What A Waste

ME: CP has that look. 

MICE ELF: Someone pissed in the morning Cheerios. 

ME: Something happened that defies logic; that CP just can't compute and I think shortwired the brain. 

MICE ELF: Well let's ask. 

ME: Nicely. 

ME + MICE ELF: CP? Are you okay? It's okay. You can tell us. 

CP: There is a reason other countries have looked at us over the last year, shaken their heads, and felt sorry for us. I could handle if they laughed at us, but they're sorry for us. 

ME + MICE ELF: Elaborate. 

CP: You saw how our Congressional representatives began receiving their COVID vaccines?

ME + MICE ELF: Right. To encourage their constituents to receive the vaccine. 

CP: Sure. But members who are not included in the first wave of qualification also received theirs. Feels as if they should set an example as well that they are healthy and should await their turns. 

ME: Good point. But there seems to be something else.

MICE ELF: Yes. Like the main point of this post. 

CP: I'm not administering the COVID vaccine. I don't have it. However, I have phriends who do have it and are working clinics for their respective pharmacies and here's a little story that I got to tell. . . 

Pfizer's vaccine is good out of its frozen state, in a refrigerator for up to 5 days. 

The clinics require there to be extra vaccine available. Just in case. 

IF the clinic does not use all of the vaccine, the extra can be returned to the fridge to live out the remainder of its 5 days. 

HOWEVER, if another clinic is not scheduled/held during that time, the vaccine is destroyed. 

ME + MICE ELF: Can the pharmacy staff administer it to their employees? Or their employees' families? Or first responders? Or anyone else in the 1A group?

CP: NO. They have been told it is against the law. 

ME: Aren't pharmacists and pharmacy staff and pharmacy store employees considered healthcare workers?

CP: No. 

MICE ELF: Wait. Hold up. You're telling me that the pharmacists administering the vaccines, or working in their pharmacies, waiting on potentially sick people all day, consulting with them in the aisles about how to treat their symptoms do not count as first-line healthcare workers; that they can't receive a vaccine that is in desperate need that is otherwise going to go to waste; and the government employees who don't qualify have already received their vaccine?

CP: Well, those administering the vaccines can get theirs at the end of the clinic, but only those staff who work the clinics can receive the vaccine. Not the rest of their staff still working the bench in the stores. 

ME: And someone in the government signed off on this? 

CP: If there was anything more American Governmental than wasting this precious commodity, I can't think of one. 

MICE ELF: I wonder if this is across the country? Across all states? *

CP: It shouldn't matter. Everyone should be pissed. There are reports of nurses that don't want it. I'm sure there is pharmacy staff who don't. But I do. Many of my pharmacy friends and staff do. If I can get it so it doesn't go to waste, why can't I? Why should I, as a healthcare worker not be allowed, be told it's against the law, to receive it? Why are these vaccines going to go to waste?

*Having checked as of the posting, it is not against any FEDERAL law. It may be state specific or local health department-specific. Check your local/state agencies and inquire about this. Do NOT let these shots go to waste!

Problems With Vitamins

From a professional view, I loathe dosing on vitamins/supplements. (This is not about my opinions on vitamins/supplements themselves, for that is another beast altogether.) The current, normal dosing is based on advertising and not ease-of-use for the patient. 

In much the same way as food labels are based on servings, so are supplements. (When is the last time you shared a can of Chunky Soup with someone? You should because a single can is two servings.)

Melatonin 5mg Gummies. It says so right on the front of the bottle. It says it on the sticker at your pharmacy. "5MG". Clear as can be. No way to misinterpret "5MG". 

Except. . . 

When you, as a do-your-due-diligence practitioner, read the back of the label and check "serving size", you notice the serving is actually two (2) gummies. Hmm. That would make each gummy only 2.5mg. Does that make each dose 2.5? 

Hmm.

When I, as a pharmacist, use these to fill a prescription, I will write "Chew 1 gummy once a day" to convey the simple fact that your dose is 2.5mg. 

When you, the patient, grab a bottle off the shelf, and see "5mg", will you only give your child one gummy? This would mean you are underdosing her at 2.5mg, right? Right.

See why I don't like this? 

Can you see what other issues may arise? 

Maybe a patient doubling the dose and actually taking the 5mg dose, (all the while believing they were taking 10mg) then buying a 10mg, thereby unintentionally doubling that dose?

Sound farfetched? Sound cynical? Sound like something I have complained about before? 

It sounds like something that actually happened recently. A mom bought the same bottle OTC that I used to fill her daughters' prescriptions. Had she not come to me for counsel, she would have doubled their dose. 

Fine. It's melatonin. No big deal. 

Okay. What about the Glucosamine-Chondroitin products? They clearly state if they are double- or triple-strength.

Sure. Just like buying paper products, the math here is frustratingly complicated. 

First, you have to know what "Single-Strength" is. And is that in 1 tablet? 2 tablets? 4? 

Then, is the "Double-strength" a single tablet? Or 2? Or 3? 

Don't get me started on the "Triple Strength" where a single dose is 2 tablets. 

It's all marketing. Unless people can do the math or are wise enough to seek counsel with the White Coats in the back, there can be issues with taking too much or too little of many OTC products. 

(Anticipatory Devil's Advocate rebuttal: geesh CP. they're only OTC supplements. who cares? it's not like they can OD or anything. they don't really do anything anyway, right? it's not like they're real medications.)

Right. Except lots of children take melatonin (and other OTC products) and lots of people believe that "if one is good, two is better" and many patients never report their OTC products while giving medication histories. 

Also, it's not just about Melatonin and Osteo-Bi-Flex. There are many OTC products that can be easily under- or overdosed due to unclear labels. 

 

Shouldn't there be a call for a change to happen? 

If the label says "10mg" then I expect the bottle to contain 10mg doses, not 2.5mg or 5mg "partial servings". 

I wonder how often mistakes are made based on OTC labeling because it's designed on marketing instead of safety?

Dear Board Of Pharmacy

I have a question for my BOP.
Perhaps you too will share this question.
CP: Dear BOP, do you have to approve pharmacist license applications?
BOP: Yes.
CP: Do you have to approve companies that do business with the State BOP?
BOP: Yes.
CP: Do you have to certify e-script providers and other vendors that do business with the State BOP?
BOP: Yes.
CP: Okay. Do you suspend licenses of pharmacists in the State?
BOP: Yes.
CP: If a pharmacist was asked to complete something as part of her registration, and told you "NO", could you revoke their license?
BOP: Yes.
CP: If a vendor said "NO", could you do the same thing?
BOP: Nope.
CP: Why not? You know that you have approved over 200 e-rx systems in the State. You know that one of the providers has refused to fix a known issue with their software.

(Here's the background. If an e-rx is sent by a prescriber, it passes from the office system to another processor who passes it on to Emdeon. They in turn pass it to a switch who is responsible for passing it to the pharmacy. IF, at any point it does not make it to Emdeon, whether due to a system outage or a "glitch", the e-rx is routed directly to my fax machine. This comes complete with no signature by the prescriber. My state has mandated that these Rx's are, in fact, not legal. We are required by the State BOP to call on each of these Rx's. They even have a disclaimer at the top that reads "Warning. This is not a valid Rx until called to verify by the pharmacist." What's even better is, we then have to transcribe it as a verbal order instead of an e-rx, thereby circumventing the intent of the e-rx in the first place.)
Still with me? Good. Now, despite repeated conversations between the company and the BOP, the company has refused to take the action that the other two big e-rx players have and that is to change their software to allow signatures to be printed on the faxes. They also contain a disclaimer that essentially reads "this started as an e-rx but due to a system error or glitch, got routed to your fax instead. It is totally valid so feel free to dispense it. Approved per State BOP", or something to the effect.
BOP: What's your question again?
CP: Why can't you just revoke their approval? Like you would a license?
BOP: Because.
CP: Oh. Okay. What do you suggest?
BOP: Call the offices that use this software and speak to their office managers. Explain the situation and why you have to call all the time, even though they get frustrated with you, and have them complain to their software vendor. Maybe, once enough offices complain about all the phone calls, the company will relent.
CP: Or you could just give them 90 days to be in compliance or threaten them with the loss of their license.
BOP: The Board of Medicine wouldn't go for that. Too many doctors would complain.
CP: Gotcha. So you approved a system that basically tells all the pharmacists to piss off, makes more work for us, then you tell us it is OUR responsibility to call on something you could fix, because you, the Board of Phrickin Pharmacy, are afraid of what a group of prescribers will do?
BOP: Yes. Pharmacists have no backbone and won't stand up to us. We only approve the systems.
CP: I got nothing. I need to relocate.

O Seltamivir (O Tannenbaum)

Pronounced: O SELT um a VEER

O Seltamivir, O Seltamivir
My how you help my symptoms
O Seltamivir, O Seltamivir
My how you help my symptoms
Your price is high but that's okay
You really don't work anyway
O Seltamivir, O Selatamivir
Nah you don't help my symptoms

O Seltamivir, O Seltamivir

Why are you never in stock

O Seltamivir, O Seltamivir

Why are you never in stock

The same time each and every year

The flu like clock-work reappears

O Seltamivir, O Seltamivir

Why are you never in stock

O Seltamivir, O Seltamivir

It's time to be backordered

O Seltamivir, O Seltamivir

It's time to be backordered

Xofluza's new, competes with you

Though it's not cheap, one dose will do

O Seltamivir, O Seltamivir

It's time to be backordered

O Seltamivir, O Seltamivir

You let us know, flu is near

O Seltamivir, O Seltamivir

You let us know, flu is near

So many scripts, we do receive

Yet out of stock, we can't believe

O Seltamivir, O Seltamivir

You're such a disappointment.

Words

CPP: Why are you laughing so hard? 

CP: Words. 

CPP: The building blocks of communication?

CP: How the wrong word at the right moment is hysterical.

CPP: Puns and double-entendres, and innuendo, oh my?

CP: Precisely. Some words cannot be interchanged in all situations. 

CPP: Like all squares are rectangles, but not all rectangles are squares?

CP: Yes. And how, sometimes, NOT saying anything to acknowledge the error allows the situation to build. Allow me to revisit my recent conversation. 

 

CP: Happy Friday! How may I help you?

Nurse On Phone Explaining: I was calling to check if you received an e-script we sent for our patient. 

CP: I know she called earlier and we had not received it. 

NOPE: Well it looks like the provider sent it, but it got rejected. 

CP: Bummer. I guess that explains it. Do you wish to resend?

NOPE: She left the office already. 

CP: Oh. 

NOPE: Can I give it to you orally?

CP: <crickets>

NOPE: <crickets>

CP: uhm

NOPE: VERBALLY! VERBALLY! Can I give it to you VERBALLY?

CP: That's probably a better idea. A lot easier, faster, and with fewer permissions required. 

NOPE: <laughs maniacally> Now I'm embarrassed.

CP: Happy Friday!

NOPE: Thanks. You too.

CPP: Orally: "by means of or through the mouth"

         Verbally: "by means of words; spoken"

CP: Some words when spoken, can't be taken back. 

New Advice/Reply

CP: From now on, whenever someone doesn't like my answer, I have a new reply. Try it with me. 

CPP: Can I drink with this? 

CP: No. 

CPP: That's not new. 

CP: Keep going. 

CPP: Can you just give me some for a few days?

CP: No. 

CPP: I don't like your answers. You don't want to help me. 

CP: My answer will not change. You don't have to like it, you do have to accept it.

CPP: Very nice. It reminds me of those televised trial circuses of government employees or mafia members. "I do not recall" and "My attorney has instructed me I don't have to answer that". 

CP: Or Shaggy: "It wasn't me". 

CPP: Good one. The questions may change but the answer does not. 

CP: You don't have to like it, but you do have to accept it. 

CPP: The sooner you accept it, the sooner we can move on. 

Aesop

CP: Welcome. 

Demands A Miracle Now: I need the Heavy Duty Flu Shot. 

CP: I can use an 18g needle to administer it but that's as heavy duty as we get here. 

DAMN: No. I need the high dose flu shot. 

CP: Oh. In that case, we are out of stock. 

DAMN: When will you get more?

CP: I have no idea. 

DAMN: You suck. 

CP: Well, it is the middle third of November; the month after the unofficial month for flu shots. 

DAMN: This is ridiculous!

CP: Did you learn a lesson today?

DAMN: Yeah. Not to get my shot here. 

CP: Wrong lesson. How about "Premature Inoculation"?

DAMN: What? I don't have that. 

CP: No. Premature Inoculation; getting your shot earlier in the season, say September, when most pharmacies still have the shot in stock.

DAMN: I don't want it too early. It needs to last all year. 

CP: Any time during peak shot months (September or October) is perfect; though I would encourage late September. And that's like knowing your grandkids want the new, hottest toy-of-the-year and waiting until Christmas Eve to buy it. Tis the season. Or using a condom after you're pregnant. Or turning on your turn signal halfway into the turn.

DAMN: I'm never getting my shot here again!

CP: If you didn't actually get one today, is that really a threat? I wonder how many places you visited who gave you the same answer. 

DAMN: This is my 4th pharmacy today that doesn't have it!

CP: Here endeth the lesson.*

*If you choose to wait, it may be too late.

Empty Returns

How do you return something to stock if you don't physically have the product? I had a tech who, when she couldn't find the prescription to return, would just delete it. Worse, she would cancel a prescription without pulling it from the will call bin. I have seen this happen at every pharmacy where I have worked.
Occasionally the misfiled bag will be discovered hiding in another bin weeks or months later but ofttimes it has been sold.
I'm going to try that at Best Buy and Target.
CP: I am here to return my purchase.
Blue Shirt: Okay. Was there a problem?
CP: This 70" TV I purchased was too small. It didn't fill the space.
BS: Okay. Um, where is the TV?
CP: Right here <sweeps arm around>
BS: I don't see a TV.
CP: It's okay. You can just return it and give me back my money.
BS: Do you have the receipt?
CP: No. Can't you just look it up?
BS: Do you have your rewards card?
CP: No.
BS: Oh. Okay then. Here's $800.00 cash. Have a good day.

Essentially, that IS what we are doing.

Sometimes, The Truth Hurts (If The Real World Worked. . . )

Uber-Tech: Why don't people want us to do our jobs? 

CP: Oh, they want us to do our jobs. They just expect us to do them while altering the laws of time and physics. 

UT: I'll rephrase. Why don't people want to give us the necessary time to perform our jobs? 

CP: Your example, please? 

 

One Needing Expedient Rush Of Usual Service: I just left the office. How long?

UT: Okay. They just sent it. That'll be about 20 minutes. 

ONEROUS: What? Really?

UT: Yes. Really, really. 

ONEROUS: I waited there for hours and now I have to wait here?

UT: You waited as long as was necessary for them to do their job, correct?

ONEROUS: Yes.

UT: Well, I am sure they appreciated that. Your prescriber and office had time and did their job. Now I need time to do mine. 

CP: Nice example. 

UT: Thanks. I get it from working with you. 

CP: I can imagine this another way as well. In a checkout line at a local retailer, you see lots of people in front of you. Pharmacy patients would be expecting to just walk to the front and check out. 

UT: The difference is, in this scenario, those in the standing queue can see the "work" waiting in front of them. 

CP: Whereas in the pharmacy, they can't see the queue in our computer. Nice. 

UT: I got that from our Disney discussions. 

CP: Speaking of, have you read about how they innovated the switchback queue and different staging areas to distract crowds from the boredom of standing in line?

UT: I think we need those in the pharmacy. We could start them outside. 

CP: As long as we get the time to do our jobs. I'm going to have to use that next time. "Your office was allowed time to do their jobs, now allow me the time necessary to do mine."

#IfTheRealWorldWorkedTheWayPharmacyDoes

#TheTruthHurts

Least Busy

CP: Ah, fall. The end of flu shot season Part I, and a pause in the number of times we are asked "when are you least busy"?

Uber-Tech: Now what? 

CP: The mad rush through the holidays and end of the year. . . and a surge in "are you going to be busy when I get there" questions. 

UT: Right. How are we going to know? 

CP: I've been answering "we are least busy when we are closed" and thought I'd pay homage to a great book.

UT: Which likely means you have something prepared for us today. 

CP: Halloween is not the only time for playacting. Let us begin. 

CP: From now on, I don't want anyone to come in and see me or call or me while I'm in the pharmacy. Is that clear?

UT: Yes, CP. What do I say to people who want to come in and see you or call for you while you're in the pharmacy?

CP: Tell them I'm in and ask them to wait. 

UT: For how long?

CP: Until I've left. 

UT: And then what do I do with them?

CP: I don't care.  

<patient approaches>

Pt: Is CP in?

UT: Yes. 

Pt: About how long will I have to wait before I get to see CP?

UT: Just until we close. Then you can go right in. 

Pt: But CP won't be here then, right?

UT: No, ma'am. CP won't be back in the pharmacy until we reopen tomorrow. 

Pt: Okay. Will I be able to see CP in the morning when you open?

UT: CP never sees anyone in the pharmacy while CP is in the pharmacy. 

Pt: What did you just say? 

UT: I said that CP never sees anyone in the pharmacy while CP is in the pharmacy. 

Pt: Are you trying to make a fool of me? 

UT: No, ma'am. Those are my orders. You can ask when you see CP. 

Pt: That's what I'm trying to do! When can I see CP!?

UT: Never. 

<patient leaves>

UT: That's quite some catch, that Catch-22. 

CP: The best there is

 

#PharmacyPhun

#Catch22

#MajorMajor

You Are Going To Die

I am going to kill you.

Perhaps it won't be me, but it will be a pharmacist. 

Perhaps it won't be you, but it will be someone you know and love. 

When the authorities and lawyers and judges and family members ask what happened, I will have to accept responsibility. 

It will most likely kill me to know something I did at work, which could have been prevented, directly contributed to your loss. 

When those people dig deeper in an attempt to discover how this mistake could have occurred, they will only find gossamer-thin whispers of leads that will ultimately end in a cul-de-sac around the pharmacist, around me. 

We all understand the ultimate responsibility for a mistake ends with the pharmacist; the buck stops here and all that drivel. 

What if you are put into a losing situation? 

What if the circumstances in which you work are beyond your control? 

You can only control what you can control. 

What if you are set up to fail? 

Does anyone care? 

No. No one except your pharmacist. 

Who is doing her best despite the deck stacked against her. 

When any error occurs, whether at your home or in my pharmacy, the common response is to identify the error, discover how it occurred, implement a plan to prevent another error of this type, and learn from it. It's how we evolve.
Pharmacists must self-report errors made.
Reporting errors in the pharmacy brings about two major results: a citation from the company and a lawyer making sure the company is safe from a lawsuit.
When we report errors, there is a question on the form: "What caused the error?"
The reply of "distractions and not enough help" is met with a scoff from the powers-that-be.
Do they attempt to fix it?
No.

I have spoken truly about what takes place in the pharmacy. On the most basic level, we enter, count, fill, and check prescriptions. That has always been the job. Over the years, new tasks and distractions have been added to our workload, each one increasing the chance for a mistake to occur.
Phones ring off the hook. With corporate-mandated automatic outgoing phone calls, patients call to ask why they received a call or a text. We have to sell products and services. We offer immunizations. We are in an open area of the pharmacy where patients can just shout at us their questions. Drive-thru lanes that ring incessantly are a distraction upon one's focus and concentration.
Walk into any pharmacy and count the number of bodies behind the counter and match that with the number of stations available.
(Stations include: Drop off window, pick up window, consultation window, drive-thru window, Data Entry workstation, Counting workstation, Pharmacist checking station, and anywhere from 3-10 phone lines available.)
The employees are stretched thin but the corporate budget predicts the amount of help necessary to man the battle stations. Their numbers can't be wrong, right?
While manning all of these stations, sometimes multiple stations at once, your pharmacist is also checking your prescription for mistakes. Imagine reading a book in a crowded bar with a DJ playing music, a few friends trying to include you in the conversation, your phone going off as your kids are trying to locate you, someone tapping you on the shoulder every few minutes excusing themselves past you on their way to the loo, and random shouts of "GOAL" echoing from the match on the telly.
How much of what you were reading do you remember?
How many times did you restart that page, that paragraph, that sentence?
This is the life your pharmacist leads.
This is the life into which you put your life.
She is set up to fail and one day it will kill someone.
It will not be anyone's fault she couldn't remember what she read on that last page in her book, your prescription.
Except hers.
She is set up to fail.
Until pharmacies work to change their work environments for their employees, someone is going to die. Unfortunately, I believe it is going to take such an event to occur before changes happen. Pharmacies will file it under "cost of doing business".
Shouldn't you want something better for yourself, for your loved ones than to be considered a "cost of doing business"?

Focus is paramount in our profession. We are the last line of defence between your prescriber and an awful day.
Now another scenario for you. Imagine yourself lying on an operating table. We've all seen the movies where the staff are all in their precise locations, assisting with the procedure, monitoring the monitors. We usually have a surgeon, assistant, nurse, tech, and anesthesiologist. Each person has a specific job to do. Now imagine the hospital cut the staff in the OR down to just the surgeon and one nurse. Someone has to hand the surgeon his instruments. Someone has to monitor the vitals. Someone has to administer the anesthesia. Someone has to prep the patient and be on hand for calling in help when needed.
As the procedure starts and these two lonesome souls are wrists deep in your chest cavity, the phone rings in the OR and the surgeon has to answer it because the nurse stepped aside to call for a radiologist. Someone needs to know what's taking so long and where the vending machine is located in the waiting room. Oh, and a family member just poked her head in the door asking "how much longer?' because they have dinner reservations in 10 minutes.
Is this a most absurd scenario? A professional team being decimated to save a few dollars for the hospital?
Yes.
Is this what your pharmacists and their teams deal with on a daily basis?
Yes.
Is this an exaggeration?
No. Not really at all.
For 12 hours a day this is what we do with skeleton crews.
Is that the environment in which you want your pharmacy staff to work?
Apparently it is because patients like to yell and scream at the pharmacy staff for taking too long and don't consider the repercussions if their interruptions lead to a mistake.
Until someone dies, no one will care.
Except your pharmacist.
Unfortunately, when I discover I killed you, my life will end.
I will not be able to live with myself knowing what I did.
I will have to surrender my licence and leave the profession I love.
The pharmacy? No remorse.
Maybe a statement from their media mouthpiece about "thoughts and prayers" and how "that pharmacist no longer works for us".
But that's it.
They won't change a damn thing.
Until we demand it.
Actually, until YOU demand it.
Your pharmacists have been demanding it for years. But they don't listen to us. In their eyes, we are not smart enough to understand budgets and staffing demands.
I don't want to kill you.
I don't want to hurt you or anyone you love.
Please understand this.
I am going to kill you.
I don't want to, but it will happen.

Masked

CPP: What's got your knickers in a knot? 

CP: Maskholes. 

CPP: Eh? 

CPP: The people who believe they have been ordained as judge, jury, and executioner in the proper wearing of masks. Suddenly people who never had to wear one are self-appointing themselves as the mask police. 

CP: Have you ever accidentally seen someone naked? That's like mask-free time in the pharmacy.

CPP: I'm just going to sit over here and let you, you know, do your thing. 

CP: <inhales deeply> It started with people telling me my techs need to stop touching their masks, or pulling them outward to talk. Then we were visited by the ghost of Christmas Present, the Health Department. Funny how they were wearing neck gaitors instead of real masks, but that's not for me to judge (wink). It has now become a point of contention with regards to customer complaints. "The pharmacist should not be behind the counter without her mask." Really? Why? I hate to break it to you but, and this may be shocking, I am a human being. I need to eat. I need to drink. I'm not allowed to take a break. It must be nice to work in a place that allows you to take breaks for these necessities. Me? I'm stuck back here for 12 hours a day. (And before any of you say it, this is NOT what I signed up for in college and it has certainly changed over the previous 6 months. Also, NO, FYI, I am NOT compensated to put up with people passing judgement on me and criticising MY mask wearing.) 

Where was I? 

Right. Where I stand is more than 6 feet from my counter. It is far enough away from my staff that I can eat and drink without regard to my mask status. News flash, when I am alone in the pharmacy, before or after hours, I may take off my mask. Why? Because I can replace it when someone comes to my counter. I'm not going to wear it at home just in case someone comes by to ring my bell and pop over for a visit. Same with work. My nose runs more during the day when I wear my mask. I must remove it to address the issue with a tissue. I'm pretty certain my white mask would look weird with a brown hole in the middle if I were forced to drink my morning Starbucks through the mask. 

CPP: Don't you just love how 6 months ago we were essential?

CP: FIGHTING to be considered essential, as I remember it. 

CPP: Right. But people were thanking us for being there for them and now? 

CP: Now they are back to yelling and screaming because we are too slow or our masks may be off for the short period it takes to blow a nose or eat a Cheeto. Hell, even our normal complaints are tainted with some dig at our mask etiquette.

CPP: I really think your post about "taking a snapshot in the pharmacy" is relevant here. My old preceptor never wore her lab coat. The days when she put it on, our boss would walk in about 10 minutes after. Her partner always wore his coat. He'd take it off on a warm day and that's when the bosses would stroll into the pharmacy. You can't capture the entire scene from one photograph of one second in the pharmacy. 

CP: True. But it doesn't stop people from judging us. I really wish we were considered healthcare professionals. 

#JudgeNot

#NoRespect

#WhyYourPharmacistHatesYou

Case Study

CP: We should change our pharmacy's name. 

CPP: To what? 

CP: Justin. 

CPP: That's it? 

CP: That's it. 

CPP: Why just Justin? Why not Justin's Tinctures and Tonics? Or Justin's PharmaCity? Or whatever other weird crap has fallen out of that gourd of yours over the years.

CP: Because Justin is much more apropos. 

CPP: Ok. I'll bite. . . rabbit hole, here we go. 

CP: We are "just in" for everything. 

We are the patients' backup plan for mail order and everything else:

Mail order late? Go to your local pharmacy. 

Mail order out of stock? Local pharmacy will help. 

Lost your medication? See the locals. 

Your normal pharmacy is closed on weekends? See the chains. 

Your pharmacy that delivers doesn't on holidays? Go to the neighbourhood folks. 

Prescriber won't call in a refill until you're seen in the office in 2 days? Yep, the pharmacy peeps, if they say "NO" it's their fault. 

If there was a problem, yo I'll solve it. check out the hook while DJ revolves it. 

CPP: NnnnnnnICE. And please don't do that again. 

CP: We are the backup bitch. The fallback crutch. The bailout. 

Prescriber forgot to refill your scripts? Expect the Pharmacy to help. 

Out of insulin? And it's the weekend? A Holiday weekend?? See the pharmacist. (But only in town.)

CPP: Is there a new name badge in it phor me? 

CP: Yes. I will be Case and you will be Time. 

CPP: Case and Time? 

CP: Whenever you need us, we will be there. Justin Case and Justin Time. At your service. 

CPP: We should get business cards.

 

Thanks, Dad

CP: Have you ever noticed the similarities between corporate and a really awful parent?

ME: The beatings will continue until morale improves?

MICE ELF: KMFDM, nice touch. 

CP: Yes, but I was also thinking more mental. 

MICE ELF: Mind games?

CP: More along the "you'll never be good enough" line. 

ME: Someone you keep trying to impress but who never loves you back?

MICE ELF: "Here daddy, I made you this drawing" only to be told it looks like a 3-year old drew it. . . then telling him you are 3 years old?

CP: That, but also grades. No matter what you bring home, he will never be impressed or happy. 

 

Child: Dad! Look! I got a B! And I thought I failed. 

DAD: Mmm. Why not an "A"?

Child: <next test> Dad! I did it! I got a 94% A!

DAD: Hmm. That's all? Why not a 100%?

CP: No matter what we do, it will never be good enough. 

ME: I gave 27 flu shots today!
MICE ELF: Why not 30?

ME: I diagnosed a woman over the phone as actively having a heart attack and saved her life. She couldn't stop thanking me (true story). 

MICE ELF: Harumph. But did you give her the PP-FLUSH. . . Prevnar/Pneumovax-Plus FLU-Shingrix triple?

CP: Difficult to do over the phone. . . 

MICE ELF: You should try harder. 

CP: Yep. Never enough. 

ME: You're so right. It's all about "why didn't you do better?".

MICE ELF: Or "what have you done for me lately to make me money?". 

CP: Yeah. We don't get paid to save lives or prevent deaths. Those don't impact the bottom line. 

ME: Must be why filling prescriptions is a distant 2nd right now to COVID tests and shoTS! shOTS! SHOTS!

MICE ELF: SHOTS! SHOTS! SHOTS!

CP: And you'll give 31 today yet be asked "why not 35? or 42?".

ME: Not even an "atta girl!" or "good job".

MICE ELF: Criticising and putting down those beneath you, it's on the test to become a corporate stooge.

CP: Like I said, Never enough. . .

All the shine of a thousand spotlights
All the stars we steal from the night sky
Will never be enough.

 

 

Phactory Of Phear

CP: I know it's early yet, but I was on hold with CVS and Walgreens last week. . .

Uber-Tech: Are you still on hold with them?

CP: Some days it feels that way. Anyway, it got me thinking.

UT: Well there isn't much else you can do while on those interminable holds.

CP: Be nice. It's not their phault the Powers-That-Be only give them enough staff to answer one call at a time.

UT: Right. Drop off, pick up, drive-thru, data entry, counting, 10 phone lines. . . itty bitty personnel scheduled.

CP: Sounds like Jafar's fate in Aladdin. 

UT: Sorry. As you were saying.

CP: As I was thinking, though you already did a good job making my point, I thought we could make a House of Horrors for Halloween.

UT: It's already scary enough here every day.

CP: True. We'd call it the Pharmacy Phactory of Phear. Lines of Q-Tips and Cue Balls snaking slowly through the queue, arms raised, moaning "flu shots. . . we want flu shots. . . HD flu shots. . . shaaaahhhhhhhhhtssss". 

UT: That is truly horrifying.

CP: Now imagine hearing nothing but the hold music for Walgreens and CVS. We could record the pharmacy staff trying to contact these pharmacies and screaming as they get phrustrated.

UT: Haunting, on all fronts. 

CP: That's the stuff of which nightmares are made. 

Your Irritation Is Misplaced

CP: Welcome to CP's Phunhouse. How may I help you?

Pissed Off Old Person Yelling He's Expecting A Deal: I need my medication. 

CP: Okay. I have it here. 

POOPYHEAD: And I'm irritated with you. 

CP: Let's go back to the intro. . . Welcome to Thunderdome!

POOPYHEAD: <confused look>

CP: Okay. Now I'm ready. 

POOPYHEAD: You need to stop sending texts to my wife. 

CP: I do not text your wife; nor would I. 

POOPYHEAD: What? No. From here. It's none of her business about my prescriptions. In fact it's no one's business but mine. 

CP: Sure thing. Did you sign up for the courtesy refill program? 

POOPYHEAD: I don't want any texts from you. 

CP: Not the question I asked, but let's roll with it. Let me check your profile. 

POOPYHEAD: Stop calling me. 

CP: In the balladic words of Guns N' Roses. . . All we need is just a little patience. Now hush while I do my thing. 

POOPYHEAD: <mumbles>

CP: What phone number should I have on file for you? 

POOPYHEAD: <recites wife's phone number>

CP: Ok. That IS the number we have for you. Should I have another number listed?

POOPYHEAD: NO! That's my main number.

CP: Just to be clear. You want no communications to go from us to your wife? 

POOPYHEAD: I SAID THAT!

CP: Yet you want us to keep her phone number on file as your primary contact phone? 

POOPYHEAD: YES! 

CP: And if I remove you from all automatic texts, alerts, notifications, and calls, I still have to have a number on file to contact in case of any issues filling your prescriptions. 

POOPYHEAD: Whatever. Just don't call my wife. 

CP: The wife whose number you still want listed as primary phone number?

POOPYHEAD: Yes. 

CP: Is there, maybe, another number you'd like listed? Like, I don't know, your own personal cell#?

POOPYHEAD: There is. 

CP: Should I enter that instead? I'm just throwing it out there that you want no notifications sent to your wife, but you insist hers be the only number on your file. I am not sure how to comply with that. It's like you wanting a vegan menu, but all dishes must include bacon. 

POOPYHEAD: Phine. Enter mine. But don't text me. It no one's business but mine. 

CP: I'm afraid to ask who answers your phone calls.

#MisdirectedAnger

#SoAngryHeConfusedHimself

#HowDidIGetIntoThisConversation

#WhyYourPharmacistHatesYou

#WhyYourPrescriptionTakesSoLong

Oh No You Didn't

CP: What is the first rule of retail pharmacy? 

ME: The customer is. . . 

CP: I will rip out your spine and floss with it if you say "always right". 

MICE ELF: Sometimes, the customer is an asshole. 

CP: Thank you to MICE ELF. That is, of course, the second rule.The first rule is you do not get to yell at my techs; you do not get to mistreat them; basically, you can treat them no worse than I do. 

ME: <smacks forehead> Of course!

MICE ELF: Why the rephresher, CP? 

CP: A recent interaction reminded me it's time to extend plaudits to the hardest working members of any pharmacy team, our technicians. 

ME: How sweet!

MICE ELF: Okay. Who pissed you off?

CP: This guy, but there's a plot twist, lol.

Grumpy Foreskin: I'm leaving. 

UT: It's done. I am literally labeling it right now. 

GF: It was supposed to be done an hour ago. 

UT: We have been exceptionally busy with the holiday but it is done. The pharmacist just has to check it. 

CP: <waiting in the wings, listening for my cue>

GF: <makes eye contact with CP (big mistake)> You need to hire faster people. 

CP: That was the wrong thing to say. 

GF: Why? Your service sucks. 

CP: Correction. Our service is exemplary. Even with you complaining, my techs are still smiling and doing their jobs. What I lack is the volume of techs required to meet your speedy request. You can have it right or right now, but not both. I will choose "right" every time. My techs are among the best I have ever worked beside. I lack quantity but not quality. You may call my boss and tell him I need more people but you cannot complain they are slow. 

GF: Maybe I need to find another pharmacy. 

CP: I think that would be wise. Since we cannot meet your needs in a timely manner and you believe it is okay to denigrate my staff and suggest I need better people for you then you can take your business to any competitor you choose. 

Lady On Line: Yeah! Way to go CP! I work retail too and in customer service and this Rumpled Foreskin has no right to be such a flaccid schlong to you or your staff. These people are doing a great job and are working extremely hard in difficult situations with grumpy people yelling at them all day. 

GF: <glares menacingly>

LOL: I LOVE YOU CP! WAY TO STAND UP FOR YOUR STAFF!

CP: Love you too!

GF: <notices crowd staring, slowly skulks backwards, nears main aisle, disappears>

UT: Order ready for Foreskin. Grumpy Foreskin? 

LOL: He shriveled up and left. 

CP: Premature evacuation of the premises. Thank you. 

LOL: You rock. That was the best thing to watch, ever.

Now Go Away

CP: Welcome. My name is CP. I am here to unwittingly phrustrate you and simultaneously get annoyed by your behaviour. How may I accomplish this today? 

Demands A Modern Miracle I Think: I am here for my refill. 

CP: Oh, drat. It does appear as though this is on backorder. We did call to notify you. Sorry.

DAMMIT: This is unacceptable. 

CP: Sorry. I agree. We looked everywhere, called your prescriber and, as we have been telling you for 7 months now, it is still on backorder. 

DAMMIT: This is ridiculous. 

CP: Sorry. Agreed. Good day. 

DAMMIT: You need to fix it. 

CP: Sorry. As we have explained, we have exhausted all our options. Perhaps it is time to call your prescriber again. 

DAMMIT: This is absurd. 

CP: Sorry. Agreed. Good day. 

DAMMIT: I need this to live. 

CP: Sorry. It is quite obvious by the 7 months you have survived on a 30 days supply you will perish without this. Good day. 

DAMMIT: I don't know what kind of pharmacy you're running here. 

CP: Me either. Sorry. Good day. 

DAMMIT: I cannot believe this. 

CP: Neither can I. May I ask you a question?

DAMMIT: If it will help.

CP: I have been polite. I have been courteous. I have offered multiple solutions to your singular problem. I intend this in the nicest way possible: What can I say, and how can I phrase it, to make you go away? 

DAMMIT: Pardon?!

CP: I can only say "sorry, this is beyond our control. please contact the one person who can fix it" yet you continue to pretend your name is Roget and ask the same question with new synonyms each time while my answer has not changed, nor will it. Now what can I say to make you go away? 

DAMMIT: Well I never. 

CP: And you never will with that attitude. Good day.

School (Shot) Days

Flu shot, flu shots 

Time to give those flu shots

Prevnar and Pneumo and Shingrix too

Don't matter to me just need to stab you

Please say yes the questions won't end

My boss will yell, help me my friend

If quickly you accede a hand you'll lend

In making my quota this year.

It's Your Dime. . . But My Time

CP: Thanks phor calling. . . 

Caller Having One Aneurysm Cursing Here: Finally! Someone answered. 

CP: I did. That's what happens when the phone rings. 

CHOACH: I've been trying to get through for hours. 

CP: And your persistence paid off. 

CHOACH: That's no way to run a business if people can't get through. 

CP: Well we do have many ways to reach us. . . 

CHOACH: You need more people down there to work. 

CP: Thanks. I'll alert my boss. She won't care, but I'll dare to share, mon frere. 

CHOACH: How do you stay in business? 

CP: Was your initial desire when dialing me to ask about how I run my pharmacy? If it was, I think I answered your probing questions. If not, why DID you call me? Would you like to argue with me, and continue complaining about how backed up we are right now, or would you like me to get your prescription ready? I'm just trying to plan my day and you can only pick one option. Should I grab a chair and some Cheetos? 

CHOACH: This is why nobody likes you.

CP: Wrong! This is precisely why people like me. This is also #WhyYourPrescriptionTakesSoLong and I can't ever answer my phone; instead of simply stating your business, you felt the need to spend your dime chastising me. Now I need to call my support line and ask for grief counseling to recover from this incident so your prescriptions won't be ready for 3 more days. 

CHOACH: That's ridiculous!

CP: It may be. It may not. Would you like to put another dime in to discover for yourself? Or I can hang up and you can try your luck again. 

CHOACH: It better be ready when I get down there. 

CP: Or what? You'll call back to volley vituperative invective at me? A threat, then? Well, "the only verdict is vengeance; a vendetta, held as a votive, not in vain, for the value and veracity of such shall one day vindicate the vigilant and the virtuous". 

CHOACH: <click>

UT: Well you did warn him he couldn't have it both ways. You can't complain about the wait time when you are keeping me from my work. 

CP: Verily.

Why Insurances Suck #245

CP: <hangs up phone, disturbed look on face> Huh. 

CPP: That sounded interesting and bad and confusing all at the same time. 

CP: <shakes head> It was. 

CPP: Care to share?

CP: Hoping you'll help me make sense of it. 

CPP: Role-play? 

CP: We have to. I'll be "Auditor Harassing With The Facts" and you be "ME". 

CPP: Okay. 

Auditor Harassing With The Facts: Hi. 

ME: Hi. 

AhWTF: I need you to reprocess a claim for me. 

ME: Ok. Was there a mistake? 

AhWTF: Not exactly. It's just the days supply was entered incorrectly. I need you to fix it before it gets filled again. You could lose the payment on this claim as well. 

ME: I see. <checks hard copy and how we filled it> What, exactly, was the problem? We filled and billed it correctly. 

AhWTF: Well, the directions state the patient is to use it 4 times a day. 

ME: . . . as needed. 

AhWTF: Yes. Four times a day, as needed. Since she was prescribed 60 tablets, that means that 60 divided by 4 is 15 so it should be a 15 days supply. 

ME: Right. I know how to do math and calculate days supplies so thanks for the lesson. My concern here is that the prescriber wrote, in the directions, that these 60 tablets "MUST LAST 30 DAYS", thereby making this a 30 days supply. 

AhWTF: No. It's a misfill due to the math. 

ME: If a prescriber writes for 1 tablet to last 30 days, then it's a 30 days supply. 

AhWTF: No it's not. 1/1=1. 

ME: Okay. What happens when this control gets reported to the State PDMP? The prescriber's intention for this to last 30 days isn't seen by anyone checking the report. It shows as a 15 days supply. This then thwarts the system, allowing for early (re)fills.

AhWTF: You either get paid for the claim with the correct days supply or you report it to them correctly. We don't care about anything other than the proper billing. 

ME: BUT IT WAS BILLED PROPERLY! The prescriber wanted it to last 30 days. 

AhWTF: You can put whatever you want in the directions; we don't care about that. 

ME: I'm pretty sure my State BOP will have a different opinion on this matter. 

AhWTF: Please change the days supply to ensure payment. 

ME: No. Proper billing is not part of my Oath of a Pharmacist, but taking care of my patients is. You can call my State BOP and explain this to them. If they acquiesce and change the law for you, then I will change it. Until then, off you may bugger!

CPP: How'd I do? 

CP: Bang on. I especially enjoyed "off buggering". 

CPP: I can't believe the insurance wanted you to make the days supply wrong.

CP: It would sound like insurance fraud if it weren't coming at the behest of the insurance. 

CPP: It's cases like this that remind me of your favourite John Grisham quote: "If it wasn't for lawyers, we wouldn't need lawyers". 

CP: If it weren't for insurances making things harder, we wouldn't need insurances?

CPP: Something like that. I wonder what the days supply for a Depo-Provera shot should be? 

CP: Good question. I wish I had thought to ask.

Why Insurances Suck #244

CP: Thanks for calling Commiseration Palace, home of CP, Pharmacist du jour, how may I help you?

Nurse Is Calling Explaining Our Niggling Endeavour: I am calling about a prior auth you initiated with us. 

CP: Do go on. 

NICE ONE: I called and they said it doesn't need one. 

CP: Ah. My favourite game to play. I bill it and receive a one sentence reply: "prior authorisation required, have prescriber call 1-800-THATS-A-NO". I call you only to have you call them and have them tell you the pharmacist erred or misinterpreted our "prior auth required" message and that no such auth is required; prior or otherwise.

NICE ONE: Well, they did provide me with this alternative billing information to give to you. They said "provide this BIN, PCN, ID#, and GRP# to the pharmacist and it will go through".

CP: Sure. What the hell. Why not? 

<enters billing info as provided>

Well that worked!

NICE ONE: So it didn't need a prior auth?

CP: Yes. No. Wait. Hold on. What in the actual name of #PharmacyPhuckery just happened? 

NICE ONE: What is it?

CP: The card information you gave me? 

NICE ONE: Yes. What the insurance gave me to give to you? 

CP: Yes. It's not new billing for the patient and her insurance. 

NICE ONE: It's not? That's weird.

CP: No. <laughs> What's weird is it's actually a discount card from the manufacturer. Instead of paying for the medication or approving the prior auth, the insurance looked up a manufacturer coupon and gave that to you to give to me. 

NICE ONE: That's pretty lame. 

CP: No. That's pretty low.  

NICE ONE: That's a lot of unnecessary legwork for the both of us. 

CP: That's a pretty sardonic wild goose chase. Now I know the insurances are just messing with us. Must be today's game on their desk calendar. 

NICE ONE: How to phuck with the pharmacy and prescriber?

CP: Indeed. 

NICE ONE: I can't wait to see what tomorrow brings. 

CP: That's why I get out of bed in the morning; to see what fresh hell pharmacy, insurances, prescribers, and patients have dreamt for me over night. It keeps our one-sided masochistic relationship phresh.

                                

You Cannot Help Those Who Will Not Help Themselves

I can explain it to you, but I can't understand it for you. 

CP: CP's Pill Pauper Paradise. How may I help you? 

There Was A Time This Was A Thing: Can you give me a price? 

CP: $42.00

TWATTWAT: Huh? 

CP: You asked if I could give you a price. I did. $42.00 is "A" price. 

TWATTWAT: No. For my medication. 

CP: It could be $42.00. 

TWATTWAT: And it could not. 

CP: But it could be. Do you have insurance?

TWATTWAT: Yes. 

CP: Do you have the card? 

TWATTWAT: I used to use you guys. 

CP: And I used to sell drugs. I still do, but I used to too. 

TWATTWAT: I should be in your system. 

CP: Yes. I see a profile from 4 years ago. Has your insurance changed? 

TWATTWAT: Yes. 

CP: Ok. I'll ask again. Do you have the new information? A card perhaps? 

TWATTWAT: No. 

CP: Then I cannot give you a price. 

TWATTWAT: Why not? 

CP: I need the insurance to know whom to bill or at least to whom I should submit an online inquiry for a price. Since you will not, or cannot, provide this information, I cannot provide a price. I'm going to throw this out there as I'm sure you've already considered it, but you could call your insurance. 

TWATTWAT: This is ridiculous! I just need a price. I'm staying at my current pharmacy. 

CP: Probably best for all of us. And I still say it's $42. 

The Retail Phlu Phallacy

ME and MICE ELF: Are we going to be participating in this discussion or is this a solo diatribe?

CP: Solo diatribe. Try to keep up.

Flu shots are here. While the CDC generally recommends administering vaccines "as soon as they are available", they have not been anticipating the earlier-than-usual arrival of flu vaccines into retail pharmacies. We used to expect them around the last week of August/beginning of September. Now that we are receiving them the last week of July, perhaps we should press pause and wait until September to start vaccinating.

ME and MICE ELF: But you teach the class and recommend "as soon as available" and that the effects last.

CP: I do. I have also been administering shots for 15 years, and teaching classes for near as long. I have witnessed the change from "we are providing a valuable service to our patients" to "if you don't meet your goals, you don't care about your customers". Let me care about my patients and you worry about the other stuff. No matter what I do, my focus will always be on the safety and well-being of my patients. I ask for tech help and pharmacist overlap to care for my patients and you deny it. Yet you want me to vaccinate everyone in my county before Labor Day on top of ensuring I fill their prescriptions safely; on top of counseling them about vaccinations they need. I was doing a great job of this before you decided to force the issue (because of that $25.00 PROFIT YOU make on each flu shot; never mind the administration fee you collect on shots I give).

Personally, and through this page, I heard DM's quoted as saying: "if you miss your goal, you should feel bad because that's a person you failed to care about. you must not care about your patients if you let those shots walk out the door".

When we sold our souls to the Devil known as Corporate Retail, there was an implicit contract to which we all agreed: We, the pharmacists, would exchange our freedom, any ownership rights, and essentially money, for you, the Corporate Overlords, to handle insurance contracts, advertising, promotion, and the general running of the business side of pharmacy. Let's just say that I am doing a better job of caring for my patients than you are at running the business side.

If you really, truly cared about MY patients, as I do, then you would give me what I need to help them.

I need tech help.

I need pharmacist overlap.

I need time to counsel my patients about their medications.

I need time to discuss the needs for vaccinations with each patient.

Look, everyone knows every pharmacy offers vaccinations. I used to joke that patients would not simply stop by on their way home after seeing a sign and say "hey, hon. they're giving flu shots. let's get one while we're thinking about it", but I have seen this come to fruition in less than a decade. Much like getting gas, they pull into whichever corner is easier to get into/out of on the drive home.

How sadistic and unrealistic can you be to make someone's goal 8,000 flu shots when the population of the town and the total number of unique patients to that store is below that? Especially when the store administered fewer than 2,000 flu shots last year! Oh, you have such lofty expectations for the business but you did not increase tech help demand more than 20 hours per week. Nice. Not sure where I'll spend all that ~3hrs/day. Do I plan for a morning rush? A lunch rush? An after work rush?

ME and MICE ELF: In summary?

CP: I love administering vaccinations. I DO believe we are best-positioned to find these patients and administer vaccines to them. I have finally reached the point that no matter what any employer says, I am not going to try to reach my goals. I am going to continue to care for my patients, ALL OF THEM, not just the ones being pestered for shots, and make sure each patient receives the same amount of care. Now the CDC is recommending patients wait until September and that everyone should receive one by Halloween. Why should we have daily/weekly goals if the new CDC recommendation is to wait? And to every corporate shill who tells ANY pharmacy employee "a missed flu shot/vaccine is a missed opportunity to help/care for your patients" you can take these needles and shove them up your ass. (uncapped, of course.)

ME and MICE ELF: Basically, you can't tell the public you care about their health while forcing goals on employees and not providing them the help and safe practices necessary to protect the public. 

CP: Both from disease and their pharmacies. 

Reach your goals.

Don't reach your goals. 

But don't compromise your integrity simply because your bosses are trying to make you feel guilty for not giving that last patient a shot they had no interest in receiving. Remember, only ~45% of the country receives a flu shot annually. That means you can expect to get rejected more than half the time.

How Not To Be Seen

ME: What's the greater infraction? People who drop their keys on the counter or the coughers?

MICE ELF:  Coughers. You didn't have it when you entered, and you're not DJ Kool. 

CP: Let me clear my throat!

ME: Next one - People who stand between drop off/ pick up/ or consultation windows like lost puppies looking for a good home? or people who stand next to a line and get mad because you keep skipping them? 

MICE ELF: Lost puppies, especially with the COVID/ social distancing tape on the floors. 

CP: Here's a better one. Why do patients always stand behind the one pole/support beam for our gates in the pharmacy? 

ME: Then get mad when you don't notice them. You pick up your head, thinking you heard someone but there is no visual evidence confirming your suspicions. 

MICE ELF: Like truckers; if you can't see my mirrors, I can't see you. 

CP: Exactly. If you can't see me, and cannot make eye contact with me, I cannot see you. Just because you're used to working the pole doesn't mean your affinity for them is warranted in my pharmacy. 

ME: Especially when they are going to get mad they had to wait so long. 

MICE ELF: Perhaps they're used to bigger tips. 

CP: Or they're trying to hide in plain sight. Like little kids. . . or they're practising their championship hide-and-seek skills. 

ME: Perhaps they are shy and don't want to be seen?
MICE ELF: You mean they made it all the way down here, extricated themselves from their vehicles, only to plant themselves behind the nearest pole at my pharmacy? 

CP: Maybe they think we are going to snipe them with our blow dart flu shots. 

ME: Duck season!

MICE ELF: Rabbit season!

CP: They also hide behind the window frame. 

ME: What's worse is when they try to speak to us through it. 

MICE ELF: Glass is a great medium for voice conduction. 

CP: But the pole. I still don't understand the whole pole hide-behind. 

ME: They want to complain no one waited on them. 

MICE ELF: Maybe they don't want to be known at the "key dropper'' or the "cougher".

CP: Well, they're going to forever be known as either Mrs. Nesbitt or BJ Smegma going forward.

Clearly Canceled

CP: CP's Playhouse. How may I help you?  

Miserable And Demanding Doctor Of Grumbling 2020: I am calling about my patient's Rx which she claims is not there but I clearly sent last night. 

CP: I was here last night and have no recall of her prescription. 

MADDOG2020: I sent it at 7:29 last night. 

CP: Well that is of no help. Perhaps, if you use eClinicalWorks as your software provider. . . 

MADDOG2020:I just sent it again. 

CP: Ok. Let me check. . . 

MADDOG2020: <clearly grandstanding and frustrated> You should have it now.

CP: I do see it. Let me look at it. . . Aha!

MADDOG2020: It's the same thing I sent last night. I don't know why you told her. . . 

CP: I DO remember this one! I even had both my techs look at it before I canceled and deleted it. 

MADDOG2020:Why would you do that!?

CP: Read the directions. 

MADDOG2020:<mumbles>

CP: Out loud. So those in the back can hear.

MADDOG2020:  "oral caps cancel this fill tid"

CP: Yep. It clearly said to cancel it, so I did. 

MADDOG2020: Oh, I just resent what my NP sent the last time. 

CP: Good strategy, Silly Boy. And I'm guessing we followed those directions and canceled her previous refills the last time, when this note was relevant. 

MADDOG2020:Well that's not what I wanted. 

CP: Yeah, that's why we encourage you to review what you send before you hit 'send'. It's also why I don't allow verbal corrections on e-scripts from anyone in your, or any prescribers' offices. If it's not fixed on your end, it will continually be automatically renewed the wrong way and may, eventually, be filled that way which could harm a patient. 

MADDOG2020: Looks like I'll have to retrain her. 

CP: May want to be "starting with the man in the mirror". 

MADDOG2020: <humbled> I'll talk to her next week. 

CP: "I'm asking him to change his ways."

MADDOG2020: Good-bye. 

CP: "Yeah, make that change!"

<click>

Don't Think Too Hard

CP: Since we constantly have this debate, and we like to involve our students to teach them how to think, we are going to play a game.
CPP: The Professional Judgement Game?
CP Yes.
CPP: My favourite! Is this because everyone likes to comment on your posts about how we should just call? Or how they wouldn't ever call? Or how a counsel with the patient would have cleared things? Or how a consul wouldn't have provided an answer?
CP: Like those cure-all natural oil remedies - essential-ly.
CPP: Nice. Let's see this test.

1. Amoxicillin 500mg - Take 1 tablet by mouth 3 times a day.
(Do we dispense tablets or capsules? Or does it matter on this particular Rx?)

2. Amoxicillin 500mg Tablets - Take 1 capsule by mouth 3 times a day.
(Do we dispense tablets or capsules? Or does it matter?)

3. Duloxetine 60mg Tablets - Take 1 capsule by mouth 2 times a day.
(How do you dispense this one? If you said tablets for either of the above based on the drug written, then you have to answer tablets here and you have to call the prescriber, right?)

4. Motrin 800mg Capsules - Take 1 tablet by mouth every 8 hours.
(Tablets? Capsules? Call prescriber? If you answered tablets to any of the previous 3, then this has to be tablets, rights? Or is it Capsules because it's in the name?)

5. Insulin Glargine
(Do you dispense Lantus or Basaglar? If you try Lantus and it requires a prior authorisation, can you just switch it?)

6. Levothyroxine Capsules - Take 1 tablet by mouth once a day."

(But the patient ALWAYS gets tablets. Med selection error? or did the prescriber want Caps?)

Answers:
1. It doesn't matter. Just because "tablets" is written in the directions does NOT mean the prescriber intended for tablets to be dispensed. Often it's a default sig. Or pre-printed. Either way, it does not matter.

2. Meh. Same answer. It does not matter. Maybe his drop down menu only had tablets; or it was listed first. Same with the directions. As long as the patient gets 500mg of Amoxicillin, it doesn't matter. But if you claim that #1 HAS TO BE tablets based solely on the sig, then you must abide by your rule and dispense capsules here. Otherwise, your "steadfast" rules conflict and have no basis in real e-prescribing/dispensing.

3. Capsules. It's the only way the product is available. This is to prove that just because the directions use one dose form and the drug name is selected as another, albeit unavailable dose form, does not mean we have to move heaven and earth and call the prescriber to fix this. . . unless of course you disagree with either of the first two answers. In that case, stop wasting time. You know you just dispense capsules, so use that logic on #1 and #2.

4. Tablets. Period. Even though I have seen this very same prescription multiple times, there is no way the prescriber(s) intended to give the patient 800mg ibuprofen capsules. Tablets all the way. Again, if you disagree with any of the previous answers, then you MUST call this prescriber and verify capsules was correct as submitted. Another waste of time.

5. Please tell me no one does this. If a patient asks for ibuprofen OTC you can give them Advil or Motrin. Same here. If Lantus is not covered, try the Basaglar. It's written for the generic name, NOT the brand. Had the Rx been sent over as "Lantus Solostar", then you'd have to call, per insurance pain-in-the-assitude. I hate floating to stores and my first doctor calls are about these exact scripts; fix it.

6. Patient gets tablets. Give tablets. New prescription and the patient never had any Levo previously? It doesn't matter. But be a good Pharmacist and, if you try the capsules (Tirosint) and they are ridiculously expensive, simply change it to the tablets and save them money. We'd rather they be compliant and take their medication than quibble over whether or not the prescriber chose the first option from the drop-down menu (which she did).

Every pharmacist has her own quirks and panty-bunching idiosyncrasies. Don't put your brain out to pasture by forgetting why you went to school: to learn HOW to think, not what.

CPP: Think everyone passed?
CP: Most likely. We have a great group of phollowers. I think we will catch shit from people justifying why they call (insurances and audits and on and on) but I stand by our answers. Even if I get audited on 1000 Amoxicillin Rx's over 5 years, I'm only out like $42.00.

It's So Obvious It's Confusing

UT: How difficult are the terms "drop off" and pick up" to comprehend?

CP: Generally they are self-explanatory. If you polled random people around the world 84% of them would be able to correctly identify which one meant drop off and which once meant pick up. Unless. . . UT: Unless you polled patrons of retail outlets.

CP: Well of course then. It goes without saying that the retail world operates in a Bermuda Triangle-like set of parameters. Nothing is ever as it seems.

UT: <Sees patient at pick up window with prescriptions in hand> Do you want to handle this one?

CP: Certainly.

<CP pops up from behind computer like a prairie dog>

CP: Hello. Are you dropping off today?

Misses Out On Signs Explaining Key Nuances Usually Comprehensively Known Leading Everywhere: No. I am picking up.

CP: Hence your reason for being under the sign clearly marked as "Pick Up Here".

MOOSE KNUCKLE: Correct.

CP: <searches computer for MOOSE KNUCKLE. . . > I have nothing ready for you.

MOOSE KNUCKLE: She said she sent it.

CP: Who is this mysterious "she" of whom you speak?

MOOSE KNUCKLE: My prescriber. I just left her office and she said she sent it.

CP: Did she say she "sent it"? or that she "sent you away with it"? as in "sent it with you"?

MOOSE KNUCKLE: Huh?

CP: What's that in your hand?

MOOSE KNUCKLE:I don't know.

CP: May I see it?
MOOSE KNUCKLE: <hands over papers in hand>

CP: As I suspected. This would be your prescription.
MOOSE KNUCKLE: Right. I need to pick it up.

CP: Right. After you drop it off.
MOOSE KNUCKLE: She said she sent it.

CP: She did. She sent it to me via your hand. You are the delivery person of your own prescription. You can't just walk into Five Guys Burgers, head to the pick up window, and grab the first order number you hear them shout. You need to place your order first.
MOOSE KNUCKLE: But I thought it was placed.

CP: No. Your mates wrote down the order for you to take to the counter and place it yourself. Had you used doordash, someone else would be here picking up your order, not you.

MOOSE KNUCKLE: Ok. So what do I do now?

CP: Now that I have your prescription, you may sit until I call you. Then you may return to the Pick Up window as I now know you are quite familiar with its location.

MOOSE KNUCKLE: Why did she say she sent it?

CP: As I am not her, and since you have to wait, why don't you use this time to call her and ask her? UT and I are both dying to know.

MOOSE KNUCKLE: I don't want to bother her; she's busy.

CP: Right. Yet here I am, doing my job, herding people into the correct locations at my counters because they don't understand words while answering questions that should be posed to other people. Nope, not busy here.

New Twist On A Classic

CPP: What's your favourite, or at least most popular, question asked of you?
CP: The alcohol one.
CPP: Can I drink with this?
CP: Exactly. People always treat it as if it's a negotiation.

 Pt: How much can I drink with this?
 CP: None.
 Pt: 3?
 CP: Nope.
 Pt: 2?
 CP: Fewer.
 Pt: 1?
 CP: Keep going.

CPP: I asked you this because I know you enjoy answering questions literally and thought you might have a quick quip for this.
CP: I do. Let's play.

Forcing Rx's Over Gums: Can I drink with this?
CP: Yes. Absolutely. In fact, I encourage drinking while taking this medication.
FROG: <excited> Really?
CP: Yes. A dry swallow is a difficult feat and will leave a bad taste in your mouth, or get stuck in your throat.
FROG: That's not what I meant.
CP: I encourage drinking. It is healthy to stay hydrated. It is a difficult task for a pharmacist, what with the "no drinks allowed on the bench" policies and the mandatory masks. Lemme tell ya, 12 hour days in these things really parches the ole gullet and they don't make them yet with straw holes.
FROG: I wanted to know if I can drink. . .
CP: I assume you CAN drink. Water would be the potable liquid of choice. As I said earlier, I solidly encourage drinking while taking this medication.

CPP: You know that's just cruel, right?
CP: Next time he will be more specific. Or get to the point faster.
CPP: Surely someone out there is going to think you're serious.
CP: I am serious. I would totally answer the first question this way. . . knowing my patients and the rapport I have with them, this answer would go over very well with the crowd. And don't call me Shirley.