The Gospel according to Me.

I’ve seem to have made a few doctors upset with my last few posts. I want to help clear up some confusion about this blog, and other items of interest. I type at over 40 wpm, so expect grammar and spelling errors (yes, i’m talking about you grammar nazis out there).

  • This blog is the distilled down anger of the profession of pharmacy. This is the kind of stuff that really annoys us pharmacists. This is an insiders look at the profession. No matter where you work you’ll find that we all get annoyed by this
  • The statements made are just generalized. Seriously, take it with a grain of salt. Its meant to be angry and postal. This isnt my day-to-day life here, just aspects that really irk me.
  • I am no way this angry at work, nor treat my patients like this. I do however refuse to fill narcotics early and stand my ground using a firm and polite tone. If they want to get it filled somewhere else, thats fine. Doctors (and their staff) know that when they put down “Do Not Fill Until 2/5/07” that the patient will not get a single tablet until 2/5/07. Doctors respect that, I’m not a cave-in who can be threatened for medication.
  • This blog is used to blow off steam, steam that a lot of us pharmacists generate by working with the public. As you can see by the comments, a lot of people agree with what I say. I think that says something.
  • I’m never an asshole to any doctors (when I get to speak with them). Sometimes i’ll act a bit short to get my point across, but my main concern is to get the medication covered and out to the patient in a timely manner. When I tell a doctor that drug X is covered, and he wants drug A, B, or C (and gives me no justification to even try to get a prior auth, other than ‘im the doctor, this is what i want’) it irks me. We need to listen to each other, and this blog (i hope) will help doctors understand what we deal with on a daily basis. Im sure that you wouldnt want your grandmother spending $400/month for the (not covered) latest and greatest vs having a drug thats covered thats not being pushed by some drug rep (and not even give justification for the latest and greatest)
  • When a doctor makes a drug or dosage mistake, do I tell the patient “Hey, your doctor screwed up, i need to call them to get it fixed”? No, of course not. I say I need to call for a dosage clarification. I never ever bash individual doctors to the patients. Never ever ever.
  • I am never an asshole to your office or front-end staff. They have to deal with the public just like I do, and I feel that we are in the same boat (with respect to dealing with asshole patients).
  • Keeping us in the loop really means a lot to us. Nothing makes us happier than to get a call from a doctor in town saying “Hey, I need help with patient X”. I will drop everything i’m doing to help that doctor out to get exactly what his/her patient needs. I’ll gladly research whats covered. Got a patient with CHF and not really sure what the 4-5 medications he/she needs to be on? Call me up! I’ll tell you. Wondering why that ACE-I isnt working in that African American patient of yours? Gimme a call! We know the answer! The ‘ego’ that you all say I have isn’t myself at all, its having a person who took 3+ years of pharmacology a phone call away, and ignoring our advice.
  • Pharmacy is the only profession where we aren’t paid for our time or advice. Try getting legal advice from a lawyer and you’ll get a bill. A doctor? A bill. A pharmacist, a smile and advice. Even though I may never ever see this patient, nor fill a drug (and make money) from them. Igive advice to that frantic mother at 7pm on how much tylenol to give her sick baby (whom i’ll never see) the same as I do to a patient who has been here for 20 years.
  • We are the most accessible healthcare providers. We answer the stupid questions so you don’t get a phone call or a page during dinner. I have no problems doing this for any doctor. It really makes my day when a doctor calls up and says “Hey, you talked to patient X about Y last night after my office was closed, thanks a ton!” This sounds sappy, but sometimes your local pharmacist just needs a quick call saying thanks for the work they do and the service they provide to our patients. Those simple words will really make an impact on us.
  • We are the translators of big words, and make scary sounding procedures sound not as scary. We are your translators from medical to common. We are also the translators of your handwritten notes to the patient (which they cant read).
  • We are your eyes and ears outside the office when patients go doctor shopping, or swipe one of your Rx pads. We let you know whats going on so you can take care of your ‘problem’ patient on your turf, not the DEA.
  • I treat all patients with dignity and respect. I am never initially hostile to any patient regardless of sex, creed, religion, blah blah blah. However when the 5th phone call from the same patient in a day comes asking for an early fill on vicodin, I lose my temper. I don’t lose it at them, but on this blog. I never lose my temper in front of patients, nor scream at them from across the store. I write about the 1 patient that ruins my day and not the 300 that made my day. This isn’t a day-to-day blog about a pharmacist working, its about the frustrations that come with the one asshole that walks through my front doors.
  • When a medication isn’t covered, and we ask you (the doctor) to change it to a covered medication, give us a reason why the covered wont work. We will be happy to fill out the initial Prior Auth paperwork for you just to sign. Saying “well this is what I want” isn’t respectful to someone who is trying to help you out.
  • If a new drug comes out, and you (the doctor) have a question about coverage, usability, or just want to know if its just more of the same, call us! We probably read about it in Drug Topics while taking a shit, and we’ll be really upfront with you if we think its just another money-maker for a dying pharmaceutical company. We don’t get paid by the manufacturers, so why would we lie and say the latest = the better unless we really do mean it.
  • All pharmacists have a sense of humor. Sometimes twisted (like myself), but we like a good joke, or a tounge-in-cheek comment when you call in that Viagra Rx.
  • My opinions about things are just that, opinions. “Opinions are like assholes, everyone has one and they all stink”. They don’t reflect upon the profession, other pharmacists (even though they may agree to some degree) or even other doctors.
  • I don’t belittle doctors, think they are all idiots, or slaves of drug-reps. Although I must admit the nicest (and most willing to work with you) doctors I have experienced are pediatricians, podiatrists, psychiatrists, and medical residents. Male OB/Gyn’s can be a kick and I’ve never talked to a proctologist.
    This list could go on and on and on. However:

  • Listening to a peon drug-rep vs your local pharmacist is really upsetting, seriously. Its like thinking the only way to make salsa is via some new rocket chef gizmo on paid-sponsoring television
  • Treating us like bean-counters is also upsetting. There is a reason why we went to college and have degrees (sometimes even doctorates). Sometimes we feel like we are your pharmacology book sitting there on your shelf (collecting dust) holding something up.
  • We are as much “wanna be doctors” as you are “wanna be pharmacists”. Anyone can work on a car, but a mechanic is going to get the job done right the first time.
    So if I offended any doctors out there reading, my apologies. This blog is like going out for beers after work with your colleagues and bitching about what happened. I had a really angry response to a nasty comment (from a doctor) I received, but I think i’ll just sit on it for now.
    Now approve my damn refill requests! Its been a week! :)

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  • 16 Comments

    1. Another peeved pharmacist says:

      AMEN fellow RPh brother! You hit the nail on the head! Yeah! MD’s get so freaking offended by the stupidest things. Why would we “play” doctor when we babysit them? Oh, by the way Dr. Smith, just in case you are reading this (like you have the time, right), I never got the tiniest thanks for catching the lethal overdose of the Tegretol susp. you gave to an infant. Guess I am just another RPh in a Burger King hat.

    2. jerri lynn ward says:

      Thank God for pharmacists. You have saved my clients (nursing homes) more than once from the inattention of physicians who have prescribed a conflicting drug regimen that could have killed a patient.

    3. Nurse Ratchett says:

      First off, as a nurse-let me say, I love your blog. I work in managed care for a medicaid plan- prior auths, etc. I know exactly what you mean and could tell you many more horror stories. But you already know them. When I did work inpatient, I always respected the RPh I worked with- they generally knew anything and everything I needed to know when it came to certain specialized needs- areas like pain management, equianalgesic dosing for med changes, and working oncology, the pharmacist generally had the last word. However- just like there are idiot nurses, I have seen my share of dipshit RPh’s too. I did get the MAOI as first line therapy joke. We “geniuses” are always gonna’ be lumped in with the less desirable in whatever profession we choose.
      I did feel the need to point out that in the poll below, I can’t find pharmacist. Maybe it’s an oversite on the part of those Harris pollsters?
      Anyway, keep up the great posts, it’s refreshing to see someone putting it bluntly instead of sugarcoating the crap out of something as unethical as prescribing clomid to medicaid recipients. It’s almost as bad as requesting gastric bypass for active AID’s patients who shall soon be wasting away anyway. It happens.
      TABLE 1
      TRUST IN VARIOUS PROFESSIONALS TO GIVE GOOD ADVICE
      “If you were getting professional help or advice from each of the following, how much would you trust them to give you advice which was best for you?”
      Base: All Adults
      Completely
      Somewhat
      Not At All
      Not Sure
      A doctor
      %
      50
      43
      4
      3
      A dentist
      %
      47
      44
      4
      5
      A nurse
      %
      46
      46
      3
      4
      An accountant
      %
      28
      58
      7
      7
      A lawyer
      %
      18
      62
      14
      6
      A banker
      %
      16
      67
      12
      6
      A financial advisor
      %
      16
      64
      12
      8
      A mechanic
      %
      12
      68
      14
      6
      An insurance agent
      %
      9
      63
      21
      7
      A real estate agent
      %
      7
      65
      20
      8
      A stockbroker
      %
      6
      57
      25
      12
      Note: Totals may not add exactly to 100% due to rounding.
      Methodology
      The Harris Poll� was conducted online within the United States between March 17 and 21, 2006

    4. Another supportive outpatient/retail pharmacist says:

      As a fellow pharmacist…I have one question….why are physicians reading these rants anyway? These rants are healthy stress busters for all of us. Thank for verbalizing our thoughts and keep them coming.

    5. canoehead says:

      I love my drugstore pharmacists- they call the ER once or twice a day to double check prescriptions, or to let us know that patient just got 50 Vicodin from their PCP, are we sure they need 10 more? We are coconspirators against stupid and sneaky.

    6. pharmj77 says:

      The Role of Multi-tasking in the Life of the Pharmacist
      So there have been alot of negative response from doctors on this website complaining
      about pharmacists being wanna be doctors. There have been alot of great responses from
      the angry pharmacist in reply but here is just another aspect that the pharmacist must be
      able to perform that doctors don’t seem to know anything about….
      Multi-tasking
      Do doctors see more than one patient at a time? No, they give each patient a 15 minute
      appointment (which usually goes over 15 minutes). This is why doctor’s waiting rooms are
      ALWAYS FULL. God forbid a patient gets up and tells the receptionist they can’t wait any
      longer and will have to reschedule (because this will result in a 25 dollar cancellation
      fee). So when pharmacists have to tell a patient they must wait, lots of patients get real
      upset because they just did so much waiting at their doctor’s office. Hey, they can always
      come back later free of charge (and I work at a 24-hour pharmacy so they can come back
      whenever they feel like and we will be open unlike your MD’s office).
      Pharmacists are usually handling more than one task at a time. Like answering the phone
      grabbing a stack of labels off the printer. Counting pills and answering questions at the
      same time? Piece of cake!! Giving a consultation over the phone while checking
      prescriptions? No problem. Doctors again see one patient at a time, do chart reviews one
      at a time, etc….
      Also, does anyone else have this problem…Patients seem to think that it is perfectly
      alright to come up to the counter while talking on their cell phone. Do they do this at
      their doctor’s office? No, because that is more important than answering our questions
      like what is their address and do they have any questions? Whenever I ask someone if they
      have any questions, I get looked at like I have three heads. What would they have any
      questions about that I could answer? I love patients who actually realize that I just
      might know something about those pills I just put in their bottle!!!
      Submitted 1/27/07 by Another Angry Pharmacist

    7. Jamie says:

      Your post is right on. I love your blog by the way. Keep writing for the sake of us other pharmacists! :)

    8. I HEART Canoehead says:

      Someone LOVES us!! I am a happy RPh today! Maybe I will look into getting my PharmD today. Oh but wait–none of the chain retailers care about our degrees. Just serve it up fast, don’t talk shit to the customers and give them a handful of methadone while you are at it so they keep coming back. LOVE-Fast Food Pharmacist (blog coming soon)

    9. CeeKay says:

      I personally am sick and tired of covering anyone’s ass. Doctors are getting pissy with me. Had one say that he was a pharmacist and a doctor and why would I question him! We cover for insurance, doctors, patients, the government, nursing home idoits and anyone else that needs covering. I’m tired of being the stopgap. Some appreciation (and payment) would be nice.

    10. lilywhite says:

      Amen to everything you’ve said. Sorry you’re catching flack for writing what we are all thinking.
      Like the new layout, by the way.

    11. Hope says:

      It speaks volumes about you to take the time to apologize to people who have not thoroughly read your posts to begin with. This is the only place a lot of us have to lick our proverbial wounds, considering that pharmacy in a retail setting is performance art at its finest. There is no place to quietly go pound our collective head on the wall without someone leaning in, seeing a body, and screaming ‘where are the balloons?’ Anyone who has actually read anything you have written already knows you don’t scream at patients, you DO care about what goes on for them, and you do want to help. It comes shining through. Provided one READS. If, of course, the commenter chooses not to read the posts, well, s/he should just shut the fuck up.

    12. Bill says:

      Ok, I know I’m going to sound like a tool for asking, but does the ‘stealing a doctor’s pad’ thing happen that often? From the sounds of one of the posts, I’m guessing it does. That has to be the stupidest thing you can do in that, well, even if you get away with it, you’re 100% busted if anyone catches on. And I’m guessing after a while pharmacists can just ‘see’ con artists or people looking to ‘score’ pills. Although I think it a profoundly stupid idea, I think I’d much rather brave a breaking and enter late at night into a pharmacy than forging a script.

    13. Bill says:

      It’d be better if more doctors blogged away their frustration. I have a few family members that are docs and they are pretty much powder kegs. In all seriousness, when I was young and we had to tell what our parents did for a living, I answered my dad is an anesthesiologist and my mom is a stupid nurse – b/c I heard that phrase used so often every time we ever got a call at home.
      I sent out links to your page and even linked to it on my blog, no word from any of the docs in my family, but I suspect they’ll did this.

    14. disgruntledrph says:

      Your blogs are a far cry from insulting and have helped me to start taking retail with a grain of salt. If some doctors out there with the “God Complex” would get off of their perfect asses and spend one day in our work environment, they would leave with a real appreciation of the bullshit we put up with every day. No scheduled lunch breaks (pb & j gets really old), no time to go to the restroom in a 12 hour shift because we would not dare leave an md holding to call in an rx when there is voicemail they could use, but prefer not too. We stand up all day and the first time you even try to sit down after standing for 4 or 5 hours straight a customer walks up or the phone rings. When we tell a patient their rx requires a PA, what they think you are saying is “I am sorry. I don’t want to fill your rx today.” Blah, blah, blah.
      I love these blogs. Keep them coming and if it pisses off the MD’S, too damn bad.

    15. drh says:

      Thanks for your posts. I don’t think you are necessarily ranting about all doctors, just the dumb and rude ones. I’m a true believer that we are all in this together and I’d much rather have a pharmacist call me, than screw up or make a patient pay way too much because the drug I prescribed wasn’t formulary, etc. Thanks to you and all the other pharmacists on here. I LOVE your posts, especially about the drug seekers. I love that when I have someone in urgent care who tells me they haven’t had narcs in years, I can call my local pharmacies and find out they got 60 Percocets yesterday! Thanks guys and girls!

    16. vicodinfairy says:

      I called an MD on a patient who was prescribed nefazodone. He was already on sertraline. And gabitril. The doctor didn’t see the problem…we asked what they were adding the nefazodone for. Sleep. That’s what he said. Seriously. Also “just dispense what I wrote!”.
      Fine, dude, along with a big note in the profile stating we tried to change the med to no avail. I’ll be damned if I’m going to get sued because you are all-knowing.
      I toyed with the idea of going to med school after pharmacy school. I had a brilliant pharmacology professor who told me to go for it, if that’s what I really wanted. He also said “Just do me a favor and don’t become an asshole”.
      Love the blog. Love it. I’d buy you a bunch of beers just for the bitching that would go along with ’em.

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