The Pharmacy Chick

Pharmacy Chick has developed a tight relationship over the years with her customers. She learned Dale Carnegie’s tennets of winning friends: Let them talk about themselves and what interests THEM, and listen well. If you love golf, I will ask about your game. If you love to sail, I will ask you if you got to the river last weekend. If you love Nascar, well, I’ll just smile and let you talk. I may not have any interest in golf, sailing or Nascar, but I care enough about you to ask you about your life.

I do not however discuss politics. Now now, nor at anytime in the future will I discuss politics with you, so do not even ask. Thankfully not too many people ask me my opinions about anything other than health issues. I learned a long time ago that when people politely ask me “how are you?” that its purely a rhetorical question and the only answer they want to hear is “Fine, thank you.”.

I only wish “Dan” would learn that lesson. Dan is a tech that blows thru our pharmacy now and then like a bad wind. If you ask him how he is, he will tell you in detail, with great length and flair until you are left glassy eyesdand begging for whatever oxygen remains in the room. If you share a story, he can one-up you. No matter what disease you might have had, he has either had it or know somebody who has. No matter what weird experience you went thru, Dan did it better (or worse) than you did. Go ahead, make up something and he will trump you every time.

Dan also has an opinion, and wants to share it with you. The trouble is, he has no interest in hearing yours. He is vocal and very boorish. If you share a counter-opinion he will turn you off like a switch. He loves to hear himself talk.

(an aside) Around Pharmacy Chick’s pharmacy, sex, religion and politics are off limits. Nothing good can come from talking about it. We are a diverse group here and I know that we do not share the same moral values/political preferences/social backgrounds. It is much better that we discuss work issues at work and non-work issues someplace else. We work in a small space, if somebody doesnt’ get along, there isn’t a good way to separate the feuding parties. You may ask about what I did over the weekend, but any commentary you may have must be kind and polite, even if I told you I went to homophobic hate rally. You slept with your best friends wife? I don’t wanna know. Don’t even go there..

When Dan works, there will be the inevitable subject of politics broached. And, PC will squash it like a bug. If he sees somebody wearing a button supporting some candidate he either likes or dislikes, he will say something. And, PC will shut him down. I had to tell Dan one day that if he makes one more comment to a certain customer about a certain hot issue that I will make him personally apologize to this customer, a public official of some rank.

All that hot air and no release valve–I have to wonder, if I poked him with a pin, would he hiss like a tea pot?

Tags: employees, national news, pharmacy life, ranting | |

Pharmacy Chick was internet surfing the other day when she came upon a little news item that yet another major pharmacy and grocery chain was joining the ranks of the apostates and offering the $4 prescriptions on “over 300 drugs”. (bear in mind that warfarin 1,2, 2.5,3,4,5,7.5,and 10mg counts as 8 drugs). I wish I could ask WHY?

Pharmacies have never been known for their intelligent decision making. But this one takes the cake. When Walmart ( I can use their name because its widely known) came out with their $4 offering, I bravely hoped that it would be a passing fad. After all, pharmacy amounts to what? 2% of their business? Who cares if they lose money if they can get Mr Joe Six pack to fill his cart while waiting for his $4 loss leader. Target followed later with their own list. Target is a relatively new player in pharmacy. Now its Kroger. I don’t know much about these guys, they aren’t around my neck of the woods. But Pharmacy Chick is hopping on her soap box for a few observations:

95% of my business is already managed by health insurance. These are people whose prices are already fixed and the rate of reimbursement can be called sucky at best. There are a few precious plans that have a fixed generic copay, $10 for example whether its 100 metformin or 2 lorazepam, its 10 bucks. Why are we giving a PBM incentive to cut our reimbursements even more? Ya’ll think they are blind and won’t notice?

The few cash payers that I have left are snatched up by “discount cards”. What the hell is this? Since when can Quickie Lube and Tire offer a card that decides how much I can or cannot charge for my services? Why did we ever accept this from the start? When I used to work for Joe Independent, he refused the cards. “If its not insurance, I’m not takin’ it!” And he didn’t.

Generic medications were the last bastions of profitibility in the pharmacy. If we bought it for $2 and sold it for $22, we made a tidy $20 gross profit, which was still a great deal over the $99 it would have cost the patient for the brand name. I dont care what you say, there isn’t going to be great profit in some of these auxilliary services like vaccines and MTM, they are too labor intensive. It costs a lot of labor to run those services, and in no time, PBM’s will be cutting reimbursements to is for them too. Just wait, you will see. Why are we buying the rope they are hanging us with?

One of my buddies works in a pharmacy that will price match the $4 when asked. He doesn’t get asked very much cuz he works for a discounter that sells stuff pretty cheaply already. The “when asked” part bugs me. If you are gonna do the $4 deal, either do it or don’t, this sliding scale thing bothers me. That means you have to keep track of Ms C who gets her Lisinopril for $4 and Mrs D who gets hers for $12.99. In fact the whole price matching thing gets me going, but that is a blog on its own, suffice to say that Pharmacy Chick thinks that if you are gonna do this $4 nonsense, either jump in or stay out, sticking your toe in only is gonna cause trouble with customers.

Imagine this, cuz I already have: Its a big conference room, BPOP (Biggest PBM On Planet) is having a meeting with all their decision makers. They have, in front of them, the lists of all the $4 prescriptions that all these players are offering. Mr Big in his bigger suit stands up and addresses the group: “Gentlemen, we have a golden opportunity here, these jokers have cut their own throats, and we dont have to do it for them. All we have to do is rake in the profits, because effective at next renewal period, all these meds will be contracted at $3.50. If they can accept $4, they will accept $3.50″ HAHAHA, ” Lets go have lunch, and take the rest of the day off, we didnt’ have to earn it, they just gave it to us.”

Its the beginning of the death of pharmacy, and unfortunately for us, this one can only be classified as “suicide”.

Tags: competitors, national news, pharmacy life, prices, ranting | |

The USA Today published an article focusing on pharmacy errors in the workplace and their relationship to work load http://www.usatoday.com/money/industries/health/2008-02-11-prescription-errors_N.htm. It’s a good read for anybody not our field to realize that there is a damn good reason why your prescriptions shouldn’t be treated like its a race to the finish line. Its also a wake up call to all of us IN the field as to why it should be OK to tell Ms I’m-in-a-hurry to cool her jets and sit down. Nobody wants to be the victim of a pharmacy error, and there are always two victims: the patient and the pharmacist. I have never met a deliberately neglectful pharmacist. No pharmacist wants to hurt a patient, but almost everybody has thrown the dice now and then, gambling that they have done everything correctly when they have a fire burning under their feet.

I try to be respectful to all my patients, whether they deserve it or not (and trust me, some dont deserve much), but occasionally somebody will cross that line and cop an attitude when I tell them it will be over 30 minutes for their prescriptions. They assume “the posture” and usually spit out “THAT long?” To which I generally reply–”This is not a race and I am not serving fast food–I work at 2 speeds, SAFE and UNSAFE, you pick”

One thing that was not mentioned specifically in the article was the concept of interruptions in the workplace, something that probably more frustrating to me as a pharmacist than the workload is itself. It is one thing to have much to do, and plug along one at a time, getting it done. Its another thing entirely to have the same amount to do, but suffer the failure of not getting anything done without at least 2 interruptions. You know what I mean. The inability to bring one single prescription from beginning to end without having to stop somewhere along the line, breaking that line of concentration. I have had days where I have done 200+ rx’s and it has been a breeze, with myself and 2 techs. AND, there have been days where I was ready to stab the next person who interrupts me even ONE MORE TIME.

Even the pharmacy layout condones this. Mos of us work in a fish bowl. Walgreens may not do much right, but they have at least put the bulk of their pharmacy behind a wall. Most pharmacies are open from drop-off to pick-up. I can be seen at every spot in the pharmacy but the cubby hole where our coats are hung. Unfortunately, I cannot work back there….

What I am getting at is this. Every part of the filling process is important, but every part of it is fully in view and completely interruptable. I can be inputting a prescription and hear “ahem, can I ask you a quick question?” I would love to say “NO, I am saving a life here. you must wait til I am finished”. Do Doctors see their patients in the waiting room? Do surgeons perform surgery in the hallway? Do lawyers counsel their clients in the lobby? How many times have you called an office to get clarification on a prescription to be told “the Dr is with a patient, I’ll get back to you when he is done”

Some jobs can be done in the public view, but I am pressed to say that Pharmacy shouldn’t be one of them. Yes we should be available, to counsel, to help, to whatever. But we should NOT be ON-DEMAND. I could never walk into a Dr’s office, my Accountant’s office, my Lawyer’s office (thank God I dont have one), and say “I want to speak them…right now” You would likely be greeted with “AND, do you have an appointment?” If other professionals pace their day and have gatekeepers to shield them from unnecessary interruptions, why can’t we do the same to some degree, to minimize our risks, and maintain our sanity?

Think about it for a minute. Do we really need to be in view 100% of the time to be good pharmacists? If somebody wants to ask a question of a pharmacist, do they really need to hang over the counter and interrupt, creating a potential mistake? We are only human, and humans we will always be.

There is a chain in the city I work in that is all about SERVICE–they even get graded by so called “secret shoppers” to make sure they meet all the criteria from the Hello to the Goodbye. I have talked to their employees and they have told me what a stressful environment it has created. They get points for doing it right and deductions for missing something. For the company, its all about getting 100% on these secret shoppers, and not much else. I doubt that company will ever put a wall up to shield their pharmacists from interruptions.

A national celebrity’s infant child was given a (likely) fatal dose of an anti-coagulant in a hospital recently. Fortunately it was caught soon enought before harm was done and the antidote was administered. I believe the dose was 10,000 times the amount for an infant (don’t hold me to that figure, I dont have it in front of me) I wouldn’t want to be the nurse to did it, and I certainly woudn’t want to have been the pharmacist who sent it up to the floor. It was an error of similar packaging. High profile person+huge mistake=big fallout.

Every mistake is a breakdown somewhere along the workflow route. I truly believe that the fewer the interruptions, the healthier the work environment (including a lunch and break for EVERYBODY) , the better the layout, sufficient labor, and the proper technologies (scanners etc) and the time to counsel properly, the fewer the mistakes.

Now I’ll get off my soap box.

Tags: mistakes, national news, pharmacy life | |