Testing the waters

Posted by The *Angriest* Pharmacist as --Not Pharmacy--, Education, Just a question, True Story, Video

Following yesterday’s testing the waters with the mention of a pharmacy-based sitcom or show, I wanted to follow up with something funny to hammer home the point. I failed. I don’t have a funny bone in me tonight.

I’ll do what I do best then. I’ll  be angry! Surely, I can pump out some golden rage — especially considering a personal confidant and mentor, The Ole Apothecary, called my words from yesterday, “a Gettysburg Address for the profession.” Yet, I had a pretty good day. It wasn’t hectic. I was working with a well trained staff. Not much went wrong. So I’m not the angriest today…or even angry.

Let’s get real for a minute then. As far as any of you all know, I’m Jim Plagakis playing a grandiose game with everyone’s mind. Of course, that’s absurd. But, I am a young man. I have a nice home, a new car, a dog, a cat, and even..eeeeek…a wife. That’s right — TheAngriestPharmacist is actually a husband. There’s a woman out there that has heard every store you’ve read come out of my lips (plus some), and still decided to marry me and spend the rest of her days with me.

For a long time, she hated the blog. It was a fixation that I created with which to waste my time. As time went forward, it became accepted by her because of my love of doing it (for so many reasons) and the popularity it had gained over the months to years. I also know she loves me because of how she’s dealt with my recent stress caused by the pains of retail pharmacy as well as other drama in my life — unrelated to our marriage mind you. My point is — she is the one.

How can she have the same faith (in me as well as our relationship)? I certainly hope she does. But, merely uttering the words, “I do,” does not love create! If she were to ask it of me, every word of this blog would disappear into nothingness…only to be seen by the great google archives. If she were to ask it of me, I’d uproot our lives and move anywhere in the country — an offer she recently made me bringing about this revelation. She is willing to give up what she has — a job that she loves and is very good at — for my overall happiness. I had to ask myself the same question of her happiness. Arriving at the same answer proves the existence of true love — selfless and pure.

Well, first comes love and marriage….then comes what? That’s right! The incessant questioning of friends, family, coworkers, and random strangers about when you are going to have children. As if asking once per month will inspire offspring. The truth is, we want to have kids…in a long ass time. I don’t want to be an old man when my son wants to throw the football, but I don’t want to be so young that I’ve not had time to enjoy the waning years of my own youth. As it stands right now, I could still be out hitting the clubs and rocking the party scene anywhere I wish. I have no desire to do that as I married up in the first place, but you get my point.

Besides enjoying my youth prior to children, I want to enjoy that youth coupled with the freedom couples have prior to children. If I want to randomly make a trip to the nearest large city for a weekend, I can plan that Friday afternoon. Try doing that with anything under the age of 4 in your house. Not always easy unless Grammy and Pop-Pop are suckers. Additionally, I want to enjoy the freedom coupled with the money to explore the limits of said freedom. I have the money to go to Europe with just my wife — and stand under the Eiffel Tower with her (as cliche as it is, she will dig it!) — I want to enjoy that prior to becoming a parent. I want to explore ancient churches, ruins, and do a little bit of urban exploration (UE) before I get to the point I have to think about getting home before X o’clock or the babysitter gets paid extra. I want some time to enjoy my wife…my life…before moving on to bigger and better things.

[It also could be said that I have a fair amount of growing up to do before I should be procreating. I also need to make sure that I'm somewhere stable -- i.e. in a job I can depend on and won't be hopping around the country.]

The final thing is what I pose to the readers. How irrational is my fear of having children because of my own mortality? I can accept the fact that everyone dies — but not all of us die in due time. The fear driving these thoughts is two sided in my mind. I’m scared that I could die leaving a young man to grow up without a dad. I’m also dually scared that I might find myself a widower. Am I man enough right now to raise a child in today’s society as a single father? Will I ever be? I certainly hope (and think so). It’s not the overcoming of the task that gives me the most fear. I’ve overcome some serious hurdles in my life — my friends reading this knowing the real me can attest to the strength of my character and resolve — but the fact of the matter is that I don’t want to be faced with that option because I know what it would take to get to that end.

Right now, my wife is everything to me. This child has yet to enter my life. What if they are forced to trade places? I feel so horrible that there are men out there (perhaps reading these words) that have lost their wife during what should be the most joyous time of their life — childberth.

So there it is. I know what the future holds, but I’m terrified. I’m terrified to go it alone. I’m terrified my wife may be forced to go it alone. Together? I know we can do it — we’ll be great. Those ifs and buts may drive me nuts.

For now, I’ve resolved to take the, ugh, cliche/cutesy way out. Whenever my wife becomes pregnant (which will be hard as I inject her with DEPO q3mos in her sleep), I’m going to make video recordings. Thinking back on my life, I remember the times when I needed my father, when he was there with positive advice or kind words. While our relationship is far from perfect, I know when I needed a dad — and that’s precisely what I hope to reproduce with nothing more than a tripod and a handful of SD cards. [Quote: "Anyone can be a father. It takes someone special to be a DAD."] Sure, it’ll be awkward…but someday, albeit down the line, it will be appreciated and perhaps help forge a relationship with my son/daughter that otherwise couldn’t / wouldn’t exist.

Don’t tell them about the blog til their 18 though, okay?

Logical Rage

Posted by The *Angriest* Pharmacist as Courtesy, Drug Seekers, Insurance Companies, Just a question, Lazy People, Me being a dick, Me hating others, Patient Education, Rude, Stupid People, True Story, Work Sucks

I’m sitting here desperate to post something. I’ve literally stared at this empty text box for going on 10 minutes. All I’ve typed amounts t0 25 words…no 29…wait, 30.

My thoughts have staggered and stammered here and there, back and forth. I started to post about a lady, angry at me because she had to drive 8 miles both ways twice because her doctor’s office sent in 1 eRx at 1pm and another at 5:45pm….totally my fault. She also had to wait each time. Totally my fault. What was her gripe? Gas money. Gas money? I drive a car that get’s 26 miles per gallon. Even if she drives a truck getting 16mpg, she’s out what? $2.50 — That’s the cost of being sick. Going to the doctor and then them being inconsiderate and doing a crappy job at clicking OK.

I also thought about bitching about that same doctor’s office sending ALL their eRx’s for the day at 5:45pm — when my main staff was all gone and I had around 50 prescriptions to process with a young, untrained, skeleton crew at best. One called in sick. It was loads of fun. I (and every other pharmacy) let them know of our displeasure with that practice and how it would stop. I went as far as telling them I would make it known to their patients that if they continued that practice, having no respect towards my staff and business practices, those prescriptions would not be filled until the following morning. [Which is of course bullshit. I would just have 2 or 3 hour waits -- finishing most sales and Rxs up after close]

I’ve also, for a long time, wanted to write a post about some weird ambitions I’ve had for some time. I’ve considered converting some of my stories and anecdotes into a short comedy routine / spot and going to an open mic night somewhere. I know it sounds absurd. I’d probably bomb.

Ya never know though. I’m a funny guy outside of my serious job. I can make up bullshit to make people laugh on the spot. But, can I make pharmacy funny? Can I convert my anger, hostility, and, most recently, pain, into something enjoyable? Something to brighten someone else up? As a reader, you might quickly say — “c’mon of course you can this shits hilarious dood!” And it is…to us. The average reader reads my stories an empathizes with my plight. Can a layperson empathize? Can they even sympathize?

It’d be much easier to convert to a tv show…like “The Office,” which is perhaps one of my most favorite shows. Or perhaps a different concept. Maybe three short 8-minute episodes in a half-hour spot. Pharmacy is 15 minutes or less anyway right?

So, whose going to pay for her fucking gas money? I don’t know what hit me in that moment, but I was struck by the rod of golden logical rage.

“Who’s going to pay for your gas money? Well, I guess I will. But, from now on, I’m going to start charging you for all the free services I once provided. Next time you have a question about whether you should take APAP, Ibuprofen, or Aspirin, call me with your credit card number ready, and I’ll be glad to help. When your daughter has the flu and you have no clue what to do with the 7 different types of Triaminic, Tylenol Cold, Tylenol Sinus, and Motrin Cold and Sinus you have in your closet, I’d be glad to help you for a price.You see, you expect me to always be here for you — always free. You pay for your prescriptions, yes, guaranteeing you a certain set of specific services, but I’m so much more to you — whether you realize it or merely respect me so little you don’t care. I’m your “doctor said” fact-checker, your pill identifier, your prescription insurance problem finder AND fixer, your store-next-door-phone-number finder, your late-night fever buster, your icky medicine flavorer, your idea man for reducing rx costs. Always there….a phone call away. Do you really want to bother me with 3 dollars worth of gas? Is it so important to you that you simply must rant and rave until I dig a few dollars out of my pocket? I thought not. ”

PS — Go check out THE RAGING SERVER. He’s back and cooking up some good shit…

PPS — Since it’s the Christmas Season, T-shirt sales have shot through the roof. Apparently, pharmacists enjoy getting bomb ass shirts for Christmas.

The *Angriest* Pharmacist Store

Why Would I Lie?

Posted by The *Angriest* Pharmacist as Courtesy, Engrish, Insurance Companies, Laws, Me being a dick, Me hating others, PHARMACY SECRETS!, Patient Education, Rude, Stupid People, Technicians, True Story, Work Sucks

I hate how several times per day I find myself in a situation where the only possible outcomes in the mind of the patient is that I am either A) Idiotic and know nothing about what I’m talking or B) Lying.

For instance, a patient approached today (who was confrontational from the get-go) and told us he wanted all of his medicines filled as a 90 days supply rather than 30/month. I’m more than happy to do that. DUH!! Our profit margin is usually better on 90 days– especially if it is a generic drug or one of Wal-Mart’s famous 4-dollar respect killers. [One dispensing fee, one label, one count, one check, one vial/lid -- it's savings all around!]

The older gentleman, of course, had already called his insurance company and “Nancy” told him that he certainly could get ninety days for 3 times the copayment of one month. Guess what…Nancy was wrong.

The patient knew that this would happen though — Nancy told him so! Nancy told him that the Pharmacy would merely have to call after getting the rejection and the insurance company would input a code. Right…insurance companies are constantly helping people out, giving out correct information, and speaking English in an understandable accent!

At this point, my tech told him that she thought our keystone tech called the insurance company yesterday and confirmed that the 90-day option was a fallacy. He would have to use their mail order pharmacy. Whoever Nancy is was wrong or he misunderstood. This did not sit well with him — and he did what patients always do: act like an asshole and reduce yourself to the level of merely a customer.

He looked me in the eye and told me, “Now, lookie here. Ya’ll gun’ call that inshowance cumpny right herre an’ now to have’m put dat 90 day in der or he wuz gun’ take his bidness to ‘nother fahmucy that’a doo wut he say.” — This of course did not sit right.

“Now, you lookee here. There’s absolutely no reason to get nasty and make threats about going to another pharmacy. I understand you want 90 days. You see right here on this rejection that says 30 days max. However, since I cannot confirm or deny that my other tech called the insurance company for you, we will call again. Just hold on for a little bit.”

I called the insurance company. He cannot fill 90 days unless he uses their mail order pharmacy — big fucking surprise. I asked them if there was any way for me to fill 90 at the retail level, and to my surprise, there was. I would have to have the MD’s Office call and get a PA on each prescription (he has 5 total), and they will allow 3 mos.

How many offices will call at 5 different times over the course of 30 days for non-essential PAs for a patient? Luckily, this office has a nurse that will take care of this — she’s very good.

I asked this insurance company to fax me the PA form. He wouldn’t do it. Absolutely refused. The office would have to call, give their information, and have the PA Form faxed to them. Is there a portion for the pharmacy to fill out? Yes: Name, Addy, Phone, NCPDP, NPI, DEA, Rx#, and Signature Line. Why couldn’t he fax it to the pharmacy so I can fill out my portions and forward it to the MD Office? Absolutely not. Did he have a good reason? Absolutely not. He just “couldn’t do it” — or “didn’t want to do it.” Regardless of his reasoning (or lack thereof), I wasn’t getting that damn form faxed to me. Did I mention “Dut Dut Dut.” He called me MA’AM the entire conversation. I faked a very good cry at one point to try and get the form, but he didn’t know what to think. He just feigned empathy and told me he couldn’t understand me! HA!

Back to my original thesis of this post. The patient-turned-customer, holding a copy of the rejection plainly stating “30 days max” from the insurance company, and being told by a technician that a 90 day option wasn’t possible in a retail store, still challenged the facts we posed to him.

The only way he was right in the situation and we were wrong is that we are either OBSCENE IDIOTS or LYING TO HIM for some random, unknown, stupid ass reason. The thing is, we have nothing to gain by not filling 90 days — so that suggestion is asinine. Like I said, 90d in most cases is more profitable. I want to do what patients want if it’s  in their best interests and allowed by governing bodies, insurance companies, and in-line with my professional judgment.

Patient’s need to understand that things in the world, and especially in pharmacy, are not black and white. Sometimes, there is a little gray — a little bit of gray area isn’t the end of the world. Open your eyes and see it!

Customers are like poodles. The world is black and white.  There is no gray. If you even HINT that there is any gray area, what happens? Yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip. Fucking Yip.

Liberal is too Liberal

Posted by The *Angriest* Pharmacist as Doctors, Drug Seekers, Just a question, Laws, Patient Education, True Story, Work Sucks

I’ve got a problem. There’s a physician in my town wreaking havoc on the livers of everyone in the entire area. Drug seekers rejoice! If your drug of choice is Fioricet (Butalbital/Acetaminophen/Caffeine), Soma (Carisoprodol), or Ultram (Tramadol) you are in luck.

I’m not joking when I say that he has put them in the ground — 6 feet under. He’s got more people addicted to more drugs than should be possible. I’ve been told by several of his “patients” that do their trading with me that they enter his “exam room,” state a problem that they have, and he begins writing. He doesn’t touch them. He doesn’t ask any questions. I couldn’t tell you the number of times folks have gotten to the counter and not known what X-drug was written for as they aren’t having that problem at all — for instance, Detrol LA for a 24-year old male.

He’s also a big fan of Nubain, Promethazine, and Syringes. I call it the SCUZ-BALL COCKTAIL! They give they Phenergan so you can inject more NUBAIN! It’s a GREAT idea!

But, TAestP, why on earth is he writing for Nubain and Fioricet when he could write for Demerol and PERCocet. That’s because this fuck wrote so many controls (and neglected to chart a single word) that they took his DEA license from him! So, he’s been reduced to writing drugs that SHOULD be controlled rather than drugs that ARE controlled.

What I hate about this situation is that I feel like I am an accessory to his negligence. I don’t fill things early. I don’t do cash prices after insurance rejects. I make notes about an (8 per day max) on Tramadol even though his 1-2t po q4-6h prn pain #240 clearly suggests 12 per day. [Seizure anyone?]I don’t fill anything above the Tylenol limit per day.

I’m doing everything by the book on my end. What type of liability falls to me (and every other pharmacist in my area filling these scripts)? I’ve got documentation outlining reports / complaints that I’ve made to the DEA and Medicaid Fraud and Waste Department. I’m trying to get this felon off the streets — or at least get his pad taken from him!

Pharmacists are fighting tooth and nail to get just PPIs or Statins as behind-the-counter / prescriptive-authority drug classes for RPhs and this jackass can’t get his taken away fast enough!