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