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>

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.