Updated ODDS!

Posted by The *Angriest* Pharmacist as True Story, Update

Some may remember when I outline the odds of your getting a misfilled prescription (as well as dying as a direct result). You can refresh your memory HERE.

http://www.nsc.org/research/odds.aspx outlines the odds of your dying from everything imaginable. I could copy some over to this post, but that would insult your intelligence. I’ll just say this…you’re more likely to get struck by lightning taking a shit…

Funny Story

Posted by The *Angriest* Pharmacist as --Not Pharmacy--, Engrish, True Story

I’m back! Sorry for the absence…I was delayed.

Anyway, I’m telling you that only to tell you this, I’m leaving again. It’s vacation time for The Angriest Pharmacist, and I will have NO access to the website for 10 days or so. Lil’ Laura will probably post a few things, and she will tend to the comments to make sure that they get released from moderation and properly berated in bold (As I’ve begun doing lately - it’s easier than replying).

So, here’s a funny story from last night - not pharmacy. I went to the gas station to pick up some chewing tobacco. Save me your comments on the evils of nicotine. If I cared, I wouldn’t do it. Anyway, I went into a random shop and asked if they had my brand of choice. They did. So, I told the lady, who was Mexican and didn’t speak fluent English, but she knew enough to get by easily. I told her I wanted all of them. She was aghast. Who would want ALL of these little cans of dirt?

She started pulling them out, and I stopped her at 7. The rest went like this:

I’m going on vacation, and I don’t know where I’ll be.
You going on vacation and you don’t know where?
Well, I know where I’m going. I just don’t know if I’ll have access to a gas station that sells this fine product.
Well, since you gonna be lost, at least you have a lot of dirt to suck on.

I’ll be back after my ten days of sucking on dirt. See you all then!

TAestP

PS - I added a Tweet on the right sidebar. I’ll definitely send some stuff to that as hilarious/irritating things happen while I’m in paradise.

Discharge Scripts

Posted by The *Angriest* Pharmacist as Doctors, Errors, Lazy People, Me being a dick, True Story, Work Sucks

Do they even look at these damn things?

I have a hospital near me that generates discharge scripts via computer. It’s all based on what meds the patient was on during the stay in-house. I know the process there because I called and spoke with their pharmacist on duty one night. We hate our jobs equally.

It goes like this. The Ward Clerk generates a list of all current meds on the MAR (Medication Administration Record). This sheet includes PRNs, parenterals, orals, rectals — the works. The doctor then goes down the list and circles YES or NO. This sheet is then sent to the pharmacist who removes the NO drugs from the profile (by D/C’ing them). Then, the pharmacist prints these sheets directly on the floor and they are reviewed by the patient’s nurse based on what was said and what s/he expected. There is a space for the doctor to sign. My pharmacy will fill these w/o the docs signature because we deal with the hospital so much and these sheets are not “fake able.” I will admit though, that only 1 out of every 50 are unsigned. So, for the most part, the doctor has the OPPORTUNITY to review these sheets again. A quantity is written in on the bottom as well — usually it’s ONE MONTH.

So I can say, without a doubt then, that at least THREE sets of eyes see (or should see) these damn things before being given to a patient — Pharmacist, [Ward Clerk perhaps?], Nurse, and Doctor.

Why in the fuck did I get a sheet today that listed:
1. Fentanyl PCA 10mcg/hr Basal with 10mcg on Demand Every 10 Minutes.
2. D5NS 100mL/hr
3. Naloxone
- This was obviously in a ’set’ with the Fentanyl to pull from a Pyxis if needed.
4. Heparin Lock Flush 100 Units prn
5. Ancef 1g one hour pre-op

How did this shit get by? It was fucking signed by the doctor. He even wrote in *his* DEA number to cover the fentanyl…the only Narc on the script.

There was more on the script of course - they always leave OTC/PRN stuff and we just use our professional judgment on how to get those things to the patients (Ibuprofen, Docusate, Baby ASA). Usually we just grab it off the shelf if they want it.
But seriously? Dextrose in Normal Saline? Would you like me to educate the patient on how to start a line on himself? Should I also work through with him on how to operate the PCA Pump he has in his bedroom - making sure he sets it for MICROgrams rather than MILLIgrams since it’s fentanyl? [End Sarcasm]

I’m expected to review my work before it leaves my pharmacy. Why is this healthcare team not expected to do the same? I could get in serious trouble for not checking my final product prepared by my technicians.

If you care about the outcome I reached - I just scratched the bullshit out. Later in the night when it slowed down, I called the pharmacist on duty there and let him know that that stuff snuck through. He attributed it to “a student screwing around on the computer.” I attributed it to his laziness or lackadaisical demeanor. He did not like my analysis — nor did he apologize for the actions of himself or his student. If his lame-ass excuse was valid/true — it’s still his fault for not staring over the student’s shoulder…which would be the law for the student entering orders in my state of residence.

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).

Circle Of Spite

Posted by LilLaura as Lil Laura, Rude, Stupid People, True Story, Work Sucks

Generics are the best way for a government, a health service, a GP practice and a local pharmacy to economise, without putting the patients health or wellbeing at risk.

Yet there are those patients who refuse to believe that generics are the same. They “don’t work the same”, “make me feel sick”, “have odd side effects”, “consultant says I should have…”. One word-BULLSHIT.

IT’S ALL THE FUCKING SAME PEOPLE!!!

Par example, a woman in her 70’s today. She condecends to pay us a visit every….3 months (checked the computer). Apparently the pharmacist here is ALWAYS a man (strange considering the last manager was a woman…). So she has a script for flucticasone aq nasal spray (anti-allergy). So, I dispense as on prescription the generic. She leaves the shop. 2 minutes later she’s back demanding the brand, Flixonase. I can’t give her it because we have stock of generic-”but the other pharmacist always gives me it-hes SOOO much nicer than you”. I explain to her that, if she has a problem, take it up with her GP. Of course-the GP wrote it for Flixonase. When I showed her it was NOT the case, she asked for it back. I nodded in agreement and went back to work…..

“Can I have a word with you?” (customer) Bear in mind the shop was packed and I was up to my eyes in items waiting to be checked…

This woman gave me a dressing down like you would not believe in front of other customers, just because I obeyed the law and didn’t bend the rules for her. I said nothing, let her have her little rant-which I think made her more angry. Other customers watched and some looked more embarrassed than me. I finished checking the scripts and gave them out personally-each customer giving me a look and smile of compassion and sympathy.

Like Don Corleone, I let her have her rant….embarrass me in front of my regular customers…Why compound the problem by conforming or retaliating? Revenge is a dish best served cold…and when her doctor delivers the message that she is no longer a patient deserving of my attention because she behaved in a ludicrous manner..

Game, Set, Match.

On a sadder note, my second in command is leaving us. I will miss her, but I cannot deny her the freedom she yearns.

Oh, and FAO Scott,

What would you say to me, a pharmacist who is a descendant of one of the possibly greatest pharmaceutical minds of our time? Sir Alexander Fleming? My grandfather was his great nephew, and he was a JOINER in the shipyard, Harland and Wolff, that built many warships and my great uncle, Austin Fleming, was a pharmacist and fought with the Americans during WWII. Probably served alongside a member of YOUR family. Remember that NEXT time. Remember that you are speaking to someone’s daughter, someone’s son; someone’s family. And when you walk out the door of that pharmacy, you may not remember the pharmacists name, you may not care…..

But OTHERS do. They remember the good things about the pharmacist who worked there; how they helped them when they truly needed it. Their names may not be remembered, but their legacies LIVE on because people DO remember. Who the fuck is going to remember a bitter twisted shit like you?

The *Angriest* one’s rant at this guy made it easier for me to complete this blog. Because, at the end of the day, we know who we are, we know what and why we do the job we do; and like many other professions we feel like we deserve better. And when we are gone, people will remember us-some even tell stories. After all, you always hear about “that bastard of a plumber never finished that fuckin’ job!”, never the good things. I always remember going to the pharmacy as a kid, and remembering that, no matter what, the job was always precise and detailed, and you were treated as a person.

And, at the end of the day, I would rather be remembered as “that pharmacist” than “a fucking waster”.

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.

TAP Stands Up

Posted by The *Angriest* Pharmacist as Blogs I like, Doctors, True Story

So, I got a link emailed to me for this post. I’ve been busy lately, so I forwarded it to The Angry Pharmacist for him to handle….and handle it he did!

I really don’t have anything to add other than fuck that doctor’s attitude towards our profession. I’m merely posting this so everyone can read the complete an utter pwnage handed down by the DrugLord.

“Omnipotent” Assholes and Dirty Ol’ (wo)Men….

Posted by LilLaura as Doctors, Lil Laura, Sexy Time, Stupid People, True Story, Work Sucks

This post comprises of the last few weeks of work, which have been unusually uneventful for me…. I start to worry as NOTHING EVER goes quietly for me. I couldn’t write as the last post dive bombed, so I’ll see how this goes, and if I cock up, I shall blog no more.

The *Angriest* one’s funniest post to date (IMHO) comprised of a complete arse of a “pharmacist” (no way was that real) trying to communicate with a patient (which makes me think it is a couple of medical students taking the piss out of our profession-because doctors don’t know or care how the drugs work).

There are two types of medical students-the chilled and relaxed (the minority) and the stressed and partied out (the majority, that become “omnipotent” assholes). So unfortunate that my little sister will fall into the latter category, though my blog is fast becoming an icon amongst the med students in her class-not quite what I intended!! Though a few have decided to try dentistry instead….as they now fear the wrath of the pharmacist!!

Omnipotent….used when describing a god because they are faultless and are never wrong, they know everything. Doctors may play with lives and like to play god, make mistakes like all humans do (otherwise they’d never learn ANYTHING-and usually we pharmacists are their reference guide) yet know FUCK ALL. I always laugh when a patient says they’d rather take their doctors word for it….because the very next week they are banging down your door because the doctor couldn’t be bothered with them! For example, yesterday I had to call for an ambulance for a patient who was suffering from severe dehydration after a bout of food poisoning-which the GP dismissed as “hyperchondrical”…..(fucking knob).

A local doctor (the same one as above, ahem) made the mistake of missing a patients adverse drug reaction to ibuprofen (Advil). I spotted it, reported it and did my duty. The doctor said to just dispense the prescription (”omnipotent” asshole). I told the patient that if he had any further trouble to talk to the doctor, as I was overruled. Like Pilate, I washed my hands….

Now, for the Dirty Ol’ (wo)men. Now, you’d think that for all the censorship, rules and regs we have to face in our personal lives, that those that set the standard originally would adhere to it-apparently this is not the case in Bonnie Scotland….

Last week, a woman, in her 70s asked to speak to me. In front of other customers, she proceeded to describe how itchy her lips were and that the doctor had given her a cream for them. I could see nothing wrong, until she uttered the words that nearly put me off sex for life “NO, not those lips dear. The lips DOWN UNDER” and pointed. Nice. Then there’s the “confident” (i.e. limp) men over the age of 60 getting Viagra for free, and they ALWAYS wink at me when I hand them their items (shudder). The worst has to be a man in his 90s (yes, over NINETY YEARS OLD), telling me that my name was very “Victorian” and he imagined me in a corset and crinoline dress… Never have I felt so used….

I think as a pharmacist you develop immunity as you always have to appear professional. When it happens to my staff though, I really laugh. These are women 20 years older than me, and they still get embarrassed, even though they’ve probably seen it all before! A member of my staff got very embarrassed the other day as she was witnessing a man take his trousers off-she froze and didn’t know what to do! Thankfully he had another pair on under them! HAHAHAHAHA! I stood watching her face getting redder and him wrestling with his trousers in front of a shop full of people. Fair enough, I probably should have intervened, but I couldn’t. (Probably the reason why I have an impacted wisdom tooth now, and am on antibiotics-which means that the alcoholic beverages are out for the next week, and the pain of it makes me VERY bitchy.Karma).

Damn Bicycles

Posted by The *Angriest* Pharmacist as --Not Pharmacy--, Laws, Me being a dick, Stupid People, True Story

I was driving home tonight, and I came to a “T” in the road. I was turning right. A bicyclist flew across the intersection the same way I was headed. I was nowhere near hitting her, but she ran the stop sign plain and simple. I made my turn, passed her in the left passing lane, and proceeded. She ran another fucking stop sign — passing me up. I made my way past her another time and got to the light….She didn’t run the light, but I rolled down my window.

“IF YOU ARE GOING TO BE ON THE FUCKING ROAD, YOU NEED TO FOLLOW THE RULES OF THE ROAD. STOP RUNNING FUCKING STOP SIGNS YOU STUPID BITCH”

She rattled off some inane babble about “did you see that red car right in front of me? were you watching that red car???”

I think she was implying that since she was tailing a red car very closely, that the red car’s stop counted as her own. Readers, I can assure you that while, in theory, this sounds correct — she is in fact a stupid, dumb bitch and needed a good kick in the cunt…which I would had delivered had I not be on a very important mission to get home and drink beer.

Attention bicyclists! I can accept your hippie ways. I can become accustomed to your unwashed hair and your vegan lifestyle for the betterment of ‘mother earth’ — but, when you’re on my fucking roadways, you obey the laws of the road you hippie scum. I don’t give a fuck how much you are reducing your carbon imprint…or mine!

If I had hit that fat, pear-shaped slut, my ass would have been in trouble…not hers. The cops wouldn’t have said…”Ohh she ran the stop sign…have a nice day!” They would have said, “You hit a pedestrian? I’ll see you in hell, motherfucker!” Then I would have been locked up.

Stay on the sidewalk, off my roads, and off my fucking last nerve.

Next time I’m going to door-check that sperm-burping whore….

Mind Your Own Business

Posted by The *Angriest* Pharmacist as --Not Pharmacy--, Money, Rude, Stupid People, True Story

The Angriest Fiance and I visited a local eatery tonight. Not a high priced place like PF Chang’s, but we certainly weren’t at McDonald’s. Quite frankly, I think the place is into witchcraft. I saw their delicacy of choice in a large tank of dihydrogen monoxide when I entered, and they were brownish black. Yet, when they served me a dead one to eat, it was obviously bright red. Either they are wikken-kind or someone has some talent with the paint brush in the kitchen.

All kidding aside, it was 9pm. It was an odd assortment of customers. We sat across from a black man and woman. It was her birthday. Our waiter was amazing. He was polite, quick, and always around when he needed to be. Anyway, it was the lady’s birthday - she was rewarded with a free daiquiri for her achievements.

As our wonderful waiter was serving us our salads and asking us if we needed anything else, our neighbor across the aisle decided that he needed my waiter’s attention more than I did. I guess he didn’t notice the fact that I had a male waiter, while his server was most definitely a female. Nonetheless, he let out a resounding, “Excuse me!” while a salad was being placed before me. In pure Angriest-Pharmacist fashion, the waiter ignored the man like he was a fart in the wind. After we were tended to, the waiter’s response was perfect. He acknowledged the man (barely), told him to wait just a second as he returned the “serving table” to the back, and walked away. He never returned — however their waitress came by a few moments later. I found this absolutely hilarious.

Finally, they brought out our main course. I proceeded to chow down on my feast before me. As most may know, there is some splatter involved with food that lives in water. You break a hard shell to get to the sweet, succulent, heroin-like substance within. I’m also a very, very, very messy eater. I got a little on me…and my date. She was not as amused as I was.

Our neighbors thought my entire meal was quite funny. They giggled and laughed. Hell, I think they pointed. It was pretty fucking irritating. I’m not sure why someone would spend more time watching someone else eat than staring at their own food and their own wife’s tits. I hope they enjoyed my dinner - I did.

Moral: Keep your eyes on your own fucking plate.
Tip on $50 check? $15 for service. $5 for ignoring rude ass people.