Size, Color, and Frequency

We have a patient, Mr. Staples, that has been coming to this pharmacy for several years. He is a nice enough guy, but his little quirkiness is starting to get annoying. On my first day in the pharmacy, he came in to pick up a prescription, and I was told by the pharmacy manager not to staple his bag. I thought he was kidding. No, he wasn't kidding. Mr. Staples reminded me himself as I was about to bag up one of his prescriptions. But that's not all. Mr. Staples will come to the pharmacy, inform you that he is about to pick up a prescription, then wander about the store, picking up a few items here or there and dropping them off at the edge of the pharmacy counter. Sure, that's ok, but when he's done and comes up to pay for everything, this is when it gets weird. I'll start by ringing up his prescription. Then he gets out his club card and scans it himself... then he starts scanning his own groceries which have been carefully placed far enough away so that we can't touch them. Then he bags his own groceries. Ok, so he has some issues with people touching his stuff. That's ok, I don't like people touching my food. But this is a little weird because he must know that people touched the packages at the warehouse, the delivery truck, and in the grocery when they were placed on the shelf for sale, right?

Well, that's not the end of Mr. Staples' weirdness. He loves to discuss his bowel movements, in detail. Size, color, frequency... I know all about this man. When it is slow, and he finds me there, I'm a fish in a barrel. I can't get away. I'm stuck. I have to listen to his worries about size, color, and frequency. Although I'm a pharmacist, he sees me as a healthcare professional who can diagnose the meaning of various sizes, colors, and frequencies, despite the fact that my replies like "What does your doctor say?" and "I don't know what to tell you" doesn't seem to sway him a bit from continuing. I've worked out a system with my technician that after five minutes, she goes to the other end of the pharmacy and calls the pharmacy phone number using her cell phone so I can break free. But if I'm alone... fish in a barrel.

Mr. Staples is very concerned about his sleep. He's a regular user of generic Ambien. Ambien is a nice little controlled substance hypnotic that induces sleep extremely well. Hence, the name... AM for "morning" and BIEN (Spanish for "good") -- translation "morning good." Not all drugs are named so well. Ambien has been available as a generic for years now. It is called Zolpidem. Zol is for "Morning" in Swahili... naw, just kidding. Anyway, the package literature says that you should only use Ambien/Zolpidem for no more than a few months because it is habit forming. Well, apparently doctors don't care because most people on the drug have been on it for YEARS. Mr. Staples is no different.
 

Among Mr. Staples' phobias, he also suffers from some sort of fear that he's going to run out of his sleep aid. He has on hold at our pharmacy one good fill of a 30 day supply ready to fill at any time. He sees his doctor regularly (but somehow forgets to discuss size, color, and frequency) and gets extra prescriptions that he keeps in his "hip pocket" just in case. He has felt a need to remind me of this several times. Just in case of what, I don't know. He also keeps a quantity of 90 at home at all times... you know, just in case there is a disruption in the supply chain or something. (If there is a disruption in the supply chain, how are the written prescriptions in his hip pocket going to help?)

Recently Mr. Staples came in to fill another quantity of 30. He does his own drug rotation at home, using the 30 he obtained 60 days ago, thus keeping his stock fresh. Well, he discovered that the quantity we filled 60 days ago was from another manufacturer (which we likely explained in detail 60 days ago). After taking ONE tablet and not falling asleep in 15 minutes, he said he had to "chew off" part of another tablet to fall asleep. Therefore he's not happy with the generic he obtained. Pharmacies shave a few bucks here and there by going with the lowest price on a continual basis. Generics are FDA approved one to another, but Mr. Staples is not convinced. He doesn't like the generic we dispensed him 60 days ago. There is nothing we can do about it now except give him (at a loss to the company) a quantity of our current generic, which he is also squinting his eyes at me about.

Fortunately, the current generic Zolpidem incident of 2013 has avoided my having to discuss size, color, and frequency... for today.