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I have never been treated so horribly in my life
An Indian guy came up to the drop-off tonite. He wanted a refill for his wife. It was for amlodipine. The bottle 6 tablets left in it. It had zero refills left. I, very nicely, told the man that it had no refills, but I printed a note to call the doctor the following morning. He asked me why I couldn't call immediately. I told him it was 7pm, and the office was closed. He looked very discouraged and would have to call her. He grabbed his cell phone and I immediately knew where this was going. He spoke in an Indian dialect to her for a few minutes (I heard my name uttered as well). Then he tried to hand me his nasty, grubby ass phone. Side note: I refuse to talk on people's cell phones. I hate them. They are nasty, covered with ear wax, and who knows where they have been. I quickly handed him a business card and told him she would have to call me.
She called 7 seconds later and began immediately dressing me down. I got a word or two in and told her it had no refills. I explained that her bottle had 6 tabs left. I told her if it were empty I would have no problem giving her as many tablets as she needed. I explained how we have to call doctors every day for refills and there would be no problems filling the prescription tomorrow.
Then the berating began. I heard a swear-filled mix of Hindi, English, Sailor, Bihari, Tamil, and Irish. I didn't comprehend much of it because it was so fucking fast. I could make out the following phrases in this general order:
"I have a lifetime prescription"
"Dut dut dut"
"This is blood pressure medicine"
"Dut dut dut"
"I could die"
"Dut dut dut"
"I will sue you"
"Dut dut dut"
"You are not a pharmacist"
"Dut dut dut"
"I want to talk to the store manager"
"Dut dut dut"
"They fill this all the time without refills"
"Dut dut dut"
"Just put the pills in the bottle and shut up"
I'm sure there was more mixed in there. I don't remember it. Much like Unwritten Law, I was "Seein' Red" -- I told her (while she was still screaming in the phone at the top of her lungs) that I didn't deserve to be talked to like this and that I was hanging up. After a while, I did just hang up. She was no longer giving me a chance to speak. We were getting nowhere.
I went down to her husband. I told him that his wife was screaming at me at the the top of her lungs and was very rude. I told him I did not deserve to get spoken to like that. His reply? He acted like he was not shocked. "I figured she was going to do that."
I, once again, explained the situation to him. No refills. Six tabs remaining. Filled within 18 hours. Would front tablets if needed. He just got back on the phone with her, began speaking another language, and walked off. I wanted to tell him he needed to go home and give her a good beating. People that treat others like that need a good slappin'.
She called back again. My tech got the call this time and pretty much said the exact same fucking thing. Then got off the phone.
Next time this bitch brings in a prescription to me...I am not filling it. Conincedently, I see some ordering troubles with amlodipine. I'm pawning this bullshit off on Walgreens.
Update 12-11-07: I never wrote this up, but the next time this bitch came in, I asked her why she yelled at me. [She was handing me her bottle to refill] She halfway apologized and said she was having a bad day...dut dut dut. I told her that because of her, I had a horrible day because I didn't deserve that or enjoy having such words screamed in my ear. She then began to try and convince me I was wrong because I should have filled it - she tried to get loud. Then I said, "Hold on just one second. I'm going to talk now, and all I want you to do is listen. Don't speak. Don't yell. Don't interrupt. Just listen to me. Your prescription was out of refills. Regardless of how long you have been on or will be on a medicine, when your bottle has zero refills, we have to call your doctor for more. Your bottle had 6 tablets in it that would have lasted you SIX days. It was Sunday night at 7pm so your doctor's office was closed. I called for you the next morning and got the call back from their office that afternoon, less than 24 hours later. You never expressed a need for those tablets prior to that, and you had no reason to believe that I wouldn't fill the prescription. You just began screaming because you refused to listen to me. That is a horrible way to act and you should never ever do that again to anyone especially someone you entrust your health care with. Now, do you have anything to say?" [Hence, say you're sorry cuntbag]
"Yes...dut dut dut...I have lifetime prescription...dut dut dut...you should have just filled it...dut dut dut..." [At this point I put up both hands as if to stop her.] "Whoa. No. No more. Here's your bottle back. I'm no longer filling prescriptions for you at this store. You can take this bottle to any pharmacy in the country, of this chain or not, and they will fill it for you, but you are no longer welcome to get your prescriptions filled here. Goodbye." And just like that, I walked away. I could have handled it differently. Of course, she could have just as easily apologized. I love that I have the power and free reign to tell that bitch to go fly a kite...it's empowering and a good backup. It allows me to effectively manage. But, know this, I don't just run people off because I can. She's the 4th person I've told to never come in the last 4 or 5 years (and one of those people tried to steal a bottle of Beer by cramming it up her va-jay-jay) -- The others were doctor shoppers, users, and/or abusers.
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Why did you ask if you are smarter than me?
You know exactly what I'm talking about. Everyone has dealt with it -- some of us in 'the suck' deal with it daily. Patient presents to the POD (Pharmacist On Duty) with a random question and a product they removed from the shelf. The question is asked and regardless of how simplistic it is and how straightforward the answer may be, the patient has the gall, the arrogance, the nerve, and the self-centeredness to argue, rebut, or question your expert opinion...that THEY ASKED FOR. You didn't charge them. You didn't blow smoke up their ass. Yet, suddenly, a person that does not have a B.S. or Pharm.D. knows considerably more about pharmacy than the white-coat-wearing apothecary standing before them.
Here's my story from today (it's long, but *completely* worth it):
25-year old female and 55-year old male approach. She's holding a bottle of generic "Women's One-a-Day."
Lady: "What vitamin should I take?"
-- "Well, what are you taking them for? A doctor's suggestion?"
Lady: "No. I'm just taking them as a supplement. I don't always eat healthy."
Man: "Is this a good one?" [At this point, I look at her hand that's holding the vitamins and see that she's wearing a huge rock on her 'special' finger. She's relatively cute, and it's painfully obvious that the grisly, buck-toothed, beast of a man with her is her father.]
-- "This is just as good as the name brand stuff, and it's a lot cheaper. Are you taking and medicines? Any prescriptions, over-the-counter stuff, or herbal medications?"
Lady: "Well, I take Tegretol for simple seizures." [Bingo.]
-- "And you're not already taking a vitamin or two?" [She said, "No."] "What other prescriptions are you taking?"
Lady: "I've been taking Ortho Tri-Cyclen forever."
-- "Okay. Well, there are a couple things here. Are you aware that the Tegretol greatly reduces the effectiveness of all birth control pills? It's fine to take them as a backup, but you cannot depend on them alone to prevent pregnancy. [She nodded affirmatively as if to say, "I knew that, but I never believed it or gave a shit before."] And, due to that fact, you need to be taking Folic Acid as well."
Man: "What? Folic Acid? What about Vitamin C?"
Lady: "Yeah. I take 1,000 mg of Vitamin C a day for my immune system...to prevent colds."
Man: "How much Vitamin C is in these things?"
Lady: "It says 65 mg." [We're getting way the fuck away from where I was headed.]
Man: "Is that enough to prevent colds?" [Didn't even wanna bring up the fact that Linus Pauling faked or "misinterpreted" his data.]
-- "No. That's merely the amount you would need to prevent scurvy, and that's it. The doses I've heard used to 'bolster the immune system' range from 2 grams all the way up to 20 grams, but researchers are always going back and forth. They'll never be able to prove whether or not it actually works. You can continue to take it with this multivitamin though." [They nodded in agreement] "But, like I was saying, you need to be taking Folic Acid every day as well."
Man: "How much Folic Acid are in them?"
Lady: "It says 400 m-c-g." [At this point, the man commandeers the bottle.]
Man: "This here says that 400 is 100% of the daily value."
-- "That's exactly right. It is. But, since she is taking Tegretol and is of child bearing age, she needs to be taking a *lot* more Folic Acid.
Man: "Well how much do yoooou think she should be taking?" [He really did stretch out his word like that -- it was very accusatory, and it also activated Super-Dick Mode.]
-- "Well, she neeeeeeds to be taking, based on the number of micrograms, between 1,000 and 4,000 a day. [I'm not full of shit here. It's 1-4 mg per day if on antiepileptic, right? 4mg if you are GOING to get preggo.]
Man: "So, you're gonna stand there and tell me that she has to take 10 of these things a day?" [This statement alone proved to me that this man was, in fact, the dumbest person within a 25-mile radius of my location at that time. And I work down the street from a nursery school.]
-- "Absolutely not. She should take one of these a day just as it says. In addition to that, she should take a Folic Acid tablet or two. It's made as a supplement. We have it, and it's pretty cheap."
Man: "But this bottle says right here [He points because I can't remember what's said from one minute to the next -- apparently I resemble either a goldfish or an Alzheimer's patient in my white coat.] that one of these tablets is 100% of her daily value. Why should she take more than 100%?"
-- "The medicine she is taking for her seizures will cause birth defects should she become pregnant by accident or plan. Point blank. There's no maybe involved. It will cause birth defects. These defects are caused because of a lack of Folic Acid. By taking Folic Acid in amounts above what a normal person not taking this medicine would need, we can hope to prevent these birth defects.
Man: "I don't understand why a person would need more than 100%." [Ultra Mega Dick mode has now been activated by the degree of stupidity abound. This man treated me as a goldfish a few moments ago by pointing to a number on a bottle that I have known since I was in my first year of pharmacy school. Now, keep reading as I show him that he is the dumbest person on the face of the planet and cannot remember from one minute to the next. Now, I commandeer the bottle.]
-- "You're concerned with her taking too much Folic Acid? Let's look back. You said you were taking 1,000 mg of Vitamin C each day. Hmm. 100% of your daily dose of that is 65 mg. By my crude calculations, she's taking about 15 times her daily value. I said that 20 gram doses have been studied. That's like 30,000% of the recommended daily dose, and you didn't seem to contest doing that. The fact of that matter is that these Recommended Daily Allowances are outdated, not entirely accurate, and need updating. All I'm saying is that she needs to take one of these vitamins once a day and two or three of these Folic Acid tablets." [By this time, my wonderful tech had already retrieved a bottle of 100, written the price on a post-it, and handed it to me. So, I held up each of the bottles as I referenced them. BTW, I bought her lunch.]
-- "If you are concerned about the specifics, call her regular doctor or a gynecologist and ask them if I am lying or wrong." [I wanted to add, "...or next time, don't ask my fucking opinion if you are so qualified to make all the medical decisions."]
Man: "I don't doubt that you're right. I just don't understand why this says 100% if she needs to take more." [What? Are you fucking playing with me? I just explained that you inept asshole.]
-- "That *is* 100%. It's 100% for me -- a 30-something male because I'm not pregnant, I'm not taking medicines for seizures, I'm not sick, and I'm not a nursing mother. I have no reason for more than 100%. She does. And that is precisely why these Daily Allowances need clarification and updating.
Lady: Well, all right. Thanks a lot for the help. [I'm assuming they walked away saying, "I can't believe that guy thinks he can get pregnant. He should know that he can't get pregnant cause he don't got no boobies to feed the baby."]
-=+=-
Anyway, as headed down the aisle, I watched the man put the bottle of Folic Acid my tech had so perfectly retrieved (without prompt or request) and I handed him (which cost $2.97) on a random shelf. I wasn't even mad. Hell, I didn't give a shit then, and looking back, I care even less now. If they are that stupid/inept, it's quite likely that the child will be just as feebleminded and dimwitted as them, if he's not born a 7-lb turd with legs. With any luck, the lack of folic acid will disable her from ever reproducing.
I know that a neural tube defect will definitely keep the baby from ever being anything worthwhile (if it can be alive in the first place).
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Medicare Part D — WTF?
I received this email through the pharmacist-grape vine.
-=+=-
From:[Contact TheAngriestPharmacist for Sender's Email]
To: rick.larsen@mail.house.gov
Subject: Medicare Part D Merry Go Round 2008
Date: Wed, 28 Nov 2007 22:57:54 -080011/28/2007
Representative Rick Larsen
United States House of Representatives
1529 Longworth House Office Building
Washington, DC 20515Dear Rick:
From time to time you have been able to stop in our pharmacy when on
Lopez Island and I always felt you listened to our concerns about health
care. I thought I'd share with you what I call the Medicare Part D
Merry-Go-Round. Each year the Medicare patient must reevaluate their
respective Medicare Part D drug plan, only because the coverage that they
had during the current year can and does change each year.Plans have low balled premiums only to raise them in latter years
with the hope that most Medicare patients won't change their plan. If they
don't raise their premium they change what they cover. If that isn't enough
the plans then still covers their drugs, but then changes the copays, or
other criteria for their drugs. This is a unbelievable complicated system
for our seniors. We try to help our patients make sense of the changes, and
when we can we provide education to them to show what their plan was, is or
will be. Again most of the plans are betting that the patient will not
change plans.I've got a good grasp on the system and it takes me hours to
evaluate the plans, can you imagine how a Medicare patient that isn't
computer savvy feels? This system needs to be fixed and fixed now. Think
about these common sense ideas.1. Make a fixed list of drugs that are covered for a basic, premium and
deluxe plan.
2. Make copays fixed for generics and brand name.
3. Get the rebates that are lining the pockets of the managers of these
plans into the patients pocket by getting rid of the donut hole.
4. Let the PBM's make their money by being claims processors, not slight of
hand artists in hiding their rebate dollars.
5. Remove the self-referrals that the PBM's are making by steering the
Medicare patient into their own mail order pharmacies.
6. We need to allow medications to stand on their own two feet for their
effectiveness, not how many TV ads that can generate.
These direct to consumer ads are adding huge amounts to the cost of
prescriptions in this country. We all know that more dollars are spent on
promotions than on research.
7. Finally make one plan ran by Medicare itself, not by the private plans.Our elected officials have the power to change this system and it
must be changed. What is important is getting quality care to our seniors.Respectfully,
Richard C.McCoy,Jr.R.Ph.
Lopez Island Pharmacy
Lopez Island, WA 98261
360-468-#### x103 [Contact TheAngriestPharmacist for Phone Number]***Reproduction and publication rights are granted on this letter to any
group or individual ***
I think Mr. McCoy has hit the nail on the head. The Federal Government conceded the fact they they could not handle adequately implementing Medicare Part D, so they allowed the insurance companies to step in and take a crack at it. Much as we would have expected, the PBMs have concerned themselves with their pockets and not with the welfare of our seniors/recipients.
I've said for a long ass time that direct-to-consumer advertising needs to be made illegal. The average American cannot be expected to comprehend the many factors that go into prescribing. And the fact that Pharma sidesteps the law by merely stating, "Ask your doctor about DrugX" really pisses me off. If they do not state the indication, they do not have to specify the potentially dangerous (and common) side effects. Another practice Pharma has resorted to is that of completely ignoring the law. Throw together a commercial. Get it on the airwaves quickly and widespread -- then watch the profits roll in. They may be breaking the law, but by the time complaints can be registered and the FDA can get an injunction (they don't have any real power) Big Pharma has already seen profits well above potential fines they may incur. That's fucking bullshit isn't it?
Don't even let me get started about what Part D's reimbursements have done to the independents. These guys are fighting tooth and nail to stay afloat. They don't have a 200 thousand square foot store to account for losses incurred to balance things out.
Rick has also nailed the complexity of the plans. If I have to struggle to comprehend the assorted plans, I can't imagine what our country's seniors are thinking. This has created a viscious cycle. Pharmacists don't have time to learn the plans and/or help the people due to the increased volume generated by the number of people covered and the decreasing number of pharmacies.
I'm pissed off -- how about you?
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