Proving the Public is Clueless

Posted by The *Angriest* Pharmacist as Blogs I like, Education, Hate Mail, Me being a dick, Pharmacy School, Stupid People, True Story

I got this from Pharmacy Chick. I’m not sure who this motherfucker is that sent this to her, but his name is Scott. I hope he gets a case of malignant hyperthermia and his “medication vending machine” didn’t know what he (or his doctor) wanted and instead of spitting out numerous bottles of dantrolene spits out a few aspirin and a cyclobenzaprine.

“I’ve been reading your blog and you seem to be upset when people treat you no better than a cashier at Walmart. To top it off, you compare what you do for a living (counting pills and dropping them in a bottle) with the work of skilled trades like carpenters, electricians, and plumbers who work on your house.

Let’s face it: You work behind a counter in a retail store, you hand things that you didn’t build or produce to people and then you take their money. Why would you expect people (customers) to treat you any differently than a Walmart cashier?

Yes, you may have invested $150,000 more in your schooling than the person wearing the Walmart smock but what else separates you? Why should customers treat you like a deity?

By your own admission, you draw a pretty serious salary. I think you should just cash your humongous paychecks and try to give people the service they think they want or deserve. You are not a wise old doctor who is treating a patient. You are simply counting 100 pills (which you did not invent or manufacture) and putting them in a plastic bottle.

I have seen “medication vending machines” in the lobby of hospital emergency departments. I can’t wait for the day when these automatic dispensing machines are available in every supermarket. I don’t need to talk to someone who went to college for eight years just to get another thirty days worth of a medication I’ve been taking for years. I want to put my credit card in a machine, press a few buttons and have my prescription drop into a chute.

I get nearly all of my refills via Medco (mail order). I like using my PC to order medication refills in the middle of the night and then seeing the meds in my mailbox in a few days. I don’t need someone who is making $150,000/yr to put three Advair 100/50’s in an envelope and mail them to me. Some college kid getting $12/hour can do that. I can’t stand going to Walgreens and being told “you have to wait for the pharmacist to come over and talk to you before you can leave the store with your new prescription.” Why doesn’t that rule apply when I purchase meds through Medco?

I’m sorry that customers treat you like dirt. But look at the scene from my side of the counter: You are handing a product over the counter and taking money from the customer. In the customer’s mind, you are not very much different than a cashier at Walmart or the college kid working the cash register at a gas station.”

Now that he’s had his 2 cents (which I wouldn’t pay him for), I get mine — which is worth $55/hr. Advair eh? Who are you going to call when you get a white growth in your mouth that tastes horrendous? I sincerely hope you call the college student. He’s going to laugh and ask for a picture to put on Collegehumor. He’s not going to tell you that it’s a fungal infection, because he didn’t go to college and learn that inhaled steroids, like the one in your Advair can do that.

Your Medco scripts are reviewed by a pharmacist. If there are any problems (i.e. drug interactions), I guarantee that you and your doctor will be notified. You aren’t “counseled” because a ton of literature is included, and they give a phone number…Legal obligations covered.

Do you have kids? Sick kid at 11pm. Better give the ole’ vending machine a call and see what he says to give your 6 month old for a bad cough and high fever. Ask it for the dosing as well…some parents have been killing their kids by OD’ing them on antihistamines. Make sure it double checks the calculations. Or, there’s a 24-hr Walgreens around the corner. The pharmacist may be asleep or watching a movie, but if you wake him up or get his attention, he’ll be glad to help.

You’re right in accessing our knowledge versus carpenters, electricians, mechanics or other trades. They have vast knowledge. I planned on doing a post on this in the future, but I’ll address it know. If my car is going ca-chunk ca-chunk, I’m fucked. I know nothing about cars. I’m not super handy around the house. I can change a lightbulb, but I probably wouldn’t trust myself to hang a ceiling fan. I’ve just never had to do that stuff before. Here’s the thing though, if those things don’t get done — I won’t die. If grandma stops taking her Warfarin because she doesn’t know what it’s for, she will die. I can tell you how the Warfarin works, why it works, what it treats, and most importantly, what OTHER drugs interact with it and could cause problems — leading to that death thing I was talking about. Let’s see an electrician explain what an INR is to a patient.

I paid a lot for my education. Sure, I do my fair share of ‘merely putting pills in bottles that I didn’t create or manufacture’ — but here’s the real bitch of it, I could have. I could have gone into pharmaceutical research and development. Hell, two guys in my class DID! I am just not methodical enough to do that. You are right though, I didn’t make those pills — but here’s the real bitch of it, I could have. I spent numerous classes learning aliquots and compounding. I could’ve made that cream, punched that capsule, or molded that suppository. It’s mass produced cheaper and faster than I can do it. Many years ago, everything was made by the pharmacist, much like I could do it now. I just don’t make every single product to save my patients money.

Scott, you may not think you need a pharmacist. You may not want the help of the pharmacist. That’s fucking fine. We don’t want you. As the international representative for all pharmacists, I hereby ban you from ever speaking to a pharmacist for any reason. You cannot ask questions. You cannot ask directions. You cannot ask for a tissue when you have a runny nose. You’re officially blacklisted, cunt. To be honest, I’d rather spend my time and effort helping those that want to help themselves and respect my educated opinion.

Next time, if I want your opinion — I’ll head over to the Dairy Queen and see which is better: Chocolate or Strawberry.

Funniest Pharmacy Video Ever

Posted by The *Angriest* Pharmacist as Disgusting, Education, Me being a dick, Pharmacy School, Stupid People, Video

I just had this video forwarded to me a few minutes ago, and I had to immediately share it with the world. This has got to be the most awkward “patient counseling session” I have ever seen. All pharmacists did these little pretend sessions with a TA at one time or another. This is the absolute worst.

I have no idea when the video was taken or who these kids are, but it makes me want to vomit.

Some of the quotes the “pharmacist” in this video says:

“Uhm”
“We’re starting you on lisinopril which will lower your cholesterol.” [The patient's response is classic]
“The Zocor could react with the lisinopril you are already taking and I would definitely go see your physician tomorrow morning. If you’re not feeling well have someone take you to the hospital cause we don’t want you in a car accident.”
“He wants you to take this at bedtime because Zocor works…is…the way it works by coating the intestine and keeps flushing it out…”
“It works very well at keeping obesity in young people down and other factors.”
[Pharmacist looks around like a fucking idiot for a knife or something to cut his wrists - hopefully]
“The only concern I’m having with your medications is that they may have an interaction. The lisinopril and Zocor could interact and possibly cause death. Might want to avoid that as much as possible.”
“Otherwise…we filled it with gelcaps for you cause it’s easier to swallow. We used the smallest that we had. It may be a little more on the copay, but in the long run it’s easier to swallow a smaller pill than a larger.”

I sincerely hope this is a fucking joke. Good luck at regaining the prowess and prestige of pharmacy if this is what our future looks like. I think the kid must have taken a roll of ecstasy and cranked one out before this session, because he looks way too calm to not know what the fucking fuck he’s talking about. The real bitch of this is, he has an information sheet (or script for this joke video) sitting right in front of him. If he had the answers in front of him and he thinks lisinopril is for cholesterol, may we all die in our sleep along with our profession.

I wonder if all pharmacy students are this fucking stupid. Here’s the video…enjoy:

Crappy Consultation

So you are going to pharmacy school

Posted by The *Angriest* Pharmacist as Education, Just a question, Pharmacy School, Update

I’m sure by now most of you have taken a look at my post on Advice for 2008 Pharmacy School Graduates. Needless to say, the post has been very popular and commented on extensively. It’s also been added upon by some others in the Pharmacy Blogosphere, each adding some thoughts based on their career and personal experience. Not long after that gem hit the net, I got a request from PharmerBill, who wanted some advice for high school seniors embarking on Pharmacy School in August. Here we go…round 2!

NOTE: Most pharmacy schools are offering 6-year Pharm.D. degrees, whereas others offer a Pharmacy School program after achieving a 4-year degree and being accepted to the 4-year program. I went for 6 years and will refer to this as such. When I talk about 1st year or 2nd year, it’s on a 6 year scale. Others would refer to this differently — meaning they only consider pharmacy school as four years: P1, P2, P3, P4. So, when I say ‘first year,’ I mean 18/19 year olds taking basic general education stuff. On my scale, “pharmacy school” doesn’t officially start until third year.

Point 1 - First year is a joke.
Point 2 - Since first year is a joke, get drunk, party, and study the night before exams and get pretty decent grades. However, remember, your first year grades do a lot to prop you up throughout the rest of your collegiate tenure. If you start to slip, stop-fucking-partying, and get on the ball. If you don’t finish first year with above a 3.0, it’s going to be a rough go for you.
Point 3 - Pharmacy School (3rd year and up) is a fucking bitch. Be prepared to fail, but don’t fret — the rest of your class is failing as well. Rack up all the points you can in labs, quizzes, and other stuff, as it will boost your grades as you get D- after D- on the test.
Point 4 - There will be those students that take a 50 question multiple choice test in 14 minutes. You are required to hate them. You must hate them because they are so incredibly smart that they know the answer after reading the first half of the question or because they are so incredibly stupid that they put C for every answer…and that’s stupid (unless it boosts the curve — if you’re lucky enough to have a curve in ANY class — in that case, praise them and get them drunk the night before exams)
Point 5 - Hate those that think, “Does anyone have any questions before we conclude for the day?” means, “Time to ask and asinine question that no one cares about and is only theoretical bullshit.” They will be in your class and you will know them by Day 2 of General Chemistry. They will ask questions about weird diseases, stupid fucking theoretical interactions, and stuff they read in the NEJM last week. They suck balls.
Point 6 - If you make it past third year and then drop out for any reason other than severe disease requiring all of your attention, you are a fucking idiot. You’ve already got 60k+ tied up in an education. How are you going to pay that back in with a degree in accounting? Exactly…
Point 7 - GET YOUR ASS IN A FUCKING PHARMACY. You will encounter some douche bag that is a 5th year and has only seen the inside of a pharmacy on required experiential trips. These people are twits and will find themselves in a world of hurt when they get to their rotations and/or the real world. The things you learn on the job may seem inconsequential, but I couldn’t tell you how many times a little bit of experience or familiarity with the drugs saved my ass on an exam. Even knowing the OTC drugs helped in some classes and especially on rotations in community pharmacies.
Point 8 - Do NOT be one of those ass clowns who comes to pharmacy school saying “I’m just going here so I can go to Med School/Law School.” That’s bullshit. No 18-year old realistically heads to pharmacy school with those high hopes — they are mommy and daddy inspired and you will see most of them crash and burn faster than a NASA space shuttle (eek - I apologize for that one). Their tune will change as they realize their debt is astronomical and retail money is easier — especially with that hefty sign on bonus.
Point 9 - Go Greek…It worked for me. I know, deep down, that part of the reason I graduated was because of my Brothers. They helped me - they kept me honest - they provided and outlet for me to vent and gain from. I couldn’t have done it without them. I don’t care what fraternity you would join. Looking out for the mutual welfare helps — regardless of the letters (except for Phi Dex, they are dicks — and everyone knows those fools in KY are gay…just kidding — relax!)
Point 10 - OLD TESTS ARE GOLD! Gather as much old material you can — the work is done FOR YOU. Most tests will have 10-15% duplicate questions. Some professors have a limited test question bank and if you have several years worth of tests, you may have access to the vast majority of their questions. Of course, you have to study — otherwise you might get burned with a new test. Fraternities help here. My chapter had tons of old stuff that we shared amongst each other.
Point 11 - Don’t be a dick to your classmates. You will come to realize that you are in it together. What started as 250 will dwindle to 150 by graduation (seriously). Working together will get you a lot farther than being competitive. What do you gain by competing for grades? Not a damn thing. Everyone still gets a degree.
Point 12 - Don’t allow the faculty to convince you that clinical pharmacy is the only thing worthy of your degree…that’s a load of bullshit, but that’s what you’ll hear from day one. Drug expert this, therapeutic guideline that, residency this, Board Certified Pharmacotherapy Specialist that…Fuck that - my Pharm.D. is the same as theirs, and I make a tad bit more coin than then. I’ve got the same training and education as them; I just decided to go another direction. Why they look down on retail? I dunno. If I weren’t standing in the trenches, one of them might be…
Point 13 - Live in the dorms or close to campus! Those that live on campus get 15% higher grades than those that don’t — my school once “crunched the numbers.” Why? Because they are more involved in their school and their education. If you commute, stay on campus, make friends. They will help when it comes to getting old tests and such. Don’t go to class and run home.
Point 14 - I’m not saying give up your friends from “back home,” but for Pete’s sake, don’t live in a fucking suitcase and run back to your hometown every weekend. Homecoming? Sure. Anything else? Meh.
Point 15 - I hate to burst your bubble, but you and your high school girlfriend aren’t going to make it. It’s a 99.9999% certainty that you will be broken up by New Years. Why? Because there are hundreds (if not thousands) of 18-year old bitches throwing their boobies in your face…and you’re going to like it — and probably open your mouth once or twice (and your fly if you’re lucky). Don’t screw yourself out of all those fun experiences and random strange because “you’re in love” with the same girl you’ve been dating since freshman year.
Point 16 - If for some reason you do keep a significant other outside of your school or immediate area, DO NOT be one of those stupid motherfuckers that runs out of class at EVERY 5 minute break and jumps on the cell phone. I hated those fucking kids. As soon as the teacher said the word, they were pushing the dial button…it’s like they only had that on their mind the last 15 minutes before our break. I hated those kids - and I’ll hate you if you turn into one.
Point 17 - Keeping number 15 in mind, don’t be a fucking slut. Like I said, pharmacy schoool is about 250 people. You nail 3 girls in a week and it’s going to get around. You are going to be avoided by the plague (unless you are the master). Chicks talk more than dudes. You don’t want to be labeled a man-whore or slut after a week of drunken fun. Sure, it was a blast - but it will be the only play you get for a long ass time.
Point 18 - Real men marry pharmacists. Can you imagine the possibilities of being married to a pharmacist as well as being one? That 250k gross is a lot of money. You can have awesome cool shit - Xbox 360, PS3, Wii, Nintendo 64, all the works…This also provides a solid fall-back - you fail out, she graduates, you still got a solid income to mooch off of…:-)

Got any to add for our 1st years, Pre-Pharms, and/or P1’s? Toss it in a comment!

If you read this far and aren’t going to pharmacy school, worry not, some if not all of them will apply to you in some way. Read and learn….

Okay I Screwed Up

Posted by The *Angriest* Pharmacist as Education, Errors, Me being a dick, True Story

I was discussing the USA Today Article with a local insurance salesman yesterday. We were talking about the ramifications of the article for pharmacy, insurance companies, and patients. I also gave him my take on the article and how increased volume (not decreased volume as Walgreens would tell you) inherently leads to more prescription errors. I then explained the error that lead to the child’s premature puberty and the infant that was given five-times the acceptable dose of Amoxicillin (which I doubt the whole “writhing in pain” statement - UPDATE: The Angry Pharmacist Debunked this).

The salesman and I parted company and a lady that was standing behind him in line approached to pick up a prescription. She said, “Hi. I’m here to pick up my infants Amoxicillin prescription.”

“Oh my gosh - I’m so sorry! I wasn’t intending to scare you or anything.”
“It’s okay. My stomach is up in my throat right now.”
“You have nothing to worry about. Our dispensing system has several places where quality control checks are made. Our computer checks all doses and drugs for interactions, and every prescription is personally verified by a state-licensed pharmacist.”
“How do you know and error is not made?”
“Well, when the human element is incorporated into any process, we can never be 100% sure that errors are not made, but pharmacy and especially pharmacists pride themselves on perfection. I treat every prescription like I’m filling it for my own child’s use.” [No kids yet - but she smiled]
“Would you check it again to be sure?”
“Absolutely. That’s my job.” [I went and checked it all again: verified the handwritten script, the dose, allergies, etc.]
“Everything looks great. Ya know, the article we were talking about was exploring the premise of high volume leading to prescription errors. The infant that got the incorrect dose of Amoxicillin was filled in a CVS that filled more than 400 prescriptions that day.”
“Oh yeah? How many have you filled today?”
“About 75 — and we close in about an hour. We’ll be lucky to fill 80.”
[I then proceeded to give the most personalized counseling session ever. 'Shake it up. Keep it in the fridge. Dispense 2.5 mL twice a day - morning and evening. Here's the line for 2.5 mL and you can keep this syringe. Be sure to give this for 10 days only then pitch the rest. You shouldn't notice any problems. If a rash develops, call the doctor's office. If the baby develops any stomach problems, try giving the dose after feeding her. Do you have any questions for me?']

I felt about 3 inches tall. I was shaken. I now vow to never talk about anything edgy to non-pharmacy staff again. I should’ve known better. I was trying to put down CVS and WAG to the salesman, but I failed - extremely.

Anyone else had a situation similar to this? Eating crow for breakfast, lunch, and dinner? I’m still full from my meal.

Funniest. Message. Ever.

Posted by The *Angriest* Pharmacist as Doctors, Education, True Story

I got a REDONKULOUS message today left on my voice mail. I couldn’t believe it. I had to listen to it twice. You’ve GOT to read this. This is EXACTLY what it sounded like. Note: The (…) typed below represent actual PAUSES in the message.

Hello. This is Dr. Houston. I’m calling in a prescription for…uhh… Angela Edwards from myself, Dr. Houston. It’s for Amoxicillin 500mg 30 of them taken po TID, and this is Dr. Houston. I also want to call in a prescription for Angie Edwards for…uhh…uhh… Promethazine with Codeine…one teaspoonful po every 3 to 4 hours. Give her…uhh…4 ounces. And this is Dr. Houston. So once again that is for Amoxil 500mg po every 8 hours and promethazine with codeine every 4 to 6 hours. This is Dr. Houston for Angela Edwards. Her date of birth is January of 1976, the first. Uhh… My name is Dr.Houston. My call back number is 555-5555 and my DEA number is AE111-1119. This is Dr. Houston. Thanks.

Holy shit. Wow. He said his name 7 times. He’s sure proud of this name of his. I could understand that if his name was something cool like Dr. Sledgehammer or Dr. Whoopass. Anyway, everything was out of order. He gave me different directions on both prescriptions when he repeated them (Granted that TID is the same as q8h). He even said the ‘DASH’ in the DEA number (there’s not really a dash in DEA numbers, it’s NOT a phone number). I thought for a second it might’ve been a fake call or something - but no one calls in antibiotics and promethazine on fake calls. If it woulda been a farse, it would’ve been 10/650’s an Xanax. I know a doctor I’ll never go to now…

Here’s how the call should’ve sound for those of you reading along (or not in pharmacy and not seeing any problems with the call). First, he should KNOW what he’s going to prescribe a priori… Second, he should call like this:

Hello. This is Dr. Texas Houston. I’m calling in a prescription for Angela Edwards. Date of Birth January 1st, 1976. Prescription is for Amoxicillin 500mg po TID #30 and Promethazine with Codeine - one teaspoonful by mouth every 4 to 6 hours as needed - 4 ounces. My office number is 555-555-5555 and my DEA number is AE1111119. Thank you.

And that, my friends, is how you do it. 2 minutes versus 20 seconds…and the 20 second version is easier to transcribe. The first version needed translation…:-)

Pharmacy Skewls? Idiots!

Posted by The *Angriest* Pharmacist as Education, Management, Me being a dick

I just got an ANGRY ass email from a student at that fuck-stick-of-a-school, St. Louis College of Pharmacy. The 2nd year student was absolutely livid about some curriculum changes which he thought unecessary. It goes as follows:

Current 2nd year student: 300 Required IPE (Intro to Pharmacy Experience) hours
Current 5th year student: 65 Required IPE hours

Holy shit….what a jump! Now, why would the school mandate such a change? Well, it’s all because their accreditation councils (Accreditation Council for Pharmacy Education) has mandated the change. Of course, without hesitation, the school has jumped through the hoop.

I remember my IPE days…they sucked. They were worthless. These are not to be confused with my APE’s though….those were absolutely flawless, necessary, educational, and pivotal. However, IPE? Not so much. My first IPE found me working in a hospital. I followed a pharmacist around as he did nothing…all damn day. I did this one day a week for nearly two months. Granted, I had to make one presentation about the benefits of an injectable Zyprexa. I learned a bit there. The rest wasn’t worth a shit. My next year’s IPE found me working at a retail pharmacy that was slower than molasses. I did nothing. I learned nothing. All I did was spend several hours, one day a week working as a fucking technician for some pharmacy. It was a waste of my time. I would have rather been in a classroom actually LEARNING something. I was also required to do some community service. Doesn’t that fucking contradict the point of community service? REQUIRE COMMUNITY SERVICE? What a fucking oxymoron! My pharmacy school should be slapped in the face for such bullshit.

Anyway, the point I’m trying to display here is that IPE’s are worthless…or at least they were for me. My school’s system needs serious revamping before they could ever implement some bullshit like this. Apparently, StLCoP is the same way. I dunno for sure. Either way, quadrupling the number of hours, pushing them to the summer break, and making them even more worthless, does nothing for our students and future pharmacists.

I hope StLCoP makes their IPEs challenging and educational. Otherwise, all they’re going to gain is a semester of bored students, no-shows, and pissed off pharmacists who signed up for a student pharmacist and ended up with a hungover pile of pig shit.