Saturday, January 31, 2009

Responding to a Comment

I don't usually respond to comments in new posts, but I felt like directly addressing this one. Please note that it is not my intention to mock or insult the commenter. I just thought this comment deserved a thorough response.

Mike, I will let you in on a "secret" about this damn gimmick which you sound like you've at least half figured out anyway. I attended a lecture about a year and a half ago by a guy who coaches independents to grow their business. The original idea is genious if looked at from a strictly business point of view and, more importantly, if executed properly. So here goes... You announce you're giving away the free antibiotics, and people come in to get them. The next point is the critical one which no one does and that's why the whole idea ends up not working to its full potential. When the customer comes in with the prescription, the PHARMACIST, and NOT the techs or interns should be taking in that prescription, start up little talk, basically build a foundation with some kind of interaction that the customer should enjoy. Just as importantly, while taking in their demographics, you should be recording as much of their medical history as possible, not just drug allergies, but the most important thing: Disease States. This is the key to the whole thing.
Once all the info is collected, it is entered into the database... including, and most especially the disease states. The lecturer described databases as being the equivalent of Gold or Platinum in the marketing world. You need to build yours up as much as possible. What you do with it next is up to you, but it's worth a LOT of money, whether used for your own business, or sold to someone else who wants access. In this case, it is supposed to be used internally to then send mailers and fliers to attract these customers back to the store as often as possible. The most lucrative patients are the diabetics if I remember correctly (estimated annual prescription and supply expenses abour $7000-$8000 every year).
So you see, the original idea is a great business generating idea, the problem is no one gets the medical history and the disease states, and rarely does the pharmacist get to interact with these new customers, so they don't end up coming back. Hope this helps you understand it better.

Now I'll let you in on a secret...

That model sounds wonderful in theory, but it does not work in the wonderful world of busy retail pharmacy.

Let's say my company decided to do this free antibiotic thing and put it on me to get all this disease-state information. We fill 400 prescriptions per day (20 to 30 of them would probably be for antibiotics on that free list). I don't have time to be going to the counter every time someone comes with an antibiotic script. Moreover, out of the 20 to 30 free antibiotic scripts, maybe only 2 or 3 will be new customers. We already have all the drug information for the rest of those customers (assuming they're not just chasing coupons, or in this case, free antibiotics).

Even if I had the 5 minutes to spend with everyone dropping off an antibiotic script, even if I got all that information, I have nowhere to record it. Our pharmacy software does not have a place to enter disease states. I would guess that most pharmacy software doesn't. The reason? Knowing disease states isn't entirely necessarily to filling prescriptions. Good pharmacy software streamlines the filling process. Having to wade through disease states just slows us down.

Besides, we already have a pretty good idea what disease states our customers have by looking at the medications on their profiles. If you see someone getting metformin, glipizide, and lisinopril every month, you can be pretty confident they have diabetes. Our computer systems look at drug/disease interactions based on the drugs in the profile not some medical history we got from the patient.

A disease state history, while being nice in the utopian world of pharmaceutical care, is superfluous to 99% of my job.

Maybe the idea of disease state tracking has a chance of helping a small independent grow business in a specialized area. After all, new independent pharmacies (do they exist anymore????) cannot compete with the big chains as far as pricing and prescription volume. However, if they can get the word out that their pharmacists specialize in diabetes care, perhaps they can attract just enough diabetics to make them profitable. If you couple that with diabetes education classes and other health screenings, you have a chance for a nice specialized practice.

However, the point of your comment was that the free antibiotics are the means by which these small independents collect this information. The thing is that small independents are not the ones giving away free antibiotics. Right now, as far as I can tell, it seems to be confined to grocery store chains. Independents have a hard time doing any of the special pricing or the promotions that the big chains have. That’s why most pharmacists were outraged when Walmart brought out their $4 prescriptions. They knew this would drive 3rd party reimbursements down and would put more pressure on independents that were already struggling to stay in business.

The FACT of all this is that free antibiotics are nothing more than a sneaky way of having a coupon or gift card promotion without using coupons or gift cards. Instead of giving out a $20 store coupon with new or transferred prescriptions, they get to increase traffic into the store while putting up the appearance of caring for the public’s health. For reasons I already mentioned in my previous post, free antibiotics do more harm than good for the public's health.

The lecturer was correct that it is beneficial to new independents to use disease state information to attract new customers. They just aren't doing so through free antiobiotics.

Tuesday, January 27, 2009

An Unfortunate Side Effect of Free Antibiotics

With most drugs, a less costly generic will work just as effectively as the expensive brand name only medication. However, in some cases, this isn't true. Antibiotics is one class of drugs in particular that this can be a real problem.

I would venture to guess that at least 70% of the antibiotic prescriptions we dispense are completely unnecessary. The common cold is caused by a virus. Nearly all upper respiratory tract infections are viral. Bronchitis is usually viral. The Flu is a virus (obviously). We go through ZPaks like water, but most patients don't need azithromycin.

However, there are some cases where antibiotics are warranted. Pneumonia is one of them. One of my coworkers recently was diagnosed with pneumonia. We asked him what his doctor prescribed for him, and he told us he was taking Cipro. The generic version of Cipro is on a local pharmacies free antibiotic list, so he thought it would be a great way for him to save money and get better at the same time.

Any pharmacist should have cringed upon reading that. Yes, we can use quinolones to treat community acquired pneumonia, and while Cipro is a quinolone, you will not see it on any pneumonia treatment guideline. It is not considered a first line therapy for treatment of communitry acquired pneumonia as it has poor activity against Streptococcus pneumoniae (a major cause of pneumonia). Avelox and Levaquin are first line treatments, but those are expensive brand name medications.

This pharmacy's commitment to "help out the public" by providing free antibiotics caused a doctor to prescribe an inferior therapy.

The whole free antibiotic idea is absolutely asinine. It actually does more harm to the public than good. First of all, if you mark something as free, people will inevitably flock to get some of it. It doesn't matter what the product is. We used to get free samples of things like Prilosec OTC, Metamucil, and other various OTC products. Within an hour of putting those things on the pharmacy counter, they'd be gone. You'd see people taking handfuls of stuff even if they've never used it before and had no reason to use it at the time. It was free, so they had to have it.

The same thing applies to antibiotics, except overprescribing antibiotics can have some very dire consequences. Antibiotic resistance is a growing problem, and by giving them away for free, you're encouraging their use in situations they are not merited.

Let's not even mention the fact how pharmacies make absolutely no money off this idea. In fact, the more antibiotic prescriptions a free-antibiotic pharmacy fills, the more money it loses. Remember, they are taking a loss on every antibiotic sold. Yes, it's usually a very small loss, but these are products on which pharmacies used to make a pretty decent profit. I suppose the idea is that people will bring in their other prescriptions along with the antibiotics. We all know this doesn't happen though, at least not to the point of significance. People will chase the free antibiotics just like they chase coupons and gift cards.

The other argument is that it will increase traffic in the store and lead to increased sales in other departments. Maybe that is the case. However, let's just break it down a bit. Say you're a grocery store pharmacy giving out free antibiotics, and let's say that the antibiotics have increased your script volume a little. Although your script volume has slightly increased, your gross profit either stayed the same or went down, so it hasn't helped your pharmacy's business one bit. However, let's say that the entire store's sales increased slightly after implementing the free antibiotic plan. Suddenly, the pharmacy is in a situation where they're doing less business as a percentage of total store sales. Since the corporate guys cannot positively tie the increased store sales to the free antibiotic program, all they see is a pharmacy department with a decreasing gross profit. The pharmacy is making less money, so the corporate bosses decide that they need to cut hours to cope with the falling profit margin.

Now, you're stuck in a situation where you're filling more scripts, making less of a profit, and doing so with less help. The whole store might reap the benefits, but the pharmacy department suffers.

No matter how you look at it, these free antibiotic programs are just stupid. Clinically they lead to poor prescribing habits. Financially, they do more harm than good.

Monday, January 26, 2009

What a day...

I got to work at 11 today. Immediately upon walking through the door I was informed that basically our entire staff of technicians and clerks had called out. If it were Betty working, I would have guessed that they all got together and planned this.

In total 5 of the 9 employees scheduled for the day didn't show up. Well, actually our lead tech (who I only call the lead tech because she's the most competent) showed up for an hour and left with serious back pain. She had complained of severe pain a couple weeks ago. Then she took a vacation during which she snorkeled, drank, and partied hard without any problems. Upon returning to work, her severe pain magically returned. I'm not saying I don't believe her pain. I'm just a little skeptical on the severity.

Anyway... one of our evening clerks had pneumonia. Another clerk just didn't bother showing up. Another tech in the morning said she was sick, but since her husband is a corporate hotshot in the company and makes a lot of money, she doesn't really have to work. Therefore, she calls out whenever she feels like it.. usually about once a week (and she's only scheduled for 3 days per week).

Another clerk had a family emergency, so she called out. The string of call-outs was actually kind of hilarious. We tried calling in someone to help, but no one was available. At least no clerks or technicians were available. Amazingly, we were able to convince a floater pharmacist who lived nearby to come in for the day. At one point in the day, we had 4 pharmacists and no clerks or technicians.

Has anyone ever worked in a situation where there were 4 pharmacists and no other help? I think this might have been a first in the history of retail pharmacy. You would think that I'd be cursing the disastrous day. Instead, I'm actually quite calm and relaxed. The reason? I WORKED WITH 4 PHARMACISTS TODAY!!... and no Betty I might add.

It was great! We all knew exactly what we were doing. We all could take phoned-in scripts. We all could check voice mail. We all knew how to fix all of the little problems that popped up. I never had to be interrupted to go answer a question or take a phone call. It was literally like a dream come true.

Of course... I'll most likely never experience this situation ever again. For 8 hours today, the only employees in the pharmacy were 4 pharmacists and a 20-year veteran technician. We were a little busy, but boy did the day go smoothly.

Sunday, January 25, 2009

Staying Put

I decided to stay in retail. I thought long and hard about it. I actually made a list on the positives and negatives for each choice. In the end, I couldn't do it.

Here's the thing. I just don't like hospitals. I don't like the environment. I don't get all tingly with the thought of working side by side with doctors and nurses. Honestly... I don't care much for the health care profession as a whole. That's the beautiful thing about retail pharmacy. You can be in a health care profession without actually doing any health care stuff. Yes, I dispense medication to people. Yes, I counsel them and happily answer any questions I'm asked regarding medications or common disease states. That's the extent of it though, and that's what I'm happy with.

Working with the public is both the best and worst part of my job. A lot of retail pharmacists complain about all the stupid things they get asked and the customers with bad attitudes. For the most part, I don't care about that stuff. Maybe it's because I work in a nice area, so I'm not presented with the same sort of challenges other pharmacists are. I'm sure that's part of it, but I think I have a different attitude than most pharmacists toward the job in general.

I hear all the time that we're too well educated to be spending all day on the phone with insurance companies and directing customers to the bathroom. Maybe that's true. I do only use maybe 10% of what I learned in school in my job. However, I'd like to think that my education and my intelligence is what makes me good at my job. Just because I can do something more intellectually challenging does not mean I'm obligated to do so. Why can't I just do something a little less intellectually challenging but use my intellect to do it better than others?

I actually enjoy solving insurance problems. I actually get a lot of satisfaction from stepping out from behind the counter to show a little old lady to a bottle of Tylenol. I actually like interacting with the customers... even the angry ones. I view an enraged customer as a challenge to see if I can manage the situation. This is what makes my job interesting.

Perhaps the thing I dislike the most about retail is dealing with the other health care professionals. I freaking hate calling doctors' offices for the 9,000th time about a prescription that the doctor wrote incorrectly. I hate doctors with god complexes. I hate making a recommendation that I know will help the patient only to have the doctor ignore or ridicule me. Therefore, the whole clinical aspect of my profession really doesn't thrill me at all.

Basically, the only reason I was even interested in that clinical position was a way to be a step ahead of a possible future collapse of retail pharmacy. I figured that if retail someday dries up, I'll have already moved onto a clinical environment, and this would ensure my long term success. That's really it. It had nothing to do with dissatisfaction in my current job. It had nothing to do with an overwhelming desire to use my extensive clinical knowledge. It was just a concern over something that may or may not happen some time in the near or not-so-near future.

I'm not a psychic. I have no idea how things will play out in the future, so it's stupid to leave a good job that I like because of something that might possibly happen some day. Moreover, I'd be going to a job I don't really like at all. I'd be trading in happiness for long term stability. I feel like I've spent my whole life doing just that. Maybe it's time to live in the moment for once. Maybe it's time to just do what makes me happy and not worry about what's 5 or 10 years down the road.

When I look at it that way, it makes absolutely no sense for me to take that clinical job. Therefore, I'll be staying in retail, hopefully in my current position, for as long as I can. If some day retail jobs start to vanish, then maybe I'll look into somehow getting into hospital. If that's not possible, fuck it; I'll do something else even if it's not related to pharmacy at all. Flexibility is the beauty of being single. I can move. I can change careers. I can take a pay cut without worrying about anyone else but myself.

Anyway... that's the update. Pharmacy Mike will remain Retail Pharmacy Mike.

Tuesday, January 20, 2009

An Opportunity I That I Probably Shouldn't Pass Up

Last week at work, the phone rang, and I picked it up just like a do probably over 100 times per day. This time it wasn't a patient asking for a refill or a doctor's office calling in a script. It was a pharmacy recruiter inquiring about if I or any of the other pharmacists on staff had an interest in a job at a local hospital.

We get these calls at least once per week. I've spoken recruiters plenty of time in the past. Usually, my aim is to get off the phone as quickly as possible so that I could go back to doing my job. For some reason, I actually listened to what he said this time.

He was talking about a clinical pharmacist position at a local hospital. They were looking for a recently graduated PharmD that would round with the medical team and work directly with both the medical staff and patients on the unit floors. It was a decentralized pharmacy, so I wouldn't be spending all day in the hospital basement. He even said there would be plenty of opportunities for teaching. Finally, the salary would be very competitive, ranging into 6-figures, and they would pay for any relocation expenses.

I'm a retail pharmacy guy. I like retail. Maybe it's just because I work in an absolutely great situation. My company gives plenty of staff hours, and my store is in a small, middle class town. We're busy, but it's more than manageable. Plus, I feel like I'm pretty good at my job, and I continue to get better as I get more and more experience.

If it were up to me, I'd stay in retail pharmacy at my current store for the rest of my career. However, I don't have the greatest confidence in the long term outlook of retail pharmacy. With more and more insurance companies mandating mail order and ever decreasing 3rd party reimbursements (made worse by companies giving out $4 prescriptions and free antibiotics), I don't know how long retail pharmacy can support itself.

Yes... There will always be retail pharmacies because patients will always need some place to go and get their antibiotics and pain medications. I just worry that 10 years from now, retail pharmacy won't be as robust of a profession as it is now. I fear that many retail pharmacists will find themselves without a job as companies struggle to turn profits. Look at Rite Aid. It's a pharmacy giant, but it's stock is below 50 cents per share. That's not a good sign for the profession.

Whether this happens or not, I cannot say. I know people have been predicted doom on retail pharmacy for 30 years now, and for the most part, it has just kept chugging along. The one thing I do know is that my window of opportunity for moving into hospital pharmacy is shrinking with every passing year. Three years from now, I will no longer meet the criteria of a recently graduated PharmD, and with no hospital experience at all, there's little chance of me ever getting a hospital job... especially a clinically oriented position.

If I got this hospital job and five years from now decide that I don't like it, I could always go back to retail (if retail still has openings then). However, if I stay in retail now, I think I'll be keeping myself in retail forever. I've already forgotten so much of what I learned in school. I still remember most things in general terms, but a lot of the specifics have escaped my mind. They'll continue to escape my mind the more I don't use them or think of them.

I'm really torn on this... I feel like the right decision to make is to apply for that hospital position, and at the very least, get some experience in hospital pharmacy now before I've become completely entrenched in retail. However, that's not what I really want to do. I don't want to leave my job. I'm good at it. I'm highly respected by my coworkers and customers. I like the hours (I would really struggle to be at the hospital at 7:00 AM five days per week). It's very convenient in that it's 2 miles away from my apartment. Most of all, I like it better than hospital. The environment is just better to me. I found hospitals depressing.

I guess I'm looking for opinions here. What do you retail people think about the long term outlook for retail pharmacy? Are there any hospital pharmacists that jumped into it after working exclusively in retail for a longtime? Was the transition difficult?

I'm not looking for anyone to make my decision for me. I'm just trying to gather a little more information.

Sunday, January 18, 2009

Some Pet Peeves Regarding Prescriptions

This post is for the doctors out there that might happen to stumble upon my ramblings. I've ranted about your worse than kindergarten level handwriting. This isn't the only problem with your prescriptions though.

Yesterday (which was Saturday, a weekend, when doctor's offices are closed), I received a prescription for Fentanyl Patches. The handwriting was beautifully legible. The directions were there, the quantity, the dosage. That part of the prescription was a thing of beauty. Then I look down to see who wrote the prescription. There was nothing but a scribble on the signature line with a DEA number written under it.

I thought to myself, "great! The doctor even wrote his DEA number on the script." Then I looked at the doctor's name on top of the prescription and realized that while it was written on Dr. John Doe's prescription blank, John Doe was not the doctor who actually wrote the script because the second letter in the DEA number began with a P and therefore, must have been written by a doctor who's last name begins with a P. I go to search our computer system by the DEA number and (surprise, surprise) no matches.

Just fucking wonderful! It's Saturday. The office is closed. I tried calling the answering service, and they were absolutely no help. I had a CII script without knowing what doctor wrote it. Technically, I should not have dispensed the Fentanyl patches to the patient without knowing the prescriber. However, since there was absolutely no way of finding the prescriber on that day, I was forced to use the doctor's name on top of the script (who didn't write it). This was the only way to ensure that this cancer patient would have his pain medication. I had to break federal controlled substance law in order to serve the patient. You're welcome!

Seriously... How fucking hard is it to write your name legibly? Here's my advice to you doctors: When you write a script, quickly look around for a small child, preferably in the range of 2nd or 3rd grade. Give that prescription to that small child and see if he can read it to you. You are only allowed to give the patient the prescription if the 3rd grader can read the script.

No small children around? It would take too much time? Then just imagine a small child reading the script yourself! If any part of that prescription is illegible, it should not go out the door. That includes your name. If you simply cannot write your signature neatly, then print your damn name under the signature. Some prescriptions even have a line under the signature line that says, "Please Print Name Here." I would say that no more than 5% of prescribers actually follow those directions.

Another thing (and I've mentioned this one before), write the patient's entire name on the prescription with the date of birth. This is what was actually on a prescription I received not too long ago:

Patient: R. Smith
Drug: Percocet 5/325
Sig: 1 tab q4-6h prn pain
Quant: #30

R. Smith was actually the patient, but I don't think the HIPAA police are going to come after me for posting that info on the internet. I wonder how many R. Smith's there are in this country. A few hundred thousand? That was how the patient's name was written though. No first name. No address. No date of birth. Just R. Smith. Does that mean that technically that prescription is valid for any R. Smith that just so happens to come in contact with it? Apparently it's just a blanket authorization for the R. Smith's of the world to get some Percocet.

The take home points for you prescribers out there:

- Write the patient's full name and date of birth.
- Include all necessary information on the prescription, which includes the prescriber's name.

- And finally... DOUBLE CHECK the prescription before it goes out the door. Pharmacists double and triple check pretty much everything we do before the patient gets a prescription. That's why we make so few errors. Yes, that's right... Despite the sensationalized stories you may hear on the news, Pharmacists make a ridiculously small number of errors as a percentage of the volume of work they do. Most professions should strive to reach the level of accuracy that pharmacists have. Maybe... just maybe... rereading the prescription you just wrote might cut down on a few of those prescriber errors.

I don't know... I think it's worth a shot.

Thursday, January 15, 2009

I Abstained from Writing About Her For So Long

I spent a wonderful day with Betty, who I've not-so-lovingly called the Horrible Pharmacist several times before in this blog (although I'm not sure if those posts are still published or not). She annoyed me to the point of frustration today, so I just have to vent.

When I have to work with her, I have to not only do my job but also make sure she doesn't screw up her job. Anything thing that's more complex than putting pills in a bottle is an adventure for her, which then becomes an adventure for me. Customers universally complain about how rude she is to them. Even medical assistants have gotten into the habit of asking to speak to the other pharmacists when calling in scripts. These are people who only know her through 30 second phone conversations.

Knowing that, it's not hard to imagine just how freaking annoying she is to work with for 8 hours straight. Actually, no... It's actually very hard to imagine how annoying she is. She's easily the most annoying person I've ever met. She's so annoying that I try to avoid all conversations with her. When she's there, I make an effort to not make any jokes or make any comments on any issues. For one, her laugh is like nails on a chalkboard to me. Secondly, she has a habit of repeating everything you say if she thinks it's funny or otherwise noteworthy. Or even worse... she'll make you repeat it to every single person in the pharmacy that may not have heard it the first time.

It goes something like this...

Me: (Semi-funny/sarcastic remark.)

Betty: HEHEHEHHEHEHEHEHHEHAHHE... That's a good one!!!! Did you hear that Joe??? Joe?? Did you hear it? Go ahead Mike, Tell Joe what you said!!

I honestly can't take her for more than 5 minutes. After an hour, I want to bash my head onto the counter repeatedly in attempt to get her voice out of my brain. By the end of the day, I'm totally fried.

I would love her to just shut up and not say a word all day. The problem with that is that if she likes you, she will not stop talking to you all day. In fact, if she notices someone has gone longer than 30 seconds without speaking, she'll comment, "Sally is being quiet today!"

On the other hand, if she doesn't like you, she won't say a single word to you all day and avoid all contact with you... which sounds nice until you realize she stops doing half her job in an attempt to be spiteful.

I don't know which is worse: The happy Betty or the bitchy Betty. I suppose the happy Betty at least tries to be helpful, even if she's borderline incompetent about a lot of things.


The thing that sent me over the edge today was her insistence on trying to send our techs home early. All day long it was "maybe we can get so-and-so out by 4," or "maybe we can let so-and-so go home now."

And that's fine. If we're really slow for some reason, and a bunch of techs are just standing around, if one wants to go home early and miss out on a couple hours of pay, I don't really mind. Betty's problem is that she insists on running all of this by me... as if I outrank her in some way.

I don't outrank her. I'm not a manager. We're both staff pharmacists. We both have the exact same job description. We have the same responsibilities. She does not need my approval to do anything in the pharmacy. Moreover, I don't want to have to spend the entire day making decisions about things which I have no more authority over than her. If the techs ask her any question that requires her to make a decision of any kind, she refers them to me. Even a question like, "Can we give someone a couple Cymbalta to hold them over?", she tells the techs to ask me. I think it's just her way of keeping all the blame away from her if something goes wrong. Ironically, when a mistake is made, her initials are usually on it.

Soooo... No one was asking to go home early, but she kept on suggesting it to the techs. If there's one thing I know, it's that if you suggest the possibility of going home from work early, most people will start to get their hopes up about it. It wasn't long before people started asking if they could go home. When they asked, she referred them to me. "Ask Mike," she'd say.

Hold on one second here... Not one time did I say one word about anyone going home early. She was the one that spent all day talking about it. She was the one that put the thoughts in their minds. Then, when they finally do ask to leave, she tells them they need to ask me first???? What the fuck is that about? Maybe if the final word was going to be up to me anyway, she shouldn't have even mentioned anyone leaving early without talking to me first about it. That would have been the mature, logical thing to do.

On the topic...

I don't understand this whole leaving early thing anyway. It's a fucking epidemic at our pharmacy. Everyone wants to skip lunch and go home early. Everyone wants to leave an hour early in the afternoon. Then these same people complain when their hours get cut by corporate. How can you complain about hours when you don't even want to work your whole shift anyway?

Maybe it's because I actually work hard when I'm in the pharmacy, but I actually enjoy our rare moments of peace. We don't get them very often. Every once in a while, some miserable weather will keep people away for an afternoon. During those times, I grab a stool, take a seat, get a magazine, and simply relax (after I have everything else done of course). We spend so much time being stressed out and going crazy, I figure it would be nice to actually get paid to just sit there and do nothing for a little while.

Ok... I'm sort of rambling all over the place now, so I'm going to stop.

Wednesday, January 14, 2009

I'm Sitting Next to a Big Pile of Candy... and I Couldn't Care Less

Next to my desk, no more than 2 feet away is a big pile of candy that someone gave me as a late Christmas present. There's a box of sweettarts, a box of Mike and Ikes, 2 bags of Skittles, a bag of mini Airheads, and a big bag of Sour Patch Kids. These are my favorite candies in the world. I always liked the sugary candy more than chocolate. I've never really been a person to crave chocolate or ice cream or cupcakes or brownies. However, you give me a bag of Sour Patch Kids or a box of Sweettarts, and I'll polish them off in a matter of minutes.

I used to joke that I survived on sugary candy. However, this pile has been sitting there for several days now, and I've barely touched it. The reason? About 8 weeks ago (the week of Thanksgiving), I made a commitment to get back in shape and start eating healthier. The night before I started this, I finished all the leftover pizza, candy, and chips in my apartment with the thought that I would not be eating them again for a LONG time. The next day, I went out, restocked my kitchen with chicken, fruits, vegetables, seasoning, and whatever else I needed to prepare leaner, healthier foods. At the same time, I started a workout regimen that had me exercising 6 days per week for an hour per day (free weights, cardio, flexibility). My goal was to trim down and get in shape so that I could attempt to play basketball in the summer.

It was tough at first. It was hard to muster up the motivation to come home from a long day of work and cook a meal every day. It was really hard getting up over an hour earlier than usual so that I could exercise before going to work. For the first few weeks, I was perpetually sore and tired. In addition, I was constantly fighting the temptation to go out and pick up some fast food or order a pizza. However, I was determined to see this through, so I kept on going.

It's now 8 weeks later, and I haven't had a single slice of pizza since this began. I ate one cheeseburger in the last 2 months (I went out to a restaurant with some friends), and I indulged in some alcohol around Christmas and New Years (I was at a couple parties). Otherwise, I've stuck to my healthy diet. I've also stuck with the workouts. I missed a few days in December because of a stomach bug (it's not easy doing sit ups when you feel like you're going to throw up at any minute). Because of this, I'm the lightest I've been in five years, and I'm fairly certain I have my lowest body fat percentage since high school. I've played some pick up basketball games recently, and I feel great. I don't get tired. I'm quicker on offense and defense. I can jump again! That might actually be the best part of all this. I've strengthened my legs to the point where I can actually get up for rebounds and knock down pull-up jumpshots again. I have a long way to go, but I'm excited about my progress.

That brings me back to the pile of candy next to me. After eating healthy for 2 months, I don't crave the junk anymore. I really have no desire to eat pizza. The thought of a greasy burger and fries upsets my stomach a little bit. I used to come home and drink a bottle of beer every day after work. Now, I only drink water and milk. I look healthier. I feel healthier. Most importantly, I feel mentally healthier. I haven't really gotten down on myself in quite some time. Despite getting up earlier every day, I feel more rested.

Ever since I got out of college and broke up with my ex, I kept telling myself that I'm going to use this opportunity to get myself back into shape. However, I always put it off. When I got my apartment, I said I was going to start cooking on my own, but I never did. Things just got worse and worse until I finally decided to stop whining and do something about it.

Like I said, I have a long way to go, and it will take a lot of hard work to get there. All I know is that there's absolutely no way I'm going back to my old lifestyle.

Friday, January 9, 2009

A Random "Blow Your Mind" Thought

The History Channel has been airing a bunch of shows on the creation of our universe lately, and it got me to thinking about something I think about from time to time.

The number of events and coincidences that had to come together in order for life to develop on this planet is staggering. The planet needed to be just the right size in order to maintain an atmosphere. It had to be just the right distance from the sun in order to allow for liquid water. It had to have a large moon to stabilize its rotation and tidal forces. It had to have plate tectonics to dissipate heat from the core. The proper elements, minerals, and climate needed to exist to spark the initial chemical reactions that gave rise to life. Then, once life developed, it took a truly miraculous chain of events to bring about a life form as intelligent as humans.

I firmly believe that the development of intelligent life in the universe is such an absurdly rare event that we'll probably never, in the entire lifespan of our planet, identify another planet harboring intelligent life. The odds are simply that small.

However, it's estimated that there are between 100 billion and 300 billion planets in our galaxy and about 100 billion galaxies in the known universe. Even if we said the chances of intelligent life developing is so rare that it is 1 in a billion, that means there are a billion planets in the universe with intelligent life.

That's a billion civilizations that we'll never know. A billion lifeforms that we'll never be able to learn from or observe. Perhaps all of them are like ourselves, isolated by thousands of light years from the other intelligent civilizations, trying desperately to unlock the secrets of the universe and find out if they're all alone.

The immense size of the universe is staggering. We can't possibly comprehend just how big it is.

This is the famous Hubble Deep Field image. It represents 2 parts in a million of the entire sky. There are about 1,500 galaxies visible in the image each with billions of stars. To say that the Earth is just 1 grain of sand out of all the beaches in the entire world compared to the universe is a great exaggeration.

Anyway... that was my mind blowing thought of the day.

Thursday, January 8, 2009

What is the Big Deal About Giving Out Your Address???

Our company policy is to ask every patient picking up a prescription for their address. We do this to ensure that we are giving the correct prescription to the correct person. We do this for everyone's safety.

About once per week or so, we get some lunatic who goes crazy about having to give out his address at the counter. Yesterday was one of those days...

Our pharmacy counter has multiple cash registers, so multiple people can pick up prescriptions at the same time. Each register is situated about 5 feet apart. There is some room for privacy, but not a whole lot. Unfortunately, that was the way the pharmacy was designed, and we do the best we can with what we have to work with. Well, this one lady decided to make a scene because we asked her for her address while another customer was at another register picking up a prescription. She started proclaiming that we were violating HIPAA and invading her privacy. She started complaining that we shouldn't even have more than one person at the counter at one time. She was really making quite an ass out of her self.

One of the pharmacists went up there to try to address the situation, but the woman kept on going about this grievous invasion of her privacy. She told the pharmacist that she obviously has no idea about HIPAA, and she even called this pharmacist pathetic in the way she handles personal privacy. She asserted that she should never have to say her name or her address when coming to the pharmacy counter. "Even doctor's offices don't call out names in the waiting room anymore!!" (How do they call people when it's time for their appointment then????)

The other customers in line (who she had no problem making a huge scene in front of, but wouldn't want them to possibly know her address) started to chime in and basically tell her to shut up. One guy said to her, "lady, it's just your address." This, while being funny, pissed her off even more. She told us to just give her the prescriptions, and she'll find a new pharmacy.

The pharmacist responded, "I wish that pharmacy good luck dealing with you."

I was busy trying to help a customer while all this was going on, so I couldn't really get involved in the situation. The whole time she was ranting and raving at the counter my blood was boiling just thinking about the things I wanted to say to her but couldn't (for various reasons). This blog is my chance to respond.... to EVERYONE who makes a fuss over giving their address at the pharmacy counter:

Who the fuck do YOU think you are??? Do you think anyone really gives a shit about your address? No one gives a shit about you. No one cares. You're not Angelina Jolie. You're not Brad Pitt. No one knows who you are. No one wants to know who you are. You're a nobody picking up a couple prescriptions at a local pharmacy. Stop acting like somebody cares about your inconsequential life.

Furthermore, saying your address at the pharmacy counter is NOT a violation of HIPAA, and if you assert that I do not know HIPAA, you are WRONG! I know HIPAA. I've been "HIPAA trained" countless times. HIPAA is part of my job. My company pays me quite well to know this stuff. What do YOU do for a living that makes you such an expert on private health information? In 99% of the cases, I know more than you about this, so don't fucking argue with me.

A violation of HIPAA would be if I attached your name, address, or some other identifier to your health information. For example, if I asked you for your name and then loudly blurted out, "Are you picking up Klonopin?", that would be a violation of HIPAA. It allows other people to know your health information. Stating your name and address is NOT a violation. No health information is contained in your name and address except for the fact that you use our pharmacy to pick up prescriptions. If you want to argue that this is a violation of your privacy, then maybe you should show up with a bag over your head so no one could see you either.

In fact, please show up with a bag over your head because anyone who makes a big scene about this shit probably shouldn't be seen in public.

Our pharmacy fills over 2,000 prescriptions per week for hundreds of patients. 99.9% of them don't complain over giving out their address at the pharmacy. If you complain, don't you think there's something wrong with YOU and not US. You are the extremely vocal and retarded minority in this case.

Right after the moron stormed away from the counter, the next man in line said, "There's always an asshole in every bunch." He's damn right about that one.

Saturday, January 3, 2009

Reason Number 152,710 Why I Hate Anthem Blue Cross

How can one of the biggest pharmacy benefits managers in the United States be offline for nearly 6 hours on the first business day of the year? Do you know how much that completely fucked up our day in the pharmacy? As if it wasn't bad enough that everyone's insurance cards suddenly stopped working (with 90% of those customers having no idea why), we had to wait 6 hours before we could put a single script through under Anthem. By the time some claims started going through, we had over 30 prescriptions (new ones and refills) just sitting there waiting to be processed.

We filled over 500 prescriptions while dealing with the shit storm of new insurance cards and customer questions. Do you know what it's like to be going crazy and suddenly find over 30 extra prescriptions to fill? It fucking sucks.

The occasional computer glitch is forgivable, even one at such an inopportune time. However, this is the second year in a row that Anthem went down for an extended period of time on the first business day of the new year. Can't they get their shit together before January 2nd? How come Caremark or Express Scripts didn't have this problem?

I could rant all day about this, but I'm too tired at the moment. Anthem, consider yourself lucky that you didn't get the full force of my wrath.