Favorite Transaction of the Week

So I get change back from a purchase... There on the back of one of the dollars, written in bright red ink: "Please return this bill to me. I am very poor. -Gary" Then his address followed. I looked up his address using google maps and he happens to live in some very expensive apartments.

Gary, nice try.

Random Observation: Tired of Waiting on a Friend

We have an automated blood pressure unit here in the store. It's free. People use it all the time. And much like the freebies provided by government, boy do people complain when it isn't available for any period of time. "How am I going to check my blood pressure?!" a lady wailed at me when it was gone for a few months during a construction period. 

It's back now and the freebie crowd is satiated, for the moment... but I wonder what will happen when their food stamp debit cards stop working when the government goes broke....

Anyway, today three well-dressed dudes are shopping in the store. They're dressed like their staying at the resort down the road and it's golf day. One of them is using the blood pressure machine, but one of the other two "gentlemen" is getting anxious. Perhaps he's worried about missing a tee time... who's to say?

From my vantage point in the pharmacy I can see them but they can't see me. Mr. Anxious turns around with his butt to the back of the guy getting his blood pressure measured. He bends over. I can't hear it from where I'm at, but apparently he let one rip. The guy is stuck in the cuff and can't immediately get away without hitting a rescue button to deflate the cuff. But he did manage a gesture with his free hand.

Moral of the story: Don't keep your friends waiting while you check your blood pressure.

Rejected by the supplier

This is a portion of a form 222 to keep track of controlled substances.  We use this as an order form which is sent to the supplier.  This particular one was rejected.  They said the number 9 looks "altered."  I've asked about twenty people who all say it looks like a bolded number nine.

I don't get it myself.  Oh well.

Here's another one.  Everything else was perfect.  This was rejected because of the blotch where Mickey started to write the old supplier's name and then scribbled over it.  To our new supplier, this indicates fraud, forgery, or truancy of some kind:

George Orwell called...

...he wants to make sure you're giving flu shots.

A recent email from upper management: 

"Just an FYI on Phone audits done by corporate call center. They are calling the pharmacies and asking: 

1. If they provide flu shots- You answer YES. (Duh)
2. Can I come in any time? You answer YES. (Regardless of your work schedule, lack of help, and apparently even if you don't even have any flu shots in stock, you better damn well answer YES.)
3. How long will it take? Tell them they go into the workflow and it takes about 15-20 minutes start to finish... (again, ignoring the fact that it might be Monday morning and you're overloaded with orders from the weekend, new scripts, and the tech isn't even there yet because of the new GALAXY PLAN HOURS which means you have 3.5 hours of tech coverage to clean a room that's never used but no extra tech hours for where the real pharmacy work is done.)
4. You may suggest a time that might be less busy for the customer and more convenient for them but DO NOT tell the customer that you do not do them before or after a certain time. (In other words, trying to run a flu shot business with any reasonable expectations of time realities or prudently managing your pharmacy workflow issues is not of any concern.)
5. Work with the customer through positive conversation to make it an acceptable time for them. Example: What time would be best for you? (Yeah, and if the customer says 3am on Sunday, we're supposed to just drive on down there and take care of them? Really? At some point you HAVE to manage the situation. At some point there has to be acceptable and unacceptable, and it's not up to corporate. It should be handled at the store level based on the needs of all the pharmacy patients and the pharmacist, not one single flu shot patient.)

There are so many troubling things about this email. The first is that the company actually PAYS people to call our pharmacies and engage in this George Orwellian secretive questioning bonanza. WHY are we paying for people to secretly check up on the pharmacies? Maybe if we'd STOP paying people to do crap like this and START making sure there is enough technician coverage at every store then there wouldn't be any issue as to when someone could get a flu shot. WE HAVE TO TRY TO ARRANGE THE FLU SHOTS TO MATCH OUR NEEDS BECAUSE WE'RE UNDERSTAFFED AND OVERWORKED. Printing signs that say "Get your Flu shot ANY TIME" isn't helping us. I recently had a guy come in FIVE minutes before closing time after I had been there the entire day, asking me for a flu shot. I gave him the flu shot, but it WASN'T reasonable for me to do so. I needed to be somewhere in 30 minutes. Despite what the company thinks, YOU DON'T OWN ME and I do have a personal life. But I felt like I had to do because of insane emails like this one. For all I know, the company may have hired this guy to test our store's compliance with their policy. Crazy? Yeah, I agree. But so is secretly calling pharmacies and grilling them.  

Every store is different. If people at corporate would stop looking at numbers and actually come down to our level and SEE what is going on they would back off of crap like this. Yeah, flu shot numbers are down, in our division and every other division. Flu shot numbers are down this year, but not just for us. They're down everywhere. Trying to schedule people for a flu shot around workflow issues and pharmacy needs is NOT the reason the numbers are down. Digging into the files and trying to reeducate the one pharmacist who did 45% of the flu shots while his partner did 55% is not going to make the number of flu shots go up either. Wearing a button and asking every patient if they've had a flu shot this year does accomplish two things, but not what corporate thinks it does. The button takes away from our credibility as a professional. Clowns wear buttons. Pharmacists don't. Second, asking people over and over just ticks them off. I recently went to see my own doctor. I was asked at the front office, in the examination room, and at check out if I had received a flu shot this year (probably because their numbers are down and their corporate wahoos are pushing them too). All it did was piss me off. I get tired of being asked the same question multiple times. Don't you?

Sunday Funny: Just Sayin'

Abe said it best...

Favorite Patient of the Week

Young girl in her late teens or early twenties: "I would like to get a flu shot."

"Have we filled a prescription for you before," I ask. It's a lot easier if they already have a profile.

"No."

"Have you filled a prescription at another one of our locations?" It's a reasonable question.

"No."

"Ok, let me get your information. Do you have your prescription card?"

"No. My mom has it."

"Is she in the store?"

"No."

"Has she filled a prescription at any of our locations?"

"No. Is this going to take long?" She's agitated.

"I need some way to bill your prescription coverage to pay for the flu shot."

"You mean they're not free?" Young girl rolls her eyes.

"No, but there may be no cost to you depending on the insurance. I just need your insurance information to process the claim. Maybe I can call your mother and get the information over the phone?"

Young girl: "She's not home."

I sigh. "Well bring in that insurance information and I'll put it in the computer and see what comes up."

"Ok, but can I get the discount coupon you're offering for getting a flu shot?"

"No, we give those out when you get the shot."

Young girl looks upset and walks off. Five minutes later one of the brain-washed sub-managers is at my window. He asks for one of the coupons. He says he has a customer who didn't get a coupon. I ask if it's the young girl that just came by. He says yes. I explain to him that she has yet to receive the flu shot and that she doesn't get the coupon until she gets the shot. He argues with me and tells me some yarn about customer service and keeping the customer happy.

So you don't even need to get the flu shot to get the coupon. Great. What a company!

Happy Thanksgiving!

Crazy RxMan wishes you all a very Happy Thanksgiving!

Random Observation: It's the Holidays

Yes, its that holiday time of year again. Time to meet with family you haven't seen... sometimes it's only been a few months, or maybe even years. It's time to gather around the table and toast the warm feelings and thankfulness you feel for those around you.

And what better way to celebrate the holidays than with a nice full bottle of Vicodin... oh, you know what I mean. You've been coming in droves this week to get it filled. It happens every year a few days before the holidays start. You need the Vicodin to get through this week. Some of you will be breaking the law and passing them out to other family members and guests too. And now that I've written this, I guess its not really that random at all.

Insubordination

Management is hugely upset that our number of flu shots are down from last year. One answer to this is to make sure we ask every patient at both the IN window and the OUT window if they've had their flu shot this year. There is no deviation from this direct order, we're told.

Unfortunately, I'm disobeying the direct order. I know my patients and I know which ones I've already given a flu shot. Asking them again when I already know the answer makes me look foolish.

"Mr. Brown, have you had your flu shot this year?"

"Yes, Dr. RxMan. You gave it to me yesterday." Mr. Brown looks puzzled. He looks at his bottle of medication, wondering if I've actually given him the right medication. Maybe I should switch to the pharmacy across the street, he thinks to himself.

So no, I'm sorry Corporate. I'm not following this direct order. Stick it! And I don't mean a flu shot.

Manufacturer coupons and discount cards...

They annoy me.  They annoy me like you wouldn't believe.  Doctors hand them out like candy, especially to the elderly on Medicare, leaving it up to the pharmacist to deliver the bad news.  Other people can't seem to read.  They hand you the card and tell you "It says here I'm going to get this Rx for $10."  Did you see the little asterisk?  Yeah...  And did you see where it says YOU MUST CALL 1-800-WE-DON'T-PAY to activate the card?  No, we don't activate it for you.  No, we won't call them for you.  No, even though it says $10, that doesn't mean you're going to get it for $10.  And actually, your doctor gave you an old card.  This one is expired.  Yes, it is expired.  See, looky looky right there.  Yes, that was six months ago.  No, I don't have any new cards.  No, I'm not going to call them.  

My favorite is some Restasis promotion.  They give out a Visa debit card with coupon information ON THE CARD.  At the pharmacy we put in that information, bill the patient's insurance, split bill to the coupon, then it spits out a message like "Debit card credited with $10."  Then the customer uses the $10 toward their co-pay at the register, which has already been reduced by the split bill.  WHAT IS THE FRIGGIN SENSE OF THIS WITCHCRAFT?  Talk about gumming up a system already a mess!

Last year there was the $4 Lipitor card.  We received a ton of them.  Only TWO people in our pharmacy actually were able to get their Lipitor for $4.  But EVERY ONE of them thought they were going to get their Lipitor for $4.  Any every SINGLE time they would argue with us because it says so on the card.  And every SINGLE time I had to point to the asterisk and tell them it doesn't apply to their situation.  Thanks Lipitor.  Not only did you destroy the credibility of your medication with this phony promotion, you beat up a lot of pharmacists doing it.  

Sunday Funny: Might have happened to me...

Flag-Gill

Favorite Voicemail of the Week:

"Hello, this is Jenny from Madstone Family Medicine. I'm calling in a new script for patient Joe B. Blow, date of birth 12/10/1956.  It's for Flag-Gill (She means Flagyl, which is pronounced "Flad-Jill") 500 million-grams (she means milligrams), one by mouth BID (she pronounces it like it rhymes with "hid") for seven days."

<CLICK> Jenny hangs up.  No phone number, name of doctor, etc. Fortunately I look on my smartphone (which we're actually not supposed to have in the pharmacy) and am able to look up Madstone Family Medicine and get a number and then call and get a name. I would look on the Internet and get the number but we don't have access to the Internet at my company. Too many pharmacists were using the Internet to make their jobs easier.

I tell you, this blog writes itself.

Favorite Comment of the Week

"Is it possible for you to run my dog's medication on my insurance?"

I stared at her for a good ten seconds, then firmly said "No."

Please trust the automation... PLEASE

Ok, so I told you about our Auto Refill system.

For those of you not paying attention (and those of you from Idaho), let me explain again. You others can skip the next paragraph.

The company developed an addition to our computer system called Auto Refill.  Just as the name implies, it will automatically print labels for patients two days before they (normally) run out of medication. This is a brilliant system, win-win for both patient and pharmacist. For the patient, they don't have to do any thinking... just come in when you run out of your medication and it is there on the shelf waiting for you. If you forget after a few days, the system automatically calls you to remind you. Plus, if you are out of refills, it will automatically fax the doctor for a refill, providing seamless drug therapy. For the pharmacist, it prints out a stack of labels two days ahead of time and we can fill them during down times in the pharmacy. And the BEST feature is that people who for whatever reason are afraid to type in their Rx number when they dial the pharmacy and then get connected to the pharmacist/tech and bug us during business times; now they don't have to bother.

I'd like to think that this system is completely altruistic in terms of helping the patient and the pharmacist, but I'm sure it is more of a form of "push technology" to get more business. Cha-Ching. I can certainly attest that I have presented a medication on Auto Refill to various patients who didn't really want the medication but took it anyway because it was filled and ready, Cha-Ching.

What has been helpful is that with a lot of people, it has stopped the monthly telephone calls to give us their Rx number. Here's a sample:

Ring-Ring, Ring-Ring, Ring-Ring

Me (answering before the 4th ring because THAT would be rude not to. Corporate said so):

"Pharmacy, may I help you?"

Patient: "Yes, I want to refill my prescription, but I don't have the Rx number."

Me, hearing the bottle of medication make noise as it rattles in their hand (yes, we CAN hear that over the phone, by the way): "Ok, what's the medication?"

Patient:  "Hy-dro-clor-ROT."

(The label is too short to print the entire name of hydrochlorothiazide, so it is abbreviated, but they don't know that, and they always emphasize the "ROT")

Me: "Ok, we'll get that ready for you..."

Now instead of that exchange, we get this one:

Ring-Ring, Ring-Ring, Ring-Ring

Me. "Pharmacy, may I help you?"

Lady: "Yes, I just had a call from your automated thingy saying I have a prescription ready to pick up?  I didn't know I had anything there.  Is it my Alprazadonastatin?"

Me:  "Yes, it's your Atorvastatin.  You don't have to call us... just come in and get it."

Next month... same thing happens with same patient. So instead of calling us to give us the number, they call us to tell us they're going to pick it up. I even had one lady say she talked to the computer. Seriously, she says she talked to the computer and the computer replied.

Personal Observation # 1

Men who back in their truck into parking spaces ALL THE TIME are insane sport heads who have more regard for their favorite football team rather than their girlfriend or wife.

Many of them live with their mommy.

It's a personal observation.

It's soooo "Unprofessional"

I work in a national chain pharmacy... recently we received an email stating that absolutely there will be NO chairs anywhere along the workflow area... no chair to sit on at the IN window (and if you're like me you don't like standing and typing), no chair along the workflow, or at the register.  No, no, no. Why? You'd think maybe they're worried about someone tripping on one in the workflow area... sure, I might accept that. No, that's not it. They don't want a chair anywhere in sight because it's considered UNPROFESSIONAL.

My associates and I have talked about this and we all agree that to the customer/patient, it looks MUCH MORE UNPROFESSIONAL to have pharmacists and techs running around like idiots trying to answer the phone, type new scripts, fill other scripts, and sell at the register without decent tech help... ALL because the retail chain is too damn cheap to hire enough technicians or have enough tech hours.

What a load of crap!

Thank you, Veterans!

A few weeks ago a young man came up to the pharmacy window for a Z-pack prescription. I get his Tricare info and run the claim. Bingo, it works fine. It is not busy and I tell him it will just be a few minutes. I see him at the out window, get his co-pay, counsel him, and then bag his Rx.  I then take a moment to tell him how much we appreciate his service for our country. He gets misty-eyed and replies, "We do it for people like you."

Please make sure you thank all those who serve for our freedom, young or old, male or female, active duty or not. 

Also check out a cute story about Stubby, a four-legged veteran...  Sergeant Stubby

Random Observation # 2

Now that he's all alone he'll probably go on the dole.

Please don't confuse me!

A little story about Auto Refill:

Awhile back the company developed an addition to our computer system called Auto Refill.  Just as the name implies, it will automatically print labels for patients two days before they (normally) run out of medication. This is a brilliant system, win-win for both patient and pharmacist. For the patient, they don't have to do any thinking... just come in when you run out of your medication and it is there on the shelf waiting for you. If you forget after a few days, the system automatically calls you to remind you. Plus, if you are out of refills, it will automatically fax the doctor for a refill, providing seamless drug therapy. For the pharmacist, it prints out a stack of labels two days ahead of time and we can fill them during down times in the pharmacy. And the BEST feature is that people who for whatever reason are afraid to type in their Rx number when they dial the pharmacy and then get connected to the pharmacist/tech and bug us during business times; now they don't have to bother.

SO I'm checking out a lady who has prescriptions on Auto Refill. She doesn't want them on Auto Refill any more. I explain that all she has to do is come in when she runs out of her medication and it will be ready for her to pick up.

In all honesty, she said to me, "That's too confusing."

Levaquin Lady, part deux

Levaquin Lady returns to get some meds refilled. Time for yet another round of Levaquin. Today, however, she's also shopping for a test meter for her diabetic son. Money is tight, she says, and she needs a good one that will provide the best accuracy at the lowest cost. So I show her the various options on our shelf, spending a good fifteen minutes explaining everything about what she might expect with what we have. I'm reminded again that money is the key factor in the issue. Finally, after a line forms behind her and scripts are ready to check, I convince her to look online first (i.e., PLEASE LEAVE ME ALONE) and see if there are any companies that might send her a meter and strips for free. She likes that option.

Twenty minutes later I'm almost caught up when she appears at the window again, this time to buy a box of Oscillococcinum. It's about $15. Just being told how money is so important to her, I point out to her that she would do better to skip the product and save the $15. I didn't even attempt to address the fact that she was back to see me for Levaquin for a bacterial infection, not the flu.

"Oh, no, I've had it before. It's 'Homeopathic,' you know," she retorts, thinking she's using $20 medical verbage. 

"Do you know what 'Homeopathic' means?" The words left my lips before I could stop myself. 

"Well," she paused, "Yes." It was obvious she had no idea. I secretly hope she doesn't vote.

I tell her she really needs to read up on Homeopathy and Oscillococcinum and that she's really better off just drinking more water. She still insisted on spending the $15, and another reason for the French to make fun of Americans presents itself.

I love the way the author on Wikipedia puts it:

http://en.wikipedia.org/wiki/Oscillococcinum

Something to do today...

Come see the BEARDED WOMAN

So this guy comes up to my drop off window, looks me straight in the eye, hands me a $30 coupon for a gift card for transferring a prescription from another pharmacy, and says, "I have refilled prescriptions on your shelf ready to pick up now, but I have this $30 coupon.  If you don't give me the $30 gift card, I'll just have my prescriptions transferred to your competitor across the street."  I was flabbergasted.  Yes, that's actually a word, and no it doesn't adequately express my utter surprise, shock, and dismay.  I just couldn't believe it.  This guy wanted me to just hand him a $30 gift card for him NOT to transfer his prescriptions out of our pharmacy.  

I told him that I would be happy to transfer another prescription to our pharmacy but he wasn't interested in that.  He was only interested in trying to extort money out of us to keep his business here.  Instead of providing a valuable professional service for medical patients, we've become carnival barkers begging for business.  Come on down to the pharmacy, get your free $30 gift card and SEE the BEARDED WOMAN.  

Is this REALLY the kind of clientele we want at our pharmacy?  Is it really?

Post script...  the guy mentioned above transferred all three of his prescriptions across the street the next day.  No worries... he'll be back when another $30 coupon prints and we can reward him once again for his overwhelming loyalty to our pharmacy...

It's about awareness

Favorite Comment of the Day

"I want BRAND.  Generic is 75% less potent.  I read it on the Internet."

The Levaquin Lady

My Levaquin Lady has been on Levaquin, non-stop, for two years now. You see, everything has mold, which causes her to get a respiratory infection, and the only thing that will treat her is Levaquin. Right now she's up to a 750mg daily treatment every couple of weeks. Now based on how she smells when she comes to the pharmacy I'm certain she smokes 2-3 packs a day, but that's not the source of her respiratory problems. No, it's the mold. She knows this because her Internet-savvy, 26-year-old-living-at-home son looked it up on the Internet. The Internet never lies, and HE knows all about this and that because HE has looked it up. I didn't mention the evil landlord who won't do anything about the mold. He's to blame, too. He refuses to do anything about the mold. Evil man.

There's so many problems here. We have a doctor who throws out Levaquin scripts like candy, a mother who blames "the mold" for all her problems, and a son who enables here by finding "supportive" and "definitive" evidence on the world wide web.  

Soon we won't need pharmacists at all-- people will just be able to google their own counseling online. And you have to trust it, afterall, BECAUSE it's ON THE INTERNET...

This is why...

This is why pharmacists make fun of doctors: