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!