Wednesday, January 30, 2008

I've never been in a fight

In my entire life, I've never actually physically fought another person (siblings don't count). My parents taught me, and rightfully so, that you should always try to avoid fighting and try to settle disputes in non-violent ways. You can't argue with those words of wisdom. However, I can't help but wonder how I'd fare in an actual fight.

I'm not a big guy. I'm 5'9" and weigh 165 lbs. I'm not particularly strong as far as lifting weights. However, I think I have a surprising amount of practical strength. I'm athletic. I have very quick feet and even faster hands. My hand-eye coordination and reflexes are very good. Therefore, I think I could hold my own in a fight.

I suppose it would depend on the size of the person I was fighting. Anyone my height or shorter, I think I can hold my own. I have a friend who's 6'3" and a ripped 265 lbs. He'd crush me if I was freaking Bruce Lee.

Under most circumstances, I'm entirely non-confrontational. I don't argue with co-workers. I don't fight. I don't like telling people what to do. In fact, I demonstrate almost no leadership skills at all.

Anyway... The point of all this is that I really feel that if my back was against the wall, and I was forced to fight someone or take charge, I'd be great. Forget about the fighting part for the moment. As far as being a leader, I have all the skills necessary to be a good leader (which in pharmacy world would mean being a manager). I know how to organize. I know how to delegate tasks. I know what kind of rules and guidelines I would have in my ideal pharmacy. Most importantly, I know that my ideas would work, and if they don't, I have the intelligence and flexibility to make adjustments until they do work.

The reason I'm not more of a leader is because I'm hesitant to ruffle any feathers. I try to please everyone. That's always been one of my problems. On the bright side, all of my coworkers like me. On the downside, the pharmacy runs less efficiently than it could. I know how to fix our flaws. I just won't do it for fear of makiing people mad.

Alright... I'm running out of steam here. Still no word from eHarmony girl. Oh well... in retrospect, I don't think she was a good match for me anyway. She's pretty, and we have a lot of things in common, but she's not a good match intellectually for me. She's kind of superficial about a lot of things, and she has no appreciation of good film or good literature. Moreover, she has absolutely no interest in politics or world affairs. She's a nice girl. She's caring and knows how to be a good friend. However, I need someone who can challenge me intellectually.

If it turns out she's still interested, fine. If not, no big deal. I've been single for 2.5 years now. I'm pretty used to it by now.

Tuesday, January 29, 2008

Pharmacy Dreams

I'm sure every pharmacist gets dreams like this every once in a while....

This morning, I woke up at 5:00 AM in a panic. I was having a dream that I made an error during my previous workday, and I was just realizing it in the middle of the night.

The error was due to the doctor's poor writing and me being in a rush. The prescription read "Norvasc 10mg, #30, QD." However, I misread the prescription as "Norvasc 10mg, #30, TID." Hours later, I realized that taking Norvasc 3 times a day doesn't make much sense, and this is how I realized I made a mistake.

Of course... This didn't actually happen. It was just a dream. However, it felt so real, and it was so plausible that it made me nervous. I kept trying to tell myself that I know it's just a dream, but being not quite awake yet, my mind wouldn't let go of the belief I made an error. I actually had to open my eyes, roll over, and stare at the ceiling for a little while before I could believe it was all just a dream.

Despite it not actually happening, this does illustrate one of the potential pitfalls of working in retail pharmacy. At times, you can get so caught up in checking individual prescriptions that sometimes you don't stop to ask yourself if the prescription makes sense. You just make sure that the info written on the prescription is what makes it to the label.

For example, yesterday, one of the pharmacists checked 2 prescriptions for the same patient. One was Fluoxetine 40mg, QD, with 2 refills. The other was Lexapro 10mg, QD, with 2 refills. That's obviously a therapeutic duplication as they are both SSRIs. However, the pharmacist (it wasn't me) just checked them and kept on going. Both were filled exactly as the prescription stated. However, no one even thought to question why the patient would be taking both drugs at the same time. (I called the doctor today, and it turns out that he, indeed, meant for the patient to be taking both, but that's besides the point).

I've made 2 significant prescription errors (that I know of) in my time as a pharmacist. Significant errors don't include miscounting tablets, putting the wrong doctor's name, or the wrong amount of refills on a prescription. When I say significant errors, I mean making a mistake on the drug, dose, or directions.

My first error was entirely due to an interruption during the filling process. I was working by myself in an extremely slow store. I got a prescription for Prednisone 20 mg. I typed it incorrectly for Prednisone 10mg. I was about to check the script, but the phone rang. I picked up the phone and spent 5 minutes answering some sort of questions (I can't remember what). During that time, the customer came back to the counter expecting to pick up the finished prescription. By the time I hung up the phone, I forgot that I didn't check the script, and I filled what was on the label. Two minutes after she walked away, I realized I never checked the script, and this is where I realized I made a mistake. I promptly called the patient to tell her I made a mistake, I corrected the prescription, and refunded the patient her money (all $1.XX worth). I felt so bad I was on the verge of tears when I was refunding her money.

My second mistake came on a Saturday at my current store. This occured nearly a year ago. I got a prescription for Avinza 30mg for 60 capsules. I typed the prescription correctly. However, I filled the prescription with Avinza 60mg capsules. Avinza is an extended release Morphine, so this obviously could have been a pretty significant mistake. You never want to mess up a morphine script, and you especially don't want to give too much morphine to a patient. I didn't realize I made the mistake until hours later. At the time, our pharmacy manager got us in the habit of posting all our CII scripts in our perpetual inventory logbook at the end of the day instead of right after filling the script. Therefore, when I went to post the Avinza script, I realized that I filled it incorrectly.

I flipped out. I ran around the pharmacy tearing through the bins to see if it was still there. Unfortunately, the patient picked it up already. Then, I called him, but got no answer. I called one of the other pharmacists (who had 17 years of experience at our store). She told me that it wasn't a big deal because this particular patient had been on Avinza for quite some time. She told me to try him again in a little bit. I did and finally spoke to him. I found out he had already taken a dose, but he felt perfectly fine. Regardless, I told him to come back in, so that I could correct my mistake. Once again, I felt very very bad about the mistake (the customer wasn't mad at all though. He was quite nice about the whole thing).

Those are the only 2 significant errors that I've made that I know of, but I've had to explain other pharmacists' errors to customers, and that's never fun. The customer is mad, and understandably so, that a mistake was made, and they are directing their anger at you. However, you can't tell them it wasn't your fault. You don't want to go and pass the blame on someone else, so all you can do is apologize profusely, refund their money, and hope that this appeases them.

Anyway... I just wanted to write something. Things aren't looking too good with eHarmony girl. She hasn't called or emailed me in a few days. I'm pretty sure I blew it with her. It sucks because I really liked this girl. Looks like I'm back at square one... again.

Saturday, January 26, 2008

I need to grow a pair...

I got some pharmacy stuff and some love-life stuff to share this time....

Tonight was my 3rd date with eHarmony girl(From here on out, I'm going to refer to her as Jen because eHarmony Girl takes too long to write). It was another enjoyable evening. We did dinner and a movie again (we saw Untraceable... interesting premise, but the ending was kind of stupid). Afterwards, we went back to her condo, played with her dog, and just talked for 3 hours. Lots of talking. Interesting conversation. However, that's all it was. When it started to get late, I got going, and all I could muster up the courage to give her was a slightly longer than usual hug.

Man, I'm a wuus. 3 dates, and I haven't even made an attempt to kiss her yet. I was kind of looking for the opportunity tonight, but I never saw it. I figured a kiss goodbye might be my best chance, but even then, I wasn't sure if she wanted me to.

I can read people pretty well usually. I usually know what a person wants to hear, and I usually know the kind of reaction I'll get before I say something. However, I can't read when a girl wants that kiss. I know... I sound like a freaking 12 year old. How could a guy make it to 25, have a nearly 6-year relationship with a girl, and still freak out over a first kiss? It boggles my mind.

I think back to how that first kiss happened with my ex, and I realize that it was pretty much all her doing. We were sitting on her couch, and the next thing I know, she leaned up against me so that we were basically cuddling on the couch. Then, when I told her I had to leave, she said, "How about a kiss goodbye," and she kissed me. After that first kiss, the ice had been broken, and the next time I saw her, I had no hesitation to kiss her.

With Jen, I can't seem to get that icebreaker, and it's because I'm afraid of being rejected. I keep wondering if she considers me as just a friend, which I'm not really looking to be, even though she is a very nice girl who I probably could be really great friends with. I guess I'm just not that take-control guy. I need her to basically come out and say, "Kiss me dammnit!" I also wonder if she's actually thinking that. Maybe she's sitting at home now calling her friends saying, "What is this guy waiting for???"

I think she likes me. She keeps seeing me. That has to be a good sign. I can't imagine she's just looking for a friend. That's the one thing I don't understand about eHarmony and other dating websites. I know why I need to go on eHarmony to get a date. I'm shy, nervous, not all that smooth around women, and I tend to make a bad first impression in person. However, I have no idea why SHE needs to be on eHarmony. She's a pretty, successful, nice, and an all-around normal girl. She could get a ton of guys elsewhere. Why does she choose online dating?

I know a couple things that could provide clues. She said this was her first Christmas at her condo (which she bought 3 years ago) where she didn't have a guy around. To me, that sounds like she had been in a pretty serious relationship and was living with some guy for quite some time before they broke up. Secondly, she mentioned that 2007 wasn't a great year for her personal life, which I take to mean the breakup with her boyfriend happened in 2007 sometime.

Granted, I don't know for certain if this is the case, but I think there's a enough evidence to support the claim. If so, she might be in a similar social situation to me. We both had a big, recent breakup of a longterm relationship. She may be hesitant to get into a another relationship for the same reasons I am (maybe not quite over her ex, afraid of getting hurt again, a little untrusting of the opposite sex, etc.). If this was true, it would be understandable that she'd want to take things slowly. If it isn't true, my indecisiveness could be putting me square in the "friend zone."

I don't know how or when, but hopefully soon, I think I'm just going to point blank tell her that I like her a lot and see what happens. Taking action isn't one of my strenths. However, I'm very very good at talking things through and being honest. Therefore, I think I'm just going to stick to my strengths and just tell her how I feel, and see if she reciprocates those feelings. That way, she'll know for certain that I'm interested in her, and I'll find out if she's interested in me. That would probably be all the icebreaker I'd need to get things going.

And now for the pharmacy stuff...

In the past couple of weeks, I've made a bunch of little old lady friends because I'm such a "nice, young pharmacist." One lady, who I just know is going to end up being a major pain the ass, will only deal with me. In fact, I think I'm the only thing keeping her at our pharmacy. She tried a couple of other pharmacies, and "they were terrible," so she asked me if we were any good. I assured her that we do a good job, so she emptied out her bag containing about 10 different prescription bottles from a variety of pharmacies all over the front counter. She wanted all her prescriptions transfered to our pharmacy, and bless my heart, I took care of them all for her. Then, she proceeded to complain about her copay, and since then, every time I see her, she has something to complain about. It's weird though, because she does it in a friendly way. Here this lady is blatantly insulting one of the other pharmacists on staff as she tells me how rudely she was treated by her, but she's doing it with a friendly smile and a soothing tone of voice. Weird.

In any case, I was starting to think that it would be best if this woman would just take her business elsewhere, so we wouldn't have to put up with her complaining anymore. Then, out of the blue, she called me (and recognized my voice on the phone) and asked if I could help her identify some tablets. She gave me a pretty poor description over the phone, so I told her it would be best if she brought them in, so I could see them. She agreed and asked "When do you take your lunch break?"

I responded jokingly (sort of), "I'm a pharmacist. I don't get a lunch break."

Her answer to that almost made me laugh out loud. "Oh... Well maybe I should bring in a roast beef sandwich for you."

I couldn't help but chuckle, and I assured her it wouldn't be necessary. I have to admit though, I did appreciate the sentiment. It made me think that even the biggest pain in the ass customers can surprise you sometimes.

It's those random acts of kindness that make me act nice to everyone even if they don't particularly deserve it. You just never know when they're going to surprise you with a kind guesture.

Monday, January 21, 2008

I Love Mondays

Another Monday. Another shitty fucking day at work.

This day's problems seemed to originate from Friday of the week before. See, both I and the pharmacy manager had the day off on Friday, and neither of us worked the weekend. That left Friday's staff as a floater, Betty (AKA horrible pharmacist), and another pharmacist who I'm realizing more and more that while she isn't as annoying as Betty, she has many of the same lazy tendencies (I'll call this pharmacist Allison). None of the daily cleanup tasks got done (file prescriptions, load ScriptPro, take out garbage, etc.) There were a million little problems that didn't get resolved, even though they weren't all that difficult to figure out. Worst of all, nobody remembered to go into the computer to receive the order we got on Friday. When we get an order, we have to go into our automatic inventory system, and receive the order. That way, all the quantities on hand get updated. Without receiving the order, our inventory is off, and the next time you go to generate an order for the store, it will be all screwed up. I wasn't too pleased when I found out about this.

I knew getting up this morning that the pharmacy was going to be a disaster when I walked in, but I wasn't fully prepared for the mess that I saw. When I walked in at 11, there were prescription labels everywhere. Betty didn't even let me get my coat off before she handed me 3 "gifts" (i.e. problems that I must solve because she and whoever else saw them before me were too stupid to figure out). I spent the first 2.5 hours of my day on the phone with doctor's offices and insurance companies. As if that weren't bad enough, I had to listen to Betty's whiny, high pitched squeal of a voice recount how horrible it was to work on Friday. She wouldn't shut up. I wanted to take a whole roll of prescription tape and tape her mouth shut.

It still shocks me just how much she doesn't know how to do. The simplest freaking things are a complete mystery to her. She even has trouble putting in new insurance cards. I'm not even talking about the difficult ones. I'm talking about the ones you see 30 million times a day. I was on the phone with one of our most annoying customers for nearly 15 minutes, and during that time, a guy brought in a new insurance card to use on the prescription he had to pick up. It wasn't a complicated card. She should have known how to put it in. In fact, I have no idea how she could make it through weekends by herself without knowing. In any case, she made that guy wait 15 minutes for me to get off the phone, so that I could do it for her. It took me a grand total of 30 seconds.

All day long, all I heard was "Mike, you have to do this" and "Mike, what should we do with that?". I wanted to kill her. The worst part is knowing that I have to put up with her all day tomorrow too. At least our manager will finally be there to absorb some of her stupidity.

In addition, she always wants to talk shit about everyone. There's nothing I hate more than listening to my coworkers talk about people behind their backs. I refuse to participate in that bullshit. If I have a specific complaint, I'll let my manager know. Sometimes, I'll be frustrated when something isn't done when it should have been, and I'll make a comment under my breath about how lazy someone is. Otherwise, I don't complain at work simply for the sake of complaining. That's what this blog is for.

Today was such a bad day that when I closed the gate at 9:00, I suddenly realized that I hadn't taken a piss the entire day. Have you ever had that happen to you where you're so busy that you simply forget that your bladder is about to explode?

I've decided that I'm going to go in an hour early tomorrow so that I can finish some of the stuff I wasn't able to get done today (due to finishing the shit that wasn't done since Friday). Betty's closing the pharmacy tomorrow night, so when I have to open the store on Wednesday morning, I'll silently throw a fit over how she was too fucking lazy to put things away the night before.

Oh yeah... we're getting audited on Wednesday!!!

Sunday, January 20, 2008

Why Retail?

I've written about how I chose retail and how, against all odds, I actually like my job. I don't think I ever mentioned just how close to doing a residency I was though.

My first 3 rotations in my 6th year were highly clinical. I did a rotation in a cardiac ICU, a geriatrics rotation, then a general medicine rotation where I rounded with doctors and medical students on hospital floors. Going into my rotations, I knew I was book smart. I breezed through pharmacy school. I only studied for a couple hours before each exam, paid attention in class only half the time, and still managed to make Rho Chi (the "pharmacy national honors society," which basically means you were in the top 10% of the class).

I attributed my success in school to an innate ability to do well on tests. I'm a good test taker. I don't get nervous before exams, which is pretty amazing because I get nervous before doing just about anything else. I swear that sometimes I don't understand the material until the test is put in front of me. Then, suddenly, everything becomes very clear. I can focus completely on each answer, and I even amaze myself sometimes with the little details I can recall from the very back of my mind.

However, acing tests and actually applying that knowledge in a clinical setting are two entirely different things. Before starting my rotations, I worried that I would be one of those A students that struggled with rotations because I couldn't put it all together. To my surprise, this wasn't the case at all. In fact, I was very good in rotations. Moreover, the seemingly disparate pharmacy knowledge that I had acquired started to come together. All of a sudden, all the P450 inhibitors that I had trouble keeping straight weren't hard to remember. Suddenly, with some help from my incredible cardiology preceptor, I could go into detail on the pathophysiology of heart failure, A-fib, myocardial infarctions, etc. Suddenly, I could quote statistics from specific clinical trials, and in doing so, I knew (for example) that adding eplerenone to a post-MI patient with a LVEF of less than 35% could decrease mortality up to 25% (It's been a while, so I'm not sure of those percentages are 100% accurate).

This cardiology knowledge carried over into my geriatrics and general medicine rotations. I found myself really drawn to clnical pharmacy. I was good at it. I was good at dealing with patients (though I admitedly was still pretty intimidated by the medical staff). At this point, I decided that I did not want to waste my "talent" for clinical pharmacy by going into retail. Therefore, I planned to do a residency after graduating.

This wasn't a half-hearted plan. I fully expected to do it. I started getting my applications together. I got letters of recommendation. I attended residency showcases. I pretty much abandoned the idea of continuing on with retail (I still was an intern at a retail pharmacy at the time).

Since, I'm now a retail pharmacist, obviously, something changed my mind. Actually, there were a couple factors....

First... I was still dating my ex at the time, and after over 5 years together, we started having relationship problems. I attributed all our problems to the fact that I was absolutely broke and still in school. I had less than $500 in my account during my last year of school. I was only working every 3rd weekend because I wanted to make sure I had free time to spend with my girlfriend. In addition, working every weekend probably would have driven me insane. I was already working 40+ hours per week for free (rotations), so I couldn't imagine spending my 2 off-days at work at the pharmacy.

Without a lot of money, I couldn't afford to do very much with my girlfriend. We'd go out to eat or to the movies from time to time, but I couldn't afford to go away for a weekend with her. I couldn't afford to take her to a show. Our time spent together was mostly just watching TV in her tiny apartment. It was driving me mad, and it was making her even more mad because she started to complain that I never take her anywhere. It's not like she was asking for a lot. She was always dying to take a vacation with just the two of us, but I just never had enough money.

In addition, she was in her second year of law school, and when I was on rotations all week, she was hanging out with her law school crowd, which contained a bunch of guys that wanted her. For most of our relationship, I was never a jealous guy, but when she started blowing me off to go hang out with her law school friends, I got a bit jealous. In fact, I tried to discourage her from spending so much time with them. It wasn't necessarily the time she spent that bothered me. It was what she did. She went to a ton of law school socials, parties, out to the city bars for drinks, etc. She was basically acting like a single girl. I went to one of her law school semi-formal dances with her, and she ignored me the entire night.

During all this time, I kept thinking to myself, "we just have to make it through a few more months. Just wait a few more months, and I'll have a job with some money, and everything will be OK." That's when I began to do the math regarding residents' salaries. They were pathetic. $35,000/year tops. I had school loans. I had a girlfriend of nearly 6 years that I wanted to live with and eventually propose to. I started thinking that if I did a residency, it might set me up to pursue a clinical job that I desired, but it would just be another hard year on our relationship.

The second factor that pushed me towards retail was my schools "interview day." All the chain pharmacies were represented there, and they were all just dying to tell us how much they wanted to pay us. Here's me, $500 to my name, and the first chain I talked to wanted to pay me well over $100,000/yr to work for them. Those dollar signs looked really really good. I always knew retail pharmacists made good money, but you don't truly comprehend it until you get that salary offer.

I thought all that green would be the solution to all my problems. I could move us out of that crappy apartment. I could finally take my girlfriend on vacation and to all the other nice places that she had been dying to go, but I always refused. Moreover, I could finally afford to put a ring on her finger, which was something that I had wanted to do for a couple years. It was something we talked about for quite some time.

I ended up abandoning the residency. I never completed the applications. Then, a few months later, she broke up with me. I kept telling her just to wait a few more months, but she said she was too unhappy to hold out any longer. I had abandoned my career aspirations in order to make my personal life better. In the end, that sacrifice was for nothing.

That's the story of how I ended up in retail pharmacy. As I've stated numerous times, over my first year as a pharmacist, I suffered through some of the harshest working conditions you can imagine, but I survived them, and now my job has become so much better than I thought it would be. In addition, I've become a better pharmacist because of those initial hard times. I like my job. I feel appreciated. Perhaps, I don't make a great difference in anyone's healthcare outcomes, but you know what?... I feel like I can make a greater impact on a person's life being a friendly community pharmacist than by working side by side with a medical team.

It's annoying, but at the same time, it makes you smile a bit when you work at a 4 pharmacist store, and you have customers who trust you so much that they'll only talk to you and not any other pharmacist when they have a question. It's nice to have customers that just drop by to say hi or to wish me a Happy New Year.

Yes, my clinical knowledge is going to waste. Yes, I'm forgetting a lot of the things I learned in school and on rotations. However, if I had to go back and make the decision between residency and retail again (this time knowing that my relationship wasn't going to work out anyway), I'd still choose retail, and this time it wouldn't be just for the money.

Another thing I've learned about myself is that I'll always put career aspirations secondary to my personal life. I will never live for my job. It will never be my source of happiness, nor will it ever be a great source of discontent for me. Being a clinical pharmacist takes a committment to the job that I'm incapable of making. I continually write about how I lack any semblance of a social life (although things are looking up in that department recently), but despite what I lack in that department, I'll just never throw myself into my job.

Perhaps that's the best part of community pharmacy. When I close that gate at 9:00 PM, my day is over. I don't have to be on call. There are no real emergency situations. I don't have to pull any nightshifts, nor do I have to be at the pharmacy by 7:00 AM five days per week. It's just a good situation for me.

Alright... this is probably the longest post I've ever written (maybe second longest to me "Peak Oil" post). I haven't written in a few days, and I felt the need to write about something. I guess I also wanted to clarify my entire decision making process when it came down to choosing what area of pharmacy to practice in.

Monday, January 14, 2008

I'll never change the world

And with my last post, I realize that this is the reason I'll never do anything of any importance for this world...

I always accept the status quo. "This is the way things are, and we should all just accept them." That's me. To me, I know a lot of things in this world suck. I know that our government and corporate leaders are, for the most part, a lot of corrupt, money hungry bastards. I hate it. It shouldn't be that way. In the perfect world, it wouldn't be that way.

However, I just accept our imperfect world and try to make the best for myself in light of all the bullshit that goes on around me. That's why I won't fight for my profession. That's why while I'm interested in politics, I don't vote. I just don't feel like I can change anything, and it's just a waste of my time to try.

If everyone in the world was like me, nothing of any consequence would ever be accomplished. Therefore, it's a good thing many people are different and will fight for what they believe is right even if the chances of getting things changed are slim.

Alright... I've written too much today.

Just some thoughts on the profession

A lot of prominent pharmacist bloggers have recently written about how the big chain pharmacies' (Rite Aid, CVS, Walgreens, etc.) emphasis on prescription volume is killing the profession. I just wanted to put my 2-cents into the ongoing discussion.

Now, what I'm about to say might ruffle some feathers, but I don't mean to be argumentative about the issue. This is just my opinion, and everyone else is more than welcome to their own.

The concern with a lot of pharmacists is that they are being stretched so thin by the prescription volume that they feel they are unable to effectively counsel patients, do DUR reviews, and other pharmacist things that the profession SHOULD include. They assert, and correctly so, that the department is not given enough pharmacist and technician hours to accomplish these tasks, and the lack of hours is making their days incredibly stressful and tiring.

I whole-heartedly agree with that part. Working in a busy pharmacy is very stressful. During a typical day, your lucky if you get 5 minutes to eat lunch, and you can forget about that being 5 uninterrupted minutes. Actually, more likely you'll eat something while working. Bathroom breaks are few and far between simply because in the 2 minutes it takes you to take a piss and wash your hands, you could have 2 calls you have to answer, a customer question, and 5 more prescriptions dropped off that you have to get done in 20 minutes. You spend most of the day hoping that no one will ask you a question about their medication because you just don't have the time to explain things to people. Moreover, the sheer amount of shit happening at the same time is maddening. It can be really hard to get a grip on the situation, and it only takes one tiny little problem to send your day spiraling out of control.

A little extra help would make the situation so much better. Just a few more pharmacist hours or another technician during a shift could relieve a lot of pressure and stress.

Here's the thing though... a combination of factors is hitting retail pharmacy all at the same time, which is makes this very hard for our employers. For one, third party reimbursements keep getting lower and lower. With a lot of plans, we're lucky if we make a 5% profit on each prescription, especially on very expensive medication.

Secondly, mail order pharmacies are really starting to cut into our prescription volume. Last week, my store filled nearly 700 fewer prescriptions than we did during the same week of 2007 (a 21% decrease). We can't explain the decrease other than we must be losing a lot to mail order. Every pharmacy in our chain is down. It's not just us.

Thirdly, pharmacist's salaries are still going up (although it has slowed down in the last couple of years). When I was going into college in 2000, I was told that pharmacists could make $75,000 to start. When I got licensed in 2006, I started at $102,000. That's nearly a $30,000 increase in starting salary in 6 years. We all know the reason for the skyrocketing salaries is the national pharmacists shortage. It's simple supply and demand. The supply of pharmacists is low, and the demand is high, so salaries have gone up. Many companies offer huge sign on bonuses for pharmacists working in certain areas simply because they are in such desperate need.

With decreasing reimbursements, decreasing prescription volume, and increasing pharamacst's salaries, I'd have to imagine that fewer staff hours is the only way our employers can go.

Speaking honestly here, and I don't care what it makes me sound like, one of the major reasons I chose retail is because of the money. In fact, my initial choice might have been solely because of the money. After working for 1.5 years, I've come to appreciate my job more and like it for other reasons. In fact, I'm certain I would like hospital or other clinical jobs far less than I like my current job. Those areas of the profession just aren't for me.

I'm quite happy with the money I make in retail. Afterall, isn't that what I really went to college for? I didn't go with the noble intentions of saving the world. I just wanted a well paying job. Unless you're good in business, you can't get a job like that without a college education. That's how I landed on pharmacy. I was always very good in math and science. I could have been a doctor, but I didn't feel like going to school for 8 years, then a year of internship, and 2 years of residency before even having a chance to make decent money. Shit, I'd still be broke and in med school right now if I wanted to be a doctor. I could do 6 years of pharmacy school though. That wasn't too bad, nor was the curriculum all that difficult.

What I'm trying to get at here is that while I would love the extra help, I'm not willing to give up my salary for it. In the end, that's what it would really take. Think about it... If your employer came to you and offered to give you tons of extra hours of help with the catch that you'd have to take a substantial pay-cut, would you accept the offer? I wouldn't. I don't think many would, though it certainly would be a solution to the stress.

I made about $115,000 last year. Now if my employer cut mine and every other pharmacist's salary to, say, $90,000/yr, and then took that extra money and put it into staffing, software technology, and other areas that would make the pharmacy more efficient at filling scripts, it would free us up to counsel patients, consult with doctors, and anything else that takes advantage of our clinical skills and training.

I would never do that though, no matter how much better it would make my job. I guess it's because I can tolerate the stress level, and I really don't mind sacrificing the clinical aspects of the profession in the name of filling scripts. That doesn't mean I blow off anyone with a question. I will take as much time as necessary to help someone understand something about their medication. However, it doesn't bother me one bit that I don't have the time to counsel every single person on all of their medications. I do feel appreciated and liked by most of my customers, and that's enough for me.

Now, I'll play devil's advocate for just a moment. I realize that cutting pharmacist salaries will decrease the number of new pharmacists coming into the profession, which in turn will increase the shortage at the absolute worst time (baby boomer's retiring and taking lots of meds). Therefore, I know the notion of cutting salaries wouldn't work in the long run. Moreover, there of course, is no guarantee that our wonderful employers wouldn't take the extra money and pocket it, or even worse, run a bunch more coupon promotions.

The situation is purely hypothetical from the vantage point of a pharmacist with very little real world experience and not a great deal of business sense. The example is just here to illustrate that a lot of us complain about the state of the profession while, at the same time, reaping the monetary benefits of it.

Then again, Walgreens, CVS, and Rite Aid could be turning bigger and bigger profits every quarter, and the problem could solely be with those corporations being run by a whole bunch of greedy bastards that want to milk us for every last dollar.

In fact...that's almost certainly the biggest problem with the profession.

Another Stupid Question

(Phone Rings)

Me: Hi, __________ Pharmacy. How can I help you?

lady: Can I speak to a pharmacist?

Me: I'm a pharmacist, can I help you?

lady: I'm trying to become an LPN, and I just had a pharmacology test, and I was wondering if you could help me with one of the questions I couldn't answer.

Me: (Thinking that this might actually be interesting) Sure. What was the question?

lady: (Reading the question) The order is for Synthroid 150 micrograms once daily. The only dose available is Synthroid 0.05 milligrams. How many tablets do you have to give to complete the order?

Me: (Trying to educate) You see, there are 1,000 micrograms in 1 milligram. Therefore, 150mcg would equal 0.15 milligrams.

lady: (complete silence for a few seconds)... So, what's the answer? I couldn't even guess on it. I just left it blank and moved on.

Me: 3. The answer is 3 tablets.

lady: Thank you! (hangs up)

Wow... The funniest thing of all is that she felt that ONLY a pharmacist would know the answer to this question. Hell, she probably could have found some random 12 year old that could have figured that one out. Moreover, she distinctly stated that this question was on a pharmacology exam. Apparently, pharmacology for aspiring LPNs is idiot's math with a drug name thrown in.

Monday, January 7, 2008

This is why I'm best suited for this job

Near the end of the day today, a woman called the pharmacy to check if her prescription for Botox was ready to be picked up. She brought the prescription to us on Friday 12/28. We explained to her that Botox had to be drop shipped to us, and since it was a holiday weekend, it may take several business days for us to get it. Initially, she seemd OK with this explanation.

On Wednesday of the following week, she called the pharmacy asking if the Botox came in. Of course, it had not. We told her we weren't sure when it would get here, but probably within the next couple of days. She called the following day (Thursday). Once again, we told her we did not receive the Botox yet.

Friday is when things started to breakdown. She called late in the day on Friday, and unfortunately she spoke to a clerk who is fairly new. The clerk looked in the computer, saw the prescription on her profile, and told the woman it was all set to be picked up. The woman came in the next day (Saturday) looking to pick it up, and mass confusion ensued. The woman kept telling us that someone told her the presciption was all set, so the pharmacist and technician on duty tore the place apart looking for it, and after 20 minutes of looking to find out what happened to the Botox, they came up empty.

The woman was in a rush and left before the problem could be resolved. Eventually, the tech figured out that we never received a shipment of Botox, so she called the woman and left her a message telling her the Botox still hadn't come in and that she would call our warehouse first thing Monday morning and figure out where the hell it was and why it was taking so long.

When Monday (Today) came along, the tech did exactly that. In fact, she called several people and eventually learned that the order should be arriving via FedEx by 3:00PM on Tuesday.

This all brings us back to the woman calling the pharmacy at 7:30PM today. She was extremely pissed off at us for "messing up her order." I guess because the shipment took so long to get to us, she had to cancel and reschedule her doctor's appointment twice. At the time, I didn't know much of the backstory with the prescription. All I knew was that she brought us a prescription, and it still hadn't arrived. I also knew we called all over the place trying to figure out what happened to it.

Apparently, the woman misunderstood the message our tech left her and interpreted it as us getting the order some time last week, but we sent it back because we got some sort of wrong paperwork with it. She was raving mad. She told me that not only would she never use our pharmacy again, she'd tell everyone she knew to never trust us.

The whole sequence of events didn't make much sense to me, so I told her that I was going to call the technician who worked the weekend and find out what happened. I told the woman, I'd call her right back.

When I spoke to the tech, I learned that whole backstory I already described. I quickly called the woman back (after no more than 5 minutes), and explained to her what really happened. I told her that one of our inexperienced workers incorrectly told her on Friday that the Botox came in, and I apologized for the confusion it caused. I calmly explained to her that we never received the Botox, and we have been going out of our way to find out where it is and when we're going to get it. I further explained that unfortunately, the timing of the order was really bad being that it was on a Friday right between Christmas and New Year's. It usually does not take us over a week to get a product in after we ordered it, but the holidays must have thrown everything off. Finally, I told her that we got a confirmation from our warehouse that it should arrive by 3:00 PM tomorrow, and I promised we would call her the second we received it.

Within the span of 10 minutes, this woman went from being really pissed off to actually apologizing a little to me for misinterpreting the message left on her machine. While, of course, she wasn't happy that her prescription was not ready, she came to understand that it wasn't really our fault.

I know that this may sound trivial to some people, but being able to calm down a pissed off customer is harder than it may seem. A lot of pharmacists simply do not have this ability. Had a certain other pharmacist I know got that phone call, she would have made matters 1,000x worse. This situation was a tough one because I had to find a delicate balance between being apologetic and assertive. I owned up for our part in the whole confusion, but at the same time, I asserted that we did everything in our power to get her order to arrive as soon as possible.

Many pharmacists think that any moron with a pharmacy license could count pills all day and that you aren't truly practicing pharmacy unless you're in a more clinical environment. Maybe some of that is true. Maybe you do have to be smarter and more knowledgeable about drugs to work in a hospital or be a consultant pharmacist. However, one thing I know for certain is that not many pharmacists could have handled that situation as well as I did, and quite frankly, I take much more pride in that than I do in knowing a million pharmacy interactions. If you think about it, any pharmacist can look up any piece of drug information in a book or on lexicomp. However, you can't just read a book to find out how to relate to your patients and diffuse a potentially explosive situation.

Saturday, January 5, 2008

First Date Impressions

I'm pretty happy right now because my date went very well... Much better than I expected actually.

First of all, she's pretty cute in pictures, but she looks even better in person. She's a very pretty girl. She's definitely the prettiest girl I've ever gone out with, so I was definitely happy about that. Besides that, she was just as nice in person as on the phone. We were able to talk the same as we have been, and there were no awkward pauses. Our personalities meshed very well.

We went to see the movie Juno, which was very very good. In fact, Juno was one of the best movies I've seen in a while. The girl who played Juno did an amazing acting job. The dialogue was very well written, and the story was funny, but very heartfelt at the same time. I can't say enough good things about it. I get the feeling she wasn't quite as keen on the movie as I was, but she still enjoyed herself.

After the movie, we went to a nice, little Italian restaurant. The food was good. We drank wine. The conversation was good. Everything was going well. Then, we went back to her place, and she invited me in for a little bit. This is where I think I really made a good impression. She has a dog that she loves more than anything. She says the dog doesn't normally like strangers, but it loved me. I don't really know why, but dogs pretty much universally like me. Maybe they can sense that I'm a trustworthy person. I have no idea.

Whatever the case may be, the fact that the dog liked me worked very much in my favor. We hung around drinking wine, watching TV, and talking for a little over an hour. If I actually pursued it, I might have had a chance for a little more. However, I'm a perfect gentleman, and I don't like rushing things. Therefore, I gave her a hug and left when it started to get late.

I think we're going out again next week. I'm definitely looking forward to it now. I got that first date out of the way, so I won't feel as nervous next time.

Alright... I have to keep myself in check a little bit because I feel like I'm getting a little too happy over a first date. Therefore, I'm going to go back to my cautiously optomistic approach. I still don't want to be disappointed, but tonight was a great step in getting on with my life post breakup. When I got back from my other dates, I used to always think about my ex and how I wished I was going out with her instead of the girl I just saw. Now, I don't care one bit about what my ex is doing. I'm just quite happy thinking about eHarmony girl.

First date

So, I'm meeting eHarmony girl today for dinner and a movie. Actually, we're a movie then dinner, which seems a little odd to me, but I suppose watching the movie first will give us something to talk about during dinner. In any case, it was her idea, not mine, so whatever...

I've been talking to this girl for a couple months now. We get along really well on the phone. It's taken so long for me to actually meet her because for one, I'm nervous about it. Remember, I'm generally a shy, quiet guy. Plus, I write better than I talk, so I'm always a little nervous about how I come across in person, especially if I've never met the person before. Secondly, our schedules just never seem to sync up. Whenever I have to work, she's off, and vice versa.

Here's the thing though... I don't know how many people have tried the whole internet dating thing. I have to admit, even as I'm taking part in it, I'm a little skeptical about it. Nevertheless, I'm attempting it due to lack of other options. Anyway... We've been talking for a couple months. Everything has been great. We have a lot of things in common. We never run out of things to say. Then, we set that time for our first date, and all of a sudden everything feels a little uneasy. The last couple times I talked to her, I got a different vibe. I can't quite put my finger on it, but it just doesn't seem like she's all that interested in a date, even though we both made it clear that we wanted to meet each other... soon.

That is one of my worries about online dating. You talk to the person. You develop a certain rapport. In doing so, an idea of the person forms in your mind. You put a voice and personality to the spoken words. You see a few images of the person and develop an idea of what they look like. However, when you finally meet, the person just will not be exactly like you were expecting. She'll look a little different. Her mannerisms won't be the way you envisioned, and whatever chemistry you had online or over the phone just won't be the same.

I have to admit that I worry about this because I know that I'm just different in person than I am on the phone or in writing. When I write, I'm generally grammatically correct. I can be eloquent. I command a fairly decent vocabulary. Plus, with that trusty backspace key, I can take back something I wrote, and replace it with something that sounds better.

There's no backspace key in real life. When you say something, you can't take it back. I have a habit of jumbling words and mispronouncing things even when I know the correct way to pronounce them. I also don't have the most expressive voice in the world. I tend to speak in a monotone, which is something I just can't help. However, it makes me sound boring and sometimes disinterested.

My hands also shake when I'm nervous, so I can be a little clumsy. As a side note, this works to my advantage in poker because my hands shake and I breathe a little heavier whether I have a good hand or a bad hand. I actually find it a bit comical how clumsy I can come across, especially when you consider some of the dexterity drills I can perform flawlessly with a basketball. Hell, I can spin a basketball on any finger of either hand and keep it spinning until my arm caves in, but I have a hard time getting my credit card out of my wallet without dropping it.

With all this rambling, I'm trying to talk through my own anxiety. I've gone on a few dates since the break up, but they were really to kind of test the water. I didn't really care if they went well or not. I just went out with them for something to do. With this girl, I want this to go well. I like her. I know that seems odd to say about someone who you've never really met face to face, but it's true. I just don't want to get disappointed.

I guess I'll find out tonight. Either way, I'll probably write my impressions later.