I just want to clarify my remarks about the NAPLEX in response to a comment I received.
I don't believe one's performance on the NAPLEX has even the slightest bit to do with what kind of pharmacist a person will be. Hell, I don't think grades in school have much to do with what kind of a pharmacist someone will be either.
I was merely voicing a random thought that popped into my head regarding the NAPLEX. The blog entry was more about how shitty the NAPLEX is as a licensing examination. Think about it... if 85%+ of the students who take it pass, and no one has any idea how the stupid exam is scaled, what's the point of even having students take it?
Would anyone honestly feel less confident in newly licensed pharmacists if they didn't have to take the NAPLEX to get licensed? I really wouldn't. I suppose the NAPLEX is used simply to set people's minds at ease that potential pharmacists have to be tested in something, regardless of how little it has to do with the actual practice of pharmacy.
Tuesday, February 26, 2008
Random thought
Does anyone know someone who actually failed the NAPLEX? I'm not going to count anyone who barely speaks English and couldn't understand the questions. I mean, do you know anyone who failed the NAPLEX simply because they thought the test was too hard?
Whenever a student asks me about how to study for the NAPLEX, I say the same thing; "Study as much as you need to in order to ease your mind, but just keep in mind that as long as you know how to do pharmacy math, you will not fail it."
Like everyone else, I was nervous about taking the NAPLEX. Everyone tells you that you'll do just fine on it, but as a student, you never accept that. I bought a review book that I planned on reviewing starting roughly a week before the exam. However, before starting my review, I decided to take the practice NAPLEX online just to see where I stood. The practice test seemed pretty challenging to me (aside from the pharmacy math which is ridiculously simple). I felt like I was guessing on a lot of the answers, and I didn't really know what to expect for my score.
Upon finishing, I learned that I got a 112 on the practice test (you only need a 75 to pass). Basically, I passed that exam by a fairly wide margin before I even started to study. My nervousness immediately vanished and was replaced by a sense of incredulity. How could anyone fail this thing??? I felt like I was mostly guessing on the non-math problems, yet I still passed easily.
My review strategy changed. I ended up not bothering to use the review book. I didn't go over any pharmacy school notes. In fact, I basically put the exam out of mind until a couple nights before I was scheduled to take it. I started to think that my pre-NAPLEX score could have been a fluke. Therefore, I took another practice test online just to reassure myself. Once again, it felt pretty challenging. This time, I scored 122 on it. That night, I calmly went to sleep and didn't give that stupid test another thought.
My score on the actual NAPLEX ended up being 130 (I've heard the average score is somewhere around 100, but I'm not entirely sure how accurate this is). When I found out my score, I wasn't relieved that it was over. Nor was I really all that thrilled that passed. The only thought that kept running through my mind was how in the world ANYONE could fail that thing?
Pretty much half the questions on the exam are pharmacy math questions. Pharmacy math isn't difficult. In fact, you pretty much only need to know basica algebra to solve them. Moreover, you don't need to know anything about drugs or therapeutics to answer them. Therefore, if you simply taught someone pharmacy math, they've pass the NALPEX... easily I might add. I'm 100% confident that a lot of pharmacy technicians without ever taking a class in pharmacy school could pass the NAPLEX on their first try.
Again, this isn't because the actual pharmacy questions easy. They aren't. In fact, they can be quite challenging. The ease in passing the test is entirely based upon how the test is scaled. According to the official NAPLEX registration bulletin:
I have no idea what they mean by "ability level," but whatever the "predetermined minimum acceptable ability level" is, it's ridiculously low.
This is why I tell students to just as much studying as they need to in order to put their minds ease. I also tell them to make sure they know how to do pharmacy math because as long as you know that, I promise that you cannot fail this exam.
The MPJE is another story....
That exam scared the shit out of me. Pharmacy law is very very vague. The MPJE will throw questions at you where all the answer choices seem like they could be correct, and you'll see questions where all the answer choices seem entirely wrong. I'm usually a very confident test taker, but when I finished that exam, I went home and starting throwing things because I was sure I failed it.
It took a little over a week to get my score back, and it was the most agonizing week of my life to that point. It was my last exam, so getting a passing grade meant I was a pharmacist. I ended up getting an 84 on it (75 is passing).
This is when I started truly analyzing the numbers for the MPJE. According to various websites, the passing rate is roughly 86%. You need a 75 to pass. 99 is the maximum score. I found a site that told me the average score for the MPJE in 2005 was a 79.
Think about that. 75 is passing. 79 is the average score. 86% of people passed the test. What the hell is the standard deviation from the mean on that test? 2 points????? Basically, all the scores must fall between 75 and 85. In my pharmacy class, the highest score that I knew of was an 88, and the lowest score was 78. Most people got between 82 and 84.
The MPJE is scaled the same as the NAPLEX. Therefore, it seems that as long as you at least read the stupid law book before sitting down to take the exam, you'll pass.
I don't know what made me think about all this now. It was just a random thought upon waking up this morning. Perhaps I have too much time on my hands.
Whenever a student asks me about how to study for the NAPLEX, I say the same thing; "Study as much as you need to in order to ease your mind, but just keep in mind that as long as you know how to do pharmacy math, you will not fail it."
Like everyone else, I was nervous about taking the NAPLEX. Everyone tells you that you'll do just fine on it, but as a student, you never accept that. I bought a review book that I planned on reviewing starting roughly a week before the exam. However, before starting my review, I decided to take the practice NAPLEX online just to see where I stood. The practice test seemed pretty challenging to me (aside from the pharmacy math which is ridiculously simple). I felt like I was guessing on a lot of the answers, and I didn't really know what to expect for my score.
Upon finishing, I learned that I got a 112 on the practice test (you only need a 75 to pass). Basically, I passed that exam by a fairly wide margin before I even started to study. My nervousness immediately vanished and was replaced by a sense of incredulity. How could anyone fail this thing??? I felt like I was mostly guessing on the non-math problems, yet I still passed easily.
My review strategy changed. I ended up not bothering to use the review book. I didn't go over any pharmacy school notes. In fact, I basically put the exam out of mind until a couple nights before I was scheduled to take it. I started to think that my pre-NAPLEX score could have been a fluke. Therefore, I took another practice test online just to reassure myself. Once again, it felt pretty challenging. This time, I scored 122 on it. That night, I calmly went to sleep and didn't give that stupid test another thought.
My score on the actual NAPLEX ended up being 130 (I've heard the average score is somewhere around 100, but I'm not entirely sure how accurate this is). When I found out my score, I wasn't relieved that it was over. Nor was I really all that thrilled that passed. The only thought that kept running through my mind was how in the world ANYONE could fail that thing?
Pretty much half the questions on the exam are pharmacy math questions. Pharmacy math isn't difficult. In fact, you pretty much only need to know basica algebra to solve them. Moreover, you don't need to know anything about drugs or therapeutics to answer them. Therefore, if you simply taught someone pharmacy math, they've pass the NALPEX... easily I might add. I'm 100% confident that a lot of pharmacy technicians without ever taking a class in pharmacy school could pass the NAPLEX on their first try.
Again, this isn't because the actual pharmacy questions easy. They aren't. In fact, they can be quite challenging. The ease in passing the test is entirely based upon how the test is scaled. According to the official NAPLEX registration bulletin:
The minimum acceptable passing score on the NAPLEX scale is 75. The passing score reported is not a percentage value. The score is calculated by first determining the candidate’s ability level on the NAPLEX and then comparing the candidate’s ability level to the predetermined minimum acceptable ability level established for the NAPLEX.
The passing standard has been established by a panel of pharmacy experts, and the ability level that defines the passing standard is the same for all NAPLEX administrations.
I have no idea what they mean by "ability level," but whatever the "predetermined minimum acceptable ability level" is, it's ridiculously low.
This is why I tell students to just as much studying as they need to in order to put their minds ease. I also tell them to make sure they know how to do pharmacy math because as long as you know that, I promise that you cannot fail this exam.
The MPJE is another story....
That exam scared the shit out of me. Pharmacy law is very very vague. The MPJE will throw questions at you where all the answer choices seem like they could be correct, and you'll see questions where all the answer choices seem entirely wrong. I'm usually a very confident test taker, but when I finished that exam, I went home and starting throwing things because I was sure I failed it.
It took a little over a week to get my score back, and it was the most agonizing week of my life to that point. It was my last exam, so getting a passing grade meant I was a pharmacist. I ended up getting an 84 on it (75 is passing).
This is when I started truly analyzing the numbers for the MPJE. According to various websites, the passing rate is roughly 86%. You need a 75 to pass. 99 is the maximum score. I found a site that told me the average score for the MPJE in 2005 was a 79.
Think about that. 75 is passing. 79 is the average score. 86% of people passed the test. What the hell is the standard deviation from the mean on that test? 2 points????? Basically, all the scores must fall between 75 and 85. In my pharmacy class, the highest score that I knew of was an 88, and the lowest score was 78. Most people got between 82 and 84.
The MPJE is scaled the same as the NAPLEX. Therefore, it seems that as long as you at least read the stupid law book before sitting down to take the exam, you'll pass.
I don't know what made me think about all this now. It was just a random thought upon waking up this morning. Perhaps I have too much time on my hands.
Sunday, February 24, 2008
Nothing better than being called in on a Saturday
Saturday started out great. I woke up around 9:00 AM after getting a full 8 hours of sleep. I then proceeded to read 70 pages of my book (A Prayer For Owen Meany by John Irving... I highly recommend it). Around 11:30, I felt a little bit hungry, so I popped a Freschetta Brick Oven frozen pizza in the oven (nothing better than frozen pizza for a lazy, lonely, single guy). At noon, my favorite college basketball team was playing, and it was nationally televised in HD, so I was all set to enjoy the game in full HD splendor.
Almost perfectly timed with the halftime buzzer, my phone rang. It was one of our techs; "Mike, Betty is sick. She doesn't feel well enough to stay. Can you come in to cover for her?"
FUCK!!!!!!!!!!!!!
I had no excuse to get out of it. Someone had to cover for her. If it wasn't me, my manager would have covered for her. However, he lives 35 minutes away (compared to my 4 minutes away). In addition, he has a wife and young kids who are always active in sports and other things on the weekends, so he's actually never available to work a weekend unless it's an emergency. He would have had to cancel his plans for the evenings to come in.
Unfortunately for me, I had no plans for the evening, and I would have felt really bad making my manager cancel his plans and drive all that way, so I felt obligated to go in.
FUCK!!!!!!!!!!!!!!
Of course, I had to miss the rest of the game (my team ended up losing). Within 10 minutes of my arrival at the pharmacy, one of the clerks, who is a premed student, asked if she could go home early to study for an exam.
AHHHHH!!!!!!!!!!!!
Seriously.. What the fuck!?!?!? I let her go home. We were slow. We didn't really need her. However, that's not really the point. I'm getting pretty fed up with all this going home early bullshit. I feel bad about getting angry over it because this girl is probably the nicest person you could ever meet, but she simply has some sort of problem staying for her entire shift. Everytime I work with her, she asks to leave early. Usually, she'll pull that bullshit where she won't take a lunch break, and she'll think that this entitles her to leave 30 minutes early.
That brings me to another issue that my store is having; We have a horribly inflexible staff. There are just so many people who can only work certain days and certain hours that we don't have any way of covering for someone who calls out sick (pharmacists not included obviously). Most of our staff is made up of students or people who have other jobs which makes it impossible for them to come in at a different time to cover for someone.
What ends up happening is we have 3 clerks working the evening shift until close on most nights even though we're usually pretty dead after 7:00 PM. Then during the morning and afternoon hours, we don't have enough help. Ideally, it would be nice to take one or two of the clerks from the evening shift and have them work in the morning or midday, but their rigid schedule makes this impossible.
In any case, working a Saturday when you weren't intending to work sucks.
Almost perfectly timed with the halftime buzzer, my phone rang. It was one of our techs; "Mike, Betty is sick. She doesn't feel well enough to stay. Can you come in to cover for her?"
FUCK!!!!!!!!!!!!!
I had no excuse to get out of it. Someone had to cover for her. If it wasn't me, my manager would have covered for her. However, he lives 35 minutes away (compared to my 4 minutes away). In addition, he has a wife and young kids who are always active in sports and other things on the weekends, so he's actually never available to work a weekend unless it's an emergency. He would have had to cancel his plans for the evenings to come in.
Unfortunately for me, I had no plans for the evening, and I would have felt really bad making my manager cancel his plans and drive all that way, so I felt obligated to go in.
FUCK!!!!!!!!!!!!!!
Of course, I had to miss the rest of the game (my team ended up losing). Within 10 minutes of my arrival at the pharmacy, one of the clerks, who is a premed student, asked if she could go home early to study for an exam.
AHHHHH!!!!!!!!!!!!
Seriously.. What the fuck!?!?!? I let her go home. We were slow. We didn't really need her. However, that's not really the point. I'm getting pretty fed up with all this going home early bullshit. I feel bad about getting angry over it because this girl is probably the nicest person you could ever meet, but she simply has some sort of problem staying for her entire shift. Everytime I work with her, she asks to leave early. Usually, she'll pull that bullshit where she won't take a lunch break, and she'll think that this entitles her to leave 30 minutes early.
That brings me to another issue that my store is having; We have a horribly inflexible staff. There are just so many people who can only work certain days and certain hours that we don't have any way of covering for someone who calls out sick (pharmacists not included obviously). Most of our staff is made up of students or people who have other jobs which makes it impossible for them to come in at a different time to cover for someone.
What ends up happening is we have 3 clerks working the evening shift until close on most nights even though we're usually pretty dead after 7:00 PM. Then during the morning and afternoon hours, we don't have enough help. Ideally, it would be nice to take one or two of the clerks from the evening shift and have them work in the morning or midday, but their rigid schedule makes this impossible.
In any case, working a Saturday when you weren't intending to work sucks.
Saturday, February 23, 2008
Questions
Perhaps, I shouldn't think this way. As a pharmacist, I should be ready and willing to help the public with all of their healthcare issues. However, some of the questions I get are ones that I wouldn't be able to answer any better than the person asking. Yesterday provided me with 2 examples of these types of questions...
1) A women called on the phone to tell me that her 9 year old daughter fractured her pinky finger. Great. I thought maybe she'd ask me how much ibuprofen she could give her or some other medication related question. Instead she asked, "The doctor told me to buddy-tape her pinky to her ring finger, but it still hurts her when she moves it. What can I use to hold her finger in place and keep her from moving it?"
Now I've never broken my finger before. I've never cared for anyone with a broken finger. Moreover, in pharmacy school, they never taught us how to splint broken fingers. Any advice I could give her would simply be my best guess, which I'm not really entirely sure is any better than her best guess. After confirming with her that her daughter has a follow-up appointment to see a doctor in the not-too-distant future, I told her that she could probably tape the finger to a popsicle stick or a tongue depressor. Either that or she could just heavily tape around the joint so she's unable to move the finger.
A popsicle stick?!? That was my advice. I had no freaking clue.
2) A man brought me 2 boxes of non-stick gauze pads and asked me if either one of them would be OK to put over someone's eye (kind of like an eye patch). Again, homemade eye patches weren't covered in my pharmacy school curriculum, nor did I ever have the need to make a homemade eye patch for myself or anyone else. I stood there dumbfounded looking at the 2 boxes, and all I could muster up was to shrug my shoulders and say, "They'd probably work, but I really have no idea." Once again, his guess was as good as mine in this situation.
It's not that I don't like getting asked questions. I just don't see how I'd be expected to know the answer better than anyone else simply because I'm a pharmacist. Now, if someone asked me what's a good athletic brace to use for someone with a sprained ankle, I could tell you everything there is to know about ankle braces (and sprained ankles in general). However, that has nothing to do with me being a pharmacist. Instead, it's simply because I've sprained each ankle at least a dozen times. Therefore, by now I'm an expert on ankle sprains. Of course, my expertise would be the same if I happened to be a janitor instead of a pharmacist.
I guess I should be happy that people think so highly of pharmacists that they'll come to them with any medical issue they have. I'm just not qualified to help with some of them though, and while I'd love to go out in the aisle and help them make an educated guess, I worry about giving someone the wrong information. Therefore, if I do help, I'll usually preface it with, "this is beyond me area of expertise..." or "I'm just guessing here..." That way, they'll know to take whatever advice I give them with a grain of salt.
There was one time when a teenage girl in one of the aisles right in front of the pharmacy suddenly had a seizure and fell to the floor. The parents, nervous of course, came running to the pharmacy for help. Once again, I've never had a seizure. I don't know anyone with a seizure disorder. Luckily however, one of my techs' father had a long history of seizures, so she ran out into the aisle and kind of took control of the situation. The only thing I could do was make sure someone called 911.
In this case, I could have told them how to pharmacologically treat a seizure, but it's not like I could run out there and give her some valium (and considering we only have tablets and oral solution in stock, it probably wouldn't have been much good anyway). My tech had lots of experience in what to do while waiting for the ambulance to arrive, so she was the pharmacy's "expert" in this situation, and once again, it had nothing to do with her working in a pharmacy.
I suppose just about the only emergency situation I could respond to and actually be of some help would be if someone was having a heart attack in the store. This was actually covered in pharmacy school. I know the questions to ask. I know that it's generally a good idea to give someone a 325mg aspirin. If the person was someone who suffered from angina and had nitroglycerin tablets, I could instruct them to take the NTG and help determine whether the pain is simply angina or a possible heart attack.
Ugh... I'm rambling now. In any case, the point was that I get frustrated when people ask me healthcare questions that were not covered at any point in my pharmacy school curriculum. Most of the time, I don't have any better idea than the person asking the question, but I look like I should simply because I wear the white coat.
1) A women called on the phone to tell me that her 9 year old daughter fractured her pinky finger. Great. I thought maybe she'd ask me how much ibuprofen she could give her or some other medication related question. Instead she asked, "The doctor told me to buddy-tape her pinky to her ring finger, but it still hurts her when she moves it. What can I use to hold her finger in place and keep her from moving it?"
Now I've never broken my finger before. I've never cared for anyone with a broken finger. Moreover, in pharmacy school, they never taught us how to splint broken fingers. Any advice I could give her would simply be my best guess, which I'm not really entirely sure is any better than her best guess. After confirming with her that her daughter has a follow-up appointment to see a doctor in the not-too-distant future, I told her that she could probably tape the finger to a popsicle stick or a tongue depressor. Either that or she could just heavily tape around the joint so she's unable to move the finger.
A popsicle stick?!? That was my advice. I had no freaking clue.
2) A man brought me 2 boxes of non-stick gauze pads and asked me if either one of them would be OK to put over someone's eye (kind of like an eye patch). Again, homemade eye patches weren't covered in my pharmacy school curriculum, nor did I ever have the need to make a homemade eye patch for myself or anyone else. I stood there dumbfounded looking at the 2 boxes, and all I could muster up was to shrug my shoulders and say, "They'd probably work, but I really have no idea." Once again, his guess was as good as mine in this situation.
It's not that I don't like getting asked questions. I just don't see how I'd be expected to know the answer better than anyone else simply because I'm a pharmacist. Now, if someone asked me what's a good athletic brace to use for someone with a sprained ankle, I could tell you everything there is to know about ankle braces (and sprained ankles in general). However, that has nothing to do with me being a pharmacist. Instead, it's simply because I've sprained each ankle at least a dozen times. Therefore, by now I'm an expert on ankle sprains. Of course, my expertise would be the same if I happened to be a janitor instead of a pharmacist.
I guess I should be happy that people think so highly of pharmacists that they'll come to them with any medical issue they have. I'm just not qualified to help with some of them though, and while I'd love to go out in the aisle and help them make an educated guess, I worry about giving someone the wrong information. Therefore, if I do help, I'll usually preface it with, "this is beyond me area of expertise..." or "I'm just guessing here..." That way, they'll know to take whatever advice I give them with a grain of salt.
There was one time when a teenage girl in one of the aisles right in front of the pharmacy suddenly had a seizure and fell to the floor. The parents, nervous of course, came running to the pharmacy for help. Once again, I've never had a seizure. I don't know anyone with a seizure disorder. Luckily however, one of my techs' father had a long history of seizures, so she ran out into the aisle and kind of took control of the situation. The only thing I could do was make sure someone called 911.
In this case, I could have told them how to pharmacologically treat a seizure, but it's not like I could run out there and give her some valium (and considering we only have tablets and oral solution in stock, it probably wouldn't have been much good anyway). My tech had lots of experience in what to do while waiting for the ambulance to arrive, so she was the pharmacy's "expert" in this situation, and once again, it had nothing to do with her working in a pharmacy.
I suppose just about the only emergency situation I could respond to and actually be of some help would be if someone was having a heart attack in the store. This was actually covered in pharmacy school. I know the questions to ask. I know that it's generally a good idea to give someone a 325mg aspirin. If the person was someone who suffered from angina and had nitroglycerin tablets, I could instruct them to take the NTG and help determine whether the pain is simply angina or a possible heart attack.
Ugh... I'm rambling now. In any case, the point was that I get frustrated when people ask me healthcare questions that were not covered at any point in my pharmacy school curriculum. Most of the time, I don't have any better idea than the person asking the question, but I look like I should simply because I wear the white coat.
Monday, February 18, 2008
A Comforting Thought...
I don't believe in predestination. However, you have to admit that it's a pretty comforting idea.
Think about it... If everything really happened for a reason, and we are all just heading along a path of destiny, there's nothing to worry about along the way. What a liberating view point! If I thought that way, my breakup with my ex-girlfriend, while sad, is not really a big deal because it was meant to happen anyway. Now I regret the things I could have done to save the relationship. However, if I look at it from the perspective of we were never meant to be together, I would think that no matter what I did, it was going to end anyway. I wouldn't have to worry about finding a new girl. If I was meant to be with someone, I'll eventually find that person. If not, then I'll just be single.
Most people desire to have more control over their own lives. I actually desire less control. The knowledge that ultimately I control my own destiny puts too much pressure on me. Right now, I'd just love to hand the reigns over to someone else and go along for the ride. No pressure. No worries. No regrets. The notion that everything happens for a reason would allow this.
It's too bad I don't believe this. I think I'd be happier.
On a related note: I swear that the happiest people in the world are simple people. There's this one woman at work whoe comes to mind. She's and almost 70 year old clerk. She's dumb as a brick. She may very well be one of the dumbest people I've ever known. She's very nice. She's just stupid. However, despite her intellectual shortcomings, she's very very happy with life. She's been married several times. She has seemingly a thousand grandchildren who she loves to spoil. She doesn't worry about politics or the issues of the world. She's simply happily oblivious to everything.
Then there's me... I overthink EVERYTHING. I write hundreds of pages in this blog searching for some existential meaning. Even when things are going well in my life, in the back of my mind, I'm constantly worried about the impending oil crisis, global warming, the economy, health care, the needs of the poor, etc.
Unfortunately, there's no way for me to suddenly become oblivious to the world around me. I can, however, pretend to believe that I serve some kind of purpose in this world that is beyond my control. When I look at things that way, my life almost makes sense.
Think about it... If everything really happened for a reason, and we are all just heading along a path of destiny, there's nothing to worry about along the way. What a liberating view point! If I thought that way, my breakup with my ex-girlfriend, while sad, is not really a big deal because it was meant to happen anyway. Now I regret the things I could have done to save the relationship. However, if I look at it from the perspective of we were never meant to be together, I would think that no matter what I did, it was going to end anyway. I wouldn't have to worry about finding a new girl. If I was meant to be with someone, I'll eventually find that person. If not, then I'll just be single.
Most people desire to have more control over their own lives. I actually desire less control. The knowledge that ultimately I control my own destiny puts too much pressure on me. Right now, I'd just love to hand the reigns over to someone else and go along for the ride. No pressure. No worries. No regrets. The notion that everything happens for a reason would allow this.
It's too bad I don't believe this. I think I'd be happier.
On a related note: I swear that the happiest people in the world are simple people. There's this one woman at work whoe comes to mind. She's and almost 70 year old clerk. She's dumb as a brick. She may very well be one of the dumbest people I've ever known. She's very nice. She's just stupid. However, despite her intellectual shortcomings, she's very very happy with life. She's been married several times. She has seemingly a thousand grandchildren who she loves to spoil. She doesn't worry about politics or the issues of the world. She's simply happily oblivious to everything.
Then there's me... I overthink EVERYTHING. I write hundreds of pages in this blog searching for some existential meaning. Even when things are going well in my life, in the back of my mind, I'm constantly worried about the impending oil crisis, global warming, the economy, health care, the needs of the poor, etc.
Unfortunately, there's no way for me to suddenly become oblivious to the world around me. I can, however, pretend to believe that I serve some kind of purpose in this world that is beyond my control. When I look at things that way, my life almost makes sense.
New Drugs?
I'm writing this from the point of view of retail pharmacy because that's what I know about....
Does anyone know if there are any potential blockbuster drugs in development for the big pharmaceutical companies? I admit that I've fallen a little behind when it comes to recent developments in the pharmaceutical industry.
The other day, I was thinking about what pharmacy will be like in 10 years, and I got to thinking about how just about all the drugs out right now will be off-patent with generic versions available. Lipitor will be generic. Plavix will be generic (again!). Pretty much all the blockbuster brand name drugs will be generic.
If this is the case, what are the pharmaceutical companies developing to replace these drugs? I know in many cases, they'll just make an XR version or a single enantiomer version (i.e. Zyrtec to Xyzal), but insurance companies tend to limit the use of those drugs.
I've touch on this before when I mentioned how treatment guidelines for the major longterm diseases (hypertension, hyperlipidemia, chronic heart failure, diabetes) haven't changed all that much in quite some time. Statins are still the drug of choice for high cholesterol. Heart failure and post-MI patients still use beta-blockers and ACE Inhibitors. Type II diabetics still use mainly Metformin and/or a sulfonylurea.
I haven't heard of anything coming out in the near future that will completely change our guidelines for those diseases. Therefore, if no big advances come out in the next 10 years, we'll be looking at the majority of chronic illnesses being treated pretty much entirely with generic drugs. This will be great for the patients, great for the insurance companies, and great for pharmacies. However, the big pharmaceutical companies won't be too happy about this.
The pharmaceutical companies will have to respond to this in some way, and I don't think making products like Ambien CR or Xyzal will be sufficient. Will they be forced to drop their prices in order to compete with generics? More likely, they'll spend tons of money trying to convince doctors that their latest and greatest "me too" drug is a HUGE improvement over the less costly generic.
I think it will be interesting to see how this all plays out. I suppose we'll get a really good glimpse when we see how Pfizer responds to Lipitor coming off-patent. All I know is that if I were in charge of one of those big companies, I'd cut my enormous direct-to-consumer advertising budget and start spending a lot more cash on drug research and development. Without a revolutionary new drug, these companies could be in a lot of trouble.
Does anyone know if there are any potential blockbuster drugs in development for the big pharmaceutical companies? I admit that I've fallen a little behind when it comes to recent developments in the pharmaceutical industry.
The other day, I was thinking about what pharmacy will be like in 10 years, and I got to thinking about how just about all the drugs out right now will be off-patent with generic versions available. Lipitor will be generic. Plavix will be generic (again!). Pretty much all the blockbuster brand name drugs will be generic.
If this is the case, what are the pharmaceutical companies developing to replace these drugs? I know in many cases, they'll just make an XR version or a single enantiomer version (i.e. Zyrtec to Xyzal), but insurance companies tend to limit the use of those drugs.
I've touch on this before when I mentioned how treatment guidelines for the major longterm diseases (hypertension, hyperlipidemia, chronic heart failure, diabetes) haven't changed all that much in quite some time. Statins are still the drug of choice for high cholesterol. Heart failure and post-MI patients still use beta-blockers and ACE Inhibitors. Type II diabetics still use mainly Metformin and/or a sulfonylurea.
I haven't heard of anything coming out in the near future that will completely change our guidelines for those diseases. Therefore, if no big advances come out in the next 10 years, we'll be looking at the majority of chronic illnesses being treated pretty much entirely with generic drugs. This will be great for the patients, great for the insurance companies, and great for pharmacies. However, the big pharmaceutical companies won't be too happy about this.
The pharmaceutical companies will have to respond to this in some way, and I don't think making products like Ambien CR or Xyzal will be sufficient. Will they be forced to drop their prices in order to compete with generics? More likely, they'll spend tons of money trying to convince doctors that their latest and greatest "me too" drug is a HUGE improvement over the less costly generic.
I think it will be interesting to see how this all plays out. I suppose we'll get a really good glimpse when we see how Pfizer responds to Lipitor coming off-patent. All I know is that if I were in charge of one of those big companies, I'd cut my enormous direct-to-consumer advertising budget and start spending a lot more cash on drug research and development. Without a revolutionary new drug, these companies could be in a lot of trouble.
Thursday, February 14, 2008
My take on the USA Today article
http://www.usatoday.com/money/industries/health/2008-02-11-prescription-errors_N.htm
That's the link to the article in the USA today that many of my fellow pharmacist bloggers are writing about. I don't really feel like rehashing the whole article, but to summarize, a small boy was supposed to get propranolol to help alleviate shaking hands but instead received methytestosterone. How in the world anyone could mistake Inderal (brand name for propranolol) and Methitest is beyond me. Regardless, the boy kept receiving the wrong medication for 2 months before a Walgreens pharmacist caught the error. The author of the article asserts that high volume and poor staffing contribute the prescription errors.
REALLY??? YOU DON'T SAY!!! That was a no-brainer if you ask me. Of course, the fucking corporate clowns of Walgreens, CVS, and Rite Aid are trying to say that there is no evidence that high prescription volume is a factor in pharmacy errors. They said mistakes were (and I quote) "more related to lack of focus."
WHAT THE FUCK DO YOU THINK CAUSES THAT LACK OF FOCUS??? A year ago, my pharmacy was setting store records for prescription volume. That January, our store had a record week of over 3,000 scripts. Then the next week, we broke our record again. When you do the math using the actualy figures (which I've edited out of the post), it comes out to about 37 prescriptions filled per hour. Remember, that's taking into account lower volume days like Saturday and Sunday. A couple years ago, we filled over 700 scripts on the Monday after Easter. It worked out to about 54 scripts filled per hour.
Think about that. 54 scripts per hour is almost a prescription filled per minute. It's awfully hard to focus on one particular prescription when the total filling time (including computer entry, check, filling, final check, and bagging) takes about a minute.
In the article, the President of Pharmacy Affairs for CVS bragged that their error rate was a fraction of 1%. Sounds great, right? Well, let's analyze that percentage. My pharmacy currently fills about 2,500 scripts per week. If we were 99.9% accurate, we'd average about 5 prescription errors every 2 weeks. That's not a number I'd like to live with.
In any case... Other bloggers have already pointed out how understaffing and emphasis on high volume by big chain pharmacies are contributing to these errors. I'm going to also direct some blame elswhere....
Every single customer that walks into a pharmacy and bitches about the wait time for a prescription is partially to blame for prescription errors. Pharmacy is not fast food. If Burger King gives you fries instead of onion rings, it's simply an inconvenience. If a pharmacy gives you the wrong drug, you can die.
This goes for everyone getting a prescription filled at a pharmacy. If the pharmacist says your prescription will take 2 hours to fill, you smile and nod and come back in 2 hours. I don't want to hear you moan in exhasperation and say, "2 hours?!?!?!" I'm using 2 hours as an exagerated example, but the actual time shouldn't make a difference. The wait time we give is the pharmacist's approximation of how quickly he believes he can fill your prescription accurately. It's based on the number of prescriptions you drop off. It's based on the type of drugs on your prescriptions. In addition, it's based upon how many people dropped off prescriptions before you.
I want to punch someone everytime I heard, "Why does it take so long? All you have to do is throw a label on a box!" Once again... this is not fast food. We have to check for proper directions and interactions. We have to double check what we typed into the computer to make sure everything is accurate. Finally, we have to ensure that the product that gets labeled is the correct one. We do this for your safety! We're not trying to inconvenience you. We're trying not to harm or kill you.
When you go for a doctor's appointment, don't you want your doctor to spend as much time as possible with you? You don't want him to look at you for 30 seconds and send you on your way. You want to make sure he's paying very close attention to you. Why the fuck do you expect the pharmacy to be different? Why do you want us to rush your healthcare?
Know what I find really hilarious? I would say more often than not, when I catch an interaction and need to call the doctor to either verify that he was aware of it or to have him switch the medication to something else, customers will complain that they can't have their prescription right away. Are these people fucking insane??? I just told them I spotted a potentially dangerous interaction, and all they can think about is how it's such an inconvenience to have to wait longer. However, these same fuckers would be the first to slap me with a lawsuit if I didn't follow up with the doctor, just let them have the prescription, and they were harmed by it. Fuck you people.
While I'm ranting here... prescriptions for monthly maintanence medications don't need to be filled immediately. I should be able to tell you to come back the next day for your atenolol that you've been on for 10 years. I shouldn't be expected to bang it out in 10 minutes for you.
See... We place so much blame on our employers for forcing this high volume and high stress environment on us. They are a great deal of the problem. However, you have to realize that they're only responding to the demands placed by our customers. They won't tolerate having to wait more than 10 or 20 minutes for a prescription to be filled. Until the attitude of the general public changes, we're going to be forced to rush, and in turn, mistakes are going to be made that shouldn't be.
Basically, my take-home message is that all you people reading these pharmacy horror stories and pointing fingers of blame should pause for a second, take a good look in the mirror, and point that finger right at yourselves. You're attitude is every bit as responsible for prescriptions errors as our employers are.
That's the link to the article in the USA today that many of my fellow pharmacist bloggers are writing about. I don't really feel like rehashing the whole article, but to summarize, a small boy was supposed to get propranolol to help alleviate shaking hands but instead received methytestosterone. How in the world anyone could mistake Inderal (brand name for propranolol) and Methitest is beyond me. Regardless, the boy kept receiving the wrong medication for 2 months before a Walgreens pharmacist caught the error. The author of the article asserts that high volume and poor staffing contribute the prescription errors.
REALLY??? YOU DON'T SAY!!! That was a no-brainer if you ask me. Of course, the fucking corporate clowns of Walgreens, CVS, and Rite Aid are trying to say that there is no evidence that high prescription volume is a factor in pharmacy errors. They said mistakes were (and I quote) "more related to lack of focus."
WHAT THE FUCK DO YOU THINK CAUSES THAT LACK OF FOCUS??? A year ago, my pharmacy was setting store records for prescription volume. That January, our store had a record week of over 3,000 scripts. Then the next week, we broke our record again. When you do the math using the actualy figures (which I've edited out of the post), it comes out to about 37 prescriptions filled per hour. Remember, that's taking into account lower volume days like Saturday and Sunday. A couple years ago, we filled over 700 scripts on the Monday after Easter. It worked out to about 54 scripts filled per hour.
Think about that. 54 scripts per hour is almost a prescription filled per minute. It's awfully hard to focus on one particular prescription when the total filling time (including computer entry, check, filling, final check, and bagging) takes about a minute.
In the article, the President of Pharmacy Affairs for CVS bragged that their error rate was a fraction of 1%. Sounds great, right? Well, let's analyze that percentage. My pharmacy currently fills about 2,500 scripts per week. If we were 99.9% accurate, we'd average about 5 prescription errors every 2 weeks. That's not a number I'd like to live with.
In any case... Other bloggers have already pointed out how understaffing and emphasis on high volume by big chain pharmacies are contributing to these errors. I'm going to also direct some blame elswhere....
Every single customer that walks into a pharmacy and bitches about the wait time for a prescription is partially to blame for prescription errors. Pharmacy is not fast food. If Burger King gives you fries instead of onion rings, it's simply an inconvenience. If a pharmacy gives you the wrong drug, you can die.
This goes for everyone getting a prescription filled at a pharmacy. If the pharmacist says your prescription will take 2 hours to fill, you smile and nod and come back in 2 hours. I don't want to hear you moan in exhasperation and say, "2 hours?!?!?!" I'm using 2 hours as an exagerated example, but the actual time shouldn't make a difference. The wait time we give is the pharmacist's approximation of how quickly he believes he can fill your prescription accurately. It's based on the number of prescriptions you drop off. It's based on the type of drugs on your prescriptions. In addition, it's based upon how many people dropped off prescriptions before you.
I want to punch someone everytime I heard, "Why does it take so long? All you have to do is throw a label on a box!" Once again... this is not fast food. We have to check for proper directions and interactions. We have to double check what we typed into the computer to make sure everything is accurate. Finally, we have to ensure that the product that gets labeled is the correct one. We do this for your safety! We're not trying to inconvenience you. We're trying not to harm or kill you.
When you go for a doctor's appointment, don't you want your doctor to spend as much time as possible with you? You don't want him to look at you for 30 seconds and send you on your way. You want to make sure he's paying very close attention to you. Why the fuck do you expect the pharmacy to be different? Why do you want us to rush your healthcare?
Know what I find really hilarious? I would say more often than not, when I catch an interaction and need to call the doctor to either verify that he was aware of it or to have him switch the medication to something else, customers will complain that they can't have their prescription right away. Are these people fucking insane??? I just told them I spotted a potentially dangerous interaction, and all they can think about is how it's such an inconvenience to have to wait longer. However, these same fuckers would be the first to slap me with a lawsuit if I didn't follow up with the doctor, just let them have the prescription, and they were harmed by it. Fuck you people.
While I'm ranting here... prescriptions for monthly maintanence medications don't need to be filled immediately. I should be able to tell you to come back the next day for your atenolol that you've been on for 10 years. I shouldn't be expected to bang it out in 10 minutes for you.
See... We place so much blame on our employers for forcing this high volume and high stress environment on us. They are a great deal of the problem. However, you have to realize that they're only responding to the demands placed by our customers. They won't tolerate having to wait more than 10 or 20 minutes for a prescription to be filled. Until the attitude of the general public changes, we're going to be forced to rush, and in turn, mistakes are going to be made that shouldn't be.
Basically, my take-home message is that all you people reading these pharmacy horror stories and pointing fingers of blame should pause for a second, take a good look in the mirror, and point that finger right at yourselves. You're attitude is every bit as responsible for prescriptions errors as our employers are.
Monday, February 11, 2008
I've gone pretty emo lately, so here's a pharmacy post to try to make up for it
I worked last weekend. On Sunday, a woman came to the counter looking to pick up a prescription for her daughter. The day was going pretty smoothly up to that point, but as she made her way to the counter, I had just gotten off a 20 minute relay call with a deaf person that just happens to be a complete moron. During that call, a couple insurance problems popped up that my clerks didn't know how to deal with, so in my aggravated state, I had to figure them out. This is exactly when the woman came to the counter.
The clerk looked through the bin and couldn't find her daughter's prescription. Then she checked the computer. Nothing was filled recently.
"Her prescription didn't have any refills, and you had to call the doctor for more. If the doctor didn't call it in, it would be a disaster," the woman proclaimed, getting irritated.
Noticing how agitated she sounded, I decided to see if I could help the situation.
"I called it in a few days ago, so you should have been able to call the doctor by now," the woman said.
I started looking through our doctor calls. I found the slip for her daughter's prescription. It was for birth control. It was called in late on Friday after the doctors' offices closed.
"Ma'am, the prescription was called in late on Friday, so we can't get in touch with the office until Monday," I told her.
"Well, the office was open all day on Saturday. You had all day to call on it," she fired back at me in an angry voice. "This is really a disaster. What am I supposed to do now? She has to take it."
On normal occasions, I'd bite my tongue and act as politely as I could to her in order to try to calm her down. However, she picked the wrong day and the wrong time to point the blame on me.
"Ma'am... We have no idea that your doctor's office is open on Saturday. We usually do not place calls to the doctor (we didn't have the office's fax number) on weekends because most offices are closed," I told her.
"Well, you people deal with this every day. You should know," she shot back.
"We don't keep track of your doctor's office's hours. Next time, don't wait until the last minute to call in for a refill, and you won't have this problem," I responded to her in a not-so-pleasant tone.
She murmered something, then said, "well, what am I supposed to do now?"
"You're going to have to call the office, speak to the answering service, and have them page a doctor on call who will hopefully call in the prescription for you. Otherwise, there's nothing I can do," then I turned around and walked away from her.
She got out her cellphone and started dialing the office as she walked away in a huff. What a fucking joke. It'll be a disaster if she doesn't have her prescription.
A disaster??? It's fucking birth control. It's not like it's fucking seizure medication or heart medication. It's fucking birth control. Missing one dose of birth control will have exactly ZERO negative health effects to her as long as she keeps her legs closed for a couple days. Moreover, if it was such a freaking emergency, why wait until late in the day on Friday to call for a refill, especially when you know that the script had no refills left on it.
I'm usually as patient with customers as humanly possible, but when some idiot starts whining that we didn't call her doctor's office on a Saturday, one day before her daughter needed to start the next cycle, and proclaims it a "disaster" that we didn't obtain the refill, I won't stand for it. It's not my fault you suck at planning.
She wasn't the only bad customer of the day. The first customer that came to the pharmacy Sunday morning showed up with a bad attitude.
"I'm picking up for Hernandez." He was mumbling and chewing on something at the same time, so it was hard to hear him.
"I'm sorry. What was your name again?" asked the clerk.
"Hernandez." This time, it was less intelligible than the first time.
"Could you please spell that for me?" asked the clerk.
"H-E-R... HERNANDEZ! Haven't you ever heard that name before???" he said getting pretty pissed off.
The clerk affirmed that she had, indeed, heard the name before, but she had a hard time hearing him. He looked back at me, and I shot him the coldest look you can imagine. The look basically told him that if he said one more rude word to her, I'd start yelling.
I guess he got the message because he immediately apologized for being rude. Damn straight.
I guess the moral of these stories is that while I appear pretty passive most of the time, I won't allow someone to just walk all over me or any member of our staff. Most of the time an angry customer is a case of misunderstanding, and those are the times you want to stay calm. Sometimes though, the customers come in angry for no good reason, and those are the ones you have to put in their places.
The clerk looked through the bin and couldn't find her daughter's prescription. Then she checked the computer. Nothing was filled recently.
"Her prescription didn't have any refills, and you had to call the doctor for more. If the doctor didn't call it in, it would be a disaster," the woman proclaimed, getting irritated.
Noticing how agitated she sounded, I decided to see if I could help the situation.
"I called it in a few days ago, so you should have been able to call the doctor by now," the woman said.
I started looking through our doctor calls. I found the slip for her daughter's prescription. It was for birth control. It was called in late on Friday after the doctors' offices closed.
"Ma'am, the prescription was called in late on Friday, so we can't get in touch with the office until Monday," I told her.
"Well, the office was open all day on Saturday. You had all day to call on it," she fired back at me in an angry voice. "This is really a disaster. What am I supposed to do now? She has to take it."
On normal occasions, I'd bite my tongue and act as politely as I could to her in order to try to calm her down. However, she picked the wrong day and the wrong time to point the blame on me.
"Ma'am... We have no idea that your doctor's office is open on Saturday. We usually do not place calls to the doctor (we didn't have the office's fax number) on weekends because most offices are closed," I told her.
"Well, you people deal with this every day. You should know," she shot back.
"We don't keep track of your doctor's office's hours. Next time, don't wait until the last minute to call in for a refill, and you won't have this problem," I responded to her in a not-so-pleasant tone.
She murmered something, then said, "well, what am I supposed to do now?"
"You're going to have to call the office, speak to the answering service, and have them page a doctor on call who will hopefully call in the prescription for you. Otherwise, there's nothing I can do," then I turned around and walked away from her.
She got out her cellphone and started dialing the office as she walked away in a huff. What a fucking joke. It'll be a disaster if she doesn't have her prescription.
A disaster??? It's fucking birth control. It's not like it's fucking seizure medication or heart medication. It's fucking birth control. Missing one dose of birth control will have exactly ZERO negative health effects to her as long as she keeps her legs closed for a couple days. Moreover, if it was such a freaking emergency, why wait until late in the day on Friday to call for a refill, especially when you know that the script had no refills left on it.
I'm usually as patient with customers as humanly possible, but when some idiot starts whining that we didn't call her doctor's office on a Saturday, one day before her daughter needed to start the next cycle, and proclaims it a "disaster" that we didn't obtain the refill, I won't stand for it. It's not my fault you suck at planning.
She wasn't the only bad customer of the day. The first customer that came to the pharmacy Sunday morning showed up with a bad attitude.
"I'm picking up for Hernandez." He was mumbling and chewing on something at the same time, so it was hard to hear him.
"I'm sorry. What was your name again?" asked the clerk.
"Hernandez." This time, it was less intelligible than the first time.
"Could you please spell that for me?" asked the clerk.
"H-E-R... HERNANDEZ! Haven't you ever heard that name before???" he said getting pretty pissed off.
The clerk affirmed that she had, indeed, heard the name before, but she had a hard time hearing him. He looked back at me, and I shot him the coldest look you can imagine. The look basically told him that if he said one more rude word to her, I'd start yelling.
I guess he got the message because he immediately apologized for being rude. Damn straight.
I guess the moral of these stories is that while I appear pretty passive most of the time, I won't allow someone to just walk all over me or any member of our staff. Most of the time an angry customer is a case of misunderstanding, and those are the times you want to stay calm. Sometimes though, the customers come in angry for no good reason, and those are the ones you have to put in their places.
For every step I take forward, I seem to take two steps backward
This week marks the one year anniversary of my ex-girlfriend telling me she was finally "unloading her emotional baggage" and moving on. Over the year since, I've really really tried to put things in the past and get on with my life. A couple times I actually thought I had succeeded in doing so. This morning, I find myself right back to where I was a year ago. I freaking hate my life.
Time is supposed to heal my wounds. It's supposed to get easier. It's not. Every morning I wake up, and the pain feels new. It's not pain from a relationship that ended badly. The pain is from the mountains of regret from my part in the whole breakup. There were so many times when I could have saved the relationship. Neither of us wanted it to end. I should never have let it get as far as it did. My words and actions are pretty much the only reason we're not together right now.
She asked me point blank a couple months after our initial breakup, "Is this it? Do you never see us being together again."
I answered, "I just don't feel like I can trust you anymore, and right now, I can't see us being together again."
She paused then said with a quivering voice, "that's sad.... It's really sad."
"Why are you sad? You're the one that broke up with me," I responded.
The whole discussion was bullshit. I still loved her, but I was just being difficult for no reason, which is the fucking stupidest thing you can do when the girl of your dreams is basically trying to tell you she loves you and wants to work things out. The next day, I tried to take back a little of what I said by telling her I was just being a jackass the night before. I thought she understood because I had a history of doing that from time to time. I was wrong.
After that conversation, things went the same as before. We still hung out all the time. We still went out to dinner. We still went to the movies. She still called me every day. I assumed everything was OK between us. I didn't know that she used that conversation as a turning point in her life. That conversation made her believe that I was a lost cause, and she better try her best to move on.
She applied for an internship in Washington DC. She was accepted, which meant she'd have to live in Washington DC for 4 months. The night before she left, I took her out to dinner at the restaurant we had our first date. It was probably the most enjoyable dinner I ever had with her. We had our favorite dishes and ordered a great bottle of wine. We finished our meals and stayed in the restaurant for over an hour later finishing the wine. We talked, laughed, reminisced, and even held hands for a little bit. It all felt so natural as it should have after spending close to 6 years together as a couple.
That night, I wanted her more than any time in our relationship. However, I knew she'd be going away the next day, so the timing was just horrible. I dropped her off at her house and drove away.
That night, she wrote me a long email telling me that she still loved me and wished she didn't have to go to Washington. She laid it all out there for me telling me about how she wanted to move on, but couldn't. She told me how she valued our relationship more than anything and hoped that someday we'd be able to work things out.
I never responded to the email. Well, at least not right away. I actually let it sit in my inbox for 3 months before finally figuring out what I wanted to say to her. By that time, it was too late. See, she had taken the internship in Washington DC in an attempt to get away from me and her past. Right before she left, she realized that she didn't want to run away from me anymore, but she was already committed to going. She sent me that last email to see if I felt the same as her. I never responded. I broke her heart. She moved on from me forever.
Three months later, something finally clicked in my head, and I realized what I was losing. By that time it was too late. She had already started seeing other people. I hurt her too badly for her to come back to me. She committed to going in a new direction. I had thrown away the greatest thing that ever happened to me.
That's why this is just so damn hard for me to cope with. If she just didn't love me anymore, I could handle it. If we simply grew apart, I'd accept it. However, I simply cannot accept the fact that we should be together right now, but the only reason we're not is because of my own stupidity. All I had to do was tell her how I felt. After 6 years together, it shouldn't have been that hard. I don't know why I didn't. I really have no explanation. Maybe she hurt my pride when she initially broke up with me. Maybe it was out of spite. It most certainly was because I never in a million years thought she'd actually leave me for good.
Now I'm here, a year later, typing my sob story to the virtual masses because I literally don't have any other outlet. I'm trying to make sense in all of this and figure out where I should go from here, but nothing has changed since last February. I haven't seen her in over a year. She still sends me the occasional short email to say hi. We don't talk about the past anymore. We don't mention our personal lives. I don't know if she's dating anyone now. I'm afraid to ask anyone. In fact, I know it's best for me if I don't know.
She's going to be retaking the Bar exam in July (she failed it in 2 states the first time). She's taking a bar exam in another state first. If she passes that, she'll likely move to that new state to get a job there. This complicates things for me. I'd really like to follow my heart and make one last attempt to pour out my soul to her. However, she knows that she's likely to be moving away soon, and I think even if she'd like to perhaps try to start over again, she wouldn't allow herself.
The heart is just an inexplicable thing. I wish I could just choose to stop feeling this way. I don't want to be in love with her anymore. It's almost too painful to stand. However, the heart just doesn't work that way. It has a will of its own, and right now, mine is tied to her. I don't know what I'm going to do. I guess my only plan right now is to keep surviving. Against all odds, I keep a glimmer of hope that we'll find each other somehow, some way, in the future. That glimmer of hope is just about all I have left. It's the reason I keep trudging along day after day.
Time is supposed to heal my wounds. It's supposed to get easier. It's not. Every morning I wake up, and the pain feels new. It's not pain from a relationship that ended badly. The pain is from the mountains of regret from my part in the whole breakup. There were so many times when I could have saved the relationship. Neither of us wanted it to end. I should never have let it get as far as it did. My words and actions are pretty much the only reason we're not together right now.
She asked me point blank a couple months after our initial breakup, "Is this it? Do you never see us being together again."
I answered, "I just don't feel like I can trust you anymore, and right now, I can't see us being together again."
She paused then said with a quivering voice, "that's sad.... It's really sad."
"Why are you sad? You're the one that broke up with me," I responded.
The whole discussion was bullshit. I still loved her, but I was just being difficult for no reason, which is the fucking stupidest thing you can do when the girl of your dreams is basically trying to tell you she loves you and wants to work things out. The next day, I tried to take back a little of what I said by telling her I was just being a jackass the night before. I thought she understood because I had a history of doing that from time to time. I was wrong.
After that conversation, things went the same as before. We still hung out all the time. We still went out to dinner. We still went to the movies. She still called me every day. I assumed everything was OK between us. I didn't know that she used that conversation as a turning point in her life. That conversation made her believe that I was a lost cause, and she better try her best to move on.
She applied for an internship in Washington DC. She was accepted, which meant she'd have to live in Washington DC for 4 months. The night before she left, I took her out to dinner at the restaurant we had our first date. It was probably the most enjoyable dinner I ever had with her. We had our favorite dishes and ordered a great bottle of wine. We finished our meals and stayed in the restaurant for over an hour later finishing the wine. We talked, laughed, reminisced, and even held hands for a little bit. It all felt so natural as it should have after spending close to 6 years together as a couple.
That night, I wanted her more than any time in our relationship. However, I knew she'd be going away the next day, so the timing was just horrible. I dropped her off at her house and drove away.
That night, she wrote me a long email telling me that she still loved me and wished she didn't have to go to Washington. She laid it all out there for me telling me about how she wanted to move on, but couldn't. She told me how she valued our relationship more than anything and hoped that someday we'd be able to work things out.
I never responded to the email. Well, at least not right away. I actually let it sit in my inbox for 3 months before finally figuring out what I wanted to say to her. By that time, it was too late. See, she had taken the internship in Washington DC in an attempt to get away from me and her past. Right before she left, she realized that she didn't want to run away from me anymore, but she was already committed to going. She sent me that last email to see if I felt the same as her. I never responded. I broke her heart. She moved on from me forever.
Three months later, something finally clicked in my head, and I realized what I was losing. By that time it was too late. She had already started seeing other people. I hurt her too badly for her to come back to me. She committed to going in a new direction. I had thrown away the greatest thing that ever happened to me.
That's why this is just so damn hard for me to cope with. If she just didn't love me anymore, I could handle it. If we simply grew apart, I'd accept it. However, I simply cannot accept the fact that we should be together right now, but the only reason we're not is because of my own stupidity. All I had to do was tell her how I felt. After 6 years together, it shouldn't have been that hard. I don't know why I didn't. I really have no explanation. Maybe she hurt my pride when she initially broke up with me. Maybe it was out of spite. It most certainly was because I never in a million years thought she'd actually leave me for good.
Now I'm here, a year later, typing my sob story to the virtual masses because I literally don't have any other outlet. I'm trying to make sense in all of this and figure out where I should go from here, but nothing has changed since last February. I haven't seen her in over a year. She still sends me the occasional short email to say hi. We don't talk about the past anymore. We don't mention our personal lives. I don't know if she's dating anyone now. I'm afraid to ask anyone. In fact, I know it's best for me if I don't know.
She's going to be retaking the Bar exam in July (she failed it in 2 states the first time). She's taking a bar exam in another state first. If she passes that, she'll likely move to that new state to get a job there. This complicates things for me. I'd really like to follow my heart and make one last attempt to pour out my soul to her. However, she knows that she's likely to be moving away soon, and I think even if she'd like to perhaps try to start over again, she wouldn't allow herself.
The heart is just an inexplicable thing. I wish I could just choose to stop feeling this way. I don't want to be in love with her anymore. It's almost too painful to stand. However, the heart just doesn't work that way. It has a will of its own, and right now, mine is tied to her. I don't know what I'm going to do. I guess my only plan right now is to keep surviving. Against all odds, I keep a glimmer of hope that we'll find each other somehow, some way, in the future. That glimmer of hope is just about all I have left. It's the reason I keep trudging along day after day.
Thursday, February 7, 2008
I'm not just a pharmacist...
... I'm also a repair man.
In the last 2 days, I've had to fix all 3 of our laserjet printers. I fixed our fax machine twice, and I figured out a couple of computer glitches I wonder if fixing printers and fax machines is in my job description. Perhaps part of the reason pharmacists' salaries are so high is because we're expected to repair things around the pharmacy as well as fill prescriptions and counsel patients.
I tell you one thing though... Nothing in my job gives me more satisfaction than fixing something that's broken (be it a printer, fax machine, computer, ScriptPro, whatever). I would have so say the second best thing is when our perpetual CII inventory is off, and I'm able to figure out what happened. Both of these instances actually require using problem solving skills, which unfortunately, don't get used a great deal during the normal course of my job.
For example, yesterday, every label that came out of one of our printers had a huge smudge mark right in the middle of it. A couple people couldn't quite figure out what was causing the toner to smudge on the paper. I came over, pulled the printer apart, and realized that a couple warning labels somehow managed to get stuck behind this roller type thing that's between the toner cartridge and the label. After removing the warning stickers, the printer was good as new. I know that sounds simple, but it was kind of fun to take a second to solve that little mystery.
I suppose it's pretty sad that I get more satisfaction out of fixing a printer than I do from counseling a patient or catching a drug interaction. However, I bet if I was fixing printers for a living, I wouldn't have the same opinion.
In other news... I think I'm just going to forget about eHarmony girl. I've talked to her a few times since the last time I posted. I'm not so sure that she's disinterested in me as much as she's just not really looking for a relationship right now. Between working 50+ hours each week and hanging out with her friends, she really doesn't seem like she wants to invest the time for a relationship. Plus, as I said before, I'm starting to realize that we really don't mesh well together.
Honestly, as much as I bitch about being lonely, I'm not sure I'm ready to devote time to a relationship either. I got out of work at 4 today. I had all the time in the world to go and do something, but I was just too tired. I needed the rest of the day to rest. The only days I feel up to doing anything are my 3 days off each week. Even on those days, I don't want to stay out too late because then I'll be tired for work the next day.
I think I'm just destined to be single. I took one shot at love. It was great for the 6 years it lasted, and I still wish there was some way to get her back. Sometimes I think about how I'd react if she just called me out of the blue one day saying she wanted to give us another shot. I'm pretty sure I'd be just about the happiest person alive. You wouldn't be able to knock the smile off my face.
Since this is unlikely to happen and I'm really not willing to change my attitude, I'll probably just be single for the rest of my life. Is there really anything wrong with that?
In the last 2 days, I've had to fix all 3 of our laserjet printers. I fixed our fax machine twice, and I figured out a couple of computer glitches I wonder if fixing printers and fax machines is in my job description. Perhaps part of the reason pharmacists' salaries are so high is because we're expected to repair things around the pharmacy as well as fill prescriptions and counsel patients.
I tell you one thing though... Nothing in my job gives me more satisfaction than fixing something that's broken (be it a printer, fax machine, computer, ScriptPro, whatever). I would have so say the second best thing is when our perpetual CII inventory is off, and I'm able to figure out what happened. Both of these instances actually require using problem solving skills, which unfortunately, don't get used a great deal during the normal course of my job.
For example, yesterday, every label that came out of one of our printers had a huge smudge mark right in the middle of it. A couple people couldn't quite figure out what was causing the toner to smudge on the paper. I came over, pulled the printer apart, and realized that a couple warning labels somehow managed to get stuck behind this roller type thing that's between the toner cartridge and the label. After removing the warning stickers, the printer was good as new. I know that sounds simple, but it was kind of fun to take a second to solve that little mystery.
I suppose it's pretty sad that I get more satisfaction out of fixing a printer than I do from counseling a patient or catching a drug interaction. However, I bet if I was fixing printers for a living, I wouldn't have the same opinion.
In other news... I think I'm just going to forget about eHarmony girl. I've talked to her a few times since the last time I posted. I'm not so sure that she's disinterested in me as much as she's just not really looking for a relationship right now. Between working 50+ hours each week and hanging out with her friends, she really doesn't seem like she wants to invest the time for a relationship. Plus, as I said before, I'm starting to realize that we really don't mesh well together.
Honestly, as much as I bitch about being lonely, I'm not sure I'm ready to devote time to a relationship either. I got out of work at 4 today. I had all the time in the world to go and do something, but I was just too tired. I needed the rest of the day to rest. The only days I feel up to doing anything are my 3 days off each week. Even on those days, I don't want to stay out too late because then I'll be tired for work the next day.
I think I'm just destined to be single. I took one shot at love. It was great for the 6 years it lasted, and I still wish there was some way to get her back. Sometimes I think about how I'd react if she just called me out of the blue one day saying she wanted to give us another shot. I'm pretty sure I'd be just about the happiest person alive. You wouldn't be able to knock the smile off my face.
Since this is unlikely to happen and I'm really not willing to change my attitude, I'll probably just be single for the rest of my life. Is there really anything wrong with that?
Sunday, February 3, 2008
Enjoy being a student
After reading Chris Bronson's latest blog entry about how he feels his social life has taken a hit due to trying to be a student, work, and live on his own all at the same time, I decided that I want to send a message to all the future pharmacists out there.
I am 100% dead serious when I say this: I would give up every dime that I've made over the last 2 years if I could go back to college and be a student all over again. College was the best time of my life, and I honestly can't think of anything in my future that could match it. I got to hang out with my friends all day long. My girlfriend was at school with me, and I got to be with her whenever I wanted. There was no pressure, limited responsibilities, and best of all, I had a sense of hope and optomism for the future.
See, when you're in college (or any school for that matter), you're always striving towards a goal. There's the ultimate goal of graduating and getting a good job, but there's also those little goals that pop up during the week. Maybe you want to get an A on your next test or paper. Maybe you want to do really well during your next intramural contest. Whatever the case, there always seems to be some sort of purpose to your life, and you get to have A LOT of fun while trying to achieve your goals.
Contrast that with my life now... I'm single. I live in a small, one bedroom apartment all by myself. My friends all work and have lives of their own, so I only get to see them once or twice a week. Because I see them so rarely, there's this idea that we have to go out and do something exciting whenever we get together, so we always end up at a bar, club, or some other entertainment venue.
Know what I miss the most about school? Just hanging around my dorm room with my two roommates watching TV and talking about sports or other pointless stuff. I also miss just hanging out at my girlfriend's dorm, sitting on her very uncomfortable futon, trying to tune out her annoying roommate, while watching Friends and the other shows on NBC's "Must See TV." The biggest thrill in the world was deciding to skip the dining hall for one evening and order out.
Life was so simple back then. We didn't need to create excitement for ourselves. We had a nice laid-back lifestyle, and I loved it. Now, I have to hunt for dates, and when I meet someone I feel "compatible" with, I have to figure out a place to go. Moreover, if I actually like the girl and want to go out with her multiple times (i.e. eHarmony girl), I have to rack my brain for date ideas because god forbid we go to a dinner and a movie 2 dates in a row. 4 years ago, the greatest thing in the world was getting the chance to go out to dinner and a movie. Now, it seems like it's not good enough to entertain someone.
I never realized how good I had it until I started working. Even if I thought my job was the greatest job ever, it still sucks to have to put 40 hours per week into it for pretty much the rest of my life. What am I striving for now? In 40 years, I'll be doing the same damn thing as I'm doing right now. I'm a pharmacist. I've met my goal. Now, I suppose the only thing left is to keep trying to be the best pharmacist possible. That's not exciting though. That doesn't fill me with a sense of optomism. It just means I have to keep putting in hours and gaining experience in my profession.
That's the main reason I write this blog. I spend every waking hour looking for meaning in my monotonous life. Perhaps, if I was married like I was supposed to be now, my outlook would be different. I would be enjoying the fruits of my labor with someone that I truly cared about. I'd be looking to buy a house and start a family. Basically, I'd be working towards goals.
Right now, I'm just floating aimlessly, and I feel like I'm under constantly increasing pressure. I have bills to pay, loans to pay off, and at the same time, I feel the precious few years remaining of my youth passing me by. If college was the best time of my life, this is easily the worst time of my life. However, I made twice as much money last year than I made my entire life up to that point. I said in a previous post I wouldn't take a pay cut to make my job better. Well, I WOULD take a pay cut to make my LIFE better. I'd work the shittiest, lowest paying pharmacy job there is if it meant I could have that same sense of contentment I had cuddling with my girlfriend on that uncomfortable futon watching TV.
So back to my original point... If you're a student, be happy being a student. Don't try to rush into adulthood. Just enjoy the rest of your time as a "kid." Afterall, you only get to be a kid for a little over 20 years. You'll have the rest of your life to be an adult.
I am 100% dead serious when I say this: I would give up every dime that I've made over the last 2 years if I could go back to college and be a student all over again. College was the best time of my life, and I honestly can't think of anything in my future that could match it. I got to hang out with my friends all day long. My girlfriend was at school with me, and I got to be with her whenever I wanted. There was no pressure, limited responsibilities, and best of all, I had a sense of hope and optomism for the future.
See, when you're in college (or any school for that matter), you're always striving towards a goal. There's the ultimate goal of graduating and getting a good job, but there's also those little goals that pop up during the week. Maybe you want to get an A on your next test or paper. Maybe you want to do really well during your next intramural contest. Whatever the case, there always seems to be some sort of purpose to your life, and you get to have A LOT of fun while trying to achieve your goals.
Contrast that with my life now... I'm single. I live in a small, one bedroom apartment all by myself. My friends all work and have lives of their own, so I only get to see them once or twice a week. Because I see them so rarely, there's this idea that we have to go out and do something exciting whenever we get together, so we always end up at a bar, club, or some other entertainment venue.
Know what I miss the most about school? Just hanging around my dorm room with my two roommates watching TV and talking about sports or other pointless stuff. I also miss just hanging out at my girlfriend's dorm, sitting on her very uncomfortable futon, trying to tune out her annoying roommate, while watching Friends and the other shows on NBC's "Must See TV." The biggest thrill in the world was deciding to skip the dining hall for one evening and order out.
Life was so simple back then. We didn't need to create excitement for ourselves. We had a nice laid-back lifestyle, and I loved it. Now, I have to hunt for dates, and when I meet someone I feel "compatible" with, I have to figure out a place to go. Moreover, if I actually like the girl and want to go out with her multiple times (i.e. eHarmony girl), I have to rack my brain for date ideas because god forbid we go to a dinner and a movie 2 dates in a row. 4 years ago, the greatest thing in the world was getting the chance to go out to dinner and a movie. Now, it seems like it's not good enough to entertain someone.
I never realized how good I had it until I started working. Even if I thought my job was the greatest job ever, it still sucks to have to put 40 hours per week into it for pretty much the rest of my life. What am I striving for now? In 40 years, I'll be doing the same damn thing as I'm doing right now. I'm a pharmacist. I've met my goal. Now, I suppose the only thing left is to keep trying to be the best pharmacist possible. That's not exciting though. That doesn't fill me with a sense of optomism. It just means I have to keep putting in hours and gaining experience in my profession.
That's the main reason I write this blog. I spend every waking hour looking for meaning in my monotonous life. Perhaps, if I was married like I was supposed to be now, my outlook would be different. I would be enjoying the fruits of my labor with someone that I truly cared about. I'd be looking to buy a house and start a family. Basically, I'd be working towards goals.
Right now, I'm just floating aimlessly, and I feel like I'm under constantly increasing pressure. I have bills to pay, loans to pay off, and at the same time, I feel the precious few years remaining of my youth passing me by. If college was the best time of my life, this is easily the worst time of my life. However, I made twice as much money last year than I made my entire life up to that point. I said in a previous post I wouldn't take a pay cut to make my job better. Well, I WOULD take a pay cut to make my LIFE better. I'd work the shittiest, lowest paying pharmacy job there is if it meant I could have that same sense of contentment I had cuddling with my girlfriend on that uncomfortable futon watching TV.
So back to my original point... If you're a student, be happy being a student. Don't try to rush into adulthood. Just enjoy the rest of your time as a "kid." Afterall, you only get to be a kid for a little over 20 years. You'll have the rest of your life to be an adult.
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