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Monday, July 31, 2017

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. 

Thursday, July 27, 2017

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.
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.

Wednesday, July 26, 2017

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.

Sunday, July 23, 2017

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.
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".
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.

Wednesday, July 19, 2017

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?

Thursday, July 13, 2017

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.
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.