Monday, March 31, 2008

CII Prescriptions

I'm posing this as a question to all you wonderful pharmacy professionals out there:

What exactly is a pharmacist allowed to change on a CII prescription without having to obtain a new hard copy?

I used to know that pretty much the only things that had to be 100% correct were the patient's name, the name of the medication being prescribed, and the prescribers signature. Otherwise, a pharmacist, after obtaining clarification from the office, could change the date written, quantity prescribed, and directions.

A few months ago, one of our pharmacists told me that apparently the DEA made new, stricter guidelines regarding what could and could not be changed on a CII prescription. It was part of that notice about post-dating prescriptions. I read the notice several times, and I couldn't figure out where it said the requirements about what changes a pharmacist could make had changed. However, the pharmacist who told me was so adamantly sure that it's making me question myself.

I still adhere by the old rules, which made a lot of sense to me. A couple other pharmacists on staff now want to obtain a new hard copy for any change, which I think is stupid even if it is, infact, correct.

I've looked all over the net for some kind of confirmation about this but have been unable to find it. Could someone please enlighten me to the actual law and provide me a link to an official looking web page that states it? I would greatly appreciate it.

That didn't last long

I thought I wouldn't get worn out from work until at least Wednesday, but I was wrong. Today was the day from hell.

I walked in the pharmacy to find a disaster. One of our computers wasn't working. My manager was on the phone with the pharmacist who worked the weekend for nearly 30 minutes listening to her bitch about how the weekend crew talked shit about everyone. Our lead tech called out for some reason. I'm still not really sure why. I know she wasn't sick. Our other tech was so thrown off by our new fax machine that she could barely get any work done. There were a million calls to make from the weekend. Everyone picking up a prescription had some sort of problem. It just fucking sucked.

Of course, the shitty day and our stupid computer system contributed to me making a mistake today. No, I didn't fill a prescription wrong. Instead, I basically accused someone of trying to get an early Klonopin refill when in reality they were perfectly on time.

It was a comedy of errors that caused my mistaken accusation. The patient had transferred 4 or 5 prescriptions to another pharmacy because they were offering a coupon promotion for transferred prescriptions. This person is one of those coupon chasers. All his prescriptions had been transferred into us from another pharmacy, were filled once, then he asked us to transfer them to an entirely different pharmacy. The only problem is that federal law only allows a precription for a controlled drug to be transferred once. The new pharmacy took wouldn't fill the script for him. However, whoever had been on the phone from our pharmacy decided to mark that the Klonopin was transferred out anyway.

When a prescription is marked as transferred out, it voids the prescription number. Therefore, when he came back to have us fill it instead, our prescription number was voided. For whatever reason, all this wasn't taken care of over the weekend, and I was left with a transfer sheet to try to sort out the mess. Our transfer sheets have (supposedly) the refill history of the script being transferred. According to that sheet's refill history, this patient got his Klonpin 2/20, 2/23, 2/24, and 2/28all at different stores in our chain. It looked like a pretty clear-cut case of a patient paying cash in order to get early refills. Therefore, when I called the patient to inform him that I would not fill it, he got mad and tried to explain the transfer situation. Feeling agitated from the hellish day, I told him that he shouldn't need a refill anyway because he should have quite a stock pile from all his early refills. I wasn't very pleasant.

Immediately, he said it was impossible because he never used any other pharmacy in our chain except ours. This is when I double checked that transfer sheet and found out that the fill dates and RX numbers listed from all the other stores in our chain did not even come close to matching this guy's Klonopin. I was totally wrong and felt like a complete jackass.

I immediately apologized to him and did what I had to do in order to fix the situation, which was to fill RX with the refills that his doctor originally intended before it was mistakenly transferred out. He obviously wasn't very happy with me for basically accusing him of being a druggie. What else could I do though? I made a mistake. I could only apologize and do what I had to do to reconcile things. I even made sure to apologize to him in person when he came to pick up his Klonopin. I explained that it isn't at all like me to act that way towards a customer, and I didn't want him to get a poor first impression of me because of it. I told him I felt really terrible about it. I didn't make excuses (even if that stupid computer print-out was 90% of the reason I said it in the first place). I just sincerely apologized.

He accepted my apology and shook my hand. However, it doesn't make me feel any better about the situation. It's quite bad to make an accusation like that and be entirely wrong. Considering I don't get a chance to see this customer very often (due to the fact that he bounces from pharmacy to pharmacy chasing coupons), I'll probably never get a chance to prove that it was just a stupid mistake. I'm glad I handled the situation with integrity and owned up to my mistake, but I'm still mad at myself for it. It shouldn't have happened in the first place.

Anyway... Right now, I'm exhausted from my long and frustrating day. I have to be there bright and early tomorrow to open the store, which is good and bad. When I open the store, I feel like the day goes more smoothly, but the trade off is being really tired by the afternoon from getting up so early.

I need a vacation.

Sunday, March 30, 2008

Great Weekend

This weekend was so great for me. It really elevated my mood. Basically, it was a weekend of basketball, and I loved it.

Saturday I went to my alma mater to play some pickup hoops. As I stated before, I loved college. It was the best time of my life. Playing basketball there was a huge part in those good times. The best pickup games in the state are at my former college, so one of my good friends (who was a roommate of mine at school) decided to make the nearly hour drive.

We got on those courts and ran the youngsters out of the gym. It was freaking great. We were at least 4 years older than anyone we played. We're both not exactly in the greatest shape of our lives. Despite this, we still kicked ass. We won 5 games in a row before getting beat, and that was pretty much only because we were so tired we couldn't run anymore.

For months now, I've been lamenting about how I've lost some of my game over the last couple of years. Well, I think I must have left it up at school because when I went back, I seemed to have found it. I brought it back to my hometown with me, and on Sunday night, I played a few more pickup games against some pretty good and athletic players. I won all 4 games I played. I was hitting 3's from every where, step back jumpers, taking it to the basket and finishing in traffic, pull up jumpers in the lane... it felt like I had everything back. Even my first step seemed to come back.

Of course, I got to watch all the NCAA Tournament games including Stephen Curry going off on everyone. For the last week, he was my new favorite college basketball player. Of course, with his incredible showing in the tournament (despite finally losing to Kansas) he'll probably enter the NBA draft. The NBA just isn't as fun to watch as college ball.

Anyways... I didn't mean to bore you all with my basketball stories. I promise there's a point to this.... which is that my mood has been greatly elevated from playing basketball well. I said before that nothing really makes me happy, but I guess that's not really true. Basketball makes me happy. It doesn't always make me happy. Sometimes, I play like crap, and it makes me really miserable. When I play well though, I feel like the I'm on top of the world.

Actually, my mood is very dependent on how well I play basketball now. It's pretty sad when I think about it. I'm still in my mid 20's, so I'm still relatively young. However, in a few years, I'll be turning 30, and it won't be too long before my athleticism and therefore, my play drops off significantly. I shudder to think about my life then. What will I do for happiness?

Tomorrow, it's back to work. I expect my good mood will probably last me through Tuesday, but then the work week will finally catch up to me and bring me back down to earth.

Friday, March 28, 2008

Brand Medically Neccessary

(I read Pharmacy Chick's latest post and thought I'd like to put my own 2-cents in on this topic).

I believe that a prescriber should only be able to write for Brand Medically Neccessary if the patient has tried every single other option, and the doctor thoroughly documents how the generic was either ineffective or not tolerated. Basically, every single Brand Medically Neccessary script should require Prior Authorization, and insurance companies should strictly enforce this.

I'm sick of this brand name bullshit. Zocor is simvastatin; Norvasic is amlodipine; Toprol XL is metoprolol succinate. There's no fucking difference between the brand name and the generic except perhaps a little extra filler in one tablet. Hell, 1/2 the time, the generic is made by the same company that makes the brand name. There's almost no possible way a brand name could work any better than an AB rated generic. The only possible excuse I can think of is that someone could be allergic to certain dyes and therefore, requires the brand name that doesn't contain these dyes. Of course, the patient could probably switch to another generic manufacturer and accomplish the same thing.

I don't think doctors should be able to write Brand Medically Neccessary simply because the patient is some old lady who won't touch anything generic. I can't even count how many times I've seen absurdity like this: Lipitor, Brand Medically Neccessary. Uhhhh.... There is no generic for Lipitor yet. How do you know the brand name is medically neccessary if the patient has never even tried the generic? I actually think doctors should be reported for writing scripts like that. Basically, it's insurance fraud.

In my world a patient would not only have to fail a trial of a generic drug, but they'd have to exhaust almost every other clinically equivalent generic option in the same drug class. For example, if a patient fails pantoprazole, they'd have to also fail omeprazole before Protonix would be covered under the insurance.

If the patient truly needs the brand name, then he is entitled to it. However, all other options have to be exhausted and the therepeutic failure must be well documented. I guarantee that if a rule like this was enforced, you'd see a whole lot fewer Brand Medically Neccessary prescriptions, and the effect it would have is to lower the cost for patients, insurance companies, and increase the reimbursements to pharmacies. It's a win for every involved.

Thursday, March 27, 2008

Yet another self-loathing post

I'm a loser. I really am. I may be well educated, intelligent, and morally decent. I'm kind. I have a good job that makes pretty good money. I have a lot of things going for me, but despite all that, I'm still a loser.

Someone I know has been trying to set me up with her very attractive sister for literally 2 months now. She told her sister about me. Her sister stopped into work to "check me out," and then told her she'd like to go out for drinks with me. She gave me her sister's number telling me she wanted me to call her.

I never did. It's not because I'm not interested. I am. From all reports, she's a really nice girl, and some have even said that we'd probably hit it off right away if we met. I really have no explanation as to why I haven't called her or at least made some attempt to meet her, except that I'm scared to death... Hence, I'm a loser.

I suppose it's a self-esteem problem, but with me, it's more stupidly complicated. I feel like I'm not good enough for her. I actually feel that I'm not good enough for anyone. I feel that no matter who I'm with, I'll always be holding them back from being with someone better. If I thought higher of myself, perhaps I wouldn't think like this. However, I'm a person who's grounded (too much so) in logic. I think that any girl that I'd be interested in would be able to get a better looking, more fun, more adventurous, more caring guy.

See, I'm the kind of guy who's not really offensive in any way. I'm OK looking; not ugly, but certainly nothing special. I'm nice. I'm smart. I can converse about a wide range of topics. I have a good job. I'm polite. There's nothing about me that would make someone turn and run quickly away.

However, I don't have a lot that would make someone interested to be any more than friends with me. I'm not exciting in the least bit. I'm a slave to routine. I'm not especially keen on trying new things. I tend to pick a few restaurants I like and eat at them all the time, rarely trying some place different. I don't like to dance (at least not at clubs). I don't have much passion for anything (except maybe examining my own shortcomings).

You know how some people are so excited about things that their energy is infectious, and it makes others get excited as well? These are the kind of people that could be so enthusiastic about reading a phonebook that others wouldn't be able to wait to join in. I'm the exact oppossite. I have a knack for making everything I do sound incredibly boring.

"What did you do last night Mike?"

"Oh... nothing."


"Well, I went to eat."

"Really??? Anyplace good?"

"No... not really."

"Who'd you go with?"

"No one really... just a few friends."


That's generally how a conversation about anything I do goes with me. A great example of this was my trip to Miami with a few friends last fall. My friends tell everyone stories about late night drunken fun, and always say how much fun they had. I tell everyone that it was OK, or that the weather was nice.

Often times, I feel like the only emotion I feel is frustration. I get frustrated with stupid people at work. I get frustrated with my boring life. I get frustrated with my parents and friends. I rarely feel happy. I rarely feel excited about anything. Few things move me at all.

Anyway... Within all that stupid meandering are the reasons I haven't called this nice, intelligent (at least her job would make you think she had to be intelligent), very attractive girl. The reason I'm writing about this now even though it's been going on for a couple months now is because the girl who was trying to set me up with her has pretty much given up and is now trying to set her up with someone else.

I actually feel jealous about this. How stupid is that? I have repeatedly shrugged off calling her, but now I'm feeling jealous that she's now trying to set someone else up. I think that's the definition of insanity. It actually goes right back to what eventually caused my break up with my ex; I'm afraid to say how I really feel. I want to scream out, "Wait! I really do want to meet your sister!," but I just can't. I can't get the words out of my mouth. It's almost as if it physically hurts to say what's actually on my mind.

In any case... that's why I'm a loser. I lament about how miserable my life is, even though I know perfectly well what I have to do to make it better. I'm really not lost or confused. I just won't, or maybe more accurately, I can't take those steps to self-improvement... and that makes me more miserable.

So again, I'm a loser.

Tuesday, March 25, 2008

I realize that I've been a little too specific

From day one, this blog was supposed to be anonymous, so that I can write what I was thinking, and it would be very hard to trace it back to me. I don't mind giving out some of the specifics of my own life and situation, but it worries me a little bit when I start mentioning very specific examples of events that happen in the pharmacy. For example, while there might be a lot of you who know someone like Betty, when I start mentioning specific examples of what she did and how I responded, it narrows it down to our pharmacy's Betty. Even though I've never given any real names and only hinted at my location, it would still be enough for my fellow coworkers to figure it out if they happened to stumble across this blog.

Therefore, from this point forward, I'm going to make an effort not to be so specific when I retell events. I worry that this will have a negative effect on my writing because I find that a lot of the humor, irony, or aggravation of a situation is largely dependent on the specifics.

One of my favorite books is The Things They Carried by Tim O'Brien. In that book, he writes a chapter entitled "How To Tell A True War Story." I think this exert, while being incredibly well-written, is poignant to pharmacy blogs:

You can tell a true war story by the questions you ask. Somebody tells a story, let's say, and afterward you ask, "Is it true?" and if the answer matters, you've got your answer.

For example, we've all heard this one. Four guys go down a trail. A grenade sails out. One guy jumps on it and takes the blast and saves his three buddies.

Is it true?

The answer matters.

You'd feel cheated if it never happened. Without the grounding reality, it's just a trite bit of puffery, pure Hollywood, untrue in the way all such stories are untrue. Yet even if it did happen - and maybe it did, anything's possible - even then you know it can't be true, because a true war story does not depend upon that kind of truth. Absolute occurrence is irrelevant. A thing may happen and be a total lie; another thing may not happen and be truer than the truth. For example: Four guys go down a trail. A grenade sails out. One guy jumps on it and takes the blast, but it's a killer grenade and everybody dies anyway. Before they die, though, one of the dead guys says, "The fuck you do that for?" and the jumper says, "Story of my life, man," and the other guy starts to smile but he's dead.

That's a true story that never happened.

I don't mean to compare pharmacy to war. I'm just saying that changing names, genders, and certain events in a story doesn't necessarily take away from the underlying truth of it. For example, instead of leaving me a note asking to figure out how to fill a prescription for a certain vaccine that she horribly misspelled, I could have just as easily said the prescription was left on the voice mail as aripiprazole (which is the drug name for Abilify), and Betty couldn't figure out what that was. It wouldn't have changed the underlying message of the story, which was to convey that Betty got a perfectly valid prescription for a drug we had in stock, but didn't know how to fill it because she was too stupid and/or lazy to look up what it could possibly be.

When it relates to other people, I'm going to start switching things around like that. I'll keep the specifics to stories about my non-professional life... however lacking that may be.


I'm in the process of going back and removing or editing all posts that mention Betty, so you probably won't understand this bulletin if you're a newer reader.

It was still a great way of incorporating a Tim O'Brien quote.

Sunday, March 23, 2008

I Need A Vacation

Lately, I've been feeling pretty worn down from work, and I could really use a vacation to revitalize myself. However, being that I only get 2 weeks off per year, I make sure to take them during the summer. Afterall, who wants to have a week off in cold weather... unless you go somewhere warm, but then you have to come right back to the cold weather, and that just sucks.

I'm really tempted to plan a trip somewhere, but the catch is that I kind of just want to go somewhere by myself. I've gone to Miami with friends the last couple of years, and while it was fun for a little bit, I always felt like I came home more tired than when I left. I just feel like going some place warm and quiet. You know, somewhere I can just relax on a beach all day, take a walk or drive around in the evening and just be at peace.

I thought about just taking a road trip somewhere. Despite my concerns about wasting gas, I really enjoy going for long drives. However, I'm quite a long way from any beach that's worth going to, so I imagine all that driving would tire me out. Therefore, I figure if I go somewhere, it would have to be by plane.

Ideally, I'd love to go to Hawaii. I've been there twice. The first time I went was with my family when I was 14. We visited Oahu and Mauii. That was my favorite vacation. The next time I went was again with my family when I was 22. That time, we went to Kauai and the Big Island. I loved Kauai. It wasn't as overrun by tourism as Oahu, so a lot of the natural beauty of the island was still intact. It was so peaceful there. I'd love to go back. If I had to pick a vacation for myself now, 5 days on Kauai would be really nice.

The only problem is that it would be pretty expensive. For one, the airfare is outrageous now, and only getting more expensive. Hotels aren't cheap either, and I don't think I can justify spending all that money on a vacation by myself, even if it would be exactly what I was looking for.

Moreover, wouldn't it be a little weird to go somewhere like that alone? I wouldn't mind hanging out at the beach by myself all day, but going out to restaurants and eating alone would be awkward. Plus, I don't think I've ever isolated myself from people I know for that long. I'm not sure how well I'd handle it. Afterall, a big part of the experience is sharing it with someone.

As you can see, I'm pretty torn on this issue. I know it doesn't have to be Hawaii. That's probably too grand for what I'm looking for. Maybe I'll look for a peaceful place that's a lot closer.

Maybe what this is all really about is that I miss the warm weather. I hate winter. I feel trapped in my little apartment because it's too cold to do anything outside. I can't wait for it to warm up, so that I can go down to the park and just shoot hoops by myself.

Shooting hoops is actually pretty therapeutic for me. For one, it gives me some much needed exercise. Secondly, it provides me with a way to escape the daily madness. I can listen to my MP3 player, think about things, all the while I'm treated to the comfortable rhythm of the ball going through the net over and over again.

If you've never played basketball, or if you're simply not a very good shooter, you probably wouldn't understand the kind of rhythm I'm talking about. All I know is that when I go to shoot around, the ball releasing from my hand and then going through the hoop feels all part of one smooth motion. For me, it's no big deal to start on one side of the hoop and go around the key making 15 to 20 shots in a row. It's just so rhythmic and calming, and it's also a nice little boost of confidence to succeed at something over and over again.

Anyway... I'm just kicking around ideas now. All I really know is that I feel like I need a break from the daily grind.

Of course, I say this on the eve of the busiest pharmacy day of the year for us. The Monday after Easter always puts us close to 700 prescriptions for the day (on a normal Monday, we'll do in the low to mid 500's. I have to open the store tomorrow, and I can't wait to see how many are waiting for us on the refill line. I'm betting around 70 or 80. It should be fun.

Saturday, March 15, 2008

My Favorite Piece of Music

Beethoven's Sonata 23 (Appassionata), Movement 3

Claudio Arrau performs his interpretation in this video. I like it. I have Willhelm Kempff's complete collection of Beethoven's Piano Sonatas on CD. Kempff performs this movement a little bit slower but with perhaps a little more feeling. I think they're both equally good.

I took piano lessons when I was really young. I stopped at the beginning of 4th grade once I started getting serious about basketball. I had some talent for the piano, but I was lazy. I didn't like to practice, but I had a good ear for the music. I never bothered learning how to read sheet music that well, so I pretty much learned to play songs through listening to them and watching my teacher. I hated the lessons though. It took away from my time playing basketball, so I begged and pleaded with my mom to let me quit.

Nearly 20 years later, I wish I had kept going with it. I love classical piano music. I could listen to the Appassionata, Tempest, Moonlight Sonata, Pathetique, and countless other Beethoven piano sonatas a billion times and never get sick of them. They're quite simply works of pure genius and beauty. I don't think I'm overstating when I say that music like this is one of the greatest achievements of our species.

It kind of makes you think what would happen if someone with the genius of a Beethoven, Mozart, or Bach were around in our current generation. Would we even know about him? Would he even get a chance to show his talents?

Classical-style music is all but dead in our society. The only times we even hear orchestras and symphonies are when they're playing music from classical composers, or they're making music for plays or movies. Hollywood, believe it or not, is where the greatest composers of our time our wasting away. It's a shame that someone as talented as John Williams is best known for the Indiana Jones and Star Wars theme songs. He's essentially a high class jingle writer. 300 years ago, John Williams would have been composing original music for the masses. His music would be appreciated on its own merit instead of for the movie for which it was composed.

If Beethoven were around today, he'd be overlooked in favor of Britney Spears, Jessica Simpson, Justin Timberlake, Fergie, and the plethora of other talentless stars. Great music should be timeless. It's not something you look back on 20 years later and laugh at. A thousand years from now (assuming we don't wipe ourselves off the face of the planet) we'll still revere Beethoven, Bach, and Mozart's music, but we'll have long forgotten the stars of today.

It's just sad to me to think that right now, there could be some 6 year old kid with a pitch-perfect ear for music already performing and writing classical music. He might get a headline or two. Maybe he'll make a showing on the Tonight Show where everyone will call him a child prodigy. Perhaps he'll go on to be a great soloist in some world renown orchestra. I can tell you one thing though... we'll never hear one of his own original compositions... unless of course it winds up in a movie or Broadway musical. It's sad because that 6 year old kid could be the next Mozart, but we'll never know, and even worse, our society will never care.

We're too busy worshiping the next hot, but completely talentless train wreck we turn into a celebrity.

Thursday, March 13, 2008

Looking for opinions

Here's the situation:

A woman picked up a brand new prescription for Byetta today. Before leaving the pharmacy, she asked me to show her how to set up the pen. I took out the pen to show her and realized that she would need pen needles to use it. I asked if she had a box of pen needles at home, and she, of course, said no.

Well, the doctor never phoned in a prescription for the pen needles. To me... if a doctor writes for byetta, then the RX for the pen needles is inferred. Afterall, the Byetta pen wouldn't be much good if you don't have the needles for it. Therefore, I simply wrote up a prescription for pen needles instead of wasting time calling the doctor.

Is this the right thing for a pharmacist to do in this situation? My gut tells me that it is, but I have a few doubts. I'm just looking for other opinions.

I Don't Have Pet Peeves; I Have Major Psychotic Fucking Hatreds

Not really. Well sort of... I'm just trying to see how many posts in a row I can use George Carlin references in the title.

- Not Marking Opened Bottles- It's pretty irritating when you get a prescription for 30 tablets of a medication, and you go to the shelf and grab what you think is a nice 30 count bottle only to open the bottle and find it's already been opened. Therefore, you have to waste your time by walking back to the shelf to get a second bottle. Just put a nice X on every bottle you open. It's not that hard. It takes 2 extra seconds.

- Not fully ripping out the foil and leaving in the cotton- I can't stand when I go to pour tablets out of a bottle and find that the foil was sloppily punched through leaving an irregular hole which impedes the flow of tablets during pouring. Rip that foil off. It looks neater and the tablets pour out much more easily. In addition, if there's cotton in a bottle, please take that shit out when you open the bottle. There's no reason to leave it in once the bottle has been opened.

- Manufacturers who decide that a great place for the patient package insert is INSIDE the bottle- Why do you do this? That stupid insert becomes just one more thing I have to take out of the bottle in order to get the tablets to pour out easily. Secondly, the second that bottle gets opened, I'm just going to throw the package insert into the trash. All package inserts should be glued to the side of the bottle. There, it doesn't get in your way, so you never have to throw it out. Furthermore, if you ever had to read the insert for something, you could do so without opening a new bottle.

- Coupons and Gift Cards- I don't know or care about what items are on sale in the store from day to day. I am a pharmacist. I'm not a cashier. If your toothpaste rings up for $3.00 instead of $2.00 like it says it should on your coupon, I don't want to hear it. Go to the front end to get that shit sorted out. Don't waste the pharmacy's time. I firmly believe that all coupons and gift card stuff should be handled by the front end. If the store is offering some kind of gift card promotion, the pharmacy shouldn't be the one handing out those gift cards. If the gift card has something to do with prescriptions, then I'm willing to give someone some kind of signed ticket for them to go to the front end to get their gift card. I just thinking it's fucking stupid for us to waste our time filling out gift card logs and do all the rest of that bullshit that comes with giving out a gift card.

(Section edited out to maintain anonymity)

Anyway... I'm still sick, and I have to get through one more day of work tomorrow. Just 10 more hours to go. I can do this.

Wednesday, March 12, 2008

H.S.I.O.W. (Holy Shit It's Only Wednesday)

I don't know how you Monday through Friday people do it. I can't imagine working 5 days in a row every week. I just finished day 2 of 4 days in a row, and I'm just about at my breaking point. I'm dead tired now, and I'm not sure how I'm going to make it through my next 2 days. It doesn't help that I've had some sort of respiratory bug since Friday. I'm not sleeping very well at night, and I have this constant, horrible, hacking cough. It's only 4 days in a row though. It shouldn't feel this hard. If someone told me I had to work a 5th day, I think they'd have to throw me in a room with padded walls.

Comounding my fatigue is having to listen to everyone's drama at work. Apparently, our clerks/techs are at war with each other. I'm not 100% sure what it's about because I do my best to not listen to this kind of bullshit. However, the tension level is pretty high between some of them. I guess some of them feel that they're being treated unfairly by some of the pharmacists. Therefore, we're getting serious attitude problems between the clerks/techs and other clerk/techs as well as between them and certain pharmacists. It has to do with certain employees do more counting and pharmacy benchwork than other techs, and their complaints are that the pharmacists allow this to happen because they don't treat all of them equally.

I'm actually not part of these complaints. I guess it's because when I'm the only pharmacist working, I tend to do almost everything myself. I hate delegating tasks. For one, I don't really trust other people that easily. I worry that things won't get done quite as I want them to. This ties into my belief that "if you want something done right, you have to do it yourself." I figure it's my license at stake, and if I'm responsible for the pharmacy, then I want to do as much as I can.

The thing with me is that I have very high expectations for my work. I judge myself by a different standard than I judge everyone else. I strive to be perfect and the best at whatever I do. I don't expect this same level of perfection out of anyone else. Therefore, I feel bad holding someone else up to my impossible standards, so instead of being dissappointed with their work, I do the work myself. I know this isn't a good character trait for someone who will probably be a manager in the future. I can't help it though. I see an imperfection, and I feel compelled to fix it.

Anyway... 2 more days before I can rest. How sad is my life that the major reason I'm looking forward to Friday night is going to sleep for a long time?

Friday, March 7, 2008

Sometimes you just have to talk to the doctor directly.

When I walked into the pharmacy on Thursday, I wasn't in the best mood. I had a crappy day on Wednesday; a transformer blew and our whole street loss power for 4 hours on Wednesday morning. By the time the power was restored, and we could get back to normal business, we were well behind. By late afternoon, we finally were just about caught up when suddenly our computers went down for an hour. It was a frustrating mess.

Therefore, it's understandable that I wasn't too thrilled to be walking into work the next day. The first thing I did was check our voice mail, which had 7 prescriptions just waiting for me. One prescription was left by a local doctor, who I'll call Dr. Smith. Dr. Smith called in Voltaren for this certain 94 year-old patient of ours. Once I heard "Voltaren" come out of his mouth, I immediately thought it was a terrible drug to prescribe to someone her age. I checked her profile and saw that she was on a bunch of heart medications as weel as Coumadin.

Voltaren (and NSAIDs in general) are terrible drugs for the elderly. It is well known that NSAIDs are affect platelet aggregation and can damage the mucosal lining of the GI tract, which in turn can cause GI ulcers. A bleeding ulcer is certainly not a good thing to have in someone taking Coumadin. In addition, NSAIDs can decrease renal function, which is already decreased in the elderly population. NSAIDs can also increase blood pressure, which isn't a great idea for someone taking a lot of cardiac medication. Finally, a little known thing about NSAIDs is that studies have shown that they actually increase the rate of falls in the elderly. The reason isn't quite clear, but there is a definite statistical link. For all these reason (especially the patient being on Coumadin), I decided to call the office to inquire about the doctor's choice of drugs in this patient.

I figured Dr. Smith simply wasn't aware she was on Coumadin when he prescribed Voltaren. Granted, it still wouldn't be a great choice of drugs for her, but without the Coumadin, he could make some kind of risk vs. benefit case about why he prescribed Voltaren. I spoke to a nurse at the office and told her I was questioning Dr. Smith's choice of drugs in this elderly Coumadin patient. The nurse put me on hold to ask the doctor about it. When she came back, she told me that Dr. Smith didn't want to change the drug because "she wouldn't be taking it that often anyway."

I wasn't satisfied by this answer, so I requested to speak to the doctor himself. Begrudgingly, she got the doctor for me.

(As a side note- Why is everyone at these offices so damn afraid to ask the doctor about stuff? Are doctors really so mean and unapproachable that no one dare question their decisions? Every time I ask to speak to the doctor directly, I get someone telling me, "He's going to be mad." I think it's pretty ridiculous. When a customer calls to speak to a pharmacist, I'm expected to personally answer that phone call regardless of whether the situation actually warrants a pharmacist.)

Anyway... The doctor got on the phone, and I explained to him my concerns. He told me that he wasn't the least bit concerned about her being 94 years old. He then asked me what I was worried about with the Coumadin. I was kind of dumbfounded by the question. Was he really asking me why NSAIDs and Coumadin are a poor mix? "Well, my concern is that she can develop a GI bleed that won't stop bleeding, and she can die," were my exact words to him. I guess the possibility of death got to him, and he changed the prescription to Ultracet (the patient had some kind of back pain), which while not being great, is a considerably better choice than Voltaren.

I felt pretty good about myself for actually talking to the doctor himself to get him to change the drug. I felt even better about myself when the patient came in for her prescription. Everyone at the pharmacy is very familiar wiith her. She's been using our pharmacy for over 20 years. She's a cute old lady, couldn't weigh over 90 pounds, and about as mentally alert as a 94-year old could be. She always comes in with her daughter, who helps take care of her. This was her first time seeing Dr. Smith, so when he gave her the prescription, she immediately called her primary care doctor to ask him if it was OK to take with her other medications. Her doctor, like me, told her that she should not take Voltaren along with her Coumadin. After relaying all this information to me, I assured her that I had already called Dr. Smith and got the medication changed to something that was safer for her to take. She was pleased.

I walked away to let one of our techs ring her out. After she walked away, the tech came back and told me that her and her daughter kept on saying what a "nice, young pharmacist" I was. That was my little victory for the day, and moments like that make my job worthwhile. Perhaps, changing therapies and catching interactions happens a thousand times a day for hospital and other more clinical pharmacists, but how often do they get to see the patient's appreciation of their efforts? This is a big part of the reason I like retail better than the other areas. You get to develop personal relationships with the customers, and in doing so, you build up a level of trust. I'd like to think that most of my customers know that I work hard for them, and they trust me enough to know that when I say I'll do something (i.e. call a doctor, call an insurance company, etc.), I actually do it.

Like I said, that was my little victory for the week. Maybe that's not enough for some people, but it's OK for me.

Monday, March 3, 2008

My body is sore, I'm not really tired, and I feel the need to write...

I just got back from playing 2 hours of pretty intense pick-up basketball games at my local recreation department. My body just isn't in good enough shape to handle that kind of exertion. Over the last 30 minutes, I couldn't even take a jumpshot anymore because my calves would cramp up. Now, every muscle in my legs hurts in some way. I'm still feeling the remnants of all that adrenaline, and even though it's after midnight, I don't feel tired in the least bit. I feel like writing something, but I'm not quite sure what. Therefore, I'm probably going to ramble on for a bit and be all over the place. Just a warning...

I've been trying to develop a new outlook on life. Actually, it's not so much new as it is the way I used to think long ago. I'm always going to be a thinker. That's just me. I'll always analyze every nuance of my existence. However, I'm trying not to be so harsh on myself, and I'm trying to think more positively. Most of all, I'm trying to get back to just being myself.

After a disappointing and utterly frustrating trip to a club recently, I've decided that I will never go to a club again. In addition, I'm going to stop drinking alcohol. Ever since I became single, I pretty much followed my friends wherever they felt like going. They wanted to go to the club, I'd go with them. They wanted to go to some crowded bar, I tagged along. What else is there to do for a single guy? I was bored and lonely. I needed all the company I could get to take my mind off my shitty situation with my ex. Hell, I still need the company.

This recent trip to the club, however, made me realize that I fucking hate clubs, and I fucking hate crowded bars. I hate the pretentious and often sleazy people who populate those places. I can't stand techno music. In fact, I hate it with a passion. It's not even music. It's the same stupid bass beat over and over and over again. It numbs your brain, which is I suppose the point. After all, you wouldn't want to appear intelligent to anyone at one of those clubs. All anyone cares about is if you look hot. For guys that means you must make sure to get one of those retarded looking blow-out haircuts, pop the collar of your half-buttoned clubbing shirt, and slather on that tan-in-a-bottle shit. Shit... It's like these assholes roll off an assembly line. Every one of them is the same fucking person, just in varying heights. Every time I see one, I have a nearly uncontrollable urge to punch him in the face. However, I guess that's how you get all the good women... and you know what I mean by good women (at least in club terminology); The ones that wear the skimpiest, tightest outfits imaginable.

Anyway... I was at the stupid club, drinking one $8 mixed drink after another, and outwardly I seemed like I was enjoying myself. In reality, I kept checking my watch every 2 minutes to see if it was close to last call (which is amazingly early where I live), so I could get the fuck out of there. Most of the time, I was thinking that I'd much rather be at home, by myself, reading my book than to have to put up with all these people.

Finally, we left, and upon getting back to my apartment, I realized I was a little drunker than I thought I was. As I put my head on my pillow, the room kind of spun a little bit. I knew that I would the next morning wouldn't be fun. Of course, I woke up with a horrible hangover and proceeded to spend most of the day in bed. I hate feeling hungover. I always chastise myself for drinking so much, but I always end up getting drunk again at my next opportunity. I started to think, "What's the point?" Really... What does alcohol do for me? Did it make me enjoy the club any more than I would have without it? No. Did it remove my inhibitions and make it easier to talk to women? No. What the hell was the point of drinking for me?

I didn't have a sip of alcohol until well after my 21st birthday. I didn't drink during my first 4 years of college. In fact, I didn't start drinking until my girlfriend got to law school, and she started going out drinking with her classmates. I figured I either had to start drinking, so I could hang out with her, or say goodbye to any chance of spending time with her. (We all know how well that ended up working out for me). Before that, I was never even tempted. My roommates had parties in our dorm room with tons of beer and liquor, and I would never drink. People laughed at me and asked what was wrong with me, but I didn't care. I wasn't the one passed out with my head on a toilet at the end of the night. While they were sleeping off a hangover on Saturday, I was at the gym breaking ankles on the basketball court. I was proud of being alcohol free. It made me different. I felt mentally tougher than all those kids that went away to college and succumbed to the social pressures to drink.

Look at me over the last two years though. I took up drinking simply to give me something to do with my friends. I started acting like the people I ridiculed, and what has it gotten me? Nothing. It only made me lose some of my self respect, which in turn has made me even more of a social outcast (at least in the dating circle). After all, how can I expect someone to like and respect me if I don't even like or respect myself?

Therefore, I've made a decision to get back some of that self-respect by avoiding the things that don't bring me any contentment. Clubs, over-crowded bars, and drinking large quantities of alcohol don't add one bit of happiness to my life. I'm much happier when I read a great book or watch a movie. This isn't to say I'm not going to hang out with my friends anymore. If they want to go to a non-crowded local bar to hang out, I'll go with them. I'll spend the night drinking Diet Coke and eating wings instead of drinking beer, and I'll still have the same amount of fun.

I guess that's my first step towards self-improvement. I have to make myself happy before I can even think about having a relationship. If I can accomplish that, then everything else will probably fall into place.

Saturday, March 1, 2008

The Disconnect Between the Customer Service Line and the Pharmacy Help Desk

Every pharmacy employee has been through this situation, and we all know how much it sucks....

A customer comes to the pharmacy with a nice upper respiratory tract infection for which her doctor (most likely inappropriately) prescribed some expensive antibiotic (we'll say Levaquin for this example). You got to fill the prescription for her, and you get the message "Covered Terminated." That beautifully simplistic message is usually the beginning of a stressful and frustrating customer encounter.

You get the attention of the waiting customer to tell ask her if she has a new insurance card. Of course, she does not. You then ask if anything has changed in her job since the time she last filled a prescription. From here, the story can vary a little bit. Sometimes she'll say "no, everything is the same." Other times, she'll all of a sudden remember that she just changed jobs a month ago. In this example, the customer changed jobs, but never received an insurance card.

From here, the standard advice is to tell her to contact her human resources department; They can give her the number of her PBM, and she can call to find her coverage information. She complains a bit, but after you assert that there's nothing you can do, she leaves to make a few phone calls. Before leaving, you tell her to make sure she gets the correct BIN, PCN, ID#, and RX Group, which will ensure you'll have all the information necessary to bill her PBM.

An hour or two later, she calls the pharmacy saying she has all the information. However, the only information she has is that her insurance is through (insert big name PBM here because apparently I can get in trouble over using an actual insurance company name in a fictitious example). She called them, but they wouldn't give her ID#, and instead, told her told her that the pharmacy can call this 1-800 number, and he'll be able to get all the information.

Of course, this makes you flipping mad because there's no good reason why her insurance company would deny telling a customer her own ID#. Now, because the PBM is so fucking stupid, you have to waste 10 minutes of your valuable time calling to get the processing information that A) they should have sent to the customer in the form of an insurance card already, and B) they could have just told her over the phone.

Then there's the other variation to this story that maybe even more infuriating. The customer calls the customer service line to get the information only to talk to someone who has no fucking clue about how a pharmacy claim needs to be billed. Therefore, the dumbfuck will give the customer the completely wrong ID# (I honestly have no idea where this ID# ends up coming from), and you'll waste even more time trying to bill the claim with the wrong ID#. Eventually, in the name of good customer service, you'll have to call the PBM help desk and ascertain the correct number. Another waste of time.

When this happens, I always make it a point to tell the customer that for whatever reason, the people you talk to when you call the customer service line have no idea what they're doing, and the information they give is almost always the wrong information. It really is a small miracle when customers actually are able to get all the necessary infomation on their own without an insurance card. You'd think it would be easy. You'd think that if a customer call the customer service line and asks for their pharmacy insurance information, all the person would have to do is transfer the customer to the pharmacy department. I guess this requires an advanced degree to figure out though.

One of our clerks (a particularly grumpy old fellow) made a great suggestion. He said that there should be a phone right outside of the pharmacy that has the 1-800 numbers of all the major PBMs programmed into it. If any customer has a problem, we just point them to the phone and tell them to call. I loved this idea, but my only concern would be that there would end up being a line that wraps around the pharmacy 3 times with all the insurance problems that pop up during the day. We'd be better served to have a freaking call center attached to the pharmacy.

Hey... maybe that's the future of pharmacy. You have a a prescription department and right next door, you have a call center with about 10 telephones for people to call their insurance companies.