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The Good versus the Popular Pharmacist

The popular pharmacist doesn't pay attention to refill dates. He/she just fills whenever the patient asks for a refill, no matter what the medication.

The good pharmacist pays attention to dates and doesn't refill dangerous and/or controlled substances early.

The popular pharmacist hurries and gets the scripts ready in minutes, disregarding any other issue.

The good pharmacist is careful, checking drug profiles, drug interactions, and whether the medication is appropriate and appropriately dosed for the patient. This takes extra time.

The popular pharmacist would fill this script without doing any dosing calculation:

The good pharmacist would check the age and weight of the patient and make sure it is correct for that patient. The good pharmacist would also remind the prescriber not to write "1.0" on prescriptions.

The popular pharmacist says "take this with food" and sends the patient on his/her way.

The good pharmacist takes time to counsel each patient on drug interactions, side effects, and checks patient understanding of the medication and counseling.

The popular pharmacist is more concerned about what management thinks.

The good pharmacist is most concerned about patient safety regardless of what management thinks.

The popular pharmacist would just fill the following script, no questions asked:

The good pharmacist would call the prescriber for clarification and reference to the "off label" indication.

So which kind of pharmacist are you?

Which kind of pharmacist should you be?

If you're a patient, which kind of pharmacist do you want to be your pharmacist?

Some of my days...

feel just like this:

The Iron Maiden, part two

This is the second part of the story from Tuesday.

So I type of a letter to fax to the doctor about the iron supplement. Here's what I wrote:

Dear Dr. Iron-Prescriber,

Regarding Old Patient, dob long time ago, 

Mr. Old Patient's daughter asked me to contact you directly regarding her father. Mr. Old Patient has been taking an iron supplement per your instructions. It is no longer available in the marketplace. We have given his daughter several therapeutically equivalent options, but she insisted we contact you regarding your input on what YOU would like Mr. Old Patient to take.

[I list several available products, including NDC, manufacturer, address, etc.]

Mr. Old Patient's daughter is EXTREMELY, UNCOMMONLY, IMMENSELY, and INTENSELY concerned that her father gets an equivalent to the iron supplement he was taking. Despite my best efforts, she will ABSOLUTELY not be satisfied unless YOU look into this matter personally and recommend the BEST product to meet Mr. Old Patient's immediate iron needs. When I tried to assure her (being a pharmacist with a doctorate in pharmacy) that these were all therapeutically equivalent, she once again insisted that I contact you and only you. She considers this an "emergency situation" but does not feel it necessary to take her father to the emergency room. She is also extremely concerned that you deal with this question directly and not a member of your staff.

If you would please give us a 30 second phone call to resolve the matter, it would be greatly appreciated. Please call Goofmart Pharmacy at the phone number below.

Thank you,

Crazy RxMan, PharmD

As expected, and entirely to my complete enjoyment, the doctor did not call. Instead, he wrote on the bottom of the fax:

"Give Mr. Old Patient whatever you feel is equivalent" 

He initialed it below and faxed it back within a couple of hours.

I simply can't tell you how much I enjoyed telling Mr. Old Patient's daughter the doctor's response. It was not much different than being on the beach in a lounge chair with a cool ocean breeze and enjoying a frozen drink with an umbrella in it.

Pharmacist: 1
Insane Patient's Daughter: 0

Three minutes is all you get

I'm on the phone with Miss Loosey. She's asking me about something she's convinced has given her cancer. She doesn't have cancer but thinks everything is giving her cancer, so she calls ME to argue with me about it.

This is getting old real fast.

So anyway, I'm on the phone, desperately trying to tell Miss Loosey that she doesn't have cancer and she'll be all right. It's Saturday and I'm alone in the pharmacy.

I see Norma step up to the drop off window. It's on the other side of the pharmacy so I make eye contact and tell her I'll be with her in a moment.

Miss Loosey won't stop with her diatribe. Norma is getting impatient. I tell Miss Loosey I need to help someone else. Miss Loosey keeps on yapping. 

And then there she goes... Norma becomes Stormin' Norma and bolts off, fed up with the poor service from yours truly. 

Three minutes has passed.

So if you're playing the home game, remember: THREE minutes is all you have before the customer becomes completely fed up and storms off. Set your timers for three minutes, folks. That's all you get.

The Iron Maiden

You might recall a blog post a couple of weeks ago about a lady who is convinced that her phone lines are tapped and refused to talk about her father's medicine because she wasn't on a secure line. You can read that story here.

We've had even more fun with this lady recently. And when I say fun, I mean the opposite of fun. Let's review the "fun."

Her dad, age 90, is on an iron supplement. According to her, the doctor recommended a specific brand of iron supplement. For whatever reason, this brand is currently not available. Not here, not next door, not around the block. We don't know why. We don't care why because there are many other iron supplements which give the same elemental amount of iron. They're therapeutically equivalent.

So last Friday afternoon (we get busy then-- people are on their way home for the weekend and try to get their errands out of the way) the lady calls about the iron supplement. I'm running around like a monkey trying to do everything while the technician is on the phone for a full 45 minutes discussing the options available for an iron replacement. She wants to know the name, NDC, and also where it is manufactured.

The technician keeps interrupting me while I'm helping people to find out information about these supplements because, well we don't know why... yet.

The time goes by, tech on phone, me doing on the work, and then it is time for the tech to leave. Five minutes after he leaves, the lady starts calling me. I'm not as polite as the technician, so I ask her why on earth she needs to know where the iron is from. "They're therapeutically equivalent," I tell her. They're suitable replacements for the brand her father was taking. She tells me some nonsense that the doctor told her it is important to know where it is from. I tell her I have to help some people and that I'll call her back later.

Ten minutes pass and she calls me. She's whispering.

"The reason why we need to know where it is from is because he suffers from Post Traumatic Stress Disorder. If it is from another country my father won't take it."

Me, trying to fill prescriptions and talk to her on the phone: "It's a global economy now. All of the companies the technician told you about have United States' addresses, but it will take quite a bit of research to find out exactly where they were manufactured. I really need to help some people. I'll call you back when we slow down."

Fifteen minutes pass. I'm still busy. She calls again, whispering.

"It's not my father that has PTSD. It is my husband."

The demon inside me can't help it. "Then what does it matter where the iron is from?"

"Because my husband will know where it is from and it will freak him out. He listens and watches everything."

PTSD is a real, disabling issue. My heart goes out to those who really, truly suffer from this condition. I just seriously doubt it has anything to do with iron supplements for another family member.

There's more to the story... which I will continue later...

What Happened?

Why don't patients believe us anymore?

"Where's your Advil for children?"

"We don't have that. We have Motrin and a store brand right next to it. It's on aisle 7 there on the right."

The lady looks at me like I'm trying to pull a fast one.

"Advil and Motrin are the same thing... they're Ibuprofen," I add.

The lady raises an eyebrow in a Spock gesture, analyzing the logic of what I've just said. Instead of returning to aisle 7, she walks off.

Fascinating, I think...

<Later in the day>

"What do you have for diarrhea?"

"We have Imodium. It's in white and teal packaging there on the left. There's our store brand next to it."

The guy looks at me for an uncomfortable five seconds, then asks, "For diarrhea?"

"YES," I say, perturbed. I have things to do.

This guy also gives me the Spock eyebrow gesture, doesn't get any Imodium or our generic, and walks off.

<Yet even later in the day>

"My one eye is itchy and has a lot of discharge. What do you have for it?"

"You have an infection. There isn't anything to treat it over the counter. You need to go to the doctor and get a prescription for an antibiotic. You have 'pink eye.'"

He looks at me, raising the eyebrow over his pink eye, and asks, "But what do YOU have to cure pink eye?"

"We have eye solutions and suspensions. They must be prescribed by a doctor."

"So you don't have anything out here?"

Was I not clear on this, I'm thinking. "No, you need to see a doctor."

Man wanders off, shaking his head as he leaves.

So what happened? When did people start distrusting everything the pharmacist says? At some point somebody somewhere started thinking pharmacists were lying to them and it spread around.

We don't lie. We tell you the honest truth, sometimes even if the truth hurts.

Trust your pharmacist.