Friday, June 25, 2010

A Really Difficult Job

When my friends complain about their jobs, sometimes I want to tell them, "I don't care what you do. You're job is easier than mine." Of course, I've never said that, and I never will. It doesn't make it less true though. Working in a busy retail pharmacy is one of the most frustrating professions you can imagine.

There are so many things wrong with the idea of retail pharmacy that I almost don't know where to begin. I guess I'll just start by saying that pharmacists are always in a losing battle because the very nature of the business conflicts with the nature of the profession of pharmacy. We are in business to fill as many prescriptions as possible as quickly as possible with as little help as possible in order to maximize profits. That's how our employers make money. That's how our salaries get paid. The crazier and more stressful it gets, the more money we generate.

The nature of the profession is one of health care. We're supposed to be promoting health and well-being. We're trained to make clinical decisions and judgments about the medication therapy of our patients. We're supposed to not only know which drugs a patient should be on, but also which drugs they shouldn't be taking. We're supposed to be teaching these people how to take their medication correctly and which side effects to look out for. In fact, we're actually mandated to at least offer that kind of counseling on every new prescription.

Therein lies the problem... The things we learned in school that make up the profession of pharmacy don't actually generate money for the business of retail pharmacy. However, we're still expected to do them, which is in direct opposition of the goal of filling as many scripts as possible. Every time we tell a customer they might not actually need that acid reflux medication they've been on for the last 5 years ever since they were discharged from that one brief stint in the hospital, we might be making the correct clinical recommendation but making the wrong business recommendation. Every time we tell a patient that the best thing for that cold is rest and plenty of fluids in place of selling them on some OTC medication that probably won't really work, we're losing sales. For the pharmacist that cares at all about health care, this is really hard to reconcile.

Then there's the way we're supposed to treat our patients/customers. In pharmacy school, we're taught to think of these people as our patients. We're supposed to be making recommendations that will improve their health. We're supposed to teach and educate them. We're supposed to be assertive in getting our points across. However, the business of retail pharmacy tells us that "the customer is always right." We shouldn't say anything that customers might not like because they might get mad and take their business elsewhere. We're supposed to kiss ass and be apologetic at the slightest sign of a customer not being pleased.

How can we educate people and make health care decisions and recommendations if we're supposed to kiss everyone's ass? It's impossible to have a health care provider/patient relationship at the same time as having a employee/customer relationship. The two roles do not mesh. In the end, when it comes time to choose one or the other, most of us choose to bite our tongues and treat our patients like customers so as to not possibly piss them off and complain to management.

Even if we forget about the irreconcilable differences between the profession of pharmacy and business of pharmacy, we have the crazy work environment to contend with. Everyone hates being interrupted when they try to perform a task. Let me tell you, no professional in the world gets interrupted more than a pharmacist working at a busy retail pharmacy. Trust me, it's not even close. The phone rings all freaking day long. I have nightmares of the phone ringing. Depending on how good your technicians are at triaging phone calls, up to 60% of those phone calls require a pharmacist.

The law might differ slightly between states. In my state, if another pharmacy is calling to transfer a prescription, it has to be handled by a pharmacist. If a doctor is calling in a new prescription, you need a pharmacist. Checking the voice mail requires a pharmacist. Any customer question about medication or anything that might require some counseling needs a pharmacist. It seems like no matter what I am doing, I cannot finish a single task without being interrupted by a phone call.

If it's not a phone call, it's someone barging their way to the pharmacy counter to ask a question. Usually, this question has absolutely nothing to do with my pharmacy knowledge. Last week, I actually had to leave the pharmacy to go show an old man where the cereal was. At first, I told him which aisle it could be found, but two minutes later he returned saying he couldn't find it. Therefore, I, a pharmacist making nearly $60/hour who went to school for 6 years to be a drug expert, had to personally show someone where the cereal was. This type of shit happens all the time.

If it's not a phone call or a customer interrupting you, a lot of time your very own staff is the source of the interruption. Now, this isn't true of all pharmacies, but I'd say it probably is for the majority. The pharmacist is the smartest employee in the entire store. Often times, the pharmacist is MUCH MUCH smarter than anyone else in the store. Therefore, while we are inputting, filling, and checking scripts, we're always paying at least a little attention to what all our technicians and cashiers are doing in the pharmacy. I can tell you that I'm always on alert listening for any sign that my employees are making a mistake, telling a customer the wrong information, or not handling an irritated customer well. I'm always ready to step in to solve whatever problem comes up... while at the same time dealing with insurance companies, inputting scripts, checking scripts, and calling the doctor to make sure he really didn't want to give Cipro to that patient taking Coumadin.

At my pharmacy, this is perhaps the most frustrating thing of all. We have employees that have worked in the pharmacy for years, but they still don't understand what certain insurance rejections mean. They don't know the best way to explain things to customers. Hell, most of my technicians and cashiers have only very basic knowledge of how to use our pharmacy software. They make the same mistakes over and over again inputting prescriptions. They ask me the same questions over and over again but seemingly tune out my explanations. Some of them work so slowly that I almost wish they'd just stand in the corner and not do anything because all they're doing is getting in my way.

Moreover, despite being much more intelligent and more educated than pretty much everyone in the entire store, I ultimately have to answer to and follow the asinine rules made up by "head cashiers." Once again, I went through 6 years of college to get a doctorate in pharmacy. I graduated in the top 10% of my class. I'm looked upon as a drug expert. However, when it comes to the business end of things, I ultimately am outranked by people that never went to college, barely graduated high school, and make less than half the money I do.

I'm sure this situation is familiar to most pharmacists. The reason we have so many problems with management is often that we're much much smarter than management, and we realize just how stupid and illogical most of the store policies are.

Even if you're somehow not bothered with the disconnect between the profession of pharmacy and the business of retail pharmacy. Even if you're the world's greatest multi-tasker and are able to effectively tune out the perpetually ringing phone. Even if you have the patience of a saint and have no problem dealing with the intellectual short comings of your staff and store management, there's still the whole issue that we're often so busy that we don't have time to take a break.

I have a buddy that complained to me about how hard it is for him to work 12 hour days and how tired he is when he gets home. He's a car salesman. He actually works at the dealership where I bought my car. The last time I took my car in for service, we stood around talking for about 10 minutes. During that time, he didn't have a single customer walk through the door. The phone never rang once. No one asked him to do anything. He had all the time in the world to have a conversation with me while he was at work. Most of his day is usually spent sitting down in his office. However, he says his 12 hour days are so tiring that he doesn't have the energy to do anything when he gets home.

My 12 hour days at work involve me working like a mad man for 12 hours straight. The phone never stops ringing. Customers never stop coming. I get, if I'm lucky, maybe 10 minutes to scarf down my lunch, and that's the only break I'll get in those 12 hours. The rest of the time is spent on my feet working.

The craziest part is that my store is actually one of the better retail pharmacy situations you can be in. We're busy, but not insanely busy, and at least for now, we get a pretty decent amount of pharmacist overlap and tech help. There are pharmacies that are much worse than mine is. When standing on your feet for 12 hours with only maybe a 10 minute break in the entire day is a good retail pharmacy situation, trust me when I say that the average person can't even fathom how it feels to work in a bad situation. I used to work in a bad situation. It was quite literally the worst time of my entire life.

In light of all this, I keep thinking about how pharmacists are up in arms with a lot of the changes the big chains are proposing and trying out. Pharmacists are nervous about centralized filling because they fear it will take away jobs. Pharmacists are pretty much universally scoffing at the idea of increasing the role of pharmacy technicians in the filling process. We're all fighting against any change that could possibly take away jobs.

However, the more I think about it, the closer I am to coming to the conclusion that maybe that's not a bad thing. Maybe pharmacy has to fundamentally change. Maybe pharmacists can't and shouldn't get paid $60/hr to count by 5. Maybe big box drug stores are not the best future for all of us highly educated drug experts. I think a new business model might not be a bad thing. Sure, a lot of pharmacists as we know them would lose their jobs if the role of the pharmacy technician was expanded. It's probably necessary though. Right now, retail pharmacy is really kind of a broken profession. It's not serving the best needs of our patients, and it's certainly not serving the best interests of the pharmacists who practice in these settings.

Change like that is really scary, but maybe in the long run, it's what we need.

Tuesday, June 15, 2010

Stupid Fax Machine

I swear that modern technology makes people brain dead...

The other day a patient brought us a prescription for Lipitor. However, the doctor completely forgot to write a dose on it. The patient had never been on Lipitor, so we couldn't even make an educated guess.

I called the office and left a message explaining that we needed the dosage and to give us a call back at the earliest convenience. Three hours later, a receptionist called back and asked what the problem was. Apparently my message, which explained the problem in detail, wasn't good enough, so once again I had to explain the incredibly difficult concept that we cannot properly fill a prescription without knowing the dosage.

"Can you fax the prescription to us?" the receptionist asked. She said she had to show the nursing staff the prescription, so they could understand what's wrong. I told her that I really thought it would be a whole lot easier if she just looked in the chart or asked someone what dosage we were supposed to fill. After a few sighs, the receptionist took my message and told me a nurse would call me back.

Several hours later, a nurse calls me back saying they've been waiting for me to fax the prescription to them this whole time and that they couldn't get anything done without getting the fax first. I was starting to get frustrated by the run around, and I started to explain how it would be a whole lot easier for them just to ask the doctor, but she cut me off. "Can you just fax it?"

Fine... I faxed the damn prescription to them. The rest of the day went by, and I never heard back from the office. The next morning, the patient called back to ask what the status was. Of course, we still hadn't heard, so I called the office back...

For those keeping score at home, just to obtain the dosage on a prescription we've so far gone through me calling the office, then the office calling me back, then the office calling me back again, then me faxing the script to the office, then the patient calling me, then me calling the office yet again.

Anyway, I was ready to lace into someone there for being a FUCKING MORON. I told the receptionist that we faxed the script to them just like they asked and still didn't get a response.

"Oh... Our fax machine isn't working at the moment. We'll call you back tomorrow."


If this was a one time thing I wouldn't be so exasperated over the whole thing. However, the fact that this kind of shit happens all the time drives me fucking insane. Seriously... How fucking difficult would it have been for a nurse to go tap the doctor on the shoulder, "Hey doc, you didn't write a dosage on this prescription. What dose was it supposed to be?"

Would that have been that difficult? Really? It would have taken 5 minutes tops. Instead, we're going on 72 hours without an answer for which strength of Lipitor to dispense.

I swear, it's like the fax machine and e-prescribing has lowered their intelligence even lower than it already was.

This situation pops up about 100 times per week: A patient calls us asking if we've been able to contact the doctor to get refills on a prescription. We check and see that the fax was sent 2 days ago, but the doctor didn't get back to us yet. In these situations, we advise the patient to call the office to speed things along. Twenty minutes later, the patient calls back saying that the office never received a fax from us. We assure the patient that we got confirmation the fax was sent, but we'll resend it again.

An hour later, the patient calls back up saying that the office still hasn't gotten our fax, and they told him to have the pharmacy fax it over again... and the cycle of faxing and calling goes on and on and on. Finally, I'll get fed up with going around in circles and call the office myself.

"No, we never received the fax. Are you sure your faxing to the right place?" the nurse asks.

"Yes, we have the fax number correct, but regardless can I just take the verbal authorization while I have you on the phone now," I say, not wanting to go through the whole process again.

"I'll just e-prescribe it to you," says the moron nurse.


Everything has to be a fax or an e-prescription. Even when I have someone from the office on the phone, they still insist on doing everything electronically when it would be SOOOOOOO much simpler just to take 2 seconds and tell me over the phone.

Modern technology certainly makes a lot of things easier for us. I like the fax machine. I'd hate to have to call on every single individual refill authorization request. It would take forever. However, in situations where there is an obvious communication problem or when things need to get done quickly, I like having the option of doing things the old fashioned way.

That was the most frustrating part of my last two days. I have a couple other things I want to write about too, so maybe I can get my blog jump started again.

Thursday, June 10, 2010

I'm Still Alive

So... How is everyone in the blogosphere? For many months now, I've completely lost my inspiration to write. However, I felt like reading through some old blog posts of mine, and I figured I'd update my eager readers about my life.

What has changed in the passed 6 months? Not a whole lot. My job is just as annoying as ever. I'm still more than frustrated with my coworkers and their amazing laziness. I still haven't been sick, while my coworkers have missed probably about 20 days during that same span.

Personal life... Still with my girlfriend. Things are going pretty well. Not too much to write about. I'm just going week by week.

Professional life... I became an immunizer, so come this fall, I'll be giving out flu shots. I hesitated to become an immunizer because I couldn't really see how it was a giant step forward for pharmacists. I mean, medical assistants can give flu shots. Giving a shot isn't exactly a huge clinical step forward.

However, I started thinking about things. Our script volume has plummetted. When I started at this store, we were doing 3,000 scripts per week. Now, we're struggling to hit 1,900. Mail order is killing us. It's gotten to the point that my company has started to lay off pharmacists. For the time being, my job is safe. I'm pretty established in my store, and I have a pretty good work record and reputation. Despite this, I figured that it couldn't hurt to make myself even more marketable.

That's where flu shots come in. Flut shots bring in a lot of profit to pharmacies. Medicare pays us a nice administration fee for each shot we give. You give a few hundred shots per period, and you really increase your gross profit. Moreover, I hate being a pharmacist that can't do what other pharmacists can do. I hated when customers came to the counter asking for a flu shot, and I had to refer them elsewhere. I hated saying, "well, some pharmacists are certified immunizers, but I'm not one of them, so you'll have to get the shot from someone else." It made me feel like a lesser pharmacist.

Finally, flu shots are actually beneficial. They prevent disease and save lives. I'd much rather be administering the flu vaccine than handing out hundreds of unnecessary Zpaks per week. I've been complaining about how I feel like this job isn't really helping people. Well, here's my opportunity to actually help people by keeping them from getting the flu. Why should I let that opportunity go to waste?

I'll try to write more often. I just haven't had the motivation lately. I've had some thoughts that I really wanted to write about, but I never got around to doing it.