Tuesday, August 28, 2007

A Moron and Fake Tits

Customer came to the pharmacy counter today. To protect the names of the "innocent," we'll say her name was Paris Hilton.

Paris: I'd like to pick up a prescription for Hilton.

Tech: (checks bin) There's nothing in the bin for you. (Checks computer) We haven't filled a prescription for you in over a month.

Paris: I called to have it refilled a a couple weeks ago.

Tech: We probably put the medication back to stock. Any prescriptions not picked up in 14 days get credited and returned to stock. What were you looking to pick up?

Paris: I have no idea.

Tech: You don't remember what you were picking up.

Paris: No, but you returned it to stock.

Tech: I know, but how can I fill the prescription for you again if you have no idea what you're here to pick up? (said as politely as could be)

Paris: You don't have to be so rude about it. You put the prescription back to stock. Just fill it again!

The technician in an attempt to avoid lashing out at the moron at the counter came to me for guidance. After several minutes of questions, we figured out it was her acne medication that she wanted to fill again.

I filled the prescription quickly, and since the tech didn't want anything to do with her, I rang her up for it.

Paris: (to me) Did you hear what that girl said to me?.....

Fortunately for her, she never went any further. I was almost hoping she said something to me because I would love to tell her that only a MORON would come to the pharmacy over 2 weeks after asking to have a prescription filled and have ABSOLUTELY NO IDEA what she was looking to pick up. Seriously, what the fuck? It was your prescription!! You knew it was here or else you would have never came to pick it up. You obviously realized you needed the medication that had been sitting in our bins for 2 weeks. If you knew you needed it, how on earth could you not know what you were picking up?

Stupidity has no bounds.

Later in the day, 30 minutes after I was supposed to leave, an attractive woman with HUGE fake tits walked up to the pharmacy with a few questions for me regarding a rash that developed on her tubby son.

First, let me say that this woman looked really good to have a teenage kid.

Secondly, let me set the record straight that I hate fake tits. I hate the way they look, and though I've never felt them, just looking at them gives me everything I need to know that they don't feel to great either. There's just something wrong about them. Even the best boob job looks terribly unnatural. It's almost like (and it basically is) the woman has these 2 obtrussive mounds set on her chest. Real breasts have a natural curve from neckline to bust. Fake tits are like neckline, neckline, neckline, BIG BUMP. I'd rather a girl be small breasted than her to get a boob job.

With that said... It's really really hard to avoid staring at a very attractive woman's large breasts, even if they are fake. Additionally, this woman (as often woman with implants do) was doing everything she could to showcase her augmentations. She was wearing a skimpy tank top that came down to just above her belly button and skin tight pants. She looked basically like she just came from the gym.

Here I am, out in the OTC aisle trying like hell to maintain eye contact with this super hot, huge fake-breasted woman. She's explaining to me that her son's rash is on the skin that is underneath the flabby fat rolls where his stomach meets his waste. She's explaining this to me by exposing even more of her stomach and showing on her body the exact location of the rash would be.

I'm proud to say that I handled myself completely professionally. A lesser man would have snuck a peak at her ample fake cleavage. Just remember that this is another reason why it's good to have me as your pharmacist.... If you're a hot woman, you can ask me questions without worrying about me staring at your rack or your ass.

Monday, August 27, 2007

Refill Authorization Request Forms

Anyone who has worked in a pharmacy knows what the title to this entry refers to. For those who don't know... When a customer calls for a refill on his/her medication and there are no refills remaining, we usually will fax a form over to the doctor's office asking for authorization to refill the prescription.

This usually works very well. However, as you'll see, this can lead to major problems...

Today, CVS called our pharmacy asking for a transfer. They didn't have our prescription bottle, but the patient told them that we needed to transfer his prescription for gabapentin 100mg. I looked in our computer and couldn't find a script for gabapentin 100mg. The patient had always gotten gabapentin 400mg. I didn't think much about the mix up at first. A lot of patients generally have no idea what they're taking and at what dose. I was sure the patient had just made a mistake and told CVS his dose was 100mg instead of 400mg.

I started to give the other pharmacist the info on the script, but once I got down to the directions, both of us kind of paused for a second. The prescription: Gabapentin 400mg, 2 capsules 4 times a day. That's a whopping 3,200 mg of gabapentin per day. It's not unheard of, but it is a pretty large dose. Both the CVS pharmacist and I started to wonder if this was some sort of mistake, so I tried going back to pull the original script. Unfortunately, our software is behind the times, and I was unable to bring up an image of the original RX on my computer. Furthermore, the first fill with those directions was from a couple years ago, and the script was no longer in the pharmacy. The only thing I had was the refill request form that had those directions on it that was approved by the doctor's office.

The CVS pharmacist said that he'd call the doctor's office to double check the dose, and then he hung up. 10 minutes later, he called back to tell me that the office told him the patient should be on Gabapentin 100mg, 2 capsules twice daily. That's a 400mg daily dose.... FAR different than the 3,200 mg dose he'd been getting for years.

I had to know what the hell was going on, so I called the doctor's office looking for an explanation. What I got was some receptionist who couldn't possibly be a nurse considering just how stupid she was. She looked at the chart and told me that since January his dose of Gabapentin has been 400mg per day. I explained to her how shocking this was to me considering the office had approved the refill request for the 3,200 mg per dose in April.

This was her explanation: When we send refill request forms to the office, she looks at the drug, looks at the patient's name, and just signs off on them without the doctor ever looking at them. Thefore, she wasn't at all surprised that she had been approving a dose that was 8 times larger than the one the doctor wanted the patient to be on. She also couldn't understand why we were just a little concerned that the patient had been taking 3,200 mg of gabapentin all along and was now going to be dropped down to 400mg once he picks up the prescription at CVS.

This whole scenario might sound shocking, but I'm willing to bet it happens a lot more often than we'd like to think it does. You can tell just by looking at what's written on the replies that the doctor (or whoever is approving these refills) is just signing off on the refills without even looking at the prescription or the patient's chart. We'll often write notes on the fax forms asking whether a dose or directions haver changed, and we'll just receive a fax back for #30 with 5 refills and absolutely no response to our question. Moreover, you can fax over a request for some kind of cream that the patient hasn't used in 5 years, and we get approval on it. I often wonder if we faxed over a bunch of refill requests for Percocets how many would get approved? I bet if we faxed over 10 requests, at least 4 or 5 would get signed off on.

In any case, after about 5 minutes of explaining to that stupid receptionist why it was very important to me to know whether we screwed up the first time the script was called in or whether it was their mistake that they kept approving these refills, she finally looked back 2 years ago and told me that the patient was, indeed, on 3,200 mg per day at one point. Everything after that was a chain of fuckups on their part. She didn't care though. She still didn't understand what the problem was.

The take away message: If you work in a doctor's office, and are in charge of approving refills, LOOK AT THE FUCKING REFILL REQUEST AND CHECK THE DAMN CHART BEFORE APPROVING IT!!!

Random Facts About Me

I haven't written in almost a week. Quite frankly, I'm running out of things to write about. I guess I just don't have as many crazy stories as other pharmacists, or more likely, I just don't get all worked up about asshole customers as much as other pharmacists. I guess I expect people to be jackasses 99% of the time. In fact, the stuff I remember are the rare times a customer is actually patient and understanding.

Anyways, in an effort to keep this blog going, here are some random facts about me. I'm going to number them, and I'll stop when I feel like it.

1. I like going to the bar and having a few drinks with friends. However, when I get home, I always regret doing so. For one, it takes a lot of alcohol to get me drunk, but only a little bit to induce a hangover. Secondly, I'm ashamed of myself that I require alcohol to have a good time with friends.

2. Speaking of drinks... I would rather drink a margarita or some girly mixed drink than beer any day of the week. Of course, when out with the guys the least manly drink I'll order is a Jack and Coke. Damn myself for worrying about appearance so much.

3. In high school, I memorized Pi out to 75 places, and I still remember it (3.14159265358979323846264338327950288419716939937510582097494459230781640628). This is what I did instead of paying attention in my geometry class.

4. While on the subject of school, I think I only missed one pharmacy class my entire time in pharmacy school. I made it a point to go to every single class.... and sleep through them. My classmates knew me as the kid that slept through every class. Well, at least every class I could. Obviously, you can't sleep through those active participation classes or small discussions. I still managed to get straight A's in school because, as evidenced from my Pi memorization, I can remember a whole lot when I need to. I'd just read the notes 1 time the night before an exam, and I'd be good to go.

5. I love pizza. I can eat a whole medium pizza all by myself. I like think crust pizza, not thick crust. I'm not sure what my favorite pizza is. It depends on my mood. White pizza with broccolli, plain chesse, or pepperoni are my main stays. However, I like a good tomato and basil pizza too. I haven't had really good pizza in a long time. I miss it.

6. I chose to become a pharmacist because I thought it would be an easy way to make decent money. I had no idea what a pharmacist actually did when I decided on my current career. I just thought they counted pills all day and got paid well to do it. Sounded good to me. No one in my family is a pharmacist. I never knew a pharmacist. I rarely took medication. It was kind of a random decision. I could have done well in just about any field. I just picked one.

7. I come off as very very serious, and I am a serious person. However, there's a really silly side of me that nobody ever sees. I make up stories and give personalities to inanimate objects. I also do incredible impressions of Justin Timberlake's voice. He has a TERRIBLE singing voice. He can't really sing high notes. He fakes them by singing them in a whine. Sure, he may be a good looking guy, but don't people hear how awful he sounds??? I miss the days when R&B singers had good voices. Remember how incredible Boyz II Men sounded singing accapella? Those guys could really sing. Timberlake should take notes.

8. I like to read, but I haven't read a book (and finished it) in about 4 years. I have no explanation for this.

9. My favorite television show is Scrubs. Dr. Cox is one of the best characters in the history of television.

10. I'm a pharmacist, but I'm pretty sure that I'll never take any prescription medication for the rest of my life. I don't feel the need to. Some people need to take medication. I don't. I'm not worried about high cholesterol or blood pressure. I don't care if I live to be 100. I just hope that if I do have a heart attack or stroke, it will kill me in one shot, so I don't have to live with any of the after effects.

11. 11 is my favorite number.

Monday, August 20, 2007

He sure told me!

"Shut the hell up!!!," the cranky old man exclaimed to me. This was an order I had no problem following... mostly because I had yet to say anything to the guy.

I'm not exactly sure what happened. From what I gathered from his conversation with our tech, he called in for a refill on 2 medications that had no refills on them. We faxed refill requests to the doctor, but the doctor had yet to approve them upon the cranky old man's arrival at the pharmacy counter.

I fail to understand how this is at all our fault, but regardless of my common sense, the man got "very frustrated" with us. When I heard him say this, I walked over to try to smooth the situation over and to shield the tech from an undeserved verbal assault. I was just about to ask him if he was completely out of the medication, and I was going to offer to give him a couple days worth until the doctor approves the refills. However, before I could even open my mouth, the man threw his hands up in the air, and muttered, "forget about it. I'm leaving."

"Sir, are you out of your medication?," I inquired politely.

"Just forget it. I'm leaving. Shut the hell up!!!," he proclaimed loudly as he stomped away from the counter.

I couldn't even get mad at him. I just wanted to know what the hell just happened.

Saturday, August 18, 2007


All things considered, a good pharmacy intern is probably the most valuable employee in a pharmacy. For those who aren't familiar with pharmacy or the concept of an intern, an intern is a pharmacy school student. The reason why they are so valuable? They can do anything a pharmacist can do except make the final check on prescriptions. An intern can type prescriptions, fill prescriptions, take phone-in scripts from doctor's offices, take prescriptions off the voicemail, transfer scripts in and out of the pharmacy, and even counsel patients under the supervision of a pharmacist.

A few months back, our store had an exceptional intern. He was an extremely bright kid going into his last year of pharmacy school. He had more years of retail pharmacy experience than I did. His clinical knowledge was outstanding, so I felt perfectly at ease allowing him to counsel anyone with a question, and if he was unsure of something, he'd always ask for my help. In addition, he could fill scripts so quickly that he could do the work of 2 great techs. He worked every weekend while he was on rotation, and let me tell you, his presence in the pharmacy made those days a whole lot more manageable.

Now, this kid was above and beyond probably any intern you'll ever meet. However, in my experience, I've never met an intern who wasn't a valuable addition to the pharmacy. With that in mind, I plead with my fellow pharmacists to appreciate the opportunity to work with students. In addition, remember that they are watching and learning from you. The future of the profession lies in the hands of pharmacy students. If you demonstrate hardwork, dedication, and a willingness to help fellow employees and customers, your interns will be likely to follow your example. On the otherhand, if you are lazy, uncaring of patients, and treat the profession as nothing more than an assembly line type job, your interns will either do likewise or, worse, lose respect for you.

Don't believe you can have this kind of effect on a student? The next time you answer a customer's question on a medication take a glance over your shoulder. I guarantee that your pharmacy intern is listening intently to every word you're saying.

Friday, August 17, 2007

Show just a little responsiblity...

Let me pose this question to my few readers out there:

If you were leaving to go on vacation Saturday, and you knew your blood pressure medication did not have any refills, would you wait until Friday night at 7:00 PM before even checking with the pharmacy to see if your doctor refilled it?

I can hear all of you out there screaming out "NOOOOOOOOOOOO!!!!" Of course, you wouldn't wait that long. You'd have to be a complete idiot to do that.

Well, 3 separate customers today came in with this problem. The kicker was when a woman came to the pharmacy at 7:00 PM today saying she was leaving for vacation tomorrow morning. She had called in her refill using the touchtone refill line on Wednesday. Since her prescription had no refills, the automated voice told her the pharmacy would try to contact her doctor to get refills approved. From the time she hung up the phone until 7:00 PM on Friday night, she made no other contact with the pharmacy or her doctor's office to see if her medication was ready.

Genius-lady fully expected her medication to be ready and waiting for her when she arrived at the pharmacy. When we told her that her doctor never had yet to approve the refill, she got pissed off at US. She asked if we had really faxed the request. We showed her that we not only faxed it, but faxed it on both Wednesday and Thursday with no response. Did she get angry at her doctor's office for taking so damn long to approve her refill??? Of course not. She got even more pissed at us that we didn't go out of our way to call her doctor and get the approval by phone.

Listen... We fill close to 3,000 prescriptions per week. Every single day, we fax in the vicinity of 70 refills requests to doctor's offices. There's no well in holy hell we can give each and every one of those requests our diligent, personal attention. I know it may come as a shock to you, but we don't fax your refill request and then stand in front of the fax machine just waiting to get the approval faxed back to us. We fax it, mark that we faxed it, and then forget about it.

Moreover, shit-for-brains never even informed us or her doctor's office that she was leaving for vacation in a few days. Had she called us and let us know we needed to have the approval in a certain time span, we probably would have paid a little more attention to it. If she decided to let her doctor's office know about it, maybe they would have approved it in a timely manner. No... the dumbass just assumed it would be done.

I don't know. Maybe I'm crazy, but if I was leaving on vacation, and I was due for a refill on my blood pressure medication that had no refills on it, I would have started calling both my doctor and the pharmacy on Monday before leaving on Saturday. I would have called both the doctor and pharmacy every single day (maybe multiple times per day) until the refill was approved. I would have taken some personal responsibility and not just trusted MY MEDICATION in the hands of others.

Again... maybe I'm just crazy.

Thursday, August 16, 2007

Nothing a little exercise won't help...

I've been feeling a little down lately for no particular reason. Today, I had the day off, and I finally got off my lazy ass and got some exercise. I don't really like your typical forms of exercise (gym, treadmills, runnings, etc.). To me, doing that stuff is just exercising for the sake of exercising. I need to have some sort of point to my physical activity. Therefore, whenever possible, I get my exercise in the form of sports (usually basketball). Today, I went down to the nearest park and just shot hoops by myself for over an hour.

This simple act does wonders for my mood. I'm happy and full of energy now. Put it this way... I'm almost ready to face the long work day tomorrow... almost.

Fridays always suck at work. For one, we get a big order in on Fridays, which means we have to divide our time between usual pharmacy tasks and putting away the order. With the order comes like 20-30 extra scripts we have to fill in the form of "owes" (we didn't have enough medication the first time we tried filling it, so we had to owe the patient when we get our order). In addition, we have to spend time filling our ScriptPro machine, which by Friday has run out of several drugs.

This brings me to another issue... Automatic Inventory Management, which is a fancy way of saying computerized ordering. Now, I've never worked in another retail pharmacy, so I don't know how this works in other stores, but it ABSOLUTELY SUCKS in our store. Suppposedly the system calculates a reorder point every morning based on the number of units of each drug used over the past 16 weeks. It supposedly factors in average quantities dispensed per week, per day, as well as highest quantities dispensed per week and day. Then it takes into account that we get 2 orders per week and somehow determines a reorder point.

That sounds great, but it doesn't work all that well. When we create an order, incredibly expensive, rarely used stuff like Lovenox, Betaseron, Procrit, Xeloda, and Xifaxin automatically appear on the order, so we always have to go in and manually remove them. On the otherhand, stuff we use a whole shitload of (Lipitor, Singulair, Nexium, generic Vicodin, etc.) never shows up in a high enough quantity. Therefore, we have to go back and manually adjust those quantities too.

This begs the question: What the fuck is the point of computerized ordering if we have to go back and redo the whole damn thing anyway????

With the old system, we always had an order window up on one of our terminals. Every time we used up a bottle of something, we put it on the order. I had the ScriptPro set up so that the low quantity of each drug was basically the reorder point, so all you had to do was print the "cells to refill" list and order the "low quantity" worth of every drug on that list (i.e. Lipitor 10mg's low quantity was set at 1,000, so any time we had less than 1,000 tablets of Lipitor 10mg, it would show up on the "cells to refill" list, and we'd go and order roughly 1,000 tablets of it). It was a pretty simple system. Since we were reordering anything not in ScriptPro as we used it, on the days we had to send an order, all I needed was like 20 minutes to punch in the stuff from ScriptPro.

Now, it takes me over an hour to do the damn order, which is really fucking stupid considering automatic inventory management was supposed to make this easier on us. They keep telling us that it gets better after you've been on the system for a couple months. I'll believe it when I see it.

Wednesday, August 15, 2007

Why do I blog?

I got to thinking why I actually bother to write this blog, and I realized that I have no idea. Many people do this as a release, as a way to vent off the frustrations of the day. This isn't a release to me because I still hold back a lot of the things I'd really like to say. I originally thought that this blog would be a place for me to share funny stories like other pharmacists. The problem is that while I have a lot of funny stories to tell, I don't tell them in a funny way.

So why do I continue posting these unimportant, uninteresting dribbles? I honestly don't know. Quite frankly, the more people that read this, the more uneasy I get about it.... and I've barely revealed anything about myself in my writing.

Do you know that I write, erase, then rewrite my posts over and over again before finally settling on something that is just blah enough to not really offend anyone? The reason: I'm offended by my own thoughts sometimes. I write something, then can't believe that's how I really feel, so I rewrite it, but I'm not really happy about that version either, so I write it again.

Just now, I wrote a whole paragraph and erased it because I didn't like what I was saying. This begs the question... If I can't even be honest in an anonymous blog, how can I ever be honest in any part of my life?

And I just erased another paragraph. This is getting me nowhere. In any case, I'm not sure how much longer I can keep this blog up.

The best part of my day....

When I'm the pharmacist that opens the store, I usually get there 45 minutes to an hour early. I don't do this out of dedication to my job. I do it because the time before the pharmacy opens is, without a doubt, the best part of my day.

At 7:15, the lights are off, the phones aren't ringing, there are no customers in line, no radio, no technicians or other coworkers, and no faxes coming in. It's just me and the soft glow of our flat screen monitors. The only sounds are from the laser printer spitting out prescriptions labels from our refill line and the sounds of our ScriptPro machine filling scripts. There's no rush. There's no pressure. There's no one else to mess up my organization. I'm basically free to do whatever I want.

It almost feels like the sun rises on cue with raising the pharmacy gate at 8:00 AM. I can almost hear a rooster call the second the gate goes up, but instead of a rooster call, it's almost always a phone ringing precisely at 8:00 AM. I swear that there is a whole community of our pharmacy patrons that just sit by the clock with phone in hand waiting to call the pharmacy the second it turns to 8:00. After hanging up that first phone call, I look up and, without fail, a line of at least 3 people just seems to materialize at the registers.

I think that a pharmacy is the only place where people arrive consistently early. If they're told that their prescription will be ready at 10:00 AM, they're at the pharmacy at 9:00. We tell them 30 minute wait time for new scripts, they come back in 15 minutes. However, while the act of getting to the pharmacy is consistently early, the act of calling to have their medication refilled is consistently late. They always wait until the absolute last minute to call for refills, and they're pissed off when they fail to notice there are no refills remaining, and since it's friday at 7:30 PM, their doctor will not be around to approve a refill request until Monday.

That's why I enjoy getting to the pharmacy well before it opens, and even why I don't mind staying a little while after it closes. It's about the only time I can be at work and be completely relaxed.

Monday, August 13, 2007


The first blog entry I ever wrote (on another site, over a year ago) was about my inability to multitask. I was an intern at the time, and I was still learning the ropes of community pharmacy. Basically, I wrote about how I would never be a good community pharmacist because I could not concentrate on one particular task while the phone is ringing, customers are asking questions, the fax machine is going non-stop, and all the other distractions that go on in the retail setting.

Well, a year later, I can proudly say that I've overcome that initial multitasking hurdle. I can now more than adequately handle myself in a community pharmacy. Yes, I still get pretty stressed out when the work and problems start piling up on me, but it doesn't cripple me like it used to. However, this doesn't mean I've conquered my multitasking problem. My inability to multitask extends to my life as a whole.

For example, I can't focus on relationships and/or friendships while I am working full-time as a pharmacist. I put so much focus and energy into my job that I don't have anything left over for anything else. Unlike many other pharmacists that chose the retail setting, I don't believe my job is just about punching a clock. While I may have a set number of hours I'm supposed to work in a week or a day, I don't pay attention to them because to me, I get paid to do a job, and I won't leave unless the job is done to my satisfaction. Since the standards I set for myself are so high, doing the job to my satisfaction means staying late every day, going in early, and even coming in on my days off.

My coworkers think I do this because I have nothing better to do. They think I do this because I love my job, or perhaps it's more likely that they're completely confused that I do this because I show no love for the job at all. I work so hard because I feel a personal obligation to do the job right. It honestly bothers me when someone forgets to order a product for one of our customers. It really bothers me when someone gets one rejection from the insurance and doesn't put in any effort to figure out why. It bothers me when someone doesn't want to deal with some sort of tricky customer or prescription, so they leave it aside for someone else. Meanwhile, the customer comes in and finds out that his/her prescription was never filled due to nothing but laziness on our part.

I feel like I've earned the trust of a lot our customers due to my committment to doing the job right. However, I've sacrificed my personal life for it. It's not even really a sacrifice. It's not my conscious choice to choose work over personal life. It just happened that way. When I was with my ex, I didn't care about work. It was nothing but a paycheck for me. I didn't care what happened when I wasn't there. I didn't want to stay one minute passed the end of my shift, and I certainly would not be anywhere near the pharmacy on my day off. The reason? All my energy was focused on her and us, so I didn't have any left for my job. Now that I'm single, the only thing I have is this job, so the opposite is true.

My view on life is that if you're going to do something, you might as well do it well. Unfortunately, doing well in anything requires my constant attention and focus. Right now, I simply cannot accept being just a mediocre pharmacist. This will make it impossible for me to improve my social life, and it's also why I'm almost at the point where, despite my many positive characteristics, I'm ready to accept that I'll remain alone.

I thought I could teach her something...

Today, a woman came to the pharmacy and picked up her prescription for Toprol XL 50mg. Recently, Toprol XL went generic, so in the name of saving our customers money, we've been dispensing said generic.

No more than 20 seconds after walking away from the counter, the woman came right back. "I usually get Toprol XL. What is this Metoprolol XL?"

Me: "Toprol XL just went generic within the past week or so. Metoprolol XL is the generic for Toprol XL."

Lady: "Who authorized switching to the generic?"

Me: "Generally, once a generic becomes available, we automatically substitute unless the doctor or patient requests otherwise. Generics are exactly the same as the brand medication. The only difference is that they're less expensive."

Lady: "Well, my doctor wrote the prescription for Toprol XL, and he said that even if the medication is the same, generics can have different fillers. I've always gotten the brand, and I want to stick with it."

Me: "Before you make that decision, let me show you something."

This is where I thought I was going to completely blow her mind. I ran back to the shelves, picked out a bottle of Toprol XL 50mg and a bottle of Metoprolol XL 50mg, and ran right back to the counter.

Me: "Here's a bottle of Toprol XL. You can see that it is made by AstraZeneca. Now, here's a bottle of Metoprolol XL. Look, it's also made by AstraZeneca. The company that makes Toprol XL is the one making the generic for it. This isn't almost exactly the same medication. It is the EXACT SAME medication. They just took their Toprol XL and threw a different label on the bottle."

Lady: "I've always gotten Toprol though, and that's what I want."

I was just completely shocked. I didn't even know what else to say to her, so I just took back the bottle and gave her the brand name, which amazingly only cost her $9.20 more, which is still ridiculous considering it's EXACTLY THE SAME.

I'm still utterly confused by it all. Why on earth would someone pay more money for exactly the same thing. The only difference is the freaking label on the bottle (and the tablet looks slightly different because it's not scored). What did this woman think, that AstraZeneca would waste time and money coming up with a different formula to make a generic version of their own drug???

Now, I know that I just wrote an entry about how customers cannot be expected to know very much about medications, and they can't be expected to understand that generics work just as well as brand drugs. However, when I show someone that their "new generic" is made by the same company that makes their trusted brand, and she still doesn't believe they work the same, I have to chalk that up to personal stupidity on her part. What else can it be? It's completely asinine.

Sunday, August 12, 2007

Ignorance is Bliss

Zack De La Rocha of Rage Against the Machine once said (or screamed in typical Rage fashion), "If ignorance is bliss, then knock the smile off my face."

I have to disagree with this sentiment. I wish I could forget some of the things I now know. I wish I could un-open my eyes, so to speak, to the bullshit that I now realize goes on in this world. Maybe then, I wouldn't be up in the wee hours of the morning posting shit on this site. Maybe, in contrast to De La Rocha, somebody could knock a smile back onto my face.

I look at the average people walking around completely oblivious to the things around them. They don't think about much, or at least they don't think very deeply about it.

Here's an example: A lot of people bitch about why drug prices are so damn high. That's one I hear all the time. The pharmaceutical companies are ripping everyone off by making drugs $5, $10, $20+ per tablet. That's such an easy explanation. It puts the blame on the evil pharmaceutical companies. However, the average person doesn't realize that it costs an average of $900 MILLION to bring 1 compound from synthesis to market as a drug. I forget the exact number, but it's something like 1 out of every 10,000 potential drugs actually gets approved by the FDA. That means, drug companies OFTEN spend millions of dollars on drugs that never reach the market, and thus, never make any money for the company. Moreover, the patent on a drug lasts 17 years. This patent starts just after the compound is synthesized. It takes an average of about 10 years to bring a drug from synthesis to FDA approval. That means that the drug company only has about 7 years in order to make back the $900 million it spent on that drug, as well as the multiple millions it spent on failed drugs.

Wait Pharmacy Mike... If it's so hard to make money off drugs, then why do drug companies keep posting record profits? Good question there. That would seem to contradict every thing I've just said. However, if you look at it, only a handful of brand pharmaceutical companies are doing well. You have Pfizer of course, Merck, GlaxoSmithKline, AstraZeneca and I'll even throw in Bristol-Myers Squibb, and maybe one or 2 more I can't think of at the moment. Even these companies have hit some hard times lately. Pfizer lost BILLIONS when it's HDL raising drug torcetrapid was rejected by the FDA. In addition, Zocor going generic has cut into its sales of Lipitor a little. In response, Pfizer has laid off a ton of employees. Merck got hammered when Vioxx was pulled from the market. Bristol-Myers Squibb hasn't been on really steady financial footing for some time now.

What else contributes to high drug prices? Here's an answer no one wants to hear. THE CONSUMER, or more specifically, the consumer that runs, grabs a lawyer, and sues for billions every time a prescription drug causes some sort of adverse reaction. Ask Purdue how they feel about the multibillion dollar lawsuit over supposedly down playing the abuse-potential of Oxycontin. I'm sure Merck would have something to say regarding the suit against Vioxx causing heart attacks. Now I'm not defending Merck for covering up evidence that Vioxx increased the risk of cardiovascular events. That was bad of them. Very bad. However, the risk of these ultra expensive lawsuits is one of the factors as to why drug prices are so high. Basically, whenever a company makes an effective, relatively safe drug, they have to charge the shit out of everyone for it in hopes to make enough money to pay for research and development costs of that drug and other failed drugs as well as future R&D costs. Remember, they only have about 7 years until the patent expires and generics come out.

If you want to get pissed at drug companies, get pissed at generic makers like Watson, Teva, and Mylan. These companies let the Pfizers of the world pay for all the R&D on new drugs, then when the patent expires, they just run 2 bioequivalency studies, and within a few months, they have a blockbuster generic that costs them pretty much nothing to make. Generic Zocor (simvastatin) should cost pennies, yet they charge a pretty hefty amount considering it's a generic.

Here's something that ties into drug costs: A lot of people are complaining about how the FDA keeps approving drugs that have serious health risks or adverse effects. The FDA is doing a shitty job. They should be doing much better everyone says. Well, you want to know why the FDA is doing a shitty job? It's because pharmaceutical companies put pressure on the FDA to approve drugs as quickly as possible. Afterall, the longer it takes for the FDA to approve a drug, the less time the drug has remaining on patent, thus less time for it to make money. This is just one more reason why drug prices are so high. I don't quite remember exactly, but I'm pretty sure that drug companies are actually able to pay the FDA a certain amount of money in order for the FDA to hire more workers, which would help speed up the approval process.

It's not all the FDA's fault that they're terribly understaffed and poorly financed though. Afterall, the FDA is under control of the U.S. Government. Why doesn't the government fund the FDA better? I can't say for sure, but I'd wager that it has something to do with spending billions and billions and billions of dollars on this little war we're inappropriately involved in.

This is what I'm talking about when I say that I wish I had a simpler mind. Most people don't realize that everything is connected. They don't realize that there isn't a simple explanation for everything. To me, it's much more of a curse than a blessing to be able to see all the angles and connect the dots. It would be so much easier to just have something or someone to blame for every little thing that goes wrong in my life or in this world.

Basically, as much as a retard he is, I wish I had a mind like George W Bush. Dubya has such a simple mind. He firmly believes the United States is the greatest country in the world, and does so with no other reasoning other than it's the United States. He spews out democracy, freedom, and liberty with such pride and conviction, but never stops to think what those words really mean. He just knows they're good things. He figured that Sadam Hussain equaled evil, and the fact that he removed Sadam from power justifies the whole Iraq War. He never gave a thought to stability of the region. He never thought that perhaps Iraq doesn't want to be like the United States. In fact, Dubya actually believes with all his heart that the whole world wishes they were just like us. He sees issues as black or white, right or wrong. Dubya does not see the various shades of gray that exist. And you know what? He's a happy person. Nothing can bring him down. Nothing can make him doubt himself or his vision.

I'm jealous of that. Yeah, maybe being a simpleton would get me ridiculed by people like me, but it wouldn't matter. I'd just be able to shrug them off as liberal elite assholes and go on with my happy, oblivious life.

Saturday, August 11, 2007


I started this blog with the idea to rant and rave about all the stupid/hilarious/infuriating shit that happens on a day to day basis in a retail pharmacy. I love reading other pharmacists' blog who do so, and since I have plenty of my own stories, I decided I'd share a little.

Now, I seem to have lost the heart to do so. I don't know why, but I just feel bad getting angry at our customers over this stuff. I laugh hysterically when other pharmacists do it, but I've found out that I just don't like sharing my own stories all that much.

Perhaps it has something to do with customers not knowing anything about how things work behind a pharmacy counter, especially those that don't use a pharmacy all that often. You would say it's common sense for someone to know that a pharmacy needs your date of birth, address, phone number, allergies, and insurance in order to fill a prescription for someone, but you'd be surprised how many technicians I've worked with who still don't understand this concept.

I remember the first day I ever worked in a retail pharmacy. I had just finished my second year of pharmacy school (4th year overall). I knew a lot (compared to my classmates) about medication, but didn't know dick about how stuff actually gets filled. Some guy walked up to the counter while the pharmacist was on the phone and put a prescription on the counter. I swear to you, I looked at the thing as if it was from another planet. I didn't know what to do. I wasn't sure what information I needed to get from him. I wasn't sure what I was allowed to get from him. After looking at the script for about a minute, the guy pulled it out of my hand, turned it over on the counter, and waited for the pharmacist to help him. The pharmacist explained that I was new, and the guy said, "I hope he knows what he's doing."

Now, I'm a pretty smart guy, and I like to think that I have at least a little common sense, but I didn't have the slightest idea what to do with the prescription. Now imagine someone who's never been to pharmacy school (maybe even never went to college), has no idea what the doctor just prescribed them, can't read the prescription, can't even tell if the name on top of the prescription is actually their name, and just generally clueless as to how the pharmacy actually bills the insurance company for this. All this guy knows is that at a pharmacy, he hands a piece of paper to someone, and then magically some time later a medication is ready for him.

Almost all situations where a customer gets angry are due to some sort of misunderstanding. It's not their job to know how prescriptions are filled. It's our job. They don't understand why their insurance company won't cover Crestor but will cover Zocor (generic of course). They don't understand how the generic can possibly be as good as the brand name medication. They think generic medications are no different from store brand foods, makeup, or something else like that. They've never been educated that generic products have the exact same active ingredients in the exact same doses and are tested to ensure they have similar bioavailability (yes, I realize that in some products such as coumadin and synthroid, the generics are not quite the same as the brand, but neither is better or worse, but just different).

Customers also don't realize that we have to put up with the same bullshit from doctor's offices that they do. There is no miracle pharmacy line with receptionists, nurses, and/or doctors waiting on the other end just to answer all our questions and approve all our refill requests. We get put on hold just as long, if not longer than patients do. Half of the time, the second we say we're from the pharmacy, they send us straight to a voice mailbox where we have to leave a message no matter what we were calling about. Moreover, the time when the most people are dropping off new prescriptions is right after everyone gets out of work, which just happens to be precisely when doctor's offices close for the day, and even though we still get prescriptions called in and faxed in from the office after it closes, we'd have a better chance of calling and speaking to the President than we do talking to someone in a doctor's office after hours.

In addition, generally customers know absolutely nothing about drugs. My mother works in healthcare, so I had a little bit of knowledge about which drug is in which product and what the products are for. Most other people don't know anything except what is advertised on TV. For all they know, Tylenol and Motrin are the same. I remember thinking I was a genius when I learned Motrin and Advil both contained Ibuprofen, which I learned was an anti-inflammatory drug, while Tylenol contained Acetaminophen which wasn't good for inflammation. How would you know that stuff without someone teaching it to you, and who could teach it to you besides someone with healthcare training?

This is why even though it can be infuriating spending 10 minutes trying to explain to some old lady that she doesn't need brand name Keflex (true example), I feel like I have to at least be understanding about it. That's why, even though I find it hilarious when other pharmacists write about how people can't even follow very clear and simple directions on their prescription bottle, I feel a little bad doing so myself. Medication is intimidating to a lot of people.

For example, "Take 1 tablet 4 times a day until finished." Those are typical penicillin directions. What can be more basic than penicillin, right? Well, which 4 times a day should he take it? She he take it every 6 hours? Should he wake up in the middle of the night to take a tablet on the 6 hour mark? Will something happen if he misses a dose? Until finished with what? The infection? The tablets? The symptoms? Someone who doesn't know anything about medication and is intimidated by it could conceivably ask all these questions.

Yeah... so that's my state of mind right now. I'm sure I'll write about stupid customers again, but I'll always feel a little guilty doing so. Doctor's offices on the otherhand.....

Tuesday, August 7, 2007

Stressed out...

I don't know how much longer I can put up with the stress of the pharmacy. Maybe I just don't handle stress well. I don't really know. Whatever the reason, I seem to be under more stress than anyone else.

Stress Source: Untrained clerks

Our non-pharmacist employees cannot handle anything more complicated than grabbing a prescription from the bin and ringing it up at the register. Actually, half the time, they can't even do this without incident. Can't find the prescription in the bin; Let's call the pharmacist. Patient has a new insurance card; Let's call the pharmacist to rebill the claim. Patient has no refills; Let's call the pharmacist just to make sure. Of course, they don't just call any pharmacist. They all call me. Therefore, I'm bouncing from place to place to place to place trying to help everyone all the while not getting anything done.

Stress Source: Terrible, lazy pharmacist coworkers

I've already ranted about "one of the world's worst pharmacists" (**then I subsequently removed that rant several months later to maintain anonymity, so this might not make a lot of sense to newer readers). Well, she makes my day a living hell. Today, she worked with me and the young new pharmacist she hates. Well, because she doesn't want to interact with the new pharmacist, she stood on the other side of the pharmacy doing technician tasks all day long. She did not answer the phone once all day. She did not take any doctor's calls. She refused to go to the counter to answer customer questions.

One time, I was in the middle of 3 things that needed to be done 5 minutes ago and the other pharmacist was checking scripts while being on hold with an insurance company. The phone rings, and of course, it's a pharmacy looking for a transfer. The tech who picked up the phone called this out. I was busy. The other pharmacist was busy. Betty (AKA bad pharmacist) was basically doing nothing. She was checking our doctor's fax forms to see if some of them were already called in. This isn't that important, especially in the middle of a busy day. Moreover, it's something that a pharmacist does not need to do. On the otherhand, a pharmacist is needed to transfer a script. Betty did not make even one motion towards the phone. Therefore, I had to drop what I was doing for the 2389430598734250987345 time and pick up the phone for the transfer.

All I wanted to do after that was take the nearest 500 count bottle of Klor-Con 20mEQ and peg her in the head with the force of a Nolan Ryan fastball. You're a fucking pharmacist. You're goddamn job, first and foremost, is to check scripts, take doctor calls, answer patient questions, and transfer scripts. Those are the only things that a pharmacist can do that a technician cannot. If you want to sit around, fax doctors, put away the order, and only process the prescriptions on the refill line, then you should sacrafice your $50+/hour and work for a technician's salary.

The killer was that at the end of her shift (she left on time, while I stayed well over an hour late), she bragged to me about how much work she got done. Yeah, I could get a lot of things done too if I sit in a corner and NOT BOTHER TO DO ANYTHING ELSE! I'm not the only one who realizes how much of a lazy ass she is. Everyone comments about it. She's only been here for 2 months, and half of the customers can't stand her. It just really fucking sucks when you're absolutely killing yourself trying to help out every single person in the pharmacy, while someone who has the exact same job description and salary as you is just sitting around DOING FUCKING NOTHING!!!

Stress Source: Rookie pharmacist who can't make a decision on her own.

Now, I like our recently graduated pharmacist. She's a really nice person. She's smart. She really tries hard to do a good job. These are all commendable traits. However, she simply cannot make a decision on her own, she has to ask me about everything.

"Should we call the doctor on this interaction?"
"The patient wants to know if this and this are OK together; Are they?"
"Do you want me to call the insurance company about this problem?"

Anything that requires her to think a little bit ends up being a question that I have to think a little bit about. Perhaps, I'm being a little harsh because she's only been licensed for a month. I too was hesitant to make decisions when I first got licensed. However, I don't think I was this bad. She says she gets nervous any time she sees our DUR software come up with a "serious interaction." You do want to be careful with those interactions, but you cannot call on every single one of them when you're trying to fill 500 scripts per day. For example, you can't call every single time you get a hyperkalemia warning when a person gets lisinopril and spironolactone at the same time from the same doctor. It's just a waste of time for us. Furthermore, if you absolutely insist on calling, just do so without asking my permission.

I think I just need to get out. I'm tired. I'm stressed out. I spend my entire shift at work swearing under my breath, pulling my hair out, and bashing my head against counters, walls, and shelves. When I get home, I don't have energy to work out or go out.

Life sucks... yeah, that pretty much sums it up.

Wednesday, August 1, 2007

Pharmacy Eutopia

I've been thinking about this for some time now. If you could create the perfect retail pharmacy, what would it be like? I'm going to talk about changes I would love to see in our pharmacy that would make everyone's lives a lot easier.

First of all, the first thing I would want in my dream pharmacy is a receptionist (or 2) to handle all the phone calls. I can deal with long lines at the registers. I can deal with customers asking questions all day. One thing I cannot handle is the GODDAMN PHONE ringing all day long. It never stops! Every time I need time to think in order to solve some problem or look up the answer to some question, the phone rings 20 times. It's never an important phone call by the way. It's never something that actually requires a pharmacist. Most of the time, I go rushing to the phone to find that it's simply someone looking to refill a prescription. Listen people... there's a refill line. It's really easy. You just punch in your prescription number, and the computer will tell you whether you have any refills available or not, and if you do, it will tell you what time you can pick it up. You don't neeed a pharmacist for that, so quit calling me with your prescription numbers.

These receptionists should be pharmacy technicians that simply screen phone calls. They could work in their own little office-like area. Whenever a call goes to the pharmacy, it would ring in that office first. The tech will answer it and determine whether it is truly something that a pharmacist must deal with. Insurance problems, refills, simple questions about whether there is something called in for a customer or not can all be solved without a pharmacist ever hearing a ringing phone. These techs could also handle all the refill requests to doctor's offices as well as prior authorization requests. The only time a phone call goes through to the pharmacy is if it is a doctor's office calling in a script, a pharmacy requesting a transfer, or a customer with a question about medication that can only be answered by a pharmacist. I figure this would cut down the call volume by 80%. Wouldn't it be lovely to not hear the phone ring all day???

Now, let me focus on the work flow. Many pharmacists like to have technicians inputting and filling scripts while the pharmacist just checks them at the end. Personally, I prefer it when a pharmacist enters the scripts into the computer. I apologize to pharmacy technicians, but I simply don't trust you imputting scripts. It's just that I know there are a million little DUR screens, and you can't possibly call me over to check on every single one of them, so there are some you simply have to ignore. I do the same thing. However, I'm trained to know which DUR screens I can ignore. In addition, I know which ones are serious interactions that don't necessarily register in the computer as a serious interaction. A lot of therapeutic duplications slip right by the DUR software. For example, today an insurance company called me asking me why we filled both lovastatin and simvastatin for a patient on the same day. The answer: It didn't present as a serious DUR warning screen, so the tech just blew right by it. When I type a script, I can also check that our Vicodin cash customers aren't filling their scripts 20 days too early.

I do think technicians are very very capable and essential employees in a pharmacy. However, they have no incentive to be as thorough as a pharmacist. Afterall, if something goes wrong, the blame falls on the pharmacist. For that reason, I'd at least like a pharmacist to see all the warnings our software kicks out (note- I'm talking about new scripts here. My receptionist techs are more than able to fill refill scripts because any interaction has presumably already been checked by a pharmacist). Without the other phone call distractions, the pharmacist entering scripts should be able to call doctors any time a script needs clarification or when there is an interaction the doctor needs to know about.

Technicians would take care of all the filling duties. That means, they'd organize the labels off the printer, pull the drug from the shelves, fill the script, then place it in an area for the pharmacist to check. This would probably take 2 technicians. One would organize the labels and pull the drugs. The other would fill and set them up to be checked.

So keeping track here... we have 2 technicians handling phone calls and 2 handling filling. One pharmacist is typing prescriptions and 1 pharmacist is checking scripts. 4 techs to 2 pharmacists. We're still within that nice 2:1 tech to pharmacist ratio (can be 3:1 if one is nationally certified).

Moving to the front counter (register/drop-off area). You technically just need 2 clerks to work here. All they have to be able to do is pull the script from the bin and ring it up. Not too difficult. It's also not too difficult to get the necessary information on new scripts. No matter how busy your pharmacy is, you should only need 2 people ringing out customers. Any problems that might arise at checkout can be resolved by the 3rd pharmacist. This pharmacist will answer any customer questions, provide medication counseling, help customers choose OTC drugs, and generally handle any problems that arise at the register. This pharmacist will kind of be like a free-safety in football, surveying the pharmacy and going where he is needed at that particular time.

So, if you're scoring at home.... that's 3 pharmacists, 4 technicians, and 2 clerks for a 6:3 non-pharmacist to pharmacist ratio. Not bad. The pharmacists and technicians would rotate positions either on a daily basis or every couple of hours as to not get stuck doing one thing for too long.

This example is from my pharmacy which fills roughly 2800 scripts per week. Obviously slower stores would have fewer pharmacists and technicians to work with. However, the lower volume would probably still allow this to work. You would just need to combine a few jobs. Furthermore, I'm only talking about having that full staff during the 9 to 5:30 regular doctor's office business hours. Before 9 and after 5:30, you could decrease staff.

Now that I think about it... this actually isn't entirely unfeasible. You would need 4 good, experienced technicians though, which can be very hard to come by. If I couldn't have all this though, I'd just love to have that receptionist tech to handle the phone calls. I hate the phone with a white hot blinding fury.