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Friday, June 21, 2019

Paging Mr. Pink

I'm rather used to patients asking for their "little white pill".
I have also had patients refer to their "little blue pill" and their "little green pill" as well.
Which got me thinking. . . 
Despite the thousands of bottles of medication on our shelves, patients must think we only have 7 or 8 different medications at any given time: 
The White One.
The Red One.
The Orange One.
The Yellow One.
The Green One.
The Blue One.
The Purple One.
The Pink One?
It's like the #ReservoirDogs of Healthcare.

Wednesday, June 19, 2019


CP's Partner: You've got that look in your eyes again.
CP: Which look?
CPP: The thousand yard stare. The one where you're either contemplating rearranging the shelves again, or you've struck on an idea for a post.
CP: The latter.
CPP: Okay. Let's flesh it out.
CP: What would happen if Amazon decided to purchase Visa?
CPP: They'd prefer all transactions take place with a Visa card.
CP: Right. First they'd tell Congress it is not a conflict of interest for a retailer to own a credit card company. Then, in practise, Amazon would offer discounts to buyers if they use a Visa card, probably in the form of a percentage or cash back. Eventually, as the novelty of the news fades, people will realise that Amazon no longer contracts with American Express or Discover. If you want to use those cards, Amazon's online shopping is unavailable to you; you'd have to shop at smaller online or terrestrial retailers. Now, in order to shop at Amazon, you are obligated to sign up for a Visa card. If you want to sell on Amazon, your other business outlets would be required to accept Visa. Amazon gets the credit card fees, the business sale, the transaction fees from the credit card, and the interest.
CPP: Sounds about right. . . and oddly familiar. Now where have we heard this story before? she asked sardonically.
CP: Any pharmacy company that owns an insurance company, a mail order facility, and a PBM. It's vertical monopolization. Patients have an insurance that dictates which pharmacy they may use. There is often a contract of which they are unaware that may mandate mail order, through their wholly-owned subsidiary. All of the money is ultimately collected by one company.
CPP: Well that hardly sounds phair. I can understand an in-network vs. an out-of-network hospital or provider, but didn't people voice these same complaints when the mergers and acquisitions were first proposed?, she asked rhetorically. . .
CP: Right you are, Ken! Indeed they did. And guess what happened?
CPP: Congress and the courts believed the companies when they were told "no, we'd never do that!"?
CP: Yes. As if they hadn't considered it before the courts mentioned it to them, this is precisely what happened.
CPP: So you foresee Amazon, in a theoretical phuture, acquiring its own credit card company, then, at some date in the phurther phuture, mandating that all businesses must go through that credit card company to get to Amazon?
CP: It's purely hypothetical. But there is a precedent for it.
CPP: A phunny thing happened on the way to the phorum.
CP: Oh Yeah?
CPP: The day after you wrote this, Amazon announced a new credit card for low-income customers. It's offered through Synchrony Bank. And they also offer a Visa card. Perhaps your postulations are a little too eerily prescient.
CP: Perhaps. We shall see. Let's just continue to be outraged by the vertical monopolization of pharmacy right now.
CPP: Right. So Amazon can crash that party soon too.
CP: Exactly.

Tuesday, June 18, 2019

Not Paying It. . .

CP's Partner: What did you do on your day off?
CP: Antiquing.
CPP: Like, buying antiques? That doesn't seem like you.
CP: Sort of. I visited funeral homes.
CPP: Wow. Now that sounds a LOT like you. Pourquoi?
CP: Business related reasons.
CPP: Do go on.
CP: I was collecting business cards.
CPP: Research? You're not that old.
CP: It's never too early to start planning, as patients here constantly remind us with their constant whingeing of "I'm going to die!"
CPP: Wait. You said "business reasons", right?
CP: I did.
CPP: This should be good.
CP: You know how we always have those patients that are mere seconds from an untimely demise every time we interact with them?
CPP: The overdramatic, "I'm going to die if I don't get my medication this second even though I missed half my doses over the last 3 months of my one month medication and it's all your fault and I'll sue you if I die"? Those ones?
CP: Yes. But this is more for the "I'm not paying that, it's too expensive" sect. You know how we always have this conversation?:
     On Death's Door: "I never paid that before!"
     CP: Well you're going to pay that today if you want your medication.
CPP: It's like the price of gas. Or if Rip Van Winkle woke up today with $5.00 in his pocket and expected to do all his grocery shopping and receive change.
CP: Precisely.
CPP: What's the plan?
CP: When they say "I'm not paying that. What are you going to do about it?", I am going to reach into my pocket, fan out a pile of these cards and say "pick one!".
CPP: And when they ask "what is this"?
CP: My reply will be, "OOOH! That's a good one! Better hurry, they've been booking up quickly of late. If you act now, they'll even throw in an after-mourning pill for your widow(er)."
CPP: I like the "after-mourning pill" myself. Seriously though, you're crazy.
CP: I suppose I should visit the local cemeteries as well to see if they are booking. Perhaps we could link our website for our soon-to-be-departed phriends with a plot-purchasing service. It could be an all-in-one pricing service similar to Priceline or Expedia.
CPP: What would you call such a service? Personally, I like YoureDone.com.
CP: DebtAndBuried.com or FinalDeathtination.com.


Monday, June 17, 2019

It's Not That Hard. . .

. . . that's what she said.
CP: Thank you phor calling CP, Purveyor of Phine Pastilles and Pauper of Pills. How may I assist you this phine morning? 
So Perfectly Obvious It's Literally Easily Discerned: Urine idiot!
CP: I do need to pee, but I phail to understand how that makes me an idiot. 
SPOILED: No. You are an idiot. 
CP: Thanks. I think. Though it would be more helpful if you would enunciate. Easier to understand your insults. Hey, guess what Tessalon is used for? 
CP: Fuh Cough!
SPOILED: Excuse me?!
CP: Anyway, you were insulting me? 
SPOILED: Yes. You left me a message that my medication is on backorder. 
CP: I did. It is. How does that make me an idiot? 
SPOILED: Why did the CVS and Walgreens have it? 
CP: Not sure. Can I . . . 
SPOILED: See! Idiot. 
CP: Allow me to hazard a guess. 
1. They have a warehouse that has vast quantities of inventory. Think Sam's Club. If a smaller retailer runs out of product, these stores will likely have more and may weather the backorder without interruption to their sales. 
2. My store uses more of this product than they do. Even stores separated by less than 3 miles have entirely different inventories and dispensing habits than each other. Sometimes, one store may carry it while the other does not. 
3. Volume. Your CVS or Walgreens could have received the last bottle from their warehouse's shelves. If those stores do not dispense it with any frequency, they could still have it. 
Unfortunately, just because they currently have it in stock does not mean they will receive more before I or anyone else does. 
SPOILED: That's ridiculous. I've never heard of such a thing. 
CP: Have you ever run out of something in your kitchen? 
SPOILED: Of course. 
CP: Have you ever tried to buy it at a store, only to discover that, like Old Mother Hubbard, their cupboards too, were bare? 
SPOILED: Certainly. 
CP: Have you ever run to the neighbour's to borrow a cup of sugar for a recipe? 
CP: This is much like that. When a product goes on backorder, it means the company cannot keep up with demand, or there was a recall. This means. . . 
SPOILED: Right. You don't know how to order. 
CP: This means, when its supply is interrupted, we have to find who may have it. Your neighbour, another pharmacy, etc. 
SPOILED: That doesn't make sense. Why did they have it? 
CP: Did you see Avengers, Infinity War? 
CP: Remember how, at the end, 50% of everything died? 
CP: Backorders are not at all like that. When a product goes on backorder, the current supplies do not instantly evaporate. Just because you ran out of milk and had to borrow from your neighbour does not mean that her supply instantly vanished. Could you imagine walking to her house, her opening the fridge, and both of you watching the milk disintegrate into ash? 
SPOILED: Well, no. 
CP: It'd' be rather silly if every time YOU ran out of something, everyone else who had it had to watch their stock evaporate. Just like me, those who have it will continue to have it until they don't have it, whether due to a recall or an inability to resupply. 
SPOILED: I'm going to the other pharmacy. 
CP: <snaps fingers> 
SPOILED: What was that? 
CP: Just trying to see if I could have saved some time and made you disappear earlier, like my inventory. 


Wednesday, June 12, 2019

Lame Pharmacy Jokes

Pt: Are Oxybutynin and Vesicare for Overactive Bladder?
CP: Oui, Oui.

Shopping at WalMart shouldn't be painful. If you rearrange the letters, you get AWL TRAM (Ultram).

Has anyone else noticed that Lupin's birth control packs are not easy to open? Unlike other brands' packs, the foil doesn't tear.
Does this mean Lupin's packs are ... impregnable?

New Viagra Ad
"Working hard? Or hardly working?

CP: Did you want to wait?
Pt: How long?
CP: However long you want to wait.

CP: Will you be waiting or coming back?
Pt: Tomorrow.
CP: Well, since you can't sleep here, I'll mark you down as "coming back". You don't have to go home but you can't stay here.

What did my doctor say when I described my bladder symptoms?
"Urine Trouble"

I always knew my little brother was going to become a urologist. Every time I beat the crap out of him he'd run to mom, then come back pointing his finger at me tauntingly saying "Urine Trouble". Pissed me off.

Saw an advertisement for a Clam Bake on my long drive to work the other day.
Nothing unusual; 'tis the season,
except this one was promoted as a "Clam Jam".
I thought to myself, that sounds like a condition a gynecologist would diagnose.
She would then proceed to send an e-script for a CREAM to treat this case of "Clam Jam".
Unfortunately, like all prescribers with e-scripts, it would be full of typos so it would probably read:
"Clam Jam Cram" with directions of "Apply 1 finger cram to clam jam ma'am."

I do not like to treat clam jam.
I do like it here or there.
I do not like clam jam anywhere.

Q: What do you recommend for hirsutism?
A: Bactrim

Mahna, Mahna = Sphygomanometer

Tuesday, June 11, 2019


How to counsel passive-aggressively in the #Pharmacy:

Pt: What's Tessalon for?
CP: Fuh cough.
Pt: Excuse me?

Pt: Why did my prescriber give me this inhaler?
CP: Fuh Cough!

Pt: What's a common side effect of Lisinopril I should watch out for?
CP: Fuh cough.

Friday, June 7, 2019

Can I?

<sees that searching look in a patient's eyes>
CP: Is there something I can help you find?
Looking Over Store Things: Where are these? <shows picture on phone>
CP: I don't know.
LOST: But you offered to help!
CP: No. I asked "CAN I help?" and now we both discovered together the correct answer is "NO". No, I cannot help.

Thursday, June 6, 2019

Nothing For Nothing

CP: Hello! This is Head Pill Pauper CP. How may I help you?
Person Is Not Knowing Everything Years Earlier: Yeah, I was holding for a price?
CP: On?
PINKEYE: An eye ointment.
CP: Any one in particular?
PINKEYE: One for pinkeye.
CP: You need a prescription. . .
PINKEYE: No. I can get it over the counter.
CP: You really can't, unless you have a prescription and hand it to me. Then I will slide your prescription over the counter to you.
PINKEYE: Can you just tell me a price?
CP: On what, exactly?
PINKEYE: An ointment for pinkeye.
CP: There isn't one. They can use a prescription ointment, which would be uncommon as I've always dispensed drops but. . .
PINKEYE: I just want a price. I had it before years ago and it was OTC.
CP: Okay. What's the name?
PINKEYE: I don't know. I threw the package away years ago.
CP: Okay. You want me to give you a price on an ointment, the name of which you do not know, for a condition that is not treated with an OTC ointment, right?
PINKEYE: I just want a price.
CP: Well I can't give you a price on nothing. Other than "nothing".
PINKEYE: This is ridiculous.
CP: You're telling me. This is like calling a used car lot and asking for a price on a car. A car you passed on the freeway while driving through Arkansas 7 years ago. Though it could have been an SUV, or a van, or maybe a truck; maybe a motorcycle. It could have been a colour, or not a colour.
PINKEYE: I just want a price on an ointment for pinkeye!
CP: Okay. My assorted OTC selection right now contains eye unguents that range from $7.99 to $29.87. Sound good? You now have a price.
PINKEYE: There. Why was that so hard?
CP: You have no idea.

Wednesday, June 5, 2019

Can I Make This Your Job?

Ah, people. If not for the people, working with people would be a great job.

ME: What happened today? 
MYSELF: People. 
ME: No kidding. 
CP: I had two stories cross my brain this week and they are amazingly related. 
MYSELF: Do tell. 
CP: We offer courtesy refills, MTMs, phone calls and text alerts to remind patients, or their caregivers to fill and pick up their medications. 
ME: Right. It's all about compliance. 
MYSELF: And STAR ratings. 
CP: Right. But as we al know, that's not quite good enough. Remember when I wrote a post, jokingly positing that the next evolution of healthcare would be to hire a person to go to patients' houses and watch them take their medications? 
ME: Yes. Then you said we should cut out the middleman and hire someone to simply TAKE patients' medications for them. 
MYSELF: So much easier. 
CP: I had a woman ask: "Can you make sure my mom takes her medications?". 
ME: Not sure how that would work. 
MYSELF: Especially since the adult daughter was picking them up for her. 
CP: This relates to the other story I have. A teacher I know had a student who was always late in the mornings. Despite repeated calls from the school about truancy, the child just could not make it to school on time. (Missed the bus, mom had to drive.)
ME: I can see where this is going. 
MYSELF: Me too. 
CP: One day the mother, tired of the calls and threats from truancy officers, came to visit the school. She asked the teacher if he could "have a talk with her child and make sure the child got on the bus to come to school so she didn't have to drive the child to school."
ME: Seriously? 
MYSELF: Your reply? 
CP: Look lady, we do everything we are obligated to do to get your kid to school. We pull a bus right up to the end of your driveway. We honk the horn. We turn around and go back down the street. I can't send the driver up to your door, even if you gave her a key, to enter your house, drag your kid out of bed, and throw the child in the bus. You'd probably complain about that too. 
ME: And the daughter who wants us to make sure her mom takes her medications? 
MYSELF: Probably the same thing. She probably wants us to have a key, drive over there three times a day, let ourselves in, and shove the medications down her mother's gullet. 
ME: That's called nurse, right? Or aide?
CP: And she would complain that we administered them with tepid tap water instead of slightly chilled bottled. There comes a time when people rely too much on others to do everything for them. It's great that we offer services to assist, but eventually reliance becomes dependence and the system crumbles. 
ME: I bet we'd get amazing STAR ratings though. 
MYSELF: Or arrested in both cases. 
CP: Prison can't be worse, than retail, right? 
ME: Well, orange is my favourite colour.