The Pharmacy Chick

Pharmacy chick logged in today to see that blogpharm as changed its format. Because I am a major techno-phobe, I dont appreciate having changes made to my computer stuff or my internet experience.  I mean, its taken me months just to figure out how to put a picture on my blog and now everything behind the scenes has moved.   Did anybody ask me?  They should have since I am one of only about 5 bloggers that use Blogpharm.  Harrrumph!  I cannot find squat on the composition pages.

I am the same way at the pharmacy.  Change some policy, some procedure, or move some of my stuff and expect some fall out.  Occasionally I won’t comply at all but don’t tell anybody about that.  Every evaluation I get has some comment about my “resistance to change”.  You’d think after 16 years they would give up.

Its been really bad lately in PC’s Pharmacy–We are being micromanaged to death.  Somebody at corporate is trying to justify his job. Every little movement is tracked, monitored, evaluated, then “improved”.  I suspect I couldn’t even pass gas without somebody offering a better way to do it. No longer is the end product the important issue, its all about the PROCESS–and uniformness.  After I unloaded a particular diatribe on the boss,  he exasperatedly asked “Why do you do this?”  I said.  ” I find it much more satisfying to complain than to comply without question. WHY do YOU keep doing this to ME? ”  ( it IS all about ME you know..heh heh) Lets put it this way: The sun rises in the east, sets in the west and the Chick hates change.   Except one.

Give me the winning lottery numbers and I’d be happy to CHANGE my employment status,  CHANGE my residence,  and make some major lifestyle CHANGES!

Til then, don’t mess with my stuff!

PC is checking out for a few days- time for some R&R with Mr Chick in the mountains, hence no computer, no posting, no email!

Tags: pharmacy life, ranting and feeling the squeeze | |

Every now and then we have a day that causes us to check the calendar to see if its a full moon. This day was one of them. She was in her 30’s, a yuppie type lady with high heels under a smart suit. She handed me a prescription from a clinic very nearby. She was not in my computer so I collected the basic bio-data from her and told her it would be ready in 20 minutes or so. “Oh no”, she said “I dont want to fill this here. I want it at the 99th and Standish store next week” (insert blank look here) I told her that if she drops it off HERE, it wont be THERE next week, it will be HERE at the 12th and main location (where she is NOW). She exhudes a look that says “can you be THIS stupid?” and said “Can’t you call this to them?” Just being a tad pissy that day I responded with “Cant you TAKE this to them, since you want to pick it up there anyway?” She huffily responded “I don’t have time”.

OK, lets recap. Miss I-dont-have-time drove a prescription to a pharmacy she didnt’ want to fill it at to put it on hold so WE could call somebody else next week to fill it elsewhere and she could drive and pick it up there. Perhaps I am missing something but wouldn’t it have been just as easy to have Dr Wonderful pick up the phone, call 99th and Standish, have the rx filled there? Just a thought.

I put the rx on hold and forgot about it. I have no idea if 99th and Standish ever called. I don’t care.

Tags: customers, pharmacy life | |

One of the things Pharmacy Chick thinks is important is the presentation of the prescription given to the patient. I do not like wrinkled tape on the label, the labels crooked on the bottle, and I don’t like to have mispellings. I cannot tell you how many times I have sent a label back to be retyped because pain was spelled “apin” or THE was spelled “hte”. To me, having something spelled wrong tells my customers ” I do not care enough about this process to handle the details and do it right”

Therefore when I got (for the thousandth time) a prescription given to me with the prescribed drug spelled incorrectly, I had to shake my head. Care to guess which two drugs are mis-spelled most of all? Vicodin and Percocet. Give me a break! These two drugs are so common that even the most newly hired medical assistants should be able to spell them correctly.

So why then, do I still see Vicodan and Percoset? What does that say to the patient when the physician’s office gives him/her a drug that they seemingly cannot even spell right? Its not like we are having them spell Afluxihydrodoxyaminodinodab (don’t bother looking it up, you won’t find it). I have seen Vicodin spelled wrong so many times that “vicodan” starts to look normal…

There are times I wish I could just hand the script back to the patient. “There is no such drug”, but for obvious reasons I can’t do that. So I just decided to add it to my gripe list….and blog about it.

Tags: pharmacy life, rambling | |

Going to work on a monday is like beating myself over the head with hammer. It hurts, but for some stupid reason (money??) I keep doing it. You’d think that after a while, I’d get out of the way of the hammer.

Since people who receive faxes from pharmacies probably look at them for 7 nano seconds before passing them off, I have tried to dumb them down to their basic components. I try to use simple terms (first grade) and sharpies to make my point. TWICE today, it was ignored like I was writing sanskrit or something.

Case in point number 1. We asked for a refill for a patient for 90 days supply of Atenolol 50mg She had been on 1/2 tab BID, #90. A couple of hours later a prescription was faxed for same lady for Atenolol 50mg #90 1 po BID. with 11 refills. Because this was inconsistent with what we asked for we sent it back for clarification “Did you intend to change directions from one-half tab twice daily to one tab twice daily?” Please Verify and fax back. … A few hours later we got yet another prescription from the same office–no note, nothing, Atenolol 50mg #180 1 po BID….with 11 refills. First off, do they have any idea that they just ok’ed refills for this woman for 36 months? Secondly, they did not specifically address my question. The other pharmacist said “Fine, it will be filled as written and the patient can talk to the dr if they disagree, just make sure they know whats been changed”

Case in point number 2. Armour Thyroid is on backorder in all strengths. We gave Mrs Jones the last 5 of the 120mg tabs (1qd) we had over the weekend. The patient asked US (not my job) to contact the dr to find out what she should do. We send over a nicely crafted note that said in summary ” ALL Armour thyroid is on back order, is there an alternative you’d like to use in the mean time?” He faxes back (God’s honest truth here…) Use Armour thyroid 60mg 2qd. Brilliant…Hello? is there anybody in there? Can you read? I’m not an ignoramus. If I HAD 60mg Armour, I’d have used it….

It was such a Monday…

Tags: doctors, pharmacy life | |

For the umpteeth time this year, I have had to process and respond to yet another drug recall sent out by manufacturers. As I was stuffing yet another confirmation of recall response into my file cabinet I commented outloud (perhaps too loud for my employees) “Do we live in a freaking third world country? Are we simply incapable of making drugs anymore that work and last thru their expiry date?” It set off an interesting conversation.

Honestly lets ask ourselves that question. In my early years of pharmacy, we’d have 3-5 drug recalls per year, maybe less. Gads, I process hundreds a year now. Most say something like “drug my not maintain potency thru expiration date”. Some recent ones like the ever popular Digoxin recall, required a lot of work of notifying patients and processing returns and reimbursements. Who is going to reimburse me and my staff for the TIME? Nobody. And then, on the heels of that one, we got the morphine recall of an erie similarity: tablet might be of double size. Back to the drawing board: notify patients and accept returns. Ironically on this recall , of the 3 patients I had, nobody would bring theirs back. Seems they get a little possessive of their narcotics. Whatever, I am not going to beat down their door. Honestly I’d think I would notice a tablet DOUBLE the size coming out of a bottle, but hey, apparently they don’t have much quality control in the plant.

Does anybody remember the ABLE Pharmaceutical fiasco a few years ago. My company was out several thousand dollars on that one when they declared bankruptcy on the heels of their own company wide recall. Now I hear the FDA wants into Ranbaxy to look at their records.

Ya know what? Maybe we need to start manufacturing our drugs in the US again. It seems I get more and more people wanting to know WHERE their drugs come from. And since India seems to be the driving force of generics nowdays, “India” seems to be the meek answer I give people more and more. I do not feel comfortable with this. I believe I have a personal responsbility to my patients to provide them with safe and effective medications and if I dont feel very confident about the source of the drugs, why should they?

I have no more control over what I carry anymore than I do the price of gas. The company negotiates contracts with whomever and we get whatever they agree to. It creates interesting conversation at the cash registers every year at this time when the “new contract” goes into effect and just about every generic I have been using has changed. I cringe when I hear a patient say something like “oh it changed again? I quit looking, it changes all the time”. Apotex this month, Ivax the next month, Aurobindo the next month after that.

It used to be that I could identify a loose tablet just by looking at it. When I carried the same generics for years, it was easy and sometimes a fun game: Identify this loose tab: and more often than not, I got it right the first time. Now, who knows.

How many times did we have a levothyroxine recall? three? four? AND, Daytrana recently sent out their second one for the same patches. Purpac (actavis) recalled most of the vitamins they manufacture. I could go on and on.

What is going on? Are drug manufacturers slacking on their manufacturing practices? recordkeeping? Do they make it and hope nobody asks? or is the FDA crossing the line and saying “hey you didn’t dot this “i” and we are going to pull your entire product line”?

Any opinions?

Tags: law, pharmacy life, recalls | |

One of the results of my recent pitching fit was the abundance of returns. This time was no exception. As much as I try, I cannot keep from having returns. I can send anything back within 30 days without a restocking fee but most of the time I have to keep stuff for longer than that. My Man Friday is good for ordering stuff that one person asks about but nobody buys. In my opinion, if something doesn’t move in 6 months, then it needs to go back. Sometimes it becomes more problematic than I think it should: partials, outdates, etc. I try to send what I can back to my wholesaler, the rest goes to the company who handles outdates.

I have some specific gripes about returns. When I first came into practice we bought a significant amount of merchandise directly from the manufacturers. When they would introduce some new and wonderful drug, they would “guarantee” the sale for us. If we bought X amount of Wondermycin, they would take back whatever we couldn’t sell if we returned it within the specified time. What happened to that? Taking possession of something nowdays is like burning a bridge behind you. “Thank you very much, good luck with that…”

AND in the olden days of pharmacy our wholesaler rep used to come by a couple of times a year and handle returns for us. He’d sit in back with his Telxon unit amongst the boxes of outdates and make them vanish for us. That service is gone too.

I tried to return some Zyrtec syrup. I purchased it before it went OTC and now I cannot return it because its “discontinued” . Well I dont give a flying whup if its disontinued. It wasn’t discontinued when I purchased it, its unopened, in date and as long as I purchased it from my wholesaler, then they should take it back. Let them decide what they want to do with it. I only bought it 5 months ago. Now I get to sit on this til next year when it finally outdates and get squat from DrugDestroyers INC.

I’m learning also how to play their game. I send back anything that arrives to me less than perfect. If the box is bent and I keep it for more than 30 days, they will refuse to accept it because it “damaged” even tho that is exactly how they sent it to me. Therefore, if its not pristine and perfect, back it goes.

When I send back my outdates I get a report from DrugDestroyers INC telling me what they are crediting me for and what I get nothing: nada: zero: the big goose egg. I get $0 for too many items now days. And, for everyone of those items there is a reference letter directing me to the bottom of the page as to WHY I got no credit for that item. There are about 30 reasons for them to deny me credit. If they can think it up, its on this page: No partials: Missing seal. Product returned is less than mfr minimum. Not in original container. Item not returnable…And it goes on. They have a lot of ways to deny credit.

I just boxed up another $4000 worth of outdates. $4000 worth of drugs I didn’t sell. $4000 I spent on inventory that didn’t move. What really gets my goat is some of the items in the box. The bottle of Synthroid 200 (1000ct) I had to order because the 100ct were out…its mostly full, The bottle of Prilosec 40mg capsules and I used 7 on a coupon offer. It was never refilled. The Cozaar 25 (#90) that I special ordered, labeled and returned to stock when it was transferred to a nearby competitor for their gift card promo. The brand name Flonase that Mr. I-gotta-have-Brand wanted until his copay went from $25 to $75. The bottle of Dyrenium (triamterene) that I used 30 out of because the Dr didn’t like HCTZ….then put the patient on Dyazide anyway. A big tube of Elocon that we werent’ successful in removing the label (therefore non returnable to the wholesaler) and since its gone generic…never moved again. A box of Arixtra with one syringe out of it…the patient got the rest of the rx at the hospital pharmacy. A box of Nitro-Dur patches with 10 missing (ok, HOW many times do I have to say–no broken boxes of nitro patches??) 2 bottles of Meridia (30ct) because they come 3×30ct and I used one…

No wonder my old boss used to pop a vein when he did returns. Its like flushing hundred dollar bills down the toilet.

Tags: , pharmacy life, rambling, returns | |

You know the routine, a sketchy character comes with a couple of rx’s usually an antibiotic and a pain killer and only wants the pain med. Happens all the time. We have an urgent care center nearby so this happens quite a bit. Thankfully the Dr. writes all his prescriptions on one blank so the patient cannot pocket one and fill the other. Today we had a guy bring in one of these rx’s for Ery 500 and some Vicodin. On the script the tech wrote “hold” by the Vicodin. I took a second look and asked Are you sure you got this right? Fill the antibiotic and hold the Vicodin? It was affirmed and I filled the rx. When I did the counseling he said the Dr thought he’d need some pain relief, but he didn’t hurt that much. He didnt’have insurance so he didnt’ want to buy something he wasn’t going to use.

Hell didn’t freeze over, Pigs didn’t fly…Cool.

Tags: customers, pharmacy life | |

Fred came to the counter clutching a pharmacy bag. He had been in a few hours ago picking up a prescription for his wife. I was at the other end filling a prescription and our poor tech got the brunt of his tirade. “You shorted me 3 pills”. He was waving his bag, going on and on about who is going to take care of this, what kind of business we run around here, ripping off old people, etc. I let him rant for while. He was going to have his say, and I was going to let him. After all, Pharmacy Chick knew exactly where this conversation was going to end up. After the cork holding in his steaming brain blew off, I walked over with an overly big smile and said ” Hi Fred, Do you you remember when you came in on Friday and wanted a refill on this and we had to call the Dr?” He nodded ” And do you remember you told me you were OUT and I loaned you 3 tablets AT NO CHARGE (my emphasis added)? The blood began to drain out of his face. “well, 30 minus the 3 we gave you is 27, so your bottle had 27 tablets in it, and was marked as such, if you look at your receipt” . “oh, yes, so it was” he mumbled “never mind” and he slinked away. No apologies offered, and no apologies accepted. Marvelous tech said “He didn’t even say he was sorry?” I guess embarassment trumped traditional social graces.

Another day, Another issue: Eileen comes to the drop off window with her bag from moments ago. She was literally shaking with irritation. “This rx is $121.00? I only paid $5 for it last month.” We had had this discussion at the register on an different rx, different day day but apparently it went completely over her head. “you are in the Donut Hole remember?” “Yes, but I only paid $5 for this last month” She paid $5 for everything last month… Could it actually be she thinks this eye drop only costs $5?? I tried to explain that she wasn’t in the donut hole last month and that her $5 copay was only a very small part of the cost. “You mean I am the one who has to pay for it while I am in the donut hole?” Uh, hello, who else would you expect would be paying for it?…. yes that is exactly what it means…the unwelcome reality of the Donut Hole.

Had she asked SOMEBODY, we might have been able to keep her out of the dreaded Hole. Dump the Lipitor the Cozaar, try the Simvastatin and the ACE or Beta-blocker first. Accept my recommendation to not get the Vanos with the $35 manufacturer loyalty card, “But its FREE!” and use the Fluocinonide cream.

The donut hole has a purpose. It’s a reverse incentive to not waste the drugs you take, and be ever watchful about what these things cost. If you play your cards right, many people can get thru the entire year before reaching the donut hole. $2500 ads up right quick when your profile is full of single source brand products like the Lipitor Cozaar, Advair, Januvia, Nexium, Alphagan, and Effexor. Toss in a few infections treated with Levaquin and TaDa, YOU are in the hole.

I offered to take back her unopened box of eye drops. “but I have to have them!” She kept them but said she would get samples for the rest of the year.

Hey, I tried.

Tags: behavior, customers, insurance, pharmacy life | |

I had a customer come in one day, who also happens to be the Chick’s family friend. He had a prescription filled, we had a few friendly words a the counter, I sent my well wishes and off he went.

A few days later I saw this man and as our conversation wound around, he learned that Mr Chick had no idea that he had been in to see me..

“You can’t tell him that?” “nope, unless you say something like, :say Hi to Mr Chick for me:, I don’t say anthing”.

“Its THAT confidential?..even me?”

Yes, even you. And for that you might be very grateful someday.

Tags: customers, ethics, pharmacy life | |

I was ringing up a sale at the register when a long time customer asked me Do you like being a pharmacist? It seems like a fun job. After I checked to see if she had alcohol on her breath I took a moment to respond. I didn’t want to lie and tell her I had the coolest job on the planet, but I also didn’t want to make it sound like my job was akin to mucking out port-a-potties either. Since she had asked a sincere question, I decided that a sincere, honest and to-the-point answer was in order: I said “Depends on the day”.

I told her the truth. The business has been good to me financially. I have made a good living in a field that to date, has been largely immune from the trials and tribulations of economic instability. For 20+ years we have weathered pharmacist shortages that has virtually guaranteed that I will not have to stand in the bread line anytime soon. I could walk off my job tomorrow and by the middle of next week I could have my pick of any number of jobs. Granted, they may not be GREAT jobs, but they would put food on the table. For a lot of people, that is a lofty aspiration and one that I do not take for granted. Neither do I consider myself indispensable (forgive the pun). Everybody is replaceable even if it DOES take a while.

I told her that the job however is rarely “fun”. The cost of this good income is long hours, working in a retail setting that is open 363 days a year, and dealing with the public who comes to me largely because they HAVE to and not because they WANT to. My hours are decided by somebody else, not myself. I cannot choose to close early because I am tired or sick. For the priviledge of being a retail pharmacist, I also forfeit uninterrupted lunches and working in a quiet unhurried environment. I cannot choose my workload. The wearer of the white coat lives under a microscope most of the time, micromanaged by the company she works for, and pressured all day by the demands from whomever is the most persistent.

“Line 1, Guess who?” Like I’d have to guess. For the 6th time today Harold has called to see if his Doctor has ok’d his Vicodin. AND, despite my promises that I will call him the very moment its authorized, Harold calls about every hour….and demands to talk to me.

“Line 2, Guess who also?” Harold just hung up so it has to be Dina, who just picked up her prescription. We play 20 questions every time she comes in. No human on the planet has called our store more often than Dina. While I like her, I wish she would go away. “Can I take Aspirin when I am using Patanol?”, “Can my son take Ibuprofen with his Amoxicillin?” “If I have an allergic reaction to Claritin, can I take Benadryl?” “What happens If I have a reaction to Benadryl?” “Can I take Benadryl and Tylenol at the same time?” “Will I overdose if I take Claritin and Patanol?” There will be, in fact, at least 2 followup phone calls for every single rx she picks up, whether it be new or refills. She has even called us while she is on vacation.

When you are a pharmacist, there is no closed door to retreat behind (but the potty) when you’ve had enough. Go ahead, try… somebody will demand your attention before the aforementioned door closes…and you will again be at somebody elses beckon call. Thats what its like to be a retail pharmacist. I should have a mantle full of Oscars for the performances of a lifetime I have played out in the white coat.

This customer then asked me if they took it all away, would I go to pharmacy school again? Tougher question: Its a good thing that I was an uninformed college student when I chose Pharmacy as my major. I worked thru each quarter, one at a time, always amazed that I survived to pass on to the next one. It was harder than I had imagined…and its even harder now with the Pharm D as the entry degree. Ignorance is bliss I think. There are a lot of things that I have done in my life that were harder than I had thought when I started them. I have completed a lot of things that if I had the opportunity to repeat, I probably wouldn’t simply because I would remember the effort involved. “Glad I did it once, don’t want to do it again” might be a good motto for the things in THAT category.

I guess I didn’t have an answer for her. I dont remember exactly what I said, but in retrospect, if I was 20 years old and had my life before me, yes I’d probably do it again. If I was 45 and starting over with a new career, not so sure.

What made me write about this was the following conversation:

A nurse called me the other day on a refill auth to inform us that at the end of the month, the Dr was closing her practice. I casually asked “Having a baby?”. No, the nurse replied, she is giving up medicine to go to Law School. WHOA. Pharmacy school was one thing, that took 6 years. But Medicine? This physician likely had a dozen years or more in school and residency before she hung her shingle…and she is giving it all up. I wish I knew her well enough to ask her why.

I know the nurses name and when I go back to work next week, I am gonna call her and ask her. I’ll let you know.

For now I put the same question to you–Would YOU do it all over again? or better yet, If you were going to start over, what WOULD you do?

Thats an easier question for Pharmacy Chick–I am passionate about animals, I’d be a vet.

Tags: , drivel, general junk, letting you in to my life, pharmacy life, rambling endlessly | |