I think 30 years from now when I look back on my life, I'll point out 2008 as a major turning point for me. I have no idea where my life is going from here on out, but I do know that it will be in an entirely different direction than the one I was going when I started this year.
Let me recap my year:
- In January and February, I attempted to date eHarmony girl. It was my first serious attempt at dating someone since I broke up with my ex. Nothing much came out of this attempt, but it was an attempt nevertheless. Of course, the main reason why nothing came out of the attempt was because I was still in love with my ex-girlfriend. I was merely trying to date eHarmony girl as a way to force myself to get over her. It didn't work.
- After the whole eHarmony girl thing fell through, I spiraled into a depression of sorts. I was still convinced I was madly in love with my ex, and I still thought that some way, some how, we'd end up together. In other words... After being broken up for more than 2 years, I was completely delusional.
- It all hit rock bottom in May. At that point, I completely miserable. I had stopped exercising. My diet was filled with fatty foods. The combination of not exercising and eating like crap made me gain weight. I was absolutely sucking at basketball because I was so out of shape. In addition, I became convinced the world as we know it would soon end. All these things added up to me hating my life, hating my job, and hating everything and everyone.
- May marked the true turning point of the year (and possibly my life). That was when I hung out with my ex for the first time in over a year. It was then that I realized that I no longer needed her in my life. It made me realize that I had wasted 2 years of my life pining over someone that no longer existed. I was ready to put the past behind me... FINALLY!
- The rest of the year has been spent trying to figure out who I really am. What do I really want out of life? After spending so long regretting a failed relationship, did it ever dawn on me that perhaps I never really wanted a relationship in the first place?
Everyone needs to experience a serious relationship at least once in their lives. Most people make it their life long goal to find a significant other and start a family. However, some people just aren't wired in that way. I thought I was. I was headed on that track. I thought I was happy with it, but if I was happy, why did I let my relationship end? I had so many opportunities to straighten things out and get back together with her. She basically asked me on several occasions if I wanted to get back together, and I shot her down. If she was the most important thing in my life, then why did I keep turning her away?
The more I think about it, it becomes clearer and clearer to me that I'm just not a relationship kind of person... and I mean relationships of any kind. I'm only marginally interested in my family. I don't really care to have a lot of friends. I need a lot of time to myself. I like waking up alone, and I like going to sleep alone. I like not having to run it by someone if I want to go buy something for myself. I like having complete control over everything in my apartment.
That's not to say that I always like being alone. Yes, sometimes I get really bored, and sometimes I wish I had someone to talk to. That's really all I desire out of other people though. I don't really want to share in anyone else's hopes and dreams. I don't want to live with someone. I don't really have much of a desire to have a family. I just want to be able to occasionally talk to someone and hang out. Maybe that's selfish on my part. I guess I don't really care. It's just the way I am.
That's where I am right now. I'm just happy being single. I've gotten into a real exercise routine (weight lifting, cardio, etc.), and I've significantly cleaned up my diet. My goal is to be under 10% body fat by spring... and that's really the only thing I'm focused on at the moment. I'm not worried about dating. I'm not worried about whether I'm too old to be doing certain things. I just do what I want to do. It's nice. I'm content.
Who knows what the future may bring now? Maybe some girl will come along and take my breath away (yes... I did use that corny line). I've decided not to go out looking for it though. If it happens, it happens. If not... Oh well.
Monday, December 29, 2008
Friday, December 5, 2008
A Tiny Pet Peeve
As is the case with most retail pharmacists, I don't get a lunch break. Luckily, I work in a store that is allowed enough pharmacist hours for me to be able to sit down and eat my lunch (usually a sandwich) relatively uninterrupted. I'll still answer customer questions. I'll still pick up the phone if there's no one else around. However for the most part, I get about 10 to 15 minutes of relative peace. Then it's back to the grind again.
I'm not complaining about this at all. I'm used to it and perfectly fine with it by now. However, our full-time technicians do get a 30 minute lunch break (as they rightfully should). It just bothers me a little bit when our lead tech punches out for her lunch and then comes back to the pharmacy for her entire 30 minute break.
When the phone is ringing non-stop and a line is forming at the registers, it's a little annoying to look around for some help and see our lead technician just sitting down in the back balancing her checkbook and text messaging her friends. Sometimes, I just feel like yelling out, "I'm stuck on hold, and everyone else is at the registers. Can you please pick up the phone that has been ringing for the past 2 minutes?" Of course, I can't ask her to do that though because she's not officially at work during this time.
I'm not complaining about technicians getting lunch breaks. They deserve and should definitely get them. However, I just ask that they please find somewhere else to spend those 30 minutes. Go out to your car. Go to the store's breakroom. Just get the hell out of the pharmacy. If I'm working my ass off, and I see someone just sitting around doing nothing, I don't care that you're not officially on the clock. I'm going to be mad.
Maybe it would be different if our pharmacy was a little more spacious. However, because we're so cramped, there's absolutely no way that someone could sit down and do nothing for 30 minutes without being in the way. Our store has a nice break room. It's quiet, and I imagine it would feel much more like a break if you were out of the pharmacy for those 30 minutes.
It may be a tiny thing, but it would make me just a little bit happier.
I'm not complaining about this at all. I'm used to it and perfectly fine with it by now. However, our full-time technicians do get a 30 minute lunch break (as they rightfully should). It just bothers me a little bit when our lead tech punches out for her lunch and then comes back to the pharmacy for her entire 30 minute break.
When the phone is ringing non-stop and a line is forming at the registers, it's a little annoying to look around for some help and see our lead technician just sitting down in the back balancing her checkbook and text messaging her friends. Sometimes, I just feel like yelling out, "I'm stuck on hold, and everyone else is at the registers. Can you please pick up the phone that has been ringing for the past 2 minutes?" Of course, I can't ask her to do that though because she's not officially at work during this time.
I'm not complaining about technicians getting lunch breaks. They deserve and should definitely get them. However, I just ask that they please find somewhere else to spend those 30 minutes. Go out to your car. Go to the store's breakroom. Just get the hell out of the pharmacy. If I'm working my ass off, and I see someone just sitting around doing nothing, I don't care that you're not officially on the clock. I'm going to be mad.
Maybe it would be different if our pharmacy was a little more spacious. However, because we're so cramped, there's absolutely no way that someone could sit down and do nothing for 30 minutes without being in the way. Our store has a nice break room. It's quiet, and I imagine it would feel much more like a break if you were out of the pharmacy for those 30 minutes.
It may be a tiny thing, but it would make me just a little bit happier.
Saturday, November 22, 2008
Something I Forgot To Mention From My Crappy Day
I had the pleasure of being lectured by a physician about a drug interaction. It was regarding Zithromax and Coumadin.
Basically it started out with the doctor calling in a prescription for a Zpak for a patient who is taking Coumadin. This comes up as a major interaction in our computer system and seeing that the patient had never taken the two of them together and the Zpak was from a different prescriber than the Coumadin, I wanted to call the office to make sure if the doctor calling in the antibiotic was aware.
I must have hit a nerve with this doctor because, amazingly, I ended up speaking to him directly. "Name one antibiotic that doesn't potentially raise the INR. Azithromycin is not like the other macrolides. It's not like Biaxin or Erythromycin. Those drugs I would absolutely avoid in a Coumadin patient as well as any patient taking statins such as Zocor. I've never had a single problem with Zithromax."
He wouldn't allow me to get in a word. All I could say was "Yes, I agree," and I repeated it over and over again.
You see... The doctor is correct. Zithromax (azithromycin) isn't like the other macrolides. It doesn't have the same cytochrome P450 interactions, and it generally is much safer to use in patients taking Coumadin than the other macrolides. However, there are a number of case reports where the INR was elevated following a course of azithromycin. The mechanism is unclear (azithromycin may inhibit p-glycoprotein), and a good pattern could not be established. These case reports do show that there is some risk. Moreover, I actually worked for a little bit in a Coumadin clinic, and I've seen a patient's INR increase after getting a ZPak. It may be the safer choice, and in general, I don't mind seeing azithromycin used in Coumadin patients as long as the patient's INR is checked shortly after, and the patient is advised to monitor for signs and symptoms of bleeding. However, if it's possible to treat someone just as effectively with a different antibiotic, I'd rather see that.
And that was the case in this situation. Before calling the doctor, I asked the patient what he was getting the antibiotic for, and he said he had a cold. What do we know about colds? The common cold is caused by a virus. In fact, well over 90% of all upper respiratory tract infections are viral. Therefore, an antibiotic really isn't appropriate, especially in this case where the chosen antibiotic has the potential to increase the patients risk for bleeding.
Unfortunately, I'm not assertive enough and the doctor was too pushy to allow me to explain my reasoning for calling him about the interaction. All I could say was that I understood and agreed with what he was saying, but their still was some risk. If he wanted to stay with the Zpak, I wouldn't have much of a protest. I just wanted to make sure that he was aware of the situation.
After he was done lecturing me, he changed the patient to Amoxicillin. He and I both knew that he was simply giving out an antibiotic to make the patient think he was doing something to treat his cold. It didn't really matter which antibiotic he chose because the patient was going to get better in a couple days anyway. A ZPak is just so easy to write for, and with its once daily dosing, it's easy for patients to take.
That could lead to another point about overusing antibiotics, especially broad spectrum ones like azithromycin, but I'll save that for perhaps another day.
Basically it started out with the doctor calling in a prescription for a Zpak for a patient who is taking Coumadin. This comes up as a major interaction in our computer system and seeing that the patient had never taken the two of them together and the Zpak was from a different prescriber than the Coumadin, I wanted to call the office to make sure if the doctor calling in the antibiotic was aware.
I must have hit a nerve with this doctor because, amazingly, I ended up speaking to him directly. "Name one antibiotic that doesn't potentially raise the INR. Azithromycin is not like the other macrolides. It's not like Biaxin or Erythromycin. Those drugs I would absolutely avoid in a Coumadin patient as well as any patient taking statins such as Zocor. I've never had a single problem with Zithromax."
He wouldn't allow me to get in a word. All I could say was "Yes, I agree," and I repeated it over and over again.
You see... The doctor is correct. Zithromax (azithromycin) isn't like the other macrolides. It doesn't have the same cytochrome P450 interactions, and it generally is much safer to use in patients taking Coumadin than the other macrolides. However, there are a number of case reports where the INR was elevated following a course of azithromycin. The mechanism is unclear (azithromycin may inhibit p-glycoprotein), and a good pattern could not be established. These case reports do show that there is some risk. Moreover, I actually worked for a little bit in a Coumadin clinic, and I've seen a patient's INR increase after getting a ZPak. It may be the safer choice, and in general, I don't mind seeing azithromycin used in Coumadin patients as long as the patient's INR is checked shortly after, and the patient is advised to monitor for signs and symptoms of bleeding. However, if it's possible to treat someone just as effectively with a different antibiotic, I'd rather see that.
And that was the case in this situation. Before calling the doctor, I asked the patient what he was getting the antibiotic for, and he said he had a cold. What do we know about colds? The common cold is caused by a virus. In fact, well over 90% of all upper respiratory tract infections are viral. Therefore, an antibiotic really isn't appropriate, especially in this case where the chosen antibiotic has the potential to increase the patients risk for bleeding.
Unfortunately, I'm not assertive enough and the doctor was too pushy to allow me to explain my reasoning for calling him about the interaction. All I could say was that I understood and agreed with what he was saying, but their still was some risk. If he wanted to stay with the Zpak, I wouldn't have much of a protest. I just wanted to make sure that he was aware of the situation.
After he was done lecturing me, he changed the patient to Amoxicillin. He and I both knew that he was simply giving out an antibiotic to make the patient think he was doing something to treat his cold. It didn't really matter which antibiotic he chose because the patient was going to get better in a couple days anyway. A ZPak is just so easy to write for, and with its once daily dosing, it's easy for patients to take.
That could lead to another point about overusing antibiotics, especially broad spectrum ones like azithromycin, but I'll save that for perhaps another day.
Friday, November 21, 2008
As Predicted, It All Evened Out
Wednesday was a great day at work for me. I predicted that my next day would probably be pretty shitty to balance things out. Yup.
I knew things were going to be bad even before I left my apartment this morning. When I pulled the laces tight to tie my shoes, they broke right off. No big deal I thought. I'll just take the laces down a loop and tie them from there. Once again, they broke. I was running a little late and had no time to tear apart my apartment looking for new shoelaces, so I brought them down one more loop, knotted both ends and went to work with my left shoe functioning basically as a slipper. Great start.
Within 5 minutes of walking into the pharmacy, everything started to go wrong. I spent an inordinate amount of time on the phone today trying to clarify poorly or incorrectly written prescriptions. I got a whole bunch of weird insurance rejections that I had never seen before, and I had to call to get those clarified. One customer had Lumenos insurance, and it literally took me 30 minutes to get 3 claims through due to a seemingly never ending string of "host processing errors."
A little later in the day, I had to apologize to a customer for one of Betty's prescription errors. It wasn't major (we gave her the wrong box of syringes), but I felt bad about it because I don't like it when the pharmacy makes any kind of error. Betty laughed about it. I still don't quite understand the humor in the situation.
Later, one of our other stores called to ask if we had any Fragmin in stock. Luckily, we had just ordered a box a day before to fill a Fragmin script for someone else, so we did have a few syringes. I let the other pharmacist know this, and she said she'd send the customer over with the prescription. About an hour later, a new customer to our pharmacy showed up with a prescription for Fragmin. As I was told over the phone, it was for more than we had in stock, but we had enough to get the customer through the weekend. Therefore, we dispensed what we had and ordered another box for Monday. The customer was happy.
About an hour later, another new customer showed up with... you guessed it... a Fragmin prescription. We had already given out all our Fragmin, but when we relayed this information to the customer, she told us that another pharmacist called and checked to see if we had it in stock before she came. Yup... The first Fragmin customer wasn't the one I was alerted to on the phone. The other pharmacist had been talking about this second customer.
Now, we're a pretty busy pharmacy by our company's standards. We fill about 2,300 scripts per week (which is down 20% from a couple years ago). Therefore, we see a wide variety of prescriptions. Do you know how many Fragmin prescriptions we received in this calendar year? Three! All three were presented to our pharmacy within the last 3 days. I never thought in a million years that two customers would come to our pharmacy looking for Fragmin on the same day. To further illustrate how rare Fragmin is, the customer had checked half a dozen pharmacies and came up empty on all of them. It's just not a popular drug, and most pharmacies don't stock it due to its very high price.
We ended up calling an on-call doctor to get the prescription changed to Lovenox, which we still didn't have the entire quantity on. The whole situation was frustrating to all parties involved (the patient, the doctor, and us).
Our clerks spent most of the day acting like they never worked in a pharmacy before. I have a lot of patience when it comes to helping them figure out a tricky insurance or helping them handle difficult, hard to understand customers. However, when they scream out "I NEED A PHARMACIST UP HERE!!!", and I go running to the front expecting to handle some kind of emergency only to find that they accidentally clicked onto a different window than the one our pharmacy software is on, I get quite annoyed. If you've been working in the pharmacy for a year and still mess up 50% of the time at taking a prescription number and putting in a refill, perhaps you should find a different department to work in.
In addition, when someone approaches the counter and says, "I have a question," please don't immediately scream for the pharmacist. Seventy-five percent of the time the customer simply wants to know something as trivial as which aisle the vitamins are located or where the restrooms are. You don't need a pharmacist license to point your finger to the desired section of the store.
At the end of the day, I knew alcohol would be in order for tonight. As I finish this post, I'm halfway through a 6-pack of Killian's. No, it's not healthy (or classy like scotch), but it suits me tonight.
I knew things were going to be bad even before I left my apartment this morning. When I pulled the laces tight to tie my shoes, they broke right off. No big deal I thought. I'll just take the laces down a loop and tie them from there. Once again, they broke. I was running a little late and had no time to tear apart my apartment looking for new shoelaces, so I brought them down one more loop, knotted both ends and went to work with my left shoe functioning basically as a slipper. Great start.
Within 5 minutes of walking into the pharmacy, everything started to go wrong. I spent an inordinate amount of time on the phone today trying to clarify poorly or incorrectly written prescriptions. I got a whole bunch of weird insurance rejections that I had never seen before, and I had to call to get those clarified. One customer had Lumenos insurance, and it literally took me 30 minutes to get 3 claims through due to a seemingly never ending string of "host processing errors."
A little later in the day, I had to apologize to a customer for one of Betty's prescription errors. It wasn't major (we gave her the wrong box of syringes), but I felt bad about it because I don't like it when the pharmacy makes any kind of error. Betty laughed about it. I still don't quite understand the humor in the situation.
Later, one of our other stores called to ask if we had any Fragmin in stock. Luckily, we had just ordered a box a day before to fill a Fragmin script for someone else, so we did have a few syringes. I let the other pharmacist know this, and she said she'd send the customer over with the prescription. About an hour later, a new customer to our pharmacy showed up with a prescription for Fragmin. As I was told over the phone, it was for more than we had in stock, but we had enough to get the customer through the weekend. Therefore, we dispensed what we had and ordered another box for Monday. The customer was happy.
About an hour later, another new customer showed up with... you guessed it... a Fragmin prescription. We had already given out all our Fragmin, but when we relayed this information to the customer, she told us that another pharmacist called and checked to see if we had it in stock before she came. Yup... The first Fragmin customer wasn't the one I was alerted to on the phone. The other pharmacist had been talking about this second customer.
Now, we're a pretty busy pharmacy by our company's standards. We fill about 2,300 scripts per week (which is down 20% from a couple years ago). Therefore, we see a wide variety of prescriptions. Do you know how many Fragmin prescriptions we received in this calendar year? Three! All three were presented to our pharmacy within the last 3 days. I never thought in a million years that two customers would come to our pharmacy looking for Fragmin on the same day. To further illustrate how rare Fragmin is, the customer had checked half a dozen pharmacies and came up empty on all of them. It's just not a popular drug, and most pharmacies don't stock it due to its very high price.
We ended up calling an on-call doctor to get the prescription changed to Lovenox, which we still didn't have the entire quantity on. The whole situation was frustrating to all parties involved (the patient, the doctor, and us).
Our clerks spent most of the day acting like they never worked in a pharmacy before. I have a lot of patience when it comes to helping them figure out a tricky insurance or helping them handle difficult, hard to understand customers. However, when they scream out "I NEED A PHARMACIST UP HERE!!!", and I go running to the front expecting to handle some kind of emergency only to find that they accidentally clicked onto a different window than the one our pharmacy software is on, I get quite annoyed. If you've been working in the pharmacy for a year and still mess up 50% of the time at taking a prescription number and putting in a refill, perhaps you should find a different department to work in.
In addition, when someone approaches the counter and says, "I have a question," please don't immediately scream for the pharmacist. Seventy-five percent of the time the customer simply wants to know something as trivial as which aisle the vitamins are located or where the restrooms are. You don't need a pharmacist license to point your finger to the desired section of the store.
At the end of the day, I knew alcohol would be in order for tonight. As I finish this post, I'm halfway through a 6-pack of Killian's. No, it's not healthy (or classy like scotch), but it suits me tonight.
Wednesday, November 19, 2008
Follow Up on Basketball and a Little Bit About My Good Day At Work
I didn't end up playing. Not because I didn't want to play, but rather the team had picked up a few extra players to replace me. Therefore, while I have a spot on the roster, there's kind of too many players showing up for the games. In short, they don't need me, and my presence would just serve to thin out everyone's minutes.
Like I said, it was my decision, and I'll have to live with it. It will probably end up saving me a lot of stress in the long run. I won't have to worry about getting all pissed off at myself after missing a few jumpshots.
On another note...
Have you ever had one of those days where you just knew that you did a really good job? I mean, I'm sure that most people feel like they do a good job at work, but we all have those days where we just really feel more on our game than usual. That's how I felt today. For every problem, I had the best solution. I was quick and efficient. I helped a number of customers. I even had the best one liners when joking around with my coworkers. It just felt like everyhing went right all day long.
Of course... That means my next day at work will probably be pretty shitty to balance out this one. However, I have a day to relish the feeling of this good day.
Like I said, it was my decision, and I'll have to live with it. It will probably end up saving me a lot of stress in the long run. I won't have to worry about getting all pissed off at myself after missing a few jumpshots.
On another note...
Have you ever had one of those days where you just knew that you did a really good job? I mean, I'm sure that most people feel like they do a good job at work, but we all have those days where we just really feel more on our game than usual. That's how I felt today. For every problem, I had the best solution. I was quick and efficient. I helped a number of customers. I even had the best one liners when joking around with my coworkers. It just felt like everyhing went right all day long.
Of course... That means my next day at work will probably be pretty shitty to balance out this one. However, I have a day to relish the feeling of this good day.
The Urge to Look Back
Several months ago I made a decision: The only way I could move forward with my life was to let go of most of the people and things that held me back. I stopped talking to most of my old friends. I made it a point to stop going to places and doing things that were out of character and against my own values. I figured that I had lived a lie for most of my life. I spent so much energy trying to conform to what I thought others wanted me to be.
So far, this approach hasn't brought me a great deal of happiness. In the absence of most of my friends, I pretty much just sit around my apartment on my days off. To say I'm bored is an understatement. However, I don't find myself feeling miserable any more. I don't hate myself for failing to live up to others' expectations. Moreover, I know that I now have the opportunity of forming new friendships and new relationships with people that are truly compatible with me. I'm nothing like most of my old friends. I'm an intellectual. I like to think and learn. I have a great interest in current events. I'm also, admittedly, a dork. I like sitting around playing video games. I don't like bars and clubs. I'm not big on parties. I don't have the same taste in women as my friends do (meaning that I don't go after a girl just because she's hot).
It's not that I think my friends are bad people. Not at all actually. Most of them are really good people. They're just not like me. I really never should have been friends with them in the first place. We have nothing in common... except I was very good basketball player. I'm a reserved, video game playing, straight A, science geek who just happens to be a really good athlete. Basketball was my ticket into the cool guy clique. It was my identity in middle school and high school. Hell, it was the one area where I stood out. It was an area that people recognized my strength. Even at college, I'd go to the gym and despite all the tall, athletic looking guys that were around, I was the one that people wanted to play with. I was the one that they tried to figure out how to shut down. I was the kid with the deadly jumpshot. All 5'9" 160 pounds of me. It made me feel good... One of the only things that did.
Earlier this year, I wrote about how I had played really poorly in my summer basketball league. I wrote about how I no longer had my quick first step. I no longer was able to explode to the hoop and finish strong. Even my jumpshot was failing me. I was completely miserable. I knew the reason my game had declined. I knew that standing on my feet for 10 and 12 hour days was ruining my athleticism. I didn't have the time or energy to keep in shape, so my game suffered because of it. In most people, that's just a part of growing up. To me, it was heart breaking. I felt like I lost my identity. There were so few things that I did really well, and losing my basketball ability was a big blow to my self esteem.
That's when I decided I had to give it up. I had to step away from the game I loved because it wasn't just a game to me anymore. I was letting it define me, and it wasn't healthy. I didn't give it up entirely. After all, basketball is still pretty good exercise. I'd still go down to a local park and shoot hoops several days per week during the summer. If some other people happened to show up, I'd gladly play some pick up games with them. However, I vowed I wouldn't play in any more leagues.
This brings me to my point... My former team's first game in the winter basketball league is tomorrow night. I told them that they could put my name on the roster, but I'd only play if they were short players. Now, I'm fighting the urge to go play tomorrow night. I really want to. I love basketball. However, it brings out the worst in me. If I play poorly, I'll go right back to hating myself. However, if I play well, I'll be incredibly happy, but I'll hate myself for being that happy over a stupid game.
I'm 26 years old. I basically have no true friends. I don't have a girlfriend or any prospects. I get very little happiness out of my existence, and the thing that makes me most happy is knocking down 3-pointers in a meaningless basketball game. It's sad.
This was my decision though. I have to live with it. It's not easy though, especially since both college and NBA basketball are starting up. Watching basketball gives me the urge to play. This is part of the whole moving on process though, so I'm going to try not to give in to that urge. I have a feeling I'm not going to be successful.
So far, this approach hasn't brought me a great deal of happiness. In the absence of most of my friends, I pretty much just sit around my apartment on my days off. To say I'm bored is an understatement. However, I don't find myself feeling miserable any more. I don't hate myself for failing to live up to others' expectations. Moreover, I know that I now have the opportunity of forming new friendships and new relationships with people that are truly compatible with me. I'm nothing like most of my old friends. I'm an intellectual. I like to think and learn. I have a great interest in current events. I'm also, admittedly, a dork. I like sitting around playing video games. I don't like bars and clubs. I'm not big on parties. I don't have the same taste in women as my friends do (meaning that I don't go after a girl just because she's hot).
It's not that I think my friends are bad people. Not at all actually. Most of them are really good people. They're just not like me. I really never should have been friends with them in the first place. We have nothing in common... except I was very good basketball player. I'm a reserved, video game playing, straight A, science geek who just happens to be a really good athlete. Basketball was my ticket into the cool guy clique. It was my identity in middle school and high school. Hell, it was the one area where I stood out. It was an area that people recognized my strength. Even at college, I'd go to the gym and despite all the tall, athletic looking guys that were around, I was the one that people wanted to play with. I was the one that they tried to figure out how to shut down. I was the kid with the deadly jumpshot. All 5'9" 160 pounds of me. It made me feel good... One of the only things that did.
Earlier this year, I wrote about how I had played really poorly in my summer basketball league. I wrote about how I no longer had my quick first step. I no longer was able to explode to the hoop and finish strong. Even my jumpshot was failing me. I was completely miserable. I knew the reason my game had declined. I knew that standing on my feet for 10 and 12 hour days was ruining my athleticism. I didn't have the time or energy to keep in shape, so my game suffered because of it. In most people, that's just a part of growing up. To me, it was heart breaking. I felt like I lost my identity. There were so few things that I did really well, and losing my basketball ability was a big blow to my self esteem.
That's when I decided I had to give it up. I had to step away from the game I loved because it wasn't just a game to me anymore. I was letting it define me, and it wasn't healthy. I didn't give it up entirely. After all, basketball is still pretty good exercise. I'd still go down to a local park and shoot hoops several days per week during the summer. If some other people happened to show up, I'd gladly play some pick up games with them. However, I vowed I wouldn't play in any more leagues.
This brings me to my point... My former team's first game in the winter basketball league is tomorrow night. I told them that they could put my name on the roster, but I'd only play if they were short players. Now, I'm fighting the urge to go play tomorrow night. I really want to. I love basketball. However, it brings out the worst in me. If I play poorly, I'll go right back to hating myself. However, if I play well, I'll be incredibly happy, but I'll hate myself for being that happy over a stupid game.
I'm 26 years old. I basically have no true friends. I don't have a girlfriend or any prospects. I get very little happiness out of my existence, and the thing that makes me most happy is knocking down 3-pointers in a meaningless basketball game. It's sad.
This was my decision though. I have to live with it. It's not easy though, especially since both college and NBA basketball are starting up. Watching basketball gives me the urge to play. This is part of the whole moving on process though, so I'm going to try not to give in to that urge. I have a feeling I'm not going to be successful.
Thursday, November 13, 2008
Pseudoephedrine
No, this post will not be about the federal law which keeps pseudoephedrine products behind the pharmacy counter. For the record, I honestly couldn't care less about the methamphetamine problem in this or any other country. If someone wants to take the initiative to buy 100 boxes of sudafed and cook up some meth in their basement, it doesn't bother me in the least bit. After all, I'm not the one that's developing a life threatening addiction for the sake of getting high. I'm not the one throwing my life away. Moreover, alcohol is a far bigger problem in this country than methamphetamine ever could be, but no one is trying to make alcohol illegal. If you want to fight a war on drugs, then I propose throwing alcohol in there for the sake of consistency.
Anyway...
When a customer comes to the counter with nasal congestion and wants some advice about which product to take, we always ask one question: "Do you have high blood pressure or take medication to treat high blood pressure?" If the patient answers yes, we automatically rule out the only OTC option that's effective for nasal congestion. In fact, it's one of the only OTC drugs that actually is effective at all.
With every new study that comes out, dextromethorphan looks less and less effective at suppressing cough. Guaifenesin has never really been proven to break up chest congestion. Ask allergy sufferers how well loratidine (Claritin) works for them, and you'll meet some pretty disappointed people. Pseudoephedrine really does work to relieve nasal congestion though, which is more than we can say about its replacement, phenylephrine.
If it's effective, then why are we so quick to rule it out for people taking antihypertensives? The answer we're taught to give is that pseudoephedrine can raise your blood pressure, which would be bad for a person that already has high blood pressure. However, I contend that a short, as needed course of pseudoephedrine probably isn't any more harmful than a stressful day at work. Moreover, someone who's blood pressure is well controlled by antihypertensive medication is at as much risk as someone who doesn't have high blood pressure and doesn't take any medication.
If you really look at the data, pseudoephedrine's effect on blood pressure isn't all that alarming. This patient counseling point is pounded into us from the very beginning of pharmacy school as if taking pseudoephedrine could send someone into a hypertensive crisis. In reality, it raises blood pressure by a few points on average, and its effect certainly isn't powerful enough to offset someone taking one or several antihypertensive medications.
If you really want to get serious about all these OTC interactions, we can include some we usually don't talk about. For example, someone taking beta blockers such as metoprolol or carvedilol for high blood pressure or chronic heart failure probably shouldn't be taking antihistamines either. Both metoprolol and carvedilol are metabolized by cytochrome P450 2D6, and most over the counter first generation antihistamines (i.e. diphenhydramine) inhibit 2D6, which would raise the levels of those drugs in their systems and put them at risk for a bradycardic episode. That never seems to stop us from recommending these products to people taking metoprolol or carvedilol, and rightfully so because the risk just isn't that great.
It's the same with pseudoephedrine. For the vast majority of cold sufferers the risk of a short, as needed course of pseudoephedrine causing an adverse event is very small. Therefore, when these situations come up, I usually ask patients if their high blood pressure is being well-controlled by their medication. If they say yes, I ask them if they check their blood pressure regularly and ask what the results tend to be. If they say that every time they go to their doctor's office, their blood pressure comes out 120/80 (or close to it), then I tell them that while pseudoephedrine can possibly raise blood pressure a small amount, using it for a few days on an as needed basis is generally safe. However, if the nasal congestion lasts more than 3 days, and/or you're not getting any relief from the pseudoephedrine, contact your doctor.
Of course, if the person has high, uncontrolled blood pressure, CHF, or poorly controlled diabetes, I wouldn't recommend pseudoephedrine products. However, in the other cases I mentioned, I feel like pharmacists are too quick to rule out one of the few effective OTC cold medications.
Anyway...
When a customer comes to the counter with nasal congestion and wants some advice about which product to take, we always ask one question: "Do you have high blood pressure or take medication to treat high blood pressure?" If the patient answers yes, we automatically rule out the only OTC option that's effective for nasal congestion. In fact, it's one of the only OTC drugs that actually is effective at all.
With every new study that comes out, dextromethorphan looks less and less effective at suppressing cough. Guaifenesin has never really been proven to break up chest congestion. Ask allergy sufferers how well loratidine (Claritin) works for them, and you'll meet some pretty disappointed people. Pseudoephedrine really does work to relieve nasal congestion though, which is more than we can say about its replacement, phenylephrine.
If it's effective, then why are we so quick to rule it out for people taking antihypertensives? The answer we're taught to give is that pseudoephedrine can raise your blood pressure, which would be bad for a person that already has high blood pressure. However, I contend that a short, as needed course of pseudoephedrine probably isn't any more harmful than a stressful day at work. Moreover, someone who's blood pressure is well controlled by antihypertensive medication is at as much risk as someone who doesn't have high blood pressure and doesn't take any medication.
If you really look at the data, pseudoephedrine's effect on blood pressure isn't all that alarming. This patient counseling point is pounded into us from the very beginning of pharmacy school as if taking pseudoephedrine could send someone into a hypertensive crisis. In reality, it raises blood pressure by a few points on average, and its effect certainly isn't powerful enough to offset someone taking one or several antihypertensive medications.
If you really want to get serious about all these OTC interactions, we can include some we usually don't talk about. For example, someone taking beta blockers such as metoprolol or carvedilol for high blood pressure or chronic heart failure probably shouldn't be taking antihistamines either. Both metoprolol and carvedilol are metabolized by cytochrome P450 2D6, and most over the counter first generation antihistamines (i.e. diphenhydramine) inhibit 2D6, which would raise the levels of those drugs in their systems and put them at risk for a bradycardic episode. That never seems to stop us from recommending these products to people taking metoprolol or carvedilol, and rightfully so because the risk just isn't that great.
It's the same with pseudoephedrine. For the vast majority of cold sufferers the risk of a short, as needed course of pseudoephedrine causing an adverse event is very small. Therefore, when these situations come up, I usually ask patients if their high blood pressure is being well-controlled by their medication. If they say yes, I ask them if they check their blood pressure regularly and ask what the results tend to be. If they say that every time they go to their doctor's office, their blood pressure comes out 120/80 (or close to it), then I tell them that while pseudoephedrine can possibly raise blood pressure a small amount, using it for a few days on an as needed basis is generally safe. However, if the nasal congestion lasts more than 3 days, and/or you're not getting any relief from the pseudoephedrine, contact your doctor.
Of course, if the person has high, uncontrolled blood pressure, CHF, or poorly controlled diabetes, I wouldn't recommend pseudoephedrine products. However, in the other cases I mentioned, I feel like pharmacists are too quick to rule out one of the few effective OTC cold medications.
Wednesday, November 12, 2008
"He's been much better lately"
That's what my manager said in reference to the "improved" behavior of one the biggest assholes that fills prescriptions at our pharmacy. For the purpose of this post, the asshole's name is Sal. I wrote about Sal in the past when he decided to report us to the state board of pharmacy because we refused to fill his Lantus prescription when he had no refills left and still had enough insulin to last him for several more days.
That incident was with the previous manager of our store. Our new manager has decided to avoid the possibility of any future episodes by bending over backwards and giving Sal pretty much anything he wants. If it's a weekend and Sal has run out of test strips and doesn't have refills, we'll give him a box and get the refill authorization later. If we don't have enough medication to fill Sal's entire prescription at one time, we'll take some away from another customer (who called well in advance of when they'd run out of medication) so that we could give it to Sal. If Sal is too busy to wait 10 minutes, we'll push Sal's prescription to the top of the pile and get them done right away. Basically, the pharmacy staff is Sal's bitch.
Let me say that I don't necessarily disagree with my manager in his approach to handling Sal. He's just one customer, but he can cause a lot of problems. Therefore, getting him in and out of the pharmacy as quickly as possible while minimizing the chance of him having an outburst is generally a good strategy.
However... When my manager had the nerve to proclaim that Sal has been pretty pleasant recently, I had to call him out on it:
"Of course he's been pleasant lately. I'd be pretty nice too if everyone bent over and kissed my ass all the time. He's not too bad when he gets everything he wants whenever he wants it. However, the second he doesn't get his way, he throws a temper tantrum. The guy is an asshole and any attempt to say otherwise is just wrong."
It's sad and unfortunate that in many cases we act nicer and do more for our worst customers than for our best customers. However, when those asshole customers fill 10 or more prescriptions per month at your store, the threat of them taking their business elsewhere carries some weight. Therefore, we'll put up with more shit and bend over just a little further backwards to keep them happy. It sucks, but it's a reality of the retail world. I accept this reality.
I just refuse to think any more favorably of those assholes when they start acting just a little bit nicer after months of being waited on hand and foot. They're still bottom of the barrel scumbags to me.
That incident was with the previous manager of our store. Our new manager has decided to avoid the possibility of any future episodes by bending over backwards and giving Sal pretty much anything he wants. If it's a weekend and Sal has run out of test strips and doesn't have refills, we'll give him a box and get the refill authorization later. If we don't have enough medication to fill Sal's entire prescription at one time, we'll take some away from another customer (who called well in advance of when they'd run out of medication) so that we could give it to Sal. If Sal is too busy to wait 10 minutes, we'll push Sal's prescription to the top of the pile and get them done right away. Basically, the pharmacy staff is Sal's bitch.
Let me say that I don't necessarily disagree with my manager in his approach to handling Sal. He's just one customer, but he can cause a lot of problems. Therefore, getting him in and out of the pharmacy as quickly as possible while minimizing the chance of him having an outburst is generally a good strategy.
However... When my manager had the nerve to proclaim that Sal has been pretty pleasant recently, I had to call him out on it:
"Of course he's been pleasant lately. I'd be pretty nice too if everyone bent over and kissed my ass all the time. He's not too bad when he gets everything he wants whenever he wants it. However, the second he doesn't get his way, he throws a temper tantrum. The guy is an asshole and any attempt to say otherwise is just wrong."
It's sad and unfortunate that in many cases we act nicer and do more for our worst customers than for our best customers. However, when those asshole customers fill 10 or more prescriptions per month at your store, the threat of them taking their business elsewhere carries some weight. Therefore, we'll put up with more shit and bend over just a little further backwards to keep them happy. It sucks, but it's a reality of the retail world. I accept this reality.
I just refuse to think any more favorably of those assholes when they start acting just a little bit nicer after months of being waited on hand and foot. They're still bottom of the barrel scumbags to me.
Sunday, November 9, 2008
Diabetic Testing Supplies
I think it's wonderful that Medicare covers test strips and lancets for diabetics. My only complaint is why do they have to have such strict prescription requirements. I fully understand the need to have specific directions, quantities, and a diagnosis code as to whether the patient requires insulin or not. I don't understand why pharmacists can't take that information over the phone.
Why can pharmacists accept a phoned in prescription for Vicodin or Lortab, but we need a hard copy (faxed or brought into us) in order to bill Medicare for test strips and lancets? Why are there no requirements like this for Medicaid? What makes Medicare different than Medicaid in this regard?
It's really just a giant pain in the ass, and it inconveniences both patients and doctors. What often happens is that the patient will call the pharmacy and use the telefill to ask for a refill on their test strips. Our, and many other pharmacies', telefill system will automatically fax the doctor a renewal request if the patient is out of refills. The doctor's office will get the request, and in a day or so, they'll fax the approval back to us.
This creates a problem because when we go to process the approved refill, we'll realize that the patient has Medicare. Therefore, we need to contact the doctor's office again for a new script that has all those wonderful Medicare requirements (specific product, quantity, directions, diagnosis code). Getting verbal confirmation over the phone simply isn't good enough, so we have to wait for the doctor to send the Medicare compliant prescription to us before we can fill it.
I just don't understand why all of this can't be accomplished with a phone call and the pharmacist documenting on the script the proper directions, quantity, and diagnosis code. Why does it have to be directly from the prescriber? Like I said, if we can get verbal confirmation of a Vicodin script, what's the harm in allowing it on a Medicare prescription? It's just a waste of time, in my opinion.
Why can pharmacists accept a phoned in prescription for Vicodin or Lortab, but we need a hard copy (faxed or brought into us) in order to bill Medicare for test strips and lancets? Why are there no requirements like this for Medicaid? What makes Medicare different than Medicaid in this regard?
It's really just a giant pain in the ass, and it inconveniences both patients and doctors. What often happens is that the patient will call the pharmacy and use the telefill to ask for a refill on their test strips. Our, and many other pharmacies', telefill system will automatically fax the doctor a renewal request if the patient is out of refills. The doctor's office will get the request, and in a day or so, they'll fax the approval back to us.
This creates a problem because when we go to process the approved refill, we'll realize that the patient has Medicare. Therefore, we need to contact the doctor's office again for a new script that has all those wonderful Medicare requirements (specific product, quantity, directions, diagnosis code). Getting verbal confirmation over the phone simply isn't good enough, so we have to wait for the doctor to send the Medicare compliant prescription to us before we can fill it.
I just don't understand why all of this can't be accomplished with a phone call and the pharmacist documenting on the script the proper directions, quantity, and diagnosis code. Why does it have to be directly from the prescriber? Like I said, if we can get verbal confirmation of a Vicodin script, what's the harm in allowing it on a Medicare prescription? It's just a waste of time, in my opinion.
Friday, November 7, 2008
What did she say?
Conversation with our lead tech:
Me: I'm going to this party, and they're having a Secret Santa. I ended up drawing this guy. I have to figure out what to get now.
Tech: That shouldn't be too hard. Just get him a gift certificate to Dick's. What guy doesn't like Dicks?
All I had to do was look at her to make her turn bright red.
Me: I'm going to this party, and they're having a Secret Santa. I ended up drawing this guy. I have to figure out what to get now.
Tech: That shouldn't be too hard. Just get him a gift certificate to Dick's. What guy doesn't like Dicks?
All I had to do was look at her to make her turn bright red.
Thursday, November 6, 2008
If I won the lottery
For whatever reason, I was thinking about what I'd do if I won the lottery. Of course, I've never bought a lotto ticket in my life, and I don't really have any plans on doing so in the near future. Despite this, that hypothetical, nearly impossible situation has been on my mind.
Honestly, I think my life would pretty much be the same. I'd take care of a few things of course. I'd pay off my car and college loans. Then, I'd probably buy a house or nice condo. Nothing extravagant. I don't need 12 bedrooms and a 10,000 square foot bathroom. I just want a nice, comfortable place.
Other than that, I don't think I'd do anything different. I'm pretty certain I'd still work, not out of love for my job, but because it's pretty much the only thing I do that makes me feel useful to society. I wouldn't take vacations to exotic locales. I wouldn't buy an Italian sports car. I wouldn't update my wardrobe with expensive, designer clothes. I wouldn't hit the clubs or fancy restaurants every night. In essence, it wouldn't change who I am or how I act in the least.
The only things I truly desire in life right now are things that money can't buy. Winning the lottery wouldn't bring me love and enable me to start a family. Those are things I'll have to figure out on my own, regardless of my financial situation. Otherwise, I hae pretty much everything I've always wanted from a maetrial sense. There was a short list of things I always wanted that I said I was going to get myself once I graduated from pharmacy school. I wanted a particular, near-luxury car. I wanted a big, flat screen TV with surround sound, and I wanted to get my own place. That was it. Those were my only desires.
I type this today while sitting at my comfortable desk chair in my modest one bedroom apartment. I have a Samsung LCD television in my living room. I have an entertainment system that includes surround sound speakers and all the newest videogame systems. My near-luxury sports sedan is parked outside. If I'm hungry, I can buy food. If I want new clothes, I can get them. If my computer breaks, I can replace it. I'm comfortable, more comfortable than most. From a materialistic standpoint, I have everything I could ever desire, and more than I probably deserve.
Maybe it's anti-American for me not to want more. After all, the backbone of our country and capitalism in general is that you constantly work to aquire and create more wealth. It's almost sad to think that our economy would break down if people who are in similar fiancial situations to my own decide they don't need anything else. If all these people just decided to stop spending money on extravagances, companies would go bankrupt and jobs would be lost.
There are a lot of statements I could make about modern society, but I'll hold off. I just find it amazing how if a couple things fell into place, I'd basically be living my ideal life. I'm fortunate.
Honestly, I think my life would pretty much be the same. I'd take care of a few things of course. I'd pay off my car and college loans. Then, I'd probably buy a house or nice condo. Nothing extravagant. I don't need 12 bedrooms and a 10,000 square foot bathroom. I just want a nice, comfortable place.
Other than that, I don't think I'd do anything different. I'm pretty certain I'd still work, not out of love for my job, but because it's pretty much the only thing I do that makes me feel useful to society. I wouldn't take vacations to exotic locales. I wouldn't buy an Italian sports car. I wouldn't update my wardrobe with expensive, designer clothes. I wouldn't hit the clubs or fancy restaurants every night. In essence, it wouldn't change who I am or how I act in the least.
The only things I truly desire in life right now are things that money can't buy. Winning the lottery wouldn't bring me love and enable me to start a family. Those are things I'll have to figure out on my own, regardless of my financial situation. Otherwise, I hae pretty much everything I've always wanted from a maetrial sense. There was a short list of things I always wanted that I said I was going to get myself once I graduated from pharmacy school. I wanted a particular, near-luxury car. I wanted a big, flat screen TV with surround sound, and I wanted to get my own place. That was it. Those were my only desires.
I type this today while sitting at my comfortable desk chair in my modest one bedroom apartment. I have a Samsung LCD television in my living room. I have an entertainment system that includes surround sound speakers and all the newest videogame systems. My near-luxury sports sedan is parked outside. If I'm hungry, I can buy food. If I want new clothes, I can get them. If my computer breaks, I can replace it. I'm comfortable, more comfortable than most. From a materialistic standpoint, I have everything I could ever desire, and more than I probably deserve.
Maybe it's anti-American for me not to want more. After all, the backbone of our country and capitalism in general is that you constantly work to aquire and create more wealth. It's almost sad to think that our economy would break down if people who are in similar fiancial situations to my own decide they don't need anything else. If all these people just decided to stop spending money on extravagances, companies would go bankrupt and jobs would be lost.
There are a lot of statements I could make about modern society, but I'll hold off. I just find it amazing how if a couple things fell into place, I'd basically be living my ideal life. I'm fortunate.
Monday, November 3, 2008
Where this country fails...
She approached the counter nervously and asked to speak to a pharmacist. Her hands were shaking and voice quivering as she explained that her hours had been cut at her job, and she was dropped from the company's insurance plan. However, since she still maintained part time status, she made just a little too much money to qualify for Medicaid. She had various panic and mood disorders, and without insurance, she would have to pay about $1,000 per month for her medication.
She started to cry as she pleaded for us to help her in any way we can. There was just no way she could afford $1,000 per month for medication. However, going without them meant putting her mental stability and ultimately her life in jeopardy.
Not knowing what else to do, my pharmacy manager (a great guy) called social services on her behalf. Nine times out of ten, this causes you to wait on hold for 30 minutes until you finally speak to someone who tells you there's nothing they can do. This time, he got lucky. He still waited for 30 minutes, but when someone finally picked up, they were actually able to help him. He was able to get her set up with an appointment with a Medicaid "triage specialist" first thing the next morning.
We explained what she needed to bring to the appointment and gave her 3 days worth of her medication at no charge. Our efforts to help calmed her down as she was no longer crying. She was still shaking a bit, but she was very grateful. As she walked away, all I could think about is that she'll most likely be denied coverage...
This highlights a major flaw in this country. Health care, in our current system, is a privilege instead of a right. If you are lucky enough to get insurance through your job, or if you make enough money that you can afford the $12,000 per year for the average insurance policy, you get access to health care. Everyone else is fucked.
What kind of society do we live in when we have to choose between being able to pay a mortgage or pay for health care? How can we live with ourselves when we have to look at patients struggling to get by and tell them, "Sorry, you can't have the medication that keeps you healthy unless you can afford to pay for it." Or, "I'm sorry it's too expensive for you to see a doctor."
Just about every other industrialized nation in the world has some form of national health care. We stubbornly resist. Just like we stubbornly resist to join into agreements to cut carbon emissions. Just like we stubbornly resist to adopt the metric system. Just like we stubbornly resist accepting the scientific consensus that climate change and evolution are real. As much as we love to make fun of France in this country, France's system of national health care far exceeds our own. France is ranked #1 in the world in health care by the World Health Organization. The United States is ranked 37. Perhaps it just might be a good idea for us to stop insulting France just long enough to look at what they're doing with health care and try to incorporate that into our own system.
The only 2 arguments I hear against it are wait times and that it will increase our taxes. As for wait times, do you think that person who currently has no coverage at all right now cares about the wait times? Canada, with all its supposed wait times is also ranked higher than the United States in overall health care. The cost of Canada's health care plan is also less per citizen than the average cost of $12,000 per year for the average health care policy in the U.S. In fact, the United States pays the second most in the world for health care as a percentage of GDP. We're ranked first in per capita health care spending. For spending all that money, you'd think we'd be better than 37th in the world.
And don't give me the socialism argument. Socialistic institutions seem to be just fine when it comes to the police, fire departments, education, public works, etc. In the name of the free market, why don't we privatize all of those? Yeah, stupid idea, right? About as stupid an idea as privatizing health care insurance.
There's no good reason for people to be denied health care simply because they can't afford to pay for it. I dream of a day when the United States stops dragging its feet and finally adopts a superior model that is more in line with the rest of the industrialized world. Maybe then we can actually have something to back up our persistent claims of being the greatest country in the world.
She started to cry as she pleaded for us to help her in any way we can. There was just no way she could afford $1,000 per month for medication. However, going without them meant putting her mental stability and ultimately her life in jeopardy.
Not knowing what else to do, my pharmacy manager (a great guy) called social services on her behalf. Nine times out of ten, this causes you to wait on hold for 30 minutes until you finally speak to someone who tells you there's nothing they can do. This time, he got lucky. He still waited for 30 minutes, but when someone finally picked up, they were actually able to help him. He was able to get her set up with an appointment with a Medicaid "triage specialist" first thing the next morning.
We explained what she needed to bring to the appointment and gave her 3 days worth of her medication at no charge. Our efforts to help calmed her down as she was no longer crying. She was still shaking a bit, but she was very grateful. As she walked away, all I could think about is that she'll most likely be denied coverage...
This highlights a major flaw in this country. Health care, in our current system, is a privilege instead of a right. If you are lucky enough to get insurance through your job, or if you make enough money that you can afford the $12,000 per year for the average insurance policy, you get access to health care. Everyone else is fucked.
What kind of society do we live in when we have to choose between being able to pay a mortgage or pay for health care? How can we live with ourselves when we have to look at patients struggling to get by and tell them, "Sorry, you can't have the medication that keeps you healthy unless you can afford to pay for it." Or, "I'm sorry it's too expensive for you to see a doctor."
Just about every other industrialized nation in the world has some form of national health care. We stubbornly resist. Just like we stubbornly resist to join into agreements to cut carbon emissions. Just like we stubbornly resist to adopt the metric system. Just like we stubbornly resist accepting the scientific consensus that climate change and evolution are real. As much as we love to make fun of France in this country, France's system of national health care far exceeds our own. France is ranked #1 in the world in health care by the World Health Organization. The United States is ranked 37. Perhaps it just might be a good idea for us to stop insulting France just long enough to look at what they're doing with health care and try to incorporate that into our own system.
The only 2 arguments I hear against it are wait times and that it will increase our taxes. As for wait times, do you think that person who currently has no coverage at all right now cares about the wait times? Canada, with all its supposed wait times is also ranked higher than the United States in overall health care. The cost of Canada's health care plan is also less per citizen than the average cost of $12,000 per year for the average health care policy in the U.S. In fact, the United States pays the second most in the world for health care as a percentage of GDP. We're ranked first in per capita health care spending. For spending all that money, you'd think we'd be better than 37th in the world.
And don't give me the socialism argument. Socialistic institutions seem to be just fine when it comes to the police, fire departments, education, public works, etc. In the name of the free market, why don't we privatize all of those? Yeah, stupid idea, right? About as stupid an idea as privatizing health care insurance.
There's no good reason for people to be denied health care simply because they can't afford to pay for it. I dream of a day when the United States stops dragging its feet and finally adopts a superior model that is more in line with the rest of the industrialized world. Maybe then we can actually have something to back up our persistent claims of being the greatest country in the world.
Sunday, October 26, 2008
Customers Who Like to Show Off
Do you ever get customers that try to show off what they know about the drugs they are taking? It's always an interesting experience. Most of these customers only think they know what they're talking about. They read two sentences about the drug on drugstore.com, completely misinterpret the information, then spit that jumbled mess back out at you in an attempt to show you how smart they are. Most of the time, I have to stop for a second to try to figure out just what the person is talking about before proceeding with some form of an answer to whatever question they might have. Sometimes, the person doesn't even really have a question. They just tell you something about the drug as if they're giving an answer on a game show.
We have one woman who comes to our pharmacy who's especially annoying in this regard. I guess her boyfriend is a medical resident, so she apparently feels that his knowledge somehow transfers over to her. No matter what she's picking up or how many times she's picked up that medication in the past, she always has to speak to a pharmacist. It's not that I mind talking to customers or answering questions. Quite the opposite actually. However, her questions have no real point, or they start with a point but soon end up as just an opportunity for her to tell you how much she knows.
Take my last encounter with her: She picked up a new prescription for carbamezapine (it was being used as a mood stabilizer in her case). She asked me if the carbamezapine would affect any of her other medications.
I immediately thought to myself, "Great! This is a question that actually has some kind of clinical significance." However, before I could even get a word out of my mouth she starts reciting carbamezapine plasma concentration levels, how she knows it can make her drowsy, and that it might decrease the effectiveness of oral contraceptives.... Of course, she added, "but I'm not taking oral contraceptives, so I guess I don't have to worry about that."
What was the point of all that? She asked me a specific question relating to her other medications, but then she cut me off and started telling me random drug facts as well as how it interacts with a medication that she doesn't even take. Thank you very much for telling me stuff I already know. Who's the pharmacist here?
I've decided that any time she does this to me, I will respond by telling her everything I know about the drug and using as much medical terminology as possible. Therefore, after her little spiel, I told her about how carbamezapine is an inducer of the cytochrome P450 enzyme system responsible for metabolizing many drugs. I told her that it, over the course of several days to weeks, will cause the plasma concentrations of her Geodon to drop, and it might be necessary for her doctor to increase her dose to keep it therapeutic. I also told her that carbamezapine is the only drug (at least that I know of) that is capable of inducing its own metabolism. Therefore, what may start out as an effective dose for her may gradually need to be titrated up to make up for the self induced increase in elimination. I could have gone into the myriad of side effects it can potentially cause, but I figured that will undoubtedly come up the next time she comes in.
Listen... I think it's very good for all people to try to read up on the drugs they are taking. I also encourage everyone to ask questions about their medications to help them understand how they work, what kind of effects can be expected, and in order to ensure the medication is taken correctly. Just don't come to the pharmacy counter reciting a bunch of drug facts that really don't have anything to do with your situation. It's just annoying and serves no purpose.
As a sort of related aside.... If you ask a pharmacist a question about your medication and it seems like he's having a hard time answering you, it most likely isn't because he doesn't know about the drug. It's probably more that he's having a hard time explaining it without using fancy medical terminology.
For example, a woman recently asked me if I could recommend any supplement that might help ward off frequent urinary tract infections. I told her that Cranberry supplements might help help. She wanted to know how Cranberry worked, and I tried to explain that it's thought that an ingredient in cranberries actually works to prevent bacteria from attaching themselves to the lining of the urinary tract. I was trying to use as much simple language as possible, but couldn't quite grasp the concept of bacteria sticking to the lining of the urinary tract and why it would be beneficial to prevent this. I immediately thought of bacteria colonies growing on agar plates in biology labs, so I asked her if she ever took a biology class, and of course, she hadn't. I ended up relating it to mildew growing on shower walls, and explained that if the bacteria have nothing to attach themselves to, they just get flushed out of the system. That seemed to click with her. (Of course... Just how effective cranberry actually is for preventing UTIs is another story completely)
That's a simple example too. Sometimes it's just really hard to put things in non-medical terminology, especially when you start dealing with drugs with complicated mechanisms of actions that involve very specific receptors located at specific sites of the body. Therefore, if it seems like we're stammering when trying to answer a question, it's probably because we're just searching for the right words that the average person would understand.
We have one woman who comes to our pharmacy who's especially annoying in this regard. I guess her boyfriend is a medical resident, so she apparently feels that his knowledge somehow transfers over to her. No matter what she's picking up or how many times she's picked up that medication in the past, she always has to speak to a pharmacist. It's not that I mind talking to customers or answering questions. Quite the opposite actually. However, her questions have no real point, or they start with a point but soon end up as just an opportunity for her to tell you how much she knows.
Take my last encounter with her: She picked up a new prescription for carbamezapine (it was being used as a mood stabilizer in her case). She asked me if the carbamezapine would affect any of her other medications.
I immediately thought to myself, "Great! This is a question that actually has some kind of clinical significance." However, before I could even get a word out of my mouth she starts reciting carbamezapine plasma concentration levels, how she knows it can make her drowsy, and that it might decrease the effectiveness of oral contraceptives.... Of course, she added, "but I'm not taking oral contraceptives, so I guess I don't have to worry about that."
What was the point of all that? She asked me a specific question relating to her other medications, but then she cut me off and started telling me random drug facts as well as how it interacts with a medication that she doesn't even take. Thank you very much for telling me stuff I already know. Who's the pharmacist here?
I've decided that any time she does this to me, I will respond by telling her everything I know about the drug and using as much medical terminology as possible. Therefore, after her little spiel, I told her about how carbamezapine is an inducer of the cytochrome P450 enzyme system responsible for metabolizing many drugs. I told her that it, over the course of several days to weeks, will cause the plasma concentrations of her Geodon to drop, and it might be necessary for her doctor to increase her dose to keep it therapeutic. I also told her that carbamezapine is the only drug (at least that I know of) that is capable of inducing its own metabolism. Therefore, what may start out as an effective dose for her may gradually need to be titrated up to make up for the self induced increase in elimination. I could have gone into the myriad of side effects it can potentially cause, but I figured that will undoubtedly come up the next time she comes in.
Listen... I think it's very good for all people to try to read up on the drugs they are taking. I also encourage everyone to ask questions about their medications to help them understand how they work, what kind of effects can be expected, and in order to ensure the medication is taken correctly. Just don't come to the pharmacy counter reciting a bunch of drug facts that really don't have anything to do with your situation. It's just annoying and serves no purpose.
As a sort of related aside.... If you ask a pharmacist a question about your medication and it seems like he's having a hard time answering you, it most likely isn't because he doesn't know about the drug. It's probably more that he's having a hard time explaining it without using fancy medical terminology.
For example, a woman recently asked me if I could recommend any supplement that might help ward off frequent urinary tract infections. I told her that Cranberry supplements might help help. She wanted to know how Cranberry worked, and I tried to explain that it's thought that an ingredient in cranberries actually works to prevent bacteria from attaching themselves to the lining of the urinary tract. I was trying to use as much simple language as possible, but couldn't quite grasp the concept of bacteria sticking to the lining of the urinary tract and why it would be beneficial to prevent this. I immediately thought of bacteria colonies growing on agar plates in biology labs, so I asked her if she ever took a biology class, and of course, she hadn't. I ended up relating it to mildew growing on shower walls, and explained that if the bacteria have nothing to attach themselves to, they just get flushed out of the system. That seemed to click with her. (Of course... Just how effective cranberry actually is for preventing UTIs is another story completely)
That's a simple example too. Sometimes it's just really hard to put things in non-medical terminology, especially when you start dealing with drugs with complicated mechanisms of actions that involve very specific receptors located at specific sites of the body. Therefore, if it seems like we're stammering when trying to answer a question, it's probably because we're just searching for the right words that the average person would understand.
Friday, October 24, 2008
How to Make Your Pharmacist Happy?
We pharmacists complain a lot about customers and doctors' offices. However, I don't really think we're asking that much. Just a few simple things would make us very very happy.
For customers:
- Always have your insurance card readily available. This is especially true if you've never been to the pharmacy before. You wouldn't dare go to your doctor's office without an insurance card. Why do you come to the pharmacy without one?
- When dropping off or picking up a prescription, be prepared to give the address (and possibly the patient's date of birth). We don't ask this to annoy you. We ask to help make sure we fill the prescription correctly, and when you come to pick it up, we ask to make sure we're giving the right prescription to the right person.
- Pay attention to the number of refills and the prescriptions expiration date. Both of these are on every prescription label. Therefore, when you are out of refills for a maintenance medication, you can call us 3 or 4 days ahead of time in order to allow us time to contact the doctor to get more refills. If you're completely out of tablets, have no refills, and you call us on Friday after 5:00, we're going to be really pissed off.
- Keep in mind that pharmacies do not receive orders on weekends. If you have a prescription that needs to be special ordered, please call us no later in the week than Thursday. If you call us on Friday, we will not be able to receive your medication until Monday at the earliest.
- Never wait until you are completely out of your medication before calling in a refill. Call us at least 3 or 4 days ahead of time. I guarantee you'll be much happier with our service if you call us several days before your refill due.
- Do not under any circumstances stand at the counter while waiting for us to fill your prescription. For one, this is a violation of HIPAA privacy laws because you can possibly overhear some private health information for another patient. Secondly, it's just plain annoying. How would you like it if I came to your job and stared at you while you tried to work? Your prescription will not get done any faster if you stare at me.
- We love to hear: "I'm just dropping this prescription off. I'll be back in a couple days to pick it up." If it's not something you need right away, and you're going to be back to the store in a few days anyway, then just give us that extra time.
- Understand that we don't have any say over your insurance company. We fill type up a prescription and submit a claim electronically to your insurance company. We have no control over how much they charge you. If your copay suddenly went up, we have no idea why (unless you have Medicare Part D, and we can take an educated guess that you hit the donut hole). Don't get angry at us if your copay doubled in price from last month.
- On a related note... If your copay does double in price, don't ask us to call the insurance to find out why. It's not our insurance company, and it's not our prescription. If you want to know why the price went up, you call the insurance company. There's a number on the back of your insurance card... You know... the one that you're supposed to have on you every time you go to the pharmacy. You can dial it just as well as we can.
- We also have no control over your doctor's office. Trust us when we tell you that we faxed the doctor for that refill a couple days ago, and your doctor has not responded. In addition, when we tell us that your doctor hasn't called in that prescription yet, don't look at us incredulously. We're not lying to you. If your doctor called it in, we would have filled it. That's how we make money you know.
For doctors and their representatives:
- Please don't have minimum wage employees who can barely speak English call in prescriptions to the pharmacy. It is very important that the person calling in the prescription to the pharmacy has some idea as to what he or she is calling in as well as the ability to clearly communicate it to the pharmacist. Pharmacists are amazingly good at deciphering butchered drug names and poor English. However, it would be a lot easier if we didn't have to waste our time doing so.
- When leaving messages on the voice mail SLOW THE FUCK DOWN!!!! It's not a race. We're not timing you, and I promise if you take the extra 15 seconds to clearly enunciate, it will not set you back. In fact, it will save you time in that we won't have to call you back to get clarification.
- Again with the voice mail... When leaving a message, ALWAYS spell the patients last name (and even the first name if it's an unusual name in this country). ALWAYS give the patients date of birth. ALWAYS leave a call back number for the office. Any time the doctor's name can't be easily spelled by a 3rd grader, spell it. Even if you've called in 1,000 prescriptions to that particular pharmacy in the past, still spell it. There could be a floater or a new pharmacist who's never heard of that doctor.
- Prescribers... Please write neatly. If you're a doctor, you've gone through 4 years of pre-med, 4 years of medical school, an internship, a residency, and possibly more training. Somewhere among all those years of school, you were taught to write neatly. There's absolutely no excuse to writing so poorly that we cannot make out the name of the drug or directions. In addition, please sign your name neatly. If you absolutely cannot sign your name neatly, circle your name at the top of the script, or neatly print your name below your signature. We fucking hate having to guess which doctor wrote the prescription. It's an epic waste of our time.
- When writing a prescription, write out the patient's complete first and last name and date of birth. Simply writing "J. Smith" on the top of a prescription is not valid when you're trying to prescribe Percocet. I've even seen some doctors write "Mrs. Smith" as the name. How many Mrs. Smiths are there in the world?
- Write your DEA number ON ALL CONTROLLED SUBSTANCE PRESCRIPTIONS. EVERY TIME.
Seriously... these are all easy things. Most of them are common sense. If patients and doctors adhered to these simple rules, it would make pharmacists' lives much easier.
For customers:
- Always have your insurance card readily available. This is especially true if you've never been to the pharmacy before. You wouldn't dare go to your doctor's office without an insurance card. Why do you come to the pharmacy without one?
- When dropping off or picking up a prescription, be prepared to give the address (and possibly the patient's date of birth). We don't ask this to annoy you. We ask to help make sure we fill the prescription correctly, and when you come to pick it up, we ask to make sure we're giving the right prescription to the right person.
- Pay attention to the number of refills and the prescriptions expiration date. Both of these are on every prescription label. Therefore, when you are out of refills for a maintenance medication, you can call us 3 or 4 days ahead of time in order to allow us time to contact the doctor to get more refills. If you're completely out of tablets, have no refills, and you call us on Friday after 5:00, we're going to be really pissed off.
- Keep in mind that pharmacies do not receive orders on weekends. If you have a prescription that needs to be special ordered, please call us no later in the week than Thursday. If you call us on Friday, we will not be able to receive your medication until Monday at the earliest.
- Never wait until you are completely out of your medication before calling in a refill. Call us at least 3 or 4 days ahead of time. I guarantee you'll be much happier with our service if you call us several days before your refill due.
- Do not under any circumstances stand at the counter while waiting for us to fill your prescription. For one, this is a violation of HIPAA privacy laws because you can possibly overhear some private health information for another patient. Secondly, it's just plain annoying. How would you like it if I came to your job and stared at you while you tried to work? Your prescription will not get done any faster if you stare at me.
- We love to hear: "I'm just dropping this prescription off. I'll be back in a couple days to pick it up." If it's not something you need right away, and you're going to be back to the store in a few days anyway, then just give us that extra time.
- Understand that we don't have any say over your insurance company. We fill type up a prescription and submit a claim electronically to your insurance company. We have no control over how much they charge you. If your copay suddenly went up, we have no idea why (unless you have Medicare Part D, and we can take an educated guess that you hit the donut hole). Don't get angry at us if your copay doubled in price from last month.
- On a related note... If your copay does double in price, don't ask us to call the insurance to find out why. It's not our insurance company, and it's not our prescription. If you want to know why the price went up, you call the insurance company. There's a number on the back of your insurance card... You know... the one that you're supposed to have on you every time you go to the pharmacy. You can dial it just as well as we can.
- We also have no control over your doctor's office. Trust us when we tell you that we faxed the doctor for that refill a couple days ago, and your doctor has not responded. In addition, when we tell us that your doctor hasn't called in that prescription yet, don't look at us incredulously. We're not lying to you. If your doctor called it in, we would have filled it. That's how we make money you know.
For doctors and their representatives:
- Please don't have minimum wage employees who can barely speak English call in prescriptions to the pharmacy. It is very important that the person calling in the prescription to the pharmacy has some idea as to what he or she is calling in as well as the ability to clearly communicate it to the pharmacist. Pharmacists are amazingly good at deciphering butchered drug names and poor English. However, it would be a lot easier if we didn't have to waste our time doing so.
- When leaving messages on the voice mail SLOW THE FUCK DOWN!!!! It's not a race. We're not timing you, and I promise if you take the extra 15 seconds to clearly enunciate, it will not set you back. In fact, it will save you time in that we won't have to call you back to get clarification.
- Again with the voice mail... When leaving a message, ALWAYS spell the patients last name (and even the first name if it's an unusual name in this country). ALWAYS give the patients date of birth. ALWAYS leave a call back number for the office. Any time the doctor's name can't be easily spelled by a 3rd grader, spell it. Even if you've called in 1,000 prescriptions to that particular pharmacy in the past, still spell it. There could be a floater or a new pharmacist who's never heard of that doctor.
- Prescribers... Please write neatly. If you're a doctor, you've gone through 4 years of pre-med, 4 years of medical school, an internship, a residency, and possibly more training. Somewhere among all those years of school, you were taught to write neatly. There's absolutely no excuse to writing so poorly that we cannot make out the name of the drug or directions. In addition, please sign your name neatly. If you absolutely cannot sign your name neatly, circle your name at the top of the script, or neatly print your name below your signature. We fucking hate having to guess which doctor wrote the prescription. It's an epic waste of our time.
- When writing a prescription, write out the patient's complete first and last name and date of birth. Simply writing "J. Smith" on the top of a prescription is not valid when you're trying to prescribe Percocet. I've even seen some doctors write "Mrs. Smith" as the name. How many Mrs. Smiths are there in the world?
- Write your DEA number ON ALL CONTROLLED SUBSTANCE PRESCRIPTIONS. EVERY TIME.
Seriously... these are all easy things. Most of them are common sense. If patients and doctors adhered to these simple rules, it would make pharmacists' lives much easier.
Sunday, October 19, 2008
Just One of Those Days
Another lovely day of dealing with the public. Here's a recap:
Barely two minutes after raising the gate at the start of the day, I got a phone call from a woman looking to refill a monthly prescription less than 5 days from the last time we filled it for her. I asked if she had some left at home and if she had ever picked up the previous fill. She said she never picked it up, and she was completely out. I checked our signature records and found, not suprisingly, that she was the one that signed for it less than 5 days ago. I relayed this information to her and asked her to please check again. She put down the receiver for about a minute and then returned saying that she had found it in her medicine cabinet. For one, I don't understand how someone could forget they picked up a prescription. What's more unsettling is that she argued with me for 5 minutes that she didn't have it without even checking her medicine cabinet. Wouldn't that be the first place you look? Those are five minutes of my life I can never get back.
About a minute after I hung up the phone with that lady, I get a call from an 85-year woman looking to refill her prescription. I asked if she had her prescription number. She said yes. The next thing I heard was "BEEP BEEP BEEP BEEP BEEP BEEP BEEP." Yes, she was dialing the prescription number into the phone as if I could decipher the touchtone sounds. I couldn't help but laugh. While she was dialing away, I did my best to suppress my laughter and literally started yelling into the phone, "NO, SPEAK THE NUMBER TO ME!" A hot girl who was at the counter picking up a prescription started laughing at me before rolling her eyes and walking away. Alas, the elderly woman could not hear my desperate pleas, and it took about 2 minutes before I could get her attention. I honestly think she thought she was speaking to a machine the entire time.
A little later in the day, a woman came to the counter to pick up a prescription. There was nothing unusual about her, so I barely noticed her at first. I just kept on entering in prescriptions about 15 feet away from her. Suddenly, a strange odor started to permeate my nostrils.... MOTH BALLS!!! This woman reeked so powerfully of moth balls that I could literally taste it in the air while standing all the way across the pharmacy from her. And the smell just wouldn't go away even after she left. I had to grab some Oust and deodorize the entire place.
Then there was the guy who was picking up a prescription for a 10 day course of Amoxicillin. He wanted to know if this medication was included in our special 3-month pricing for certain generic medications. I tried to explain to him that he's only going to be taking it for 10 days and that there was no need for any special pricing on it. He just stared blankly.
I suppose it wasn't all bad though. A middle aged, not terribly attractive woman who, judging by her profile, I'm pretty sure is a Vicodin junkie, told me she thinks she's in love with me because of my friendly, patient, and polite service. If you remember, the hot girl who was at the counter earlier in the day didn't think so highly of me. Story of my life...
It was a day that required alcohol... but I didn't even have any in my apartment. I ended the night sober and alone. Again, story of my life...
Barely two minutes after raising the gate at the start of the day, I got a phone call from a woman looking to refill a monthly prescription less than 5 days from the last time we filled it for her. I asked if she had some left at home and if she had ever picked up the previous fill. She said she never picked it up, and she was completely out. I checked our signature records and found, not suprisingly, that she was the one that signed for it less than 5 days ago. I relayed this information to her and asked her to please check again. She put down the receiver for about a minute and then returned saying that she had found it in her medicine cabinet. For one, I don't understand how someone could forget they picked up a prescription. What's more unsettling is that she argued with me for 5 minutes that she didn't have it without even checking her medicine cabinet. Wouldn't that be the first place you look? Those are five minutes of my life I can never get back.
About a minute after I hung up the phone with that lady, I get a call from an 85-year woman looking to refill her prescription. I asked if she had her prescription number. She said yes. The next thing I heard was "BEEP BEEP BEEP BEEP BEEP BEEP BEEP." Yes, she was dialing the prescription number into the phone as if I could decipher the touchtone sounds. I couldn't help but laugh. While she was dialing away, I did my best to suppress my laughter and literally started yelling into the phone, "NO, SPEAK THE NUMBER TO ME!" A hot girl who was at the counter picking up a prescription started laughing at me before rolling her eyes and walking away. Alas, the elderly woman could not hear my desperate pleas, and it took about 2 minutes before I could get her attention. I honestly think she thought she was speaking to a machine the entire time.
A little later in the day, a woman came to the counter to pick up a prescription. There was nothing unusual about her, so I barely noticed her at first. I just kept on entering in prescriptions about 15 feet away from her. Suddenly, a strange odor started to permeate my nostrils.... MOTH BALLS!!! This woman reeked so powerfully of moth balls that I could literally taste it in the air while standing all the way across the pharmacy from her. And the smell just wouldn't go away even after she left. I had to grab some Oust and deodorize the entire place.
Then there was the guy who was picking up a prescription for a 10 day course of Amoxicillin. He wanted to know if this medication was included in our special 3-month pricing for certain generic medications. I tried to explain to him that he's only going to be taking it for 10 days and that there was no need for any special pricing on it. He just stared blankly.
I suppose it wasn't all bad though. A middle aged, not terribly attractive woman who, judging by her profile, I'm pretty sure is a Vicodin junkie, told me she thinks she's in love with me because of my friendly, patient, and polite service. If you remember, the hot girl who was at the counter earlier in the day didn't think so highly of me. Story of my life...
It was a day that required alcohol... but I didn't even have any in my apartment. I ended the night sober and alone. Again, story of my life...
Friday, October 10, 2008
Once Daily Cialis?
Maybe I'm missing something here, but I thought that Cialis' claim to fame was that one tablet lasts 36 hours. Apparently, these new dosages (once daily comes in 2.5mg or 5mg) can be taken once daily every day, so that you're "ready any time the moment is right."
Again... Call me crazy, but I don't understand this. If regular cialis works just fine when you take it as needed, and it lasts up to 36 hours, then what's the point of taking a tablet EVERY DAY? Who would want to take a medication every day when you only have to take it as needed?
Are drug companies starting to run out of ideas?
Again... Call me crazy, but I don't understand this. If regular cialis works just fine when you take it as needed, and it lasts up to 36 hours, then what's the point of taking a tablet EVERY DAY? Who would want to take a medication every day when you only have to take it as needed?
Are drug companies starting to run out of ideas?
Thursday, October 9, 2008
Retail Pharmacists Overeducated?
"After having been through pharmacy school and having worked retail for a year I remain unconvinced that retail pharmacists can't be replaced by robots, certified techs or some combination thereof. While I can describe several instances where I made meaningful interventions the fact is that I'm over educated for 99% of my actual job. Six years of doctoral level training simply isn't needed to count by fives, put pills in a jar, sit on hold with insurance companies and politely explain to customers that you have no idea why greeting cards aren't on sale this week. Even the bulk of counseling can be reduced to bullet points that any literate person could read off a computer screen or brochure.
Personally, I feel that the future of retail pharmacy lies with technicians filling prescriptions and a couple of pharmacists sitting in a district call center fielding questions about the more challenging issues regarding drug interactions and complex disease states.
Highly educated professionals should handle issues that require a significant knowledge base, not do menial tasks like order entry and prescription filling."
That was a comment left by an anonymous poster to my post about agreeing with The Angry Pharmacist. I think this is a poor and potentially dangerous attitude, so I want to address it.
First of all, I'm sick of my job being demeaned by uppity pharmacists who think you're only truly practicing pharmacy when working in a hospital or clinical environment. Retail pharmacists are looked upon as the dumb pharmacists. It's insinuated that all we do is call insurance companies and count by five, and therefore, we don't really have to know anything about drugs to do our jobs.
Let me state that I could have been whatever kind of pharmacist I wanted. If I wanted a clinical job, I could have gotten one easy. I probably would have been accepted to any residency to which I applied. School was fucking easy for me. I studied for a couple hours the night before exams, and still breezed through with a 3.7. I'm not a dumb pharmacist. I know drugs, and the stuff I don't know about them, I can learn as quickly as anyone.
I chose retail because I like it better, and I believe I make more of a difference in people's lives as a retail pharmacist than I would in any other area of pharmacy. I see my patients several times a month. Some of them, I see nearly every day. I'm on a first name basis with many of them. I've talked to them. I know their histories. I know their families. They come to me when they have questions about their medication. Hell, they come to me when they have questions about their general health. I've earned their trust because I work hard, and I care about them.
Do you know how rewarding it feels when one of your patients visits the pharmacy for no other reason but to tell you that the OTC recommendation you made for them worked really well? Do you know how good it feels when someone comes up to you and says, "My doctor said I should take this, but I wanted to check with you first because you know more about this stuff than he does." ? I don't need to be making interventions to feel like my job is meaningful. Simply caring and being an easily accessible, trustworthy source of information is meaningful enough.
Let me break it to you... No matter where you work, your job becomes routine and mindless. Whether you work in retail, a hospital, long term care, consulting, etc. your job ends up becoming a lot of the same things over and over again. After a little while at any job, we all stop using most of what we learn and instead become experts at the small percentage we have to know. Think about it... What do you really do in a hospital job? You input and check orders all day.
"But wait... I'm responsible for aminoglycoside dosing. I'm using what I learned in school."
I can teach a high schooler with first year algebra skills and no knowledge of pharmacy how to dose aminoglycosides. It's not rocket science. Every hospital has their own dosing parameters for the pharmacists to follow. The job is given to the pharmacists so that the doctors don't have to waste their time figuring it out on their own.
"I round with the medical team and give my advice on how to treat patients."
Sure... I guess you can say that's making a meaningful contribution while using your education. However, I've been on rounds with pharmacists, and most of them don't speak unless spoken to. Occasionally they'll get asked about which antibiotic to use in a certain situation or whether a particular drug needs to be dose adjusted in renal function. The pharmacist may or may not know the answers to these off the top of his head, and if he doesn't, he'll simply look it up. If the pharmacist can look it up, then anyone can look it up, and if that's the case, what makes the pharmacist so special?
"That's not the case for me though. I have the respect of the medical team, so they listen when I make suggestions."
That's the point I'm trying to make. Any job is what you make of it. I can work in a hospital and not do much more than input and check orders all day, and I'd still get a paycheck every week. In much the same way, I could count by fives all day and still get my paycheck working in a retail pharmacy. However, that's not all I do. I choose to interact with my customers. I choose to help them understand their medications. I choose to listen to them when they're crying on the phone to me about how their doctors don't listen to them. I choose to stay up to date on new drugs. I believe that's part of my job. I suppose it doesn't have to be, but I do it anyway.
Because of that, I can't be replaced by a robot or a tech. Sure, they can type up a script. Sure, they can count out the pills and slap a label on a vial. However, they don't have the knowledge to know if what they're doing makes sense. Furthermore, they can't provide the same kind of advice that I (or any pharmacist) can.
You take pharmacists out of pharmacies and prescription errors will go up 10 fold over night. You make customers call some remote call centers in order to ask a pharmacist questions about their medication, and you'll find that they'll be hesitant to do so. Just like you or I wouldn't be so keen on calling a doctor we've never met face to face for medical advice, patients won't want to call a pharmacist they've never seen before.
If you're still not convinced (and I'm sure you won't be), then I hope you don't end up becoming the victim of a prescription error made by a pharmacy technician who didn't know what he was doing. Maybe you'll bring in a prescription for Coumadin where the doctor mistakenly wrote "take 1 tablet 3 times a day" on it, but since the tech doesn't really know how Coumadin is supposed to be dosed, he typed it as it was written, and the robot dispensed it as it was typed.
Or maybe your doctor puts you on Coreg for a heart problem, but you find you get really dizzy shortly after taking each dose. Maybe you'd love to ask the pharmacist if that's normal, but alas, there's only technicians at the pharmacy, so they wouldn't know to tell you to try taking your Coreg with food because taking it with food slows the rate of absorption but doesn't decrease the extent of absorption.
Or maybe it'll be 8:00 PM on a Saturday night, and your baby will be running a fever despite the antibiotics the pediatrician gave him the day before. The baby won't stop crying, and your doctor can't be reached on the weekend, so the only person you can turn to is a community pharmacist who will be able to tell you what dose of Tylenol you can give the baby.
You're right though... If all pharmacists did was count by five and call insurance companies, we wouldn't be needed. If you take pharmacists out of pharmacies, you'll get the same kind of service from pharmacies as you would get from a fast food restaurant. I don't know about you, but I'd rather not treat my medications like fast food.
Personally, I feel that the future of retail pharmacy lies with technicians filling prescriptions and a couple of pharmacists sitting in a district call center fielding questions about the more challenging issues regarding drug interactions and complex disease states.
Highly educated professionals should handle issues that require a significant knowledge base, not do menial tasks like order entry and prescription filling."
That was a comment left by an anonymous poster to my post about agreeing with The Angry Pharmacist. I think this is a poor and potentially dangerous attitude, so I want to address it.
First of all, I'm sick of my job being demeaned by uppity pharmacists who think you're only truly practicing pharmacy when working in a hospital or clinical environment. Retail pharmacists are looked upon as the dumb pharmacists. It's insinuated that all we do is call insurance companies and count by five, and therefore, we don't really have to know anything about drugs to do our jobs.
Let me state that I could have been whatever kind of pharmacist I wanted. If I wanted a clinical job, I could have gotten one easy. I probably would have been accepted to any residency to which I applied. School was fucking easy for me. I studied for a couple hours the night before exams, and still breezed through with a 3.7. I'm not a dumb pharmacist. I know drugs, and the stuff I don't know about them, I can learn as quickly as anyone.
I chose retail because I like it better, and I believe I make more of a difference in people's lives as a retail pharmacist than I would in any other area of pharmacy. I see my patients several times a month. Some of them, I see nearly every day. I'm on a first name basis with many of them. I've talked to them. I know their histories. I know their families. They come to me when they have questions about their medication. Hell, they come to me when they have questions about their general health. I've earned their trust because I work hard, and I care about them.
Do you know how rewarding it feels when one of your patients visits the pharmacy for no other reason but to tell you that the OTC recommendation you made for them worked really well? Do you know how good it feels when someone comes up to you and says, "My doctor said I should take this, but I wanted to check with you first because you know more about this stuff than he does." ? I don't need to be making interventions to feel like my job is meaningful. Simply caring and being an easily accessible, trustworthy source of information is meaningful enough.
Let me break it to you... No matter where you work, your job becomes routine and mindless. Whether you work in retail, a hospital, long term care, consulting, etc. your job ends up becoming a lot of the same things over and over again. After a little while at any job, we all stop using most of what we learn and instead become experts at the small percentage we have to know. Think about it... What do you really do in a hospital job? You input and check orders all day.
"But wait... I'm responsible for aminoglycoside dosing. I'm using what I learned in school."
I can teach a high schooler with first year algebra skills and no knowledge of pharmacy how to dose aminoglycosides. It's not rocket science. Every hospital has their own dosing parameters for the pharmacists to follow. The job is given to the pharmacists so that the doctors don't have to waste their time figuring it out on their own.
"I round with the medical team and give my advice on how to treat patients."
Sure... I guess you can say that's making a meaningful contribution while using your education. However, I've been on rounds with pharmacists, and most of them don't speak unless spoken to. Occasionally they'll get asked about which antibiotic to use in a certain situation or whether a particular drug needs to be dose adjusted in renal function. The pharmacist may or may not know the answers to these off the top of his head, and if he doesn't, he'll simply look it up. If the pharmacist can look it up, then anyone can look it up, and if that's the case, what makes the pharmacist so special?
"That's not the case for me though. I have the respect of the medical team, so they listen when I make suggestions."
That's the point I'm trying to make. Any job is what you make of it. I can work in a hospital and not do much more than input and check orders all day, and I'd still get a paycheck every week. In much the same way, I could count by fives all day and still get my paycheck working in a retail pharmacy. However, that's not all I do. I choose to interact with my customers. I choose to help them understand their medications. I choose to listen to them when they're crying on the phone to me about how their doctors don't listen to them. I choose to stay up to date on new drugs. I believe that's part of my job. I suppose it doesn't have to be, but I do it anyway.
Because of that, I can't be replaced by a robot or a tech. Sure, they can type up a script. Sure, they can count out the pills and slap a label on a vial. However, they don't have the knowledge to know if what they're doing makes sense. Furthermore, they can't provide the same kind of advice that I (or any pharmacist) can.
You take pharmacists out of pharmacies and prescription errors will go up 10 fold over night. You make customers call some remote call centers in order to ask a pharmacist questions about their medication, and you'll find that they'll be hesitant to do so. Just like you or I wouldn't be so keen on calling a doctor we've never met face to face for medical advice, patients won't want to call a pharmacist they've never seen before.
If you're still not convinced (and I'm sure you won't be), then I hope you don't end up becoming the victim of a prescription error made by a pharmacy technician who didn't know what he was doing. Maybe you'll bring in a prescription for Coumadin where the doctor mistakenly wrote "take 1 tablet 3 times a day" on it, but since the tech doesn't really know how Coumadin is supposed to be dosed, he typed it as it was written, and the robot dispensed it as it was typed.
Or maybe your doctor puts you on Coreg for a heart problem, but you find you get really dizzy shortly after taking each dose. Maybe you'd love to ask the pharmacist if that's normal, but alas, there's only technicians at the pharmacy, so they wouldn't know to tell you to try taking your Coreg with food because taking it with food slows the rate of absorption but doesn't decrease the extent of absorption.
Or maybe it'll be 8:00 PM on a Saturday night, and your baby will be running a fever despite the antibiotics the pediatrician gave him the day before. The baby won't stop crying, and your doctor can't be reached on the weekend, so the only person you can turn to is a community pharmacist who will be able to tell you what dose of Tylenol you can give the baby.
You're right though... If all pharmacists did was count by five and call insurance companies, we wouldn't be needed. If you take pharmacists out of pharmacies, you'll get the same kind of service from pharmacies as you would get from a fast food restaurant. I don't know about you, but I'd rather not treat my medications like fast food.
Wednesday, October 8, 2008
It's so bad that all I can do is laugh
As of this morning, my 401k has lost 23% of it's value. I've decided not to be upset over this. I'm just going to laugh as my money disappears. Luckily, I've only been contributing to my 401k for a couple years now, so I don't have a huge amount of money in it.
Long-time readers will remember that I freaked out earlier this year when I predicted an impending global financial meltdown. I'm not going to outline the whole argument, but I'll just say that if you don't think this crisis is related to what I was saying, you're kidding yourself. However, I'm not really panicked about things now. Maybe I'm just in a better place now, which is allowing me to better cope with all of this. Whatever the case, I'm more amused than anything.
I never really planned on retiring anyway. I always kind of figured by the time I reached retirement age, retirement will be a long forgotten concept to the average worker. Therefore, while I do contribute to a retirement account, I make sure to contribute to my regular savings account as much as possible. I'm incredibly grateful to have a job that allows me to do this... I just hope I'm able to keep this job for a long time.
Long-time readers will remember that I freaked out earlier this year when I predicted an impending global financial meltdown. I'm not going to outline the whole argument, but I'll just say that if you don't think this crisis is related to what I was saying, you're kidding yourself. However, I'm not really panicked about things now. Maybe I'm just in a better place now, which is allowing me to better cope with all of this. Whatever the case, I'm more amused than anything.
I never really planned on retiring anyway. I always kind of figured by the time I reached retirement age, retirement will be a long forgotten concept to the average worker. Therefore, while I do contribute to a retirement account, I make sure to contribute to my regular savings account as much as possible. I'm incredibly grateful to have a job that allows me to do this... I just hope I'm able to keep this job for a long time.
Sunday, October 5, 2008
Agreeing with The Angry Pharmacist
http://www.theangrypharmacist.com/archives/2008/10/debunking_the_myth_of_what_bri.html
The Angry Pharmacist wrote a great blog entry regarding the realities of retail pharmacy. I couldn't agree more with what he said, and I encourage everyone to check it out. I just had a few of my own thoughts that I'd like to add.
Since I started working as an intern during my second year in pharmacy school, I've been saying that pharmacy school teaches you everything except how to be a pharmacist. They overload you with pharmacology, therapeutics, medicinal chemistry, etc., etc., but they give you (at least they gave me) only ONE lecture over a 4 year professional program about the business side of pharmacy.
In retail, the business side of pharmacy is what keeps us having jobs. All those professors can lecture about patient care and medication therapy management all they want, but in the end, if pharmacies are not filling prescriptions, they're not getting paid.
By the way... Under the MTM model, just how many patients would we have to counsel an hour to make it profitable. A pharmacist is making almost a dollar a minute. How much are we looking to charge for these MTM sessions, and would we be able to have enough sessions to make up for a pharmacist's salary? I didn't even include the cost of all the time spent keeping records of our MTM sessions, nor did I include the cost of supplies (charts, storage bins, new computer software, etc.) to do so.
Moreover, does MTM mean that we stop providing medication counseling to everyone else? We used to do that shit for free, so under MTM if Mrs. Old Lady calls up with some questions about her medication, do we tell her she needs to make an appointment? I'm sure that will go over really well. One of the big reasons that the public looks so favorably upon pharmacists is that we're the most readily available source of health care information. With a simple phone call, anyone can speak to a drug expert within minutes. You start restricting what kind of information pharmacists can give out for free and suddenly, we're not any different from any other health care professional. However, if you want to set up MTM and don't put up any restrictions on free information, then what's to stop people from not setting up appointments and just demanding whatever info they can get over the phone or when they get their mandatory counseling upon picking up a new script? It's all very confusing.
Pharmacies fill prescriptions. That's how we get paid. That's the main service we provide to the public. We do our very best to make sure that every prescription that comes through the door is dispensed safely and accurately. In most cases, we are the last line of defense against medication errors. Every time we correct a prescriber's mistake or catch a potentially dangerous drug interaction, we are potentially saving someone from harm or (in the worst cases) death. In doing so, we save the health care industry probably billions of dollars per year by cutting down on serious adverse reactions and potential malpractice suits. That's the pharmacist's role in all of this.
Many people are worried that we'll be replaced by technicians or robots because it would save our employers money. Perhaps this is a real worry, but MTM isn't the answer to that either. If Walgreens or CVS wants to save money by taking pharmacists out of pharmacies, then why would they want to spend the extra money to have a pharmacist do MTM?
Furthermore, even the very best technicians cannot fill prescriptions as reliably as pharmacists. My store has a nationally certified technician that, by all accounts, is very very good at her job. Even still, I catch and correct a lot of mistakes she makes inputting scripts. Sure, technicians can type what they see on a script and fill it that way, but they can't ask the most important question, "Does it make sense?" A robot can't do that either. Only a pharmacist has the education and training do to so, and that's why we're vital to the success of the business as well as the safety of our patients. Our task is to make our employers understand this instead of trying to change the way we do business.
The Angry Pharmacist wrote a great blog entry regarding the realities of retail pharmacy. I couldn't agree more with what he said, and I encourage everyone to check it out. I just had a few of my own thoughts that I'd like to add.
Since I started working as an intern during my second year in pharmacy school, I've been saying that pharmacy school teaches you everything except how to be a pharmacist. They overload you with pharmacology, therapeutics, medicinal chemistry, etc., etc., but they give you (at least they gave me) only ONE lecture over a 4 year professional program about the business side of pharmacy.
In retail, the business side of pharmacy is what keeps us having jobs. All those professors can lecture about patient care and medication therapy management all they want, but in the end, if pharmacies are not filling prescriptions, they're not getting paid.
By the way... Under the MTM model, just how many patients would we have to counsel an hour to make it profitable. A pharmacist is making almost a dollar a minute. How much are we looking to charge for these MTM sessions, and would we be able to have enough sessions to make up for a pharmacist's salary? I didn't even include the cost of all the time spent keeping records of our MTM sessions, nor did I include the cost of supplies (charts, storage bins, new computer software, etc.) to do so.
Moreover, does MTM mean that we stop providing medication counseling to everyone else? We used to do that shit for free, so under MTM if Mrs. Old Lady calls up with some questions about her medication, do we tell her she needs to make an appointment? I'm sure that will go over really well. One of the big reasons that the public looks so favorably upon pharmacists is that we're the most readily available source of health care information. With a simple phone call, anyone can speak to a drug expert within minutes. You start restricting what kind of information pharmacists can give out for free and suddenly, we're not any different from any other health care professional. However, if you want to set up MTM and don't put up any restrictions on free information, then what's to stop people from not setting up appointments and just demanding whatever info they can get over the phone or when they get their mandatory counseling upon picking up a new script? It's all very confusing.
Pharmacies fill prescriptions. That's how we get paid. That's the main service we provide to the public. We do our very best to make sure that every prescription that comes through the door is dispensed safely and accurately. In most cases, we are the last line of defense against medication errors. Every time we correct a prescriber's mistake or catch a potentially dangerous drug interaction, we are potentially saving someone from harm or (in the worst cases) death. In doing so, we save the health care industry probably billions of dollars per year by cutting down on serious adverse reactions and potential malpractice suits. That's the pharmacist's role in all of this.
Many people are worried that we'll be replaced by technicians or robots because it would save our employers money. Perhaps this is a real worry, but MTM isn't the answer to that either. If Walgreens or CVS wants to save money by taking pharmacists out of pharmacies, then why would they want to spend the extra money to have a pharmacist do MTM?
Furthermore, even the very best technicians cannot fill prescriptions as reliably as pharmacists. My store has a nationally certified technician that, by all accounts, is very very good at her job. Even still, I catch and correct a lot of mistakes she makes inputting scripts. Sure, technicians can type what they see on a script and fill it that way, but they can't ask the most important question, "Does it make sense?" A robot can't do that either. Only a pharmacist has the education and training do to so, and that's why we're vital to the success of the business as well as the safety of our patients. Our task is to make our employers understand this instead of trying to change the way we do business.
Saturday, September 27, 2008
Don't I get a discount???
A woman came in to pick up her precription for 90 capsules of generic Dyazide. Our company's price on this prescription was roughly $10.
"Excuse me. Don't I get a discount?" said the woman.
"What kind of discount?" I inquired.
"I'm a physician! Isn't there some kind of physician discount?" said the woman. It was at this time that I noticed she was the doctor who wrote for herself the prescription in question.
"No. There are no discounts. That price is set at the corporate level, and that's the same price for everyone," I informed her.
The woman didn't protest any further. She wasn't particularly pleased, but she didn't make a big issue of it. However, the nerve of the woman to even ask for a discount simply because she's a physician really ticks me off. Does that mean I can go to a doctor's office and ask for a "Pharmacist's Discount" on my next appointment? It's the same kind of reasoning. I mean, what exactly does being a physician have to do with the pricing at our pharmacy.
The really sad thing is that this woman probably makes $250,000 per year, and $10 is too much for her to pay for a 90 day prescription. She's one of the privelaged members of society that CAN actually easily afford to pay for her prescription medication. If anything... We should be charging her more to make up for some of the money we lose on Medicaid reimbursements.
I think this says something about society as a whole...
"Excuse me. Don't I get a discount?" said the woman.
"What kind of discount?" I inquired.
"I'm a physician! Isn't there some kind of physician discount?" said the woman. It was at this time that I noticed she was the doctor who wrote for herself the prescription in question.
"No. There are no discounts. That price is set at the corporate level, and that's the same price for everyone," I informed her.
The woman didn't protest any further. She wasn't particularly pleased, but she didn't make a big issue of it. However, the nerve of the woman to even ask for a discount simply because she's a physician really ticks me off. Does that mean I can go to a doctor's office and ask for a "Pharmacist's Discount" on my next appointment? It's the same kind of reasoning. I mean, what exactly does being a physician have to do with the pricing at our pharmacy.
The really sad thing is that this woman probably makes $250,000 per year, and $10 is too much for her to pay for a 90 day prescription. She's one of the privelaged members of society that CAN actually easily afford to pay for her prescription medication. If anything... We should be charging her more to make up for some of the money we lose on Medicaid reimbursements.
I think this says something about society as a whole...
Thursday, September 18, 2008
I want my prescriptions NOW regardless of whether the doctor made a mistake or not.
A customer came in today and dropped off a prescription. Immediately after looking at it, I realized the doctor had made a mistake (the prescription simply didn't make any sense as he wrote it). I told her that we'd have to call the doctor's office to clarify the prescription, and I told her to check back with us in about 20 minutes to see if we'd gotten the clarification. She agreed and walked away to do some shopping.
I went to call the doctor's office, but of course, I couldn't actually speak to a human being. Therefore, I had to leave a message. Twenty minutes later, the woman came back looking to pick up her prescription. I told her I couldn't get in touch with the doctor and had to leave a message. Then, she flipped out. She demanded her prescription back saying that she needs it right away and will take it to another pharmacy. I tried to explain to her that no other pharmacy would be able to fill the prescription because it was written incorrectly. She didn't care. She stormed out literally stomping her feet like a 4-year old.
What is wrong with people?????? I tell her that the doctor made a mistake, and she gets pissed off at us? Sure, I could have taken a guess as to what the doctor actually wanted, but it would have been just a guess? Would she have been happy if I simply guessed at it? What if I guessed wrong? I guess it doesn't matter to her though. Apparently her time was more important to her than her personal safety.
At times like that, I wish I could whip out a contract that would absolve us from any wrong doing if we filled the prescription incorrectly and have the patient sign it before dispensing. Then after she signed, I could hand her whatever I felt like and say with a smile, "Have a nice day. I hope you don't die!"
Actually... I kind of hope people like that do die.
I went to call the doctor's office, but of course, I couldn't actually speak to a human being. Therefore, I had to leave a message. Twenty minutes later, the woman came back looking to pick up her prescription. I told her I couldn't get in touch with the doctor and had to leave a message. Then, she flipped out. She demanded her prescription back saying that she needs it right away and will take it to another pharmacy. I tried to explain to her that no other pharmacy would be able to fill the prescription because it was written incorrectly. She didn't care. She stormed out literally stomping her feet like a 4-year old.
What is wrong with people?????? I tell her that the doctor made a mistake, and she gets pissed off at us? Sure, I could have taken a guess as to what the doctor actually wanted, but it would have been just a guess? Would she have been happy if I simply guessed at it? What if I guessed wrong? I guess it doesn't matter to her though. Apparently her time was more important to her than her personal safety.
At times like that, I wish I could whip out a contract that would absolve us from any wrong doing if we filled the prescription incorrectly and have the patient sign it before dispensing. Then after she signed, I could hand her whatever I felt like and say with a smile, "Have a nice day. I hope you don't die!"
Actually... I kind of hope people like that do die.
Sunday, September 14, 2008
Searching for Things to Write About
This blog was really easy to write for the first year. I had a lifetime worth of pent up emotions and frustrations that I needed to get out. In addition, I was just going through a very busy and stressful time at work, so I had plenty of pharmacy things to write about. Lately, I just don't have much to say.
Here's the problem: I tend to write from extreme emotions. If I'm pissed off at something, I can write 10 pages without breaking a sweat. If I'm feeling depressed, the words just flow from me. It's the same thing when I'm really happy about something (as I was over the possibilities that eHarmony Girl presented). Right now, I'm kind of middle of the road. I'm not feeling down at all, but I'm really not soaring with happiness. I guess my life is just kind of in this holding pattern now where I'm waiting for the next big thing to come up.
I'm finding it especially hard to write about pharmacy because work has been pretty great lately. Two years ago, we were really the only pharmacy in town, so EVERYONE came to us. We were crazy busy (for the kind of store we are), and our help (technicians and clerks specifically) was terrible. Within the last year, 2 major competitors opened up within a half mile from us, and our script volume has dropped roughly 20%. Amazingly, our department hours haven't been cut yet, so it's been pretty stress free. Two years ago, we were busy every second of the day. We never had time to take a break. Now, we often stand around looking at each other trying to figure out what to do. Of course, the company isn't pleased with all the business we lost, but it sure has made my job a lot better. Plus, when they inevitably do cut our hours, I have seniority in the store (thanks to a major staff overhaul over a year ago in which I was the only pharmacist who stayed at the store). I don't have to worry about being transferred or having to pick up hours elsewhere. I'm in a really good position.
Long time readers (those readers who followed me before I jumped off the deep end and then came back with few things to write about), will remember I used to write about Betty (AKA the Horrible Pharmacist). Well, she's still in my store, and she's still up to her same old antics. However, the decreased work load makes it a lot easier to put up with her. Additionally, since I made it a point not to write so specifically about the people I work with anymore, even if she really pisses me off, I can't write about it.
As for my personal life... I've opened up a bit and made some new friends, which I'm pretty happy about. However, I ended up getting involved in a little bit of drama because of it, but it's really not something worse discussing. I've finally made it to the point where I'm not bothered at all by what my ex does or doesn't do with her life. In fact, she doesn't even live in the same state as me anymore. She moved in with her boyfriend who she's been dating for nearly 2 years. Her boyfriend IS that dumbass that I thought it was. This bothered me at first, but not anymore. She sent me this long email out of the blue last week, which explained, in detail, everything that happened to her and all she'd been through since we broke up. There was a lot I didn't know, which shocked me a bit. She also described how her new boyfriend treats her, and he doesn't seem like such a bad guy after all. Therefore, I don't really have a problem with any of that. I FINALLY got closure after 2.5 years.
Sooooo.... Work is good. My personal life is OK, even if it's still pretty boring. I really don't have much to do on my days off. This is the last day of a 4 day weekend for me, and I didn't really do anything except to go to some terrible party for a few hours on Saturday night. Therefore, I still complain about being bored, but at least I'm not sitting around all day lamenting on the past anymore... It actually feels odd to say that because I've spent so much of the last 2.5 years lamenting on the past. I'm finally ready to move forward. I just wish I had come to this state sooner, so I didn't waste all that time. Oh well... Can't change that now.
There's not really much of a point to this post. I guess I'm just explaining why I'm not writing much anymore, and why, when I do write, the tone is different than before.
Here's the problem: I tend to write from extreme emotions. If I'm pissed off at something, I can write 10 pages without breaking a sweat. If I'm feeling depressed, the words just flow from me. It's the same thing when I'm really happy about something (as I was over the possibilities that eHarmony Girl presented). Right now, I'm kind of middle of the road. I'm not feeling down at all, but I'm really not soaring with happiness. I guess my life is just kind of in this holding pattern now where I'm waiting for the next big thing to come up.
I'm finding it especially hard to write about pharmacy because work has been pretty great lately. Two years ago, we were really the only pharmacy in town, so EVERYONE came to us. We were crazy busy (for the kind of store we are), and our help (technicians and clerks specifically) was terrible. Within the last year, 2 major competitors opened up within a half mile from us, and our script volume has dropped roughly 20%. Amazingly, our department hours haven't been cut yet, so it's been pretty stress free. Two years ago, we were busy every second of the day. We never had time to take a break. Now, we often stand around looking at each other trying to figure out what to do. Of course, the company isn't pleased with all the business we lost, but it sure has made my job a lot better. Plus, when they inevitably do cut our hours, I have seniority in the store (thanks to a major staff overhaul over a year ago in which I was the only pharmacist who stayed at the store). I don't have to worry about being transferred or having to pick up hours elsewhere. I'm in a really good position.
Long time readers (those readers who followed me before I jumped off the deep end and then came back with few things to write about), will remember I used to write about Betty (AKA the Horrible Pharmacist). Well, she's still in my store, and she's still up to her same old antics. However, the decreased work load makes it a lot easier to put up with her. Additionally, since I made it a point not to write so specifically about the people I work with anymore, even if she really pisses me off, I can't write about it.
As for my personal life... I've opened up a bit and made some new friends, which I'm pretty happy about. However, I ended up getting involved in a little bit of drama because of it, but it's really not something worse discussing. I've finally made it to the point where I'm not bothered at all by what my ex does or doesn't do with her life. In fact, she doesn't even live in the same state as me anymore. She moved in with her boyfriend who she's been dating for nearly 2 years. Her boyfriend IS that dumbass that I thought it was. This bothered me at first, but not anymore. She sent me this long email out of the blue last week, which explained, in detail, everything that happened to her and all she'd been through since we broke up. There was a lot I didn't know, which shocked me a bit. She also described how her new boyfriend treats her, and he doesn't seem like such a bad guy after all. Therefore, I don't really have a problem with any of that. I FINALLY got closure after 2.5 years.
Sooooo.... Work is good. My personal life is OK, even if it's still pretty boring. I really don't have much to do on my days off. This is the last day of a 4 day weekend for me, and I didn't really do anything except to go to some terrible party for a few hours on Saturday night. Therefore, I still complain about being bored, but at least I'm not sitting around all day lamenting on the past anymore... It actually feels odd to say that because I've spent so much of the last 2.5 years lamenting on the past. I'm finally ready to move forward. I just wish I had come to this state sooner, so I didn't waste all that time. Oh well... Can't change that now.
There's not really much of a point to this post. I guess I'm just explaining why I'm not writing much anymore, and why, when I do write, the tone is different than before.
Thursday, September 11, 2008
White Coat Update
I apparently have won the battle.
Our DM came to our store earlier this week for an issue entirely unrelated to this whole white coat thing, and he didn't care if we wore the coats or not. Therefore, the wonderful store manager (note it wasn't a pharmacy manager) who chastised me last week for not wearing a coat can go blow himself.
The best thing is that my pharmacy manager also never wears a white coat. In fact, he hasn't worn one in 20 years, and he refuses to wear it too. Now the store has two pharmacists openly defying the new dress code, and there's nothing they can do abou it.
It's really nice to be able to stick it to your store managers every once in a while. I mean, I know it's a relatively insignificant thing, but I'm sick of them determining pharmacy policy. I'm sick of them overruling our authority. I'm sick of them handing out gift cards to asshole customers who complain simply because they don't get their way on something they're obviously wrong about.
It's just a small victory, but it still feels good.
Our DM came to our store earlier this week for an issue entirely unrelated to this whole white coat thing, and he didn't care if we wore the coats or not. Therefore, the wonderful store manager (note it wasn't a pharmacy manager) who chastised me last week for not wearing a coat can go blow himself.
The best thing is that my pharmacy manager also never wears a white coat. In fact, he hasn't worn one in 20 years, and he refuses to wear it too. Now the store has two pharmacists openly defying the new dress code, and there's nothing they can do abou it.
It's really nice to be able to stick it to your store managers every once in a while. I mean, I know it's a relatively insignificant thing, but I'm sick of them determining pharmacy policy. I'm sick of them overruling our authority. I'm sick of them handing out gift cards to asshole customers who complain simply because they don't get their way on something they're obviously wrong about.
It's just a small victory, but it still feels good.
Tuesday, September 9, 2008
No one to talk to
Do you ever have those times when something happens in your life, and you just feel like you need to talk to someone about it to try and make some sense of it? That's how I feel right now, but of course in my never-ending solitude, I have no one to talk to. I don't really want to write here what it's all about. I just wanted to talk through this feeling.
It's frustrating, and it eats at you. It's not even like it's this life changing thing that just happened, but it's something that made me think differently about a lot of things that happened over the last few years. It won't affect my future, but it changed my perception of the past, and I just feel like I need to talk it out. I'm not sad. I'm not angry. I'm not happy. It's just this anxious, frustrated feeling.
Actually... it feels a lot like embarrassment. My face is flushed, and my heart is beating quicker. I feel very warm and uncomfortable. Maybe it is embarrassment. Embarrassment over needing a friend and having no one to turn to.
That's the thing that scares me about my life. That's the thing I struggle with. Granted, I don't like being single, but it's not too bad. I can manage it. It's the lack of companionship of any kind that really bothers me. I have friends now, but I'm not close enough to them to talk about a lot of things. What's really kind of sad is that the person who knows the most about me and whom I'm able to talk to about most things is someone who lives 3,000 miles away, and we've never met face to face.
This is the tightrope I walk on: I can be myself, be emotional, optimistic, and willing to face the future head on. However, when I open up that emotional, sensitive, caring part of myself, I realize my solitude much too often. The other option is that I just shut down my emotions, go numb inside, and basically never let anything affect me. That helps me deal with the rigors of going through life every day, but it prevents me from ever making new connections.
Right now... I've made a committment to myself that I'll do my best to not go emotionally numb anymore. I need to feel. I need to be open to caring. Yes, it might hurt at times, but life hurts sometimes. If I block everything out, I may avoid the pain, but I'll also avoid happiness and fun and excitement... and all the things that make life worth living.
But unfortunately, right now, I'm feeling frustration and anxiety. These are the hard parts...
It's frustrating, and it eats at you. It's not even like it's this life changing thing that just happened, but it's something that made me think differently about a lot of things that happened over the last few years. It won't affect my future, but it changed my perception of the past, and I just feel like I need to talk it out. I'm not sad. I'm not angry. I'm not happy. It's just this anxious, frustrated feeling.
Actually... it feels a lot like embarrassment. My face is flushed, and my heart is beating quicker. I feel very warm and uncomfortable. Maybe it is embarrassment. Embarrassment over needing a friend and having no one to turn to.
That's the thing that scares me about my life. That's the thing I struggle with. Granted, I don't like being single, but it's not too bad. I can manage it. It's the lack of companionship of any kind that really bothers me. I have friends now, but I'm not close enough to them to talk about a lot of things. What's really kind of sad is that the person who knows the most about me and whom I'm able to talk to about most things is someone who lives 3,000 miles away, and we've never met face to face.
This is the tightrope I walk on: I can be myself, be emotional, optimistic, and willing to face the future head on. However, when I open up that emotional, sensitive, caring part of myself, I realize my solitude much too often. The other option is that I just shut down my emotions, go numb inside, and basically never let anything affect me. That helps me deal with the rigors of going through life every day, but it prevents me from ever making new connections.
Right now... I've made a committment to myself that I'll do my best to not go emotionally numb anymore. I need to feel. I need to be open to caring. Yes, it might hurt at times, but life hurts sometimes. If I block everything out, I may avoid the pain, but I'll also avoid happiness and fun and excitement... and all the things that make life worth living.
But unfortunately, right now, I'm feeling frustration and anxiety. These are the hard parts...
Saturday, September 6, 2008
Some thoughts
I don't think I mentioned this before, but I have a younger brother. He's in graduate school right now and has no interest in pharmacy or anything science related (not that I really care about this). We were a lot different when we were young, but as we grow older and mature, we're becoming a lot more alike. I can't say that we're particularly close. We don't fight. We get along just fine. We just don't talk very much. Actually, we don't talk at all.
Anyway... I just thought to write about this because we're an interesting study of what can be considered being successful in this world. My brother gets good grades, but he has no ambition. He doesn't desire to do anything with his life. He has no career aspirations. Right now, he's perfectly comfortable living with our parents and allowing them to pay for everything in his life. In so many ways, he's a spoiled bastard who has no idea of what the real world is like. If you only heard some of the nasty, selfish remarks he's made to our parents, you'd want to beat the shit out of him. He has no idea how good he has it.
Then there's me: I graduated near the top of my class in high school and pharmacy school. I'm completely financially independent. My brother probably has no chance to make the kind of money that I do now. I have my own place. I'm well-liked and respected by my peers at work as well as our customers. I've never been in trouble. I'm a model citizen in a lot of ways.
On paper, I look like the runaway winner in this success comparison. Here's the thing though... Are career and financial achievements a good way to monitor success? I don't really think so.
See... the thing with my brother is that, no, he'll never have a job that pays as well or is as respected as mine. He may end up living with our parents until he's 30. However, he has a life that I don't. In the past 4 years, he's been to Hawaii 3 times. He's been to the Bahamas on spring break. He has almost a thousand pictures of he and his friends at beaches, parties, mud volleyball games, etc. He's not passionate about his career, but he's passionate about life, and that's so much more important. He's seemingly always trying new things, meeting new people, and going to different places. He's not letting school and work dictate the rest of his life.
That's something I can really learn from him, and that's a revelation to me because I never thought he could teach me anything. Growing up, I was the one with the friends, while he struggled to fit in. I was lean and athletic, while he was fairly chubby. I excelled in school and sports, while he had trouble in certain subjects and wasn't very athletic. I was always clean cut and well-dressed, whereas he continually went through phases where he had long, unkept hair and wore punk rock band t-shirts. I was always a happy kid, while he struggled with depression (which is evident from the scars all over his legs where he purposely cut himself with a razor).
Somewhere along the line, he made some changes in order to better himself. He decided he didn't like being overweight, so he started to run. Now, he's thinner than I am and can run a mile in 5 minutes. He decided the punk rock look wasn't cutting it anymore, so he got a very clean looking, short haircut and started dressing in nicer clothes. Instead of being swallowed by his depression, he challenged himself to make the best of his life that he could. It's sort of inspirational, probably even more so if he didn't act like such an asshole to our parents. He's not perfect of course. He's still pretty high strung about certain things, and he's prone to pretty bad mood swings. However, he's in a much better place than before.
Once again, compare that to me, the supposedly successful one, and the vision of success gets a little muddy. Yes, I'm respected and very comfortable financially. However, I'm not living life to the fullest. Maybe if things didn't go bad with my ex, I wouldn't be saying the same thing. Maybe if I were married now like I thought I'd be, I'd think I was the one with the full and meaningful life. Instead, I'm still in this rut of waking up and going to work every day. I'm trying to form new, meaningful relationships, but it's so damn hard at this point. I've made a couple new friends, but both cases are sort of complicated at the moment.
It all goes back to the consequences of devoting the 6 most important social development years of your life to one person, and then having that one person walk out on you. It doesn't matter how good of a person I might be. It's just hard to form new relationships if you don't come into contact with people (pharmacy patrons don't count) on a regular basis. It sucks when people ask why you didn't go anywhere during your vacation week, and you don't really have an answer except to shrug your shoulders. It's not like I didn't want to go anywhere or do anything. There's not many places to go that are fun for one person, and there's not much that a person can do on his own.
I kind of got off track with this post... The point is that for all my supposed success and my brother's lack thereof, he has the better life. It's not a life that I can't have for myself. I just don't have as many opportunities now. If I could re-live my college years, I'd do so many things differently. Unfortunately, that's not possible, so I'm left trying to make the best of my current situation. I'm trying. I feel like I'm making progress. I've made some pretty big leaps in the past few months (getting over my ex was the biggest of course). There's such a long way to go though, and through it all, I have to keep getting up and going to work...
Anyway... I just thought to write about this because we're an interesting study of what can be considered being successful in this world. My brother gets good grades, but he has no ambition. He doesn't desire to do anything with his life. He has no career aspirations. Right now, he's perfectly comfortable living with our parents and allowing them to pay for everything in his life. In so many ways, he's a spoiled bastard who has no idea of what the real world is like. If you only heard some of the nasty, selfish remarks he's made to our parents, you'd want to beat the shit out of him. He has no idea how good he has it.
Then there's me: I graduated near the top of my class in high school and pharmacy school. I'm completely financially independent. My brother probably has no chance to make the kind of money that I do now. I have my own place. I'm well-liked and respected by my peers at work as well as our customers. I've never been in trouble. I'm a model citizen in a lot of ways.
On paper, I look like the runaway winner in this success comparison. Here's the thing though... Are career and financial achievements a good way to monitor success? I don't really think so.
See... the thing with my brother is that, no, he'll never have a job that pays as well or is as respected as mine. He may end up living with our parents until he's 30. However, he has a life that I don't. In the past 4 years, he's been to Hawaii 3 times. He's been to the Bahamas on spring break. He has almost a thousand pictures of he and his friends at beaches, parties, mud volleyball games, etc. He's not passionate about his career, but he's passionate about life, and that's so much more important. He's seemingly always trying new things, meeting new people, and going to different places. He's not letting school and work dictate the rest of his life.
That's something I can really learn from him, and that's a revelation to me because I never thought he could teach me anything. Growing up, I was the one with the friends, while he struggled to fit in. I was lean and athletic, while he was fairly chubby. I excelled in school and sports, while he had trouble in certain subjects and wasn't very athletic. I was always clean cut and well-dressed, whereas he continually went through phases where he had long, unkept hair and wore punk rock band t-shirts. I was always a happy kid, while he struggled with depression (which is evident from the scars all over his legs where he purposely cut himself with a razor).
Somewhere along the line, he made some changes in order to better himself. He decided he didn't like being overweight, so he started to run. Now, he's thinner than I am and can run a mile in 5 minutes. He decided the punk rock look wasn't cutting it anymore, so he got a very clean looking, short haircut and started dressing in nicer clothes. Instead of being swallowed by his depression, he challenged himself to make the best of his life that he could. It's sort of inspirational, probably even more so if he didn't act like such an asshole to our parents. He's not perfect of course. He's still pretty high strung about certain things, and he's prone to pretty bad mood swings. However, he's in a much better place than before.
Once again, compare that to me, the supposedly successful one, and the vision of success gets a little muddy. Yes, I'm respected and very comfortable financially. However, I'm not living life to the fullest. Maybe if things didn't go bad with my ex, I wouldn't be saying the same thing. Maybe if I were married now like I thought I'd be, I'd think I was the one with the full and meaningful life. Instead, I'm still in this rut of waking up and going to work every day. I'm trying to form new, meaningful relationships, but it's so damn hard at this point. I've made a couple new friends, but both cases are sort of complicated at the moment.
It all goes back to the consequences of devoting the 6 most important social development years of your life to one person, and then having that one person walk out on you. It doesn't matter how good of a person I might be. It's just hard to form new relationships if you don't come into contact with people (pharmacy patrons don't count) on a regular basis. It sucks when people ask why you didn't go anywhere during your vacation week, and you don't really have an answer except to shrug your shoulders. It's not like I didn't want to go anywhere or do anything. There's not many places to go that are fun for one person, and there's not much that a person can do on his own.
I kind of got off track with this post... The point is that for all my supposed success and my brother's lack thereof, he has the better life. It's not a life that I can't have for myself. I just don't have as many opportunities now. If I could re-live my college years, I'd do so many things differently. Unfortunately, that's not possible, so I'm left trying to make the best of my current situation. I'm trying. I feel like I'm making progress. I've made some pretty big leaps in the past few months (getting over my ex was the biggest of course). There's such a long way to go though, and through it all, I have to keep getting up and going to work...
Sunday, August 31, 2008
White Coats
My employer just instituted a new dress code policy stating that pharmacists MUST wear their white coats. I know that most of you are saying, "Big deal; I wear a white coat everyday." Well, I don't. In fact, I don't even have to wear a tie to work (and even with the new dress code, I still don't). Our dress code has always been very casual. As long as you looked professional (button down shirt, no jeans), you were fine.
I don't know how others feel about this, but I absolutely hate the white coat. The only good thing about them is that they have pockets to hold your pens. Otherwise, they get dirty, especially the sleeves which get covered in black dust which must come from the toner in the laser jet printer. They're also pretty restrictive. You don't have as much range of motion in your arms unless you get a coat that's a little too big for you, and then you feel like you're swimming in it. I get hot wearing the coat. Finally, since I'm constantly hurrying from one side of the pharmacy to the other, I tend to get the pockets of the white coat stuck on corners, especially the corners of the bins. Maybe the best reason not to wear the stupid coat is that I firmly believe we look better without them, or at the very least, I certainly do. I feel like I dress pretty well. I'm thin. The coat makes me look bulky and overly nerdy.
I feel that the time of the white coat has passed. At this point, it's only a symbol of status. It's designed to tell people that we're medical professionals because we wear a white coat. Since most of us are no longer compounding prescriptions on a regular basis, we're not using them to shield our clothing from aquaphor or coal tar. They no longer serve a practical purpose.
I love the casual dress code. I think it allows me to look professional while still appearing approachable. I think this look encourages customers to ask questions because I don't look as intimidating as someone in a white coat.
In any case... I'm currently rebelling against the new dress code. I've decided that I will not don my white coat until someone threatens me with some kind of punishment. I'm not about to lose my job over a stupid coat, but I want to see just how far I can push this thing. I get to work early every day. I never call out sick. I work hard. My coworkers like me. Our customers like me. I dress well. Surely, my employer wouldn't fire me over refusing to wear a stupid white coat.... at least I would hope so. With so many piss poor pharmacists out there, there's no way they can justify doing anything to me over it.
I don't know how others feel about this, but I absolutely hate the white coat. The only good thing about them is that they have pockets to hold your pens. Otherwise, they get dirty, especially the sleeves which get covered in black dust which must come from the toner in the laser jet printer. They're also pretty restrictive. You don't have as much range of motion in your arms unless you get a coat that's a little too big for you, and then you feel like you're swimming in it. I get hot wearing the coat. Finally, since I'm constantly hurrying from one side of the pharmacy to the other, I tend to get the pockets of the white coat stuck on corners, especially the corners of the bins. Maybe the best reason not to wear the stupid coat is that I firmly believe we look better without them, or at the very least, I certainly do. I feel like I dress pretty well. I'm thin. The coat makes me look bulky and overly nerdy.
I feel that the time of the white coat has passed. At this point, it's only a symbol of status. It's designed to tell people that we're medical professionals because we wear a white coat. Since most of us are no longer compounding prescriptions on a regular basis, we're not using them to shield our clothing from aquaphor or coal tar. They no longer serve a practical purpose.
I love the casual dress code. I think it allows me to look professional while still appearing approachable. I think this look encourages customers to ask questions because I don't look as intimidating as someone in a white coat.
In any case... I'm currently rebelling against the new dress code. I've decided that I will not don my white coat until someone threatens me with some kind of punishment. I'm not about to lose my job over a stupid coat, but I want to see just how far I can push this thing. I get to work early every day. I never call out sick. I work hard. My coworkers like me. Our customers like me. I dress well. Surely, my employer wouldn't fire me over refusing to wear a stupid white coat.... at least I would hope so. With so many piss poor pharmacists out there, there's no way they can justify doing anything to me over it.
Thursday, August 21, 2008
Considering being a preceptor
That's pretty much the only update I have in my pharmacy world. I'm really considering becoming a preceptor.
Our store's long time pharmacy intern returned to work this summer (she goes to school out of state, so during the semester, she can't work). She's now just starting her rotations during her last year of school. This summer, I made a little bit of an effort to try to at least get her thinking about some of the things she will inevitably have to know for rotations. I didn't go out of my way to quiz her about drugs, but if I happened to pick something off the shelf that I knew a little nugget of wisdom about, I'd ask her something.
I never really gave serious thought to being a preceptor before, but at the end of the summer, she told me that she thinks I'd have a lot to offer as a preceptor and that I should look into it... so I did a little bit.
It's something that I could really see myself doing, and I think I would find it to be very rewarding. I think I have a pretty unique view on retail pharmacy. I recognize that, unfortunate as it may be, it is a business first and foremost. However, just because it's a business, and we have to deal with a ton of bullshit from that perspective, doesn't mean we can't make a difference in people's lives.
Maybe Medication Therapy Management (MTM) is coming soon. Maybe it's not. Regardless, we don't need it to be viewed as professionals. I don't think most of our customers want to make appointments to see their pharmacist. I don't think they really want another person telling them what they should or should not be taking. That's not to say that we shouldn't make suggestions if we feel one is appropriate. However, I don't think that's what they're looking for in their pharmacist.
I think in most cases, your long term and elderly customers just want someone who cares. They want a pharmacist who makes them feel comfortable enough to ask questions. They want a pharmacist that even if he doesn't know the answer to a question right away, he'll go and look it up and get back to them. They want someone they can trust who they view as different from their physician, but still as an expert.
Of course, there are exceptions, but I think these things apply to a good portion of our customers. Therefore, I think this is what pharmacists need to keep in mind when doing their jobs. It's mostly about building trust and showing you care. That's what I would try to pass on to students.
Retail pharmacy is an important job no matter what pharmacy school professors try to say. We are the face of this profession. We deal with more patients on a daily basis than the busiest doctor's office. No, we aren't able to get really in-depth with all of them, but most retail pharmacist know their long time patients pretty well. Hell, I can probably rattle off a med list for about 20 of our customers off the top of my head. These people depend on us, so it's important that they trust us. That trust is what will keep them coming back.... which is good for business.
Anyway... I kind of got side tracked.
I was thinking about how I would set up a rotation for students, and I think had some good ideas. For one, students on my rotation would be doing pretty much all of the counseling. If anyone has a question, the student is the first to answer it (or try to). If someone needs an OTC recommendation, the student will go out in the aisle and help them out.
I wouldn't have much written work, but I think I'd have them to write-ups on some of the more important interactions we spot during the rotation. I might even have them do one drug write-up. I didn't really think about projects (every student is supposed to have one project due at the end of each rotation), but I'm sure the student could do blood pressure screenings, or even help show customers how to use their glucometers more effectively.
You know... I'm still single. I complain about not having much of a life. I think it's time for me to stop my whining and complaining and start being productive. There are a lot more ways to make a difference in this world other than having a girlfriend or getting married. Maybe that will come eventually. Maybe it won't. I can't waste my life waiting for it though.
In any case... Nothing is set yet. I have to do some more planning and figure out if my coworkers would be on board with the idea. After all, I'm not at the store 24/7. My coworkers (both pharmacists and technicians) would have to be accepting of students. I see a few potential issues there, so I want to make sure those are worked out before I dive into this.
There are also some personal concerns that are holding me back a little. I worry that while this is all playing out well in my mind, I won't be able to execute my plan as well as I'm imagining it. After all, I'm not exactly the most outspoken and charismatic person, especially when you first meet me. All things considered though, I think it would be good for me both professionally and personally.
Our store's long time pharmacy intern returned to work this summer (she goes to school out of state, so during the semester, she can't work). She's now just starting her rotations during her last year of school. This summer, I made a little bit of an effort to try to at least get her thinking about some of the things she will inevitably have to know for rotations. I didn't go out of my way to quiz her about drugs, but if I happened to pick something off the shelf that I knew a little nugget of wisdom about, I'd ask her something.
I never really gave serious thought to being a preceptor before, but at the end of the summer, she told me that she thinks I'd have a lot to offer as a preceptor and that I should look into it... so I did a little bit.
It's something that I could really see myself doing, and I think I would find it to be very rewarding. I think I have a pretty unique view on retail pharmacy. I recognize that, unfortunate as it may be, it is a business first and foremost. However, just because it's a business, and we have to deal with a ton of bullshit from that perspective, doesn't mean we can't make a difference in people's lives.
Maybe Medication Therapy Management (MTM) is coming soon. Maybe it's not. Regardless, we don't need it to be viewed as professionals. I don't think most of our customers want to make appointments to see their pharmacist. I don't think they really want another person telling them what they should or should not be taking. That's not to say that we shouldn't make suggestions if we feel one is appropriate. However, I don't think that's what they're looking for in their pharmacist.
I think in most cases, your long term and elderly customers just want someone who cares. They want a pharmacist who makes them feel comfortable enough to ask questions. They want a pharmacist that even if he doesn't know the answer to a question right away, he'll go and look it up and get back to them. They want someone they can trust who they view as different from their physician, but still as an expert.
Of course, there are exceptions, but I think these things apply to a good portion of our customers. Therefore, I think this is what pharmacists need to keep in mind when doing their jobs. It's mostly about building trust and showing you care. That's what I would try to pass on to students.
Retail pharmacy is an important job no matter what pharmacy school professors try to say. We are the face of this profession. We deal with more patients on a daily basis than the busiest doctor's office. No, we aren't able to get really in-depth with all of them, but most retail pharmacist know their long time patients pretty well. Hell, I can probably rattle off a med list for about 20 of our customers off the top of my head. These people depend on us, so it's important that they trust us. That trust is what will keep them coming back.... which is good for business.
Anyway... I kind of got side tracked.
I was thinking about how I would set up a rotation for students, and I think had some good ideas. For one, students on my rotation would be doing pretty much all of the counseling. If anyone has a question, the student is the first to answer it (or try to). If someone needs an OTC recommendation, the student will go out in the aisle and help them out.
I wouldn't have much written work, but I think I'd have them to write-ups on some of the more important interactions we spot during the rotation. I might even have them do one drug write-up. I didn't really think about projects (every student is supposed to have one project due at the end of each rotation), but I'm sure the student could do blood pressure screenings, or even help show customers how to use their glucometers more effectively.
You know... I'm still single. I complain about not having much of a life. I think it's time for me to stop my whining and complaining and start being productive. There are a lot more ways to make a difference in this world other than having a girlfriend or getting married. Maybe that will come eventually. Maybe it won't. I can't waste my life waiting for it though.
In any case... Nothing is set yet. I have to do some more planning and figure out if my coworkers would be on board with the idea. After all, I'm not at the store 24/7. My coworkers (both pharmacists and technicians) would have to be accepting of students. I see a few potential issues there, so I want to make sure those are worked out before I dive into this.
There are also some personal concerns that are holding me back a little. I worry that while this is all playing out well in my mind, I won't be able to execute my plan as well as I'm imagining it. After all, I'm not exactly the most outspoken and charismatic person, especially when you first meet me. All things considered though, I think it would be good for me both professionally and personally.
Tuesday, August 19, 2008
Observations on the Olympics
I haven't posted in a while. Frankly, I don't have much to write about. I've been busy living life to the fullest (HAHAHAHAHAHAHAHAHA). No seriously... I've been pretty active recently, so no time or material for the blog. Not that anyone really cares anyway...
I've been watching the Olympics pretty much non-stop for the past couple of weeks, and I have a few observations I'd like to share with you.
First in women's beach volleyball: I got a kick out of their being cheerleaders for women's beach volleyball games. The cheerleaders were were wearing bikinis, and they still had more clothing on than the girls actually playing volleyball. This is another sport that makes an interesting statement about women. Men beach volleyball players have full uniforms (shorts and sleeveless t-shirts). Women beach volleyball players wear tiny bikini bottoms and basically a sports bra. Is there any particular reason these women can't wear shorts? Is it really more comfortable to dive around in sand in a bikini than it is with more clothing on? Of course, the scantily clad (incredibly tall) women are what draw in the viewers.
On the subject of volleyball: I'm convinced that Lebron James would be the greatest volleyball player in history if he ever tried playing. Really... He'd be unstoppable. He's 6'8", jumps incredibly high, and has great quickness in speed. Plus, he's very strong, so one of his spikes would probably be about 90 mph. I dare anyone to get in the way of one of those bullet spikes. How would anyone be able to spike it over or through him? He could get so high that he could practically block or spike the ball with his head. I'm telling you, he'd be the greatest of all time.
Moreover, I'm convinced that if you took the USA men's basketball team and put them on a volleyball court with only about a week to practice, they'd be competitive. Give them a year to practice, and they'd win a gold medal in the sport. Could you imagine that team? Lebron James (6'8"), Kobe Bryant (6'6"), Dwight Howard (6'11"), Chris Bosh (6'10")... All of them are quick and can jump. You could even add Jason Kidd (6'4") to give them all perfect sets to spike the ball. Honestly... Would you bet against that team? Too bad professional volleyball players can't make $15 million per year. Watching those guys dominate volleyball might actually be more fun than watching them play basketball.
Finally, by societal norms I'm obligated to say something about The Golden Boy, Michael Phelps. By now, we've all been convinced that Phelps isn't actually human, but instead a perfectly engineered swimming cyborg. I'll spare you more talk about how great he is (is there anything left to say???). I just want to mention this new term that is being used to describe amazing athletic achievements: Phelpsian. Yesterday, the USA women's volleyball team won their 107th straight match, and the announcer described that accomplishment as Phelpsian.
My prediction... If it hasn't already happened, we're going to get pretty sick of hearing about Michael Phelps. By now, we all know what's on his MP3 player, what and how much he eats every day, how many days per week he trains, how many hours each day he trains, and I'm sure someone somewhere has the schedule which outlines exactly when he can take a shit. Remember folks... This is swimming here. Three weeks ago, no one cared about swimming. Three weeks from now, no one is going to care about swimming... until the 2012 games when the golden cyborg decides to swim for 10 gold medals. Then the hysteria will start again. Let's just give the kid's name a little bit of a break for now so that when he does come into the national spotlight again 4 years from now, we all won't be sick of hearing about him.
I'm currently in the middle of a week off from work, and I'm enjoying my free time immensely. Maybe when I get back to the source of frustration that I call a job, I'll have more to write about.
I've been watching the Olympics pretty much non-stop for the past couple of weeks, and I have a few observations I'd like to share with you.
First in women's beach volleyball: I got a kick out of their being cheerleaders for women's beach volleyball games. The cheerleaders were were wearing bikinis, and they still had more clothing on than the girls actually playing volleyball. This is another sport that makes an interesting statement about women. Men beach volleyball players have full uniforms (shorts and sleeveless t-shirts). Women beach volleyball players wear tiny bikini bottoms and basically a sports bra. Is there any particular reason these women can't wear shorts? Is it really more comfortable to dive around in sand in a bikini than it is with more clothing on? Of course, the scantily clad (incredibly tall) women are what draw in the viewers.
On the subject of volleyball: I'm convinced that Lebron James would be the greatest volleyball player in history if he ever tried playing. Really... He'd be unstoppable. He's 6'8", jumps incredibly high, and has great quickness in speed. Plus, he's very strong, so one of his spikes would probably be about 90 mph. I dare anyone to get in the way of one of those bullet spikes. How would anyone be able to spike it over or through him? He could get so high that he could practically block or spike the ball with his head. I'm telling you, he'd be the greatest of all time.
Moreover, I'm convinced that if you took the USA men's basketball team and put them on a volleyball court with only about a week to practice, they'd be competitive. Give them a year to practice, and they'd win a gold medal in the sport. Could you imagine that team? Lebron James (6'8"), Kobe Bryant (6'6"), Dwight Howard (6'11"), Chris Bosh (6'10")... All of them are quick and can jump. You could even add Jason Kidd (6'4") to give them all perfect sets to spike the ball. Honestly... Would you bet against that team? Too bad professional volleyball players can't make $15 million per year. Watching those guys dominate volleyball might actually be more fun than watching them play basketball.
Finally, by societal norms I'm obligated to say something about The Golden Boy, Michael Phelps. By now, we've all been convinced that Phelps isn't actually human, but instead a perfectly engineered swimming cyborg. I'll spare you more talk about how great he is (is there anything left to say???). I just want to mention this new term that is being used to describe amazing athletic achievements: Phelpsian. Yesterday, the USA women's volleyball team won their 107th straight match, and the announcer described that accomplishment as Phelpsian.
My prediction... If it hasn't already happened, we're going to get pretty sick of hearing about Michael Phelps. By now, we all know what's on his MP3 player, what and how much he eats every day, how many days per week he trains, how many hours each day he trains, and I'm sure someone somewhere has the schedule which outlines exactly when he can take a shit. Remember folks... This is swimming here. Three weeks ago, no one cared about swimming. Three weeks from now, no one is going to care about swimming... until the 2012 games when the golden cyborg decides to swim for 10 gold medals. Then the hysteria will start again. Let's just give the kid's name a little bit of a break for now so that when he does come into the national spotlight again 4 years from now, we all won't be sick of hearing about him.
I'm currently in the middle of a week off from work, and I'm enjoying my free time immensely. Maybe when I get back to the source of frustration that I call a job, I'll have more to write about.
Thursday, July 31, 2008
Putting to rest another part of my past
I've decided to put away my basketball sneakers for good.
Every summer, me and a bunch of guys I played high school basketball with play in a men's league. When we first started playing in this league right after high school, we were one of the best teams in it, and the overall competition level of this league is pretty high. We were the young guys. We ran teams out of the gym with our quickness and athleticism. This last season, we finished 1-9. The other teams aren't any better. We're just not as good as we used to be. Basically, we're getting old.
My play has deteriorated so much over the last couple of years that its amazing. I've lost half my quickness, most of my leaping ability, my ability to finish at the hoop in traffic, and finally I've lost my jumpshot. In 3 years time, I went from being one of the top guards in the entire league to being a guy you can leave wide open from the 3-point line all game. It's pathetic.
At 26 years old, all my past injuries and time spent standing on my feet at work has finally taken its toll on my legs. I can't be the player that I used to be. I can't even be a shadow of my former self. Basketball stopped being fun for me because I dissappoint myself every time I walk on the court. Therefore, I'm done playing.
It's OK. I had to grow up some time. I'm not a college kid anymore. I know I should be focusing on different things, such as becoming a better pharmacist and possibly starting a new relationship. However, I'd be lying if I said I wasn't a little sad by this. Basketball was such a huge part of my life ever since I was 7 years old. I feel like I'm walking away from a great friend.
I look at myself now, and I realize that there's almost nothing left of my former self. There's nothing left from those good college days. No girlfriend. No basketball. No more innocent idealism. My ties to my past are almost completely severed. I think I can finally say that I'm officially an adult. It kind of sucks, but I accept it.
Anyway... I was just thinking about how much things have changed in such a short time. I'm not saying change is a bad thing. It's just different (that's the point). I feel strangely optimistic about my future. Things haven't gone close to plan up until this point, but I have a feeling that a few years from now, I'll be looking back at all of this and saying it was all for a reason.
Every summer, me and a bunch of guys I played high school basketball with play in a men's league. When we first started playing in this league right after high school, we were one of the best teams in it, and the overall competition level of this league is pretty high. We were the young guys. We ran teams out of the gym with our quickness and athleticism. This last season, we finished 1-9. The other teams aren't any better. We're just not as good as we used to be. Basically, we're getting old.
My play has deteriorated so much over the last couple of years that its amazing. I've lost half my quickness, most of my leaping ability, my ability to finish at the hoop in traffic, and finally I've lost my jumpshot. In 3 years time, I went from being one of the top guards in the entire league to being a guy you can leave wide open from the 3-point line all game. It's pathetic.
At 26 years old, all my past injuries and time spent standing on my feet at work has finally taken its toll on my legs. I can't be the player that I used to be. I can't even be a shadow of my former self. Basketball stopped being fun for me because I dissappoint myself every time I walk on the court. Therefore, I'm done playing.
It's OK. I had to grow up some time. I'm not a college kid anymore. I know I should be focusing on different things, such as becoming a better pharmacist and possibly starting a new relationship. However, I'd be lying if I said I wasn't a little sad by this. Basketball was such a huge part of my life ever since I was 7 years old. I feel like I'm walking away from a great friend.
I look at myself now, and I realize that there's almost nothing left of my former self. There's nothing left from those good college days. No girlfriend. No basketball. No more innocent idealism. My ties to my past are almost completely severed. I think I can finally say that I'm officially an adult. It kind of sucks, but I accept it.
Anyway... I was just thinking about how much things have changed in such a short time. I'm not saying change is a bad thing. It's just different (that's the point). I feel strangely optimistic about my future. Things haven't gone close to plan up until this point, but I have a feeling that a few years from now, I'll be looking back at all of this and saying it was all for a reason.
Sunday, July 27, 2008
Sometimes I Wonder...
I get asked this question more than should be possible...
A tech and I will be standing around in the pharmacy on a slow afternoon (usually a weekend), and a customer will cautiously approach the counter. "Hi... Are you open?" they ask with a puzzled expression.
Honestly, what can be going through these people's minds? I'm standing behind the pharmacy counter. The lights are on. The gate is up. Why would I be standing in the pharmacy like that if we were closed? Do these people think I live at the pharmacy? Why would I be there if I didn't have to?
I often wonder what they'd say if I told them we were closed. I bet it wouldn't stop them from asking if they could get a prescription filled. Therefore, if the answer to the question, "are you open?" doesn't make any difference to them, why did they bother asking in the first place?
This completely puzzles me.
The other question that irritates me comes about in the following situation:
(Phone Rings)
Me: Hi, this is the pharmacist. Can I help you?
Customer: Are you the pharmacist???
This occurs at least 5 times per day. Someday, I'll cease being amazed by this stupidity, but I don't think it will be any time soon.
A tech and I will be standing around in the pharmacy on a slow afternoon (usually a weekend), and a customer will cautiously approach the counter. "Hi... Are you open?" they ask with a puzzled expression.
Honestly, what can be going through these people's minds? I'm standing behind the pharmacy counter. The lights are on. The gate is up. Why would I be standing in the pharmacy like that if we were closed? Do these people think I live at the pharmacy? Why would I be there if I didn't have to?
I often wonder what they'd say if I told them we were closed. I bet it wouldn't stop them from asking if they could get a prescription filled. Therefore, if the answer to the question, "are you open?" doesn't make any difference to them, why did they bother asking in the first place?
This completely puzzles me.
The other question that irritates me comes about in the following situation:
(Phone Rings)
Me: Hi, this is the pharmacist. Can I help you?
Customer: Are you the pharmacist???
This occurs at least 5 times per day. Someday, I'll cease being amazed by this stupidity, but I don't think it will be any time soon.
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