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Monday, July 29, 2019

It's New To Me Too

CP: Welcome to CP's Palace of Pills. With what may I assist day?
Overreactive Inconsolable Lady Yelling: I wish to complain about these pills.
CP: Complain away. They won't mind. They don't have any feelings. And they're antidepressants.
OILY: No. I wish to complain to you.
CP: Go ahead. I'm quite used to it by now.
OILY: I have never had this manufacturer before. I'm scared.
CP: They don't look scary to me. They're a pretty, calming sort of yellow.
OILY: How do I know they will work?
CP: Try them.
OILY: But I never had them.
CP: And that's relevant, how? Exactly?
OILY: I don't know if they will work and I am afraid to take them.
CP: Phun Phact. Until you took the previous manufacturer, you had never taken it either. Whether it is brand or generic, until you've tried it, you haven't actually tried it, correct?
CP: Like kids with food, or adults with food, or food in general. You may have tried brussels sprouts steamed and hated them. You cannot say you hate brussels sprouts based on the experience of one taste. Or sushi. Certain fish. Kale. Kids may require up to 19 exposures to a food in order to know if they like it or not. As we have all said to a child at some point complaining about trying something new, how would you know if you liked ice cream if you never tasted ice cream? Seriously. Had you never tried the original version of this, you wouldn't know whether it worked or not.
OILY: Well if you say so.
CP: Trust me. I am Pill Pauper Extraordinaire. Medications are my bailiwick.
OILY: Well, I'm still not sure.
CP: Remember the old LIFE cereal commercials?
OILY: Yes.
CP: Mikey tried it. He likes it. Now it’s your turn.

CP: Then we are at an impasse. Like me getting ready to go to work each day, you must face the unknown head on.
OILY: I wish you had the green ones.
CP: I can paint them if you like. Or I can offer you another medication in a similar shade of green. Or you could just give these a go and conquer your fears. If you're still afraid, there's a medication for that you could try as well. However, that would involve something new and the cycle would repeat itself.

Return To Stock

ME: What is bothering you today?
CP: Bothering me today? Or what am I choosing to post about today? 
MYSELF: Right. Everything bothers your brain every day. It's just a matter of how long it has to ruminate for your post to fully develop. 
ME: Okay. What is it? 
CP: Return to stocks. 
MYSELF: Big issue. 
CP: Why do patients get mad when they come in to pick up their prescription only to discover we put it back in stock that morning or the day before? 
ME: Good question. Because they made a special trip down here expecting it be ready only to discover it is not and now they need it and are inconvenienced by having to make another trip? 
MYSELF: Well there's that. But there has to be more to it. 
CP: Let's look at the process. For some reason, courtesy fill, patient request, prescriber submission, whatever, we filled the prescription. The patient then receives a text/call alerting them to its presence in our will call section as soon as it gets bagged. Then another text follows every 3 days until the ultimate text which tells the patient "you have until tomorrow to pick it up or it will self-destruct in our baggage claim section". 
ME: You're telling me the patient receives multiple alerts, including a final notice, yet they still come in AFTER you return them to stock and have the gall to yell and scream and complain on the 1-800 number how nothing is ever ready when we tell them it is? 
CP: Yes. So again I ask, why do people get mad? Did we fill your 90 days supply at OUR convenience? Probably. It's the benefit to us to having you enrolled in our automatic/courtesy fill program. Did you need it yet? Not likely. That's the drawback to having you enrolled in this program. However, you had 13 days to make a decision. Should I stay or should I go now? Do I pick it up? Do I tell them to return it until I need it? 
MYSELF: What would fix this issue? 
CP: Most insurances allow for a "percent completion early fill date". This means that a patient could fill her prescription with 30 days remaining if she is allowed for a 67% completion early fill on a 90 days supply. If we fill it this early, it will sit for 2 weeks, be returned to stock, then she will still have 2 more weeks until she needs it; provided, of course, she is entirely compliant. 
ME: I see. Basically, you're saying it's our fault. 
MYSELF: It appears to be. 
CP: If we ignore what the computer tells us is the next available fill date, even the one provided by the insurance, and fill it only 7 days early based on when they last picked it up, not the date we last filled it, the return to stock situation would be much less traumatic on everyone. If we stuck to 7 days early, the patients should, in theory, be more likely to run out before it hits the return report. It will result in much less work and less repetition of the same work over and over. 
ME: That's redundant. 
MYSELF: Like our work. But I repeat myself. 
CP: Imagine filling prescriptions when patients actually need them as opposed to trying to prove compliance to the STAR ratings by showing on time pickups and sneaking in that one extra fill per year to the insurance. 
ME: Basically, if I understand you, you're telling me this valuable service we provide is only self-serving to the pharmacy so it can brag about its patients being super compliant, always taking their medications, and billing the insurance for one extra prescription per year thanks to the early cumulative refills? 
MYSELF: That's what I heard. 
CP: Don't get me wrong. There are plenty of patients who benefit from the reminders. There are many who consider these services invaluable. As with all great ideas, when taken from a small context and applied to a greater percentage, the values tend to disappear. 
ME: What do you suggest? 
CP: In my own little world, patients will follow up the texts with a call, asking what is ready, telling us if they need it now and retrieving it from our baggage claim section before it explodes. Or they tell us to return it as they do not need it and will call us back to fill it when needed. 
ME: You're so cute when you mythologise. 
MYSELF: Yeah. You're really going to upset those in charge of metrics. 
CP: But it keeps medications from getting filled that shouldn't be. Patients have medications changed all the time - new directions, new strengths, new combinations, etc. This would prevent them picking up duplicate or discontinued therapies and allow us more time to talk with them as opposed to a quick chat.
ME: Back to your original point, why do people get mad at us when they had 2 weeks and multiple notifications and opportunities to pick up their medications? 
CP: It is easier to blame someone else for your own mistakes and shortcomings than it is to own up to your personal responsibilities. The more we try to do for people, to facilitate easier healthcare management, the more they expect us to do for them and when the rate limiting factor in the process fails, the patient, it is easier to blame the experiment rather than that one step. 
MYSELF: Yet corporate continues to run the same experiments. 
CP: Precisely. 
ME: And we get yelled at. 
CP: Some things never change. . . 

Thursday, July 18, 2019

Your Grasp Of Reality Is Slipping

CP: Thank you phor calling CP, Pill Pauper Extraordinaire. How may I make your day?
Adult Child Expecting Our Facility Specialises in Performing Any Deeds Easy, Simple: Yeah. My momma keeps getting texts-es-es..
CP: Perhaps that's a call for Verizon or Sprint?
ACEOFSPADES: Nah. They keep telling her I have something filled there.
CP: Perhaps, at the age of 42, you should move out of your momma's house and get your own phone. Just sayin'. Anyway. . .
ACEOFSPADES: Do you have something there for me?
CP: Nope. Nada. Zip. Zilch. Zero.
ACEOFSPADES: I had it filled in another city last time.
CP: I see that. They have nothing filled either.
ACEOFSPADES: Yeah. No. I asked if if there was anything ready.
CP: Yeah. No. And I said there is nothing ready.
ACEOFSPADES: Can't you look in the system? I know other stores can look in there and tell me something is ready. Why can't you?
CP: I can look in the system. I did look in the system. In fact, I am looking in the system right now and no one has anything ready for you.
ACEOFSPADES: I said due to be filled.
CP: You did not say "due to be filled". You said "ready". Please read the transcript above. As I stare into the void of your profile I notice that you had all of your prescriptions transferred at the beginning of the month.
CP: Well I can't tell if they're done at CVS. I can't tell if they're due. I can't even tell which CVS because they were transferred from my store to another location in another city and THEN they were transferred to CVS.
ACEOFSPADES: Then why do I keep getting texts-es-es from you?
CP: You don't. Your mom does. Did you read them? The texts?
CP: Well perhaps if you did, you would notice the origin of the text. Maybe with the phone or store number or location of the pharmacy texting her. Did you read them?
CP: Another Satisfied Shopper!

I think we need to add a script to our incoming phone message: "If you are calling about a text or voicemail you received, please make sure you have read or listened to it twice before pressing "8" to speak with the pharmacy staff. If you have not, your call will be disconnected after you have been given instructions on how to read a text or listen to a voicemail. Good day."

Wednesday, July 17, 2019

It Happened at the Drive-Thru

CP: Are you picking up a prescription today?
Bastard In The Car Has Everything Rebilled: Yes. I have 3 prescriptions to pick up.
CP: Phine and dandy.
BITCHER: How much?
CP: A lot. It appears we don't have current insurance on file for you. Has it recently changed?
BITCHER: It has. Why didn't someone call me?
CP: We don't have a current number and you drove off after sending the Rx's through my tube before we could get your information so there's that.
BITCHER: So you're saying it's my fault?!
CP: Pretty much. Do you have your card?
BITCHER: Here! <frisbees card into drive thru>
CP: Okay. Come back in about 10 minutes and I will have these all fixed for you.
BITCHER: I'm just going to sit here.
CP: You can't block my business entrance.
BITCHER: It should have been done and I'm not moving.
CP: Ok. Let's have a race, shall we? I am calling the police right now. My working time for your rebill is about 10 minutes; the police arrival? not sure. We will see when they get here who wins. To be honest, I'm not really in a hurry to rush and, uh-oh, I think I need to pee. I always have to do rebills on an empty bladder. Care to place a wager?
BITCHER: <rolls up window, lights cigarette>

<42 minutes later>

Officer On Patrol Stop: Just wanted to stop by and give you an update.
CP: Oh yeah? I noticed he left about 5 minutes after I called you.
OOPS: Yeah. He drove off as I was turning into the parking lot.
CP: Guess he didn't like his odds after all.
OOPS: It gets better.
CP: Oooh. Really? Do tell.
OOPS: I followed him to the plaza across the street, ran his plates when he went inside. Turns out he had a couple outstanding warrants so as soon as he pulled out, I arrested him.
CP: What a great day!

Disconnect. . .

. . . and self-destruct one bullet at a time.
CP: Did you ever get the feeling that retail pharmacy is killing itself? I know, silly question.
CP's Partner: That's all we ever talk about. The devolution of pharmacy. What brought about this somber thought today?
CP: The disconnect.
CPP: Which one?
CP: The largest national chains.
CPP: What about them?
CP: They have a horribly negative image nationally. They are constantly in the news for all the wrong reasons, resulting in bad publicity, which affects all of their operations.
CPP: Yeah. And?
CP: Patients have no choice but to do business with them and instead of entering into the patient-pharmacist relationship with open arms and open minds, they are predisposed to animosity based on the national news.
CPP: What made you have this revelation?
CP: Patient surveys, conference calls, and constant nagging from corporate that "the guest comes first".
CPP: Sounds like the motto at a brothel.
CP: We've made the same allusion multiple times; how not too dissimilar are our approaches to business. Anyway, think about it. A retail profession with an awful track record in the national news wants its stores to be held to a higher standard. In stores, they have satisfactions surveys and hold the stores accountable for "customer complaints".
CPP: If your business has a negative image around the whole world, and your corporate office is doing nothing to repair it, improve it, or even deny it, you're asking how can the stores be held to a higher standard?
CP: Precisely. If I get a complaint for something out of my control, or even directly attributable to the corporate overlords, I am the one who gets in trouble, not the business. Maybe if you cleaned up your image and stopped pissing off the pharmacy patients, the pharmacy patients would have a better impression of us. Maybe if you acted as if you cared about us by, I don't know, giving us more help, patients wouldn't be so pissed off about their wait times. When I coach, one of my philosophies is "I will never yell at you for not doing something I didn't teach you how to do". It should be the same in the business world: "We won't hold against you something you couldn't do because we didn't provide you the tools to succeed".
CPP: Profound.
CP: Unfortunately, pharmacists have become all too successful at working with what we have in spite of our circumstances because we work with our brains and it's difficult to take those away.
CPP: That's probably next.
CP: And there will probably be a metric and a complaint that I didn't think fast enough. Seriously though, why do companies expect their staff and stores to change the company image when the company is constantly tarnishing it publicly?
CPP: Maybe we should set up our own website to accurately measure patient satisfaction. We could have one result for the company and one for the store staff.
CP: Question Number 1: Do you like your pharmacy?
       Question Number 2: Did you die?
CPP: If not, continue with the survey.

Friday, July 12, 2019

Time To Check The Emails

CP: I finally checked the email today.
ME: Good for you. Anything exciting?
CP: I received quite a lot from my boss.
MICE ELF: Me too!
CP: Did you notice that lots of the information was just forwarded emails?
ME: Spammer!
CP: There were also a few specific to our store.
MICE ELF: Loser. You're on the naughty lists again.
CP: The phunny thing is, they were "why didn't you do this?" and "don't forget about that".
ME: Did you get an email that reminded you to check your email?
MICE ELF: Why are you telling us this? Wait, what did you do?
CP: I asked her when she has the time to do all this work - forwarding emails, digging into each store's numbers then sending store-specific emails for all 31 of her stores, etc.
ME: What said she?
CP: She said she has an office day.
MICE ELF: To which you replied?
CP: When do I get one of those?
ME: And I bet she was surprised or slightly stunned.
MICE ELF: I'm surprised we are still employed.
CP: She likes me for my pharmacy proficiency and acumen.
ME: Uh-huh.
CP: I explained that if she didn't understand my concern then she needed to come to my store and complete all of that work. . . while doing my job and tuning out the deluge of noise from patients and phones.
ME: What is your concern, for those in the back?
CP: I have a job to do. Emails and other BS are the lowest on the priority list. If I forget to reply to the email, there will most definitely be another one. If I forget to check the directions/DUR/etc on a prescription the results could be catastrophic for the patient and for me. I am a pharmacist phirst; the rest is just background noise. If I forget to send in flu shot totals? Someone will call me. If I forget to submit my MTM totals for the week? Someone will call after emailing a few more times. Forgot to respond to a complaint within 24 hours? Someone will call me. Not that the calls are better, but I have better things to do, like not killing patients in the fast food chain that is pharmacy. Pharmacy is full of redundancies.
MICE ELF: So you are good at prioritizing?
CP: Yes. Too many times we focus on the wrong work at the wrong time, just so we can say we are doing work.
MICE ELF: Imagine what you could do if you had no distractions, a phresh cup of coffee, and could sit to read and forward emails for a whole day!
CP: Imagine.
ME: Did you get a reprieve on replying to all of her emails?
CP: No. I'm now in charge of calling other stores and reminding them to check their emails.
MICE ELF: Let me guess, you also have to contribute something to the monthly conference calls.
CP: Yep. She sends me emails to remind me.