This is a guest post from a technician known for now as J.S. -- s/he will be responding to all comments as necessary. Should you want to send a private email, please use the CONTACT Page and I will forward it on to him/her.
"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.
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.
This was emailed too me and seemed quite compelling. I don't have much to add to it except my curiosity. I was hoping to present this to the community and see what your thoughts were. Please share them with me (and the author).
From: leon <email@example.com>
Subject: too many incompetent foreign graduates
I am sorry to switch gears on you, but I felt the need to address another issue in the field of pharmacy. As most pharmacists already know, it is very tight job market out there. When I graduated, it was completely the opposite. Sign-on bonuses were common and hourly rates were very negotiable. Most employers were willing to train old and new pharmacists from the very beginning. Fast forward a few years later and all those jobs have practically vanished. Without networking, it is nearly impossible to get your foot into the door.
While I have been fortunate enough to find another job in pharmacy, I noticed a disturbing trend. Generally speaking, I will say most of my classmates were competent pharmacists. They were hardworking and eager to learn and keep up with the latest drug therapies. As I worked in the real world, I noticed some really ignorant and incompetent pharmacists. These pharmacists would not know the difference between Keppra and Keflex (no, I am not kidding). These pharmacists could not tell you the names of other drugs in the same family (ACE inhibitors, ARBs, Cephalosporins, Fluoroquinolones, etc). They could not even tell you the generic name of a drug, much less if there was even a generic on the market. Worse, I started catching their prescription errors on a regular basis and had to explain to customers why our pharmacy was making mistakes. My technicians would tell me, “That floater we had yesterday was dumb as hell. He was asking me questions about drugs.” My other regular pharmacists would shake their heads in disgust after seeing the kinds of mistakes that were being made.
Who are these pharmacists? Foreign graduates. I spent 6 years getting my Doctorate of Pharmacy degree. By contrast, most of these foreign graduates spend only 4 years in school. Unlike most medical schools in foreign countries, pharmacy schools outside the United States are basically looked down upon in their respective countries. Part of the reason is because the education is lacking and does not challenge the prospective student. A pharmacist in China, for example, would make little money and he or she would be working every day to make ends meet. As for a place on the healthcare team, you can forget about it. Pharmacists in other countries are poorly thought of and would not be considered true healthcare professionals. On the other hand, getting into a medical school in China is very difficult. After one enters and graduates from medical school, he or she would still be required to perform a residency in the United States for a minimum of 3 years. Despite all of this, it is apparently pretty easy for a foreign graduate to get a Pharmacy License in just about any state by taking a couple of simple exams such as the Foreign Pharmacy Graduate Equivalency Examination and a Test of Spoken English. Throw in a few hundred dollars and you basically have bought a Pharmacy License.
The biggest consequence in all of this is the rise in prescription errors. I have seen it over and over again at different pharmacies and settings. These pharmacists and pharmacies are a danger to public’s health and safety. Another effect these foreign pharmacists are having is that they are over saturating the job market. I can live with the fact that another pharmacist gets the job I was looking for. There are many competent and very good pharmacists out there in the marketplace. They are mentally very sharp and do their job very well. However, when I see a pharmacist make errors repeatedly, I start thinking to myself, “How can this person not know what they are doing? Where did this person even go to school?” And on most occasions, he or she did not attend a pharmacy school in the United States.
At the end of the day, this country needs to stop just handing out Pharmacy Licenses to anyone who claims to be a pharmacist. A pharmacy education in foreign countries is not equivalent to a pharmacy education in the United States. I am sure there are exceptions to the rule. I am certain there are some highly motivated foreign graduates who proved themselves over and over that they are more than qualified to handle the responsibilities of a pharmacist. I just have yet to see one such pharmacist. In my experience, some schools do a better job of putting capable pharmacists onto the marketplace (UCSF seems to do a good job, in my opinion). Personally, I think all foreign graduates should have to attend pharmacy school in the United States in order to acquire a Pharmacy License (a 3 year or 4 year Pharm.D program). Before someone thinks I am too eco-centric, I was actually born in another country, but I grew up here in America, and English is my primary language. And yes, I am a United States citizen. I just think our profession needs to have a serious discussion on what a pharmacy education in the Unites States is really worth before it is too late.
BEFORE COMMENTING READ THIS:
TheAngriestPharmacist did NOT write this post. He has not commented about the validity, certitude, or accuracy of anything written in the post or in ANY of the comments. Please stop submitting comments accusing TAestP of racism, discrimination, or having anything to do with this post. I only posted this because the author asked to use my site as a place to reach many pharmacists. I will not post accusatory comments about myself. I will delete them and ban the author from the site entirely. If you have an opinion, feel free to post it. Keep the other pointless shit off my site.
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.
I know I know...you're thinking, "WHO THE FUCK DOES THIS GUY THINK HE IS?"
Today, I spoke Engrish with a lady for 10 minutes. It took me a while, but I figured out that her mother had the sniffles and a deep, hacking chest cough.
My suggestion was generic Benadryl and generic Robitussin-DM. She was very happy with my choices. She asked my about the name brands. I told her that the generics were the SAME THING (samm-ting) and there was no reason to spend the extra money. She spoke crappy English, but she understood me when I told her that generics were not inferior products.
I went back to my dungeon. I watched this bitch put both the diphenhydramine and guaifenesin/dextromethorphan back and exchanged them for Benadryl KAPSEALS and Robitussin-DM...at 10 times the price.
WHAT. THE. FUCK.
This exact same thing has happened twice in the past week with Asian-born customers.
I guess were they're from if it's not the most expensive, it's not worth a shit.