Lame Pharmacy Jokes, Again

Insulin Using Dude: I need to get my diabetic stuff refilled.

CP: Ok. What do you need? 

IUD: My supplies. 

CP: Needles? Strips? Lancets? 

IUD: I think so. I'm not sure. 

CP: Ok. I'll get it all ready. Your copay total will be $175.00. 

IUD: That's a lot. 

CP: Do you need insulin? 

IUD: No. I have some left. I really can't afford all of those today. 

CP: Well I can't choose for you. What are you currently out of? 

IUD: I have enough insulin for the weekend but I need the needles to make it work. I can't take it all right now. 

CP: Got it. You can't take it all right now. So. . . 

IUD: So what? 

CP: Just the tips?

Uber-Intern: That was so wrong.
CP: I know.
UI: What's really phunny is that people won't believe you actually had this conversation recently.
CP: It's phunnier because it's true.
UI: Another phor your "lame joke" file, I assume.
CP: Indeed. 

Big Shoulders

--8:31am--
CP: I see that we received a new Rx for DAGWOOD for his Lexapro 10mg.
Uber-Tech: Yeah. He called the other day looking for it.
CP: I'll have to counsel him. It appears as if they changed him from his previous fill of 20mg. I wonder if they're tapering him off it, replacing it eventually, or adding something new.
UT: I'll let you know when he arrives.

--11:38am--
Deserved Aged Guy Wanting Of One's Drugs: I am here to retrieve my new Rx.
UT: Sure thing. CP has a question for you.
CP: Your prescriber sent over a new Rx today.
DAGWOOD: I know! I've been waiting for days.
CP: Right. This is for 10mg. Were you expecting a change in dose? You had been receiving the 20mg for months now.
DAGWOOD: Yes. My new Rx is supposed to be for 10mg.
CP: If you have some of the 20mg remaining you may halve them should you choose not to waste them. Or you could hang on to them should you go back to that dose.
DAGWOOD: Thanks.
CP: Enjoy your new 10mg Rx.
DAGWOOD: I will, now that I finally have it.

--1:33pm--
<phone rings>
CP: Chello?
DAGWOOD: You gave me the wrong ones!
CP: Really?
DAGWOOD: YES! It's supposed to be 20mg.
CP: Ok. Well you'll have to get a new Rx from your prescriber or you can double the 10mg you received earlier today.
DAGWOOD: You should just give me a new bottle for free.
CP: You're cute, and funny. I realise it's Christmas and all but. . . How do you figure?
DAGWOOD: It was your mistake!
CP: <laughs>
DAGWOOD: I fail to find humour in this!
CP: And I fail to find logic in your, um, logic. You received a new Rx with a new dose. We verified the drug, strength, and dosing with you during our consultation at pickup. You verbally replied "yes" to each question; that you knew there was a change made. At what point is this my fault?
DAGWOOD: Why would my doctor change it?
CP: That's why we ask. Typically we don't make your office visits with you. We expect that you actually attend your scheduled appointments, have a discussion with the office, then leave with either an Rx in hand, or assertion that one will be transmitted for you anon.
DAGWOOD: Well what do I do now?
CP: Have your hearing tested. We had a conversation, you and I, during which you actively participated. You then complained your prescriber changed your medication unbeknownst to you. I then explained that you should call your prescriber and that you could double the 10mg Rx you received just hours ago, if you believe the 20mg should be correct. I'm pretty sure the common denominator here is your ears.
DAGWOOD: So you're not giving me more?
CP: No. I have given you all that you need. Merry Christmas!

UT: That was rough.
CP: Yes. After this conversation, I'd swear I was talking to a millennial. They don't know how to find answers. They want to know all the answers, but they don't know what to do with them once they have them and, worse yet, they don't know how to find them unless you directly stick their noses in it.
UT: Bad dog!

How To Bring Down Satan

like al capone and tax evasion

little things: 

-state audits

->180 days from written date (state dependent)

-ins billing fraud 

(misbilling/labeling/branding, esp OTC NDCs)

-not calling to verify rx's

-Just put them on auto refill
 -we're filling old drugs/strengths/quantities/days supplies which adds time because we now have to enter notes to counsel at pickup about which is correct. or the system tries to fill old rx's from many months prior for no reason

She's Just Not That Into You

ME: What's today's topic, CP? 

CP: Masochism. 

MYSELF: Come again? 

ME: <titters>

CP: As in "a taste for suffering".

ME: Odd. 

MYSELF: Not odd. Totally normal. 

CP: Anyway. I was reading complaints people had sent me and hearing their stories about how their bosses were telling them to apologise. I remembered a few of my personal complaints where people were being assholes to my techs despite repeated warnings from ME. 

ME: I like to give them a chance to realise their behaviour is not welcome. 

CP: If I have to step in, it's their last chance. If they have a problem with me, then decide to complain, our relationship is over. 

MYSELF: What does this have to do with suffering? 

CP: As I was reading the latest complaint about a situation where following the law trumped the patient's desires, I asked MYSELF "Why do we work so hard to retain people who hate us?". 

MYSELF: To which I replied "good question". 

CP: People will write bad reviews, call after every visit and complain, or cause a scene. Go away. Maybe something will change. Maybe. Take some time off from here. You can always return in the phuture. 

ME: It's like going to a restaurant, getting bad service, and continuing to go there, and continuing to give them severely negative Yelp reviews. 

MYSELF: Better yet, it's more like being in a toxic relationship. Sometimes you just need to break up with your SO. It's not working out anymore. If one partner or the other is abusive, GTFO. I'm pretty certain your phriends aren't going to stand behind the abuser's behaviour just to watch you suffer. 

CP: Precisely. Which then begs the question, If only a baby's handful of patients are unhappy, why are we focusing so much time, effort, and energy on making them less unhappy? Shouldn't we focus these resources on the people who actually like us? Wouldn't that be more impactful? 

ME: As you put it to me: "If we keep bad people, we will both be miserable".

MYSELF: You're right. That makes no sense. 

CP: Negativity is infectious. We don't try to make the cancer happy and comfortable so it can continue to grow in peace before ultimately destroying us. We excise it. 

ME: I think next time this happens, you should respond to the complaint with a TV show sendoff. 

CP: Dear patient, thank you for voicing your concerns, again, about how we don't have a drive-thru, how you get too many/few calls/texts, and how our business hours are not convenient for you despite being open 84 out of 168 hours a week. After a store conclave, we have decided to vote you off the island. 

#TheTribeHasSpoken

#YouveBeenChopped

#PleasePackYourKnivesAndGo

MYSELF: That'll probably get us a complaint. 

ME: #GoodDay

#IfWeKeepBadPeopleWeWillBothBeMiserable

Honesty

ME: What's new this week, CP?
CP: Just thinking about something a patient said to me last week.
MICE ELF: Oh? Do tell.
CP: He said "I like you."
ME: Was he high?
CP: No. He continued by saying that he liked my honesty.
MICE ELF: I suppose that is a worthy attribute to which many professionals should aspire.
CP: But he qualified it with: "You're direct. Some people don't like that and take that as being arrogant but you don't sugarcoat the truth. It may not be what they want to hear, but you simply restate it for them."
ME: Nice.
MICE ELF: Why were you reflecting on this nice compliment?
CP: I've always believed in being honest. Whether it's the brutal or plain kind, giving the facts is the best course.
ME: You have a need to be right, don't you?
CP: Perhaps. I just don't let people's emotions interfere with my facts.
MICE ELF: Was this that transfer from last month?
CP: Yes.
ME: About the guy who argued with you?
CP: Yes.
MICE ELF: Why were you reflecting on that particular interaction?
CP: His mom came in the other day and tried to get a refund. We explicitly told her, if she paid cash and bypassed the insurance, there was a good chance we could not refund her; especially if the prior authorisation was not backdated. Not only were the prescriptions transferred to another pharmacy, but the insurance changed from the previous month and it had been over 5 weeks since they picked up the prescriptions.
ME: So he sent his mommy in to face you?
CP: Which made me think: I love being honest. It gives me great pleasure when people are so embarrassed about making fools of themselves that that is the reason they transfer.
MICE ELF: How did his mommy respond?
CP: She was obviously unhappy and kept trying to provoke me. I kept repeating the facts and gave her a stern "I-told-you-so" about her assuming all the risk by paying cash which, at the time, she swore he needed "or he'd die".
ME: How'd that go over?
CP: She tried again to make me feel guilty for charging cash to someone who had insurance and that I should have known not to charge them. I told her "you can't have it both ways: either he's going to die without his Trazodone or he isn't. You made the choice to pay cash thereby making the decision for me. You can't say I took advantage when I advised against your decision".
MICE ELF: To which she replied?
CP: Something along the lines of the punchline to the Benzonatate joke.
ME: Why are Tesslon Perles prescribed?
MICE ELF: Fuh Cough.
CP: Pretty much. But there wasn't much venom behind it. It was a half-hearted attempt at best.
ME: He really transferred out of embarrassment?
MICE ELF: Then sent his mommy to fight for him?
CP: Yep. At least I like to believe that's the reason. I've had it happen a number of times.
ME: Classic.
CP: Remember, just because you don't want to hear it, that doesn't make it any less true.

I Saw It On Da Google

CP: Hey Uber-Tech. It's only 9:01 and I don't have a headache yet. Something's amiss.
UT: Wait for it.
<phone rings>
CP: CP's Drug Domicile. This is CP, Drug Dealer Du Jour. How may I help you?
NAME: There's this drug that used to be prescription but now it's OTC. Do you have it?
CP: Can you be a tad more specific?
NAME: You have to ask the pharmacist for it.
CP: I don't have to ask for it. I'm a pharmacist. That would be a weird conversation, me talking with myself.
MYSELF: <ahem!>
ME: <shhhh>
NAME: That's all I know.
CP: Well the list is rather long.
ME: Like these posts.
CP: Pretty much everything in our OTC section was, at one time, a prescription medication. How about a class? Indication? Use?
NAME: It's spelled something like "B" and "U" or "O" or something.
CP: Helpful. Where did you see this product?
NAME: Online. They said you have to ask the pharmacist for it. I remember that.
CP: So you remember what it's for and how to get it, yet, when it comes to the critical part, "Ask the pharmacist for it by name", you can't remember the name?
NAME: You're the pharmacist. I thought you'd know.
CP: Did you happen to see anywhere else you could get it? Or try Amazon? Da Google?
NAME: No. It used to be prescription though.
CP: Do you remember the ingredient?
NAME: Yes. Hyo-Something.
CP: Then why don't you ask your prescriber for that?
NAME: Damn. I never thought of that. She'd do it for me no problem!
CP: Lucky the office has people to answer the phone for her.
MYSELF: Yeah. I feel bad for that secretary.
UT: Need that ibuprofen now?
CP: You mean the former Rx, now OTC, NSAID? Please!

(For the record, after some online research, it turned out to be Buscopan. Available in the UK but not in the US.)

I miss the old commercials that told people to "Ask for it by name". Hell, even Meow Mix ran a commercial that said "cats ask for it by name". If your cat can do that, shouldn't you be able as well?

#PeopleSeeWhatTheyWantToSee
#PeopleHearWhatTheyWantToHear
#TheDevilIsInTheDetails

Did You Though?

Saying "I watched him send it" is like saying "I watched him paint my portrait".
Sure, you sat there for the portrait.
Sure, he looked at you, dipped his brush in the colours on his palette, and placed some strokes on the canvas.
But did you actually SEE what he painted?
Especially odd if your artist was Dali, Escher, or Picasso.

Sure, you sat there facing him while he tapped his fingers on some keys on the computer.
But did you actually SEE what he typed?
Did you watch him select MY pharmacy?
Did you actually SEE the confirmation on the screen?
He could have been making lineup changes to his fantasy teams, moving the money from your visit into his "new car fund", or making dinner reservations.
Especially odd if you see Dr. Acula or Dr. Lechter.

"We only see what we want to see."

Boss Woman

CP's Partner: Did you listen to last month's conference call?
CP: I heard it, but I did not listen to it.
CPP: Did you hear Boss Lady Orating Words Making Excuses?
CP: I try to tune her out. If she says something important, I tell the techs to say BLOWME is calling on you. What did BLOWME say this time?
CPP: She issued one of her more contradictory statements to date.
CP: Do tell.
CPP: You know how we continue to lose hours and we can't seem to get ahead and our complaints are on the rise?
CP: Nope. Hadn't noticed. But please, continue for the others.
CPP: She said "I'm tired of hearing about staff and hour shortages".
CP: Please tell me someone said "Good! I'm tired of answering to patients about why we are behind, BLOWME. It's about time you finally did something about it!"
CPP: Alas, no one did. You really need to pay attention to these calls.
CP: Can't wait to see what next month's call is about. She reduced our staff budget by 33% during the holiday week and 10% for the week after. Our volume will not go down by the same amount just because some corporate pencil pusher thinks it will. I have yet to work a Thanksgiving week that fills 33% fewer prescriptions than a normal week.
CPP: Yeah. And let's not forget that the Monday after Thanksgiving is often one of the busiest days of the year. Good time to make cuts.
CP: Maybe they forgot the holiday is the very end of the month? Or that the following Monday, it's the first of the month?
CPP: <so cash your checks and get up!> This is how they contribute to their Christmas Club fund at corporate.
CP: Oh well, next time BLOWME decides to tell me she doesn't want to hear it, expecting it to just go away, I will remind her she can't just put her fingers in her ears, close her eyes, and mutter "lalalalalalalalalalalalala"and everything will get better. In fact, I will probably say, BLOWME, if you can ignore that which you no longer wish to hear, then I no longer wish to hear you complain about my performance, so I too will employ your tactics and ignore them. You're such a good leader, BLOWME, that you have taught me how to be a better boss in my own store so, BLOWME, I shall follow your example. Good day, BLOWME!

To quote a favourite author of mine, Caitlin Doughty, "But it's also reality, and reality doesn't change just because you don't like it."

Order Up

Uber-Tech: I'm phrustrated, CP
CP: As am I. Why don't anal, banal, and canal rhyme?
UT: I loathe you.
CP: Sorry. Continue.
UT: Why are patients not prepared when they come to the pharmacy? Especially the drive-thru?
CP: Is this rhetorical? Or a metaphor for life?
UT: A metaphor. I need to learn your language to communicate with you.
CP: Proceed.
UT: A patient orders a refill and we confirm a refill is ready when they arrive.
CP: Okay.
UT: They then have the nerve to ask "where are my other 3 medications?" or complain that we filled the wrong one.
CP: True. This happens with pretty much every interaction. What's your analogy?
UT: This would be like going to Chik-Fil-A and ordering a Spicy Chicken sandwich and a lemonade. When the perky cashier repeats your order immediately back to you ("that's one spicy chicken sandwich and a lemonade") you confirm it and await its delivery. THEN, when the order is set in front of you, mere seconds after being placed, you proceed to argue and complain about its inaccuracy.
"Where are my nuggets? And the waffle fries? And my chicken strips? Every time I come here you can't get it right!"
I just don't understand how patients become such vacuous oafs when they arrive at the pharmacy.
CP: I see the rest of the conversation happening as -
   Impatient Mad Patron: "Why didn't you give me waffle fries?! It's not a meal unless you include the      waffle fries!"
   UT: You didn't order waffle fries, or a meal.
   IMP: I never have this problem at Wendy's!
   UT: Well this isn't Wendy's and they don't serve waffle fries, so there's that. If you could just park in the little "drive-thru parking" spot to your left, I'll get those waffle fries right out to you.
   IMP: Now I have to wait? Nope. I'm sitting right here.
   UT: Well either way, you're going to wait. It's either here, blocking my drive-thru, or up ahead where I will bring them out to you.
UT: Yeah. Except that doesn't happen at Chik-Fil-A. Or anywhere else for that matter.
CP: Manners and decorousness seem to evaporate as soon as patients near a pharmacy. I like your new term for them, Vacuous Pharmacy Oafs.
UT: Thanks. I think we're going to have to start referring to them that way whenever we have a call/issue/complaint. "CP, there's a VPO for you at the DT".
CP: Love it!
UT: Oh, and I have one of those anagrams for you too.
CP: Go on.
UT: You know all those vacation commercials for Sandals?
CP: Yes. Quite picturesque.
UT: If you rearrange the letters you get "ASSLAND".
CP: Nice. Changes my image of those honeymoon ads.
UT: Sounds like Eden for all those VPO's.
CP: Indeed.

I Know What I Need

CP: Oh baby, I. . . I know what I need.

Uber-Tech: Why are you bastardizing songs again? 

CP: For this little vignette

CP: CP's Pharmacy. This is CP, Proprietor and Head Pill Pauper. How may I help you?

Can't Understand News That I'm Sharing Here: I'm calling to see if my prescription is ready. 

CP: Over the phone? 

CUNTISH: Yes. 

CP: How can you "see" if it's ready over the phone? You should come in for that. 

CUNTISH: I wish to know if it is ready. 

CP: AH. That makes more sense. Name, DOB, favourite author?

CUNTISH: Um. CUNTISH, 5/5/75, Seuss?

CP: Got it. Thanks. Unfortunately I have nothing ready for retrieval. 

CUNTISH: Why the hell not? 

CP: Many reasons, I suppose: We didn't feel like filling anything for you; we blackballed your order; you didn't call it in; you opted out of on-time refills; you're out of refills; the prescriber didn't call in anything yet; you have the wrong pharmacy; it's Wednesday; Mars isn't in retrograde; I have a headache; APhA still sucks. . . 

CUNTISH: Yeah yeah yeah. Just fill my prescription. 

CP: Now that you have called and politely requested I prepare your prescription, I shall fill it forthwith. 

CUNTISH: You mean to tell me that if I hadn't called, you wouldn't have filled it? 

CP: Pretty much that's exactly what I said. That is how the system works. 

CUNTISH: <scoffs> Unbelievable!

CP: Why unbelievable? I don't send money to places that don't send me bills. Even babies cry for attention. They cry to be fed, to be changed, to be held and it's up to you to determine what they need when they cry. A happy, quiet baby is usually sleeping and doesn't need to be stirred and asked "are you hungry? do you need changed? wanna play?" or it gets a little angry and now you have to phix a problem you created. Unless and until you cry to be fed, I'm not going to harass you begging to fill your prescriptions. Now a corporation may text and call and email and do drone flyovers begging for your business, annoying you, but a happy, quiet you is not of my concern. Unlike a newborn, you are fully capable of operating the technology required to contact me, use your words, and ask for a refill when you notice your ba-ba is empty. Grow up!

CUNTISH: <click>

UT: Wow. Nicely done. 

CP: Adulting is hard. I often wonder what these people do when the supplies in their refrigerators are exhausted. Or the gas in their cars. 

UT: Toilet paper. Can't you just hear them in their bathrooms screaming for help, or calling Charmin asking why they weren't told they only had a single square to spare and how last night was Taco Tuesday?

CP: I should rerun my "But Her Refrigerator Was Still Running" post. 

UT: Still one of my faves. 

I Felt Better

CP: CP's Palace of Pills and Potions. How may I help you? 

Not Enjoying Withdrawal Symptoms: I have a problem. 

CP: You have a problem? She turned me into a newt!

NEWS: A newt? 

CP: I got better. Anyway. You were saying? 

NEWS: I was taking medication for my sciatica. And it helped. 

CP: Good news. What's the problem with it working? 

NEWS: I felt better so I stopped taking it. 

CP: I see. Let me guess. . . it stopped working when you stopped taking it? 

NEWS: Yes! Now I don't feel as good. And I have these terrible withdrawal symptoms. 

CP: Makes sense.  

NEWS: Why? I got better. 

CP: You weren't treating the disease, you were only blocking the symptoms. You got better BECAUSE you were taking the medication. You quit taking the medication and, ipso facto, it stopped working.  

NEWS: How's that? 

CP: Pretend you're a car. 

NEWS: What kind? 

CP: A Yugo. Doesn't matter. You fill it with gas and drive around town. You stop by the local pharmacy, then the grocer, then head off for a picnic in the country. On your way home, the gas tank runs dry and the car stops. Is there a correlation between the gas tank and why the car stopped working? 

NEWS: So you're saying that because I didn't put my medication in me, I didn't run?

CP: Succinctly, and oddly, disturbingly, visually stated. 

NEWS: Can I start taking it again? 

CP: Fill 'er up. 

Uber-Tech: Is there any situation you can explain to a patient without a scenic analogy? 

CP: No. Why be boring? Besides it's easier for people to comprehend something they already understand than it is to teach them something novel for which they have no prior experience to apply. 

UT: You are rather wordy. 

CP: I prefer loquacious. And she had her "aha!" moment. 

UT: We're talking away. 

What's Right Is Right

CP: You know how we see prescriptions from prescribers that make us look at each other and ask if they even know what they are prescribing?
CP's Partner: Yes. Or if they just heard about it on TV, or from a patient who heard about it on TV and the prescriber shrugs and says "let's give this a go".
CP: Right. On the flip side of that, we have medications that we just KNOW the correct way they should be written.
CPP: True. There are a certain number of medications that we can tell by a glance are correct, are completely boffo, or that need a little of our professional massaging. We are the experts after all. What happened to initiate this conversation, again?
CP: My last weekend. I had another of those arguments with central processing.
CPP: Is this another one of those "not to denigrate another professional, but. . ." issues?
CP: It is. I like to think that we as pharmacists know the same things. Certainly there are specialists within each practise location. An expert in retail may be a novice when transitioning to hospital, or the reverse could be true. But I would expect a similar level of competence from a peer in my practise location.
CPP: Okay. What happened?
CP: You know how the central pharmacists review our prescriptions after they've been typed?
CPP: Right. They have a few dozen stores they help with verification.
CP: Since we aren't supposed to be typing and checking our own work, I entered a prescription so it would be worded correctly as the e-script left a lot to be desired.
CPP: Makes sense. You are the responsible pharmacist at the end of the day. I'm guessing this didn't go well?
CP: Nope. It was rejected. By a Pharmacist. Because the directions I typed did not match verbatim what was sent on the e-script.
CPP: Okay.
CP: To make matters worse, I sent it back through, he rejected it again. I sent it a third time, he again rejected it. Finally, I selected "local" and finished it myself.
CPP: I'm guessing that's not the end?
CP: No. I took the package insert out of the box, enlarged the directions, then faxed them to him and his boss and our boss.
CPP: What did she say?
CP: Nothing. Just shrugged and said "we have no control over the central processing center".
CPP: So they are making more work for us instead of helping?
CP: That's the point.
CPP: So by now everyone wants to know what the medication was.
CP: It was for NTG 0.4mg sl tabs. The e-script directions were "1 tab every 5 minutes for chest pain".
CPP: Which is wrong.
CP: Which I corrected, as always, to: "Dissolve 1 tablet under tongue every 5 minutes up to 3 tabs in 15 minutes as needed for chest pain. No relief, call 911".
CPP: Which is in the package insert.
CP: Right. Can't you just see someone popping an entire bottle of 25 tablets, getting no relief, and suffering a heart attack while experiencing a wicked headache?
CPP: Okay. This then begs the question we have to ask everyone: What other medications do you just know how to type correctly, e-rx directions be damned?
CP: I'll give you three.
1. Lidocaine 5% patches - apply patch(es) to area and leave on for 12 hours then remove for 12 hours.
2. Clotrimazole Troches - Slowly dissolve 1 tablet in mouth.
3. Miacalcin NS - Use 1 spray in 1 nostril every day. Alternate nostrils daily.
CPP: Yeah, that last one gets entered incorrectly all the time.
CP: Can't you just see some pharmacists out there calling on these?
CPP: What's worse is them not fixing these mistakes or missing them altogether because they've never seen them written correctly; or weren't taught these during their retail experiences.
CP: Yeah. The preceptor site was either too busy or they used the students as free labour instead of teaching them the ways of the phorce.
CPP: I have one more to add.
CP: You have the phloor.
CPP: SL vs ODT. We receive prescriptions all the time that say "Take one tablet by mouth" or that confuse the two terms.
CP: What's the correct way to enter these directions, call center and e-script directions be damned?
CPP: SL is sublingual which literally translates to "under the tongue". ODT, or Orally Disintegrating Tablets should be remembered as dissolving On Da Tongue. ODT. Get it?
CP: Nice.
CPP: With that in mind, what else do you have to offer, oh mighty phans of CP?

Stroke Me = Troche

CP: Are you familiar with the 80's hit The Stroke, by Billy Squire?

ME: Of course.
MYSELF: Natch. Why?
CP: You know how the chorus repeats?
Stroke Me
Stroke Me
Stroke!
Stroke!
Stroke Me
Stroke Me
Stroke!
Stroke!
ME: Yes.
MYSELF: Where are you going with this?
CP: What's the name of a dome-shaped cover, usually for food dishes?
ME: Cloche.
CP: And another name for a lozenge?
MYSELF: Troche.
ME: TRO-Key
CP: And now that song reminds me of two people arguing over the proper pronunciation of that word.
TRO-Key
TRO-Key
TrOsh!
TrOsh!
TRO-Key
TRO-Key
TrOsh!
TrOsh!
ME: Has anyone ever told you there's something wrong with you?
CP: Yes. My techs and interns every single day.
MYSELF: Your brain works in mysterious ways.
CP: It does. I can either embrace it or ignore it. I choose to share it.
MYSELF: I still say it's pronounced TrOsh.
ME: TRO-Key!
CP: You're both correct. TRO-KEY is the first pronunciation, but TrOsh is listed as a British variant.
MYSELF: Thanks for ending that debate. Now does that make you a Dooshbag?
ME: Or a Doo-key-bag?
CP: I'm team Tro-Key.

Dear Diary

Dear Diary:

Flu Shot Week 9:
ME: So many people have promised to come back for shots and not returned that I am soon to abandon all hope of making the bosses happy. I feel jilted. I will forever be on the bottom.
CP: Bottom isn't bad. It means you're good at something.
ME: What?
CP: Screwing up.
ME: <moans>
CP: Now you got it. But that gave me an idea.
MICE ELF: How did that give you an idea?
CP: Promise rings.
ME: Huh?
CP: It's another measurable metric for Corporate Overlords to hold over your head. Promise Rings. You give them to patients and they swear a solemn vow to be loyally yours in flu vaccination. They will repeat after you: "With this ring, I do hereby vow to return to you tomorrow, next weekend, or next year and receive my inoculation."
MICE ELF: Nice. You could use that in lieu of a waiting list for other shots.
ME: Sounds like more heartbreak for me. I can just see it now, people skulking by the counter, surreptitiously sliding their rings behind the register in an effort to break their promise with me.
MICE ELF: You should be used to the stealth breakup by now. Anyway, the CO would still expect you to make good on those promised shots.
CP: Something else for you to screw up. See! You are good at something! And what's the best part about being on the hourly conference calls berating you for not administering enough vaccines?
ME: What?
CP: You're not giving shots because you're on the phone telling them why you're not giving shots!
MICE ELF: It's like when they ask why your complaints have risen over the last month and you remind them they cut your hours and you are now in peak shot season.
CP: They will wave a dismissive hand and blame you because they set you up for failure! They EXPECT you to fail! It's genius. In this way, not only are you meeting their expectations, you are exceeding them! Genius!
ME: Well, when you put it that way. . . Promise rings, huh? I like it.
CP: Just don't get too attached. People seem to be loyal to wherever they happen to be at that exact moment.
ME: But they promised.
CP: And with this ring, they shall return.
MICE ELF: Maybe we could repurpose used Nuvarings?
CP: One ring to rule them all?
ME: Gross.

Another Damned If You Do, Damned If You Don't

ME: What's you Topic Of The Week, CP?

CP: Days supply. 

MICE ELF: Sounds zzzzzzzz

ME: Specifically?

CP: 30 versus 90. 

MICE ELF: zzzzzzzz

ME: I'm sure others are on the edges of their seats with anticipation. Please continue. 

CP: Some insurance plans only allow us to bill for 90 days supplies; some for only 30 days. 

Some patients only want 30 days at a time; some for 90 days. 

Some patients want certain of their prescriptions to always be filled for 90 days; some for 30 days. 

MICE ELF: zzzzzzzz

ME: Why is this important? 

CP: If the prescription is written for 30 days, and has enough refills, I can fill it for a 90 days supply. Honestly I'd rather all prescriptions be written for 90 days at a time. That way I can fill for any quantity the patient wants. 

ME: OK. Not getting any less boring.

CP: Here is the problem. Regardless of how many prescriptions we fill each week, it is impossible for any pharmacy to manage the needs of not only each individual patient, but his or her specific needs as it regards to each individual prescription in their profile. Add to that the fluidity of copays as they change over the course of the year (deductibles start/end, tier changes, new insurance plans, etc.) and no amount of notes in the profile will enable the pharmacy to make each person happy on each prescription. 

MICE ELF: <sleepily opines> make them responsible for their own prescriptions <zzzzzzzz>

ME: Yes. Thanks for that. Is that your goal here? 

CP: Simply put, Yes. As a patient, you have the obligation to ensure your prescription is filled to your satisfaction. 

If you want your HCTZ 25mg filled as cash for 180 days at a time, ask when you place the refill order. 

If you want the Eliquis filled only for 30 days, ask. 

If you want the Januvia filled on a discount card, make sure I do, by asking. 

If you want everything filled for 90 days, even when you hit the Medicare Gap, don't be surprised when I explain the $500-$1000 copay totals. 

ME: Seems simple enough. Why is this an issue again?

CP: People will complain that we should just know how they want everything filled each time. I once had a patient who paid cash for a week of medication every Friday. Simple. Yet if he forgot a dose, he wanted one fewer tablet that week. Or if he wanted an extra for a vacation day, he added a dose or two. Now consider the patient whose insurance charges him $15.00 for a 30 days supply of one of his medications but $75.00 for a 90 days supply of that one medication. His prescriber always writes for 90 days supplies which he gets on some of his other prescriptions. How am I supposed to remember this one patient and his individual needs among the other thousands I will fill each week? 

ME: I'm guessing he's the one you have in mind for this post. 

MICE ELF: <yawns>

CP: Not wholly. It does exemplify the point however. Both of these men have unique filling needs. One is nice, the former, and one is simply an ass, the latter. Unfortunately there are more of the latter than the former. If you have unique filling needs for each of your medications, it is up to you to ensure it is correct. While I may fill 2000 to 4000 prescriptions per week, the last thing on my mind is "how does Little Old Lady want this particular Rx filled?". 

ME: Any words of advice for the prescription phillers out there? 

CP: Yes. 

Ask before you come to retrieve it. It is easier to fix BEFORE you get in my pickup line than being the wrench in my gears that slows down the whole system. 

Ask before you pay for it. Note the word "ASK". 

Just ask instead of yelling at me that I should know how you want it filled each time. It's like yelling at the pizza place because you changed your mind AFTER you placed the order and, now that it's ready, you want a new pizza, made the way you like, to be already cooked and waiting. 

MICE ELF: Pizza? 

#ItsNotMyPrescription
#IWillFillItAsWritten
#TheyRevokedMyMindReaderLicense
#ThatsThePersonHoldingMyDriveThruHostageInFrontOfYou

You're An Adult?

Unequaled Bright Energetic Radiant Tech Enjoying Counter Help: How may I help you today?
Lady At Counter Energetically Yelling Undeniably Now Demanding Everyone Readily Accept Limited Listening Skills: I need this prescription filled.
UT: Ok. Your insurance may not cover it. If they do not, I can fill it as cash or on a discount card if you like.
LACEY UNDERALLs: Let me call someone at my house.
UT: Fair enough.
LACEY UNDERALLs: <on phone> not sure. not sure. not sure.
CP: Pretty sure you explained the options well.
UT: I did. Maybe they're for someone else?
LACEY UNDERALLs: Here. <shoves cell phone towards UT> Can you talk to them?
UT: I'm sorry but we can't talk on cell phones. They are welcome to call the store phone so I may discuss it. Here is the number.
LACEY UNDERALLs: <on phone> They can't talk on my phone. I don't know. They said you can call the store phone.
CP: I see this taking a strange turn in 4. . . 3. . . 2. . . 1
LACEY UNDERALLs: They want to know how they can call the store phone if you're not allowed to talk on the phone at work?
CP: And there it is.
UT: No. I said I can't talk on YOUR phone. I can talk on my phone. The store phone. The business phone. The phone on which people call me all day.
LACEY UNDERALLs: Oh. Ok. They will call you then.
UT: Um. That really happened.
CP: It did. Right before our very eyes. Good luck with that conversation once they call you in 3. . . 2. . . 1
<phone ringing>
CP: <touches nose> Not it!

Sometimes, You Forget

Uber-Tech: Welcome to CP's Playhouse.
Husband In Trouble: I am here to pick up a prescription.
UT: Okay. Give me the name and DOB and I'll check the portal of patient prescriptions (P3) to see what I have ready.
HIT: Knapp, Anita. DOB 6/7/82.
UT: Gotcha. It's been a long day for me. Let's see, Anita Knapp. Sounds familiar. Hmmm. I don't find her in P3.
HIT: This is where I always pick up our prescriptions.
UT: Anita Knapp. DOB June 7th, 1982?
HIT: Yes.
UT: Silly question. Are you sure this is the correct pharmacy? It could be at CVS or Walgreens if the prescriber sent it there instead?
HIT: No. This is where she sent me.
UT: Okay. How sure are you of the DOB?
HIT: <chuckles> Very sure. It's my wife. I'd better know it.
UT: Ok. Better call her then because unfortunately, I have no profile for her. Anita Knapp, DOB 6/7/82.
CP: <pssst>
UT: <whispers> what?
CP: Ask him what he got her for her birthday.
UT: Sir. My pharmacist wants me to ask you what you got her for her birthday.
HIT: Nothing yet. Why?
CP: <whispers to UT> because 6/7 was yesterday. Today is 6/8. He's either got the wrong DOB or he's got the right DOB AND he forget to get her something.
UT: Did you hear that?
HIT: Oops. <quickly hangs up phone> It's July. 7/7/82.
UT: Lucky she hadn't picked up the phone yet.
HIT: Yeah. I'd be in a lot more trouble.
CP: Want to know the easiest way to remember your wife's birthday or your anniversary?
HIT: What's that?
CP: Forget it once.
HIT: Haha. Thanks.
UT: Quick thinking CP.
CP: That's our job. Saving lives.

I Shall Phix It No More

CP: Thank your for calling Pill Palace. This is CP, Head Pill Pauper, how may I help you today?
Just One Lady Encouraging Nurses Everywhere: I received a message from you that there was a problem with a prescription we sent electronically?
CP: Yes. I see that you sent an e-rx with a couple mistakes. The patient takes Metoprolol Tartrate 50mg twice a day and needs a 90 days supply which is 180 tablets. You wrote for Metoprolol Succinate 50mg twice a day and only 90 tablets which is a 45 days supply.
JOLENE: Ok. I see that.
CP: Can you correct it and resend it?
JOLENE: Can you take a verbal?
CP: Can you not answer a question with a question? And I CAN take a verbal but I am not going to take it.
JOLENE: Why not?
CP: While it may be easier for you, and by easier I mean lazier, it will not fix the problem.
JOLENE: But the patient needs her medication and I can fix it in the system.
CP: True. While I was waiting for you to return my call, I had a few hours to review her profile. Guess what I discovered?
JOLENE: She's out of refills?
CP: Phunny. Each of the previous 3 e-rx's you submitted for her were written this exact way, incorrectly. I personally documented on each one that I called, with whom I spoke, and when, to correct your mistakes. Phorgive me if I have no phaith in your "I will fix it in the system" plea. One of these days she will receive the incorrect medication or dosing. Perhaps she has to switch pharmacies, or another pharmacist sees nothing wrong with your prescription and fills it as written. Either way, you know it is wrong and a verbal order will not correct your continued error-making on this prescription.
JOLENE: I see. I will send it back for the prescriber to correct. Thank you.
CP: Welcome.

Uber-Tech: Wow. That went surprisingly well.
CP: Well the next step was to tell JOLENE: I was going to tell the patient her prescriber continues to write her prescriptions incorrectly.
UT: You should do that anyway.
CP: I did. The last time. But JOLENE: doesn't know that. And I will tell the patient again. She will not be happy. E-scripts only work if you use them correctly.
UT: There should be a class on this.
CP: Yeah, but the prescribers would probably skip it; just as they skipped handwriting and all math classes offered since kindergarten.

I'm Mad

CP: Good Day! Welcome to The Pill Pauper Express. How may I. . .
Mad Old Lady Droning That We're All Tossers: I'm mad!
CP: Why?
MOLDTWAT: My doctor sent my prescription here.
CP: Then I too am mad.
MOLDTWAT: Why are YOU mad?
CP: Because you are here.
MOLDTWAT: Why?
CP: Because your doctor sent your prescription here. Were you not following your own complaint?
MOLDTWAT: That doesn't make sense.
CP: Sure it does. I offered you a welcoming pleasantry as you approached my counter. Before I could finish, you were already complaining. Perhaps you are upset that your doctor inconvenienced you by sending your prescription to the wrong pharmacy. While that can be frustrating, it can be remedied. However, that is not my fault and no reason to start our interaction with a complaint. Would you like to try again?
MOLDTWAT: See! This is why I don't come here.
CP: Are you not entertained?
MOLDTWAT: Yes. No. I'm so confused. What just happened?
CP: You were mad. Now you're confused. Soon you will be excited.
MOLDTWAT: Why excited?
CP: Because your prescription is filled, despite this not being your regular, intended pharmacy and because you are no longer mad.
MOLDTWAT: Well. I'm still a little mad.
CP: But not at me. And you cracked a smile.
MOLDTWAT: Thank you for that.
CP: You are welcome.
MOLDTWAT: How'd you do that?
CP: It's what I do.
MOLDTWAT: Thanks.
CP: Do you wanna get a flu shot?
MOLDTWAT: <scowls>
CP: Okay. Moment over.

Highway Hypnosis

Have you ever heard of the driving condition referred to as highway-hypnosis? It's a condition where the driver tends to "zone out" while operating her vehicle, yet manages to safely complete her drive. It is an example of "automaticity" which is defined as the ability to perform actions without consciously thinking about them.
Have you ever experienced this at work? Experts in a field constantly rely on their professional training to make quick decisions. However, when this rapid fire response is not called upon, the sharp acuity is lost. In an average day filled with the mundane repetition of "muscle memory" tasks, the professional operates on autopilot. Much as the driver would be surprised and miss a sudden emergency, (deer or armadillo crossing, a tree falling across the road, etc), a pharmacist could miss a serious interaction or pass along a potentially fatal error to the patient.

Is this what you want?
As a professional?
As a patient?
As a parent?
As a relative of someone who uses any pharmacy in this country?

Think about it for minute.
I have had a few conversations with some friends of mine recently who are still in retail or who moved on to greener pastures. We shared stories similar to this.

CP: What's one of your personal records for prescriptions?
CP's Phriend: I did 669 on a Monday with only 2 techs.
CP: Nice. Mine was 487 on a 10 hour Saturday with no overlap. We did 1059 the following Monday but I had 2 more pharmacists.
CPP: That's horrible.
CP: Right? How did you manage your day?
CPP: Like eating an elephant, one bite at a time. All I remember about that day was that there were pills in bottles. I had no idea if they were correct. When I got home, I remember hoping and praying they were okay and no one would call me the next day saying they died.
CP: We operated on muscle memory. Lots of repetition. At that pace and with the lack of help, the only thing we could do was trust that it would be a perfect day; the techs were on their A+ game and didn't make any mistakes and that if they did, I happened to catch them.
CPP: That's why I got out when I finally could. That was my last straw.
CP: How can companies justify putting their patients at risk like this?
CPP: Better yet, how can the State Boards of Pharmacy, sworn to protect the public from the professionals, continue to allow the pharmacies to operate like this?
CP: Touche. We, as a profession, are quiet. We need to enlist the help of the public. They should demand that their prescription receives all the attention it deserves. They should cry out to their media that the pharmacies are too rushed.
CPP: It wasn't like this when we graduated. People gave us time. Now they complain we are taking too long despite seeing the line in front of them.
CP: The phunny thing is, I know the majority of patients behave properly but the minority who adversely affect our day is growing rapidly. Each time they interrupt us, each time they distract our focus, each time they yell and scream, it takes longer to regain our sharpness which snowballs until we are forever behind needing to operate on auto-pilot.
CPP: I still love your post about closing the pharmacy. I wish the Board would mandate the pharmacist to be uninterruptible.
CP: It won't happen but one can dream. The companies in retail set us up for failure. They demand more from us but either give us no tools to accomplish more or, if they do, the tools are broken.
CPP: And they remove help yet wonder why they are continually complained about for service.
CP: Exactly. Unless and until the public become outraged enough to demand more from their pharmacies, NOT the staff, nothing will change and their lives will be at risk.
CPP: Honestly, if I didn't work at a pharmacy, I'd have a hard time finding a place to trust to fill my prescriptions.
CP: Sad. It's been good catching up with you.
CPP: Yeah. Better shift back into auto-pilot.
CP: Especially since it's now The Season Of The Shot and all the abuse that goes with it.
CPP: That's why I am in compounding. Good luck!

I Don't Want To Get A Flu Shot

CP?

I don't wanna get a flu shot.
Don't ask, now go away!
I just came here to grab my script
And you've all flipped
I want to run away.

I used to ask you questions
Now there's no time
Please stop asking me for more

I don't wanna get a flu shot
I can ask if I want a flu shot

(Please come back Madam)

No way, die!

I don't wanna get a flu shot
Tetanus, Pneumo, or Shingrix too
Pushing these shots on me is rather rude
Though I've said no to you
It's time to get a clue!

(Now take the hint)

I just can't stand harassment
Questions every time
Of all those who just walk by. . .
(Shot-shot shot-shot shot-shot shot-shot)

Pharmers please know we can hear you
Asking us with every phone call
You say, I'll be quick, but I don't want to
Get my flu shot from you
Just leave me 'lone

I really hate to come here
I feel bullied
So please stop pressuring me

I don't wanna get a flu shot.

Dear Diary-Flu Shots

Dear Diary,
Flu Shot Week 4.
I'm not sure I can make it. I think I'm losing my mind. I'm talking to MICE ELF, again.
ME: You're always talking to yourself.
MICE ELF: What have we been discussing?
CP: Last week, the end of Forcing Flu Shots (FFS) Week 3 and I'm seeing pushback and hallucinations.
ME: So it wasn't just me?
MICE ELF: Or me?
CP: Nope. I had a patient come to the counter to retrieve a prescription. The conversation went like this:
     CP: Hello. Are you picking up today?
     Shh. He's Onto Our Tactics: Yes. And I don't want a flu shot.
     CP: Ok.
     SHOOT: So don't even ask.
ME: Wow. Harsh. FFS Fatigue has already settled in.
CP: And I'm pretty sure he hasn't even been in since we started pestering, er, asking people.
MICE ELF: What about these hallucinations?
CP: I see my MICE ELF answering "flu shot" for every question I am asked.
ME: Such as?
CP: What's the best thing for constipation?
       What's the best thing for allergies?
       What's the best thing for crabs? For Lice?
       Where are the shoelaces?
Flu shot! Flu shot!Flu shot! Flu shot! Flu shot!
MICE ELF: Does it work?
CP: I got one that way but I didn't even realise I said it. Which leads to my new idea.
ME: You know some corporate overlord somewhere is writing down your ideas and they will become policy in some of your phollowers' stores next year, right?
CP: We need to convert our drop off window to a flu shot window.
MICE ELF: Lame.
CP: I'm not done. We need to make an ornament out of syringes. My original idea was a syringe mistletoe; a needle-toe, if you will. When people come to that window, we have to point up at the ornament and tell them they are standing under the "needle-toe" and they have to get a flu shot now.
ME: So help me if someone does this.
CP: A little decoration makes the pharmacy seem inviting. It's a great conversation piece. People will laugh and acquiesce.
MICE ELF: Are you going to make it out of used flu shot syringes? Or . . . ?
ME: Or the current day's quota?
CP: Not sure. Both would be equally entertaining. Look! Only 3 shots to go. Get yours before they're gone! We could add a little fake blood, or just use used syringes for that Halloween effect. It'll be a blast, a real shot in the arm for business.
ME: That was horrible.
CP: I had to take a shot.
MICE ELF: Please stop. Don't you have an ornament to make?
CP: And a new song to write.
ME: Oh no.
CP: "All right stop. Inoculate your children. CP's plan is to give vaccinations."
MICE ELF: Save us. . .

Bribery

How long before these scenarios transition from hypothetical, to reality, to mandatory?

Pt: May I speak to the pharmacist?
Uber-Tech: For the cost of a flu shot.
Pt: But I don't need a flu shot.
UT: Then you don't need to speak to the pharmacist.

-----

Pt: Just a quick question?
CP: Agree to a flu shot and you may ask me anything.
Pt: It's just a quick question.
CP: It's just a quick prick.
Uber-Tech: That's what she said.

-----

Pt: How long until it's ready?
Uber-Tech: About 20 minutes should do it.
Pt: Can't it be any faster?
UT: I can do it in 15 minutes if you get your flu shot today.
Pt: But I don't want a flu shot.
UT: Then you don't want it in 20 minutes. You can come back tomorrow.

-----

Pt: I'm here to pick up my prescriptions.
Uber-Tech: And to get your flu shot.
Pt: I don't want a flu shot.
UT: Then I guess you don't need your <checks scripts> insulin, albuterol, and losartan today.
Pt: Actually I do need them.
UT: And a flu shot.
Pt: No.
UT: FLU SHOT! Say it!
Pt: <stutters> f-f-f-flu sh-sh-shot?
UT: Thank you. Have a seat. CP will be out with you shortly.

-----

Pt: I'm here to pick up my daughter's prescription.
Uber-Tech: And to get a flu shot.
Pt: No thanks. She's really sick and I need to get this home to her.
UT: Then I suggest you agree to a flu shot now.
Pt: No thanks.
UT: It's going to take  a while to mix this for her. I think it would be in the interests of everyone involved if you would agree to the shot now.
Pt: Are you trying to blackmail me into a flu shot?
UT: Blackmail is such a harsh word. Think of it as strong encouragement. You do want Little Susie to get better soon, don't you?
CP: You have a sick daughter. I have a quota. Let's help each other.

Now Hear This

CP: Welcome back. Picking up?
Angry Woman Mad About Nothing: Why didn't you page me?
CP: I did.
AWMAN: I didn't hear you.
CP: Okay. That's not really my fault.
AWMAN: I've been waiting in this store for over an hour!
CP: That's nice. Did you do some shopping? We have some nice sales right now. Back-to-school and all that.
AWMAN: No! I've been waiting for my damn prescription. What took so long?
CP: Let's see. You dropped it off at 11:03am. We told you 15 minutes and . . .
AWMAN: And I've been here for an hour!
CP: . . . and I checked it out at 11:13 whereupon I paged you, both by yelling out your name and, when you didn't return, by our overhead paging system.
AWMAN: This is ridiculous!
CP: I agree wholeheartedly. It is ridiculous.
AWMAN: Thank you.
CP: It is ridiculous that, despite multiple attempts to contact you verbally you somehow, while by your own admission remaining in the store, missed our attempts to reach you.
AWMAN: Are you mocking me?
CP: <mocking tone> are you mocking me? No. I just can't believe that this is the reason you are upset. Let's see:
1. We called you to the pharmacy. Twice. You missed them both. It's not a big store as I can hear conversations throughout the store all day.
2. I gave you a time of 15 minutes, which I beat. Somehow, at no point did you check your watch or ask someone for the time. Not sure how an hour feels like 15 minutes to you, but you certainly could have returned at any point and asked if it was ready.
3. You are mad at me because you didn't check the time AND you didn't hear my pages.
In short, YES, I agree, you are being ridiculous.
AWMAN: Well I never.
CP: With that attitude I'm not surprised. Will there be anything else?
AWMAN: Huh?
CP: <pulls out bullhorn> Anything else?
AWMAN: <brushes hair out of face> No.

#GetOffYourPhone
#DistractedShopping
#Projection
#HearMeNowAndListenToMeLater

She Hate Me

If you hate a business enough to take the time to call the complaint line after every single visit or give a "0" on every survey you can find, why are you still going there?

(I call bullshit on insurance requirements. You're not limited to only the Big 3 and even if you are, they have multiple locations. You have options. This is a bigger picture issue.) 

Seriously. Do you really think that by bringing down their scores you are helping improve their operations? If I had a problem every time I shopped a business, I'd leave. Perhaps it's me. Perhaps it's luck. Perhaps that's how they run their business and our expectations are quite dissimilar. Either way, that is the definition of insanity; repeating the same thing expecting a different result. After a time, it becomes habit. 

Odds are, if you've made a name for yourself, we don't want your business either. You are toxic to our environment and you unfairly poison others against us. 

Move on. 

Like a bad BF or GF. 

Move on. 

You both deserve better. 

Getting pissed off because you always come at us with a pissy, uppity, challenging attitude will only further reaffirm your strongly held belief that we are bad. There is nothing we can do to change your opinion. The slightest misstep, as if we weren't already walking on eggshells, will set you off anew. 

Maybe you're the type of person that thrives in a toxic relationship. 

Maybe you like to be treated poorly. 

If that gets you off, let me know. I can arrange to treat you accordingly. 

In the end, I am still left wondering why, if you hate a business so much, you voluntarily and consciously continue to do business with them? 

Phlu Shot Issues

Guys, rolling up your dress shirt to receive a flu shot is like trying to roll up your jeans to take a leak.

Conspiracies

As far as #ExcusesToNotGetAFluShot go, I've always been amused by the "conspiracy theories".

So I ask, if Big Pharma and vaccines are a government conspiracy for mind or population control, then why are colonoscopies not a conspiracy to map our asses for alien probing?

Flu Shot Season

DM: It's flu shot time!
CP: Already?
DM: Yes. Why haven't you met your quota yet?
CP: It's August. I got them yesterday.
DM: And your goal is 1082.
CP: Rather arbitrary, don't you think?
DM: Scientifically proven to be obtainable this year.
CP: Not sure what science you're using. Sounds more in line with L. Ron Hubbard's Scientology. Besides, you only sent me one box of shots.
DM: All you have to do is ask and people will throw themselves at you.
CP: Yeah. That didn't work for me getting dates in high school so I doubt it'll work now.
DM: Everyone wants one, they just need to be asked.
CP: When is the last time you worked in a store and twisted patients' arms to get flu shots?
DM: If you don't ask, you don't care.
CP: I ask. And despite getting rejected almost as much as I did in college, I keep asking but people still say "no". Great for the self-esteem.
DM: Why?
CP: For whatever reason, perhaps decades of marketing to people to get their flu shots in October, people want to wait. Patients and prescribers have it stuck in their heads that October is flu shot month.
DM: But all you have to do is ask, and inform them.
CP: I know. The CDC recommends the flu shot to be administered as soon as it is available. I know this. You know this. Others do not and don't care what we tell them. Once old people in particular get an idea in their heads, it is nigh on impossible to change their minds. They know only two things: Early Bird Dinner times at all the local restaurants and October is flu shot month.
DM: What about all the other people?
CP: There are a few insurances that won't pay until September or October.
DM: So focus on the other people.
CP: Sure. Did you get yours yet?
DM: I'm waiting.
CP: For what? Here are the excuses I have received so far and we are only 1 week in to the 2019-20 campaign.
a. I get mine at my doctor.
b. I get mine for free at work.
c. I already got mine.
d. I want it to last all season so I always get mine in October.
e. I am in the 55% of persons annually who never get a flu shot.
f. I'm not mentally prepared to receive it today.
g. I don't believe in them.
DM: You have to try harder.
CP: Why? I believe in flu shots. As long as my patients get them somewhere, anywhere, then that is all that matters. I hate doing business with places that force their employees to push services on their customers. I know what is available. I know what I want. I know I can return for other services should I so desire. After awhile, it gets to be annoying. Companies have marketing departments. Honestly, if people don't know by now they can receive a flu shot, or any other vaccine at any pharmacy in the country, then they've been living under a rock.
DM: You don't care about your patients.
CP: Right. I only care about filling the other 500 Rx's safely and accurately today. If patients miss the 11 signs, counter stickers and mats, syringe-juggling clown, and neon sign on their circuitous journey to my counter, me pleading to stab them won't help me get a flu shot from them.
DM: I'm watching you.
CP: Before you go. . .
DM: Yes?
CP: <sings> Do you wanna get a flu shot?

If It's Measured It's Not To Help You

CP's Partner: Okay. Let's just jump into this one with both feet. How do you feel about metrics, especially as they regard flu shots and other vaccines?
CP: First off, I'd like to thank the Academy for allowing me to speak today. Secondly, as you are well aware, I am all for vaccinations and believe pharmacists are well-positioned in the community to meet the need. I love being able to help patients in this way.
CPP: Great. Now about the metrics related to shots?
CP: Yes. It is my personal belief that if you are truly interested in helping your community, if your stated goal is to provide healthcare to your patients, then you absolutely cannot set goals on how much help you provide.
CPP: Basically, telling your pharmacists that they don't care about their patients if they don't administer their minimum number of 1082 shots, runs contradictory to the statement about being in the business to help people.
CP: Precisely. Let's put a metric on preventing opiate overdoses. I can just see the email now: "Why didn't you administer any Narcan last week and save a life?! Don't you care about your community?"
CPP: Like a funeral home. People die all the time! Why didn't you bury more people this month?
CP: They said they were dying to get into the place across the street.
CPP: You need to bury more people to meet quota!
CP: Do they have to be dead? Is kidnapping illegal? Or just slightly frowned upon?
CPP: I also love how corporate loves to give us statistics but I wonder if they ever read them or, better yet, know how to interpret them.
CP: I had to laugh. Remember a few years ago I ran the stats on how many patients receive flu shots, on average, each year?
CPP: Yeah. It was around 45%.
CP: Yes. And that number is relatively unchanged year over year. What's funny is our DM recited that stat back to us the other year in one of her meetings.
CPP: Really?
CP: Yes. I did the research and she unknowingly repeated my own stats to me.
CPP: That's funny. You never told me that.
CP: The point is, the acceptance rates of patients remain relatively unchanged, perhaps increasing by 1% or 2% per year. If the goal of community pharmacy is help people, to become a full service healthcare destination, they need to stop treating our services as a competition; they need to stop holding these metrics over our head like Damocles' sword.
CPP: Agreed. Allow us to do our jobs.
CP: I went into this business to help people; cliched, I know. I did not go into pharmacy to be bullied by corporate overlords. So far, we have had flu shots for 7 days and had 3 conference calls, multiple texts to report our numbers, phone calls to report our numbers and a few stores have been visited by Ramsay Bolton.
CPP: It's either you care about people and want them to be healthy, or it's a competition.
CP: Just like you can't force people to compete in a marathon, or Monopoly, or D&D, you can't force people to make a competition out of healthcare.
CPP: You also can't force people to receive something they don't want.
CP: Enemas all around! Seriously though. You simply cannot claim to be focused on patient health and all the valuable services you provide whilst also telling your employees they don't care about their patients or their jobs if they don't meet these arbitrary metrics tied to this one sector of healthcare.

#IfTheyMeasureItItsNotToHelpYou
#ItsAllAboutTheGreed
#GetYourFluShotSaveMyJob

Filter/Translator

CPP: That was an interesting conversation you had.
CP: Thanks. It got me thinking.
CPP: I'd hate to be inside your brain.
CP: Why?
CPP: Your brain never stops. I'm believe I'd get tired and afraid of what I'd see. Does it ever take a break?
CP: Unfortunately, no. And I can't keep up with it most times. It works faster than I can write. That's why my handwriting is so sloppy. And I can't type fast enough either.
CPP: People are already bored. What was this thought you had?
CP: You know how no matter how well we explain something, people will still not get it?
CPP: Yeah.
CP: You also know that there seems to be a disconnect between the words we speak and the words patients hear?
CPP: Yeah. Something gets lost in translation. It's as if we and the patients are speaking different languages; or having two distinctly disparate discussions.
CP: Precisely. And not just in a medical, learned context either.
CPP: Of course. Simple explanations about no refills, prior authorisations, and copays seem to be met with a look of confusion. What do you propose?
CP: With apps allowing us to learn languages and translate so we may communicate while abroad, what is next? I'm thinking we need a common sense translator.
CPP: Oh yeah?
CP: You've seen video of UN meetings, right?
CPP: Of course.
CP: Each nation's representative has a headset for receiving the translation of the speaker's language into their own.
CPP: Right.
CP: What if we employed an automated translation device for our patients?
CPP: Right. We could each pick up a telephone at the counter. As you spoke into it, it would speak patient-ese into the patient's brain.
CP: And as the patient spoke, it would translate his gibberish into a logical, understandable question.
CPP: This would be quite practical.
CP: Similar to the telephone game we used to play in kindergarten, or the grapevine scene in Johnny Dangerously.
CPP: No more misunderstandings.
CP: We would finally be able to communicate in the same language.
CPP: Do you think we could make one for sarcasm?
CP: That would be awesome. We could give our sarcastic response to all our "favourite" patients, nurses, and prescribers, and the translator would change it into something more acceptable.
CPP: We'd probably break it.
CP: Clearly.

Quote of the Day: "If words of command are not clear and distinct, if orders are not thoroughly understood, the general is to blame. But if his orders ARE clear, and the soldiers nevertheless disobey, then it is the fault of their officers." Sun Tzu

Why Are All Patients Canadian?

ME: I have made an observation.
MICE ELF: Do go on.
CP: Please do not encourage ME.
ME: <ahem> Whenever we say anything to a patient?, particularly with regards to price?, they always become Canadian?
MICE ELF: Nice. I too? have noticed that?
CP: They do?
ME: Yes! Just like that?
MICE ELF: Everything is inflective?
CP: So when we tell the patient?, "That'll be $200?", they respond with?
ME: "$200? For an eye drop?"
CP: Right? Or your copay today is $50.00?
MICE ELF: "$50? For an antibiotic?"
CP: Right? Everything is a question? Whatever happened to people just saying "okay" and being done with it?
ME: Right? It's not as if different medication classes have different pay tiers.
CP: Imagine extending that argument to anything else; shoes, houses, vehicles, etc.
MICE ELF: Though that would be something; flat-rate pricing based on class.
CP: Or if the prices were based on how old they are? Medications over 50 years old, $5.00. Medications 30-49 years old, $10.00. Medications 15-29 years old? $25.00. Anything newer than 15 years is market price.
MICE ELF: Imagine what would happen if there were a list of medications moving off the <15yo list! Can't wait until Pregabalin falls onto the 15-29yo list!
ME: Yeah. Imagine how cheap Tetracycline would have to be.
MICE ELF: Or Penis-Illin.
CP: You know it's pronounced PEN-uh-SILL-in, right?
MICE ELF: <shrugs> Tomato. Penis. Whatever.
ME: There's something wrong with you, eh?

You're Still Wrong

CP: Good Morning! How may I help you on this beautiful Sunday?
Her Early Arrival Reminds She's Not On Time: I am here to pick up my prescription.
CP: It is not yet ready.
HEARS NOT: Why not? I was told it would be ready today.
CP: You were also told both days you called this week that it would be ready 2 hours after we opened by both myself and my tech who is here right now.
HEARS NOT: You open at 9am.
CP: No. We open at 10am on Sundays.
HEARS NOT: Since when?
CP: About 20 years ago. Give or take.
HEARS NOT: No one told me that.
CP: Again, both I and my tech explained our hours to you when you called, twice, during the week.
HEARS NOT: I thought it was 9am.
CP: Even then, the current time is 10:23am. That is not 2 hours after opening at 9am either. You would still be early.  You're either a little early or a lot early. However you look at it, you're still wrong.
HEARS NOT: Well when will it be ready?
CP: Really?
HEARS NOT: Yeah. You're open now. So how much longer?
CP: What's 10 + 2?
HEARS NOT: I don't know. 12?
CP: Is there a 12 on your clock?
HEARS NOT: Yes.
CP: Come back when your clock shows 12. Or when you get the text. Something tells me these two events will miraculously occur simultaneously.

Returns Not Allowed

CPP: Plans for tonight?
CP: Drinking with a friend.
CPP: Who?
CP: Mr. Vesa. Or as he prefers to be called, Sir.
CPP: Sir Vesa?
CP: Yep.
CPP: You need a day off.

<a woman approacheth>
CP: Good evening mademoiselle. How might I help thee?
Lady Exchanging Merchandise: As my name clearly states, I am here to make an exchange.
CP: I see. I see. And what is it that you wish to exchange?
LEM: <lays toothbrush on counter> This toothbrush I purchased last night.
CP: I see. I see. And why do you wish to return it?
LEM: I used it and found the bristles to be too hard for me.
CP: You used a toothbrush, found the bristles to be too hard, and now wish to return the used toothbrush?
LEM: Correct. I believe I need softer bristles.
CP: Rather than simply purchasing a new toothbrush for a few dollars, you expect me to exchange it for you?
LEM: Correct. I did not become wealthy by wasting my money on frivolity.
CP: Of course not. Have you not used toothbrushes for most of your adulthood? It seems you should have some experience in what types of bristles you would prefer by this point in your life.
LEM: I am not here for a lecture. I simply wish to exchange this for a softer one.
CP: Alas, that is a request I cannot honour.
LEM: Why not?
CP: Well, first off, it's used. It's not as if I can sell it now. No one comes to my pharmacy asking for the "used toothbrush" section. Can't you see that now? "Previously tested! Already broken in! Save 15% off the full price of a brand new toothbrush. Only used once!"
LEM: You're mocking me.
CP: A little.
LEM: It's a simple request.
CP: No. It's an outrageous request. Imagine watching the ubiquitous commercials for toilet paper. Seriously though, why do we need ads for TP? Who hasn't heard of it and doesn't use it? Anyway, after watching these commercials you decide your whiny heinie requires Charmin Ultra. After using it, you discover its softness level does not agree with your tushy, or it rubs your no-no square the wrong way. Do you attempt to return the used portion of said TP?
LEM: No. That would be preposterous.
CP: Why?
LEM: It's disgusting and I'd never touch it.
CP: Nor would I. Nor would I expect you to attempt to return a half-used roll. Also disgusting and unsanitary.
LEM: Well I am going to talk to the owner.
CP: Okay. You're putting in an awful lot of work for a $3.00 oral cleansing device.
LEM: It's the principle.
CP: Of what? Proving you can bully people into doing whatever you want, bending them to your will simply because you want it that way?
LEM: Yes.
CP: Please. Feel free to discuss it with the owner.

<next day>

Owner Of Our Pharmacy's Stuff: Anything exciting happen while I was away?
CP: A lady asked to exchange a toothbrush. Said she was going to call you.
OOOPS: Did you exchange it?
CP: It was used.
OOOPS: Seriously? People never cease to amaze me. It used to be all you had to do was explain the rules and they'd obey. Now everything is a challenge.
CP: Can I get more tech help?
OOOPS: Sure.
CP: Thanks.

Phollower Submissions

Not sure if you need any new stories but I have to share what happened today. Quite possibly the dumbest phone call ever.

A dad of a 4 year old just called to complain that we didn’t tell him how to take his daughters medication.

I asked him if there was a label on the bottle.

He said yes, it says to shake the powder and add water.

I told him that was the manufacturers label. Is there a Pharmacy label?

Him - yes, it says to shake the liquid well and give her.... oh. Well what happens if I already added water?
Me - Sir, why did you add water?
Him - because y’all didn’t tell me it was already mixed.
Me - How much water did you add?
Him - I don’t know, I turned on the faucet like I was making a bottle.
Me - ok, so you don’t know how much water you added to something you didn’t need to add water to?
Him - nobody told me it was mixed. Y’all should have told me it was already mixed.
Me - you’re complaining that we didn’t give you information that I haven’t had anyone ask me for in nearly 20 years? I’ve never had anyone not recognize it wasn’t mixed
Him - how would I know it was mixed?
Me - Um. It was liquid. In nearly 20 years I’ve never had anyone not know. I’m not sure what to say.
Him - you need to chose your words more wisely because what you're saying is calling me an idiot and I’m not. I don’t appreciate you and your 20 odd years and if I need to come down there and complain to the store manager I will. I’m not scared.
Me - ok, I’m not sure what to tell you at this point.
Him - well what am I supposed to do with this medication?
Me - well you have some options. You can guess how much water you have added and try to mathematically calculate the correct dose off of that. You can give her 5 mls of the bottle you diluted and hope she gets better, or you can buy a new bottle for 74 dollars.
Him - well I don’t have that kind of money.
Me - I guess you can underdose her then.
Him - fine.

And he hung up

CP: All I can think of is a Kool Aid analogy. Imagine you're thirsting for Tropical Punch Kool Aid. You stride into the kitchen to find a pitcher and packet of mix, already torn open, on the counter. You observe the pitcher contains a red liquid. Do you pick up the packet, read the directions and, again, observing there is a red liquid in the pitcher, continue to follow the directions and ADD water to the nearly full pitcher?

In the immortal words of Joe Hallenbeck, "water is wet, the sky is blue, and women have secrets".
That's all I can think to say. 
#WaterIsWet.