Happy Halloween!

Pictured below is my 11 year old son's kitty.  She's a sweet little kitty, but like most cats, she does not appreciate being dressed up in a costume.

This is from 2011.  As you can see, kitty does NOT like being in a bee costume.  Yes, its a little blurry.  It's from my 11 year old son's camera..

So do you think 2012 would be any different?  Nope.  Same costume.  Same expression:

HAPPY HALLOWEEN EVERYONE!

Do doctors apologize when they make a mistake?

Not very often.  

The other day one of our regular patients asks for a refill on his medication, but it is out of refills.  As is customary, we fax a request to the doctor's office.

Later in the afternoon, we get a fax back. Written on the top of the page in big letters is "FRAUD!" Below that, "This is NOT our patient!  This is fraud!  I'm notifying the State Board!"

It was not April Fools day. This patient has seen this doctor many, many, MANY times for several years and has been prescribed the same medication for many, many, MANY years. So I go to our file, pull out the latest hand-written script from that doctor for that patient, tape it to the fax we received from the doctor, and fax it back on over.

The next day we get a refill Rx faxed over for the patient from the doctor. No apology, not a mention of the fax we received the day before... nothing... except the new Rx.

Doctors... gotta love 'em. So far, no call from the Board of Pharmacy either.

Ok, this is pretty gross

I don't know what it is, but there's a few people out there who need a good solid cleaning with some industrial soap and a brush. It's happened too many times to me and it grosses me out EVERY time. I'll take an alcohol swab and rub the arm of my flu shot victim and then discover that I've either wiped off a layer of their skin, or more likely, a layer of DIRT. It's just soooooooo gross. Here's one of my recent swabs:

Eeeeeewwwwwwwwwwww!

Random Observation # 1

Selective 1st Pass Metabolism

Lady:  "Where's the Motrin?"

Me:  "We have Advil and our company's generic on aisle seven on the left."

Lady: "No, I need Motrin, not Advil."

Me:  "Advil and Motrin are the same thing... They're both Ibuprofen."

Lady: "Not after you swallow them!"   She walks away mad.

Doctors make the WORST patients

It's bad enough that patients show up with a fistful of prescriptions, hand them to you, and say they'll be back in ten minutes.  Yeah, right.  But then there's the doctors...  oh my, the doctors.  The ones that have a friend or colleague call in an Rx for them, or just show up at the counter and demand a Z-pack.  Then they act annoyed when you ask them to fill out a prescription form.  You see, they have the gift of the gods... the ability to give and take life, how dare YOU the pharmacist ask them to follow protocol.  How dare you ask them to wait a few minutes...  these are the same people that make their patients wait forever in the waiting room, then wait another forever in the examining room, only to be given 5-10 minutes of time for an examination.

I have one doctor who consistently prescribes Viagra for himself.  And by the quantity he's going through at age 36 I think he's out to set a new record or something.  I think he's a little embarrassed though because he's always wearing Unibomber sunglasses when he comes in.  Sometimes I've seen him out in the store with a fluffy little dog-- apparently that's great trolling material.  I'll let you know how that goes when I get my fluffy little dog.

But the one guy that really pisses me off is a fertility specialist.  He shows up at the craziest times demanding antibiotics then quibbles with me about the price.  The last time he was in I reminded him that he had the same antibiotic just recently.  He said it was ok, so I filled it.  Then after he paid he leans over the counter and says in a whisper, "It's for my wife..."  What?  Now you're lying to me?  Oh my gosh!  Get out of here!

For Pete's sake, PLEASE use your debit card!

Ok, then there's the Domino family.  They call the pharmacy, and despite the fact they can use the automated system to put in the their Rx number OR use the Internet, they just HAVE to talk to a pharmacy staff member and give us the Rx numbers over the phone.  This is time consuming.  That's WHY we have the automated systems.  It's FOR YOU and FOR ME.

So after going through all that for their three family members, the Dominoes show up, ALWAYS, during the busiest part of the day.  ALWAYS.  And Mrs. Domino, no matter how many people are in line behind her, no matter how busy we look... she's going to write a damn check EVERY SINGLE TIME.  In 1970 it wasn't a big deal.  In 2012 that's a lifetime!

Oh my they wear me out.  I'm literally exhausted right now just from thinking about them...

Careful... I'm watching!

I never cease to get a kick out of patients who try to hide their PIN number as they type it in on the point of sale machine. These people usually do the same thing... they swipe their card, then when it pops up to enter the PIN, they'll partly look up to see me standing there, then cup their hand over the PIN pad and type away. 

I'm sure they're just protecting their MILLIONS of dollars, right? Do they really think that I'm going to memorize their PIN number, somehow steal their debit card, then have a free-for-all down at the Walmart? Part of me wants to be insulted by this, and another part of me just wants to just laugh.

(For those of you who don't know, PIN = Personal Identification Number)

"I'm here for my Lactulose!"

Randy is nice kid.  He's 18.  He folds napkins at the local steakhouse for a few bucks.  But Randy is a little different.  He's dressed like Martin Short on SNL with his pants pulled up really high and his hair is slicked back with a lot of grease.  You'd think he's kidding, but this is how he really wants to look.  I wish I could get away with a look like that but I can't.

Randy is a little loud.  He comes up the aisle toward the pharmacy shouting his arrival.  "I'm here for my lactulose... I'm here for my lactulose...  I'M HERE FOR MY LACTULOSE!!"

Most of the time we're ready for Randy's arrival.  And there's a reason why...  if you DON'T have Randy's lactulose ready, he stands at the counter, thrusting his pelvis toward the counter and grunting.  He's not trying to be pornographic... he's actually having a panic attack.  And when that happens, it scares people and we get it ready ASAP.

As Randy leaves, he shouts his way down the aisle, "I got my lactulose! I got my lactulose!  I got my lactulose"

No Confusion costs $40

Now this one is interesting...  I have a lady very upset we saved her $40 by switching her to generic Plavix. 

It's not an issue of therapeutic equivalence.  It's because the tablet looks identical to another medication she's taking and she doesn't want to get them mixed up.

She was very mad.

I give up.

An OPEN question to the people out there...

If you're just going to take the pharmaceutical product that YOU THINK you need, why do you bother to ask the pharmacist his/her opinion?

Pranking the doc's office

I admit it.  I love a good prank.  And I enjoy watching it unfold anonymously.  

What you see here is a shelf with jars of goodies.  It's at my doctor's office.  It's up high so little kids can't get into it, but moms and dads can pick a little treat to keep the kids busy while they're waiting to see the doctor, get a prescription, run over to the pharmacy, and demand that it be filled in ten minutes or less.  But right now we're in the waiting process at the doctor's office.

What you can't tell is a couple of cans of sardines and potted meat that I've set on the shelf.  Here's a close up picture.

Oh it was fun.  Watching people with a stunned look on their face as they pick up a can of potted meat and then quickly put it back.  They don't want anyone to think they actually want a can of potted meat.  You wouldn't, would you?

Later my son took the cans of sardines and meat and put them inside of one of the jars while no one was looking.  Then we went to our appointment and left.  We told no one of our plot.

Several weeks later on a follow up visit I noticed the meat and fish were gone.  I asked the doctor why they weren't offering sardines for treats anymore.  She could see the quirky smile on my face.  "Oh, that was YOU!  I should have known!"

Yep, it was me.  Pharmacist 1.  Doctor 0.  Game on.

I made a huge mistake

I was with my son on the other side of town and we saw a building which had a big banner reading "Huge Clearance of Top Quality Merchandise."  So we had to stop and see what was going on.  I'm a sucker for a discount.

I saw these babies.  I regret not getting them now.

Clarification needed...

I've blanked out the name of the urgent care, but the rest of the prescription is just as it was handed to me.  No patient name, date, or any idea who prescribed it.  Naturally the patient who handed it to me just expected me to fill it, but I needed a little more.

It was solved with a phone call, fortunately.  The MD was quite surprised about it.

Shake well

I try to type up labels exactly the way the doctor wants the Rx labeled...

A few weeks ago a lady brings in a new script for her ear.  I type it up just as it was written:  "Instill 2 drops to affected ear three times daily.  Shake well."

Yep, you guessed it.  I get a phone call later in the day.  The lady complains, "It hurts when I shake my head."

If you don't think the system is broken...

...take a look at this.  I have a patient that by looking at the address lives in a really nice part of my pharmacy's neighborhood.  She's on a state funded Medicaid program which recently told us she's been approved for Diovan FOR LIFE.  Diovan is expensive and there ARE alternatives which cost less.

Anyway, she pays $4 for a month supply.  We take it in the shorts.  But what's really annoying is that this same lady stepped up to the counter to pick up her prescription then paid cash for two jars of Olay cream.  Here's an actual copy of the receipt:

Doesn't that make you feel good to know that this lady gets her Diovan for practically nothing... WE PAY FOR IT FOR HER, so she can have plenty of money to pay for her face cream?  

Your medication...

May cause side effects...

Favorite comment this week

Aubrey is 90 years old.  She recently had surgery to repair a hiatal hernia.  I ask her how things went.  She says it was complicated because her intestines were all wrapped up around her esophagus.  

Yes, I kept a straight face.  It was really hard.  Really.

Following Directions is Apparently Difficult

People want flu shots this time of year. And that's ok because we have a lot of them. We have it down to a 10 minute venture start to finish unless the phone starts ringing or some other interruption. But for some reason, people can't seem to follow directions. Maybe it's my delivery, OR maybe people are just trying to intentionally piss me off. I think the latter.

Lady: "I'd like a flu shot please." (She starts rolling up her sleeve like I'm going to reach out over the counter and stick her).

Me: "Ok, we will get you a flu shot." I proceed to get her personal information and billing information. I process a claim and a label prints. So then I hand her a consent and release form, stating the following, "I just printed a label (I'm holding it in my hand), so you don't need to fill out the top part. I just need your doctor's name, sign and date, and answer questions one thru eight." (It even rhymes which I think makes it easier). I point to the parts of the release form where I said I needed her to fill it out as I'm saying all this.

I go draw up a syringe with the magic Nixon/CDC mind-control potion then walk back to the patient.  There it is, completely filled out from top to bottom, including answers to all 14 questions. Once again, the patient has failed to listen to me. I sigh, have her sign out the shot like a regular prescription, then take her to our million dollar GOODNESS room and immunize her.

This scenario has played out SOOOOOO many times it can't be a coincidence. I've tried different approaches, even telling the patient to LISTEN TO ME CAREFULLY, or even highlighting with a pen what needs to be filled out. And still, over 80% of the time, the patient fails to follow the directions. It's not really a big deal unless we're really busy (which is most of the time) and they're taking up precious time filling in parts they don't need to because THEY DIDN'T LISTEN TO ME. So yeah, it aggravates me. And I worry, I really worry, because they vote too.

Chicken Scratch

Free iPad with Flu shot!

Get yours today!

Quake and Zap

You would think that a pharmacist is pretty busy, right?  Yeah, we really are.  In fact, we're VERY busy.  But that doesn't stop corporate from adding to our list of things to do.  From medication therapy management to insane training videos we have to watch yearly to flu shots and flu shot clinics and everything else, yeah, we're DAMN busy.

Keeping track of the inventory is a really good idea, and no one with a business degree will argue with that.  Keeping an accurate inventory is a really good idea in terms of cost accounting and inventory control.  And in terms of tax accounting, estimating your inventory is not only a legal requirement but prudent.  But the time to actually count every tablet would be extremely time consuming, however.  It's a good thing that there are brilliant people to figure all this out for us, though.

Some corporate muckity-muck who has obviously never stepped into a pharmacy decided he had a great idea on how to address just that issue utilizing the three things he knew each pharmacist had: a computer with a scanner, a technician with absolutely nothing to do, and an inventory.  It was then that Quake-N-Zap was born.  This is how it works:

A special DOS program (we only utilize the latest in computer programming technology at our pharmacy) is executed which prints a listing of barcodes representing 10%, 20%, 30%, etc. all the way to 100%.  Then the tech or pharmacist scans a bottle of inventory, THEN shakes, quakes, and does a little magic dance to estimate how much is left in the bottle, be it 10%, 20%, etc., and then scans that barcode, hence the QUAKE-n-ZAP!  This is done multiple times until the tech either dies of boredom or it gets busy again.  Usually this means about 50 zaps.  THEN the computer compares what was scanned to the inventory on hand, and if it is off by a certain percentage, it updates the inventory on hand...

But here's where it gets insane.  No one can accurately "estimate" how much is left in the bottle to any degree of accuracy, so we end up mostly only zapping full bottles.  EVEN THEN, the computer gets it wrong about 30% of the time, updates the inventory with a wrong number, and now the computer inventory is WORSE than when you started.  At that point you have to go back into the computer inventory and pull up all the items it changed and change them back to the correct number you had on hand to begin with, and that doubles the time you spent on this amazing endeavor.

Brilliant, wouldn't you say?  For a while it was a corporate request.  Now it's a corporate mandate and if you don't do a certain number of zaps every period you get a nasty email, a mean phone call, and then a warning.  Get enough warnings and then you go on double secret probation.  After that you get taken out behind the pharmacy and whipped with a switch.

Oh, no one likes this Quake-N-Zap system.  NO ONE.  But don't try to complain.  Complainers go through the same warning, probation, whipping system.  One time I even tried to suggest maybe we try what ABC pharmacy was doing.  What happens there?  Every week a list of 20 drugs prints out.  You do a physical count of those 20 drugs (every tablet, capsule, troche, suppository, whatever) and compare to what the computer has and adjust as necessary.  No estimating -- this is exact counting.  After 52 weeks you've updated the inventory on a continual basis.  And it takes much less time.  BUT don't try to suggest this superior way of handling the inventory to my company.  I was beat down immediately.  "Don't you know that we're NOT ABC company?" I was told.  No, I really thought we were the same company.  Duh.  Besides, I'm sure that muckity-muck got a bonus or a raise or a pat on the back for his brilliant Quake-N-Zap idea and we wouldn't want him to look bad, would we?

Flu shots, Nixon, and HIV

Me: "Would you like to get a flu shot today?"

Lady: "Absolutely not!  That's how the government controls the minds of the weak! I'm not going to let them take control of my mind! The government has been messin' with germs and stuff for years. That Nixon had the 'Control Center of Disease' (I think she meant CDC) make that AIDS germ to kill off all the homos, you know..."

Me: speechless, absolutely speechless.

Time Spent at the Pharmacy

As shown above, the patient spends about 5% of their time dropping off a prescription, 15% of their time waiting for us to fill it, then 80% of their time complaining about the co-pay.

I'll take TEN!

Why is that when men come in to ask for a refill on their Viagra, some feel compelled to come in wearing sunglasses?  Do they think we don't know what the medication is for?  Do they think they are the only one on that medication?  Do they think that by hiding their eyes, they are somehow keeping us from seeing their pro-creative lusty soul?

This happens with men age 35-55.  After that age, the sunglasses come off and then these older men are loud and boisterous, like they're announcing to the world, "Yeah, I still do it!"  If there are people around, they're even louder.  "ONE REFILL OF MY VIAGRA, PLEASE!"  Plus, at this age price is no object.  "$18 per tablet?  I'll take 10.  Did you hear me, lady over there that I don't know... I'LL TAKE TEN!"

Today on the voicemail...

Doctors (and their minions) often call the pharmacy and choose NOT to speak to a pharmacist to relay a new prescription, instead opting to leave it on our voicemail.  That's fine with us.  Our automated system pleasantly asks the prescriber to S-P-E-L-L as much of the information as possible.  That makes it easier for us to GET the message and make sure the patient gets what is prescribed without having to call the prescriber back.

Unfortunately, that's not always what happens.  Today, we received this:

"This is Amy, that's A-M-Y, from Dr. Szxciufhtx's office (I could hearly hear an S sound, but the rest of the name was long, unintelligible, and most importantly, NOT spelled). We have a new script for patient Fred Fart, dob 12/10/1964.  That's FRED, F-R-E-D, FART, F-A-R-T.  Fred gets Piojkydhhdbjfbjcwe (again, said quickly, not spelled, not even a hint what it was) 100mg B-I-D times 10 days.  Our number is 333-333-3333.  Please call if you have any questions."

Yeah, you bet I'll call.  My first question is this.  WHY ARE YOU SPELLING THE EASY WORDS BUT NOT THE NAME OF THE DOCTOR OR THE DRUG?

Monday Morning Pharmacy Phun

Guy: Drops off SIX prescriptions.  Two of them are controls.  I love the extra paperwork there.  He starts to walk off and belts out, "I'll be back in ten minutes."  What are you, the Terminator?

Me: "I'm backed up right now.  It's Monday morning.  The tech just went to take a break.  I'll work fast but it will be at least 45 minutes."

Guy: Looks angry.  "I just got my wife out of the hospital!  She's waiting in the car right now.  Can't you step on it, sonny?  Mickey (that's my pharmacy partner) would do it for me."

Me: "Listen, I just had three other people drop off prescriptions.  I saw you waiting in line behind them.  I will do the best I can.  You should probably take your wife home and come back."

Guy: Rolls eyes, walks off.  It's hard not being Mickey.