Priorities

Patients with Medicare Part D sure don't have good memories. No, they certainly don't remember a long, long time ago, all the way back in 2005, when there was NO DRUG COVERAGE for Medicare patients, and they had to pay out of pocket for everything. I remember little old ladies meticulously writing out their checks for their monthly meds in the $700 to $800 range. Now, these patients have just gotten spoiled. Spoiled, I tell ya!

I had a patient call and ask for the total on her medications. Everything was covered by Part D, except for her Vitamin D 50,000IU. Eight capsules, for a two-month supply, was $15.49. I explained that it wasn't covered under Part D law because it is a vitamin, but that if she is deficient, it was important to her health. Her response? "I ain't paying for THAT! My insurance pays for my meds! If they ain't payin' then I ain't either."

This is awesome. This is where I get to do my job! "Ma'am, did your doctor explain why she prescribed this for you?"

"Yeah, she said my Vitamin D was low."

"Did she explain why it was important for you to get your Vitamin D up?"

"Well, no..."

So I go into the explanation of what Vitamin D does, how it's important for bone health, keeping the immune system healthy, and decreasing risk for some cancers. I tell the patient, "If your lab tests show that your levels are low, I think $15.49 for two months worth of medication would be a good investment for your health."

"Let me think about it..."

When she picked up her prescriptions, she told me, "I thought about what you said...and I'm going to just pay for the Vitamin D."

"I think you have made a good decision. Have a nice day!"

Now I'm not going to pretend that I know what it's like to worry about 16 bucks. I don't. I have been very blessed in that regard. My patients often have to struggle with how to pay for their meds and the light bill. I don't know what my patient had to forgo in order to buy that Vitamin D, but I'm glad I could encourage her to make her health a priority.

I thought I had seen it all...

So I got a phony phone-in prescription the other night. Not so unusual, right? What was it? Vicodin? Xanax? No...this chick was trying to call in her own prescription for...Diflucan! It went like this.

Ms. Itchycooch: "This is ER PA, agent of Private OBGYN, and I need to call in a prescription."

Me: "Ok..." I call shenanigans on this one at the first sentence, but I play along.

IC: "..."

M: "Yes?"

IC: "It's for Ms. Rotten Itchycooch."

M: "Ok, what are we giving her?"

IC: authoritative tone "Diflucan, one dose."

M: "What strength?"

IC: "The one dose pill."

M: "Ok, what strength?"

IC: "The one dose pill. I dunno, it's like 250mg or something like that?"

M: "It's 150mg."

IC: "Yes, yes, of course, it's the 150mg."

I collect the prescriber's phone number and thank the caller. A quick call to the ER, where ER PA works, and I confirm that this is a bullshit Rx.

Ms. Itchycooch walks up to the counter and I do something I have never done in all my 13 years in the pharmacy...I laugh in her face. Rude? Yes. Unprofessional? Absolutely. Wrong? Probably. I said, "I talked to the real ER PA, and she didn't phone in this Rx. You have got to be kidding me with this." She smirked and walked away.

What should I have done? Probably should have been a little nicer, and more helpful, and directed her to an OTC treatment for her issue. I actually feel like I let down a patient in need, but I just get so sick of the bullshit that patients try to pull every day in the pharmacy, and this was the first one that was so clear cut that I could say whatever I wanted to this girl and there was no way anyone could argue that I was wrong. So I guess I took it out on her. Yeah, I feel a little bad about that now.

Anyway, it must not have bothered her that much, because the very next day she showed up at my pharmacy with that same smirk on her face, and a prescription for Diflucan in her hand from the ER. Diflucan 100mg once daily for 10 days. I guess it must have been really bad...

Professional Judgement a.k.a. You Are Not A Robot!

I understand that a lot of drugs have dosages that vary according to various factors, such as weight. But can we please use some professional judgement and round some doses? I saw a Lovenox prescription today for... are you ready? 99.7mg. Yes, that was 99.7mg. For those of you not in the know, Lovenox is an injectable drug that comes in a variety of strengths in prefilled syringes, among those being 80mg, 100mg, and 120mg. Now if we calculate the dose based on weight and we come up with 99.7mg, can we please use our FREAKING BRAINS and round that dose up to 100mg? How the hell is someone going to measure 99.7mg?

Or how about those Amoxicillin doses...I have seen such craziness as 6.13mL. Are you freaking kidding me? I don't think a kid is going to die of an Amoxicillin overdosage if we round it up to 6.2mL, which is a volume that can actually be somewhat accurately measured. That "extra" 0.07mL isn't going to kill anyone.

Prescribers, you are not robots! Use your judgement and try to do things that make some damn sense!

Thank You, Techs!

October 26th, 2010 is National Pharmacy Technician Day! I would like to thank all of the hardworking technicians out there for all that you do to make my job easier. Being a pharmacy technician is often a thankless job. They man the front lines, solving problems before they even come to me. A good technician will take care of as much as they can, letting me focus on being a pharmacist. Techs do not get paid anything near what they are worth, especially with the increased demand placed on them by the cut in hours and flu shot program.

I am very thankful that I have a wonderful partner pharmacist at my new store, but I am even more grateful to have excellent techs. My two daytime "keystone" techs have made a choice to treat their jobs as careers, and they are excellent, with lots of experience, and fabulous customer service skills. My evening techs are mostly pharmacy school interns, and they do a good job of juggling the demands of a rigorous program with the need to work one or two nights a week.

What are you doing to let your techs know how much you appreciate their hard work? I'm bringing Krispy Kreme in the morning :)

Aaaaawwwkward!

So there is this guy who was a very regular customer of mine when I worked overnights. He would come in, I would remember his name, we would chit-chat. He thought he was pretty sexy with his shirt unbuttoned and his leather cowboy hat and ponytail, but our chats were friendly and quite harmless.

Fast-forward a few months later, when I had come off of days and was covering a leave at my old store. He came in, I helped him, and he told me about an injury that his daughter had sustained, hence the reason he was there. There was a question of whether it was more serious than a simple injury, and tests and assessment were to follow. I gave him my good wishes, and he left. A couple of days later, he comes in with his wife, whom I had never met. I see them finish up at the counter, and as they walk away past the consultation window, I say, "Hey, how is your daughter?" Wife looks at me, her eyes wide, then looks at her husband and her eyes narrow. Ooookay. He mumbles, "She's fine," and they walk off.

Um, I don't know what kind of extracurricular activities of his that she was used to dealing with, but I most certainly was NOT one of them...just your friendly neighborhood pharmacist. He came in on my shift a couple times after that, and out of extreme awkwardness, I always made sure I was way too busy to even make eye contact with him. Thank goodness I have switched stores and don't have to deal with that again.

"I Hope You Feel Better"

It was about 3 a.m. A young woman in her twenties and her concerned boyfriend presented prescriptions for Keflex and Percocet to be filled. Her right hand was heavily bandaged. She was crying, and the boyfriend was very quiet and looked extremely serious and upset. I filled the prescriptions quickly, and after I rung them out, I made a horrible mistake. She was still crying, and the boyfriend just grunted, "Thank you," when I looked at her with concern and said, "I hope you feel better."

At this point, her face fills with rage, she waves her bandaged hand in my face and screams, "Well, I DON'T HAVE A FUCKING FINGER!!!"

She stormed out and the boyfriend quickly followed, and I just stood there, shocked. I then realized how callous and glib my words must have seemed to someone whose life will never be the same after losing a finger. I felt absolutely terrible for making her difficult day even worse. And I realized that expressing my wish for her to feel better was only to make myself feel better.

I did learn from that encounter, and I try to read people a bit better before offering my wishes, and I have learned that in a serious situation, a simple, "Take care," voiced with concern works much better. And the folks that want to talk about why they went to the ER, or what kind of phlegm they are hacking up are more than happy to share.

Fear of needles...

I walk out to the immunization area to greet my next flu shot patient. She sits nervously as I introduce myself to her. She is wearing a sleeveless shirt (thank you!) and I can see several well-done tattoos on each arm. As I'm cleaning the area on her left arm with an alcohol swab, she turns her face and clenches her eyes shut.

"Are you ok?"

"I'm terrified of needles!"

Uhhhhhh....ok. I guess her tattoos were done with ink pens.

"But you have all these gorgeous tattoos! That one of the praying hands on your right arm is beautiful...tell me about that one!"

She looks at it, her head turned away from me, and starts to tell me about how she and her daughter went together to get tats...yadda yadda yadda, and I quickly stick her, discard the syringe in the sharps container and start applying a bandage. She looks at me and says, "Did you give me my flu shot already? I didn't even feel it!"