Sunday, December 30, 2007

Blog note-

I realize that lately I've been referring to people (doctors, pharmacists, customers, etc.) using the masculine gender (him, his, he, etc.).

I just want to note to all the politically correct police out there that I'm well aware there are plenty of women doctors and pharmacsts. However, it is really a big pain in the ass (and generally sounds pretty stupid) to write he/she, him/her, his/hers all the time instead of just picking one gender.

I don't know if this is correct, but I was taught in school (elementary school, I think) that if you are not referring to any person in particular, you should use masculine pronouns by default. Whether that's 100% correct or not doesn't matter because that's the way I'm going to do it. It just sounds better than saying him/her, and it definitely sounds better than using "them" or "their" when you only mean to refer to one person.

That is all.

Another term for the pharmacy contract

A few weeks ago, I wrote about how I would love to make every customer sign a pharmacy contract before using our pharmacy. I just thought of another term to add to it.

- The pharmacy has the right to charge the customer for wasted time. For example, if the pharmacist explains why a copay is high or a drug is not covered, and you choose not to believe him and force him to call the insurance company, if it turns out the pharmacist's initial explanation was correct, you will be charged a fee for wasting the pharmacist's time.

I figure what to charge could be left up to the discretion of each store. My suggestion would be to charge the patient based on the pharmacist's per-minute salary. If the pharmacist makes $60/hr, you would charge the patient $1 for every minute wasted. Therefore, if some dumbass customer forces you to call the insurance company just so they could explain to you what you already know, and this phone call happens to take 10 minutes, you can charge the patient $10 for time wasted.

Saturday, December 29, 2007

People... Please talk to your doctors!!

I got 2 absolutely idiotic questions yesterday:

1) Customer brought in a prescription for an antibiotic and cough medicine. "Does this cough medicine have Codeine in it? I can't take codeine."

2) Customer brought in a prescription for a 2 week course of Bactrim DS. She had already been given a prescription by another doctor for a 2 week course of Bactrim DS 8 days ago. "This doctor didn't know I was already taking Bactrim. Should I take a second course?"

These are questions that should be asked BEFORE LEAVING THE DOCTOR'S OFFICE!

I want every patient in the world to pay attention to what I'm going to say: TALK TO YOUR DOCTOR!

I know that a doctor can be intimidating. A lot of doctors come across as being too busy to take time to talk to their patients. In addition, many doctors (whether consciously or unconsciously) give off this vibe that they're smarter than you are, they're doctors, and they're judgement should never be questioned, especially by a lowly patient.

However, as a patient, you must get over this fear and intimidation and ask the doctor whatever comes to mind about your therapy. Patients don't realize just how important a role they play in the whole healthcare process. If you have a concern about taking a medication, talk to your doctor about it. Let your doctor know what other kinds of medication you are taking. In addition, don't, UNDER ANY CIRCUMSTANCES, let a doctor write a prescription without telling you what drug he's giving you, and what it is used for.

Looking at my previous examples:

1) This woman went to the doctor looking for cough medicine. The woman knew she couldn't take a codeine product (due to GI intolerance). She knew that many cough medicines have codeine in them. Despite this, she waited until she got to the pharmacy (and actually until we already filled the prescription) before she asked whether the medication had codeine in it. Of course it did, and she would not take it, so we had to call the doctor's office, wait on hold for 5 minutes to speak to a receptionist, only for her to tell us that the doctor was with another patient and would have to call us back. Had she just asked the doctor that simple question before leaving the office, we would have avoided all of this trouble.

2) The woman with the Bactrim script knew she had been on Bactrim before. When she asked me if she should take another course, she said, "I think the new doctor thought I was taking Cipro before, so he wrote me a prescription for Bactrim instead." Then why the fuck didn't you let the doctor know this????? It's fucking asinine to ask the pharmacist this question. I don't know what you're being treated for. Even if I did, I don't have access to whatever susceptibility cultures you might have. What can I do besides track down the doctor and ask him the question you should have asked before you left his office?

This sort of thing pisses me off maybe more than anything else. The worst of them all are the people who are on Coumadin and don't tell their doctors that right off the bat.

Here is a lesson that I want everyone who takes Coumadin to learn:

If you are on Coumadin and you go to a new doctor or any doctor who would have no way of knowing you are currently taking Coumadin, the first words out of your mouth should be, "Hi, my name is so-and-so, I'M ON COUMADIN."

Because so many different medications interact with Coumadin, that knowledge is absolutely critical to a prescriber. All too often, I see Coumadin patients come to our pharmacy with a prescription for Cipro or Bactrim. In almost all cases, they failed to let the prescriber know they were taking Coumadin, and now the responsibility falls on the pharmacist to track down the prescriber and try to get the antibiotic changed.

Basically, the take home points of this post are

1) Don't be afraid to ask your doctor any questions or express any concerns over your therapy.

2) Always know what medications the doctor wrote and ask any appropriate questions BEFORE leaving the office.

3) Patients on Coumadin absolutely have to tell each and every doctor they see that they are taking Coumadin.

If Patients would just adhere to these simple rules, it would save a lot of time, confusion, frustration, and, not to mention, it would cut down on prescribing errors and adverse drug reactions.

Sunday, December 23, 2007

The worst thing is having your professional judgment and decisions questioned and overturned by a non-pharmacist store manager

A little over a month ago, our store was running a coupon promotion. As with any coupon offer, Medicare and Medicaid patients were excluded.

Well... one woman with a long history of being a royal pain in the ass came in and complained that the coupon offer was discriminating against Medicaid patients like herself. I explained to her that it was a federal law and not simply a store policy. She would not hear it. She proceeded to lash out about not only the coupon, but also about how the entire pharmacy staff was "incompetent." She said that her doctor told her that she hates the pharmacy staff and refuses to call in prescriptions to our pharmacy. The doctor supposedly makes an exception for this one woman because it's convenient for her to use our pharmacy. She wanted my name, the pharmacy managers name, the store license number, and any other information she could get so that she could go complain to the state board of pharmacy about how we were treating her.

I called a manager over to the pharmacy counter to help deal with her outburst. This particular manager was a good guy, and he stood up for the pharmacy and staff while telling the woman that the law prevented her from getting the 20% off coupon.

The conflict did not end here though. Unsatisfied, the woman went and complained to the manager of the entire store. Acting under the retarded principle that the customer is always right, the store manager gave her a 20% coupon and apologized for whatever inconvenience she had.

In doing this, the store manager (who knows absolutely nothing about pharmacy) made us all look like assholes. He broke the law in order to please one bitch of a customer who, being on Medicaid, can't afford to do much business with the store anyway.

Why do we even have these laws if they get overturned at the slightest complaint? I brought this to the attention of my pharmacy manager, and he actually took the side of the store manager. His rationale was that it's better to just quell her complaints now before she takes the issue to the board of pharmacy.

I was not at all satisfied with this explanation, and I let him know it. I made a decision... actually it wasn't even a decision since I was simply following the law. When I have absolutely no support from my pharmacy manager and my store manager in backing up what I believe was the correct response to her coupon tirade, it makes it look like I'm the one that was wrong and the moron customer was right.

This wasn't the first issue we've had at our pharmacy where our initial by-the-book judgement was questioned. Almost a year ago, another customer with a long history of being an asshole came in on a Saturday looking for a refill on his insulin. He had no refills remaining, so the pharmacy manager (a different pharmacist than the current one) told him that we'd give his doctor a call for him on Monday morning. He wanted his insulin at that moment and would not wait until Monday. The pharmacy manager asked him if he had any insulin left, to which the customer replied that he had enough for several days. Therefore, since the customer was not in danger of running out of insulin, the pharmacy manager told him that he would have to wait until we got refill authorization from the doctor.

The man flipped out. He started calling the pharmacy manager (Tom) a "pompous asshole" He said that Tom was on an egotistical power-trip, and he threatened to contact the board of pharmacy unless he got his insulin at that moment. Tom simply looked at him and smiled and told him that he will wait until Monday.

After firing off a few more insults (to which Tom kept smiling and gave him some smartass remarks back) the man walked away. During the following week, we got a visit from someone from that Board of Pharmacy. He asked Tom for his side of the incident. Tom told him the entire truth, and amazingly, it actually exactly matched what the customer had told the board. Tom had every right to tell that man we could not fill his precription. However, the guy from the Board of Pharmacy basically told Tom that this customer was "a very demanding man," and in the future, we should pretty much do whatever he wants just to avoid some kind of incident.

That was the stance from the FUCKING STATE BOARD OF PHARMACY!!!! "Just give him whatever he wants." They basically said, "We don't want any problems, so go ahead and break the law so we don't have to deal with it." However, you know that if we dispensed that insulin to him without a prescription, and he somehow had some incident due to a change of dose or medication that we weren't aware of, the Board of Pharmacy would be the first ones to throw us under the bus for it.

How can we use our professional judgement if whenever a customer disagrees with it, they can simply go over our heads and get our decisions overturned? That's not right, and quite frankly, it's dangerous. Otherwise, why bother even having all these dispensing laws?

What made me think of this after all this time was reading the Angriest Pharmacist's post about how he threw out a customer who treated him like shit. It got me to thinking how I'd love to be able to do that with a few of our customers. I've been sworn at, insulted, and borderline humiliated by customers, but if I say the slightest thing back to them, they can run to the store manager and get ME in trouble.

I firmly believe that in order for a pharmacy to be run safely and effectively, it has to be treated as a separate entity from the store. The pharmacy manager should have the final say on any issue that involves the pharmacy. Furthermore, unless a pharmacist's decision is blatantly wrong or endangers the saftey of a patient in some way, the decision should not be overturned if a customer decides to climb the ladder of authority. We cannot practice our profession while worrying that every decision we make will be undermined or overruled by someone above us.

Wednesday, December 19, 2007

Stressed out

Perhaps, I'm still reeling from my horrible Saturday, but all I know is that I've been really stressed out at work lately. We haven't been any busier than usual. There haven't been a lot of problems or asshole customers. I'm just feeling worn out.

On Tuesday, I hardly said a word to anyone all day. Normally, I joke around with my coworkers and talk about sports or whatever else comes up. On Tuesday, I just wanted to be left alone.

Really, I think some of it is the constant stream of questions that our clerks ask us. They can't seem to do anything on their own, and it's really hard to have to hold their hands while trying to do my own job. I just wish they'd start catching onto a few things that they should know how to do.

Ideally, I'd love to personally train each and every one of them. However, I can't do that and work at the same time. It becomes too overwhelming, for me at least. I feel pressure to do everything quickly because I hate falling behind. Therefore, whenever a question comes up, I tend to just go over there and resolve it as quickly as possible instead of taking the time to teach them.

Part of the problem is that most of our clerks just do not catch on quickly to anything. I must have walked on of them through the same thing 10 times, and she still asks me how to do it every time the situation comes up. I feel like screaming to her, "HOW DO YOU STILL NOT GET THIS???" But, I'm sure that wouldn't go over very well.

Another source of stress is just the general interactions I have with my coworkers. When I'm just joking around and busting balls, I'm fine. However, I hate seemingly simple and harmless questions like, "What did you do on your day off?" or "How was your weekend?" I hate those questions because my answer is always the same. "I didn't do anything. I just sat around all day."

Generally (as one can discern from reading this blog), I have nothing worthwhile to do when I'm not working. I haven't been on a date since August. Other than a couple parties, I haven't done much of anything.

Moreover, I hate talking about my personal life. I still haven't met the eHarmony girl yet (although that's probably going to change very soon), but even when I do, and even if it goes incredibly well, I don't want to talk about it. That's always been my way. I hate discussing the things I do on my own time with people who aren't very close friends. I don't like explaining my actions. I don't like giving details. I generally don't want people to know what I think. When I started dating my ex, I didn't admit it to my friends until a few months later (even though they all knew).

I'm not sure why, but I always hold back. Sunday was the last day for one of the girls who worked in our pharmacy for close to a year. She was a really nice girl. I liked working with her a lot. In fact, her pleasant personality kind of made my day many times. However, I could hardly muster up a smile to say goodbye. I didn't want her to know that I cared one bit whether she left or not. That's so stupid because it makes me look like I'm cold hearted, but that can't be further from the truth. I just have a hard time showing and expressing my feelings. The truth is, I'll miss working with her. I wish she didn't have to get another job. I just couldn't express this. I don't really know why. I guess it just feels weird to me.

It's a continual conflict between what's really in my mind and how I actually act. I firmly believe that my true self is this gregarious, super-friendly, thoughtful person who likes to laugh and talk about all sorts of things. However, all anyone ever sees of me is a quiet, reserved, super-serious, and (at times) cold hearted person. I hate that I act like that. I want to let go and just be myself, but I'm so inhibited that it makes it impossible. My inhibitions are so deep set that not even tons of alcohol can cause me to lower them.

These inhibitions have prevented me from reaching the kind of success I should have had in all areas of my life. I always look at basketball as a microcosm of my whole life. Through countless hours of practice I had developed more skills than probably any player who ever came out of my town. Hell, when I was in middle school, I was probably the most gifted ballhandler of any person my age in the entire world. I religiously watched and practiced the drills in the Pistol Pete's Homework Basketball videos. By 8th grade, I had mastered just about all of Pete Maravich's ballhandling drills. I could throw perfect full court behind the back passes. In the open court, I could dribble the ball so well that I was just about unstoppable. I could dribble with either hand faster than just about any other kid my age could run.

As I've stated in a previous post though, I was never a star. I had a few great games. I made for some memorable moments. I drew oohs and ahhs from some coaches and spectators. However, it was always the same story with me...

"He's such a good dribbler and shooter, but he needs to look to score more."

"Mike, you need to shoot more. Stop passing up open shots."

"There's no reason you shouldn't be taking at least 15 shots per game."

"Mike, you need to play with more confidence. Don't worry about missing a few shots."

If any other person possessed the basketball skills I had, they would have DOMINATED everyone. I was afraid to use all of them. I had a million different kind of shots that I could take, and I made them a billion times shooting around in my yard, but I would never take them in games because I felt they were unorthodox. I could have gotten a shot off anytime I wanted to, but I barely shot the ball 10 times per game.

It's just an example of me holding back my true self. I was afraid of how good I could be, so I never allowed myself to be great. That's how my life is. I'm a great and fun person, but I'm afraid to show it.

I have no answers for this, and this long blog entry probably isn't going to provide any either.

Monday, December 17, 2007

The worst kind of employees

I'm becoming convinced that (in general) the worst employees you can hire are ones that don't really need the job. I'll explain...

We have a part time technician. Her husband is some corporate hotshot who gets an annual bonus that is roughly half of my salary. Basically, she doesn't need to work. She does it just to get out of the house and to give herself a little extra spending money. For the most part, she does her job well, although she tends to be a bit of a chatter box, which can sometimes lead to her telling stories instead of working.

Really, the only problem I have with her is that she calls out whenever she feels like it. If she gets up, and it's too cold, she'll call out. If her one of her kids has a sniffle, she'll call out. If she just wants to go shopping instead of come to work, she'll call out.

Maybe in some jobs, this isn't such a huge problem. In a tiny pharmacy, it can ruin your day. We're busy. We need employees. We don't have any built in redundancy. We can't simply just grab a cashier from the front end to replace her. If she doesn't show up, we're down a tech, and unfortunately, she's one of our only techs.

I was about to write that I'm convinced the best employees to hire are the ones who are desperate to work, but even that doesnt' seem true. Yesterday, I listened to one of our clerks complain about all day about how our manager didn't schedule her for enough hours next week and how she really really needs all the hours she can get.

Well, we were incredibly slow yesterday, and we spent half the day sitting around with nothing to do. She was bored, so near the end of the day, she kept asking me if she can leave early.

OK... let me sum that one up... She desperately needs hours. However, she doesn't want to work her full shift. Am I the only one that sees something wrong with this???? I kept telling her to just enjoy how slow it is because we barely ever get days like that. I told her that she's getting paid to basically sit around and do nothing, and I reminded her about how she continually complained about not having enough hours.

None of this mattered. Eventually I got sick of her whining, and I let her go home early. We were so slow that I didn't need her, but that's not really the point.

On a somewhat related note....

There's been a trend in my pharmacy that has to stop. Our company mandates that any employee that works 8 hours must punch out for a half hour lunch break. That means a person working 8 hours must be scheduled for 8.5 hours to accomodate that break. What's going on recently is that our technicians and clerks aren't punching out for their half hour lunch breaks, and instead are simply punching out and going home a half hour early. They still get paid for the 8 hours they worked, and they get to leave early.

This is pure bullshit. When we schedule someone 9-5:30, we expect the person to stay until 5:30. If they leave a half hour early, then we're short a person for that last half hour of their shift... which often ends up being one of the busier times of the day. Moreover, it's not like the person worked non-stop for 8 hours and didn't take a break. We're not crazy busy the entire day (at least not anymore), so it leaves plenty of time for someone to walk out, get a coffee, get a muffin, get a sandwich, etc. Basically, they end up getting paid for their lunch breaks.

This has to stop.

Saturday, December 8, 2007

A pharmacy contract...

It would never fly in the real world, but in my own imaginary pharmacy paradise, I would have every customer who fills a prescription do so only after agreeing to the terms of my pharmacy contract.

Here are some points I would include on this contract (in no particular order because I didn't feel like putting enough thought into this to make it look like an official document)...

In order to make your experience at our pharmacy as pleasant and beneficial as possible, we ask all our customers to abide by certain terms. These terms are designed to help ensure customer safety and privacy, as well as to help the pharmacy abide by federal and state dispensing laws.

1) Customers will be asked their names, date of births, and addresses every single time they drop off a prescription. Even if you've been going to the pharmacy for 20 years, we will still ask this information and require that you give it to us at the time of prescription dropoff. This is done to help ensure the accurate filling and dispensing of prescriptions. If you have a problem with giving out this information at prescription drop-off, find another pharmacy.

2) In the event that you run out of medication and have no refills remaining on your prescription, we can only give out a 72 hour supply of medication. This only applies to long term, necessary medication. That means we will not spot you a couple viagra without a prescription, nor will we give out an entire pack of birth control without approval from a prescriber. This means that CUSTOMERS are responsible for keeping track of refills on their prescriptions. If in the event you run out of refills and wait until you're out of pills before asking us to get approval from a doctor, we reserve the right to tell you "it's your own damn fault."

3) Prescriptions for controlled substances will be allowed to be refilled no more than 2 days before the customer runs out of medication. We will not fill a prescription for Vicodin, valium, xanax, or any other control earlier than this even if the insurance company allows it. Any exception must be verified and approved by the patient's prescriber before dispensing. If the office has already closed or if it's a weekend, the pharmacy will have to wait until the next day the office is open before dispensing.

4) In the even that a customer runs out of refills, the pharmacy can call or fax the prescriber requesting more refills. However, customers must keep in mind that the pharmacy is doing this out of courtesy to the customer, and is in no way responsible if the doctor takes a long time to approve the request or if the doctor decides to deny the request. Ultimately, it's the patient's responsibility to make sure his/her request for a prescription renewal gets approved by the prescriber.

5) There will be absolutely no talking on the cell phone while waiting in line at the pharmacy counter. Any customer talking on a cell phone will not be waited on until he/she hangs up the phone.

6) If you're copay is higher than you expected, it is not the pharmacy's responsibility to call your insurance company and figure out the reason. We may do this as a courtesy in certain situations. However, ultimately it is the customer's responsibility to contact the insuranace company in regards to questions about copays or NDC not covered rejections. The pharmacists have a good deal of knowledge about the general workings of pharmacy insurance companies. However, they do not know the specifics on every single plan that's out there.

In choosing to fill a prescription at this pharmacy, you have agreed to abide by the terms spelled out in this contract. Any complaints or grievances filed by customers who have violated any of the aforementioned terms will be ignored, ridiculed, or (in severe cases) result in the customer being denied future pharmacy services.

Sign Name Here____________________________________________________

(*** I think I'll add more terms as I think of them. Feel free to make suggestions. Together we can come up with the ideal pharmacy contract)

Wednesday, December 5, 2007

Possibly a good sign?

In recent weeks, my ex-girlfriend has made a few attempts at patching up our friendship. Notice I said friendship and not relationship. See... even before we started dating, we were good friends. We became best friends while dating and remained that way for an entire year after we broke up.

We've talked a few times recently, and we still have that good chemistry that we always did. No matter what she or anyone else says, we still have a connection and probably always will. We understand each other better than anyone else, so we're able to talk for hours about just about anything.

Now here's what I think is the positive sign in all this... I really don't have much of a desire to be friends with her.

The hardest thing I ever did in my life was to stop depending on her as a friend and to unlink my life from her's. I'm not joking when I say that it nearly killed me. I was lost. I had no idea what to do. I felt hurt and lonely beyond all comprehension. I begged and pleaded to keep her in my life in one form or another because after all our time together, I just couldn't imagine my life without her.

For a long time, I would take any contact with her as a sign of hope. I would use it as an excuse to continue to hold onto what we once had. Now... she's telling me to call her if I ever wanted to get something to eat with her sometime. 3 months ago, I would have jumped at the opportunity. Now, I couldn't care less.

I don't need her as a friend, and I don't need her in my life at all. I've gone nearly a year without her friendship. It was tough (especially because I had few friends other than her), but I'm still living. Sometimes, I'm not that happy. Sometimes, I reminisce about days gone by. However, I'm pretty sure I've reached the point where I can move on and accept the possibility of a future relationship and future love. If I never saw or heard from my ex-girlfriend again, I'd be OK with it.

I've met a girl on eHarmony that I actually like. We haven't met in person yet, but I've talked to her several times. We get along well, and as long as I don't screw up on our first date, I really think there's potential here. I'm taking things very very slow at the moment, but I'm optomistic.

It's a little weird because it's the first time in pretty much 8 years that I've even considered the possibility of liking someone else. Even if this doesn't work out. Even if the whole thing crashes and burns on the first date, at least I've shown myself that I won't be stuck on my ex for the rest of my life.