Before the 'But' = After The 'No'

CP: Why is "no" such a difficult word to understand?

CPP: What are we discussing today?

CP: The word "NO". 

CPP: Usually one of the first words we learn as toddlers. 

CP: And a word whose boundaries we, as toddlers, like to continue to push; even more so as adults. 

CPP: No is defined as "not any; a negative response; not at all; to no extent".

CP: Yet people will try to find wiggle room; to attempt to modify or attenuate the meaning by arguing unreasonably. 

CPP: Meghan Trainor had it right when she preempted her potential suitor with "NO". 

CP: Yet he persisted. 

CPP: Like our patients when we tell them "no" to anything. 

CP: Do you have the covid vaccine? NO.

Is my Percocet due today? NO. 

Can I get my refills early? NO. 

Did my prescriber call yet? NO.

All followed with "but, but, but."

CPP: Jon Snow. 

CP: Precisely. I think of a bastardization of his quote to Sansa: "Everything before the word 'but' is horseshit." In this case, "everything AFTER the word 'NO' is horseshit". 

<example conversation (how it should go)>

CPP: Do you have the covid vaccine?

CP: NO. 

CPP: Thank you. 

CP: Good day. 

<end scene, applause for a great performance, curtain. . . right?>

NO. . . 

 

<Actual Pharmacy Scene>

CP: Do you have the covid vaccine?

CPP: No. 

CP: But I have a medical condition. 

CPP: No. 

CP: I'm 65yo. 

CPP: No. 

CP: I'm diabetic.

CPP: No. 

CP: My doctor said I should get it. 

CPP: No. 

CP: I'm a healthcare worker. 

CPP: No. 

CP: I like to lick doorknobs. 

CPP: Weird. No. 

CP: And shopping carts. 

CPP: No. 

CP: But I needs it. 

CPP: No. 

CP: Your mother was a hamster. 

<repeat. all day. every phone call. every visit.>

CP: Persistence will not reward you. Patience will. 

CPP: All you are doing is delaying my ability to help others. 

CP: Well, to help them by telling them "no". 

CPP: Of course. I wish we had a "no" button on the phone or a digital board that flashed with a big red "NO" or "X" when we hit it. 

CP: It would break in the first hour. 

CPP: Accept the fact that no really means no. 

CP: No always means no.

Time Is An Illusion

Uber Tech: <training The Nu Tech> Here, we tell people a time to return, not the generic "15 to 30 minutes" or "Next Tuesday" like your average Chain Gangers.

The Nu Tech: Why?

UT: Perception. People will walk from the drop off window to the pickup window, 6 whole feet and believe hours of time have elapsed. They won't check the time on their phones or on the car radio. They will return when they feel it has been "15 minutes". Just ask CP. 

CP: What?

UT: I was telling TNT why we tell return times and not wait times. 

CP: It's due to men. 

TT: Men?

CP: Yes. They warp time and convince others more time has passed, or will pass, than actually has. 

UT: Tell her the anecdote. 

 

CP: UT once said "that'll be 10 minutes". The patient, a woman, strolled down to pickup. I asked if I could help with something and she, pointing at UT, said "she told me '10 minutes'". I replied "it's not even been three seconds."

Pt: "Well it felt like 10 minutes."

CP: I bet you have this conversation with your boyfriend too. Here, we prefer to under-promise and over-deliver.

Pt: <snickers>

TNT: <snickers>

-----

 

Pt: My inhaler is out. 

CP: You need a refill. 

Pt: I do. 

CP: You have no refills. 

Pt: But I need it. 

CP: <gesticulates with Spatula Wand-O-Matic while chanting> But She Neeeeeeeeds It. Om!

Pt: WTF was that?

CP: Trying to summon your refill from the "ButSheNeedsIt" Demon. 

Pt: You need to call my doctor. 

CP: Au contraire. I faxed them, but I don't need to call them. 'Tis your provider and your prescription.  

Pt: This is ridiculous. I am out and I need it. 

CP: You should probably stop arguing; you need the Oxygen.

Ask Siri

ME: "Siri, what is 30 days from today?"

Siri: Find a calendar. 

MICE ELF: She told you. 

ME: What? I learned that from a floater one day.

CP: Who couldn't use a calendar, or his brain to figure out 30 days from today?

ME: No. Maybe. 

MICE ELF: How long have you been calculating days? 

ME: <shrugs>

CP: Since you were a wee tyke, trying to figure out how many days until your birthday or Christmas most likely. 

ME: I guess so. 

CP: And did you look at a calendar first, then progress to doing the math in your head?

ME: I guess. 

CP: And you're still not sure what 30 days is from today? Or how to calculate it without asking Siri?

MICE ELF: I prefer Alexa. 

CP: Initial fill date, 1/1/21. The last day they will have medication is 1/30. With me so far? 

ME: That was easy. 

CP: This makes the fill date 1/31/21. Understand why? 

ME: <shrugs, shakes head side to side> yeeeesss???

CP: A day early would be the 30th. Why?

MICE ELF: Because the patient would still have a dose left for the 30th and they would start the new Rx on the 31st. 

CP: Correct. This also means that 2 days early would be the 29th. 

ME: So when should we fill something 30 days from today?

CP: Hey, Siri. What's 30 days from today, 3/12/21?

Siri: "Sunday, the 11th of April, 2021". 

ME: Why is she British? And what's the point of the maths today? 

CP: Did anyone else watch the Netflix series "Night Stalker: The Hunt For a Serial Killer"?

MICE ELF: You know we did. You were there. 

CP: They messed up the dates. 

ME: Yeah. I caught that. Took me right out of the series in the first episose. 

MICE ELF: How could they do that? 

ME: Did you notice the errors of the first dates shown? 

CP: If Day 2 was March 18th, then Day 1 would have been March 17th, yes?

MICE ELF: Yes. 

CP: Following. . .

Day 1 = March 17th

Day 2 = March 18th ✅

Day 3 = March 19th

Day 4 = March 20th

Day 5 = March 21st

Day 6 = March 22nd

Day 7 = March 23rd

Day 8 = March 24th

Day 9 = March 25th

Day 10=March 26th ❌

ME: Yeah. Something's not right. 

CP: Apparently they hired a pharmacy patient to calculate the days supply of this investigation.

I could just hear someone in the room shouting "but February only had 28 DAYS!"

It's Just Bad

CP: Nothing good can come from this.

UT: From what? 

CP: High turnover. 

UT: I know. We are in an endless cycle of hire, onboard, train, destroy life, replace, hire. . . 

CP: What is the average number of years of experience of the technicians in your store? 

UT: Less than 5 years. 

CP: When I started, and even 10 years ago, there was nearly always an average of greater than 5 years; often it was over 10 years. Today, I have worked stores where the average is less than 2 years. They aren't the exception. I asked myself this question regarding pharmacy staff:

Q: What hiring/scheduling issues currently affect retail pharmacy? 

A: High turnover. 

A: Lack of training

A: Overuse of cross-trained front end help. 

A: Expensive to hire and train constantly. 

A: Lack of experience.

UT: What's wrong with FE help? 

CP: It's not reflected in our payroll. 

UT: How so? 

CP: Let's say we are given 150 hours of tech help each week. However, due to demands far exceeding what corporate allows us to budget, we need to borrow FE employees daily. My last two stores used an average of 30 hours per week of this help to cover breaks, short staffing, drive-thru line(s), pickup lines, and to triage the phones. 

UT: That's almost a full time person. 

CP: True. But made up of multiple people over several days. The problem is these 30 hours were not reflected in my payroll. Corporate thinks I used my 150 hours of tech budget and the FE used their budget. They have no way of knowing I borrowed 30 of their hours. 

UT: How is this bad? 

CP: Corporate then pats itself on the back for making budget because they see the work is getting completed. "Hooray" they tell themselves. They also proclaim that, if we could do the work with 150 hours, we could probably do it with fewer. Guess what happens? They cut the budget even lower. Now it's 130 hours per week. Guess what? We still use the same 30 FE hours, or possibly more. Overall, we still come in under the original 150 + 30 we were using so they view it as a win-win. 

Now my techs aren't getting their hours and because they are often alone and overworked, because the FE people can't process or fix the billing on prescriptions, they quit. 

Now the FE people transfer to the pharmacy. (Or we have to hire and train new people with zero experience.) 

They don't get adequate training. Apparently the thinking is that simply being exposed to the environment is training enough for them; like ingesting little doses per day of poison will make you immune. 

Hire new FE people who expect to cashier but then are asked to float to the pharmacy when they need help.

UT: And let me guess, we can equate this lack of experience with prescription errors, low satisfactions scores, failing metrics, and an overall negative opinion of retail pharmacy in general.

CP: You're starting to sound just like me. 

UT: Well we have worked together for some time. 

CP: That's because we can't get anyone to stay.

UT: It's kinda like Resident Season in the hospitals. Don't go there during June or July when the new ones start. 

CP: Yeah, except our turnover is constant. There is no "season"; it's an ongoing cycle. 

UT:  Like the cicadas. 

CP:  The tension mounts, on with the Body Count.

Desperate But Not Really

Not Exactly Exuding Desperation In This Now Are We:  I need to schedule a covid vaccine shot. 

CP: We have yet to receive any in our store. Perhaps you could try the local health department. 

NEED IT? NAW: But I need it!

CP: Oh. In that case. . . I still don't have it. Try next Tuesday when the state updates its website. Maybe we'll all get lucky. I'm up all night to get lucky.

<2 hours later>

NEED IT? NAW: How about now?

CP: Is it next Tuesday yet? 

NEED IT? NAW: No. But I was hoping some may have come in on your shipment. 

CP: No. Pony Express arrives at 1600 hrs. 

<1600 hrs>

NEED IT? NAW: Now?

CP: Tuesday?

NEED IT? NAW: No. Can you add me to your list?

CP: You're on the list. We actually had to stop adding people because we aren't sure when we are going to receive vaccine and we expect only 100 shots. More people than that would be unmanageable. 

NEED IT? NAW: So I'm on the list? 

CP: You are at the top. We even put a start by your name. 

NEED IT? NAW: I'm a star?

CP: Sure. That's what it means.

<lather, rinse, repeat 7 times per day for 10 days>

 

CP: <calling NEED IT? NAW; leaves message> We have it now. Please complete the paperwork online and call us to schedule your appointment time. 

<2 hrs later>

CP: Hello? Is there anybody in there? Just nod if you can hear me. Is there anyone home? 

<2 hrs later>

CP: Hello? This is the United States calling. Are we reaching?

Uber Tech: No answer?

CP: Nope. 

UT: Nice. Calls us every 42 minutes for two solid weeks asking about vaccine appointments and when we finally get them, he doesn't answer or call back. 

CP: Did he receive it elsewhere? Or he just happened to spend today as his phone-phree holiday?

<2 days later>

NEED IT? NAW: Do you have the vaccine yet?

CP: We did. All 100 shots have been appointed. 

NEED IT? NAW: Why didn't I get one? 

CP: You need to answer your phone. We left 7 messages and sent a text. 

NEED IT? NAW: I ignore the texts and don't answer my phone.

CP: We can put you on the list for the next round. 

NEED IT? NAW: When will those arrive? 

CP: No clue. But don't call us. We will definitely call you. Just make sure you answer your phone. I'm sure you have our number in there. Maybe change our pharmacy name to "COVID TIME" so when it rings you know to answer it. 

Texting. Texting 1, 2, 3. Texting!

CP: Good Day, Ma'am. 

Mad At Us Needs Daily Early Refills: Y'all done messed me up. 

CP: Sorry. I'll take back the Good Day then, shall I? Perhaps I shall sport a withering glare to match thine own?

MAUNDER: <harrumphs>

CP: Anything in particular or just our presence in our pharmacy mess you up?

MAUNDER: I'm not getting my textseses. 

CP: Texts not being received. Got it. Allow me to check on this for you. 

MAUNDER: They're not working. 

CP: <verifies phone number>

MAUNDER: Yeah, that's it but they still ain't coming. 

CP: I checked your enrollment as well. The box is checked to sign you up, acknowledging your acceptance of our texts. Try turning your phone off then back on. 

MAUNDER: I'll be back tomorrow. 

<tomorrow>

CP: Happy to see you again!

MAUNDER: Snuff it. I'm still not getting them and I'm really angry with you. 

CP: I shall self-flagellate in penance for our computer's stubborn refusal to deny you your texts. 

MAUNDER: Are you mocking me?

CP: Not exactly. Just trying to match your assessment and approach to the urgency of your situation. Shall we try something else?

MAUNDER: What is it?

CP: I just sent you another text. Check your phone now. 

MAUNDER: I left it at home. 

CP: Of course you did. When you come back to pick up this prescription, bring the uncooperative phone. Perhaps we can place it near my computer and we can offer them counseling, or an intervention. 

MAUNDER:<glares menacingly>

<2 hours later>

CP: Welcome Lady MAUNDER and her odious iPhonious. Did you receive the texts?

MAUNDER: <sheepishly sullen> No. 

CP: Your attitude has changed from your previous visits. Do we still need to get these devices into therapy?

MAUNDER: No. 

CP: Pray tell. What epiphany had you?

MAUNDER: <whispers> I didn't pay my phone bill. 

CP: You. . . Didn't pay? . . . Your phone bill?

MAUNDER: Right.

CP: And you didn't notice for 2 days? 

MAUNDER: Uh-huh. 

CP: Seems like punishment enough. Though self-flagellation always hits home. Remember, I can only send them to you; I can't receive them for you. Go forth and get thee to a nunnery!

MAUNDER: <confused look>

CP: Or somewhere to pay your bill. Off you pop!

You Lost Me

CPP: What's new?

CP: Boss Lady came in to discuss a complaint she received about me.

CPP: How'd that go?

CP: She said I need to "not focus on the 1% of people who complain, but remember that 95% of people are good".

CPP: Where are the other 4%?

CP: No clue. But I told her that while only 1% may complain formally, to the point it reaches her desk, she doesn't have to deal with the dozens of people per day who verbally abuse us and complain vociferously to our faces.

CPP: We can't control that our companies have horrible images in the public eye; that they are viewed as evil. 

CP: It's to the point that cable and phone customer service used to be. Everyone knew they sucked; it was a constant joke. The employees couldn't help the company's public reputation. They had to deal with it. 

CPP: Exactly. Except no one is begging them to fix it. Why do I sense there is more to this story/

CP: Because I didn't exactly take this comment lying down. I literally called her a hypocrite. 

CPP: I need to know how you still have employment. 

CP: Here's the rest of the story:

Boss Lady Says Hilarious Things: We had a complaint about the drive-thru. 

CP: People like to stay in their cars. 

BLSHT: He said you told him Lane 1 was for COVID testing only. 

CP: True. It is. I wouldn't want to use that for general pickups for my family members. 

BLSHT: You can't do that anymore. 

CP: But the signs you brought to us months ago literally read: Lane 1-COVID testing only. All other services use Lane 2. 

BLSHT: I'll be taking that with me. 

CP: Riddle me this, Batman. If one, singular complaint over the previous 7 months of testing is resulting in this wholesale change of my workflow, can I hire more people?

BLSHT: No. Why?

CP: Because of the hundreds of complaints that we are too slow, too far behind, don't wait on people fast enough, never have anything ready, don't answer our phones, and never have anything ready when they want it. Hundreds of complaints and people yelling at us. I figured if we are going to change policy for one lazy bastard, we may as well make real change where it counts-for the literal hundreds of patients that hate us. 

BLSHT: That's not what I meant. 

CP: Bullshit. You're a hypocrite. You just finished telling me I should "not focus on the 1%" because the rest are good, wholesome folk. Then, when I ask why you changed my workflow for one bastard who cried like a bitch because he left the long line only to find himself in the COVID-only line you have the nerve to tell me his complaint matters more than the rest? What's the point of me reviewing my metrics and customer service scores if I can't change anything? I can't man enough windows to make people happy when you handcuff me with 3 employees. We can't answer all the phones and count prescriptions. I can print you 100 of these complaints from just the last two months. If 95 people complained we don't have enough staff, can I schedule more people since 1 person got you to change my workflow?

BLSHT: You're missing the point. 

CP: No. I see the point clearly. You are no longer allowed to come here and complain about what I do and how I run my store. I will schedule what I need and run it how I want. I am the one getting yelled at by patients and I'm done now. But you are still a hypocrite. You could give me more help. You could take my side when patients complain or ask what happened. You don't. You're not a pharmacist and if I walked out right now you wouldn't know what to do and you could deal with the yelling 1 percenters. 

 

CPP: How are you still here?

CP: She has no one better and she knows it.