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Friday, November 22, 2019

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.

Monday, November 18, 2019

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? 
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. 

Wednesday, November 13, 2019

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. 

Monday, November 11, 2019

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?