Lengthy Reply to an Ignorant Commenter

Posted by The *Angriest* Pharmacist as Hate Mail, Me being a dick, My nose itches, Stupid People

Most of you read my recent post titled, “The last day I’ll ever be questioned.” It was a pretty aggressive piece of writing. I went complete berserk on a member of my front-end staff for defending who I called a, “Scumbag.” I received a range of comments — some applauded me for standing up and telling the front-end staff to butt out. Others didn’t agree with the ferociousness with which I went after him but agreed with the overall message. Then I had one jackass who took the opportunity to attack our profession, calling it a trade and a vocation. Here is my rebuttal. I hope he returns for round two.

Mr. Old Fashioned (REMOVED) aka N., a 28-year old from REMOVED [IP Address REMOVED] says, “Simply put you are a pharmacist NOT a doctor, NOT a DEA agent, and certainly NOT an elected official charged with the care of the public. Your job is to decipher a Dr’s handwriting and dispense what you are told in the proper dosage. Most people in your craft today are being replaced by computers because apparently a trained chimp could do the job just as well. You like to put yourself on some higher plane thinking that you are a member of the medical field when the extent of your knowledge can be obtained by the reading of a PDR. You are in a customer service based industry. It has always been a customer service based industry. Only through the bastardization of the industry by power hungry idiots who couldn’t hack it in real medical school has it become anything more. You have been given “POWER” by the DEA to judge people you have never meet and impose a sentence upon them based on 0 fact or evidence. On nothing more than your gut feeling that this man was a “Scumbag” you decided to refuse him service. And if you can even say with a straight face that you would have treated Little Miss Blue Hair the same way I applaud you sir, you should think about politics. Keep your double standards and you Napoleonic Complex to yourself and get back to servicing the customer that pays your friggin check. You are not some shining light of justice and righteousness. You my friend are a bean counter, nothing more. I respect the fact that you were “Doing your job” but it is high time that you and others in your field of vocation learned what their job is.”

Let me begin by saying you are a very ugly man. This is compounded by the fact that you are a WoW Fag. I would like to thank you for reminding me that I am not a doctor or a DEA agent. Thank goodness! I was confused. Frankly, I have too much common sense and ethical obligations to be a Doctor. I’m not clean cut enough to be a Fed. However, I am charged with protecting the public as well as caring for those that are too unintelligent or inept to care for themselves. The Combat Methamphetamine Enforcement Act essentially laid that job at my feet. Forgive me for wanting to protect our streets from the viscious methamphetamine epidemic. It is my job to police this shit — as much as I don’t like it. The law is the law. Albeit a technicality, if a chipped license allows me to keep a mass-PSE-purchaser from getting one more box to throw in the trunk, so be it. If enough of us “stupid pharmacists” enforced the rules rather than focus on making a buck, we could be a real thorn in the side of those manufacturing this junk. However, the way to really cut this shit down is to make it Rx only, as I explain in the link above.

Now I’d like to address your claims that my job is to ‘decipher a doctor’s handwriting’ and that ‘most people in my craft are being replaced by computers’. Let me explain this, PART of my job is to decipher doctor’s handwriting. Most of my job deals with something called Drug Utilization Review (DUR). This means that I review your past medicines, disease states, allergies, and demographics to make sure that they drug you’re getting is just perfect and safe for you. Sure, the computer can check for interactions. It can tell when you could be allergic. Example: You are allergic to Penicillin [cause it gave you a *laugh* bellyache *laugh*]. After I talk with you and try to explain that a bellyache isn’t an allergy, it’s a side effect, you still don’t want to take Amoxicillin your doctor prescribed [cause he didn't know they were related at all]. I call him, and he wants to know what drug would be an appropriate switch and safe for you. I, of course, find out that you have an Upper Respiratory Infection and suggest a Azithromycin 5-day pack. He concurs, and we all go about our day. When exactly do you plan on writting the 50 million lines of code that can teach a computer to: A]Recognize the DI and attempt to explain to the patient about the difference between and allergy and Side Effect. B]Shutter in disgust at a patient’s idiocy (still knowing that the crossover between Penicillin and Amoxicillin is ~3% — so, if you got hives, we give it to you. If you got anaphylactic shock, we don’t.) C] Call the Doctor and wait on hold for 10 minutes until someone answers. D]Explain the situation to the doctor then make a therapeutically sound change. I’m sure you’ll get right on that after this next round of WoW, right?

I’m sure you like to think I’m ‘putting myself on a higher plane’ merely because I work in healthcare. But the fact of the matter is, I am on another level. I’m not some asswiping nursing-student. Also, a “PDR” as the public likes to refer to so often is nothing more than an ad-rittled piece of shit. If you pay enough money, suddenly your product is the Drug Of Choice — regardless of what the standard of practice is. I use pages of the PDR to light campfires. If you want a good reference book, go buy Dipiro (But, it is written at graduate level, you likely wouldn’t understand most of it). Go buy Briggs for Pregnancy and Lactation. Go buy Sanford for Antimicrobial therapy. Go buy Remingtons for Pharmacy Practice. Go buy Harrison’s.  Go buy something by Koda-Kimble — she’s the endall source for Therapeutics/Clinical Pharmacy. You get my point yet? PDR = Shitty crap made available to the public to make them think they are smart by looking up Lupus.

Customer Service Based Industry? Fuck customer service. I have patients. What the patient wants isn’t always what’s best for them, their health, or others. The patient is NOT always right. If I always did what a patient wanted, I’d be breaking federal law most of the time. Sorry that Walmart and it’s do-whatever-for-the-customer attitude has skewed your view of the REAL world, dude. My actions have consequences.

It’s cute that you think that every pharmacist is some idiot that failed out of med school. I bet you think every doctor is some schmuck that couldn’t make it through veterinary school as well. Fact of the matter is that I went to pharmacy school out of high school. It was my first choice. I agree that our big pharmacies are really having detrimental effects on pharmacy by giving away antibiotics and selling some prescriptions for $4. But, you thinking that people failing out of medical school have done this is really off base.

I don’t ever judge my PSE buyers by their looks. Hell, some fuckwad could be buying it for his sickly girlfriend. I don’t know. I judge them by their past history. No one needs their limit of 24-hour Sudafed every month for a year (on three consecutive days) from my pharmacy and the one next door (which turned out to be the case with that dude — I found that out since I wrote that Post). Normal people don’t just walk away quietly when they are denied a sale because they already bought their limit for a month (Because we aren’t abusers — we don’t ever hit our limit). Normal people don’t buy 2 boxes one day then another the next day, “just to stock up.” I buy one box when I’m sick — and it lasts me a long ass time. I judge people by their actions — not by their looks. I’m not always as petty as you would want me to be. My evidence is in the books — Cold. Hard. Facts.

Little Miss Blue Hair gets the same scrutiny — I know for a fact my store sold Sudafed to a little old lady who was buying it for her nephew to use to manufacture meth. Our PSE logs were used in the case against them. He used her to go around to pharmacies, thinking she would not be questioned due to her appearance. However, for lil old ladies, I usually call their doctor and tell them about the use of liberal PSE and the effect of it on hypertension…especially in little old ladies. I’m a nice guy and don’t want my PATIENTS stroking out.

I’m 6′3″ — I don’t have or need a Napoleonic Complex. I leave that to short, fat fuckers like you, Shadowzfell. I exert my authority when it is what is best for my pharmacy, my patients, and occasionally, my bottom line. For what it’s worth, the ‘customer’ as you so retardedly call them, don’t pay my check. My company does. They make their money from a variety of things from OTC, to beer, to birthday cards — even some various holding companies. They’ve had to broaden their income sources due to the ‘bastardization of pharmacy’ as you so eloquently put it. Pharmacy is quickly becoming a cost center rather than a profit center due to decreasing payments from insurance companies/PBMs and increasing costs from our drug manufacturers because of their various endeavors (i.e. Big Titted Drug Reps).

I may not be a shining light, but believe me, one day you’ll be thankful that a pharmacist was there for you to have access to when no one else was available — At 2am when your 4-month old is coughing, running a fever, and your pediatrician just won’t return your call even though you’ve called the exchange 5 times! You’ll call Walgreens and some old pharmacist will help you through it, maybe even give you the dosing for your childs age/weight. You’ve cursed us before, you’ll praise us then. Or when your kid is 16 years old and beginning to experiment and try new things. Some new friend got his hands on some Oxycontin 80mg cause a senior had a forged prescription. Your child takes the pill, but she bites it first. Her friend said the buzz would be better. By cracking the time-release coating she screws up the release mechanism and gets all 80mg of oxycodone at one time. She dies a few hours later of hypoxia due to respiratory depression. You’ll wish a real person - a license pharmacist - had looked at that prescription rather than the 50 million lines of code you wrote.

Believe me, a pharmacist is much more than some old bastard that counts by fives. That’s part of it. That’s not it. Hopefully, I’ve expressed some of that in this post. I didn’t go to school for 6 years and earn my doctorate in pharmacy to learn simple 2nd grade math. I learned diseases, pharmacology, mollecular mechanisms of action, treatment algorithms, monitoring parameters, primary literature evaluation skills, biostatistics, pharmacoeconomics, etc. etc. etc.

Finally, pharmacy is not a vocation. It’s not a trade. Pharmacy is a profession. It’s high time that you (and the rest of the ignorant public that think like you) learn that fact. Pharmacists are the most respected and trusted practicioners in the healthcare field. Day in and day out, doctors refer to pharmacists for help in treating their patients. This is more evident in the younger generation of doctors, as pharmacy has really advanced in the last 10-15 years. The profession has gained steam and medical schools have acknowledged that. They have taught their students that we can be trusted, relied upon, queried, and respected. In many states, pharmacists are allowed prescriptive authority in collaborative practice with physicians. Even more, some states allow pharmacists to apply for DEA Licenses allowing them to prescribe controlled medications. Almost every state allows pharmacists to give vaccinations to children and adults alike.

If need my car fixed, I go to a mechanic. When I need a leak fixed, I call a plumber. These are skills. These are vocations. I cannot do them. I am not qualified to even begin to attempt in doing them. If a mechanic or a plumber screws up, people cannot (usually) die as a result of incompetence. I’m not saying that these men are less of a man than me. I’m not saying they don’t deserve my respect and admiration — they do and they get it. But, people’s lives do not hang in the balance. Plumbing and Mechanical work is a respected trade, but it is not a profession.

Believe me when I say, PHARMACY IS A PROFESSION. Professional people working in a professional setting to help patients get the best results from their pharmaceutical therapy with the least amount of side effects and adverse events.

If you think like I do, feel free to send REMOVED an email telling him all about it.

Let this also be a warning — Don’t fuck with an angry pharmacist when your e-penis needs a little lengthening. You won’t win.

Our D.rugseeker is back

Posted by The *Angriest* Pharmacist as Drug Seekers, Hate Mail, Laws, Me being a dick, Stupid People, Work Sucks

He’s back, and I was right — he is a cocksucker. He’s not a troll, and it wasn’t a proxy. It came from the same IP address.

A new submission (form: “Contact Form”)
============================================
Submitted on: September 23, 2008
Via: http://www.theangriestpharmacist.com/contact/
By 173.33.78.245 (visitor IP).

Don’t get it… Why would it be trolling, just because I happen to be in Toronto? Would the Canadian socialized healthcare be so magically different, that pharmacies, oxycontins and scammers don’t exist?

As some kind of proof, I guess I could send you a pic of a handful of mscontin bottles… The label on the original OC80 bottle was so fucked up (Take 1 pill every 4-6 hours), that I believe I took a picture of it, that I could send you.

But I shouldn’t really prove myself now, should I? Because of your regular rants about ignorant doctors and PA’s, I assumed you’re a decent healthcare professional. And a decent doctor, nurse or hell, even pharmacist should always give the patient (or in this case the poster), the benefit of doubt.

BTW: Read your post about a junkie trying to quit cold turkey, and you’re way wrong with the benadryl. The only thing that would even start to help with sleep would be Restoril. A benzodiazepine with a really long halflife, such as valium, would also be helpful.
Most doctors would also prescripe clonadine, and in my own experience, Codeine or Tramadol also helps on the pure misery of it.

I do give a shit about patients. I just don’t give a shit about the ones that don’t give a shit about themselves…like you. I’ve read studies that say clonidine is shit for opiate withdrawal due to ADR of hypotension. And, no, I wasn’t way wrong with “the benadryl.” A man asked what I could do for him OTC. I couldn’t give him a handful of Temazepam or Diazepam just because he seemed genuine. He didn’t want to go to the doctor — that was the point of the post. I guess you were so caught up in trying to find something I have done wrong or incorrect, you overlooked that.

Well, now I’m overlooking you. You’re banned, motherfucker. Bye Bye.

I would have assumed Canadian Healthcare, BECAUSE of it’s socialization, would do a better job at preventing this kind of bullshit — hell a nationwide computer network the likes of WAG or WM would do the trick to stop this asshole. But, alas, they are in the same boat we are here. Many different pharmacies, many different doctors, none of which are connected.

The solution? It’s going to take some level of government intervention…period. The corporations aren’t going to do it because they don’t care — they make their money off those people as well. Why spend millions connecting to stop them — the minority of pharmacy visitors?

Get my point?

We got a hotshot here

Posted by The *Angriest* Pharmacist as Drug Companies, Education, Hate Mail, Me being a dick, Pharmacy School, Stupid People, Update

So this guy flew off at the mouth in the comments on Circle of Spite by my former accomplice, Lil Laura. Here’s his comment and below that is my rebuttal.

Hey, I think it is important that patients be given the same brand that they have been taking. Its not the same, no matter what you learn in pharmachology school. Studies show that two brands of the same drug can vary as much as 20% in concentration. That is a big deal if your epilepsy dosage is a carefull balance of seizure control and side effects, or if you are taking psychiatric medications whereby flucutating concentrations can lead to mental instability. 20% can be a big deal and patients diserve reliabaility. Taking the same brand may at least lessen the likelyhood of dosage differences or drug release patterns in the case of XR formulations.

You’re right. The *can* differ as much as +/- 20% in AUC and +/- 3% concentration in the plasma per unit time. Here’s what *I* learned in pharmacy school — they don’t. The FDA has reported and actual indexed studies on PubMed (not your commoner WebMD bullshit) saying that most drugs vary in both of the above categories by minuscule amounts.

There are very few exceptions to the rule. For instance, Synthroid doses are measured in micrograms. When dealing with small doses like that, your 0.25% plus or minus could amount to a lot more (or less medicine). My second exception is an allergy to an excipient. Yes, I have taken the time to list out all excipients in a patient’s profile to figure out if an allergy can be attributed to them (or if there’s gelatin hanging around for the vegans). The final one is Comadin. With the weird every other day regimens and the time it takes to stabilize the patient. I don’t want to rock the INR-boat with that one. Just leave well-enough alone.

Are there any more *reasonable* examples?

Is there anyone out there that would be willing to delve into the pharmacokinetics studies on Pubmed and prove me right (or wrong)? I’m basing all my comment above on what I was told in Pharmacokinetics, Biopharmaceutics, Pharmaceutics, et al. I’d be willing to listen to CITED DISSENT, but I will not accept anecdotal bullshit. You come to me with a PubMed ID number or the Title and Author of a statistically and clinically significant randomized control trial — not with, “my 2nd cousin once removed was taking Allegra, then the druggist switched her to fexofenadine and she started sneezuhn and shit…Them generics and worth a lick.”

Headhunters

Posted by The *Angriest* Pharmacist as Disgusting, Drug Companies, Hate Mail, Me being a dick, Rude, True Story, Work Sucks

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).

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.