Recently in The Wonderful Public Category

The first of the month is always super stressful for pharmacists.  Not only are we usually busy, but it seems like everyone saves their shit/drama to explode on us.  If you think that I'm a callous asshole (and obviously are not a pharmacist because if you were you'd understand) then read on and maybe it'll give you a bit of insight as to why not only myself but all pharmacists either drink or are on antipsychotics.

First thing in the morning, I have to do the backlog of call-ins from the answering mac-

Phone rings.. Pharmacist on line 1.  Mrs Jones needs all of her regular medications refilled.  She wont give any of the numbers to any of the clerks, will not give you the numbers, says "you know what I normally get" and she wants them delivered.  She mumbles like she has marbles in her mouth as the answering machine is blaring in the background because you forgot to pause it when you grabbed the phone.

-hine.  There are about 15 Rx's on the machine, and after playing each about 4 times you think you can understand what they want.  You write down everything and start to fill them as people start to mosy around the store.  Vicodin, Soma, Vicodin, Soma, Valium, Vicodin, Soma you fill and fill and-

Pharmacist line 3.. Dr Dumbfuck's high school dropout receptionist is trying to sound out amitryptline but it sounds like amultryptillyinyling.  She cant make out the strength so she has to-

Pharmacist out front for a question.  Some woman is bawling in front of you asking for her somas early because her grandbaby died and she has to leave for texas RIGHT NOW.  You tell her that you'll be right with her as she gets pissy and yells and says that she has to leave RIGHT NOW.  You pull up her profile to see a nice array of Vicodin/Valium/Soma with a huge note that says "NO EARLY REFILLS PER MD".  You tell her that you really can't refill it early as she throws a fit that would make 2 year old proud right in a store full of people making you look like a complete asshole because HER COUSIN DIED AND YOU WONT FILL HER NARCOTICS EARLY.  You're the only one who caught that her story changed half way through.

-ask the doctor for clarification.  You wait on hold trying to hold back the urge to scream at this ignorant non-english speaking twat but the Doctor is one of your heavy writers so you just bite your toung-

Pharmacist on line 4.  Dr Smith is on the line.  You tell your clerk to hang on line 3 while you talk to Dr Smith on Line-4.  He wants Wellbutrin XR 75 and manages to hang up before you can tell him that strength doesn't exist. 

The phone gets thrown at you from your tech who is waiting on line 3 from you with Dr Dumbfuck giving you both barrels because you didnt understand his fucking daughter who must of just gotten off of the boat from India.  You make some backhanded smart-ass remark about being sorry for caring for patient safety and the horrendous idea of filling the correct medication and hang up on him.

-fill. (still with me? Good!)  You wonder if any of your patients are on any blood pressure medications or just narcotics.  You put the calendar you have right by your workstation in front of your monitor so you can count the days to see if people are due for their refills.  Notes such as "Wants to see if she can get early" or "Requesting early fill going out of town" litter your stacks of refill call-in requests that your clerks relentlessly place up for you to process.  Obviously you know the answers to these early fill questions already, but you pull up the numbers just so you dont put your foot in your mouth later on.

The more you process, the more the stack grows.  Your techs are a flurry of counting awesomeness as the printer churns out the labels like they are going out of style.  Wellpoint goes down, and your entire pill churning operation decides to start to nosedive as you make a stack of Rx's to bill later when Wellpoint comes back up.

You take a few deep breaths to try to keep the wave of panic from destroying your day as your tech scratches your back in a half-ass comforting way-

Pharmacist Line 2.... Its Mrs Jones..  Mrs Jones got her delivery, and WHY IN THE HELL DID YOU SEND HER LISINOPRIL.  HER DOCTOR TOOK HER OFF OF THIS LAST WEEK AND LIKE HELL SHE IS PAYING THE $1 COPAY FOR THIS.  YOU TAKE THIS BACK RIGHT NOW AND SHE CANT BELIEVE YOU SENT THIS OUT *click*.   Life just got a little bit worse, you didn't even get to yell at her to call in the Rx's numbers next time and this shit wouldn't of happened.

Pharmacist requested out front rings throughout the pharmacy.  A mother does not know what 1.0mL means on the TriVitFlor (for those who are NOT pharmacist/techs, TVF has a dropper that has 1 mark on it.  1.0mL).  You are walking back to your station as your tech screams at you to check off the counter-full of Rx's filled so they can be put-

Pharmacist Line 3!  Its Mrs Jones again, she wants to know why her copays went up from last month.  You balance the phone on your ear as you try to check off the Rx's on the counter so your techs can continue to work.  Mrs Jones is screaming at you like you are some sort of monkey at the zoo flinging poo at her.  You run to the computer to find her copays have not changed in 2 years.  You pray for either your death or hers.

You try to work on things throughout the day to have customers scream at you from across the counter as if it is their personal pharmacy.  They get pissy because they are going "on vacation" and need their shit RIGHT NOW.  You feel less and less like a professional and more and more like a fucking vicodin dealing slave.

You'll feel anger towards your fellow man, that how someone that stupid can continue to pop out kids as if they have no idea how they are being generated.  You'll feel disgusted at the healthcare system and allowing people who contribute nothing continue to further their own genetic legacy.  You bust your ass and are treated like shit so these people can live a "good life" without having to work one honest day, and they have no problem cracking the whip over your head for not counting out their valium faster.

The day goes on, you almost have a breakdown.  You dont feel like eating lunch because you are so stressed out.  Your techs try to give you some comfort and your clerks try to handle the brunt of the insanity of the public coming in but eventually the walls crumble.  After your day is done, you sit there alone in the empty pharmacy wondering why in the hell you went into this profession, where we went wrong, and how you can do this again.  You stand up, knees aching and back tingling and make your way to your car.  You sit at home and prepare yourself to do the same thing in the morning.

Ask any pharmacist out there who works retail, and they will agree that its EXACTLY like this.  Pharmacy is a interruption based profession.  You have no time to actually concentrate and work on something from start to finish in an environment that fosters good thinking.  You have people screaming at you, demanding things, bitching and blaming you for stuff that you have no control over (like copays and not-covered drugs).  You went to school to learn really complex shit to use in an environment where the only 5 min's of peace is spent sitting on the toilet.

However, take heart that there are others like you.  Others that are in the same boat and feel the same way about work.  I, for one, take some comfort in that.

This post is due to an educational grant from The Raging Server.  Blame him that I'm ripping on all of the FibroFakers(tm, ie: TAestP dont steal this).

Usually when I write stuff like this which pisses off a ton of people, there is an implied concept that I'm bitching about one small subclass of people.  Unfortunately, some of my readers here just got off the short bus.  Example: I made a rant recently about Type-2 diabetics stupidly testing 5 times a day, and got tons of comments by a bunch of well educated Type-1 folks on insulin pumps (obviously well educated, low in common sense).  So I have to make the following statement:

This post is about the joke diagnosis known as Fibromyalgia.  If, in fact, you do have Fibromyalgia and are on Lyrica, Neurontin, TCA's, Ibuprofen, and everything BUT SOLELY Vicodin/Valium/Soma, then disregard the rest of this post.  I am not talking about you.  Unless you want to be publicly made fun of on here, do not write me a 10 page comment bitching me out about your life story, how you are on ALL of these drugs to treat this "condition", how much of an asshole I am, wah wah wah.  I repeat, I am NOT TALKING ABOUT YOU.  Other readers of this website will be quick to point out the error of your way.

There are two types of people who have "Fibromyalgia" - Those who actually have something wrong with them, and those who just use it an an excuse to get narcotics.  I must say that I have seen a whole lot more of the latter than the former.  From just my own experience, it effects the poor more than the rich, and only Vicodin/Valium/Soma combination will ease their pain.  To hell with Lyrica or anything else like Ibuprofen.

For those of you NOT in the medical profession.  Fibromyalgia is one of those diagnosis which amounts to "You say you are in pain, yet we have no idea what is wrong with you".  Its a crap diagnosis which even the inventor of it says it does not exist.  Basically what this comes down to is that it is indeed the new "low back pain" that people use to get narcotics.  It indeed is the "low back pain" for the 00's.

I do a ton of prior auths for patients to get their Norco/"Somas"/"Vico-DAN 7.5's" covered. Its gotten to the point now that when the patient or doctor responds with "Diagnosis: Fibromyalgia" and I see nothing but narcotics on the patients profile for the last 10 years I want to put down on the prior auth "Diagnosis: Patient has a shitty life and just wants to get high".  For an Incidence of 2% of the general population there has to be something big that ALL of my patients seem to have acquired this condition.  Maybe its transmitted by toilet seats or welfare folk having sex with unicorns or leprechauns.  Or heres a novel idea, maybe they are just FAKING IT.

I see patients who have something obviously wrong with them, be it Fibro or something.  They usually are all crippled up, walk with a cane, are on Depakote/Lyrica/Neurontin/Ibuprofen/other than solely Vicodin/Valium/Soma and get their 30 norco filled every month for breakthrough pain.  They don't bitch about early refills and actually take an active part on their healthcare.

Then I see the very vocal patient who has "Fibromyalgia".  I see them stroll through the parking lot to have the hand of God suddenly inflict them the most unbearable pain once they hit the front doors.  They use phrases like "Good Lord Jesus save me from my pain" as they stumble to the counter.  Johnny Depp, eat your heart out, these folk have you beat in the acting department.  They act like the world is going to end until you say that the doctor denied their pain pills.  At that time they stand STRAIGHT UP and YELL about how they have FIBROMYALGIA and are IN PAIN as they march straight out that door on their cell phone.  Yeah.. I know.. See why I'm jaded?

---

The wikipedia article linked above has a lot of great tidbits about Fibro.  My absolute favorite is:

"In addition, many patients experience cognitive dysfunction (known as "brain fog" or "fibrofog"), which may be characterized by impaired concentration and short-term memory consolidation, impaired speed of performance, inability to multi-task, and cognitive overload."

Yeah, brain fog/fibrofog.  Gee, do you think its because of the condition, or the fucking truckload of dope these people get from their doctors to treat this "condition".  The jury is still out on that one.

---

Wait, wait, the NYT article (on page 2) has another gem:

"The potential for weight gain is a special concern because many fibromyalgia patients are already overweight: the average fibromyalgia patient in the 2007 survey reported weighing 180 pounds and standing 5 feet 4 inches."

I wonder if carrying all of that excess weight around has anything to do with your chronic muscle pain?  Nothing a little soma and valium wont fix!  Oh wait, we should feel sorry for them because they have fibromyalgia.  Lets just rename the disease FATSOmyalgia and stop with the candy-coating.

---

So yes, I do think Fibromyalgia is a fucking joke.  I am not disputing that people have actual legit problems that require medication, but its really hard to take this as a real condition when people are just using this to get tons of free narcotics from the state program.  Now I need to prepare for all of the people who didn't read the disclaimer to send me their life stories and call me an asshole.

I've seen a lot of things come through my workplace.  Crackheads, addicts, people with guns, seekers, screaming children, teenage mothers, people who should be in a care home rather than on the street, etc.

However you know what really makes my asshole pucker when I see them walk through the glass doors? You know what makes me want to run and hide the moment they come into my sight?

Old people, with a baggie full of medication.

I know right then and there that if I get suckered into talking with them, there goes about 45 min of my day and the remainder of my patience.  Why do the elderly have to be so stupid and so difficult to deal with.

You tell a crackhead that they can't have their vicodin, and although they may pitch a fit and threaten you, eventually they get the hint and leave.  Tell an old person they got their lisinopril filled 2 days ago, and they just stare at you expecting god-knows-what to magically appear in front of them.

Here are some signs and symptoms of oldfartitis:

Females: Usually they will give you the infamous blank stare (AKA: Cow Eyes) and expect you to know exactly what they are thinking.  After about 45 seconds of silence and her staring at you, she will finally throw some random curveball at you like requesting refunds for drugs she picked up at another pharmacy.  No matter how long you explain to her about Medicare Part D deductibles or how she received 30 atenolol just 2 days prior, it will appear that you are just talking to yourself.  The same "Cow Eyes" just stare at you devoid of any sort of knowledge or common sense.  Its quite frustrating.  Eventually, you'll use every technique in the english language to say "Okay, you're done, you can go now" without outright booting her.  She'll pick up her baggie, walk out, and in 30 mins will call you and ASK YOU THE SAME FUCKING QUESTIONS YOU JUST WENT OVER WITH HER!!!  Im surprised she doesn't trip over her cordless phone (and you're surprised you don't hang yourself with your phone cord)

Males: Everything is your fucking fault.  You are the reason why Hitler killed those jews, why Jag got canceled from channel 12 and why Hometown Buffet and Cracker Barrel was closed last Saturday so they can repaint.  In their mind, you have screwed the pooch big time, and the only solution is to sit there and express their confusion via yelling at you.  No cow-eyes for them, they just blab their frustration with why they cannot pee and why they have not pooped today right over that counter all over your little white coat.  You can show them the video tapes of them coming into your store 2 days ago and picking up their pills and they will STILL yell at you and call you a liar and demand their refills.  They squack about their $1 copays each time every time, and you wonder how Mrs Cow Eyes can live with Mr Poopy Pants.

Both of them share one thing: The inability to grasp and understand simple concepts.  I'm not talking about people who are on 10 different medications here, I'm talking about 2 pills both taken at bedtime.  At what point do you draw the line and say "Hey, listen.  No offense, but I don't think you are mentally capable of taking this lisinopril once daily.  Let me put corks on the end of your forks and give you the rounded scissors so you don't harm yourself".  These patients are super high maintenance, and to be honest I'd rather deal with the scummiest crackhead off the street who can understand what I'm saying.

Its sad that I have to rag on the aging population, however they are pissing away all of my Medicare money that I pay into and will never see, so since I'm footing the bill for their lives I can rag on them all I want.

Hi TAP I know I have called you an ass hole and a dick, but... well... there is a topic I have never seen your opinion on.

Thats a great way to start an email. "I want your opinion on something, and I've called you names before." Hm... I guess I already know what my opinion is going to be.

You talk about addicts who refill their vicodin 2 weeks early, and are frequenting many pharmacies using their insurance, and doctor shopping and ER hopping. I know all about this, I am one of those addicts, or I should say WAS one of those people. I have been clean 2 years and counting.

Reading that right there sorta offsets you calling me an asshole and a dick in the past. Being clean for 2 years after something like this is nothing to scoff at.

I would like to explain some stuff to you from the addicts point of view. It's a growing problem, prescription pain killer addiction. I blame everyone for this. It's not 100% the addicts fault.

Oh, here we go. Its not the addicts fault that the pills fall into their mouths or they are FORCED to lie. Lets see if this email gets any better.

Maybe put some blame on the MD's who get the person addicted by giving high doses of the pain meds, and give refills and believe the crap about them losing their script, and losing their meds and so on, vacation refills. Blame should be placed on the ER who treats the seeker with more morphine/demoral/dilaudid, they know he/she is an addict, their there 3 x a week with a migraine, but yet they give the pain meds. The insurance company who keeps authorizing the refills.

Yes yes yes, its everyones fault but your own. Hate to tell you sweety, but in today's sue-happy day and age, if you go into the ER complaining of pain (ie: lying to them to get a fix. Something that they are not forcing you to do) and they refuse to treat you; and for some strange reason you stroke out and die, the hospital gets to pay your loser family a buttload of money. ER's cannot refuse treatment. Morphine/Demerol/Dilaudid are fast acting, cheap, and get you in and out.

As far as doctors go, most do not have a good bullshit-o-meter to tell when you are lying. Most will just give you what you want just to keep you from pitching a fucking crying fit there in the office and wasting time. Doctors dont just look at you and say "Yup, you're in pain, here are some norco 10's" and send you on your way. It doesn't work like that. YOU bitch that you are in pain. YOU bitch that the vicodin are not helping. YOU call in for an early refill. YOU LIE to US then have the balls to put the partial blame on us for not calling your bullshit (Upon which then you pitch a fit like a fucking child?) Catch a trend here? All of this STARTS WITH YOU MAKING UP SHIT. Since when are health care professionals your mommy and daddy to make sure you don't cut yourself on that knife or poke yourself with that fork? If you want the government/someone to wipe your ass for you then move to China.

It makes me sick that you even consider us to be part of the problem when this is something that YOU start, YOU continue, and YOU pitch a fit when things don't go some way.

I had been addicted for 11 years to vicodin, dilaudid, morphine, norco, vicoprofin, and many other narcs. I had aid and they paid for everything including the frequent er visits, different doctors, 10 refills of vicodin in 1 week. No BS!!

Yeah, 10 refills of vicodin seems like a lot when you are hitting every ER in town and paying cash for those 14 tablets the ER gives you before giving you the boot. I hope you have a thick skin, because I feel the readers of this blog are going to skin you alive and hang your bleeding body from the nearest overpass.

The crappy thing for you pharmacists you get caught in the cluster fuck, stuff that is no fault of yours gets taken out on you. I can imagine the names you have been called. I have done my share of bitching on pharmacists. I know I was pushed to the brink of calling in my own scripts. I could not function without the meds. Iwas sick and mean and a total wreck "tore up" without those meds. That's probably why these people are so demanding and so nasty. You have to feel for them, while the blame is theirs you also have to think of who contributes to this persons problem. It's scary to run out of your medicine, very scary. That's the whole reason I quit, I was tired of being scared. I am sure you know all of the withdrawal symptoms. The vomiting, the shits, the sweats, the lethargy, the depression, even as far as suicide. I have been there. I use to go to the ER 3x per week, now it's maybe 1x per year if that!. I have only 1 problem, as a recovering addict if I do go to the ER for a migraine I am thought of as a frequent flyer, it's a double edge sword, if I tell them about my past and say I am a recovering addict I may not get the meds that will kill the headache. If I say nothing they'll think I am fulla shit and not give the meds. Once an addict always an addict!! I've bitched out my MD about this. I still get narcs, but I am carefully monitored, it started out with 2 vicodins now I am up to 20 unmonitored per month. I take them cautiously, and only for severe headaches. When I do need to go to the ER it's the same one I went to, to detox. They know my history, they test me and then give the meds. They know I am on vicodin. They also call the area hospitals to see if I have been a pt in the last few months. Not a problem, I have nothing to hide. :) Sorry this is so long but I wanted you to hear the addicts side of thestory.

The quote "You shit in your bed, you sleep in it" really rings true here. I'm sorry (actually, im sorta not) that you did not receive the pain control that you require. However thats 100% all you right there. Its called personal responsibility and being an active part of your healthcare and well-being. You can ask to be referred to a pain management clinic. Morphine/Vicodin/Opium-products aren't the only thing to relieve migraines. TCA's? Neurontin? Depakote? Tegretol? Oh, those don't give you the buzz that you look for. Sorry.

So no, I don't "feel" for these people, much like people wouldn't "feel" for me if I pissed all my money away on toys and couldn't pay my bills (or you all don't give 2 flying fucks about my feelings as you scream at me in the store). Until we put a gun to your head and make you take 1000 Norco (then lie to everyone on the planet as to why you need more) the only person that you can blame for your "condition" is yourself. Personal responsibility and accountability. Big words, learn them.

Thanks for letting all of us know the "addicts" perspective where we are viewed as just another person to try some sob story before hitting up the doctor or ER for more dope. Cue the addicts from http://www.drugbuyers.com now to tell me how much of an asshole I am.

When people bring in their blood glucose monitor to me for help (which I don't mind really, as long as it was filled here and not Liberty Medical (fuck you)) there are a few things that are consistent as the sun rising in the morning and white bread/Velveeta cheese at a redneck BBQ.

• The machine, strip container, lancet device, everything will be smeared in blood
• The lancet device will have a loaded, used lancet in there cocked and ready to stick yourself with

Lets look at point one first:  Why can't people keep their fucking blood glucose machine half-way clean?  Most machines I see look like they have been used to cave someones head in, or was used as a tampon.  Dried blood all over the place, on the buttons, on the screen, everywhere!  I have seen less blood at a murder scene than on some of these machines.  Am I the only person who finds this utterly disgusting?  Let me shit all over something and have YOU deal with it.

This brings me to my second point: People love to have a loaded lancet device there waiting for you.  It never fails, I look at a machine, and I pop the top off of their lancet device to see if its working to find a used lancet needle staring me straight in the face.  Why can't people use a lancet once, safely recap it, and throw it in a fucking sharps container?  How hard is that?  We give them the fucking sharps container for free!  Now fortunately both myself and the other pharmacists treat a lancet device like a loaded gun and stay safely away from the business end, but seriously, if its going to go off, have it be a loaded gun so it can just end my life quickly vs me having HIV or Hep C by some ghetto dirty ass whore who couldn't take the two seconds to properly dispose of her used lancet.  The last thing I need it so accidentally stick myself and have to miss work because I'm out having every test to man done.  I can just see the Work Comp bill for that little fiasco.

So please, if you are one of those type-2 diabetics who test 30 times a day just to waste money, please make my life a bit easier and use a bit of common sense (HAHAHA) and unload your lancet device before you bring it in.  My safety and general sanity really do depend on it.

Its a fine, (if not lost) art to get the point across to a patient that they are too stupid to manage their medication without sounding like an asshole.  Unfortunately this skill is not taught in school (but really should).  We all know the types of patients that really have no clue what they are doing.  They still have bottles from 5 years ago (and call in those numbers when they want refills).  You insist that they did sign for some pickup (which they deny) only to magically "find it" once you already have the replacement refill done.  Patients like this really do gum up pharmacies all over the nation and are a source of not only stress for the pharmacist and their staff, but themselves as well.  Sometimes they are so stupid that they don't realize how much danger they are putting themselves in, which is why Mommy/Daddy pharmacist needs to have a "time out" and tell the lady who's ship should of sailed 10 years ago why they are so confused.

So how do you break the news that taking a pill twice a day is beyond their mental capacity?  To be honest, there is no easy way.  Well, I take that back; there is an easy way, but "You're too stupid to do this by yourself" tends to drive patients away. 

Some pharmacists take the "confusion" route.  By saying they are "confused" instead of "stupid", it takes the blame away from them, and puts it towards their age.  Old people are confused, its a fact of life.  You have a car engine that has 600,000 miles under its belt and see how well it runs.  Confusion is always a safe bet that won't make the patient feel that they should be wearing a helmet and winning a medal at the Special Olympics.

Another avenue you can try is by telling the diaper-wearing drooling patient that you want them to bring all of their bottles in so you can "Make it so they all get filled during the same time of the month".  Uh huh, right.  This is translated pharmacy speak for "Throw away all of the 10 year old bottles so you'll call in recent numbers" or "Seeing if you are actually taking your Aricept and Haldol".  The retard thinks you are doing him/her a favor, so they will have no idea that you are mentally murdering them as they bring in their shoe box full of empty vials.

Speaking of retards:

What really makes my blood boil are people who live in these "assisted living" joints.  These people aren't old, they are just truly borderline retarded and are too well to be in a 100% ass-wiped-by-Filipinos nursing home, but too mentally challenged/retarded/handicapped/etc to live on their own.  Whats truly retarded about this whole thing is that the "caregivers" allow the patient to manage their own medication to give them a sense of independence.   Trusting someone with a IQ thats my shoe size to manage medication so they feel independent is a REALLY dumb thing to do.  If you want them to feel independent, then let them use the shitter by themselves, or don't clap when they do a somersault without help.  I know that I'm going to hell for making fun of retards here, but we need to draw the line at how mushy-political-correct-huggy we are willing to take without having common sense step in.  If you think I'm an asshole, then you try correcting their blister-packed medication 4-5 times a month because they thought it would be a good idea to make little pill piles sorted by color.

I recieved a comment recently from a fan (although I'm not sure if they will still be one after they read this) that took exception to my use of the word "retard" to describe some of the people I deal with on a daily basis.

Short Answer: Deal with it, I'm using retard.  Sorry that you are offended by it.  The site is the ANGRY pharmacist.  If you want political correctness this is not the place to go.  I'm not going to censor or take into consideration the 2% of the population that I might offend using the word 'Retard' on a site that is dedicated to venting about the public.  Even then, they themselves probably would not take offense, but people who want to be offended for them.

Long Answer: 
Being all gushy and PC about stuff like this really bugs the hell out of me, so I decided to make a rant about it.  There are a bunch of people who want the word "Retarded" stricken from the English language as a reference to someone who is diagnosed with Mental RETARDation (because the two obviously arent related).  They want to be called "Learners with Exceptionalities" or "Mentally Challenged".  Yeah, lets call cancer "Abnormal Tissue Growth" - AIDS "Immunology Challenged" and schitzophrenia "Socially Unacceptable Thought Processes"  so we might not offend the people with that either. 

The world is not going to cater and wrap everything in foam and bubble-wrap for you.  Dont try to candy-coat something that is a serious issue.  Mental Retardation is not something that you can just put fancy/huggy words to make it "less offensive" and have it magically be somehow "better".  I would be MORE insulted by people trying to side-step my condition rather than just call it what it is.  Just say what it is rather than trying not to offend me by blowing smoke up my ass.  A duck is a fucking duck, not some huggy words that I cant think of right now that would describe a duck.  Which brings me to my next point.

Just because I use a word on here does NOT mean that I'm using it in reference to a particular person, class of people, or your crazy uncle (whoops, i meant mentally abnormal uncle).  Nor does it mean that I am putting down a certain class of people.  You would think that some common sense would be implied here since you are reading this from a site called 'The ANGRY Pharmacist', but some people would be surprised to see naked boobs and cock on site called 'HOT TEENS EAT BUTTHOLE'.

In closing, I'm sorry that you were offended, and as someone who (for a living) puts more medication into blister packs for people who are diagnosed with Mental RETARDation than you can shake a stick at (and also sorts them out when they punch out ALL the pills) you can rest soundly knowing that I think political correct terms for things are retarded.  Hey, at least they aren't called Invalid's anymore.

Here is a really good post on the issue I found on the LiveJournals.  You can find the original here: http://hardvice.livejournal.com/157411.html

There's a reason you aren't offended: because people who are offended by humour suck.

Seriously, I've said this before and I'll say it again: when someone tells a joke that's potentially offensive and you laugh, you're either laughing at the humour (the timing, the unexpected punchline, the fact that it's taboo) or the content (rape, murder, racism, sexism, etc.)

For me, I assume people are laughing at the humour and not laughing at the content. Why? Because there's nothing genuinely funny about any of the content. Racism itself isn't funny, but racist jokes can be--and people's indignant reactions to them even more so.

However, when someone draws a line--that is to say, when someone has a "sacred cow", like "racist jokes are funny but jokes about rape aren't", then I have to assume that they're not laughing at the humour. Otherwise, they'd realise that both are funny. That leaves me with the intolerable belief that they're laughing at the content of the racist jokes.

The minute you draw a line or decide that some subjects are just not appropriate for humour, you're saying that subject is somehow more important than all the stuff you laughed at. It's a definite implied value judgment--AIDS jokes aren't funny because AIDS is serious, but jokes about rape are funny because rape somehow doesn't matter. Moreover, you're saying that racist jokes are funny because racism is funny, etc. These are not the sort of people I care to share a laugh with.

It's the same philosophy Trey Parker and Matt Stone follow. They've said over and over again with South Park that the minute they decide something is off limits, then everything else they've ever done becomes offensive.

In other words, be proud and happy that you don't have a "sensitive" issue. It means you're not a fucktard. Part of the reason I try to offend the offendable is that I hope some day they'll learn this lesson and join us on the side of humour for humour's sake.

All pharmacies have patients like this.

• The village idiot. 
  
• Always really late or really early. 
  
• Cant manage to take 3 medications (all once a day, at the same time) correctly. 
  
• You think you are doing him a favor by putting all of his medications in weekly planners or blister pack, only to have a plastic baggie full of pills be returned to you because he decided to "punch them all out". 
  
• No matter how specific you make the instructions, he will always come in confused as all hell and need for you to explain it to him. 
  
• Doctors think its a cruel joke to prescribe him a blood glucose monitor with insulin and defer the instruction to you.
• The lady who's time has long come and gone
• Is about 100 years old
• Gets hospitalized about twice to three times a month.  Each month she gets discharged with 4 pages of meds, all different sigs and strengths which means that you have a whole mess of stuff that needs to be sorted out with insurance companies.
• Has no idea what shes on, what shes taking, when she takes it (see above with the joys of this)
  
• Decides that arguing with you about the most retarded things (like how many refills are on her Toprol) somehow is a good thing.
• Ms Know-It-All
• Retired Teacher
• Swears by Airborne no matter what you said (CREATED BY A SCHOOL TEACHER!)
• Always asks you your opinions and then tells you how WRONG you are because she looked it up on the internet
• Would take advice from the homeless druggie behind her than from you, because the homeless guy has "real world experience"
• Hypochondriac
• "Can I get gout over my whole body?"
• "I saw Lexapro on TV, can you tell my doctor to give me some, I think I have agoraphobia!" (as he's standing in front of you with a store full of people)
• Any daylight savings time changes completely crushes his life
• He keeps a log of what he has eaten for the past year (3 bites of tuna, 2 crackers) and takes his blood sugar about 10 times a day.  Did I mention that he's not a diabetic?
• "I drank a gallon of water and now I'm pee'ing all the time! I think I'm losing my potassium"
• Any explanation about anything medical just leads to another 20 phone-calls that day with another 100 questions.
• Other pharmacies have gotten restraining orders against him (no shit!)
• The last minute filler
• Comes at 10 min until closing wanting hospital discharge meds filled or a plastic baggie full of empty pill bottles from another store (thats closed)
• Wants to wait
• Insurance wont go through or they go through but were filled by another pharmacy thats closed for the day
  
• Doesn't have any cards
• Makes you want to go home and drink.
  

After letting that little diabetic rant stew for a few days (Oh, the uppity folk who pitched a bitch-fest came from here. Notice how almost ALL of them are on insulin and proudly display their insulin pumps and a1c score.  Now notice how the people I was bitching about probably think an insulin pump is where soda comes from at taco-bell and the a1c is a new brand of steak sauce.  Enough about that, draw your own conclusions) its time for me to talk about one of my favorite topics of all time.  Something I see almost nothing of on a daily basis, and something that ties into my diabetic rant.

Patients need to start taking an active role in their own care of whatever they have.

Foreign concept isn't it?  Amazing how many people I see on a daily basis not only do not care that they have HTN, DM, etc that can possibly kill them, but as long as someone else is footing the bill, they do things that make the condition worse!

For those who work retail; how many grossly overweight type-2 diabetics come to pick up their meds, and as your clerk is checking them out, the plop about 5 candy bars on the counter and begin unwrapping and eating NOT one but TWO! (2!).  Now add on a few grossly fat 10 year olds on top of that and have them plop their candy on the counter as well.  Hm, is that silence I hear from the diabetic whiners (or are you going to stand up and defend the type-2 450-lb fatty eating that Baby Ruth as shes signing for $200 worth of taxpayer-paid Avandia)? Is that the collective sighs from the retail folk out there because im absolutely fucking right? Now how many of you actually say something?  I usually make a comment of "You know those have a ton of sugar in them".  I'm usually met with a laugh and an "I know".  Temper, meet roof.  Let me dispense to her a gun so she can just take herself out NOW and save us the billions of dollars of hospital visits, medication costs, and crotch-fruit checks.  That right there has me pissed off at the world, not the uber-compliant diabetic who is always on time and breaks a bottle of Humalog once every other year (and wants to pay out of pocket when I'm insisting that I'll get an insurance override for them).  It makes me happy when patients come to me and brag about their a1c, it makes me angry when patients brag how high they got their glucose machine to read as they eat candy and drink pepsi.

I'm sure the diabetes police will whine about something related to this (because they ALL see this sort of stuff 9 hours a day 5 days a week for a living).  Diabetics can obviously do no wrong, and heaven forbid I bitch about them eating fucking candy-bars in the store.  Maybe they should just stick the test strips in a jar of Karo Syrup, since testing that and their blood has the same result; and in both cases the patient is able to do the same thing, just watch the meter explode.

Thats one example, another one is actually taking responsibility and planning ahead for your medication refills.  If you are leaving for Mexico and are going to run out early, you do NOT come into my store the morning that you are leaving and want 10 Rx's refilled RIGHTNOW.  Then get all huffy and pissed off when I say that the insurance company is going have to be called and if they want to pay cash we can work something else.  The icing on the cake is when they say "Well i'll just have to cancel my trip because of you".  Wait a sec, back the truck up.

You know when you received your medications last.  Now I know math is hard, but if you take 1 pill twice a day, and you have 60 pills, 60/2 = 30day supply (unless its vicodin, then 60/2 = 4.5days and an escalade payment).  So right there you know if you are going to be out during your trip or not.  Now unless you just found out and planned this trip RIGHTNOW, you had a few days to call me and get this shit-storm sorted out.  Yet here you are, screaming at me and blaming me for canceling your vacation (which how welfare patients can afford to always go on so many "vacations" boggles my mind) over something that was YOUR responsibility.  Lets bitch at Cadillac because your escalade ran out of gas because you thought it was someone else's job to check the gauge.  I just don't get how people can bitch and blame /ME/ over something that is 100% preventable for THEM just by taking 2 seconds and a quick phone call.  Just because I have a computer that has all of your medication in it does NOT mean that it knows when you are leaving on vacation.  I don't check every morning to see what refills are due for the thousands upon thousands of patients that I see every month.

As my boss likes to say "A lack of planning on your part does not constitute an emergency on my part".  I'm not going to drop everything that I'm doing just because you're an idiot.

My final point drives pharmacists up the walls from CA to NYC.  We need to be kept in the loop when your doctor changes directions.  Its a little known fact that doctors and pharmacists only talk when the doctor either whines that something expensive isn't covered, or he thinks we fucked up.  Thats all.  When the doctor tells you to take 2 furosemide a day, and we have a record of only 1 a day, and you come in 15 days early and want more, it really puts us and you in a bind.  You see, your insurance company (along with us) thinks that because the label on your bottle says "one tablet a day", it means you are taking "one tablet a day" not "one tablet twice a day" like your doctor told you and nobody else.  Medication changes aren't a fucking secret.  Take some responsibility for your medication and call me and say "Hey! Doctor said for me to take Rx# 2349234 twice daily now!".  I'll confirm this, and get you more when you run out.  Case closed.  Coming to me on a FRIDAY night 5 min before closing when EVERYONE has gone home to tell me that you're out of digoxin because doctor told you to take 2 a day last week really pisses me off.  Amazing how many times a day I bitch at people who do this and they STILL think that medication changes are some sort of secret and that I'll never find out about them.

I'm not going to get into doctors telling patients who can barely wipe their asses about medication changes.  Talk about a whole messed up clusterfuck of misunderstanding.  Thats for another time though.

Why must people be obsessed with testing their blood sugar?  Its about 3 times a week where I run into the typical uncompliant patient who needs a refill on 100 test strips they picked up 2 weeks earlier.  A quick scan of their profile shows only oral meds, no insulin, and uncompliance.  So then the 20 questions starts:

• Are you on insulin? "No"
• Do you adjust your oral medications based on your readings? "No"
• Do you have any problems working your machine? "No, it works fine"
• Do you waste strips or get errors which make you waste strips? "No, this machine is easy to use"
  
• Do you bring your doctor your machine to look at? "No"
• Do you do anything with the readings other than just collect them? "No"
• Why do you test that often then? "Doctor told me to"
• So if the doctor told you to wipe your ass 20 times a day even though you dont need to, you would do it? (alright, so I didn't ask this question.. :) )
• Its been a month and a half since your glyburide refill, did doctor change the directions? "No"
  
• Then why do you test this often even though you don't do anything with the results? "Doctor told me to, I dont know.  Is my vicodin due yet?"
  

At this point my head explodes as I fight the urge to say "Your doctor is an idiot".  What doctor worth any sort of medical degree will tell their patients whom are solely on oral meds to test 5 times a day?  They aren't adjusting insulin nor are they adding additional doses of glyburide or anything like that.  Does the doctor realize that test strips average about $1/test?  Oh, wait, $ + MD = ???

Patients on insulin is another issue because these patients are expected to adjust their dosage based upon readings (sliding scale) or will call the doctor for dosage adjustments (Take as Directed as sig).  So I very simply put that if they are on ORAL MEDS then they only need to test once maybe twice a day. 

Hell, I have patients who after getting 10 test results of 112 every morning they pretty much assume that the next one is going to be around 112 and test every other day or every 3rd day (These are the patients who pay cash for the strips, go figure).  But of course, being on Medicaid/Medicare with your FREE/Low copay test strips means that you can just waste them as you wish, because they are in fact "FREE" and the nanny government will in fact supply you with more because you are too fucking stupid to use some common sense.

Best dialogue I ever had:
Me:  "The F in Pharmacy stands for Free" 
Them: "But TAP, there is no F in pharmacy"
Me: "Exactly!"