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. 

Reading

CPP: Good Morning, CP!

CP: And good morning to thee as well. 

CPP: What do you have phor us today?

CP: General phuckery. 

CPP: Perfect. Can you be more specific?

CP: People are stupid. 

CPP: Yes. And I reiterate my request to be more specific. 

CP: What do you think is worse: The lack of reading what is right in phront of you? or the lack of reading comprehension?

CPP: Tough one. I'd say it's a tie. As I believe I know what this is about, I'm going to say everyone is a loser. 

CP: Here we go. 

UT: I put a sign on our new SigCap device. 

CP: Is it remarkable?

UT: It is! It's on a large, pretty pink Post-It with fluorescent gel pen. In beautiful, printed handwriting, large letters and all, it says: "NO PEN. USE FINGER TO SIGN." I even added a few little flourishes to draw the eye. 

CP: Phool-Proof! 

UT & CP: hahahahahahahaha

CP: What about our vaccine sign? Did you phreshen that up a bit?

UT: I did. I placed it on the side we don't use at pick-up. It reads: "PLEASE STEP TO DROP OFF WINDOW FOR ALL VACCINES!"

CP: That should keep people away phrom pickup and help us run efficiently. 

UT: No one is going to believe you typed this all with a straight phace. 

CP: <shrugs> Reality Bites. 

CPP: Ok. I see the new signs. UT did a great job. 

UT: <bows> Danke. 

CPP: Back to the reading lesson, CP. What happened?

CP: No one reads the sign on the SigCap device. No one. They will look all around, grab the power cord and yank it, slap the counter in phrustration, and throw their hands in the air and wave them cuz I just don't care before I politely say "phinger" while pointing near the sign.

UT: But you always wait until you've had a good laugh. 

CP: Schadenfreude, baby. It's the little things that bring me joy in this world. 

CPP: And the other sign? 

CP: I love it when people head to drop off and this happens:

CP: "Dropping Off?" 

Didn't Understand My Board: "No. The sign said to come down here". 

CP: No it didn't. 

DUMB: Yes it did. 

CP: Go back and reread it. 

DUMB: <enunciating loudly and deliberately> STEP. TO. DROP. OFF. 

CP: Keep reading. 

DUMB: For. . . oh. 

CP: So, picking up then?

CPP: I see your point. 

CP: I've learned that people either don't read signs or, if they do, they don't comprehend what they read. 

CPP: Short attention spans. 

CP: You should read the book "Death At Yellowstone". There's a great section in there about signs and posters and warnings and people's ignorance of them. 

CPP: So which is worse? Not reading? or Not comprehending?

CP: Well if you don't read you can't mis-comprehend anything. 

CPP: Better to remain silent and be thought a phool than to speak and to remove all doubt. 

CP: Just goes to show, you can lead a man to an education but you can't make him think. 

Or should it be "You can give a man an education but you can't make him take it"?

PSA #8

UT: What is today's lesson, O Wise One?

CP: If YOU change something, you must relate that information to all affected parties. Should you forget to notify someone of said changes and it adversely affects their relationship with you, it is YOUR responsibility to fix it, not the uninformed parties with whom you conduct business. 

UT: Short version?

CP: YOU have to notify US any time you

-move (change address)

-change phone number(s)

-switch providers

-switch provider locations

-switch insurance(s) 

-stop taking a medication

-start a new medication (perhaps not filled with us)

-change strength (sans new Rx)

-change directions (sans new Rx)

-discover/develop new allergy/ies

-change preferred email

-change contact preferences 

-want us to order a specific manufacturer (yes, each time)

-die 

UT: Our computer doesn't know this. Your friends don't know this. No one knows any of these things have changed unless and until YOU tell them, directly. 

CP: Yes. Because INdirectly must be how everyone expects these notifications to take place.

UT: It's in the cloud. It's in "the system". 

CP: There's no "system". Any database is only as good as the information entered. 

UT: And THAT information comes from?
CP: YOU. 

UT: Next time you get mad that something changed to which we were not alerted, I shall place the mirror on the counter so you can vent to yourself. Because you're not smart enough, you're not good enough, and doggone it, people don't like putting up with your self-righteous, entitled bullshit". 

CP: As a coach and preceptor, I have always told my players and students: "I will never yell at you for not doing something I didn't teach you how to do". 

UT: Adulting is hard. No one told me I'd have to do things for myself. 

MICE ELF: You do lots of things for me. I appreciate you. 

UT: Awwww. And I appreciate you. 

CP: Be responsible and take your Tessalon#. 

#PhuhCough 

PSA #7

CPP: What are we discussing today?

CP: Back orders of medications. 

CPP: Again?

CP: Under the heading of PSA. 

CPP: Why?

CP: It occurred to ME that no one has properly explained what people, especially we in pharmacy, mean when we tell them asses a product is on back order. 

ME: For the last time, it's The Masses. 

MICE ELF: Tomato, Tomahto. 

CPP: You were saying?

CP: Back order - An item not currently in stock but to be sold or delivered when it becomes available; an order, or part of an order waiting to be filled. 

UT: Which means we have it on order but it is unavailable. 

CP: Yet people continue ask when it will be available. 

ME: I don't know. I don't make it. 

CP: When we will get it. 

MICE ELF: As soon as they make it. 

CP: Why some places can get it but others cannot. 

CPP: This is always a favourite of mine. There's a difference between "being able to get it and currently having possession of it". Yes, I currently have it. Once people find out, I will no longer have it because, like them asses, I cannot get it. 

ME: I give up. 
CP: We order from the same place. A pediatrician I have been working with the last few months calls me every Monday to check my inventory because I have been the lone star in town with Adderall, Concerta, Amoxicillin, et al. (Don't ask, I'm just awesome with my inventory skills.)

ME, MICE ELF, UT, CPP: <groan>

CP: Last week she called again and I finally had to tell her I was almost out of a couple items. She asked what to do now because "you have been my go-to for months". Yeah. I know. Which means you bled my inventory dry. As the last mainstay of these medications my provisions were bound to exhaust. 

ME They have ceased to be. 

MICE ELF: They are no more. 

UT: We are bereft of. 

CP: As for why some places HAD them, think about this. Can you buy a Pontiac? Packard? Oldsmobile? Sure. Used. Are they still making them? No. As long as someone has something that has been discontinued or is experiencing manufacturing issues, those that have it will continue to have it until they use, lose, or dispose of it. But it will not be replaced. 

CPP: “Today a young man on acid realized that all matter is merely energy condensed to a slow vibration, that we are all one consciousness experiencing itself subjectively, there is no such thing as death, life is only a dream, and we are the imagination of ourselves. Heres Tom with the Weather.”

TOM: Don't bring me in to this. 

PSA #6

CP: Be prepared.

ME: This isn't the scouts. 

MICE ELF: But it is a good motto nonetheless. 

CP: When calling the pharmacy, or any business really, be prepared. Know what you want and be prepared to answer any relevant questions asked of you. 

CPP: Uh oh. What happened now?

CP: We've always discussed the similarities between our job and placing an order for pizza. 

ME: #PizzaIsntWorking 

MICE ELF: Right. 

CPP: How do you screw up ordering pizza?

Pizza The Hutt: What do you want?

CP: Um. Pizza? <to people in background> what do we want? pizza? wings? toppings? I can ask if they have that. Anyone want breadsticks? Breaded mushrooms? Jojo's? 

CPP: You're saying this should have all taken place PRIOR to phoning the pizza parlour?

CP: Right. 

MICE ELF: Ok. What's today's story for your Public Service Announcement?

CP: Enough people have called enough pharmacies looking for Adderall and other medications that they have to have been asked the same questions everywhere else by now. 

ME: True. 

CP: So why aren't they prepared? Why is it like pulling teeth?

CP: CP's House of Phlapjacks. How may I help you?

Adderall Seeker Speaking: Do you have Adderall?

CP: Which one?

ASS: 30mg. 

CP: Tablets or capsules?

ASS: I don't know. 

CP: I could have either, neither, or both. You have to be specific. 

ASS: Extended Release Tablets. 

CP: That's not a thing. 

ASS: Tablets then?

CP: How many do you need?

ASS: A month's worth? 

CP: And how many would that be for you? Do you take one a day? Two a day? Three?

ASS: Last time I got 60. 

ME: In summation, how should this have gone?

MICE ELF: Like you said when you most recently updated your profile pic: Start with "Hello. My name is. . . "

CP: And finish with ". . . I am calling to ask if you have any Adderall XR 30mg capsules in stock. Brand or generic. And my prescription is for 60". 

#BePrepared 

#YouShouldKnowHowToDoThisByNow 

#AdultingIsHardWithoutMyAdderall 

“Pick the soup you want! Have your money ready! Move to the extreme left after ordering!”

History

CP: How about all these manufacturer backorders?

CPP: Yeah. Worst I've seen ever, across multiple classes of medication. Why are you asking?

CP: I was just thinking about an interaction the other day and was reminded of a great movie dialogue exchange:

Cosmo: In prison I learned that everything in this world, including money, operates not on reality...

Martin Bishop: ...but the perception of reality.

Cosmo: Posit: People think a bank might be financially shaky.

Martin Bishop: Consequence: People start to withdraw their money.

Cosmo: Result: Pretty soon it *is* financially shaky.

Martin Bishop: Conclusion: You can make banks fail.

CPP: Sneakers. Great movie. 

CP: And cast. 

CPP: What was this inspiring interaction?

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

Seeking Particular Adderall Manufacturer: I'm looking for the TEVA version of my Adderall 30 mg tablets. 

CP: That is the wrong approach. 

SPAM: Why?

CP: In this market, where Adderall Caps and Tabs are impossible to find, one does not ask for a specific manufacturer; you first ask if we have Adderall at all. 

SPAM: But I need the Teva brand. 

CP: You're lucky to find ANY. It's a take-what-you-can-get market right now. I order it daily, as I have for 3 weeks, and have yet to receive even one bottle on any of those orders. If I get it, I celebrate. 

SPAM: But it's the only one that works for me. 

CP: May I suggest now is the time to try others, risk-free. If they don't work, you've at least tried another manufacturer you otherwise would have ignored or refused. If it doesn't work, it's no worse than you having not tried it. If it does work, however. . . it will alter your perception.

SPAM: I'll keep looking. 

CP: Fine with me. Someone else will take the ones I have at some point today so it doesn't bother me. It's like the oil embargo and gas rationing of the 1970's. People would wait in long lines for gas, wasting more gas in the process, only to get however few precious gallons they could. I bet you would've waited for hours, gotten to the pump, and asked for regular leaded and driven off if they had none, instead of taking unleaded. 

NUTIT: Why was that movie quote so significant?

CP: The perceived panic induced by this temporary shortage. 

CPP: Not that temporary. 

CP: Sorry, ephemeral, transient, fugacious. It will end eventually. But the panic of "what-are-we-going-to-do-now-I-can't-handle-my-kids-without-it" is more catastrophic than the shortage. 

CPP: I just wish offices and patients would not act surprised when we tell them this is still an issue. Months ago we told them to prepare a Plan B and a Plan C, just in case. I know, I know, Concerta and Ritalin are now seeing supply issues but that was pretty short-sighted if those were the only options explored. 

NUTIT: Like Ozempic and Trulicity also?

CPP: Don't get me started. 

ME: Did someone say Ozempic?

CP: Shut it. Beggars can't be choosers. This reminds me of when Maalox and Mylanta brands were pulled from the shelves over 5 years ago. The first versions to return to shelves were the store-brands. 

CPP: And people refused them; brand snobs, they were. 

CP: Until they desperately needed the help they provided. 

CPP: Suddenly, everyone was praising the store brands. 

CP: "Why did I never try this before?" "It's so much cheaper!'

NUTIT: People are really that bad?

CPP: Just wait. 

CP: Around here, you'll see it all. 

WWCPD

ME: CP would put it on file. 

MICE ELF: At least let us discuss the issue first. 

ME: Phine. 

UT: Hey, Dr. Zoffis sent a prescription for PITA for Lipitor 20mg #30 with 1 refill. 

CP: Finally. They've only been calling us every day for the last fortnight. 

UT: It's not just that. I wouldn't announce every prescription we receive. 

CP: Right. Sorry. There's always more to the story. Do go on. 

UT: After I typed that one, another Rx popped up for Lipitor 20mg. This time it is for #90 with 3 refills, with no notes or acknowledgment of the first.

CP: The plot thickens. 

UT: I know what you're going to say, but NUTIT doesn't know how we do things here. 

NUTIT: Huh?

CP: Keep doing your new hire CBTs. 

UT: Thoughts?

CP: Put it on file. It's a valid Rx. We have the tracking ID#, a time stamp, and no note on the hardcopy to disregard previously sent Rx. 

UT: That's what I was going to do. Some pharmacists will call or cancel one. 

NUTIT: My last ones did. 

CP: Mostly newbies I'd assume. Why? It's a waste of time. Think about it. For as many times as we have trouble getting new refills from patients' providers, this is a bonus, a boon. File it away for next time and move on. I'll do this for every prescription except C-IIs.

NUTIT: You don't call? You don't delete one? 

CP: Again, why waste my time? It's valid and will save us time in the future when the patient thinks they are out and needs to request another refill. 

UT: Considering all the ways to request refills now: Pharmacy app, MyChart, in office, in person, etc, it's amazing how difficult it has become to actually get patients their refills. 

CP: Never mind the ones whose requests are denied for "needs office visit". 

UT: This way we have one in the bank. 

NUTIT: Never thought of it like that. 

CP: Because you didn't work with us and your former pharmacists were obsessed with the wrong mundane minutiae. 

UT: What does everyone else do? 

#NotAMindReader 

#YouSentIt

Rationale?

CP: We asked the question many posts ago about "what happened to yesterday?".  It was about the hot new drug to hit the market and how everyone forgot yesterday. What did you use yesterday that this new drug replaced? Wasn't it the "IT" drug at some point? Until today?

ME: Right. And we asked why that one is no longer good. 

MICE ELF: We're looking at you dermatologists. 

ME: Among others. Those who graduate today (pharmacists in particular) know today's market as it is. Those of us who graduated in another decade, or century perhaps, have a different view of the market. 

CP: THEN-we were happy to hit 40% generic dispensing. 

ME: NOW, it's a bit different. 

MICE ELF: Where were you going with this?

CP: People and their idiosyncrasies; specifically as it pertains to generics. 

ME: Ok. As in why the hangup when switching?

MICE ELF: Or the brand exclusivity rights and insurances not covering lower-cost alternatives that have been on the market for years?

CP: Yes and yes. But mostly this:

CP: Welcome to CP's Concoctions and Pessaries. What brings you in today?

Stay With It Until I Call Her: Picking up my prescriptions. 

CP: Ok. On the Dexilant, I see that it is on a manufacturer backorder, like half of the rest of my stock. You've been receiving the brand for a while, even though the generic has been available. I can readily order the generic for you and it is a few dollars less. 

SWITCH: I'm not sure. 

CP: About what? The words I used? I was pretty clear. Generic available; Brand not. You wish to continue taking this, you switch. Pretty succinct. 

SWITCH: No. Not sure I should switch to the generic. 

CP: What's the uncertainty? 

SWITCH: I should probably ask my provider first. 

CP: Ask them what?

SWITCH: If it's okay to switch. 

CP: Trust me, they don't care. 

SWITCH: Well I need to check with them first. 

CP: You have been taking amlodipine, hydrochlorothiazide, losartan, atorvastatin, and levothyroxine for the last 10 years. 

SWITCH: Yeah, so?

CP: So they are all generic medications. They may have been generic since the time you started them, or shortly thereafter, but they are all generics. I've been working long enough to remember when these were all brand only; except the HCTZ, that predates even me. What makes this one different?

SWITCH: <shrugs> I just have to ask them. 

CP: That's not an answer. If you had started on this medication today, you would only know it as generic, same as all your others. Those brands were so yesterday. Choose, or I shall choose for you. 

“Choose a life. Choose a job. Choose a career. Choose a family. Choose a fucking big television. Choose washing machines, cars, compact disc players and electrical tin openers...  choose your future. Choose life... But why would I want to do a thing like that?”

#IfYouChooseNotToDecideYouStillHaveMadeAChoice 

Dr. Zoffis

CPP: Okay. We have covered that the good Dr. Zoffis is terrible at math and at using e-scripts. 

CP: They'll blame the staff and the e-script software. This Dr. Zoffis is above reproach. 

CPP: True. But what else are we missing to complain about today?

CP: Let's go with a two-parter: 

a. There Should Be A Test and 

b. Things We Have To Do That Our Dr. Zoffis Does Not

CPP: Okay. I'll take "There Should Be A Test" to get things started. 

CP: Before you are allowed to prescribe something, anything, you should have to know HOW to write it. 

CPP: I am in favour. Are we talking dosing or strengths or quantities or what?

CP: All of the above. But also HOW to write a prescription. I had these conversations last week:

1.

Office Receptionist Calling: I'd like to call in this prescription for Phenobarbital. 

CP: Ok. Quantity and refills?

ORC: One month with 8 refills. 

CP: <shakes head> Huh? It's a controlled substance. You can't have 8 refills. 

ORC: Well that's what they wrote. How many can they have?

CP: Five. It's a law. Dr. Zoffis should know this by now. You've been practicing for decades.

2.

CP: We received an Rx for Maxitrol Eye Drops, filled them, patient retrieved them and went home. The next day, we received a second Rx for Maxitrol for this patient and filed it since it was too soon. The NEXT day, the patient brings us a hardcopy Rx for Maxitrol. 

CPP: Wow. Her Dr. Zoffis really wanted her to have these drops. 

CP: Except Dr. Zoffis, an EYE doctor/specialist, told her the pharmacy misfilled her Rx because she is allergic to Neomycin and he wrote for Maxitrol which he knows for a fact doesn't have Neomycin in it. 

CPP: Dafuq? 

CP: Oh yeah. And not a new Dr. either. We showed the patient the ingredients and she called the office herself and went off on the ORC who promptly put the Dr. on the phone. 

CPP: Let me guess. He meant something else?

CP: Nope. Didn't know, all these years on, that Maxitrol has Neomycin in it. Guess what I had to do?

CPP: Write the Rx for him?

CP: Yep. Give him a list of everything we had in stock that is LIKE Maxitrol, sans Neomycin. 

CPP: There should be some kind of test your Dr. Zoffis has to pass to be able to prescribe medications. 

CP: Especially a specialist. 

CPP: And this, kids, is why your pharmacist is important. 

CP: The more you know. 

CPP: Ouch. I can pheel that conversation. Let's move along to "Things We Have To Do. . . "

CP: We already established that, when laws take effect, pharmacists must be compliant that day, but Dr. Zoffis gets to plead ignorance and continue along as if nothing changed. 

CPP: Right. 

CP: This is more of a "problem of yesterday" when we had handwritten prescriptions, but it still bothers me. We were drilled in pharmacy to never abbreviate certain words, particularly when it came to directions. This is especially true with "UNITS". We were told to never ever abbreviate units to "u". 

CPP: Yet Dr. Zoffis continually writes prescriptions to administer 42u instead of 42 units. 

CP: Right. As I said, it's not as big a deal as it once was now that we have e-scripts and a "u" is clearly a "u" but I recently saw this again and was reminded about how we were taught this but Dr. Zoffis apparently graduated without this lesson. (Though they still shouldn't abbreviate units. tsk tsk)

CPP: I always wondered why they stressed it with us when WE weren't writing the prescriptions. 

CP: Ability to telepathically force prescribers to write correctly; another one of our disrespected superpowers, like math. 

CPP: Math is hard. 

CP: I also miss rounding on calculations. 

CPP: Dispense 66.507 ml to be administered as 3.167 ml TID for 7 days. 

CP: Ask them if you can give them Benzonatate as well. 

CPP: Why? Oh. 

CP: So you can tell them phuh cough.