Order Up

Uber-Tech: I'm phrustrated, CP
CP: As am I. Why don't anal, banal, and canal rhyme?
UT: I loathe you.
CP: Sorry. Continue.
UT: Why are patients not prepared when they come to the pharmacy? Especially the drive-thru?
CP: Is this rhetorical? Or a metaphor for life?
UT: A metaphor. I need to learn your language to communicate with you.
CP: Proceed.
UT: A patient orders a refill and we confirm a refill is ready when they arrive.
CP: Okay.
UT: They then have the nerve to ask "where are my other 3 medications?" or complain that we filled the wrong one.
CP: True. This happens with pretty much every interaction. What's your analogy?
UT: This would be like going to Chik-Fil-A and ordering a Spicy Chicken sandwich and a lemonade. When the perky cashier repeats your order immediately back to you ("that's one spicy chicken sandwich and a lemonade") you confirm it and await its delivery. THEN, when the order is set in front of you, mere seconds after being placed, you proceed to argue and complain about its inaccuracy.
"Where are my nuggets? And the waffle fries? And my chicken strips? Every time I come here you can't get it right!"
I just don't understand how patients become such vacuous oafs when they arrive at the pharmacy.
CP: I see the rest of the conversation happening as -
   Impatient Mad Patron: "Why didn't you give me waffle fries?! It's not a meal unless you include the      waffle fries!"
   UT: You didn't order waffle fries, or a meal.
   IMP: I never have this problem at Wendy's!
   UT: Well this isn't Wendy's and they don't serve waffle fries, so there's that. If you could just park in the little "drive-thru parking" spot to your left, I'll get those waffle fries right out to you.
   IMP: Now I have to wait? Nope. I'm sitting right here.
   UT: Well either way, you're going to wait. It's either here, blocking my drive-thru, or up ahead where I will bring them out to you.
UT: Yeah. Except that doesn't happen at Chik-Fil-A. Or anywhere else for that matter.
CP: Manners and decorousness seem to evaporate as soon as patients near a pharmacy. I like your new term for them, Vacuous Pharmacy Oafs.
UT: Thanks. I think we're going to have to start referring to them that way whenever we have a call/issue/complaint. "CP, there's a VPO for you at the DT".
CP: Love it!
UT: Oh, and I have one of those anagrams for you too.
CP: Go on.
UT: You know all those vacation commercials for Sandals?
CP: Yes. Quite picturesque.
UT: If you rearrange the letters you get "ASSLAND".
CP: Nice. Changes my image of those honeymoon ads.
UT: Sounds like Eden for all those VPO's.
CP: Indeed.

I Know What I Need

CP: Oh baby, I. . . I know what I need.

Uber-Tech: Why are you bastardizing songs again? 

CP: For this little vignette

CP: CP's Pharmacy. This is CP, Proprietor and Head Pill Pauper. How may I help you?

Can't Understand News That I'm Sharing Here: I'm calling to see if my prescription is ready. 

CP: Over the phone? 

CUNTISH: Yes. 

CP: How can you "see" if it's ready over the phone? You should come in for that. 

CUNTISH: I wish to know if it is ready. 

CP: AH. That makes more sense. Name, DOB, favourite author?

CUNTISH: Um. CUNTISH, 5/5/75, Seuss?

CP: Got it. Thanks. Unfortunately I have nothing ready for retrieval. 

CUNTISH: Why the hell not? 

CP: Many reasons, I suppose: We didn't feel like filling anything for you; we blackballed your order; you didn't call it in; you opted out of on-time refills; you're out of refills; the prescriber didn't call in anything yet; you have the wrong pharmacy; it's Wednesday; Mars isn't in retrograde; I have a headache; APhA still sucks. . . 

CUNTISH: Yeah yeah yeah. Just fill my prescription. 

CP: Now that you have called and politely requested I prepare your prescription, I shall fill it forthwith. 

CUNTISH: You mean to tell me that if I hadn't called, you wouldn't have filled it? 

CP: Pretty much that's exactly what I said. That is how the system works. 

CUNTISH: <scoffs> Unbelievable!

CP: Why unbelievable? I don't send money to places that don't send me bills. Even babies cry for attention. They cry to be fed, to be changed, to be held and it's up to you to determine what they need when they cry. A happy, quiet baby is usually sleeping and doesn't need to be stirred and asked "are you hungry? do you need changed? wanna play?" or it gets a little angry and now you have to phix a problem you created. Unless and until you cry to be fed, I'm not going to harass you begging to fill your prescriptions. Now a corporation may text and call and email and do drone flyovers begging for your business, annoying you, but a happy, quiet you is not of my concern. Unlike a newborn, you are fully capable of operating the technology required to contact me, use your words, and ask for a refill when you notice your ba-ba is empty. Grow up!

CUNTISH: <click>

UT: Wow. Nicely done. 

CP: Adulting is hard. I often wonder what these people do when the supplies in their refrigerators are exhausted. Or the gas in their cars. 

UT: Toilet paper. Can't you just hear them in their bathrooms screaming for help, or calling Charmin asking why they weren't told they only had a single square to spare and how last night was Taco Tuesday?

CP: I should rerun my "But Her Refrigerator Was Still Running" post. 

UT: Still one of my faves. 

I Felt Better

CP: CP's Palace of Pills and Potions. How may I help you? 

Not Enjoying Withdrawal Symptoms: I have a problem. 

CP: You have a problem? She turned me into a newt!

NEWS: A newt? 

CP: I got better. Anyway. You were saying? 

NEWS: I was taking medication for my sciatica. And it helped. 

CP: Good news. What's the problem with it working? 

NEWS: I felt better so I stopped taking it. 

CP: I see. Let me guess. . . it stopped working when you stopped taking it? 

NEWS: Yes! Now I don't feel as good. And I have these terrible withdrawal symptoms. 

CP: Makes sense.  

NEWS: Why? I got better. 

CP: You weren't treating the disease, you were only blocking the symptoms. You got better BECAUSE you were taking the medication. You quit taking the medication and, ipso facto, it stopped working.  

NEWS: How's that? 

CP: Pretend you're a car. 

NEWS: What kind? 

CP: A Yugo. Doesn't matter. You fill it with gas and drive around town. You stop by the local pharmacy, then the grocer, then head off for a picnic in the country. On your way home, the gas tank runs dry and the car stops. Is there a correlation between the gas tank and why the car stopped working? 

NEWS: So you're saying that because I didn't put my medication in me, I didn't run?

CP: Succinctly, and oddly, disturbingly, visually stated. 

NEWS: Can I start taking it again? 

CP: Fill 'er up. 

Uber-Tech: Is there any situation you can explain to a patient without a scenic analogy? 

CP: No. Why be boring? Besides it's easier for people to comprehend something they already understand than it is to teach them something novel for which they have no prior experience to apply. 

UT: You are rather wordy. 

CP: I prefer loquacious. And she had her "aha!" moment. 

UT: We're talking away. 

What's Right Is Right

CP: You know how we see prescriptions from prescribers that make us look at each other and ask if they even know what they are prescribing?
CP's Partner: Yes. Or if they just heard about it on TV, or from a patient who heard about it on TV and the prescriber shrugs and says "let's give this a go".
CP: Right. On the flip side of that, we have medications that we just KNOW the correct way they should be written.
CPP: True. There are a certain number of medications that we can tell by a glance are correct, are completely boffo, or that need a little of our professional massaging. We are the experts after all. What happened to initiate this conversation, again?
CP: My last weekend. I had another of those arguments with central processing.
CPP: Is this another one of those "not to denigrate another professional, but. . ." issues?
CP: It is. I like to think that we as pharmacists know the same things. Certainly there are specialists within each practise location. An expert in retail may be a novice when transitioning to hospital, or the reverse could be true. But I would expect a similar level of competence from a peer in my practise location.
CPP: Okay. What happened?
CP: You know how the central pharmacists review our prescriptions after they've been typed?
CPP: Right. They have a few dozen stores they help with verification.
CP: Since we aren't supposed to be typing and checking our own work, I entered a prescription so it would be worded correctly as the e-script left a lot to be desired.
CPP: Makes sense. You are the responsible pharmacist at the end of the day. I'm guessing this didn't go well?
CP: Nope. It was rejected. By a Pharmacist. Because the directions I typed did not match verbatim what was sent on the e-script.
CPP: Okay.
CP: To make matters worse, I sent it back through, he rejected it again. I sent it a third time, he again rejected it. Finally, I selected "local" and finished it myself.
CPP: I'm guessing that's not the end?
CP: No. I took the package insert out of the box, enlarged the directions, then faxed them to him and his boss and our boss.
CPP: What did she say?
CP: Nothing. Just shrugged and said "we have no control over the central processing center".
CPP: So they are making more work for us instead of helping?
CP: That's the point.
CPP: So by now everyone wants to know what the medication was.
CP: It was for NTG 0.4mg sl tabs. The e-script directions were "1 tab every 5 minutes for chest pain".
CPP: Which is wrong.
CP: Which I corrected, as always, to: "Dissolve 1 tablet under tongue every 5 minutes up to 3 tabs in 15 minutes as needed for chest pain. No relief, call 911".
CPP: Which is in the package insert.
CP: Right. Can't you just see someone popping an entire bottle of 25 tablets, getting no relief, and suffering a heart attack while experiencing a wicked headache?
CPP: Okay. This then begs the question we have to ask everyone: What other medications do you just know how to type correctly, e-rx directions be damned?
CP: I'll give you three.
1. Lidocaine 5% patches - apply patch(es) to area and leave on for 12 hours then remove for 12 hours.
2. Clotrimazole Troches - Slowly dissolve 1 tablet in mouth.
3. Miacalcin NS - Use 1 spray in 1 nostril every day. Alternate nostrils daily.
CPP: Yeah, that last one gets entered incorrectly all the time.
CP: Can't you just see some pharmacists out there calling on these?
CPP: What's worse is them not fixing these mistakes or missing them altogether because they've never seen them written correctly; or weren't taught these during their retail experiences.
CP: Yeah. The preceptor site was either too busy or they used the students as free labour instead of teaching them the ways of the phorce.
CPP: I have one more to add.
CP: You have the phloor.
CPP: SL vs ODT. We receive prescriptions all the time that say "Take one tablet by mouth" or that confuse the two terms.
CP: What's the correct way to enter these directions, call center and e-script directions be damned?
CPP: SL is sublingual which literally translates to "under the tongue". ODT, or Orally Disintegrating Tablets should be remembered as dissolving On Da Tongue. ODT. Get it?
CP: Nice.
CPP: With that in mind, what else do you have to offer, oh mighty phans of CP?

Stroke Me = Troche

CP: Are you familiar with the 80's hit The Stroke, by Billy Squire?

ME: Of course.
MYSELF: Natch. Why?
CP: You know how the chorus repeats?
Stroke Me
Stroke Me
Stroke!
Stroke!
Stroke Me
Stroke Me
Stroke!
Stroke!
ME: Yes.
MYSELF: Where are you going with this?
CP: What's the name of a dome-shaped cover, usually for food dishes?
ME: Cloche.
CP: And another name for a lozenge?
MYSELF: Troche.
ME: TRO-Key
CP: And now that song reminds me of two people arguing over the proper pronunciation of that word.
TRO-Key
TRO-Key
TrOsh!
TrOsh!
TRO-Key
TRO-Key
TrOsh!
TrOsh!
ME: Has anyone ever told you there's something wrong with you?
CP: Yes. My techs and interns every single day.
MYSELF: Your brain works in mysterious ways.
CP: It does. I can either embrace it or ignore it. I choose to share it.
MYSELF: I still say it's pronounced TrOsh.
ME: TRO-Key!
CP: You're both correct. TRO-KEY is the first pronunciation, but TrOsh is listed as a British variant.
MYSELF: Thanks for ending that debate. Now does that make you a Dooshbag?
ME: Or a Doo-key-bag?
CP: I'm team Tro-Key.

Dear Diary

Dear Diary:

Flu Shot Week 9:
ME: So many people have promised to come back for shots and not returned that I am soon to abandon all hope of making the bosses happy. I feel jilted. I will forever be on the bottom.
CP: Bottom isn't bad. It means you're good at something.
ME: What?
CP: Screwing up.
ME: <moans>
CP: Now you got it. But that gave me an idea.
MICE ELF: How did that give you an idea?
CP: Promise rings.
ME: Huh?
CP: It's another measurable metric for Corporate Overlords to hold over your head. Promise Rings. You give them to patients and they swear a solemn vow to be loyally yours in flu vaccination. They will repeat after you: "With this ring, I do hereby vow to return to you tomorrow, next weekend, or next year and receive my inoculation."
MICE ELF: Nice. You could use that in lieu of a waiting list for other shots.
ME: Sounds like more heartbreak for me. I can just see it now, people skulking by the counter, surreptitiously sliding their rings behind the register in an effort to break their promise with me.
MICE ELF: You should be used to the stealth breakup by now. Anyway, the CO would still expect you to make good on those promised shots.
CP: Something else for you to screw up. See! You are good at something! And what's the best part about being on the hourly conference calls berating you for not administering enough vaccines?
ME: What?
CP: You're not giving shots because you're on the phone telling them why you're not giving shots!
MICE ELF: It's like when they ask why your complaints have risen over the last month and you remind them they cut your hours and you are now in peak shot season.
CP: They will wave a dismissive hand and blame you because they set you up for failure! They EXPECT you to fail! It's genius. In this way, not only are you meeting their expectations, you are exceeding them! Genius!
ME: Well, when you put it that way. . . Promise rings, huh? I like it.
CP: Just don't get too attached. People seem to be loyal to wherever they happen to be at that exact moment.
ME: But they promised.
CP: And with this ring, they shall return.
MICE ELF: Maybe we could repurpose used Nuvarings?
CP: One ring to rule them all?
ME: Gross.

Another Damned If You Do, Damned If You Don't

ME: What's you Topic Of The Week, CP?

CP: Days supply. 

MICE ELF: Sounds zzzzzzzz

ME: Specifically?

CP: 30 versus 90. 

MICE ELF: zzzzzzzz

ME: I'm sure others are on the edges of their seats with anticipation. Please continue. 

CP: Some insurance plans only allow us to bill for 90 days supplies; some for only 30 days. 

Some patients only want 30 days at a time; some for 90 days. 

Some patients want certain of their prescriptions to always be filled for 90 days; some for 30 days. 

MICE ELF: zzzzzzzz

ME: Why is this important? 

CP: If the prescription is written for 30 days, and has enough refills, I can fill it for a 90 days supply. Honestly I'd rather all prescriptions be written for 90 days at a time. That way I can fill for any quantity the patient wants. 

ME: OK. Not getting any less boring.

CP: Here is the problem. Regardless of how many prescriptions we fill each week, it is impossible for any pharmacy to manage the needs of not only each individual patient, but his or her specific needs as it regards to each individual prescription in their profile. Add to that the fluidity of copays as they change over the course of the year (deductibles start/end, tier changes, new insurance plans, etc.) and no amount of notes in the profile will enable the pharmacy to make each person happy on each prescription. 

MICE ELF: <sleepily opines> make them responsible for their own prescriptions <zzzzzzzz>

ME: Yes. Thanks for that. Is that your goal here? 

CP: Simply put, Yes. As a patient, you have the obligation to ensure your prescription is filled to your satisfaction. 

If you want your HCTZ 25mg filled as cash for 180 days at a time, ask when you place the refill order. 

If you want the Eliquis filled only for 30 days, ask. 

If you want the Januvia filled on a discount card, make sure I do, by asking. 

If you want everything filled for 90 days, even when you hit the Medicare Gap, don't be surprised when I explain the $500-$1000 copay totals. 

ME: Seems simple enough. Why is this an issue again?

CP: People will complain that we should just know how they want everything filled each time. I once had a patient who paid cash for a week of medication every Friday. Simple. Yet if he forgot a dose, he wanted one fewer tablet that week. Or if he wanted an extra for a vacation day, he added a dose or two. Now consider the patient whose insurance charges him $15.00 for a 30 days supply of one of his medications but $75.00 for a 90 days supply of that one medication. His prescriber always writes for 90 days supplies which he gets on some of his other prescriptions. How am I supposed to remember this one patient and his individual needs among the other thousands I will fill each week? 

ME: I'm guessing he's the one you have in mind for this post. 

MICE ELF: <yawns>

CP: Not wholly. It does exemplify the point however. Both of these men have unique filling needs. One is nice, the former, and one is simply an ass, the latter. Unfortunately there are more of the latter than the former. If you have unique filling needs for each of your medications, it is up to you to ensure it is correct. While I may fill 2000 to 4000 prescriptions per week, the last thing on my mind is "how does Little Old Lady want this particular Rx filled?". 

ME: Any words of advice for the prescription phillers out there? 

CP: Yes. 

Ask before you come to retrieve it. It is easier to fix BEFORE you get in my pickup line than being the wrench in my gears that slows down the whole system. 

Ask before you pay for it. Note the word "ASK". 

Just ask instead of yelling at me that I should know how you want it filled each time. It's like yelling at the pizza place because you changed your mind AFTER you placed the order and, now that it's ready, you want a new pizza, made the way you like, to be already cooked and waiting. 

MICE ELF: Pizza? 

#ItsNotMyPrescription
#IWillFillItAsWritten
#TheyRevokedMyMindReaderLicense
#ThatsThePersonHoldingMyDriveThruHostageInFrontOfYou

You're An Adult?

Unequaled Bright Energetic Radiant Tech Enjoying Counter Help: How may I help you today?
Lady At Counter Energetically Yelling Undeniably Now Demanding Everyone Readily Accept Limited Listening Skills: I need this prescription filled.
UT: Ok. Your insurance may not cover it. If they do not, I can fill it as cash or on a discount card if you like.
LACEY UNDERALLs: Let me call someone at my house.
UT: Fair enough.
LACEY UNDERALLs: <on phone> not sure. not sure. not sure.
CP: Pretty sure you explained the options well.
UT: I did. Maybe they're for someone else?
LACEY UNDERALLs: Here. <shoves cell phone towards UT> Can you talk to them?
UT: I'm sorry but we can't talk on cell phones. They are welcome to call the store phone so I may discuss it. Here is the number.
LACEY UNDERALLs: <on phone> They can't talk on my phone. I don't know. They said you can call the store phone.
CP: I see this taking a strange turn in 4. . . 3. . . 2. . . 1
LACEY UNDERALLs: They want to know how they can call the store phone if you're not allowed to talk on the phone at work?
CP: And there it is.
UT: No. I said I can't talk on YOUR phone. I can talk on my phone. The store phone. The business phone. The phone on which people call me all day.
LACEY UNDERALLs: Oh. Ok. They will call you then.
UT: Um. That really happened.
CP: It did. Right before our very eyes. Good luck with that conversation once they call you in 3. . . 2. . . 1
<phone ringing>
CP: <touches nose> Not it!