Retail Pharmacy, Life, and General Lunacy

Writing to Keep My Mind Sharp

2011-05-24T20:39:00.002-04:00

For the past couple of weeks, I've felt an urge to write. The only problem is that I can't think of suitable topics. Therefore, I've produced nothing. Basically, the intent of this post is to just write for a little bit to see if something worthwhile comes out of it.

I've always said that I used writing as not only a means of expression but also as a way to try to make sense of the jumbled thoughts in my mind. Writing also serves another purpose for me. I find it very intellectually stimulating.

A lot of my blog posts were about my feelings at certain times of my life. However, there were also many posts where I would give my opinions on a specific topic. These posts could be looked at almost like persuasive writing. I'd put out an assertion and then try to back it up using logic or evidence.

I find those kind of posts the most intellectually stimulating. As I'm writing them, I can literally feel different areas of my brain come to life. Working through the logic and creating my argument kind of feels like an adrenaline rush. It's a challenge, and even though I'm the one who made the particular assertion in the first place, I feel like I'm teaching myself about it. It's hard to explain.

It's also hard to get that kind of stimulation anywhere else. At work, I have to constantly defer to other people. Corporate makes a new policy, and I'm expected to carry it out. There's no room for argument, no room for disagreement. If corporate wants to give out free antibiotics, no amount of persuasive logic is going to change their minds.

With customers, I'm either the drug expert who dispenses medical advice, or I'm the customer service representative who has to basically kiss ass. There's not a whole lot of genuine back and forth. The customers don't challenge my knowledge, and I can't challenge them when I think they're being stupid.

My girlfriend and I hardly ever argue. I know; most people would consider that a good thing. And it is. Sometimes though, I feel like there's something missing if there's no arguing. I feel like neither of us are challenging each other. We certainly can't agree on everything, so if we're not arguing at least sometimes, then we really aren't being completely honest.

However when it comes to my blog, anyone reading is free to fire back at me. They can agree, disagree, or bring up another point that I never considered. I crave that back and forth. It keeps my mind moving. It keeps me from getting complacent. I need my beliefs to be challenged occasionally.

That's why I haven't quite given up this blog. I don't write very often anymore, but I like leaving open the option to write. I've thought about starting a new, non-anonymous blog, but then I have to come up with some kind of clear narrative. For example, I can't bitch about how an absent coworker made for a shitty day at work when everyone at work could read about it. I'd have to only write about certain things. I'm sure I could do still get some good writing done, but it wouldn't feel quite as authentic.

For example, if everyone knew about my blog, then I couldn't write about how sometimes I think I'd be better off single than in a relationship. I'm sure my girlfriend wouldn't be too pleased by that entry. Sometimes I do feel that way though. It doesn't mean I want to break up with her. It just means that I'm not entirely sure what I want just yet. Or maybe it means that even people in committed, caring relationships sometimes wish they could have the personal space of a single person. It doesn't mean they don't leave their significant others. Sometimes it just feels good to be your own person and not have your entire identity intertwined with someone else.

I can't have that conversation without this blog though. However, I crave that kind of conversation. I like examining those deep thoughts and putting them out there for people to think about and comment on.

Anyway... I just wanted to get something written. Maybe that will spur some more writing in the near future.

This Is Why Pharmacists Are Suspicious of ALL Narcotic Prescriptions

2011-04-11T22:44:00.002-04:00

A couple weeks ago a woman called our pharmacy asking if we had Oxycontin 60 mg in stock. We informed her that we did, but the only tablets we had were of the old formulation.

I swear that she couldn't have been more excited if she shouted Eureka! into the phone. "I'll be right down," she said.

A few minutes later, this perfectly able-bodied woman shows up at our pharmacy counter with a prescription in hand for the Oxycontin. "How much is it for 30 tablets?" she inquired. Surprise, surprise... She wanted to pay cash for them.

We looked it up, and she decided 30 was too expensive for her, and she wanted to know the price for 25. Apparently, 25 tablets wouldn't completely wipe her out, so she then asked us to fill it for 26 tablets.

To enlighten those of you who might be uninformed about drug prices, 26 tablets of Oxycontin cost in the neighborhood of $200. Moreover, the script was from a doctor's office located over an hour away, and she was a new customer to us. There was no way this prescription could be legit. Therefore, we called the office to find out just what was going on.

The nurse gets on the phone and she listens as we tell her how shady this woman appears to be. The nurse checks with the doctor and a couple minutes later, she returns to tell us, "Dr. Dipshit said you can definitely trust her."

OK... Whatever he says. So we document the shit out of the situation, and fill the script for her 26 Oxycontin. Several minutes later, she returns to the pharmacy counter holding about $200 in cash, and proceeds to slap $20 after $20 on the counter as she pays for the prescription.

Yeah... Really trustworthy.

A couple weeks later, the woman calls our pharmacy inquiring once again if we had Oxycontin in stock. Once again, we did, and once again, she gleefully remarked that she'd be down in a few minutes.

Same prescription from the same doctor, only this time, the full 30 tablets would be just fine. Little did she know, she had nearly wiped us out of the old formulation last time, so we had to dispense the new formulation to her. I decided not to tell her this little fact because I was curious to see what would happen when she found out.

The technician went to ring her up at the register, and she almost had a heart attack because the price of the tablets was $22 more expensive than she thought it would be. "That must be some kind of mistake," she proclaimed. "Is that the new formulation?"

I confirmed her suspicion, and she immediately asked whether we had any of the old formulation left. Alas, we only had 10 tablets left, not enough to fill her script.

"No problem. I'll just take the 10," she responded.

Yup... completely trustworthy.

In the end, she did us a favor because she helped us get rid of all the old formulation tablets we had left. In addition, I'm reasonably sure that she'll never come to our pharmacy ever again.

Here's the thing though... All you people out there who have legitimate reasons for taking narcotics don't realize that these kinds of stories are closer to the norm than the exception. We fill ridiculous amounts of Oxycontin and oxycodone prescriptions and a good majority of them are for very sketchy people. However, every time we call the physician, we get the same response. "Yes, fill the prescriptions."

Just recently we had a guy and his buddy come to the pharmacy both presenting prescriptions for 240 tablets of Oxycodone written on the same day by the same out of state doctor. We called the office, and they didn't understand why we'd be questioning it. Yeah... two well built young men who happen to be friends getting the same narcotic prescription for massive quantities from the same out of state doctor on the same day. I have no idea why that's suspicious at all.

How about the woman who takes Percocet 7.5, Avinza (extended release morphine), and Exalgo (extended release hydromorphone) twice daily? We called the office wanting to know not only why she's taking two different 24 hour extended release narcotics, but also why she's taking one of them twice daily. Moreover, she has a sister that goes to the same office, and the doctor writes Avinza, Percocet, and Tylenol with Codeine prescriptions for her as well. The nurse didn't take too kindly to us questioning these pain management regimens. In fact, she was quite annoyed.

How about the woman who was getting 120 Vicodin a month from one doctor and also getting 90 Percocet a month from another doctor? We called to let one doctor know she was getting pain meds from another doctor, and we were told that they were aware of the situation. You see... She's taking the Vicodin during the day, and the Percocet when she needs pain relief at night. Oh, I see... I totally should have figured that one out. After all, it's not at all unusual for someone to chew through 120 Vicodin and 90 Percocet per month, especially if the Percocet is only supposed to be taken at night. Completely normal.

See... the biggest drug dealers in this country aren't slinging dope on the streets or cooking up meth in a basement laboratory. They're actually the doctors who will write for whatever narcotic patients ask for as long as they say they're in pain. As pharmacists, we're told that we have to be constantly vigilant for signs of drug abuse and misuse. We're forced to keep tabs on pseudoephedrine because it's apparently OUR job to stop meth junkies and sellers from cooking up meth in their basement laboratories. We're encouraged to use controlled substance databases to help reduce doctor shoppers and people who pay with cash at multiple pharmacies. Our license could be on the line if we don't document that we at least tried to verify any suspicious prescriptions. However, prescribers have free reign to allow patients to basically write their own prescriptions for narcotics.

My biggest issue is if doctors don't care, then why do I have to care? If they're prescribing habits are going to facilitate drug abuse, then why do I have to try to clean it up? I just can't seem to figure it out.

My Technician's Kid Gets Sick Means I Work More

2011-04-05T20:26:00.003-04:00

This is a serious question to all you working parents out there: What do you do when your kids get sick?

I need to know how the normal person handles this situation because I can't imagine that every single time one of your kids get sick, you call out of work to take care of them. That's what happens with one of our technicians though. She has 3 kids, and every single time one of them has a sniffle, she has to stay at home and take care of the little cretin. She only works 3 six hour days per week, and I can't even remember the last time she went 3 weeks in a row without calling out at least once.

As you can imagine, a technician constantly calling out in a busy retail pharmacy kind of sucks. In fact, it pretty much screws the rest of the staff. Case in point, the last 2 days, I've had to stay well past when my shift was supposed to end because we were short staffed all day and constantly behind.

This really pisses me off. Why does her kid getting sick mean I have to work my ass off even more than I usually do in order to pick up the slack left by our absent employee? I've written before about how much I hate when people call out sick. However, this is even worse because she's not even sick and calling out. It's her fucking kid!

The kid is 13 years old by the way. I just wanted to give additional context. To me, a 13 year old is perfectly capable of taking care of himself at home for a few hours. I know I did when I was 13. However, her 13 year old isn't allowed to be home alone.

While I'm ranting and raving here, let me state as clearly as I possibly can that I don't care about anyone else's kids. They're not my kids. I don't care what they do. I don't care if they suddenly drop dead. However, despite my not wanting to have anything to do with them, they certainly seem to be able to interfere in my life. If I wanted to worry about and be inconvenienced by kids, I'd have some of my own.

Oh, by the way... Driving kids from one activity to another is not hard work! And every time I hear someone complain about having to spend all day playing taxi for their kids' extra curricular activities, I have to fight the urge to unleash an expletive laced tirade. You think driving a car from one place to another is hard work? TRY MY JOB! Try standing on your feet for 12 straight hours with barely a 10 minute lunch break (if I'm lucky) while trying to do 5 things at the same time with the phone ringing all fucking day long. Carting your fucking kids around would be a goddamn vacation for me.

I'm just tired of this shit. I killed myself at work the past 2 days (and have done so plenty of other times over the past 4 years) simply to cover for someone else. Where is the reward in all of this? Most of those extra hours go unpaid, so it's not like it benefits me financially. I don't get extra time off to compensate for working so damn hard. My job is only as secure as the amount of seniority I have in the company (which isn't a whole lot). There are no promotions, so there's no room for advancement.

You want to know the worst part though? The harder I work, the less everyone else works. I used to think there was such a thing as leading by example. You work hard, and everyone else will see your example and do their best to match it. That doesn't really happen though. If people see me constantly do something, they just assume that I will always do it. Therefore, instead of doing it themselves, they'll just leave it for me to do for them. And I always fucking do because I know it has to be done, and it bothers me to not do the absolute best I can.

I'm telling you... I'm getting closer and closer to the breaking point. If I do snap one of these days, I just hope whatever I do really inconveniences someone who has kids.

"You're Lucky to Have a Job"

2011-03-15T23:44:00.003-04:00

I should be sleeping right now. I have to get up less than 6 hours from now in order to get ready to open the pharmacy tomorrow morning. I just really felt I had to get this post done. I've been wanting to write it for a week now, but I've been putting it off for various reasons. Anyway...

A couple weeks ago, I had a particularly rough day at the pharmacy. Nothing went right. A technician called out. We were incredibly busy. There was one insurance problem after another, and the phone would just not stop ringing! I was going insane.

Finally, with about 30 minutes left in the day, things started to settle down, and I got a little quiet time to finish up some paperwork that I didn't get a chance to do earlier. I started ranting to one of our technicians about how something has to change in this pharmacy because I don't know how much longer I can deal with all this crap.

She listened for about 30 seconds before saying, "well, just be happy you have a job." You see, working at the pharmacy is her second job, and she doesn't get paid particularly well for it. It was supposed to be something to supplement her income. However, she's getting laid off at her primary job. Without her primary source of income, she's unsure if she can make ends meet.

This made me feel kind of stupid for ranting about my situation to her. After all, she was right. I do have a job, and I get paid quite well. A lot of people would kill to have my salary, especially at my age.

However, later that night, I got to thinking that there has to be a point where "you're lucky to have a job" no longer applies. I understand that a lot of people don't have jobs. I understand I'm very fortunate to be paid very decently. However, just having a job and being paid decently shouldn't preclude me from complaining about shitty work conditions.

By the "lucky to have a job logic," my company could force me to fill 1,000 prescriptions per day by myself without any help at all while dealing with all the customer complaints and all the phone calls, and I'd have no reason to complain because at least I'm employed and making 6-figures. At some point, the stress reaches a level where it doesn't matter how much damn money I make, I'd rather be unemployed and broke than be treated like shit.

I can't think of a single profession that forces you to multi-task more than a pharmacist does on a daily basis. At a busy pharmacy, there's always 5 or 6 things going on at the same time, and the pharmacist is responsible for directly supervising EVERYTHING. While we're trying to fill prescriptions, the phone is ringing. It's a doctor calling in a script, and only a pharmacist can take that call. However, there's also a customer at the counter that wants to ask a question that only the pharmacist can answer. While trying to decide which to attend to first, the prescription for Celebrex you were typing into the computer just came up "prior authorization required," which means that you have to send a fax over to the doctor's office in order to let them know they either need to call the insurance company or switch it to something else. Naturally, the guy in line after the customer asking the question is looking to pick up that Celebrex prescription...

This goes on ALL DAY LONG, and it happens EVERY DAY. Oh yeah, and while you're trying to handle these pharmacy tasks, you just got an email saying another drug has been recalled. It's the third one of the day, which means for the third time, you have to check your shelves, quarantine the recalled product, and fill out the paperwork that corporate requires. The next email is telling you about the Aetna audit that's taking place next week. You have to make sure to make all those prescription files available for the auditor. And the warehouse is out of vial caps for the second time this week, and since you're running extremely low on them, you have to call a bunch of other stores to hunt down some that you can borrow.

Between filling prescriptions, dealing with customers, dealing with doctors, handling insurance issues, and following corporate policies, you're head is spinning all day long. You're constantly racing around. You work 12 hours without a proper break. You just briefly pause for 5 to 10 minutes to scarf down a sandwich, and then it's back to the grind.

And know what your reward is for busting your ass all day? Customers complaining, "20 minutes???? Is it really going to take THAT long??!?!?"

However, community pharmacists can't complain about this because, hey, at least we have a job, and we make over $100,000 per year. We should just shut up and take it because we're "lucky" to have the opportunity to be overworked and overstressed.

That's what the chains count on though. The reason they can get away with this crap is because, at the end of the day, most of us subscribe to this lucky to have a well paying job mentality. We hate the work, but we're addicted to the money, so even though we may complain, we won't do anything to really rock the boat and risk that paycheck.

I'm guilty of this. I want to quit my job so bad. Sometimes I actually get a little giddy imagining myself just walking right out of work one day and never coming back. I'm scared to death to do it though. I've become accustomed to my paycheck. I'm used to not having to pinch pennies. I'm used to just going out and buying what I want without having to worry about whether I can afford it or not. I'm addicted to the money.

Because of this addiction, my employer has me by the balls. They know that as long as they keep the money coming, I'll put up with whatever extra responsibilities they throw at me. The money provides an illusion of freedom when in reality, it is the thing that imprisons me.

However, I feel like I'm very close to boiling over. I'm not quite there yet, but I feel like soon, I'll reach the point where the money just isn't worth it anymore. It would be scary, but losing this job might be the best thing that could happen to me. It would be the kick in the ass that I need to find something that I'm happier doing.

***I said I was done writing here. However, I guess I haven't quite run out of things to say. I'm sort of feeling the urge to write recently, which is probably a sign of mind not being at ease. In any case, if I have something to write about, I'll write about it.***

Another Prescription Error That Could Have Easily Been Avoided

2011-03-09T11:40:00.002-05:00

I'm going to turn this blog into ranting and raving against the forces in our profession that seek to put the public in danger. My focus will be on prescription errors, and how often the simplest of things can help avoid them.

Our pharmacy had another prescription error last week. This one, to my knowledge hasn't been reported to the Board of Pharmacy. Although, I almost wish they would report it because I would go before the board intent on kicking up a shit storm.

A customer presented to our pharmacy counter carrying 3 prescriptions. For the sake of this entry, we'll say this customer's name was Thomas Richards. Thomas has been on pain medication for quite some time. He's had several recent procedures that have required him to get a number of different pain meds. His need for opioid pain medication is perfectly legitimate. He is not the problem here.

The 3 prescriptions were for 3 different pain medications. They were from the same doctor's office, written in the same pen, and given to the patient at the same time. The technician at the drop-off counter, added Mr. Richards' date of birth and address to all 3 prescriptions, and told him the scripts will be ready for pick up in about 20 minutes. Everything was seemingly going smoothly.

The other pharmacist on duty was the one who inputted the prescriptions into the computer. He noticed that the doctor had given Mr. Richards prescriptions for MS Contin, Dilaudid, and Percocet. He wondered out loud why the doctor would give this patient both Dilaudid and Percocet. However, since that office is an orthopedic group, and we see a ton of interesting pain med combinations from them, we just kind of shrugged it off. I've seen patients get prescriptions for Percocet designated for moderate pain and Dilaudid designated for severe pain. It's not that common, but not unheard of. Therefore, we decided to just let it go. After all, it wasn't like they wrote the scripts for large quantities, and Mr. Richards was certainly in pain.

Twenty minutes later, Mr. Richards comes back and his prescriptions are all set for him. He pays and goes on his merry way. Several hours later, he calls the pharmacy saying we made a mistake. He said that the prescription couldn't have been for Percocet because he gets very ill when taking it. The doctors know that and wouldn't prescribe him that. The script was supposed to be for Flexeril.

I look back and double check the prescription. It most certainly said Percocet 5/325. I quickly checked the name and date of birth (that we had to write on the prescription when he dropped it off). Yes, it was filled correctly. Mr. Richards sighed and muttered something about the dumb doctor's office, and hung up. A little later the prescription for Flexeril was callled in to us. I guessed that he must have let the office know of the mistake.

Several days later, we get a call from that office. "The prescription you filled for Thomas Richards for Percocet was filled in error," proclaimed one of the nurses. "Mr. Richards was never prescribed Percocet. That prescription was for Thomas RICHARDSON."

Sure enough, when I went back and triple checked the script, the name on the top was Thomas Richardson, not Thomas Richards. It was a prescription error.

However, let's back things up just a little bit. How the hell did Thomas Richards get Thomas Richardson's prescription?

You see... This is a practice that I think is unfamiliar to the general public. Doctors don't actually physically write most of their prescriptions. They usually have a nurse write them, and then they sign their names at the bottom. We see it ALL THE TIME. The patient's name and all other prescription info will be written in these big, bubbly, girly looking letters, and the doctors signature is scribbled at the bottom. It doesn't matter whether we're talking about prescriptions for blood pressure medications or for Oxycontin. Many doctors don't write their own scripts.

Secondly, the only conceivable way that Mr. Richards was given Mr. Richardson's prescription was if the prescription was written out ahead of time and stored in some kind of file at the doctor's office. Obviously, the doctor or nurse did not see Mr. Richards and Mr. Richardson at the same time. If he was only writing for one patient at a time, there's no way that one patient could have come into contact with another patient's prescription. The only possible way was if a nurse had to sift through a file to find Mr. Richards prescriptions, and it just so happened that Mr. Richardson's script was mistakenly filed under the wrong name.

Moreover, the patient's address and date of birth was not written on ANY of the 3 prescriptions for schedule II controlled substances that Mr. Richards dropped off. The technician at drop-off had to inquire to the patient's address and DOB, and she was the one that wrote them on all 3 prescriptions.

Therefore, when the scripts finally made it to the pharmacy, all 3 of them were written in the same pen, from the same doctor's office, on the same prescription blanks, dropped off at the same time by Mr. Richards, and all had the same address and DOB on them (because the tech wrote them in on all 3). However, one was for Mr. Richardson instead of Mr. Richards.

The nurse who called to tell us about the error gave me the "YOU FILLED IT WRONG!" attitude, and quite frankly it really pissed me off. Yes, I suppose ultimately, it was a pharmacy error. However, the patient, the technician, and 2 pharmacists both looked at these scripts and didn't notice the slight difference in the name on one of the prescriptions.

It goes down as a pharmacy error, but if the doctor had A) not written the prescriptions ahead of time, and B) had included the patient's address and DOB on every prescription (which by LAW, they are supposed to), we would have easily caught the mistake.

It's just another incidence when pharmacies are the ones getting shit on for prescription errors, even though we're seemingly the only entity in all of health care the gives a shit about doing things to prevent them. Every time a doctor writes sloppily, every time he uses unapproved abbreviations, every time he doesn't include the patients date of birth and address on the prescription, and every time he doesn't provide his DEA #, there is a chance for a prescription to be either misfilled or therapy to be delayed to a patient due to the pharmacy's attempt to try to fill in the missing information.

Everyone laughs about doctors' messy handwriting. It's a big fucking joke. The public just assumes that's the way it is, and it isn't going to change. If the pharmacy can't read what the doctor writes and has to call to verify a prescription, the patient gets mad at us and not the doctor. The public jumps all over pharmacy mistakes, but the doctor can write illegibly, prescribe the wrong dose, wrong drug, or a medication with a significant drug interaction, and the public just shrugs it off.

Why is everyone so afraid of doctors and people in their offices? People come in and treat the pharmacists and pharmacy staff like dirt on a regular basis. They yell and scream about customer service. They look to us to fix everyone else's mistakes, and then get mad at us when it can't be done in 5 fucking minutes.

I'm sick and tired of it. I really am. I can't be the customer service representative, insurance trouble shooter, I.T. help desk, store printer technician, cashier, secretary, business manager, AND pharmacist at the same time. Every time you interrupt me with something that isn't related to verifying the safety and accuracy of prescription orders, the chances of someone being harmed by a pharmacy error increases. Every time my District Manager requires me to personally walk customers directly to any item in the store that they might be looking for, I'm interrupted from possibly teaching someone how to use an inhaler or inject insulin.

I'm a pharmacist. I'm not a fucking customer service rep. I'm not a fucking cashier. I make sure prescriptions are safe, accurate, and that patients know how to use them. Everything else is superfluous. I don't give a shit about the fucking inventory being over budget. Get an ordering department. I don't have time to spend 2 hours on the phone with an insurance company to get a claim to go through that provides a $2.50 profit. Get a billing department.

I know I'm kind of ranting off topic now, but my overarching point is that we're asked to do too many things at one time, and even asking other medical professionals to take literally a few extra seconds to write patients' addresses, DOB's, and prescribers DEA #s on prescriptions seems to be too much of a hassle for them. It would literally take 5 extra seconds, but they can't be bothered, and because they can't be bothered, the chances of pharmacy prescription errors increase.

If you're a prescriber reading this, and you're one of these fucks that don't take those 5 extra seconds, FUCK YOU! Seriously, you're scum. You make pharmacists lives miserable because you're too fucking lazy to do what you're supposed to.

The Anatomy of a Prescription Error

2011-01-11T08:24:00.003-05:00

It should be an easy day. It's a Thursday. Thursdays are never really that busy in this pharmacy. The big order doesn't come until tomorrow. You don't have to create an order. It's in the middle of October, and while flu shots are really starting to pick up, you haven't had enough of them to really impact your work day.

You're scheduled to be at the pharmacy at 10, so you have plenty of time to sleep in. You get up at a decent time, have a nice breakfast, and even get some exercise in before showering and getting ready for work. You're nice and relaxed, and you truly feel that this will be a good day.

When you arrive at the pharmacy and take that first step through the door, you come upon what looks like a disaster area. Labels are all over the place. There's a long line at the register. The other pharmacist is hung up on a phone call, and the lone technician is getting frustrated dealing with a customer. No, the customer is not being rude. He's simply having an insurance problem that the technician, despite working in the store for 25 years, has no idea how to solve... mostly because she's completely computer illiterate.

You see... The pharmacist scheduled to open the store that Thursday got there 10 minutes late. Therefore at 10:00, a full 2 hours after we open, all the scripts that were left on the refill line overnight still were not finished, and those labels were in no particular order all over the pharmacy counter. That one technician, despite having all that experience and being full-time, has never counted a prescription or typed a new prescription. She's basically a highly paid cashier.

Before even taking off your jacket, you walk over to the computer to help the technician. It takes you less than 30 seconds to solve the problem that had frustrated her for the last 5 minutes. Afterwards, you hang up your jacket, take a deep breath, and get to work. No time for pleasantries. No time to get settled. You jump right into the fray in an attempt to get the pharmacy to the point it should have been over an hour ago.

However, it's never as easy as just putting your head down and filling scripts. The second technician was supposed to be in at 10:00, but at 10:20, she's still not there. Therefore, you're forced to constantly jump between being a pharmacist and the world's highest paid cashier. Finally, at 10:30 the second technician strolls in. There's no explanation for the tardiness, and quite frankly, you don't have the time to listen even if there was one, so you just keep chugging along.

Just when it looks like you're starting to gain some control, the phone calls start coming. The other pharmacist (the one that showed up 10 minutes late), is the floater scheduler for the district. He has to get that floater schedule out by Thursday of every week. However, the stores for which he schedules and the floaters that work in them are such major pains in the ass that he has to constantly revise the schedule all week. Therefore, in the middle of this crazy Thursday, he has to stop for 10 to 20 minutes at a time to handle scheduling emergencies. That leaves you to work the bench alone.

The scripts keep piling up, and on this day, the customers seem to be in extra need for pharmacist attention. You do your best, but you're only one pharmacist trying to do the work of two without much help from your cashier-level technicians. Now, the other pharmacist gets called upstairs to speak to the main store manager, so he disappears for a good 20 minutes. At this point, frustration is really starting to set in.

The wait time at the pharmacy is usually no more than 20 minutes, so when dropping off scripts, the techs/clerks habitually tell the customers it will take 20 minutes for their scripts to be ready. Realizing that you're so far behind that there's no way you can fill new scripts in 20 minutes, you tell everyone that the wait time is now AT LEAST half an hour. The next technician/customer exchange goes something like this:

"The wait time is 30 minutes, but it might not actually be that long. We're just really busy, so we're just telling people 30 minutes, but it will probably be done before that, so stop back and check in a little bit."

Therefore, despite the at least 30 minute wait time, customers routinely return to the pharmacy counter in 15 to 20 minutes. Upon return, the technicians apologize to the customer that it's not ready yet, and then both the customers and technicians look at you expecting you to drop everything you're presently doing to finish their prescriptions. You don't want to, but you can't help but start rushing in this situation.

One customer wants his Suboxone prescription that he dropped off 15 minutes ago. It's for a box of the film strips, so you think it's a quick one. You find the label, grab a box off the shelf, label it, and send the customer on his merry way relieved that you no longer have to look at him.

Eventually, the other pharmacist returns to work, and you steadily grind down the mountain of prescriptions. At the end of the day, you actually filled only slightly more than normal for a Thursday, but it felt like 10 times that. Exhausted, you go home and pass out without even eating dinner. The only thought in your head is that you have to rest up, so you can be at the pharmacy at 8:00 the next morning to do it all over again.

Over a month later, a doctor calls you up inquiring about one of his Suboxone patients. The guy was complaining about having withdrawal symptoms and needing to increase his dose. The doctor couldn't understand why after being stable for so long the man was suddenly going through withdrawal, so he wanted to check with the pharmacy to see if you could perhaps shine some light on the mystery.

This month, the patient received the 2 mg Suboxone, just like the doctor ordered. However, the previous month, he got the 8 mg dosage. In fact, that was the only time he ever got the 8 mg dosage. Upon checking the prescription, you find that your initials are on the hard copy of a prescription that was filled in error. The man got 4 times his usual dose because instead of dispensing the 2 mg to him like he always got, you dispensed the 8 mg film strips.

Your error, while thankfully not harming the patient, caused the doctor to have to alter his treatment plan and increase his dose to accommodate for his withdrawal symptoms. The doctor reported the error to the state board of pharmacy, and 3 weeks later a drug control agent wants to speak to you about the mistake.

In the end, you don't suffer any serious penalties as no one got hurt, and it was your first offense. However, it's still embarrassing because you know how hard you work and how serious you are about being accurate. You're professional about the whole situation. Your initials are on the prescription. You missed the check. It's ultimately your fault, so you take the blame. However, you know that there were a lot of factors that contributed to that error. It wasn't just carelessness on your part. The error was part of the retail pharmacy culture that promotes speed, volume, and business-related paperwork over accuracy and patient care.

You were lucky this time. No one got hurt. Maybe the next error won't come with such good fortune. All you know is that you don't want to be around to find out.

My Last Post

2010-11-18T20:06:00.002-05:00

My first blog entry was June 24, 2007. In the 3 and 1/2 years since that first post, I've experienced a whole lot of life. While my original intentions for writing this blog were to entertain, it quickly evolved into a form of self-therapy. I looked deep inside myself to figure out what I really wanted in life. I explored the darkest emotions and analyzed past events repeatedly until I covered every conceivable angle. In the process I learned about not only myself but also the world in which I live.

In 2007, I was a 25 year old kid. I had no idea what I wanted. I was less than a year out of school. I still wasn't certain if I could cut it in the pharmacy world. I still viewed the world through the immature eyes of a child. There wasn't a single area of my life with which I was at peace, and I couldn't find a direction in life that would provide me with peace. Lost is easily the best way to describe my situation.

Over the following 2 years, I attempted to build up a life which could bring me some satisfaction. I took more responsibility at work. I attempted to make more friends and go out whenever the opportunity presented. I was determined to not let the breakup with my ex-girlfriend stand in the way of my future love life, so I even ventured as far as to try an online dating service... twice I might add.

I took the suggestions of friends and readers who commented on my posts. I made what many self-help gurus would say were healthy attempts at picking up the pieces of my life and moving on. However, no matter how hard I tried, my life always came crashing right back to square one.

The reason for the repeated crashes didn't occur to me until much later. My foundation wasn't solid. I was trying to build a life upon a flawed and shaky foundation. Therefore, no matter how many times or how many techniques I would try to build up to a higher and happier place, that faulty foundation would always cause my efforts to collapse back to ground level. I realized that the only way I could get to a better place was to start all over again and build my entire being from scratch.

In order to do this, I had to really analyze who I was and what brought me the small slivers of happiness that occasionally pierced the ever-present darkness in my life. I had to decide what, if anything, I wanted to believe in, and what were my core values. Anything that didn't fit in with those beliefs and values had to be removed from my life.

Everything was eligible for the chopping block. Family, friends, work, basketball... absolutely everything. I had to figure out the key components of that solid foundation I desperately needed. The first thing that went were most of my friends. People, who upon deep reflection, didn't value me as a person and whose lifestyles didn't mesh with my own interests and values were removed from my life. I knew that I wasn't a guy who was interested in going out partying and getting drunk, so any of my friends who thought the best use of their free time was to hit up a club and get wasted weren't going to fit into the life I wanted.

The next important step was deciding the best use of my free time was to get in shape. Having been an athlete for most of my life, it always upset me that I had put on 20+ pounds of mostly fat since the end of high school. No, I wasn't fat by any stretch of the imagination. However, I knew that I was out of shape. I knew that my diet of pizza, pretzels, beer, and cookies wasn't healthy for me. Objectively I knew that exercise and eating properly are far superior to any anti-depressant medication for lifting one's mood, but I was always too lazy to maintain a workout plan.

I educated myself on how to eat properly. I participated in online health and fitness forums in which knowledgeable posters showed me the evidence that proved that most of what I had known about nutrition and fitness was incorrect. I learned how to exercise efficiently. I learned how to eat a balanced diet, and more importantly, I learned the differences in the way our bodies metabolize different nutrients. Understanding the difference between high and low glycemic index carbohydrates and learning the fallacy of low fat diets enabled me to make great progress towards cutting weight and getting into good shape.

In less than 6 months, I shed 17 pounds (mostly of fat) and greatly increased the strength and efficiency of my muscles. I went from barely being able to do 3 pull-ups to being able to do sets up 8 reps with 35 pounds of weight strapped to me. Through high intensity interval training, I increased my cardiovascular endurance to the point where I could play basketball for 3 straight hours and barely feel winded. I brought my mile-run time down under 6 minutes for the first time since I was in middle school.

Besides the physical benefits of being in-shape. The absolute best part was that I felt happier. I didn't stress out as much. I found it easier to remain calm. I had more energy to do more things in my free time, and that led me to be in better spirits most of the time. It was wonderful.

Being in an almost perpetual good mood allowed me to finally come to terms with my, what many people would call depressing, beliefs. I knew I didn't believe in any organized religion. I knew I was a strict science and logic guy. There's no heaven. There's no hell. Human beings aren't a part of some big plan, but rather an evolutionary accident that will some day vanish from the earth just like virtually every species throughout all of the planet's lifespan has done and will do. Life will continue to thrive on this planet long after humans are extinct. We will ultimately be forgotten by the universe and nothing we ever did or will do will ultimately matter.

With that in mind, I don't believe in angels. I don't believe in demons or ghosts. I don't believe things are "meant to be," and there is no divine plan. I believe praying does absolutely nothing besides provide a placebo effect (and even that is being shown to be untrue by newer studies on the subject). Moreover, as I've noted before in this blog, prayer is kind of a stupid notion because when you break it down logically, it makes no sense at all. I don't believe everyone is special. I don't really believe anyone is special. We're all just kind of here entirely by accident, and we're all going to die sooner or later.

Depressing, right? I know. I struggled with it for a long time. It's hard to come up with a reason to go on when you don't believe there's any real point to all of this. It all just seems so unimportant, and objectively speaking, it isn't important at all.

However, in my fitness induced good-mood I had a moment of clarity. Why does there have to be a purpose? Who cares if we live a few decades and die without leaving any real lasting impression on the universe? The funny thing about human intelligence is that we're the only species in the entire history of the planet who could even care about a meaning to life. For a billion years, life has been rolling along. Each individual life form lives out it's comparatively short life-span, and the cycle just keeps going.

Maybe the point of life is simply to live. In that way, no living thing is any more special than any other living thing. However, the simple fact that we're alive makes us all special. In case, you haven't noticed, life is pretty rare in the universe. The chances of the right compounds being present in the right environment for the chemical reactions of life to start are very very slim. However, right here on Earth, it happened, and in that sense, we've hit the universal lottery. Our mere existence is incredible. In my eyes, that's all the reason I need to live.

That was the last piece of my foundation. I knew it was a solid one because it came entirely from myself. No part of it was unconsidered or handed down from a parent or other authoritative figures in my life. It was my own.

From there, I could slowly start building up the life I wanted without excessive worries or expectations. I was finally content, and that happy feeling allowed me to finally pull my heart away from my ex-girlfriend and open it up to someone new. As I've said before, I'm not happy because I have a girlfriend. I have a girlfriend now because I'm happy. She didn't save me, and if this relationship doesn't work out, it won't ruin me either. I saved myself, and my happiness is completely derived from myself.

That brings me to the end of this blog. The previous 325 posts have helped me accomplish everything I wanted to when I wrote that first post in June, 2007. It was important to me in ways, despite all my analysis, I'll never fully understand. I thank everyone who has ever read my blog, and I especially want to thank those who took the time to comment on my posts (regardless of whether the comment was positive or negative, whether it agreed or disagreed with what I was saying). Whether you realize it or not, your shared in my strange, enlightening, and often times frustrating journey. I was a kid when I started this blog. Now I'm nearly 29 years old, and now I'm a nearly 29 year old man with a renewed sense of self. I'm sure if you go back and read my earlier posts, the change in tone is very noticeable. Looking back, it's actually quite fascinating to see how my mind was working at each stage of my metamorphosis.

The blog will remain up for a little while I try to back up my posts. I've written nearly 1,000 pages here. I'm not just going to throw them away. However, once I get everything archived, I'm taking the blog down. I'm sure this won't be the end of my writing. I like to write, so I'll continue in one form or another, but it won't be here. Maybe I'll start up a new blog. I'm keeping my options open.

(Typical of my writing style, this last post was incredibly long-winded. I'll apologize one final time for writing too much.)

This Free Antibiotic Bullshit Has to End

2010-11-09T21:50:00.003-05:00

I'm so sick and tired of free antibiotics. It is the most pointless promotion in business history. ALL BUSINESS. I'm not even talking about just pharmacy here. I challenge you to come up with a dumber business strategy than handing out free antibiotics.

Free antibiotics have not increased our script volume. They have not increased our sales of OTC medication. They have not brought in new loyal pharmacy customers. The only thing they have accomplished is decreasing our gross margin.

It hasn't even made our community healthier. If anything, we've jeopardized public health by promoting wide spread use of antibiotics when not really necessary, which could in turn increase the growth of antibiotic resistant bacteria.

I've hated this program the entire time we've been running it. However, the tipping point was last Friday when I heard the store manager bitching about my flu shot table. You see... I have a table set up in front of the pharmacy where I set up all the stuff I need to give flu shots. While I'm working at the pharmacy, I keep a flu shot sign, a box of gloves, bandaids, and gauze pads on the table. I used to keep the sharps container there too, but the store manager said it could be a safety hazard, so I now keep it behind the pharmacy counter and carry it out with me whenever I have to give a shot.

The store manager never really liked my flu shot table from the start. However, the company was actively promoting flu shots and had signs up all over the store, so he didn't really contest its presence. Apparently, my employer thinks that the end of October marks the end up flu season, and it pulled pretty much all of the flu shot advertisements. The new signs that went up were all promoting the free antibiotic program.

Since the flu shot signs came down, my store manager thought that it would be a great time to voice his disapproval of the table. On Friday, he asked how much longer it would be there and complained that it was just taking up space in front of the pharmacy (as if they were going to use it for something more constructive).

This seriously pisses me off. The store goes all out promoting this moronic free antibiotic program that does nothing but piss away money. However, when it comes to flu shots that actually net us a very decent profit, it can't wait until I stop giving them. To reiterate, the store promotes a program that can endanger the public by spurring the growth of resistant organisms, but it pushes aside a program that helps to prevent illness and saves the health care system money.

As much as I disagree with my employer's policy on free antibiotics and the rampant use of gift cards to promote the pharmacy, my store manager is the one that really draws my ire. He's such an arrogant bastard. He constantly wants to know what our sales numbers look like for the week, and if we report a low figure to him, he acts like it's because we're just not working hard enough. It's our fault we're not generating a lot of revenue. It has nothing to do with the company's policy of giving our most popular drugs away for free.

Last week, we actually did fairly well sales-wise. Upon hearing our figures, he sarcastically applauded us and couldn't resist mockingly saying, "it must be all the flu shots."

Fuck you, you arrogant prick. What have you done that's so fucking great? From my view point, you mostly stock shelves all day, and just like every other store manager we've ever had, you'll only be around for another 5 or 6 months before corporate ships you off to another store. Store managers are a dime a dozen. They're entire job is to make the store look neat and to otherwise act as a bitch to the corporate offices. They don't think on their own. They don't enact policies or promotions. They just follow orders.

Therefore, this glorified grunt worker mocking my professional services is a real fucking joke. I haven't given out a ton of flu shots in the grand scheme of things, but I am over 100 for the season so far. That's over $1,500 of pure profit that only I could bring in. There are no other immunizers in my store. It's just me, and if it weren't for my flu shot table, that $1,500 would be in Walgreens' or CVS's pocket and not ours. Maybe it's not a lot, but it's more profit than our current store manager has ever been solely responsible for producing.

Since, I'm back on the subject of profits, let me further illustrate how ridiculous these free antibiotic and $4 generic programs are. They're actually amazing in that at the same time they are decreasing our profit margins, they are increasing drug prices. Yes, that's correct. Instead of making drugs more affordable for patients, they are actually raising costs (and decreasing the quality of pharmacy services I might add).

North Dakota has a law that stipulates that all pharmacies must be majority-owned by a licensed pharmacist. Obviously, CVS, Walgreens, and the other major chains don't like this law because it excludes them from opening pharmacies in North Dakota. Therefore, they've attacked the law saying that North Dakota is depriving its residents of the cheaper drug prices that the major chains can provide (in the form of $4 generics and free antibiotics).

Well, in January 2009, the Institute for Local Self-Reliance showed this not to be true. In fact, it concluded that repealing the law "would cost the state millions of dollars in annual economic activity and tax revenue, dramatically reduce the number of pharmacies serving rural areas, and degrade the overall quality of pharmacy services in the state."

Among the report’s key findings is that rural areas of the state have far more pharmacies and greater access to these vital health care services than is found in other states. Census tracts with 2,001-3,500 people in North Dakota are 31% more likely to have a pharmacy than those in South Dakota. And, while only one-quarter of census tracts with 1,001– 2,000 people in South Dakota have a pharmacy, nearly half of those in North Dakota do.

The report also mentioned how North Dakota has prescription prices that are well below the national average, and how repealing the law would result in a net loss of $23 million per year in direct economic benefits.

The moral of the story is that maybe big chain pharmacies should reconsider their pricing habits considering the one place in this country that doesn't make a habit of giving shit away for free is the one providing the best care and making decent profits at the same time.

Baby steps though. Let's start slow. Just get rid of the stupid free antibiotics.

"We Made the Mistake. You fix it."

2010-10-28T20:35:00.002-04:00

At least that's what one medical assistant wanted us to do today.

Two weeks ago, the office called in a prescription for the wrong dose of Metoprolol. The patient was supposed to get 50 mg, but the office called in 100 mg. By the time the patient realized the mistake, he had already picked up the medication and started taking it.

Today a medical assistant called up and informed us of the mix up. She told us that it was supposed to be for 50 mg. Then she stated that the patient will be returning the 100 mg tablets and exchanging them for the correct ones.

I quickly corrected her by saying, "we won't be exchanging the prescription. It's against federal law to take back medication once it has left the pharmacy. It's been 2 weeks. The patient will have to pay another copay."

"You won't take it back?" she exasperatedly asked. "Other pharmacies have taken medication back before. You're going to force her to pay another copy?"

Now, I was a little pissed off. "Is that how it works?" I said. "You guys make the mistake, and we end up footing the bill for it? YOUR error prevents US from getting paid? Does that make sense?"

She paused for a couple seconds before saying, "well, I'm not going to argue with you." Then she hung up.

If this was an isolated incident, it would be one thing. However, it's something that happens quite often. The people working in doctors' offices seem to forget that we actually have to buy the drugs before we can sell them to people. Therefore, when they tell the patient that the pharmacy will simply do an exchange to make up for their mistake, they forget that the pharmacy ends up being the loser.

The only time I pull this exchange bullshit is if the error is clearly ours. If we make the mistake, well, that's our fault, and we'll do what we have to in order to correct it. If the doctor's office makes the mistake, and the patient ends up having to pay a second copay because of it, I'll often tell the patient to go ask the office for a refund of their wasted money. The pharmacy already gives away so much. There's no way I'm wasting more money when we had nothing to do with the error.

Is It OK to Have Secrets?

2010-10-26T01:12:00.002-04:00

For the past 2 weeks, I've been wrestling with the thought of whether it's OK to keep some parts of your life separate from your significant other. I guess I've hit the point where I need some advice, so it's finally making it's way to a blog post.

To cut straight to the point: My girlfriend doesn't know I write this blog. She has no idea that I'm Pharmacy Mike or that Pharmacy Mike even exists. This blog has been a window into the inner workings of my mind. Therefore, in order to truly understand me, one would have to read my blog.

It's sad, but my readers know me better than my girlfriend does. My question is whether that's OK? If I'm in a committed relationship with this girl that someday might end up in marriage, am I obligated to tell her about this blog? Does she need to know?

Whether she needs to know or not is really the crux of my pondering. Do committed couples have to share every last details of their lives together? Should they be privy to their significant other's every thought and feeling? Or are there somethings that can be kept private in order to spare feelings?

I used to think that every person needs a little bit of privacy, but now I'm not so sure. It's not exactly like I'm overtly hiding anything from her. I've just never been comfortable divulging every thought that pops into my head. I usually don't speak without carefully considering the consequences of every word I might say. Moreover, every action I take is done so after great deliberation. Nothing I say or do is spontaneous. Nothing is unplanned.

I may say and do all the right things in this relationship, but sometimes I feel that I'm not being genuine. While it may not necessarily change my eventual action, I feel that the action is somehow less important than the inner monologue that leads up to that action. Without letting her in on what I'm thinking, I'm keeping her at an arm's distance. A big part of me thinks she deserves more honesty than that.

However, another part of me thinks that a lot of my thoughts and actions could be misinterpreted. For example, even though she knows about my ex-girlfriend and the basics about what happened, she doesn't quite understand the depth of my despair and how it took 4 years to be OK with everything that happened. Does she need to know that stuff?

I question where our relationship is heading, and what the next step will be. It bothers me that despite being together for almost a year now, she still has no plans or desire to move in with me any time in the near future. Moreover, even if we wanted to live together, I struggle with the logistics of our jobs being over an hour apart. I feel like we're both waiting for the "right time," but what if we never find the right time. Then we have to go and make the time.

I see that as a potential problem because I'm pretty much settled where I am. I own a condo and have a high paying job. Rationally, if one of us were to move, it shouldn't be me. However, how can I ask her to move here and be an hour away from work? Even though she doesn't really like her job and would like to find a new one, in this economy, how could I expect her to leave her job without another one lined up?

I have so many questions and concerns, but I feel like bringing them up will rock the boat and possibly ruin a good thing. Therefore, they remain mostly as an inner narrative. I act as positive as I can in order to mask my doubts. I do this to protect both of us, but am I actually doing more harm than good?

See, this blog is just one of the many things I keep to myself. Should I open up and share my innermost thoughts with this girl, or is it fine and maybe even normal to keep some things to myself? If I were to open up, I think it would make sense to let her know about this blog first. Of course, that brings to light a lot of things about my past that she'd probably rather not read. However, those things are part of who I am, and it would be nice to no longer have to hide from them. It could be liberating.

My question to my readers is simple: Should I let her know about this blog, or can I keep it to myself?

Saturated Fat and Dietary Cholesterol Are Not the Enemies

2010-10-25T18:07:00.002-04:00

This post is in response to Harry's comment on my last post. He wanted more information about how saturated fat isn't evil.

Dietary cholesterol from animals and dairy products has a very small effect on blood cholesterol levels. One can expect dietary cholesterol, no matter how poorly one eats, to make up for roughly 15% of blood cholesterol.

This makes sense. Think about the drugs that block intestinal absorption of cholesterol, like Zetia. Zetia lowers cholesterol levels by roughly 10% to 15%, which is about what would be expected if you blocked dietary cholesterol.

Moreover, as pharmacists and other medical professionals are learning, there's not much evidence to show that Zetia has any mortality benefits. We know from Merck's very own trial that Vytorin does not decrease mortality or reduce plaque size any better than simvastatin alone. In fact, there was a small (but insignificant) increase in plaque size in the Vytorin group.

Enormously high cholesterol levels are still bad for you. However, these levels are are due to the body's overproduction of cholesterol, which is where Statins come in. Statins have established mortality benefits, and they work by decreasing the body's endogenous cholesterol production.

(As an aside- Statins also are known to have antioxidant and anti-inflammatory effects, which may also play a huge role in their reduction in mortality. Clearly, when it comes to Statins, lowering cholesterol is only part of the story.)

Now, the question becomes why does the body produce lots of cholesterol. Well, in some people, there'a genetic predisposition for it, i.e. homo- or heterozygous hypercholesterolemia. In other people, the body produces high levels of cholesterol due to our poor diets.

As is well known, cholesterol is vital to the body. It plays an important role in cell membrane integrity. It also acts as an antioxidant in that it cleans up free radicals.

Consuming a diet high in processed sugars, trans fats, hydrogenated oils, and rancid fatty acids, our bodies produce more cholesterol. Some of it acts to help clear up our bad diet. However, some of it gets clumped up into the mess and ends up leading to blocked arteries. In this way, high blood cholesterol is more a marker for disease than disease itself.

As for saturated fat...

Modern research is finally starting to shed some light on this too. The following quotes are taken from Wikipedia (which despite what some may say isn’t a bad source for quick information. Obviously, I wouldn’t use it if writing a formal report, but most of the information is from valid sources that are cited in the articles):

“In 2010, a meta-analysis of prospective cohort studies including 348,000 subjects found no statistically significant relationship between cardiovascular disease and dietary saturated fat.[8][9]”

“In 2009, a systematic review of prospective cohort studies or randomized trials concluded that there was "insufficient evidence of association" between intake of saturated fatty acids and coronary heart disease, and pointed to strong evidence for protective factors such as vegetables and a Mediterranean diet and harmful factors such as trans fats and foods with a high glycemic index.[10]. Pacific island populations who obtain 30-60% of their total caloric intake from fully saturated coconut fat have low rates of cardiovascular disease.[11]”

“Mayo Clinic highlighted oils that are high in saturated fats include coconut, palm oil and palm kernel oil. Those of lower amounts of saturated fats, and higher levels of unsaturated (preferably monounsaturated) fats like olive oil, peanut oil, canola oil, avocados, safflower, corn, sunflower, soy and cottonseed oils are generally healthier.[13] However, high intake of saturated dairy fat does not appear to increase the risk of cardiovascular disease.[14]”

We all know this information to be true, but we’ve been mislead so long that we have trouble accepting it.

Here’s another article that contains some interesting information: “http://www.menshealth.com/men/health/heart-disease/saturated-fat/article/a03ddd2eaab85110vgnvcm10000013281eac.”

I’ll just briefly mention a bit from the article about the Masai, a nomadic tribe in Kenya and Tanzania that were studied in the 1960s. They got 60% of their calories from fat and half of that was saturated fat. Despite this, they had an incredibly low incidence of coronary artery disease and very low cholesterol levels. However, when some tribe members moved to Nairobi and began eating a more modern diet, cholesterol levels sky rocketed, despite the reduction in saturated fat.

There are so many other cultures that we wonder how they could eat what they eat and remain so healthy. The French are a classic example of people who eat loads of butter and other sources of saturated fat, and they are some of the healthiest people in the world, and that’s even with them smoking far more than we do. The Japanese eat plenty of shrimp, seafood , and other foods that are very high in cholesterol and saturated fat, and they have a low incidence of heart disease.

When you start piecing the evidence together, it becomes readily apparent that the common medical belief that saturated fat and dietary cholesterol is bad for you is simply wrong. Eating healthy basically comes down to eating whole wheat carbohydrates in place of processed and added sugars. Eat plenty of vegetables, some servings of fruit, and grill, bake, or pan-sear your meats as opposed to frying them. Appropriate portion sizes are also important. It doesn’t matter what you eat if you eat so much of it that you’re 50+ pounds overweight.

It sounds so simple, right? It would be if we weren’t so addicted to high glycemic index sugars and fried food. It’s harder to quit sugary and fried food than it is to stop smoking. Just try, and you’ll see what I mean. It’s an addiction, and it’s very very hard to break. I know how unhealthy this stuff is, and I still have a lot of trouble giving it up, especially when society is not on the same page. If you want to quit smoking, there a bunch of nicotine replacement products and self-help classes you can take. If you want to stop eating junk food, people look at you like there’s something wrong with you, especially if you’re not overweight. When a group of people get together and order a pizza, it’s just about impossible to be that one person who chooses not to eat it for health reasons. Eating these kinds of food are a personal problem, but it’s also a societal problem. Since society is doing nothing to help people change their eating habits, most people will not be able to do it on their own, even if they knew how unhealthy they're being.

Anyway… that was my long-winded explanation as to why saturated fat and dietary cholesterol is not bad for you. You can do more research on your own, and in doing so, I’m confident you’ll come to the same conclusion. It’s the one that makes the most sense. It’s funny how good science usually makes sense.

I Hate Recommending OTC Meds

2010-10-23T22:24:00.003-04:00

"I have a cold. What can I take for it?"

I get this question at least once a day, but I never feel comfortable answering it. It's not that I don't know how to treat common cold symptoms. I just don't know how to explain to people that the answer isn't necessarily in one medication bottle.

Whenever people ask for a recommendation about what to take for a cold, the first question I always ask is what symptoms they have. I can't make a proper recommendation without knowing what symptoms I'm trying to treat.

"Cough"

Great... I'll always follow up by asking whether the cough is productive or dry, but the answer doesn't really matter I suppose. By this point, we all know that dextromethorphan does absolutely nothing to relieve coughing. Therefore, all OTC cough suppressants are ruled out. For productive coughs, most pharmacists will recommend Mucinex. However, if we're going by evidence, there's not much evidence that guaifenesin loosens up mucous, so I always hesitate before making that recommendation.

According to the American College of Chest Physicians, acute cough should be treated with a first generation antihistamine, like clorpheniramine, and pseudoephedrine. They also say naproxen can be used to help reduce cough. Nowhere in the entire executive summary of the cough guidelines does it mention guaifenesin, dextromethorphan, or any opioid cough suppressant for that matter. There's very little evidence that they actually reduce cough.

How do you explain that to a customer though? When there are dozens of products in the OTC aisle that say "cough and cold" on the box, how do you explain to people that most of them are unlikely to reduce cough? You have to see the looks customers give me when I go out in the aisle and grab a box of store brand "Allergy Medication" (containing chlorpheniramine) as a recommendation to reduce cough. They think I'm crazy.

Moving away from cold medication... People often ask about vitamins. "What brand multivitamin should I take?" is a very common question. My response: You probably don't need to take a multivitamin.

People have this obsession with vitamins. They think they're the answer to all their ailments. However, in most cases vitamins are a waste of money. Unless a doctor diagnoses you with a specific vitamin deficiency, there's really no need to take a multivitamin. In fact, a recent large study showed that taking antioxidant vitamins not only didn't increase life expectancy and reduce the incidence of diseases like cancer, but people who took them actually had a 16% increase in mortality.

The modern diet, as poor as it might be in terms of overall health, usually provides enough of all the important vitamins to stave off any deficiency condition. About the only vitamin that a normal person might need to supplement is Vitamin D, and that's because we lather sunscreen all over ourselves, and sunlight is needed for the body to produce Vitamin D. Otherwise, if you aren't malnourished, you probably get plenty of vitamins in your diet.

You can show people a million studies on this stuff, but they won't listen. It's ingrained in their minds that vitamins are good for you and Robitussin is a great cough medicine, and there's nothing you can do to change their minds. After all, it must be true; they saw it on TV!

Or if they didn't see it on TV, their doctors said it was true, so it must be. You ever try to convince someone that what their doctor said is entirely incorrect? It's very difficult, especially when just about every doctor says the same thing.

For example, every doctor tells you to avoid saturated fat and cholesterol like the plague... and every doctor is wrong. No matter how hard I try though, I'll never get those health nuts to go back to drinking whole milk and eating whole eggs instead of just egg whites.

The problem is that conventional wisdom is murky at best instead of scientifically tested truth. Since I know that the evidence is quite shaky, I can't in good conscious recommend what others would without batting an eye. Therefore, I've come to dislike the part of my job that involves counseling on OTC meds.

I'm my employer's worst nightmare in this regard. I actually prevent more OTC sales than I facilitate. That can't be good for business even though what I say is backed by the most current scientific evidence. That's why I'm so happy to be promoting flu shots. Flu shots are the rare occurrence in pharmacy where what's best for the patient is supported by science and good for our business.

I Don't Work For Free

2010-10-19T07:23:00.003-04:00

"Glad to know the employer is making money off of the pharmacists training and risk. When will pharmacists learn no to give their talents away?

We have already labeled ourselves as less than human by working long hours with no breaks or lunches.

Bad for the profession..Stand up for yourselves. Shame on you."

This statement was a response to my post about how I love to give flu shots. I disagree with it.

For one, there is very little risk involved in giving flu shots. Most people don't have any significant adverse reactions to them. Moreover, there's not much technique involved in giving one. You simply take the syringe and stick it in someone's shoulder muscle. It's really hard to mess that up. I hardly consider flu shots to be one of our "talents."

Finally, how exactly are we just giving these flu shots away. We make $15-$20 profit on each shot. That's good for the profession. It actually is smart business to do more flu shots because they are great for your gross margin. In addition, I do get paid to give them. I make nearly $60/hour to be a pharmacist. That salary encompasses all of my professional responsibilities. I'm not a mercenary. I don't get paid per task I perform. My company pays me that because I am a pharmacist and capable of performing the duties of being a pharmacist.

Quite honestly, flu shots are one of most worthwhile things that I do. I am preventing disease. My flu shots might prevent people from being hospitalized with the flu, and in that way, it saves the health care system a lot of money. I don't see how this is a bad thing.

Of all the useless things we do in the pharmacy (dispensing Zpaks for colds, codeine products for cough, free antibiotics, etc.), there's no way I'm going to "stand up" and refuse to do something that actually is beneficial to both our business and our customers' health simply because I don't get paid more to do it. I get paid enough already.

Pharmacist's salaries are not one of the problems with the profession.

More Shit That Doesn't Make Sense

2010-09-23T22:23:00.002-04:00

Everyone knows where I stand on the health care debate in this country, so I won't repeat my reasoning and the facts that back up my reasoning. This blog post will not take a side in the health care discussion. It will simply point out a GIGANTIC logical flaw in the reasoning I often hear used to argue against universal health care.

"Health care is not a right. The Constitution doesn't have any mention of providing health care for the citizens of the United State."

These people are absolutely right. The Constitution makes no mention of health care. Want to know why? Because there practically was no health care in 1776!!

Penicillin wasn't even discovered until 1928. Surgery was rudimentary at best. Blood-letting was an accepted treatment for disease. Pretty much at the time the Constitution was written, a minor infection could, and often did, lead to death.

Perhaps if Thomas Jefferson lived in a time that had antibiotics, laparoscopic surgery, chemo and radiation therapy, X-Rays, MRIs, EKG's, blood work, and other common tools of modern health care practitioners, he would have made some mention about health care in that original Constitution and Bill of Rights.

Of course given the time period, he didn't, so we'll never truly know. Regardless, using the Constitution as argument against making health care a right to every citizen makes no sense at all. Hell, the original Constitution makes no mention of ending slavery either, but nearly 100 years later we managed to realize that perhaps our founding fathers had made an error on that issue.

Again, I'm not endorsing one side or the other in this post. I'm just pointing out some really stupid reasoning.

Something I Love About My Job

2010-09-21T21:28:00.003-04:00

This is the first year that I've been able to give them, but now that I can, I have to say that I love giving flu shots. I'm finding that I actually look forward to going into work every day because of the chance that I can give some flu shots that day. In the past, I would dread the days I had to work. Flu shots have re-energized my enthusiasm for pharmacy.

Maybe it's a little stupid. I guess it's really not that big of a deal. Medical assistants can give flu shots. They don't jump up and down for joy every time they get to stick a needle in someone's arm. Despite this, I can't help but like doing it. For one, it's something different. Different is good.

Retail pharmacy, despite all the craziness, is a repetitive job. Every day is exactly the same. You fill prescriptions. You check prescriptions. You answer mostly the same questions all the time. You deal with the same insurance problems all the time. The days just seem to blend into each other because day after day after day you're doing the same damn thing.

Flu shots at least break up that repetitiveness. It gives me a momentary break from the prescription mill. I have a table set up in front of the pharmacy. I go out and talk to the patient for a minute or so. It's not really private, but it almost feels like I get a little bit of one on one time with every patient to whom I give a flu shot.

The best part is that my employer can't complain about me halting the regular prescription mill in order to give a shot. We make $15 to $20 profit on each shot. They're great for business. That's why pharmacies push these flu shots like crazy. They put signs and banners all over the place. They record messages on the store's automated system. They hold clinics, schedule appointments, and accept walk-ins. Flu shots are a gold mine.

What's great is that they're a gold mine we don't have to feel bad about pushing to our patients. Let's face it, most of the prescriptions we fill are completely unnecessary. How many Zpaks do we dispense for people who have the common cold? How many Robitussin with Codeine prescriptions do we dispense even though there's no strong evidence that codeine-related cough suppressants actually reduce cough? We dispense weight loss drugs to people that don't want to exercise. We dispense Vicodin to seemingly any patient that goes to the ER for anything.

Even the drugs that have some value mostly just treat chronic illnesses. There's not a whole lot of drugs that cure disease. We just treat them. We can't cure diabetes, so we give people insulin. Thanks to the modern diet, we can't prevent heart disease, so we load people up on statins and blood pressure medications.

Flu shots are different though. They PREVENT the flu. When I give a person a flu shot, I know that I have prevented that person from getting those particular strands of influenza for that season. For example, everyone I give a flu shot to this season will not get H1N1. 30,000 people die of influenza every year in this country. Getting people immunized would drastically reduce that number. In that way, flu shots are saving lives. I know that has nothing to do with why my employer wants me to give them. I know my employer just wants the money from them. However, no matter what the reasoning is, the more people that get flu shots, the better for public health.

Finally, flu shots have separated me from the other pharmacists I work with. My store has 3 pharmacists. The other 2 want nothing to do with injections. Both of them actually say they're afraid of needles. They don't want to even watch me give an injection. That's how opposed to giving flu shots they are.

That's fine with me. If they want to stay behind the times and limit their own scope of pharmacy practice, I'm not going to convince them otherwise. Right now, my competitive edge in my company is that I can immunize. I've given out 20 flu shots so far this season. I only started a little over a week ago. I know that's not a lot. I know a lot of other chains hold clinics and do other things that allow them to give dozens per day. My chain is behind the other pharmacies in its flu shot promotion. Even still, those 20 shots netted the store $300 in profit. That's $300 that no other pharmacist in our store could have generated. It's early in the season, so I'm sure I'm going to give out a whole lot more than that. Whatever that final number ends up being, the profits that go along with it are entirely because of me. I'd say that gives me a nice competitive edge.

In addition, our patients look at me different. I know that sounds corny and cliche, but they really do. I didn't think it would happen either, but it's true. They all ask questions, not just about the shot, but about other health issues they might have. They ask for information about other vaccines, and whatever else might come into their minds.

The best thing is giving the shot and hearing the patient say he didn't feel a thing. They see the professional way I carry myself, and the painless shot reinforces the idea that I'm someone that knows what I'm doing. They ask how long I've been giving out flu shots. Some have even ask who I work for because they're so used to going in and out of the pharmacy without ever interacting with a pharmacist that they never noticed I've been working in the store for over 4 years. Some comment, "they got you doing everything back there," and that makes me chuckle a little bit.

Flu shots are one of the few things I do in the pharmacy that I think are worthwhile. There's no downside to them. They're good for the store financially and in crafting a positive image. They're also good for public health. I don't feel bad advising and/or convincing someone to get a flu shot, which is more than I can say about almost every other product we sell.

It Goes With the Ongoing Discussion

2010-09-21T12:28:00.003-04:00

There's a nice discussion going on in the comment section of the previous blog post. I thought this fits quite well with it.

Leave it to George Carlin to rain the truth down in the best possible way.

My Generation and Younger is Screwed

2010-09-19T17:57:00.003-04:00

Forgetting all the doom and gloom regarding dwindling oil supplies and climate change, this country has an enormous problem on the horizon, and it's mostly affecting my age group and younger.

How many people my age or younger will ever pay off a house? Most of my friends, despite working 50 to 60 hours per week, can't even afford to live by themselves. How will they ever afford a home? Even if they did some how scrape together enough money to pay a mortgage, how will they have families? How will they support children? How will they put those children through college?

Back 50 or 60 years ago, if you had a job, any job just about, you were OK. It didn't matter what you did. If you worked on an assembly line somewhere, chances are you made enough money to buy a home and pay the mortgage. You could put food on the table and pay the bills. You could raise kids. Your wife could work if she wanted, but you could get by without her income. You would have very little debt, and when you retired, chances are you'd be able to live off a company pension plan.

Back then, being employed meant being able to live. You might not be rich. You might not have the fanciest car or the best furniture, but you'd have a home. You wouldn't starve.

Fast forward to today...

I have a friend who is a manager at a restaurant chain. By all accounts, he does a pretty good job, and he's really energetic and enthusiastic about it, probably more than the job deserves. He makes less than $40,000 per year in a part of the country where the average home price is upwards of $250,000. He's tried to move out of his parents' house 3 times now. Each time, he only made it 4 or 5 months before running out of money. The last time, he rented an apartment with a roommate, and even with the roommates' contribution to the rent and bills, he couldn't afford to stay in the apartment.

Therefore, it was back to his parents' house for him. He's 28 years old, a manager, and he can't afford to live on his own. The kicker is that it could be even worse. He doesn't have any college loan debt because he went into the NAVY after high school. A lot of people my age are in the exact same position as him, except they also have over $60,000 in student loans.

When you start crunching the numbers, it doesn't seem possible that these people will ever get out of debt. They'll go to their graves owing money all over the place, or they'll file for bankruptcy, which of course doesn't eliminate the student loan debt.

This is the outlook for my generation though, and it's not pretty. I'm fortunate enough right now to have a job that makes well over $100,000 per year. That sounds like a lot, but even with my salary, and even just by myself, I can't have as comfortable a life as my parents did, and they were raising 2 kids! When I was growing up, we went on vacations just about every year. We had nice things. I pretty much had everything I could ever ask for. I can't afford the things my parents were able to afford for me, and I make more compared to my peers than they ever did.

My girlfriend has a job in a city. She has a 4-year college degree, and she makes just over $30,000 per year working in that city. As I wrote about before, she's trying to find an apartment in or near the city she works, but it's nearly impossible for her. She can't afford anything. She really wants to live without a roommate, but any decent apartment is well out of her price range. She has student loans and a car payment, so the only apartments she can really afford are 400 square foot efficiencies with long outdated appliances.

In order to find a decent apartment that she could afford, she'd have to look 40 or 50 miles outside of the city. How messed up is that? She works in the city, but she gets paid so little that she has to move 50 miles away in order to keep her job.

It's getting increasingly difficult for anyone my age or younger to live on their own. We're encouraged to go to college because "education is the key to our future success," or so we're told. However, most of us come out with huge student loan debt and degrees that get us jobs that pay a starting salary barely above minimum wage. It's no wonder people my age seem to me maturing more slowly, moving out on their own and starting families later than the previous generations. We simply cannot afford it. It takes a $100,000+ annual income to be able to do the things that the average American citizen of previous generations did.

It was a huge talking point during the previous Presidential election, and it drew a lot of ire from everyone on the right and a lot of people on the left. However, Barack Obama was 100% correct when he asserted that he have to redistribute the wealth in this country. It IS a problem! This isn't imaginary. It's not something crazy liberals are making up.

As of 2001, the top 1% of the wealthiest Americans owned 38% of the wealth in the country. The bottom 40% owned less than 1% of the nation's wealth.

Think about that for a second. Even though we hadn't quite reached 300 million citizens in 2001, we were pretty close, so lets use that as our nice round number. The top 3 million Americans OWNED 38 TIMES MORE WEALTH than the bottom 120 million Americans.

Again... 3 million people owned 38 times more wealth than 120 million people, and most sources say the disparity has only grown larger since 2001.

The top of society has everything, and the average American is working harder and harder to just get by. How is that right? How is that just?

From 1932 to 1981, the lowest tax rate for the top tax bracket was never below 63%. For most of the 1950's, the golden years of The United States, the top tax rate was over 90%. Despite this, the rich still managed to do just fine, but more importantly, the average American was far better off than he is today.

I don't know if taxing the richest Americans more is necessarily the ultimate solution. I don't think it's a bad thing though. The government has to work to help the people. That's it's role. It doesn't serve Wall Street. It doesn't cater to the top 1% of society. It's supposed to represent the masses and the collective good of the people.

All I know is that if the current trend continues, the economy will completely collapse because the other 297 million Americans won't be able to afford to own anything. When the majority of Americans work 50 to 60 hour work weeks and still struggle to make ends meet, it's definitely a sign that something is wrong.

We Don't Realize How Much We Know

2010-09-17T13:40:00.003-04:00

We forget sometimes that even a pharmacist with a below average knowledge-base knows much more than the average person. Concepts that seem so simple and easily understood to us can be very difficult for the average patient to comprehend.

How many times do we roll our eyes when a customer comes to us with a box of Tylenol and asks, "my doctor said to get Tylenol. Is this the right one?" We're thinking that it says Tylenol right on the box. What a stupid question. It doesn't take a pharmacy degree to read.

Have you ever wandered out into the aisle and just marveled at the variety of Tylenol Brand products there are (well, there were at least, considering Tylenol is still in short supply from the recall)? There's Tylenol Cold, Tylenol Arthritis, Tylenol PM, Regular Strenght Tylenol, Extra Strength Tylenol, Children's Tylenol Liquid, Infant Tylenol Drops, Tylenol Severe Congestion, Tylenol 8 Hour, Tylenol Rapid Release Gels, Tylenol Allergy, etc., etc.

If I didn't know a thing about medication (and why would I if I wasn't in a medical profession?), I'd be completely lost. The doctor just said Tylenol. He didn't say there were so many different options. Is Extra Strength OK? How do I choose?

It's simple to us. We know that Tylenol is acetaminophen. We know that you can take 2 Extra Strength Tablets up to 4 times per day without exceeding the maximum allowable daily dose of 4 grams. We know that store brand acetaminophen works just as well as Tylenol, so we can save money. Hell, we even know that weight based dosing of Tylenol is 10 to 15 mg/kg per dose, so we can tell someone the correct dose for an infant even though it doesn't say it on the box.

That information is right at the front of our brains because it's one of the first things we learn when studying to become pharmacists, and we use it often. However, it's kind of complicated for a regular person, and that's only one drug! We can tell people just about everything about other common OTC active ingredients such as ibuprofen, naproxen, pseudoephedrine, phenylephrine, dextromethorphan, guaifenesin, diphenhydramine, doxylamine, chlorpheniramine, meclizine, dimenhydrinate, ceterizine, loratadine, famotodine, ranitidine, omeprazole, lansoprazole, cimetidine, simethicone, clotrimazole, terbinafine, salicylic acid, and on and on and on...

I just rattled off 22 ingredients off the top of my head (23 if you count acetaminophen). I can tell you the drug class of each of them, indications, common dosing, side effects, and important drug interactions. Again... That's simple stuff. Every pharmacist can do this. The average person doesn't have a chance in the world of knowing all that stuff.

Then we move behind the counter, and we have ACE Inhibitors, ARBs, HMG Co-A Reductase Inhbitors, sulfonyureas, the different types of insulins, Calcium Channel Blockers (dihydropyridine and non-dihydropyridine varieties), bisposphonates, proton pump inhibitors, all the varieties of beta blockers, corticosteroids, diuretics, and so many more classes. We know multiple drugs in each category, and we know a lot about them.

The amount of information is staggering, especially when you really get down to the nitty gritty. For example, not only do I know that simvastatin is an HMG Co-A reductase inhibitor, I also know that it's one of the more lipophilic ones, and has a higher risk of muscle related side effects (myalgias, myopathy, and extremely rarely rhabdomyolysis) than less lipophilic statins like atorvastatin. It's extensively metabolized by cytochrome P450 3A4, and thus, a lot of clinically significant interactions can be seen when used in combination with 3A4 inhibitors such as verapamil, diltiazem, clarithromycin, amiodarone, and even grapefruit juice. Because of this interaction, it's listed as a contraindication in the package insert to use doses over 20 mg in patients concurrently taking verapamil. I know that simvastatin is available in 5, 10, 20, 40, and 80 mg dosages. And again... I know all this information off the top of my head, and so do most pharmacists.

That's one drug. I can do this with dozens, maybe even hundreds of drugs. It's amazing when you actually stop and think about it.

The point of all this is that perhaps the next time a customer comes to the counter and asks what you immediately think is a stupid question, just remember how much more drug information you know and understand than he does. Maybe cut him a little slack. He's not supposed to know this stuff, whereas you get paid to know it.

In addition, be proud that you have accumulated this massive drug information database inside your brain, and don't ever be afraid to use what you know to help other people. Whether you like the title or not, you are a drug expert. No other professional in the world knows more about a wider variety of drugs than a pharmacist, and this information is incredibly useful even when you're away from the pharmacy. Pharmacists never stop being pharmacists just like doctors never stop being doctors. Being a pharmacist is more than just counting pills, even though that may be what you do the majority of the time you're at work. If someone asks you a drug related question when you're away from the pharmacy, be happy to answer them. It really won't take that long, and the person will greatly appreciate it. If you are able to help the person, it will put pharmacists and our abilities in a good light.

You want to save the profession? Start by helping the people around you. Slowly but surely, the word will spread that these pharmacists are full of information and important to society. Let's face it, pharmacists alone appealing to their corporate masters are not going to change anything. However, if not only pharmacists but the people start demanding better care from their pharmacists, that will have an effect. If we want to play by the rules of capitalism, then we have to make the market decide that pharmacists are valuable.

This was a strangely upbeat post from me. I gave myself a flu shot yesterday. Maybe delusions of grandeur is one of the side effects.

Follow-up to My Previous Post

2010-09-16T20:50:00.002-04:00

Isn't it amazing what divides people? You mention religion or politics and suddenly all sense of civility is gone, and people are at each other's throats. Good people. People who would otherwise really like each other and would get along swimmingly suddenly are fighting (sometimes violently) with each other over something so trivial.

Take this whole 9/11 "mosque" issue. You know... If there were no religions around, there would be no Islam. Without Islam, those muslim fundamentalists that crashed planes into the World Trade Center and Pentagon wouldn't be religious fundamentalists. They'd just be a bunch of crazy people who hate America, and everyone in the whole world would agree that those people are crazy, and that's all there would be to it.

Now, we have people blaming Islam for the actions of crazy people. We have an old tech at work. He's in his 60's. He fought in Vietnam. He likes to think he's as American as apple pie. He stated the other day that Muslims have no regard for human life and shouldn't be allowed to worship anywhere in this country. He said this despite the fact that we've had 3 Muslim employees who have worked for us within the last 2 years who were the nicest people you'll ever meet. Seriously, I can't think of nicer people than them, but our old "American" tech thinks all Muslims should be "round up and shot."

Religion divides more people than it unites, and it doesn't even make sense in doing so. For example, if you're a Christian, you believe in Jesus and the resurrection and all that stuff. Since you believe in that, do you believe Muslims are wrong? How about Jewish people? Are they wrong too? Is anyone who doesn't believe in your particular faith wrong?

I'm sure even if you believe they're wrong, any rational good-hearted Christian would say that it's OK. As long as they live a good and moral life, they'll still be accepted into the kingdom of Heaven. If that's the case, what's the point of any religion then? Why don't we just all agree that we should treat each other well and stop sectioning ourselves off into little groups who believe different things that ultimately don't matter?

As for prayer, I'm not saying the "power of prayer" has never helped anyone. Sugar pills have helped people too. Placebos actually work, that's why you have to compare drugs to placebo and not just to nothing at all. If people really believe something will help them, there's a good chance that it will.

Know what the crazy thing to think about is? A million years from now, humans, as we now know them, probably won't exist. The Earth will still be here. It will still be teeming with life, but the human race will be long gone. We'll have either evolved into another species or gone extinct from either a natural disaster or our own tendency towards violence. However, let's say by some incredibly long shot that humans actually do still exist a million years from now. I can assure you that your religion and all the other religions on this planet will no longer exist. The Earth will still be here though, and so will life in some form.

My point is that any religion or way of thought that somehow places a higher importance on human beings than any other animal or plant will be shown to be wrong when we no longer exist. Humans are no more important than a dog or a cat or a cockroach in the grand scheme of the universe. We're here now, but the span of human civilization will be nothing but a nanosecond compared to the entire span of the universe.

And that's the answer to what happens after we die... Life just keeps rolling along. It doesn't miss a beat. It just keeps going like we were never there. People don't like this explanation though. It makes them feel sad, lonely, and worthless. Therefore, they look for something that makes them feel like they matter. We don't matter... but that's OK. It really is. Life doesn't have to have a purpose. It can just exist, and that's perfectly fine.

- This post was originally an email to a friend regarding our differing views on religion. I thought it fit in nicely on the blog, so I copied it and made a few small alterations. Therefore, if it seems a little disjointed, it wasn't originally intended to be a blog post. I just like putting my ideas in my blog, especially if they are pretty well thought-out.

Shit That Doesn't Make Sense

2010-09-14T20:58:00.004-04:00

I'm not going to make many friends with this post, but that's never my intention anyway, so oh well...

"Everything happens for a reason."

Is that not the most stupid, insane, bullshit statement ever? Everything happens for a reason? What kind of reason could there be for a 6-year old girl dying of Leukemia? Girl gets leukemia. The family's health insurance drags their feet over paying for anything to do with her care. Therefore, the family nearly goes bankrupt trying to pay for a treatment that might possibly save their child's life. However in the end, it doesn't work. The father withdraws into himself and becomes a workaholic because he doesn't know how else to deal with his little girl's death. The mother, who just lost her child, is now abandoned by her husband when she needs him most. She develops a drinking problem, and the entire family, once happy, spirals out of control until tragedy after tragedy falls upon them.

I completely made that situation up, but it could easily happen, and I'm sure it's happened thousands of times before. Again, what was the reason for that? And, if there was a reason, who decided what the reason is? God? Does God decide the fate of everyone? Is that what it means when people say "everything happens for a reason?" Do they mean it's part of God's plan?

What kind of asshole God would do that to a little girl and her family? I was raised a catholic. I went to catechism and did all that church stuff. I was taught that God loves us all. Yeah? Well, he sure has a fucked up way of showing it.

God loves us all... except for the people he just randomly decides to shit on for no apparent reason other than it fits into some cosmic plan in some indiscernible way. Then you get the bat shit fucking insane religious people that come along and say, "God loved that little girl so much that he brought her to the kingdom of Heaven early." Fuck these people. Seriously... When you have to start dipping into ridiculous reasoning like that, you need to just give up and admit that the whole ideas of everything happening for a reason, God's plan, and God loves us all is just bullshit.

Then there's prayer... Say that little girl's family was religious (and it doesn't even matter what religion). They undoubtedly prayed every day for a miracle to save their child. Every day they prayed and hoped and wished as hard as they could that God would hear them. Religious friends of the family offered their support and prayers. Hell, knowing today's world, all 400 of their Facebook friends probably chimed in saying they'll keep them in their prayers. Then the girl dies, and those same people who endlessly prayed for the girl turn around and say, "well, God had a special purpose for her in Heaven."

Well, that ties back into God's plan. If God had a special purpose for her, then why the fuck did you bother praying in the first place? You pretty much admitted that God does whatever he wants whenever he wants. If he has some sort of giant plan for the universe, why would he change it because a few people decided to pray? It's a contradiction.

Even if you don't believe that God has a plan for everything that ever happened and ever will happen, even if you don't believe in predestination, wouldn't you be pissed off that God didn't answer your prayers? Shit, if I had a 6-year old daughter dying of cancer, and I prayed to God for her life only to have God completely ignore me, I'd say fuck that all powerful deity. I would have been better off praying to her doctors. At least they tried to do something. God just sat around and let it happen.

Hunger, poverty, war, disease, natural disasters, United Health Care... All of these are signs that if there really is a God, he just doesn't give a shit about us. He doesn't love us. He doesn't care for us. If he exists, he just lets us be. He doesn't answer prayers. He doesn't perform miracles. He just sits back, maybe with a big bowl of popcorn, and watches us destroy ourselves and the planet. In God's eyes, the human race is nothing more than a multi-trillion dollar Roland Emmerich film.

Do you see why I have a problem with God and religion in general? When you start using logic, it makes no sense at all. That's not to say that I'm against the notion of spirituality. There are a lot of things that we'll never know and understand about this universe. I believe that there has to be some purpose for the existence of the universe. There has to be some way it came to be, and it only makes sense that a higher power (whether it be an intelligent power or some other form) must have created it. I just don't believe in the God that religions try to push on people. I don't believe in the hocus pocus aspects of them. I don't believe in God having a son, Jesus. I don't believe Mohammed was a prophet of any kind. I don't believe Moses spoke to a burning bush (unless he was high off his ass), and I certainly don't believe he waved his staff and parted the Red Sea. They're all fairy tales, just like every other thing that goes into these so-called Holy Books.

If you want to treat religion as a social club, that's fine. It can be just like those Star Trek conventions where people dress up like Spock and speak Klingon to each other. It's utterly meaningless, but those people enjoy it and find camaraderie in it, so it's fine and harmless. They really get into it, but none of them actually believe Captain Kirk, Spock, and the Starship Enterprise really existed. That's the way religion should be. People can get together and talk about their favorite episodes from the Bible, perhaps the one where Jesus healed the cripples, and then go home to their normal lives.

Like I said at the beginning, I'm sure I won't make friends with this post, but this is how I really feel about this stuff, so it's about time it made an appearance on my blog. I plan to write more entries about stuff that doesn't make sense in the future.

Sick Time

2010-08-31T21:44:00.003-04:00

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.

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

2010-08-30T21:16:00.002-04:00

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.

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

2010-08-09T19:44:00.002-04:00

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.)***

The Future of Retail Pharmacy

2010-08-06T09:00:00.002-04:00

$4 Generics

Free Antibiotics

Free Diabetes Medication

POWER

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.

Friendly and Helpful

2010-08-03T08:45:00.002-04:00

"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!"

Let's Stop Pretending There's Privacy in Retail Pharmacy

2010-07-30T09:00:00.003-04:00

HIPAA, HIPAA, HIPAA, HIPAA... Everyone's pharmacy employer pounds those 5 letters into us all the time. We're all concerned with privacy. Every time there's a privacy leak in a health care facility (be it a hospital, pharmacy, whatever), we all go ape shit about it. "How could this happen?" "Why aren't they more careful?"

I'm going to let you in on something that's not really a secret: THERE IS NO PRIVACY IN RETAIL PHARMACY. Now, that that's out of the way, we can all stop pretending and get back to doing our jobs.

See, the problem is that people are only selectively concerned about privacy. For example, many times some customer will get all belligerent because we'll ask for his address when picking up a prescription. "I don't want to shout out to the world where I live!!" (Of course, he has no problem loudly broadcasting how much of an asshole he is). Not to stereotype, but there seem to be more women worried about this one than men. It seems the skittish ones are always worried about someone following them home and raping them or something. Who knows? Who cares?

The big one is that we can't say the name of the medications our customers are picking up. It's a HUGE no-no to tell the world that John Smith is picking up Viagra or that wholesome looking Jane Doe is getting Valtrex for the raging case of Herpes she picked up from one of her wild weekends. I completely understand the desire to keep information like this private. Some of this is embarrassing shit. Therefore, it makes sense that a person might be a little peeved if some of this information was intentionally or unintentionally made public.

However, people only seem to be worried about privacy when it conveniences them. They really don't want complete privacy at all times, just when privacy doesn't get in their way.

Want proof? Here's a very simple way to illustrate what I mean. Go get your phone, and call your pharmacy. Make sure to speak to a pharmacist because all calls regarding this kind of sensitive material should be handled by a highly trained professional. Once you have the pharmacist on the phone, ask if there are any prescriptions filled for yourself. Ask for the name of the medication, what it's used for, and the price. I guarantee you that the pharmacist answers all your questions in his most customer-friendly tone of voice.

Now, if you're being consistent about this whole privacy thing, you should stop the pharmacist mid sentence as he's explaining your medication to you, and loudly proclaim, "YOU'RE VIOLATING MY PRIVACY!!!!"

I work in a pharmacy that fills a little less than 2,000 scripts per week. We have a lot of customers. I can match a face to a name of maybe 15% of our customers. Out of that 15%, there are only a handful of them that I'm so familiar with that I can recognize their voices over the phone. Therefore, any time I give out any information over the phone to anyone whose voice I don't recognize, I'm violating HIPAA.

95% of the time I don't have the slightest idea who I'm talking to over the phone. Someone calls and asks a question. I answer it. Someone calls and wants to know if a prescription has been called in for so-and-so. I tell them. I'll even tell them what it is and what it's for. I'm sure this is true of any pharmacy.

Have you ever tried to tell someone you can't give out information over the phone? The person gets all pissy. They don't care about the privacy laws in that instance. They only care about privacy when being private doesn't stand in the way of getting information they want at a time that conveniences them.

Here's another question: What percentage of prescriptions are actually picked up by the person for whom the prescription is filled? 30-40%? Maybe? It's almost comical. Seriously, try to keep track of who picks up for who one day. Most of the time, the person picking up is the mother, father, husband, wife, girlfriend, boyfriend, son, daughter, relative, friend, etc. of the person for whom the prescription is filled. We have no clue who any of these people are. If Jane Doe comes to pick up Jane Smith's prescription, most of the time, unless told otherwise, we'll just assume that Jane Doe is Jane Smith. We'll even offer to counsel Jane Doe on Jane Smith's medications!!! What kind of privacy is that???

In most cases, anyone can walk up to any pharmacy and pick up anyone's prescription. We don't ask every customer for ID. Hell, we hardly ask anyone for ID. Just about the only time anyone whips out an ID at our pharmacy counter is when they're buying pseudoephedrine products. There's more discretion in buying fucking Sudafed than there is picking up a medication for someone. Once again... How is this privacy?

You know what though? We want it this way. How fucking inconvenient would it be to have to show an ID for every pharmacy transaction? It would be incredibly frustrating to have to cut through miles and miles of privacy red tape just to find out over the phone the copay on your prescription. Let's all face it: We don't really want true privacy at the pharmacy. We just want the illusion of privacy. We want there to be just enough privacy protocol and procedures followed to demonstrate to us that the pharmacy at least cares enough not to blurt out your medical history to the entire store. It makes us feel comfortable and maybe helps us sleep at night.

It's all just an illusion though. Therefore, let's stop with the HIPAA pretenses and get rid of all that stupid red tape so that we might be able to more easily do our jobs.

I Feel This Needs to be Said

2010-07-23T08:26:00.004-04:00

There are parts I agree with in your blog and parts I do not agree with.

Let's start with opposing opinions and then I'll state was opinions I share with you.

First, let me give you some background information

- I am a 20 yr old female college student, in school full time and working roughly 25 hrs/week part-time at a retail pharmacy. (no school this summer so I'm working more hours but you get the picture). I have worked at this retail pharmacy for 10 months.

I don't get why you give so little respect to your technicians? How long have they been working for you? Also, it's good to have them ask you questions in my opinion. Would you rather them shut up, make a mistake, you not catch up, and serious repercussions arise from this incident or spending 10 seconds out of your hectic schedule to answer their question? Are these certified/senior techs or what? In that case I could understand some but otherwise no.

Another thing is your arrogance is seemingly obvious. Let me quote you

"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."

Are you serious, sir?

Yes... I am absolutely serious.

I'll get to the tech thing in a second, but let me start with the arrogance accusation.

I'm sick of this prevailing attitude where intelligent people are not allowed to say or act as if they are more intelligent than others. Note that more intelligent does not mean "better." It simply means more intelligent.

On a personal level, it's not arrogant to state that I'm more intelligent than most people I meet. In just about every single way you can measure intelligence, I've always ended up in the 90th to 95th percentile. My grades, my class ranking, my grade school standardized testing scores, the SATs, the NAPLEX, my IQ. In all of these things, I've consistently been in that top 5 to 10%. Now, I realize that using any one of them to measure intelligence is obviously flawed. However, when you take into consideration the combination of all those things, you just have to state, as a FACT, that I'm more intelligent than most people. I'm not the most intelligent. There are a lot of people who are a lot smarter than me. I'm not a genius in anything. I'm just pretty bright.

That doesn't mean I go around telling everyone I meet that I'm smarter than they are. People don't like it when you boast about how great you are all day. It's fucking annoying. However, I do walk through life with the thought that I'm probably smarter than 90% of the people I meet. You call it arrogance. I call it confidence based on a lifetime of testing and evaluation. It's one of the few things about myself I am very confident in. That doesn't mean I think I'm always right. That doesn't mean I'm unreceptive of other people's thoughts, opinions, or suggestions. All it means is that I trust myself to make good decisions, solve problems better, and know more things than most of the people around me. I have confidence that I can depend on myself to correctly evaluate situations and come to a logical conclusion.

Moreover, this is my blog, and I'm not at all worried about offending the delicate sensibilities of random people on the internet. I hate being politically correct and having to watch what I say in order to not offend anyone. However, I do it in real life because, quite frankly, it's too much of a hassle to argue with people all day over stupid shit. Not a problem on my blog. I don't have to work with any of my readers. I don't have to get along with any of my readers. I can write what's truly on my mind, and if people don't like it, they can tell me in a comment, and we can have a nice discussion about it. Or they can not read anymore. It doesn't bother me either way. I'm not doing this to make money. I write a blog because occasionally it helps to put ideas into writing. Plus, it keeps my mind and writing sharp.

In addition, I used myself as an example of an intelligent pharmacist, but I wasn't necessarily talking about just myself. In most cases, the pharmacist is going to be the most intelligent employee in the store. It's just a fact. Pharmacists go through 6 years of what everyone always says is rigorous college courses in order to be certified a drug expert. You have to be pretty intelligent just to get into pharmacy school. Then you have to be even more intelligent to make it to the end of pharmacy school. I'd like to think that someone who has survived that kind of weeding out process gets the benefit of the doubt on being smarter (or at the very least more knowledgeable) than a career cashier or merchandise manager.

As for the technicians...

There are a lot of really great technicians out there who really do a good job. Unfortunately as in pretty much every other profession, the good ones are far outnumbered by the poor and mediocre ones. The technicians in my store are mediocre at best. We have 4 certified pharmacy technicians (one is nationally certified). Out of the 4, only 2 can input a new prescription, and when they do, they make a mistake probably 40% of the time. We have a tech who has worked in the store for over 25 years, and she absolutely refuses to input new prescriptions because she's worried she'll make a mistake. She makes over $20/hr and spends the majority of her day at the register or going through our doctors' faxes. She has nothing to do with the filling process. Our nationally certified technician is such a ditz that I'm afraid to depend on her for anything. She's in her own world for most of the day... that's of course if you can get her to do anything other than text message and take bathroom breaks.

I want my staff to ask questions because I don't want them to screw something up by trying to do something they don't know how. I answer all these questions without showing frustration. I try to help them. However, I also expect them to catch on and improve over time. They don't. It's frustrating, and it creates one more thing I have to worry about during the course of the day. I have to watch and listen for any sign that they might be making a mistake, which takes my attention away from filling prescriptions accurately and counseling patients.

It's not just my pharmacy either. If you look around the pharmacy blogosphere, you'll see countless posts about dealing with lazy, inept technicians. In general, technicians aren't as smart as pharmacists. Secondly, they don't care as much as pharmacists. It's not their licenses on the line. A lot of technicians are working part time while going to school, so they don't think very much about calling out sick on a sunny day when they'd rather be at the beach than work. They don't have that same sense of responsibility as pharmacists, and it shows.

Let me reiterate that I'm not including all technicians. I know there are great ones out there. I've worked with great technicians before. They help so much that it's impossible to overstate how nice it is when you're lucky enough to have a great technician. Therefore, the last few paragraphs are not aimed at the great technicians reading this. They're aimed at their coworkers.

Agree with me. Disagree with me. Comment. Email me. Ignore me. Whatever. I'm game for a discussion if anyone really desires one.

Twitter

2010-07-17T18:53:00.003-04:00

As you can see, I decided to join Twitter. I figured that I've been having a lot of trouble writing full blog posts, but I still have a ton of observations I'd like to share. Therefore, it's a whole lot easier to Tweet a one sentence remark at the time of my observation than it is to save it up for a whole blog post later.

I will continue to add to my blog. I'm just having great difficulty find the inspiration to write at the moment. Twitter can sort of be an outlet for me in the mean time.

A Really Difficult Job

2010-06-25T00:39:00.004-04:00

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.

Stupid Fax Machine

2010-06-15T23:42:00.002-04:00

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."

AHHHHHHHHHHHHHHHHHHHHHHHHHHHH!!!!

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.

JUST TELL ME IF I CAN FILL THE DAMN THING OR NOT!!!!

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.

I'm Still Alive

2010-06-10T13:06:00.002-04:00

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.

The Weekend is Almost Over

2010-03-14T13:36:00.002-04:00

I wish I could change jobs, but I have no idea what I would do. I've come to the conclusion that I don't really like the profession of pharmacy or the health care profession in general. I feel like I'm doing more harm than good by promoting medication therapy to people. As I've said before, I don't take anything besides sudafed or Tylenol every once in a while. I don't believe medication is the secret to staying healthy for longer. I firmly believe that a healthy diet, good exercise, and an overall active lifestyle does more to help pretty much everything than drugs do.

Sure, medication has it's place. However, I just feel like in my pharmacy, most of the drugs we dispense are unwarranted. I mean, how can the most prescribed drug in the United States be Vicodin? Why do we have to keep more Percocet in stock than HCTZ? How come every child in the world now gets Ritalin, Adderal, Concerta, and now Vyvanse? Is it right to be handing out Lipitor to the man that's 100 pounds overweight, when if he just ate right, exercised, and lost weight, he'd decrease his risk for heart disease more than Lipitor ever could?

Everyone is looking for shortcuts to good health. Everyone wants to just take a pill and go right on doing what they were doing before. Hell, they're even doing research to see if they can make a pill mimic the effects of exercise on the body. We've reached the point where we even want our exercise to come in pill form!!

Furthermore, what happens if we just took all these drugs away? No more Lipitor. No more Actos. No more blood pressure medication. Basically no safety nets. You tell people, "look, you can live however you desire because this is a free country. However, if your poor eating habits and sedentary lifestyle end up causing you to develop heart disease or diabetes, you're going to have to live with it." No drugs to bail them out. If they don't live healthy, then they increase the chances of being sick, and once sick, there's nothing anyone can do for them.

Maybe if there were no drugs to fight these more or less preventable diseases, maybe people would take better care of themselves in the first place.

I think I'd love to be a personal trainer or a dietitian of some sort. I'd love to tell people how to work out in order to be as strong as they can be, and I'd love to teach people how to eat healthy. However, it's difficult making money in that kind of field, and sadly, I've grown accustomed to my 6-figure salary. I don't think I could afford an $80,000 per year pay cut in order to do the thing that I like the most and feel has the most worth. Therefore, I'll just keep chugging away at a job I don't particular like or believe in.

Maybe one day, I'll have the courage to just say "fuck it." I'll walk right out that pharmacy door and never look back. I wouldn't worry about money or plans for the future. I'd just go wherever my heart leads me. Maybe I'll only end up making minimum wage and struggling to make ends meet every month. At least then, a little part of me wouldn't die inside every time I go to work.

Starting to Crack

2010-03-10T22:28:00.003-05:00

Sometimes you just know right from the very beginning how the day will go...

I opened the door, turned off the alarm, and saw the mess left over from the night before. Scripts from the previous day weren't filed. Prescriptions were strewn about the counter half filled with little post-it notes on them that didn't do a good job of explaining their half finished state. A bottle of Percocet was left on the counter instead of being put back into the safe. Upon seeing this mess, I knew the day's fate was sealed.

No, a floater didn't work the previous night. If that were the case, the mess would have at least been understandable (though not less infuriating). One of our regular, full-time pharmacists closed the store... or at least I thought.

Thirty minutes after the gate went up, the pharmacy manager called me. Apparently, the day before was a disaster. Our lead tech called out sick... again (she's just about used up all her sick time for the year already, and we're barely into March). The staff pharmacist who was supposed to close went home sick at 2:00, which left the pharmacy manager to work the entire afternoon until close by himself. He also informed me that we didn't get our order yesterday because that same pharmacist who left sick forgot to send the order the night before, which would be forgiveable if she didn't manage to do this at least once a month. Therefore, our order today was going to be twice as large as normal.

Great, I thought. What a lovely day it will be!

The first customer of the day paid for his prescription in pennies. He didn't ask if it was ok. The tech told him the price, and he proceeded to dump a whole pile of pennies on the counter. I wanted to refuse them, but my company's new hassle free policy forced me to smile as both he and the tech tried to count the pennies at the same time, both interrupting each other's counting numerous times.

Just as things were starting to look bleek, a tiny sliver of light shined upon the pharmacy when the lead tech miraculously showed up for work. She had been out since Friday, but she decided to give it the good old college try. By college try, I mean she came to work, did nothing but complain for 2 hours, and then left feeling sick. She had been out all week because of bronchitis, but that wasn't why she left today. In fact, I don't think I heard her cough one time the entire time she was there. Nope, today she left because she thought she had bruised ribs, and simultaneously (and unrelated to the ribs) she felt like she was going to puke.

Later in the morning, a woman on crutches after surgery dropped off a prescription for Percocet. Nothing at all unusual. The script was pefectly legible. No crossouts. No erasures. No mistakes. Beautiful... except for on the line that says "physician print name here," the doctor scribbled down something that had no discernible letters in it. I don't even have to mention that the script was written at a not-so-nearby hospital. I called the hospital to see if anyone could provide me some information that might lead to the identification of the mystery doctor, but I was transferred to a voice mail box. It took me 30 minutes to find someone that could tell me who wrote the script.

And now I will offer my unedited feelings about this doctor and every doctor who can't write neatly. FUCK YOU!! FUCK YOU ALL!! How fucking hard is it to write your name??? You went to medical school. You passed your boards. You have to have some sort of intelligence. Therefore, it completely mystifies me why you would write everything else neatly on the script and then scribble in the spot you're supposed to print your name. You saved yourself all of 1 second, and you wasted 30 fucking minutes of my time. I think this should be punishable by death, or at the very least, a good thorough ass kicking. Go fuck yourself.

Two hours later, a customer who could barely walk shuffled his way up to the counter using a walker. He too presented a Percocet prescription. His numb nuts doctor didn't write a strength on it. I suppose I could have called the office, got the strength (everyone knows it was supposed to be 5/325), and had them mail me a new hard copy. However, I'm sick of fixing everyone else's fuck ups. Therefore, I sent the barely mobile patient back to the office to have his doctor rewrite it. The idea is for him to be mad at his doctor for screwing up. Instead, I'm pretty sure he was just pissed off at me.

Then there was the lady who spent 10 minutes at the counter demanding to know why the price of her prescription increased the exhorbitant amount of $0.99. Highway robbery she proclaimed! I wanted to tell her that she could of borrowed the $0.99 from the guy who dumped the pennies on the counter earlier. I think they would have made a great pair.

The last asshole of the day was a guy who demanded that we transfer all his prescriptions to another pharmacy because his flexible spending account card was rejecting. He didn't have time to call the customer service number to find out why it wasn't working. He just knew it was our fault, and it would work just fine at the pharmacy next door. I wanted to send him to the other pharmacy so bad, but two things held me back. One, the new, unjaded pharmacist who was working with me quickly jumped to his aid and called the customer service line for him. Two, if I transferred the prescriptions I wouldn't get the satisfaction of seeing his face when his card rejected again.

If I was Drug Monkey, I'd be overindulging in scotch right now. However, I'm not that classy, and I've stopped drinking entirely for the time being. Therefore, I'm forced to drown my sorrows in water and Thin Mint Girl Scout Cookies. I'm actually not sure if that's any better for you than scotch.

The best part: I get to do it all over again tomorrow. I LOVE MY JOB!

A Hypothetical Situation

2010-03-03T21:41:00.003-05:00

Let's say you're working at a job you don't particular like for not all that much money. An opportunity suddenly comes up where you can get a job you like that will pay more. The catch is that you have to relocate to halfway across the country in order to take that job.

Now, here's where it gets interesting. What if I told you that if you stayed in your current location, you'd meet someone truly amazing and fall madly in love? Therefore, the choice becomes move in order to get a potentially great job or stay in order to meet what could possibly be the love of your life. Which would you choose?

I'll step back and analyze the situation...

Say the job market for your particular skill set is very slim in your present location. It took you forever just to find your current job, and you only took the job because you really didn't have any other options. It's not something you envision yourself doing for the rest of your life. It was just a stepping stone to hopefully a better position. Therefore, when that opportunity to get that great job presents itself, you'd be doing yourself a disservice not to at least give it a shot. After all, you're presently single, and even though your friends and family are all in your current location, you're confident you can make new friends and connections when you move. Maybe you'll even meet someone very special there. Who knows?

While moving is a tough thing, at least on a theoretical basis, moving for the great job seems like the right thing to do in that situation. Therefore, let me complicate things a little...

Say that the whole situation with your current job is the same, but instead of meeting that amazing someone in the future, let's say you've already met him/her. The relationship is young (only a few months old), but the two of you really have something special together. You don't want to get ahead of yourself, but you feel like if you give the relationship a shot, it could end up being "the one."

Now that decision is much more complicated. You still hate your job. However, you now have something really tying you to your current location. You don't want your relationship to end, but at the same time, you don't know how much longer you can last at your present job before going crazy. You want to ask your significant other to move with you, but being that the relationship is only a few months old, you're unsure if that's a good idea. Moreover, he/she has a house, a great job, and basically has a pretty good thing going in the current location. How can you ask someone to uproot his/her life for you when you've only been dating them for a few months? In addition, maybe that job that you have to move halfway across the country for won't work out that well. Maybe it's not as good as it seems on paper. You'll kick yourself if you threw away the greatest relationship you ever had to chase a job that ultimately didn't work out.

What would you do in this situation? On one hand, you have the possibility of a great career. On the other hand, you have the opportunity for long lasting love. Neither is certain though.

How would you choose?

The January Experience

2010-01-20T16:47:00.003-05:00

Every retail pharmacist has a wonderful little anecdote about the craziness of working in a retail pharmacy in January. I figured I'd share a story that I feel epitomizes the entire January experience.

A customer comes to pick up some prescriptions. They were filled, but billed for cash because we needed her new insurance information.

"But I have the same insurance as before!!" she exclaimed.

"No, I'm sorry, but something must have changed because when we billed it, it came back 'filled after coverage terminated,'" I replied.

She continued to insist that nothing changed and then busted out her insurance card as proof. It was a Cigna card, and of course, it wasn't a pharmacy card as it didn't mention RX anywhere on the card. I explained to her that it was only her medical card, and she must have a separate pharmacy card.

"This is the only card I got!!!" she asserted.

"Fine... I will call the insurance company, but I guarantee they're going to tell me exactly what I told you," I said to her. Then I proceeded to call them. After 5 minutes on hold, I got to speak to a representative. This representative, as predicted, told me she no longer had prescription coverage with Cigna. However, amazingly, he was able to tell me that her new coverage was through Express Scripts.

I thanked the representative, hung up the phone, and then proceeded to call Express Scripts. After another 5 minutes on hold, I was able to speak to a representative who gave me all the information I needed to bill the claim.

Great! It only took 20 minutes of my time, but I was able to bill her prescriptions to the correct insurance. I told her that she was all set, and she responded, "Did they just change the ID number or something?"

"No... Your insurance is through an entirely different processor now. Your pharmacy claims are now being handled by Express Scripts," I informed her.

"Express Scripts? OHHHHHHHH!!!! So that's what must be in that letter from Express Scripts that's sitting unopened on my kitchen counter!!!" she said.

(FUUUUUUUUUUUUCK YOOOOUUUUUUU!!!!!) I didn't yell out loud but really really wanted to.

Every part of that story is true, and I think it perfectly sums up the entire month of January in the retail pharmacy world. We waste so much freaking time trying to bill and rebill insurances because customers are too fucking stupid to bring the new insurance card to the pharmacy.

Furthermore, how can you not know what benefits you have? I don't know how other places work, but I know that every year, I'm responsible for choosing my benefit options. I must enroll in medical, pharmacy, and dental plans. I get a big information packet that fully explains all my options. Is this unique to my employer? Is it really a big mystery to some people?

And while I'm ranting, why the hell do people save old insurance cards? I get so annoyed every time I ask someone for a new insurance card, and they pull out a wallet containing every insurance card they've ever been issued for the last 15 years. Get rid of the old cards! You don't need them anymore. Even if by some incredibly small chance you do need one of them some day, just keep them at home. Why do they all have to be in your wallet?

I had another conversation with a different customer about why her copay suddenly jumped from $10 to $40.

"Why is it so much now? It's always been $10!" she said.

"Ma'am, it was $10 on your old insurance. You have new insurance now, and they're charging a $40 copay," I tried to explain.

"But, why would it suddenly go up when it was always $10," she once again stated.

"That... was... your... old... insurance. This is a different insurance plan," I tried to spell out as clearly as possible to her.

"Whatever... I don't get it. I'm going to call them to complain," she said becoming irritated.

"Good... You do that," I replied.

I hate to side with insurance companies on anything because they make our jobs about 100 times harder than they have to be. However, often times, the customer's stupidity is just as much to blame for these situations. Whether it's not bringing in their new insurance cards, not knowing that they have new insurance, or not understanding that different insurances have different formularies and copay structures, customer stupidity is just as hard to deal with as insurance company stupidity.

I can't wait until this month's over. Who am I kidding though? February is only marginally better.

I Feel Like I'm Going Crazy

2010-01-19T22:50:00.002-05:00

I go days at a time without turning on my TV. Work, which I used to not mind all that much, has suddenly become a huge chore to me. I've completely lost track of my favorite sports teams, and I've even lost the urge to play basketball 24/7.

The things and activities that made up my entire life for the previous 3 years suddenly feel so unfulfilling to me. Basically, the reason for this is that I spend every moment of my day thinking about how I wish I could see my girlfriend. I've never felt so strongly towards someone so quickly. She consumes my thoughts. I think about ways I can make her happy literally all day long.

I know that it's so early in this relationship, but I'm pretty sure I love her. When I'm away from her, I eagerly await the next time I'll get to see her. When I'm with her, it just feels right. It feels so natural to wake up with her right next to me. When she's not here, I go to bed and wake up feeling so lonely.

I was never like this before, even with my ex. Honestly, I hated sharing a bed with her. I never felt like I could get a good night's sleep, so I never wanted to sleep over. Even when we lived together for a couple months, I just could never get used to it. Now with my girlfriend, I have no problem.

We've already said "I love you" to each other. She said it first, but the timing was less than ideal (it was New Year's Eve, and she was pretty drunk at the time). She apologized the next day for blurting it out so soon, but she also affirmed that she did mean what she said. I told her I felt the same, despite it being early in the relationship.

Despite all this, we both admitted to each other that we have fears about the relationship. She said she's afraid that the "magic" we're feeling now will some day go away. I told her I was afraid of being hurt again. However, I also told her that I wasn't going to let fear rule my life. The bottom line was that I'm presently extremely happy, and that's all I'm going to think about. She agreed this was a good outlook.

All of this just doesn't seem real to me. I've spent so long feeling like every meaningful thing in my life was destined to fail. It's this expectation of catastrophe that is so hard for me to handle. I'm just waiting for something to go wrong, so despite the fact that I love her, love being with her, and will do just about anything to make her happy, I don't feel completely comfortable with the relationship. I'm taking things one week at a time because I'm too afraid to make plans any further in the future.

While I'm rambling, let me tell you a little about the girl that stole my heart. She went to the same high school as I did, but we never knew each other in school. Her best friend is one of my best friends' sister. We've both been friends with these siblings since we were in kindergarten, so we have shared memories of my friend's house and the neighborhood even though we never knew of each other until recently.

She was quiet in high school... like me. She admits to thinking too much and over analyzing things. Sound familiar? Her mind works a lot like mine. We tend to think of the same things, and often, we think of them at the same time. It's actually almost eerie how much we think alike.

She studied photography in college and now works as a photo editor and a photographer. She's artistic and very creative. She likes arts and crafts. She has a million art supplies in her room, and her floor is perpetually covered in glitter. However, she's terrible at math and not particularly good at science. See, her strengths are my weaknesses and vice versa. I joke that the two of us combined would make one pretty incredibly talented person.

She also loves to cook and bake, and she likes a wide variety of food, which makes her great to go out to eat with. Since I love to eat (probably as much as any guy you'll ever meet who weighs 155 pounds), she's a really good match for me in this regard.

Oh yeah... and she's cute.

I'm sorry for rambling on. I'm just feeling simultaneously excited and nervous right now. I'm excited things have gone so well up to this point. I'm extremely nervous because I really don't want this to fall apart. I'm doing everything in my power to ensure it doesn't, but I know I can't control everything in life. I guess the only thing I can do is constantly show her how much I care about her and never give her any reason to doubt it. If I do that, and things still go wrong, then I can't have any regrets because I'll know I did everything I could.

That's probably the only positive lesson I learned from my breakup with my ex. I spent years regretting many of the words I said and decisions I made in that relationship. I didn't always treat her like I should have, and that's ultimately one of the reasons it failed. I won't make that mistake again. I promise myself that.

Because Someone Asked...

2010-01-10T22:09:00.003-05:00

Someone asked for a "girlfriend update," so I guess you'll have to endure one...

Yes, she is officially my girlfriend. Overall, things are going quite well. There are a few little things that have been bugging me a little bit though.

First, the distance, while not being an insurmountable obstacle, is a bit of an issue for me. I don't mind driving an hour to see her. I've driven to her place after getting out of work, and I've driven back from her place late at night when I had to work the next morning. I'm not concerned with not getting enough sleep because I can always make up sleep. I just don't like the feeling that we have to plan out every time we want to do something.

It's hard to be spontaneous when we're so far apart. For example, I can't just rent a movie after getting out of work and have a nice relaxing evening with her. In fact, seeing each other during the week is very hard. If I get a day off where I don't have to work super early the next day, I'll make the trip up there. Otherwise, we're confined to just weekends... and our weekends together have been great! I have absolutely no complaints about the time we spend together. She's great. The time we spend apart is another story.

Maybe I lack the experience of how to handle new relationships, but I find myself struggling when she's not here. I hate to compare relationships, but it's my only frame of reference. With my ex, we never spent a lot of time apart. From the time we started dating until the very end, we were pretty much inseparable. There were very few days where we didn't see each other. Not only did we see each other, but we spent most of our time together.

I guess that's the only way I know how to be in a relationship, so when we spend 5 or 6 days without seeing each other, the seeds of doubt start springing up in my head again. I talk to her on the phone everyday day, but I feel like our phone conversations aren't that great. It has nothing to do with us not getting along. We just live entirely separate lives during the week. Our jobs are entirely different. I don't really understand what she does, and she doesn't have a good grasp of what I do. We have a couple mutual friends, but otherwise, we don't know the same people. She talks about her friends, but since I've never met most of them, I can't participate in the conversation as much as I would like.

Basically, we don't have much to talk about. It really hurts that neither of us watch much TV. She doesn't even have cable in her apartment, and I haven't actually watched TV in weeks, so neither of us are that up to date on current events. If we can't talk about work that much, and we can't talk about current events, and we've already gotten past the getting-to-know-each-other phase, what else is there to talk about?

I don't know... I feel like when we're together, there's major fireworks, but when we're apart, that spark just isn't there. It's probably just a new relationship thing. This is probably the way people normally feel after only a month of dating. As we have more common experiences and get more comfortable with each other, the connection will probably become much stronger. After all, two people never start out deeply in love. That kind of bond takes time to form.

For now, I'm going to try not to think too much about it and just go with the flow. All I know is that she's a great girl, and I love the time we spend together. I just need to be patient.

My New Year's Resolution

2010-01-05T09:20:00.003-05:00

I think my resolution for this year is for me to start calling things as I see them. This mostly applies to the pharmacy. I'm just sick of having to kiss ass and be ultra polite and "professional" in the face of people who lack any form of common sense.

Take for example the woman from this past weekend who flipped out at the pharmacy counter when she came to pick up her birth control that she called in to refill Thursday afternoon (New Year's Eve) only to find that we didn't have it in stock and had to order it for Monday. She completely blew up on us saying that we should have called her to let her know we didn't have it. We were irresponsible, etc., etc.

Maybe she's right. Maybe the polite and customer-friendly thing to do would have been to let her know. However, if we want to talk irresponsible, why the fuck do you wait until the day before a long holiday weekend to call in a refill for a medication that you seemingly desperately need? If it was sooooo important to you to take that first tablet on time, why didn't you give us several business days notice?

The answer of course was that she wasn't thinking. Thinking customers are a rarity. Seriously, doesn't it blow your mind when someone actually says that they usually call in their medications a week in advance? Despite the fact that I tell just about everyone to do this, it happens so rarely that I'm literally overwhelmed with joy when a customer tells me they actually do it.

I'm sick of having to apologize for shit that doesn't really matter and isn't really our fault. My responsibility is to fill whatever prescriptions I am presented with safely and accurately. It is not my responsibility to ensure a product is in stock at all times just so one particular person can call in a script and pick it up in the same day. It's not my responsibility to be tracking down customers in order to tell them we had to order something for the next day. Honestly, I don't care.

There are some exceptions, of course. If the out-of-stock item is something that skipping a dose could be harmful for the patient(like antiepileptics or HIV drugs for example), I'll do my best to let the patient know we're out of stock. Birth control? Not that important. A person can go without for a day or two.

Then there was the moron who called up to see if a prescription was called in for her. It was, but instead of being happy that her doctor's office called it in, and it was ready for her, she questioned why we never bothered to call her to let her know the prescription was ready. Lady, we filled 500 prescriptions yesterday. How the hell are we supposed to call every single person who had a prescription called in?

So... My resolution is that if you say something stupid, I'm going to call you on it. To hell with the motto "the customer is always right." Fuck that. I'm right much more often than they are. I work 40 hours per week in the pharmacy. I think I should get the benefit of the doubt.

Blank Expressions for the Holidays

2009-12-21T19:13:00.003-05:00

There are few things that irritate me more than the blank expression of a customer who simply does not understand what you're telling them or looks completely unable to do anything for himself.

Today, we had some woman come to the counter. She was out of her Xanax. We contacted the doctor for refills the day before, but we still didn't get a response. We told her this, and her response was to stare blankly at us without saying a single word. She just stared. She wouldn't move from the counter. Didn't ask what she could do to help. Didn't complain about her doctor's office. She just stared.

I felt like saying to her, "What the fuck do you want us to do?" I bet that would have gotten some response. Or maybe not. Who knows?

I'm a little more sympathetic to the dumb stare when it comes from an elderly person. However, all I can think about when seeing it is if I get that way when I'm old, I want someone to just shoot me.

I'm dead serious. I do not want to be a forgetful, half-retarded old man. I've spent my whole life up to this point having a fairly sharp mind. I can't imagine not being able to grasp simple concepts. I don't want to live a life in which I can't do things for myself. If and when the day comes when my mind deteriorates to that point, I want someone to just put me out of my misery... because I will certainly be miserable at that point.

I look at these people and think that at one time in their lives, they must have been more like me. They must have been young, energetic, and quick-witted. That realization scares me because it just seems inevitable that we all end up that way. That's why I'm doing everything I can now to keep myself healthy and active. If it's in my fate to be just like every other elderly person, then I'm going to fight fate with everything I have.

I simply refuse to be that way.

A Day Late on the Update but Definitely Worth the Wait

2009-12-06T22:17:00.003-05:00

I feel like a teenager when I talk about this stuff, but considering how low I've been the last few years, this is great to write about.

Where to start???

OK... First date. I met her at her place, and we ended up going out for dinner. She likes to eat out just as much as I do. A BIG plus! We had a pleasant dinner, and then stopped at a bar for drinks afterwards. We were out until almost 2 in the morning before returning to her apartment. She made hot chocolate for us, and we just kind of talked and joked around until 3 AM. I had to go home at that point. It was an hour drive back to my place, and I had to be at work at 8 in the morning. I left, but I couldn't get up the nerve to try to kiss her goodnight.

Sounds familiar, right?

I woke up after only 3 hours of sleep and somehow made it to work the next day. A couple hours in, she texted me asking how I was doing and if the drive home was ok the night before. That set us off basically text messaging back and forth all day again, which led to another LONG conversation online at night.

At the end of the conversation, we talked about possibly getting together again the next day (Sunday) to go out to a restaurant we had talked about during our first date. However, she said she wasn't sure if she'd be able to fit it into her schedule.

That planted the seeds of doubt in my head... again.

Maybe she didn't really like me that way. Maybe she only wanted to be friends. What happens if I tell her how I feel, and she doesn't feel the same way? Since she's friends with some of my friends, wouldn't that be awkward?

Thoughts raced around my head all day as I waited to hear whether she was going to meet me tonight or not. Finally, she texted me around 2 asking if I still wanted to go, and of course, I did. It seemed like a casual invitation though. I was actually starting to worry that she might decide to bring a friend with her or something.

After work, I had a mini freak out. I realized it was pretty much now or never. We couldn't keep going on the way we were. We had been staying up until the wee hours of the morning talking for like a week straight. I've never been so short on sleep in my life, and it must have been the same way for her. Either we were going to go somewhere, or it was just going to go away entirely.

So, I did what only Pharmacy Mike would do... I analyzed the shit out of the whole situation. My problem: I wasn't sure if she liked me or not. After putting all the facts together and thinking of things from her perspective, I came to the conclusion that she had to like me. She stayed up until 3 in the morning talking to me one night when she had to work the next day. We had a 3.5 hour phone conversation. Not only did we have our "coffee" date Friday, but she actually canceled what she had planned in order to make more time for me that night. Then, instead of coffee, it ended up being dinner, and instead of just saying goodbye to me when I got to my car, she invited me into her apartment. Even the whole date tonight required her to completely rearrange her schedule and go way out of her way to make time for me.

It became obvious that no sane person would do those things for "just a friend." I thought about how I approach my friends, and how I would never go that far out of my way just to hang out or talk to them. No one would. She had to like me.

In addition, what business did she have not liking me? I'm not the most confident person in the world, but I look at a lot of other guys with girlfriends and think that I'm a better catch than they are. I'm not bad looking. I'm lean and athletic. I'm smart. I have a job that pays me a 6-figure salary. I'm honest and sweet... and nice. Seriously, I'm like nice to the point of sickening sometimes. If she didn't think I was worthy to date, who the hell was she waiting for?

In any case... After all that thinking, I decided I would just go out, enjoy dinner with her, and then just tell her exactly how I felt afterwards as I was saying goodbye to her. And that's exactly what I did. It wasn't the smoothest delivery in the world. I kind of stopped and started and mumbled my way through it, but I got it out. Then I kissed her, and with that huge weight lifted from my shoulders, I was able to talk to her about how that was probably the most nerve-wracking thing I've ever done in my life.

I'm seeing her again Saturday. Now, I can truly relax knowing she's in the same place I am.

Wow... that was a long time coming, huh? I feel like this is the culmination of everything I've been through over the past 3 years. Things can still go wrong from here. There's one more hurdle to jump over before I'm 100% in the clear. Right now though, I'm just happy... and relieved.... and proud of myself.

Thanks to all my readers for the advice.

Here's How It All Went

2009-12-04T01:07:00.003-05:00

As I said, I got the date. I actually asked her out via text message. I didn't want to do it that way. It wasn't the plan, but it was the only opportunity, so I just went with the flow. I kind of smoothed it in there. We were joking about how I kept her up late talking the last few nights, and how coffee was the only thing keeping her awake at work. She joked that I owe her a cup of coffee, so when I texted her, I basically said let's go get that cup of coffee I owe you. She agreed.

I called her on the phone tonight to kind of figure out the details. We ended up talking for 3 and a half hours. We're going to meet up and go out around where she lives.

This is where I'll mention the one hiccup in this whole thing. She lives over an hour away from me. We both grew up in the same town, but she took a job an hour away. Last month, she moved to an apartment 5 minutes from her work.

She spends enough time back in our hometown where I'm sure the distance won't be that big of a problem. It might get a little annoying driving over an hour each way to see each other. I'm getting WAY ahead of myself here though. I still have to see how the night goes.

By the way... I have to work Saturday morning. I'm driving over an hour to meet up with her at 9:30 at night. I'm assuming that I'll be out to at least 1:00 AM. Then, I won't make it back here until after 2 in the morning, so that I can get up to get ready for work less than 5 hours later. It's going to be a tiring night. I might actually have to start drinking coffee to date this girl.

She must like me, right? All the late night chats, the 3.5 hour phone call tonight, agreeing to go out with me... She must be interested, right?

No matter how things end up turning out, I have to be at least a little happy with myself. I mean, these are big steps. It's probably your average Friday night for a lot of guys, but this is the first date I've been on in almost 2 years. In this situation, I actually took the initiative more than I ever had in the past. I met her in person. I reached out to talk to her after meeting her. After taking a little while to get to know her, I asked her out. I'd say I'm progressing in leaps and bounds compared to where I was just a year ago.

Last December, I wrote a year in review post in which I mentioned that I'd probably look back at 2008 as a major turning point in my life. I also wrote that I wasn't even sure if I was a relationship person at all. How things have changed... If 2008 was the turning point, 2009 was me taking off running after the turn.

Wish me good luck tomorrow night. You can expect an update Saturday night. LOL... My blog has a purpose again.

Update to Follow

2009-12-03T07:45:00.002-05:00

It's early, and I have to get to work soon, so I don't have much time. I just wanted to update everyone. I got a tentative coffee date for this Friday. I say tentative because it won't necessarily be coffee. It just kind of fit into the conversation. However, I have a day and a time if not necessarily a particular activity. I'll clarify later.

Thanks to everyone who chimed in with advice. It seems weird to be getting dating advice from strangers on the internet. However, I think a lot of people get all kinds of advice before asking someone out. They just get it from their friends. Since I'm a little shy, and my friends aren't great for doling out dating advice, my blog seems to be a better place for me. Quite honestly, anyone who reads my blog regularly knows more about how my mind works than any of my friends. Ok... That might be a little sad.

By the way... I like how everyone kept saying, "My husband/boyfriend is a nerdy internet guy..." It's funny because I guess I am nerdy in many ways. On the other hand, I did score 20 points in my basketball game this week. I'd like to know how many pharmacy nerds can do that! haha

I Need Advice

2009-12-01T20:50:00.002-05:00

I mentioned a couple posts ago that I have been talking to a really nice girl. I've now hung out with her on 3 separate occasions. They weren't dates. The last couple of times, she invited me to go out with her and a friend. We had fun both times.

I really like this girl... a lot. We talk often online. The last couple of nights we were up past 1:00 AM talking. I get along with her really well. She's a sweet girl, and we share a lot of interests.

Basically, I want to know what should be my next move? I'm starting to feel like if we keep talking like this without anything more coming out of it, she might get either annoyed or disinterested. I don't want that to happen. I want to ask her out on an actual date. I've been trying to work up the courage for the past 3 weeks. I just don't know how to do it. I don't want to come on too strongly, but at the same time, I know that I have to at least make some kind of move.

I'm not smooth. I'm not the most charming guy in the world. I don't know how to be all cool about things like this. However, I am good at being honest. I was thinking that the next time I talk to her, I should just lay it out there and see what happens. Something like this...

"I'm not smooth, so I don't really know a better way of asking. I just think you're a really nice girl, and I like talking to you a lot. I was hoping we could go out some time for dinner and maybe some drinks."

Something along those lines... It sounded better in my head than it came out on the screen. Some people have told me the best thing is to casually ask her if she'd like to join me going to something I was already supposed to be going to. For example, if I was planning on getting drinks on Saturday, ask if she wanted to come along. That's a good idea, except I don't have stuff like that going on unless someone asks me first. If I haven't hammered this home already, I don't have the most eventful life.

I'm not good at dealing with all this signal reading. I just think it always works best for me to be open and honest. Let her know that I like her. Let her know I'd like to go on a date with her. Just be sincere and honest.

So, I think that's going to be my game plan. The next question is when should I do it? I've spent several hours talking to her online the last couple of days. The day before that, we spent the day text messaging each other back and forth. We've never really talked on the phone, so it feels a little weird just calling her out of the blue to ask her.

Should I though? Would it be best to call her? Should I wait a couple days to give her a little space? We've done a lot of talking recently. I don't want to become annoying. Should I just wait until the next time I get a chance to talk to her online, or would it be better to act quickly?

I want opinions here... preferably female opinions. I'm at the point right now where I'll actually listen to advice from random strangers over the internet. I swear, if a number of people comment telling me to call her now, I'll call her within the next 5 minutes. I don't want to screw this up. I don't want this to be like all those other times when I do nothing and let the girl get away. I like this girl too much.

Advice would be greatly appreciated.

Electronic Prescriptions: Now We Can Clearly Read All the Errors

2009-11-26T21:29:00.002-05:00

I might be the only pharmacist in the world saying this, but I don't care. I'm so sick of electronic scripts. I swear I spend more time calling doctors' offices clarifying electronic scripts than I ever did for written ones.

The problem with electronic scripts is that you actually have to know how to use the program in order to send them accurately. Now, I have no idea what the software interface looks like. I just know how they show up on my computer, and often, there's some sort of problem with them.

The most common problem is whoever is inputting the script (medical assistants, RNs, and seemingly rarely the physician) keeps selecting the wrong drug. I can only assume that the interface is similar to our pharmacy computers where you type in at least part of the name of the drug and then choose the correct one from a long list of options. The problem is that while pharmacy employees work with these drugs every single day and are well aware how they're named and supplied, doctors' representatives seem to not really know which is the correct drug to choose.

Here's an example...

Drug: Tussirex
Sig: Take 1 teaspoonful q 12h prn
quant: 4 ounces

I don't even know what Tussirex is. Upon looking it up in the PDR, it apparently existed at one time as some sort of cough medicine. I've never seen it, and I'm pretty sure it doesn't exist anymore. Of course, any pharmacist knows that it was supposed to be for Tussionex. However, I can't just assume that. I've seen physicians write for products that are no longer available plenty of times before. Therefore, and especially since Tussionex is a controlled substance, I had to call the office to verify it. As you could have guessed, by the time we got the script, the office was closed and was no longer accepting phone calls. When we finally contacted the office a day later, the nurse confirmed what I already knew; She had selected the wrong drug.

Problems like that are amazingly common. Wellbutrin is another one that drives me crazy. Whenever I see an electronic script for Wellbutrin, there's probably about a 50% chance it was inputted incorrectly. There are 3 different formulations of Wellbutrin. There's just plain old Wellbutrin, the 12 hour Wellbutrin SR, and the once daily Wellbutrin XL. It's not at all uncommon to see scripts that read just like this...

Drug: Wellbutrin SR 12 Hour 150 mg
Sig: Take 1 tablet once daily.
quant: 30

This drives me insane because there are so many things that could be wrong with that script that even after calling the office, it usually takes forever for me to get it resolved. Was it supposed to be for Wellbutrin SR? If so, are they really only taking it once a day? Shouldn't it be twice daily with a quantity of 60? Or did the doctor really mean Wellbutrin XL, and someone just selected the wrong Wellbutrin? AHHHHHH!!!!

Then there's the ones that come across with completely messed up directions...

Drug: Klonopin 0.5 mg
Sig: Take 1 po qd po 1 po HS (30 days)
Quant: 60

That's exactly how the script came across. My first thought was that the doctor meant for the patient to take it twice daily. That seemed to make sense. The quantity was for 60, and it said 30 days in the directions. It looked pretty obvious to me, but once again, it was a controlled substance, so I just wanted to double check. Of course, I couldn't get anyone at the office right away, so I had to leave a message. Five hours later the doctor called back to say that it was only supposed to be 1 tablet at bedtime, and he had no idea why the script got messed up like that.

A lot of pharmacists probably would have filled that as twice daily, and it would have been an error (albeit not really the pharmacist's fault) because it wasn't what the doctor intended. That leads me to wonder just how many scripts are filled incorrectly due to someone in the office choosing the wrong drug or inputting the wrong directions? I'm guessing more than a few.

I think that electronic scripts were aimed at solving one prescribing problem: Bad handwriting. However in doing so, they opened up the potential to make plenty of other mistakes. In reality, bad handwriting was never the biggest source of prescription errors. The biggest problem causing incorrectly written (or filled) prescriptions is not double checking them before they go out the door. Prescribers (or whoever is actually writing the scripts, which I know often times is just the medical assistant, and the doctor just scribbles his signature on it) just quickly write out a script without ever giving it a second look. Therefore, careless mistakes are made. Usually the handwriting is at least good enough for pharmacists to figure out. I really don't call offices that much to clarify poor handwriting. Most of my calls for clarification involve the actual content of the prescription. Wrong drug, wrong dosage, wrong directions, wrong or missing quantity, etc. Without making double checking mandatory, these errors will continue to happen whether the scripts be hand written or electronically sent.

What I don't understand is why there's no emphasis on double checking the script before it ever leaves the office. Pharmacists double and triple check every single prescription before it leaves the pharmacy. If I'm the only person working, I will type the script myself. Then once the label prints, I will check what I typed against the hard copy. Then, I will grab the drug from the shelf and check the NDC on the bottle vs. the NDC on the label. Then I'll count it out. If it's a control, I'll double count it. Then, I'll check the name on the bottle vs. the name on the pharmacy receipt that gets stapled to the bag. Finally, I'll verify the patient's address before giving the prescription to them.

Notice that there's a half dozen checks in there for each script I fill. However, prescribers don't seem to even do a single double check. I know decreasing insurance reimbursements have them strapped for time while trying to fit as many patients in as possible. However, I can't imagine that it would take more than 5 seconds to check a prescription one just wrote for accuracy.

There's no excuse for the number of mistakes I see. Absolutely none at all, and since electronic scripts, at least from my observations, aren't doing anything to cut down on these mistakes, what's the point?

What's this??? I'm Actually Happy.

2009-11-23T22:48:00.003-05:00

I guess it was a gradual (some would say it was at a glacial pace) process, but the realization hit me suddenly within the last couple of weeks. "Holy crap! I'm not miserable anymore. I'm actually happy." Not only am I happy, but I'm optimistic. I'm actually looking at the positive side of things instead of constantly dwelling on the negative.

It wasn't a magical transformation. It took a lot of hard work on my part. I didn't set out with happiness in mind. I wanted to take things one step at a time and see where I ended up. The first thing on my agenda was getting healthy and physically fit. I cleaned up my diet. I greatly cut back on most processed foods and anything with added sugar. Then, as I've stated several times in this blog, I started an exercise routine, and I've been pretty consistent. It's been almost 3 months since I started, and I feel more fit than I have in a very long time.

Being healthy and in-shape is a wonderful thing because it not only affects your body but also your mind. It's been pretty well documented that lack of physical activity can lead to depression. There was even a study that came out recently saying that processed foods (i.e. non-whole wheat carbs, and foods with added sugar) were linked to depression. It's become abundantly clear to me that we really are what we eat. If you have a poor diet, you're going to feel like crap mentally and physically.

Becoming healthier changed my entire mood. I just felt better overall. I felt more confident and less miserable. I had more energy, and therefore, I had more desire to go out and do things. I started hanging out with friends more often. I branched out and met some new people. Again, there was no particular goal in mind. I just decided that I no longer wanted to watch life pass me by.

My more active social life ended up expanding my circle of friends. I mentioned a couple months ago how I was dying to go on a vacation. Well, along with one long time friend and a couple other relatively new friends, I booked a vacation in February. It's only a 5 day trip, but I'm very excited for the chance to travel with a bunch of friends to a place I've never been.

I've also been talking to this sweet girl that I met not too long ago. We've hung out several times and talked on several other occasions. She's a very nice person, and I think I just might like her. We'll see how things unfold, but for now I'm just happy that things seem to be falling into place for me for once.

There's that saying "the definition of insanity is doing the same thing over and over again and expecting different results." That was me for all these years. I wrote about my miserable life. I lamented on how I was alone, single, and seemingly going nowhere. I wished things would change. However, I didn't do anything about it. I just sat around hoping for some sort of miracle to fall into my lap and fix all my problems.

Finally, I realized that I had to do something or else I would be doomed to misery for the rest of my life. I didn't have any idea how I wanted things to play out, but I knew that the first changes had to be in myself. Without making those changes, none of this other progress could have occurred.

I move forward from this point without any regrets. I'm happy, hopeful, and looking forward to whatever the future may bring.

Hand Sanitizer

2009-11-20T00:41:00.003-05:00

There are no studies to back me up. Despite this, I'm convinced that the use of hand sanitizer in a non-institutional setting causes people to get sick more frequently. In institutional settings (i.e. hospitals or long term care facilities), studies have definitively shown that the use of hand sanitizer dramatically reduces the risk of spreading infections from patient to patient. However, to my knowledge, the use of hand sanitizer has never been studied in the general public. Just like we have different guidelines for treating community vs. hospital acquired pneumonia, I believe the use of hand sanitizer works differently in the community than in a hospital.

In hospitals, most of the patients are already immunocompromised. They're sick. They have open wounds, catheters, tubes, and other entry points into the body that aren't in your average person walking the streets. Hospital workers must frequently wash and/or sanitize their hands in order to prevent resistant bugs from being spread patient to patient.

In the community, people are relatively healthy. They generally aren't immunocompromised in the ways that hospital patients are. In addition, a healthy person is covered from head to toe in bacteria. Lots and lots of bacteria. However, this is not a bad thing. The normal flora covering your skin and mucosal linings help keep you healthy. The presence of this normal bacteria prevent more dangerous bacteria from adhering and forming growing colonies.

I postulate that hand sanitizer in a community setting is bad for you because it does exactly what it claims to do. It kills 99.9% of bacteria on contact. The only problem is that it doesn't discriminate between bad and good bacteria. It just kills 99.9% of everything on your skin. Therefore, upon eliminating the normal flora on your skin, bad bacteria are better able to latch on and replicate unimpeded.

People seem to have this idea that we should live in a sterile environment. They spend an inordinate amount of time cleaning and sanitizing themselves and every surface they might ever touch. It's next to impossible to convince these people that they actually have an immune system, and it does fight off germs if you let it. However, when you kill off your normal flora with sanitizers, you're weakening one of your body's primary defenses against infections.

I just wish someone would do a study on this. I'm almost positive that it would show people who use hand sanitizer regularly get sick more often than people who don't.

Money: The Great Divider

2009-11-14T09:48:00.003-05:00

I went to this dinner party last night (yes, it was as exciting as it sounds). A girl I know just got a new apartment and wanted to have some friends over. The apartment was very nice. Hardwood floors throughout. Very spacious. We were all joking that it looked like an apartment you'd see on Friends.

A bunch of us were sitting in the living room in front of the television armoire, and someone decided to check out the TV inside. It was almost comical. There was this huge armoire, but inside was a tiny 19 inch flat screen TV, only a little bit bigger than the screen on my laptop. Everyone kind of joked about it, and I remarked that you could get a pretty nice 32" flat screen for around $300 these days. Of course, one of my friends looked at me and said, "Only $300? That's a lot of money! We all aren't pharmacists!"

This short anecdote illustrates how seemingly all my friends and everyone I meet, on some level, can't get beyond the fact that I make a lot more money than they do. I never talk about my salary. I don't show off expensive things. My clothes are just as normal as everyone else. I've worn the same moderately priced watch for about 6 years now. I do everything I can to not let on how much money I make. However, in the end, no matter how close friends we are, they still hold it over my head in some way.

Back when I was young, stupid, and still in school, I used to constantly talk about how much money I'd be making. I didn't brag about it. It was more of a statement of "wow, I can't imagine that." At the time, I worked with a pharmacist who was only a couple years older than me. She warned me that it's probably best to never tell anyone how much money you make because once you do, they start looking at you differently. I didn't understand why that would be the case. Money, while important to living a comfortable lifestyle, never factored into how I judged a person.

Well... maybe a little bit. I always had a little bit of contempt for the uber rich who had everything they could possibly want and still wanted more. However, $100 to $200 thousand per year doesn't make you uber rich. It makes you pretty comfortable.

In any case, upon becoming a pharmacist and noticing for myself how people looked at me when I told them I was making over $50 an hour, I stopped talking about money altogether. I never bring it up anymore. I try to act like everyone else. However, when I do that people will remind me about the money.

If I don't want to call a big raise playing poker...

If I talk about wanting to save money by cutting back on eating out...

If I'd rather not spend my money on some expensive item...

In all these cases, someone will inevitably cut in saying, "C'mon, you make more money than all of us combined."

Even every new person I meet will say to me, "You're a pharmacist? I heard they make a lot of money." I swear that's the first thing out of everyone's mouth. I'm so sick of hearing about it. It makes me feel bad for having a good job. It makes me feel like everyone else thinks I'm better than them in some way.

I've actually been thinking of some sort of career change, and I think a lot of it has to do with this issue. I can't do it yet because I still have loans to pay off. That'll only take a little over 2 more years at my current pace, and at that time, I think I'd seriously consider changing professions entirely. I want to do something that makes me happy regardless of how much money I make. I want a job I look forward to every single day. Maybe that job doesn't exist. All I know for certain is that I've never even bothered looking for it.

The other option that I've been kicking around is after my loans are paid off, donating half my salary to charity. I make $120,000 per year. If as a single guy, I can't live comfortably off $60,000 per year, then there's something wrong with me. At the same time, I'd be doing good for the world. Maybe I could even start my own charity foundation, although I would have no idea where to start.

Those are just some ideas I'm kicking around. I just wish I could explain to people that after a certain point, money doesn't make you happier. Once you get to the level where you can live comfortably, the only thing the extra money allows you to do is buy more stuff. Stuff doesn't make you happy. I'm not any happier having a big screen TV than I was when I was watching an old 20" TV in a 100 square foot college dorm room. My condo's granite counter tops and hardwood flooring don't care about me. They're nice to have and nice to look at, but they don't make me any happier. Money hasn't gotten me the admiration of women. If anything, making much more than all my friends has only served to alienate me.

OK... That's enough rambling for today.

Sometimes That Old Lady Isn't the One Losing Her Mind

2009-10-30T11:17:00.003-04:00

In a pharmacy, this situation presents itself numerous times every week. Some old customer will come to the counter looking to pick up a prescription, except there will be nothing in the bin for him. Upon looking in the computer and checking signature records, we learn that he picked up the prescription he was looking for just 2 days earlier. However, he can't recall ever picking it up and swears to all that is holy that he checked his medicine cabinet a dozen times and that pill bottle just wasn't there.

Usually, this story always ends the same way. Several hours later, the old customer will call in saying he found his medication "way in the back" of his medicine cabinet. Thus, order is restored in the world.

Being so experienced with these situations, we were not at all surprised when the 82-year old Mrs. Smith came in one day trying to pick up a prescription that none of us could find in the bin. The computer said that it was filled 2 days earlier. One of our technicians checked the signature log and told Mrs. Smith that she had signed for the script on 9/25, the day after it was filled. Mrs. Smith couldn't recall ever coming to the pharmacy the day before. Nevertheless, the technician assured her that she must have it at home somewhere and implored her to check her medicine cabinet again.

A couple hours later, Mrs. Smith called the pharmacy saying that not only could she not find the prescription at home, but she had called her daughter, and her daughter said that they had been out shopping all that day and never made a trip to the pharmacy.

A different technician took this phone call. She also checked the signature log (which is a computer print out showing the patient's electronic signature and the date signed). The technician again informed Mrs. Smith that they she definitely signed for it on 9/25. Once again, Mrs. Smith was told to recheck her medicine cabinet.

"Mrs. Smith is really losing it," remarked the technician. "She really can't remember being here at all."

Two hours later, Mrs. Smith showed up at the pharmacy again. You can see she was getting noticeably frustrated. She swore on her life that she had not come to the pharmacy the previous day, and she demanded to see the signature record thinking that someone else must have signed it. Once again, the technician printed out the signature record. This time was no different than all the other times. Mrs. Smith's signature was unmistakable, and she signed for it on 9/25. The tech showed the signature to Mrs. Smith, and despite it being just about identical to all her other signatures, she was convinced that someone must have forged her signature.

Finally, the tech showed the signature log to me and asked if I thought the signature could possibly be a forgery. Let me note, that this was not a controlled substance. It was Benicar, a blood pressure medication. No one goes to a pharmacy looking to steal Benicar. I looked closely at her signature, and I concluded, like the tech, that it wasn't forged.

Therefore, I took the computer print out in my hand and approached Mrs. Smith. "Mrs. Smith, this is definitely your signature. You signed for prescription number 123456 on September 25... TWO THOUSAND EIGHT!!!!!!," I yelled out.

The entire day, we were driving this poor old woman mad telling her she signed for a prescription the day before when she knew she never went to the pharmacy that day. The whole day, we were remarking how terrible it was that Mrs. Smith was losing her mind. In reality, two technicians kept reading 9/25/2008 and thinking 9/25/2009!

I apologized profusely to Mrs. Smith (and fought the urge to strangle both technicians who put the poor woman through hell all day). I don't know what actually happened to the Benicar prescription that supposedly was filled 2 days earlier. I think we must have lost the label somewhere before it ever got filled. Therefore, I quickly filled the script for Mrs. Smith and sent her on her way. Fortunately, she was a good sport about it. I think she was just relieved that she was right the whole time, and she wasn't losing her mind.

On that day, an 82-year old woman proved to be sharper than the pharmacy staff. Lesson of that day: Don't automatically assume the customer is wrong.

Learning from Tragedy

2009-10-19T21:25:00.003-04:00

Today, I learned that someone who graduated with me from high school committed suicide. I haven't seen him in years. I think I've ran into him maybe 2 or 3 times since I graduated. We weren't good friends, but I wouldn't hesitate to include him as one of my friends. He was always a good guy. Not overly bright, but he had a good heart. He always seemed like a happy person, so the news that he took his own life is shocking.

People always try to look for reasons or come to some sort of understanding when things like this happen. I certainly can't make any sense of it. I always thought he was one of those guys that had everything you could ask for. He was a good person. He was good looking and athletic. He had bulging biceps and shredded abs since he was 12 years old. He played basketball with me in middle school. Mind you, he had absolutely no basketball skills whatsoever. He was on the team because he was just about the most athletic kid you've ever seen. I'm fast. He made me look like I'm standing still. He could run, jump, and play defense... and that's all we asked him to do. He was happy to contribute however he could.

He was a police officer in a neighboring town, and from all reports, he did a very good job. I used to joke around with friends that I'd feel bad for the criminal that tried to run away from him. Unless you were Usain Bolt, you weren't outrunning him.

A "self-inflicted gunshot wound" is how the newspaper worded it. All my friends on Facebook immediately posted how it was a tragedy. They said things like "RIP" and "we'll miss you." You know... the standard things everyone says when someone dies. I couldn't help but think that if all of us had showed him how much we cared about him when he was alive, he may have not wanted to end his life.

Why do we always wait until after someone dies to show an outpouring of love and support? I'm guilty of this as anyone else. We take so many things and so many people for granted. We fight over little, insignificant things. We don't make enough of an effort to support the people we care about. Then we talk about how it's such a tragedy when someone decides to take his own life at such a young age.

I think it's a tragedy too... a tragedy that we weren't good enough friends to at least try to help him overcome his problems. I'm sorry that I didn't know he was having such great personal troubles. He was a good guy. He always treated others with decency and respect. A part of me feels like we failed him.

I don't believe in heaven or hell, so I can't make such throw-away statements as "I hope he's in a better place now." If things were really that bad for him that he felt the only option he had was to end his life, I can only say I'm sorry. I hope we remember the good in him and strive to cherish the friends we have.

I Hate Buying Jeans

2009-10-08T15:45:00.006-04:00

I hate clothes shopping. I really do. Some people absolutely love the process of buying new clothes. I am not one of those people. I'm the type of person that likes to know exactly what I'm looking for when I walk into a store. I don't browse. I don't hunt for sales. Usually a trip to the store for me takes less 5 minutes. I walk in, proceed directly to the item or items I want, pay for them, then leave. No time wasted.

You can't do this with clothes shopping. You have to see what the stores have. You have to try things on. Ask associates if they have other sizes in back. The entire process is irritating to me.

I've been putting off buying new jeans for a while now because of this. I own two pairs of jeans. I've had them for a couple years now. I alternate the pairs. However, a couple months ago, one of them got a rip in the knee. At first, it was a small tear, so I kept wearing them trying to pass it off as something I did on purpose (it may have worked if this was the early '90s). Unfortunately the rip got bigger and bigger, so I eventually had to put those aside as junky jeans that I would only wear around the house.

That left me with one pair. Well, having only one pair of jeans means that they get washed twice as often. That along with wearing them twice as often ends up wearing them out twice as quickly. Of course, being a couple years old, they were already worn out. Without an alternate pair, their condition got worse pretty quickly.

So, today I finally bit the bullet and took a trip to the mall to buy new jeans. This brings me to the overall point of this blog post and probably the biggest reason why I hate jeans shopping. It is extremely hard to find a pair of jeans that fit me.

I'm going to tell you a little something about my physique. As I mentioned before, I exercise fairly frequently, and I eat pretty healthy. I'm 5'9" and weigh 160 pounds. I'm not all shredded like an Abercrombie model. I don't have a 6 pack, but I'm probably only a few body fat percentage points away from one. No normal person would ever call me overweight.

However, I cannot fit into a pair of nice jeans for anything. The reason? For my size, I have a huge ass and big legs. Think of a guy version of Jennifer Lopez. It's not fat. My lower body is all muscle. My quads are ripped with all the muscle groups readily visible. My legs are just very strong for my size, which is probably why I'm as quick as I am.

Of course, this doesn't help me find a decent pair of jeans. If you were to take a tape measure and measure my waist, it would be less than 30 inches. However, if I bought pants with a 30 or 31 inch waist, they're made so tight in the legs that I can't even got them up over my thighs. Today, I had to try on 4 different sizes until I found one that fit. It ended up being a pair with a 34 inch waist. Then, I run into another problem. They fit great in the legs, but they're so loose in the waist that I have to tighten my belt to the last hole just to keep them up. The waist of my jeans end up looking like they're scrunched tightly together with a draw string.

The whole situation is just very frustrating to me, and I find myself asking who are they making these jeans for? Seriously, you would need to have no ass and legs like a toothpick to fit into the jeans that coincide with my actual waist size.

You know it used to just be women that had to worry about clothes made for unrealistic body types. After all, it seems like designers think your average woman has a body like this:

As gorgeous as I think Mila Kunis is, her ass isn't exactly a shining example of the female figure.

Apparently, designers have noticed the trend in women, and tried to copy it in men by bringing skin tight jeans, that I thought we had left behind for good in the '80s, back to the mainstream. The only guys that can fit in them are the effeminate ones. Do women really like their men to be scrawny with chicken legs?

It's not like I'm only talking about top of the line designer jeans here. I'm not looking for Calvin Klein or Gucci (do they even make men's clothes???) jeans. I'm talking about the middle end stores like J. Crew and Banana Republic.

As a guy with strong, muscular legs, the only options I'm left with are to purchase low quality jeans (from Walmart or something) or stick with decent jeans but have to buy them 5 sizes too big in the waist just so my ass can fit into them. I choose the latter option and invest heavily in belts.

I realize this was a feminine sounding rant, but it really was the thing that pissed me off the most today. My next post will have to be about basketball or something to balance this out.

What Does It Mean to be "Nice" Anyway?

2009-10-04T13:12:00.004-04:00

"Nice" is one of those words that doesn't really have a meaning, at least not one that I can tell. Every day, all I hear is "you're a nice guy," or "Mike's so nice." What does that even mean?

Seriously... What does it mean to be a "nice guy?" As far as I can discern, being "nice" is about never saying anything that might offend someone. See, I'm nice because I avoid confrontation. I'm nice because I don't say bad things about others. That's the extent of it though. It just seems to me that being "nice" is about being so bland that people can have no strong feelings toward you whatsoever.

"Nice" shouldn't be mistaken with being "kind." A "kind" person is one who is constantly helping others and putting others before himself. A "kind" person is a giving and sharing person, and one who's always ready to compliment someone or congratulate someone for a job well done.

Being "kind" is a very good thing. Being "nice" just seems to be meaningless. That's me though. I'm a "nice" guy, but I'm often not an overly "kind" guy. That's not to say that I'm a mean spirited person. Far from it. There are times when I'm kind, but not really on a regular basis. I'm just "nice."

The other day, one of our technicians (a middle-aged woman) said to me, "You're a nice guy. If you can't find a girl, it's because you're not looking hard enough." True as that may be, it's not exactly like when I'm super successful when I try to meet girls. It's not like I've never tried before. They're just not that into me.

The reason? There's nothing to me. I'm not interesting. I'm not fun. I'm not outgoing and gregarious. I don't have many interests or passions. I'm just "nice," and that's what I always hear.

eHarmony girl (like 2 years ago now) told me "You're a really nice guy, but I'm not ready for a relationship now." I'm just so sick of the damn "nice" label. I mean, it's good to be nice if there's something else to you. If you're fun and interesting, then being nice is just kind of an added benefit. However, if you're like me, and all you have is being "nice," that's the formula to remaining single forever.

How do I fix that though? It's just the person I am. I can't change it. I can't just decide to be more fun and interested in more things. It doesn't work like that. At least I don't work like that.

It seems that while I have plenty of admirable traits (honesty, hardworking, loyal, smart, nice), the combination of them all just makes me boring.

Obviously, I'm in the middle of a very reflective time. I'm trying to work some things out in my head. It's becoming clearer and clearer to me that pretty much nothing in my life gives me a sense of fulfillment or purpose. I have a job I sort of like but don't really believe in. I moved into a condo that most people would say is very nice, but despite the entire place being newly renovated, it just doesn't feel like my own. I'm thinking I need to make some kind of radical change in my life, but I have no idea what. I'm not really sure what else I could do. Moreover, I know that right now, even if I knew what I really wanted, I wouldn't have the courage to go out and chase my dream.

I'm just stuck in this rut, and I keep digging myself deeper and deeper.

Today My Past, Present, and Future Flashed Before My Eyes

2009-10-01T19:21:00.002-04:00

The phone rang.

On the other end was a voice I've heard so many times before. It's been some time since I've talked to that voice, but there were many years when it would be the first and last voice I heard each day.

I didn't know why she was calling me. I guess I didn't care. She was a part of my life I had left behind, nothing more than a fond memory of a more innocent time. We talked for a little bit, just like old times. We always could talk to each other. We were always better friends than relationship partners. Even during the worst times of our relationship, we still had that bond of friendship. It might be more distant since we haven't spoken in quite some time, but it's still there.

After about ten minutes of chatting about some random things, she paused for a moment. The next words out of her mouth would have scared me to death eight years ago.

"Mike... I'm pregnant."

During our time together, those words were quite literally the worst thing she could have ever said to me. We were barely out of our teens and still in college. Neither of us had a dime to our names. An unplanned pregnancy would have altered our lives forever.

She's 28 now. She's been living with her boyfriend for over a year. He's a big city lawyer and makes probably close to twice as much money as I do. The pregnancy wasn't planned, but seeing as they're both adults and financially stable, it's not like the timing was bad.

I heard those words, and I was hit with a wave of emotions like I've never felt before. I was happy, proud, sad, nervous, and scared all at the same time. I congratulated her, and we talked about the whole thing. We spent nearly an hour on the phone just talking and laughing and speculating about her unborn child. It was a good conversation... Really nice.

I hung up the phone, and I couldn't stop smiling for a while. I was happy for her. Overjoyed actually. She's an incredible person, and she's gone through so much in her life. She's one of those women that were just born to be a mommy. She loves kids and loves caring for people. For the last few years, she had been struggling with physical and emotional problems (that she attributes to our breakup). To hear that she finally got her life together and was going to have a baby made me really happy.

Happiness was the predominant emotion, but there was some sadness and regret not to far from the surface. When we were together, we often talked about "our kids." I wanted a girl. For one, the idea of having "daddy's little girl" really appealed to me. Secondly, since my girlfriend was so small (and I'm not exactly a big guy either), I knew whatever children we had together would grow up to be small. It's easier for a girl to be short than it is for a guy. Short, petite girls are cute. Short guys... not so much.

Back then, I always thought that whenever she finally did say the words, "I'm pregnant," I'd be the first one to hear. I'd be the one there to hug her and hold her. I'd be the proud and happy father-to-be. I'd get to tell all my friends "we're having a baby!" I'd get to go to the ultrasound appointments and take care of her.

As I type this, I'm holding back tears. Not because I wish she was still with me and having my baby, but because it's a moment I may never get to share with someone. I may never get that moment of pure joy that you get when you first learn that the woman you love more than life itself is having a baby with you.

Occasionally, I've written about how I don't really know what I want out of my life. I've said that I'm not even sure if I ever want to be in a relationship. Well, times like today remind me of who I really am... Who I'll always be.

I'm that proud father kind of guy. I want to teach my son how to throw a baseball and shoot a basketball. I want to bring my daughter to her dance recital. I want to help my kids with their homework, watch their baseball games, see their faces as they unwrap gifts on Christmas.

There are so many dead beat dads out there. So many guys that don't deserve to have children, but they have several from several different women. Then there's me... Someone with all the traits you'd look for in a good dad, but there's a good chance I'll never be one. And it'll be such a waste.

Every day I look in the mirror and I see an image I hardly recognize anymore. The hair is getting greyer, and the hairline isn't where it was when I was 18. The fine lines, wrinkles, and saggier skin remind me that I'm not young anymore. I don't feel any different than when I was 18, but people sure don't look at me the same way. I regularly get referred to as "sir." No one cards me when buying alcohol. Why would they? I'm nearly 30 years old.

I'm nearly 30, and I'm still alone. I've had one real relationship in my life, and that one ended 4 years ago. As the years go by, instead of becoming more refined and sophisticated, I've become simpler. I'll never wow a girl. I'll never sweep someone off her feet. I'm boring. The only way I'm getting a girl is through pure dumb luck.

For now, I sit in this barren room in my newly renovated condo and type my thoughts out to strangers because there's no one else I can talk to. I'm still happy for my ex, which goes to show that I really don't have romantic feelings for her anymore. I just hope one day I'll get to share that moment with someone, even though I know that the chances of that happening keep getting smaller and smaller.

It Was Too Long to be a Comment

2009-10-01T10:55:00.002-04:00

This was supposed to be a follow-up comment to the last post, but since I kept writing and writing and writing, I figured I might as well make it a new post.

I go in early for myself. It has little to do with the patients. Yes, they may benefit from speedier service and because I have more time to talk to them about their medication. While those are positives, they're not why I go in early.

I don't believe there is a remedy to the situation. I think that most people out there just function in this way. It's their nature. Yes, you can try to impose rules and crack the whip in order to get them to work harder and be more focused. However, in the end, they don't become better workers because they want to be. They become better because you forced them to become better. They don't appreciate you for it. Instead, they hate you for making them work so damn hard. They think you're unreasonable.

It's the same thing in every environment I've ever worked in, pharmacy or otherwise. There are always people that fight over who gets to do certain daily tasks. They'll argue about who takes too many breaks, who comes in late, who leaves early, etc. You replace the problem workers with new ones only to find out that your new workers have the same problems.

The situation actually doesn't stress me out that much. Yes, sometimes when everyone else is slacking off, and I'm the only one working, things can get a little crazy for a while. However, I usually don't feel stressed as much as I feel that I'm being treated unfairly. Why am I the only one busting my ass? Why do I bother doing what I do when everyone else can get away with doing so much less while still getting paid the same?

Moreover, why when it comes to being hired or fired does seniority count more than job performance?

We had an intern at our store for several years now. She started before she was even in pharmacy school working as a tech. Then she worked as an intern throughout her entire time in school. She'd work weekends. She'd cover people's vacations. She'd come in when someone would call out sick. She worked hard, and she did a very very good job.

Well, she just got her pharmacist's license. What should have been one of the happiest times for her turned bitter sweet when our DM told her that there are no pharmacist positions in the company for her.

She had worked with the company for over 5 years. She was a great intern, and she's going to have a great career as a pharmacist. She's extremely smart, works hard, is constantly striving to expand her knowledge base, and gets along very well with all the customers. However, she can't get a job with us. Meanwhile, my company has some pharmacists that quite literally begged to be fired still on payroll.

One floater in particular was so bad that several stores refuse to have him sent there anymore. He'd go in 30 minutes late, close the gate 30 minutes early, spend the entire day bad mouthing to customers and staff, in addition to constantly saying how much he hates the DM and everything to do with the company. He still gets his hours. He still collects his paycheck. Our new pharmacist, on the other hand, has done everything right, but simply because she got her license during a hiring freeze, the company has nothing for her.

It also bugs me because if my company ever decided that it needed to start laying off pharmacists, I would be one of the first to go because I'm one of the newest pharmacists. I work harder and do a better job than probably 90% of the pharmacists we employ, but if it ever came time to cut someone, my name would be near the top of the list.

It just goes to show you that if you work for a chain, you're nothing more than a license to them. If they need more licenses they hire more people. If they need to get rid of licenses they just pick the ones they hired most recently. They don't care how hard you work. They don't care how much your coworkers and customers like you. It's all about the chronological order in which they hired you.

That's why I feel there's almost no point in even complaining to management about laziness or poor job performance. They might give those offending workers a slap on the wrist and a stern "you better start working harder" talk. It might even work for a couple weeks. Then, they'll fall right back into old habits. When you bring it back up to management, they'll start getting annoyed and questioning why you're the only one that seems to have a problem. Then, you end up being the one that's on watch. The truth is that management doesn't really care unless enough people come forward that they have to care. If it's just one person, they don't want to be bothered. Managers are just as lazy as every other employee. They just stuck around long enough that someone decided to make them managers.

Of course... I'm speaking generally here. I know there are plenty of sparkling examples of good employees and good managers. One thing's for certain though. They certainly are not the majority.

People Will Get Away With Whatever You Let Them

2009-09-30T21:05:00.003-04:00

It had been a busy work week up until today. It was my turn to open the store. Like usual, I arrived at work 45 minutes before we opened in order to fill all the prescriptions called into the refill line the night before and organize the place so that we could start the day smoothly.

My coworkers, along with probably every other normal pharmacist out there, get to work right when we're supposed to open. When I come in an hour later, the pharmacy usually looks like a bomb went off with prescription labels all over the place, voice messages yet to be checked, and customers waiting in line. It looks like chaos to me, but I guess most people don't mind it. It drives me crazy though, so I've decided that, for the sake of my own sanity, I will get there extra early in order to have everything done, so we're not playing catch-up. I don't get paid for those 45 minutes, but to me, the peace of mind is totally worth it. Plus, I get to spend the first 45 minutes of the day listening the music on my PDA instead of whatever generic garbage that happens to be on the radio.

See, I know I'm strange in this regard. I don't expect anyone else to be like me. That's not the point of this post. The problem I have is that my coworkers see that I've done all this work and just assume that means I'm going to do everything all day long.

It's the same thing all the time. They stroll in and before they do anything, they look for breakfast. Then, they spend 10 minutes eating breakfast. Then they look around to see just how much work has piled up, and if it doesn't look like that much, they decide it means they can take another break. One of them might take a walk around the store to see if there's anything she needs to get for home. One of our pharmacists sometimes announces, in the middle of the day, that she has to go pick up something at Walmart, and then leaves for 45 minutes. They'll all sit down and have conversations about who the hell knows and watch me while I do everything.

Today, right around noon time, the second pharmacist decided that she wanted to go into the store's backroom and watch as our pharmacy manager built us some shelves for the room where we keep all the old prescriptions. If she wanted to take 5 minutes to check it out, I'd have no problem with it and wouldn't be complaining now. SHE TOOK AN HOUR!

During that hour, I got swamped with work. One of the technicians, realizing I was getting killed tried paging her back to the pharmacy. She didn't come. Fifteen minutes after the page, she strolled leisurely back to the pharmacy, apparently having seen enough of the shelves. Then she acted completely shocked that I might have gotten busy and backed up during the busy lunch hour trying to do the work of 2 pharmacists by myself.

I guess I bring it upon myself. When I'm at the pharmacy, I spend the entire time working. I don't come to socialize. I don't come to grocery shop. I don't drop what I'm doing in the middle of the day and run to the store down the road to pick up some shoes (I'm not making that up). If there's work to do, I do it. If by some small miracle, we're all caught up, and there's nothing at that moment to do, I wait until there is something to do. Then I do it.

The kicker is that I sometimes get jokingly accused of stealing everyone's work. They'll see scripts start to come in, and they'll say, "Oh, Mike's here. He can handle it." Then they go right back to talking or otherwise wasting time.

Maybe I wouldn't steal anyone's work if people actually did the work when they were supposed to. It just seems to me that for a lot of my coworkers (and I'm sure it's the same way with most people) unless you constantly stay on them to keep busy, they'll do everything but what they're supposed to. Sometimes, I swear half of them need Ritalin. They have such short attention spans when it comes to working. They'll fill 3 or 4 scripts and then get sidetracked for the next 5 minutes because they have to talk about someone who just walked by with ugly shoes.

Yes, I know what a lot of you are saying. "Stop whining about it and say something to put an end to it." You're right. That's what I should do. However, I'm spineless when it comes to confrontation with coworkers. In addition, this is my blog, so I can complain about whatever I want (and I often do.)

The point isn't whether I should or should not be cracking the whip on these people. The point is that I shouldn't have to. Everyone knows what they're supposed to be doing at work. Why do they have to be continually told in order for them to do it?

The other day, one of our techs (our lead tech who thinks she's too good to wait on customers) looked at a customer in line, then walked right past them and out of the pharmacy. The customer looked exasperated to be ignored like that. I watched it happen, but I figured there had to be some sort of explanation. Maybe she had just put the phone down and ran out in the aisle to check the price on something. Maybe she was going out to help someone find an item. Not knowing what was going on, I dropped what I was doing, and went to help the customer at the register.

You know what that tech was doing? She went out into the aisle to get a chew toy for her dog. She walked right by a customer, so she could go buy a fucking chew toy! That one almost made me lose my cool. That time I know I should have fucking let her have it, but once again, I'm a wimp.

I've watched my coworkers look at customers in line, but then let them wait there for a minute while they finished a conversation.

I've seen my pharmacist coworkers completely ignore a customer asking a medication question, which causes me to stop what I'm doing to answer it. Know what the excuse often is? "That was a 'Mike question'" meaning that they thought I'd know the answer better than them, so they let me take it. You know... in a lot of cases, I actually don't mind them deferring to me on medication questions. I'm not exactly an encyclopedia of pharmacy knowledge, but there are some areas that I consider myself very well-versed. Therefore, if a question comes up in one of my strong areas, I don't mind playing the role of "resident expert." However, when they start deferring to me before they even hear what the question is, that's just being lazy.

I thought all this lazy crap would go away once we got rid of Betty. It hasn't. In a lot of ways it got worse. Interestingly, the fact that Betty was so lazy and such a shitty pharmacist made everyone work a little harder to not be like Betty. After all, you can't really complain about someone if you pull the same shit. Her extreme laziness also forced everyone else to pick up a little more slack just to get the work done. Now that she's gone, much of the staff has relaxed and collectively filled the void of laziness she left behind.

I guess their laziness is what makes me valuable to the pharmacy though. My coworkers think I work so damn hard and do such a good job simply because I do what they all should be doing. The truth is that I feel like I could be doing so much more, and I continually try to improve on the areas where I feel I'm lacking.

That's the main difference between me and what seems like most other people. Most people do some work and are satisfied with themselves for being productive. I'm never satisfied with anything I do. I always feel I should be better. I always feel like I'm not working hard enough. It's just not in my nature to be like them.

Back to my original point (I'm getting really sidetracked) about coming in early. I come in early so that we never have to fall behind during the day. When I get a new script, I can do it right away without having to worry about 30 scripts on the refill line that need to be done. However, because several of my coworkers seemingly only work when we start falling behind, my coming in early ends up not making a difference. We end up falling behind anyway because they don't start working until they see a pile of script building up. I end up running around like crazy either way.

Pretty much the only thing I get from coming in early now is a couple extra hours of peace in the morning. I'll still take that over being crazy busy during those 2 hours. It just shouldn't be like that though. I come in early so that we're caught up. If everyone did the work they were supposed to do, we would never all behind.

Ok... I'm having such a hard time writing lately. Everything I write comes off sounding disjointed. Back when I didn't have any readers and was completely anonymous, I wrote about anything I wanted as much as I wanted. If I wanted to write 30 posts in a row about how my life sucked without my ex, I could. Now, I try to not be so repetiive, but it's taking away from my writing quality.

Hopefully, I'll get back on track soon.

I Don't Think People Understand the Importance of Exercise

2009-09-24T08:08:00.002-04:00

The thing that bugs me most about my fellow coworkers is the frequency that a few of them call out sick. Now, I entirely understand that people do actually get sick from time to time. Moreover, I'm not talking about someone that develops some kind of chronic disease like an autoimmune disorder or something rare and random like that. However, we have several people on our staff that call out every single week, and it always seems like it's for the stupidest reasons.

"I have a cold."

"My back hurts."

"I'm nauseous."

I also see a number of my friends who are constantly getting sick and complaining about being sick. I think I'm starting to detect a pattern...

OVERWEIGHT people who live a SEDENTARY lifestyle get sick far more often than people who exercise regularly.

I know that the medical community has known this for quite some time. However, I'm writing about it now because it has become so abundantly clear when comparing myself to the people around me.

I've mentioned in this blog before that I rarely get sick. I've never called out sick for work a day in my life. I haven't taken an antibiotic or gotten a prescription filled since I was a freshman in college 9 years ago, and that was for a relatively minor sinus infection that had I known then what I do now, I wouldn't have gotten that prescription either. I don't get headaches. I don't get the sniffles. I get a minor sore throat and a stuffy nose maybe once or twice a year, usually in the winter months, and the symptoms usually go away on their own within 2 or 3 days.

As I also stated before, I take absolutely no special precautions to avoid germs. I don't shy away from contact with other people. I don't constantly wipe everything down with alcohol. I don't carry a bottle of Purell with me wherever I go. I don't excessively wash my hands every 5 minutes. Basically, I don't do any of the things that germophobes do, yet I find that they happen to get sick much more often than me.

The only reason that I can come up with to account for my resistance to colds is that I exercise quite regularly, and, for the most part, my diet is relatively healthy. I do slip from time to time, splurging on pizza or a restaurant like Chili's maybe once a week. I also have a weakness for Octoberfest beer, but the season will be over soon, and I can cut those empty calories out of my diet too. Other than those few indulgences, my diet consists mainly of chicken, brown rice, eggs, broccoli, oranges, bananas, whole wheat bread, and milk.

I do some form of exercise almost every day. I follow a body weight workout routine 3 days per week. In between workout days, I try to get in a session of high intensity interval training (HIIT). However, HIIT generally leaves me feeling like I want to die after about 10 minutes (and that's how it's supposed to feel), so if my legs aren't quite up to it, I substitute going down to the park and shooting some hoops for 45 minutes to an hour. Saturdays are usually my rest days, but many times I'll go shoot hoops or some other form of light exercise for a little bit. On Sundays, I usually play a couple hours of full-court basketball in the morning.

That is a routine week for me. I don't even feel like I'm in that great of shape. However, compared to the average person, I'm like an Olympic athlete. Everytime when I hear the regular absentees call out of work sick again, all I can think is that maybe if they got off their asses and exercised every once in a while, they might be healthier (as in sick less frequently).

Really, it doesn't take long to work out. My body weight routine takes me 45 minutes. HIIT takes 10 to 15 minutes at the absolute most (trust me, if you're doing it right, you're not going longer than 15 minutes) 2 or 3 times per week, and that will take care of your cardio. That's a total of 3 hours of exercise per week right there. No, it's not professional athlete level, but it's sufficient to maintaining some form of physical fitness. No one can say they don't have 3 hours per week they can devote to exercise.

I've ranted about health care several times on my blog. As everyone who reads my endless drivel knows, I'm a proponent of Universal Health Care. However, I feel the absolute most important thing we can do as a nation to improve our health care is to do a better job teaching people how to be healthy. We need to start at a young age and stress the importance of exercise. We need to begin teaching children as early as elementary school how to eat right. We have wars against drugs and smoking, but when it comes to the food we eat and our level of exercise, we seem to be very passive. Eating right and routinely exercising are probably the single best way to improve the health of the nation. Healthier people spend less money on health care. Healthier people are more productive at work. Hell, healthier people are happier people in general.

I work in a grocery store, so it's quite common for me to hear overweight, out-of-shape people trying to decide what and how much to eat by reading the caloric content and other nutritional facts on a box of muffins or crackers. I still get shocked when I see people pushing around carriages full of regular Coke or Pepsi. Maybe it's because I gave up regular soda so long ago, but I'm shocked that people still buy non-diet soda.

I understand if people are confused over which kinds of fats (saturated, polyunsaturated, monounsaturated, trans) are unhealthy. Nutritionists can't even seem to decide what kind of fats are bad for you. However, I thought everyone knew that all the added sugar in soda was unhealthy. Maybe everyone does know that, but they just don't care. That's probably the case, and honestly, I think that's a tragedy. People shell out big bucks for medication in this country, but in many cases, the most effective way to treat their conditions is lifestyle modification. For example, people with metabolic syndrome will probably be on a statin for cholesterol, an antihypertensive, and/or an oral diabetes medication like metformin or glipizide. However, want to know the absolute best way for these people to improve their health and prolong their lives? LOSE WEIGHT THROUGH EXERCISE AND EATING HEALTHY.

It's easier to take the pill though, isn't it? Medication is becoming a way for people to, once again, shift responsibility away from themselves. Even the way the medical community names these "diseases" shifts blame. For example, metabolic syndrome makes it sound like something that just randomly went wrong with your body. If you have high cholesterol, heart disease, and insulin insensitivity, it's not because you're overweight and out of shape. It's because you have this "syndrome." So you go and take medication to treat your "syndrome," but that medication better work well and not cause any side effects or else you'll go screaming to doctors, pharmacists, and pharmaceutical companies about how they're trying to kill you with these dangerous drugs.

Let's shift the blame back where it belongs. Instead of calling it "metabolic syndrome," let's call it the "Disease of the Obese and Inactive." Instead of prescribing drugs, you prescribe proper diet and routine exercise. Tell them that they're the ones who got fat and out of shape, and the situation will not go away or improve unless they lose weight and exercise.

Of course, this would be bad for business in the world of pharmacy, so maybe I really don't wish that. I sort of like feeling like I have a super human immune system. I also like having a job, so I guess I retract everything I've said up to this point.

Thanks For the Responses

2009-09-04T00:33:00.002-04:00

Thanks to all who commented regarding Walgreen's pseudoephedrine tracking system, as well as several commentors who explained that the law is a little different in other states.

Your comments made it very clear to me that the problem lies in my own company's system for tracking pseudoephedrine. It's glaringly obvious that our paper log book is not sufficient to ensure we properly follow the federal law (regardless of how dumb I think that law may be).

I plan on bringing the issue up to my superiors and seeing if I can get anywhere with it. My guess is no, but it doesn't hurt to try.

Is This True?

2009-09-03T07:49:00.002-04:00

The walgreens system is computerized and will not let you sell the product if it is over the daily or monthly limit and the data is readily retrieveable.

That's what someone left as a comment to the last post. If that's true, then I have a bone to pick with the Walgreen's pharmacist down the street from us who told me he had no way to find a specific person's history in their electronic database. If it turns out that it's readily available, then he was being lazy (and that's not even a busy store), and I'll be calling him back soon.

Is it possible that it could differ from state to state? It doesn't make much sense, but I'm completely oblivious to other state's laws.

The Dumbest Law

2009-09-02T23:04:00.002-04:00

I absolutely hate that we're required by federal law to keep track of pseudoephedrine sales. For one, I don't see how people turning Sudafed into methamphetamine is a problem for me. Honestly, I couldn't care less if people are getting high off the stuff. Shit, they can make all the Meth they want. It's never affected my life one bit.

I have the same attitude towards the whole "war on drugs." Do I think people should do drugs? Absolutely not... except if they're getting prescriptions drugs at MY pharmacy. I think it's important to educate people on the dangers of drugs, but, in my opinion, that's the best we can do. If after learning the dangers, people still want to get high, then I say we let them. They were warned. If they still choose to do drugs, then they can only blame themselves for fucking up their lives.

Moreover, I hate how we pick and choose which drugs against which we stage this "war." We're made to keep track of Sudafed, a drug that's been sold over the counter for fucking decades, but when it comes to alcohol, nobody cares. What the fuck is that? Alcohol has killed more people and ruined more lives than methamphetamine, heroine, and cocaine combined, but we have commercials for Budweiser before every fucking sporting event. It's especially weird when you compare it to a drug like marijuana, which has an adverse effect profile that pales in comparison to alcohol. But judging from commercials, if you get drunk, no matter where you are, you'll probably be surrounded by models in bikinis, whereas smoking pot will destroy your life. If we're going to fight a war against drugs, then I say we should be consistent and fight against all drugs.

I digress... Besides the above reasons, the biggest reason I hate the "Combat Methamphetamine Epidemic Act" is that it's completely unenforceable. I'm a firm believer that a law can only be a law if you can enforce it. The whole Sudafed log book thing is really just designed to be a speed bump to try to deter people from buying massive amounts of pseudoephedrine and making methamphetamine, and like most speed bumps, there are plenty of ways around it.

First of all, there's no central pseudoephedrine database that all pharmacies can access. I have no idea if the person that just bought 2 boxes of regular Sudafed from me has a stuffy nose, or if he's bought 2 boxes of Sudafed from every pharmacy within 5 miles over the last 24 hours. A person can literally go from pharmacy to pharmacy buying Sudafed, and as long as he stays within the daily limit at each store, no one would think twice about it.

Secondly (and this is the reason for this post), some pharmacies do not even have a good system for tracking pseudoephedrine sales. For example, my pharmacy keeps a log book. This log book is a simple, old-fashioned binder where we write down the customer's name and address along with the product he bought. In a slow store, this might work fine. However, when you're filling 400 scripts per day, and there's literally 5 or 6 different employees who might be at the register during the course of the day, it's really hard to keep track of who bought what and when. I'll admit, we generally do not look through the log book to check if the person is within the monthly limit of pseudoephedrine. In fact, a customer could probably come at 9 in the morning, buy 2 boxes of Sudafed, and then come back 8 hours later and buy 2 more boxes from a different cashier, and we wouldn't even realize it. We're just too busy, and it takes too much time to always check.

This became clear to me over the weekend when one of our clerks thought that one of the pseudoephedrine-purchasing customers looked a little sketchy and decided to look back through the log to see if he had a history. Well, she found out that he had purchased Sudafed 12-hr about 15 times during the months of July and August. Technically, he was within the legal monthly limit. However, after reading the article The Angriest Pharmacist mentioned, I decided that some asshole undercover narcotics agent might consider these sales "reckless" and arrest me on felony drug charges.

I brought the issue up to my pharmacy manager, who kind of laughed it off. I don't think it's funny though. A paper log book is not a good enough on-the-fly tracking method. Sure, we can look back and see who got what, when, and how much if we were alerted to someone who might be buying a heck of a lot of pseudoephedrine. However, it's very unlikely we'd ever deny someone the sale on the spot because we just wouldn't have the time to thoroughly analyze the book. I suggested that we try to bring our situation to corporate (along with a copy of the article to which Angriest linked) in order to try to get an electronic tracking system.

Upon calling the closest Walgreen's in order to ascertain if our Sudafed Guy had been getting it at other pharmacies too, I was told by the Walgreen's pharmacist that even though they have an electronic system that monitors and makes sure no one is sold more than the legal limit, the pharmacist cannot actually access the records and search for a particular customer's purchasing history. Therefore, he could not tell me if our Sudafed Guy was getting Sudafed from them too. He just knows that if they did sell it to him, he would be within the monthly limit at Walgreen's.

What good is that? Just like I said, even with the electronic tracking system, there's nothing stopping someone from going pharmacy to pharmacy purchasing the legal limit. Therefore, like I said, the law is simply meant to be a deterrent making it a little bit harder for someone to acquire enough pseudoephedrine to make methamphetamine.

While I think a law as a deterrent is pretty stupid, it wouldn't upset me so much if not for the fact that, judging by the Oklahoma Bureau of Narcotics actions against that pharmacist, the federal government takes the law very seriously... so seriously that they're arresting pharmacists because they're selling perfectly legal quantities of pseudoephedrine to "suspicious" customers.

If you want to have your stupid law, fine. Just don't pretend that it makes a difference. Yes, it seems that ever since the law has gone into place, there have been far fewer methamphetamine labs in the United States. However, despite fewer labs, the supply of methamphetamine on the streets has stayed roughly the same. The reason? Mexican producers have noticed the increase in U.S. demand of their methamphetamine and have increased shipments into the country using the cocaine shipment routes from the '80's. Therefore, just as many people are getting high on Meth now as they were before the act was implemented. Doesn't sound too successful to me.

All the federal government is doing now is taking the focus off the real methamphetamine dealers and putting it on pharmacists, thus adding another responsibility to our ever growing pile. When will this shit end? We get so bogged down in following the stupid laws that we forget the whole point of the law in the first place. It's the COMBAT METHAMPHETAMINE EPIDEMIC ACT. The new law didn't do a damn thing to stop the epidemic. It's now simply inconveniencing pharmacists and possibly turning them into felons for selling a drug that has been perfectly legal for decades. The stupidity never seems to end.

I Want To See Some Palm Trees

2009-08-31T23:35:00.002-04:00

One of the biggest disadvantages of being alone is that I have no one to go on vacation with. I haven't gone away for vacation in almost 2 years now. I know, I know... That may not seem like a long time to a lot of people, but I've been dying to go somewhere for a while now.

The truth is that I've never really taken a vacation where I got to do what I really wanted to do. My most recent trip was to Miami a couple years ago. I went with a few friends, and I got dragged to clubs, bars, and through the entire Miami night life scene. Some would have a grand time on that kind of trip. I think anyone who has read my blog for a reasonable amount of time would know that night life isn't exactly my style.

I just have this overwhelming urge to go somewhere with beautiful beaches, lush scenery, and warm weather. I'd love to go to Hawaii or somewhere in the Caribbean. I want to spend about 5 days just relaxing in the sun, sand, and ocean. I want to go see the sights that I want to see and have nice quiet dinners. I'm not in college. I don't need to go away and party. I would say that phase of my life is over, but I never went through it in the first place.

Every time I get a vacation week off from work, I get bombarded with a million questions about where I'm going and what I'm doing. There's only so many times I can tell people I'm just going to be relaxing at home until I feel like a complete loser. I know they're just harmless questions, but how am I supposed to answer them? Sometimes I just want to shout, "LOOK! I'm single and at an age where most of my friends are either married, engaged, or in long term relationships. Who am I supposed to go on vacation with?"

I know some people travel by themselves, but I just can't picture myself doing that. I think I'd just be miserable the whole time thinking how lonely it is to be in such a beautiful place by myself. Therefore, I'm stuck here and forced to listen to everyone else talk excitedly about their vacations.

And just to make it clear, I have no desire at all to brag about my vacations to everyone I know. I generally don't like talking about my personal life. (Instead, I just tell everything about myself to the world via the internet). I just want the experience. Hot sun, warm water, palm trees.... Just a few days of that is all I want.

Six Years Ago, I Knew. I Don't Know Why It Was A Mystery To So Many Others

2009-08-30T10:05:00.002-04:00

I've had my current email address for over a decade now, and sometimes I like to take a walk down memory lane and read old emails I sent and received. I stumbled across this email dated February 23, 2003, and I thought I'd share it with you:

All I know is that this is a scary time. I don't know why we are so bent on starting a war. It seems like he is not doing anything wrong. We only guess that he has nerve gases. We have no real proof other than a couple of satellite photos that don't tell you anything. Saddam said it; Bush will start this war whether or not he complies with the UN. Bush is actually pushing Saddam to do something. Someone needs to assassinate him. lol. I'm not even kidding. I hope someone shoots Bush. This is ridiculous. Our country looks so bad right now because of him and his stupid Iraq policy. So what if Iraq has connections to Al Queda. So does every single country in the world that has Arabs in it. For god's sake, we're probably financing Al Queda without even knowing it. I don't understand any of this. Saddam hasn't done anything in over 10 years. He hasn't attacked anyone. Hasn't threatened anyone. Hasn't done a damn thing, and now all of a sudden we are starting a war with him. We, the US, are starting a war. The world's policeman is turning into the world's bully. We're supposed to stand for peace, but we're starting war on a country that hasn't done anything to anyone in over 10 years. Meanwhile, N Korea is over there threatening everyone with nuclear weapons and we ignore them. I don't see the sense in that. We attack the country that is under such close scrutiny right now that they couldn't attack anyone if they wanted to, but N Korea, a country that no one can even get into, is allowed to make nuclear weapons and threaten us. We're spending trillions of dollars on this stupid war, and at home, everyone is losing their jobs. How exactly is he making the world better again??? The economy is the worst its been in probably 15-20 years. Our war policies are looking exactly like the Vietnam war policies. We're going after a bunch of ghosts. The threat just doesn't exist... at least not to the point that he is making it seem. If we drop this whole war idea, Saddam is not gonna bomb us tomorrow. The whole thing is just stupid, and of course it's perpetuated by the biggest moron to ever lead a country in all of history.

Remember... This was from February 23, 2003. It was a full month before we invaded Iraq (which a quick wikipedia search tells me was March 20, 2003). I was barely 21 years old at the time. To say I was naive and inexperienced would be an understatement. However, I somehow knew what the President, his cabinet, his advisers, Congress, and about 50% of the population of our country did not. Could everyone really have been that stupid?

This is why I have very little faith in humanity. This is why I stay home by myself on most days instead of going out and mingling with the rest of the world. It just seems that ever since 2000 (and I only go back that far because that's when I started to pay attention), when given a choice, we always make the wrong decision.

In 2000, it was Bush vs. Gore. I'm pretty sure everyone in the country knew that Gore was smarter, more politically experienced, and more knowledgeable on foreign affairs than Bush. However, gosh, we just didn't like the way Gore sighed at Bush's stupidity in that first debate. In addition, Bush seemed like a guy we'd like to have over for a barbeque, and that's clearly the most important attribute of a potential President of The United States.

We go to war with Iraq in 2003... for no reason whatsoever. We stay in Iraq for over 6 years (and counting) because we wouldn't want to leave until "mission accomplished." Of course, when there was a never a point to begin with, it's hard to accomplish anything.

In 2004, we re-elect Bush despite the fact that the economy tanked, he unapologetically gave every single break imaginable to the wealthiest 1%, and started a war for no reason with no intentions of ever stopping it. Meanwhile, Republicans somehow made John Kerry's military service and awards look like a bad thing, and they coined him as the "flip-flopper" because he actually took his time and reasoned out his decisions instead of just being "the decider" and acting quickly regardless of the facts.

We finally did something right in 2008 when we elected Obama. This was a man running on an agenda of "change" and "hope." He was a progressive democrat who promised to bring about the changes this country desperately needed. Of course, when he got into office and started drafting policies to enact this change, people stepped back and said, "Whoa... I thought that "change" he kept talking about was just beautiful sounding rhetoric. I didn't know he really wanted to change things!"

Thus, we're now in a situation where Obama can't get nationalized health care passed because even the democrats (who are taking just as many campaign contributions from the pharmaceutical and insurance companies as republicans) don't want to rock the boat and possibly upset the shareholders of Aetna, Cigna, United Health Care, or any of those other altruistic corporations. Now, instead of getting a system along the lines of EVERY OTHER INDUSTRIALIZED COUNTRY, we'll have to settle for Co-ops, which are run by the very corporations that were the problem to begin with.

I wish I could say I have hope for our nation and our planet, but I don't. People are too stupid and too easily fooled. When a 21 year-old kid, who's biggest daily concern was which dining hall to eat at, is able to predict the outcome of what turned out to be possibly our country's biggest foreign policy blunder ever, it doesn't say much about the people who are actually in charge.

Who Comes Up With These Ideas?

2009-08-14T23:41:00.003-04:00

I may be stepping further out of the realm of anonymity in this post, but at this point, I don't care. Something has to be said about these completely asinine rules my corporate office is enacting.

My chain is one of those wonderful ones that give away antibiotics for free. It was supposed to be a temporary thing, but because of the program's "great success," corporate keeps extending this "promotion." Apparently, corporate's idea of "great success" entails prescription counts falling, my store alone losing about $10,000 per week in dispensing fees, not attracting new long term customers, and not pushing any additional OTC products. Corporate says they've gotten great feedback from customers. Sure... You can get a lot of great feedback by giving shit away for free. Hell, I bet if we dispensed everything for free, we'd get some truly glowing customer reviews.

The evils of free antibiotics aren't what I really mean to write about though. It's the procedures that they make us go through in order to give a customer a free antibiotic. First of all, these antibiotics are only free for a certain advertised days supply (which is really just a preset quantity in the computer for each drug that will print out with no charge). If we're going strictly by our advertisements, anyone getting 30 day supplies, for example, of antibiotics must pay for them. Of course, if we're going by how we advertised the program, ALL antibiotics would be free of charge too, which is far from the truth. However, instead of making customers pay for maintenance antibiotic scripts, we're told that if customers question the price, we're to edit the script so that it only goes through for the number of pills that is allowed for free. Of course, going back and editing those scripts forces us to do extra work... extra work for free because it's in the name of a FREE ANTIBIOTIC.

That's not even the peak of the idiocy of these policies. Because we cannot put a price of $0.00 on a medication, corporate had to set the free quantities of these antibiotics to be $0.01. When the program first started, we were instructed to simply cross out the 1 cent charge and give out the prescription for free. Simple. Hassle free. Therefore, we all should have known that wouldn't last.

Because corporate policy dictates that it must take every simple procedure and add at least 10 pointless steps to it in order to accomplish the exact same thing, the procedure was changed. Now, the "free antibiotic" has to be rung into the register, and we're instructed to ask customers for their store scan saver cards. Upon scanning their cards, the 1 cent is removed, and the price goes to zero.

Now, this almost makes sense. You see... If the idea was that you had to apply for a store scan saver card in order to take part in the free antibiotic promotion, I'd almost not oppose the free antibiotic program with every fiber of my being. After all, it would actually be an active attempt by our store to recruit new customers and bring in more business. Like I said... It would almost make sense.

However, it turns out that while we're instructed to ask for their savings card, the customers aren't actually required to have one. If they have a card, great! If they don't have a card, we'll just put in some code in the register, and the antibiotic prescription goes back to being free. So, if the customer doesn't have to have a scan saver card, then why the fuck are we even bothering to ask them for one?

Corporate's answer: We're supposed to have card applications at the pharmacy counter for customers to fill out if they don't have a card already and are picking up a free antibiotic prescription. My response to that: Fuck you! Obviously none of those corporate geniuses have seen how long it takes a customer to fill out a HIPAA profile release form or to even do something as simple as write a check. That's all we need in the middle of a busy day is for customers to be holding up the line as they take 10 minutes to fill out a fucking scan card application at our counter.

Here's another corporate policy that went from simple and straight forward to pointlessly convoluted. Like many pharmacy chains, we offer to flavor suspensions and solutions for people who can't stand the usual taste. Several years back, it couldn't have been simpler. If a customer wanted something flavored, we'd charge them a small fee (something around $3.00) and add it to the cost of the prescription. Simple, straightforward. The customers are happy because they get an extra service performed for a very small fee. We're happy because not only did we make the customer happy, but we got paid for our effort. It was a win-win situation. Then at some point in the past, corporate decided that win-win situations apparently suck for business, so we stopped charging for flavoring. After all, our pharmacists really have nothing better to do than spend our time performing services that don't help the business at all. Well, at least there wasn't any additional paperwork, so other than not getting paid, it wasn't really a hassle.

No hassle? "That can't be right," decided corporate one day. "Let's add a few more steps to the process." Now, when a customer wants something flavored, we're supposed to enter it into our computer system and get a label to print out with a small fee. Great! We're going back to getting paid for flavoring!

NOPE. You see, that small fee will be entered into the register at which time we're instructed to ask for the customer's scan card. Scan the card, and the fee vanishes, kind of like a stain in one of those Billy Mays OxiClean commercials. At this point, it becomes just like the free antibiotic bullshit. If they don't have a card, we just enter a code into the register, and the fee for flavoring comes off anyway. This begs the question: If everyone is just going to get the flavoring for free anyway, then why are we even bothering printing out a label with a price on it in the first place? If everyone gets it for free, then why did they even put a price on it? And if they knew everyone was going to get it for free, why didn't they just make it $0.01 like the antibiotics? Why does the label say a few bucks before scanning their cards? It makes no sense.

Those are just 2 examples of corporate taking simple policies and adding a bunch more steps for the ultimate purpose of accomplishing THE SAME DAMN THING as before.

While I'm ranting, I might as well throw in our policy on gift cards. Now, with the shear volume of gift card promotions that places like CVS and Walgreens run, I know they must have a simpler policy than ours for handing them out. It takes us like 5 minutes to give out a gift card, and that's after the prescription has been typed, checked, filled, bagged, and the customer is standing at the register waiting to pick it up. We have to enter each gift card into a gift card log. Then we have to fill out a form that goes into the register that lets our cash office know that a gift card was given out at the register (because the gift card log and coupon in the tray aren't enough). Then we have to activate the stupid gift card which is often a trying process for some of our less than stellar cashiers. It's not impossible for us to spend an hour per day simply handing out gift cards if it's a busy day in the middle of a gift card promotion.

See... This is really the only part of retail pharmacy that I can't stand. I don't mind screaming customers. I can tolerate moron receptionists and doctors with god complexes. I just hate being a bitch to our ridiculous corporate policies and procedures. I guarantee that I spend twice the amount of time every day trying to be compliant with corporate policies in order to avoid being penalized in our own internal audits than I do counseling patients. If the policies at least made some kind of sense, I might even be able to tolerate those too. However, 99% percent of them seem to be thought up by some moron sitting hundreds of miles away in an office somewhere just trying to figure out ways to waste our dollar per minute time.

Women Really Hate Each Other

2009-07-18T22:15:00.003-04:00

Retail pharmacy is slowly turning into a woman's profession. I don't think there's anything wrong with this at all. Woman make just as good pharmacists as men. However, in my experience (and generally speaking of course), women tend to bring MUCH more drama into the workplace than men do.

I spent two days in a row last week as the only man in the pharmacy surrounded by 5 women. I'm a quiet person by nature. I tend to just go about my business and let everyone else talk. And talk they did!

First there was the hour long conversation about how their pansy husbands refuse to stand up to their "wretched" mothers. Granted I'm a little rusty on my relationship linguistic abilities, but I'm pretty sure by "standing up" to their mothers, they really meant that they should do whatever their wives say and tell their mothers to go to hell at the slightest hint of a disagreement. It's all about control I think. They want to be in control of their husbands, and their mother-in-laws represent a huge threat to this control.

(As a related side note- Ladies, a good guy loves his mother. Therefore, if you married one of the good guys, don't be surprised that he doesn't always immediately take your side whenever you happen to disagree with his mother. I'll lump myself in with one of the good guys here. We spend the majority of our lives giving our mothers the utmost respect and obediently following their orders. Do you think that immediately changes just because we marry or enter a long term relationship with someone? You women should learn that even though we might love you more than anything in the world, we'll always respect (and fear) our mothers because their influence played an integral role in making us the good guys that we are. Therefore, you have to understand that we're not going to take your side every time you disagree with our mothers, and you'd be better served picking your battles carefully to avoid needless frustration... for both you and us.)

Then, after one of the women left work, this gave the other girls a wonderful chance to talk about the other girl behind her back. "I can't stand it when she does this." "Did you hear what she said to me yesterday?" "Oh my god, did you see what she was wearing?"

This is the pattern every single time I work. All the girls act friendly to each other when they're working together, but they're nasty when their backs are turned. I just don't think women can coexist with each other peacefully. At least I've never seen it.

I think back to college and my ex...

She had a bunch of different roommates, and she couldn't stand most of them. She got into huge fights with her first roommate over how they wanted to arrange their dorm room furniture. Sounds trivial, right? I thought so, but apparently this was such a HUGE deal that she had to request to switch roommates after the first semester. Miraculously, she got along with the next roommate. Then, she moved into a quad where her and 2 of the other girls ganged up on the 4th girl because they all decided they didn't like her. That girl didn't even make it a semester before she transferred out of the quad.

Contrast that to my college experience. I lived in a triple with the same roommates for 4 years. During that time, I can't remember us having a single disagreement larger than not agreeing on which dining hall to eat dinner. Basically, our existence consisted of going to class, coming back to the dorm, watching Sportscenter until lunch, going to lunch, going to some more classes, then watching Seinfeld until it was time to go to sleep. Maybe throw in some basketball a couple times per week, and repeat that for 4 years straight. No drama. No arguments. No problems at all.

Even at work, there still are some rare times where I'll work with all male pharmacists, and those days go so much smoother than days when all women are there. We don't partake in useless gossip. We talk, but it's mostly about sports or to make the occasional wise crack. Otherwise, we just focus on our work and get the job done.

Men, in general, seem to not have the same kind of animosity towards each other that women do. I can't explain why woman have so much more trouble getting along then men do. All I know is that if you stuck 10 women in a room together for several hours, there's a high probability that they'll walk out hating at least one person in that group.

If you stick 10 men in a room together, there's a high probability you'll come back several hours later and find them playing poker and watching some sporting event on television.

I think that pretty much sums up the difference between the sexes. Sure, I'm generalizing as it's certainly not the case for ALL women. Just the majority it seems.

I Hate Liars

2009-07-18T06:24:00.002-04:00

One of our regular customers called up looking for a refill on her Vicodin. Let me give you a little background on this woman. She's been getting a month's worth of Vicodin every single month for as long as I've worked at the store. It's the same deal with her husband, except he gets Vicodin ES every single month. She always comes to the counter with a big smile and very conversational. For the first few times you meet her, you think she's one of the nice customers. However, every once in a while she'd leave a little clue that she was completely full of shit.

This just happened to be one of those times. She was about 10 days too early to get her Vicodin refilled. I told her I couldn't fill it due to it being too early, and of course, she tells me that she's leaving for vacation early the next morning and would run out before getting back.

Those wonderful words start a long process of getting an early refill approved for her. I called the doctor's office. As always, they didn't care if she was asking to have a whole year's worth filled at one time. Next, I called the insurance company to see if they would approve the early fill. Well, they only sort of approved it. Her plan had some kind of plan limit where no matter what, she could only get a certain number of tablets within a certain number of days. Therefore, instead of getting her usual 90, she'd have to settle for 75 this time.

I informed her of the plan limit only to have her respond with, "can I pay cash for the other 15 tablets?"

If the stink of bullshit wasn't strong enough before, that question made it unbearable. I told her that she had more than enough tablets to get her through her vacation considering she still had 10 days left from her last fill, and now was getting another 25 days worth. I would not allow her to pay cash for the rest of it. Of course, she argued with me for a few minutes, but after realizing she wasn't going to get anywhere, she hung up the phone.

About an hour later, she showed up at the pharmacy to pick up her Vicodin. One of our techs waited on her. She was lively and conversational as always. I was busy behind the counter filling prescriptions, but I could hear every word she was saying. After she paid for the prescription, right before walking away from the counter, she mentioned that she was going away to the technician. The tech inquired, "Oh, that's nice. How long are you going?"

"Just for the weekend." Then she said bye and walked away.

FUCKING LIAR!

Let's recap that. She had 10 days of Vicodin left before calling in this refill. Then upon filling a 25 day supply for her early, she bitched about not being able to get the other 5 days due to her insurance's plan limit. This gave her a 35 day supply of Vicodin.... SO SHE COULD GO AWAY FOR 2 FUCKING DAYS!!!

These are the kind of people that I wish would just die. Seriously, it would have made my day if she got hit by a bus and died in a fiery crash on her way home. I have no concern for people like that. I think they deserve whatever misfortune they get. To me, she's the scum of the earth.

Therefore, outside of hoping that she dies a painful death due to acetaminophen induced liver toxicity (which I'm sure won't happen because it's never the fucking lying Vicodin addicts that end up with liver problems), she can be sure that she will never get her Vicodin a day early ever again. She'll have to bring me a goddamn travel itinerary to pull off that one again.

Let this be cautionary advice for anyone on long term opioid pain medication...

Pharmacists understand that your pain may increase in such a way that you would want to take more tablets than directed by your physician. If you work with us and your doctor by telling us that your pain is not being well controlled, we can help improve your medication regimen in hopes of getting better pain control. We know that not everyone who takes opioids is a drug addict. Hell, we know that the vast majority aren't addicts.

However, if you lie to us in order to get your pain medication filled early, whether you have a legitimate reason or not, you will go to the very top of our shit list. Well, at least you'll go to the very top of mine. I can empathize with people who really have pain issues. I can even empathize with people who have developed an addiction. If you're upfront about it with me, I will help you. If you lie to me, I'll hope you fucking die.

I can tolerate a lot of things in retail pharmacy, but I can't stand liars.

Tonight Was a Shining Example of What I Was or Could Have Been

2009-07-06T23:55:00.001-04:00

Tonight, I had a summer league basketball game. It's a men's league. It's ultimately meaningless, but the spirit of competition is strong in this league. Moreover, the talent level is pretty high, so it's a great outlet for my competitive drive.

We played the best team in the league tonight. This team has won this league for 4 years in a row. It's made up of a bunch of former all-state players, some stand-out athletes (one actually played major league soccer for a short time), and some guys who currently play in college.

One player on that team is generally considered the best player in the league. He graduated from a prep school a few years ago and went on to play for one of the best division 3 college basketball teams in the country. He's a 6'3" point guard who was a McDonald's All-American nominee (which isn't quite as spectacular as it sounds, but you still have to be a pretty solid player) in high school. He averaged over 20 points per game during his prep school days, and now starts for his college team.

He's a very good player. Very fundamentally sound. Good shooter. That said, anyone watching the game tonight would have said that I completely outplayed him.

Let me break that down: I'm a 5'9", 27 year old pharmacist who has chronic pain in his feet and ankles which isn't helped by spending 10 to 12 hours standing up at work. He's a 6'3", 20 year old, high level division 3 college basketball player who presumably keeps his conditioning up in the off-season in order to be ready for his college season. I outplayed him.

This wasn't a fluke either. I've played him before, and he simply cannot guard me. Granted, if I were to cover him, I wouldn't be able to guard him either because he has a lot of size on me. He'd just post me up all day. However, he's supposed to be a college point guard. He's supposed to be able to defend other point guards. I'm sure he's asked to guard the other team's point guard in every game he plays in college.

He can't guard me though. I'm too fast for him. Again, I'm 7 years older than him with a job that pretty much laughs in the face of anyone who tries to maintain a high level of fitness, and I'm too fast for him.

I scored 29 points tonight. I hit 7 three-pointers, most of which were the quick catch and shoot variety. I even got a chance to talk a little trash to this college player. I came down the right side of the court one time and realized I had a whole side cleared out. I crossed over hard to the left, and he bit on it. Off of the left cross, I quickly put the ball back through my legs to go right. He recovered a little bit, but he was completely on his heels, so I pumped the ball through my legs 2 more times really quickly as he kind of stammered backwards before finally just blowing right by him to the right. The only thing he could do was reach out and grab me so I wouldn't get an easy layup.

After that play, I just looked at him and proclaimed, "he's too slow," and I just repeated it a couple times for emphasis. He tried to talk trash right back to me, but what could he really say? I could get by him any time I wanted. He knew it. I knew it.

We ended up losing the game in overtime, but we really had no business being that close to that team. They're better than us. However, I'm so pleased with the way I played that I sort of consider it a moral victory.

You know... Maybe it is completely meaningless. You'll never find a stat sheet for this game. There's no media coverage of a men's summer league basketball game. There are no record books in this league. People will forget about this particular game within a couple of weeks.

It's not meaningless to me though. I knew I was never going to play in the NBA, and I chose my college for it's pharmacy program without regard to whether I could play basketball there (and for the record, I wouldn't have had a chance. I went to school at one of the best division 1 college basketball programs in the country). Even if I could have played college ball somewhere, I wouldn't have because I knew I had to build towards a future career. However, this shows me that I could have played at a higher level than high school. It shows me that the thousands of hours I spent dribbling a basketball when I was a kid weren't a total waste of my time.

Even if ultimately, whether I'm a good basketball player or not doesn't change my life in any meaningful way, I figure most other people spend plenty of time on meaningless endeavors. For example, how many people play golf in their spare time? How many of those are on the PGA Tour? Yet, they still all go out there trying to improve on their scores each time. People draw, paint, write, knit, and do countless other things to occupy their time. Do they not try to do as good a job as possible even if ultimately it won't get them anywhere?

Why should basketball be different? If anything, it's better than all that stuff. Basketball is a physically demanding sport. How many 27 year olds do you see that can go toe to toe with current college basketball players? Most of my friends have reached the age where they're starting to give up on basketball in favor of playing softball, which basically amounts to hanging out for a few innings just waiting to drink beer after the game. I, on the other hand, am still too fast for a college point guard. I can shoot a basketball as well as anyone, and I can dribble a basketball better than pretty much anyone.

It's something I'm proud of. I worked really hard and sacrificed a lot of time when I was young developing these skills. My basketball skills are obviously not readily apparent to people just meeting me. That's why I like it when people I know come to watch me play. It's a part of my personality that goes mostly unnoticed, but it's such a huge part of who I am. Sometimes, I feel like you can't truly understand me until you see me with a basketball in my hands. Some guys want to show off that they can play an instrument or cook well. I want to show that I'm a good basketball player. It's a form of self-expression to me.

Anyway... I rambled on for long enough. I'm just excited that I played so well tonight. Felt like sharing. Unfortunately, the virtual masses are my only audience at the moment.

A Personality Flaw

2009-07-03T22:34:00.002-04:00

I know, I know... You're all saying, "which one?" Yes, I have quite a few character flaws. However, this one recently came up, so that's what I'm going to write about.

Quite some time ago, I was talking to someone, and she commented that I liked to be right all the time. I responded, "doesn't everybody? Who wants to be wrong?"

She didn't even hesitate when she said, "But I feel like you just NEED to be right." I thought about it for a little bit, and realized that she was 100% correct. I have this overwhelming desire to be right about everything.

Now, that doesn't mean that I'm someone who thinks he's always right. There is a subtle but important difference between thinking you're always right and constantly wanting to be right. People who think they're always right don't listen or take into consideration what other people say. All they know is that they're right, everyone else is wrong, and they don't want to hear anything else.

I don't think I'm always right, and I certainly don't always think everyone else is wrong. However, I have this incredible desire to be right. Actually, it might be more appropriate to say that I have this need to know what is right. For example, if I'm talking to someone about a drug, and the other person thinks a drug works by one mechanism of action, while I think it has a different mechanism, I will stop whatever I'm doing to look up the answer and find out for sure whether I'm right or wrong.

I hate being wrong. In fact, I hate being wrong so much that I will pretty much never talk about a subject in which I'm not well versed. I will sit quietly for hours listening to other people talk until the conversation turns to a subject that I know well. Only then will I contribute.

However, if I do say something, and you happen to disagree with me, you better have a good argument or evidence to support your claim. I like to argue, and I will defend my position with every bit of logic and evidence I can come up with. Note, that I do not dismiss other people's thoughts or opinions, but I will make people defend them. If you make a comment or observation about something around me, I will question it, especially if it's something I don't agree with. If you choose not to defend your opinion or fail to come up with a logical or fact based argument in favor of it, I will dismiss it. However, if you push back at me as much as I push you to defend your opinion, I'll more than give you the proper credit. Moreover, I'll probably incorporate your thoughts into my own beliefs.

I don't really consider myself a strong person, but I believe I hold strong opinions about things. I also believe that most of the time, when I choose to say something, I'm usually right. Some people have told me that I can come across as arrogant and lacking modesty. A coworker once told me that it's like I know that I'm smarter than everyone else there, and I do nothing to make people think otherwise.

I can see how his would be annoying to people. However, I don't believe I'm arrogant at all. I'm also one of the most modest people you'll ever meet. I deflect flattery of any kind like it's a deadly disease. I shy away from praise. You can't say anything remotely nice about me without my face turning bright red in embarrassment. However, there's no such thing as modesty when it comes to being right or wrong. If someone says something that I know to be in error, I will correct it. I'm not going to just sit back and let people spread false information and uninformed opinions, especially on things that really matter.

Somewhere in all this rambling is an actual point. I'm not even sure I know what it is anymore. I guess what I'm basically trying to say is that a have a personality flaw where I feel like I always need to be right, and if I feel strongly enough about what I'm talking about (whether it be a clear-cut fact or a well thought out opinion), I will defend it. Therefore, in order to get along well with me, you have to be strong in your opinions and not afraid to argue with me to defend yourself.

In fact, when I was using eHarmony, I listed that as the most important characteristic for a girl to have. I tend to find myself attracted to girls who challenge what I say and aren't afraid to tell me when I'm being stupid (which is quite often). I'm one of the only people on this earth that doesn't want to be drowned in flattery. I don't want a girl that tells me how great I am. I want someone that can point out all my little flaws because then I know that she's really paying attention to me. Moreover, only through realizing my deficiencies will I be able to improve upon myself. Anyone who can make me realize something about myself that I don't already know is someone worthy of my admiration.

I have no idea how I ended up talking about what I desire in a woman. This post is a shining example of how stupid I can be.

Confirming What I Always Knew

2009-07-02T09:30:00.003-04:00

Tip of the day...

If you're going to be late to work, it's probably best not to be seen online on Facebook 10 minutes before you're scheduled to be at work when you have an over 30 minute drive.

See... Your coworkers all pretty much knew you were full of shit all those times that "traffic" made you 20 minutes late. Now, I have proof.

Don't worry though. I won't say or do anything about it. Even though I hate how you're constantly late AND how you take a hundred mini breaks all day long AND how you'll stand around and do absolutely nothing but talk about your boring fucking life unless specifically told to do something, I won't voice my disapproval.

You see... I hate confrontation so much that I'd rather quietly fume about it all day at work until I can come home and vent about it on this blog than to address the issue and fix the problem. Basically, I'm a wuss.

But I already knew I was a wuss. Just like I already knew you were full of shit. This just gives me something more to complain about, and what's my life if I don't have something to complain about?

Joining the Health Care Debate Once Again

2009-06-24T18:40:00.002-04:00

Let me start off by listing some facts for you comparing the US health care system to France:

- The World Health Organization (WHO) ranked the U.S. 37th in the world in health care.
- France was ranked #1 (http://www.photius.com/rankings/healthranks.html)

- U.S. was ranked 24th in average life expectancy (70 years)
- France was ranked 3rd (73.1 years) (http://www.photius.com/rankings/healthy_life_table2.html)

- According to the CIA Fact Book, the U.S. has the 43rd lowest infant mortality rate (6.3 deaths/1,000 births)
- France has the 6th lowest (3.36 deaths/1,000 births) (http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate)

- American citizens were ranked 72nd in overall health.
- French citizens were ranked 4th. (http://www.photius.com/rankings/world_health_performance_ranks.html)

- As of 2002, the U.S. spent $5,267 per person per year on health care. $2,364 (or 45% of that money) came from government spending on mainly Medicaid and Medicare.
- As of 2002, France spent $2,736 per person per year on health care. $2,080 (or 76% of that money) came from the government. (http://www.nytimes.com/2005/04/15/opinion/15krugman.html?_r=3&oref=slogin&oref=slogin&oref=slogin)

- In 2007, there were 45.7 million uninsured Americans. (http://en.wikipedia.org/wiki/Health_care_in_the_United_States#Shared_costs_of_the_uninsured)
- In France, there are ZERO uninsured citizens.

Remember... Those are FACTS. They're just STATISTICS and the links to the sources and studies that provide those statistics. Unlike the people who oppose nationalized health care, I actually use STATISTICS to back up my claims. Notice the lack of anecdotal evidence that the opposition is so fond of using. Notice the lack of unsubstantiated opinions. I provide facts so that when I do give my opinions on the subject, you'll understand that I'm not talking out of my ass.

There are 45.7 MILLION uninsured people in this country. That's roughly 1/6th of our population. People who oppose nationalized health care seem to have no problem with this though. They have health insurance, so who gives a fuck about those 45 million people who don't? After all, if they were worth caring about, they'd have insurance, right?

It seems like people only care about ME ME ME in this country. "I have a job. I have health insurance. Why should my tax dollars go towards giving everyone health insurance?"

I guess their right because those freeloaders on Medicaid we all love to rant about must make up maybe 1 or 2% of those 45 million uninsured citizens. Jeez, we wouldn't want to help out all the other outstanding citizens of our nation because a very small fraction of that money might go to someone that's trying to abuse the system. You know what they say... One rotten apple spoils the bunch. Because we are so loath to support fat, lazy, smokers who might need health care, the other 99% of those without insurance will just have to die or go bankrupt if they happen to get sick.

Clearly, the way to go is privatized health care. I mean, why wouldn't you want to put your health in the hands of giant corporations whose sole priority is to make money? Corporations that actually set goals for the percentage of rejected claims they should have. Corporations who will deny you coverage or send your premiums through the roof if you have pre-existing conditions.

You know what the hilarious thing is? There's no other country that has a similar model of health care as us. You can't look at some wealthy European country and say, "they have privatized health care. Look how good they're doing." Pretty much every other country in the industrialized world has nationalized health care, and statistically speaking, in nearly every way you can measure, those other countries put our health care system to shame. Again... This is statistically speaking. Not anecdotally speaking.

I used France in the statistical comparison for two reasons. One, France has the best health care system in the world and 76% of it is funded by its government. Secondly, Americans love to bash on the French. Well, the French are kicking our ass in health care. It's not even close. They spend roughly half of what we do per capita, and they get far better results in just about every meaningful way you can measure health care results.

Obviously, looking at the numbers, the problem lies in our system. It needs to be radically overhauled to eliminate the waste. There's no reason we should be spending twice as much as everyone else and getting worse results. The process needs to be streamlined. That means we need to bulldoze the whole fucking system right to the ground and start all over again.

Only this time, maybe we can put our American egos to the side and ask the French for help on this one because they surely know how to make a health care system better than we do.

We won't do that though because it's un-American to approve of the French in any way. We'll just continue going on bitching about Canadian wait times (which pretty much every study shows are greatly exaggerated)and how it's "immoral" to have to pay taxes to support fat, smoking slobs who develop heart and lung problems. That's the American way, and it must be great... because American is great... Right?

The Best Way to Get Prescribers to Write Prescriptions Correctly

2009-06-23T22:30:00.003-04:00

I'm dead serious when I suggest this. I also know that it will never happen. However, it will stop prescribers from making stupid mistakes on prescriptions pretty damn quickly.

There should be a law mandating that every single prescription must be written correctly in order for pharmacies to legally fill it. That means every time a doctor doesn't write a quantity, doesn't include directions, doesn't sign his name, doesn't write the patient's full name, writes illegibly or makes any other stupid mistake, pharmacists send the patient right back to the office to get a new prescription. After a dozen or so patients return to the office by lunch to get their scripts rewritten, the prescribers will quickly learn to write them correctly.

I'm so sick of calling to clarify every other prescription I get. The percentage is even higher on e-prescribed scripts. Really... How hard is it to write a fucking prescription correctly? More importantly, how can you just laugh it off when I call to clarify it?

Today, I called the office because I couldn't read whether the doctor wrote felodipine or amlodipine on a prescription. It looked a lot like felodipine, but the patient had amlodipine in the past, so we had to call to clarify it. For one, they couldn't tell me right away. They had to call me back... 6 hours later. Then, the woman on the phone said, "It's for amlodipine, but I have no idea what the rest of the prescription says."

That's great! It's a good thing I could read the rest of his chicken scratch because otherwise, I might have had to wait another day to get the directions clarified.

Then, there was the e-script that came through just like this:

Valtrex 500mg
Quantity: 426
Sig: 2 tabs (1,000mg) three times a day for 7 days

426 Valtrex, huh? So, I called to clarify the quantity just to make sure she really meant 42. Yes, the nurse meant 42 tablets. However, she suddenly realized she made another mistake, saying it was supposed to be for 500 mg, 1 tab 3 times a day for 7 days.

"So, the quantity should be 21 then, right?" I queried with the feeling that she just screwed up.

"No... It's for 42 tablets. She's taking it 3 times a day for 7 days," she answered.

"Three times daily for 7 days would be 21 tablets. Seven times 3 is 21," I informed her.

"Oh.... Well, that's weird because the doctor quite clearly wrote for 42," she responded confused.

I was done playing games with her. "Listen, the original prescription came through for 1,000 mg TID. That's the usual dose for treating shingles (which this patient had). I'm pretty sure the doctor meant her to take two 500 mg tablets or one 1,000 mg tablet TID."

"No... the doctor quite clearly wrote 500mg, 1 tablet TID," she insisted.

I told her that I would feel much more comfortable if she asked the doctor to clarify the dose and get back to me. She begrudgingly agreed.

Ten minutes later, the prescription was e-prescribed again to us with the original directions of 2 tablets TID. She never called to tell me if she got clarification on the script, so I had to call her back. It turned out I had been right. Had I not been insistent about getting the proper directions on the script, it would have been filled incorrectly and those incorrect directions would have been verified with a member of the office staff.

Isn't it comforting to know that often times the doctor's office staff is guessing on prescriptions when they call them in to us? I go through this same speil every freaking day. And are the patients happy that I took the time to make sure the prescription was correct? NO!! They're pissed at me for making them wait.

When they're not pissed, they think it's a big joke. "Oh.. Dr. Whathisname's writing is so terrible. HAHA."

You know... It isn't fucking funny. It wastes my time. It wastes the patient's time. Most importantly, it's DANGEROUS. People get killed because of poor handwriting. People get killed by incorrectly written prescriptions. Pharmacists are fucking awesome at correcting 99.9999% of the mistakes that prescribers make on scripts, but while we just might be the most accurate and obsessive compulsive perfectionists outside of NASA, we do occasionally miss these mistakes. Many of us are working long hours, under high prescriptions volumes, and with little help, so it's hard enough for us to make sure that the right pills go in the right patient's bottle. We don't need the added pressure that comes from poorly written prescriptions... especially when those errors are so freaking easy to eliminate if prescribers would just take 2 extra seconds.

Therefore, I call for pharmacists to revolt and refuse to fill prescriptions unless they are written correctly. We need to stop wasting our precious time bickering and bargaining with the office staff, and let them realize just how often they screw up. Let them waste their OWN time correcting their OWN mistakes.

An Ability I Wish I Had

2009-06-19T18:24:00.002-04:00

The renovations on my condo are well under way. The contractor and his workers are in there ripping stuff out and preparing to install all the new things I bought. Watching these guys rip stuff out and make repairs makes me wish I knew how to do stuff like that.

I can't build anything. I have absolutely no mechanical talents. These guys can do everything. They know how to do electical work, plumbing, carpentry, tile, everything. This man could literally build a house from the ground up if he wanted to. I can't do anything even close to as great as that.

I spent a little while just shooting the breeze with these guys today, and it's crazy how intellectually superior I am to them though. I mean, they have a hard time understanding even the simplest concepts. I have to make sure to use small, common words around them or else they won't understand me. However, they can look at my water heater for 2 seconds and tell me everything about how the pipes run through the house.

My contractor and his workers are all nice guys, but they all look at me like I'm a step above them in society. It actually makes me a little uncomfortable. For example, one of my neighbors is a girl that went to school with me. While I was outside talking to the workers, she came out of her condo to get into her car. She saw me, waved to me, and I waved back. After she drove off, the guys were talking about how "hot" she was, and how I'm the only one of all of them that has a chance with her. One guy even commented about how he should be a "doctor" like me so he could get girls like that. (I quickly corrected him saying I was a pharmacist. I don't like being called a doctor even if my abitrary doctor of pharmacy degree technically makes me one). The ironic thing, of course, is that I'm fairly certain that he gets way more woman than I do. Any amount is more than zero.

Since then, I've been thinking about how I often forget that not everyone can afford the things that I can. I bought a condo I didn't particularly like, so I hired a contractor, had him gut the place, and after they're done, I'll have basically a brand new place. A lot of people have trouble even affording a condo like this place originally was. My job enables me to have nicer things than most others. Why is that though? Why do I make more money doing what I do than the contractor and his workers do?

They can't do my job. Intellectually, it's way over their heads... and I don't even think my job is all that intellectually challenging. They wouldn't be able to handle the classes I had to take to get my degree. It's beyond their mental capacity. On the other hand, I could never do what they do. I just don't have the ability to build things. I've tried before. I just don't have that natural talent.

If neither one of us can do the other's job, then why do I get paid so much more than they do? What makes my job worth more money than their's? If anything, I would think that being able to build a house is a far more useful ability than knowing how to dispense drugs. Yet the world seems to think that because I went to school for so long, I deserve to be paid more. Are there really fewer people who could be pharmacists than can build a house from the ground up?

See... While going through these renovations, I think of how much easier my life would be if I could do this stuff my self. It would save me tens of thousands of dollars. In addition, it would be constantly useful. Knowing how to rebuild and repair things never loses its value. However, my pharmacy knowledge becomes completely useless to me the second I walk out of the pharmacy.

I guess that was my random thought for the day.

Silence

2009-06-17T23:19:00.002-04:00

The silence gets to me sometimes. As I sit here typing this post, the only sounds I can hear are the soft clicks of my fingers punching the keys. It's been this way for hours now. No phone calls. No text messages. I can't even hear cars outside. It's just me in this little apartment. The rest of the world may as well not exist.

It's not so much the loneliness that bothers me but the sense of isolation. It's a feeling that I'm completely inconsequential. Even though I can't hear it, I know people are going about their lives all around me, and I have absolutely no effect on them. I don't matter. If I happened to die in this apartment, no one would know about it for days. No one would call looking for me. I'm not expected to be anywhere. I have no plans with anyone. It's just me in my little apartment, which might as well be my own universe.

No matter what anyone says or tries to convince themselves, you cannot be happy living like I do. That's not to say that my life is miserable. It's just not happy. How could it be? "Happiness is only real when shared." Without friends or loved ones in my life, everything I have and everything I do is ultimately meaningless. I have no one to reflect with. I have no one to be happy with me. No one to be excited for me. No one to be proud of me...

The question then becomes, if this life doesn't make me happy, then why don't I correct the situation? Why don't I make more of an effort to be with friends and family? Why don't I try to meet new people? Why don't I try to date? There's a million things I could be doing to remedy my situation, but I don't do any of them. If I refuse to do anything about it, then I really shouldn't complain about it, right?

Here's the reason I choose to live this way: I'm so acutely aware of my personal faults that I don't want to subject anyone to me. I tend to hurt the people I care about. The only conversations I have with my parents involve yelling and arguing. I don't even talk to my brother. I haven't seen my other relatives in years, even though, as an adult, I can hop in my car and see them whenever I want.

Even with my ex (who I haven't written about in a long time)... I can't even count how many times I made her cry in our nearly 6 year relationship, and I loved her more than I thought I could ever love someone. It was stupid stuff. It's always stupid stuff with me. I get frustrated over something dumb (like not being able to find a parking space), and I lash out. Afterwards, I always tell myself I'll never do it again. I get mad at myself and try to change, but I can't. I get easily frustrated, and when I get frustrated, I can't control my emotions.

It happens to me playing basketball too. I miss a few jump shots, and I start muttering to myself. Miss a few more, then the frustration really sets in. At that point, if I miss another one, I usually let out a FUCK!!!!! at the top of my lungs, so loud that everyone within 100 yards stops what they're doing and looks at me. It embarrasses me because I'm not at all that kind of person normally. I'm really one of the most soft spoken, well-mannered people you'll ever meet in most circumstances. However, if I get frustrated enough, I lose control. I hate that part of myself. I tell myself that I need to be calm, cool, and collected like my favorite player Ray Allen, but I can never do it.

My embarrassment over my frustrated outbursts causes me to be overly controlling of my emotions in every other aspect of my life. If you talk to me when I'm not frustrated, I come across as the most bland person in the world. I have no passions. Nothing excites me. Nothing pleases me. I'm just blah all the time. I'm afraid to let my emotions go unchecked because I don't know how I will react.

I just can't be like everyone else. My brain doesn't work that way. I accept that, and I make what I think is the best out of my situation. However, it doesn't stop me from desiring more. Think of it like a double leg amputee. Yes, the amputee can make the best of his life given his physical limitations. However, he'll always wish he could walk. Similarly, I know I can't handle any kind of personal relationship (friends, family, significant other) without inflicting mental anguish on the other person, and I've found ways to not be miserable giving my situation. However, I'll always desire to be like everyone else.

It's taken me about an hour to write this post. In that time, I didn't get an email. Didn't get a text message. Didn't get a phone call. No one knocked at my door. My existence has gone completely unacknowledged all day. Days like these, which happen far too often, cause me to think about stuff like this.

*** As a blog note... I've kind of given up on pharmacy blogging. I don't have much left to say about my job. I feel like I've written every thing worth writing about already, so unless some new and different ideas pop into my head, you'll probably be seeing much more of these kind of posts than anything to do with pharmacy. I apologize to those that actually cared about what I had to say regarding pharmacy. I figure I'm too pessimistic to be a voice for the profession anyway. Pharmacy is certain to go nowhere if people like me are writing about it.

Condo Update

2009-06-13T11:02:00.004-04:00

Last post, I complained that the worst decision in my life was to buy this condo. I still think that's probably true. However, what's done is done, so now I have to make the best of it. The only way to make the best of the situation is to just go out and spend lots and lots of money.

I have all my repairs and renovations lined up. I had an initial budget in mind when I bought the place, and I've gone over that initial budget by over 25%. I know that I will never get back the money I put into the place. However, I did significantly increase the value of the home, so I'll get a lot of it back. As someone pointed out in a comment to my last blog post though, I shouldn't think of it as much as an investment as it is a home. In fact, I've always said myself that I wasn't concerned with making money on a home. I intend to live there for quite some time, so it has to be something that I like. After these renovations, it will be quite nice.

The money in the whole thing is what's freaking my out, and it's also why I'm calling it the worst decision of my life. It's really a gamble on my part. It's probably a small gamble, but there's still a chance this could all blow up in my face. My financial philosophy has always been to stay well within my means, and always have plenty of money in savings to spare in case something goes wrong. Before buying this home, I had well over a year's worth of take-home pay sitting in my savings account. If for whatever reason I lost my job, I could have stayed in this apartment and lived the exact same lifestyle for about 3 years before running out of money. That's quite a safety net.

Now, I don't have that safety net. After all this is done, I'll be broke. My mortgage is small (all things included, I'll be paying about as much to live in the condo as I am to live in my apartment), so once the renovations are through, I'll be able to go back to saving money at the same rate as before. I'm good at saving money. I guess I should be good at it. I make a pharmacist's salary, and I'm single with no kids. There's just about no way for me to go out and spend more than I make unless I start blowing money on really extravagant things. Since I have no desire to live any more luxuriously than I do now, I think I'll be OK.

Of course, being OK is dependent on me having a job. This is where I get nervous. I don't have a crystal ball. I could lose my job tomorrow or a couple months from now. In order for me to recover to a point of comfort, I have to maintain my job for another year or two. That probably won't be a problem. However, maybe it will be. Maybe early in the fall, the economy takes another nose-dive, only this time worse than before. Maybe our store's business plummetts, and they have to cut another pharmacist. Anything can happen, which is why I've always planned for the absolute worst case scenario.

In that way, buying this home was a deviation from my normal financial philosophy. It was a purchase based on blind optimism. It was a decision based on the hope that everything will be OK. It's dependent on the economy recovering like it always has in the past. It probably will, but I can't help to be uneasy about it. I'm naturally a pessimist. I always think the worst is going to happen. Thinking optimistically does not suit me. In fact, I'm entirely incapable of doing it. I simply cannot see the bright side in anything. I always see everything that can go wrong. That's why I hate gambling no matter how much the odds might be in my favor. This condo feels like a gamble to me.

In a year, I may look back and say getting this condo ultimately turned out to be the best decision in my life. That's if everything goes according to plan of course. As for right now, I don't have a safety net because I'm completely broke. I'm just hoping everything goes well, but I know that there are a lot of factors that are beyond my control. That's what scares me. That's why I'm freaking out.

For now... I'm set in my path, so I'll have to see this through. I just feel like I'm steering blindly.

The Worst Decision I've Ever Made

2009-06-05T21:18:00.003-04:00

I bought that condo, and now I wish I could give the damn place back. This is, by far, the worst decision I've ever made in my life. I bought a place that requires more work than I'm capable of doing at a price that was probably much more than it was worth, and worst of all, I realized I'm just not ready to be a home owner. I'm so disappointed in myself.

I've been waiting forever and saving up money in preparation for buying a place. I had the money. I had the plan. Then when the time came that to finally make a purchase, I rushed in like an idiot. I had the money to buy a really nice home. However, for some reason, I went out and bought a fixer-upper. I have no idea why I bought a place that needed so much work. I am not in the least bit handy. I have a hard time changing a light bulb. However, I went out and bought a disaster of a condo thinking that if I buy it cheap, I can spend a little bit of money and make it a whole lot nicer and worth a whole lot more.

Of course... I greatly underestimated how much it would cost to fix the place. Now, I'm struggling to figure out how to make all the necessary improvements with a very tight budget. I said "yes" to buying the place so quickly that I didn't really pay attention to all the things that were wrong with it. Since, I can't do anything by myself, I have to hire someone to do it. Contractors are coming in with estimates of over twice as much as I have to spend. Therefore, I'm trying to piece this giant home renovation project together for the cheapest amount of money possible.

Of course, if I was a person that actually liked to do little projects, this wouldn't be so bad. The problem is that I fucking hate it. I hate being bothered with this stuff. I hate calling electricians. I hate calling plumbers. I hate Home Depot. I just hate doing this kind of handy work even if I'm not really the one doing most of it. To save money, I'm trying to paint the place myself. I've never painted anything in my life before, and I already know that I hate painting. The last 2 weeks have been a living hell for me.

Through all of this, I learned the hard truth that I'm just not mature and responsible enough to be a home owner. I like the apartment life. If something goes wrong, I call maintenance, and they fix it. As long as I pay my rent every month, the apartment complex takes care of everything else. It's nice. It's hassle free. It perfectly suits my personality.

I kind of think of my apartment as a really nice college dorm room. It's not my home. It's just a place where I hang out in between going to work. You can't think of a house or condo in the same way. You own it. You're ultimately responsible for everything. No one is there to bail you out if something goes wrong. You have to take the initiative to get it fixed yourself. I'm not responsible enough for that. When I get home from work, I just want to throw my stuff on the floor, sit down, and relax. I'm often too lazy to hang up my clothes, so they just pile up on my dresser for a week or so. When you're not worried about your apartment's future value, you tend to not care what happens to it. With a home, you're constantly trying to protect your investment.

Maybe it wouldn't have been so bad if I actually bought a nice place in the first place. I was so set on living only a couple miles from work that I would not even look at a nice place that was more than 5 minutes away. I wanted to live in a certain condo complex, and I chose the first unit that became available. Unfortunately, it was a piece of garbage, and instead of saying "no," I bought a place that I didn't even really like that much.

I don't know why I do these things to myself. I limited myself to a certain price range even though I could easily afford twice as much. If I spent even just a little bit more, I could have gotten a place that I really loved that required little to no work. Then, I wouldn't have had to deal with all the shit I'm dealing with now. But nooooo.... I had to make it difficult on myself.

Sometimes I think that I subconsciously punish myself whenever the opportunity presents itself. I constantly have to rationalize to myself that I'm a good person and worthy of whatever I desire in life. However, in the back of my mind, I think there's always this lingering feeling that I don't deserve nice things and that I've taken the cheater's way through life. I try to convince myself that I'm nice and do a lot of good for a lot of people, especially at work. However deep inside, I can't stand myself. Therefore, I constantly sabotage myself to keep me from getting what I truly want.

I would say that I'm destined to be miserable for my entire life, but I don't believe in destiny. I'll just say that I don't think I'll be anything but miserable for the foreseeable future.

Sometimes I Get Tired of Being Rational

2009-06-01T23:34:00.002-04:00

Like Pharmacy Chick I hate it when people call out sick. I know, I know. People get sick. They should be allowed to take sick days in order to get better. I completely understand, and I'm accepting of it.

Despite being understanding of people calling out sick, I freaking hate it. I shouldn't hate it. It shouldn't bother me because I know people need sick days every once in a while. However, sometimes I just get sick of being understanding, and I'm going to use this space to vent a little.

I've never called out sick for work. I've just never been so sick that I didn't think I could work. As I mentioned in an earlier blog post, I only get maybe 2 minor colds per year. They usually amount to a sore throat and a sinus headache. That's hardly a reason to call out of work.

In the time span between my minor colds, I have coworkers who get sick a dozen times and use several sick days. It's starting to make me feel like I might have a superhuman immune system. I have coworkers who are such germophobes that they keep bottles of Purell with them at all times and constantly wipe down the counters in the pharmacy with those Lysol wipes. Despite trying to kill every germ in the world, they still manage to get sick all the time. On the other hand, I take absolutely no extra precautions to avoid germs beyond washing my hands after eating and using the bathroom, and I never get sick.

That's part of the reason I can't stand when people call out sick. I never have to call out sick, so I question why they do. A part of me feels like they're faking, or at least exagerrating, their illnesses. Seriously, I'm the most average person in pretty much every aspect. Why would I have a better immune system than seemingly everyone I work with???

Unless you're on death's door step, I think you should drag your ass into work because that's what I do. My philosophy is that I'm very grateful to have a job, and my job pays for my life. Therefore, if I'm scheduled to work, you can bet your ass I'm going to be there. Plus, I take pride in showing up to work every single day. I don't love doing it, but I pride myself on being dependable. I think more people need to have that same sense of pride.

I Hate Being the Controlled Substance Police

2009-05-21T22:52:00.002-04:00

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.

I Don't Get Mad Anymore

2009-05-19T23:55:00.003-04:00

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.

Why I Play Basketball

2009-05-07T10:13:00.003-04:00

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.

Anyway...

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.

Some People Grossly Overestimate the Importance of Their Medication

2009-05-06T22:49:00.002-04:00

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.**

Why I Could Never Have Played in the NBA

2009-05-04T23:06:00.002-04:00

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

2009-05-04T18:45:00.003-04:00

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.