Why did you ask if you are smarter than me?

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

You know exactly what I’m talking about. Everyone has dealt with it — some of us in ‘the suck’ deal with it daily. Patient presents to the POD (Pharmacist On Duty) with a random question and a product they removed from the shelf. The question is asked and regardless of how simplistic it is and how straightforward the answer may be, the patient has the gall, the arrogance, the nerve, and the self-centeredness to argue, rebut, or question your expert opinion…that THEY ASKED FOR. You didn’t charge them. You didn’t blow smoke up their ass. Yet, suddenly, a person that does not have a B.S. or Pharm.D. knows considerably more about pharmacy than the white-coat-wearing apothecary standing before them.

Here’s my story from today (it’s long, but *completely* worth it):
25-year old female and 55-year old male approach. She’s holding a bottle of generic “Women’s One-a-Day.”

Lady: “What vitamin should I take?”
– “Well, what are you taking them for? A doctor’s suggestion?”
Lady: “No. I’m just taking them as a supplement. I don’t always eat healthy.”
Man: “Is this a good one?” [At this point, I look at her hand that's holding the vitamins and see that she's wearing a huge rock on her 'special' finger. She's relatively cute, and it's painfully obvious that the grisly, buck-toothed, beast of a man with her is her father.]
– “This is just as good as the name brand stuff, and it’s a lot cheaper. Are you taking and medicines? Any prescriptions, over-the-counter stuff, or herbal medications?”
Lady: “Well, I take Tegretol for simple seizures.” [Bingo.]
– “And you’re not already taking a vitamin or two?” [She said, "No."] “What other prescriptions are you taking?”
Lady: “I’ve been taking Ortho Tri-Cyclen forever.”
– “Okay. Well, there are a couple things here. Are you aware that the Tegretol greatly reduces the effectiveness of all birth control pills? It’s fine to take them as a backup, but you cannot depend on them alone to prevent pregnancy. [She nodded affirmatively as if to say, "I knew that, but I never believed it or gave a shit before."] And, due to that fact, you need to be taking Folic Acid as well.”
Man: “What? Folic Acid? What about Vitamin C?”
Lady: “Yeah. I take 1,000 mg of Vitamin C a day for my immune system…to prevent colds.”
Man: “How much Vitamin C is in these things?”
Lady: “It says 65 mg.” [We're getting way the fuck away from where I was headed.]
Man: “Is that enough to prevent colds?” [Didn't even wanna bring up the fact that Linus Pauling faked or "misinterpreted" his data.]
– “No. That’s merely the amount you would need to prevent scurvy, and that’s it. The doses I’ve heard used to ‘bolster the immune system’ range from 2 grams all the way up to 20 grams, but researchers are always going back and forth. They’ll never be able to prove whether or not it actually works. You can continue to take it with this multivitamin though.” [They nodded in agreement] “But, like I was saying, you need to be taking Folic Acid every day as well.”
Man: “How much Folic Acid are in them?”
Lady: “It says 400 m-c-g.” [At this point, the man commandeers the bottle.]
Man: “This here says that 400 is 100% of the daily value.”
– “That’s exactly right. It is. But, since she is taking Tegretol and is of child bearing age, she needs to be taking a *lot* more Folic Acid.
Man: “Well how much do yoooou think she should be taking?” [He really did stretch out his word like that -- it was very accusatory, and it also activated Super-Dick Mode.]
– “Well, she neeeeeeds to be taking, based on the number of micrograms, between 1,000 and 4,000 a day. [I'm not full of shit here. It's 1-4 mg per day if on antiepileptic, right? 4mg if you are GOING to get preggo.]
Man: “So, you’re gonna stand there and tell me that she has to take 10 of these things a day?” [This statement alone proved to me that this man was, in fact, the dumbest person within a 25-mile radius of my location at that time. And I work down the street from a nursery school.]
– “Absolutely not. She should take one of these a day just as it says. In addition to that, she should take a Folic Acid tablet or two. It’s made as a supplement. We have it, and it’s pretty cheap.”
Man: “But this bottle says right here [He points because I can't remember what's said from one minute to the next -- apparently I resemble either a goldfish or an Alzheimer's patient in my white coat.] that one of these tablets is 100% of her daily value. Why should she take more than 100%?”
– “The medicine she is taking for her seizures will cause birth defects should she become pregnant by accident or plan. Point blank. There’s no maybe involved. It will cause birth defects. These defects are caused because of a lack of Folic Acid. By taking Folic Acid in amounts above what a normal person not taking this medicine would need, we can hope to prevent these birth defects.
Man: “I don’t understand why a person would need more than 100%.” [Ultra Mega Dick mode has now been activated by the degree of stupidity abound. This man treated me as a goldfish a few moments ago by pointing to a number on a bottle that I have known since I was in my first year of pharmacy school. Now, keep reading as I show him that he is the dumbest person on the face of the planet and cannot remember from one minute to the next. Now, I commandeer the bottle.]
– “You’re concerned with her taking too much Folic Acid? Let’s look back. You said you were taking 1,000 mg of Vitamin C each day. Hmm. 100% of your daily dose of that is 65 mg. By my crude calculations, she’s taking about 15 times her daily value. I said that 20 gram doses have been studied. That’s like 30,000% of the recommended daily dose, and you didn’t seem to contest doing that. The fact of that matter is that these Recommended Daily Allowances are outdated, not entirely accurate, and need updating. All I’m saying is that she needs to take one of these vitamins once a day and two or three of these Folic Acid tablets.” [By this time, my wonderful tech had already retrieved a bottle of 100, written the price on a post-it, and handed it to me. So, I held up each of the bottles as I referenced them. BTW, I bought her lunch.]
– “If you are concerned about the specifics, call her regular doctor or a gynecologist and ask them if I am lying or wrong.” [I wanted to add, "...or next time, don't ask my fucking opinion if you are so qualified to make all the medical decisions."]
Man: “I don’t doubt that you’re right. I just don’t understand why this says 100% if she needs to take more.” [What? Are you fucking playing with me? I just explained that you inept asshole.]
– “That *is* 100%. It’s 100% for me — a 30-something male because I’m not pregnant, I’m not taking medicines for seizures, I’m not sick, and I’m not a nursing mother. I have no reason for more than 100%. She does. And that is precisely why these Daily Allowances need clarification and updating.
Lady: Well, all right. Thanks a lot for the help. [I'm assuming they walked away saying, "I can't believe that guy thinks he can get pregnant. He should know that he can't get pregnant cause he don't got no boobies to feed the baby."]

-=+=-

Anyway, as headed down the aisle, I watched the man put the bottle of Folic Acid my tech had so perfectly retrieved (without prompt or request) and I handed him (which cost $2.97) on a random shelf. I wasn’t even mad. Hell, I didn’t give a shit then, and looking back, I care even less now. If they are that stupid/inept, it’s quite likely that the child will be just as feebleminded and dimwitted as them, if he’s not born a 7-lb turd with legs. With any luck, the lack of folic acid will disable her from ever reproducing.

I know that a neural tube defect will definitely keep the baby from ever being anything worthwhile (if it can be alive in the first place).

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Popularity and Link Exchange

Posted by The *Angriest* Pharmacist as --Not Pharmacy--, Blogs I like

Hello all! I’ve been writing stories, anecdotes, rants to The *Angriest* Pharmacist since February 5th, 2007. So, for the last 10 months, I’ve been ripping people’s face off by being real, telling it like it is, and putting a little fire/passion into my writing. There’s been some great discussion and excellent emails as well as some pointless spam and meaningless hate mail with no basis. The popularity of this site as grown to extents that I would’ve thought were impossible for a mere pharmacist’s blog.

I switched domain providers in the middle of October, so all data prior to that concerning hits was lost. But since October 18th, this website has gotten over 55,000 unique hits *without* counting the various bots (like Googlebot, Lycos, etc.) that scour the internet for new pages/websites. That’s around 1200 each day!

The amount of page views is also off the charts. In that same time frame, I’ve seen about 100,000 page views. That means that most people viewed at least the main page plus one additional page/post on my blog. I’m lucky my hosting provider’s plan alots me plenty of bandwidth, otherwise I would have exceeded that each month and be forced to pay a fee for each megabyte gone over. I could double my traffic to more than 60,000 pageviews each month and still not hit my limit. I doubt I’ll ever get there.

That number is amazing to me — especially considering that this is what most would consider a “specialty” blog where the majority of posts won’t be understood or read by the vast majority of internet users. However, I’m sure a sizeable amount of those hits are people seeking drug information or medical advice. Some of them are also going to be repeat hits at different times (at least 10 minutes apart is how I have it set) whereas each one counts as a unique visit.

I am not looking to make any money off of my website. I don’t have the time to put into it to make any kind of profit worth my time. What I am looking to do is share this volume of potential readers with all medical blogs. If you’ll notice, the right most frame has a dropdown box on the right side at the very top. I read every one of those pharmacist blogs. Most of them have a return link here.

If you would like my to link to your webpage/blog in that drop down box, let me know. I’d ask that you return the favor and link to me, but it’s highly unlikely that I will ever check that you do so. So, if you want me to link you, click the contact link at the top of my page and shoot me a message with the name of your blog, the category it would likely be in, the URL, and your tagline. I’ll add it to my links as soon as possible. I don’t care if it’sa pharmacy blog or not — I’d just like it to be related to medicine in some way. If I get several that are in a different category from pharmacy, I will adjust the dropdown box to separate them from the Pharmacy/Pharmacist blogs.

On average, I’d say 10 hits per day leave this site to each one of those dropdown links — some get more, like Drug Nazi, but I’d be willing to bet that if I link you, you will see a few more hits each day. Just let me know…it will be a positive, mutual association.

Also, I’d suggest everyone register. You do this by clicking the “Register” link the right-most frame near the bottom. I’ve made some changes that allow you to comment without restriction if you are registered. All you are required to provide is a login name, email address, and password (which I can’t see - I can only delete). In the past, I’ve had to approve each comment 1 at a time as they come in. I’ve grown tired of that tedious process, so I’m relaxing the rules a bit. The login process should still keep the spam bots at bay. With registration, you will also get a short email each time a new post or page is added. I won’t ever share, post, or exploit your email. Nor will you ever get an email from me for any other reason except for a new post — so get to it!

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Medicare Part D — WTF?

Posted by The *Angriest* Pharmacist as Drug Companies

I received this email through the pharmacist-grape vine.

-=+=-

From:[Contact TheAngriestPharmacist for Sender's Email]
To: rick.larsen@mail.house.gov
Subject: Medicare Part D Merry Go Round 2008
Date: Wed, 28 Nov 2007 22:57:54 -0800

11/28/2007

Representative Rick Larsen
United States House of Representatives
1529 Longworth House Office Building
Washington, DC 20515

Dear Rick:

From time to time you have been able to stop in our pharmacy when on
Lopez Island and I always felt you listened to our concerns about health
care. I thought I’d share with you what I call the Medicare Part D
Merry-Go-Round. Each year the Medicare patient must reevaluate their
respective Medicare Part D drug plan, only because the coverage that they
had during the current year can and does change each year.

Plans have low balled premiums only to raise them in latter years
with the hope that most Medicare patients won’t change their plan. If they
don’t raise their premium they change what they cover. If that isn’t enough
the plans then still covers their drugs, but then changes the copays, or
other criteria for their drugs. This is a unbelievable complicated system
for our seniors. We try to help our patients make sense of the changes, and
when we can we provide education to them to show what their plan was, is or
will be. Again most of the plans are betting that the patient will not
change plans.

I’ve got a good grasp on the system and it takes me hours to
evaluate the plans, can you imagine how a Medicare patient that isn’t
computer savvy feels? This system needs to be fixed and fixed now. Think
about these common sense ideas.

1. Make a fixed list of drugs that are covered for a basic, premium and
deluxe plan.
2. Make copays fixed for generics and brand name.
3. Get the rebates that are lining the pockets of the managers of these
plans into the patients pocket by getting rid of the donut hole.
4. Let the PBM’s make their money by being claims processors, not slight of
hand artists in hiding their rebate dollars.
5. Remove the self-referrals that the PBM’s are making by steering the
Medicare patient into their own mail order pharmacies.
6. We need to allow medications to stand on their own two feet for their
effectiveness, not how many TV ads that can generate.
These direct to consumer ads are adding huge amounts to the cost of
prescriptions in this country. We all know that more dollars are spent on
promotions than on research.
7. Finally make one plan ran by Medicare itself, not by the private plans.

Our elected officials have the power to change this system and it
must be changed. What is important is getting quality care to our seniors.

Respectfully,

Richard C.McCoy,Jr.R.Ph.
Lopez Island Pharmacy
Lopez Island, WA 98261
360-468-#### x103 [Contact TheAngriestPharmacist for Phone Number]

***Reproduction and publication rights are granted on this letter to any
group or individual ***

I think Mr. McCoy has hit the nail on the head. The Federal Government conceded the fact they they could not handle adequately implementing Medicare Part D, so they allowed the insurance companies to step in and take a crack at it. Much as we would have expected, the PBMs have concerned themselves with their pockets and not with the welfare of our seniors/recipients.

I’ve said for a long ass time that direct-to-consumer advertising needs to be made illegal. The average American cannot be expected to comprehend the many factors that go into prescribing. And the fact that Pharma sidesteps the law by merely stating, “Ask your doctor about DrugX” really pisses me off. If they do not state the indication, they do not have to specify the potentially dangerous (and common) side effects. Another practice Pharma has resorted to is that of completely ignoring the law. Throw together a commercial. Get it on the airwaves quickly and widespread — then watch the profits roll in. They may be breaking the law, but by the time complaints can be registered and the FDA can get an injunction (they don’t have any real power) Big Pharma has already seen profits well above potential fines they may incur. That’s fucking bullshit isn’t it?

Don’t even let me get started about what Part D’s reimbursements have done to the independents. These guys are fighting tooth and nail to stay afloat. They don’t have a 200 thousand square foot store to account for losses incurred to balance things out.

Rick has also nailed the complexity of the plans. If I have to struggle to comprehend the assorted plans, I can’t imagine what our country’s seniors are thinking. This has created a viscious cycle. Pharmacists don’t have time to learn the plans and/or help the people due to the increased volume generated by the number of people covered and the decreasing number of pharmacies.

I’m pissed off — how about you?

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Thoughtful comment. 100th post. More farting?!

Posted by The *Angriest* Pharmacist as --Not Pharmacy--, Disgusting, Update, Work Sucks

I received the following comment from Mary A. who identified herself as a pharmacy student. I am going to break the comment up and address things one by one.

I’m imagining that this blog forum has been useful as an alter-ego, but I can’t imagine that the work as a pharmacist is so mind-blowing that venting on such silly topics is useful in ‘taking one away’ like the discussion of laser pranks, intestinal gas, drunkenness, etc. Hey, I mean, coming to work hung-over is grounds for being fired in some jobs, notwithstanding the dereliction of ‘duty’. Doing pharmacist work requires mental wherewithal to carry out on to the best of one’s ability.

This is what differentiates you from me. You are a student, not a pharmacist. You’ve not actually worked 40 hours a week holding the ship afloat. Sure, you’ve worked and counseled some old bitty on metamucil, but you’ve never been the captain. At the end of a 12-hr day, where you filled like there was no tomorrow, you are drained — physically, emotionally, psychologically, verbally, and any other adverb you want to add in there (semenally?).

When I started this blog, it was to vent. Now it’s to vent and make myself laugh — perhaps some others get a few laughs out of this as well. I like making people laugh, and I’ve even considered doing an open mic night somewhere telling pharmacy jokes to the commoners. It’d take a shit ton of work, but I think I could pull it off. The blog is allowing me to feel out what is funny and what is not (based on hits to that post, emails, comments, etc). And it’s not an alter ego. If you personally knew me and read my blog, you may not realize it was me. The second I told you, the connection would be made and you’d be embarassed you didn’t see it sooner. I am the same person on and off. I’m a dick. I’m sometimes funny. I tell fart jokes. I make fun of people that are different from me, and I am always right.

I don’t know what world you’re living in, but as long as I’m capable of doing my job, and not still drunk, hungover is not against the rules. Just like being tired is not against the rules if you stayed up all night taking care of your sick kids. They can’t prove I’m hungover anymore than they can prove I have the flu. Either way, I can’t call in sick. So, I might as well bitch about it…Did I mention that I function just as well hungover? Yes, I did. There’s no way someone’s going to fire a pharmacist in this day an age for being hungover. Perhaps if you are a drunk, stink like Wild Irish Rose, or show up late they might can you. But, we’re worth to much to the business to dismiss. I’m sure they’d just have a word first. Finally, stop using big words. It doesn’t make you sound smarter. Especially when they are archaic…”wherewithal”? Honestly?

What are some personal reasons for embarking on a career in this profession? How long have you been in this career choice? Do you feel as if you’re in a corner with no other choices in carrying out your job? No matter how old a person is, there are always options to improve one’s lot and opportunities for improvement. Sure, there’s a lot wrong in our society and pharmacists that show up to work regularly tend to be on the front-line (to see it and bear the brunt). Because of the complexity of the job, there is plenty of room for disenchantment. Sarcasm and carping can be a hilarious way to cope, but surely there’s something redeeming about your chosen profession (other than the lovely lolly that pays bills).

I went to pharmacy school because I could. I worked in a pharmacy prior to that sweeping the floors and sometimes helping in the prescription process. I just thought it was easy, and I was good at chemistry. To an 18-year old, that seemed like enough. I’ve been in pharmacy for longer than you’ve been graduated from high school — we’ll put it that way. I’ve already outlined what was wrong with society here. I’m more disenchanted than what one would think. My posts are the best way to cope. The only other way would be to find a new job where I can write blogs about pharmacy, or something else I know, and get paid nearly $50 an hour to do so. Or, find a pharmacy that’s willing to let me rule with an iron fist — a pharmacy where I call the shots and the customer is not always right — a pharmacy where if you raise a stink, I’ll just tell you to find a new place to trade. Right now, the money ain’t hurtin’.

The blog on the patient needing a liver transplant or too sick to get one was classic. Bring on some more, rather than digression into silliness.

I’m very proud of that post as well. It’s not too often I’m able to make those connections, however. Why is that? It’s because of the shit that I talk about in the first link. How can I fully understand every aspect of a patient’s care when I only see them on a Sunday evening for a Vicodin script? Let’s not beat around the bush. It’s the regular patients that get the best care. You develop a repore with them. You know them and their meds. You know that their daughter had surgery last month. You can really make the connections there. I can’t make any connections on the Vicodin script you got filled if I never see you again. People are too transient — trust all pharmacists — but pick one to be YOUR pharmacist. Your outcomes will be better…I promise.

I was in a VA situation where everything was done to someone with HCV enrolled, physically prepped, into the operating theater, and transplanted with some accident victim’s liver, and within 2 yrs out, the organ wasn’t being properly cared for, and the docs were saying, no way, no how, were they going to invest the medicine necessary to retain it, if the patient couldn’t take better care of it, and himself.

Mental health and sociological issues. This society has a lot of people in it with them, and we see a lot of it. Pharmacists see a lot of it. We’re not prepared to change society. We don’t always know how to deal with it in a helpful way.

I don’t really know where you were going here, so I can’t respond. Either way, I appreciate the comments, Mary. I’ll try to throw in more hardcore pharmacy posts…but, there’s no way we’re getting rid of the silly. That’s my bread and butter.

-=+=-

THIS IS MY 100TH POST! Please go back and read them all…and rate them all! If you can’t rate them, it’s because you still have the cookie from the first ratings system that I ditched (it didn’t display properly). Clear all your cookies and you’ll be able to rate them again if you so choose. Once I get a plethora of ratings, I’ll compile some sort of list of my most popular/best posts and put them on the sidebar.

So, I’m not the only pharmacist-written blog that likes to write about farting out there. The Angry Pharmacist analyzed the shart and how to effectively hide the mishap should it happen. Whereas, I go into *explicit* detail on how to THROW a fart. If you’ll notice, my post predated his (in this instance) by about 2 weeks…:-)

Final Note — I’m changing the way I handle comments submitted to me via the form at the top of the page. No longer will I display your email address, IP address, or location. I will merely share your name, title, and the message if I choose. The disclaimer will be updated accordingly. I’m doing this to facilitate more comments and questions for me without fear of spiteful repercussions. I’m changing my evil ways…

Working hungover

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

I hate going to work hungover. I was really hungover today. Usually, I give myself 7-8 hours to sleep and that’s good enough for me. With 7-8 hrs I’m good to go. Today, I’d say I got 6 hours. I’d figure I could make due. No dice. I was extraordinarily drunk last night. I was so drunk I went dancing. I absolutely hate dancing…mostly because I’m horrible at it. Yet, after 6 beers, four long islands, and a whiskey and coke — I was on the floor doing the “Soulja Boy” after a 300-pound black lady (who was fucking awesome at it) taught me how.

I then taught her how to do the Casper Slide. I think she now may be carrying my baby…I cannot disprove the theory.

Anyway - I went to work today and felt worse than the vast majority of our patient’s look and smell. I’m not unsafe when hungover - I’m still 100% capable of doing my job and doing it safely. The hangover just puts me in a worse mood than I usually am. It causes me to be a bigger dick to those that deserve it. I don’t hold anything back on hangover-days.

It usually causes me to tell some lady to go stuff her cell phone up her fat ass rather than converse in front of me in her mindless-dribble. It does me no good, but it makes me feel better.

You’d think I learn my lesson — Stop drinking heavily before opening the next morning. Or, better yet, drink in moderation.

To hell with that. I was put on this earth for two things — getting drunk and dancing with voluptuous black women, eatin’, and fuckin’ — And I don’t see any Jack-in-the-Box or hot bitches around right now…I’d better go hit da club…

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