2. Had a very rotund person (never seen her before -- so not a regular) came in and ask me about getting a shingles vaccine as she did not want to catch it from any of her friends. I told her that it was in no way contagious. She goes on to say that 2 or 3 of her friends have it or have had it and that her doctor told her that "IT. WAS. CONTAGIOUS!" I told her that "I will back off my previous statement a very small bit -- If a person comes into contact with a shingles rash, for instance if they are covering the wounds and come into contact with the actual seeping wound, they could potentially catch CHICKENPOX if they had not previously had CHICKENPOX or the CHICKENPOX Vaccination. Shingles, meaning the form of chickenpox that comes back up later in life and causes serious pain, cannot be transmitted from on person to another." [Source: http://www.immunize.org/askexperts/experts_zos.asp] Her response was a steadfast, "Well, my doctor doesn't agree. He says you can get it from anyone that has shingles on their skin or has ever had it."

At this point, I once again took the position of not giving a fuck. Either listen to reason or go away. I told her, "If your doctor is telling you this, and he is serious, I think you need to get a new doctor. As I can print out several different papers and references in just a few minutes that would disprove that notion."

Her response was, nothing less than I expected, "Maybe I should get a new pharmacist..." I just sad, in a trailing voice but loud enough for her to full figure out what I PROBABLY said, "I think you should do that you stupid fat bitch..."     Believe me...she was being a standoffish, stupid, fat bitch.

3. Had a lady come to pick up a refill for, of course, Xanax. It was later in the night -- slowed down immensely. I was completely caught up and actually listening to the radio a bit. She came to the pickup window, I looked up her name and immediately saw that we had requested refills, and we had not heard back. She looks me right in the eye and says, "Is it in you box? I mean...can you check your box?...Is it in your box?"    I really wanted to say, "Why no, have you checked YOUR BOX? I'm sure we could hide a set of car keys in there!"  Instead, she goes into a long diatribe about how a 3 months ago she came to pick up her refill and we told her it wasn't called it...only to find out that after she drove "all the way to the doctor's office," [a gas-chugging 4-5 minutes away] "it was sitting on the counter as there was a problem with it." [The doctor faxed it back sans signature] So, I stand by the statement that the doctor hadn't really done his job! At that juncture, we had faxed them back for ANOTHER Auth. Today, I told her that our inBOX didn't receive prescriptions (just email). She asked me to check our voicemail BOX, and I told her I didn't need to as our number of VMs is displayed on screen [I had ZERO]. No other BOXes to check...cept yours, biggun'!

I've been working for [this pharmacy] in [the Southeastern USA] for many years (5+ let's say). Before that, I spent 12 years at Walgreens. Is there any legal issue in a company not allowing their pharmacists a legitimate, leave the pharmacy, timed, lunch break? Well, legally, it must not be, or they would not be so easily getting away with it. As far as I know, it is the ONLY corporately run pharmacy not giving a lunch break in the state in which I live. All the usual suspects, when it comes to these human rights issues, Walgreeens, CVS, Wal-mart, Sam's Club, provide lunches -- sometimes even within a CLOSED PHARMACY. Do you have any comments? How can I post such a question on your site to ask other professionals?

Well, you did it in the right way. Send your questions, comments or guest articles via the CONTACT Page and I'll see what I can do.

Anyway, readers, tell him what you know. Here's what I know. Pharmacists are sometimes listed as salaried management and therefore fall under different guidelines than your every day cashier, technician, or stocker. I'd bet my bottom dollar that is the case where you work. That's the exact story where I live. Fortunately, I'm able to go sit down, even if just for a few minutes to eat some lunch every day. Even if it's a scattered 15 minutes. I shoot for noon when I know the phone will slow down as the nurses are all out to lunch, and patient's slow a bit too -- at least the ones that have jobs. So, I woof down my lunch. If you can't do that, I'm sorry. Move to another store/chain or transfer to a slower store that would allow you more time in general for afternoon tea...:-)

Anything else for the good of the order?

This is a submitted question/dilemma from a young pharmacist known as "M" -- s/he is requesting that the community help her with some professional advice and recommendations from our little blogosphere community.

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As a new pharmacist, I have a dilemna concerning my role/authority in the pharmacy.  Since I'm new to the store, I have a lot to learn from the senior techs as far as managing the pharmacy is concerned.  In essence, they are actually training me to run the pharmacy.  For this reason, I sometimes feel like they take advantage of that, and they do whatever they want.  They often come in late and call off last minute.  One technician doesn't like to 'fill' so I end up filling most of the scripts, verifying, and then ringing it out as well.  She claims she has other stuff to do, which she sometimes does.  I can't complain much because she will do certain tasks and help free my ear from the telephone.  However, I'm just not comfortable with her not listening when I ask for her to help in filling. I'm trying hard to learn much so I don't find myself solely dependent on them (technicians).  So far, I've been nothing but nice to them, and they've yet to call in on my shift.  But I know that day will eventually come... Regardless, this has got to stop. We must be able to depend on them as our patients depend on us.

Please help me by providing me some ideas on how I can approach the situation with both my pharmacy manager, other staff pharmacists, and most importantly, address my concerns gingerly with the technicians without alienating them and subsequently finding myself on the wrong end of a string of sick days! I've also got to consider various friendships (or grudges) between techs and pharmacists, or even techs and techs.

Any advice would be most appreciated! Thanks!

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Do you want to submit a guest post or discussion topic [since I don't post nearly enough]? Type it up and email it to me via the contact page. Also, let me know if you want your name/email address shared publicly, what POLL question you would like to accompany it (if any), and anything else you think is important. Guest Posts will be edited for grammar and spelling. I may also add emphasis, clarification, funny links, or other silly stuff [I might remove inappropriate stuff as well]. I will NOT alter the content/message of your post.

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"REFILL TOO SOON," GUYS. That means, in pharmacy lingo, your insurance will not pay for your prescription until the resubmit date. One late night at the pharmacy, which by the way is in the ghetto, a woman comes in to refill her son’s prescription. As I processed the prescription I explained to her that it is a REFILL TOO SOON and the insurance wouldn’t pay for the refill until tomorrow morning. She obviously wouldn’t accept that answer and went into a rant against me (a technician), the pharmacist working with me, and our drug store. As I recall it went something like this:

“My baby needs his medication! He is sick! He needs it NOW!!!!! You stupid white bitch you had better fill my prescription or im going to kick your ass! Her's too. That other bitch pharmacist! What you think yous better than me? I want it now! Ima get me suma that shit now and my momma gon' pay for it! Make it now! Get it ready, Bitch!”

I looked at her, looked at the pharmacist, and explained to the woman that if she would WAIT ONE MORE DAY [less than 18 hours, actually], the prescription wouldn’t have copay because this woman was on state assisted insurance.

I told her that the medication would be $45 and if she wanted it, she could pay for it, but that amount wouldn’t be refunded the next day. Her response, although not responsive to the information, went something like this:

“What you think I’m broke, bitch? I can’t pay for my babay's medicine? Fuck you ima just buy it ima just buy it you can’t tell me what to do, this my babay, THIS MY BABY AND HE NEEDS HIS MEDICINE NOW GET IT READY DUMB BITCH.”

You're not broke? Oh, okay. Then I guess you’re just one of those lazy folks who doesn’t work and just expects the government to pay for your prescriptions. I can safely assume you are probably on food stamps too? Welfare? You're yelling at me, and I am partially paying for your prescription by paying taxes? I have no choice but to have my tax dollars used to pay for “your babay's medicine,” and I have no choice but to abide by your every wish and want because 'the customer is always right,' right? So, I swallowed my insults, and I bottled my anger, and filled the prescription.

By this time, her mom (the "babay's" grandma) came to the counter and apologized profusely with the accurate explanation that woman was mentally retarded. MENTALLY RETARDED. And she has children? What the fuck. You can draw your own conclusions on that one. And by the way, after all that, she didn’t, or better yet, her mom didn’t buy the medication because she, having some sense about her, WANTED TO WAIT UNTIL THE NEXT DAY. By the way, the drug was for SEASONAL ALLERGIES. Not seizures, not juvenile diabetes, not horrible psoriasis, not dangerous asthma, not epi or glucagon. SEASONAL ALLERGIES. Couldn't wait 18 hours, and *I'm* the dumb bitch.

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Do you want to submit a guest post [since I don't post nearly enough]? Type it up and email it to me via the same contact page. Also, let me know if you want your name/email address shared publicly, what POLL question you would like to accompany it (if any), and anything else you think is important. Guest Posts will be edited for grammar and spelling. I may also add emphasis, clarification, funny links, or other silly stuff [I might remove inappropriate stuff as well]. I will NOT alter the content/message of your post.

"Prescription for Cal Ripkin. Zpak. No Refills. This is Dr. Johnson."

Luckily, I knew who Dr. Johnson was because he did not say his first name. I could just hear it in his voice that Mr. Ripkin called him at home or through the exchange acting as if he would absolutely die without a ZPAK STAT! And, rather than tell Mr. Ripkin to stop being a pussy and take a nap and some Tylenol, he just called in the prescription. Is antibiotic begging becoming some sort of weird variation of drug seeking?

Mr. Ripkin called me moments later and arrived mere minutes later. He needed that fucking ZPAK...

As I'm ringing him out, he doesn't ask about cough medicine. He doesn't ask about Advil or Tylenol. He doesn't ask me any REAL questions at all. He does hold out his hand and show me his palm. He's got a giant blister -- looks like it was from fighting a push mower without gloves.

"Will this ZPAK help with this blister?"

"I don't think it will. It's not super-red. It's definitely not infected. I wouldn't have torn it open -- maybe you could cover it with some super glue or Nu-skin to keep it from hurting."

"Oh. I kinda thought.....well....okay...thanks...."

So, let's recap here. Patient calls doctor for antibiotic. Doctor doesn't ask why, what for, or any questions. (It's for a blister, by the fucking way) Patient doesn't tell doctor what it's for. (It's for a blister, by the fucking way) Pharmacist fills it, patient comes to pick it up and pharmacist discovers patient wanted it for a blister, BY THE FUCKING WAY.

What a waste of time, money, resources, and my patience. This is one of the biggest examples of problems within our healthcare system -- WASTE and MISUSE OF ANTIBIOTICS. Super bug, anyone? This is how we are going to create it....

I get talked to like I'm a piece of shit all day. I'll be damned if I'm gonna come home and take e-shit from some nameless fuck over the internet (I do realize the hypocrisy of using the term 'nameless fuck' as I am one). But, what I mean is, people stumble upon this site and give me shit -- non-pharmacists, non-healthcare workers, nobodys.  I'm not that bad. I'm not a horrible person. Some of this is a joke. It's an act. It's a persona in some ways.

I do (or envision and reimagine) the things that you want to do but can't. A favorite comment from these nameless fucks is that I would/should be fired in their business for doing X or saying Y. Who are they to judge me or question what I do.

I can't fully express how much this pisses me off. Nor can I adequately express how some of these hatred and anger is misplaced. I'm not a bad guy. I'm not an unethical dick. 'You' just don't like THAT post.

Now, don't get me wrong -- I'm not deleting these comments because they person questions my judgment or doesn't like what I did. I can handle a dissenting opinion. That's not the issue. I would be FINE with that. But, I've yet to have a dissenting opinion posed in a professional manner worthy of being posts. For instance, in response to, "Unfortunately, this is  a true story" I got the following comment:

"This was written in a humorous way I’ll give you that.. Guy sure was stupid LOL!! I would fire you ASAP but I suspect you probably own or manage the pharmacy in the story, which is even more repulsive. You sir sicken me, and should be ashamed of your profession."

Now, do you see how that has no point? That serves no purpose other than to push me down (as well as the profession of pharmacy. Now, I can accept that this situation could have been handled a different way. But, unless you present a clear and concise rebuttal without resorting to belittling me or our pharmacy, I don't give a fuck what you have to say. Now, you don't have to be a kissass, but you can bring about a different POV without being a prick. Here's what you could say:

"While I agree that was frustrating, you handled it dead wrong. You're a pharmacist and obviously have some education. Not everyone in the world is a smart as you. Some people need things spelled out to them. Some people have learning disabilities. Did you ever things of that? Did you do what they taught you in school and ask him to show you how he will use the inhaler after you educated him? Oh, I forgot, you barely did educate him. This situation is nothing but a failure of a pharmacist to counsel a patient effectively.

See how that works? With a little cunning, you can tell me I'm wrong, pose your opinion, maybe even take a jab at me, have your comment posted, and not get permanently banned from my site WITHOUT BEING A SNIVELING PRICK. I'm not saying you can't swear. I'm not saying you can't question me or what I did. Just don't be a jerk. Don't attack me -- unless it is REALLY fucking funny and REALLY fucking good.

So, how do I remedy this? I thought about deleting all comments and blocking all future comments/discussion, but I value that input from fellow pharmacists and technicians. Instead, I've decided to require registration. That means that initial registration will require a name, verified email address, and maybe some other information as I see fit (such as an acceptance of terms of service). Then you can post comments on the site. After a certain number of approved comments, you will get the ability to post comments that skip my moderation -- after earning trust so to speak.

http://www.theangriestpharmacist.com/wp-login.php?action=register

We'll see how this goes for a while. Maybe a little bothersome registration will prevent assholes from doing what they do best.

4) REPLY TO ALL FAXES REQUESTING YOU GET A PRIOR AUTHORIZATION BY SIGNING IT AND AUTHORIZING "1+2" REFILLS. This is a GREAT way to both waste a pharmacist's time and really frustrate them. In most instances, they've told the patient 48-72 hours. By replying to the fax with refills, you show that you really want the patient to get the medicine, but it shows the pharmacy that you've got better things to do than read their stupid faxes. To really put a cherry on top of this one, schedule the fax to send at 4:55pm. This will ensure that even if the fax even goes through successfully in the first place, the pharmacy can't contact you again until the next day because the phones cut off at 5pm on the dot (and you cut out at 4:30pm in the first place)!

3) When they call you the next morning, make sure they have to leave you a voicemail. If you're feeling particularly randy, respond to that with a copy of the fax from the day before and a SNARKY  NOTE at the bottom of the fax. Some suggestions for the note are:
"Authorized (1+2) yesterday. Is your fax machine working?"
"I got your VM -- here's the auth you need. Thought I faxed this yesterday. WEIRD!!
You could also just skip the reply all together...

2) When they finally get a hold of you at the end of the second or the third day, tell them your office's standard is at least 3-5 business days on a PA Request. Tell them you'll get back with them at the beginning of next week. After you say this, don't do anything. Don't even ATTEMPT to get the prior authorization. Why you ask? Duh -- the pharmacist will probably call and remind you again on Tuesday or Wednesday when you actually need to do it anyway. Out of sight out of mind! [If you wanna be a real bitch, at this point you need to send another refill authorization in to pharmacy. No note this time -- you don't want to appear "catty."]

1) After they call you Wednesday, if it's a different pharmacist than the one you talked to the previous week you need to go off on him. Make a huge scene. Act as if everything that was sent in and you cannot figure out why the pharmacy refuses to fill the prescription. When they explain the PA Process to you, acknowledge it, say you'll get right on top of it, and completely ignore every word of it. At this point you need to go straight to your doctor and tell them the following, "Doc, I don't know what the heck is wrong with Walgreens. They are pretty much refusing to fill Mr. Johnson's _________.  I've dealt with several different members of their staff. I've faxed in the prescription at least two different times, called it in once, and I can't seem to get them to fill it!" Then, the doctor will call and ABSOLUTELY TEAR THAT STUPID PHARMACIST A NEW ONE! Sit back and laugh. You've done a good job. You've waste almost a week of the pharmacist's time, and you've not had to do much work or call for the PA.

Final Step) Now, when the doctor returns to you,  he'll explain to you that they just need you to get a PA. They'll be so scared of the doctor, they won't say anything about your prior shenanigans. Your response should be, "Well, why didn't they just SAY THAT!?! STUPID PHARMACISTS!" He will agree and, at this point, you need to call the pharmacy again and have them fax you the information on how to get the Prior Authorization. They will probably say something about how they sent you the information -- just tell them you never got anything. Now, buckle down and actually get the PA...dag nabbit!!

And that is how you get a PA!

He came back in...as angry as every. I asked him what the problem was and his exact response was precious: "I asked you what I'd need to do if I get this inhaler home and it didn't work and you SWORE UP AND DOWN IT WOULD. Well guess what -- the motherfucker don't work. Ya'll are selling defective shit in here, and I've done spent like $80 bucks on these sumbitches and you, yeah, you...right here [pointing at me as if I were the master of all things Ventolin HFA]...are gonna give me my money back....plus some, find out whose got one of these Gaht DAMN things that work, and transfer this prescription there."

Can you hear a big bellied redneck saying this? HAHAHAHA!

He brought all this stuff with him so I said, "Okay...calm down just a second. Pull out the inhaler you got the other day, and let's take a look."

He pulled it out and I nearly laughed because the answer was INSTANTLY OBVIOUS to me what this guy had done. He handed me the Ventolin HFA inhaler. It was in fine shape. I even squirted it in the air to check. I saw the medicine come straight out in burst of air.

Then, he handed me the Aerochamber. It still had the little plastic piece in it from a Proventil HFA inhaler that they had used once upon a time!

He was either removing the canister from the Ventolin HFA, inserting it into the Proventil HFA inhaler (sans canister), and trying to use the mismatched pair which was obviously unsuccessful [and EXACTLY how he broke the 1st Ventolin HFA - which he attributed to manufacturing flaws and ME!!!], OR he was spraying the Ventolin HFA IN TO the Proventil "plastic piece" and bitching about how the medicine wasn't making it into the chamber.

If only he would have removed his head from his ass and the stupid little Proventil HFA shell from the Aerochamber, he might have wondered, "I wonder what goes in this little inhaler-shaped hole on this Aerochamber." And then, combined that statement with the thought, "I just BETCHA this masked end of the Aerochamber, that's shaped like a nose and mouth covering, goes over the nose and mouth!"

So, I removed the yellow Proventil HFA 'shell' and held it up and said, "this is trash." I flipped the cap off 0f the Ventolin HFA and inserted it into the chamber. I held it up to my mouth, depressed the cannister, and low and behold, the chamber filled with a life-saving aerosol. To hammer the point home, I held the mouth piece near my face and feigned a big breath as if to say, "This is how you inhale the medicine."

Now, ignorance and common sense aside, this is obviously an example where I thought I had counseled a parent sufficiently, but I failed to account for the aforementioned confounders (ignorance and lack of common sense).  I mentioned this in the last post -- he showed up and I thought THEN, I didn't explain well enough how to use it. Him coming back a second time, just shows ignorance...plain and simple.

When he calmed down and realized that he now knew how to operate an inhaler, something that I had mastered at the age of 4 years old as I was strickened with childhood asthma, he didn't apologize for his swear-laden rant. He merely tried to shift blame onto me.

"Well, the other day when you were showing me how to use it, you didn't take that little piece out of there!"
"That's because I just thought you had the rest of that yellow inhaler at home. I didn't realize that was from something different. See how this Ventolin HFA has a metallic canister and plastic shell. That yellow shell is a Proventil HFA that, once-upon-a-time had a metallic canister with medicine in it as well. I just thought you would've assumed it fit into this chamber much like the other. I had no idea my not removing it would lead you to believe it were a part of this chamber itself. I'm sorry for the miscommunication."

Then...he did the thing that pissed me off more than anything so far -- more than pointing at me like a child, more than cursing at me, more than calling me an idiot to my face. He just walked away. He gathered his things and walked away.

Now, in this whole debacle, I wasn't all that rude, testy, or unkind/unthankful. I was just average...if anything I was a touch condescending. But, I would contend that if he weren't smart enough to grasp the use of an inhaler and chamber, he could not recognize the presense of condescension. But just to up and walk away? To just turn your back without a thank you, fuck you, or hell, even a thanks for nothing, that's just bogus. With all due respect, you fat bastard, eat shit and die old man...

Here's the Abstract:

I've also had a recent brash of problems with patients being rude/uncaring about the difference between requirements of a pharmacist versus services provided by a pharmacy. Some things we do are required by laws, federal or state, while some things are done to ensure patients have a good pharmacy experience and return with more pieces of paper.

Requirements:

1. I take the prescription from you. I ensure it meets all legal requirements (Name, Date, Drug name, directions, quantity, refills, doctor signature, and in my state, the Rx symbol on the face of the prescription).
2. I input in the computer (the computer system is not required. I could use a typewriter or even hand write the labels).
3. A prospective DUR (Drug Utilization Review) is performed by either the pharmacist manually and/or the computer system automatically ensuring that there are no drug-drug, drug-disease, or drug-patient interactions requiring concern. If there is, the physician in contacted. The patient is educated or the drug is changed to an alternative at this point. If there is no problems, we move on:
4. A label is generated and placed on an amber bottle.
5. The appropriate drug is counted and placed into the bottle.
6. Final check is performed by pharmacist and all aspects of the process is verified again. Finalized product is bagged and put into the pharmacy's WCB (Will Call Bin).
7. Patient picks up medicine. Patient is provided the opportunity to ask a pharmacist any questions concerning the medicine with the magic question, "Do you have any questions for the pharmacist?" -- this requirement not being added until 1990.

Services:

1. Billing your prescription insurance (or Medicaid) for the cost of your medicine (I don't have to take any insurance - let alone YOUR insurance). Some compounding pharmacies refuse to accept insurance and are cash-only.
2. Calling your insurance if their is a problem such as them not wanting to pay for the expensive name-brand drug your doctor wrote for, the quantity he wrote for, or for any of millions of other reasons they could dream up. Perhaps you remember when CVS made the decision to not call your insurance for problems any more. They accomplished this by placing a phone in the waiting room. It didn't go over well, but it proves my point.
3. Calling your doctor for refills when your prescription runs out. This is the job of the PATIENT that has been performed by pharmacy's striving to merely keep patients from having the opportunity to take their pieces of paper elsewhere if they are forced to visit the doctor for refills.
4. An easy open lid is placed on your bottle instead of the safety lid which is the legal requirement. (Screw your arthritis - I don't have to cater to you!)
5. Paging your name overhead when your prescription is ready -- that's all southern hospitality, buddy!
6. Taking checks or credit cards is also optional. Cash is the only requirement -- read the dollar bill. Does your credit card or check say that I *have* to take it? Nope.
7. Flavoring your child's antibiotic with out FlavorRx system.
8. Anything or everything related to having a drive-thru or providing services through it.
9. Being nice to you in any way, shape, or form. I just have to be there and be sober...I don't have to be my normally delightful self...

I'm sure this second list has a BUNCH more items on it. Fill in the holes for me...I'll add them to the list.