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!"


Anonymous said...

Love your blog generally. On this one though - yes if he did without Efexor over the weekend he may well be sick. From the SPC 31% of patients had withdrawal effects in clinical trials, these include "Dizziness, sensory disturbances (including paraesthesia), sleep disturbances (including insomnia and intense dreams), agitation or anxiety, nausea and/or vomiting, tremor and headache"
It doesn't explain why he didn't sort it out earlier - but it could have something to do with depression sapping his motivational & organisational skills - I'd usually try and give this group of patients as much help as they need.

We get a load of naff requests for "urgent" simvastatin etc, this was perhaps just a bad example though.

Keep blogging xx

rxmeds96 said...


Pharmacy Mike said...

Perhaps Effexor isn't the greatest example. I know you can develop withdrawal symptoms. I think it's more the words he used and the tone of his voice.

"I can't go without it" implies that it's impossible for him to miss any doses. It implies that his life would be in grave danger if he missed a couple doses of Effexor XR. It implies that he cannot live without it.

I contend that missing a couple days won't kill him. It might make him a little uncomfortable, but he'd survive with most likely zero long term effects. Perhaps missing a few days and going through a little withdrawal would do him some good. Maybe it would make him be a little more careful not to run out of medication in the future.

Ros said...

Mike I am putting this here cuz I dunno where to put it. Have you seen Sicko? In pharmacies with National Health Service, patients have to tolerate what the govt gives them. So no squabbling about insurance since everything is same price. The British RPh.laughed about American Pharmacies selling diapers/cough drops, etc.

Pharmacy Mike said...

Yes, I saw Sicko. I actually wrote a blog post about it. A single payer system would be a dream come true to me. It's never going to happen in this country though. NEVER. Big businesses won't allow it. They've bought off every single politician, and brainwashed a large majority of the American public into thinking that giant corporations designed to generate profits are perfect for a health care system.

Anonymous said...

And Mike, you think an even more giant government designed to generate bureaucracy is a better alternative?

Pharmacy Mike said...

I've covered it before, so I really don't feel like saying it again and again. All I'll say is that giant government involvement in health care is a billion times better than it being run by giant corporations who function only to make as much money as possible. Therefore, it's in their best interests to not pay and deny claims whenever they possibly can. More denied claims while still raking in monthly premiums equals more dollars in the share holders pockets.

They don't give a fuck about us. Not a single bit. They have us all by the balls. We're forced to play their games by whatever rules they concoct. The system isn't capitalism any more. It's not part of the free market. In a free market, we're free to choose whether we want a product or not. If another company sells a better product for a lower price, we could purchase from that company instead.

With health insurance, we have no choice. We have to have it or risk going bankrupt from health care bills if we ever get sick. Hell, even with private insurance, there's often a limit to coverage, and really sick people end up bankrupt anyway. We can choose one company over another, but in the end, they all do business in pretty much the same way. One isn't more ethical than another, so we're forced to put up with the same shit no matter what.

From a philosophical view point, a system where a company profits by NOT paying for our health care when we are sick, is certainly not ethical. I'll take the bureaucracy any day over it.

I don't even have to mention that other countries (nearly the entire civilized world) have national health care systems and most of them provide better overall health care than our system as measured by infant mortality, overall public health, life expectancy, rates of chronic diseases, access to care, ratio of doctors, nurses, and hospital beds per patient... and they do this spending far less per capita than we do.

But once again... this post isn't even about national health care, so I'm not even sure how we got onto this subject. I said my keep (again). I won't say any more about it.

Anonymous said...

Hear, here. Let's hear it for the concept of National Health Insurance. The idea of it sounds a lot better than the rapacious monster previously available, even now, with what's been legislated into law --National Corporation Private Health Insurance.

Anonymous said...

Ummm since you do not seem to like any of your patients maybe you should change professions. I have been in retail pharmacy for almost 20 years and still like and respect my patients. No one is perfect. Maybe a little compassion would do you good.

Pharmacy Mike said...

Where in my entire blog do I even imply that I do not like any of my patients?

I like most of my patients just fine. I do not like all of them though. If you like all of your patients, good for you. Personally, I wouldn't mind if about 5 or 10 of mine got hit by a bus the second they left the pharmacy. However, the vast majority are good people.

However, I absolutely do want to leave the profession, and I've written about it. I don't like this profession. Retail pharmacy in particular is kind of pointless in my eyes. I really don't believe I'm doing anything to help the world by filling dozens Adderall and Vicodin scripts each day, not to mention the shit load of ZPaks that we fill for people who have colds.

I'm trying to figure out what I can do to get out of pharmacy altogether. I do not want to practice in any other setting. I want out completely. I'm just trapped at the moment by college loans and a car payment. Once I pay those off, I'm seriously going to figure out what else I can offer this world other than pushing drugs.

Anonymous said...

Mike, you're awesome. People like you prevent me from going AWOL in the pharmacy QD. Thanks!

Anonymous said...


burned-out medic said...

absolutely agree with you - some people need to get run over by a bus.

Anonymous said...

Sorry, I know this is months late, but @ Anon 8/5/10 2:44am... You LIKE most of your patients? Freak. I don't live in the same town that I work in, so most nights I drive home praying -- yes, futiley PRAYING -- that a Goddamn meteor will hit that town. Except, of course, the ones that survive the strike will have lost their Vicodin and I will need to call their (dead) physician for authorization.

You know which patients I LOVE -- the ones in tank tops (college town). Yeah, they can get as much counselling as they need. Jesus, I love boobs. BOOBS! Who's with me?? In my pharmacy, if you are showing me cleavage, you will get a 3-day advance no prob.

In my 1st year of practice -- and I swear to God this is true -- two sorority pledges came in with a scavenger hunt list. One of the items on the list was "impotency pillz" (sic). I told them I would give them whatever, but they had to make out in front of me for 30 seconds. Without hesitation, they did. So I took an almost-empty Viagra 50mg bottle, dumped the last few Viagra into antother stock bottle, threw like nine Aleve into the empty, and GLADLY handed it over.