The importance of lifelong learning
I got this guest post submission from a student and found it pretty funny. I'd be there are a TON of pharmacists that are just as clueless here in the states. If you don't use it, you lose it. I know that I don't remember a lot of the intricate stuff I knew back during and right after school. But, I do read, learn, and occassionally challenge myself. This is one of the reasons I like to have students. Constantly explaining things to them helps me remember it, and at the same time, they will know things that I do not remember. Having them teach me benefits me with knowledge and them with recollection and presentation. If you want to keep up and remember stuff, get some students on rotations -- trust me. CE's are worthless in general. When compared to students, they are a waste of time.
-=+=-
I understand the Unites States requires every pharmacist to get a doctorate prior to becoming qualified. However, in Australia, it isn’t required. It is still an undergraduate degree, so we come out after only four years of studying, do a year’s internship, pass our registration exams and we’re done. Every year, we have to enough “points” every year to remain registered as a way to encourage our ongoing learning.
As I’m still in my third year of my degree at the wonderful University of Sydney, we are required to undertake externships, where we get sent to pharmacies for “workplace experience”. I undertook my externship at a medical centre in Sydney’s north.
As one would presume, the entire purpose of my presence there was to learn. The medical centre pharmacy was small enough for only one pharmacist and pharmacist assistant to run the store.
I was questioning the pharmacist present at the time of the several of the drugs people came in for. One of them was quetiapine- as one should know- an atypical antipsychotic.
“What class of antipsychotic is quetiapine?” I asked.
The pharmacist replied curtly, “I don’t know.”
At that time, the pharmacist assistant, who is also qualified, hospital nurse, commented that he should know coz he just passed his registration exams a few months ago.
So I continued to ask: “Why do antipsychotics cause suicidal thoughts at times?”
“I don’t know.”
Do you fucking know anything?
Let’s try something else then. “Why do topical corticosteroids thin out the skin?”
“I don’t know.”
How much did you bribe the examiner to let you pass your registration exams?!
Ok, so I dropped that topic. So I asked about shingles. “I heard shingles is called herpes zoster, but it’s caused by the varicella virus. So does that mean herpes and varicella virus are the same?”
Again, “I don’t know.”
The pharmacist did not look at me the entire time, so I looked at the computer screen he was typing away at. He was on Wikipedia searching up shingles.
WIKIPEDIA.
SURELY, THERE ARE MORE RESPECTABLE & TRUSTWORTHY REFERENCES TO TURN TO? ALL OF THEM HAVE AN ELECTRONIC VERSION AVAILABLE. MEDSCAPE. AUSTRALIAN MEDICINES HANDBOOK. MIMS ONLINE. THERAPEUTIC GUIDELINES.
“I don’t know anything. Stop asking me questions.”
That’s exactly what I did. So for the rest of my externship that day, I didn’t ask any questions. This incompetent pharmacist went on to report me with an “attitude, and is not willing to learn”.
Oh wait, what? So did not see that one coming.
I have seen a variety of pharmacists in the professional field over the three years I’ve been studying and working in pharmacies. I’ve seen the best pharmacists who are able to treat palmoplantar psoriasis and various skin conditions better than doctors can. I’ve also seen the negligent; one pharmacist gave out Nurofen Plus to a patient with an active peptic ulcer just because they requested it by brand. Even with my incomplete education, I know that I should have offered an alternative, perhaps paracetamol [acetaminophen] for your headache?
The pharmacist I worked with during my externship rivals the worst pharmacists simply due to his knowledge gap. I don’t think customers realise it because all he does is assume the doctor has given all the instructions to the patient, so he doesn’t have to do it, and most customers are regulars so they’ve been on the medications for many years.
Being a young pharmacist isn’t an excuse for being ignorant. Pharmacists are the second most respected profession [second only to emergency workers] so don’t tarnish our reputation!
Two months worth of reader email
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
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.
No fix needed — you’re an IDIOT
Some of you may remember the post from a few days ago where a guy asked me to fix his inhaler / aerochamber. Well, tonight I finally filled in all the holes.
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...
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