What's My Motivation, Here?

Pharmacists are all highly self-motivated and hyper-responsible. You don't get through pharmacy school by not pushing yourself. Even the brainiacs had to buckle down at exam time. My next door neighbor was a big loveable goofball of a guy who had a photographic memory. When he had to study for a test, he sat the book and notes on his coffee table, looked at them for a minute, then paced to the front door and back. Then he would move on to the next page, and so on. Most of the time there was a Cubs game on the t.v..
Finals week, a bunch of us would hop in the car together and drive in to campus to take exams. This guy's routine was to put "Chain" by Fleetwood Mac on the stereo, do a crazy, frenzied dance at the end of the song, and off we went. I stalked him on the internet recently, and found out he is now an anesthesiologist in Connecticut. Boy, what a dummy :).

Every day I have to face a day of work in a pharmacy, I have to find a motivation. I am sure everybody has that, no matter what they do for a living. I think the thing about my job is that I hold people's lives in my hands every day. That is a daunting responsibility, and not one of us takes it lightly. What you see happening externally behind the counter is nothing compared to what is going on in our heads. Granted, it's not like an episode of ER in there. I found out I couldn't handle that kind of pressure after 3 years in hospital. When they started talking about sending us on code blues, I had to move on. God bless the people who can do that, I'm glad they can.

But I guess what I am trying to say is that I can't go in to work without mentally and physically preparing myself. There is no such thing as "dogging it'' in retail pharmacy. On days when I have been especially tired or was sick, I have told myself I was going to take it easy that day, but that never happens, because ''there are no gray areas in pharmacy''. It's black and white, either it is right or it is wrong.

It's not just the medication part of the job, either. We get most of our complaints about insurance problems, prices, and delayed prescriptions. And also about coupons that don't scan, or items out front that are not properly marked. We are also supposed to remember to answer the phone with the advertising phrase of the month, promote prescription transfers, flavorings, immunizations, and charity donations (''would you like to buy a shoe for juvenile diabetes?''), and whatever else they come up with to make a buck. What they don't seem to understand is that we are TRYING NOT TO KILL SOMEBODY TODAY and we really don't give a flying frick about any of the rest of it. We just can't. I know myself and what I am here for. Success as measured by their standards just doesn't get it anymore. Actually, it never really did, if you want to know the truth. And patients are smart enough to see through all the artificial crap anyway. They know the chains are not their friends, anymore than they are the pharmacists friends, but hopefully their pharmacist is somebody they can trust to look out for them.

In one of our pharmacy meetings, the DM actually said that what we do is not that hard. Anybody can look at a pill and compare it to the picture on the label. Needless to say, he is neither a pharmacist, nor my favorite person in the world. Unfortunately what I and my fellow pharmacists do can't be accomplished by schmoozing and bullshitting, or by adjusting numbers on a paper.

The buck stops here, and it has to be right.

BP

I Will Remember You, Part III, the Patients...

I have a list.You do not want to be on this list. If you are on this list, you have made my life miserable on several occasions, and the sight of you standing at my counter causes my soul to sink into my shoes .

People make the list for a variety of reasons. There are the pharmacist stalkers who have a boat load of questions every time, no matter how busy we are. Questions are ok, unless they are just for the sake of asking something. There are the crabby, nasty patients, who never seem to be happy with anything. There are the oddballs, who request things like no staples on the bag, no bag, no receipt, or special bottles because they can't use the ones everybody else does. There are dirty old (and young) men who say inappropriate things, and the stool gazers and worry warts that also say inappropriate things. And show us inappropriate things!  And there are people who have a ton of meds or take care of someone who does. They earn a spot on the list, not because of anything they have done, but because every time they come in there is some kind of hassle.

I told one of my technicians that every time one of these people goes elsewhere, for whatever reason, I breathe a sigh of relief, and do a little happy dance in private. I said that sometimes reading an obituary for one of these people makes me involuntarily breathe a sigh of relief, which is sick and wrong, but honest!
She told me I was awful, and I told her if she tried to tell me her soul did not emit an involuntary "WHEW"
when it knew there was one less tormentor coming in, then she was either a liar or a saint.

The most endearing patients to me are the ones that find a way to use humor in the face of their difficulties. While some people fuss and fume over every little inconvenience or perceived slight, these people seem to take it on the chin and keep their dignity intact. We had one little sweet lady who came in with her husband to pick up his medicine, and we had to tell them it was going to cost them some horrendous amount of money.  She turned to her little husband and said in her southern drawl, ''well, Clifford, honey, I think it would be cheaper to just shoot ýe''. Of course, he just smiled.

Then there was the little old man who had to go in for a biopsy to check for prostate cancer, and he said he asked the doctor if it was going to be painful, and the doctor said ''well, Charlie, did you ever fall astraddle of a board fence?'' He laughed and said it wasn't a true story, but I suspect there might have been an element of truth (and fear) in there.

There are certain mannerisms, actions or statements that have come from people over the years that I don't completely understand. There are the old men who ''flick'' their credit card at us, or toss their money, including coins, on the counter at us. Was it cool in 1945 to throw things at the cashier John Wayne? ''Hey barkeep, here's two bits for me and my pardner a couple 'o whiskeys...'' toss, clink, bottoms up!''

''Well, there's fifty cents, if you never get anymore'' What???

''Who comes in here more than me?'' (Well, everybody that works here for starters!)

"I probably own half this company by now'' (pleased to make your acquaintance, Mr. Trump, your hair looks different in person!)

When you work in the same location for a long time, you see the rise and fall of humanity in this little microcosmos. When you see somebody go through something that takes them from the picture of health to the depths of despair, it scares the living shit out of you. Fortunately, it sometimes goes the other way. The girl who used to rock back and forth and arrange our vitamins in front of the counter for us, comes in bright eyed and coherent because they finally got her medications right. The girl who went through drive thru, who I remarked would be pretty if she had teeth, lo and behold comes through with a new set of choppers. The old man who wasn't supposed to make it comes in and says his cancer is in remission.

Aside from the generalizations I could make about my patients, there are a few characters who have earned their own special place in my memory. I already mentioned the "Hall of Fame'' members in an earlier post. Here are some more, names changed to protect the innocent:

"Annie McDuff'' the little Russian lady who wore a head scarf, had a mole with a hair growing out of it, and liked to drink '''wodka", heh, heh, heh, (picture a less than glamorous Natasha from Bullwinkle).

 "Artie Jones'',   my book buddy, who always had interesting reads to recommend, and who taught me that Somerset Maugham, is pronounced "Summerset Mom" not ''Summerset Maugam".

''Mary Steeple" who asked my pharmacy manager "Cora" if she could pray for her, and when she told her ''yes'' proceeded to put her hand on "Cora's" head and prayed right there in the store in a loud voice ''OH LORD, HELP THIS WOMAN!!!!!'' This same lady was in a constant fight with the lady in the apartment next to her, mainly because she put a glass to the wall and listened to her conversations.

"Beth'',  who told me her parents house smelled so bad, because the neighbor lady had burned her dead horses in a field,  and the smell drifted down to their house, and her Mom and Dad were so mad, which I believed and told several people before her Mom came in and scolded her for telling me the story, which turned out to be a complete fabrication.

"Bill Moody'' who came in to the pharmacy I worked at, and who also swam at the ''Y'' when I lifeguarded, and said "I have a crush on you, do you have a crush on me?'', and told me if I ignored him, he would ''come in every Wednesday and Friday and splash you, and that is not all I will do, either!''. The poor guy apparently got mad at some lady and went into the racquetball court and took her racquetball, which landed him in the local mental hospital where ''I can't have my tape player, or my tapes, or anything''.

There are a few memories of people who were more ''notorious'' than notable, like the girl who called me a ''white ass ho'' because I rang up the little old lady who had been waiting on her prescription for an hour before ringing up the candy bars she and her friend had tossed on the counter. Or the creepy old man who was scary looking , like Frankenstein, when he was mad, and even creepier when he smiled. And who did not want staples in his bag, or a bag for that matter, or a receipt, either. And who knew what kind of car each and every one of us drove.  Or the guy who threw the phone over the counter onto the floor when his doctor's office refused to ok an early refill on his pain medicine.

Ahhhh. such lovely memories! Actually, they truly are. I have more than enough to last a lifetime!

BP

I Will Remember You... Part II, The Technicians

The pharmacy technicians I remember the most fondly are the ones back in the days when there were no certification requirements or specific standards, other than being a decent human being and showing up with the best they had to give every day. There were always people who brought drama to the work place, but it tended to be minor.

Hospital techs are different from retail techs.  The ones that worked in the IV room were smart, fast, and impatient, especially when they had to work with me right out of pharmacy school. They taught me everything I know about IV's, at least the hands on part of it. The filling techs and the delivery techs were more rambunctious, prone to playing practical jokes and harassing each other and the pharmacists. Some of them formed little cliques, which would sometimes battle it out with the other little cliques, but most of these tiffs were minor. I do recall one incident where one of the guys stuffed another guy into a trash can, and both of them got fired, even though they swore it was all in fun and no harm done.

Back in the 80's, the AIDS epidemic was just starting to emerge. Some sources pinpoint the official start of the epidemic as June 5, 1981, when the CDC reported an unusual strain of pneumonia (PCP) in 5 gay men in Los Angeles. In 1984, when I started my first job in a hospital, there were 3 gay men working with us in the pharmacy. I later learned that 2 of these guys died of AIDS. Two other men died at the second hospital I worked at, one with AIDS, and one who had a seizure disorder which was later determined to have been caused by a malignant tumor growing by his pituitary gland, where the optic nerve crosses. He was a sweet little guy, looked like Michael Jackson back in the day, skinny with an afro. He sang the song ''Memories" (from the movie'' The Way We Were'') to me and gave me a rose for my goodbye gift, which embarassed the hell out of me, but was still pretty sweet.

I had another technician, a stock boy actually, who ended up having the same type of tumor in the same location, but thankfully his was non-malignant and he survived and continues to do well. This guy was into restoring old cars and bought a Chevy Impala to restore. He and his Dad went to car auctions all the time. He told me that sometimes, they would find the original paperwork under one of the seats, and that they would collect boxes and boxes of parts from different shows. I could see the appeal of the hunt, and the fun of finding out the history of the car. He later told me he ended up selling the car and never getting it restored.

Another stock boy at that store went on to become a pharmacist, and he had me write a recommendation letter for him to get into pharmacy school, which I considered an honor, since this kid had a huge heart and a lot of integrity. When his grandmother was bedridden with breast cancer, she had some lymph nodes removed, and she had severe swelling in her feet and legs. One way to relieve the swelling is to massage the feet and legs and get the fluid to move out of the extremities and back into the blood stream. This kid would sit with her in the evening and massage her feet and legs, sometimes falling asleep at the foot of her bed.

There were two more pharmacists produced by that store, both girls, one who went on to be a doctor, and one we lost in a horrific car/train accident. She would have been a good one. It made me proud to know that somebody looked up to me that much.

Some of the best techs I have had were middle aged women that I could rely on to show up every day, who took care of the customers in a professional manner, and who kind of took care of the pharmacists as well.One lady was a dispatcher for the police department at night, slept a few hours in the morning when she got off shift, and came in to work with us at noon, never complaining, always nice and patient. I probably took them for granted then, before I had been introduced to the type of technicians I have now, who always have drama going on in their lives, who disrespect the pharmacists, and who may or may not show up or do their job on a regular basis. And who, I suspect, are employed by management as moles to report back any infractions or perceived shortcoming on our part.

When I worked in the little clinic pharmacy, there was one tech who stood out because she had an ornery streak and was a little hyper. When she sat at the computer to type, she actually faced away from the patients, and would be nice to their face, then turn around and mouth obscenities in our direction, so we had to control ourselves and not laugh, which made it all the more fun for her. Her parents had made her take care of the chickens on their farm as a kid, so she hated chickens. She would start by imitating the low, threatening '''baaaaawwwwwkkkkkkk'''they would start with whenever she entered the barn (there were hundreds of chickens, not just a little coop). They would escalate into a full blown cacophony of clucks and ''bawks'' , which she said was very disturbing. She used to be sitting there and suddenly say, ''did somebody say ''chicken?!'' and bust out into a loud ''ba cock!'' . This was a great tension breaker and made us laugh, until the pharmacy director told her to knock it off. Apparently she also used to get in the dumbwaiter that traveled between the pharmacy and the floors above and ride up and down before somebody put a stop to that, too.

I had one technician who actually remembered me from my first job in the hospital, and said I had trained her on IV's. I didn't remember, so I asked her if I was mean to her. She said, no, I was actually very nice and patient. Whew! Anyway, we met up later in retail, and she had the best stories of anybody I ever worked with. She, her husband, and their 3 sons, essentially could have survived quite nicely off the grid. They were self-sufficient in the way that people used to be when they had small farms and raised animals.

 There was the time her husband stood up on the horse's water tank, lost his balance, and grabbed hold of the electric fence as he went into the water. There was the time her son went out in his pajama pants and slippers, smoking a cigarette, to round up a bull that had gotten loose.He ended up flicking the cigarette, kicking off the slippers, and running for dear life, clearing tthe fence before the bull could catch him. They had a nasty old rooster that would chase her every time she went out into the yard. Even when she would try to sneak out of the house, he would come charging out of nowhere and attack her legs. She finally had enough of it one day, took a broom, and beat the hell out of that rooster. I asked her if she killed, it, and she said no, but he walked kind of crooked after that! But by far,  the best story she told was about how they used to do  historic reenactments. Her husband portrayed a French Trader, and she was his wife. She made all their costumes, beaded buckskins and all, but she had no interest in learning the historical facts surrounding their portrayal, so she left that to her husband. She said ''I decided that Marie DuPree, the French Trader's Wife, was deaf and dumb." She not only lived off the grid, she thought outside the box, too!!

I still have a couple of the old breed left, but the pickings are becoming mighty slim. No one can survive on the wages they pay technicians, so we have a lot of women who tough it out in less than ideal circumstances with men who treat them badly because economically, they don't really have a choice. Another scenario we see is the here today, gone tomorrow, lost my job, got a DWI, spent time in jail, boyfriend or ''fiance'' who contributes nothing to the cause except an occasional black eye or domestic dispute. These women are understandably not fully engaged in their jobs, because their life is a train wreck.

Most of the male techs I have had are college students who move on after a few years, guys who need a second job, or guys who are semi-retired. Women have a reputation for causing drama in the workplace, but, believe me, men stir the pot, too, just in different ways. Gossip is not just for women anymore!

Next time, Part III , the Patients...

BP

I Will Remember You...Part I, the Pharmacists

Someday, when I am strapped in my wheelchair in the nursing home, shouting ''CAN I HELP YOU!'' every time a bell rings, and counting my peas by 5's , I hope I still have enough clarity to remember the people and places that have made my career more bearable. I am a storyteller, and I have a rich storehouse of material from years of being in a unique position to see people at their very best, and sometimes at their very worst.

Every time I complete another decade of work, I send my old Purdue class ring in to Josten's and have them replace one of the ''diamonds''  with a tiny little ruby. I wear it on my left pinky, so the poor thing is as battered and worn as I feel after a 14 hour shift.  Next year I will be having them put in the third ruby. It's gonna be a little off , because of the uneven number of little pinkish red stones, but most people I know would tell you that's probably appropriate.

When I was in college, I used to work half a Saturday at a professional pharmacy. It was a very nice set up, and the owner and his son had a loyal following of customers. I wasn't licensed yet, so I had to work with a pharmacist. Once, on a particularly slow Saturday, we had our technician get into the sling on the Hoyer lift, and we cranked it up as far as it would go. Picture a very large baby being carried by a very unlucky stork. Then, of course, we wouldn't let her down. We let her dangle for awhile before we cranked her down, helped her up, and went back to work, before the boss found out what a bunch of goofballs he had working for him.

The next summer, I worked in a little hospital pharmacy, where the director was a grizzled old veteran of the trade, and a take-no-bullshit kind of  guy. Back then, there were 2 ladies who did the billing, and they would write down numbers in a huge ledger, line by line by line. He would challenge them to pick any drug, and he could name the numbers that corresponded to that drug. He was always right, and these were very long sequences of numbers. He owned a powder blue convertible, and every Friday, he would ice down a six pack of beer, put on his Speedo under his cut-off shorts, and motor up to the lake. The beer would be gone by the time he got there. These days, we would call him a functioning alcoholic, but I didn't have sense enough to know it then.

My first job right out of college was at the hospital I was born in. I was thinking about saying something about ''coming full circle'', but then I thought, no, that's only if I would die there. Anyhow, they have torn the place down, now, but it was still there in 1984. There were a few characters in the bunch, and it didn't take long to find out who they were. Apparently I missed working with a really colorful Rph who would crawl up and stand on the med carts they were filling just for fun. He got in trouble for sleeping in his car in the parking garage when he had a back to back shift. They said he would eat food off the trays that people had put on the conveyer to be scraped off and washed. I guess he viewed it as a mobile cornucopia of half-eaten delights.

My next job was at another hospital in town, with about 30 pharmacists and a whole bunch of technicians. We had one pharmacist that would do a '' Charo'' imitation if we bugged her enough. One of the younger pharmacists was heavily into alternative music. He bought a little record (CD) store from an older guy, but he never really made a go of it, so he brought in some of the CD's to give away when he closed. He also volunteered at radio station that played some really weird stuff. ''And that last selection was by the Roche Sisters...''(check them out at www.roches.com). We used to tune the pharmacy radio to his show so we could listen on Friday nights. Some of the guys were pretty into bicycling, until two of the guys got hit by cars in 2 separate incidents. All in all they were a pretty smart and interesting bunch, but hospital wasn't my thing, so I moved on after 2 years.

Next stop was a little clinic pharmacy in the basement of an old building. My boss was a huge guy, picture Herman Munster He even had shoes like Herman's. He grew up in a little town by Lafayette Indiana, and his Mom turned their house into a nursing home. He said once in awhile somebody would die and he would have to take care of the body. He would find guys peeing in the curtains, stuff like that. Probably explained why he was a little different.

Next came 10 years with a little local chain pharmacy. They had been a pretty powerful player in their day, but by the time I went to work for them, they were starting to lose ground to the big chains, and I suspect the last few years were spent just trying to get even so someone would buy them. The old guy I worked with at one of the stores was pretty gruff, but a pretty nice guy all in all. He had little phrases he would say all the time. When the phone rang after close, he would always say ''anybody expecting a phone call? If not, let her ring!'' There was ''the robbery talk'': ''If you ever get robbed, after they leave, lock the front doors and circle the last transaction on the register tape and write 'robbery' on it !'' And the advice about the big patient with a seizure disorder: ''If he goes down, just stay the hell away from him, 'cause you might get hurt!'' He had a real shrew of a wife. I guess one year he was having trouble getting out of the store to go home on Thanksgiving. She called several times, and then, there she was out front of the store, banging on the window and yelling at him to come home, because everybody was ready to eat.

There were a lot of pharmacists through that little chain store. There was a ''cowboy pharmacist'' who used his pharmacy income to supplement his farming and truckdriving, and yes, he wore cowboy boots to work. He also rode a motorcycle, and one time he rode to the store in full leathers to turn off the alarm, and the police thought he was robbing the place until he showed them his pharmacy license. There was an odd little pharmacist who kept a picture of his dobermans in his wallet and went gambling with his Mom at a casino in  Michigan all the time. Every time he worked, we had customer complaints, but they wouldn't fire him because he would work any time any where at the drop of a hat. There was an alcoholic who finally pushed it too far, and the manager had me come in and relieve him, and she sent him home. He was upset with her , but the smell of alcohol on him was pretty obvious.

I met another colorful old guy when I jumped ship from the little chain for about 6 months, until I realized it was even worse than the place I came from. He was what another old pharmacist described as a ''rounder'', apparently the old term for a player. He drove a little red Fiero, and had the smallest and coolest cell phone they made at the time, complete with a little case. He told stories about how he used to work in a hotel pharmacy, and he met several of the movie stars, including John Wayne, who came in one time to buy a fifth of vodka from him. He would call his wife at the end of his shift, and tell her ''I'll be home to get the lady''. Somebody said they went to a local steakhouse to have dinner every night and hang out with their cronies and have a few beers. He was a lot of fun to talk to, but he didn't get much work done. Before I left and went back to my old job, he bought himself a new Camaro with T-tops,  which he only drove when the weather was nice.

Now that I work for a big chain, the rugged individualists are either gone or have gone underground. Individuality and independent thinking are not valued by the chains, so pharmacists learn to tone it down and ''dummy up'' for fear of drawing the wrong kind of attention to themselves from Big Brother. We are all kind of vanilla now, not even gourmet vanilla with the little black specks, but ice milk, really, bland and boring and compliant.

Next installment, Part II, the Technicians.......

BP







.

Don't Shoot the Pharmacist

I mentioned robberies in one of my previous posts, and whenever I work, the thought of  being robbed, and what would I do, and could I handle it, is in the back of my mind. When I unlock the narcotics cabinet, I do a scan of the methadone, the morphine, and the oxymorphone, and I go through the scenario in my mind. Get one of the large plastic bags, talk about every move I am making, go over to the narcotics cabinet, unlock it and sweep everything into the bag. Walk quickly back to the counter and hand the robber the bag and hope that he leaves.

I profile people. I know, it's not politically correct and it's not 100% accurate, but when you've been doing this as long as I have, it pays to trust your instincts. I have had a few little old lady and little old men addicts, but I'm fairly certain that they don't have the desire or the inclination to pull a handgun on me. However, their no 'count grandson or granddaughter might.

From the news stories and the accounts given by pharmacists I know that have been robbed, the first thing that happens is the robber hands you a note. They usually have a gun, and sometimes it is hidden and sometimes they display it. One pharmacist told me the guy actually put the gun on the counter and conducted an impromptu therapy session, telling her all about his hard life and all his problems and how he wasn't going to hurt her, but his life was just so tough right now. There was another robbery in our district where the robber put the gun on the counter, but this time the pharmacist swatted the gun away, jumped the counter, and tackled the guy. We cheered for him when we heard about it, then we feared for his job.

According to the official robbery handbook, we are not to try to be a ''hero''. Since most of us are not combat ready, it is more likely that we would escalate the situation than save ourselves and the other people in the store. However, it does not tell us what to do if one of us is taken hostage, or if the robber starts shooting, or if he jumps the counter and holds a gun to our head. If  I saw a chance, and thought I had the ability to disarm the guy, I would worry about not getting killed first, and then look for another job, if need be.

We are not allowed to carry concealed weapons, although some pharmacists do and it doesn't become apparent until they need to use them. I know a guy who wore a bulletproof vest on the night shift. It cost him over $600, and he said it was hot and uncomfortable, but it made him feel more secure. Of course I had to mention the fact that it would do him no good if they shot him in the head. I'm helpful like that.

We are still allowed to sell needles over the counter. Back in the day we also could sell Schedule V cough syrup 4 ounces at a time with a signature. I have gone back and forth, sometimes I would sell them and sometimes not. These days I don't sell them without a prescription, unless I know the patient, or the person is from out of town but can tell me their insulin type and how many units they use. We have questions we use to parse out the bullshitters from the legitimate patients, although sometimes if I'm busy and don't want to screw with it, I just tell them ''no''.

''My poor old granny is diabetic and she sent me in to get her some needles.''

''Ok, did she say how many units of insulin she uses, or what size syringe? Or, if you want, we can call her and ask her so you make sure and get the right ones.''

''No, Granny doesn't have a phone and she can't hear (or write???) and I think she uses the 100 cc syringes, so just give me those.''

''Oh really. Is your Granny a pachyderm, because otherwise I'm not selling you the damn syringes!'''

I have found out through the years that the druggie grapevine must be pretty efficient, because every time I have lost my mind and sold needles against my better judgement, within hours there are a raft of people suddenly needing syringes. They come out of the woodwork. My opinion is that the less of these people I have in my store, the safer the rest of us are. Most of these people are down on their luck and either desperate or unstable. Some pharmacists think that if we make them happy, they will go away. My experience has always been the opposite, so I would rather stand up to one scary person than 10 of his friends.

One story told to me by an older pharmacist illustrates my point. Years ago, pharmacists could sell laudanum over the counter. Laudanum (tincture of opium) contains approximately 10% powdered opium by weight, so people would boil it down in a spoon and inject it. Apparently there was a pharmacist who took to carrying the stuff by the gallon in order to keep up with the demand in his neighborhood. The folly of his ways became clear when a guy came in with a gun, told him to kneel down by the safe and open it, and then shot him in the head.

I think that there should be one or two stores per district that carry the narcotics for the whole area. Admittedly, this would be very inconvenient for cancer patients and other patients with chronic pain, or even for patients who have an acute need for narcotic pain medications. These stores should have an armed guard on duty, metal detectors at the door, and bulletproof glass enclosing the pharmacy. Not very professional or personable, but neither is getting shot or roughed up.

In conclusion, let me say that this is yet another thing I didn't envision when I was in pharmacy school. I don't remember Robbery 101 being in the curriculum. So, keep in mind that when I seem tense and nervous when I wait on you, it's most likely not you, but the ever-increasing horror show I have going on in the back of my mind that I can't seem to switch off anymore.

Pleasant dreams!!

BP

It Ain't Me...

I have a bone to pick with the movie and t.v. people. Whenever I see a pharmacist depicted in a movie or on television, I cringe to think that people may actually see us the way we are portrayed. Most of the time the pharmacist comes off as a dork, a jerk, a crook, or a lost cause. I can't think of a single movie or t.v. show that shows what a pharmacist actually does....maybe because it's not all that entertaining!

The South Carolina College of Pharmacy actually got a research grant to study the way pharmacists have been depicted in American film and other media over the last 35 years. Pharmacy professor Brandon Bookstaver, and pharmacy student Amy Yanicak led a team that watched these portrayals on the internet and Netflix, compiling a list of over 200 so far. The results are not encouraging. 

"Unfortunately, it's very negative, '''Bookstaver said. ''Often, pharmacists are victims of crimes or perpetrators of crimes themselves. Even in a show like 'ER' they show up only once or twice, and when they do, they're either making a mistake or appearing unprepared.'' Here is the link to the article on the University of South Carolina's website:
http://www.sc.edu/news/newsarticle.php?nid=6138

I decided to do my own informal research and see how many pharmacists I could find depicted in movies or television. I also noted the pharmacists' basic characteristics in each case.

Movies:

The Pharmacist 1933-W.C. Fields as himself (''Get away from me, kid, 'ya bother me!'').
In Old California 1942-John Wayne- Acts like, well, John Wayne
Pink String and Sealing Wax 1945- Puritanical, rigid, mean
It's a Wonderful Life" 1946-Drunk, mean, unbalanced
Murphys Romance 1985-Good old boy
The Check is in the Mail 1985- Frustrated, jaded, in debt
Drug Store Cowboy 1989-Bald, middle aged, frazzled
Nikita 1990-Victim (shot and killed in robbery)
Nuns on the Run 1990-character that is ''chemist assistant''
Niagra Niagra 1997-Vigilante
Signs 2002- Hallelujah! A female pharmacist!!
Are We There Yet 2005-hero (clown pharmacist)
Don't Shoot the Pharmacist 2008-Frustrated, jaded
The Pharmacist 2012- Obedient, compliant
Pharmacists, Unsung Heroes (PBS)- documentary

Television:

Caeser Presents (1955, Sid Caeser)-overworked, underpaid

The Andy Griffith Show-female! Plucky, confident, capable

Monty Python's Flying Circus-''chemist''- zany, mock professional

Grace Under Fire- impeccable grooming, dependable, dorky

Fridays (ABC)- pill popping, hallucinating, crazed
Desperate Houswives- filanderer, unethical, seeks revenge
Curb Your Enthusiasm- respected and moral
Family Guy-needy, whiney, dorky, renaissance fair attendee
The Simpsons- (pharmaceutical sales rep Ned Flanders)-religious, timid, a pushover
The Simpsons-Homer sees pharmacy in new superstore-"WooHoo!! Free medical advice!!''
Friends-Phoebe's dad is a pharmacist
Law and Order- unethical (dilutes cancer drugs)
House MD-longsuffering (he has to deal with House!)
House MD-billionaire owner of pharmaceutical company, unethical, on board (big donation$$$$$$)
Scrubs-pharmacy/pharmacist in background of scenes
ER-Invisible (drugs magically appear in the drug locker)
Grey's Anatomy-over-the-hill, retiree, second career
Girls (HBO) clean cut, responsible kid

I saved this ''gem'' from Jerry Seinfeld for last....makes me wish I didn't like the show so much:

'' Why does that pharmacist have to be two and a half feet higher than everybody else? Who the hell is this guy? 'Clear out everybody, I'm workin' with pills up here. I'm taking pills from this big bottle and then I'm gonna put them in a  little bottle! That's my whole job. I can't be down on the floor with you people. Then I'm gonna type out, on a little piece of paper. And it's really hard'.''

Yeah, well, so is a show about Nothing, Jerry...

BP

Grace Under Fire, 1993-1998- Russel Norton- fussy neatnik



Girls on HBO

Hannah goes home for her parents anniversary,  meets up with Eric, a former classmate who is now a pharmacist. Hannah is a free-spirit and a bit of a mess, Eric has his life together. Doesn't go anywhere.

Miss Ellie on Andy Griffith

"Well, now, that's a nice smile, just as toothy...I 'spect people will pay for that!''


Grey's Anatomy

House MD
Marco the hospital pharmacist

Nurse Jackie

Jackie has chronic back problem which leads to pill addiction, which leads to an affair with hospital pharmacist Eddie Walzer, who becomes her supplier.

Fridays

Russell the Pharmacist 2 and 1/2 Men
Who has been known to both abuse and sell illegal drugs, and swig cough syrup straight out of the bottle. ''What, are you a cop?''.

Happy Mother's Day!

For the first time in a long time I am actually off on Mother's Day. Nothing is more depressing than working the holiday and having people tell you ''Happy xxxxxDay ! Anything with Day in it is definitely not going to be happy if you are working retail. I usually try to take my birthday off every year for that very reason. Something about having somebody yell or complain on my birthday makes me want to scream ''It's my birthday, for crying out loud! Be nice to me!''

One year, a very kind hearted pharmacist who owns his own store drove by my store and called me on his cell phone to wish me Happy Mother's Day. He said he was sorry I had to work on Mother's Day. That helped some, mainly because it reminded me that although he takes Sundays and holidays off, he works his tail off the rest of the time.

There is an interesting phenomenon that occurs every Mother's Day and Valentine's Day, the only two days of the year when men are actually required to buy a card and gift all by themselves. Without fail, the day of the holiday (oh, no, not even the day before!)the card aisle is packed, and there are hoards of men gallumping through the store with their mouths hanging open, gawking at all the ''pretties'' and trying to find that one special item that will keep them out of the dog house and say that they care enough to give the very best.

Here's a huge hint....you ain't gonna find it here!! I smile to myself when these guys come up with their purchases, because they are so clueless. I'm sure your Mom has just been drooling over that Hurricane 360 Spin Mop, and your wife or girlfriend will love that Pocket Hose! Better pick up some trial size toothpaste and shampoo while you're here, I have a feeling you will be spending the night somewhere other than your home!

Anyway, short and sweet today, on a counta I gotta go to my Momma's house!

BP

I Have a Dream...

When I think about the complexity of the healthcare system, I am amazed that it functions as well as it does. I
don't pretend to have knowledge of all the intricacies of financing and staffing involved in putting together a model that works. I do know that standing behind the pharmacy counter day in and day out has allowed me to observe some of the things that don't work.

Patient Advocacy is a step in the right direction. I researched this concept as a possible alternative to pharmacy practice, and found out that there are numerous programs and organizations dedicated to this idea of helping the patient navigate the healthcare system. Most people could use some help coordinating their healthcare. Usually this task falls to an over-burdened family member, a visiting nurse, or an independent caregiver hired to either stay with or look after a family member that needs help. By default, this patient representative often has to take on way more than just caring for the person in their home, since problems arise ''on the fly'' and cannot be predicted. If the caregiver is worth their salt, they end up trying to resolve issues that have nothing to do with what they were hired to do in the first place.The whole goal of healthcare is for people to be as happy and functional as they can be. The official term for day to day functionality is ''activities of daily living'' or ADL.

Think about basic things people want and need:

1. A grocery store or market
2. A pharmacy with over the counter products and sundry items
3. A clinic with medical staff, an optometrist, and a dentist
4. A restaurant or diner
5. Transportation
6. Exercise/recreation facilities
7. Other people

What if we could create complexes that contained all these amenities, sort of like little small towns, with everything within walking distance or at least a short drive away? Sometimes people choose where they want to live based on the fact that an area meets most of their basic needs. I have thought of retiring to a condo or villaminium where I can walk or bicycle to the places I want to go. In my dream world, I also see this place as being close to cultural centers and entertainment venues, as well as having a nice library, and a fitness center with state of the art exercise equipment and an olympic size swimming pool.

Ideally, there would be the option of assisted living, and eventual skilled nursing facilities if needed.

Sometimes churches build these types of complexes for their members, and these can work well, because social and spiritual networks are maintained, and the church community can assist the patient with transportation and other needs that arise that are not specifically handled by the facility itself .

Unfortunately, when I get around to the question of who would build and maintain such a mini-town, I keep envisioning the creepy Mr. Potter in the movie, "It's a Wonderful Life''. Potterville was a nasty little town, owned by a nasty little man. Big Brother would always be watching and controlling it's citizens.

So, I defer to city planners or social planners or whoever else might be qualified to put this idea into practice.

 ''Ýou may say I'm a dreamer...but I'm not the only one...''.

BP

We Work For You...

Pharmacists are the easiest healthcare professionals to get in touch with for questions and concerns. We are available 24/7 (not each one of us personally, but there is always a pharmacist on duty at the 24 hour stores), and we do not charge you anything to talk to you.  Part of our job is to perform ''triage'', in other words, to help you determine when and if you need to go to your doctor or the emergency room, or if there is a home remedy or over the counter product that can be tried first.

Many times, we can help you avoid an office visit, but there are other times you need to see your doctor, and we will tell you when we think it is appropriate. So many times, we hear ''I don't like to bother my doctor, because he is so busy'', or ''she is always in a hurry when I go in for an appointment, and she is in and out of the room before I get all my questions answered''. Or, ''I don't have the money to go to my doctor or the emergency room. I don't have insurance''.

Be that as it may, we cannot and will not recommend something that will not work, will make your condition worse, or will delay treatment, possibly causing your condition to get worse or take longer to treat.

What I tell patients to remember is that healthcare professionals work for them. If you feel intimidated, put down, marginalized or ignored, it may be time to switch doctors (or pharmacies, or dentists, or whoever else is on your healthcare team.). You are paying for a service. There are times when you may be willing to suffer a lack of bedside manner, for example when your physician is considered to be an expert in his field, but even then, there should be someone (such as his nurse or physican's assistant) who can serve as a liason and address your questions and concerns.

I feel the same time pressures  as my patients when I go to my doctor, because that 15 minute time clock is ticking and I am in and out of the exam room before I know it.  I write out a list of questions and concerns so I stay on track and don't forget to ask anything at my  appointment. I keep asking questions until I get through my list. If I think of anything when I get home, or if I need to speak to someone in the office, I talk to the nurse (it is helpful to know the name of the nurses in the office, and especially the ones who get things done when you ask). Some receptionists seem to think their job is to keep you from bothering the nurse or the doctor. Don't be intimidated by the office personnel. If you are having a problem with any of the office staff, tell the doctor or one of his nurses. If it is a nurse, tell the doctor himself. He may not be aware of how his staff is treating his patients.

Sometimes, we all need a lesson in assertiveness. We need to remember that we are important and worthy of respect, just as we need to remember to treat others with respect. A degree in medicine does not give someone the right to be arrogant and treat other people poorly. Healthcare is a service profession. You are the ''customer''. Make sure you are getting the service you pay for.

BP

Why are you calling me?

Has your pharmacist called you recently? There are several thiings in play here, so I will go through them and try to clarify.

Some of the phone calls are mandated by corporate. If it looks like you are due for a refill and you do not order the prescription, your prescription infornation appears on a ''noncompliance'' list, or late to refill list. Noncompliance just means you didn't pick up your medication and we are checking to see if there is a reason, such as a hospitalization, an oversupply of medication, a change in doseage, or a discontinuation of the medication. When we call you, you can help us clean up your profile and make sure we have all the current medication information, which helps avoid potential errors in filling your prescriptions.

You may receive phone calls, or notifications via email regarding refills that are due. These are usually automated. There are also robo calls that tell you when your prescription is ready or delayed. These calls can be helpful, but if they annoy you, you can opt out of receiving these calls. Just let us know.

Your insurance company may ask us to call you if it looks like you have been started on a new medication. Typically, we check your profile to see if you have had the medication within the last 6 months, but if we are not sure, we will go ahead and call you to see if you have any questions or concerns.

There is a ''new'' thing called Medication Therapy Management (MTM) that is offered as a benefit through an increasing number of insurance plans, both governmental (Medicare and Medicaid) and private. MTM is not really that new, but it has taken awhile to get the ball rolling. Some pharmacists have focused on MTM more heavily than others, and so are training the rest of us to provide this service. MTM is intended to help avoid some of the problems involved in multiple medication therapies. Some patients have an extensive list of medications and health conditions, and it is these patients who are targeted to receive the MTM benefit. If you are eligible for MTM, your insurance company will let us know, and we will flag your profile so we know that you are an MTM patient. Once a year, your insurance will pay for a Comprehensive Medication Review (CMR). This is essentially the same thing as a ''brown bag session'', where the patient brings in all of their current medications and OTC products in their original containers, and the pharmacist goes over them and addresses any questions or concerns.

MTM's were developed as a way to help patients stay healthy and avoid unnecessary problems with drug therapy, and hopefully reduce costs by avoiding hospitalizations or other adverse events. Pharmacists have been providing these services for years as part of the prescription processing and dispensing process. Now, we are able to bill insurances for the services we provide. MTM also provides a framework for us to use when counseling you on your medications, so that we remember to address everything and are consistent each time we counsel.

Please feel free to call us with any questions or concerns. We will call you if we have any questions for you about your medication or insurance or any other concerns we may have. We will also call your doctor , or ask your doctor's office to call you, if we see a problem with your medication.

You need to look at your healthcare as a partnership between you and your providers. You have a responsibility to take charge of your healthcare, know what your medications and therapies are, and raise any questions or concerns with your pharmacist or doctor. If you do this, we can help you by providing you with our expertise and concern.

The healthcare system gets more and more complicated as time goes on. The good thing is that we have options to treat some of the problems that in the past were often a death sentence. Unfortunately, it is increasingly necessary that you take a hand in your own care. No longer is it ok to take what your physician or any other healthcare provider says as gospel. So call us, and ask us questions! The phone line goes both ways. We will be waiting for your call!

BP

Are You Really Gonna Eat That?

Even though we are health care professionals, pharmacists probably have one of the poorest diets around. It doesn't help that we don't get a meal break, so we have to be creative to select foods that can be eaten on the run.

Technically, we are not supposed to have food ''near the medications''.I think I'm probably aware enough that I am not going to get a glob of mayo on your prescription bottle.Of course it's ok to handle money and then go right back to filling prescriptions, because money is super clean!  I have tried several different strategies to get something down my throat in between scripts, but short of total parenteral nutrition (being fed a big bag of fat, calories, and vitamins through my vein), I'm not sure how to accomplish it in a healthy and nutritious manner.

Back in my early career, I could get by on snacks and candy I bought from the store where I was working. I went through a major junk food stage when I worked in a small pharmacy in a medical clinic building. We weren't all that busy, and the technician I worked with catered to the staff in the building when she placed her  candy order. One guy loved these brownies that were huge and full of chocolate chips. So it wasn't long before I was eating 2 of those a day. Then there were the SkyBars. There were 4 different sections in each bar: caramel, vanilla, peanut, and fudge. I went through about a case of those before we stopped getting them.  I was addicted to Wayne Bun Bars, especially the maple-filled. Luckily they were smaller than the ones Grandpa used to buy . He would buy them by the box and hide them in the garage so he could eat them in peace. There was a Corn Nut phase, a red licorice phase, a cheese cracker with peanut butter phase, an oreo phase, a fig newton phase, a giant cinnamon roll phase (I relapse every so often on that one),  a Big Otis Muffin phase, a honey bun phase, and a powdered sugar donut phase. Sadly, there never really was a carrot stick phase, a celery and ranch dressing phase, or an mmmm...good crispy apple phase.

My next store did not have as much of a selection. For months, I ate 2 rolls of Shock Tarts every time I worked. Then it was Boston Baked Beans. Then Pay Day Bars, one of the best and most filling lunch bars around, and healthy because it has peanuts (shurrr.... it is!). For some reason, lots of pharmacists seem to survive on the Giant Snicker Bar and 20 oz Coke lunch of champions.

When Glucerna bars came out, I bought some, because I thought they would keep my blood sugar on an even keel, thus enhancing my ability to think clearly and remain pleasant. What I didn't count on was the gas. Not a good side effect when you are working with the public!

I have tried peanut butter sandwiches (not good with pop), Lunchables, Activia Vanilla Yogurt (active cultures, sure, but I think it tastes the best), string cheese, rice cakes, potato chips, Cheerios, mixed nuts, pistachios, carrot and celery sticks, apples, and oranges. Somehow, the fruits and vegetables always come home with me in my lunch bag. They just never sound good to me when I am at work.

When my blood sugar bottoms out (I start to feel lousy, see black spots, and get a headache), I go up front and buy a coffee cake or donut, a giant Rice Krispie Treat with extra marshmallows, and these amazing little cinammon rolls that taste like the treats my Grandma used to make with left over pie dough and cinnamon and sugar. Then I wash all this sugar, fat, and dough down with an ice cold milk (2%, to save calories, of course). And I feel pretty darn good until the nausea sets in.

After I did Weight Watchers and figured out the "points"system, I started taking deli turkey on whole wheat bread, a yogurt, and two 20 oz Diet Mountain Dews (every day is a two Dew day!). This combination seems to give me enough carbs, protein, and caffeine to keep me feeling pretty decent for my 8 hour shift. I found out waiting too long to eat makes me foggy, crabby, and prone to migraines. I try to stick to this lunch, or some variation of it, but when I get bored with it, all bets are off.

I know I should drink water instead of pop, but for some reason it makes me need to pee more often than pop. I don't know if it is the sodium in the pop that causes me to retain water or if I it's just my imagination, but since running to the bathroom every 30 minutes is not a luxury I can afford, I stick to the pop. Mountain Dew is the only pop I can tolerate lukewarm (less fizzy, still tastes good). I buy the 20 oz bottles with the screw top....a veteran pharmacist told me never have an open container of liquid near a keyboard, unless I want to explain to IT the reason I need a new one.

A long time ago, sales reps for the pharmaceutical companies would treat us to lunch. The hospitals seemed to get the best food (think P and T committees, physician and nurse interractions). One time we got a tray of assorted bagels, meat and cheese, with little hollowed out red cabbages to hold the condiments. Drug companies would also sponsor CE (continuing education) programs, and we got fed pretty well. The food of choice for retail was pizza, delivered hot, fresh, and easy to bolt down between prescriptions. The food seemed to dry up about the same time everything else started to go downhill for us. I haven't had so much as a box of storebought cookies from a sales rep in years.Now all they are interested in is giving us their pitch, dropping off a bunch of pamphlets (and coupons) and getting our business card so they can prove they talked to us.

For some reason, patients never bring us treats, either. I shouldn't say never, there have been a few sweet souls who brought me cookies or cake, oh, and one Vicodin, Methadone, Soma patient who brought us cookies twice at Christmas because she forgot she already gave us some. One time an ornery pharmacist offered me a gummy bear out of the jar a patient had brought in for him. Turns out she had put them in a jar that had orignally contained jalapeno peppers. Tasty!

My fellow pharmacists are no better . Not to toot my own horn (Matthew 6:2 :'' When you give to someone in need, don't do as the hypocrites do--blowing trumpets in the synagogues and streets to call attention to their acts of charity! I tell you the truth, they have received all the reward they will ever get.''), but I have dropped off fast food and ice cream sundaes, ordered pizza with my credit card and had it delivered to them as a surprise, picked up ''parking lot chicken'', and on the rare occasion I have cooked, delivered a full meal hot, ready, and with all the condiments and sauces in disposable containers. I did it as a treat for one of my fellow sufferers in the trenches, since I know what it feels like to be starving and tired with 5 hours left to go in the day. I didn't do it often, because I didn't want anybody to think I was sweet on them or anything, but I felt their pain.   I get a cake on my birthday if I am working and lukewarm or stone cold pizza that has sat out all day, depending on my shift, and my manager is the only one who ever cared enough to even give his staff that much consideration.

So, enough of the whining. I am not starving to death by any means, and I probably wouldn't eat homemade food if you brought it (I have a touch of OCD, food snobbery, and germ phobia), but I surely would appreciate the gesture.

BP

Stand in the Place Where You Work...

Pharmacists are people pleasers. Most of us hate confrontation, and we are often conflicted when faced with  a difficult or necessary decision that is certain to upset the patient or their physician . No matter how long we practice, we still get that icky feeling in the pit of our stomach when we have to deliver bad news. From experience, we know which situations are going to cause you to give it to us with both barrels. It would be so much easier if we didn't care, but we have to look you in the face when we tell you these things, unlike the people who make the rules, so it is personal for us. "I apologize, I know, I'm sorry...''

Back in the day, we were able to be more flexible, but I'm not so sure that was a good thing. I once filled in for a pharmacist that had so many post-it notes stuck on the wall behind the counter that they actually resembled cedar shake siding. This guy was a tough act to follow, because his mental file was as extensive as his hard copy file. He was an excellent pharmacist, but he was a one man show. 

I never agreed with price matching, not so much from a business standpoint, but from a fairness standpoint. I had a problem with accomodating someone who wanted BMW service for a Smart Car price. For some reason these patients seemed to be more difficult than others. Although I admired their persistence, they were exhausting, and I felt bad charging them a cheaper price than my loyal patients who never complained and paid without batting an eye. 

One thing the large chains do right is to enforce compliance with policies and procedures, They have deep pockets, so they are more visible and more prone to fines and lawsuits. Not to say that they are squeaky clean and there are not , shall we say, indiscretions, but there is a basic framework that sometimes makes it easier to make confident decisions. There will always be gray areas, and those are the areas that cause the mildly OCD me to lose sleep. 

I admire people who have the ability to say what they think and stick to it without waffling. I always told my kids I was glad they had an independent, stubborn streak, but they were to use it for good, not evil. Like never use it on me. There is such a thing as being ''too nice'' and too compliant. There are sociopaths out there who use this trait to their advantage, and these people are dangerous. 

I get annoyed with people who always want to play the devils advocate. Just as aggravating are the people who second guess themselves and beat every decision to death, , and I have been known to be in this camp from time to time. I guess if I was trying to describe the type of confident decisiveness that I would like to emulate, I would have to say it would lean more toward a ''Judge Joe Brown'' than a'' Judge Judy''. Lets face it, sometimes that woman is a bitch! But old Joe, he has a way of telling it like it is that has you nodding your head and saying ''Amen, mmmhmmm...that's right Joe, mmmhmmm... Hallelujer!!!''.

On a trip to Niagara Falls a few years ago, I  had a sudden epiphany (I refuse to say ''aha moment'') when I noticed the way the tour guides handled crowds of people.'' Stand behind the line, please, Sir,Sir, Sir!

Please stand behind the line!''. They had figured out that most of us are a bunch of dumb sheep with a few renegades thrown in, and we respond best to someone who tells us what they want us to do in a clear, firm voice. Don't give us options, that screws us up. 

I got to practice this once when the famous Indiana weather took a turn for the worse, and debris started flying past the drive through window. I was trying to hear the guy in second drive through over the wind, when all of a sudden one of those industrial sized trash cans flew by. I said ''I'm sorry, sir, I can't hear you, and I am leaving the pharmacy!''. I am tornado phobic, so I started rounding up the other employees and the customers and herding them into the cooler. ''Sir, Sir, Sir! Please step into the cooler!''. By golly, they did it! I was amazed! Such power! As it turned out , there was no tornado and I took alot of crap for it,  but I learned a valuable lesson. Stand up, say what you mean and mean what you say. 

BP

There for the Asking...

In one of my earlier posts, I joked about Miss Ellie, the Lady Druggist on the Andy Griffith show. I grew up watching that show with my Grandma and Grandpa, back when everything was in black and white. Life back then was kind of like that, too. As a kid, my parents didn't mince words. Right was right and wrong was wrong, and they taught me the difference in no uncertain terms. It was only when I got out into the world  and started to interact with other people that I started to realize there were shades of gray. I think that is what is so troubling to me now, and why I can't make sense of the environment I live in 40 hours a week. I have a standard I have set for myself on how I practice pharmacy, and little by little my autonomy has been chipped away, until there is such a disconnect between what I believe and what I am told to do that my mind and body are rebelling.

Picture, if you will, a scene from one of those old black and white Westerns. Young Tom and his sweet young wife Susie head west in their covered wagon, full of grand ideas and dreams about what they're going to do once they reach the promised land. Things go pretty well for awhile. Land as far as the eye can see, and oh my! The stars are so bright and the air is so clean, why a man could really make something of himself out here! Then, all of a sudden, something seems amiss. The music shifts into a minor key. The horses start to panic. Dun Dun Dunnnnnnn....!!!! A rattlesnake is on the trail, why one more step and Tom would've been bit! Tom dispatches the snake with one shot, the music swells, and we all breath a sigh of relief. Whew!! That was close! But alas, art imitates life, and things start to go downhill. Literally. It's not long before the bad guys have kidnapped Susie, the Injuns have showed up, the wheels start to fall off the wagon as Tom races for his life, and the whole contraption, horses, wagon, Tom and all their wordly possessions Thelma and Louise it off the cliff and go bouncing down the slope to ruin.

If I had my way, I would take all the time in the world to help you with the medication piece of your healthcare puzzle. We would sit down in that consultation room I never use, with a computer that isn't there, and go over your medicines, how you are feeling, any questions or concerns you might have, and hey, do you want a cup of coffee, how is your wife doing? Grandkids? Kind of like they show on the commercials. Like that. In color. HD. Surround sound. Happy music in the background.

I am starving for that kind of interaction. I don't like feeling annoyed or nervous because my technician tells me there is a patient who has a question. I don't like holding up one finger, making eye contact, and telling the patient ''be with you in a minute'' when I know it is probably going to be much longer and I am only going to have a few seconds to spend with them. I don't like it when one of my long time patients comes in with tears in his eyes because he just found out his wife has terminal cancer, and I have to talk to him in the middle of complete chaos and get pulled away much too soon for either of us to express what we are feeling.

I think you and I are on the same page. It doesn't have to be like this, and we both know it. Someone has poisoned the water hole. I'm still going to give you the best I can, every day. I honestly can't do otherwise. My gut won't let me.

Happy Trails, Pardner!

BP

What Would You Say

There are times when we know things we would rather not know, and see things we would rather not see. We are bound by the privacy laws, and so we have to tread lightly when we see someone in trouble. 

People come through drivethru without their drivers license on a regular basis. We have to record the ID information on the hard copy prescription, and it has to be a valid picture ID (driver's license, military ID,

State ID, or Passport). For some reason, people take offense when we ask them for their driver's license. My first instinct, when they start to get sassy, is to call the police and tell them there is a person in such and such model car just leaving my drivethru who is driving without a license. I have never done this, because it's just not worth it 

Things start to get a little murkier when the person who drives up to the window is obviously impaired. I say obviously, although there are people who seem to be in a permanent state of impairment. Either way, if your speech is garbled, your eyes are at half mast, and it takes several seconds to turn your head in my direction when I ask you a question (picture the cartoon turtles on Looney Toons), chances are you have no business behind the wheel of a car.

Ditto for the elderly patients who cruise slowly up to the drivethru, see that they are too far away, and back up and pull forward several times before they zero in on the drivethru drawer. Or the ones who pull up, start to roll forward, and slam on the brake. Or the ones who hit the building or run over a cone, and pull away as if nothing happened. I have almost been taken out by one of our patients who lives by a local fast food joint. My quest for a greasy burger almost turned fatal when Mary pulled her big boat of a car out of her driveway in a Mr. Magoo maneuver, narrowly missing several other cars who had to swerve and slam on their brakes to miss her." Oh by George, Angus, why are people always honking at us?''.

There are some things that are more heartbreaking than others. I remember a little girl, about 4, standing in the cart in her bare feet, wearing a saggy two piece bathing suit with her hair still wet. It was 9:30 at night and the air conditioning was going full blast, so she was shivering. Her mother fit the meth addict profile, sores on her skin, stringy hair, tattoos, piercings, shaking, talking too fast, not tracking, bad teeth, bad hygiene. She purchased the decongestant of choice for the local meth cook. I couldn't do anything about it, and I think about that little girl every once in awhile and wonder what I could have done to help her. The ones that are really sickening are the ones who try to get their kids to 'say thank you to the nice lady'' which is a ploy to 

seem like a great parent and use the child as leverage to soften us up in case we suspect anything. 

There are cases where people use their kids to get pain medications. We see emergency prescriptions from dentists, rapid care facilities, and hospital emergency rooms on evenings and weekends. When we see the same child's name at different stores, from different prescribers, with the same group of adults, we hope to God they are not hurting the kid to get doctors to prescribe this stuff. We refuse the prescriptions from people known to do this, but always worry that the kid may actually be hurt and need the medicine. And what kind of sick bastard would do this? 

Another dilemma we encounter is the patient who has always been on top of things, who starts to slip, and we start to notice. How far do we let it go before we say something? We are lucky to live in a small community where we can usually contact a family member and discreetly hint that maybe someone needs to start checking on Aunt Susie, because she doesn't seem to be able to keep track of her medications like she used to. This is tricky because of the privacy laws, but we can usually get the person's relative or friend to catch our drift without breaking the law. 

We do the best we can to stay objective and professional, and still try to do the right thing when it comes to the stupid and dangerous things people do. I like the show "What Would You Do'' with John Quinones because it really brings up some moral dilemmas we all face. To get involved or not. To say something or do something, or just walk on by.

What we see is mild compared to what social workers, emergency room personnel, foster parents, child advocates, elder abuse investigators, policemen and firefighters, and a whole lot of other people have to see. I don't know how they do it. 

BP

With Respect to Privacy

HIPAA notwithstanding, privacy in the retail pharmacy setting has a long way to go. The consultation window is a nod to the idea that the conversation between patient and pharmacist should be private, but it is woefully inadequate. Likewise the little sign on the floor 6 feet away from the counter that says "Please Wait Here" .
This may satisfy the letter of the law, but there are several problems with this scenario.

How would you like to have to stand at a counter and speak to your physician about erectile dysfunction, a yeast infection, or a rash in a delicate place? Yet when you have questions about the medication you were prescribed to treat these conditions, that is exactly what happens between you and your pharmacist.

Some of the newer pharmacy departments do include a more private area or even a "consultation room''. Which would be great, except that we don't have the support staff to cover while we sit down with you and go over your medications and answer your questions in private.

Even when the chains started giving immunizations and providing health screenings ( which, as you probably know, is a response to the shrinking reimbursements they receive from insurance companies, and not because they are so concerned about public health), the most they could provide was a screen and a folding table with a cheap plastic tablecloth. Oh, and one cheap chair, and one nice chair (for the patient).  I am embarassed when I have an elderly lady that can't get her sleeve up high enough for a flu shot, and has to slip her shoulder out of her top so I can reach her little skinny deltoid muscle. "I'm sorry ma'am, is it ok that the whole store can see your bra?''. I offer to take them to a room if they want, but most of them tell me they are ok with it. I'm not ok with it, because it just isn't right.

The drivethru is another place that your privacy is compromised, especially if there are two lanes. Even though we speak to you over the phone, the speakers on your side blast your business across the parking lot. Drive by sometime with your windows down and you will see what I mean.

As a patient, there are a few things you can do to help us out. If you need to talk to us privately, ask to speak to us in the consultation room. Even if the store does not have an official room, there are places that can be cleared of other employees and made into an impromptu private room. A technician or manager can "hold down the fort" for a few minutes so you can get the attention you deserve.

On the flip side, if you are waiting to drop off or pick up your prescription, please keep a respectful distance from the patient we are working with, and please don't raise your hand as if you are hailing a cab, or try to make eye contact with us so you can ''just ask one quick question''.  In my experience there is no such thing as a quick question. It's just like you learned in kindergarten, wait your turn.

I once had a guy so far up on my patient's back that I thought he was her husband. She and I were discussing a very private matter , and he was right there looking over her shoulder and listening. I guess she was probably too nice or too intimidated to tell him to back the hell off. Anyway, I finished talking with her, and turned to walk away, when I heard "what do you have to do to get waited on around here". There was Mr. Snoopy Pants, chomping at the bit to get waited on. "Oh, I'm sorry, I thought you were her husband, you were standing so close to her !'' He didn't bat an eye. I don't think it even occured to him that he had done anything wrong.

The chains have us down to minimum staff and are promising maximum service. This is not fair to either one of us, but this is the hand we have been dealt. If you have a question about something out front, try to ask someone other than the pharmacy staff. I know, the managers and store staff are usually hiding in the office or in an aisle, but the front register person should be able to flush them out for you. If you have a question about medication or over the counter products, please be patient and we will help you as soon as we can. We don't like not being able to get to your question, and we don't like having to  broadcast your business to everybody in the waiting room, either.  

A few years ago, I was walking up to the front doors to unlock them for the day, when I saw a desperate man jumping up and down and trying to get my attention. "Gosh, he must really need me to fill his prescription in a hurry''. I yanked open the doors, wondering what was wrong. The guy just about knocked me over in his haste to get in the store. "Do you have any colored toothpicks!!!!?????'' Don't be that guy.

BP

Be Nice!

One of the hardest pills to swallow when dealing with patients is putting up with the verbal abuse. Actually, the patients are not the only people who feel free to let loose on us on a regular basis. Nurses and receptionists, doctors, insurance help desks, insurance reps, our store managers, our corporate managers, and , my favorite,  other pharmacists, feel free to lambast us at will. One of my happy go home songs is REM'S Bang and Blame (..."you bang on me, beat on me, hit on me, let go on me....you let go on me...."). Think the lyrics are a little extreme? Walk a mile in my Merrells.

I'm going to be completely truthful here, because this is my blog, and because I am not allowed to say what I think anywhere else. I've been doing this a long time, so keep in mind these are the status quo, not isolated occurences:

1. Nurses and doctors are never wrong and can never say they are sorry. Period. I can count on one hand the times one of them has actually admitted to causing the patient and us extra grief and work.
They order the wrong medication, the wrong strength, something the patient is allergic to ? They call us (or usually the patient calls us or them, or we relay the message). Guess what they tell the patient?
"Take that back to the drug store and have them refund your money" . We can't sell it , so it goes in salvage. Never ever has the doctor's office offered to pay for their own screw up. Or the gas, time, and aggravation the patient had to put up with because of their error.

One of our doctors, who we thought we had a good relationship with, called us and chewed us out for trying to cheat her patient because we gave her the brand name drug instead of the generic. When we pulled the hard copy, it turned out that her nurse had called it in as Dispense as Written, Brand Name Only.  Guess who never could admit it was her office's fault or say sorry, and guess who we don't give a shit about helping any more than we have to.

When we screw up, we admit it and take it in the face. It's wrong to lie and say you didn't make a mistake when you did. Not only is this dangerous, but it is immoral and stupid. There are pharmacists who lie about errors, and in my opinion they are a pathetic excuses for healthcare professionals.

2. Most insurance help desk reps that I have dealt with are pretty nice. They have a thankless job, too, and I'm sure they get yelled at all the time.  They usually are polite and try to help. The reps who are trouble are the ones who tell you it's a software problem, or who otherwise try to pass the buck by acting like we are incompetent.  When they get high handed and mean, we hang up and call back and try to get a nice one. And maybe we slam the phone down when we hang up on the mean one. 

3. When Medicare D first came in, it was confusing for everybody. We tried to help people figure out what to do , because most of these patients are elderly and on a ton of medications . My pharmacy manager actually had an insurance salesman tell a little old lady to switch pharmacists, because he had the guts to call the rep and ask him to help the lady pick a different plan , because the one he put her on did not cover some of her medications. That rep was a complete ass. He yelled at my pharmacy manager on the phone and was extremely rude.  He was willing to take the lady's  money, but he did not want to help her select a Medicare D plan that gave her the best coverage for her medications.

4. I had a pharmacist call and chew me out first thing on a Sunday morning because he had called and talked to "Mary" on Saturday and transferred a prescription for us to fill, but when the patient got there Saturday night we did not have any record of it. Actually he yelled at my tech for a few minutes before I told her to give me the phone. First of all, I had to tell him 4 times that there was no Mary at my store, Mary works at Mr. Happy Drug down the street.  Since he continued to be shitty, I told him that yes, I remembered his patient because he yelled at me in drivethru for 10 minutes right at close, and then proceeded to come into the store and bang on my window and yell at me after I had closed for the night. So, I was  late gettting off work, I got yelled at, and now Mr Know It All Rph was yelling at me.  I let him have it and he fell all over himself apologizing. Too little , too late, my friend.

5. Our store managers have a high school education, or at most a Bachelors in business or another field other than pharmacy. The pharmacists go to school for 5 years, sometimes 6 years,  and have a ton of experience and  knowledge. The chain stores put the store managers in charge of the pharmacists, so they feel free to yell at us and say whatever they want to us because corporate backs them up and throws the pharmacists under the bus.

6. And now, the patients. . Do you know who treats us the best (other than the drug abusers, who are sweet and fake until they don't get their way.)? The people who have nothing. The poor people, the little old ladies that cart their buddies or their neighbors around and sometimes buy their medication for them. The people who are going thru hell because a family member is fighting cancer. The people with a child who has cystic fibrosis, or who is fed through a tube, or who will never be able to be out of bed or their wheelchair. The guy who is paralyzed from the waist down, pays cash for everything, and  who always has a smile and tells us to have a nice night.

Do you know who treats us the worst? The pillars of society that have a sense of entitlement and feel they should never have to wait , that they should be taken care of first, that we should bend the rules to make things easier for them. The people with religious symbols and sayings on their cars and checks and t-shirts that yell at us every time things don't go their way. If you can't even be nice to a store clerk, it seems to me that you are witnessing for the other team. You are not invisible, and we don't forget who treats us badly. Ever. What would Jesus do? I don't know, but I'm pretty sure he wouldn't be screaming at me in drive thru.

BP

Robber, Faker, Methamphetamine Maker

Along with the increase in other pressures involved in pharmacy practice, the amount of robberies have increased , and the vulnerability we feel standing there behind the counter has added another nerve-racking dimension to our job. We are sitting ducks. The "security" system consists of "high definition" video cameras . Those grainy images on the tv news are supposed to help the public identify the latest hooded wonder, but they are little consolation to the employees involved in one of the most traumatic events of their lives. Adding insult to injury, upper management has become increasingly callous to our plight and harasses employees to show up to work their next shift,  implying that you are not a team player if you can't bring yourself to return to the place where 24 hours ago you had a gun pointed at your head.

We have always had patients who have trouble limiting their use of pain medication and nerve medicine.What happens in a lot of cases is that people get hurt in an accident or at work, and then it seems that they never get weaned down off of the medication. In fact, the dose and amount of medications seem to escalate over time. Pain has a huge psychological component, in other words, it is self perpetuating. The more you hurt, the more tense and anxious you get, which in turn makes you hurt worse. Unfortunately, addressing this component of pain management takes time, commitment, and collaboration between the physician, the patient, and ancillary practitioners, such as counselors, physical therapists, massage therapists, and mental health professionals.

Many patients sign a pain contract , promising to only see practitioners in one pain management group. They also promise to limit the number of pharmacies they visit. It gets a little dicey for them and for us when glitches in the system occur and their prescriptions are delayed. When a patient is desperate and in pain, they  are willing to try anything to get their medication. The stories they fabricate would be funny if the situation wasn't so sad. "I was sitting by the pool, and I dropped my bottle and all my pills spilled out on the pool deck, and my dog got hold of some of them and died". Couldn't you have saved at least some of the pills? ''It was raining".

Then there are the people who sell their medications. When we see a carload of people come through drivethru  and pick up scripts for boatloads of pain meds, it does not inspire our confidence that this is a legitimate transaction.

Last but not least are the Meth Heads who come in and buy pseudoephedrine and ephedrine tablets. We are pretty good at spotting these people, and our goal is to get them out of the store as soon as possible. It is hard not to profile someone who has tattoos and piercings everywhere, talks 90 miles an hour and can't stand still, is exceedingly polite (until the state limit is exceeded), and talks about how their poor old Granny needs this medicine so badly. Spare us the stories, we will sell it to you if it goes thru on the register. We hate doing it, but we let the State Police do their job and try to stay neutral.

So, forgive us if we are a little jaded. It would be so much easier to believe all the stories and excuses, but we are entrusted with patient safety. We hate being the drug police, but this is yet another component of our job that we do not control. As the big dufus in Blazing Saddles said so eloquently "Mongo just pawn in great game of life".

 Later,

BP

But I Have Insurance!!!

Yes, yes you do. Remember when your insurance company used to send you those booklets every year, the ones with the people on the cover that couldn't possibly work for your company because they are laughing and smiling and having fun with their families? The ones you were supposed to read, but never did, because it didn't make any sense anyway, and you figured you'd deal with it when the time came? Now you are directed to a web page with the same shiny happy people, but you have to remember another damn user name and password just to get into the website, and there are so many tabs, links, and healthy living tips , it's hard to even find your benefits.

I don't know much about the medical insurance side of things, except that medical offices dedicate a whole staff of people just to work on insurance problems. They send the bills in, and you get an EOB (explanation of benefits) either in the mail or online. I assume in between times there may be some phone calls and e-mails sent back and forth before the whole kit and kaboodle is hashed out and finalized.

Now step into the "Jamaican Airlines" of the medical world. Remember the show "Living Color"? They had a skit with a family running an airline, and they all had about 15 different jobs: '' I'm the ticket agent, the baggage handler, the stewardess and the pilot! You are only the navigator? You don't have enough jobs, you lazy lima bean!''!

As your pharmacist, I am the greeter, the phone answerer, the question taker, the recommender, the counselor, the prescription taker, the profile updater, the insurance or coupon enterer, the prescription enterer, the insurance problem fixer, the prescription filler, the prescription checker, the prescription bagger, the prescription filer, and the cashier. I also run the drive-thru (2 lanes), do what the store manager tells me to do, put the drug order away, send the drug order for the next day, fix the printer, the cash register, and the computer. Oh, and I am often the bearer of bad news (don't shoot the messenger !). Theoretically I am supposed to have technician help, but it is often non-existent, at lunch, break, or out for an appointment, or incompetent. Rarely do I have a full staff, if any staff at all.

Here is how this process works. You go to see your doctor and receive a prescription carefully selected to treat your particular problem. You bring the prescription to me, and hopefully present your current insurance card (not last year's, your Medicare Card, your AARP discount card, any other discount card, or handwritten numbers on a slip of paper). I will enter the prescription and run it through the insurance. If the numbers are correct, and the planets align, and we keep our fingers crossed, I receive a paid claim. Visions of glory and angels singing, HALLELUJAH!!!!

The relief and happiness may be short lived. I have to tell you the copay, and if it is high, or the drug is not covered , or it needs a PA (prior authorization), woe unto me. And you. You have spent most of your day at the doctor's office and have waited for me to process your prescription, only to find out it is more than you can afford, or not covered at all. This tends to make you frustrated and angry. I get that. This is why we cringe when we have to tell you how much your medication is going to cost. This is why I may get a little short with you, because I have had this happen time and time and time again, for hours, days, and years, and it never changes. I want to help you, but I have no power to do so. All I can do is contact your doctor's office (who is probably at lunch or gone for the day by now) and/or your insurance company's pharmacy help desk. This takes time, and you are already tired and probably not feeling well. The stage is set for yet another unpleasant encounter between the two of us, when neither of us are to blame and the people who  are sequester themselves so we can't strangle them with our bare hands.

What can you do to make this process less painful for both of us?

1. Insist that your insurance company send you a new insurance card at the beginning of the year. I believe that insurance companies should have to pay a fine for every day they do not get the insurance cards in their customers' hands. Tell them a piece of paper, or worse, having to call them and have them read the numbers over the phone, is just not acceptable, especially at the beginning of the year. If they refuse, get your HR person or boss involved.

2. Try to read your booklet and familiarize yourself with the basic copays for generic and brand name drugs. No, you will not understand it all, but it may help you get the general idea of how it is supposed to work.

3. When you do get a new card, please please please shred the old one. Then tell us it is a new card so we can compare the numbers to what we have in your profile.

4. If there is a glitch, give us both a break and come back later (at least an hour). We will make some phone calls and try to resolve the issue. Sometimes (but not always) we can give you a few doses to start with until we can get the insurance fixed. We understand if you are sick and really do try to get you going as quickly as we can but we can't break laws and we can't give away expensive medications. We also can't control how busy we are at the time.

5. If your insurance company requires a prior authorization, this means they want more information from your doctor. Either the medication is expensive, and there is a cheaper alternative, or there is a perceived conflict with one of your other medications , or they have some other reason they don't want to pay for it . Simple as that. While you are welcome to pay cash,  if you want them to pay for it , we are going to have to jump through the hoops. We will call your doctor's office and give them the phone numbers to call and the message the insurance sent back to us. After this initial contact, the ball is in their court. Some offices are very good at getting PA's and some are not. If yours is not, you may have to call them several times. We can call them, but they do not hurry for us, either.

Like all the other things we do, insurance problems require time and patience from both of us. We are not your enemy. Give us a chance so we can help!

BP

I Pity the Fool

I used to know a pharmacist who looked and acted like John Belushi. He would say stuff like ''oh, the colored toothpicks, yes, they are up front in aisle 3 (and under his breath 'right next to the I don't give a shit aisle').  The same guy would say "hey, have you got a kid who wants to go to pharmacy school ? Send him over to me so I can slap the shit out of him ".

I pity the fool who believes the treacly commercials and thinks pharmacy would be a great career. If the pharmacy schools and chains would be truthful in their job listings and ads, no sane person would ever apply.

ATTENTION ALL PHARMACISTS!!

Are you looking for a rewarding and stimulating career at one of our professional locations? Here are a few of the perks you can expect when you work for us:

1. A generous salary and benefits package that is geared to getting you hooked on nice things and starting a family before you know what is really going on. Kind of like the trap where they drill a hole in a coconut big enough for a monkey to put his hand in, chain the coconut to a tree, and put a treat inside. The monkey's hand fits when he puts it in, but he can't pull out the fist holding the treat. By the time he figures out 

that the only way he can get away is to let go of the treat, the hunter has come along and bashed him over the head with a club.

2. No lunch breaks,no 15 minute breaks,  no food in the pharmacy, no drinks in the pharmacy, no food or drinks in the pharmacy refrigerator. And you won't be needing that hard wooden stool we give you to sit on either. 

3. Expert technician staff, who will of course get lunch and breaks, and  will also be allowed to go home early, come in late, leave and come back, not show up at all, and call in sick for days at a time .

4. Be your own boss! We often allow you to work 8 to 14 hours straight with no help.

5. Hone your clinical skills! Give shots, take blood pressures, check cholesterol, check blood sugars, check A1c, check body mass, and mix compounds, all with no help and in between your regular duties! No appointment necessary!

6. We will provide 2 smocks a year. They will not look like the ones in the commercials! Those ones are white and crisp, yours will be yellowed, pilly, floppy and sweaty!

7.  You will learn to dispense dangerous, poisonous products to all manner of people, while you are pulled in different directions and subjected to a cacophony of noise and visual distraction.And you will do it pleasantly (or else).

8. Learn how to hold your temper while we proceed to disrespect and belittle everything you do , and let the technicians, customers, managers and cashier say and do whatever they want to you!

9. Enjoy the feeling you get when you have produced 60% of the stores profit and get treated like a bag of shit!

I KNOW YOU ARE PROBABLY SAYING WOOHOOOOO....!! SIGN ME UP!!!!!

You may have to wait in line quite awhile, though, because according to the powers that be, there are a ton of people just waiting to take these jobs!!

BP