Tuesday, August 31, 2010

Sick Time

This is a question to the audience: What is your employer's policy on sick time?

I only ask because I can't figure out if my company even has a policy. Any member of our regular non-pharmacist staff gets 5 paid sick days per year. However, there seems to be no limit to the number of times a person can call out sick to work without being penalized other than not getting paid.

We have 2 technicians who both have been absent for work over 15 times this year so far. It's always one thing or another with one of them. First it was a back problem, which somehow evolved into a knee problem. Then there was a bout of Raynaud's Syndrome that mysteriously vanished within a couple of weeks. Then she suddenly developed slightly elevated blood pressure which somehow forced her to miss a day. There were a number of migraines, sinus infections, cases of bronchitis, and other general illnesses. Now, it's a stomach problem that's caused her to get an endoscopy. The list of problems just never ends.

I just got done with a shitty day of work because on top of her calling out sick, we had another tech who had to have surgery and is missing 3 weeks of work. In addition, another one of our clerks was on vacation. We don't have the hours or the staff members to replace anyone, so we worked short 3 people on a busy weekday when we get our big store order.

Even if we accept the notion that all her sick days were legitimate, doesn't there come a point where we just say that she's hindering the pharmacy staff with her constant absenteeism, and we threaten to suspend her if she misses any more days? Does it work like this in other companies?

I complained about this to one of my friends who is a manager for a non-pharmacy company. He said that his employees get 5 sick days every 365 days. If they go over that, they either can take a medical leave of absence for an ongoing medical issue, or they get suspended and possibly fired.

I just don't know what can be done. If the ailments are real, then how do you tell a person to stop getting sick? However, if the ailments are real, I also wonder just how in the world does she get sick so often? Why does she get so sick she has to miss work twice a month, but I never get sick enough to call out of work?

I said it before, and I'll say it again: I don't understand being sick. I really don't. I almost never get sick. I get a headache every once in a while. Maybe twice a year I get a minor sinus cold and a sore throat, but that's it. Meanwhile, we have people who come down with one illness after another all year long. Do their immune systems suck that badly or is mine just that good?

I'm just so frustrated with never having a full staff. We can never catch a break. On a slow day, we get 2 or 3 call outs, and we end up going crazy trying to do a volume that should be easy. If we don't get any call outs, we get slammed volume-wise. I would just love for a nice smooth day every once in a while.

I guess I shouldn't expect that though. This is retail pharmacy after all.

Monday, August 30, 2010

We Should Not Be Sending the Message that It's OK to Be Fat

Obesity is the single biggest health problem in the United States. We spend billions of health care dollars each year on these diseases associated with obesity. However, for whatever reason, we're not taught to treat obesity with the same disdain as smoking.

Smoking is a nasty habit. It makes you look bad. It makes you smell bad. It greatly increases your risk for cancer and heart disease. In addition, second hand smoke can pose a health risk to people who do not smoke. More and more people in this country seem to be in agreement that smoking is a horrible thing, and we should do whatever we can to curb the use of cigarettes.

Now, let's look at obesity...

It's a nasty condition. It makes you considerably less attractive. Obese people tend to sweat a lot at the slightest exertion and thus emanate an unpleasant body odor. Obesity is the probably the greatest risk factor for heart disease and Type II Diabetes. In addition, the notion that one person's obesity isn't something that can affect the health of another person isn't quite correct. If you are in a relationship, if one person gains weight, the other person is also likely to gain weight. In a group of friends, if one friend gains weight, the other friends tend to put on some pounds too.

Obesity and unhealthy eating is probably even more addicting than smoking, but we just don't think of it the same way. Consider this: If someone at your work brings in cupcakes, and everyone else is eating them, you're probably going to eat those cupcakes too. If the people around you always have unhealthy food, you're also much more likely to eat unhealthy.

I can vouch for this stuff first hand. I was never obese or even close to obese, but I used to eat quite unhealthy. My coworkers used to order out for lunch a lot, and that would mean 3 or 4 times a week I was eating french fries, fried sandwiches, milkshakes, etc. Eating this way was the culture of the pharmacy, so everyone participated, and you know what? We all gained weight.

After finally realizing that I valued being healthy and in-shape, I cleaned up my diet quite a bit. I started bringing lunch to work, so whenever someone wanted to order out, I never got anything because I brought my lunch. Seeing me eat lean chicken breast sandwiches on whole wheat every day, and watching me drop 13 pounds while getting into the best shape of my life had an effect on my coworkers. Suddenly, they started bringing their lunches more often. We stopped ordering out. Everyone started losing weight and exercising more, and we all became healthier for it.

As it stands, obesity is part of the culture of the United States. Burgers, fried food, fast food restaurants, ice cream sundaes, cookies, cakes, and brownies. We all view these things as the finer treats in life. Our lives are centered around unhealthy food. It's just a part of our lives now, and we actually think it's unusual when someone tries to eat healthy.

I've actually been ridiculed for my attempts to eat healthy. Does that make any sense? "Why are you going on a diet and doing all this exercise? You don't need to lose weight," many people said. Upon telling a coworker I lost over 10 pounds, she actually told me that I'm supposed to fill out as I get older instead of getting smaller.

Those are just a couple examples of the fucked up way of thinking people have in this country. We're so used to people being overweight, that we think it's highly abnormal for someone to be healthy and fit. Instead of ridiculing the 250 lb guy with his gut hanging well out over his pants for eating that tub of ice cream, we poke fun at the 155 lb guy who refuses the ice cream because he wants to be able to run a sub-6 minute mile well into his thirties. Where's the sense in this?

Why do we tax cigarettes to the point where they cost almost $10 per pack, but unhealthy fast food is usually some of the cheapest food you can find? Those McDonald's cheeseburgers and Oreo Cookies are just as likely to cut your life short as cigarettes, but nobody acts disgusted when you break out a bag of Oreos. You have to be 18 to smoke cigarettes, but you can start cramming donuts down your throat the moment you're old enough to chew.

I can hear the dissenting voices now... "Some junk food every once in a while isn't that bad. It's all about moderation." Of course, my response is that the occasional cigarette isn't that bad either as long as you can keep it on an occasional basis.

"But cigarettes have nicotine, and nicotine is physically addictive!"

Sugar and high fat food is just as physically addicting as cigarettes. In fact, it's probably more addicting. You don't think so? I challenge you to stop eating candy, sweets, and junk food for as long as you can. How long do you think you'll last? A day? Maybe 2 before you break down and have that little piece of chocolate. You'll go through withdrawals, but a different kind than if you tried to quit smoking. You'll have that insatiable craving for something sweet or salty. The craving will be so strong that it messes with your mind. Every time you think of food, you'll crave pizza or a chocolate bar or buffalo wings. You'll have a perfectly edible healthy meal in front of you, but it will taste terrible to you because it doesn't have those bad ingredients you crave. If you stop and think here, you'll realize that you're addicted to that unhealthy food. It's no less of an addiction than smokers to their cigarettes. It's just far more socially acceptable for some reason.

Back to my main premise... Obesity is something that should be looked down upon as much as smoking. We shouldn't be passing along the notion that it's OK to be overweight. We certainly shouldn't be telling people to feel proud and unashamed of their bodies when they're 50+ pounds overweight. Being significantly overweight is literally the worst thing you can do to your body. Fat people take up a far bigger chunk of health care dollars than any other group, and in just about every case, obesity is preventable.

Therefore, I would like to lend my support to any bill or proposed law that would tax the shit out of unhealthy food. People do not have the willpower or the knowledge to stop eating so poorly on their own, and this country does not have a culture that supports a healthy lifestyle. If it takes the government to step in and mandate healthy eating in order to get the incredible number of obese Americans to eat right, get to the gym, and drop a few pants sizes, then that's what we should do. The government's anti-smoking agenda completely changed the nation's view on smoking. I'm sure it could do the same for obesity.

Monday, August 9, 2010

Eisai and Pfizer Are the Latest to Honor Former NBA Great Michael Jordan

With the approval of Eisai and Pfizer's new drug application for Aricept 23 mg, the companies are the latest on a long list of companies and individuals to pay homage to NBA legend Michael Jordan.

"Michael Jordan's awe-inspiring play, competitive spirit, and overwhelming charisma has left a lasting impression on the minds and hearts of billions of people world wide," stated Pfizer CEO, Jeffrey Kindler. In helping to maintain and improve the cognitive abilities of those suffering from Alzheimer's Disease, we hope Aricept can keep the memories of MJ's amazing athletic feats alive for years to come."

Kindler continued, "We could have made this high dose Aricept formulation be 20 mg, or even 25 mg in order to be consistent with the 5 mg increment dosing of Aricept that is already in place. However, we thought that this was the perfect time and Aricept was the right drug to honor the great Michael Jordan. Thus, we settled on 23 mg."

***(This story is obviously not true... at least not to my knowledge. Eisai and Pfizer very well could have been honoring Jordan. How else did they come up with a nice, round number like 23 mg? Was 20 mg way too low? Was 25 just too high? We'll never know.)***

Friday, August 6, 2010

The Future of Retail Pharmacy

$4 Generics

Free Antibiotics

Free Diabetes Medication


All across the pharmacy blogosphere, pharmacists and technicians have complained that these developments in retail pharmacy are steps on the road to the end of the profession as we know it. Pharmacists are being devalued by giving away product and professional services for free, and it seems like there's nothing we can do to stand in the way of our corporate masters instilling these plans.

I'm going to just lay it out there as I see it, and you can agree, disagree, discuss it, whatever. The retail pharmacist is on the way out. I don't know how much longer it will be before it happens, but I truly feel that it will eventually happen and probably within my working lifetime.

Let's just take a step back and look at how retail pharmacy started.

Back in the day, retail pharmacists possessed one special skill that no other professional had. Pharmacists could compound medication. A physician would write a prescription for a specific ointment, solution, or other dosage form that needed to be specially prepared before dispensing to a patient. Pharmacists filled that role. They were needed. No one else had the training to make complicated compounds. It was all up to the pharmacist.

As the years passed, drug manufacturers started to make their own pre-packaged dosage forms. Slowly, the need for specialized dosage forms for patients decreased as most patients could be treated using the manufactured products. Compounding started to go away, but the convention of a retail pharmacist remained. Doctors still wrote prescriptions, and pharmacists still filled those prescriptions. However, instead of using their specialized skills, they simply pulled a product off the shelf and stuck a label on it.

To make themselves feel more useful and professional, the notion of counseling on medication came along. Pharmacists felt they really should be doing more than sticking a label on a bottle, so they decided that their new professional role would be medication counseling. However, medication counseling isn't something that is unique to the profession of pharmacy. Doctors can counsel patients on medications. So can APRNs, physicians assistants, nurses, and pretty much any health care professional. You might be able to make an argument that a pharmacist undergoes more intensive schooling about drugs than any other health care professional, and therefore, they are best fitted to provide counseling. Regardless, unlike compounding, counseling is not a skill unique to pharmacists.

It shows too. Feel free to disagree with me, but from my perspective, I do not think that most retail pharmacists are presently capable of providing medication counseling to patients above and beyond any other health care provider. Some retail pharmacists take an active role in learning as much as they can about medications out of either curiosity or a feeling of professional obligation. Most others are just happy to count by five all day, and for the most part, their employers will let them. I think reading pharmacy blogs gives us a skewed perspective of the sense of professional responsibility and enthusiasm that most pharmacists have.

In my experience, most just want a paycheck. They got into pharmacy because they liked the idea of getting paid big bucks to count out pills all day. I'll admit that's the reason I went to pharmacy school. It looked like a really easy job that didn't have a whole lot of responsibilities except to not kill someone. Obviously, I wasn't quite correct, but my point stands. Most retail pharmacists do not choose the profession for the same reason that people choose to become doctors or nurses. Most retail pharmacists didn't choose retail pharmacy because they thought they were providing health care. They chose it because it was a science profession that got paid well and was on the outskirts of health care without actually being health care.

Again, I'm generalizing. This isn't why ALL retail pharmacists chose the profession, but in my experience, it really seems to be why the majority did.

Most pharmacists would rather not counsel. Now, if a law came out and forced pharmacists to counsel, I'm sure most of them would do so out of fear of losing their jobs. However, I think most pharmacists are just hoping that every customer that comes to pick up medication checks that little counseling denied box.

Since retail pharmacy is run by giant corporations like CVS, Walgreens, and Walmart, you can bet that unless there's some money involved in counseling, no corporation will truly start an initiative to promote counseling on all medications. Since giant corporations rule health insurance in this country, you can bet that they'll do very little to help pharmacies get reimbursed for standard counseling on all prescriptions. Unless some kind of law gets passed that absolutely demands counseling on all new prescriptions (and that law will be fought tooth and nail by the big corporations), you won't see big chain pharmacies really forcing their pharmacists to counsel. They'll pay lip service to the public, but their corporate policies will actually discourage services that don't provide monetary benefit.

If pharmacists are not compounding, and they're not really counseling, what purpose do we really have? Why do we get paid so much when essentially all we get paid for is to fill prescriptions? The answer is that we don't have a true purpose in the current pharmacy model. We're superfluous, unnecessary. Our 6 figure salaries are the biggest thing standing in the way of those giant corporations making more money. Since we no longer offer a service no other health care professional can provide, we can be phased out in favor of less expensive labor in the form of trained pharmacy technicians and increased use of robotics.

Is the elimination of the retail pharmacist the best thing for the public? Absolutely not. Mistakes will increase, and even if we are not using our clinical knowledge all that much, the fact that anyone who has gone through as much difficult schooling as a pharmacist has to have a certain degree of intelligence and responsibility that would serve well in any job. However, what's in the best interests of big corporations is rarely what's in the best interest of the general public. The corporations will try to make more money in any way they can, and customers will adjust to whatever future changes are made to the current retail pharmacy format. For all the talk about how the United States is the land of the free, the vast majority of the general public seems to simply adjust and accept whatever choices are taken away from them. If the corporations change and offer no other choice, the American people will go along for the ride. They might complain a little. They might say they liked things better the old way, but in the end, they'll just roll with the punches. Therefore, don't expect the public to put up much of a fight if retail pharmacists are greatly reduced or eliminated altogether.

I feel like I'm in a race against time. I truly think the days of the retail pharmacist as we know them are numbered. However, I don't know how much more time we have. Therefore, I'm hoping that my job will last just long enough for me to figure out what else I can do with my life that would provide some kind of service or benefit to the general public. I'll admit that if I thought the job would last forever, even as much as I don't believe in what I'm doing, I'd probably continue doing it simply because it pays well enough for me to live a nice, comfortable life. I don't think it will last forever though. I'm not even sure if it'll last another 5 years (for a variety of factors not just corporate elimination of pharmacists). There has to be something else I can offer that few others can. I think that's the secret to job security.

Tuesday, August 3, 2010

Friendly and Helpful

"This is a medication I can't be without. Can you give me some medication until my doctor calls it in?"

This was uttered by a man who had called in a refill for his Effexor XR late on a Friday afternoon only to realize he had no refills left. He was all out of his medication that he "can't be without."

"Yes, of course we can give you some to get through the weekend, and we'll call the office for you on Monday to get the refill authorization." That's what I politely told him. I work for a corporation, and that's what I have to say to people.

However, I really wanted to have a conversation with this man. "You need it? Oh yeah... What would happen if you don't get it?" I really wanted to inquire. If he missed one weekend of Effexor XR, would he die? Would he get very depressed? Would he get really sick? I really wanted to know. If he needs it, does that mean he'll be taking Effexor XR for the rest of his life? What happens if the company decided to stop making Effexor XR one day? That would force him to use the generic, and every crazy person knows that those generics just aren't as good as the brands. What would he do? I guess he'd just cease to exist.

Moreover, if he "can't go without it," then why didn't he call it in really early? If he "can't go without it," why wasn't he on top of how many refills he had left? Why didn't he call the doctor's office directly instead of just leaving it up to us? If I couldn't go without something, I would do whatever I had to do to make sure I didn't run out of it. It would probably get my undivided attention.

Alas, I can't say these things. I have to remain friendly and helpful or risk losing a customer.

"This IS my correct insurance card. It's the only card I ever used at any pharmacy. They never sent me a new one, and nothing should have changed. Can you call the insurance company to find out what's the problem?" This was in response to a filled after coverage terminated rejection. She stood at the counter glaring at us making no indication she would move from that spot until someone called the insurance company. So I fucking called them and acted happy to do so.

I would have really loved to make a wager with her though. "I bet you the cash price of this prescription that you have a different insurance card." How do you think she would have handled that one? I think I wouldn't have a job today if I proposed that bet to her. My district manager would have fired me on the spot probably.

I was right though. I usually am in these situations, especially dealing with customers who don't know what the fuck they're doing. I've recently been called arrogant because I stated that I'm smarter than most people. You want to know what arrogance really is though? Arrogance is a customer coming into my pharmacy and basically telling me that I don't know how to do my job. I told that woman that her old insurance coverage is expired and that we needed to see her new card. She told me I was wrong. Is that not the ultimate form of arrogance for someone who hasn't got a clue to argue with someone who, for all intents and purposes, is an expert?

I wasted of 5 to 10 minutes of my time, and what did I get out of it? Nothing. She ultimately didn't take her prescription because her insurance didn't work.

I get paid roughly a dollar per minute. Therefore, I propose that in situations like this I should be able to get out a little timer and inform the patient that I will make the call to the insurance company for her. However, if I'm right, she will have to pay me one dollar for every minute I waste confirming something I already knew to be true.

It makes perfect sense, but it could never happen because god forbid we just might piss off a customer. Instead, I waste time and money doing pointless shit all day while smiling and acting friendly. I have to wait until I get home to say "FUCK YOU!"