Yeah, whatever…….
Pharmacy should come with a warning for future students. I think something along the lines of this would be good:
"WARNING: Pharmacy is NOT as lucrative as it appears. The ones who have the money are vindictive bastards, governments, or cold high-street or supermarket chains who will flog your acquired knowledge, skills and will test your patience. Pharmacy is not a career option-it is a lifestyle. If you embrace it, you are embracing a 24/7 job, with limited opportunities (unless your dad owns a pharmaceutical company) and shite pay. Your health will always be at risk from the infected, the mentally ill, the addicted and vindictive old women.*"
*Pharmacy will turn you from a person with ideals and values, into a person with IBS and dissatisfaction. Ulcers have been reported.......
I wish someone had told me about the health risks involved when I took on the notion of being a "respected" pharmacist (hahahahahaha) 10 years ago as I was making my career choices in school. I was....enamoured by the thought that I could be in control and still have a life-working 9-5, having holidays, getting paid well and all for giving advice and handing out drugs.....
10 years later. I'm 27 and already varicose veins are showing from years of standing, running and jumping to attention <Heil Mein Patient!!!>., Everywhere I look, GPs are immortal, nurses are queens (I don't envy them, sometimes they get it just as bad as we do) and I am the patients' (NOT customers!) worst enemy. But enough about my dissatisfaction with pharmacy in general-I have found a shining light, and hopefully this time next year I will be an expert in the field of diabetes-and a supplementary prescriber, prescribing set drugs within a budget for certain patients.
Anyway, to the title of my blog. A patient, in her 70s, is quite able to move around (this pisses me off as she gets deliveries of drugs free to her home EVERY week). So much so, that she was able to manoevure her way down to the pharmacy to have a go at me yesterday. (Brief history-she's a right royal pain in the hole that my predecessor nannied, which I have no intention of doing-I prefer "tough love").
So, she says "why isn't the senna in a box?" . Me " It only comes in tubs now Mrs S."
Mrs S "Why?" Me "You'll have to ask our wholesaler that Mrs S. I can't dictate what they send in."
Mrs S "Well, what about this then? I always get paracetamol (acetaminophen) capsules"
So, I went, dug out the prescription, and showed her that the GP had prescribed TABLETS, and that 1) I can only dispense what the GP tells me to, and 2) that her problem was with the practice, not with me. I think it's one of the few times I have actually been pushed to the point of actually wanting to physically throw a patient out. She is the most horrible old doll in the universe-and as she left I said to my assistant "I wish she'd get flattened by a bus or drop dead". Her attack on me led me to forget the more important stuff-luckily I sorted out scripts for my three patients on palliative care (i.e. death row), but forgot to get the methadone/physeptone ordered in for this week. I can do it tommorrow-it'll just be tough dealing with grumpy addicts until after 4.30pm....<sigh>
I am anticipating something will happen to her-I'll probably walk into work tommorrow and hear the news that she DID drop dead....but then I'm not that lucky......
It's only my duty to help her to extend her life-though why should I when there are so many others who are in real need? She needs a dose of reality. I may have been baptised a Catholic, I don't go to mass, and I may not believe in God....but I know right from wrong-and yet....I can do nothing..but dish up that cantankerous c**ts cocktail of drugs until the day she leaves.
At the end of the day, when MY life span is up and the reaper comes, I want to be able to look back and say "Yeah, I was good at my job. I had a life and made a difference in others too. I wasn't a bad person, but I was tough because I had to be. And at least I made a difference in a good way-not sniping or being rude-for in the end I am only human."
"yeah lil' laura....whatever....."
Rant over.....now.
Discharge Scripts
Do they even look at these damn things?
I have a hospital near me that generates discharge scripts via computer. It's all based on what meds the patient was on during the stay in-house. I know the process there because I called and spoke with their pharmacist on duty one night. We hate our jobs equally.
It goes like this. The Ward Clerk generates a list of all current meds on the MAR (Medication Administration Record). This sheet includes PRNs, parenterals, orals, rectals -- the works. The doctor then goes down the list and circles YES or NO. This sheet is then sent to the pharmacist who removes the NO drugs from the profile (by D/C'ing them). Then, the pharmacist prints these sheets directly on the floor and they are reviewed by the patient's nurse based on what was said and what s/he expected. There is a space for the doctor to sign. My pharmacy will fill these w/o the docs signature because we deal with the hospital so much and these sheets are not "fake able." I will admit though, that only 1 out of every 50 are unsigned. So, for the most part, the doctor has the OPPORTUNITY to review these sheets again. A quantity is written in on the bottom as well -- usually it's ONE MONTH.
So I can say, without a doubt then, that at least THREE sets of eyes see (or should see) these damn things before being given to a patient -- Pharmacist, [Ward Clerk perhaps?], Nurse, and Doctor.
Why in the fuck did I get a sheet today that listed:
1. Fentanyl PCA 10mcg/hr Basal with 10mcg on Demand Every 10 Minutes.
2. D5NS 100mL/hr
3. Naloxone
- This was obviously in a 'set' with the Fentanyl to pull from a Pyxis if needed.
4. Heparin Lock Flush 100 Units prn
5. Ancef 1g one hour pre-op
How did this shit get by? It was fucking signed by the doctor. He even wrote in *his* DEA number to cover the fentanyl...the only Narc on the script.
There was more on the script of course - they always leave OTC/PRN stuff and we just use our professional judgment on how to get those things to the patients (Ibuprofen, Docusate, Baby ASA). Usually we just grab it off the shelf if they want it.
But seriously? Dextrose in Normal Saline? Would you like me to educate the patient on how to start a line on himself? Should I also work through with him on how to operate the PCA Pump he has in his bedroom - making sure he sets it for MICROgrams rather than MILLIgrams since it's fentanyl? [End Sarcasm]
I'm expected to review my work before it leaves my pharmacy. Why is this healthcare team not expected to do the same? I could get in serious trouble for not checking my final product prepared by my technicians.
If you care about the outcome I reached - I just scratched the bullshit out. Later in the night when it slowed down, I called the pharmacist on duty there and let him know that that stuff snuck through. He attributed it to "a student screwing around on the computer." I attributed it to his laziness or lackadaisical demeanor. He did not like my analysis -- nor did he apologize for the actions of himself or his student. If his lame-ass excuse was valid/true -- it's still his fault for not staring over the student's shoulder...which would be the law for the student entering orders in my state of residence.
Headhunters
I got the message below from what I like to call a headhunter. What do they do all day? They call us, hardworking pharmacists in the trenches, at work. They bother us incessantly....non stop. Feigning interested in our day. Telling us about "exciting opportunities" in "various healthcare field" with "immediately openings available in our area of the country."
That's right. They call me at my job, who currently pays my bills, and asks me if I want to quit and work for any company that will take me. They will promise you the world. Can they deliver? They don't know. They don't care. They likely read off a script just like every other telemarketer in America.
I understand as well as anybody that it takes a ton of different people to make the world go around. For every job, there is a worker willing to take that job at that wage. It may not be what I would want to do, or what I could earn, but the job is there nonetheless.
But, how in the fuck do these people make their place in the world? I just don't get it! I could not imagine a pharmacist, regardless of their level of disgruntlement, saying, "Yeah, I'll quit this bitch for whatever job you can find me with XYZ company." I've never heard of someone doing it. So, I've never heard of a success story. To make matters worse, they bother us at our already hectic jobs. This pisses us off and REALLY makes me want to jump ship!
What makes this specific commenter all the more asinine is that I had a run in with her a while back. The Pharmacy Alliance had an oft-used email listserv prior to their meeting in Texas. She chimed in with this same recruitment chum. I didn't reply in a swear laden hate-speech. I didn't even tell her to go fuck herself. I just replied with, "Whoa."
Now, at work, I like to fuck with these people. The way I see it is that my time is money. I'm sure my time is worth more than there's, but I'm a huge dick and I like to get a laugh at other people's expense. I often ask them for all the details and not pay a lick of attention. Then I ask them again. After that I'll ask them random questions they have no business knowing until they get the hint. "Ma'am, why can't tigecycline be used for bactermia?" or "Why is Zyvox contraindicated in people on MAOIs?" or "What's the max daily dose of Oxycodone in a properly titrated person" or my personal favorite, "Why can't enteric coated aspirin be used to treat a headache?" If they still don't get the hint, I ask them, "Why does Mickey Mouse have big ears?" -- That's usually the fuck off question that gets em.
Bonus points for answering the real questions in the comments.
A new submission (form: "Contact Form")
============================================
Submitted on: June 4, 2008
Via: http://www.theangriestpharmacist.com/contact/
By <edited out IP> (visitor IP).
| Contact Form | |
| Your Name | Libby <edited> |
| I am a | Not in Pharmacy |
| Email Address | <edited>@vermilliongroup.com |
| Website | http://www.vermilliongroup.com |
| Comment | Please contact me if you would like to find a new position! We have contracts with a lot of the Hospitals throughout the US looking for full time Pharmacist, Pharmacy director's and Managers. We work with several large retail chains as well!! We would love to help you find your dream job!!
Libby <edited> |
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