Wednesday, February 25, 2009

I Think I Have a Case for Being the Ultimate Employee

(I sort of got the idea for this from Pharmacy Chick's post about The Perfect Technician)

I didn't say that I am the ultimate pharmacist. I'm far from that. I have a lot to learn in that area. However, I believe that I may be the ultimate employee. Let me explain:

1) I'm single and without kids. There's no outside drama in my life. I don't need to make time for a wife or girlfriend. I never NEED to be home on time. I can just about always stay late if necessary. I don't need certain days off during the week. I'm available pretty much at all times. If someone gets sick, I can be there to cover in less than an hour usually. I don't need advance notice. I don't need to run it by anyone.

2) I very rarely get sick. I get maybe one mild cold per year. In my entire working history, I've never had to call out of work sick. If I'm on the schedule, I will be there... absolutely guaranteed.

3) When I'm at work, I work. I don't bullshit. I'm not there to talk. I don't need 9,000 little breaks during the day. When I'm on the clock, I work hard the entire time. I have no desire to tell anyone about my days off. I don't make any personal phone calls unless it is an absolute emergency. I just work, which is a very foreign concept to a lot of people.

4) I'm not lazy. I don't do things half-assed. When I do something, I try my best to do it right. I never assume someone else will do it for me.

5) I don't shy away from difficult tasks. In fact, I'm always looking for opportunities to try to improve in areas I'm not particularly strong.

6) I don't think I'm too good for any task. At the pharmacy, I have no problem being at the register to help out when we're busy. I'll take the trash back to the dumpster. I simply do what needs to be done without being told and without trying to pull rank on anyone else.

7) I get along with all my coworkers, even the despicable ones. I don't give anyone a reason to talk shit about me behind my back, and even if they do, I don't care. I don't respond to it. I don't treat the other person any differently. I just go about my job because that's ultimately why I'm at work... to do a job. I put all personal feeling aside in the name of doing that job. I do not get involved in workplace drama.

Basically... I have nothing that interferes with doing my job. Throw in the fact that I feel incredibly fortunate to even have a job during such tough economic times, and you get the type of employee you just don't want to get rid of. That's basically my whole goal. I don't take my job for granted. There's this constant worry in the back of my mind that pharmacy jobs will start to dry up, and many pharmacists will be out of a job. I want to work harder and be more valuable than everyone else so that if and when it comes time to make cuts, I'll be one of the last people they'd think about giving the axe.

Tuesday, February 24, 2009

It Usually Isn't a Customer That Sets Me Off

When it comes to dealing with customers, I have near endless patience. For one, whether or not it's a good thing, I automatically assume that everyone I meet is stupid until they prove otherwise. It's not a lack of respect on my part. I figure the odds are simply in my favor. Most people are stupid. Some are amazingly stupid. In fact, you meet a hell of a lot more amazingly stupid people than amazingly smart people. Therefore, I just assume that customers are going to have a hard time understanding what I tell them. I assume they will not call in a refill well in advance of running out of medication. I assume they will complain about their high copay even when it's been the same for the last 6 months.

The other reason I'm very patient with customers is simply because they don't know any better. Most of our customers don't work in a pharmacy. They don't work in a doctor's office. They don't work for insurance companies. They really have no idea what actually goes into filling that prescription for Celebrex that requires prior authorization. All they understand is that they won't be able to pick up that prescription right away.

On the other hand, if you work for a doctor's office, you better damn well know what the hell you are doing, or I will get pissed off. I've been known to make snippy remarks to medical assistants and nurses after they do something exceedingly stupid. Some call it unprofessional. I don't really care. I simply cannot tolerate stupidity coming from the people who are supposed to be telling me what to dispense to patients.

Here's an example:

For the past 2 weeks, I've been trying to get a prescription for lancets for a patient. She has Medicare, which means that we need one of those nice written prescriptions faxed to us with a diagnosis code, specific quantity, and specific directions. Well, the first thing I did was send a fax over to the doctor's office that had a cover page outlining ALL the prescription requirements for Medicare. If they simply read the cover page, it would have been abundantly clear what needs to be on the script. The doctor faxed back a script saying nothing but "Lancets with 12 refills."

Not good enough. So, I sent the fax back to the office and CIRCLED the part where it mentions needing a specific quantity and directions. Two days go by, and we don't get a response, so I call them to find out what the hell is taking so long. They couldn't find a record of the doctor ever prescribing lancets to her. Since I had a prescription right in front of me (albeit not medicare compliant), I assured the medical assistant that the doctor did, indeed, prescribe them.

"Ok.. So what are the requirements again?" she asked. I gave her my whole spiel about Medicare compliant scripts.

"Well, how are we supposed to know how often she tests her blood???" she asked confused.

"Well," I began. "I think the whole idea is that you are the doctor's office and therefore, you should be telling HER how many times she tests. That's generally the way this works."

After a little more convincing, she said she'd get a script right over to us. Ten minutes later, a perfectly legible, Medicare compliant prescription came over to us.... FOR TEST STRIPS!!!

My blood was boiling. I'd spent far too long trying to get this one freaking LANCETS prescription. Someone was getting a piece of my mind. I got a nurse on the phone this time. Now, she tells me that she has no idea why the office would ever prescribe a glucometer to her in the first place since they're primarily a pulmonary group. She told me I should check with her primary physician.

"OK," I said. "Do you know who that might be?"

After looking through her chart, "Well, it seems Doctor Retard IS her primary physician, but she usually doesn't prescribe this."

That was it. "Look... On [such and such date] Dr. Retard wrote a prescription for a diabetic glucometer for this patient. I have the script right in front of me. It is from Dr. Retard. Dr. Retard has also given her prescriptions for test strips in the past. Now, the patient is asking for Lancets. You know? Lancets, the things that prick your finger and get the blood out in order to put on the TEST STRIPS that go into the GLUCOMETER. She's not going to get much use out of the glucometer and test strips without lancets. Obviously Dr. Retard wanted her to use this glucometer because she wrote a prescription for it. What good is the glucometer without the lancets?"

"Furthermore," I continued. Dr. Retard has already written a prescription for the Lancets, but she completely ignored our fax about how it needs to be Medicare compliant. The prescription has already been authorized. It should be charted somewhere. I just need it to be written so I can bill the stupid thing to her insurance. When I asked the second time for the LANCETS, you guys sent me a script for TEST STRIPS. This is getting ridiculous. It's wasting my time and the patient's time."

I never got that script. I'm waiting for the patient to come in, so I can tell her that the people in her doctor's office are idiots.

It's that kind of shit that gets me going. I hate that kind of incompetence. I hate laziness too. Man, do I hate laziness! Like when you send over a refill request form to the office that has a nice place for them to write in the quantity and number of refills, and the office simply faxes back the same form to you with nothing but the doctor's signature. Is it approved? Does the doctor want the same quantity? Refills? A signature tells me absolutely nothing. Therefore, I send it back with a note on it in big lettering "WHAT DOES THIS MEAN?"

Here's a situation that's a combination of laziness and incompetence: I get a prescription called in for Toprol XL 100mg twice daily. Toprol XL is usually prescribed once daily. The patient has never gotten that prescription at our pharmacy, so I call the office to double check the directions. The nurse puts me on hold for a moment to check the chart. When she comes back, she says, "Yes that's how the doctor wrote it down."

"I didn't ask you to check how the doctor wrote it down. I asked you to check if the doctor actually INTENDED to dose it twice daily as it is usually a once daily drug," I remarked.

That's another major pet peeve of mine. When I call the office to verify a prescription dose or tell them about a drug interaction, I'm not questioning what was written into the chart. I'm questioning the intent. Prescribers make mistakes. They miss interactions. Rereading what was written down does not answer my question. I fully expect the prescriber to be asked directly, and in a relatively timely manner. If I call about an interaction or an incorrect prescription, I shouldn't have to wait a day to get a response. The response should be within 20 minutes (at the most).

I've mentioned this in a previous post, but I'll bring it up again: Can you imagine if it worked that way with the pharmacist? A patient calls the pharmacy saying that they think we made a mistake filling their prescription only to have a technician tell them that the pharmacist is busy and it may take us up to 24 hours to check the prescription and return the call. How well do you think that would go over? Not very well, I'd say. How is it any different when the doctor's office does it? Why do they get away with this shit?

I'll stop now. I had a frustrating day at work, and I just had to vent.

Sunday, February 22, 2009

Keeping to the Theme Set By Tonight's Academy Awards

It has been said that a smell or a song can instantly cause you to recall a certain point in time. I contend that movies can do the same thing. There are a lot of movies that bring back memories for me. It doesn't matter whether the movie was good or not. There just needs to be some event or point in time that I associate with that particular movie. When I watch or hear about that movie, I'm always reminded of the past.

Jerry Maguire is one of those movies. I don't particular like the movie. It was OK. Nothing to write home about in my opinion. However, the situation surrounding my first viewing of the movie forever changed my life.

I was just starting my freshman year in high school. Up until that time, I had always believed my family was perfectly happy. My parents treated me incredibly well. We went on family vacations every summer. My grandparents and aunt and uncle were constantly in my life. We'd have big family get-togethers around holidays and special occasions. Life was pretty good... I thought.

In the past, my parents had their fair share of arguments, but I wouldn't say they were any more frequent than for any other married couple. However, that fall they started to argue more often and more explosively. Several times I woke up in the middle of the night to the sound of them screaming at each other. I used to walk to and from school, and it seemed like every day I walked through the door, they were fighting. I knew something wasn't quite right, but I was so young and sheltered that I just couldn't conceive what it could possibly be.

After their shouting matches, I'd go with my dad to a nearby gym to play basketball. I loved playing at that gym. I wasn't even 15 years old yet, but I was playing with (and beating) guys in their late 20's and early 30's. Everyone at the gym was so impressed with my ability. It was such a great confidence booster, and I always felt really good after playing.

Over the next few months, their arguments continued to get worse and worse. Finally, one day my dad came to me and said that if my mom doesn't start treating him better, he was going to move out. I thought he was crazy. My mom did everything for the family. How could she treat us any better? Once again, I was too young to understand what all this meant, so I brushed my dad's threat aside thinking he just had a bad day.

It all reached a peak one night during a particular loud argument. My mom called the police on my dad. Five minutes later an officer was at the door trying to settle the domestic dispute. I sat at the top of the steps as I listened to my mom tell the officer that my dad threatened to hit her, and she said he had in the past (note that I had never ever seen my dad raise a finger towards her, and to this day, I highly doubt he ever would). It was then that my dad exclaimed to the officer the line that forever changed my life.

"My wife is cheating on me."

The line hit me like a ton of bricks. At first, I thought he was crazy. There was no way my mom was cheating. Why would she do that? She's a good person. Good people don't cheat.

In the coming weeks, the hard truth was revealed to me. Apparently, she had been seeing some guy she met online for a couple months. I'm not exactly sure how my dad got proof of it. However, she certainly did give him a lot of reasons to be suspicious. She started "staying at work a little later than usual." Several nights per week, she claimed she was going out to dinner with her coworkers. My mother never did those things in the past. During those months, it became a frequent occurrence.

If I thought the situation was bad before, it only got worse. She decided she wanted to divorce my dad, and she kicked him out of the house. I remember the night before he moved out, he got my brother and I together and asked us if we'd move out with him. I was just a dumb kid. I didn't know what was right or wrong in this situation. All I knew was that I didn't want to move out of the house where I lived my entire life, so I told him it would probably be better for us to just stay. The look on his face and the words that followed haunt me to this day.

"OK... I don't know why, but you guys love your mother more than me." Then he turned and left the room.

In a matter of months, my entire life had been turned upside down. I had a hard time focusing on anything. My grades started to suffer... just a little bit. Straight A's turned into A's and B's. I was playing for the school basketball team, but I couldn't concentrate in practice, and my play in games (I was only on the freshman team at the time) was lackluster. My dad would still take me to the gym after school, but even he could tell my heart just wasn't into it anymore.

You're probably wondering how Jerry Maguire fits into all of this... Well, I went to see that movie with him during the time he moved out. He just wanted to do something with me and didn't really know what, so we went to see Jerry Maguire. It was kind of a sports movie. Of course, it probably wasn't the most appropriate movie for a 14 year old, but we saw it anyway. To this day, just the thought of that movie puts me right back in that theater with him. At the time, it was the absolute most miserable time of my life.

The dispute between my parents served to divide the rest of the family. Just about the entire family took my father's side. Even my mother's father sided with my dad. My mom, being an incredibly willful woman, basically disowned her entire family (my grandparents, aunts, uncles, cousins, etc.) because of it.

Miraculously (at least it seemed like a miracle to me although my parents probably don't think of it as such), the guy my mom was seeing turned out to be a raving lunatic or was just a touch on the psychotic side. He started stalking her, so she quickly acted to get rid of him. She told me dad she made a huge mistake, and she wanted him to come back. My dad did... although I think it was more for our sake than for my mother. By the middle of the basketball season, my parents were back living together relatively peacefully.

It set my mind at ease, and my grades went back to normal. I also started playing basketball well again. It's actually kind of funny because I can pinpoint the time when things started to return to relative normalcy by my scoring during those freshman games. I started the season with a couple 15 point games,and then when my dad moved out, my scoring dropped into single digits (one time I didn't even score) for a 5 game stretch. Once he moved back in, in my next few games I scored 18,19,18,16,25,20... I remember my totals to this day because of all that was going on at the time.

Despite my parents making relative peace, our relationship with the rest of the family had effectively come to an end. My mother wanted nothing to do with my grandparents, aunt, and uncle. I went from seeing them on a regular basis to seeing them twice in a 5 year stretch. A part of my family was forever lost because of the whole incident. I don't think I ever really got over that.

All this stuff happened in a relatively short span of time, but it has scarred me for the rest of my life. It left me a colder person than before. I don't have that unnerving belief in family that many others do. I learned that I have to depend on myself because there's no guarantee that the people you love and depend on today will be there fore you tomorrow. This was further cemented into me when my ex-girlfriend left me for good. I had let down my defenses one time to allow her in, and I ended up being burned in the end.

There's that saying that whatever doesn't kill you makes you stronger. BULLSHIT! I'm not stronger from this stuff. I'm colder. I'm harder. I'm less caring. I'm more cautious. I can still be successful. I may still be able to get married and have my own family some day. These scars will only allow me to give so much though.

Anyway... I'm sorry to write such a depressing entry. I'm actually feeling quite well. Freaking Cuba Gooding caused me to get all introspective.

Thursday, February 19, 2009

Betty, Betty, Betty.....

Dear Betty,

Perhaps you'd like to explain to me why you don't take the initiative to figure out what's wrong when the physical count in a CII bottle does not match the quantity in our CII book.

You see, today we filled a Ritalin prescription for someone and upon back counting the bottle (standard procedure as you know), we realized that the quantity left in the bottle did not match that in our CII book. It was off by a whopping 60 tablets. The last one to fill a prescription for that particular strength of Ritalin was you. You back counted the bottle and wrote it down on the bottle. Then you went back and recorded the script in the CII book, but instead of using the actual inventory, you simply subtracted from the previous quantity listed and came off with an entirely different number.

I would think that any normal person would look at the number on the bottle and the number in the book and realize something wasn't quite right. Maybe a script hadn't been entered into the book. Maybe there was another open bottle in the safe that you didn't notice. There are any number of reasons why the two counts wouldn't match. However, you took no initiative at all to figure it out. You simply left it for the next lucky pharmacist to figure out.

Well, that next lucky pharmacist was me. Know what I figured out? You fucked up. There were 60 less tablets than listed of one strength of Ritalin and 60 more tablets than listed for another strength. Someone had given someone the wrong strength of Ritalin recently, and upon checking the book, I found out it was you.

Do you realize that the counts were off for both of those strengths, and you never bothered to question it? On both strengths you back counted the bottle and recorded the prescriptions in the CII book. You knew both counts were off and did nothing about it.

You see... This is why we back count the bottles. This is why we keep a running inventory in the CII book. It's not just company policy being rammed down our throats. We do it so that in the event we are ever off, we can figure out why and possibly catch a mistake before it leaves the pharmacy.

Now I realize you have a far smaller mental capacity than your average human being. However, I think even you could look at two numbers and realize if they match or not. It's not like one is written in roman numerals or something. Just plain old regular numbers both on the bottle and in the book. Who am I kidding though? Of course you realized the numbers were different. You were just too lazy to care. Well, an error occurred because of your laziness.

But you don't really give a shit about that either, do you?

Go fuck yourself,

Pharmacy Mike

Wednesday, February 18, 2009

A Trip Back In Time (note: this is a long post)

After getting my license, I was a floater for nearly 4 months before getting the opportunity to work full-time at my current store. Floating had its highs and lows. As a new pharmacist, it allowed me to get to know many other people in the company at a variety of locations. It also allowed me to see how each store was run and organized a little bit differently. Many times I worked on my own, which often made for long, boring days. However, it also gave me the opportunity to grow as a pharmacist. I had to learn how to do everything on my own. I had to make my own decisions and solve my own problems. For a new pharmacist with relatively little experience in retail, this was a little scary at times, but ultimately it forced me to get better.

On the downside, I hated not knowing where I was going to be working the next week until Friday. Many times, I would begin a 12 hour Friday shift without knowing my schedule. The in the middle of the day, I'd find that I had to work Sunday, Monday, and Tuesday in another store. It sucks to be given so short notice about your following week's schedule. It made it impossible to schedule appointments or even plan to hang out with friends or family. I finally became fed up with it when they told me my scheduler had changed, and both my new scheduler and old scheduler wrote different schedules for me for the week. I didn't even know this occurred until on my day off, I got a call from another store in which the pharmacist told me I was supposed to be working there that day. I told him I had already been scheduled in other stores all week, and I couldn't make it. He hated me for that. It wasn't my fault, and I wasn't about to drive over an hour away to cover for someone else's mistake.

Coincidentally, the following week, I got a call from the pharmacy manager of one of the stores I interned. One of their pharmacists (worked there for 8 years) was taking a job as a consultant, and he wanted to know if I wanted to take the position. I hesitated at first. The store was the busiest store in the chain. As an intern, I remembered standing in front of a computer for 12 straight hours typing scripts without a single break in the action. However, I knew I didn't want to float anymore, so it didn't take me very long to decide to take the job .

The store was extremely busy, but it was in a good location. The major upside was that I was going to be working with 3 other pharmacists who all had a lot of experience with the company and pharmacy in general. The store manager had been in that location for 23 years. He was a great guy, a great teacher, and bent over backwards to make sure his staff was taken care of. The other two pharmacists had been at the store for 17 and 10 years respectively. I had my license for less than 6 months, and being so new, I understood that I couldn't possibly be in a better place to learn than this.

A few months went by, and everything, for the most part, was going well. We had some problems with one technician calling out constantly and acting like a total bitch to every and anyone, but the experience of the rest of the staff allowed us to get by. Then unexpectedly, in January one of the pharmacists (the one who had been there for 10 years) took a job at a long term care pharmacy. He was fed up with retail and often commented about how he'd get sick to his stomach on his way into work thinking about what he'd have to deal with during the day. He also had a major problem with that one technician who seemed to call out every single weekend she was scheduled with him. One day a recruiter called, and he happened to be the one to pick up the phone. The rest is history.

After he left, the entire pharmacy quickly started going to pieces. For whatever reason, our volume had suddenly skyrocketed. We were setting store records for script counts every week. The volume wasn't really our problem though. The problem was that our district manager took his blessed time replacing that pharmacist. We lost an experienced 40 hour pharmacist, and the only thing we got in return was 20 hours of floater help. We were having record script counts with fewer pharmacist hours than we ever had.

The situation with that one technician also started to spiral out of control. She was a full-time technician, but she was actually at work maybe 20 hours per week. She said she had migraine problems, and I'm sure she did. That wasn't what caused her to call out all the time though. Just by looking at her, it was quite obvious she was a drug addict. Her boyfriend was a drug addict who was in and out of jail. She lived in an apartment with several relatives (all drug addicts), and she was constantly at war with everyone. She'd come into work looking like she hadn't slept in weeks. She'd wait on 2 customers, then get a phone call and spend 20 minutes SCREAMING at the person on the end. She'd be swearing at the top of her lungs in plain view of all the customers. We'd tell her to hang up the phone, and she would, but then she'd go hysterically sob in the back of the pharmacy for 30 more minutes before returning to work. One time, she literally sat down on a crate and cried for her entire 8 hour shift over something that was happening outside of work.

When she called out, we were short staffed. When she came in, she was of absolutely no use to us and served as a distraction. We tried to get rid of her, but management didn't really want to hear our complaints.

Therefore, we all kept chugging along... until our company decided to roll out a new software system a couple months later. They didn't exactly spring it on us by surprise, but because of numerous delays, we were never sure when exactly we were going to be converted until 2 weeks before the conversion date. We didn't have time to train everyone, so just the pharmacists and two of our full time techs went to the training classes. When the switch was finally made, no one knew what they were doing. It only took me a couple days to catch onto the system, but everyone else, particular our technicians were much slower. They couldn't put in a refill without asking for help. Anything more complicated than that, we had to do for them... and by "we", I mean "me" since I caught on much quicker than everyone else.

There we were doing record numbers with a new software system that no one knew how to use and doing all of this with 20 fewer pharmacist hours than before and a full-time technician who was hurting us more than helping us. To say it was crazy would be an understatement. All the pharmacists knew that no matter what time we were actually scheduled to leave, we would be staying until closing time. Often, we'd have to stay an hour after the gate went down just to finish filling the prescriptions that were dropped off that day. Throughout the entire day, we had lines at the register 20 people long. One time, I walked out of the pharmacy to help someone find something, and a customer walking by joked, "Are you guys giving away free concert tickets or something?" It was funny, but I didn't laugh.

We had no time for paperwork or the ordinary, non-prescription filling tasks of a pharmacy. We didn't have time to pull the old scripts that weren't picked up out of the bins. Any semblance of organization that we had was gone because we just didn't have the time to worry about being neat. The situation was horrendous.

We were getting burned out, and we started to fear that we'd begin to make mistakes. We were already noticing some smaller mistakes popping up more frequently (giving the wrong size on a cream or antibiotic suspension and putting 30 tablets in a bottle instead of 90, etc.). Therefore, we contacted or district manager and demanded that he do something to help the situation. It was more than 3 months after that other pharmacist left, and he still hadn't replaced him. We'd send emails and leave voice messages for our DM, but they never got returned. Finally, we decided enough was enough. The pharmacy manager wrote a letter addressed to our corporate office and basically spelled out the issues that needed to be quickly addressed with the threat that if they were not, we'd all request transfers out of the store. We all signed our names at the bottom before it went out.

At the same time, I started looking for other jobs. I couldn't take it anymore. I was spent. I was a new pharmacist. I wasn't vested in the company yet. There was no reason for me to have to put up with that kind of work environment and risk making a mistake. Moreover, I was dealing with a ton of personal issues at the time (specifically the break up with my ex-girlfriend). I was absolutely miserable. I was so stressed that I couldn't sleep. I'd come home from work and stare at the wall in silence for an hour just trying to unwind. One time, I actually had a mini-panic attack at work, which manifested itself in an extremely upset stomach and forced me to go home early. Of course, I felt terrible for leaving them short-handed, so I came back a couple hours later to finish the day.

Two days after the letter went out, they sent in a pharmacist and a full-time technician who both had experience with the new software to help out at our store for a few days. The extra help allowed our manager to catch up on paperwork and get things a little more organized. Over the next few weeks, our volume started to come back down to normal levels and our staff started to catch on to the new software. Things were finally starting to settle down. I think I may have even left work on time once or twice during that time.

Our DM finally decided to replace that pharmacist four months after he left the company. He hired Betty. Our DM and my manager hated each other. I swear Betty was his idea of a cruel punishment for going over his head.

The toughest times were over. Things started to go more smoothly. Want to know our reward for sticking things out? My pharmacy manager (who had been there for 23 years) and the other pharmacist (17 years) got transferred out of the store. Apparently, corporate thought that the relationship between him and the DM deteriorated beyond repair, so they transferred him to a different district. The other pharmacist had developed a heart condition, which was exacerbated by the high stress environment, so they transferred her to a slower store.

In a time period of 9 months, a pharmacy that had a stable staff of 4 pharmacists for about a decade suddenly had all new pharmacists. It left me, with my whole 11 months of pharmacist experience, as the longest tenured pharmacist at the store. Luckily for me, the new manager was also very good, very experienced, and an all-around great guy, so the transition wasn't that bad.

This was also about the same time I started writing this blog.

(We also finally got rid of that technician. After a major fight with management, they finally had to get rid of her when we caught her stealing bottles of Vicodin. We all celebrated the day she left.)

The whole year was just so weird for me because I went from being the inexperienced newbie to being the one everyone looked to for answers. Since that big transition, our volume has decreased by 20-25% thanks to two major competitors opening within a half mile of us. Basically, I went from working in the worst pharmacy environment you can imagine to working in one of the best. We now have adequate help for a reasonable prescription volume. Of course, we're probably not as profitable as we were a couple years ago (for several reasons other than prescription volume). However, I can actually say that I don't hate my job. I'm glad I stuck it out.

Tuesday, February 10, 2009

I'm Starting to Get Too Old for "Cute"

"He's so cute."



"He's so nice."

I have a swarm of customers (older female ones of course) that say these things to me and about me constantly. At first, it was really flattering and made me feel good. I try really hard to be helpful and as good a pharmacist as I can be to my customers. However, as I enter my late-20's, I think I might be getting a little old for "cute."

You see... They don't call me cute in the way, they'd call Brad Pitt cute. They call me cute in the way they'd call a 10-year old cute. They look at me like a big kid playing pharmacist. I seem so young and innocent to most of these customers. I go out of my way to explain things to them or help them find things in the OTC aisle. I'm ultra polite and brush away compliments with an embarrassed, blushing smile. Like I said... I come across as a little kid playing dress up. Thus, I get all these, "Oh, he's so cute."

I don't look young for my age. I have more than a few grey hairs and very noticeable wrinkles around my eyes. I guess it's just the way I present myself that makes me seem like I'm younger than my age. For whatever reason, instead of coming across as a mature, confident man, I exude the persona of a bashful, eager to please kid.

Perhaps that's my problem with women. I'm nice, and I can be funny (usually in a dark, sarcastic way). I'm not grotesquely unattractive. I have a good job, and I act very responsibly. However, in the end, I come across as someone that needs to be taken care of instead of someone who will take care of others. Basically, women want their kids to be like me, but not their husbands or boyfriends.

I guess it's hard to explain to people that have never met me. That's how I really feel though. It's like I'm a kid who one day woke up as an adult in an adult world. I don't know how else to describe it.

Sunday, February 8, 2009

I Think They Give Out Controlled Pain Medication Just a Little Too Easily

I'm nearly 27 years old. I've played sports my whole life. I've broken my nose and had surgery on it twice. I've had several other surgeries when I was little regarding an issue with my tear duct. I had my wisdom teeth removed. I had osgood schlatter's disease and patella tendinitis. I've severely sprained each ankle at least 3 times. I've had countless other minor to moderate ankle sprains. I've had thigh contusions that have caused my entire thigh to swell up. I've been hit in the jaw so hard that I couldn't chew food for 3 days. I sprained my left foot so badly that it took me over a month before I could walk on it without limping and over 2 months before I could jog normally on it. To this day, when I run my finger over the top of that foot, it sends a tingling sensation shooting down to my toes.

Despite all these surgeries and injuries, I've never taken a Vicodin. I've never taken Perococet. Nor Norco. Nor Lortab. Nor ANY hydrocodone or oxycodone product. The strongest pain medication I've ever felt the need to take is 800mg of ibuprofen.

Now, I don't think I have some great level of pain tolerance. Far from it. I'm just not a baby about pain. When you get injured, I realize that you're going to have a bit of discomfort, so I deal with it. I feel like a lot of people don't understand that concept. Moreover, I feel that a lot of prescribers jump to the controlled pain medications (mainly Vicodin and Percocet) far too quickly.

I realize that many people do need these medications. A ruptured disc can be excruciatingly painful and debilitating without pain meds. Knee and hip replacements, I can understand. You break your leg in 5 places, yes, you probably need some strong pain medication. And obviously, cancer patients need their pain meds.

However, most other instances shouldn't require anything stronger than ibuprofen, at least to start out. I'll give you an example... A friend of mine recently got into a car accident. The accident wasn't too major. A lot of damage was done to his vehicle, but he walked away from the accident just fine with only a couple minor bruises. Regardless, the police urged him to go to the hospital to get himself checked out just to make sure. He went to the hospital, told them he had a couple bruises but felt mostly fine. Know what they gave him? DILAUDID! For a couple minor bruises, he walked out of the emergency room with a prescription for Dilaudid!

It's those kind of prescribing habits that make pharmacists pause for a couple of extra seconds every time we come across a Percocet prescription. Those prescribing habits are what make it so easy for drug seekers to have access to prescriptions for their CII's of choice. Those kind of prescribing habits make us question even people who get pain meds regularly for legitimate reasons.

We all have those patients who have been getting a month's supply of Perocet (or similar narcotic) every month on the dot for years. You see them come into the pharmacy, and they walk just fine. They talk to you just fine. You try to find any sign of pain or discomfort, and you just can't do it. You're left wondering just what the hell they're getting all this Percocet for, but you can't even begin to guess. These are the patients that make us suspicious of everyone.

I guess my point in all this is that there should be no reason that we dispense as much Vicodin and Percocet as we do Lipitor and hydrochlorothiazide. There simply cannot be that many people that have such severe pain that they can't be treated with ibuprofen, naproxen, or even just Tylenol.

Monday, February 2, 2009

Clinical vs. Retail vs. Any Other Area of Pharmacy

I was just reading The Angry Pharmacists most recent post where he puts a douche bag clinical pharmacist in his place. This post got me thinking about what really is the difference between pharmacists who practice in different areas.

Everyone's first instinct is to think that the "clinical" pharmacists are the top-of-the-class, nerdy type and that the retail pharmacists settled on retail because they weren't smart enough for a clinical setting. I think the only thing that separates the two is experience... and it goes both ways. You stick a pharmacist who was doing clinical work for 10 years into a retail pharmacy, and he wouldn't have a fucking clue of what to do. Vice versa, if you took a retail pharmacist and threw him into a hospital, he wouldn't have any idea what to do there either.

It's all just experience. I'm sure all of the interns reading this will agree with me: They teach you everything in pharmacy school except how to be a pharmacist. You learn pharmacology, kinetics, and therapeutics. You learn all the pharmacy-related science you could ever need. However, you don't truly learn how to do ANY pharmacist job.

This is easily seen in the newly licensed pharmacists that only spent the bare minimum time in a pharmacy (hospital, retail, or any other setting) required to be licensed. These new PharmD's can quote you statistics from all the major studies and practically know DiPiro's Pharmacotherapy by heart. However, they cannot perform the simplest of tasks. We think they must be stupid because (like in TAP's case) they can't give a transfer or (in the clinical douche bag's case) they don't know you can't give 40 mEq of Potassium as an IV push (although that one is sort of common sense if you ask me). In reality, they probably are just lacking in experience.

I'm a retail guy. I've been a retail pharmacist for 2.5 years now. I don't have the slightest idea what to do in a hospital environment. The drugs you deal with on a daily basis are different. The rules are different. Your responsibilities are different. I don't know how to use pixis. I don't have a clue as to what a "y-site" is. I'd be completely lost if I had to work in a hospital tomorrow.

I assure you that it has nothing to do with my intelligence or capabilities. I graduated in the top 10 in my class, and I can guarantee you that I did so working half as hard as the other 9 students in that group. My good grades had next to nothing to do with whatever job I was going to take though. Retail pharmacy was not easy for me right away. I was one of those students who didn't spend a lot of time in a pharmacy when I was in school. I only worked about 20 hours per week and only during my semester breaks. When I got my license, I was still struggling to understand insurances. I still didn't have a good grasp of pharmacy laws. I found I had a very hard time making decisions (when I needed to call on interactions, what to do when customers get irritated, etc.). There were even a lot of things about our pharmacy software that I had to learn on the fly because I just never got the experience I needed.

My first few months as a pharmacist were rough, but by continually working 40 hours per week and putting forth an honest effort to improve, I developed into a pretty good pharmacist (I still have much to work on though). It would have been the exact same story had I chosen to work in a hospital instead of retail. All that clinical knowledge isn't much help unless you have the experience to back it. It probably would have taken me 6 months to a year to begin to feel comfortable in a hospital environment.

That's why I will never look down upon pharmacists who practice in other areas. I can't do their jobs. They can't do my job. Give me a few months to learn a clinical job, and I'll quickly learn all the little thing that any hospital pharmacist would need to know. Give them the same amount of time to work my job, and they'll do the same thing. It all comes down to experience. No particular group of pharmacists is any better than any other. They're just more experienced in their particular areas.

***One more thing***

I meant to write this somewhere in the actual post, but I forgot. Since I'm too lazy to go back and work it in so that it flows, you're getting it at the end.

A lot of the my pharmacy classmates went on to do residencies and are now working in highly clinical jobs. Most of these people weren't exactly great students. A few of them, I thought were a little dumb actually (judging by the idiotic questions they always seemed to ask and the way they complained after every single exam that the questions weren't fair). I mean, they used to come to me for answers and pointed me out as one of the smartest students. They did their residencies, and now they can be considered experts and know considerably more than I do about their respective fields. It just goes to show you that it's not really the grades or the intellectual power of the pharmacists in a particular area. Keeping with them theme of the post, it's experience.

Sunday, February 1, 2009

I Don't Know What I Want

(I'm going to be rambling a bit here, so try not to be put off by the lack of focus of this post)

I spend so much time convincing myself that I'm happy with my life and desire no more than what I already have. The truth is that I really don't know what I want. Part of me really IS happy with my life right now. I have a good job that I like. I get to do what I want when I want to. If I want to sit around and watch TV for the entire day when I'm not working, I can do that without anyone criticizing me. If I want to spend $500 on a new technological gadget, I can do so without asking anyone for permission. I eat what I want when I want. Basically, I run on my own schedule, and it's great.

However, another part of me wants something else. I mean, I'm happy being single, but I'm also lonely being single. Sometimes, I just wish I had someone around to talk to or to go out with. Sometimes, I really wish I could sit down and eat dinner with someone else. On some days, I think it would be really nice to come home from a 12 hour shift to see a warm, smiling face waiting for me.

I guess the truth is that I'm happy, but I'm not entirely happy. I don't know if I can ever be entirely happy though because the things I desire greatly conflict. I apparently desire to live like a bachelor, but be able to do relationship stuff whenever I feel like it. Obviously, it doesn't work that way. I have to make sacrifices one way or the other. Right now, I'm sacrificing relationships for my own personal space.

While I'm still relatively young, that sacrifice seems OK to me. However, I worry that I'll wake up one day and realize that I'm 40 years old and completely alone.

I don't know how to reconcile the two conflicting desires. I'm just writing this because I'm going through one of those times when I wish I had someone else just for a little emotional support.