Deep Thoughts

Watching a "You Are What You Eat: A Twin Experiment" on Netflix

CP: He just said "subscription". 

Other Person Also Looking: Yeah. 

CP: Even the subtitles said "subscription". 

OPAL: Okay. 

CP: It's wrong. It's prescription. 

OPAL: Well, isn't a prescription just a subscription to keep getting your medication?

CP: <blank stare> You've ruined my professional life now. 

OPAL: You're welcome. 

Which Do You Prefer?

CP: I have seen a variety of ways to type sig codes on bottles. Each pharmacist, and technician for that matter, will have her own preference when it comes to wording and phrasing. The one area on which there is rarely agreement is liquid dosing. 

CPP: I hate liquid dosing sigs, if they're not done my way. 

ME: ME too. 

UT: Everyone is so picky. 

MICE ELF: I'm guessing you have a poll or something?

CP: I took a transfer the other day and really felt uncomfortable reading the directions the pharmacy had typed. 

UT: How were they typed?

CP: "Give seven point five mls . . . "

ME: <shivers>

CPP: Yeah, I don't like that one bit. 

UT: WTAF?

MICE ELF: Had to be Chronic Vaginal Secretions. 

CPP: Yeah, if it's sent that way electronically, they don't take the time to fix it. 

ME: We were taught to translate it from doctor-speak to patient-speak. 

MICE ELF: Dumb it down.  

CP: Assume everyone is stupid. You will never be surprised and you will never be disappointed. 

UT: How do we prefer these written?

CP: "Give 7.5 ml by mouth. . . ". I like the space between the number and the mL. Also, mL can be plural. the added "s" on mls looks weird and is unnecessary. But let's see what else is out there and what everyone else has to say. 

a. 7.5ml

b. 7.5mls

c. 7.5 ml 

d. 7.5 mls

e. seven point five ml 

f. seven point five mls 

g. other?

CPP: Oh, and always remember to use a "0" before the decimal but to omit trailing zeroes. 

CP: I still see .50ml and just know that's a mistake waiting to happen. 

CPP: I was always mystified as to why it was drilled in our heads to never abbreviate "u" for units and to use a leading zero before the decimal but the actual prescribers writing them seem to have not been required to attend that class. 

CP: It was an elective. We know how to write but don't. 

CPP: They write, but don't know how. 

UT: People will blame the e-scripts software. 

CP: They are welcome to do so, but there is still a correct way to write prescriptions and the provider is the one who signs off on it. Much like the Curvy Vivacious Sluts Pharmacists who don't take the time to edit the data on the incoming e-script. 

UT: It happens every day. 

CPP: That's "everyday" if you work for Chocolate Violated Starfish. 

Policy? Or Professionalism?

CP: I ordered another case of Bromfed DM today. 

CPP: Great. I'll let our competition know when we speak. 

CP: Good. I spoke with Chronic Vaginal Secretions yesterday and explained we have it with no issues getting it. 

CPP: Good. Let's hope they send people our way. 

CP: They have been, which is great, but they're annoying about it. 

CPP: How so?

CP: If I knew you were the only pharmacy around that had it, and I verified it with you that morning, I would send my patients to you. 

CPP: Great. I would reciprocate in kind. 

CP: <blushes> I know. I'm just confused by this interaction, which I have had with multiple pharmacists at the same store. 

CP: CP's Chronic Perturbations. How may I help you?

Patient In Need Of The Bromfed: I'm calling to ask if you happen to have Bromfed DM in stock. 

CP: I do!

PINOT Bromfed: Great. Can you transfer it for me?

CP: Sure. Where is it?

PINOT Bromfed: Conjugal Visits/Satan. 

CP: Yeah. I can call them. What's their number?

<hears PINOT Bromfed asking the pharmacy staff for their information>

CP: Are you at the pharmacy counter?

PINOT Bromfed: Yes. 

CP: They have my information and I spoke with them this morning. Do they really need me to call? or can they send it without?

PINOT Bromfed: They want you to call. 

CP: Of course. Instead of them, with the Rx presumably on their screen, exiting it and faxing me the copy directly, I now have to stop what I am doing to call them to repeat what this patient already established. 

UT: They must be run like a PBM: The first person asks for your information, transfers you, and that person asks for it all again. 

CP: Except I spoke with the pharmacist this morning, and multiple times since the backorder on this began, and she said she would just transfer them to me. Why do I have to call? Especially on this one.

CPP: Please don't tell me they pulled the "it's the receiving pharmacy's job to initiate the transfer". 

CP: No. I expected that. Which, granted, is how it should be done and I am a staunch believer in adhering to it. However, I have worked out with other pharmacists in the past to send my prescriptions for the day without them calling, in these instances. It's especially galling if the patient is right there and the pharmacy told them to call around and they suggested my store because they know I have it. 

CPP: It does seem a little selfish. 

CP: Not to mention unprofessional. 

CPP: Did they give you a reason?

CP: Nope. They just didn't want to do it. According to the patients who have come to pick up these prescriptions. They were surprised the other pharmacists made it so hard. It wouldn't be so bad if they answered the phone when we called. Or didn't have to wait 30 minutes for the fax. I mean, it's not a control and most of us do fax transfers more than verbal anyway. 

CPP: Guess they didn't read your post yesterday. 

CP: Or they did and are still stuck on "ignore the phone, the patient here comes first". 

CPP: Except they made the patient waiting there wait here. 

CP: I guess that's the surprise. 

CPP: What surprise?
CP: At CVS - Cloaca Vent Surprise!

CPP: How much time do you spend on your acronyms?

CP: All day. 

I Disagree

ME: What's with the long stare?

CP: I'm ruminating. 

MICE ELF: Uh-oh. On what?

CP: Something someone wrote on a post I made the other week. It wasn't exactly related, but I find I can't let it go and that I ultimately disagree with it. 

ME: What was it?

CP: "The customer at the counter is more important than the one on the phone." 

MICE ELF: An immediate, knee-jerk response would be "what's wrong with that concept"? The person who entered the business is a priority. 

CP: Not necessarily. 

ME: Why not? They are here. They are present. 

CP: But the phone rang first. Yes, I can ring out their lone prescription, but for how many patients do I ignore the phone? All three in line? The drive-thru? 

MICE ELF: I'm going to argue "yes, the person is front is more important" but only because that's what people will say. 

CP: To which I will reply where do you draw the line? I got really good at ignoring a ringing phone thanks to the Culture of Virgin Suicides allowing 10 lines to ring with only 3 employees staffed. But that is not the point. If you are going to live by a policy, it has to applied equally at all times. IF you agree the patient in front of you is more important, then you MUST never answer a phone call while someone is in the store. Agree?

ME: Right. You cannot arbitrarily apply the rule. 

CP: BUT, there are two things people forget today: 

1. Our customers are PATIENTS because 

2. We are a HEALTHCARE PROFESSION. 

We just happen to practice our business in a retail setting. Imagine if your doctor had the same policy, or the hospital. The nurses would be checking in patients and checking out patients; they would not be answering phones from other offices, from pharmacies including yours, scheduling appointments, answering patient questions about their test results, or any of the other jobs with which they are tasked because "the customer at the window comes first", right?

ME: Right. 

MICE ELF: But they have multiple people. 

CP: True. And we do not. If I am working alone, or even with one technician, my prioritization and phone calls must operate differently. People are calling seeking medical advice, clarification on prescriptions, transfers, information. We don't take messages for the doctor so she can review them at lunch, or her designated time to approve refill requests, etc. WE ARE the professionals! WE have to answer those calls. Sure, many are refill requests and "do you have this in stock" queries, but many are not. The guy ringing up his Latanoprost Eye drop along with the bag of peanuts he gets every 4 weeks and I see in my store three days per week is NOT as important to me. He can wait. 

ME: What if the person at the counter has a question?

CP: It's always about balance. Remember how I wrote about Amoxicillin capsules and how pharmacists' views differ on subbing (tabs vs caps and how you don't get to pick and choose how you apply your rule)?

MICE ELF: Yes. 

CP: Same here. If you are going to say "the person in front of me took the time and effort to walk in to my store, he is more important, then you MUST 100% apply that to ALL people who walk in. If you do that, those who call with real healthcare questions and needs will be pushed aside. What if you miss the lady calling with heart attack symptoms? Your "customer" that doesn't need your well-trained, professional brain will cause you to waste your time because you're stuck on an antiquated notion of "well he's here". 

ME: I'm not going to say I disagree with you, but many will. 

CP: And they can. Keep in mind, I am talking about the absolutists. Those who say "the customer in front of me is more important" are flawed in their thinking. We are a profession. We are paid for our brains, not our ability to use a register. You can make the person in front of you a priority, but please, don't ignore the phone call. You can visibly see if that person needs your medical help, but the call is a mystery until you answer it. 

MICE ELF: While we're at it, can we address the "HOLD" that places use now instead of "such-and-such pharmacy/doctor, can you hold please?" when they DO answer the phone?

CP: It's annoying. I'd rather you let it ring. It doesn't allow you to prioritise calls. If I'm calling for a transfer, take my information, have the pharmacist fax it at her leisure, move on. Simple. But "hold" without providing an option is unnecessarily rude. 

ME: But at least they answered the phone. 

CP: And I'd be finding another provider. 

MICE ELF: Must be waiting on all those people who walked into the store. 

CP: Glad I wasn't having a stroke. 

Somebody Once Told Me

CP: Thank you phor calling CP's Chronic Plaints. How may you ruin my day phor me? 

A Little Lady Still Talking About Rejects: I want to know if my doctor called in my prescription. 

CP: They did. I was just about to call you, in fact. 

ALLSTAR: To let me know it was ready?

CP: No. To tell you it's not covered on your insurance; they require a prior authorisation. 

ALLSTAR: Okay. But I have insurance. 

CP: Uh-huh. Stay with me now. You're falling a little behind. You have insurance but this insurance does not cover this medication. 

ALLSTAR: "Somebody told me if you run it through and it rejects 3 times, they have to pay for it if you run it a 4th time". 

CP: Uh-huh. All my life has been a lie. I usually stop at two times. All these years wasted on prior auths when all I had to do was to continue submitting the prescription until it was covered. Oh me. 

ALLSTAR: "Well my friend's insurance covers it". 

CP: Uh-huh. I'm going to assume she works elsewhere?

ALLSTAR: Yes. 

CP: Well I have two suggestions phor you: you can either call your office and ask them to complete the prior auth, which may bring a large copay with it, or, and this is probably the fastest option, you could get hired by your phriend's employer, join their insurance, and know they will cover this medication once benefits kick in in 90 days or so. But that's a long way to go for Mounjaro, Ozempic, or Zepbound. 

#TrueStoriesWithCP 

Things People Say. . .

. . . if only they took a second to let their grey matter process it before it escaped. 

1. Why is the bathroom door locked?

CP: I don't know. Have you never ever in your life locked a bathroom door while in there? Never had someone lock you out at home? At work? At a rest area? While getting busy in a Burger King? 

2. What took so long to answer?

CP: Never been on a call and heard a busy signal? You're old enough to remember those. Never had another call come through while you were talking to someone else? Call waiting? Ring any bells? 

3. Would it be cheaper somewhere else?

CP: How much does a 10lb bag of potatoes cost at Costco? Oh, you don't know? Neither do I. 

#LowerYourExpectations 

#ThinkBeforeYouSpeak 

#BetterYet 

#DontSpeak 

If The Real World Worked. . .

CP: What a great day we are having today. 

UT: You know you're never supposed to say that. Just like you never say "it's awfully quiet/slow today" or "after I check this one I'm going to use the bathroom or eat". 

CP: Or say a patient's name in passing as it will magically speak them into existence. 

UT: Right. So why the optimism?

CP: I just figured we were overdue for someone to call us from an alternate reality. 

UT: And you just expect. . . 

<phone rings> 

CP: All yours. 

UT: Thank you phor calling CP's Crepuscular Pharmacy where we like to keep people in the dark. How may I help you phrustrate me?

Highly Illogical Sans Possession Of Common Knowledge: I was calling to see if you have [insert backordered drug-of-choice here] in stock. 

UT: We do not. 

HI SPOCK: Can you tell me why you don't carry it?

UT: First, that is the wrong question. 

HI SPOCK: What would be the correct question?

UT: Any of the following: Do you usually carry it? Are you out of stock at the moment? Is there a reason I can't find it anywhere? Any of these would be better than your choice of "Can you tell me why you don't carry it?" as your question implies an intentional hole in my inventory as opposed to a phorced one. 

HI SPOCK: Interesting. 

UT: I will, however, answer the question you posed. <ahem> 

CP: <mischievous grin>

UT: Do you have any gluten-free pancake mix or any asparagus in your kitchen at the moment? 

HI SPOCK: Um, no. And that's another question, not an answer. 

UT: Can you tell me why you don't carry these items in your kitchen?

HI SPOCK: I don't use them. I don't need GF products nor do I like asparagus. 

CP: <whispers> SATC funky spunk lol

UT: <shhhh> You don't stock them because you don't use them.

HI SPOCK: Correct. 

UT: And therein lies my answer to the question you asked. However, had you asked any of the other questions, I would have replied with "it's on manufacturer backorder at the moment so, whether I stock it, which means I USED to have it, or don't stock it, which means I never carry it, the answer is it is currently unobtainable. 

HI SPOCK: Thank you. Honestly. That is the best answer I have received from anyone. I wonder why no one else could explain it that well. 

UT: You kept asking the wrong question and we don't suffer fools, we post about our conversations with them. 

CP: We should start naming all of these product like a Marvel Metal - Uhnobtainium, abbreviation Uh-NO.

UT: Dorque. 

I Forgot. Remember?

CP: Thank you phor calling CP's Choice Pessaries. How may I help you?

Does One Remember Yet: I couldn't find my bottle to give you the refill number. 

CP: No worries. I can find it through your profile. Which medication?

DORY: The water pill, I think.

CP: Your "I-just-wanna-die-inside"?

DORY: Yes. That's it. 

CP: I see here we filled a 90 days supply 45 days ago. 

DORY: Are you sure?

CP: More certain than you.

DORY: You're sure I picked it up?

CP: I have the fill date, your signature at the timestamp of pickup, and video of you scrawling that signature across my tablet so yeah, I'm sure. 

DORY: Well I can't remember back that far so I'll have to take your word for it. 

CP: You couldn't phind the bottle and, despite me having all evidence of you being in my store and retrieving said prescription, you're going to go with "I'll have to take your word phor it"? 

UT: I miss when people trusted us. 

CP: This is why people question everything. News agencies put an expert next to a person with an opinion but no expertise up against each other in a "debate" and people say "yeah, that guy makes more sense than the expert who has studied this phor 35 years". Let's go listen to the conspiracy theorist who lives in his mom's basement. 

UT: <cough cough> Aaron Rodgers. I really miss when people would reply with "okay" and "thank you" instead of making everything an argument. What do I hope to gain by lying to you? This little tete-a-tete has already wasted our time and brain cells more than it should. 

CP: "Trust me, I'm a Doctor" has never felt so empty. 

UT: You don't even have to stay at a Holiday Inn Express. 

How About NO!?

Pt: Do you cut those?

CP: I don't take them so no, I don't cut them. 

PT: They said you would. 

CP: My favourite pronouns. Who are "they"?

PT: The nurses at Dr. Zoffis. 

CP: Of course. Well they don't work here so they cannot speak to what I do or do not do. However, upon your return to the office, please tell them you are going to walk straight back to the room without checking in, see the doctor, and leave without a copay because "they" said so - when they ask who "they" happen to be, please tell them the pharmacy staff. 

UT: At least they are good patients about it; now it's a running joke between us. 

CP: True. 

PT: This is Dingus, father of Mingus, son of Wingus, Destroyer of Good Days, Waster of Time. 

CP: Oh, joy. Thanks, Colin Robinson. How may I help you?

PT: My son. 

CP: Mingus. 

PT: Can you tell me what he needs?

CP: No. 

PT: What do you mean by no?

CP: Is he out of anything?

PT: I don't know. 

CP: Almost out of anything?

PT: Not sure. 

CP: Well, the general rule of "needing something" is that you are out of it and need to either get it to start on it, or you are out of it and need to replenish it. Do you call the grocery store to ask if you need milk? or eggs? or cat litter? 

PT: No. 

CP: Now you got the hang of it. You DO know the definition of "no". And that would be silly, huh?

PT: What would?

CP: To call a business to ask THEM if you NEED THEM to fill something for you. 

PT: Right. 

CP: Then, as I stated earlier, no. No, I cannot tell you what he needs. 

PT: So you refuse to help me. 

CP: It is not a refusal. You have established that you and he are beyond my help. Maybe put your heads together, along with his bottles, and you may be able to determine the answer to your quest. It's not a true quest without some hardship along the way and this, this is your hardship for I shall not allow it to be mine. Fare thee well. 

Huh?

CP: What is the definition of a prior authorisation?

CPP: A payor, usually the patient's prescription insurance, requires prior auth for a medication that is not typically listed on their formulary. The provider, usually the prescriber, must make a case to the payor, pleading their case that the patient needs this medication. The prescriber will indicate failure of previous, step-therapy treatments or allergies, or other reasons as they plead their case. 

CP: And if the provider does all this? 

CPP: The payor, in this case the insurance, can choose to cover it or deny the claim. 

CP: And if they approve it?

CPP: Then the prescription should be covered but still may incur a large copay. It could be a normal copay, but this is often not always the case. Why the lesson today, CP?

CP: Oh, just making sure it hasn't changed in the last week on me. 

CPP: I feel a story is imminent. Do share. 

CP: Hello Dr. Zoffis!

DZ: Hello!

CP: I was calling about a p/a for our mutual patient. I see you faxed us a novella regarding the p/a. 

DZ: I did. 

CP: It's still not covered and when I called Cover My Meds, they said you deleted the request. 

DZ: I deleted this one because we already did one in November and it was approved for a year; which is what we faxed you. 

CP: Curiouser and curiouser. I shall call them, armed with this fax from you. 

Stupid Ass Insurance Department Now Obfuscating: How may I frustrate your life today?

CP: I was calling about a p/a that was approved in November that I, for some soon-to-be-explained reason, cannot get to go through. 

SAID NO: Let me check. Which drug? 

CP: The patient had it approved while they were still using Causes Virgin Suicides as their pharmacy, but transferred to us the beginning of the year. 

SAID NO: Ah yes. I see they have 4 NDC's for this. 

CP: They don't. 

SAID NO: Well my system shows 4 are available. 

CP: Can you order them through your fancy system?

SAID NO: No. 

CP: Then they are NOT, in fact, available. I have all 3 of my suppliers pulled up and there is exactly one NDC, brand only, available for this product. Which, may I ask, is covered?

SAID NO: None of them. 

CP: Ok. But I have an approved p/a. For which NDC was it approved?

SAID NO: The one you are billing. 

CP: Yet here we sit, you telling me the drug is not covered. 

SAID NO: Yes. 

CP: And I have an approved p/a, complete with approval number and date of approval. 

SAID NO: Yes. But it's not covered. 

CP: Explain. 

SAID NO: This drug is not covered so the p/a should never have been approved. 

CP: Yet it was. I am going to need you to fax that information to the DZ. They would never believe me and I'm going to get yelled at. 

SAID NO: Done. 

CP: Thanks. 

CP: Hey, DZ. You're never going to believe this. <recounts story>

DZ: Damn. That's epic. I guess I'll contact them and figure out how to get it covered. 

CP: <does double-take> It's. Not. Covered. Period. Good luck in your endeavour!

*side note: as I was listening to SAID NO explain this to me, Unbelievable by EMF was playing on my XM

Who?

ME: What should we discuss to begin 2024?

MICE ELF: Do Indiana University bookstores sell "Hoosier Daddy" T-shirts? 

ME: Why is this relevant?

MICE ELF: It's nor worse than the South Carolina jokes out there. 

ME: But the relevance to pharmacy today? 

CP: It's an honest question because I was ruminating earlier about Who's Your Doctor so you can see where the inference was drawn by MICE ELF. 

ME: True. So we are discussing Who's Your Daddy, I mean Doctor? 

CP: Yes. The real question to answer is this: Are you a patient of the PROVIDER? or of the OFFICE? 

MICE ELF: Context? 

CP: A patient comes to the counter and we explain we have faxed her refill requests multiple times. She asks to which provider we are sending it and we tell her Peter Gozinya. She says "I've never heard of him". 

ME: <snickers> 

CP: . . . and we explain it's another provider in Dr. Zoffis, probably the CNP who signed off on her previous refill request. She will ask: "why did THEY call it in? I've never seen them" and I'll reply with "are you ever not home? Who answers your phone or takes your messages? Same concept".

MICE ELF: Or, as often happens, she will respond with "I switched providers last year! I don't know why you'd send it there". 

CP: When we send refill requests, they go to the person who approved them last. Now, the wrinkle we all are expecting: what happens if the provider either 

a. leaves the practice to practice elsewhere or

b. dies?

ME: Do you follow the provider to their new location? If so, you are a patient of the PROVIDER. 

MICE ELF: If you do not move with them, or they died, do you remain a patient of the "PRACTICE"?

ME: <sarcastically> Jeez, CP. Why is this knotting your knickers today?

CP: Because of the refill requests we send that are returned to us with notes like these: 

"not our patient" - really? because she was last month. 

"provider not at this location" - really? because this is the e-script I received from this location last month.

ME: Okay. Then I suppose I shall follow up with the obvious final question.

MICE ELF: Which is?

ME: Whose responsibility is it to know where the patient is being seen?

ME, MICE ELF, CP: THE PATIENTS'!

<and they all laughed and laughed until they burst into tears>