The Great Hate

Posted by The *Angriest* Pharmacist as Courtesy, Disgusting, Drive-Thru, Drug Topics, Errors, Lazy People, Management, Me being a dick, Me hating others, Patient Education, Rude, TPA, Technicians, True Story, Update, Work Sucks

Two weeks ago I promised something big and failed to produce it. Sorry about that.

So, where the hell have I been the last two months? I’ve been just focusing on living my life. Everything’s fine with me. The stresses of my job are monumental, and it is getting the best of me. I cannot take it much longer. Retail pharmacy has defeated me. I’m throwing the towel in. I’m tapping out….

I’m not quitting my job just yet, but I am looking for something else. This is evident based on the post I made two months ago concerning clinical positions and residencies. I’d really like a clinical job coupled with a taste of academia. As has become evident, that is highly unlikely. I may find myself in a residency.

For now, I have requested a transfer out of my current location to a store that is less demanding….I’m not sure if that is going to be granted. I’m also concerned with the problems that is going to create with the current management.

What could possibly be so bad about retail / community pharmacy that would make me, the self-proclaimed King of Retail Pharmacy, reexamine the direction of his professional life? I’ll tell you at length:

My store is filling more than 800 prescriptions per day. We have 3.5 pharmacists. I work 40 hours per week. Jack works 30 hours one week and 40 hours the next week, and Jill works 28 hours per week (bare minimum for benefits). TheCrown works 40 too. I, of course, am a very efficient worker. I bust my ass day-in and day-out. I care about my job — my performance — customer satisfaction, safety, and outcomes.

Jack is the slowest pharmacist on the planet….he’s been outrun by molasses. He cares about the patient, but he’s in no hurry to do anything. He’s our stereotypical old-man pharmacist. He’s overly cautious and will take no chances or make no educated decisions based on past experiences. For instance, we have one doctor that continues to write PANNAZ over and over and over….even though Pannaz has been discontinued for a long ass time. He (and his office staff) has told us time and time again to change the prescription to Scopohist with the same directions. [Why he doesn't write that in the first fucking place is beyond me!] Is Jack okay with this? Absolutely not. He calls each time. He documents the date/time, who he talked to, the new drug, route, dose, and quantity. To the letter of the law, Jack is right. In a pharmacy cranking out 800+ prescriptions per day where two pharmacists are on duty at a time (except Mon and Tues) it is very very wrong. He wastes a lot of time on pointless shit like this. I’ve compiled the data on the last 30 days that he and I had worked together (alone), and I’ve typed and verified 83-85% of the scripts. There were days where he filled less than 100 scripts — that’s with a technician typing for him. He angers patients due to their long wait time, he can’t be left alone, and puts an unnecessary strain/load on me. The stats in DrugTopics said that a pharmacist makes FOUR errors in every 250 scripts. With me processing ~700 and him processing < 100, how is this safe for me or the patients *I* am caring for?

Jill, as I wrote above, works the bare minimum for benefits. She is much more efficient (when her mouth isn’t moving). Unfortunately, this soccer mom is exactly that — she’s a mom first and a pharmacist second. When the clock strikes noon, she leaves for lunch. When the clock strikes 5, she leaves for the day. Regardless of the load, or the day we’ve just had, she’s gone. She doesn’t recall the day before where I stayed after more than an hour to help her out.

TheCrown is the king. He’s very efficient, but he’s a huge asshole. He’s the manager at the store I’m at now. (I was the manager at my past location – more convenient location and I gladly gave up responsibility) I might have referenced David in the past — he was “the legend” I followed behind at the last location. TheCrown has me in the same boat. I cannot work with him. He’s the most passive aggressive cocksmoker I’ve ever worked with. If someone neglects to Dual-Bill someone’s Prevacid prescription to the coupon on file, he doesn’t say, “Hey, you forgot to Dual-Bill this. Be sure to check the notes in the comment field as you’re running through.” — He will look at the patient blankly when they ask about the copayment, say he didn’t fill it and knows nothing about it, then throw you under the bus once he sees you’re name attached to it. “Has anyone showed you how to dual bill these coupons?” I’ve been working with this company for a long as time…I’m well aware how to do that.

TheCrown doesn’t answer the phone when it’s really busy and ringing off the hook. He says aloud to the pharmacy staff, “What’s that ringing sound?”

When a patient comes to the counter and tells him they need to speak with him, he doesn’t walk up there and say hello. He tells them, “I can be with you in about 10 or 15 minutes. I got about 5 people I’m helping right now,” regardless of how busy he really is.

When pulling prescriptions out of the middle ’staging area’ to type, TheCrown never does big orders or transfers. I, Jack, or Jill get all the shitty shit.

For the volume we do, we are grossly understaffed. You know how we are staffed as far as pharmacists go. How many technicians does one need to fill 800 prescriptions. On a busy Monday, we have 2 dedicated cashiers and 4 technicians (one of them dedicated to our damn drive-thru). We have three computers that process prescriptions — and 3 printers. TheCrown’s printer works marvelously. The printer I am forced to use, however, is a piece of dilapidated shit. It needed replacing 6 months ago, but that’ll never happen because 1) it doesn’t inconvenience TheCrown and 2) It would come out of TheCrown’s bonus. He explains it away — telling me that I am not “fanning” out the pages as I load the printer. Ahh yes, that’s why this hunk of junk jams with every print. I’m not fanning the fucking pages. Give me a break. If it were his printer, there would be no issue. Why? Because he would either buy a new one or trade it out with the SECOND best printer in the building — which is how I ended up with what I have. Scenario: I HAVE a new printer. He HAS a problem. He HAS a new printer. I HAVE a problem. We traded verbs (and printers).

Our evening staff is exceedingly shitty. Why? Because he hires high school kids to work from when they get out of school until close at 8pm. You get what you pay for — and I get minimum wage intelligence with no customer service skills and no desire to learn any new tasks. (Why learn something new? You’ll just be expected to do that task in the future!) They are also complete smart asses, treat me with a huge amount of disdain, and leave as soon as the clock strikes 8. We usually get 3 or 4 HS students per night. They are fine for working a register, but they never know shit else. Why? Because TheCrown is so mean and hateful to them, they quit after a very short time. No one is around long enough to learn anything meaningful. Just when someone becomes somewhat valuable, he chases them away. I once had a girl with the makings of a KeyStone Tech. She was bright, pleasant, new how to speak to customers, how to diffuse situations, and she excelled at our someone difficult to master computer system. She got offered a new job at a competing pharmacy. She asked for 1 dollar more per hour — which would have taken her up to, MAYBE, ten dollars per hour. He said no…and away she went. I would have taken a TWO DOLLAR paycut to keep her — yet, he let her walk. Note: The Pharmacy that got her now has 4 or 5 of our employees. He waits until they’ve worked with us about 6 mos then propositions them with a similar job, less stress, nicer boss, and about a dollar more per hour…[He doesn't need any pharmacists :-( ]

The techs are just downright disrespectful to me. I’ve tried killing them with kindness. I’ve tried reprimanding inappropriate behavior. I’ve tried being a tattle tale. I’ve tried positive reinforcement (thanking them genuinely and buying lunch on my Saturday as I talked about in THE WORKER’S PLEA). I’ve tried giving them more tasks / responsibilities to keep them busy. They just don’t respond to anything. They treat him nicely enough to his face (and talk shit about him behind his back), but they treat me like shit to my face AND talk shit about me behind my back. They are insulting, rude, hateful little bitches and bastards. They challenge me for no reason. They question my decisions. They just don’t like me….and honestly, I don’t know why. One of these little assholes honestly had the nerve to tell me last week, when it was just the two of us standing on one side of the pharmacy processing prescriptions, “Ya know, Angriest, it’s kind of funny. I’m the only person in this pharmacy that can even stand being around you.” — I felt about 3 inches tall. I couldn’t believe it was said (to my face nonetheless)….what hurt me even more was that she honestly believed it to be true — regardless of whether or not it was. That was when I finally convinced myself it was time to go. It is time to move on. I’ve been called a lot of things. I’ve been talked to by customers like I was complete trash. Never before have I actually been hurt by it…never before have I actually believed it and been hurt by it….

Anyway….moving right along….

How many pharmacists in the world get their schedule for the next week on Wednesday or Thursday night? Is this not absolutely asinine? It’s ridiculous! I’ve complained a million times to him, the district manager, Jack and Jill, and no one cares. Jill is on a set schedule. She knows what she’s working — period. Jack is, obviously, an old man who lives and breathes pharmacy and doesn’t care. TheCrown doesn’t mind it because he WRITE THE FUCKER! If he has plans, he just schedules himself around it! Why would he care? The DM drew up a skeleton schedule for us to follow recently. I converted this text document into a nice orderly spreadsheet. I even went as far as scheduling hours to match Jill’s schedule and that it was fair for myself, Jack and TheCrown (open, close, and weekends etc). Was he pleased with that? Ohh hell no. That conflicts with the game he had running so long of getting whatever he wanted. Jack is such  a pussy, he’d never speak up — that’s why everyone walks all over him. How did TheCrown deal with this? He told me that he didn’t know what I did to the schedule the DM wrote, but I had it ALL messed up. So, he tore it up and continued with the game he played for so long. I printed another copy and told him to fix the errors — then I made him compare the two with me standing there — and of course there were none. He followed it for some time. Now, we’re back to whatever he wants and I get screwed over. Fortunately, since I’m hosed most of the time, he has the courtesy to give me either a 3 day weekend every weekend or succumb to my every wish in terms of switchs, swaps, or days off. The shred of humanity shines through!

I’m working 4 ten-hour days….which is physically killing me. What sucks about my tens is that they turn in to 12’s. I come in early to get a little ahead and stay late past my time to get off (even if I’m not closing) because Jack can’t keep the store afloat on his own. Sometimes he begs me to stay late knowing that he’d be boned without me doing all the work. Or, I come in on time on days that I close and stay 2 hours after close to do the simple tasks required of me that we’d NEVER have time to do during the business day. [Like checking email, dealing with store to store inventory transfers, returning drugs that aren't moving to our DC, and any other task that requires full attention at one time rather than 10 second spurts all day long]  —  I hate it and so does my family.

When I wake up in the morning, I ache…I hurt…my first steps of the day are excruciating. This is likely due to the fact that I stand all day on hard ass floors with poor “padding” that is falling apart — again, because TheCrown doesn’t want to spend any money replacing those spongy carpets….resulting in heel spurs or plantar fasciitis for me.

Much like Jim P said in Drug Topics a month ago, I’ve got HURRY SICKNESS. I’ve always got to have 10 things on my plate. I’m rude to my family and friends. I’m impatient. I’ve got more problems than some of my patients, and it’s because my job is breaking me — physically, emotionally, psychologically.

What other options do I have? This job is killing me from the inside out. It’s ruining every aspect of my life. I thought I loved retail…I thought the money would make it worth it. It’s not.

7 to 10 of the 10+ Things Your Pharmacist Won’t Tell You

Posted by The *Angriest* Pharmacist as Disgusting, Drug Companies, Education, Insurance Companies, Laws, Me being a dick, Me hating others, Patient Education, Pharmacy School, Stupid People, TPA, True Story, Update, Welfare, Work Sucks

The first part of this post containing number 1 to 6 can be found at: http://www.theangriestpharmacist.com/2009/05/12/1-to-6-of-10-things-your-pharmacist-wont-tell-you/

Let’s get back to ripping this bitch up… [The Article was originally published in "Smartmoney Magazine" on April 28th, 2009. No primary author was identified -- that was smart...otherwise I would be CALLING him/her.]

Update: Their main source for information is a man named Larry Sasich of Pennsylvania. I visited the PA Board of Pharmacy and he is NOT a registered pharmacist in the state of PA. Way to verify your sources there Smartmoney.com — BTW, I’m sure he’s a nice man and very smart. You can’t be an idiot and make it to his position at what seems to be a very innovative, accredited  pharmacy program/school. I’m merely calling in to question every single fucking what that came out of his mouth. It’s all junk, bogus, and bullocks.

Update 2: His bio on the schools website says Larry D. Sasich, Pharm.D., M.P.H., F.A.S.H.P. — also says he’s a nuclear pharmacist and the creator of that trainwreck of a site called Worst Pills, Best Pills (WorstPills.org). DrugMonkey has a link to it — it’s how I first found it. Most of it is trash, but it opened my eyes on how they found this guy for the article. Scaring people into questioing everything and being insanely/overly cynical is right up this guy’s alley.

Update 3: I have posted a comment on the article at SmartMoney.com — You can view the comment HERE. I also sent an email to Dr. Larry Sasich who is a main contributor to items 7 through 10. You can view the email I sent him HERE.

-=+=-

7. “Paying out-of-pocket? The price of your prescription just went up.”
- I love how this article completely ignores the way businesses operate in every other sector — assuming that the business aspect of pharmacy should run differently than say, the grocery business. Does a gallon of milk cost the same at the gas station ($5.95) as it does Schnucks ($4.15), Walgreens ($4.60) or Walmart ($3.95)? [Prices made up but the point remains]. Of course NOT! It’s all based on the contract your business can garner with the milkman, the amount you sell, what portion of your business milk sales account for, et cetera, et cetera, et cetera! Why should pharmacy be different?
- Larry Sasich (Chair of Pharmacy Practice Dept at LECOM School of Pcy in Erie, PA — Year round 5 yr Pharm.D. program) seems to think “The pharmacist has to figure out his break even point.” The article also says, “Among the variables is the % of rxs filled covered by insurance. If there are lots of covered patients, the BEP (break even point) is shifted heavily to pts paying full price….generally the elderly on Medicare or the working poor….” — And again Sasich chimes in with his inane babble, “pharmacists can’t push around a big HMO, but they can push arounnd a little old lady.”
- I’m not sure what pharmacies Larry has worked at in the past, but pharmacists do not concern themselves with break even points (I doubt indy pharmacists even do — Angry, care to share?). The ratio of covered customers to cash paying customers also has little to do with how we go about charging patients. I don’t even know what my ratio is! I know that I’m a Medicaid Majority with Medicare not too far behind. Considering only primary coverage I’d guess I’m 40% Medicaid, 35% Medicare,  20% Insurance, and 5% Cash/Self Pay. This is just a WILD guess, and I know it’s off because that 5% self pay seems way too low, but the numbers aren’t working out, I’m tired, and I’ve drank about 4 beers — just enough to feel a baseline buzz and start to get sleepy.
- Next take a glance at the bolded text. This essentially says that pharmacies prey on the elderly on medicare and the poor (I’m assuming uninsured.) This is completely retarded because those over the age of 65 now have access to Medicare Part D. Even those that are poor can qualify for SOMETHING to cover their medicines. Those below 150% of the poverty level (or whatever the exact number is) as defined by MY state qualify for Medicaid. So really, the groups he’s saying pay the cost that pharmaciSTS recoup after poor  reimbursement from insurance payors DON’T REALLY EXIST due to our socialized systems set up to protect those very groups.
- Finally, we end the section by saying pharmacists can’t push around big HMO, but they can push around granny grunt. I’m offended by this statement. Firstly, I don’t need to push around HMOs or insurance companies. I have my corporate counterpart to deal with those dickheads. And, for what it’s worth, there’s no such thing as pushing around HMOs. The run the show, and not even Walgreens has the balls to stand up to them. Sure, they could drop them, but they won’t A pharmacist personally has no business dealing with HMOs in most circumastances. So, that is a pointless statement. What offends me is this dickwad insinuating that pharmacists, since they cannot wheel and deal with HMOs take out their frustration on innocent elderly women. That’s asinine. And, once again, they have Part D to cover them as well as Medicaid.

8. “This medication is stale.”
- This has an example of a crooked pharmacist diverting short dated drugs from a nursing home distributor in NINETEEN NINETY-ONE — that’s right, 17 years ago! He bought them cheap and dispensed them and some of them were out dated in some instances. It also talks about buying quantities of meds that are “far bigger than they’re legally allowed to handle.” I wasn’t aware that there was limitations on how much you could carry. I understand limits on compounding as a percentage of your total sales — as well as the likelyhood that there are limits on the number of CIIs you can order or have on the shelf….but I don’t know what the article is referring to.
- Anyway, this bullshit point is just another example of fear mongering. Believe me, the likelyhood of a person getting a short dated drug or expired medication is getting less and less each day. I know it’s hard to catch, but I always try and check the date on drugs that I don’t dispense often as I am checking them. I also put red stickers on drugs that expire within the next 3 or 6 months just as a way to ENSURE I check the bottle each time.
- And like many chains do, I return drugs that expire within the next 100 days. Picked that tip up from Wally world.
- I wouldn’t say this to a patient, but from what I’ve been told and picked up along the way, medication expiration dates are usually just a guess. They really have no idea, but the FDA requires them to have an expiration date…so they stick on on there. I, personally, will take most medications that are way expired (I dunno, a year maybe?) unless of course smell funny or have aspirin in them. [Aspirin DOES expire - sometimes before it's date Acetylsalicylic Acid breaks down into ACETIC ACID (Vinegar) and Salicylic Acid (Wart Remover)] — I love my in-laws to death. My father-in-law and I are very good friends. I wish we lived closer because I enjoy him so much, but they are PACK RATS! I’ve found meds in their closet that expired when I was still in high school. I had a headache, and their 800mg Ibuprofen was filled in July of 1997…worked fine. Don’t say placebo effect…:-)

9. “I don’t just sell drugs. I make them.”
- More fear mongering. If the mass produced product is available, you are going to get it in 99.9% of pharmacies out there. While many pharmacists may ENJOY compounding and are completely qualified to do so, I doubt ANY of them would ignore the stock bottle on the shelf so they can brush up on their aliquots and punch 30 capsules or break out the mortar and pestle to crush tablets for a suspension. It’s irresponsible, not profitable (contrary to what this article says), and TIME CONSUMING.
- Again, I’m not sure where Larry Sasich got his pharmacy experience, but I think he’s done nothing but talk out of his ASS. If he had an RETAIL pharmacy experience, he would KNOW that NO insurance company is going to pay for a compounded drug when the same thing is available commercially. He’d also know that when you take into account the time taken to compound something, you actually lose money while considering the big picture.
Example: I made an Omeprazole Suspension the other day. It was 20mg/5ml #150mL. 30-20mg Omeprazole capsules costs what? Less than 5-10 dollars? It also requires 30mL Cherry Syrup, Baking Powder, and distilled water. Total cost of goods? We’ll say 15 dollars. I had to triturate the contents of the capsules. Wash the mortar with cherry. Incorporate the baking soda. Wash again. Shake well and wait some time as it fizzes HORRIBLY, and QS to 150 with water. My total time spent was like 20 minutes (counting my interupptions). So, my reimbursement was fair. I got back the cost of goods sold and something like 13 dollars on her insurance plan. Good deal right? WRONG. As a pharmacist, I make a dollar a minute (I know, life’s a bitch). Since I spent between 15 and 20 minutes doing it, my 12 or 13 dollar profit is GONE as I didn’t make back my own salary. Of course she might have bought a lot of shit, but I doubt it.
- The Ole’ Apothecary and I often exchange emails. He sent me one last night not long after Part 1 of this post went up alerting me to the necessity of Excedrin prior to completion of the smut published by SmartMoney.com — He also produced a very good point concerning compounding. In the “olden days” Pharmacist was *THE* healthcare worker. There were no doctors. There were no manufacturers. Compounding was the LIFEBLOOD of pharmacy. That is precisely why the mortar and pestle are still the logo of pharmacy. That is precisely why pharmacy students are still trained thoroughly in what is all but a dying art. It’s cheaper to mass produce. There’s also less chance of error and CONTAMINATION.
-Contamination brints me to my next point. The example they use in this section is “some pharmacists compound drugs that already exist such as INJECTABLE MORPHINE or HRT…because it’s cheaper…they do that so they can make more money,” says Larry (flying by the seat of my pants) Sasich. Now, think about what’s wrong with this picture? INJECTABLE MORPHINE CANNOT BE COMPOUNDED IN RETAIL PHARMACIES. Why, you ask? Because it would have to be a STERILE product as it is going to be used intravenously. Products for injection are required to be sterile (or delivered from the manufacturer as sterile) due to the potential for injection if contaimnated. Have you every seen a LAMINAR FLOW HOOD IN A RETAIL PHARMACY? I haven’t. I’m sure there are a FEW out there that have them, but certainly not enough to make this statemtn not seem retarded,

10. “You can get any prescription you like online.”
-Yep, you can also pay hundreds of dollars for Pez. There are a few legitimate websites out there, and if they are legit, I’m not 100% opposed to them in CERTAIN circumstances. The circumstance? The patient is taking the medication LONG term, on a stable dose, and completely versed in the medication being delievered to them.
-But, before someone does this, I want them to ask themselves this: What do you pay for at a pharmacy? You pay for the drug, granted. But, a lot of the cost is for ME — you pay for me! And what happense? You don’t get the drug on time, or something gets CFed and you come crawling back!
- Here’s what scares me about the situation (aside from the lack of direct pharmacist intervention or counseling or people getting grifted by shady pharmacies) – people getting adulterated medications that did not come out of an FDA inspected pharmacy. Drugs that came from Canada or Mexico — an area of the world that cannot even sanitize its own drinking water for safe human consumption. Awesome….

There you have it folks — my take on the TEN THINGS YOUR PHARMACIST WON’T TELL YOU

I am going to come up with a REAL list tomorrow to share with the world. A legitimate list of things your pharmacist won’t tell you along with the explanation. Something that people can ACTUALLY benefit from without trying to scare the shit out of them.

WOMEN – A New T-Shirt

Posted by The *Angriest* Pharmacist as Me being a dick, Update, store

Drug Topics Testing Waters of Pharmacy Blogosphere

Posted by The *Angriest* Pharmacist as Blogs I like, Courtesy, Drug Topics, My nose itches, Surveys, True Story, Update

I’m sure all of you remember my Viewpoint that was submitted to Drug Topics Magazine. I toned down my writing and penned what I thought was a very inspired piece worthy of publishing. It outlined the plight of a pharmacist, Chris, who was reprimanded for taking a bathroom break. Yet, DT didn’t publish it because they receive ad revenue from the usual suspects — the chains that would be so bold, so brash as to punish an employee for taking a tinkle.

Today, Drug Topics sent out a research questionnaire/survey to an unknown number of email addresses. The email address associated with my REAL name was selected. I, of course, obliged as they were going to give out five $100 gift cards. I’m all about free money. [Go ahead and take 10 minutes and take the survey -- let them know that you support and read the pharmacy blogs!]

I had finished about 75% of the study when I was taken aback at the question.

Well, now we’re talking! Of course I read the blogs. Hell, I write this one. I read Angry, DrugMonkey, JP, and hit all of the others at least once a month.

So, I continue on to the next question, and what do I see? Holy mother of god…

Which blogs do you read?  Well, I’ll be damned! I read all of those, and I have a little bias towards one of them! That was it for the Pharmacy Blog questions…

That begs the questions, “Why do they want to know? Why do they care?” I wasn’t really sure when I took these screenshots, but I let it sit for a bit and I figured it out. I also referred back to some emails that were sent between me, Angry, Drug Monkey, and the king of all pharmacy, JP at Large.

DT is losing the battle. Print is dying, and the blog is emerging as the new hotness. The problem I see with this, and I encounter on this blog all the time, is that you cannot trust the information you read. I cannot trust the information in a comment or on a random blog. Hell, any hack with 20 bucks can start a blog/website. The information in a reputable magazine, like Drug Topics, can be trusted (except the shit in the ads).

They are testing the waters. They want to see just how popular the blogs are. Once they realize the amount of hits (and potential ad revenue) that exists on my blog, Angry, JP, et al. they are going to make some changes.

The proposal was made to allow the bloggers to have some sort of running column like JP has — where myself, Angry, and DrugMonkey would contribute an article here and there and see where it went. I was all for it — hell, I think I was the first on board. I’d love to reach more readers and, more importantly, bring more people to the site to read my old material and help inspire more comments, discussion, and new posts.

Yet, they stayed silent. Not enough COURTESY to even tell me no, later, wait, or anything. Now here they are, sticking their toe in the deep end.

Well, I’m still here. I’m still waiting…