Facebook and Twitter

and follow my blog on Twitter @pharmacynic to receive notifications on new posts.

Monday, November 27, 2017

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.

Tuesday, November 21, 2017

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?
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."


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. 

Friday, November 3, 2017

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.