The *Angriest* Pharmacist You want your prescription filled when? Eat shit…

Two months worth of reader email

Posted on December 2, 2011

Sorry, I've been....deficient the last two months. I'm not going to promise any more, but I can tell you this. I will have a response for Mr. Plagakis pretty soon. Don't expect anything revolutionary. Don't expect anything mindblowing. Just expect a clear, concise response. Naught but the truth. I also want to look back at some older posts in which he referenced me about releasing steam (in a hilarious masturbation simile) and how/why the post titled, "Jay Pee catches Wal-Mart peeping through the window" relates directly to all of it...

Below, I'm going to post several different things that came to me via email or the CONTACT link. I'll lead with the user's name, and if you wish to reply to one, just reference that name....or don't...I don't care...

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Liz writes:    In the past few weeks, our pharmacy has started checking ID for controlled drugs, scanning in new Rx and scanning in hard copies.  All of a sudden, our workload has tripled, but our company is cutting tech help.  Is anyone else finding this hard to manage?

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Rodney writes:   I work as a reimbursement specialist at an LTC Pharmacy, and I'm writing to share an interesting exchange I've had with representatives at Prescription Solutions over the past few days.

I've had a few basic rejections which, were the representatives at Prescription Solutions even modestly intelligent by today's decidedly low standards, should have been able to resolve with much rapidity. Instead, I got stuck with slack-jawed yokels and embittered, defensive inner-city youth. They turned requests for overrides to simple rejections into drawn out, unintelligible arguments, and once they'd been cornered or otherwise became bored with the exchange, they hung up on me mid-sentence.

I may not be the bubbliest person in the world. On the contrary, I'm frank and to the point, but never did I become enraged, and never did I insult or otherwise disrespect the reps in any way. Prescription Solutions - hell, the insurance industry as a whole - has no shortage of stupid, rude, and disinterested people, but I've never had any with the gall to abruptly hang up on a service call. Now, over the past two days, it has happened to me four times.

Though I feel somewhat vindicated by the fact that return calls yielded exchanges with intelligent reps who applied the necessarily overrides with absolutely no hassle, I am perturbed by this sudden shoddy treatment. I know PS has seen extraordinarily long hold times as of late, what are the odds the reps have been granted free reign to terminate calls from "problem callers" (that is, of course, callers who question the rep's ill-informed initial judgment)?

Any thoughts? Similar experiences?

[TAestP's thoughts: I believe the reasoning behind this is, as always, money. When the question is, "Why?" most of the time, the answer is money. In this case, I'd bet if you timed your calls, you got hung up on at specific intervals....something like 3 minutes, 59 seconds. If the agents keep their calls (or a certain percentage) less than 4 minutes, they probably get higher ratings or a bonus at the end of the day. They may also have rewards/cut offs at 10 minutes or 15 minutes. Of course, the person could have just been an asshole, accidentally hung up, or hung up on you because they are lazy and/or didn't know the answer.]

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Lillian writes:     I found your blog a few days ago and I love it so far. From your posts, you seem to know a lot about retail pharmacy so I was wondering if you could answer a question for me: Is it true that the field is getting very saturated, very quickly?

A few of my professors warn us that it will be much harder to find a job in retail by the time we graduate (2016). And I've been hearing a lot of people saying that retail is going downhill.

I know there will be more competition for the jobs in several years because of there are more students going into pharmacy now. And I get the feeling that maybe one of my professors is exaggerating the situation to encourage us to go into other pharmacy fields. But do you think this saturation is something to be seriously be worried about?

For the record, I would try to go into retail no matter what the situation is...I just don't want to be completely caught off guard after graduation.

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Kristin Writes:
Dear TAestP,
I know someone who filled a Rx at a CVS.  The pharmacist later called and texted her saying "Remember me from CVS?  Would love to get coffee with you some time?--Weirdasspharmacist [sic] "  She responded that she wasn't interested. She didn't get any more fills there, but she was afraid of contacting his manager or pharmacy baord because CVS had her information on file and the pharmacist could look it up and perhaps do something scary like stalking.

TAestP, what would you recommend doing?

[TAestP's thoughts: If this is true, it is creepy as hell. You are right that CVS would have the info, and he would have access to it. But, he's already pretty much risked his license by doing this -- taking it from creepy to full on stalking would definitely result in a meeting with his state's Board of Pharmacy. If he is not the pharmacy manager at that location, I would call and speak with the pharmacy manager about the incident. Tell her it made you (or her) uncomfortable and that you would like the manager to give your information to their district manager so he/she can call you at their earliest convenience. Then discuss the matter with the DM. I'd be almost anything this would squash absolutely any issue -- cause that DM does NOT want you making a formal complaint with the board. If he is the manager at that store, call a nearby store's pharmacy manager and do the exact same thing. If this does not get you to an ends that you are happy with -- or you get blown off at any level -- google the state's board of pharmacy. One call to them with an accusation like this would definitely result in an investigation and something would be done. Tell your friend I'm sorry my text creeped her out -- she's not gonna like the photos I'm sending tonight....just kidding of course.....:-D]

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Mike writes:   so...i witnessed a patient ingest 90mg of methadone...the patient's prescribed dose was 40mg...i gave him the wrong bottle

i'm getting kicked out of pharmacy school 4 months before graduation...what do i do now?  should i submit my resume to the nearest McDonald's?

 

[TAestP's Thoughts: Either this is untrue and you're trying to waste my time, you're just a general dumb ass,  or you have done a ton of other stupid bullshit.  Regardless of what anyone may think, there is only one person responsible for what pill goes out the door and into the hands of a patient -- the pharmacist on duty. I don't care if the technician accidentally typed in Oxycodone instead of Omnicef for an infant, I still believe the ultimate responsibility should lay on the pharmacist that verified the prescription. (intentional bullshit and other types of lying and deceit aside -- I'm talking about true accidents by ancillary staff not caught by the pharmacist)   However, it does sound like you are in some other kind of facility or setting. Since you witnessed the patient do it -- not sure what that means as a patient should never be handed a pill by pharmacy staff to take -- that changes the role from dispensing to administering which we cannot do (in terms of pills).

If the school threw you out, and this is a true story, you're probably fucked. Sorry dude. I guess you could appeal and plead to the school, but that's the thing with private universities, they can do whatever the hell they want whenever the hell they want. Other than that, see if another school will take you or get a lawyer....or get a job and good luck paying back all those loans....]

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That'll do for now....check back for the next post coming soon....

The History of Medicine

Posted on July 22, 2011

THE HISTORY OF MEDICINE

2000 B.C. - "Here, eat this root."
1000 B.C. - "That root is heathen, say this prayer."
20 A.D. - "That prayer is good, but you have to pray in my name me to get through to Dad."
1850 A.D. - "That prayer is a superstitious chant, drink this potion."
1940 A.D. - "That potion is merely snake oil, swallow this pill."
1970 A.D. - "That pill is ineffective, take this antibiotic four times a day."
1980 A.D. - "Bacteria aren't the problem. Viruses are enemy number 1! Get this vaccination, but you still better take our pills too!"
1990 A.D. - "Taking pills four times a day? That's ARCHAIC! Take this tablet once-a-day."
1999 A.D. - "That once-a-day tablet is cost prohibitive. Take this cheaper generic. It's the same thing."
1999 A.D. - "Their generic once-a-day tablet isn't good enough anymore. Our 'XR' tablet is now the standard of care. And you only have to take it once-a-day!!!"
2000 A.D. "This XR antibiotic kills all the bacteria in your stomach. Take this bacteria capsule four times a day."
2000 A.D. - "Those vaccines are still working, but our data shows they definitely cause autism and some other nasty shit."
2001 A.D. "No, they don't. The data never showed that. Shit happens."
2003 A.D. - "Bacteria are now resistant to this once-a-day antibiotic. We're probably fucked."
2011 A.D. - "Oh yeah, we have immune systems. That's why the vaccines work. Let's just drink the damn tap water and shut the fuck up."

Note: I amused myself writing this. I know the dates aren't even close to right, but it's all so true. Feel free to fill in the holes and make corrections via the comments. Let's tweak this, finish it up, then send it around the Internet like some of the other stupid bullshit I get.

Does ANYone fix inhalers?

Posted on March 6, 2011

I had a guy come in today with a broken Ventolin HFA. He had OBVIOUSLY broken it. As you know, you can remove the cannister from the plastic delivery device. At the bottom of this cannister is a little white piece of plastic. When this piece is pressed, the aerosol is given an exit from the cannister. Usually, this is directed out of the plasic device. Well, this old man had broken the white piece off, somehow, to where it cannot be pressed in at all. Obviously, this is my fault.

Additionally, he had the plastic device jammed into a Aerochamber in reverse -- so if you somehow were able to dispense a dose, it would spray upwards rather than into the chamber.

Now, I can see how one could say that this is merely a failure on the part of the pharmacist to effectively counsel on proper use of the inhaler...and you're probably partially right. In all likelihood, when he picked this up for his child, we BOTH assumed that a grown man would have sense enough to either use an inhaler with aerochamber or read one of the three separate inserts / literature that were purposefully put into the patient's bag. The assumption was proven incorrect. This patient was obviously too intelligent to be bothered with reading those stupid papers that patient's so often vehemently deny and exclaim, "throw all that crap away I've got tons of it at home," only to attempt to jam a square peg in a round hole and break the entire contraption. Wow...just wow...

Finally, this gentleman was mad at ME for not repairing the inhaler OR replacing the inhaler at my cost. I got him an override for an early refill (the TIME spent was my cost...right?). As he left he asked "when the boss was gonna be back." I, of course, don't do well with this comment because it's a slap in the face and passive aggressive. Just tell me what your fucking problem is and assume I have sense enough to come to a reasonable end-game.

Prior to this I took the time to look up the number to GSK for him to call and see a coupon or refund for the product he obviously broke. He was mad about it still, and his only concern was "What if I pay for this one, get it home, and it don't work neither?" -- Well, considering you broke the first one, I'd say the likelihood of you breaking another is rather high considering you still haven't opened up to me trying to show you how to effectively use it...Alas, you have more copies of the literature (illustrated ones this time -- for the kids!). If you don't break this one and it "still don't work" -- it's STILL NOT MY FAULT.

I'm sorry, I don't service inhalers. No pharmacy does. If it doesn't work, it's the manufacturer's fault. If you don't know how to use it -- that's my fault. I've done what I can to help on that front. You're gonna have to be a big boy and make a phone call for the rest -- rather than "gimme gimme gimme gimme..." like usual...

We are the side ‘The Profession’ wishes to shun…

Posted on February 27, 2011

TAestP Angriest Pharmacist:    @theangrypharm We may be referenced in a article without being contacted for FAIR rebuttal!   http://www.ncbi.nlm.nih.gov/pubmed/21098377

TAestP Angriest Pharmacist:    Website references the vitriol spilled from both TAP and I as your 'leaders'... http://bit.ly/eAIDwr

Here's the Abstract:

Use of blogs by pharmacists.

Clauson KA, Ekins J, Goncz CE.

College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328, USA. clauson@nova.edu

Abstract

PURPOSE: The characteristics of pharmacist blogs were examined.

METHODS: Internet search engines, blog aggregators, and blog rolls were used to identify pharmacist blogs. Six categories were developed to evaluate blogs, including practice-based topics, identifying information, positive language, critical language, professionalism, and miscellaneous. The most recent five posts on each pharmacist blog were reviewed. Descriptive statistics were used to characterize the results.

RESULTS: A total of 117 blogs were identified, 44 of which were designated as pharmacist blogs. No blogs contained patient-identifying information. Anonymity was maintained by 68.2% of bloggers. Bloggers practiced in community (43.1%) and noncommunity (43.1%) settings. Pharmacists most commonly used positive language to describe the profession (32%), other health care professionals (25%), and patients (25%). The highest rates of critical language were found in descriptions of patients (57%) and other health care professionals (44%). Almost half of pharmacist blogs contained explicit or unprofessional language. Overall, community practitioner blogs were substantially more likely than noncommunity practitioner blogs to use unprofessional and critical language. Twenty-five percent of pharmacist bloggers also maintained a microblog (e.g., Twitter) account.

CONCLUSION: A search using Internet search engines, blog aggregators, and blog rolls identified 117 blogs, 44 of which met the study criteria for designation as pharmacist blogs. The majority of pharmacist blogs included some type of discussion of pharmacologic therapies. Pharmacists most commonly used positive language to describe the profession, other health care professionals, and patients. The highest rates of critical language were found in descriptions of patients and other health care professionals.

PMID: 21098377 [PubMed - in process]

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I really would like the full text of this article if at all possible (meaning if a current student emails it to me I'd love them forever)....I really would like to see what they studied, who they studied, and their goals. I'd also like to see if they mentioned the upcoming @AngryPharmcast --- that'll blow their minds out of the water....

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