Replaced by machines

Ive been writing on this site for almost 5 years.  I’ve noticed a few trends come and go.

  1. Any post about crackheads instantly bring 100 page comments from legit pain management people explaining how they are not a crackhead.  This is besides the point that I make it very clear in said post what is (and is not) considered crackhead behavior.
  2. Any post about crackheads instantly bring 100 page comments from crackheads justifying their crackhead behavior.
  3. Students know absolutely nothing about the ‘real world’, except nursing students who know double-nothing.
  4. The most common crackhead response is that we are a bunch of meanies, and are going to be replaced by machines.  Legit pain management patients don’t share the same views (go figure).

Lets look at the ‘replaced by machines’ scenario, bring some non-hydrocodone influenced logic to this and how awesome it will be for the average crackhead and patient.

Imagine there are no more pharmacists.  Your doctor gets his little PDA (or whatever) out, punches in the drugs, and zips it away to some super-mart with a eFill-4000 just humming away.  Lets just ignore the fact for a second that doctors cant send eRx’s correctly to save their (or yours!) life.  The eFill receives the order, and processes it along with the 50 other orders it has lined up.

You, crackhead, smugly happy that there are no real-life pharmacists any longer punch your refill in via the telephone, and stumble your way to the super-mart to visit your BFF eFill.  You put your thumb on the little pad, type your 4 digit code, and here is what you get.

ERROR: RX 459534 – LAST FILL WAS 6 DAYS 23:19:15 – CAN BE FILLED IN 0 DAYS 0:20:45.    PLEASE RETURN THEN.

(Yeah, the math is probably wrong for the days, I don’t care, you get my point)

Damn, 20 min and 45 seconds too early for your 30 day supply.  See, a human pharmacist would of just looked at the day, saw 30 days had come and just filled it.  Hell, you cant even get all pissy and argue with a robot!

Here are some more likely responses one might see:

ERROR: RX 4593823 – MD AUTHORIZED 4 DAYS EARLY FILL ON 2/24/10 – ADDITIONAL REFILLS PUSHED BACK 4 DAYS.

and

ERROR: RX 492343 – FEBRUARY ONLY HAD 28 DAYS.  PLEASE RETURN IN 2 DAYS.

I think you get the point.

How about the doctor decides to write you some blood pressure pills.  He sends it over to the eFill and tells you to pick it up in about 3 hours.  You arrive with your crisp $0 bill in hand for your state-covered copay when you read this message:

ERROR: RX 5393834 – PAYMENT DUE $234.00 – PRODUCT/SERVICE/NDC NOT COVERED BY INSURANCE (MEDI-CAL) – CONTACT PROVIDER FOR ALTERNATIVE OR INSERT CREDIT CARD.

Damn, because your insurance company doesn’t spit out what is covered (thanks Medical!) you’re left in the dark to decipher what is covered and what is not.  You don’t even have a helpful pharmacist to guide you in the right direction.

As the late Billy Mays used to say, BUT WAIT, THERE’S MORE!  You have really bad CHF.  To the point where you’re huffing and mouth-breathing to walk to the back of the mega-mart where the eFill is at.  Dr said he wants you to take something about an hour before you take your lasix.  Here is what you get.

ERROR: RX 4938532 PENDING FOR MD OVERRIDE – THERAPEUTIC DUPLICATION OF FUROSEMIDE AND METOLAZONE!

Isn’t technology grand?

As any pharmacist will tell you, there are a metric buttload of “interactions” that flash up on our screens.  About 1 in 40 are actually real-life interactions, the rest are just theoretical interactions that we have to override because lawyers reign supreme and nobody wants to get sued for “not telling us”. Only through the use of our SCHOOLING can we determine if an interaction is legit.  One interaction may be a non-issue in patient A, but its a huge issue for patient B because of drugs XYZ and surgery A.  You think the Doctor is going to keep up on interactions? HAHAHAHA *ahem*.  Doctors have a hard enough time using eScripts, lets not get carried away here.

There are just some thinks that a robot cannot do well, abstraction, application of unrelated data into related data, and fuzzy logic judgment.  Think of it from another angle: we have the technology with high-precision GPS systems, optical sensors, and super-fast computers yet we don’t have cars that can drive themselves.  We have cars that parallel park themselves, we have cars that alter the cruise control to avoid rear-end collisions, but they both require the judgment of a HUMAN (on a FUCKING CELL PHONE) to pilot safely.

Since I used the word ‘crackhead’, cue the 100 page comments about what part of your spine is fused together, all of the medication you are taking, and how I shouldn’t be a pharmacist.  I’m not going to point out the title of this site, because obviously basic reading comprehension went out when the hydrocodone went in.

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156 Comments

  1. Sorcha says:

    Beautiful . When a pharmacy can go a day without the md’s screwing up the eRx’s or faxes or handwritten presciptions, then I’d consider letting the robot do all the work. Aww, hell, that will never happen:-)

    Btw: verification words- thiamin in

  2. Riley says:

    Well said, well said! Lets not forget all of the times that we Pharmacists give a free 2 or 3 day supply to help people out. And don’t forget about the “I’m leaving for vacation IN 2 HOURS….I know I’m not due for a refill for 4 days but…..”
    I actually got out of retail pharmacy because of all the fucktarded people in the world who pissed me off on a daily basis. I wish I had a penny for every time someone told me “You know, I could do your job. All you have to do is put pills in a bottle.” I don’t know how I never ended up in jail for assault! I give retail Pharmacists a pat on the back. I don’t know how they continue to do it every day! My hospital job may only be one itty-bitty step up, but it’s one very important step to me!
    PS: If you lie like a crackhead, look like a crackhead and smell like a crackhead…….suck it up…..you’re a crackhead!!!

    • Chuck in MI says:

      Does the cost of 2-3 free pills come out of the pharmacist’s pocket? Is it removed from inventory on the computer? I don’t want to get the Rph in trouble.

      • Pollyjenna says:

        That typically happens on pending refills, and the three days’ supply of xyz med would simply be taken out of your prescription when it’s approved.

        • Thad says:

          That’s IF it’s approved. Try going back and telling so and so they owe you $57.99 for the 3 tablets you gave them that the doctor didn’t authorize.

      • JennBpharmD says:

        depending on the medication sometimes I just eat the cost of the loaner tablets. When we’re only paying 4 cents a tablet I figure we can afford it. I’d hate to send my people away without a blood pressure, diabetes, or blood thinning med. m

    • Janet RN says:

      People are just so ridiculous and hostile at the same time. My hat’s off to you (Angry Pharmacist and Riley too) for what you do. Janet RN

  3. El-loco says:

    Some of us have been discussing this in the U.K.

    The feeling seems to be that it would take a good number of machines at any location to keep up with the workload and that, for this and other reasons, they might not be as attractive financially as the manufacturer would have people believe.

    Also they seems to be saying that these machines are used widely in Australia and the U.K. – they are NOT.

    Interesting to note how similar pharmacist’ problems are on both sides of the pond.

  4. Joe says:

    Right on!

  5. Cracky McCrackhead says:

    Hear, Hear TAP. The day I have to deal with a machine I’m out of business and heading for rehab (or the Mexican Mafia) for treatment. My skills as a script forger are legendary. I enoy the interaction with Tech’s and Pharmacist’s when I run my scam and a machine would take all the fun out of the game.

    • Sarah G says:

      But Cracky! Why don’t you just put a chain around the pill dispenser and pull it out of the concrete, like they do the ATM machines? I’d love to see you on “World’s Dumbest” this week…

    • Catch the Cracken says:

      Your days are numbered you stupid moron. You’ll get caught….they’re just gathering the data on your pathetic arse

  6. Jojo says:

    I totally agree. Retail pharmacy is really bad, hospital is bad too, but retail is just “Ughhhhhhhhhhhhhhhhhhh”

  7. J says:

    Thank you for this post. It gave me a bit of insight into what my pharmacist does monthly. I have state-subsidized insurance (not Medicaid/Medicare), and I’m lucky enough that my doctor and pharmacist have worked out a plan for me to receive my meds each month. And yes, I treat my pharmacist with respect, after all she has the education and the power to give me my meds a day or 2 early if I’m leaving town for a job interview (true story!). But then again, I’m not all hopped up on narcotics either, so even though the insurance says \can’t refill for 3 days\ and I’m there explaining to her I’ll be in another city in 3 days without meds, she gave me a 6-day supply, then I came back and got the rest of the 30-day supply. A machine would be useless for that!

    As for drug interactions – yes, the 2 meds I’m on supposedly have an interaction. However, this combo has allowed me to work for the past 2 years, without incident, so I now know that my pharmacist has to deal with another warning about my meds each month.

    I’d like to think I’m an ideal patient, both to my doctor and pharmacist. I research what’s covered, I take my meds as scheduled, I smile and am polite even if I’ve had to wait an hour to be helped. I just try to follow the golden rule – treat others as you would want to be treated.

  8. CynicalIntern says:

    See, you’re missing a pretty key part here, TAP. The part where the patient approaches the vending machine screaming “They didn’t send me no card” and the machine having absolutely no intent of calling the insurance company to find out who they’re supposed to be through.

  9. Well Illbe says:

    Angry- you forgot to mention how the Toyota auto machine tries to take over ad tht if the people driving the cars had maintained composure and common sense could have stopped their cars safely….. ie take the key out shift into neurtral etc. Machines can help us but you have to be smarter than they are!

  10. Rotten Tech says:

    The way you put it, technology actually does sound mighty fucking grand. Obviously, in any system where judgment is required, there will be a human presence. But, for a purely mechanical action such as filling scripts or, hell, even just selling them, machines are fan-fucking-tastic.

    You telling me you want to count pills all day, or run a register? Hell, how often are you truly thinking when you do these things? After enough time, filling/running a register to you becomes pretty analogous to an automated function from a robot.. actions and responses with almost no thought.

    I’d kill to have a machine do the grunt work, while I spend my time making sure everything else is done consistently and accurately. So many people cut so many quarters because they cannot escape the production line, or the cash register, with under-staffing. I support technological development over putting me in close quarters with the average masses any day.

  11. Jim says:

    Your post is typical of a technophobic Luddite. I’m sorry you don’t understand computers and fear them.

    The fact is, a computer program is far easier to fix and maintain than a mob of bad pharmacists. I would almost agree that the issues described above might occur during the first year after a deployment. These are called “bugs” in the software industry. Once version 2 rolls around, hiccups will be far and in between.

    But I can assure you that even version 1 would be far more proficient and safe than the idiots that become pharmacists.

    Good luck with your life! I mean it. Seek an occupation that a computer can’t perform better than a human being. Pharmacology is about memorization and very simple logic. Computers far exceed human beings in this arena.

    • MB says:

      I keep seeing the same “bugs” in every new release or patch of software. So many of the errors that come up are complete BS. I love the ones warning of seratonin syndrome because a patient had their prozac dose increased. I wouldn’t mind a computer to just ring the customers out but I really don’t think a computer program with its logic and concrete logic. We pharmacists are trained to look at the interaction and determine if this is a valid one or not based on the medications and the patient. Maybe if you actually decided to work in a retail pharmacy for some time, you would actually understand this Jim.

      • Rainman says:

        Jim sounds like a true computer geek. Able to interact with a machine ( probably dates one ) more than another human being. It always is entertaining to listen to the ramblings of a non-pharmacist tell you how they know more about the profession then the true professionals. I don’t understand computers, and that is my choice, but I also don’t PRETEND to know more about them than the computer programmers.

    • rukidding says:

      Jim,

      I originally had a whole schpiel to tell you how dumb you are, but instead, I’ll just say this.

      You are ignorant. I dare you to spend a day in a pharmacist’s shoes. Then you can tell us how pharmacology is “very simple logic”. Try pharmacy school on for size. Get educated, moron.

    • Rotten Tech says:

      Woah there, Jim. You forget something.. computers under-perform humans in countless occupations. This is because they’re employed in areas with specified, repetitive roles involving simple logic, rather than professional services.

      Checking interactions is easy, yes, and a computer can take an interaction that should absolutely bring the filling process to a screeching halt, however, it cannot explain to many.. less than intelligent customers, what the interaction is, and whether or not it should continue being filled, nor can it call the doctor when the patient has absolutely no idea what’s going on, or come up with more creative solutions.

      Human judgment is a required factor in pharmacy, and computers cannot fully control a role which requires human judgment.. this is why military drones have human operators, why astronauts still conduct experiments in space, why people model buildings with computers, but construct them with human work, hell, even why self check-outs are still outnumbered by real cashiers, and have cashiers supervising them as well, because, although they perform their function perfectly, humans introduce an unpredictable, imperfect seed into the operation.

      Simply, this idea that we have that computers are taking over jobs generally applies to labor that is mostly physical action and simple logic, that perform only a function rather than a service utilizing specific skills.. such as constructing cars. In reality, most “careers” will only have computers brought in as a supplement to somebody that’s knowledgeable in the field, and running things from behind the scenes.

      Granted, that still might mean we have one pharmacist sleeping in the back room getting woken up once an hour to deal with a customer, then going back to nap time.. but we’re always going to have *some*.

      As it is, the current solution to volume seems to be adding more technicians, and never more pharmacists.. and, though us technicians are perfectly capable of handling almost any situation, everything still must pass through a human pharmacist.

    • Pharmacist123 says:

      I hope someone replaces the idiot above with a computer that can leave intelligent posts.

    • Bones says:

      Troll chumming the waters, for sure…but I’ll bite.

      “Your post is typical of a technophobic Luddite”
      Is there any other kind? Is there a technophilic Luddite that I haven’t heard about? But I digress…

      Having worked as a systems architect, developer and computer programmer for the last 30 years, I, for one, DO understand computers and do not fear them. Although I find they can be quite irritating and annoying at times, much like your post, Jim. Long story short, if you actually believe what you wrote, you’re an idiot!

      “Once version 2 rolls around, hiccups will be far and in between.” (Nice command of the English language there, Bub). Yeah, right.
      And if you believe that, you can believe I won’t cum in your mouth. So get down on your knees and start humming, Jim.

      “Pharmacology is about memorization and very simple logic.” And you know this because…you’re a pharmacologist, Jim? Where’d you get your PhD in pharmacology? At Talking Out Your Ass University? That’s what I thought.

      I rely on my pharmacist for information, advice, and counseling. Human Beings (Pharmacists) far exceed computers in this arena.

      Now STFU and go back to your Borg brethren and your collective hive mind.

      Version 2…kiss my ass!

    • meg says:

      The biochemistry of humans is not simple logic. Computers are very poor at determining what information is important from a patient, many times the patient gives an overly long or overly short history and the pharmacist must determine if there is any useful information. Besides with a machine who is going to explain the intricacies of insurance (especially Medicare part D) to people who have a hard time with explanations? (Ever heard of the expression “cow eyes?”).

    • Pharm Intern says:

      I think you misunderstand the point here… There is no fear of technology in the pharmacy world. We all love our script-pros and computer systems.

      With your logic anything could be replaced by computers; and I wouldn’t disagree with you. However, there is a human aspect to all health care fields that just cannot be replaced by a computer; ie: giving loans on meds for chronic conditions like diabetes, HBP, etc, when patients run out of refills and are forced to wait for the MD to call/fax/escribe a new Rx; that practice is illegal in most states but is ethical and therefore we do it daily with good judgment. TAP pointed that out in the post if you read it. And that’s just one of many things that pharmacists do daily.

      And lol at the pharmacology being all memorization. No shit… but once again, find a computer that can discern significance of what will be safe or not for every patient, especially considering most people use multiple pharmacies and doctors.

      • Danimal says:

        You guys must like the pill-counting machines though, no? I can think of nothing so mindlessly irritating (to someone with such a high level of education) than counting pills. It would drive me mad

        • Pollyjenna says:

          I hate the machines. They are far less efficient, even in high volume pharmacies I’ve worked at. They’re nice when they run, and that is certainly not all the time. They get stuck, they can throw off inventory, they stop working for chunks of time for no reason known to anyone…I can typically count faster than the machine can. Any job has “mindless” tasks included, but that doesn’t mean they’re not important.

          • AusPharm says:

            How much you would love to work in Australia where our medications come pre-packed in monthly supplies (ie 28-30 tablet packs mostly).

            Would be interesting to see what we actually pay for this service….

          • PharmDstudent says:

            Completely agree with this! Our script-pro is more annoying than anything. We spend more time stocking it or trying to fix what is wrong with it than it spends counting medications.

    • Riley says:

      First of all, computers are only as smart as the people who program them. The fact that you think a computer can be a better Pharmacist than a human being proves how little you know about the practice of Pharmacy. There is more to it than you think. Actually, I don’t even think you deserve to know the extent. Please continue to live in your warped reality. I hope you never get sick, need to go to a hospital nor ever need a prescription filled. Good luck to you! You’re going to need it.

    • Reply to Jim,

      What techno/recession-proof field is so blessed to have you working for the betterment of society and how many college degrees have you earned, praytell? Maybe you could teach which field to enter next since our pharmacy careers will end up like the Luddites. Point- You come across as a little too defensive and self-righteous to be posting your mayhem and foolishness on The Ultimate Pharmacist Rant blog.

    • The RPh says:

      Hey Jim. I don’t know what happended to you that you had such a bad experience with a pharmacist. Or if you’ve ever taken a pharmacology class or not. But to come on a PHARMACIST blog and call pharmacists BAD and IDIOTS just kinda shows what kind of idiot you are, doesn’t it? 6+ years of school and a shit-ton of work kinda weeds out the idiots. Maybe the ones you are referring to were reacting more to YOUR personality than reflecting their own.

    • Irritated says:

      You sound like a fucktard!

    • retail blows says:

      Jim says “But I can assure you that even version 1 would be far more proficient and safe than the idiots that become pharmacists.”

      I work for an unnamed retail giant and we are on version 57 of our software, and guess what, it fixes one problem just to create another. Fifty fucking seven and I can’t have a week go by without a software problem! And although there are a few idiot pharmacists out there, they are few and far between. However, your post shows you have no real insight into the retail profession, which makes your comments ignorant. Good day to you sir douche.

    • luagha says:

      Jim doesn’t understand that the ‘bugs’ described above are actually features.

    • Kippster says:

      Pharmacology is just memorization and very simple logic??? Do you truly believe this? Then you must know that the first level of learning is memorization and that a 1st grader can do that, right? Why aren’t there more pharmacists then since its only memorization and they make over 100,000/yr??? Also explain why only 1/3 of students that desire to be a Pharmacist are actually accepted in a program and then only a 1/3 graduate???? Please do tell what was the highest chemistry class is that you took in college?

      • stiff says:

        Why aren’t there more pharmacist? well, lets see…. the board of pharmacy controls how many school opens per year and how people get license. Do you really think pharmacy pay would be 100k if there is inflow of foreign students? how about unlimited seats to pharmacy like they have in engineering, finance, etc? yeah, that sure will change things.

        Eitherway, I dont hate pharmacist but you guys need to chill out on ripping off comp. Last i knew, pharm did not do crap besides verify the medication is correct. The Pharm TECH does all the work for you. Calling the doctor, calling the healthcare, etc. Now that might be diff story for mom/pop stores but its true for cvs or WAG. Anyhow, the new machines that are in testing stage work diff. At Medco, the pills are filled by the comp and get scanned and photographed. Pharmacist at the remote site reads the info and see the high resolution of the pill and the label. She okay’s and signs it. On to next fill. Anything is possible with computer. Heck, 90% on this planet is done by computers. Do you think humans have power to see the warning ahead of time? no…. you would need 100 people to look at the power plant to see if everything is in check. You create a program that does that work for you and now you only need 10 people. When you fly… pilots dont fly planes. They put on auto pilot and when turbulance come…. FAA says to let auto pilot decide on what to do.

        anyhow, all this programs are not created by engineers only. You get pharmacist involved during the process. They work with the team of engineers and then software is released. The software is good as the pharmacist who provided the information on what to look for when you fill the RX.

    • JennBpharmD says:

      lets see… how long has e-prescribing been around and how much does it still get screwed up? I’m not afraid of a machine but these ‘bugs’ are still going to be a pain in the ass of the doctor & patient when they have to initiate overrides, contact insurance companies, etc. And, last time I checked a computer cannot run without a human behind it somewhere, whether they are a community college drop-out, a pharmacist with a doctorate, or a highly paid engineer. And simple logic in pharmacology? Are you a pharmacist/chemist/pharmacologist? Have you ever had to puzzle through 30 some odd drug profile to find where the interaction is occuring? Yours might be, but I’d hardly call my education and knowledge simple.

    • Mike D. says:

      Fascinating.

      Intellectually, it is probable that computers could help a ton more than they presently do in pharmacology. To say that “version 2″ will make all the bugs go away is just retarded in as complex of a field as this. I have some computer programming experience and zero pharmacological experience, but even *I* could tell you that.

      I’m not personally familiar with bogus interactions (lawyer prescribed bad interactions, I guess?), but one side effect of having computers doing pharmacy is that a way *would* be developed over time to deal with this issue, whether it is scoring or categorizing bad interactions against various risk factors or whatever, but once an engineer understood what the trouble was, and looked at enough data, a solution is feasible.

      Regarding other comments about “a computer being only as smart as the person who programs it”, this is absolutely true, but a computer has the advantage of being able to be programmed by dozens of people, will never forget a lesson, and can continually be improved.

      Nonetheless a live pharmacist is an indispensible resource for reasons gone over by other commenters, from doctor SNAFUs to short-term “loaner” pills. Are you pharmacists so scared of the technology that you wouldn’t even accept limited help from an automated system? How much transparency would it need for you to be able to trust it?

      It seems like a really myopic perspective to say that computers or machines can’t help you, and replacing you is simply a point a little further along the helping scale.

  12. Dr. Grumpy says:

    They tell me I’ll be replaced by a machine, too. Whatever. Because I already know what an awesome job Dr. Google is doing at diagnosing patients.

    • Karrirx says:

      Dr Grumpy…I LOVE YOU!!! hahahaha That was too funny!

    • Danimal says:

      Dr. Grumpy,

      As a computer programmer I can assure you that you’ll never be replaced with a computer. Electrical components aren’t big friends of water — what computer could take care of the quantity of Diet Coke you handle every day?

    • teachertype says:

      And I know that, as a teacher at an alternative high school, I will one-day be replaced by a set of 24 computer monitors and a badly written software program that will explain how to solve 3x+5=24. Oh wait… they already tried that, and it failed badly…

    • notgiven says:

      Worry.
      My doctor tried to get me preapproved for Zostavax 7 years earlier than my insurance company wanted to pony up by writing a letter saying it was medically necessary and why. She got turned down.
      Approximately 30 minutes of sifting through Highwire results found me two free papers. I used those, copies of bills from a bout of shingles 17 years ago and a letter describing my experience and family history of the disease, other medical problems and pointing out the relevant parts of the papers. I had the preauthorization in hand in a month.

  13. sumotoad says:

    Man, you are always the bomb. In 1994, the dean of my college told us all that we would see pharmacist layoffs within 2 years as machines replaced us. I have frequently wondered what bonehead FPGEE-ite comes up with some of the drug interactions– one that always makes me chuckle is that ibuprofen may cause drowsiness. How does a drug that impairs melatonin production cause drowsiness? Do we really need to consider placebo effect in our warnings?

  14. WrongAid says:

    Don’t get too complacent. Don’t forget who is running the vast majority of pharmacies. Corporations! These guys don’t give a squat about the person that needs 3 pills to get by, or the person that might be getting controls early. If, (and it is a big IF) they can manage to get a machine to be right most of the time and buy off the state boards to accept it, your fantasy may come true. After all, they can pay some foreign call center to apologize and offer coupons for pennies a day. All (and I repeat ALL) board members care about is bottom line. If some CEO is handed a piece of paper that says X machine will cost $500,000 and Y pharmacists will cost $600,000 over 5 years, then guess what decision will be made and guess who will get a multi-million dollar bonus for the great idea.

    Keep your eye on your state board.

  15. One of your better posts TAP! And probably too close to the truth if we ever use vending machines for drugs.

    Loved my word verification… al chick

  16. Heather says:

    Great post!

    -A 2nd yr medical student (and yes, I know nothing)

    PS: do you really get comments from crackheads (/drug seekers)? Hilarious =)

  17. Nurse J says:

    wow, jim has some balls. first, you’re a bad pharmacist, second, com-pooh-ters are ‘so easy to fix,’ AND you need to get a life. and ‘Pharmacology is about memorization and very simple logic.’

    wow.

    um, can i ask why nursing students know double nothing? i was working as a nurses aid while i was in skool, and i’m married to an awesome ICU nurse……so, anyways, just wondering.

    • Mary Augstine the pharmacist says:

      Don’t be too offended about this statement. Usually after 6-8 yeas of pharmacy schooling, graduation, and only 1-2 years working on the job with real people, we pharmacists are ‘old hands’ in establishing priorities for decision-making. And, we make life-impacting decisions ALL live-long day. Any pharmacist will tell you we love and depend on nurses that use their knowledge of patient advocacy and nurse training in assisting in these decisions that affect our patients. Because nursing is such a personal service/art, in dealing with working with physicians for which they are the ‘handmaidents’ and patients (who don’t always KNOW what is going on, yet are supposed to make informed choices) it might take longer for nurses to develop a team approach accepting pharmacist objectivity as equally valuable in making health-care decisions. Believe me, I love my nurses that are doing the best for their patients to help their patients, but I do not find it appropriate when nurses allow personal opinions to interfere with team-care.

  18. belle says:

    ANGRYpharm,
    I slightly resent the comment “Students know absolutely nothing about the ‘real world’, except nursing students who know double-nothing.”
    I am a pharm student, and read your blog with every new post and laugh my ass off because it is all so true, even in the deep South. Students (here at least) would agree that almost all the scenarios you blog about hold true. I have worked independent for 6 years, which might have something to do with it. I find myself agreeing and nodding my head at every rant and rave because someone has the balls to admit what so many won’t…the crapshoot that pharmacy really is. When you sort through all the bullshit, you might finally get to help someone. I don’t know about the rest of the country, but here in the South…we have the ability to sit in class and sort through real-life and theory. Real-life is making it through one more day….making it til the day is over. Fantasyland is counseling patients with the politically correct counseling method for 10 minutes each. Who has time for that? Real-life is dealing with the “hoverers.” Ever light up a candle right in someone’s face because you can’t work because of the smell? That’s real-life.

    I don’t think students are oblivious to the real world….

    Just some food for thought….

    • Disgruntled Student says:

      From one student to another…I whole-heartedly agree with you!

    • Rx Intern says:

      There are two different kinds of students:

      1. Those who have never so much as stepped foot into a pharmacy before deciding that they want to spend the rest of their lives in one, and

      2. Those who have worked in pharmacy for YEARS and made the decision to go to pharmacy school only AFTER putting in their time doing the “tech grunt work.”

      Pharmacy interns are not all stupid and/or useless. Some of us are an integral part of the pharmacy process (i.e., recommending things to patients, counseling them when it is necessary, dealing with MD’s offices, all so that the pharmacists don’t have to, etc).

      I do agree that most pharmacy students are as naive and unprepared for the real world as TAP believes they are. But these are also the ones who are going to go do residencies and make life saving decisions in high-pressure situations in a clinical setting every single day. Yet no one even knows they are there. When the public thinks of a pharmacist, they will think of me, at their neighborhood pharmacy. The one who recommended that cough medicine for their child that one night after the pediatrician’s office was closed, the one who gave them a couple tablets of their warfarin to get them through until we could hear back from the doctor for a refill, and the one who made that compound for them after working with the doctor’s office and the insurance compnay to get it covered.

  19. Jim MD says:

    so basically you are defending the need for pharmacists by explaining the 1% of errors that may occur? All of which could be taken care of by a minimum wage Rite-Aid Clerk. Yeah you’re right pharmacists are soooo important!

    • Rotten Tech says:

      Don’t feed the troll.

    • rukidding says:

      I’m sorry…I can’t let this dumbass go.

      Are you the same Jim we were all trashing above? If not, you’re as much a retard as he is.

      Would you rather that those 1% of errors go out to patients, some of whom could die from those errors? You are the typical asshole God-complex doctor. I’ve met plenty of those…you fit nicely into the mold.

      Doctors act like we have no clue what we’re doing in the pharmacy. You douches get what, a semester, maybe two of pharmacology? Psh. For example, I was working one day when a young lady brought a prescription in for cephalexin. She told my tech that she was allergic to penecillin, and that the last time she took it, she had a nasty anaphylatic reaction that put her in the hospital. I promptly called the doctor, seeing as how cephalosporins are cross-reactive. The doctor basically insulted me, telling me that I don’t know what I’m talking about and that cephalosporins and penecillins are NOTHING alike. I had to explain to him that there is indeed a cross allergy, and considering the patient’s history, it was probably in her and HIS best interest to change the medication. He reluctantly did.

      Now tell me…would a minimum-wage clerk at Rite Aid be able to do that? And how would you like to the in that 1% who gets a flawed prescription? You are an idiot.

      Just remember: behind every good (and douche-bag) doctor is a a pharmacist who saves his ass.

    • Pharmacist123 says:

      You are truly a moron Jim MD. You should see how many STUPID mistakes we catch each day from prescribers. There’s no 1% more like 10%-30%. The reason why we won’t be replaced is that we act a filter for your (as part of a professional whole) mistakes.

  20. Kdubz says:

    Jim,

    you are absolutely correct, version 2 will correct all the bugs from version 1. Then version 3 corrects the bugs from version 2, and in the end the operating system just runs slower and generates more errors. The fixes often times generate even more flaws, but you being a programmer would know this.

    You are also correct that a computer is capable of performing more proficient than pharmacists. I would also add that a computer typically has more personality than your typical computer programmer, has gotten laid by more women, and is less likely to live in it’s parents basement.

    So Jim enjoy your life, and just know that some kid in India can write programs for less money and probably do a much better job than you can.

  21. Dr. IHateEveryone says:

    TAP, you are the greatest! I am so very glad I have discovered your blog. Makes my anger towards society’s treatment of our profession so much less shameful.

    I always wondered: Why don’t all of us pharmacists band together on getting rights? Rights that everyone else has except for us?! To not be able to function like a normal person such as eating when you want to, or pissing when you want to is basically the daily practices of a dog. No, scratch that! Dogs actually have time frames of when they are supposed to eat and piss….so basically our quality of life is worse than dogs.

    When considered possible replacement by machines. I wouldn’t be suprised. Even better: machines don’t have to EAT or PISS, PERIOD.

    I am so sick and tired of all of us bitching and moaning to each other yet at the end of the day it is the same shit. We go to sleep, force ourselves up in the morning, go to work, be everyone’s bitch, go home, cop and “attitude” with your loved ones, go to sleep, etc, repeat.

    You know what the biggest problem of our profession is? No unity. Now why is that? From what I see, even nurses get better deals than we get. My opinion is that it’s because there are more of them working together; seeing each other on the job. Most of the pharmacists out there do not work together; we do not spend much time with each other at all. Now, there definitely are some pharmacists such as hospital settings that are in groups of 2-6 but that is not many. Most of us just work as the only pharmacist and we don’t have the luxury to sit at work or at lunch (god forbid!!) bitching around a group of other pharmacists. This is why nurses get better treatment. It’s probably also why it’s so easy for them to strike.

    So it basically comes down to this: our complacency and lack of action is leading our profession straight into the glorified world of robots and machinery. No wonder everyone is treating us so bad; they are preparing us for the inevitable…..a gradual transition into robots.

    My question is: How can we band together ALL of the pharmacists in the US to fight for rights and change our profession? And I’m not talking about organizations such as the bullshit, useless APha. Where the hell is our “Yes we can” mantra? WTF?

    • PharmGirl99 says:

      Dr IHateEveryone,

      I think that you are correct…. Pharmacists tend to be isolated from one another, so we lack the “team” mindset that nurses or physicians in a group practice would have. And we slit each others’ throats all day long. Can anyone say $4 prescription? Or would you believe that the other independent pharmacist in my town doesn’t charge anyone a copay, ever? (That’s a whole different rant.) Do other medical professionals behave this way toward each other? I don’t think they do, but maybe I’m wrong.

      How would you suggest we come together to fix the situation?

  22. crazeecatladee says:

    I work in a mental health facility where most of the patients are indigent. I’d like to see a machine get free meds from pharmaceutical companies for over 800 people, or pack backpacks for the med drop people who have to be supervised every day with their pills so they don’t eat the whole lot of them.
    I feel sorry for the machine the first time an addict takes a ball bat to it when they can’t get their fix…or somebody tries to steal it like an atm…

  23. pharmacyphil says:

    At work, I can spot a drug seeker(crackhead) coming a mile away! It is just a pattern of behavior they exhibit, reminicent of the rats addicted to morphine we watched in lab at pharmacy school. Coming down the aisle, I know what kind of RX they have in their hand before they get to the counter. They watch every move you make, very attentive to activity behind the counter, eyes fixed and bulging out of head. They lean over the counter as if they are about to jump in. They sometimes are overly friendly( if they get what they want, lol)telling their sad story of misfortune by injury, or need for early rx fill. They finally get “their” vitamin V or OXY and they scurry out like a shot>
    And I think- just another happy day at work!!

    • Danimal says:

      You know, the few times I had to pick up Vicodin or similar for my wife, I was nervous about it. I figured the pharmacist wouldn’t release a controlled med to someone who isn’t the patient. Was it not a problem because I didn’t show those cues? Or is that the standard procedure?

    • pharmacyphil says:

      Or better yet,
      I had one instance, as I was dispensing a woman’s #100 percocet on Medicaid, I overheard her cell phone conversation in the waiting area. She was setting up a drug deal for parking lot outside and had the nerve to pressure me because 15 minutes was too long for her.
      She probably made more money than me that day, Ha,Ha…

      • PharmD Student says:

        So you overheard that she was going to sell her drugs to someone else, and you still filled the script?

    • CRACKers says:

      Oh really Pharmacyphil? Thats the way addicts, or Junkies or Crackheads or what ever the hell their called now act? Lets see…. I have a friend who is a pot and vitamin V head, She sometimes get stoned I go with her to the pharmacy and she sits there quietly (stoned or not) she dont watch them, or stands at the counter….. Sorry not every “crackhead” is the same. And why do you call those addicted to vicodin and Hydrocodone products “crackheads” or are you referring to the hillbilly crack expression. Shit I was an addict, but not a crackhead. Never smoked it???!!!!???!!!???!!! WAS AN ADDICT, no!!! really it is possible to rehab

      • TheSubscriptionzReady says:

        A crackhead activist,ok not all crackheads are created equal, some might have a little more red in there eyes or smell like sh**

        favorite crackhead slurs:
        do you have the purple or the red phenergan with codeine?
        i need my vike’s, i need my HyDROCoDOAN
        do you have the watson’s?
        i got this pill what is m 357,358,363,365,385?
        do u have the pink darvocet the white ones don;t work.
        i found this pill can u identify it? yeh what does the bottle say?
        Instead of asking about food,Can I take my medication with or without alcohol?

  24. Chuck in MI says:

    TAP,
    Your blog lets me know how stressful it is to work at a corporate pharmacy. I think I’ll stop by my pharmacy and buy all the techs and the RPh a soda. Do you think they would like that? Or would they freak out?

    My uncle is an RPh and he NEVER talks about work. Now I know why.

    Also, I believe all of your stories, because I have seen these actual people you talk about. People on welfare buying food, 80% of which is high fat, or high sugar, and they sure smell like “diabeetus”!

  25. VaTech says:

    I hate e-scripts…I don’t care if they are the most convenient thing in the world, they suck..and they are prone to errors 99% of the time. I’ve had so many instances where the patient screams that their MD “emailed” it, and the MD screaming that they did and to leave them alone…only to find out that the precious MD forgot to ‘electronically sign’ it which means it never sent.

    Then there’s the patients who have been on ‘A’ medication for 3 years (i.e. Metoprolol Tartrate BID) and they mis-click and now all of a sudden they want Metoprolol Succinate…BID…um…excuse me? Or they write out the SIG for a 14 day supply and only give a qty sufficient for a 7 day supply with no refills. Half of the e-scripts we get have to be called on and 3 times the paperwork has to be generated. There’s never any apologies on the MD’s part, there’s laughter and chuckles and an ‘oh yeah, fix that for me’ and then it’s done….20 minutes and 1 pissed patient later. The patient? Oh their MD could never mess up…it must be our fault that they just tried to kill them by clicking the box of a med they are allergic to and sending it over on happy e-scribe.

    No machine will ever replace the fact that when i’m worried about my little girl and her fever and what I can give her in addition to other medications she’s taking, I know I can get an answer from my pharmacist instead of being redirected 10 times and then told that my MD is out and will call me back in the morning

    • MB says:

      E-scripts I found are nice, only from a few doctors (a total of 3 I can think of) who seem to actually know how to use the program, though they still write half their scripts in a hardcopy format because of issues with the PDA or computer not working. I remember one peds doc sending a script over for augmentin tablets for a 3 month old. Called the office and he kept saying he had sent it correctly and that I must be reading the script wrong. While this conversation is going on we got another 3 scripts for the same thing from the MD for other patients, all having the same error. I faxed the print outs the MD and he finally believed me that his vaunted e-scripts program was not working at all.

      The doc gave the excuse of the program showing he was inputing for the suspension with the correct sig but the program must have been converting it to tablets and sending it that way. He ended up giving me verbal orders of the phone for the patients that were waiting in the pharmacy with babies and little kids not feeling well and screaming.

    • Orangeblood 77 says:

      I got into this late, but you are so right. E-scripts are much more prone to errors. They have created a lot more problems than they have solved.

  26. John says:

    If there is actually a move to replace pharmacists with machines, do you think they’d stop there? Next step would be surgeons, then family doctors and specialists. Step 1: recognize symptoms. Step 2: Form diagnosis. Step 3: Prescribe medication last drug rep recommended.

    Yep, sounds like prescribers aren’t too far behind on the list!

  27. Rph4Life says:

    I find it interesting that this website – all it does is bitch. I understand that this is the purpose of the site – to vent, get it off your chest, but does it ever do anything to fix the issues, solve the problems, etc?? Machines, medicaid, insurances, etc etc, are all part of the daily grind. Its not going away any time soon. So yeah, vent and get it off your chest – but how about putting in the equal amount of time it takes you to bitch about something and develop a plan to make it better, to fix the issues, or to get your voice heard in a constructive way that could possibly lead to better outcomes?? That makes more sense then bitching about things constantly to me.

    • Mary Augusting, a pharmacist says:

      I’ve found pharmacy sites I read help provide a concise reason to press for changes, for me to help realize others are experiencing similar variations on a common theme. Despite membership in county and state pharmacy associations (and, a national one for a while before I discovered membership was no longer relevant to a level of job satisfaction), there was no group connection for support.

      In the 1990’s when a small local chain had to sell out because Medicare reimbursement rates had plummeted, there was no outcry. The government action was the price of doing business for an unproductive business model. And, the displaced pharmacists could mourn all they wanted but they weren’t the owners and it was they who had to scramble to find jobs.

      For myself, after years of extra training,experience, a post-graduate degree, and lots of over-time, I found the pharmacy-buyer still had more clout than I on what I did day-to-day, and more knowledge about aspects of the profession than I i.e. drug costs.

      Since I’ve started reading and responding to posts from Pharmacy Jim, Ol’ Apothecary, TAP, and TAPest, I’ve been more involved in local and state organizations (dropped the national membership), provided input to trade journals, local government, and helped develop a career path consistent with what I want to do with my pharmacist knowledge.

      We pharmacists often work alone. In less numbers than other professionals, we sometimes find difficulty relating dissatisfaction with our particular ‘job’ to that of others even in the profession since we work the gamut of situations from ‘working for the man’ to private and public entrepreneurial practices.

      Unlike professional organizations, a single blog site has no individual power, but commiserating and finding solidarity is empowering. Already, blogs have proved an effective forum for discussing aspects of the profession requiring redress. Development of The Pharmacy Alliance. Blogs helps overworked pharmacists realize that some of what we do crazy, but unfairly out of our hands.

    • CRACKers says:

      Yea but its freaken funny!!!!

  28. Bubba says:

    Wow, “technophobe,” eh, Jim? Funny how it just seemed like TAP was just saying pharmacy systems are already rife with idiot warnings. Say, for example Tramadol and fluoxetine. A pharm machine would scream, “danger! Danger! Serotonin syndrome!” And the crackhead-in-training will say, “Oh, shit, what does that even mean?!!” So he goes back to the doctor and wastes his time to fix a 1:1,000,000 odds interaction.

    I think you could have a machine to the side of the pharmacy for the mundane flonase, amoxicillin and ranger candy (IB 800), you know, stuff people actually might take as directed.

  29. JB says:

    Jim, really, that’s some stupid shit, coming back with “MD” at the end. Like anyone is going to believe you went to ten years of college after reading those posts. I’m a pre-pharm student and know I know nothing, so I embrace the STFU and laugh along with the madness, rather than defend my overweight, socially backward porn surfing friends who dream of being six-figure beta testers along with the rest of the World of Wartards.

  30. Mary Augstine the pharmacist says:

    I’m sorry that one either sounds savvy or a luddite… If pharmacists were all het up about programming every nuance or our job to the nth, there’d be a lot more double-majored pharmacist computer engineers. Maybe that might be a future career. Truth is, in this present stage of computer science in the pharmacy profession, one is a pharmacist first, with basic understanding of human physiology/chemistry and knowledge of drugs and therapeutic use, with facilitation of access based on optimization of computer technology.

    One would argue, then, that many in health care would dispute and find there is an obvious and fundamental difference of opinion about the statement \a computer program is far easier to fix and maintain than a mob of bad pharmacists\ and that ‘pharmacology’ is only about memorization and logical interpretation of pharmacological principles. First, while pharmacology is a science, there remains much, much more to be understood about it–especially of the major ‘controlling’ system links in humans e.g. the brain, spinal cord, and nerves. Right now, logic does not explain the central nervous system. And, secondly, there is occasionally misunderstanding from the many people that deal only with logical thinking and language, those without basic biologically understood knowledge of beings or those without a pharmacy/nursing/biology background i.e. many lawyers, politicians, accountants, ancient Greek and Latin language experts, etc., the idea that pharmacy is ONLY pharmacology. Please, try to understand that a person that graduates in pharmacy uses knowledge of sociology, organic and inorganic and other types of chemistry, psychology, pharmaceutical sciences such as pharmacodynamics, statistics, etc. to understand some of the practical viable therapeutic options presently available, and yes, we do use mathematical principles such as Fourier series for phenytoin metabolism by Michaelis-Menten, zero-, first-, and other order elimination processes.

  31. Syd Vicious says:

    Just a clarification on the student comment…nursing students are typically freshman-seniors in college. I think TAP overestimated their knowledge. Should be triple-nothing. Nothing against them or the pharm students, as I was one once, but real life is for the big people Pharmacists.
    to Jim: *sigh*. “Pharmacology is memorization and simple logic.” Wow. I truly hope you do only work with machines.

  32. Danimal says:

    Aww, man! I’m a developer, and I was all ready to pull out a can of whoopass for Jimbo up there. My brother Bones just did it for me, and much more eloquently than I could have. Good job, Bones!

  33. Danimal says:

    Excel is a great program, but it doesn’t replace an actual accountant. Same as every damned “expert system” out there — you still need a human mind interpreting the crap they spit out.

  34. PharmTechNursingStudent says:

    Here, here! I see both ends of the areas with working in a retail pharmacy and in the hospital on clinical rotations and you can tell when people are really in pain and when not etc. People are so oblivious as to why it takes so long to do things and then yell at us for things that are not our fault but their insurances fault. Then when we explain this and they call the insurance and realize we aren’t talking gibberish they could not say sorry because they would then look idiotic. Oh well, why we continue in these thankless jobs I do not know.

  35. Mike W. says:

    @Jim:
    Pharmacology or Pharmacy is no more memorization than any other profession. The same could be said about doctors, lawyers, engineers, etc. Nevertheless it would still be grossly inaccurate. All of these professions and many others use KNOWLEDGE (call it memorization if you want — everything in your head that you are capable of recalling could be considered memorized) to evaluate situations in order to determine appropriate courses of action. The APPLICATION of knowledge is where computers FAIL! This will always be the case unless we develop computers with the capability of learning, comprehension, understanding, and thought….then, Welcome to the Matrix and this entire conversation becomes irrelavent anyway.

  36. SGT says:

    This blog is enjoyable, but I still get a sense that the majority of the posters have a teabagger mentality. It seems every post gets responses about baby mommas, welfare, and lazy people even if that is not relevant to TAP’s posting.

    • pharmacyphil says:

      That is because a good percentage of our clientele are baby mommas, welfare and great percentage are LAZY. We react to situations placed before us. The amount of customers who present and pick up prescriptions without incident are few and far between unfortunately.
      TAP is probably the only outlet where we can vent our frustration, we work in a profession bogged down with regulation, laws and policy. We serve customers who often have very little regard for themselves as well as others, and we cannot take responsibily for thier behavior.
      If is makes us “teabaggers” , then guilty as charged.

  37. chris says:

    If you really boild it down, is there any jobs that COULDNT be done by machines theoretically? with increasing computer power and minituarisation I dont think there are many roles that they couldnt fill at some point. But they can only do what they are programmed, they cant think out of the box like humans can.

    How many times have patients come in and told you that google told them they had X,Y,Z disease. A computer is great at simple logic. lots of yes no questions.
    query 2 :- do you have pains in your chest?
    YES
    query 2 :- are you short of breath?
    YES
    query 3 :- are do you have pains in your arm?
    YES
    query 4 :- do you have a history of heart problems?
    YES

    RESPONSE
    pending…
    pending…

    YOU ARE HAVING A HEART ATTACK – AN AMBULANCE HAS BEEN CALLED PLEASE WAIT.

    Unfortunately when the ambulance arrived the patient had died of anaphylactic shock, he had been stung in his left arm by a wasp and, knowing how allergic he was, had sprinted as fast as he could the half mile to his nearest pharmacy to get an adrenaline shot.

    Thank god for machines and their simple logic.

    My last argument is with the patients themselves, A machine is only as good as the people that are using it, and patients make mistakes all the time.
    Patient goes in to a new pharmacy to get a script for viagra, the machine asks, are you taking any other medication? I know so many people that only count tablets as medication. The patient then goes home, takes his viagra, gets chest pains and has a few puffs on his GTN spray.

  38. VAPharmD says:

    Honestly, people who don’t work in pharmacy think our job is just putting pills in a bottle and verifying prescriptions. If a machine replaces us, who is the general public going to call at 7pm about some random rash their child has developed… or what the best option for their sore throat is? A machine might tell you to take some Cepacol, but a pharmacist is going to ask you directional questions to discover that it’s nasal drainage and direct you towards the generic antihistamine… who’s going to help you wade through all of the potential side-effects that print out with you new medication? Who’s going to show you how to give your recently discharged wife who now has 12 medications her Lovenox shot and not let you leave until you completely understand every single prescription? Honestly, checking prescriptions is what I do to pass the time in between patient questions… that’s really why I’m there. Sure checking a prescription isn’t rocket science, but to the people we take a personal interest in and help every day, it takes a lot more than just rogue memorization.

  39. Sandra says:

    Thank you, TAP, for having the guts and fortitude to put this blog and your opinions/observations out there! I am not a pharmacist, was a specialized RN for many years and am now on full disability. I am, however, forced to now look for a job. Why don’t I sit back and just collect my disability? Answer is really f’ing simple – I cannot AFFORD my medications. I am in the proverbial ‘donut-hole’ after 3 months with my insurance and they run me $1,000 a month. I do NOT qualify for any of the extra help out there because I
    a) make too much on disabilty
    b) cannot lie like the rest of the scumbags I see in the pharmacy line ahead of me so I WOULD get more $$ and not pay any insurance premiums or outrageous co-pays
    c) have NO ‘baby-daddy’ out there to complain about

    My pain meds and those I take for neurological disease are freaking outrageously priced thanks to all who have made it their occupation to sell said drugs on the street. I have the utmost respect for my pharmacists because he/she will go out of their way to try and help me. How all of you put up with the people you encounter I will never know. I do have a limited exposure to it since working as a pharmacy tech while in nursing scholl. Back then, there were no computers and we had to keep track of the known addicts and swindlers by way of handwritten lists, phone networking to other pharmacies (when they were on the prowl), and also by memory and good old gut instinct. I know how much crap I took back then, but always had the option of calling the pharmacist to the counter so they could deal with them if I hit a brick wall. I even had a gun pulled on me for not handing over a 1,000 count bottle of Darvocet-N – yeah, remember when those were a ‘desired drug’? I know each time I go in to fill a prescription, I will undoubtedly be there with one or more of those people who make ME want to pull a gun on THEM (don’t own one, so no worries there) because I know I will have to listen to every idiotic, rude, disrespectful comment and demand they ‘have the God given right to make’ to the human behind the counter. I am a very patient woman and keep telling myself that someday this will turn around. I then click the heels of my ruby slippers together and make damn sure I have a firm grasp on Toto so I do not lose him on our way home…..

    Thank you and kudos to all you pharmacists out there who have not become a suicide statistic. There are still people who care about what you do for them and I thought I would let you know that. I will continue to read your blog as long as it is going and just may jump in to comment again. Hell, it only took me a year to write this one!

  40. Ozzie West says:

    Greetings,

    When the Physiican Assistants and Nurse Practitioners can go a day without royally screwing up the E-Script, then both the RPh’s and the MD’s are going to be pretty much OUT THE DOOR. Get your student loans paid down and get ready to live simply.

    On the plus side: You will have Dr Obama to take care of you. So, no need to work anyways.

    When E-Script gets worked out and practitioners can learn to deal with it, then the pharmacy belongs to the techs and the robots.

    Oz

  41. Ozzie West says:

    BabyMommas, welfare, and lazy people are pretty much relevant to ANY arguement in the confines of the new post-modern NannyState.

    Oz

  42. Janet RN says:

    It’s too bad customers are such an awful combination of stupid and hostile. My hat’s off to all pharmacists for the work they do.

  43. Its not what you know its what you understand says:

    I was a artificial intelligence programmer hobbyist way back in the 80s. If the program cannot pass the Turing test (Google it) then it wont replace any function requiring thinking and understanding.
    However, what passes for thinking sometimes is just conditional branching logic (like in the intelligence test where a square peg is deemed inappropriate for a round hole).
    I would be more afraid if I were a tech- who are not allowed to make “professional” decisions. But really, give me a break. Giving out an early refill can be easily programmed in- assuming its not illegal.
    The reason your customers are hostile is because of ignorance, lack of manners, long wait times at the medical facility and/or pharmacy (feedback loop with long wait and ignorance/hostility), their spotty character development, lack of control over their own destiny, and perceived lack of value of your services (hey its free). Oh yea, their pimp/drug dealer/boyfriend/baby father is outside ready to party with the pills and the doctor just called back saying its a forgery and wants them arrested. But I digress…
    America has become a land of lazy slobs, oblivious to their own nature, ignorant of even the most basic things; in a word “Troglodytes”. And those who’s job its to care for them. And they “vote” AAAAYYYYYIIIIII!

  44. toddq says:

    I have seen machines like this that do dispense medication (no controls though) and if you want counseling you can pick up a phone and talk to a live pharmacist. Pharmacist would still have to listen to the “too soon” complaining BS but it would be over the phone now instead of in person.

    Patients have also said they enjoy having the phone counseling versus the one to one counseling because it feels more laid back and relaxed. They are not so embarrassed to ask face to face questions. There is a sense of anonymity versus calling your local drug store where they will remember your name. Not saying the entire profession of pharmacy will be replaced by the machines but I think some of it will.

  45. john says:

    British Columbia, canada is passing a regulation that would almost take most of the responsbilities from Pharmacist and give it to regulated technician. This would eliminate a lot of pharmacist jobs. Please sign the petition. Get the word out. It is just the beginning. Sign the petition at:
    http://www.gopetition.com/online/34742.html

    Thank you,

    john

  46. bcmigal says:

    Due to the recent flooding in the northeast, the computers in all the stores of a major chain were useless for nearly 8 hours. Even offline processing was nearly impossible and phone calls to stores were dropped or went through only on the doctors’ line. No debit card transactions could be processed, only credit cards. The most common question was “when will the system be up?”
    Tell me more about our being replaced by computers….

  47. I really don’t think any pharmacist who graduated after 1990 knows how to process prescriptions without power and computer when natural and man-made disaster strikes.

    Also, I don’t mind if Techs. takes over dispensing role and QA by Techs,either, as long as they are accountable not supervising pharmacist.
    There should be College education for Pharm Tech in Technical college and certified and trained before they work in the pharmacy.
    They should be licensed and treated as professional as Para legals do.

    Let’s say 2 years -3 years including tech internship.

    For pharmacists, managing MTM clinic and INR clinic, Immunization clinic, Lipid clinic, Metabolic syndrome clinic, Psychiatric meds clinic, diabetic clinic,prenatal care clinic after the regular doctor’s visit,etc.. you get the ideas…

    The baby boomer pharmacists will be still sought after because of their experience and ability to prioritize and manage the crisis on hand.

    The technology is valuable to our profession to organize our patient’s data
    and ability to monitor medication dose, age, drug interactions, adverse effectes and drug allergies,etc.

    Unfortunately, the chain corp. are more interested in gathering business side datas such as first fill, ready fill,promise wait time,ete., intead improving providing extra tech hours to improve the SSS, providing the mandatory counseling to all new medications to improve medication misfil and to establish the personal connection instead of giving away Gift cards after the effect .

    Giving away Gift card to anybody who complains about anything will just encourages them to call in for another complaint for another gift card,etc.
    If the complaint is legit, have involved party contact the complaint and offer
    genuine apology and learn from the incident. After all we are the professionals not the DSM or kissing RX Supervisors.

  48. amber austin disgruntled welfare patient says:

    well tap im doing good no thanks to the pharmacy who would give me an erlie fillz of my vikes cause they no that i am in severe pain and cants work. consider a NEW WORLD PHARMACY YES TAP your fears are coming true st.welfare of vikes has told u first and once again i would like to thank the wonderful american public for reporting to work as required so i didnt have too. hey vike mommy with kids i need u guys to get outta bed not me i went farma hopping and found independant pharmacy who fill vikes early cause like u they cares abouts me health thanks independants verification court adobe? could have phrophetic meaning as i use a pdf viewer to look at court documents to check to see if they catch me. cool site but i recomment an anger control drug acd to help farma out lupuline hcl a.ka flemazine not approved for anger and vike dt

  49. I can see more machines taking away SOME jobs of techs as well as pharmacists in the near future. In the end, a few live people will still need to be there to deal with the problems you listed. A one time fee of ~150,000 for a parata machine seems to make more sense for larger stores as profits are squeezed.

    I agree with your comment about students. A lot of students I meet are overly optimistic about everything, when in reality, things aren’t so perfect in the real world.

  50. bcmigal says:

    Amber austin….could you please translate what you said????

  51. fulcrum83 says:

    Hey, wait a minute… I’m an ex-US Navy Corpsman, father, and current nursing student, and I’m a bit offended by your statement. At most, I’m only “singly” a know-nothing. Sheesh. But seriously, love reading your blog, ever since I picked it up Googling a med for one of my clinical rotations awhile back. Keep up the good work!

  52. amber austin the anti-rph says:

    bcmigal and other rph my first posting was for my fellow welfare peeps. u or tap or any rph will not be able to decipher the meaning because it is profetic the whole propsy is where will arise a one world pharmacy in the end times. it will be controlled by big pharma not rph mylan 777 is the name of this pharmacist world order. mylan will pose as a solution to all of farmas woes let he/she who has knowledge understand what i say as mylan 777 repsents the beast. they play god use his seal 777 but torches like a dragon. a one world pharmacy will emerge run by the drug company generics will be outlawed we are in the final days of this wicked system. you tap and everyone on this site HAVE BEEN FOREWARNED.

  53. dr magnus ikwanna m.d phd says:

    i agree with amber austin the welfare patient to sum extent. i do feel that the drug companies are going to consolidate and buy/force out pharmacies and yes as my drug reps have indicated that they will push for banned generics under obamacare. i trust my drug reps they are very informative to me and i think ms austin is a drug rep posing as a patient. anyways the medical system is broken beyond repair and with obamacare we all should stock up on cyanide in case we have to take our own lives. id rather die then practice medicine under a one world pharmacy.

  54. Lion of Zion says:

    agree with the post, although i have that escripts works very well and i find it makes my job easier.

  55. Lion of Zion says:

    that should read: i have found that escripts works very well

    (rph)

  56. Keri P says:

    bwaahahahahah, I love that you say crackhead! I have called my patients crackheads, the newbies are crackbabies, and occasionally, I will get to meet the crackpimp. What’s really sad is crackmama and crackdaddy bringing in a crackbaby…sad, really.

  57. Keri P says:

    Just thought of a new rant for you: physician dispensing…your thoughts?

  58. Jimmy says:

    The day they put a machine in place of a human for dispensing medicines is the day I would stop my meds. I like my pharmacist, he is a walgreens pharm, and I am fortunate enough to have gotten to know my pharmacists, especially being a walgreens. I am very thankful, for them. It would be just stupid to replace a man with a michine

  59. FARMACYSUX says:

    Right on Amber- post something coherent when you get back on your meds.

    • TheSubscriptionzReady says:

      farmacy sucks but pharmacy rocks, “know your drugs and dosages its elementary”—12 monkeys

  60. I love chemistry says:

    Right now im facing a fork in my life.As a college freshman, do I pursue Pharmacy or pharmaceutical chemistry (not dealing with patients) ? Pharmacy seemed appealing until i stumbled onto this website. Your jobs seem miserable!!! So my question is this for all you pharmacists, would you do it again?

    • TheSubscriptionzReady says:

      no be a drug dealer at least u can blow your pissed of cx away, if your a pharmacist you have to be PROFESSIONAL at all cost otherwise you just wasted 4 years, just think of all the all nighters wasted , plus do you really want to work 12 hour shifts, holidays seldom off, stand all day with no breaks, and if you say well the money i ‘ll do it for the money than better think again, my advise work in a retail pharmacy for a year and then decide for yourself.

    • Canadapharm says:

      I would not go into Pharmacy if I could do it over again. In fact, as soon as my school debt is paid off, I am going to go back to school for something completely different.

  61. Rivalry says:

    Rotten Tech –

    Have I told you that I truly enjoy your posts on TAP? I also enjoy reading your site. Please visit more often. I think I love you.

  62. bcmigal says:

    Run away from pharmacy as fast as you can.

  63. My demerol is better than yours says:

    I agree with everything you say TAP, well put…

    Speaking on solutions to some of this, it would be great if pharmacy caught up with technology. Do I think for one moment we will be replaced by machines/computers? Of course not!! I do find it odd though that in this day and age we still have a PERSON calling a MD’s office and leaving a MESSAGE for a patients refill request(s), assuming the MD does not accept faxes or their machine is “down”, or that a day can be great or turn to shit real fast depending on the level of toner in your fax machine. Really?? Do all other businesses run this way in 2010? Sadly, we end up chasing our tails because of antiquated pharmacy laws that should be updated to represent the times in which we are living.
    Case in point. If you have a legitimate doctor who sees a patient and writes them a legitimate prescription, think of all the time everyone wastes bringing that script in, dropping it off, waiting for it to be filled (in-store or in drive-thru), only to find out that it is not covered/out-of-stock, and won’t be done until tomorrow. Why not allow the patient to take an image of the script via their phone and forward it to the pharmacy? Thirty minutes later, they get a text message/IM notifying them of the expected pick up time.
    Before you laugh me off this board, consider this. Banks are allowing customers to send an image of a check and text/email it to a branch and are depositing it into their accounts, the check holder maintains the check. This is probably not news to most of you. Did some asshole out there forward the image to their branch and try to cash it somewhere else, I am sure they did, but we could handle this in a similar fashion.
    Poor image quality, push a button and a resend notice is sent to patient
    Cracky decides to send his Vicodaan image to Rite-Aid and then hand delivers it to Walgreens, make all MD written scripts with serial numbers so Walgreens (or Rite-Aid) receives a message along the lines of “script void, already filled at XXX” Notice gets automatically forwarded to local police, DEA, etc for prosecution.
    Patient calls and says they don’t have a camera on their phone, can’t send images, etc and wants to “call it in to you”, they are shit out of luck
    But what about the HARD COPY!!!! Fuck it! It is information on paper, perfect for backing up on a hard drive.
    Have the automation complete the work of notifying the patient on their scripts process. As soon as you change the drugs status to “out-of-stock”, a text message is sent to the patient letting them know not to come in until tomorrow after 11:00. Let the patient choose their level of notification, some may only want to know when it will be completed others may want to track it every step of the way (your prescription has been inputted/sent to third party/rejected by third party/sent to MD for med change/received back from MD/re-inputted/sent to third party/accepted by third party/counted/being checked by RPh/your prescription is ready). Think about how much grief this would solve/save for EVERYONE.
    I know technology like this exists because four days before my dental appointment is due, my dentist uses an automated text message to remind me what time to show up. UPS sends me a text when my package arrives and Outback sends me a text when its time to come and pickup my food from their curbside takeaway. None of these are sent by actual people, but by the technology in which they employ.
    Sadly, I know I’m living in a dream world with all of this because there is too much stupid technology in pharmacy and everything I have mentioned, though possible today, wont be in place ready to use for another twenty years.

  64. bcmigal says:

    Had a customer the other day who said that her daughter, the dentist, was thinking of giving up her practice and going to pharmacy school because pharmacists had an easier job. It took all the self control I could muster not to ask: Is she nuts? I did tell her that she would not like to do an extraction with 5 people watching and asking her when she was going to be done. Nor would she be able to finish her work if the phone rang 5 times in 15 minutes. She can close for lunch and leave at 5:30 (unless someone runs in and wants her to take care of this cavity in 15 minutes because I am on my way to the airport). I am not saying that being a dentist is easy, but there are other avenues to explore: cosmetic dentistry, oral surgery, periodontics, orthodontics, etc. So if she wants varicose veins, insulin resistance, GERD, carpal tunnel, low back pain, or…..fill in your own ailment here…..by all means, jump on the pharmacy train.

  65. TheSubscriptionzReady says:

    dentist do have a high suicide rate,might be a good choice, how stressful is pharmacy, all we do is put pills in a bottle and sometimes poor liquid?

  66. Bones says:

    Someone was sayin’ somethin’ about being replaced by machines and praisin’ the virtues of software (hi, Jim!)?

    http://news.yahoo.com/s/ap/20100421/ap_on_hi_te/us_tec_mcafee_antivirus_flaw

    And for those of you who don’t like to link:

    McAfee antivirus program goes berserk, freezes PCs

    By PETER SVENSSON, AP Technology Writer Peter Svensson, Ap Technology Writer – 1 hr 56 mins ago
    NEW YORK – Computers in companies, hospitals and schools around the world got stuck repeatedly rebooting themselves Wednesday after an antivirus program identified a normal Windows file as a virus.

    McAfee Inc. confirmed that a software update it posted at 9 a.m. Eastern time caused its antivirus program for corporate customers to misidentify a harmless file. It has posted a replacement update for download.

    McAfee could not say how many computers were affected, but judging by online postings, the number was at least in the thousands and possibly in the hundreds of thousands.

    McAfee said it did not appear that consumer versions of its software caused similar problems. It is investigating how the error happened “and will take measures” to prevent it from recurring, the company said in a statement.

    The computer problem forced about a third of the hospitals in Rhode Island to postpone elective surgeries and stop treating patients without traumas in emergency rooms, said Nancy Jean, a spokeswoman for the Lifespan system of hospitals. The system includes Rhode Island Hospital, the state’s largest, and Newport Hospital. Jean said patients who required treatment for gunshot wounds, car accidents, blunt trauma and other potentially fatal injuries were still being admitted to the emergency rooms.

    In Kentucky, state police were told to shut down the computers in their patrol cars as technicians tried to fix the problem. The National Science Foundation headquarters in Arlington, Va., also lost computer access.

    Intel Corp. appeared to be among the victims, according to employee posts on Twitter. Intel did not immediately return calls for comment.

    Peter Juvinall, systems administrator at Illinois State University in Normal, said that when the first computer started rebooting it quickly became evident that it was a major problem, affecting dozens of computers at the College of Business alone.

    “I originally thought it was a virus,” he said. When the tech support people concluded McAfee’s update was to blame, they stopped further downloads of the faulty software update and started shuttling from computer to computer to get the machines working again.

    In many offices, personal attention to each PC from a technician appeared to be the only way to fix the problem because the computers weren’t receptive to remote software updates when stuck in the reboot cycle. That slowed the recovery.

    It’s not uncommon for antivirus programs to misidentify legitimate files as viruses. Last month, antivirus software from Bitdefender locked up PCs running several different versions of Windows.

    However, the scale of this outage was unusual, said Mike Rothman, president of computer security firm Securosis.

    “It looks to be a train wreck,” Rothman said.

    • The Skunkman says:

      Why hospitals, M.D.s and anyone in a position of life-or-death decision making are forced to rely on an operating system that gets viruses is beyond me. I own the second largest computer store in my city; we actually ENCOURAGE customers to TRY to get a virus. And we have a reward for the first customer who can actually get one on our Linux systems. Every hospital I’ve worked with forces their M.D.s to use Windows’ swiss-cheese Internet Explorer browser. All of that stuff should take place server-side, kinda the way this website works-it is running on Linux. If Operating Systems were drugs, there would be a line of Barbie and Ken drug reps selling you Thalidomide (Windows) and no reps at all for Cipro (Linux).

  67. Oh hugs Angry Pharmacist! This is one of your absolute best. Loved every word.

  68. ReadyforanewPost says:

    Hey, Angry Pharmacist, what happened to your pledge of “two posts per month if it kills me in 2010″? So far in 2010, we have had one post in January, one post in February, one post in March, and no post yet in April. I am going to stop checking for updates, as it appears I am wasting my time.

  69. sam says:

    It’s funny what you said about nurses. I’m a new grad RN working in a hospital and I have to agree with that statemen.

  70. AMy says:

    Dude, you are freakin hilarious and sooooooo right-on!
    I love reading your blog!

  71. ENJOY YOUR PAY CUT says:

    NOW THAT OBAMAS HEALTH PLAN HAS BEEN ENACTED YOU PHARMACIST ARE GETTING A NICE PAY CUT, SOME OF YOU WILL LOSE YOUR JOBS, HOMES, CARS ECT. OBAMA IS ACTING ON BEHALF OF A HIGHER AUTHORITY, MUCH HIGHER THAN YOU PEDDLERS OF POISON WILL EVER UNDERSTAND.

  72. ThatGuy2.0 says:

    I think that it’s more likely that a lot of tech-work will be performed by robots in the future, with a pharmacist and tech or two behind the scenes to support.
    And while I am not completely in love with the idea of computers and robots filling in vital roles once held by people, I’m going to go so far as to say that technology isn’t the enemy, here; it’s (still) human greed and laziness. There can always be someone to fix a machine’s mechanics, but the things that go wrong with people are much harder to detect and repair.
    I enjoyed the rant, though. It was a bit on the extreme side, but was entertaining. As a new tech who has already seen some of the more “enjoyable” patients/customers/royalty that visit our store, I cannot say for sure whether I would fear this reality, or watch on with an evil grin.

  73. jace says:

    The following does not apply to pharmacists/intern hire-ons:
    Dude, you are right on about students, I happen to be one, I do know about the real world (old + 5 military deployments to hostile zones), but I know jack-shit about the real world of pharmacy. The little bullshit rotations we are sent on do nothing but confirm we can count by 5’s, it would be more useful for us to stick a felt-tip marker through our eyes than to spend time with most of you. Bottom line I am not going to school and paying out the ass to be treated like a tech. Why don’t you take 30 minutes out of your schedule (yeah I know its busy) and fucking teach us something. You’re getting free labor, now fulfill your god-damn obligation. I get more education from my job in a day, which pays, than I get from a month with you.
    And as far as the guy above me goes fuck-you, you mouth breathing yocal if you had half the intellegence of of a turd, you would appreciatte the amount of labor that goes into saving your pathetic life, now go back to smelling the feces under your fingernails.

  74. PharmStudent says:

    well maybe if u stop attacking those “crackheads” and start by taking measures to decrease their number in our community (not by killing them :P by TREATING them, cuz thats what pharmacists do!) then they will stop bugging u so much!

  75. Steve says:

    Are you talking to TAP or this MD student? Those directions should be on a printed label, not hand written. “potid” probably means “po tid” which means “by mouth three times a day”. But I’ve never been to a pharmacy where they give the patient directions in sig codes so I call bullshit on that.

    And please my fellow pharmacists, don’t freak out that I just revealed sig codes that some of you think are private. It’s called google, people aren’t stupid these days.

  76. Melissa Meinen says:

    Hey all,

    I read this site for amusement sometimes when it’s been a particularly trying day. Replaced by Machines makes a lot of sense. However, I don’t know that it’s necessary to call all drug addicts “crackheads.” The term is, of course, amiable as far as insults go, but is usually inaccurate and makes the writer look childish. (As does making comments about reading comprehension when there are several grade-school-level mistakes in his or her grammar.)

    The people who piss you off on a daily basis, and who do so under the conditions you mention, do not deserve to get your blood pressure up so much.

    I know it’s trying, but just remember who’s making the big money. As long as you know they have absolutely no basis for their bitching (which is about 99% of the time) then you shouldn’t have to get worked up about it.

    Appreciation is for volunteers. We get paid to deal with this crap. Calling your patients (who obviously trust you enough to buy harmful medications from you, or who have no choice but to buy them from you specifically) crackheads is no way to behave toward people who basically pay your bills. Even if they are on state assistance, and they don’t like you, they can still take their “business” elsewhere. It’s just a good thing that most of them are restricted or don’t realize that they should do this if they are upset with the service.

    To address another note, the docs can’t send E-scribe very well because the systems sold to them are jack. I got the opportunity to play around on one at my friend’s clinic and was completely baffled. I knew exactly what the prescription had to say, and I knew exactly the correct days supply and the exact dosage I wanted. However, my Rx came out with an extra refill, caps instead of tabs, and with 14 more pills on it than normal. I tried a second time and got different errors. When I asked to see the manual, my buddy said that the company never gave them one, and they had searched online to no avail. Apparently when they called, the company said that there wasn’t one.

    To sum up, just mutter to yourself, “there but for the grace of god go I” to yourself and revel in the fact that you’re not getting paid much less to pick up people’s garbage or clean their toilets. Yeah, you had to pay and work for your well-paying job, but calling your patients crackheads could easily lose you that job if you accidentally say it loudly enough.

  77. william anderson says:

    Sooo love your site. Godddamned right with all your basic un-edited ‘saying what you think’ points. I have a whole book’s worth of “e-mails I never sent”, with self riteous indignant condecending belittlements of those sub-human peices of shit who aren’t smart enough to understand I’ve just scorched their asses. It’s a shame, really, because where’s the fun if they don’t feel the heat? Trouble is, you are right on all your points.
    Indeed: Fertility drugs given to unmarried teenaged mothers who are infirtile because they are so damned fat from their pot powered appitites. And who gives it to them? Some fucking idiot academic firtility clinic doctors who wouldn’t hesitate to abort all the feti if that’s what the retard told them she wanted. (If they inseminate her, would they use multiple donars, like she would at home? Hell, at home, most of them would offer free sperm delivery, but you can’t bill Medicaid for that.)
    Yet, these academics have no problem telling her she can’t eat trans fats, sell soda in school, or smoke tobacco!! (as long as pot is legal) Jesus! this world is full of idiots. (and, usually, as in this example, liberals)
    And, no one has reported you to the pharmacy board for “unprofessional” bitching? Fuck ‘em. Fuck the board. Free speech is fine if it is “Correct”. So, let’s say I’m a vegetarian democrat, gay transvestite, pro-pot athiest, pro-abortion contributor to greenpeace, antiwar protester, – oh .. did I mention I hate Dick Chaney? and I love Obama-care, Obama-car, Obama- bank, Obama- brokerage, Obama – tax, tax, tax ‘n’ tax, and I want Obama to have his own domestic army, stronger than the military (huh? Yep, he said he wanted that, and what the mesiah wants, the mesiah gets, so I’m for it, too!) All THAT being SAID, I can probably get away with saying my official position is “Fuck the pharmacy board!” if they give you any shit. Hell yes, FUCK’em
    But, seriously, love your web site.

  78. alisha says:

    in the event u guys (pharmacists and techs) dont get enuf thanks, a few of us nurses appreciate u more than u know. i love the doc’s, pa’s, crnp’s and other prescribers i work for but they make mistakes, like forgetting to write in the number of vicodin on a script.or a pt that wasnt completely honest and has a drug interaction or just had percosets filled there 2 days ago. nobody could replace u guys. u save us time and always have suggestions on less expensive meds or alternate meds. have only run into one grumpy gus other than that in 15 yrs of nursing! THANK YOU!

  79. kdog909 says:

    I have just one thing to say….www.instymeds.com

    To anyone who thinks pharmacists will never be replaced by machines, take a look at that website. These things are spreading like wildfire in my area. Apparantly they work great and are very user friendly. They have bright and colorful touchscreens that a five year old could operate, and if you have a question, just pick up the phone and a pharmacist at a remote location will answer immediately. Everyone loves them, except of course the retail pharmacists in the neighborhood who are losing shitloads of business to them.

  80. Hello says:

    I really do think that people here are missing the point. Replacing the pharmacists with dispensing machine would be ideal for 4 main good reaons.

    1) Without a question, there is a pharmacist shortage everywhere across both the United States and Canada. Especially in the rural areas, the people are having much difficulty to obtain their prescription drugs; they often have to travel very far.

    2) The cost of prescription drugs are likely to go down
    -> The insurance companies would simply not be able to support increasing aging population. We must reduce the cost of prescription drugs

    3) Patients are accessible to prescription drugs 24/7

    4) There is a shortage of pharmacists in clinical setting. Clinical pharmacist is one kind that cannot be replaced by dispensing machine; I do not think I have to explain why. If we introduce dispensing machine, many community pharmacists and retail pharmacists would be available to work in clinical setting.

    I don’t think pharmacists are “meanies.” My father has been a pharmacist for over 20 years and I, myself, almost enrolled in Faculty of Pharmacy as well. However, I really think it comes down to what is best for the people and what is sensible. Canadian Federal Government just spent a couple of billions of dollars to increase quota and to build more pharmacy schools (ex. University of Waterloo). I think we are heading the wrong way. I think we can do this more efficient by having adequate number of pharmacists and reasonable use of dispensing machines.

  81. luvs me sum drug pushin says:

    One of my all-time favorites. About Norco 5’s
    “Can you take the speckles out? I only want those.”

    Oh! You only want the pink speckles? Of course I’ll separate the two for you! I am just surprised you’re the first to request such a thing. Nothing would make me a happier doctor, sir! Tell you what, I’ll even prepare a slew of them for ya to fill all the following refills for the next 6 months!

    People are fucking brain dead sometimes..

  82. The Skunkman says:

    As an amateur psychologist, I would say we already have this model in place at your local Wal-Mart or Kroger, e.g. the “Self Checkout.” What amazes me about this is that people use it. No discount for using it, self-liability for any mistakes, it’s a pain in the ass, and a computer talks to you. So why is it so successful? Simple-people are afraid of other people. As a self-paying non M.D. non RPh, I actually LIKE to get recommendations for drugs instead of what I am taking, and get back to my M.D. and ask his opinion. Both my RPh and my M.D. are friends of mine, but can you guys not see why customers would rather use a machine’s instant gratification (whatever it might turn out to be, even if it IS “Wait 20 mins.”) than Doctor Ipitipi Bollywood and Pharmacist Bitchyass? IF someone can get around the legal issues of a machine, it WILL happen.

    And the argument about the machine kicking out an error “AI-RPhError 666: Potential MAOI/Serotonin conflict: Patient currently prescribed seroquel, Wellbutrin contraindicated” Simple. It will look like this:

    “I understand the risks”
    ————————
    :::::::CLICK HERE:::::::
    ————————

    At least machines will allow the gene pool to cleanse itself, until the lawsuits roll in….

  83. cardsfanbj says:

    Don’t forget that even with the best machines out there, there will always be some human element involved. I’m a tech. My store, and other stores I’ve worked at, have different counting machines in the pharmacy.

    The oldest has different “cassettes” (about 25, if I remember right, to a store) you load up the drug and, like a tape deck, load the cassette and it counts it out.

    The one at my store is the next step up; basically, it takes out the cassette loading step, and there are 89 cells in my store.

    The newer ones are a lot smaller, close to 200. This one actually takes the pills, counts them, puts them into a 20 or 40 dram vial, and labels that vial. (there is another one I haven’t seen personally that puts the lid on the vial.)

    What do all these have in common? It requires someone to open a bottle of drugs, received from your supplier and empty them into the device.
    What could possibly go wrong there?

    – Wrong drug might be loaded into the cell. Two things can come from this. 1) patient receives either the entirely wrong drug or a mix of the wright and wrong ones. 2) wrong pill is too large for dispenser, jams machine, wait for maintenance to come out to fix problem, backup of waiting customers while machine is broken.

    – Warehouse changes the manufacturer of a particular generic. Wait a week to receive replacement parts for machine and drug becomes unavailable until shipment arrives. Or see second scenario above.

    – dust builds up from normal use and obscures counter from doing it’s job or machine jams and ends up crushing tablets instead of dispensing.

    I am the go-to guy in our pharmacy for fixing our cells. They’re not perfect, they’re not really close to being fully-automated, but they’re convenient.

  84. I hate Shaquanda says:

    But what if the patient (Shaquanda) comes in and we dont have her Oxy’s or her “lean”, she wouldnt be able to yell at the machine and call it a racist and that it “needs to go back to y’all country”. Or Shaquita brings in her 8 children, all on medicaid of course, and she left the cards at home (your on medicaid, your only responsibility is to bring in your damn card), theyre new patients and wants to wait on her kids meds and anything less than 15 minutes is too long (god forbid it take longer to get your medication than your photos developed).

  85. CPhT says:

    Freakin’ Brilliant!

    thats all we need is more fax machines and printers that need weekly/daily servicing!

    corporate tells us that our pharmacy is to small for a Yuyama so we are still running with cells. So we order a specific disc for a specific ndc to load it up and it chews up the amoxicillin capsules and costing us money instead of saving it. now we have to order a new cell and end up counting the capsules by hand anyway until the replacement arrives.

    replace me if you want, but who’s going to pick up your slack WHEN you break?

  86. Scott says:

    Genius! I would love to see all our high maintenance customers be relegated to automated systems….

  87. Pharmacist Bob says:

    At some point everything will be automated. Sit, down while the machine takes a blood sample and perhaps some bone marrow and blow a bit of your breath too. The doctor/pharmacist/nurse is now the machine.
    Finding, 2 months to live, step to the right please and exit thru the door.

  88. Keith says:

    In Japan, Singapore, and Hong Kong, almost all physicians dispense and the average pharmacist earns about $40,000 per year. They have the most efficient healthcare operations so it’s safe to say that they’re leading the pharmacy towards the future. The pharmacist becomes the pharmacy technician, and the pharmacy technician gets eliminated.

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