Missing Prescription

Before you leave your prescriber's office, have him/her print the confirmation that the transmission to your pharmacy was successful. We here at the pharmacy use a variety of methods to receive your prescriptions from hundreds of prescribers every day, including, but not limited to: original hard copies, voicemails, electronic prescriptions, faxes, telekinesis, smoke signals, and hologram. Please make sure your prescriber indicates which method(s) of transmission they used.

Before leaving the office with confirmation in hand, review that your prescriber selected the correct pharmacy. If not, march right back into the room, ignoring the fact other patients may be in various stages of undress, and demand the prescriber fix it on the spot!

Prescribers are often in a hurry when entering prescriptions and are prone to making many, sometimes life-threatening, mistakes. In order to avoid this, as well as any delay in processing your prescription(s), please make your prescriber and his staff take the time to review your prescriptions for any typos or missing information. As we do at the pharmacy, make sure at that no fewer than 3 different people look at and verify the prescription for accuracy. If it arrives at the pharmacy with any errors at all, you will personally have to call the office back, from one of our phones, and demand the prescriber get on the phone and fix the problem forthwith.

Selling Your Stuff

If you bought items on eBay, or in a store, who much did you pay? Did you get a deal on them?
Let's say you choose to turn around and immediately put those items up for sale.
How much will you sell them for?
The amount you paid?
Less than what you paid?
More than what you paid? If so, how much more?

Let's pretend you are a pharmacy. You purchase some items from a wholesaler. Perhaps you got a deal on them, depending on the quantities you purchased. How much will you sell them for?
The amount you paid?
Less than what you paid?
More than what you paid If so, how much more?

Why is it that you would wish to make a profit on your personal resale business and as owner of your own pharmacy, but when a pharmacy attempts to make a profit, it's price gouging?

How many people out there have sold, or purchased, the must-have Christmas item for a woefully inflated price on eBay? Someone is able to buy multiples of this item. When demand soars, they put it up for sale to the highest bidder. While this is basic supply-and-demand, most businesses do not adjust their prices daily to respond to market conditions (see gas prices).

When we pay more for what we buy, we have to charge more. With law changes going into effect that impact what manufacturers can charge for their medications, they are raising some prices exponentially before they are not allowed to do so. This is one of the reasons medications will disappear for a few weeks then come back with 300% to 1000% price increases. While I am happy for you that you were able to get some things for under $10 last month, now it's going to cost you 2-3 times that.

Blaming the pharmacy for passing along these costs is like blaming the pizza delivery guy for the spike in pepperoni costs.

Family and Birthright

It was one of those weekends where the conversation was deeper than the prescription pile. Winter had indeed come and along with it, the quiet solitude so rarely offered in the pharmacy department. Introspection and reflection led to a few epiphanies and aha moments.

This was not one of those. It did inspire a lively debate however.

I mentioned that past customers of mine, a single mom with 3 young boys, all of different surname, were telling me the story of their annual trip to Florida. I mentioned my excitement at the start of Spring Training and heard this account: "I take the boys to spring training every year for 2 weeks. We get them new balls and bats and hats every day so they can line up and get the players' signatures." 

Huh. I must be doing something wrong.

Then the debate ensued. 

My tech posited that we should dare to live the dream life that accompanies state aid. 

I countered that we don't know how. 

Uber-Tech: It can't be that hard. 

CP: Sure it is. They have generations of knowledge. 

UT: All within the last 4 decades. 

CP: Just what was envisioned when the system was created. 

UT: But how would it be possible for us to not succeed? 

CP: We are too smart. We would try to be logical. Our way runs counter to how people think. We would have no problem paying for a $3.00 cough medicine for our children. These people, with years of experience, would yell and scream and walk away. 

UT: Perhaps we should take notes. 

CP: Like studying animals in their native environment? 

UT: Exactly. What better place than here? Either a pharmacy or an ER. 

CP: True. But we are also missing one key element. 

UT: What's that? 

CP: Pedigree. 

UT: Yeah. They always can afford dog food. 

CP: No. I mean being born into the right family. 

UT: Someone to show us the ropes. 

CP: Yes. Think about it like this. On one extreme, we have Tywin Lannister. He has the experience. He has the power. He has all the money and his children will inherit it and spend it and never run out of it. This is the product of being highborn. At the other end of the spectrum...
UT: ...you're saying that in order to be successful at the state aid game, you have to be born into the right family?
CP: Yes. Or married into it. Otherwise our family would go the way of House Reyne at Castamere.
UT: They will beat us with experience.
CP: Truly. Until then, we just have to commit ourselves to working every day to enable them to live out our dreams and live vicariously through them.
UT: I was really hoping for the new iPhone I could carry in my Coach purse while driving my Escalade.
CP: Dude. You're a guy. Why would you have a purse?
UT: Sorry. Someone has to comment on this thread with these 3 stereotypical items so I wanted to get them out of the way in the hopes I don't have to read through them later.
CP: Got it. See, there we go thinking inside the box again. I told you we don't know how play this game. 

New Directions

I read with caution the following article discussing the possibility of mandating bilingual labels. http://drugtopics.modernmedicine.com/drug-topics/news/should-california-require-bilingual-drug-labels

My question is: Where does it stop?
When I worked near a university, we had professors from all over the world living in town and filling prescriptions with us.
I didn't know if English was a primary language.
I didn't know what was their primary language.
I didn't know if their families were born here and could speak English.
What about people whose primary means of communication is American Sign Language?

I believe we should have a Themed Label Day.
Since no one is expected to learn English anymore, we could take this opportunity to teach other languages to everyone via our labels.

We could have Braille day for the blind.
ASL day for the hearing impaired.
National Talk Like A Pirate Day, just because...
We could have a special Yoda Speak label.
I am a fan of the poetic verse labels.
Haiku labels would be fun too.

One tablet a day you shall take. With food it must be.

Inhale two sprays into left and right nare
So you're not allergic to all the fresh air.

Take one tab by mouth
Two times a day with meals
As needed for pain

UpCharges and Pharmacy Phees

Pharmacies should look into modeling their services and fees on the airline industry. If ever there were an ideal model of how to run a barebones operation it's the airlines.

The following offers/price schedules would be the norm: 

1. Your first 2 prescriptions are free to process. Each additional prescription filled that day will incur an additional processing fee. 

2. Electronic prescriptions and faxes will be processed for free, following Rule #1, while handwritten hard copies presented at the counter will incur an additional fee. (Exemptions for controls that must be handwritten in states that haven't caught up and passed the requisite laws just yet.)

3. If your prescription must be dispensed in multiple bottles (i.e. 180 Metformin 1000mg) there will be an additional charge for the extra label, vial and cap.
4. Any changes made to your prescription once it has been finalised (billing changes, quantity changes, coupon cards, etc) will result in additional fees.
5. Prescriptions not picked up and returned to stock will be assessed a restocking fee.
6. Prescriptions that have been restocked that you now wish to purchase will be charged the original copay, the restocking fee, the new copay, plus an additional "convenience" charge.
7. You must have your photo ID ready at pick up on all prescriptions and the name on the ID must match the name sent by the prescriber and the name we have on file.
8. Counseling is mandatory and FREE at time of purchase only. Any questions asked once the register transaction is completed will be assessed additional fees based on type of question asked and duration of consultation.
9. Your prescriptions have the right to be "bumped" for higher priority patients (sick children, emergencies, etc) if our queue is full. You will be compensated by having the additional prescription fee waived on a future fill date.
10. You must check in at the ticket counter (drop off) before going to the gate (pick up) to ensure your flight (prescription) is ready and arriving on time. If not, please have a seat in the lounge (waiting area) where you will be called to board.  

If Real Life Were Like Phone Calls

We need a sign.

We need a signal. 

We need a visible form of communication; something people are already used to hearing. 

Customer Service Providers have this down to a science. 

If we truly wish to champion customer service in our industry, we could learn a few tricks from these professionals. 

How many times have you called a company only to hear the following message? :

"We are currently experiencing a higher call volume than expected. Our representatives are working with other customers at this time."

Can we get that here? If a tech calls off or it's the first of the month, we can post a sign that says: "We are currently experiencing a higher script total than expected. Wait times may be increased." 

Fire departments set maximum occupancies for businesses. Many places will only allow people to enter once people have begun to leave in order to remain at safe levels. I say we should be permitted to have maximums on the number of waiters permitted.
"I am sorry, we have reached capacity for the number of waiters we are allowed to process from 2-3pm. You are welcome to leave your prescriptions and return for them in the 3-4pm window or you can try your wait again later."

Please Feed the Pharmacy Staff

We work in a zoo.

Not a place like a zoo. 

A real zoo. 

I'm not talking about the chaos. 

I'm talking about our cage. 

We are behind a counter. We are behind a partial window or barrier where people can walk by and observe us. There are people who go to zoos simply to have lunch and watch the giraffes. Others prefer to run to the monkey exhibits first.
Same with pharmacy. There are those who come to get prescriptions filled and watch us while we work on their orders. There are others who come for the other exhibits in the store, but can't help walking past the pharmacy encounter and point and gawk at the lowly humans forced onto display for their amusement. 

As in the zoo where you may see some lettuce or bits of food scrap lying around, depending on the time of your visit, you are also likely to see the humans with orts scattered around the counters or in their pockets. I believe we should embrace the zoo-like habitat in which we are forced to dwell. Let's install little gum ball-like vending machines in front of our counters. Instead of pellets for the ducks, we could offer Cheetos and Orange Slices (non-projectile-like food is favoured). This way, when people get mad and want to throw something at us, it will not hurt, and be edible! We could post signs that read: "Please feed the humans!".

Patient interactions would now include more bartering.

Impatient Guest: How long is this going to take?
CP: 17-23 minutes should suffice.
IG: Why so long?
CP: I'm feeling a wee bit peckish. Hunger makes me sluggish and disoriented. Need more time to focus.
IG: You should eat.
CP: Not allowed. No breaks. I can only eat food that fits in my pockets.
IG: How can I help?
CP: See that little feeder out there? The one with the brownies?
IG: Yes…?
CP: Go put a dollar in there and feed us. May help to bring back my super powers and I can fight this mid-afternoon somnolence.
IG: And then?
CP: Your prescription will be ready in 16-21 minutes.
IG: That sounds better.

Schools of Pharmacy

We have too many.
We need to police ourselves.
Pretty soon, Community Colleges will become the Caribbean of Medical Schools. (Sure, some good prescribers have come from schools there.)

When a degree takes nearly a decade to achieve, opening schools now that take years to become accredited will only help us in 10 years. Unfortunately, by most calculations, the profession will be saturated, again, as it was in the early 90's.
We need to stop opening new schools of pharmacy.
Increase enrollment at the best schools to adjust for demand. Decrease enrollment as needed to adjust for demand. Opening new schools? Without a placement system? Without a guarantee of a need?
Senseless. Reactionary. Money-grabbing.

We need quality over quantity.
We don't need to become the lawyers of the healthcare profession where we are a dime a dozen.

What is another problem we can see with too many graduates? Loss of our identity. For some time I have quit using the term "doctors" to describe those medical professionals. Why? I don't want to give credit where it is not due. There are many groups now who can prescribe. Without knowing who is and who is not an actual doctor, I believe the generic terms "practitioner" or "prescriber"are more appropriate. There was a need for more people to take care of sick people in this country. We imported as many as we could but how else could we increase that number? Give more professionals the right to prescribe. It's like the Old Catholic way of thinking about how to increase your flock: If you can't birth them, convert them.

Soon, Pharmacists will have the right to prescribe as well. However limited or broad the scope of these rights, it does not diminish the fact that we can prescribe. What then? Doctors will have to find a new way to have their egos stroked. No longer can they monopolize the "I'm a Doctor!" mantra. Patients will recognize they can go anywhere to receive a prescription.
To them I will say "welcome to being marginalized!".

Unless we do something as a group, as a unified profession to stop the greedy reach of our professional education system, we will continue hurting our beloved profession.
We have too many pharmacists. We continue to train more than we need. New pharmacists need jobs and are cheaper to employ. Older, more experienced pharmacists are at risk of losing their jobs. Eventually, and not too far away, our profession becomes the "you want fries and a flu shot with that?" minimum wage job that Corporate America is longing for it to be.

If your state is considering opening a new pharmacy school, consider petitioning them to stop it. With the number of schools having nearly doubled over the last 25 years, and the number of graduates along with it, the number of available jobs has not kept pace.

http://www.newrepublic.com/article/119634/pharmacy-school-crisis-why-good-jobs-are-drying

We are killing our own profession and no one is going to stop us.