Good Rant on Self-Checkouts

Posted by The *Angriest* Pharmacist as --Not Pharmacy--, Blogs I like, Courtesy, GUEST CONTRIBUTOR, Me being a dick, Work Sucks

This was all thought up and written by Kurtis – I loved it and decided to share it with the world:

I know it’s not pharmacy related, but today I waited in line for 10 whole minutes waiting for not 1, not 2, nor 3, but 4 idiots to figure out how to use the self-checkout registers at a grocery store that I work in as a pharmacy tech (soon to be intern). The horrible part is these same idiots come to the pharmacy bothering me about things they know even less about, but are convinced that they are experts on. Thus, I present a new set of rules that I think should take effect immediately to prevent my lunch break from being ruined ever again:

New U-Scan Limitations to be Enacted Immediately:

1.) 15 items or less only. I do not know how many times I’ve seen someone bring a whole cartful of groceries through the U-Scan. It just ticks everybody off; just because there is no line at the U-Scan when you get there does not mean you can check yourself out any faster than if you waited in line and had somebody who knows what they are doing do it for you. Also, when you are done, you’ve created an angry mob in line behind you.

2.) Your IQ must be greater than 80. I think this is pretty generous considering this is one standard deviation lower than the median IQ. The U-Scan machine is a simple device that consists of a holding area for your unpurchased groceries (notice how small it is? seems to indicate a hand basket or less…see rule #1), a laser that scans barcodes, a touch screen that displays all of your options as you check out, an area to pay cash or credit, and a holding areas for your scanned groceries. The trickiest part of all of this is that the second holding area is a scale; it senses changes in weight to let the machine know that what you scan is what you are placing in the bags; this prevents theft. You cannot lean on, place a purse on, or have your snot-nosed kids touch or play with this scale or the whole process must be stopped and continued by a clerk. Do not get angry at the employee who runs the U-Scan if you cannot figure out how to work the darn machine. And remember, when the machine says “Waiting for cashier,” it doesn’t mean its waiting on the employee, its waiting on YOU! Odds are if you break rule #1, you are also breaking rule #2.

3.) You must be less than 65 years old. You grew up with local clerks who ran cashiers. They probably wore aprons and sweeped porches with brooms. Go take a nostalgic trip down memory lane by telling this modern 16 year old kid all about the local shop in your town, and how everyone met there every weekend for rootbeer floats or to find out if it was going to rain because Clem’s leg was swelling up, or to ask a young lady’s father if you could court her. Tell him how much a peppermint stick used to cost in 1879, tell him how you used to stare at the expensive chocolate bars, complain about anything and everything that has changed. Sure, after 10 minutes of this story the cashier may begin to fidget and the other customers may begin to get angry, but hey, you’ve saved us all a train wreck because you didn’t use the U-SCAN! Even if you obey rules #1 and #2, you still will not be efficient at using this complicated technological machinery. Cashiers; to screen for ages, simply ask an elderly looking person for their Medicare card. Their eyes will light up as they think to themselves, “Medicare pays for food!?” as they proudly show you their “Red, white, and blue” card. Kindly inform them that they are over the age limit and direct them to the nearest open register. Tell them it’s a special service for the elderly of the neighborhood, they’ll eat that up.

This is more for the readers

Posted by The *Angriest* Pharmacist as Courtesy, Doctors, Drug Seekers, Education, Just a question, Lazy People, Me being a dick, PHARMACY SECRETS!, Rude, Stupid Nurses, Stupid People, True Story, Work Sucks

I got this from a reader recently. Let’s have a little bit of discussion on the double standard which applies to pharmacy (hereafter known as ‘gimme gimme gimme!’)

Friday night, a guy comes in. Wants a refill on omeprazole 40mg. Naturally, he didn’t call ahead or even have his bottle with him. He’s obnoxious and rude, balks that it will take TEN MINUTES to fill, and proceeds to stare at me thru the glass like I’m some sort of animal. The claim comes back prior auth, with the reject that the insurance will pay for X number capsules in 90 days, then they require prior auth.

I explain this to said jerk, who naturally flips out and calls me incompetent. Then he’s going to sue me because I won’t fill his medication and he NEEDS it. Riggggggght. I explain I’ll fill whatever he wants, but his insurance isn’t paying for it at this time, so he’ll have to.

Normally, I would’ve fronted someone 3 pills for the weekend. But I play by the golden rule, so this dude was paying, no favors from me. He pays for 5 capsules and leaves in a huff.

That’s all pretty typical, now we get to the good part..Monday morning I get a call from jerk’s doctor’s office. The nurse asks why I wouldn’t fill his prescription. Uhhh, I did fill it and he paid for 5 capsules. THEN SHE TELLS ME I SHOULD’VE JUST GIVEN HIM THE PILLS AT NO CHARGE. Ok. I don’t know about anyone else, but anytime I’ve EVER been to ANY doctor’s office they have about 6 million different signs posted stating, “PAYMENT IS DUE AT TIME SERVICES ARE RENDERED.” Last time I went I had to SIGN A FORM stating that I understood that I WOULD BE FINANCIALLY RESPONSIBLE for paying for any service that my insurance did not cover.

I told her it’s not my practice to give out medication for free. If the request is denied, then who is paying for those capsules? She really had no answer for that.

I’ve been thru the prior auth, front a-couple pills song and dance a million times..what gets me is the GROSS HYPOCROSISY and DOUBLE STANDARD here. This nurse scolded me for refusing to give medication away for free. As far as I know, no doctors are EVER giving their services away for free, they make sure they’re getting paid. Why should it be any different at the pharmacy?!

Any thoughts you might have on this particular incident/topic would be appreciated.

Thanks,

Frustr8ed Pharm

I’m sure we’re gonna all agree that we will give 3 days or so if it’s a maintenance meds, but is there more to the situation then that?

Lots of stuff to look at

Posted by The *Angriest* Pharmacist as Celebrities, Laws, Lazy People, Me being a dick, Patient Education, Robbery, Salutations, Stupid People, True Story, Work Sucks

Finally, a non bullshit assessment of generic drugs from someone without their head up their ass. They got valid opinions from people that matter and aren’t retarded.

http://www.newsmagazinenetwork.com/feature/cover-stories/090512-671/brand-name-versus-generic-drugs

—

Here’s a case that is a bit odd.  Mother and son run away after MD tells them the 13 yr old’s Hodgkin’s Lymphoma  is worsening. Mother rejected chemo and western medicine and settled for tried, tested, and true homeopathic Indian Medicine.

The courts did not think this was a good idea.
http://www.cnn.com/2009/US/05/25/minnesota.forced.chemo/

Let us not forget,”Child Dies, Parents Perplexed”:
http://www.theangriestpharmacist.com/2008/03/28/child-dies-parents-perplexed/

—

Here’s a handful of bullshit. The slop was posted on AOL Health.com and made it into some even bigger channels. Everone better order a bottle of Vicodin, Norco, and Soma.

http://www.aolhealth.com/health/generic-drug-safety

—

Pharmacist robbed. Pharmacist gets mad, concealed weapon permit. Pharmacy robbed again. Robber killed by Pharmacist. Pharmacist chases down second robber and shoots him in cold blood. Pharmacist in deep doo-doo.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/05/30/MNKG17TI7S.DTL

—

Oprah’s health advice could make you very sick. Here’s an explanation from Newsweek saying why….I’ve said since the beginning that Neti Pots were the devil.

http://www.newsweek.com/id/200025

—-

Hope you enjoyed today’s helter skelter rag tag post.

Medical Assistant Stupid, Pharmacist Not

Posted by The *Angriest* Pharmacist as Disgusting, Doctors, Education, Errors, Me being a dick, Me hating others, Stupid Nurses, Stupid People, True Story, Work Sucks

Quick post today.

Answered the phone today and it was a “nurse for Dr. Sayed.”

“Oh really?” [Knowing she wasn't a nurse] “What’s your name?” [Linda] “And are you an RN or LPN?”

“Welll, I guess I’m just an M.A. – I’m in nursing school though”

“Guess? … Okay then – on your way. What do we need today?” [I didn't go for the kill and say, 'So you're NOT a nurse then are you?' -- She knew she was beaten]

“Jeff Gordon, birthday is 8/4/1971, needs his Cozaar 20mg refilled. Directions are 1 po daily. And give him 2 additional refills.” [Most of you already see the problem. I wrote it exactly like this. My brain was shut off momentarily as I enjoyed my flawless victory from moments earlier.]

“Okay, thanks a lot!”

-=+=-

So, I loaded up Jeff’s profile and didn’t see any Cozaar. It was at this point, after the call was over, I realized that what I had written didn’t exist. Cozaar (Losartan) comes in 25, 50, and 100mg. I double-checked…nope, this guy doesn’t get hypertension medicines. He does, however, have an old cholesterol medicine that’s due to be filled.

Whaddua know — It’s ZOCOR 20mg — Simvastatin.

“Hello. I talked with MEDICAL ASSISTANT Linda about a prescription for Jeff Gordon a few minutes ago, and I think she misspoke. Could I talk to her again.” [I hold for a minute or two...patiently as I've already bodyslammed her. I don't want her to go postal!]

“This is Linda. Is there a problem?”

“Well, you called in Cozaar, and I don’t see where he’s ever gotten that before. That doesn’t mean that this isn’t a new order, but I specifically remember you telling me it was for refills.”

“Ugh. I’m not in my office. I don’t have my information here. I’ll have to call you back after I get my charts out.” [I realize this isn't pivotal to the story, but I thought it was hilarious that the medical assistant made it a point to tell me she was going back to HER office and pull HER charts.]
……
“Okay, I’ve got the chart right here in front of me and it says Cozaar. I guess I’ll have to call Doc for a clarification because it says it right here — Z-O-C-O-R — Cozaar.”

“Wha wha wha waiit a second. You just spelled Zocor and said Cozaar. They are two completely different words and two completely different drugs.”

“Oh. Well, I guess you’re right.” [Guess? Like you GUESSED you were an MA and not a nurse? I know I'm fucking right. ] “He takes ZOCOR for his high blood pressure.”

“No. Wrong again. He takes Zocor for his high cholesterol. Mr. Gordon takes nothing for high blood pressure. Cozaar is for high blood pressure, but he has never taken it. Well, he almost did today, but I saved ya…Better make a note in YOUR chart.”

“Thaaaaaaanks. [She was less than enthused with me.]

-=+=-

I’m not shitting you though. She SPELLED         Z—O—C—O—R       and said, “COZAAR.”

You can’t make this shit up.

I’m just scared that she’s going to kill my own mother when she calls in TopROL 200mg po BID instead of TopaMAX for my tiny mother and stop my mom’s heart! Same word, right?

Send Complaints to The American Association of Colleges of Nursing for producing more dumbass graduates than smart ones we all love.

There’s a “Kick-Me” Sign on Pharmacy’s Back

Posted by The *Angriest* Pharmacist as Disgusting, Doctors, Drug Companies, Hospital Pharmacy, Insurance Companies, Laws, Me being a dick, Me hating others, Money, Patient Education, Politics, True Story

I guess we’re the flavor of the month as the douchbags and assholes are coming out of the woodwork to take a cheap shot at our lovely profession. A loyal reader, known only as Bond, sent me the link to an article titled, “The Great Drug Switcheroo.” This piece of shit article published by “Prevention Magazine” (which has been around since the 50’s). The tagline is, “Your pharmacist may be changing your medication without your knowledge–and what you don’t know could hurt you. Here’s how to stay safe.”

Once again, the man behind the counter in the white coat is trying to KILL you — not trying to help you achieve optimal results from your drug therapy. It begins with a story of a lady diagnosed with epilepsy who had troubles finding an effective drug regimen. After she had gotten stabilized, she fell of her bike and broke her leg — all because of an evil conniving pharmacist!

Her pharmacists, she learned, had exchanged her Tegretol for a generic that worked a little differently. “Just imagine what could have happened had I been behind the wheel of a car,” she says.

What’s wrong with this sentence besides everything?

The article then goes into THERAPEUTIC substitution and not GENERIC substitution. The article makes the point with statins as well. The problem with this entire bullshit, whacked-out piece of journalism is that therapeutic substitution does not exist outside of the inpatient setting. I cannot think of a situation where that would be legal, and I seriously doubt it is allowed in any state.

For readers not in the know, here’s an example of THERAPEUTIC substitution: I am working a shift at my local hospital. I receive an order for a patient to receive Crestor 10mg at bedtime. The hospital doesn’t carry Crestor because it’s silly expensive. They do, however, carry Lipitor because they have a contract with Pfizer for a good price for it. The Pharmacy and Therapeutics Committee at my hospital did a review and based on their specific protocol, I can swap in Lipitor 20mg for Crestor 10mg as their lipid lowering effects are very similar (based on the results of the CURVES trial). I don’t need the permission of the MD or anyone else as the P&T committee represents the MDs and they have okayed this sub. There are hundreds of places where this happens — IN HOUSE! It does not happen in a pharmacy as Walgreens does not have a P&T committee…:-)

Here’s an example of GENERIC SUBSTITUTION: Your doctor writes for Vicodin 5/500mg. Name brand Vicodin is really expensive, and I don’t carry it. Luckily, he signed the prescription on the side of the blank that says, “Generic Substitute Allowed.” This means the doctor has given me the authority to dispense a generic drug, Hydrocodone/APAP 5/500mg which has been rated AB by the FDA (meaning it is recognized as equivalent therapy by the United States Government).

I’m pretty fucking sure our seizure chick was getting Tegretol or Tegretol XR for some time and the pharmacists switched her over to an AB-RATED generic equivalent. Can we say that this was the cause of a seizure? Fuck no. This bitch has epilepsy. She can have a seizure after a loud fart — did the fart do it? The time frame fits! I just drank a cherry coke. Can we say that Cherry Coke made me a dickhead? No. I’m a dickhead and it’s expected. Anywho, I SERIOUSLY doubt the pharmacist here said, “Well, she’s been getting Tegretol for quite some time. Let’s give her some Phenytoin. It’s okay…I’m a Pharm.D.!” —- No way….They are sensationalizing this and trying to compare dissimilar things.

The article specifically says, “A generic that worked a little bit differently…” — I know it’s semantics here, but generics are the same drug that work in the same way.

The second page of the article talks of a switch done by a mail order pharmacy. This I don’t doubt happens. They know exactly what drugs their plans will cover,  but by the letter of the law, they shouldn’t be making changes. I’d bet they call the MDs and say, “You wrote for Prevacid. We’ll pay for Nexium. Is it okay if we fill the latter?” — Of course the doctor doesn’t care and the patient gets the new drug in the mail without ever being told of the switch. Is that okay? It’s bad customer service as the patient is likely going to be scared and ultimately pissed, but they most likely meet the legal requirements of the law.

Ask your pharmacist to put a blanket statement in your records that you don’t want any medications switched unless you and your doctor approve. “It’s a way of getting your pharmacist’s attention,” says Catizone. “When pharmacists know more, they can do a better job of advocating for patients.”

We’ve all got a few of these assholes in our system. “I want brand name everything! Generics don’t work for me.” It’s these type of assholes that make me lose money on a bottle of name brand Vicodin when 70 tablets expire in a 100 count bottle. But, if they wanna pay for it, that’s fine by me. I’m not gonna lie and put DAW1 — I’m putting DAW2 and you can pay the difference.

Each section in this pissass article says, “If your pharmacist makes an unapproved switch….”  — What’s the need in this statement? Is there really this much distrust in pharmacy and pharmacists? I’m blown away by this. The final section has a quote from Robert Reneker, MD, urgent care physician at Spectrum Health, a hospital system in Grand Rapids, MI. He correctly says that pharmacies are reimbursed better on generics and switches are profitable. He incorrectly states that we are motivated to make these switches by profit.

I, personally, could give a shit less about what prescription a person gets. I’m happy to get the person in the store and make the sale. Volume is volume and it all averages out. If you get name brand something, you do. I’m not going to go out of my way on each of the 800 scripts I fill a day to ensure it is generic and maximize my profit margin. That’s just silly…to think that one would do that. To change you from Nexium to generic Protonix (pantoprazole) requires a call to the MD, the wait, the recount, and the dice roll that your insurance covers it. I may make more money on it, but it’s it worth the 5-10 extra minutes of work? Never…So his claim here is valid, but off base. He also says that pharmacies have told him drugs aren’t on formulary when they are — he’s checked. This is funny to me because I have no idea what’s on anyone’s formulary, and again, I don’t give a damn. If it’s covered it’s covered. If it’s not, I try something else. I have the broad ideas of what’s covered: generics are, Phentermine isn’t, BZDs aren’t on Part D, etc. For fuck’s sake, I could process a prescription and get a rejection that says drug not covered. Then Dr. Reneker calls the insurance company, and they say, “Prevacid? Why sure it’s covered, Dr. Anything you want. Let me send you this form to fill out.”

Dr. Reneker understands that to mean that: The drug is covered. I just got the prescription for my patient. The pharmacist lied to my face. The pharmacist  sees this as: I tried to process it and it was rejected as NDC not covered. The MD called and got a Prior Authorization. Now I can fill it and the patient can pay $75 while Prilosec is 20 bucks for 42 tablets. Way to go, Doc! You think you won, caught a pharmacist in a lie, and got the patient the medicine. The fact of the matter is the insurance company won (twice), you now distrust me and don’t know the whole story, and the patient can’t afford the food anymore that causes her heartburn.

Above is an example of what happens when a journalist talks out of their ass.

I’m not sure who makes the above switches. They are insinuating that you bring in a prescription for Lipitor, your pharmacist is going to send you home with Simvastatin and there’s not a damn thing you can do about it. Well, that’s fucking bullshit. While these substitutions are all fine and dandy, I certainly wouldn’t do them on my own accord. However, Prevention magazine thinks I can and do.

Read REMOVING THE WOOL to see what changes could be made where the new isomer-removed-new-drug/patent-game-type name brands exist and the generic would be cheap to use and work just as well.

Who let the QUACKS LOOSE?

Posted by The *Angriest* Pharmacist as Disgusting, Doctors, Government, Me being a dick, Me hating others, Politics, Stupid People

I’ve done nothing but battle with crazy ass QUACKS this last two weeks. From the battle with SmartMoney.com to my letters to the editor, I’ve been a busy little bee!

Pharmagirl10 brought this crap to my attention: One Doctor’s Quest to Cut Unneeded Treatments (Behold These Six Common Medical Procedures That Do No Patient Any Good)

What happened to responsible journalism? What happened to not scaring the shit out of uneducated, not-all-of-them-are-fucking-doctor Americans? You simply CANNOT tell patients this kind of stuff and expect them to not go jumping off a cliff. There is no such thing as a grain of salt. If it’s on ABC news, it’s fact. The average American is naive and actually believes in responsible journalism. They believe that articles like this have been meticulously disseminated and combed over for errors.

They do not differentiate shitty, poorly written OpEd from high end fact giving expose. They are in the paper or on the website, they are each of the same high caliber —– Except this fucking garbage. Let’s see what Dr. Nortin Hadler, professor of medicine and microbiology/immunology at UNC, thinks is unnecessary:

1. Oral Hypoglycemic Drugs (Because they do not spare one from heart attacks, strokes, kidney failure, skin ulcers, or anything else you might care about, including death before your time)
- So, should I stop my cholesterol medicine because my knee hurts? While I understand the correlation between diabetes and all of the things you list, your logic is flawed and irrational. Oral hypoglycemics were created to keep blood sugar lower and therefore prevent morbidities related to hyperglycemia, such as neuropathy, PROGRESSION of CKD, retinopathy, and basically everything else you speak of. While Dr. Hadler believes that they don’t DIRECTLY do those things, the American Diabetes Association DIRECTLY DISAGREES. The STANDARD OF CARE contradicts your retarded dribble [The PDF is info on ALL approved Diabetes Drugs]. The rest of the ADA Guidelines proving you WRONG are here: http://care.diabetesjournals.org/content/32/Supplement_1
2. If you think coronary artery bypass surgery (CABG) or angioplasty with or without stents can save your life or improve your angina, think again.
- This one is humorous because, again, the logic is completely FLAWED! This statement is the equivalent of me saying to a person with one lung, “Don’t use Albuterol thinking it’s going to make it easier to breathe after exercise — IT WONT!”  — CABG is WAY down the line for the treatment of fucking ANGINA. CABG and angio are treatments following STEMI (ST-Elevated Mycardial Infarctions — HEART ATTACKS) which is different than angina. Angina treatment algorithm: Nitrates (ASA or Plavix to reduce risk) —> LA Nitrate –> Calcium Channel Blockers –> Beta Blockers –> Change to different CCB –> Ranexa (Ranolazine) –> THEN CONSIDER Angio.
- This guy is just a stupid dick.
3. No one should submit to a screening test unless it’s accurate, the disease is important, and we can treat the disease. Tests that fail: MAMMOGRAPHY, PROSTATE SPECIFIC ANTIGEN (PSA), HbA1c, and CHOLESTEROL.
- This guy is going to get himself shot by at least one major health organization. Now he’s going to fuck with Susan G. Komen? Right after Mother’s Day? Sorry guy…while it’s not perfect, mammographies save lives. The problem is that women don’t get them soon enough, often enough, and they are subject to MASSIVE amounts of OPERATOR ERROR due to LACK of experience. PSA is one that has gotten a bad rap. The issues with it is that levels can elevate if a man has prostatis, and they increase we age regardless. So, we really don’t have set guidelines on at what age they become erroneous and what level we need to biopsy at. General consensus right now is that we biopsy over 4 after retesting 30 days later. Nonetheless, simple, cheap blood test that has some NEGATIVE PREDICTIVE VALUE. Meaning, if your PSA is really low, you don’t have prostate cancer. If it’s through the roof, you MAY have prostate issues or it may just be high due to other causes. A1c? See those Diabetes guidelines linked above. Everything diabetes is centered around that value. He’s an idiot for questioning it. Finally, we have cholesterol. I have no idea what his beef is with either LDL, HDL, TG, or Total Cholesterol.  They are accurate tests so long as the patient has been fasting. The disease is important as cholesterol can break of and plug veins all over the body, and we can easily treat high cholesterol. It’s quackery I tell ya!
4. The argument that arthroscopic surgery for your knee will do something good for you in the short or long term is an example of the power of belief over science.
- This statement is an example of a retarded blanket statement which is misguided. I’m sure that he is referring to something specific. Because, I myself had several TORN TENDONS/LIGAMENTS in my fucking knee. I couldn’t walk as my bones had no intact ligaments holding them together. I had arthroscopic knee surgery where they were sewn back together and after many months and lots of rehab, I could walk (and play basketball) once again! To say that my surgery did nothing for me in the short or long term is absolutely wrong — I cannot fathom how one could even begin to believe that I could merely ice my knee, rub some dirt on it, and I’d be fine in a few days after some Ibuprofen.
5. Anyone who thinks that any form of surgery can benefit isolated low back pain has been fooled.
- Another very broad statement that I’m sure can be burned. Any orthopedic or back surgeons reading today? I cannot speak here as I have no knowledge in this area. I once again think he’s probably full of shit, but I have no basis here — other than the previous 4 examples where he has proven himself insane.
6. Any well woman who thinks treating a low bone mineral density will result in anything meaningful for them has been sold another old wives’ tale. Since this is so, bone mineral density screening of well women is foolish.
- If this were the case, there would be about 10 drugs not currently approved by the FDA. Granted, the bisphosphonates have pulled the wool over the eye of many doctors — THEY DO NOT BUILD BONE! They merely reduce the resorption of bone. They keep us where we are. Only the injection called Forteo can rebuild bone. It’s only indicated for use for 2 years, but it is PROVEN to rebuild bone and strengthen weakened bone — especially in the lumbar spine. After 2 years, you switch to the bisphosphonates to keep you from losing those gains. The test, T/Z-Score is very straightforward. I think it is best to do a full body scan rather than scan the ankle — I’ve read studies calling that into question for accuracy. But the drugs? They cannot be argued. The numbers prove that compression fractures as well as breaks upon falling are reduced after bone is rebuilt and maintained.

He makes a few other political claims about the stimulus bill and “comparative effectiveness trials” — I’m sure he’s talking about something he knows little about….

My work here is done…