Demotivational Hump Day... Nightmares

Jan, the INSANE Employee

You've all worked with someone who isn't just quite right... you know, the elevator doesn't go all the way to the top floor or whatever cliche you want to use...

And then there was Jan...

Jan interviewed well. She seemed like a hard worker. I thought she had a great sense of humor and humility. She'd worked retail before so I thought she would fit in well. She was pleasant, friendly, and hard working. She was on time.

But after a few weeks it became obvious that Jan just wasn't quite right. She was paranoid. She was upset that customers would ask for me (after being here for years) when she thought they should be asking for her. She detested when I finished a sale when it didn't matter who finished the sale. Over the course of the next two years, she:

1. Kept telling me she was going to quit

2. Kept faxing me "I quit"

3. Quit nine times and then asked for her job back

Other times I would come to work and she wouldn't talk to me. I had no idea what I did to upset her or why she was upset. She would be normal with the customers but acted like I was invisible. I didn't care if she liked me or not because she was good with customers and that was good for business. The next day she would act like nothing odd had happened.

But the final straw was one day she came back from lunch inebriated. She proceeded to get down on the floor and bark like a dog at the customers. That was it.

So for all you folks out there dealing with insane employees at your place of work, I salute you.

Pharmacists... Remind Yourself

Dear Fellow Pharmacists,

Step back a moment, especially if you work in retail pharmacy. Remind yourself, continually, that you're in a microcosm of the real world. You only see a portion of the population... the portion with the ongoing diseases and illnesses. Hope, dear pharmacist, hope that what you're seeing isn't a reflection of the population as a whole.

You see the scammers and the addicts... people who lie about their income so they can get free medication... people who lie about their pain so they can get narcs. You see the absolute dregs of society on a daily basis. So many people lie to you every day that you question every prescription, or you've become so numb you fill anything.

But these people are not the population as a whole. Surely the vast majority of people are hard-working people who don't take advantage of the system. Surely there are people out there that don't expect others to pay their way, pay their healthcare costs... people that love freedom and capitalism, people who accept responsibility for themselves and their situation.

Forget that the number of people on Medicaid and catastrophic Medicare has tripled in the last eight years. Forget that there's too many people out there wanting someone else to pay for their lifestyle choices. Forget about the people that obviously have sufficient income but still somehow "qualify" to have their children on Medicaid. Forget about how hard you work and how much of your income goes toward taxes to take care of these people. 

After all, it's someone else's money, right?

This is your Last Laugh

Entitlement and Attitude

A lady drops off a prescription for Augmentin for her daughter. She wants to make sure I have the insurance correct and announces to me that it is free.

It's a Medicaid plan.

I assure her we have the insurance correct. I type and run a claim. Yes, it is a zero co-pay. It's late in the evening and I'm all caught up so I tell her it will be just a few minutes.

So while I work, she paces back and forth in front of the pharmacy on her cell phone. It's the latest model of the iPhone with one of those really expensive cases. "What a nice gift," I chuckled to myself. I'm still using an iPhone 4s myself. It works great.

I snap the cap on and walk to the register. She's there, talking on her cell phone. It must be a very important call since we have several signs up indicating that you should not be on your cell phone at the pharmacy.

She signs out the medication and I start to counsel her while she's on the phone. She says, "What?" so I start counseling again. It's fun to repeat yourself. I ask her if her daughter has a penicillin allergy. She says, "What?" then says "No," and starts walking away. I wasn't done counseling but she's leaving, and as she's leaving, I hear her say on her phone, "I'm so sorry, I was at the pharmacy picking up a medication."

She apologized to her caller because I was trying to counsel her on her daughter's freebie from the taxpayers.

And just so you know, folks, these kinds of people are out there... everywhere, and they're breeding. If that doesn't scare the hell out of you, it should.

This is me...

...and the rest of the pharmacy staff when The Authorities show up for a visit...

3.5 Minutes

Patient advocate hands me a script for "Vicodin 5/325." (I love prescribers). Then he hands me the patient's Medicaid card. We had just caught up from an early afternoon onslaught of script after script with people asking for flu shots too. "Exhausted" doesn't quite describe how we were feeling.  

"How LONG is this going to take?" asks the advocate.

Now when I get tired, I get cranky. And it had already been a long day. But I composed myself and tried to be as insulting as possible without giving the advocate a reason to complain to management. I said, "3.5 minutes."

Mind you, he's getting the med FREE, and I just told him I would have it ready in less than four minutes. He replied, in all seriousness, "Can't you do it any faster? My wife is out in the car with a broken foot."

Demotivational Hump Day... Easy Open

Top Ten SECRETS to Better Pharmacy Service

A lot of people HATE going to the pharmacy. Crabby technicians, mean pharmacists, long wait times, your insurance doesn't want to pay, drugs out of stock... these are just some of the reasons why people would rather NOT go to the pharmacy.

But your medication is important! The doctor prescribed it for you to treat a condition to keep you alive or make you better! So here are the TOP TEN secrets to getting better pharmacy service!

10. You wouldn't believe this, but this one is simple: Have your ID and prescription insurance information WITH YOU when you go to the pharmacy counter. Our system works differently than dental plans. We NEED your prescription insurance information to process a claim. We have no way to "look it up" on the computer. Having your information reduces a lot of time in the process.

9. Be wary when your doctor says she's going to prescribe something "new on the market" for your condition. New usually means EXPEN$IVE and that usually means it is NOT on your FORMULARY and therefore not covered on your insurance. The drug representatives that told the doctor about this new medication most likely told the doctor the insurance plans that cover the new medication and it most likely went right out of her head. Ask the doctor to check if it is covered. If you get to the pharmacy and we find out it isn't covered, we're going to spend a lot of time trying to take care of this for you (such as a PRIOR AUTHORIZATION). Even if it is covered it is probably expensive and we won't have it in stock. These are issues to discuss with the doctor BEFORE you leave her office.

8. Some new drugs come with a manufacturer coupon to reduce your co-pay at the pharmacy. If your doctor gives you one, take a quick peek to see if it has an expiration date on it. They usually do and doctors hand them out like candy not even noticing if they're expired. Also take note... if you're on an federal or state-funded insurance (Medicare or Medicaid), you can't use the coupon. It's federal law. I don't make the rules. Lastly, these coupons often require "activation" ~ you call a number and give them personal information then they make the ID number on the coupon active. Too many people bring in coupons that are not activated and it slows down the entire filling process and YOU will have to wait. 

7. Some doctors will tell you about online discount programs... where you can "save up to 80% on your medication." Sometimes you get these in the mail. These rarely work. These programs are more about getting your personal information for direct marketing than they are about covering drugs. I have rarely seen one of these discount programs reducing the cost to the standard discount offered by the pharmacy itself. It's a waste of time for you to print the information on your computer and it's a waste of time at the pharmacy to put it in and check the price.

6. Don't want to wait? Use the smart phone app or the dial-in automated services AND request a refill on your prescription at least 24 hours in advance. Or better yet, put your prescription on automatic refill. We're always busy and answering the phone all day long slows us down. Calling in your prescription and wanting it within minutes places a heavy burden on the entire process AND increases the likelihood of us making an error.

5. Picking up medication for someone else, like a family member? Ask them the name of the item. What we have on the shelf waiting for you and what you're expecting might be different. Once it leaves the pharmacy, it is not coming back, so be sure BEFORE you pay for it. 

4. Stay away from the pharmacy on the busiest day of the week if you can. That day is MONDAY. We're in chaos. We have a huge drug order for everything we ran out of on Friday, Saturday, and Sunday. New prescriptions and refill authorizations pile up on Monday because doctor offices were closed. We're running around like crazy.

3. It's tempting to switch pharmacies when gift cards are offered for transfers. The Authorities want your business and they'll pay money to get you to our pharmacy. But as an overseer of your medication therapy, I have to tell you that you're a lot better off choosing ONE pharmacy and staying with that ONE pharmacy whether it is us or not. When the pharmacist knows your complete history and all the medications you take, we are able to make optimum decisions about drug interactions and your therapy. Pharmacy service tailored to YOUR needs is worth a lot more than a $25 gift card.

2. The time to discuss your co-pay is when you drop off your prescription, NOT at the register. We don't have anything to do with the co-pay -- that amount is given to us from your insurance. Asking us to do any kind of checking or researching at the register slows the entire process down for everyone involved, including you. If you don't think the co-pay is correct, step out of line and call your insurance to verify it and let us help the next person in line.

1. Don't forget your pharmacist and pharmacy technicians at Christmas. Goodies and treats go a long way. Is it a bribe to get better service? YES, and it actually works. Try it.

Shifting the Burden of Responsibility

Remember Mrs. Norco? She was back yesterday with yet another prescription for Ambien. Mrs. Norco has another little problem in her life. She's managed to get herself up to 2 and 1/2 tablets of Ambien every day. She takes two at bedtime and another 1/2 in the afternoon for a nap.

Oh, I know you're not supposed to do that, and she knows I won't fill her prescriptions for Ambien. She just comes when I'm not here and the other "popular" pharmacist fills her scrips without paying any attention to the instructions, quantity, or date. She's just a "customer" to him.

So yesterday Mrs. Norco hands me a prescription for Ambien, #30, take one at bedtime. Fairly straight forward, right? Except I know what Mrs. Norco is up to. She sees several doctors and gets these prescriptions and the dates overlap. The last time she had Ambien filled was fifteen days ago. Same doctor, same quantity.

"This is too early," I tell her.

"Oh, I know, but I gots the doctor approval for an early refill cuz she told me to take two at bedtime instead of one."

"Why isn't that on the prescription?"

"Cuz she says she can't write it that way. You can call her."

Mrs. Norco is trying to push her way through this one. Hasn't she learned yet that this game doesn't work with me? I tell her I'll call the doctor. Her eyes dilate slightly.

I call the doctor's office. Now for those of you in pharmacy, you know that I'm not actually going to get to talk to the doctor. It's very rare that we pharmacists actually talk to the doctors. They have a staff of people who have the specific job of keeping the doctor secluded from the outside world.

I get to talk to the doctor's assistant. I explain the situation. I explain that it is two weeks early. The assistant verifies that yes, the doctor told the patient to take two tablets at bedtime.

"Well, ok, then, I'll change the prescription to indicate that the doctor changed the sig to read 'Take two tablets at bedtime.'"

Long, long pause...

"Nooooo, the doctor wants it to say 'one at bedtime.'"

"But you just told me she's instructing the patient to take two tablets at bedtime."

Longer awkward pause...

I add, "What you're trying to do is shift the burden of responsibility onto the pharmacy if something goes wrong. If Mrs. Norco takes two at bedtime and then decides she wants a taco at Taco Bell and kills someone on the road, you want me to bear the burden of responsibility. I will not fill this prescription."

"You can't deny filling that prescription! I'll have the doctor call you herself!"

<click>

I gave the prescription back to Mrs. Norco. I explained the situation. She accepted defeat and slowly walked away.

As you can imagine, the doctor never called. I won that battle that day, but I'm losing the war. A few days later I looked on her computer profile. She saw a new doctor the next day and brought the prescription to the other pharmacist who filled it... # 60, two at bedtime.

Laugh or I Slap You