Christmas Carols

Jingle Bells

scriptions I must count

patients want them now 

questions they all shout

phones are ringing too 

bathroom's over there

you'll find shoelaces too 

we're so busy now

just leave us alone

counting pills, counting pills

counting all the way

once I fill up your Rx 

I'll stop counting pills, hey

counting pills, counting pills 

I'm still counting pills 

five by five I'm counting pills 

I wish they'd go away, hey

another script I have

to count again by fives

they think we're all just bums

out here saving lives

doctor cannot spell 

math here is not right 

pharmacist is still 

slaying it tonight 

counting pills, counting pills

counting all the way

once I fill up your Rx 

I'll stop counting pills, hey

counting pills, counting pills 

I'm still counting pills 

five by five I'm counting pills 

I wish they'd go away, hey

Pet Peeve of the Week #2

CPP: What pet peeve set your hackles aquiver most recently?

CP: The number of people this week who asked "why did my doctor prescribe that for me" is too damn high!

CPP: For the uninitiated, this is where I play Devil's Advocate, to prove we thought of the boring reasons patients are asking this question. 

CP: Right. There's a difference between "what is this for?" and the following indictments of annoyingly obtuse offenders. 

CPP: Shall oui?

CP: Lettuce. 

Uber-Tech: Is this Mr. VEM?

Better Off Forgetting About Various Electronic Medications: Uh-huh. 

UT: We received a couple new prescriptions from Dr. Zoffis today and we have to order them for tomorrow. Also, I wanted to give you the prices before we order them. 

BOFA VEM: I didn't ask for any medications. 

UT: Well your Dr. Zoffis apparently thought you needed them.

BOFA VEM: What are they for?

UT: Did you see your provider today?

BOFA VEM: Yes. 

UT: Did you just randomly bump into him on the street? Or did you schedule an official appointment for a particular illness/reason?

BOFA VEM: I did. 

UT: Did you discuss these issues with your provider? 

BOFA VEM: Yes. We discussed both of them. 

UT: And. . . what was the result of your discussion?

BOFA VEM: <shrugs, even though this is a phone call, I can feel it> I don't remember. 

UT: You had a problem. 

BOFA VEM: Or two. 

UT: And scheduled an appointment with your provider. 

BOFA VEM: Uh-huh. 

UT: To hopefully run some tests or give you, I don't, maybe medications to improve your symptoms?

BOFA VEM: I guess. 

UT: Yet you are surprised to hear from me. Me, telling you you have a prescription and acting put out by my call. 

CP: I truly wonder what happens during these visits. It used to be so simple, formulaic even. Get sick. Go to Doctor. Get a prescription. Go to pharmacy. Trade paper prescription order for actual prescription medication. Take medication, get better. Now it's so convoluted people don't even know why or when or even IF they went to the doctor within the hour, let alone any day this week. 

UT: It's amazing how many of these calls I make every day and people are surprised we have something for them. 

CPP: Maybe they're used to Chronic Vaginal Secretions not calling them for weeks since they are so far behind that the patients can't comprehend how we can contact them while they are still in the office! 

UT: That's always great. You get them on the phone and they say "I didn't know anything about that" and you find out they are literally still in the room with the provider. ASK! How did you not just hear her say "I'm prescribing you THIS!"????

CP: And how many days will that prescription sit in our waiting bin because they forgot they went to the prescriber earlier in the week. 

CPP: Yeah, that's the other one that gets me: how did you forget you were at the doctor on Tuesday? 

UT: Especially when it's a specialist! You had to have made that dermatologist appointment months ago. How can you forget you went two days ago? 

CP: As the saying goes: "The best thing about being dead is that you don't know about it. It's like being stupid - it's only painful for others.”

Climate Change Is Real

CP: I challenge you that climate change is real. 

ME: Yeah. We know. 

MICE ELF: How is this relevant to #Pharmacy?

CP: I'm talking on a smaller, yet global scale. 

ME: Again, we know. What of it?

CP: I posit that climate change exists, in microclimates, in every pharmacy and retail outlet in the world!

MICE ELF: <best Goody impression> Settle down. 

ME: <resigned exasperation> I'll entertain it. 

MICE ELF: Let's hear it. 

CP: There exists, at every pharmacy counter, a microclimate that negatively affects all humans who enter or even approach it. 

ME: How do you mean?

CP: Ever notice how, before you can see or acknowledge a person at a pharmacy window, the weather affects them?

MICE ELF: Like how?

CP: Like just by getting within the area of the drop off or pickup window, all patients seem to manifest the same side effects. Our counters should come with warnings: Danger! Achtung! Warning! Approaching the pharmacy counter has been shown, anecdotally, to cause a dry, scratchy throat, sudden coughing, sniffling, instant urge to clear throat, loss of decorum, and an inexplicable loss of dexterity and motor control rendering patients unable to hold on to their keys or to place them gently on a countertop. 

ME: <laughs at "inexplicable loss of dexterity"> 

MICE ELF: I've had the same thoughts. 

CP: I almost want to go back to school to study Sociology. My thesis would focus on people behaving differently from the time they park, to the time they near a retail building, to the time they enter the outer doors, to their standing at one of the windows, waiting for another human with whom to interact. 

ME: Like, are they coughing in the parking lot? or as they cross the threshold of the store? or once they abruptly halt their momentum at the counter? 

MICE ELF: Right?! And is this common among pharmacy shoppers only? Is this only in my neighbourhood? nationwide? globally? 

ME: We are humans. Humans do human things. Behaving poorly in public is universal. 

CP: We already established what I do when people knock on my counter. 

ME and MICE ELF: "IT'S NOT A DOOR!"

CP: I think the next time they cough or clear their throat, I should reply with: "Are you dropping off? Or do you just have a question about that cough and mucous you just ingested in front of everyone?"

ME: What about when they drop their keys? 

CP: We sell wrist braces in Aisle 13 so you can grip those keys as well as purses and pants with pockets for you to place the keys so as not to lose them or forget them on counters. 

MICE ELF: Not bad. Better than "you must be a janitor; sounds like you dropped a whole school's-worth of keys on my counter". 

ME: Idiots. Both of you. 

CP: How about #CoughMedicineIsInAisle13?

MICE ELF: I so want to take this class now. 

Moved

CPP: What did you find particularly annoying last week?

CP: Dr. Zoffis. 

CPP: Care to elaborate?

CP: I'm tired of their shenanigans. 

CPP: Care to elaborate?

CP: Patients call all the time, as do offices, to say "we watched them send it. we sent it last week. we sent it wesentit wesentitwesentit!". 

CPP: Yes. And?

CP: And what happens? We receive a refill too soon rejection at best or, the office says "can't you just call and transfer it from the other pharmacy?" making it our job to do their job since they failed the first time(s). 

CPP: What's also annoying is when patients are IN the office and specify they want their prescriptions sent to my pharmacy. They put it on the app at checkin, review with the receptionist, verify with the nurse, and confirm with the prescriber. Yet they still manage to send it to the wrong place, if it's sent at all. 

CP: Right. Well you know how we received those Sharpie-fied refill request denials from Dr. Zoffis? 

CPP: The ones that say "not our patient" or "patient died" or "no longer our patient"? 

CP: Yes. Those. Well now I've been seeing a new one: "moved office location. update your records". 

CPP: I can see why that would be bad. 

CP: How about no? 

CPP: Pushing more work onto us. 

CP: From now on, when the office sends it to the wrong pharmacy, I'm telling them that, no, I cannot do that. When I move, I fill out a change of address form alerting the post office of my new location. It is not their responsibility to inform the senders of MY mail my new address. 

CPP: It's even worse when you have providers that have multiple office locations listed but the only one from which we receive e-scripts is the "home address" of the e-rx software. 

CP: Yeah, good luck trying to discern which of the 11 offices she is working today. Maybe its #7, maybe it's #46 and #2. Maybe she's off today. Who knows. No one has even heard of her at most of the offices because she travels. 

CPP: Providers should be forced to sign in at their prescribing location when they first login to their e-scripts for the day. If they leave for another location, they need to again login to the new place. Easy. 

CP: You mean like we do when we work multiple stores?

CPP: Genius, right? 

CP: But I am not playing Where's Waldo all day. 

CPP: Let's remind people of something here, or rather ask a key question: Are you a patient of the DOCTOR? or a patient of the OFFICE?
CP: If the doctor leaves a practice for a new one, do you, as the patient, follow them making you THEIR patient? If so, then I need to know the new location to send your refill. 

CPP: Which will likely update anyway as we will continue to send requests to the DOCTOR on your file. 

CP: But, If your doctor dies/leaves and you continue to see a provider in the same office, then you are a patient of that OFFICE. 

CPP: Which means when we send refill requests, the OFFICE shouldn't send us nasty notes about "not our patient" or "doctor no longer at this location/office/practice" or any other form or quick dismissal. 

CP: Especially when the office policies "require that your pharmacy contact us for refills". 

CPP: Easier said than done when we don't know WHERE to send them. 

CP: Or TO WHOM! 

CPP: I thought e-scripts were going to make everything easier? 

CP: It certainly made it easier for Dr. Zoffis to lay blame everywhere else and shirk many responsibilities. 

Pets

CP: I don't believe animals should be allowed in stores. 

CPP: I bet the people with service animals would have a few words about that. 

CP: I'm fine with the real, honest, working service animals; not these made up "emotional support" guinea pigs and alligators and pipsqueak rat-like dogs people bring in to stores. 

CPP: Yeah, the line has been erased. 
CP: And no one says anything because we can't offer "poor customer service" or be perceived as "intolerant". I do have pets. They stay at home. 

CPP: Why the anti-pet rhetoric today? 

CP: I was thinking we should get a pharmacy phriend; a pet. 

CPP: You confuse me. 

CP: Well, it started as a post about what would make the best pharmacy pet and I ME, MICE ELF, and I were discussing it, we thought of a better topic. 

CPP: Oh do tell. 

CP: Pharmacy Mascot!

CPP: Uh-huh. 

CP: What would make the best animal representative for our profession?

CPP: I don't know. 

ME: ME! Pick ME! 

MICE ELF: I have one! Ooh! OOH!

CPP: Why can I hear the voices in your head?

CP: <shrugs> 

CPP: Okay. What did you decide? 

CP: The perfect animal would be the duck-billed platypus. 

CPP: Since you put a lot of thought into this, why is the Platypus the perfect spirit animal for pharmacy?

CP: We are simultaneously two things at once, like the DBP: we are both salaried and hourly, respected and disrespected as professionals; retail workers yet professional license holders. No one believes we exist. 

CPP: I don't think Travis Kelce will make another "two things at once" commercial based on your description of pharmacy and the platypus. 

CP: Could be fun. I think I'm going to make Pharmacy Platypus Pins. #ThePlatypusIsThePharmacySpiritAnimal 

Where Did They Go

CP: Let's play a game of where did they go?

ME: Why?

CP: I have this hatred of Outcomes and MTMs in general. 

MICE ELF: Why? Are you saying these aren't helpful? 

CP: Another post for another time but I'm saying they're a waste of time for us to fight to keep the money the insurances paid us and that it is improbable the 90 days supplies and phone calls from MTMs make patients take their medication correctly. 

ME: Thanks for the clarification. 

CP: Where do these medications go? People always say "I take these EVERY DAY! I never miss a dose. I never take more than I am supposed to take", yet here we are, 120 days in to a 90 days supply and you still have plenty of loaves and fishes to go around a few more times. 

MICE ELF: Where DO they go? 

CP: I had a guy this week looking for his one refill; no, not that one, the other one he can't remember. 

CP: Your two other medications are past due. 

Maybe It's Meth, Eh?: No I don't. I just picked them up. 

CP: If by <spits word> "just" you mean 99 days ago, then yes, you "just" picked up your 90 days supply 99 days ago. Which means you should have run out <checks math, does air calculations for dramatic effect> 9 days ago? 

MIME: I still have at least month left. 

CP: You take them every day. 

MIME: Yes. 

CP: Never miss a dose? 

MICE ELF: <they don't call him never-misses-the-mark-michaels> 

ME: <let's see who gets that reference> 

CP: Stop, you two!

MIME: Never miss a dose and it's still once a day. 

ME: I guess you're asking "where do they go" in a rhetorical sense?

CP: NO! I really want to know where they go! How do they make these supplies last so long? Outcomes tells us patients are more compliant if they receive 4x90 days supplies per year, right?

MICE ELF: So they say. 

CP: But just because we FILLED THEM, it does not mean the patients TAKE THEM! As evidenced by our MIME up above. 

ME: You could also ask: "How do they make them last so long?'

MICE ELF: <sings "marijuana in your brain. . . "

ME: Stop. No one will get that one. 

CP: Ho DO they last so long? Four fills of 90 days should last 360 days. EVERYONE tells us patients are more compliant yet all I see are patients requesting to be taken off of automatic refills and being habitually late when they call the refills in themselves. 

ME: I have the solution. 

MICE ELF: An Epi-Fanny? 

ME: You mean epiphany? 

MICE ELF: Tomato -To-mah-to. 

CP: Let's hear it. 

ME: We start a service like DoorDash or Uber and send an employee to each patient's house to ensure they take their doses of medication. 

CP: Don't let the PBMs hear that. They'll make us do that to collect our own DIR fees. Each visit nets us tenths pennies on the dollar.

ME: Call it DrugDash?

MICE ELF: Either way, patient responsibility is not OUR responsibility. Just like you can't mandate personal hygiene or car maintenance, you can't mandate personal prescription compliance AND have NOT be the end users' responsibility. 

CP: You can give a person an education, but you can't make him use it. You can give a person medication. . . 

Rhetorical

CPP: I see here in your bio that you like asking and answering rhetorical questions. 

CP: I do. It's unexpected. 

CPP: What other ways do you like to buck normalcy?

CP: Asking people to explain answers they supply that are quite unexpected. 

CPP: You are a fan of the comic, and the term itself, non sequitur. 

CP: Indeed. You are familiar with the Geico Airport commercial? 

CPP: Of course; the one where the traveler replies "you too" to the TSA agent wishing him a good trip. 

CP: That's the one. Have you ever stopped and asked a patient, or anyone, for that matter, why they said what they just said? 

CPP: Questioning the origin of their non sequitur to determine if they didn't understand what you were saying; to determine if they had their response prepared and, no matter what you said, they were going to reply the same; or if they really didn't understand the assignment and were looking for a way to safely exit the uncomfortable conversation? 

CP: Right. Like this example:

CP: Welcome to the Machine. What did you dream. This is CP's Playhouse. How may I help you?

Do I Look Dumb Or What: I need a refill on my medication. 

CP: You have no refills left. I sent a request to your office and I would suggest you call them as well. Maybe if we both attack them, they'll get back to us sooner. 

DILDOW: I've been coming here for years. 

<Option #1 - We reply with equally useless knowledge>

CP: Oh wow. I've WORKED here for years 

or

CP: Oh wow! I once scored 4 touchdowns in one game for Polk High. 

or 

CP: Oh wow! Giraffes and Humans each have 7 vertebrae. 

<Option #2 - We ask the relevance of their reply>

CP: Oh really? Wow. And what does your loyalty to our business have to do with your lack of refills? Are you implying "I've never had this problem before" or something else sinister towards me? 

PT: But. . . 

CP: Or are you letting me know that you know that I know you should know by now, due to your years of loyal servitude, that you should know better that you have to call Dr. Zoffis yourself for your refills? 

DILDOW: But. . . 

CP: Seriously. What possessed you to reply with "I've been coming here for years"? That doesn't follow the conversation. Appropriate replies wold have included:

"Oh. Ok. I shall ring my provider forthwith."

"Oh. Fiddlesticks. What are my options so I do not go without?"

"My bad." 

CPP: Sometimes that's a fun rabbit hole to investigate. Often, it's short. 

CP: It's fun watching them struggle to comprehend what just happened. That's why I have so many fun facts on hand. They always get distracted by shiny new things. 

No One Believes Us Anymore

CP: You know what I miss? When people used to take our word for something. We were seen as the experts and our answers were The Final Word on everything pharmacy-related. Now it's just become another answer patients wish to argue with you. 

ME: If we tell you it's on backorder, it is. We aren't artificially presenting a mass market conspiracy. 

MICE ELF: Now people like to argue. "Well I'll just get it where my girlfriend fills hers; she never has an issue getting stuff."

ME: Right. Somehow we are the only ones experiencing a shortage. Maybe she got lucky each time previously, but today? Today it's on backorder. Why does this have to be an argument?

CP: Or this one: You gave me expired Paxlovid. 

ME: OMG! I hate this so much. 

MICE ELF: Never mind trying to explain about concurrent trials or the company being forced to put A date of expiration on the box. 

ME: They don't want to hear it and don't care. 

CP: I was handed a box, explained the "outdated" medication and how the FDA had extended the date, so far at least, to the end of 2023. She still insisted I give her another box with a better date. 

Tries Wasting All Time: This is expired. 

CP: It is not. 

TWAT: It is. 

CP: I assure you it is not. The FDA extended it through 2023. 

TWAT: Well I want a new box that says that. 

CP: Well I don't have one. They all have the same date from the last order I received. It's not Harry Potter where I can change the newspaper headline when something changes; much like I can't change the number of refills on your bottles in your house. 

TWAT: Well that's not good enough. 
CP: Hand it to me, I'll wave my hand over it and hand it back. Satisfactory?

TWAT: No. What should I do?

CP: You got two choices of what you can do: one, take the medication to treat the covid you apparently tested positive for, yet stand here spitting venom at me at my counter without a mask or, and I like this one better, you can find a DeLorean and go back in time to 9 months ago and and get covid then and I will STILL hand you the same box but it will be in date. Your choice. 

TWAT: <harrumphs> 

ME: Yeah that was pretty surreal. I pine for the days when we were the most trusted profession. 

MICE ELF: Everyone wants to question and argue about every answer, no matter how trivial. 

CP: I used to say "just because you don't like the answer doesn't mean it's a wrong answer". I still say it, but I used to too. 

ME: Yeah. Everything is an argument or a battle. Just say "oh, ok" and move on. If you have a follow up question, ask it. 

MICE ELF: Like "where can I get it" or "do you have an ETA" or something better than blaming me for your suffering. 

CP: Hell, people will complain about this post (TL:DR, or "paxlovid is a waste anyway" or whatever. Just enjoy the ride). 

#RIPMitchHedberg 

#ICanExplainItToYouICantUnderstandItForYou 

#TrustMeImAPharmacist 

If The Real World (And People Behaved) Like Pharmacy

ME: Hey, CP. What's your annoying-behaviour-of-the-human-population-of-the-day for today?

CP: Randomly shouting, or even speaking at normal volume which is somehow worse, the product(s) you are seeking at a retail establishment. Or even for people for that matter. 

MICE ELF: Yeah. How many times are you standing behind the bench and you overhear someone in a rather forgettable conversation questioning where something is, only to find out they are directing it at you without warning. 

CP: Right? I can't see you from here. If you're on your phone or speaking with your friend next to you, you have to get my attention if you are expecting me to respond directly to you. Especially when you don't change cadence or tone or volume; it sounds like a natural part of your conversation. 

ME: It often sounds rhetorical sometimes. You didn't direct your question to me, so don't expect an answer. 

CP: You know the ones who are worse?

MICE ELF: Worse than those?

ME: Who is worse than the people who think we are always paying attention to them?

CP: The people who enter a store and proceed to shout random products into the atmosphere. 

ME: Like when we are typing or otherwise doing downward facing dog at our counter and you hear "DEPENDS!?" and you're not sure if it's a question "where are the Depends?, a proclamation "Look! Depends!!" or a noncommittal response to "are you busy tonight? it depends.". 

MICE ELF: Lol

CP: Or they shout for anything with the same ambiguous interrobang inflection - Bathroom?! Halls?! Condoms?! 

ME: Why do they shout? And they don't even break stride as they're gliding past your counter. 

CP: I think I'm going to walk in to stores from now on and just start shouting everything I'm looking for too; I'll be at Lowe's with like a brand-specific Tourette's: "Nails?! Tools?! Machines?! Chains?!" 

ME: I mean the least they could do is make eye contact with a few seconds. 

CP: Pervert. 

MICE ELF: Or get within 11 feet of the counter before drawing the attention of the entire building to them and their needs. 

CP: Remember: "All animals are equal, but some are more equal than others." All animals are important, but some are more important than others" right now. . . 

#Interrobang 

#AnimalFarm 

A Little Knowledge Is A Bad Thing

CP: I posit that a little knowledge is a bad thing. 

ME: I support this. 

MICE ELF: I think you mean "too little knowledge". 

CP: No. Simply "a little". It's the start of something. The problem is, people may discover this little bit of knowledge but not possess the ability to interpret it or use it as intended; mayhap it takes on sinister or nefarious connotations in their possession. 

ME: Agreed. If they remained blissfully ignorant, they would be less likely to cause harm to themselves or others. 

MICE ELF: What you're saying is these people tend to wave their limited, out-of-context knowledge like a sword simply cutting into things without any appreciation for the damage it can cause. 

ME: They don't understand the power that comes with this responsibility. 

MICE ELF: Why do you pester us with these mind exercises, CP?

CP: Package Inserts. 

ME: And the medication pamphlets we have to distribute with every prescription. 

MICE ELF: I wasn't a fan of those from the beginning. I understand the requirement, but I, MICE ELF, am not a fan. 

CP: Nor am I. Our biggest fears have become reality. 

CP: Thank you phor calling CP's Chancroids and Pustules, how may I help you?

Getting Independent Research Lady: I'm so glad it's you. The cardiologist wanted to start my husband on a new medication and it's expensive. I wanted to research it first and I don't want him to take it. I was online last night for hours. 

CP: If you know everything, why are you calling me?

G-IRL: To tell you we aren't going to fill it and you can put it back or whatever. 

CP: Ok. Did Dr. Zoffis explain why your husband should be on the medication? 

G-IRL: Yes. But we don't want the side effects. It causes UTIs and low blood sugar and sinus problems. He doesn't need any more problems than he already has. Why didn't Dr. Zoffis tell him this? Why did he give him this if causes all of these side effects?

CP: It doesn't "cause these side effects" in everyone. You omitted a couple of key words in your studies; it "may cause" or it "can cause". Nowhere does it say "everyone's gonna get this!". The most common side effects for this medication occurred in 0.1% to 2.8% of the people taking it. While 34.2% of those studied experienced side effects, similar to placebo, the highest reported number of any specific adverse event was single digits. 

G-IRL: But I read them and it says he will get these. 

CP: Is he also going to get vaginal discharge and neutropenia? Or just the ones you hand picked for him? 

G-IRL: Well he hates diarrhea and has had UTIs before so those would be bad. 

CP: Ok. Just so everyone is clear - Dr. Zoffis recommended a new medication to help your husband and, despite my attempts to support this decision and to allay your concerns, you are going to ignore our advice, the advice of two healthcare experts, and use your own research to make healthcare decisions. Do I have it right?

G-IRL: Yes.

CP: GIRL, bye. 

MICE ELF: You're right. A little knowledge is a bad thing. 

ME: In the wrong hands. More often, it's a dangerous thing. You can give a person an education but you can't make them use it. 

CP: Well, at least not all of it. They play "Pick and Choose". 

CP And Me And Mice Elf

ME: Why do you use both of us for your conversations?

CP: Because people prefer a dialogue as opposed to a diatribe. 

MICE ELF: Then what are we discussing today? 

CP: Pharmacy protests/walkouts. 

ME: Why do you need us? 

CP: To help be a sounding board and make our points. 

MICE ELF: And those would be?

CP: The surprising argument people have against walking out is "I care about my patients". 

ME: Oooh. That seems a little out of touch. 

MICE ELF: And selfish. 

CP: I would be willing to say that most pharmacists, when polled, would say they care about their patients. 

MICE ELF: Well, except for that one conversation you had last week. 

ME: Another story for another day. Continue. 

CP: We all care about our patients. You are concerned about not being open for one day and how disruptive that will be and that it will, sadly, put you behind a day <sniffs> 

ME: I sense no sympathy for these people. 

CP: Correct. The rest of us are concerned about every patient we will see in the future. These pharmacists are concerned about the short-term whereas we are looking long-term. If we bite the bullet and close a day here or a day there and effect change, then all our future days will hopefully be easier, better staffed, and less chaotic. That's the goal: better working conditions for everyone, even you short-term, it-doesn't-affect-me-why-do-I-care pharmacy peeps. 

MICE ELF: I sense you are seeing pushback from colleagues. 

CP: I'm not sure if they are out of touch with the practice of pharmacy, retail in general, have great stores that are never behind, or only got into the profession for the money, not the true, altruistic reason people join the ranks of healthcare workers. I'm concerned when people are more worried about "their patients" than their working conditions. We have seen a steady decline for decades now and we always wondered where the bottom of the slide would land us. Just when we thought we found it, the corporations handed us a spoon and said "keep digging". 

ME: To those pharmacists concerned about their patients: You'll still be open tomorrow. There will still be work to do. Surely you can suck up the extra volume at your store to help those who are trying to help you. If you really, truly cared about your patients, you'd want to fight so you don't have to risk their lives to protect your livelihood. 

CP: Too many people have left the profession under these worsening conditions. And while for new pharmacists this is the only working environment they have known, the rest of us should know better. 

MICE ELF: Oh, and let's not forget: THERE. IS. NO. PHARMACIST. SHORTAGE!

ME: Right. Only a growing group of dissatisfied professionals who are tired of being thrown to the wolves and getting yelled at for 12 hours a day with no help and the Fear Of Making Deadly Mistakes. 

CP: Exactly. If there were a shortage, any one of us could walk out, for good, tomorrow, and get that shiny new job wherever we pleased. Not so easy to do. I get it. We all also fear for our jobs, our livelihoods. But what good is it if we burn out and kill ourselves in the process? Or, worse yet, someone else? Stop being the people who claim to care more about our profession than those who are actually doing something to help you. Be a bandwagon fan, but don't claim to not support us; don't claim you care more about your patients than we do. You know nothing, Jon Snow, and I'm ashamed you're my colleague. 

ME: On the plus side, most of these handfuls of people have been taken to task over their holier-than-thou attitudes, but a rising tide lifts all boats; they will benefit regardless and take our gains willingly. 

MICE ELF: And ask for seconds. 

CP: As long as we remain a fractured profession, corporate wins. As long as we remain splintered amongst ourselves, they win. 

ME: Be helpful. Be supportive. Be positive. 

No One Cares

CP: Why do people feel the need to announce everything?

CPP: Like when they join or leave a social media group?

CP: I think that's where the habit started. "This group is no longer about kittens; I saw pictures of full-grown cats. <sniffs> I 'm out."

CPP: Right? Who cares? No one. It's not an airport; you don't have to announce departures or arrivals. 

CP: "Thanks for letting me in the group". All you did was click a link that said "join group". It's not a secret society; we have no secret knocks. 

CPP: Why is this relevant today?

CP: The people who feel the need to tell us anything not germane to our interaction. 

CPP: Par exemple?

CP: "I could have gotten this cheaper at (names competitor)." Okay, cool. Sweet. Good to know. If I have to buy this same item, I'll be sure to go there MICE ELF. 

MICE ELF: But I don't use that.

CP: <shhh> Seriously, though? Why do I care? I don't. You are here. You are paying me my listed price. If it really mattered to you, why are you here and not there? Hmm?

CPP: I'm going to try that at the gas station. I'll walk in to pay and tell the clerk that gas is cheaper down the street. "I could've gone there where it's $0.03 cheaper." 

CP: To which I'd reply, "yet here you stand, in front of me, at my establishment, waiting in line to pay for gas when you had the power to go there yourself". 

CPP: I'm just a girl, standing in front of a boy, asking him to take her money, while making snide offhanded comments about how he sucks. 

CP: Notting Hill, The Retirement Years. 

CPP: Right? Yet everyone does it. 

CP: GoodRx has really factored into that. Maybe you could have paid that there. Maybe not. I've seen different prices on the same prescriptions on subsequent days at the same pharmacies. 

CPP: And never mind the front end merchandise. 

CP: I'm going to try that at my local grocer. Y'know I could've bought these for less across the street. 

CPP: <scans> uh-huh <scans> that's nice <scans> 

CP: No one cares. Go there then. If I need it, I will pay for it. If comparison shopping is my goal, and I know the prices elsewhere, then I will go there. Or I won't. 

CPP: Maybe they're expecting us to say "ooh, how much? I'll match it for you"? 

CP: It's the sense of validation. Make sure you know my feelings. I don't care about yours, but I', a real person and my feelings matter. Somebody see me. <sniff>

CPP: <applauds> Nice. The sarcasm dripping off this is on point. 

CP: Not too cynical? 

CPP: Never. 

CP: And that's why people come here; the level of service and trust and commitment we provide to our patients. 

CPP: It's obviously not the prices. 

CP and CPP: <guffaw heartily> 

Dumb Things People Say

CPP: What's an embarrassing guilty pleasure of yours?

CP: I enjoy reading the little gossip news posts about people having a bad day, or crazy texts from parents to their kids, or entitled asses. 

CPP: Schadenfreude mein freund? 

CP: Precisely. A little joy at the misfortune of others. But I also find the entitlement and peculiar things people say fun to observe as well. It lets me know they are not like this solely at our establishment; they behave poorly and stupidly everywhere. 

CPP: Hence you "If the real world worked the way people believe pharmacy does" series. 

CP: I really need to make that into a book. 

CPP: Yes, but how are you going to segue this into a story? 

CP: Just dumb things people say. 

CPP: Have at it. 

CP: Top O' The Mornin' To Ya. Welcome to the House of Pain. . . Pills. How may I help you?

UT: What's the hassle, man?

CP: shhhh

Do You Know Who It Called: I think I am here to pick up my husband's prescriptions. 

CP: You think that's the reason? 

DYK WIC: Well I don't know. 

CP: Are we supposed to have something for him?

DYK WIC: Well he was expecting something, but I never got the call. 

CP: I see we filled two Rx's phor him 16 days ago; they were put back as they had been filled for 13 days and on the 14th day, PharmaGods said it must be returneth. 

DYK WIC: Well I didn't get any calls or texts; you people call or text me when my stuff is ready. 

CP: I'm sure our system deliberately singled you out as the one omission it was going to make in the notifications every other day for exactly two weeks; making that a total of roughly 7 missed calls/messages. 

DYK WIC: I didn't receive them. 

CP: I shall get them ready but, just because I already know the answer and want to hear you say it, what phone number should we have on file for your husband's prescriptions?

DYK WIC: 867-5309. 

CP: And who, Jenny, has the number 867-5308?

DYK WIC: My husband. 

CP: The person under whose name the prescriptions were filled?

DYK WIC: Yes. 

CP: The person for whom the prescriptions were filled is the person receiving the calls and texts. 

DYK WIC: Ok. And? I didn't get them. 

CP: But your husband did. They are his. YOU wouldn't get a phone call since you just confirmed they are his prescriptions. 

DYK WIC: Well he didn't tell me. 

CP: And that, alas, is something with which I cannot help. But I do appreciate you not understanding how phones and profiles and HIPAA all work and phor wasting my time today. 

My Job Is Not Me Doing Your Job

CP: Thank you phor calling CP's Pill-adium. How may I help you?

Nurse At Her Big Rad Office: I have a client who needs refills. 

CP: A Client? Not a patient? Is that code phor something? 

UT: wink wink, nudge nudge

NAH BRO: Um, no. Just a patient. 

CP: Then say patient when you mean patient. We are medical professionals. 

NAH BRO: Our patient has been there before and needs these refills. 

CP: I'm going to guess you are calling in new phills phor his pills, else you'd be planning on giving me Rx numbers?

NAH BRO: Correct. But he's had them before. 

CP: Or else they wouldn't be refills, huh?

NAH BRO: Sure. 

CP: Any time you're ready. 

NAH BRO: He needs Latanoprost drops, you should have the strength on file and same directions. 

CP: Ok. How many bottles?

NAH BRO: Three. 

CP: And refills?

NAH BRO: Let's go with two. 

CP: Sure. Let's. 

NAH BRO: Then we have Brimonidine, same directions. 

CP: Strength?

NAH BRO: I don't know. He didn't write it for me. But you should have it. 

CP: And so should you. Next one?

NAH BRO: Timolor? I think. I can't read it but it's the same directions. 

CP: Strength? 

NAH BRO: 0.05? Maybe?

CP: <squeezes bridge of nose> OK. Here's what's going to happen. If you choose to phone in a prescription and you are from Dr. Zoffis, and you elect to not use the e-scripts, then you need to have everything ready for me. You are calling me. You are giving me information. No, I am not going to look it up or trust that it is the same as last time. You're harshing my mellow. 

UT: You didn't just say that to her. 

CP: <shrugs> I'm ornery. 

NAH BRO: What do I need?

CP: <winces, sighs> When phoning in a prescription, you are required to provide me the name of each drug, the strength, the proper directions, the quantity you want the patient to receive, the number of refills to determine how long therapy will last. Since you work in the office and have ready access to the actual provider, this should all be readily retrievable. I am not going to do your job phor you. Just because the patient has had them before, regardless of if I even philled them, does not absolve you of doing your job properly. Now do yours so I can do mine. 

<1 hour later>

UT: NAH BRO calling back. 

CP: I'll get her after I give these shots. 

<15 minutes later>

CP: Thanks for your patience. Shall we proceed? 

NAH BRO: <provides all information with a smile that I can hear through the phone>

CP: Thank you phor choosing CP's Pill-adium. Have a wonderful day. 

#IfYouDontUseEScriptsYouStillMustObeyTheOtherRules 

#NotDoingYourJobForYou 

That's Not How It Works - Never Has

ME: Are we doing another PSA series? 

MICE ELF: I hope not. 

CP: Just a refresher course. 

ME & MICE ELF: Oh dear. What is it?

CP: <clears throat> ahem. Let it be known that today, I am announcing, again, for those who may be caught unawares, the following about the Patient-Prescriber-Pharmacist Healthcare Triangle:

Doctors and all Prescribers, it is not necessary for the pharmacy to contact you or your office to request refills or any prescriptions for our patients. 

ME: But. . . 

CP: You do not need to hear from the pharmacy to send a new prescription. 

Do not tell your patients it is our responsibility; it is not. 

MICE ELF: But. . . 

CP: You say you didn't receive our request? You. Don't. Need. It. 

You are fully capable of submitting a new Rx without our intervention. 

ME & MICE ELF: But why do they keep telling people that?

CP: <shrugs> I have no idea. They'll reject the refill request anyway before submitting a new Rx in its place which causes more work than me being able to match the Rx's together and fill the new one. 

ME: But what about the ones who claim it's "their policy"?

CP: My policy is to not accept this as reality. Will I send a request? Yes. Once. After that, if you have had your office on the line and they insist they need to hear from me, politely explain how this is a lie. Here's how it has always worked: Patient becomes unwell, goes to their provider. Provider performs magical dances and spells and diagnoses a problem that the medication I govern can treat. Said provider then provides a prescription indicating which of these you need and which I am to dispense. Prescription arrives at my pharmacy, whether by land, sea, or air and, after performing my due diligence, it is filled properly, patient retrieves it and, presumably, begins to get better. No steps are to be skipped. At the end of the initial treatment, their provider will indicate if they need more. If none indicated, treatment is complete and you shall go on your merry way. However, a follow up visit may also be indicated. Notice how none of this involves the pharmacy?

ME: Yeah, not the initial visit, the follow up visit, the diagnosis, whether the patient still needs it. 

MICE ELF: Yeah, we really don't need to be tracking down the refills of all thousand of our patients. 

CP: When they have only their own to worry about. Last week, a patient called and reminded us of his provider's "policy" and I reminded him of mine. It had been 11 days since we first contacted the office. I went back and pulled the successful confirmations, all four of them, circled them, and sent them along with yet another request; a request which also contained the following note, written with "Dr. Zoffis Sharpie", that said: If it is your policy to have the pharmacy request refills, then do not ignore and stop telling your patients you didn't receive them. As you can clearly see, we faxed this successfully four times. I shall remind you of this one more time: YOU. DO. NOT. NEED. THE. PHARMACY. TO. REQUEST. REFILLS. Stop telling patients this when you have them on the phone."

ME: Did it work?

CP: Three days later we received the refills. 

MICE ELF: Unbelievable. 

CP: From now on, I tell patients I will send it once. Here endeth my obligation. If your office can't figure out a way to refill your prescription without my intervention, then again, even WITH my intervention, there is nothing for me to do. But I have way too many patients to play this game. Find a new Dr. Zoffis or track it down yourself. 

ME and MICE ELF: Amen. 

 

It's Not Rocket Surgery

CPP: <aside> why are you using me as the setup person in this?

CP: <whispers> because I need a cold intro since no one else has heard of this. 

CPP: you're saying we are old?

CP: -er, old-er. 

CPP: Phine. What is the best migraine relief medication you have used that you can't get anymore?

CP: Wow. That's really out of left field. Let me think. Sprix. 

CPP: That was a good one. Why did you have me ask you about it?

CP: It's gone rogue, off the grid, escaped the tethers of reality. 

CPP: Do tell. 

CP: We were able to order it, briefly, over a decade ago. Then it became a special order from the manufacturer. 

CPP: And now?

CP: Now the prescriber has to order it online through the company. 

CPP: And the story phor today involves this, somehow?

CP: It does. 

UT: What the hell is this?

CP: Sprix! I haven't seen a prescription for this since Moby Dick was a minnow. 

UT: You're old. 

CP: Only in pharmacy years. I didn't think you could find this anymore. 

UT: You can't. I checked all suppliers. 

CP: Let's ask da google. hmmm, curious. 

UT: What have you found?

CP: It is only available online, through the manufacturer. I''ll call the office and let them know. 

Little Office Lady: What is your question?

CP: The doctor prescribed Sprix nasal spray. If they want the patient to have this, they have to go online and have the prescription sent to the company. 

LOL: Ok. Well I'll send them a message and see what he wants to do and call you back. 

CP: No. No "see". They have no other option. If he wants the patient to have it, they send it online. You don't need to involve me in this matter any further. I shall even ring the patient myself and provide them the same information. You two can hash it out between yourselves. 

LOL: Okay. Someone will get back to you. 

CP: I often wonder if we speak the same language. 

UT: People would be so much better if they weren't so people-y. 

#IfYouDontKnowHowToPrescribeItPerhapsYouShouldnt

Not On Me

Pick A Pharmacy That Executes Special Tasks: Did my doctor call in my prescription?

CP: Yes. It's ready to pick up. 

PAPTEST: Is it ready?

CP: Asked and answered. Next question. 

PAPTEST: Do you deliver?

CP: Alas, we do not. 

PAPTEST: Now how am I supposed to get my medication?

CP: <shrugs>  Not my problem. That's not up to me. 

PAPTEST: I really need it. 

CP: I don't doubt that. Needing it is not the issue here. What you really needED to do, was choose a pharmacy that offers the services you so desperately require. If you cannot pick up your prescriptions between 8-6 M-F, then skip the independent that is closed nights and weekends. You choose a restaurant based on what they DO offer, not what they don't. Besides, McDonald's doesn't tell you how to eat your food if you're NPO or can't chew and you just ordered a Filet-O-Fish and fries.

PAPTEST: I just live down the street. 

CP: That's not going to change my inability to deliver. 

PAPTEST: Can you walk it to the curb?

CP: I am by myself and cannot leave the pharmacy. How do you get other things? Groceries and other sundries?

PAPTEST: Someone picks them up for me. 

CP: So. . . ?

PAPTEST: I guess I'll call them. 

ME: But they've been here before. 

MICE ELF: And they know we have neither a drive-thru nor delivery on our menu of options. 

CP: Apparently we need to change how we operate our business for one put-out patient. 

ME: Yeah, like Chik-Fil-A will open on Sundays for me. 

MICE ELF: I do miss the days when most businesses were closed every holiday and Sundays. 

CP: Somehow we all managed to survive the cold, cruel world of the 70's. 

ME: Imagine if it had been the 40's and there was rationing with a war. 

MICE ELF: It's too difficult. 

CP: Now I'm hungry. 

ME: Door Dash us some Chik-Fil-A. 

#KnowTheRulesBeforeYouPlay 

#BecauseINeedItDoesNotMeanICanChangeMyAnswer 

#TheAnswerIsStillNo 

#WhyYourPharmacistHatesYou 

Insurance Stupidity Knows No Bounds

UT: You'll never believe this one. 

CP: Oooh. That's a challenge I'll accept. Proceed. 

<UT on phone with long-time patient>

UT: Your insurance won't pay for your NP Throid; it requires a prior authorisation.

Patient On Phone: I know. And I can't afford over $100 per month for it. 

UT: They want you to try and fail both BRAND Synthroid AND BRAND Levoxyl before they will cover the NP Throid. 

POP: Can you tell me what the cost of those will be?

UT: Sure. Well that's interesting. 

POP: I assume that is "not interesting"?

UT: If I run through Brand Synthroid, the insurance requires a prior authorisation. Same with Brand Levoxyl. Unless. . . 

POP: What?

UT: Unless the doctor writes DAW1 on the prescription, the insurance requires prior auth. 

CP: Wait. So the insurance requires these brands be tried and failed. 

UT: Yes. 

CP: But they won't pay for them unless it's with a DAW1?

UT: Yes. 

CP: So we now have to call the office and have them send another Rx to prevent prior auth?

UT: Yes. 

CP: That's not THAT surprising. 

UT: But they set the rules and changed them midgame, it seems. 

CP: You mean "why couldn't they just say that in the first place?' instead of sending us a prior auth request for brand Synthroid and Levoxyl when it was their idea? 

UT: Right. Why do they need a p/a on what they prefer? It seems stupid to require brand only to THEN require it be DAW1. Brand is Brand. It shouldn't matter. 

CP: And they're delaying for months therapy that has worked for this patient for years. 

UT: Insurance rules don't matter. It's like they're playing a different game than we are and when we discover the playbook, they change the game. 

CP: Monopoly versus Australian Rules Football. 

UT: Well said. 

Can't Catch Up

CPP: <sarcastically> Anything exciting happen this week?

CP: <sarcastically> When doesn't anything exciting happen?

CPP: Care to share?

CP: I present you the following, compiled from two, eerily similar interactions. 

CPP: Terrifying!

CP: Welcome to Vials and Victuals. Pills or fills, today?

Most Always Exact Verbatim Exchanges: Um, I'm here to pick up my refill. 

CP: I love your confidence. Name?

MAEVE: Maeve. 

CP: I see you called in a refill, but it was too soon so I couldn't fill it. We last filled this 30 days supply for you only 14 days ago. 

MAEVE: "So even though I waited more than 30 days last time, I can't fill this early?"

CP: No. Nope. Not how it works. 

MAEVE: But why?

CP: Maths. You can't make up for something you missed. If you forgot to eat breakfast yesterday, you can't make up for it by having second breakfast today. 

CPP: Elevenses!

MAEVE: I don't understand. 

CP: I. . . 

CPP: Allow me. <ahem> In the immortal words of CP: "I can explain it to you; I can't understand it for you". 

CP: Thanks. Now can you help me out with this one?

CPP: Sure. 

CP: Next!

Another Arithmetic Remeberer Of Nothing: What about mine, then?

CP: Sorry?

AARON: I called in my refill as well and you just said it was too soon. 

CP: Ok. Let's check for . . . 

AARON: "I'm behind on taking my medications so can't you just fill two months for me this time?"

CP: Again. Not how this works. 

AARON: But I didn't fill it last month, or the month before. I want those fills too. 

CP: <shhhh> You can't make up for lost sleep any more than you can make up for not filling on time, A-A-Ron. If you missed the sale at Penney's last week, you can't save on those items this week. Just because I wasn't driving when gas was $0.79/gal doesn't mean I can go back and take advantage of that deal now. And Aaron, how are you going to play catch up? 

AARON: But they're my refills. 

CP: You can pay cash for them, but the part of the deal where your insurance pays for their part has expired. 

AARON: I don't understand. 

CP: Again, maths. CPP?
CPP: I can explain it to you. . . 

But I NEED It

CP: How often do you wonder is people's' elevators go all the way up?

CPP: With every human interaction. 

CP: OMG! Samesies. 

CPP: Don't do that. Why do you inquire?

CP: One of our irregulars over the weekend. 

CPP: Do tell. 

CP: Are you dropping off? <they intone>

Compliance Usually Not This Hard: <standing under drop off sign> I think so. I just need a refill on something. 

CP: <cringes> I see your refill expired 2 days ago.

CUNTH: "I can't go without it!" <she ejaculated> "I NEED it."

CP: The evidence says otherwise. We last filled this for a 30 days supply on 5/19. I challenge that you CAN live without it.

CUNTH: It should have 6 or 7 refills left. <she exasperated> 

CP: It did. They expired. Two days ago. You filled this a total of 5 times. For 5 months. Out of the last 12 months you've had this prescription. Apparently you can and have done without it. 

CUNTH: "I'll have to have a talk with her at my appointment Friday!"<she exhorted sternly>

CP: Why? <they asked inquisitively>  She's not the one you need to talk to about this. 

CPP: Oh that's rich. 

CP: At least she didn't say "but I'll DIE"!

CPP: True. That's melodramatic in its triteness. 

CP: She really acted all stern and matronly when she said she was going to have to have a talk with her provider. It sounded like a mother saying "just wait till your father gets home". 

CPP: Not sure how she thinks that's going to go. 

CP: It's like the ending of "A Few Good Men" where Downey says "what did we do wrong? we did nothing wrong". 

CPP: In that 5 months of compliance is better than none? 

CP: <shrugs> 

#HowManyPeopleWillCheckTheDefinitionOfEjaculate 

#WhyTheRandomAFewGoodMenQuote  

#Verbatim 

#IDontWantItIJustNeedItToBreatheToFeelToKnowImALive 

Blood Pressure Two-Pher

CP: Picking up today?

HBP Lady: No. I just have a question. 

CP: Go phor it. 

HBPL: What can I take for sinuses? Another pharmacist sold me Advil Cold and Sinus and I'm not any better. 

CP: Sinuses are a physical cavity in your skull; we all have them. What are your symptoms you wish to alleviate?

HBPL: They're stuffy and congested. 

CP: What medications do you take? Rx-wise. 

HBPL: I take medications for my HBP. 

CP: Perfect. Well Advil Cold and Sinus should be a no-no. Plus I dislike combo products like that since most people have ibuprofen or acetaminophen at home. 

HBPL: Why is Advil Cold and Sinus a no-no?

CP: The sudafed in it can increase your BP. 

HBPL: But I don't have it any more. It's under control. 

CP: Because you take medications to keep it that way. Outside phorces can act upon it to elevate it. My cruise control in my car keeps a set speed until I punch the gas to pass someone. Sudafed is a punch to the gas on your blood pressure. 

CP: You're past due for a refill on your HBP medications. 

HBPL2: I know. 

CP: Okay. Do you want me to get them ready phor you?

HBPL2: I guess. My BP was really under control for a long time so I stopped taking my medication. 

CP: Your medication which was keeping your BP under control?

HBPL2: Yes. 

CP: It was under control because you took the medication. It doesn't cure you of HBP. You still have the condition but it may not show up on BP readings. 

HBPL2: Oh. Yeah. I get that now. 

CP: My electricity works as long as I pay the bill. My car runs until I stop putting gas in it. They're both "under control" until they're not.  

Negotiations Were Short

CPP: What was the silliest thing asked of you last week?

CP: I'll answer first then everyone else can have a turn. 

CPP: It's your page. 

CP: This off-the-wall conversation:

Persistently Interrupting Staff Seeking Offers For Fills: <on a walkabout passing the pharmacy windows> Do you carry Percocet?

CP: <doesn't look up, whispers to UT> did you hear something?

UT: yes. trying to not make eye contact

PISSOFF: Hello?

CP: Rude much?

PISSOFF: Huh?

CP: You didn't bother to get the attention of either of us prior to shouting a random question into the ether about a narcotic product. Care to try again now that you have disturbed us and have gained some of our attention? 

PISSOFF: Yeah. Do you have Percocet?

CP: Mayhap I do. Strength?

PISSOFF: 5ng

CP: I have some in stock. 

PISSOFF: My current pharmacy is out of it and I'm looking for more. 

UT: <whispering> no red flags on you, sir. nope, none at all. 

CP: <snickers> You don't say. It is on backorder so there are known supply issues. 

PISSOFF: How much will it be?

CP: Probably what you have been paying. Based on the less-than-the-minimum-required-to-answer-that-question, I'd say more than a nickel, less than a share of Pfizer stock. 

UT: Why does "nickel" sound so weird?

CP: <shrugs> right?

PISSOFF: Well I take 15 medications. If I transfer them all here, how much of a discount will you give me on the Percocet?

CP: Less than nothing. 

PISSOFF: But that's a lot of prescriptions; anyone would love to have them. Can't you offer me a deal?

CP: Hard no. That's a pass phrom me. This isn't a bundle business. We are not Progressive or Spectrum or a Streaming service. There's no discount for getting them all together. I have a sneaky feeling you'd also not be compliant on the other 14 medications and would cause me a ton of problems. I can afford to be selective in the headaches I take on and yours is not one I wish to undertake. 

PISSOFF: <still wandering aimlessly in front of the Rx counters> Huh? No deal?

CP: As sad as it has become, this is still a profession. I have some integrity and dignity left and, while your offer of 15 prescriptions sounds enticing, the baggage included is a lot to unpack and my back hurts phrom carrying this profession as it is so that's a no. 

PISSOFF: <still meandering distractedly as if standing in one place will result in him being hit by space debris> I'll check around and see what I can find. 

CP: You do that. And piss off. 

CPP: Wow. Monty Hall Redux, huh?

UT: No one under 40 will get that. 

CP: <shrugs> They have the internet. They'll find some cool videos of better times. 

Loaves and Phishes and Metformin

CP: Just finished watching History of the World Parts I and II, again. 

CPP: Brilliant! I take it this is relevant to today's post. 

CP: It's a lazy segue into the topic of miracles. 

CPP: The horse? 

CP: No. What happens with people and their medications. 

CPP: Like when you're doing Outcomes, call the patient because their 70 day window is down to 5 days and they still claim they have never missed a day and yet they have a surfeit to last them thru the next Olympics?

CP: Something like that. 

CPP: Well what is today's story?

He's Eager Yet Zen Expecting Usual Scripts: I'm here to pick up the refills of my medications. 

CP: It appears I have four of them ready for pickup today. 

HEYZEUS: Yes. That sounds correct. What are they?

CP: <lists all four> 

HEYZEUS: Perfect. Thank you. 

<2 hours later, a phone rings>

CP: CP's House of Cloying Purgatives, how may you make me insane?

HEYZEUS: I was just down there. 

CP: Lots of people were just down here. You need to be more specific. 

HEYZEUS: Like a couple hours ago. 

CP: Time is relative to a retail pharmacist working 12 hour days. Again, more specificity is required. 

HEYZEUS: I got 4 prescriptions. 

CP: <winces and strangles inner patience> 

HEYZEUS: You didn't fill my Metformin. 

CP: You didn't call it in. 

HEYZEUS: Yeah, last time I filled it, you guys gave me two massive bottles. I take 3 a day! Every day! I never miss a dose. This is my diabetes medication. In case you didn't know. 

CP: Right. You're telling ME, the pharmacist, why a medication is prescribed. Thanks. I'll make sure to remember it phor next time. 

ME: How did I get into this?

HEYZEUS: I need it. I'm out!

CP: Oh! I remember. You're Jesus!

HEYZEUS: It's pronounced HEY ZEUS. 

CP: Natch. Well HEY ZEUS, you managed to make a 90 days supply last you 147 days. 

HEYZEUS: I take 3 a day! You gave me too many. 

CP: I gave you 90 days. If you take 3 tablets a day, for 30 days, that's 90 tablets. 90 tablets a month for 3 months is 270 tablets; that is what you received in those "two massive bottles". If you never missed a dose, as you claim, then you made a 90 days supply last nearly 65% longer than it should have. Jesus!

HEYZEUS: It's HEY ZEUS. 

CP: Right. I also asked if you were expecting 4 prescriptions, to which you replied "yes". I further verified the accuracy of your order by checking each medication with you. So back to "YOU didn't fill my Metformin". I think you meant to say "I got home and realised I forgot to call in my refill. Could you fill it for me and I'll be down somewhere later tonight or tomorrow to retrieve it since it was my fault I forgot to refill it". 

HEYZEUS: <silence>

CP: Go ahead. Try it. Swish it around your mouth parts for a second and see how reality tastes on your tongue. In the meantime, I'll work on your prescription. Come when you get the text. 

ME: <giggles> That's what she said. 

CPP: If only it were that easy. 

Moist

CP: It's that time of year again. 

UT: Pharmacy Winter is officially over!

New Intern: What is Pharmacy Winter?

CP: The dark period of time from Labor Day thru Easter, followed by a fluctuating period that tapers off until Memorial Day. It is when the pharmacy profession is most challenging: Lice outbreaks, flu shots, cough and cold season, holidays, flu season, spring awakening aka allergy season. 

UT: I loved Spring Awakening. 

NI: Never heard of it. 

UT: Now we enter the slow season. 

CP: However, now things are moist-challenging. 

NI: How so?

UT: Sweaty time. 

CP: Time to post our sign about how, if paying with cash, it cannot be pulled from any region of bodily dew. 

NI: People don't really do that, do they?

UT: NI! I mean, nay nay. Tut tut!

CP: I had a person reach into her prodigious pectoral packaging and pull out and proffer Titty Twenties. 

She then replaced them and said "oh that's the large bill side", whereby she reached into the Left side to lay out some Lactated Lincolns. 

NI: Ew. 

UT: Our annual note phor this season is "We will not accept the following:"

Booby Benjamins 

C-Cup C-Notes 

Cleft Krona 

Double-D Dollars or Dinar

Funbag Franklins

Hooter Hryvnia or Hamiltons 

Jockstrap Jacksons (or Jeffersons)

Lady Lump Leu

Mammary Money

Milkshake Moolah 

Naughty Zloty  

Rack Rubles

NI: You've spent a lot of time on this. 

UT: You're new here. CP has been doing this longer than you've been alive. We know some stuff because we've seen some stuff. 

CP: And also adore acronyms and alliteration. 

NI: I think I'm going to like it here. 

UT: You will definitely learn some things. 

CP: NI!

Simpler Times

CPP: Did you go to the managers' meeting?

CP: Yes. It was even more pointless than the previous phew. 

CPP: Which you said were more pointless than a soccer ball. 

CP: This left me like a phlat soccer ball - deflated. 

CPP: How can you tie this in to a great story, O Wise One?

CP: Glad you asked. Phirst, I get a story at work. Then I decide which characters are necessary to phlesh out a solid intro and conclusion and we're off on an adventure. 

CPP: Thanks, Bilbo. As you were. 

CP: I miss the days when things were simpler; like that meeting?

CPP: Yeah?

CP: It should've been a memo. 

CPP: And today's story?

CP: Shouldn't've 'appened. 

CPP: That's a lot of apostrophes. Your story?

CP: An officer of Dr. Zoffis left me a voicemail. 

CPP: Nothing new there. 

CP: Officer said: "Stop sending refill requests. Patient must make appointment."

CPP: And therein lies the rub. 

CP: Indeed. Phirst, I cannot stop patients phrom calling in their Rx numbers on my phone/app/website requesting a refill phor which they have not received a new Rx as these are automatic and outside my control. Second, I called OUR patient and provided this information to them; even included the exact verbiage on their previous label of the 90 days supply you gave them as just-this-one-time-more. Third, and I know this is where I lose the officers, but STOP. CALLING. ME. 

CPP: <gasps, but with a cynical inspiration> Bite thy tongue! How darest thou insinuate it is incumbent upon the officers of Dr. Zoffis to ring their own patients. 

CP: I not only insinuate, I point blank call them out on it. Instead of calling me and, not only bypassing me where I can correct you to save us both some time by you calling the patient, leaving a message you chicken little, you could have called the patient, scheduled the appointment, and saved everyone trouble. Now, the patient will get a call phrom ME telling THEM their doctor called ME to tell THEM to call the OFFICE to schedule an appointment. WTF? Are we in grade school again? 

"Pssst. Kory told Leah to tell Kevin that Lindsay likes Brian and wants him to ask her out. Make sure Brian tells Andrew to tell Mike to tell Jen to tell me to talk to her first."

CPP: Your theory is revolutionary! If only there were a way to implement this. 

CP: <snaps phingers> Got it!

CPP: That was quick. 

CP: #TWSS! Remember the other day when I mentioned I would tell patients their doctor has "Magic Hours" from 8-10am with no appointment necessary; you can walk in any time and be seen immediately with half-off copays?

CPP: Yes. 

CP: I'm going to call these offices back, transfer to their voicemail, and tell them I scheduled their patients' appointments phor them. 

CPP: I like it. How's that work?

CP: "Hi. It's CP calling phrom Cynical Shenanigans Pharmacy. You left a voicemail telling me to call your patient to let them know they need an appointment. While I had them on the phone, I took the luxury of scheduling their appointment phor you so you would not be troubled phurther. Ana L. Fischer will be there Tuesday, 5/23 at 9:15. Should you have any questions, please phollow up directly with the patient as this is a non-callback number and messages left phor the pharmacy will not be returned but will result in phurther appointments being scheduled." 

CPP: I like this. We could see how many of these calls it takes before they "get" the message. I'd say, after the first voicemail, schedule one appointment, second voicemail, schedule another appointment, third voicemail, schedule two appointments, then schedule 3, then 5, then, 8 then 13. . . 

CP: Spiral out. 

Stay In Your Lane

<checking out at Dr. Zoffis, eavesdropping>

Nurse On Phone: Ok. Well I can check the price for you. It looks like it will be $26.42 if you use Wag's or $28.93 if you visit Chronic Vaginal Secretions. No. There's a coupon from their website. Yes. Ok. I'll send it there and you can tell the pharmacist it should be that price. 

CP: Excuse me. I couldn't help overhearing <since you talk really loud and we are inches apart>. How does that work exactly?

NOP: What?

CP: When you give them a price?

NOP: Oh, I look it up on the website. 

CP: Right. But where do you put the coupon info?

NOP: I don't know. I just click this box and hit "send". 

CP: Do you do this for most prescriptions?

NOP: Yes. I look them up on GoodRx. 

CP: That's a problem. 

NOP: <doe-eyes go dark, blinks> How so?

CP: Well, those coupons typically end up in the middle of the directions or just below. They appear on so many prescriptions that they become background noise we just ignore; they're not part of the actual prescription so we don't even look at them. No wonder patients get mad at us when they tell us "my doctor said it would be $xx". 

NOP: <shrugs> Oh. I just click this and send it. 

CP: Yes. That's the problem. Please don't quote prices to patients. You don't work in my pharmacy and those prices often don't reflect what we see. Second, my pharmacy doesn't take GoodRx, even though prices for my pharmacy are on their website. 

NOP: Why?

CP: Who knows. I can put anything I want on MY website. It doesn't have to be real. They can do the same. Also, if you insist on giving prices to patients AND you spoke with this patient and gave her a price, please put a note, either directly in the sig, or the "prescriber notes" section telling the pharmacy "Patient was quoted a price with GoodRx and opted to use that in lieu of her insurance". This way, I will more likely see the note, run her insurance, then run the coupon or my discount card to compare prices. But please stop telling patients "you will pay this". 

NOP: <stares blankly>

CP: Or I will instruct all your patients that I changed their appointment times and, that Dr. Zoffis said if you arrive before 10am, say 8-10am, you don't need an appointment, you can just walk right in and be seen and your copay is half during these premium hours. 

When Is My Job Finished?

CP: When are we actually done with our job?

ME: All of it? When the Rx is sold? 

MICE ELF: Once I sell it, our interaction is over. 

ME: Allowing for calls back with questions, etc. But I'm guessing that's not what you have in mind for us today? 

CP: Observant. It is not. I shall ask again, rewording this time. If you process a claim, and you are rewarded with a paid claim, is your job done?

ME: Of course. We bill the insurance as a courtesy to help finance the cost of the medication. 

MICE ELF: Yeah. Once the insurance replies with "yes, we accept the terms of our arrangement and hereby agree to pay our part (for now) as long as you charge the patient her $25.00 copay, our transaction can be considered concluded". 

CP: Verbosity. You definitely speak like an insurance company. But you are wrong.

ME and MICE ELF: WHAT?!

CP: Is there a cheaper manufacturer? A preferred NDC#? Just because you received a paid claim does not mean you get to celebrate yet.

ME: But that has always been the way. 

MICE ELF: Yeah. This is the way. 

CP: Alas, no longer. We have had multiple instances where we processed a claim, told the patient her copay and when she balked, instructed her to call the insurance. When she called us back, she bluntly explained we used the wrong manufacturer. 

ME: Wouldn't it make more sense for the insurance to simply deny the initial claim for "NDC not covered" than pay the claim at a higher copay? 

CP: One would think. But insurances are not in the business of making it easy for us or their patients. It's like finally getting the notification that the insurance company approved the provider's prior authorisation request, only to process the claim and discover there is a 90% copay for the patient now. Thanks for nothing. Now the patient is still mad at us because we are overcharging them. 

MICE ELF: And we continually get yelled at because we had a paid claim. How are we supposed to know which NDC is preferred? I miss the days when brand was no longer covered the day the generic entered the market. I miss all generic versions being covered by the insurance. 

CP: I miss the days when there were no insurances or PBMs and patients paid cash for everything. We need to move to the medical billing model. Patients pay an office copay before each visit. We accept their $25.00 copay up front and all of the billing takes place behind the scenes or after the fact. Pharmacies should have their own billing departments. 

ME: You are so wise.

CP: And don't get me started on "would it be cheaper with GoodRx or a discount card?". 

MICE ELF: It's not my job to figure out ways for me to lose money to you. 

ME: Could you imagine going to a business and telling them you don't like the price you are being charged and expecting THEM to help YOU pay for it? 

MICE ELF: Or to suggest a better, cheaper location. 

CP: You picked me. You don't have to come here, oh wait, damn PBMs. But once I get a paid claim, my work here is done. Transaction complete. Here's your receipt. 

Sam? Is That you?

(To Green Eggs And Ham)

I said no. I said no. No I said. 
That no-I-said! That no-I-said! I do not like that no-I-said

Is there a script ready for me?
There is no script that I can see

There is no script I have ready

Do you have one here or there?
I do not have one here or there

I do not have one anywhere

I do not have a script for you 

I do not like you, no-I-said

Did you get one on the phone?

Did you get one via drone?

I did not get one on the phone 

I did not get one via drone

I do not have one here or there

I do not have one anywhere

I do not have a script for you 

I do not like you, no-I-said

Mayhap received them on the fax?

Perhaps upon the telegraph?

Not on the fax, nor telegraph

Not on the phone, nor via drone

I do not have one here or there

I do not have one anywhere

I do not have a script for you 

I do not like you, no-I-said

Did you check the Code of Morse

Do check again, yes of course

Did check, no luck, Code of Morse

Oh do check them evermore, 

Maybe flags of semaphore?

They are not in a semaphore 

No Code of Morse no nevermore. 

I do not have them on the fax, 

I do not have on telegraph

I do not have them on the phone

I do not have them via drone

I do not have one here or there

I do not have one anywhere

I do not have a script for you 

I do not like you, no-I-said

E-Scripts! E-Scripts! E-Scripts! E-scripts!

Did you, would you, check e-scripts?

No E-scripts nor semaphore

No Code of Morse no nevermore

I do not have them on the fax, 

I do not have on telegraph

I do not have them on the phone

I do not have them via drone

I do not have one here or there

I do not have one anywhere

I do not have a script for you 

I do not like you, no-I-said

Eh? Voicemail? Yay voicemail?

Did you, could you, voicemail?

I did not could not, voicemail

Did you, could you, ASL?

I did not, could not, ASL

Not voicemail, not on e-scripts 

No Code of Morse no nevermore

Let me alone now, please, I implore

Not on the fax, nor telegraph

Not on the phone nor via drone

I do not have one here or there

I do not have one anywhere!

Have you checked the avian friends?

I have too checked them, no-I-said 

Maybe it was sent with raven

It was not sent with raven

Upon the leg of carry pigeon?

Not attached to carry pigeon

Did you, could you signal smoke?

Did not, could not signal smoke

Perhaps Pony Express's tote

No to Pony Express's tote, 

No to fire and signal smoke

I did not, could not, ASL

Not voicemail, not on e-scripts 

No Code of Morse, no nevermore

I do not have them on the fax

I do not have on telegraph

I do not have them on the phone

I do not have them via drone

I do not have one here or there

I do not have one anywhere!

There is no script that I can see

There is no script I have ready

You did not find them, so you say

Find them! Find them! yet you may

Please just check again, okay?

(checks again)

No. No script I that I can see

And still! I have no script ready

Not in Pony Express's tote

Nor in fire and signal smoke

And nothing signed with ASL

No voicemail  nor e-scripts

No Code of Morse no nevermore, 

I do not have them ask no more

I do not have them on the fax

I do not have on telegraph

I do not have them on the phone

I do not have them via drone

I do not have one here or there

I do not have one anywhere!

There's still no script that I can see

There's still no script I have ready

Can you check again?

Should I

CP: Welcome to CP's Palace of Potions. How may I help you?

Naturally Opining Makes Answers Subjective: I am here to pick up my prescription. 

CP: I have one prescription here for you. 

NO MAS: That is correct. 

CP: Treating a bird today, I see?

NO MAS: Huh?

CP: Thrush. 

NO MAS: Huh?

CP: Okay. That one missed. How about <sings horribly> "It's just, a little thrush?"

NO MAS: Yes. That's it. 

CP: Any questions today before I go over this with you?

NO MAS: Should I change my toothbrush?

CP: Great question. The answer is yes, and frequently until the infection clears, then you can continue with that one. 

NO MAS: But I don't want to replace it. 

CP: Ok. If it means that much to you, you can sterilize it. Either in mouthwash, or a baking soda or Hydrogen Peroxide solution. I'd do that until the infection clears, then replace it. 

NO MAS: I use expensive toothbrushes. 

CP: And how often do you change them?

NO MAS: Each season. So 3 times a year. 

CP: Which season do you skip? Do you change it every season, like winter, spring summer, or fall. . . 

UT: All you have to do is call. Sorry. 

CP: Or do you change it every 4 months?

NO MAS: I change it every 3 months. 

CP: When are you due to change it again? I change mine quarterly on the first of every third month so if you're like me. . . 

UT: I hope not. . . sorry. 

CP: . . . then you'd be due to change it now that it's almost April 1st. 

NO MAS: I'm supposed to change it this week. 

CP: Okay. You SHOULD change it. You CAN disinfect it. You are ABOUT to change it anyway. I'm not sure how much more I can help you. You either ARE going to change it; or you're not. You either need to, or you don't. 

NO MAS: <head starts twitching>

CP: Here's your troches. Slowly dissolve. Have a good day. <slowly backs from counter>

UT: Are you just going to leave her like that?

CP: Her head is twitching. She looks like a short-circuited fem-bot from Austin Powers. 

UT: Good thing you didn't ask her for her preferred pronunciation. 

CP: Tro-key. 

UT: I still think we should pronounce douche like that as well: Doo-Key. 

Still Need To Be Nice

CP: It's not their fault. 

ME: What isn't?

CP: That patients are forced to call pharmacies for Adderall and other backordered products. 

MICE ELF: Right. 

CP: But it hasn't stopped pharmacies from treating them with disdain and being rude about the calls. 

ME: Big Meanies!

MICE ELF: And let me guess, they're not only hostile about it, but they're not telling callers if they have it because "I'm afraid I'll get robbed"?

CP: Yes. Although Adderall has never really been atop the pharmacy theft list. 

MICE ELF: That's pretty lame. 

CP: I get it. Under normal circumstances, I rarely provide inventory information on most C-IIs. 

ME: But this isn't normal circumstances. 

MICE ELF: And we do get questions about the oddball medication from time to time. 

CP: Indeed. And if hospitals or offices call, I'm fine with telling them what I have. The problem with pharmacists refusing to tell callers if they have products in stock, and being rude about it, has nothing to do with concern about theft. Now, I have to deal with people calling saying "Hi. I'm an RN from a doctor and wanted to know. . . "

ME: No. No you're not. That's not how they speak. 

MICE ELF: You could at least try. Put some effort into your knavery. 

CP: All true. 

ME: What about "I'm keeping it in stock for my regular patients"? 

CP: I'm okay with that. But be honest about it and not rude. It's surprising to me how many fellow colleagues are rude. 

ME: But they're too busy to deal with all the phone calls all day long. <sighs>

MICE ELF: We all feel the same. But we aren't all shitty about it. 

CP: Which makes me look good when people call and I either have it in stock or I locate a product at another location. 

ME: And don't lie to people.

MICE ELF: Let me guess. You're slipping this post in between a couple of Don't Be A Dick posts on purpose, aren't you? Thinking no one will notice?

CP: Hey, it doesn't take much to be nice and answer the question. Again, it is not the fault of the patient they have to call. We cannot complain that we won't call other stores for patients, expecting them to call themselves, then, when they actually DO call themselves, we treat them with disrespect, are rude, and whine "I'm afraid of robberies". Then treat them like shite. 

ME: We can't have it both ways. 

MICE ELF: Before CP says it, Don't Be A Dick. 

CP: It's not their fault. Say "yes", say "no". But, yeah, what MICE ELF said. 

#ItsNotTheirFault 
#DontBeADick 

#ThisIsntGoingAwaySoon 

Dick And Jane Refreshed

Dick and Jane go to the pharmacy (in America). 

CP asks them for their dates of birth.

CP: Jane, what is your DOB? 

Jane: 3/6/79. 

CP: <types 03/06/1979> Danke! Here's your prescription.

Jane: Bitte 

CP: Same question, Dick. 

Dick: The eleventh of August, 1982. (Or however you know they respond that isn't mm/dd/yy.)

CP: Why are you the way you are?

Dick: I was in the military. 

CP: Does this look like a military installation to you? Did we salute when you entered? 

Dick: We are the only country that doesn't do it that way. Other countries say the day first. 

CP: I know. They're also all on the metric system. Shall I convert all your dosages? Do you request petrol in litres? I have plenty of military in my family. Never once did I go anywhere with my family and, when asked for dates of birth, did they respond with 5th of May, 1977. Never. They knew the person asking for the information was entering it the American way, not the military way, or the "everywhere else in the world" way. When you are asked to enter your DOB online in the MM/DD/YYYY format, do you adapt to this? Or do you try to force your birthdate in using your format? Do you ring customer service and complain "that's not how I was taught"? My foreign language in HS was German. They say their numbers as two-and-twenty for "22" (zwei und zwanzig). They'd be right at home singing "4 and twenty blackbirds baked in a pie". Mayhap I learned to count through that song. Yet I don't say my day of birth as three-and-twenty. The answer to "what is the meaning of life" is not "two and forty", but "42". Sure, you sound cool to yourself. But you're a dick to everyone else. 

Dick: We're the only ones who. . . 

CP: No. YOU'RE the only one who does this. I start typing "11" then have to back up and fix it all because you think you're being cute. <whiny voice "military does it like this. other countries do it like this, wahhh".> Are we on base?

Dick: No. 

CP: In a country outside the USA?

Dick: No. 

CP: Could you adapt to the current situation? Which I'm sure is part of your military training? Happy, smile. Sad, frown. Use the corresponding face with the corresponding emotion. Give the correct answer to the correct audience. 

Dick: Well, I. . . 

CP: Then don't be a dick.