Wednesday, February 27, 2013

Casino Time

A "lady" and her adult son come in for their medications. They're both on state funded Medicaid but one of his medications (Phentermine) is not covered and he always pays cash. He's paying for his medication with a credit card (not a debit card) and his mom quickly tells him to get some cash back. I'm used to seeing that-- people want a little extra money for their wallet or whatever... but he says "No, mom, we don't need no money." His voice makes an odd whistle through his missing teeth as he speaks.

Oddly enough (sense some sarcasm here), he doesn't appear to need Phentermine. But mom definitely could use some sort of weight loss help. She's sporting a hefty BMI. But I digress...

She gets more insistent. "Get $100 back! I want to go to the casino!"

My, what a marvelous example to her son. Not only is she suggesting they go blow some money at the casino, she wants him to "charge it" which will cost them 24.5% in interest in the long run. How is it that they have money to spend at the casino anyway when their on Medicaid? Oh, I forget, Obama fixed healthcare!

Skinny son tells his mom, "We ain't going to no casino, I done told you that already."

Mom rolls her eyes. She looks in the bag of medications. "Is my meh-toe-pro-laul in here?"

"Yes," I reply. "Have a nice day."

"It ain't gunna be a nice day! My son is dis-abey'in his own momma!"

Tuesday, February 26, 2013

The GIFT CARD at the O.K. Corral

Thursday, 8am: Lady Mumford is at my drop off window.

"Is my prescription ready? I gave it to the other guy on Wednesday to transfer. I want that gift card."

I look. There it is. No refills. The "other guy" (a floater) called and left a message for the doc to call back. I show her his handwriting, MD calling back. You gotta love floaters... they put in the least amount of work possible.

I tell her that unfortunately, when we do get the call back, it will technically be a "new" script because the old one didn't have refills, and that makes it ineligible for a gift card since we're not actually doing a transfer. She nods like she understands.

Friday, 8am: Lady Mumford is at my drop off window.

"Is my prescription ready? You said the doctor would call back. I want that gift card."

"No, not yet." I wimpishly remind her the issue with the gift card. I don't know if "wimpishly" is a word, but that describes how I did it. I show her the fax verification where I faxed the doctor after she left on Thursday. I give her enough of her medication to last the entire weekend and tell her at this point to come back Monday

I think of the showdown that's coming, the fight for the gift card, and the unholy evil that will come from that fight. Doc Holiday with TB firing blazing shots, zombies eating brains, cats and dogs living together, and the mother of all unholiness, a complaint sent to corporate. Oh my gosh, Noooooo...

I look at the tech. "You know this is going to get ugly, right?"

Friday, 7pm: Lady Mumford is at my drop off window.

Before she speaks, I tell her we haven't heard from the doctor. She insists that I fax the doctor again. What the heck, I'll fax it again. Why not?

Saturday, 8am: Lady Mumford is at my drop off window. 

Mind you, she's been a patient at our pharmacy for years and if we did have her prescription, she would pick it up at the PICK UP window. I don't know why we use such fancy terms like "DROP OFF" and "PICK UP" for the windows anyway. It just confuses and frightens the people who voted for the wrong guy this last election.

"Is my prescription ready? I want that gift card."

I reply, "Does your doctor work on Saturday?"


I'm not sure Lady Mumford knows what planet she is on, let alone what day of the week it is.

"Then it's highly unlikely he's seen the second fax which I sent 13 hours ago just before the weekend."

"Oh." She walks away.

Sunday, 8am: Lady Mumford is at my drop off window.

I'm in the middle of the pharmacy but she can see me just shake my head no. She walks away. I'll bet she really wants that gift card.

Monday, 8am. Lady Mumford is at my drop off window.

And for the grace of everything that is holy, or perhaps out of fear of Lady Mumford, the doctor did the e-script first thing Monday morning. I saw it and immediately filled it.

"Is my prescription ready? I want that..."

I cut her off, "It's done! Come down to the PICK UP window." I sigh and gear up for the shoot out at O.K. Corral, the mother of all pharmacist/patient disputes, the FIGHT for the GIFT CARD.

Lady Mumford signs it out and pays for the prescription. She folds the bag neatly several times and files it away in her purse like there is a special pocket just for it. She ambles away. Oddly, she never mentioned the gift card. Not a word. I was waiting for a showdown of epic proportions, but it didn't happen.

The gods smiled on me today. 

Monday, February 25, 2013

My "Attitude" on Medicaid

A recent blog post on my frustration with upper management elicited the following comment:

"I get the sense from your posts that you pretty much have no tolerance for anyone on Medicaid. I have to think not all of them are scammers. And no, I'm not on Medicaid or any other form of public assistance. I pay more than my fair share of taxes, too. I know there are some people out there mooching off of the rest of us, but I still don't understand your attitude. You can't tell me you aren't mistreating some of the innocent people out there with your attitude." (emphasis added)

This comment really threw me. I'm basically accused of mistreating people because my attitude expressed toward the people who are clearly abusing the system that come to my pharmacy. That's a stretch. But since the author doesn't understand my attitude, let me tell you where it comes from:

A few years ago people were grateful for the state-funded program and embarrassed to pull out their Medicaid card. And some were on the program temporarily and when they found work, they went off the program. They were grateful for the temporary help. I myself have family members who were on state-funded Medicaid until their situation changed, so I personally know how fortunes can change and people desperately need help. And when they're back on their feet, the go off the system. That's how the system is supposed to work and I don't have a problem with that.

MY issues with Medicaid comes from the fact that I'm in the trenches seeing abuse and misuse every single day. UNFORTUNATELY, there are too many people that stay on the program, year after year, making no attempt to change their situation. Another aspect about Medicaid has changed. Many people currently on the program have an attitude that is completely different from those who used the system temporarily. Many people on Medicaid are, quite frankly, real asses about it. They not only DEMAND that their Rx be filled immediately, they have an attitude that it OWED to them. They are the worst segment of our population... people on the dole who feel like the government owes them a living, free housing, free medication, and you better get it for me right now.

Some of the abuses I've seen: Patients with BMW keys on Medicaid picking up prescriptions. YES, they own the car. Patients with seriously expensive cell phones and bluetooth connectors hanging on their ears on Medicaid picking up prescriptions. Patients that go year after year without work, not even trying to find a job. Other patients that go month after month, at our expense, with what appears to be no hope of getting off their narc medications. And doctors that make no effort to wean patients off pain medications. Oxycodone 30mg #300 every 30 days for some mysterious ailment and no attempt to find the source of the pain or attempt to wean them off. Here's a couple of examples:

I've written about Miss Loosey before. She's been taking advantage of Medicaid for the past five years. She openly admitted to me one time that she lied on the forms to get on Medicaid. A year before that she came in with an insurance card that was not hers; it was her sister's Humana insurance. She tried to tell me that it was "just an insurance mix up" and that I could process her medication under that card. Naturally the insurance rejected it because of the difference in the birth date. When I brought that up, she said they must have mailed her the wrong card. Of course, she never brought in the "right" card.

I have another patient who lives a good twenty miles away. Somehow he's convinced the Medicaid people that he needs a taxi ride to MY pharmacy every week to get his medications and a taxi ride back home. So the state (and my tax dollars) pay not only for his medication, but he gets a state-funded ride to come get it. His co-pay is $1.10. And time after time he doesn't have the $1.10 and we just give it to him. NOT ONLY THAT, some of his medication is not reimbursed entirely by our state. WE TAKE A LOSS every time he gets that medication filled and we have NO SAY about it. Most Medicaid reimbursements are minimal... meaning that even if we do make a profit on the prescription, it doesn't really cover the actual costs. It's barely a break even situation in most cases. And the more people that go on Medicaid, the less profit the pharmacy makes, and eventually that will affect tech hours and then pharmacist salaries. This socialist agenda is just out of hand and unless something stops it, it will affect my job.

So no, I don't have a good attitude about Medicaid. I have little tolerance for people who are taking advantage of you and me and have an attitude about it. The abuses of Medicaid is yet ANOTHER sign how far down the socialist road we've gone. BUT to suggest that I'm mistreating innocent people... well that's unfounded by anything I've done or said. I work for a company which measures our performance mostly on script count. My company encourages people on Medicaid to come to the pharmacy because they want to sell them groceries. We're the S&H Green Stamps for the store. So I'm not really concerned about each script other than the fact that overall the system is obviously broken and employed people are paying for it. Maybe YOU'RE happy and ok with people mooching off of you. I am NOT, however. I earn my money, every freaking dime. Having others taking advantage of the system on my dime is not acceptable to me. You can give all your money to charity for all I care, but MY MONEY IS MY MONEY. Feeling that way doesn't affect the way I treat patients on Medicaid. I don't like it. I don't like people that take advantage of it. But if it is a valid Rx and I get a paid claim, I'm going to fill it. No one is being mistreated, except the pharmacists and techs who deal with these moochers every day.

SIDEBAR: All you liberal actors and actresses in Hollywood who are so quick to spout off your support for liberal socialist wealth redistribution... I'll be impressed when you give ALL your money to charity. Heck, I'll be still be impressed if you give all your money except for, let's say, $1 million. Keep a cool million for yourself to retire on. Give up all the rest and I'll take your "concerns" seriously. Oprah, are you hearing me?

Saturday, February 23, 2013

Friday, February 22, 2013

The Helpless Desk

I've realized that the Cleverbot artificial intelligence engine is being used to run our help desk. Our interactions are almost identical to any conversation with Cleverbot. Imagine all the money corporate is saving by not actually having a real person solve issues. Here's a recent one:

Corporatebot: Thank you for contacting the help desk. How may I assist you?

User: We're having an issue running the generic for Rowasa. We're using the correct NDC, but the system thinks it is brand and is returning the brand price.

Corporatebot: What's the issue?

User: We're submitting the correct generic NDC, but the system has it linked as a brand. It is the generic. 

Corporatebot: Ok, so you'll need to submit the proper generic NDC code to get the generic price.

User: We're submitting the correct generic NDC, but the system has it linked as a brand. It is the generic, not the brand. 

Corporatebot: What's the issue?

User: The brand for Rowasa has a specific NDC. The generic has another NDC. We're using the NDC for the generic but the system adjudicates it as if it was a brand. It is not the brand, Rowasa. It is the generic.

Corporatebot: Ok, so you'll need to submit the proper generic NDC code to get the generic price.

User: Rowasa is the brand name. It has a different NDC than the generic. WE ARE USING the GENERIC NDC, but the software "thinks" the GENERIC NDC is THE brand and is giving THE brand price. We need YOU to change the NDC specification from "brand" to "generic" so we can get the generic price.

Corporatebot: OK, so YOU WILL NEED to submit the proper GENERIC NDC code to get the GENERIC PRICE.

User: *facepalm*

Corporatebot: Thanks for using the help desk. I'm opening a ticket for you regarding this matter. Please allow 24-48 hours to resolve this issue.

User: *facepalm*

Corporatebot: What's the issue?

Thursday, February 21, 2013

Rumor: Corporate to Install New Pharmacy Software

Rumor has it at my company that soon, NEW pharmacy software will be running on our ancient Windows computers. Apparently the company has hired an outside consultant, a Twitter user named @Kya7y, to help program the new software.

"The current software wasn't clumsy and unfriendly enough, so we thought an upgrade was appropriate," said an upper manager named Manager X, wishing to remain anonymous.

@Kya7y is known for his extremely detailed 33" by 23" maze. He's worked on it for seven years. "There appears to be no workable solution," said Manager X, "which is exactly what we'd like to see with our new software. Anything that can make our techs and pharmacists work harder... we WANT that. And since @Kya7y works as a janitor and has had no relevant pharmacy experience, he's PERFECT for the job."

As with past software upgrades, the new system is said to be coming out "sometime this summer." We'll keep you posted.

Wednesday, February 20, 2013

A Clear Explanation for Upper Management Behavior

How's your pharmacy patrons? More people on Medicaid ON YOUR TAX DOLLAR when you know they shouldn't really be on it? People taking advantage of the system (Like Miss Loosey), others complaining that their co-pay went up by a dollar, or people only filling the narc and leaving the antibiotic behind? How about unreasonable expectations that an Rx be filled within minutes even when you have ten waiters in front of them?

How about your pharmacy company? Low inventory, "organization" projects (which do not increase script count), fewer tech hours, no lunch breaks for the pharmacists, inventory nightmare ideas (such as Quake-N-Zap), strange requests and bizarre mandates which make little or no sense whatsoever? Emotional outbursts from managers, RPMs, your pharmacy director, over things that are indeed trivial matters? Do you feel like all your managers are bi-polar? 

Yes, you're probably working for the same pharmacy chain I do. You scratch your head in wonder: Why? Why do they do these things?

I'm certain I've figured out why. It became crystal clear when I was reading the current article Leading Geneticist: Human Intelligence is Slowly Declining about how the intelligence of society today is dropping compared to our ancestors. As the article states, "Despite our advancements over the last tens or even hundreds of years, some ‘experts’ believe that humans are losing cognitive capabilities and becoming more emotionally unstable. One Stanford University researcher and geneticist, Dr. Gerald Crabtree, believes that our intellectual decline as a race has much to do with adverse genetic mutations."

Fluoride, Pesticides, and Processed Foods might have something to do with the genetic mutations. Or in the case of my company's managers, BAD HIRING PRACTICES. All I know is that there seems to be some really dumb patients out there and even dumber managers. It's making life at my pharmacy extremely annoying.

Tuesday, February 19, 2013

Stupid as Dirt

An old fart named Owen has his brother come in on Friday during Flupocalypse with 2 Rx, one antibiotic and another for an albuterol inhaler. I always choose Ventolin first but his Medicare doesn't cover it. So I had to try other ones. Finally after working on it 10 minutes I get Proair to go through. 

Owen, the actual patient, must have walked to the OUT window just as his brother dropped off the prescriptions at the IN window.  He's there, impatient as always, and waiting at the register. He can clearly see we're all running around like crazy-- Mickey still doing flu shots... the tech munching in the back keeping her blood sugar up, me filling scripts... but he's used to Magic Mickey's Medical Miracle pharmacy where waiting is out of the question. "Can I get a little service down here?!" he belts out. He's really not trying to be funny; he's being an ass as usual.

I get the meds ready and bring them to the register. I tell Owen the trouble I had with the inhaler and that unfortunately the price is $40. He says, "Inhaler? I don't want an inhaler!" He doesn't want to get it because of the price but $40 is NOT unreasonable.

I tell him that we're just crazy, but when someone brings us a prescription we fill it. He tells me he doesn't appreciate my sarcasm. I tell him that the doctor prescribed it for him and he'll be sorry later if he doesn't get it. Yeah, I'm sick and tired of these damn people making us do work for no reason and yes I was sarcastic. It seems pretty simple, IF YOU DON'T WANT US TO FILL A PRESCRIPTION, DON'T GIVE IT TO US.

The very next day, SATURDAY, another of Owen's relatives comes in and asks for Mickey. I said Mickey isn't here. I'm not sure why people think Mickey works here 24 hours a day 7 days a week but they do. So the guy says he's Owen's nephew and he says Owen now wants his inhaler. He can't breathe and really needs it. I have no doubt Owen was hoping I wouldn't be here today. I took a deep breath and filled the prescription, again. We're not busy enough at the pharmacy, we love filling the same prescription twice.

Stupid as dirt.

Monday, February 18, 2013

You have Flonase?

A comedy of errors... first the background... for awhile our next door competitor couldn't get generic Flonase (Fluticasone). I don't know why. I don't care why. All I know is I have plenty and I've been doing 2-3 transfers every day from people that can't get their nosey spray at the drive-thru.

Today a lady comes in and tells me our competitor doesn't have any Flonase and asks if I have any. I said, sure, I have lots. She says she'll go to the competitor and get her Rx back. She comes back in and I start getting her info and typing up the Rx. I'm typing it up and get all the way to the bottom of the Rx where the doc has written DAW (That means DISPENSE as WRITTEN, or in other words, no generic substitution). I explain to the lady what the doctor has written.

"But I asked YOU if YOU have FLONASE?"

I give a big sigh.  I try to explain but she doesn't understand. I offer to call the doc to see if he'll allow generic (it's been my experience that 99% of docs write DAW because the patient insists), but she just wants the Rx back. Just for fun, I submit the Rx to her insurance to see if they'll even cover brand. No, they won't. Good luck with that.

THE NEXT DAY a guy comes in and wants us to transfer an Rx from our competitor. It is the lady's husband, asking us to transfer the Rx from our competitor... the Rx I had in my hand...  which won't be covered. I call the competitor, and ironically enough, they missed the DAW on the Rx but the pharmacist caught it during the transfer. So after I complete the transfer I know it won't be covered. I call the doc to ask about the DAW and by some stroke of luck get to actually talk to the assistant. She says I don't have to bother... they called in Nasonex to our competitor.
I love wasting my time. Don't you?

Saturday, February 16, 2013

Dumbest Toy of the Week


Now for something in really bad taste, here's a BENDABLE Jesus toy. It's sold by a website called No surprises there.

"Get Bendy with Jesus and rejoice in his ambidexterity. This Bendable Jesus of Nazareth Toy is fun for all ages since he likes to cling to things in your car, at your desk, in your room and so many other places. He guides you to do things as he would, with great buoyancy. The king of all kings comes adorned in a red and white robe. He wears his signature sandals and his curly hair. We hear he makes wine out of water and can make one loaf of bread into several. He's pretty much the coolest guy in the entire universe and it's not just because he's Bendable. If we put Gumby and our Bendable Jesus in a boxing match, it's obvious who'll be walking on water. Get your own personal Jesus and let all bask in the glory of his majesty."

Oh, that's just awful. Awful! 

If you're feeling extra religious, a BENDABLE Mary toy is available as well.

Friday, February 15, 2013

Cool Gadget: License Plate Flipper

You're not James Bond. You're not even a spy of any kind. But you're also tired of getting tired of getting those bills in the mail from speed trap cameras every time you're in a hurry. NOW you can end that problem. All you need is the License Plate Flipper!

Imagine driving down the road. You see the sign which says "Speed Enforcement Zone." Hit the switch and presto, you're license plate flips. If it takes a picture of your car, it records the wrong license plate number and you'll never get a ticket!

Or better yet, remember that annoying neighbor? The one you've asked to please stop his dog from barking at 2am in the morning? Get a photo of HIS license plate and print it in color on your flipped side. Then he'll get the ticket, not you!

OR EVEN BETTER, choose a phrase of your choice, such as when someone is tailgating you on the road. Hit the switch and they see "BACK OFF JERK" or something a little more spicy.

I gotta get me one of these... the LICENSE PLATE FLIPPER!

Check out the Video!

Wednesday, February 13, 2013

Imagine NOT having to recharge your cell phone

All you need is $1,100. Chicken feed, right?

Apparently a company in China is selling a battery which produces power from the decay of Tritium and supposedly is perfectly safe for human use and supposedly has a twenty year life. Sorry Duracell, you lose. Of course, thinking back to all the times I've bought AA batteries for the Xbox remote for Boy # 1, I'm sure I've already spent in excess of $1,100. Actually Duracell, you won.

Interesting idea. Some of you rich folk out there go buy some so the price will come down. Thanks.

Here's the LINK.

Tuesday, February 12, 2013

Reduce the Inventory or YOU WILL DIE

"Reduce the Inventory or YOU WILL DIE." Seems harsh, doesn't it? No, Corporate hasn't really said that yet, but they might some day.

At my company, Corporate muckity-mucks and pencil-pushing accountants who have NEVER stepped inside a pharmacy are once again singing the mantra of reduced inventory. Your inventory is too high, you must reduce. They chant this over and over again but no one steps back to really look at this from a logical viewpoint. Honestly, they're brainwashed or something.

Ok, look, I'm not some stupid idiot. Before pharmacy, I worked in retail and I have a business degree and an MBA. I know all about Japanese inventory models and I see the value of reduced inventory IN MANUFACTURING. Unfortunately, no one at Corporate has bothered to see the difference between AMBULATORY PHARMACY and MANUFACTURING. You simply can't run a pharmacy the same way you run a production line in Detroit. What makes low inventory work in Detroit is that they get part deliveries up to four times a day. Most pharmacies get inventory delivery only five times a week. That's a big difference. Why does no one at Corporate get this? I've brought this up with upper management and they just look at me like I have bananas growing out of my ears.

The simplest way to put this is the hospital model: NO ONE IN THEIR RIGHT MIND would expect the pharmacy of a hospital to NOT stock a high percentage of all medicines available to treat their patients. Can you imagine a hospital telling a patient, "I'm sorry, we don't have your med in stock. We can order it for you-- have it here tomorrow by 11:30am."  I'm NOT talking about a medicine like Anascorp ($25,000 a dose)  for a rare condition like a scorpion bite. I'm talking about standard drugs.

I have a patient on Aggrenox that gets it EVERY SINGLE MONTH. Because the muckity-mucks have their hands on our computer ordering system, the computer will not automatically generate an order for more until it gets a negative on hand quantity. So EVERY MONTH this poor lady has to wait a day to get her medication. There are several people in the same situation with various other drugs. We do our best to order ahead of time for our patients but some slip through the cracks and they don't get seamless drug therapy and that pisses me off. It's completely unnecessary.  

MOREOVER, we LOSE BUSINESS with this narrow-minded view. Consider eyeball and ear solutions and suspensions of every kind. They don't cost much to keep on the shelf, but if we order a variety of them after a month the computer says REDUCE YOUR INVENTORY and send them back. So then someone does come in for the med, we don't have it, and we end up losing the sale, the patient, and all future business from them by not having the med they need WHEN they need it... WHICH IS NOW, NOT TOMORROW! 

So, Corporate muckity-mucks, add that into your spreadsheets... the LOST BUSINESS when we don't have something in stock and all the future business from that patient. I'll bet it adds up to a lot more than the measly bucks you save by turning us into a car manufacturing plant.

Monday, February 11, 2013

A Plea to Hospital Doctors/Prescribers

I don't know what the Board of Pharmacy requirements are for various states, but they can't be that different from mine. In my state, a prescription is only valid if the prescriber's information is clearly on the prescription, including name, address, phone number, etc.

You'd be surprised, though, how many prescriptions we get from discharged patients with incomplete information. Missing names, missing instructions, one doctor listed on the top of the Rx and signed by someone else, no phone number... it goes on and on. And EVERY time, we have to call the hospital to get the rest of the information, and that usually involves 2-3 phone calls to eventually reach someone who can answer the question. And 90% of the time this occurs during a busy time in the pharmacy and the patient's representative has the actual patient waiting in the car in the parking lot and are always in a hurry to get the patient home (perhaps they should have taken the patient home first, but that's another story). So there we are unable to fill the prescription right away. In some cases, I've had to give back a prescription because it's not legal and I can't fill it.

PLEASE, PLEASE, PLEASE, I implore you... if you're a prescriber in a hospital and you're writing scripts for your discharging patients, PLEASE take a few moments to fill them out correctly. Give us some idea who you are. A scribble doesn't do it. If it's a controlled substance, PRINT your name and put your DEA # on it. We're outside the hospital, not the hospital pharmacy.  We don't know you're particular scribble. We can't read your mind. Please fill out the prescription completely so we don't have to track you down or bother your nurses to find out what the hell you're prescribing or who you are. Don't do this for us, do it for YOUR patients! They're out in the parking lot and they really want to go home.

Saturday, February 9, 2013

Favorite Question of the Week

As I'm limping out of the front of the store, 15 minutes past closing, bundled up in my warm jacket, deliriously happy to be out of that mad house, a man walking in, recognizing me as "the other pharmacist" (I'm not Mickey, you see) says, "Oh, is the pharmacy closed?"

We have closed at the same time for at least ten years, maybe longer. It's on the door, the pharmacy labels, the bags, our business cards, everywhere.

"I'm sorry, we're closed. Mickey will be here tomorrow morning."

But I wanted to say, "No, the night shift is a little late. Just go on back and wait for them..."

Friday, February 8, 2013

The Future of Vaccinations

"Researchers at MIT have come up with a method to create 'super effective' DNA vaccines by relying on an array of microscopic plastic needles that measure a mere 250 microns wide and 650 microns high, and if you were to compare it to the average human hair, it measures roughly 100 microns wide.The microneedles in action can disrupt only the most superficial layers of the skin while avoiding nerve endings and blood vessels, rendering them painless to deliver the vaccine compared to hypodermic needles."

Just in time, too, because I'm tired of 13 year old boys crying like little girls just before I gave them this year's flu shot. I'm not kidding. I had multiple little girls aged 8-12 roll up their sleeve and bravely take the flu shot this year, but two 13 year old boys cried. Jeez. Really?


Thursday, February 7, 2013

Mr. Roboto's Burger

Robot Serves 360 Burgers Each Hour

The Alpha machine from Momentum Machines is said to be capable of "cooking up a storm with its tasty burger," and to produce “gourmet quality burgers at fast food prices.”

It uses a conveyor belt system where meat is freshly ground, shaped, and grilled, then cooked according to the customer's specifications. After cooking, freshly sliced tomatoes and pickles are added and the whole thing is wrapped up ready to serve.

The one in the picture doesn't look too bad, but I'd get a big kick out of seeing the ones that went haywire and wrapped up for people... the ones that if made by a human wouldn't make it to the customer. I speculate a cool website called "Damn you, Robot Burgers" much like "Damn you, Autocorrect."

And if you've ever been stuck in the drive thru line at In and Out Burger, 360 Robot Burgers per hour seems pretty fast...

Wednesday, February 6, 2013

COOL: Vitamin Reference Wheel

Your body needs vitamins to thrive and survive. Essential vitamins are found in every day foods. This handy wheel chart will help you plan your meals with foods that are loaded with each important vitamin.  Sections show the important vitamins A, B, C, D, E, and K and which foods have them.
Thanks to graphic designer Shannon Lattin, "It's easy to tell at a glance from the chart that unless you're eating vegetables, such as broccoli and spinach, or liver, you're probably not getting enough vitamin K. On the other hand, lots of foods can provide you with vitamin E and B3."
Read the Original Story

Tuesday, February 5, 2013

Playing with fire

That's what it is, really. It's like a child with a box of matches. Fire is so very magical, the ultimate chemical reaction. When something burns it is amazing to a child... and just like magic. Yet, the child doesn't realize the inherent dangers. Fire is useful, but used improperly is DEADLY. And unsupervised, it's only a matter of time until the child gets burned playing with fire... or worse...

Such is retail pharmacy, especially those in grocery stores like my national chain. You have all these corporate muckity-mucks trying to run a pharmacy like a grocery store, or much worse, like a automobile manufacturing plant. Like a child, they lack the wisdom and understanding of what pharmacy is really all about. Oh, they say they understand, but the actions are much different. When you under staff a pharmacy, you're playing with fire... and its only a matter of time until someone gets hurt, just like with fire. When you push pharmacists to the limit of their physical endurance, its only a matter of time until a serious mistake is made and someone gets hurt, or worse, dies. 

Profit is what drives any business, and pharmacy is no different. But what is different is the marketplace now. There is massive competition. Margins are thin. Grocers MUST decide whether they can handle the thin margins WITHOUT compromising patient safety. From corporate perspective, they're cutting tech hours left and right to increase the bottom line. It's a simple equation. That's the first thing they teach in you in business school... if business gets tough, cut the work force. But their calculations have failed to take into account the risk factor and what might happen... or rather what WILL happen, when you continue to push humans beyond their limits.

A colleague of mine works for another national grocery chain pharmacy. Awhile back there was an incident in one of their pharmacies where the wrong medication (methotrexate) was given to a baby with an identical name to that of the cancer patient it was intended for. Fortunately the error was caught early and there was no patient harm. The chain pharmacy immediately printed laminated cards with detailed instructions on how all pharmacy personnel are required to check name, date of birth, address, phone number, and medication for EVERY patient picking up medication. Every pharmacy employee was required to sign off that they would follow this protocol exactly and that the extra time needed to do this was fine with the company. These laminated cards were expected to be placed everywhere around the registers and even the input workflow computers. This is fine, but the people who designed these instructions really don't know what it is like at a busy pharmacy.

And once again, here is an example of a company not addressing the real issue. The error happened because the pharmacy was under staffed and overworked. Instead of addressing the real issue, they chose to place the burden solely on the pharmacists and staff... in other words, "don't blame US because you're under staffed, it's YOUR fault." Moreover, when a major mistake happens again, the company has conveniently placed a safety net for themselves... "Hey, we have a system in place to prevent that... it was the pharmacist's fault that the wrong medication was given to the patient... we regret that our perfect protocol was not followed... we're innocent."

Eventually there will be a busy pharmacy in my pharmacy chain, or one of our competitors... that has pushed the envelope too far. A baby will die, or someone will be seriously hurt. There will be lawsuits and news reports and the media will refer to articles and blogs like this one from pharmacists having sounded the warning call for years. The "perfect protocol" safety net will be revealed as a piss-poor way to handle the fact that the pharmacy was seriously under staffed. Then there will be huge settlements and payoffs... likely in excess of the money the company would have paid if they had just staffed the pharmacy responsibly and respected the pharmacists instead of working them to death. You would think that the corporate people would take that into account... but no, they'd rather roll the dice to save a few bucks on the bottom line. I'm sure at the top of their agenda is their bonus, not people's lives.

Please, corporate... wake up! Someone needs to take a stand, step up, blow the whistle. When you're dealing in healthcare, profit is the secondary motive AFTER patient safety. Otherwise, it's only a matter of time until someone gets hurt.

Monday, February 4, 2013

Mr. D-A-W

"That's D-A-W, you know. You got that right, Mr. R-X-Man?" And I'm not substituting my blog name for my real name. He did indeed call me "Mr. RxMan."

Mr. D-A-W is here again, dropping off another prescription for Xanax, brand only. His co-pay is $40, but he doesn't care because he insists on brand. And he wants to make sure he's going to get brand, so he reminds you every time.  Everyone in the pharmacy knows who he is... well, almost everyone. The new tech doesn't know who he is, but the rest of us know. Me and Mickey know that we're definitely not going to dispense anything but brand because it's D-A-W, you know. Mr. D-A-W told us so. Even though it's clearly written on the Rx "D-A-W" or "Brand Medically Necessary," Mr. D-A-W is going to point it out every single time.

Mr. D-A-W also wants to be recognized. And that's where the new tech made her mistake. She ticked him off but good last week by asking him to spell his last name. I saw what was happening and quickly stepped in to finish typing the script. I didn't want her to process it for generic and make things worse. And would you believe that Mr. D-A-W later complained to Mickey that the new tech didn't know his name and that upset him horribly and he needed to talk to the CEO of our company because he was so slighted? Mickey handled it in his usual way and we avoided having to hand out a gift card. Phew!

For some reason, though, Mr. D-A-W doesn't insist on brand Allopurinol (Zyloprim). We can actually still get that but it's about $400 for a bottle of 100. I guess having to have brand stops when it reaches a certain dollar amount. I've been tempted to ask him why he's not getting D-A-W on the allopurinol... but I don't want him to call the CEO.