I am the Crazy RxMan, your local pharmacist... smart enough to be a pharmacist, insane enough to work retail!
Sunday, February 22, 2015
Saturday, February 21, 2015
This will get his attention...
I'm all alone one day in the pharmacy. At some point in the afternoon I became aware that I was doing the "pee dance" and had to leave the pharmacy for some personal business.
I'm gone less than three minutes.
Three minutes.
As I rush back to the door to the pharmacy, I hear the phone ringing. I hate phones. I hate ringing phones even more. I hate ringing phones in a pharmacy the most. I quickly get the key in the the lock and zoom in toward the phone when out of the corner of my eye I see a patient at the pick up window. So now my intention is to place the caller on hold and zoom back to the register.
The patient snaps his 2005 flip phone shut. "Oh, that's me on the phone. I was calling to get your attention," he says.
OH MY FREAKING HELL, YOU'RE KIDDING ME...
I'm gone LESS than three minutes and some nut job wants attention NOW and calls the pharmacy in order to get me to run back to the pharmacy. You insane, impatient piece of manure. Really?
I'm gone less than three minutes.
Three minutes.
As I rush back to the door to the pharmacy, I hear the phone ringing. I hate phones. I hate ringing phones even more. I hate ringing phones in a pharmacy the most. I quickly get the key in the the lock and zoom in toward the phone when out of the corner of my eye I see a patient at the pick up window. So now my intention is to place the caller on hold and zoom back to the register.
The patient snaps his 2005 flip phone shut. "Oh, that's me on the phone. I was calling to get your attention," he says.
OH MY FREAKING HELL, YOU'RE KIDDING ME...
I'm gone LESS than three minutes and some nut job wants attention NOW and calls the pharmacy in order to get me to run back to the pharmacy. You insane, impatient piece of manure. Really?
Friday, February 20, 2015
Thursday, February 19, 2015
Favorite eScript Mistake of the Week
eScript for Atorvastatin (Generic Lipitor), 20mg:
"Take 30 by mouth daily."
"Take 30 by mouth daily."
Wednesday, February 18, 2015
Tuesday, February 17, 2015
Why? Why do they do it?
When we get a new patient, we add them in to the computer. We ask for their insurance, and they fork over their card.
But if the insurance is expired, why do they feel the need to give us the card? Why can't they say, "my insurance is expired," "I'm in-between insurance," or "this is a cash pay"?
Why do patients feel the need to go ahead and let us spend the time typing it in then let us try to bill it? It costs us money every time we send off an adjudication whether it is a paid claim or not. And it wastes time we could be filling their script or helping other people.
What's worse, a significant number of people will insist that they have coverage even when it comes back as expired or invalid ID or whatever. So we get on the phone, spend countless minutes yelling "PHARMACIST" or "REPRESENTATIVE" to try and get to talk to a live person ONLY to find out that the computer is correct, THEY DON'T HAVE CURRENT COVERAGE.
Why do they do this? Please, explain it to me.
But if the insurance is expired, why do they feel the need to give us the card? Why can't they say, "my insurance is expired," "I'm in-between insurance," or "this is a cash pay"?
Why do patients feel the need to go ahead and let us spend the time typing it in then let us try to bill it? It costs us money every time we send off an adjudication whether it is a paid claim or not. And it wastes time we could be filling their script or helping other people.
What's worse, a significant number of people will insist that they have coverage even when it comes back as expired or invalid ID or whatever. So we get on the phone, spend countless minutes yelling "PHARMACIST" or "REPRESENTATIVE" to try and get to talk to a live person ONLY to find out that the computer is correct, THEY DON'T HAVE CURRENT COVERAGE.
Why do they do this? Please, explain it to me.
Saturday, February 14, 2015
Advice from a Pharmacist: What YOU can do when someone has a miscarriage
A few years ago I had a close friend lose a baby. She was so thrilled and so happy. I look at photographs of her at the time and her face was just beaming. It was so thrilling and exciting. But tragedy started when she started to spot. She reached out to me for help and I didn't know what to do. I am a doctor of pharmacy, but I didn't know what to do. It was all very heart-wrenching and sad, and I just can't believe that I didn't know what to do and didn't try to help her. To this day and with all my heart I regret my actions (and inaction) at the time.
As pharmacists, we are in a unique position as healthcare providers, especially community and/or retail pharmacists. We are literally open to the public every day and have a responsibility to help those in need. Although not very common, there are occasions where you will encounter a patient that recently had or is having a miscarriage. They often come to the pharmacist for advice because we are so accessible and are in the top five most trusted professions. We have a duty to be ready to help in any way we can.
As pharmacists we know what medications to avoid in pregnancy. We can also recommend anxiety medications, depression medications, and even know what the doctor needs to prescribe if the bleeding gets out of hand, but... that's academic. Often its the patient trust for the pharmacist and she wants a shoulder to lean on and a listening ear. But what do you say? Our training is in medication, not psychology.
Here's some hints and tips from what I've learned:
Here's some hints and tips from what I've learned:
1. If you're in the pharmacy, take her to a quiet spot... the waiting room, or somewhere private away from the noise and listening ears. You want to give her 100% of your focus and time. The metrics can wait. THIS is no longer about some guy getting his generic Lipitor filled in 3.5 minutes. This is a genuine opportunity to help someone, and that's WHY you went into pharmacy in the first place.
2. LISTEN to her. What she's going through right now is uniquely tragic to her. This is something she may have never experienced before and the depths of complete despair are deep. She wants to unleash her feelings of sadness and disappointment. Let her do it and be supportive. Let her direct the conversation. Don't interrupt.
3. NEVER say something like "You can try again" or "Everything happens for a reason." Why? Because you don't know that. You don't know the situation, and moreover, the little spirit and life that was lost cannot just be replaced like a car part. He or she was a unique individual with his or her own personality. You wouldn't suggest to your grandmother that she can "try again" when grandpa passes away, would you? No. Let her grieve and mourn the unique soul that was lost.
4. Don't say "I know how much it hurts." Instead, listen to her as she tells you how much it hurts. Even if you've had a miscarriage yourself, you still don't know her unique situation. Be gentle, be kind. Pain of the heart is the worst kind of pain. She may dream about the loss all night long, then wake up and think about it all day long, wondering what she did wrong, wondering why God kept her from having children, wondering "Why me?" until she cries herself to sleep at night. Empathize with that pain.
5. Don't say "It's part of Mother Nature's or God's plan." That may very well be, or it may be that God wanted her to have that baby just as much as she did. We don't know everything about this life. It's a good bet we know even less how it works on the other side. If she is having a crisis of faith, be supportive and try to understand it from her point of view as she finds answers for herself. You couldn't possibly have answers in this regard, only opinions, and she doesn't need those.
6. NEVER tell her to stop feeling sorry for herself. A little life, full of love and personality, was just lost. She will always, always wonder what this little person could have been in her life, someone to hold and cherish and raise. That's NOT something you just get over. In fact, you NEVER get over it, you only deal with the pain. So never say anything like that. A better thing to say is "Nothing in the world could have prepared you for this and I'm so sorry you have to go through it."
7. If would be easy to just say you can't imagine their pain. Instead of that, try to imagine what it would be like to have a little person growing inside you. Imagine the excitement, thinking of a baby name, buying little socks, building a crib, etc. Then imagine that all taken away from you. Now do you understand why this is so hard on her? Now you'll want to hug her and hold her and console her if she's willing.
8. Refer as necessary to people and organizations equipped for this tragedy. A good place to start is HERE.
I don't pretend to an expert on the subject, but I'm a pharmacist and as a healthcare provider, I want to be ready for the next time this happens to me. You may never have this happen to you, but be prepared in case it does happen!
Also remember...
Friday, February 13, 2015
Thursday, February 12, 2015
The SECRET is OUT!
Ms. Pink Eye: "Maybe you can help me? I woke up and my eye is weeping. It is all red and it itches."
I look at the eye. It looks like pink eye. I'm not an MD, but it looks like pink eye to me.
Me: "You probably have conjunctivitis. You need to see a doctor and get an antibiotic for your eye."
Ms. Pink Eye: "Do you have an eye drop I can put in my eye?"
Me: "No, you need an antibiotic. We don't have antibiotic eye drops. You need to see your doctor."
Ms. Pink Eye: "My eye doctor? He's so far away. What can I treat it with at home?"
Ms. Pink Eye keeps rubbing the red eye and touching everything around her. The counter, the point of sale machine, the pen. I'm keeping track so I can disinfect after she leaves.
Me: "There's nothing you can treat it with at home. And you can see your regular doctor. Eyesight is precious and you need to see a doctor."
Ms. Pink Eye: "Well I've never been allergic to anything before. Can I just take Claritin?"
Me: "This is not something you can treat by yourself. You need to see a doctor and get a prescription for an antibiotic. It's not allergies. It's an infection."
Ms. Pink Eye: "You can get an infection in your eyes? I've never had one before!"
Me: "Yes, you can get an infection in your eyes. Call your doctor and make an appointment for today, or go to the walk-in clinic on the corner out front."
Ms. Pink Eye: "Don't YOU have an eye drop I can buy to put in my eye?"
THEY'RE ON TO US. Somehow, somewhere, someday they're all going to figure out that we pharmacists have a CURE for EVERYTHING that we keep secretly hidden at the pharmacy!
I sigh. Now we're starting to cover the same ground again, and since she's going to start repeating herself, I guess I'll repeat myself too."
Me: "This is not something you can treat by yourself. You need to see a doctor and get a prescription for an antibiotic. It's not allergies. It's an infection."
I look at the eye. It looks like pink eye. I'm not an MD, but it looks like pink eye to me.
Me: "You probably have conjunctivitis. You need to see a doctor and get an antibiotic for your eye."
Ms. Pink Eye: "Do you have an eye drop I can put in my eye?"
Me: "No, you need an antibiotic. We don't have antibiotic eye drops. You need to see your doctor."
Ms. Pink Eye: "My eye doctor? He's so far away. What can I treat it with at home?"
Ms. Pink Eye keeps rubbing the red eye and touching everything around her. The counter, the point of sale machine, the pen. I'm keeping track so I can disinfect after she leaves.
Me: "There's nothing you can treat it with at home. And you can see your regular doctor. Eyesight is precious and you need to see a doctor."
Ms. Pink Eye: "Well I've never been allergic to anything before. Can I just take Claritin?"
Me: "This is not something you can treat by yourself. You need to see a doctor and get a prescription for an antibiotic. It's not allergies. It's an infection."
Ms. Pink Eye: "You can get an infection in your eyes? I've never had one before!"
Me: "Yes, you can get an infection in your eyes. Call your doctor and make an appointment for today, or go to the walk-in clinic on the corner out front."
Ms. Pink Eye: "Don't YOU have an eye drop I can buy to put in my eye?"
THEY'RE ON TO US. Somehow, somewhere, someday they're all going to figure out that we pharmacists have a CURE for EVERYTHING that we keep secretly hidden at the pharmacy!
I sigh. Now we're starting to cover the same ground again, and since she's going to start repeating herself, I guess I'll repeat myself too."
Me: "This is not something you can treat by yourself. You need to see a doctor and get a prescription for an antibiotic. It's not allergies. It's an infection."
Ms. Pink Eye: "You can get an infection in your eyes?"
I sigh again.
Me: "Ok then, see your doctor. Get that prescription and get better!"
I walk away.
Five minutes later I look down aisle seven as I'm hosing the counter with alcohol. She's looking at the Clear Eye OTC medicines and scratching her eye, then making sure she touches everything around her.
Wednesday, February 11, 2015
Why Can't I Return My Medication after I Purchased It?
He handed me his bottle of Crestor. He wanted his money back.
Last night, however, he was ok with the $50 co-pay for a bottle of 90 tablets. I said are you sure? Yes, he was sure. He paid. I labeled the bottle of Crestor that comes directly from the manufacturer.
Today, he's changed his mind. He wants his money back. I tell him no, once it leaves the pharmacy, it can't come back.
He's mad. He informs me the bottle is "sealed." It was. But I'm not giving him his money back. Can you imagine the chaos that would ensue if people could just bring back their medication any time they want? Can you imagine the possibility for patient harm? Sorry, I'm just not going to participate in that, and if you don't like it, go to a competitor.
Last night, however, he was ok with the $50 co-pay for a bottle of 90 tablets. I said are you sure? Yes, he was sure. He paid. I labeled the bottle of Crestor that comes directly from the manufacturer.
He's mad. He informs me the bottle is "sealed." It was. But I'm not giving him his money back. Can you imagine the chaos that would ensue if people could just bring back their medication any time they want? Can you imagine the possibility for patient harm? Sorry, I'm just not going to participate in that, and if you don't like it, go to a competitor.
Tuesday, February 10, 2015
How One Doctor Made My Day
We get a new prescription for a controlled substance, sadly for a little old lady in a lot of pain that needs it right away. Unfortunately, the doctor didn't scribble in his DEA # on the prescription blank which even had a spot for him to write it.
Even more unfortunate is when we try to look it up on our post modern and so amazing computer system, we can't find him. We use the address of the doctor and look up a Goofmart Pharmacy close by his office and call them. They don't have him either! Our web-based database doesn't have him as well. Nothing is going right today.
At this point were forced to call the doctor, and you know as a pharmacist or technician that is our least favorite thing to do. After a couple of phone calls and a message left with an answering service (mind you, this is the middle of the day on Thursday when most pharmacists and doctors are still slaving away). Why? Because this guy is gone for the rest of the day.
So we had to tell the lady to wait in our waiting room. Poor thing, she was really in pain.
Twenty minutes later the phone rings. I talk to the doc and he gives me the DEA # then asks me to repeat it back to him. Ok, that's fine, so I did. I said "Correct?" and he says, "Yes" and hangs up.
I hand the script to the tech. He types in the DEA #. The computer says it isn't a DEA #. I check it to make sure he typed it in correctly. I'm not actually like most doctors and have really nice handwriting, but I check it anyway and what we have on the computer matches what I've written down.
Soooooo.... we call the doc again and go through the paging process.... again.
Another twenty minutes passes. Doc calls. I tell him what we need to verify his DEA #.
"What did YOU write down?" he asks, pointedly.
I tell him what I wrote down. He tells me the last digit is a 4, not a 3.
"Why did YOU write down a 3?" he asks, with attitude.
"Because that's what you said and verified when I read it back to you," I reply, but not saying "asshole!" at the end of the sentence.
Ignoring my comment, he says, "Well hopefully you wrote it down correctly this time," as a parting shot and then hangs up.
Even more unfortunate is when we try to look it up on our post modern and so amazing computer system, we can't find him. We use the address of the doctor and look up a Goofmart Pharmacy close by his office and call them. They don't have him either! Our web-based database doesn't have him as well. Nothing is going right today.
At this point were forced to call the doctor, and you know as a pharmacist or technician that is our least favorite thing to do. After a couple of phone calls and a message left with an answering service (mind you, this is the middle of the day on Thursday when most pharmacists and doctors are still slaving away). Why? Because this guy is gone for the rest of the day.
So we had to tell the lady to wait in our waiting room. Poor thing, she was really in pain.
Twenty minutes later the phone rings. I talk to the doc and he gives me the DEA # then asks me to repeat it back to him. Ok, that's fine, so I did. I said "Correct?" and he says, "Yes" and hangs up.
I hand the script to the tech. He types in the DEA #. The computer says it isn't a DEA #. I check it to make sure he typed it in correctly. I'm not actually like most doctors and have really nice handwriting, but I check it anyway and what we have on the computer matches what I've written down.
Soooooo.... we call the doc again and go through the paging process.... again.
Another twenty minutes passes. Doc calls. I tell him what we need to verify his DEA #.
"What did YOU write down?" he asks, pointedly.
I tell him what I wrote down. He tells me the last digit is a 4, not a 3.
"Why did YOU write down a 3?" he asks, with attitude.
"Because that's what you said and verified when I read it back to you," I reply, but not saying "asshole!" at the end of the sentence.
Ignoring my comment, he says, "Well hopefully you wrote it down correctly this time," as a parting shot and then hangs up.
Monday, February 9, 2015
5 Things Your Pharmacist WON'T Do
1. We will not give you medication without a prescription. Seems pretty straight forward, right? But you'd be surprised how many people come in and ask, "Hey, I'm from out of town and I forgot my Lisinopril. Can you just give me two tablets?"
The answer is NO. Imagine going on vacation and leaving something behind... perhaps your toothpaste? Do you go to the local grocery store and ask them to give you some toothpaste because you forgot yours?
I am simply amazed how many people come up to the pharmacy window and ask us to just give them a prescription medication. The most common I hear is, "Hey buddy, can you give me a 100mg Viagra? No, no, no. Now go away!
2. We will not fill a prescription that looks fake or can't be verified. All too often people come in on the weekend with a prescription that appears more than a little sketchy. And no, asking us to just go ahead and fill it and "verify it later" isn't going to fly either.
And I'm really sorry "grandma" has to be without her pain meds. Maybe YOU should be taking care of grandma's pain meds (if that's what's really going on) on the day you saw the doctor when the Rx could be verified.
3. We will not break the law for you. The prescription is written for you. We're not going to pretend it is written for your wife who has better insurance. We're not going to add refills when the doctor wrote a zero. We're not going to anything that even hints of breaking the law. No. Don't ask. It's not going to happen.
4. We will not fill a narcotic early. The doctor has written a new prescription for Norco for you. The problem is, the same doctor wrote the same prescription, a 30 day supply, three weeks ago. You have another week's worth of medication. No, we're not going to fill the new one a week early.
Do you ask your employer to give you your paycheck early? If you did ask, what do you think would be the answer? No, you're not going to get your paycheck ahead of time and you're not going to get your narcotic ahead of time either.
5. We will not give you your medication for free. I'm sorry if you don't have prescription drug insurance or if your co-pay is expensive. I can't just give you the medication. I'm not going to give you "just two tablets" or ignore the co-pay.
Imagine going into the bank and telling them your paycheck isn't large enough and asking them when they cash your check if they could just give you an extra $200. Do you think that's going to happen?
Same here. We're not going to give you your medication for free. No, no, no. Go away!
The answer is NO. Imagine going on vacation and leaving something behind... perhaps your toothpaste? Do you go to the local grocery store and ask them to give you some toothpaste because you forgot yours?
I am simply amazed how many people come up to the pharmacy window and ask us to just give them a prescription medication. The most common I hear is, "Hey buddy, can you give me a 100mg Viagra? No, no, no. Now go away!
2. We will not fill a prescription that looks fake or can't be verified. All too often people come in on the weekend with a prescription that appears more than a little sketchy. And no, asking us to just go ahead and fill it and "verify it later" isn't going to fly either.
And I'm really sorry "grandma" has to be without her pain meds. Maybe YOU should be taking care of grandma's pain meds (if that's what's really going on) on the day you saw the doctor when the Rx could be verified.
3. We will not break the law for you. The prescription is written for you. We're not going to pretend it is written for your wife who has better insurance. We're not going to add refills when the doctor wrote a zero. We're not going to anything that even hints of breaking the law. No. Don't ask. It's not going to happen.
4. We will not fill a narcotic early. The doctor has written a new prescription for Norco for you. The problem is, the same doctor wrote the same prescription, a 30 day supply, three weeks ago. You have another week's worth of medication. No, we're not going to fill the new one a week early.
Do you ask your employer to give you your paycheck early? If you did ask, what do you think would be the answer? No, you're not going to get your paycheck ahead of time and you're not going to get your narcotic ahead of time either.
5. We will not give you your medication for free. I'm sorry if you don't have prescription drug insurance or if your co-pay is expensive. I can't just give you the medication. I'm not going to give you "just two tablets" or ignore the co-pay.
Imagine going into the bank and telling them your paycheck isn't large enough and asking them when they cash your check if they could just give you an extra $200. Do you think that's going to happen?
Same here. We're not going to give you your medication for free. No, no, no. Go away!
