Now there is something really unique about me.  I have an uncanny supernatural ability to keep a straight face.  Doesn’t matter how loud someone blows a fart, or if I’m consulting on how far up your vagoo you need to shove that monistat 7 applicator (Uh, to the hilt baby, fish that fucker out with your fingertips!) I wont crack a smile, or laugh, or do anything but be Mr Professional.

In fact, its a rite of passage in the Angry Pharmacy for new employees that while they are helping a patient, I rip the loudest, rumblest, most wet sounding fart I can muster with the pot of coffee in me, then stand there looking over the very top of my monitor to what happens out front.  Ive learned that if you pretend you didn’t hear it, they patients don’t think you did it (or they are hearing things).  The seasoned employees quickly turn around to “check on the bags” or to do something while they laugh to themselves while the newbie sits there staring the patient in the face wondering what the fuck just happened.  I don’t care if its fucking unprofessional, coffee makes you fart and its better to let it rip than to hold it in and end up blowing ass-chowder later on during the day when you’re up to your armpits in new prescriptions.  A few times this has backfired on me and I actually shit my pants in the store, but even the best have a bad day.

Anyway.

It was winter, cold, damp, winter.  The day previous I stayed late with a few of my clerks to mop the floor out front.  I was pretty proud about how clean we got the floors.  That was karma warning me my day was about to get a whole lot worse.

There had been a bug going around town that caused a sudden urge to puke your guts out.  Some call it the stomach flu, I call it CHA-CHING the price of compazine just went up!  The store was absolutely full of idiots with Z-Pak prescriptions for their colds.  Im not sure why I decided to look up from my usual 1000 yard stare into my monitor trying to decypher a stupid insurance reject, but I remember the guy plain as day.  The glazed over look in his eyes, and the urgency that he must cut everyone off and march up to the front of the line.  He ran to the front, and waved the prescription in my clerk’s face like it was a winning lotto ticket.

“Can you please fill this for me right now, I dont fee-BLLLLLLLLLLAAAAAAAAAAAAAAAAAAAAARRRRRRRRRRRRRRRRRGGGGGGGGGGGGGG.”

For a second, time stopped as I saw pancake batter consistancy vomit erupt from the mans face, and plop down onto the counter.  The clerk jumped back like a snake was going to bite her vagina and threw me the prescription as the vomit was making a perfect large pancake pattern on top of the counter in front of him.  I scanned the room as the chatter of pharmacy died down to an eery silence.  Vomiting is contagious, and I looked with almost childlike glee to see who would start to dry heave.  To my dismay, everyone covered their faces and eyes and no chain-puking took place.  I was disappointed.

I looked at the prescription that had been clutched so tightly that it was nothing more than a ball of clumped moist paper.  Compazine tablets.  I decide to take matters into my own hands and change the tablets to suppositories, since I’m sure the floor doesn’t need any Compazine, and thats where these tablets were headed if he put them in his pancake-batter dispenser.

The poor man got a free garbage can and was on his way sitting down when another wave of heaves took their toll.  The sound I heard after that (over the heaving) I can replay it in my head 1000 times, but its hard to put into words.  The closest thing I can say is that if you percolated air through thick chocolate pudding and muffled it with a pillow.  Thats what I heard.  Oh, and I used chocolate pudding for a reason, because thats the consistancy of what now filled the poor mans pants.

At that point the entire store was in horror.  Me, being a compassionate caring pharmacist, was sorta pissed off that my ingenious suppository switch was in vain.  Tablets go in, tablets go out.  Suppository goes in, suppository gets shot out.  I seriously couldn’t win.

The poor man eventually left with suppositories in hand, and 2 free garbage bags to take with him on his journey home.  The bucket, gloves, mop, and squeegee came out to clean up the mess, and life went on as usual.

If you work retail, this will eventually happen to you.  Mark my words, your floor will be a magnet for vomit and poop.  Not just any poop, usually old people poop or little kid poop (that they like to step in afterwards and track all over the pharmacy while the mother ignores them while texting her baby-daddy).

It always happens after you stay late to mop the floor.  Every. Single. Fucking. Time.

I’m talking about people who work with the public.  Hair dressers, Pharmacists, Doctors, cashiers. The kid who bags your groceries to the checkout line clerk to the nice lady who takes your order at the fast food joint.  You know who they are, they greet you with a smile and a silent anxious look in their eyes that you won’t rip their head off over something that is completely out of their control.

What sparked this?  A visit to the supermarket.  They were having problems with their ATM/Credit Card thingy.  The cashier said outright “Im sorry, but we’re having system problems processing ATM/Credit/EBT cards, it make take a try or two for it to go through”.  The ungrateful waste of skin proceeded to give her both barrels about how this was unacceptable, that they should have their system fixed, they should have a system in place to fix this, should have, should have, should have (notice I didn’t say ‘should of”? Be proud Mr Woo).

I was the next in line, and by the time this douchecanoe actually got his 6 pack of natural-ice with a carton of cigs ran through the one out of 3 credit cards that were not maxed out (after getting pissed that their food-stamp card can’t be used for that/it was tapped out), the poor checkout clerk nerves had been totally fried.  It only takes one asshole to ruin your day.  I gave her a smile as she rambled through the warning that the checkout computers were going in and out, blah blah blah, to which I said that there was no problem.  I realized the look in her eyes was the same look that I probably have when I miss filling a prescription that was buried in a profile and expect both barrels from the patient when they have to drive back to the store because I overlooked something.  I was kind and patient, and she gave me a sincere thank you.  I told her that I work with the public too and its like she knew that I understood her pain.

I’ll be upfront.  I have never sent back food anywhere because it wasn’t up to my standards.  Even if its the absolutely wrong thing I just eat it.  I tip the person who cuts my hair the same even if its a horrible job or the best job they ever did.  Someone fucks up putting the price in wrong at the grocery store and I don’t get that $0.50 discount I don’t say a word.  People say that I just reinforce the mediocre half-ass-is-okay work-skill that plagues our working class.  I say that I don’t want to be ‘that guy’ that makes people drink as heavily as retail pharmacists do.

You ever stop and realize that the assholes of the public will gladly wait in line for 15 mins for a seat at a restaurant, but can’t be bothered to wait 15 mins for their 5 (free) prescriptions?  Interesting isn’t it.

During the supermarket incident, I realized that all of us who work with the public are in the same boat.  We deal with the same assholes, the same impatient fucks, the same douches who bitch that their prescription isn’t ready yet when the power is obviously out and I’m trying to keep the pharmacy systems up while a generator is obviously screaming behind the store.  I can always tell when a patient of mine works with the public.  They are pretty nice, easy going, and realize that sometimes shit happens.  They patiently wait for their prescription, and use the foreign words we never hear like “please” and “thank you”.  They are mindful of our time and actually show appreciation to the service that we give them.  How foreign is that in a pharmacy?

Its ironic that the most important aspect of retail pharmacy isn’t all the drug-drug interactions, the kinetics (learned for the test, then quickly forgotten; never to be used again), knowing the pharmacology of benzodiazepines, or even the rationale behind giving someone an ACE-I in CHF; its dealing with the unwashed masses.  The most important aspect (and the #1 cause of burnout) that is just blatantly ignored in pharmacy school.  ”You’ll just learn it on the job” they say as your day is shattered by someone yelling at you who have never worked a day in their life.  Thats like teaching you how to swim by throwing you into the deep end and yelling “You learn by doing” as you slowly sink to the bottom.

Pharmacy school should have a class that is like a boot camp, you get yelled at each class so you’re used to dealing with idiots who give you both barrels over the most stupid things. You learn how to defuse situations.  Ah shit, who am I kidding.  Pharmacy schools would probably teach you to use fruity ‘touchy phrases’ like:  ”You know by saying that, you hurt my feelings and make me feel less about myself” to which the patient would reply “Good, you’re fucking stupid, my vicodin is due now, not next week”.  Color me surprised that pharmacy schools are so out of touch with the ‘real world’ that they wouldn’t know their poop-chute from a hole in the ground.

I realize that this post isn’t your usual swear word ridden bitchfest, but fear not, I take care of my readers (sorta).  If you want to re-post this article, this would be a good time to stop copy/pasting.

So to all of you ungrateful fucking assholes out there who decide to ruin the day of us who get our asses up every fucking morning so we can serve you, heres a fucking tip from the guy who double-counts your fucking dope so you don’t come back and say that I shorted you.  Get a fucking job, work with the fucking public, see what its like to deal with your own fucking kind.  Get your day shot to shit because you had to serve a fucking asshole like yourself with the social skills of a fucking steaming turd baking in the afternoon sun.  Get a dose of your own fucking medicine.  The world owes you shit.  Be thankful you live in a fucking world that we accept you for the shit you do to us day in and day out and don’t take you out back and shove our boots in your fucking yappy twatty mouths.  If you think you can take your bad day out on us, feel fucking free; but beware, theres nothing I can really do to you in pharmacy, but I’m sure the server would be more than happy to let your fucking food you sent back 3 times because your steak “wasn’t cooked enough” fall on the floor a few fucking times when you’re not looking.

I hope I filled your use of the fucking word ‘fucking’ per post requirement.

I’m talking about the dreaded ’0 refills remaining’ with the patient being out for 2 days.  This phenomenon is so prevalent in pharmacy that we should have received a class on how to handle it.  Since pharmacy schools give two-shits about retail, here is your class on the subject.  Pay attention!

This is how 99% of the cases take place:

• The patient will call you over every little change on the label (expiration date, change in manufacturer, quantity, doctor) yet will gloss over how many refills remaining until they are out for exactly 2 days.
• The patient will let you know they are out of refills in person…. On a Friday… Before a 4 day holiday…. At 2 min’s to closing…
• The mediation won’t be Vicodin, Valium or any narcs.  It’ll be something awesome like insulin.  You know, the kind of shit that you ethically can’t tell them to go fuck themselves over.
• They won’t be out of something simple that you can drop a few tablets in their bottle, it’ll be something that comes in a unit-of-use bottle, like Januvia, Actos or Nexium.
• In the event that they are out of something simple and stupid, they will forget their old bottle despite you telling them 10 times “MAKE SURE YOU BRING YOUR OLD FUCKING BOTTLE”.  This leaves you out the cost of ANOTHER bottle and ANOTHER label.  Regardless of how shady this all is already, dispensing drugs into their open unwashed hands is just crossing the line.
• The patient will use the phrase “BUT I NEED THIS MEDICATION” or “CANT YOU JUST FILL IT”.

Here is where the legal waters get the product of Go-Lytely dumped into it.  What do you do?

• Legally (sorta), you can only give a 3 day supply without authorization.  Its insulin.  Are you going to suck out a 3 day supply?  If you are, I hope your employer fires you for being a dumbshit.  Are you going to break open that box of Humalog Flexpens to dispense just 1?  To make this worse, if the MD finds out (usually patient taddling) he/she could file a complaint against your license with the state board of pharmacy for filling without authorization.  If you billed the insurance company, they can ding you for filling a fraudulent Rx and pull your contract.  This is all worse case mind you.
• Realistically, you know you won’t get the OK from the MD for at least 5 or 6 days.  A week to 10 days if the patient goes to a county-ran clinic at the local hospital.
• Ethically, you know that if you don’t dispense this insulin, the patient will have to go to the ER (or worse) thereby costing the taxpaying citizens a few thousand.

Pretty fucked situation all around?  Yes, yes it is.  For those of you at home, we deal with shit like this about 20 times a day.  Now this is how I would handle it:

If it’s a regular patient (regular in the term that we have a professional relationship, not that they can poop fine), then I take the potential legal hit to my license (and to the store) and give them the insulin without the authorization.  I figure the patient will stand with me against the state board (and their doctor) to justify my actions as being in their best interest.  I politely tell them to bring me a new Rx before this amount runs out, and all is happy.  Wait, can you hear the collective jaws of every MD out there dropping as I spill the beans that yes, we do dispense medication without your authorization in certain cases.  Here’s a fucking reality check, your patients are dipshits.  They can program their phones to play the most obnoxious ghetto rap-song ring-tone at 1000db while waiting for their drugs, yet they can’t program a simple alarm to remind them to call in their refills a week early so we can get the authorization.  If you are unable to grasp this concept, then actually listen to the ‘blah blah blah’ that comes out of their mouth when they visit you and you’ll realize that you’re dealing with someone that’s half-step above my dog on the evolutionary chain.

If its Joe-Crackhead who treats me like utter shit, bitches at me about EVERY-FUCKING-THING and looks for things to argue about; fuck him.  Let him sit in the ER for 10 hours.  If he paid as much attention to his medication refills as he does his fucking cigarettes, we wouldn’t be in this mess.

Harsh? Yes.

Surprised? No.

Agree with me? Probably.  Here is my rationale.

Personal responsibility is something isn’t to be taught by your Pharmacist.  Sure, everyone has a brain-fart and forgets to call their medications in.  However why should I legally put MY license on the line for someone who has no respect for me, doesn’t treat me like an equal, or always tries to pick a fight for me?  This kind of bullshit patient would be the first one to throw me under the bus to not only the MD but the state board if the shit goes south.  I’m not going to put my livelihood on the line for someone who doesn’t give me an ounce of respect, and doesn’t realize that I’m doing him/her a huge favor.  Unprofessional? Sure, if you want to look at it that way, but you also need to look at the irresponsibility of the patient who put him/herself in that situation and expect me to put my ass on the line to remedy a situation that he/she put themselves in.

The easy solution is for everyone to have a little bit of self-awareness and personal responsibility regarding their own health.  Yeah, I’ll get right on that after I finish filtering all the piss out of the ocean.

Its the dreaded RTS bin.

Thats right! The Return To Stock bin.  The glorious bin of drugs that patients called in to have refilled “RIGHT NOW” yet never got off their lazy asses to come and pick up.  You know, all the simvastatin and lisinopril that the patient pitched an absolute fit right in the store because they “were out” and didn’t have any refills remaining yet never bothered to pick up 2 weeks later.

RTS’s absolutely kill pharmacies.  Here’s why (to those at home who don’t work in a pharmacy).

It takes money to fill a prescription (gasp!) other than the raw cost of the drug.  Everything from the vial, to the label, to the computer system/printer/toner that spits out the label (that you fucking don’t read) to the tech that fills it, to the pharmacist that checks it, to the clerk that puts it in a little bag and takes your whiny phone calls.  All of those steps cost money.  Thats not even counting the electricity, insurance, employee taxes, etc.

We get a dispensing fee paid for by YOUR insurance to cover these fixed costs.  Why are they fixed? Because the dispensing cost is the same if the drug costs $1 to $5000 kerzillion dollars.  When you pick up and sign for the medication, we have proof to your insurance company that you in fact received the medication and their piddly $2 dispensing fee was in fact put to its intended use.

Now say that drug filled vial with your name on it just sits out front for a few weeks.  It starts to get lonely sitting by itself in the pharmacy because contrary to what you read on the internet, just ordering your medication doesn’t make it magically work, you need to TAKE the fucking medication.  Eventually, we need that space to store medications for people who give a fuck about their health.  Your vial then gets RTS’d.  Since we didn’t dispense that medication, we legally cannot accept the money that your insurance company paid us for the drug + dispensing fee.  So now, we “back out” the prescription (meaning we give the money your insurance company paid us BACK to them, all of it), and now must PAY someone to put the drug back into the big stock bottles.  We have to throw away the vial and the label as well.

Your laziness now has cost the pharmacy double the labor + the cost of the vial/label  for which we are getting paid a whopping $0.00 for.  All because you called in a refill and didn’t get off your ass to pick it up.  My store has a policy that we call people once their medications have sat for a week, then we give them a second call 5 days later.  Yes, we PAY someone to call you to remind you that the prescriptions that YOU CALLED IN have sat here for a week.  This is after we told you when you called in your refills that they will be ready later on that day.   Ask me how this can be any more straightforward!  Oh, I guess its as straightforward as paying your fucking phone bill because every time you come in you give us ANOTHER phone number (thats disconnected 2 days later).

After about the second time I RTS a prescription for a patient, I put a big note in their profile to make sure they are told that we will fill their prescriptions when they are IN the store due to us always putting back into stock what they order.  What do I get? A bunch of swearing at me from over the counter by some idiot unwashed mouth-breather to the tune of “I called these in a week ago, why aren’t they ready yet!”  This is after they were EXPLAINED why they must be here for me to fill their “diabeetus and list-o-pril” pills.  I swear I can’t fucking win.

This shit really pisses me off.  Its a waste of my fucking time and a waste of the stores money.  Since my store doesn’t do auto-fills, if you’re not going to take your fucking medication, then save us all the headache and don’t call it in.

Oh, and a cool pharmacy fun-fact, is that controlled prescriptions are a good chunk of what I fill everyday, yet less than 1% of the drugs I RTS.  Big fucking surprise.

It was your usual day at the Angry Pharmacy.

I got a call from a resident that I’m on fairly good terms with.  She wanted to increase the dose on a patient diabetes meds.  She wondered why the patients A1C was climbing lab after lab and thought the medication wasn’t working.

I pulled the patients profile up.

Month supply filled Jan and March.  Something wasn’t right here.  Maybe he/she was going to another store? Only one way to be sure.

I told the resident to ask the patient to bring in all of his/her meds in so I could “take a look at them”, which in pharmacy speak means “See if you are fucking taking them”.

Patient comes in with a plastic bag full of pill bottles (oh dont we just fucking LOVE it when they do that) and a new Rx.

Every single bottle of maintenance med was full.  EVERY FUCKING ONE OF THEM.  It had more fucking diabetes medication than I did on my shelf in that one plastic bag.  Most were from us, some were from a different pharmacy dating back almost a year, all were filled exactly on time.  This looked like two big scoops of not-fucking-good.  In fact, the refilling gaps in MY system were accounted for by another store’s filling.  This required a “come to Jesus meeting” by yours truly.

I asked the patient, who had almost every risk factor for diabetes in the book, why it wasn’t taking the medications.  Then the bomb was dropped.

“I know my body, and I know what its doing, I dont need this shit.  I just need my pain pills”.  Hear that needle being pulled off of the record of medicine?

Now its A1C would score a solid gold in the A1C Olympics.  I could use his/her urine to compound in place of simple syrup.  If it wasn’t the copious amounts of bullshit flowing through its veins I’m sure they would of died by now.  I asked the pushy patient if the doctor knows its not taking its medication.

“No, if I told her that, she wouldn’t give me my pain pills”.

I wanted to punch him/her in the face.  I asked if he/she had side effects, or any reason why he/she didn’t want to take the medications.  Sometimes the twice a day is too much for people, there are options that I could suggest.  This resident was an awesome one who loved pharmacists thanks to yours truly (you’re welcome) and would do whatever I suggested.  Look at me! Being all pharmacist like!

“I told you, I know my body, I dont need these, I’m fine.”  I fucking love it when they use that line.

Nothing I could say could make his/her take them.  Threats of blown out kidneys, to losing his/her sight, to not having legs, nada.  So.. Fucking.. Frustrating…  I tried to play the pain card, saying that her pain could be because of damage to nerves.  “Gabapentin doesn’t fucking work on me, neither does Vico-dan.  I need Percocet”.  This was said with a straight face as I could line the entire pharmacy an inch deep in unused gabapentin caps.  I offered to work with the patient and the doctor to help her.  I even offered to fucking blister pack the medication to improve comp-LIE-ance.  Nothing would work.  The patient had either given up, had a fucking stroke and got incredibly dumb or just really wanted to get high.  Maybe if I printed “HAVE YOU TAKEN YOUR MEDICATION TODAY” on a package of cigs or a lotto ticket it would make a difference.

The conversation turned into the “I dont want to talk with you anymore.  How long until my Percs are done” song and dance when I called it on bullshitting the doctor to get more narcotics.  Sometimes it takes being an asshole to get the point made.  My preceptor used to tell me, “TAP, never argue with an idiot, they will drag you down to their level and beat you with experience”.  If I followed that advice, I wouldn’t have any patients.  I knew that short of a diabetic complication 2×4 across its face, there was nothing I could do.

Then the blood started to boil.

This person gets FREE care and FREE medications.  It isn’t out anything but his/her own time to take care of her condition that could leave her legless, blind, and on dialysis.  Of course all care related to stupidity would be happily covered by the state.  None of that mattered to him/her.  90% of the working population would KILL to have what he/she is getting for no cost.

You know when I ranted before about how a person places no value on something that they aren’t paying for? Case in point, right in fucking front of me.

Now this person is spending, nay wasting, hundreds of taxpayer dollars a month that could be used towards someone who actually gives a shit about their health, about their care, about their body.  A person who could actually get a better quality of life while they get their life back on track.  If this douchebag wanted to just get fucking high and watch his/her health spiral down the shitter, thats great – just don’t take the resources that could be used to help someone who gives a shit.

So the question remains: at what point do we, the healthcare people, decide to cut-bait on a patient that obviously doesn’t give a shit about his/her health and is only seeing you because they are being forced to (or to get narcotics)?

Oh, and I paged the resident (I REALLY hate paging doctors, but I figured this was important) and let her know what was going on.  After a bunch of “are you fucking kidding me” she requested the patient go back to her for “clarification” on the percocet prescription.  I think someone is going to get a type-1 ass-chewing, but something makes me think its not going to make much of a difference.

I love making shit up *ahem* to prove a point.

Lets keep in mind that I don’t belittle Autism or think its “not important”.  I’m hoping to not only find out what the cause is, but how to prevent it.  Autism, like Down Syndrome, happens and we aren’t sure exactly why or how.   Take a look at how many drugs are out there (that kill people no less) that the mechanism of action is “Undetermined”.  Are you throwing a shit-fest over those? No.  Is some random dipshit actor standing on his/her soapbox about that? Nope.

First off, Jenny McCarthy.  The woman who is best known for her blond hair and big fake tits speaks the gospel about how vaccines contribute to autism. The whole fact that people LISTEN and BELIEVE her shit makes me want to blow the brains out of 99% of society.  She should stick to what she does best, being being eye-candy.  We don’t need “actors” to be the voice of medicine, politics, or anything else that they know jack and shit about.  Lets be realistic, if you listen (and believe) any non-medically trained person’s bullshit about medicine, you are an idiot. Do I ask the random homeless guy on the street how to fix the breaker box in my house?  No. Do people come into my store and ask me how to replace the water-pump in their Escalade?  No. However some random dipshit actor “speaks out” on a topic and people run and proclaim the word like it was given by Oprah herself.  Yes, it sucks that her child is autistic.  It sucks that /any/ child is autistic.  However it sucks MORE that kids need to suffer a preventable diseases because their mom listens to such propaganda given by a non-medically trained person.  I’m sorry Jenny, but I am no longer fapping to pictures of you out of sheer disappointment.  I hope we can still be friends.

Second on the chopping block, the Lancet.  I had somewhat high regard for the Lancet, having used their studies while I was in school.  How in the hell could they let such a bullshit study be published? A study group of 12?  A high school science project has more people in their study group!  But oh-no, its the whole “think of the children” mentality that got this clusterfuck of a study published vs good logical science.  Good going Lancet, now you can “think of the children” as the unwashed idiots don’t immunize their children and they die a preventable death.  I’m planning on releasing a study showing how Vicodin and Soma use cause laziness and stupidity.  My sample size is 20, I hope you publish my study.

Third, and most favorite: Andrew Wakefield.  Dude, when you publish a study with a sample group of 12 on a medication that MILLIONS and MILLIONS of people have received without incident, didn’t you take a step back and think to yourself “Man, maybe something is a bit wrong”.  No, you didn’t.  You published your bullshit to the Lancet, got your 20 seconds of fame, freaked the fuck out of a bunch of ignorant dipshits because you are were a licensed Doctor and thereby had the inherit trust that goes along with the degree.  If you were selling penis pumps (because thats really all you can do now), I wouldn’t even buy one of those from you because your study group would be 12 men who used it!  You did a huge disservice to the profession of medicine.  Your fellow colleagues hate you, nurses and pharmacists hate you, and to be completely blunt you and the Lancet should be brought up on criminal charges for the damage you have done.  You should go have sex with Jenny McCarthy so maybe the common sense recessive trait could be expressed in your children.

Fourth (and finally) the parents who refuse to immunize because of Autism:  I’m a parent – so this hits close to home. To be completely honest its not the job of the government nor any governmental authority to make you vaccinate your child.  Its your child, you can do whatever you want.  However, that being said, if your child develops any preventable disease because you decided to listen to an ACTOR via the INTERNET vs listening to your DOCTOR (I can see how you can confuse the two, they end in -CTOR) YOU should receive zero state aid while the CHILD gets the treatment he/she deserves on our dime (its not the child’s fault their parents are dipshits, so why should they get shafted out of treatment?).  That’s right, no welfare or any public assistance for YOU because YOU decided to not listen to someone who deals medicine for a living.  You can sleep soundly in bed listening to your child squeal with pertussis knowing full well they won’t get the evil Autism because of your good judgment. Right after that, please stick a road-flare up your vagina, because we don’t need more idiots like you breeding.

I will commend BJM to putting an end to this madness, unfortunately its too little too late.  The damage has been done, the lines have been drawn, and you aren’t going to change the opinion of the uneducated idiots.  After all, you are just a “propaganda machine for big Pharma”.  Oh, and calling Jenny McCarthy an actor is a stretch, even in my book.

But wait! Theres more!  For your enjoyment, straight from YouTube, I present my heros Penn (he should have been a Pharmacist!) and Teller’s episode of Bullshit about this very subject:

Part 1:

www.youtube.com/watch?v=Xo97VouL0ls

Part 2:

www.youtube.com/watch?v=X_nYMEO82mo

www.youtube.com/watch?v=PWhaf5DjPF8

www.youtube.com/watch?v=AGwQzBLjOZI

Stay tuned for more AngryTV (since the site that makes this is AWESOME) as well as some user submitted gems.  If you make one, comment with the link and I’ll post them if they are good.

What does a pharmacist do at this point?  Does he try to have a “Come to Jesus” meeting with someone who obviously has no regard for their health?  After all, healthcare is “free” to them, they can just take an ambulance ride to a cushy ER at some paid-for-by-tax-dollar establishment.  Or does he/she see the writing on the wall and just fill the Rx knowing full well it won’t be taken.  We all know that the moment you refuse to fill that Rx they are going to die and you’re livelihood is in jeopardy in some civil suit.

What does an MD do at this point?  Does he/she shit-can the patient only to have him/her die of some complication and get his life ruined by a suit brought upon by the family?  Does he/she write for more medication just to cover his/her ass knowing full well it won’t be taken?  Does he/she waste his/her time filtering the piss out of the ocean when there are other patients out there who need the help?

What does a healthcare professional do when the patient really doesn’t give two shits about his/her own health?  Tough question, no real cut-and-dry answer.  If the patient dies, someone is getting sued; be it me, the doctor, the hospital, someone.  Even if the patient’s family loses the suit, you still have to deal with the mental/financial bullshit that goes along getting sued.  After all, its everyone’s fault but the patient.

A big contributor to this problem is that the patient really isn’t forced to care about his/her health.  Like I said before, the medication is free, hospital visits are free, and the proverbial “You can’t get blood out of a rock” comes true when the bill arrives for services rendered for their irresponsibility.  These patients have nothing but what the state gives them, and have nothing to lose.  So what if I’m 500 lbs and my HbA1c is around what my IQ is, I know that if the shit hits the fan I can go to the ER and get treated for “free”.  Theres no burden/penality on the patients to take care of themselves, and (much like everything in life) the responsible people end up paying the price.  People in other countries would cut their testicles off for just a smidgen of wasted care that is taken for granted here.

I hate to say it, but I think know the healthcare system is going to implode on itself in the next 15 years (if that).  There are way too many irresponsible people sapping the resources that the responsible people produce.  Nobody cares about their health anymore, and the people that do are the ones paying out the ass for services that cost a truckload to compensate for the loss accrued by the irresponsible.

You may think that I’m blowing smoke out up your ass, but take a look around next time you are in a public place at the amount of morbidly obese people are mouth-breathing around.  Look at their kids and the crap they stuff into their face at an alarming rate.  Its not ignorance thats fueling this, its the simple fact that when push comes to shove they will get treatment without payment.  We are afraid to say “You did this to yourself, you deal with it” because of some bullshit excuse like “its not their fault”.  You may think that sounds uncaring and callous, but take a second out of your candyland outlook and look around you at the people who are pissing their health down the toilet on your dime just because they can.

Healthcare is a business, All of us; doctors, pharmacists, nurses, PAs, NPs, and the staff that help us all have bills to pay and families to provide for.  Charity won’t put food on the table, and the sooner you realize this the better off you are.  If you want charity and “helping those in need” then work for free and see how far that gets you.

I hope you link this jaded-yet-true article on your website/forums/whatever, because I’d really like to know how this problem can be fixed/should be fixed or what we can do short of just making as much money as we can before the entire system explodes and we’re all out of work.

Lets look at this from a realistic standpoint.  You have say 500 patients that you fill medication for on a regular basis.  Do you really believe that you can help improve compliance for each and every one?  You don’t even have time to take a lunch, let alone remind the 90 year old Mrs Smith (who’s clock should of ran out a LONG time ago) that she needs to take her water pill?  Why spin your wheels making MORE work for yourself when you can focus on the patients who ARE compliant, who DO care about their medication, and are willing to work WITH the healthcare system vs just wasting money?  Its just a frustrating losing battle – the sooner you realize this the better off you are.

Sure, you can be one of the pharmacist in the APhA magazines who sit and talk with each patient for 45 min about compliance/MTM/unicorns and pixie dust, but after your store goes under (or you get sued into bankruptcy because your bargain basement techs you hired to do the grunt work killed someone) then will you understand that enforcing compliance is a war long lost? Compliance begins with the patient, plain and simple.  They need to choose their level of involvement of their own health and well-being.

Nothing pisses me off more than having a damn intern pharmacist spend 30 min talking to a patient about compliance.  The patient just gets a glazed over look, says “uh huh” a ton and walks out in no better shape EVERY SINGLE TIME.  Patients don’t want to be lectured about their medication, they want to pick up their government-vicodin and go about their day.  PATIENTS DO NOT CARE WHAT YOU HAVE TO SAY UNLESS THEY ASK YOU FOR HELP.  This is cold sobering fact of retail.  Unsolicited advice gives you blank stares and a “mind your own business”.

So what this boils down to is that once that patient leaves the store with their pills they are on their own to take them correctly.  Stop wasting your time with the hand-holding, they are on their own to take responsibility of their own health (foreign concept I know).  If the patient can’t get their pills straight, well, that’s a whole lot of their problem isn’t it?.  My problem is making sure that the 20 different medications don’t kill them.

You all may think that I’m being quite the asshole about the subject (gee, thats a first!), but the fact remains that I would rather spend my not-making-the-store-money-by-not-filling-Rxs time helping those whom choose to help themselves.  Choose your battles or you’ll have nothing but losing battles.  DrugMonkey and I should teach a class at pharmacy schools.

Not only are non-compliant patients a detriment to themselves, but are a detriment to the entire system as a whole.  Say Mrs Madeupname gets some glyburide.  She just blows off the doctor (and your) warnings about not taking her medication and gets a refill every month (that she just stores/ditches) so “the doctor wont yell at her”.  On her next visit, the doctor will see little/no change in her glucose.  Doctor increases the dose thinking the current medication isn’t working.  Or doctor switches/adds Avandia/Januvia/Actos thinking that will get more control.  See where this is going?  Then when Mrs Madeupname finally feels like shit because her glucose is 500 and takes her meds, she bottoms out her now maxed out dosages and ends up in the ER.  Doctor calls you all pissed off and blames you for not making sure she is compliant (but you are quick to point out by her refill records, she /is/ compliant as far as you can tell).  PLUS the moment you question her about compliance she quickly transfers her medication to WalMart who “doesn’t butt into her own business” (good riddance!).  All this for a $2 dispensing fee.

Now lets talk about the patients who ARE compliant:

There are only 2 settings where compliance actually takes place; controlled substances and patients with high copays/no free ride.

Controlled substances is obvious, when the patient takes them there is an immediate physiological reward.  Your pain/anxiety/etc is gone (or you get a good buzz).  This rewards you to take another dose, and another, and bug your pharmacist for an early refill.  You don’t take your medications and there is an immediate penalty (pain/anxiety/dealing with your shitty life/etc).

Folks with high copays are also more compliant because not only do they have to shell out the cash for the medication, but most (if not all of them) don’t have the luxury of a taxpayer funded ambulance ride/hospital stay if their health goes down the shitter.  These patients are looking at multi-thousand dollar hospital stays/ER visits – they have no safety net of the nanny-government to pick them up when they fall.

They should teach interrogation and water-boarding in pharmacy school.  While they are at it they should teach a mind-reading class too.