Thursday, May 21, 2009

I Hate Being the Controlled Substance Police

I know I should. Every other pharmacist seems to care. However, I really couldn't give a flying fuck about people who abuse controlled substances. I don't care if Mr. Smith has gone to 20 different pharmacies paying cash for Vicodin in the last few days. It doesn't bother me one bit. If he wants to get high and blow out his liver, he can go right ahead. It doesn't faze me in the least bit.

That's not to say that I just hand out Percocet, Vicodin, and Valium like candy. I don't allow early refills. I won't knowingly fill a script for someone that paid cash for the same thing at another pharmacy just a day earlier. I do everything that the board of pharmacy and federal laws ask me to do for filling scripts for controlled substances. I just hate doing it.

I will not go out of my way to find out if the person is a drug seeker. I know some pharmacists who will call every pharmacy in a 20 mile radius if a suspicious looking cash customer brings in a Percocet prescription late in the evening. I just don't care enough to do that. If a new, cash customer brings a Percocet prescription to me late in the evening after the doctor's office has closed, I just fill the damn thing.

The way I see it, due to these wonderful $4 generics, controlled substances are some of the only drugs that net us a decent profit. We have to make money somehow. It might as well be from the drug addicts.

These people all eventually get caught anyway. Inevitably, they screw up and come in early for a refill, or bring in a script from a different doctor that sets off some red flags. Trust me, I am looking to bust these people. When I catch them, I do cut them off. However, I don't waste 30 minutes of my time to track down the multiple pharmacy filling history of one drug addict. I have more important things to do.

Retail pharmacists probably have the most varied list of responsibilities of any professional. We're responsible for accurate dispensing. We're responsible to make sure that the prescriptions we receive are in compliance with both state and federal laws as well as being up to the standards of the insurance companies. We're responsible for preventing drug interactions. We're responsible for counseling patients on new prescriptions. We're responsible for being the liaison between the customer and the insurance company. We're responsible for maintaining the business end of pharmacy. We're also responsible for being the controlled substance police.

Know what's the sad thing about all those responsibilities? Pharmacists seem to be the only ones that take them seriously. We call doctors about interactions every day, and they mostly ignore us. We attempt to counsel patients, but they don't have time to listen because they're in a rush, and they swear the doctor has already explained everything to them. We constantly try to keep our inventories down and dispense as many generics as possible in order to improve our gross profits. At the same time, corporate decides to give out $4 prescriptions and free antibiotics, not to mention all the $20 gift cards.

It's the same thing for the controlled substances. We've caught several customers trying to pass off fake scripts at our pharmacy. The police show up, arrest them, and then they're right back out doing the same thing 2 days later. We call doctors about patients who are filling Vicodin scripts all over the place, but the doctors keep writing them more scripts.

I don't know about everyone else, but I always feel like I'm fighting a losing battle trying to adhere to all the laws and regulations in pharmacy. I feel like we expend so much energy trying to do things by the letter of the law, but in the end, we're the only ones who care because ultimately, we seem to be the only ones affected by the regulations. Doctors, insurance companies, and seemingly even patients do whatever the fuck they want, while pharmacists are the only ones that get penalized by not following the standards.

Therefore, my response is "screw it." I'll do what I can, within reason, to ensure that my pharmacy doesn't become a Percocet addict's paradise. However, if I have to waste too much of my time to catch a drug seeker when I could be providing counseling to a good patient or filling scripts, then it's not worth it to me. After all, my time is money. Catching a drug addict brings no money to my store and is actually a waste of money when you factor in my salary for my time spent trying to catch him.

Now if the DEA starts offering rewards for pharmacies that catch controlled substance abusers, my opinion may change. Until then, sure, I'll fill that potentially sketchy (but at the moment entirely unprovable) Oxycontin prescription 10 minutes before closing on a Friday night. It won't affect my conscience one bit if the asshole OD's on it. In fact, it would probably be doing the world a favor.

Tuesday, May 19, 2009

I Don't Get Mad Anymore

I feel like I have nothing to write about these days. I don't get mad at things like I used to. For most of my time as a pharmacist, I'd come home from work ready to boil over in rage over the way some idiot customer acted or some stupid policy management implemented. Venting on this blog was necessary for keeping my sanity. I needed it as an outlet for my pent up frustrations.

A little side story... I originally called myself The Frustrated Pharmacist. Those of you who have actually clicked on my profile (and there isn't very much of one) have seen a remnant of that original title where it says "frustrated about almost every detail of my life." At the time, The Frustrated Pharmacist was probably the best description of myself. It really seemed like I had these annoying little problems that made every aspect of my life a lot harder than it should have been.

After only a few posts, I decided I didn't like being "The Frustrated Pharmacist," and I eventually settled on Pharmacy Mike. It seemed like every pharmacist blogger out there was "The (insert adjective here) Pharmacist." I didn't want to be looked at as being unoriginal, so I went with the very "original" (your sarcasm detector should be going off) Pharmacy Mike. I actually would have preferred to be "Pharmaceutical Mike" because that's what several of my friends called me in college. They always had some name for me like that. During my freshman year when I was acing organic chemistry, they called me Organic Mike. It was pretty embarrassing actually because several girls in our dorm would constantly call me Organic Mike.

I suppose it could have been worse. I could have been Asshole Mike or Horrible Body Odor Mike. I guess being known for being smart isn't a bad thing.

Anyway... I didn't want to use Pharmaceutical Mike because I felt like the word pharmaceutical pertains more to those in the research, development, or sale of pharmaceuticals. The word pharmacy relates more to a pharmacists overall job than pharmaceutical does. Thus, I stuck with Pharmacy Mike.

To tie this back to my original point, I'm glad I didn't stick with The Frustrated Pharmacist because it's no longer a good description. I mean, I still get frustrated from time to time, but for the most part, I feel pretty calm. I can't remember the last time a customer really got under my skin. I haven't even been close to losing my cool in a long time. Few things upset me anymore. Medicaid customer bringing in 10 prescriptions a piece for each of his 10 family members. Whatever. Customer screaming over his 3rd tier copay even though he paid the same amount for the previous 3 months. No big deal. Another coupon for a $20 gift card. Have fun shopping.

Things just don't get to me like they used to, and I'm not just talking about pharmacy. I see The Angry Pharmacist and The Angriest Pharmacist still hilariously ripping people new ones. Drug Monkey is still out there exposing corporate bullshit and slicing through conservative political rhetoric. I love their sites, and I hope they never stop doing what they're doing. I, on the other hand, have a hard time getting mad at the same kind of things over and over again.

Maybe I'm just in a better place mentally than I have been in the last few years. I've reached a point of acceptance. For maybe the first time in my life, I've decided that I'm OK with who I am. While I can't say I don't wish some things were different, I no longer beat myself up over my past mistakes. I used to be this tightly wound ball of emotions that I barely had control over. I'd keep everything all pent up inside until it exploded out into some expletive laced tirade at work or a depressing blog post about the one that got away.

Now, all that emotional turmoil has been replaced by a calm acceptance of everything that happened and everything I am. I wouldn't say it's a happy feeling exactly. Just calm and peaceful and grateful for what I have. I feel lucky to be who I am. It's hard to be mad when I see the things other people have to deal with.

For the most part, I have it pretty good. Things could certainly be a whole lot worse... I could be one of those customers that The Angry Pharmacist so eloquently rants about.

Therefore, if you're wondering why my blog posts have been sporadic at best, it's because I don't have the same inspiration to write that I had in the past. My best writing comes when I'm at an emotional extreme. Most of my blog posts are when I'm really mad or really down or really happy... ummm... scratch that last one. I don't think I've written a post when I'm happy. You get the idea though. I write best when I can put my heart into it. The words just seem to flow when you really care about what you're writing. Unfortunately, a side effect to feeling calm is that I'm less prone to the kind of emotional outbursts that lead to good blog posts.

Fear not though... I think I'll have plenty to write about when I finally close on my condo and prepare to move in.

Thursday, May 7, 2009

Why I Play Basketball

The last few months have been big basketball months with the NCAA Tournament in March and now the NBA Playoffs. Basketball is constantly on my mind, so you'll just have to bear with me.


Basketball is actually a game that frustrates me more than it's fun for me. Every time I go out there and struggle with my jumpshot or playmaking, it eats at me. However, I keep on playing, and the reason is that nothing else in the world can provide me with the same sort of high that basketball can give me.

My favorite player, Ray Allen, recently exploded for 51 points in a playoff game (the Celtics' game 6 loss to the Bulls). He hit 9 three pointers total, and seemingly every single time Boston needed a big shot, he was there to hit it. He was most definitely in the proverbial zone, and being a future Hall of Famer and possibly the greatest shooter who's ever touched a basketball, Ray Allen is no stranger to being in the zone.

After a big game several years ago, Ray Allen once said that scoring 40+ points in a game isn't hard, at least not while you're doing it. When you're having a game like that, the game just feels so easy to you. You just feel like you have a great rhythm all game. Every jumper you take goes in. Every dribble move you make gets you open. Basically, you feel like you're just out there shooting all by yourself.

Now, I'm no Ray Allen, but I've been in those types of grooves before. Games like that are the major reason I play basketball.

Those games always start innocently enough. You come out, hit your first 3 pointer you take, and realize that your shot felt pretty good coming out of your hands. You hit the next open one. The next time you touch the ball, you ball fake to the right, take a couple hard dribbles to the left, pull-up and hit a jumper in the defender's face.

Now, you know you have it going. Suddenly, your whole mentality changes. Normally, when I play, I'm concentrating on what I have to do in order to hit my next shot. I think about getting my feet set, my shoulders square, and getting good extension on my release. However, when I get into that zone, I stop thinking about those things. Instead, I only think about how I can get open for my next shot. I stop worrying about whether I'm going to hit my next shot. Missing doesn't even seem like an option anymore. I just want to get open because I know if I can just get off a shot, I'm going to score.

The feeling is so empowering; I can't even describe it if you've never been in that situation. You just know there's nothing anyone can do to stop you. The other team realizes that you're on fire, and they start trying to do whatever they can to keep you from scoring. They start yelling to each other, "Watch the shooter on your side!!" or "Make sure to jump out on all those screens!" They start instructing your defender to "never leave him open to provide help defense," or they say "help off ANYONE BUT HIM."

Their efforts don't matter though, especially if you have a quick release on your jumpshot. I don't need a whole lot of separation to get my shot off, and I have range out to the NBA 3-point line. I only need a split second of daylight to get off a shot, and if I'm on, I can be a nightmare to cover. No defensive player can stay attached to your hip every second of every possession. Eventually, there's going to be a mental lapse. Eventually the defender will run into a screen, and I'll be able to get my shot off, and when I'm on, it's going to go in.

With each shot you make, the defense gets more and more frustrated. They start switching defenders on you. They start switching and making rotations that they normally wouldn't in an attempt to keep you from beating them. They spend so much energy trying to stop you that they leave your teammates wide open for easy layups. They worry about your jumpshot so much that even the slightest head fake will send them jumping out of their shoes allowing you to get to the basket. You're just in total control. It's exhilarating.

I've felt like this more than a few times, but usually it was in pick-up games that don't really count for anything. I don't want to share all the actual games I've ever been in the zone, but two of them really stand out in my mind.

In one, I couldn't make a shot for the entire first half. I was playing terrible. I had 4 points on 4 free throws, but that was it. My team was down 18 at half and looked like we were going to be run out of the gym. I don't know what changed after halftime, but I couldn't miss in the second half. I was hitting shots from everywhere. Crazy shots, with hands in my face, fade away three's, everything was going for me. I ended up scoring 28 points in the second half (32 points total), and we ended up cutting the lead down to 2 points. We still lost, but we put a scare into a team that had yet to lose that season. At the time of this game, my career high was 26 points. I scored more points in the second half of the game than I ever did in an entire game before.

The other game was quite the opposite. I started out making shots, and I just never stopped. I came out and hit four 3-pointers in the first 8 minutes of the game. By the time I went to the bench for the first time with 5 minutes remaining in the half, I hit 5 three's. I came out to start the second half and did the same thing. I ended up hitting 4 more three's in the second half for a total of 9 in the game. By the time, I went to the bench for the final time with 10 minutes to go in the game (we were beating the team by over 20), I had 30 points (the 9 three's and one three-point play). I can't remember exactly, but I think I went 9 for 11 from the 3-point line that game. I've never shot the ball that well before... or since.

Games like those are the reason I keep playing despite my frustrations with the game. Generally, I'm a good player and a good shooter, but I really play for the small chance that I'm going to go out there and be great. So few people ever get to experience being great at something. So few people get to experience invoking awe in those around them. I'm glad that I've had that experience regardless of how small of a scale it may have been.

Wednesday, May 6, 2009

Some People Grossly Overestimate the Importance of Their Medication

Early today, a woman called in a refill for her Allegra ODT 30mg. We do not usually stock Allegra ODT. We have one patient who gets it, so we do not keep it on the shelves. If the woman orders a refill, we will order it for her, but we will not keep it on our shelves as long as no doctor is writing for it.

Of course, the woman came into the pharmacy in the evening looking to pick it up. We informed her that it had to be ordered, and it will be ready tomorrow.

"BUT I NEED IT!!!!," she exclaimed. "What am I supposed to do now?"

Not wanting to bring up some obvious points that I knew wouldn't get me anywhere with her, I apologized for not having it in stock, explained that we don't usually carry the medication, and assured her that it will be in tomorrow.

What I wanted to say to her (other than to ask her why she waited until she was out of her "necessary" medication before calling in a refill) was, "no, you certainly do not NEED Allegra."

Perhaps some people don't understand the definition of the word "need." You "need" something when you can't possibly live or you put your health at risk without out. For example, I need to eat food and drink water. A patient who had an organ transplant needs his anti-rejection medications. An HIV patient needs his antiviral drugs. A patient with pneumonia needs antibiotics.

No one NEEDS Allegra. Missing one dose of your antihistamine is not an emergency. The very worst thing that can happen is you get some itchy eyes and sneeze a bit more than usual. You will survive and with no long term adverse effects. Furthermore, if your allergy symptoms do get really bad, there are plenty of over-the-counter options available that will provide relief.

Sometimes I think that people must marvel at me. I haven't taken a prescription medication since 2001. It must be a miracle that I survived for so long without at least a course of antibiotics. I must be extremely lucky to never get sick.

I do get sick though. I get sinus infections. I get sore throats. I get chest colds. I don't get them often, but 2 or 3 times per year, I will get some kind of cold. Despite this, I don't take antibiotics. Why? BECAUSE YOU DO NOT NEED ANTIBIOTICS FOR 99.9% OF ILLNESSES. Sinus infections are almost always viral. Bronchitis is viral. The common cold is the rhinovirus. A Zpak or any other antibiotic does absolutely nothing against a virus. I know this. This is why I don't take them.

I'm also not a germophobe. Not at all actually. I don't shy away from contact with people. I don't wash my hands 7,000 times per day. It makes absolutely no sense to be afraid of germs. NEWS FLASH! You're constantly surrounded by germs. All day long, every single day you have bacteria on you. You can't get rid of it all, nor do you even want to. The harmless bacteria that is on floors, counter tops, and people's hands helps prevent more dangerous bacteria from growing.

I had a conversation on this very subject with one of our technicians. She said that she's so afraid of germs that she won't even use her sister's chap stick because she doesn't want to use something that touched her mouth. In response, I asked a simple question, "You would kiss someone though, right?"

She, of course, said yes, she would kiss someone. What's the difference??? Is the mouth not the most bacteria infested place on someone's body? People are afraid to shake someone's hand, but kissing a stranger they just met in the bar is no problem. It's fucking retarded.

You have an immune system for a reason: TO KILL GERMS! I promise that it does a pretty good job of this if you just let it. I'd like to think that I'm living proof of this.

I kind of got off on a little tangent, but the moral of this post is that a lot of people think their medication is much more important than it really is. Antihistamines are not necessary. Nasal steroids are not necessary. That Zpak for your cold is not necessary. Don't act like you're going to die if you have to wait an extra 12 hours to get it. To my knowledge, no death has ever been averted from taking Allegra.

**Of course, all these people who think they need far more medication than they really do ultimately pay my salary. I guess I shouldn't complain.**

Monday, May 4, 2009

Why I Could Never Have Played in the NBA

Well... Other than the fact that I'm way too short, not nearly strong enough, and I have white man's syndrome (AKA, lack of vertical leap).

I mentioned that I was eating healthier and getting back into shape. After 4 months of working out hard 6 days per week and cleaning up my diet, I'm as fit as I ever was. Within the last few weeks, I found an open gym where they get good full court 5 on 5 games 3 times a week. For the first couple weeks, I was playing great and feeling great with my new found quickness and strength. Now, playing 3 times a week for 3 hours at a time is starting to wear me down.

As I type this, my ankles are aching and swollen. My shoulder is sore. My legs are sore and weak like I just got done running a marathon. The state of my body has even affected my eating habits. For the past couple of weeks, I've gone back to eating crappy (but yummy) food because with all the extra physical exertion, I'm craving carbs and high calorie foods.

This is from 3 weeks of playing basketball 3 times a week. I think of NBA players who practice every day and play 82 games per season not including the playoffs. It's amazing to me how durable you have to be to make it through a season like that. I couldn't do it. Well, maybe I could, but I'd definitely wouldn't be playing at a lower level at the end of the season than I was at the beginning.

I think I could get by just playing basketball. I can drag my body out there 3 times a week and not feel too tired or sore. My biggest problem is that I have a hard time working out when I play basketball this often. For the 4 months before I started playing this often, I had a great workout routine going. I would get up before work and work out for an hour. Despite working out 6 days per week, I felt like I got enough rest. I felt strong. However, when I play basketball this often, it's very very hard for me to get up an hour early so I can work out before work. I feel like I need that extra hour of sleep in order for my body to recover. My legs feel sore from playing basketball, so it makes it really hard to work out my legs. Basically I just feel tired.

Not being able to work out as hard or as often decreases my strength and explosiveness on the basketball court. Three weeks ago, I could touch the rim when I jumped. Now, I'm 4 or 5 inches away from it. I lost a little (not that much) bit of my quickness. Therefore, even though I'm playing more basketball than before, I'm actually getting worse because I haven't been working out and keeping myself in as good condition.

I marvel at guys like Kobe Bryant. Kobe gets up at 3:30 AM during the season so he can get in a rigorous workout before his day really begins. There's a story about how when he played in the Olympics last summer, he told Lebron James that he didn't want to go out with the rest of the players one night because he had a workout scheduled at 6:00 AM the next morning. This conversation is being credited for causing Lebron James to realize just how much work it takes to be the best basketball player in the world, and now he works out hard like Kobe does.

I can't even do a workout that's probably half as hard as Kobe's when I don't play basketball nearly as much as him. My body simply will not allow me to do it.

Anyway... I just wanted to vent my frustration about not being able to work out like I want to because I want to play basketball as often as possible. My sore shoulder (hurt it doing pull ups about a month ago) is forcing me to cut back on my workouts again. I just want to get back to being completely healthy and pain free, but I don't think I can do that while playing basketball. My body forces me to choose one or the other. Right now, I'm picking basketball.

She's Gone, But I'm Not Quite as Relieved as I Thought I'd Be

After years of complaining about her antics, I can now finally announce that Betty is no longer an employee at our pharmacy. I always thought that I'd be overjoyed the day she was finally gone. Trust me, I am happy.... Just not as happy as I thought I'd be.

You see... Betty was possible the most annoying person I've ever met. I couldn't stand her. The sound of her voice was like nails on a chalkboard to me. I used to intentionally avoid all conversation with her just so I wouldn't have to listen to her talk. She was so irritating to me that seeing her name on the schedule on the same day as mine would fill me with anxiety.

I know you're all thinking that you know someone just like that, but I can assure you that most of you have never met someone like Betty. She just rubs everyone the wrong way. It doesn't matter what she's doing or what she's saying, she just pisses you off. She could tell you that you just won the Powerball Jackpot, and you'd want to punch her. Literally everyone she meets says the same sort of things about her. You might not hate her, but you certainly don't want to be around her for longer than you have to be.

However despite how annoying she was, that was never the reason that I wanted her out of our store. My major complaint about her was that I thought she was a horrible pharmacist. She made more mistakes than anyone else on our staff. She provided horrible customer service. She was lazy, so the rest of us had to do more to make up for the weight she didn't pull.

That brings me to the reason I'm not overjoyed. Her deficiencies as a pharmacist had nothing to do with her removal from our store. I don't want to share the whole story, but basically one particular pharmacist and one particular technician decided that they both hated her, and they made it their goal to have her removed. They both went to the district manager threatening that they would quit if they had to work another day with Betty. This was the third time that these complaints reached the DM, and he finally decided it would just be easier for him to move her than have to listen to anymore complaints.

It's not like I'm going to go to the DM and plead Betty's case on this matter. However, I'm really not happy with the way things played out. Betty got kicked out of our store because nobody liked her. It had nothing to do with her performance. She was not reprimanded in any way. Two members of our pharmacy staff basically decided that they hated her so much they had to get rid of her. It was like something we'd see out of a group of middle school students. They talked behind her back, spread gossip, and twisted every word she said trying to make others hate her too. In short, they were doing the exact same things that they complained about her doing.

Like I said, I couldn't stand her, but I got along with her. As much as I hated working with her, I sucked it up every day, and did my best to coexist with her. I knew I didn't have to be best friends with her, but we had to work peacefully together. And we did (her job performance not considered).

I just don't think someone should lose her job (she got transferred, so she technically didn't lose her job, but it was against her will) because she's not liked by her coworkers. We're adults. Childish things like that should not get in the way of work. If you wanted to get rid of her because she sucked at her job, I'd be all for it. That wasn't even a factor in the decision though.

** I must say though... It is pretty nice that I no longer have to dread going to work on certain days of the week anymore. Whether I think the reasoning was right or wrong, the work environment and our performance as a pharmacy is better without her.