succeed in speaking to a real, live human person.

Aetna Insurance Dude: How may I help you?
CP: Are you real?
AID: I'm a real boy!
CP: Thanks Pinocchio. I need help with a vacation override.
AID: I will be more than happy to feign attempts at providing assistance all whilst successfully ruining your happy thoughts and making you curse me over drinks tonight. How may I accomplish this for you?
CP: First, use a word that means "more than happy". Tell me you'd be elated, ecstatic, overjoyed, delighted, euphoric, or even pleased as punch. "More than happy" is lame and overused. One could say it's become hackneyed, trite, banal, or even platitudinous. Second, I have a gentleman here visiting from Nebraska and he ran out of his insulin. Can we get a vacation override for him?
AID: Allow me to diligently check my files. Why does he need a refill?
CP: He is out. As I stated.
AID: I see. Well, we just filled a 90-day supply for him last month. He should have enough.
CP: He does. In Nebraska. He was due to return a few days ago but his plans unfortunately changed and he needs to spend a few more days here.
AID: The patient can call himself and request an override, but he has to do it at least 5 days before traveling.
CP: Do you hear yourself when you speak or is there some kind of philter they put on your headset that makes sense of the words you read verbatim from the "Book of Approved Phrases to Piss Off Pharmacists"?
AID: Is he out of medication?
CP: There you go again. Let me put you on hold and I'll check with him.

<This was the part that was #PhunkyPhresh to me>

AID: "Ok. But I am only allowed to hold for 2 minutes each time."
CP: Que?
AID: "I am only allowed to hold for 2 minutes each time."
CP: So first I have to navigate a lengthy phone tree, then wait on hold until you pick up and spend forever on the phone, but if I have to put you on hold, you can't be inconvenienced to wait more than 2 minutes? I guess that makes sense. What else am I going to do? Hang up? Start the whole process again? It's my time I'll be wasting. Now I know why you check on something, come back after 1:59 and tell me you're still searching, put me back on hold, then repeat the process. You'd save more time if you quit coming back until it was phixed.
AID: I am sorry but unless the patient calls 5 days ahead of his vacation, we cannot help him.
CP: I know you're just the mouthpiece for these policies, but that's a new level of #Phuckery.

From now on, just put the insurance on hold every 1:55 and keep coming back. See how many holds we can get before we lose them.
AID: What's the ID#?
CP: Please hold <1:55> MB . . . please hold <1:55> . . .

I know I'd be wasting my time, but it would be so much more phun.

You Work In The Office?

Normally, we pharmacists are the ones initiating this conversation.
I laughed.
The nurse wasn't as amused as I.
That amused me more.

CP: Welcome to Alternate Reality Friday, how may Maester CP help you?
Nurse In Charge Of Nothing: I'm calling from Dr. Zoffis and was wondering if you could help us out with a patient.
CP: Certainly. It's sort of my thing.
NICON: She's here for her visit and she says she misplaced her bottle. We are trying to figure out what she needs refilled.
CP: This sounds eerily phamiliar. Do go on.
NICON: It's for her Losartan. Which strength did she fill last time?
CP: Silly question for you. Did you not prescribe it last time?
NICON: We did. That's the problem. We can't read Dr. Zoffis's handwriting. It's either a "5" or a "50". He wrote something then scratched it out, then wrote on top of that.
CP: Now I know why it sounds so phamiliar. We are usually the ones calling you because we can't read handwriting.
NICON: <clearly not amused> Can you tell me which one she got?
CP: I can.
NICON: So. . .?
CP: . . . a needle pulling thread. . .
NICON: Which strength was it?
CP: It was the 50mg.
NICON: <whispers to patient behind her "was it 50mg?> She says that sounds right.
CP: Of course it "sounds right". I've got it here in her profile. It's sorta kinda like a patient record thingy, akin to this thing called a chart that many a Dr. Zoffis will keep in their office. It's typically used for situations like these.
NICON: Phunny.
CP: That's my line. I have to ask the obvious.
NICON: Why not?
CP: I usually call the office and someone either knows the answer, researches it for me, or directly asks the prescriber what was written. Is there a reason you didn't just swivel your chair around and ask Dr. Zoffis directly?
NICON: He was in another room and I'm updating the patient's medical records in her room for her appointment.
CP: He couldn't be bothered.
NICON: He's busy.
CP: Yet he's coming into this very room in a matter of minutes.
NICON: Yes.
CP: I'll send you my bill. I should at least receive a consulting fee or MTM credit or something for your shenanigans.
NICON: I'll bring you doughnuts.
CP: Only if you pronounce them "Duff Nuts".
NICON: Why?
CP: Dough as in "rhymes with tough"; although I'd accept Dough as in "rhymes with cough" too.
NICON: I wish my prescriber was as phun to work with as you.
CP: Come to the Dark Side.

FOR The Win!

Is it possible for a product to be used FOR a purpose while also, simultaneously, being used for its opposite purpose?
Just because of how my brain works, and the fact that I like to mess with my colleagues' heads, I often initiate conversations with my partner at work just to watch the brain squirm. So it is with this topic:

CP: What is the definition of "insomnia"?
CP's Partner: Insomnia is defined as "an inability to sleep".
CP: Precisely. Now, if I received two prescriptions for Ambien, and labeled them as follows, could they both be considered correct?
1. Take 1 tablet at bedtime for sleep.
2. Take 1 tablet at bedtime for insomnia.
CPP: Um.
CP: Another example would be any medication prescribed for blood pressure:
"Take 1 tablet once a day for blood pressure."
Does this mean that without this medication, the patient would have NO blood pressure?
CPP: Please stop. You know what they mean.
CP: Yes. They mean to treat High Blood Pressure. But that is not how the label reads. It simply says "FOR blood pressure."
CPP: Point conceded.
CP: I have another one for you.
CPP: Stop.
CP: Condoms.
CPP: What about condoms?
CP: Thinking about the Ambien examples, focus on these directions:
1. Use 1 condom for babies.
2. Use 1 condom for prevention of babies.
CPP: But . . .
CP: Yes?
CPP: That makes by head hurt. Please stop.
CP: Nope. I'm on a roll now. I have one more.
CPP: I feel sorry for your family. They have to live with you.
CP: Diarrhea.
CPP: Okay. Last one. Get it over with. What about diarrhea?
CP: If a patient asks for a medication for diarrhea, what do you recommend?
1. Take 1 tablet of Imodium for diarrhea. or
2. Take 1 bottle of Golytely for diarrhea.
One treats it and one causes it. They cannot both be correct, yet the products would be labeled correctly if I put "for diarrhea" on each.
CPP: Does your brain ever cramp? What do you feed the chipmunk running on the wheel in there? Red Bull and Starbuck's?

The Death of Professional Judgement

In the immortal words of Korben Dallas, "I am a meat popsicle". This answer shall suffice in response to any question concerning a pharmacist's job responsibilities.
Why?
Pharmacy schools (apparently) no longer teach "professional judgement" or companies have basically policied it out of existence. The new mantra is: "Don't Think For Yourself!".

CP: Why can't I just use my professional judgement, that with which I was naturally blessed as well as professionally paid to have attuned, to make a decision?
ME: Because you're not allowed anymore.
CP: Why am I not?
ME: Policies. You are a meat popsicle. You are a button pusher. You do not get paid to think.
CP: In what dystopian novel did I just awake?
ME: None. It is the era of Big Brother. It is the era of micromanaging. It is the era of fear of lawsuits. It is a direct result of ISIS and terror threats.
CP: Huh? How can you associate my using my collegiately enhanced brain and years of experience to make a professional decision to that of terror threats?
ME: What are you trying to accomplish?
CP: I wish to change an e-script from Proair to Ventolin because this patient's State Medicaid plan changed and they have a new formulary.
ME: Not allowed. They are totally different.
CP: Okay. How about Amoxicillin or Doxycycline? The insurance only cover tablets as opposed to the capsules, or vice versa. I simply wish to change the dosage form and provide service to my patients.
ME: No can do. That's practising medicine. Prescribers are infallible and there must be a reason they selected the exact option they did on their e-script software.
CP: You mean the software that doesn't make them choose Doxy Mono or Doxy Hyclate?
ME: The same.
CP: You mean the prescribers that have become so irritated with whiny pharmacists wasting their time over the last 5 years that they have changed their prescribing habits on their electronic devices?
ME: How so?
CP: Now we receive what would pass as passive-aggressive threats on any social media.
"Doxycycline 100mg, don't care what salt form or if it's tabs or caps. I just want the patient to have what's covered. Don't call me unless all forms of Doxy are not covered and rather expensive. Again, I. Don't. Care! Stop calling me."

or . . .

"Albuterol inhaler. They're all the same. I don't care what the package inserts say. So the patient switched insurance. Fine. Then they can switch inhalers. Albuterol is Albuterol. I. Don't. Care! Just stop calling me!"

or . . .

"Amoxicillin 500mg tabs to take 1 capsule 3 times a day. Look, if I were to hand write this prescription, I'd not put tabs or caps anywhere on it. It's not my phault the software makes me pick one and for some reason the sig does not match. Unless the patient has a gelatin allergy, I don't care. And you'd probably know more about that than I."

or . . .

"Prednisone tapers. Look, I tried to quickly figure out how many I would need to prescribe but my math skills suck and they make us use the computers for everything. Just give the patients what they need and we can all be happy. I Love You! You are the most helpful, underrated profession and we need to thank you more for saving our asses."

ME: So what's the real problem?
CP: New(er) pharmacists are so worried about everything that they cannot think for themselves. (I had an e-rx for a cream with directions to "apply 1 tube twice a day" and another for FeSO4 325mg with directions to "take 1 milligram once a day". A real life pharmacist refused to approve them when I corrected them to "apply twice a day" and "take 1 tablet once a day", respectively.) I have offsite pharmacists, that's PHARMACISTS (people with licenses like mine), that refuse to check or approve prescriptions like this. I see comments from pharmacists on my posts every day that echo the fear factor present in our profession. Too many times have I read "I have to call" or "I'd call on that" instead of "My alma mater and past preceptors trained me to use my brain and make this decision all on my own. It's my license and I earned it and I am damn well going to use it".
(Obviously, there are instances where we HAVE to call. Our educated brains tell us to do so. But not for many of the more trifling, petty situations I see all too often.)
ME: So ...?
CP: So we bitch and moan about being treated as equals; as peers; as knowledgeable professionals all the while calling and asking stupid questions.
ME: But won't your stupid questions cause the prescribers to change their habits?
CP: Yes. They now write notes telling us not to call. Rather than solving the serious problems, we annoyed them with petty grievances and now they don't take us seriously.
ME: What do you want?
CP: I want my profession to grow back its spine. Document your actions and thoughts and calculations on the hard copy then fill it accordingly. We are so afraid of an error, an inspection, a policy violation, an audit that we forget how to actually do our job. You didn't go to college to live in fear. You went to be a respected professional. Now grow up and be one.
ME: Tough words.
CP: Tough Profession. We fight everyone else; it makes no sense to fight ourselves.
ME: I think I love you CP.
CP: I know.

No One Is Available To Take Your Call

Patient of Irrational Expectations: Why is my medication so expensive?
CP: Baby needs diapers.
PIE: What? You always do this to me.
CP: Do what?
PIE: Overcharge me. You're supposed to be matching my price.
CP: Did you tell me that when you called in your refill?
PIE: No. You should just know.
CP: Yes. As you are the only patient keeping my business afloat, I know yours is the one prescription on which we match prices. Whom are we matching?
PIE: It's that independent across the street.
CP: Ah yes. "We Be Druggists". We purchased them 4 years ago when their pharmacist retired. With a name like that, it's no wonder they went out of business.
PIE: And you're supposed to be matching their prices.
CP: But they went out of business. Four years ago. We bought them. We have their phone number too.
PIE: I just want you to match their price.
CP: Would you like me to call them?
PIE: Yes!
CP: <puts phone to ear and dials the old "We Be Druggists" phone number>
      It's ringing.
      <picks up other line and holds it to other ear>
   CP: Hello?
   CP: Hello?
   CP: I'd like to get a price quote.
   CP: Sure thing.
   CP: How much is this prescription?
   CP: $31.38
   CP: How much do you charge?
   CP: Wow. We charge $31.38 as well.
   CP: Wow. Miss PIE wanted us to match her price.
   CP: She's a little demanding, but she's sweet. Tell her I miss her.
   CP: Will do.
PIE: What did they say?
CP: He said to say "Hi!" and that he misses you and that the price is the same as what we're charging.
PIE: How can that be?
CP: Must be inflation or something. Apparently the cost of being closed has gone up over the last 4 years.
PIE: Fine. I'll pay it today. But you better check all my prices with them in the phuture.
CP: Yes, ma'am. Just remind me before you come down to pick up your prescriptions. They're not always this easy to reach.
PIE: Will do.

Commodious Quim?

Pt: I need a refill on my vaginal cream.
CP: Sure thing. Wait. It's too soon.
Pt: What do you mean?
CP: Well, for starters, your insurance denied it because we filled a 90 day supply 21 days ago.
Pt: What's that mean?
CP: According to the directions we have, this should have lasted you at least 80 more days. It says: "insert 1 gram vaginally 2 days a week". We dispensed a 30 gram tube. That's a 15 week supply, or 105 days, whichever you prefer.
Pt: But I'm out.
CP: Okay. How are you applying it?
With a paintbrush? Like Jackson Pollock?
With a caulk gun? (ha ha)
Until full? (How deep is your love, by the Bee Gees?)
You squeeze the tube from the middle, don't you? . . .


http://gph.is/1fsLTO5

But Metrics I Met

It's like they don't care bout nothing man.
Do another MTM yea (ooh ooh ooh).

La da da da da da, Da daaa.
La da da da, La da da da, La da da daaa

I was gonna fill your scripts, but metrics I met.
I was gonna count the pills and label them too but metrics I met.
Your script is not done yet and I know why (why man?) yea hey,
Metrics I met
Metrics I met
Metrics I met.

(La da da da da da da da da)

I was gonna counsel you till metrics I met.
Given you advice about side effects but metrics I met.
(La da da da da da da da da)
I couldn't spend enough time with you then and I know why (why man?) yea hey,
Metrics I met
Metrics I met
Metrics I met.

(La da da da da da da da da)

I shoulda been helping you, but metrics I met.
Find the TP out on the floor but metrics I met.
They don't measure that type of service and I know why (why man?) yea hey,
Metrics I met
Metrics I met
Metrics I met.

(La da da da da da da da da)

I was going to pick up the phone but metrics I met.
Answer your questions and talk to you but metrics I met.
Now I'm getting a customer complaint and I know why (why man?) yea hey,
Metrics I met
Metrics I met
Metrics I met.

(La da da da da da da da da)

I was going to take your script from you but metrics I met.
Figured I'd scan and type it too but metrics I met.
(La da da da da da da da da)
Now my times for my queue are blinking red and I know why (why man?) yea hey,
Metrics I met
Metrics I met
Metrics I met.

(La da da da da da da da da)

Now I don't get to go home until metrics I've met.
And I can't do any other work until metrics I've met.
Not getting a bonus this year and I know why (why man?) yea hey,
Metrics need met
Metrics need met
Metrics need met.

(La da da da da da da da da)

Lower Your Expectations

Explain your problem to me.
I will address the issue and attempt to phix it.
Once I have reached a conclusion, I will present it to you.
Whether or not it is satisfactory is not my problem.
It is, however, the answer, and continued arguing on your part will not change the results.
Think of it as yelling at your TV after the other team scores. Or yelling at the scientists because their science disproved your personal beliefs.

CP: How may I disappoint you today?
Dude Wants A ReFund: I have this discount card and I want a refund.
CP: Okay. Where and when did you get it?
DWARF: The Other Pharmacist at another store gave it to me. I'd been paying $500 a month for this because my insurance won't cover it. She told me the drug rep came in and left these cards. She was able to give me money back.
CP: Okay. I will try. We filled this only one time for you, in April. I'm not sure it will work.
DWARF: She said if you have a problem, just call her. All you have to do is change it to this card and give me a refund.
CP: That's all, huh? Did you activate the card?
DWARF: No. She took care of everything.
CP: Okay. <makes magic in the computer. pushes buttons. pulls levers. bells and whistles sound like it's a Willy Wonka computer system>
DWARF: That sounds promising.
CP: Unfortunately, the results were negative. We lost him, sir.
DWARF: What do you mean?
CP: She activated this card on 15th May. We filled your prescription 15th April. In other words, we filled the prescription before coverage was active.
DWARF: So I'm just out $100.00?
CP: Technically you've been out $500 for the last couple months. That would be like playing the lottery and when your numbers don't hit, complaining to the lottery commission that you're out the multi-million dollar jackpot. You didn't have to buy the lottery ticket any more than you had to buy the prescription.
DWARF: <stink eye> She said you'd be able to do it. She did it.
CP: She did because she activated the card on the day she filled your prescription. If you have new insurance that won't take effect until August, they won't retroactively pay for things before you were covered under their policy. If I have to purchase a new washer and dryer in August, I can't invoke the Memorial Day sale that Lowe's held just to get myself a discount. "But I didn't need to buy them when they were on sale. You need to give me that price today, three months later."
DWARF: You don't need to explain it to me.
CP: Usually people stop arguing with me by now. You're still standing here with a look of incredulity on your face and trying to get me to change the fact that the discount card denied the claim.
DWARF: This is why I don't come here.
CP: Actually it is because you live across town and we were the only pharmacy that had that strength in stock on the day you needed it. Sometimes, even @TheOtherPharmacist can be wrong.

How Long ...

... is the wait?

CP: About 10 minutes. 

Pt: 10 minutes? 

CP: 10 minutes. 

Pt: You said 10 minutes? 

CP: Did I stutter? Is there another way to interpret "10 minutes" other than as "10 minutes"? Is there some metric conversion you are trying to perform so you keep repeating it aloud while mathing? 

Pt: You said 10 minutes. 

CP: I did. I was wrong. It's not 10 minutes. 

Pt: I knew it. 

CP: What I should have said was: Assuming all things go according to plan and we are not invaded, overrun, or otherwise turned into zombies or wights, and your insurance information is correct and they decide to cooperate and not deny your claim for any reason, and if the status quo remains as quotidian as the rest of my day so far and no one causes "scriptus interruptus" while working on your order then, and only then, shall my estimated wait time of approximately 10 minutes prove to be accurately precise. Or precisely accurate. Either way, the clock shall not drop until I have ceased speaking with you so you may continue to delay the onset of action or effectively move yourself aside so the countdown starts. The tension mounts ...

Pt: On with the body count?

CP: Ice-T! 

Pt: Lemonade!

CP: 10 minutes. 

Pt: Phine. 

Bored Today?

Did you ever wonder what some people must do with their days? When I am scheduled to work my plan is to go to work. When I am home, I make plans according to what needs done around the house or in my life. Based on some of the answers I receive from patients during conversations, I wonder ... that's it. I just openly wonder; mouth agape in awe at how life happens.

CP: You have a prescription to pick up.
Pt: What's it for?
CP: Why did you go to the doctor?
Pt: <shrugs shoulders>

---

CP: Let's play pretend again. I'll be the patient and you be the serious pharmacist.
CP's Partner: Okay. Definitely role playing.
CP: Let's do the "nothing better to do" sketch.
CPP: Got it. Ready?
CP: Ready. What are your plans today?
CPP: I'm going to Home Depot to find some plants for my garden.
CP: Sounds lovely.
CPP: What about you?
CP: Not sure. I think I'm going to the Walmart to people watch and pick up a few things, get an oil change, then I was thinking about swinging by my prescriber's office.
CPP: Why your prescriber's office?
CP: It's on the way and I want to see if anything is wrong with me. Maybe I could use a few tests, like a tuneup on my truck. Maybe I'm due for some refills or even some new prescriptions I haven't even taken before. You never know.
CPP: You can't just make an impromptu trip to your prescriber. It's not like going to the mall and window shopping. Or going to Home Depot to get inspiration for your yard.
CP: Why not? How do I know I don't need something if I don't have them rule out something to give me?
CPP: That makes my head hurt.
CP: How else do you explain so many people taking prescriptions for conditions they don't even know they don't have?
CPP: Stop it.
CP: You called to remind me to pick up my prescription. I asked what it was. You asked why I went to the prescriber. I don't know. I just randomly walked in off the street in between my oil change and getting a new iPhone and had the prescriber look at me. He uttered some medical mumbo jumbo, said he'd send prescriptions to a pharmacy, and here I am, hours later, expecting to retrieve them.
CPP: That's not how it works though.
CP: How not?
CPP: No one goes to the prescriber on a whim. Something is wrong, you go to the doctor. If it ain't broke, don't phix it.
CP: What about scheduled maintenance?
CPP: You're not a car. And that excuse is flimsier than what most patients would say in this scenario.
CP: I can't think of what they'd say. There seems to be no logical reason to why these people go their prescribers other than "we had nothing better to do".
CPP: This is why we lose every argument we have with them.
CP: They don't remember anything being prescribed for them. They don't remember having visited their prescriber in the last two weeks. They seem genuinely surprised when we call to tell them they have medications ready. Yet when we ask why they called or went to the office, all we get is "I don't know".
CPP: Must have been bored and had nothing better to do...