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Wednesday, June 16, 2021

Pharmacy Times OTC Guide (Is Stupid)

I understand this is for Brand products. It's there in the title of the survey. There's no reason to recommend brands over generics UNLESS it's to give the patient a name to remember as they peruse the aisles. If we walk them to the product, the patient most likely will walk away with the store brand. 
But I digress. 
On with my rant. 
The more years I have practiced, the more I have realised how useless this annual report really is. After completing the survey a number of times, I've also learned how incomplete and inaccurate it is.
For those who don't know, we are given survey questions in the form of multiple-choice. For some questions there may only be two options, for others, there could be ten.
What if my answer isn't listed? I guess my opinion doesn't count.
In that case, I am actually responding to "Which of the FOLLOWING do you recommend?" instead of "What do YOU recommend?"
See the difference? 
Let's look at the categories (a few). 
Stool Softeners: Your choices are 
1. Colace, 2. Dulcolax, 3. DulcoEase, 4. Phillips' Stool Softener. 
(Let's suppose this is one of those "one of these drugs is not like the other" song-y games.) Can you tell which one doesn't belong? 
Here's a hint: "It has LAX-ative" in the name" which means it's NOT a stool softener as per the category requirement. Shit. 

Let's move to Cough/Cold/Flu Combinations Daytime
Nope. Not recommending any combinations. For one, they usually don't contain what you need or contain something you don't. Two, last I checked, Claritin and Mucinex are single-ingredient products. (No, before you respond, the response did not say Mucinex Cold or Flu, it said Mucinex only.) Coricidin HBP is a marketing gimmick ONLY. Period. Its sole existence is due to the fact that, at one time, pseudoephedrine was in OTC products. Simply put, HBP = Pseudoephedrine-free. Now it's just marketing. No reason to recommend this product.

Antihistamines: Claritin? Really? It's shite compared to the other daily ones which are all better. 
Homeopathics: I'm not recommending these. If you want them, I'll show you where they are. Maybe that's what they meant. 
Acid Reducers. Why do they combine H-2 with PPIs? then separate them into their own categories? There are reasons to choose one category over the other. This makes it seem like Pepcid is the go-to for every issue. How is the patient, the target audience of this report, to make a decision off of this? 

Topical Poison Ivy/Oak
There is a true, equal split here. Why are there eight replies representing 7% - 17%? Because we usually recommend a combination of products. 

Hand sanitizers? 
Really? I'm fairly certain I have never recommended a brand of sanitizer. Does it have enough alcohol? Yes? Buy it. 

Headaches vs Migraine Headaches?
pssst. Excedrin and Excedrin Migraine are the exact same product. Same ingredients. Same strengths. 
Oral Anti-Inflammatory?
Advil and Motrin are the same thing. Technically we're all recommending Ibuprofen, aren't we? 
As I said before, the sole purpose of this report is to increase sales of Brand OTC medications. It is our responses to a list. It is NOT a reflection of what we actually recommend.

Wednesday, June 9, 2021

If There Was A Problem

yo, I'll solve it. . . 
CP: Or be blamed for it. 
CPP: Why so cynical, CP?
CP: <gives pseudo-menacing glare> Phunny. 
CPP: <shrugs> 
CP: Did you ever notice how we are disproportionately blamed for the phailings of the healthcare system? 
CPP: I work retail. And I work it with you. Of course I noticed. I think it has to do with accessibility. 
CP: The more accessible your healthcare provider is, the more you can yell at, berate, upbraid, castigate or keelhaul her. 
CPP: But those providers who are isolated within a myriad warren of halls and walls? 
CP: No issues with the public. 
CPP: I pheel a story coming. 
CP: Have a seat. Criss-cross applesauce. 

Another Lunkhead Expecting Some Transmission Of Routine Medication: I just spoke with your tech and she told me you didn't have my medication. 
CP: She lied. 
ALESTORM: I knew it!
CP: I have your medication, but I do not have the requisite prescription to dispense it to you. 
ALESTORM: That makes no sense. 
CP: Sure it does. I stock medications. The one you take is in stock. Thereby confirming that I DO have your medication. 
ALESTORM: But my doctor always sends me 3 months at a time. 
CP: Two months. 
ALESTORM: No. Three months. 
CP: It's not a haggle. We're not bartering for the best price here. Since last November, your doctor has sent your prescriptions two months at a time. 
ALESTORM: Well something is off here. 
CP: Your attention and comprehension. 
CP: <titters>
ALESTORM: "If I find the problem is with you, I WILL find a new pharmacy!" 
CP: Ooh. So adamant and threatening. I have a follow up question to that. 
CP: You threatened me that if the problem were mine, you would take your business elsewhere. Does the corollary also hold true?
ALESTORM: Cor what now? 
CP: Cor Blimey. This is rough. The corollary. If you discover the doctor is at phault phor your missing prescription, meaning HE NEVER SENT IT TO ME, are you going to then threaten him as well? Are you going to threaten him with phinding a new doctor? I'm taking my talents to another Dr. Zoffis! Better yet, will you apologise to me when I am proven right and you come skulking into my pharmacy to retrieve your medication. 
ALESTORM: <click>
CP: Thought so. 

CPP: Let me guess. . . the doctor never sent it. 
CP: No. Two months at a time. That's how often he checks the PDMP. 
CPP: Did he apologise?
CP and CPP: <laugh>
Keelhaul that filthy landlubber
Send him down to the depths below
Make that bastard walk the plank
With a bottle of rum and a yo ho ho

Wednesday, June 2, 2021

I Love You?

ME: We received another complaint that we weren't "friendly" or "convincing" enough when we said "have a nice day". 
MICE ELF: Is this from the same people who tell us we "should smile more"?
CP: Probably. Really enjoyed the anonymity of the masks; and not being told to "smile more". Now I have to reteach my face to behave. Its inner RBF was allowed to be untethered under the masks. What's this I hear about a complaint? 
MICE ELF: ME just said we didn't greet someone with enough pheeling. 
ME: Poor baby. How ever does she make it through her day? 
CP: I love you. 
MICE ELF: Huh? Um. I love you, too?
ME: Awww. And I love you. 
CP: Do you really love me? Or were you just parroting what I said because I said it first? 
MICE ELF: I am so confused right now. 
ME: ME too.  
CP: Think about those words. I. Love. You. How many times have you said them? How many different ways have you uttered those words today? In your life? As a child to your parents? As an infatuated teenager to your amour? In the heat of the moment? As a parent to your child? On the phone, ending a conversation? In each of those instances, the way you say "I Love You" and the intensity behind those words changes. Your intention is the same, to impart your feelings of love towards that person. Is a hasty "loveyoubye" different from an "I love you. Have a great day!" as you both head off to work or end your lunchtime phone call? No. It's become a quick sign off. It doesn't mean anything less based on how tired or trite it may sound when the other person says it. 
ME: You're saying "have a nice day", when repeated ad nauseum throughout a long day, can come across as less than enthusiastic but it doesn't mean we wish them any less happiness? That it reflects how we are feeling at that moment?
MICE ELF: True. I can just hear these same people complaining that their children or spouses "didn't say 'I Love You' with enough spirit and joie de vivre". 
CP: Precisely. Can't you just see it?

Angry Little Elf: Say it.
SMART Angry Little Elf's Kid: I love you. 
ALE: Do you?
ALE: Really?
SMART ALEK: Really really. 
ALE: Say it like you mean it. With conviction!

ME: Some days, I'm just not feeling it. 
MICE ELF: And that's okay. Reflexively replying with "I love you" or "I love you too" in whatever tone you can muster does not detract from the intention of the feeling behind it. 
CP: If someone is polite enough to acknowledge your presence, your very existence with a pleasantry, "hello", "good morning", "have a splendid day", accept it and move on. But don't ever complain about their sincerity based on how you heard their tone or that she didn't smile. 
ME: If there are two ways to interpret something, and one of them is negative, why do patients always choose the negative one? 
MICE ELF: To feel better about themselves?
CP: It's amazing to me how difficult it is to take a compliment anymore. 
ME: Because we don't hear them often? 
CP: You are wise beyond our years, ME. 


Is It?

CPP: What is something you thought was stupid, or redundant, that you later learned may not be as bad as originally perceived? 
CP: Directions. Specifically route of administration. 
CPP: They are necessary. 
CP: I agree. But how often do you need to state "by mouth" within the directions set? 
CPP: We were always taught that once was sufficient. 
CP: Correct. And I've adhered to that my entire career. It gets to be redundant, not to mention wordy, to write on a Prednisone taper: 
"take 6 tabs by mouth on day 1, then 5 tabs by mouth on day 2, then 4 tabs by mouth on days 3 and 4, then 3 tabs by mouth. . . " 
"Take 1 tablet by mouth every morning and take 2 tablets by mouth at bedtime."
CPP: Especially on labels at Conjugal Visits with Satan where you're only allowed 100 characters. You have to be efficient. How else are you going to take it? 
CP: I firmly believed in the power of minimalism; K.I.S.S for the average pharmacy patient. 
CPP: Until? 
CP: Until I started working at a new pharmacy that entered the route after every verb. If the directions said to take something 3 times a day, different doses mind you, the directions would read: "Take 1/2 tablet by mouth every morning, take 1 tablet by mouth at noon, and take 2 tablets by mouth at bedtime". 
CPP: That wouldn't fit on a Chronic Vaginal Secretions label. 
CP: Precisely. But then I started thinking. What's your favourite medication? The one you query all the interns about? 
CPP: Lactulose. 
CP: Why? 
CPP: Because it can be dosed orally or rectally and produce the same resul. . . oh. I get where you're going. 
CP: I'm not saying I'm in favour of it. I still think it's overly wordy, verbose, and redundant but. . . with medications like Lactulose, Prometrium, et al, there is the possibility they could be administered via different routes alternately throughout the day. 
CPP: In which case we will spell it out on the label and counsel the patient because it will be the first time either of us have seen it. 
CP: True. I'm not changing all of my Albuterol directions on the rare chance a patient "Uses 2 puffs orally every morning and rectally every evening". I'm really hoping they'd be given two separate inhalers for that. 
CPP: Or at least a spacer.

Tuesday, June 1, 2021

Time Flies

ME: Worst insect to plague pharmacy?
MICE ELF: Lice. 
ME: Second worst?
CP: Time Flies. 
MICE ELF: I really thought the title of this post used "flies" as a verb. 
CP: Nope. They're annoying little insects that suck the time out of our days and apparently transfer it to the patients that call us; those who have too much time on their hands and yet also need more of ours. 
ME: Like people who call us multiple times per day to ensure their prescription is still ready. 
MICE ELF: Is it ready? Is it ready ready? 
ME: Reminds me of prank phone calls asking if your refrigerator is running.
CP: I'm curious because I always wonder at how long people give themselves to find their "lost/missing" prescriptions before they call the pharmacy yelling. 
ME: There has to be some ratio between time spent looking for the "missing" Rx and the time until they decide to call to bitch. 
MICE ELF: Can 0:NOW be a real ratio? 
CP: Every time. Without fail. Every single time someone has called to complain, I have refused to look for their prescription. 
ME: Haha. Seriously? 
CP: Yes. 
MICE ELF: Well that's not very professional. 
CP: Neither is calling to complain without having actually checked for the prescription. I will pull up the register transaction, see that it was scanned, or recall that I scanned it out myself, then leave the patient on hold until I tire of the phone yelling at me. 
ME: Punishment hold. And?
CP: Then I will begin to politely explain that I have not found it at the pharmacy and, you know what?
CP: The patient will interrupt me and say "never mind. I found it". 
Here are the latest examples:
"Oh. I didn't see it on top and reached in the bag. While I was on hold I dumped the whole bag and it was on the bottom."
"Oh. I didn't see that each Rx was in its own bag and I only opened the first one. I found it while I was on hold."
"Oh. I opened the bag to take one as I was driving away and didn't notice the other one fell out of the bag and onto the floor of my car. It was stuck between the seat and the door. I found it while I was on hold."
"Oh. I opened it on my lap in the car and when I got out, it fell out and rolled down my driveway. I found it while I was on hold."
MICE ELF: I wonder if these people call the car dealer when they can't find their keys in the morning. 
ME: They're too used to using "find my iPhone" when they walk downstairs and can't recall where they were last. It's easier to "ping" it from their watch than it is to walk back to the bathroom, which they will have to do anyway. 
CP: Honestly, calling someone is the last thing I want to do. I will tear apart my house and retrace my steps before I prostrate myself for help. Why is it that people feel no compunction about calling me to waste my time? Why do they wait until AFTER they call me to look? 
ME: Maybe we could charge a finder's fee?
MICE ELF: Like the cable guy. That'll be $100 just for me to walk into your house. I'll send ME right over. 
CP: And while we're there we can take their medications for them. That way we can ensure compliance and that they aren't missing any doses. 
ME: This sounds familiar. 
CP: I called it "The Phuture of Pharmacy". I can add "Phinders Keepers" to the a la carte menu.