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Tuesday, April 23, 2019

A(nother Holi)Day In The Life

CP: Thanks for calling CP's Pill Palace. This is CP, Paladin of Pills, how may I help you?
Worker Of Miracles Anxiously Needy: I need a dose of my Xarelto.
CP: I see you are out of refills. I can fax your doctor.
WOMAN: I'm out! Don't you know I have afib?
CP: Yes. Yes, I can infer such a diagnosis from the medication. And?
WOMAN: Well I need it.
CP: Were it so important to you, this afib diagnosis, you would have been more proactive, right?
WOMAN: I'm going to die.
CP: Eventually, yes. But, in the words of Syrio Forel, "not today". If you are that concerned, call your office. Or go to the ER.
WOMAN: It's Easter!
CP: Didn't stop you from calling me. Besides, your refill expired in December. We last refilled it in October for 3 months. How did you make a 3 month supply last 6 months?
WOMAN: I just took my last one last night.
CP: He is Indeed Risen! It's an Easter miracle. You made a 3 month supply last 6 months. Impressive. Do it again and you'll have enough for the weekend.
WOMAN: Well why didn't you call me?
CP: And say what?
WOMAN: To refill it.
CP: We probably did. Last year. When it was due. If you have a surplus of medication, I can't see that.
WOMAN: Well something's wrong here. What are you going to do?
CP: Repeat my earlier comment, a little firmer this time: Call your prescriber. They have answering services and on call prescribers for a reason.

<2 hours later>

CP: We just received your prescription. You may come to retrieve it at your earliest convenience. We are here until 3pm today.

<WOMAN comes in to pick up>

WOMAN: Am I on that courtesy refill thingy?
CP: Yes.
WOMAN: I still don't understand why you let me run out of medication.
CP: Well, simply put, we call when it's due. Which is usually about 10 days early on a 90 days supply. If you don't want it, don't need it, or don't pick it up, it goes back in stock and we wait to hear from you.
WOMAN: Well something is wrong here. I'm very scared.
CP: I'm sorry. What? You're scared? Of what?
WOMAN: That your system let me run out of medication.
CP: How is it that you made it to 75 years old? What did you do before pharmacies did everything except actually take your medications for you? Or anything else for that matter. Your car must constantly run out of gas and your refrigerator must always be empty since no one is there to tell you they need refilled.
WOMAN: I guess I'll have to go home and figure out what to do now.
CP: You do that. But make an appointment with the prescriber. They only approved a one month supply. Happy Easter!

A (Holi)Day In The Life

Weekends at the pharmacy are their own strange little days but holidays on weekends are even more anomalous. Something happens to people to the point where their brains must shut down and enter power saving mode. It's the only explanation for some of the interactions I've had.

CP: This is CP, Pill Pauper Extraordinaire, how may I help you?
Won't Hear Any Thing: I am out of medication. Can you give me some?
CP: Whoa. Right to the chase. Unfortunately, I cannot.
WHAT: What? Why?
CP: Did you call your doctor?
WHAT: It's Saturday.
CP: Yes. And? Many offices have after hours services. You should try them.
WHAT: I'm suffering.
CP: Then you should call the office sooner rather than later.

<2 hours later>

CP: CP's Palace of Pills. How may I help you?
Wilful Husband Of WHAT: My wife is out and needs some medication.
CP: I believe I spoke with WHAT earlier. Did she call the office as I suggested?
WHO,WHAT: No. She's in a lot of pain and going through withdrawal.
CP: Better call the office now then.
WHO,WHAT: She took her last one last night.
CP: Okay. And we filled it 45 days ago. For a 30 days supply. She has missed more than one day in the last month. I'm pretty sure she will make it to Monday.
WHO,WHAT: So you won't help me?
CP: If it's that severe, call the office.
WHO,WHAT: But it's Saturday.
CP: Why do you keep saying that? Phones work on the weekends. Prescribers are on call. With e-scripts now many respond to refill requests to ease the Monday work burden. Call them.

<2 hours later>

CP: How may I. . .
WHO: Can I please have some medication?
CP: No. Did you call your office?
WHO: I called them during the week and my doctor is on vacation and no one would call in a refill for me.
CP: Okay. And what about today? Did you call like I advised you and your husband earlier?
WHO: No. It's Saturday.
CP: Call them.

<1 hour later>

CP: Hello? Is it me you're looking for?
Nice Prescriber: Calling a refill for a patient. Apparently her office didn't call in her refill this week so I wanted to give her a week's worth.
CP: You're so kind. I'm glad she called you. I've been advising her to call all day.
NP: You're welcome.

<15 minutes later>
CP: Calling to let you know your office called in a short-term supply for you. In the immortal words of Rod Roddy, "come on down!".

WHO,WHAT: Here to pick up for WHAT.
CP: Have a nice day!
WHO,WHAT: <storms off>
CP: You're welcome! <hums "Closing Time" while shutting down computer, sees an e-script for a 90 days supply from patient's prescriber; closes head in door while exiting>

Tuesday, April 16, 2019


CP: Are you ready for a new installment of "Me, Myself, and I"?
ME: No.
MYSELF: <yawns> Again?
CP: This will promise to be doozy.
ME: What can you possibly debate with us that will cause people to become irrationally irritated and divisive?
MYSELF: Yeah. It's not like you're going to attempt to tackle vaccines with logic or anything, right?
ME: Right?
MYSELF: Um. . . you're not, are you?
CP: Did you ever notice how people like to argue that they are better and no longer need their medication?
ME: Yeah. Like blood pressure medication because they don't feel any different and cholesterol because they can't feel it working.
MYSELF: They don't see or feel the effects directly so they're cured.
CP: Right.
ME: And since the numbers on their labs/tests come back WNL, they must be cured and no longer have HBP or cholesterol.
MYSELF: Except. . .
CP: Except the reason they are better is because they are taking the medications.
ME: I see where you're going with this.
MYSELF: Of course you do. We are of the same mind. Literally.
CP: It's like vaccines: there are no cases of diseases any more so we can stop getting the vaccines for them. WRONG! There are no cases BECAUSE we have been immunizing.
ME: Let's not forget that people travel and tend to carry disease with them.
MYSELF: Yes. Unlike HBP or cholesterol, these conditions are contagious.
CP: And deadly. But let's continue the game of "if I don't see it, it must not be there".
ME: Reminds me of the old contagion and miasma theories. Until germ theory was postulated in the second half of the 19th century (fun fact, by John Snow), people, including leading science and medical experts, believed diseases were spread by "bad air". (We could have a discourse on this about how they weren't necessarily wrong; as you removed what held the bacteria, you improved the air, but that's a far over-simplification of the theories. Besides, the prescribed treatments for miasma didn't work for cholera.)
MYSELF: We are seeing the rise of measles because people refuse vaccinations because they believe the disease no longer exists?
CP: Partially. In 2000 the United States declared measles eliminated from the country. Great. Except other countries' vaccination rates were less than ideal. When our rates slipped due to anti-vaxx movements, the door was opened for outbreaks and a resurgence in the US.
ME: What you're saying is that, with all of the medical advances and scientific knowledge we have gained over the last ~170 years, we are regressing?
MYSELF: As we've said before a little knowledge can be a bad thing.
CP: The point of this exercise is to show people that just because it's not staring at us every day in the mirror or on our social media alerts, it does not mean it's not really happening. I came up with this thought to leave with you:
"I suppose the real question we need to be asking these parents is: are you making the correct, most-informed decision for your child and her health or are you putting a higher value on your own personal beliefs at the risk of your child's health?"

Great Books if you wish to read more:
1. Pox Americana
2. The Ghost Map
3. The Butchering Art
4. Quackery