This is all made up.  Uh huh.  Its a bit of a hard read to protect the identity of the stupid er.. the made up stupid… Uh huh.

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.

Ive been asked on more than one occasion (by MDs), why the ‘Angry Doctors’ on Twitter have such a strong Pharmacist following.  Since I have undertaken the task of being the official spokesperson of Pharmacy on twitter, I decided to turn this answer into a well though out response vs a 120 character tweet.

If you’re looking for profanity, slurs against the downtrodden, just skip over this whole post.  This is a post to generate discussion about a real issue that us retail Pharmacists have with our MD counterparts.  Yes yes, I know that the past few posts I have been quite uppity and boring about some issues going around, but fear not, the poop-talk is coming.

What I shall grace before you is from my own experiences only.  Although I represent a voice of pharmacy, I cannot speak for every pharmacist (although I do damn near get all of them to agree with me).  I want the MD’s in the audience to think about this article, because its not meant to inflict harm, just bring to light exactly how us in retail feel we are perceived by you.

• Whenever we call for a clarification, you are “in the room with a patient”.  We are unable to speak with you directly.  Even if its about issues that can get you in serious trouble, like forgeries/stolen pads or narcotic shoppers.  We speak with your “nurse” who gives the message to you.  While we are waiting for your “Nurse” we have a line out the door and the hospital on the other line calling in discharge medications, yet we patiently wait.  Your “Nurse” then gives us a response which is totally different than the original question, obviously there was a miscommunication between us and your translator which wastes both of our time.  We feel that your time is worth FAR FAR greater than ours since you can’t spare 30 seconds to have a conversation with us even though we are treating the same patient.  We feel like our concerns about OUR patients (which if we are calling you, its a concern, we dont have time to just piss away) take a backseat to everything else in your office.
• On your answering machine or answering service, you give a option for doctors or hospitals to get an express route to you.  Yet you do not give pharmacists an option.  Since we respect you (and aren’t a hospital or doctor), we are thrown into the call pool with your patients to be answered by a staff, who transfers to another staff, to transfers us to your nurses voicemail box, all while your patient is feeling ill and just wants to get the antibiotics (thats not covered) and go home.  All of our IVR systems give you an express hotline to us, yet the courtesy is not returned.
• When we see you at the CE dinners, we introduce ourselves only to be shunned by you chatting with your MD friends.  When you do actually talk to us, you don’t ask us how we’re doing; you ask us to pass the wine, or to fetch you something.  We introduce you to our fellow pharmacists, yet you dont even extent the common courtesy to introduce us to the other doctors.  We treat the same patients, we are on the same team.
• When is the last time you spoke with a pharmacist that you do a lot of business with.  Not just call in prescriptions or yell, but actually ask how they are doing.  Have you ever offered to have a cocktail after work with them? We would gladly treat you to cocktails after work, yet we never get the chance to speak with you to extend the offer.  Do you even know what their name is? I guarantee that your local pharmacist knows what your first name is, shouldn’t you respect him/her and do the same?  You do treat the same patients.
• Pharmacists, on the other hand, talk to each other.  We ask how we are doing when giving transfers.  We go out for cocktails after work.  We warn each other about forgeries.  Even ones who are in direct competition have a fraternal-like bond regarding reimbursement rates and looking out for each other.
• Pharmacists have a closer relationship with your front end staff than we do the MD that employs them.  We know your nurses, they know us.  We laugh and crack snide jokes about our patients who want yet another refill for that prometh w/ codeine.

Notice a trend here?  Retail pharmacists get scooted to the side by MD’s in all aspects of our job.  Now compare this with the angry doctors on twitter, who openly joke, converse, and treat pharmacists there as equals.  Do you see why they have such a huge following? Do you see WHY pharmacist jumped to the defense of a faceless, nameless anesthesiologist who was bullied by an MD who seems like he fits the above description?  The doctors on twitter are the doctors that pharmacist love.  They don’t put us on hold or communicate to us via a 3rd party, they speak directly to us.  They are approachable and friendly.  I can send one a message and not wonder if they will ever get back to me because they will.  I don’t need to watch what I say around them for fear of getting the “oh he’s just a pharmacist” eye-roll and subsequent ignoring.  They are people, real people, like us.  If you, the stereotypical MD, treat a fellow professional like us this way, how are you treating your patients?

I regularly go drinking with a NP and an MD friend of mine from a hospital nearby, and we discussed this whole issue about retail pharmacy and the local docs.  They, working in solely a hospital setting, had no idea that this huge gap between us existed.  They thought that all the docs in the area called up their local pharmacist and ask questions as basic as whats covered, to a suggestion for suitable beta-blocker for a patient with a low CrCl.  They wondered how you can practice medicine safely without asking advice from someone who is knowledgeable about medication.

I find it interesting, that pharmacists; most if not all have doctorates, who went to school, studied, and work with drugs for a living, are ignored in general by your average MD (except when the patient bitches the “pharmacy wouldn’t fill what you wrote”, only to be yelled at by the MD because the drug wasn’t covered and costs $400).  We are on the opposite side of the same coin, and ultimately the person who suffers the most is the person who is generating the revenue so we both can eat.

Part of this is the fault of pharmacists in general.  Most of us really don’t have the time/balls to stand up for ourselves when push comes to shove regarding MD’s and medication therapies.  We have allowed ourselves to be walked upon for decades.  Ask a pharmacist who graduated in the 70′s what doctors were like back then (shout the orders, slam down the phone, “just fill the fucking prescription”).  However the tides are turning.  Residents are being taught to ask us for advice.  There are too many drugs and conditions now for one profession to master every small aspect of both fields.

I’m really not bitching per-se, just letting you all know what your image is like on the other side of the fence.  Do I expect this to magically change with one blog post? No.  Behavior that has been refined over the past 100 years can’t change overnight.  I hope this brings some insight on why the docs on twitter have such a strong pharmacy following.

I’m taking a break from my usual silence (I think i’ve flogged the welfare crackwhore/dumbshit patient enough) to comment on a few important points.  Social sites and you.

Thats right, Facebook, Twitter, etc and the drama/flak they cause (as well as the laughs).

I want to start with a story.  When I was a lowly intern, I was at a very large hospital being the beating-boy for the medical team comprised of a few residents, an attending, myself (go pharmacy!) and a dietitian (wtf?).  We were examining a scrotal hydrocele case that was admitted.  The attending flings back the curtain, and the guy is laying there with his legs spread, and what looked like 2 large grapefruit between his legs.  The attending said “HOLY SHIT THOSE ARE THE BIGGEST BALLS I HAVE EVER SEEN”.  I laughed, the other residents were stone-faced.  The patient looked at me and the attending laughing, got a sense of pride in his crotch-fruit, and laughed.  He completed the exam (including one of the residents who really wanted to stick a needle in them) and left.  The most senior resident said as we were walking the halls “THAT WAS THE MOST UNPROFESSIONAL EXAM I HAVE EVER SEEN”.  The attending, in true Dr Cox style, said “Listen, you need to laugh or you’ll go crazy, sure it was off-color, but thats what makes us relate to the patient in a way that makes them feel not like they are some rat on an exam table”.  The patient, after his nuts drained and looked like prunes again, personally gave his thanks to the attending to making him feel like ‘one of the gang’.  Word got around the hospital about the nut-of-the-year award, and although no names were dropped and not personal information was given out, it was something that pharmacy and medicine could open dialog about.

Thats one of those lessons that you can’t be taught in a classroom.

The second part of this rant is some Twitter drama involving @mommy_doctor and (although a valid point) a bullshit article written by DrV.  Realize that I follow a lot of MD’s, mostly from the ER who say some pretty damn funny things regarding their profession. Much like myself, they give an insiders look at really goes on in the world of medicine.  In fact, I view these angry doctors with a ton of respect, mostly because they make us in pharmacy realize that we’re not alone in dealing with idiots; and their sense of humor/rants about their job makes them (in my eyes) someone who you can hang out and have a beer with.

Before I go further, let me explain about @mommy_doctor (herein known as m_d).  I’ve been following her for a few years now. Shes an anesthesiologist (obviously she is a female, hence mommy).  Her job is rough.  She puts her ass on the line day in and day out to save people.  She deals with surgeons, scared patients, and is a really really stand-up woman.  Her tweets are funny, usually clean, and show how much she cares.  She gives us an inside look at the crazy mixed up hybrid of pharmacy and medicine.  I view her with a huge heaping of respect and admiration for doing what she does on a daily basis.

Anyways, I got a major case of blue-balls when I saw that link, because I immediately thought that ole @BurbDoc was under fire for one of his many hilarious (and totally true) tirades about the unwashed masses.  However reading the holier-than-thou rant just got me pissed off.  I really wasn’t pissed off at the whole concept, but at the bullshit cliquish high-school drama that took place in the realm of Doctors.

First off, DrV, in an article about the lack of ethics, decided to copy/paste screen-captures of the tweets of @mommy_doctor treating a priapism case, one that she obviously felt empathy and sorrow for.  The tweets weren’t crass, funny, or even note-worthy.  However the MD fanboy population decided to textually masturbate themselves about how unprofessional this was.  Mind you these seem like the MD types who will DAW-1 everything, not give you the benefit of a clarification, and refuse to speak with pharmacists.  You know, the MD’s that us as pharmacists HATE dealing with.

Rather than using the text as an example (and blurring out the name), he unethically decided to just drive the bus over her and publish the tweets unedited.  Ironic that in an article about unprofessional behavior, he commits an unprofessional act by doing something that she obviously had the moral-high ground to not do.  Pin something to an individual vs a concept/idea.  In the comments he stated “Regarding outreach, I don’t engage anonymous people.“  So wait, you dont engage anonymous behavior except when it benefits your argument?  How does that work?

Second: This whole clusterfuck over something absolutely stupid makes me realize how much MD’s are gunning at each other.  How quick and petty they are to nail someone on the cross over something that (in the grand scope of whats out there) a non-issue.  Yes, she made a joke about pripiasm, but I’m sorry, dicks are funny, and a 36 hour boner (although a medical emergency) is going to get SOME reaction.  If I had a boner for 36 hours, after the 10 tubes of KY jelly and the absolute destruction of my wifes vagina, I’d painfully tweet about it on my way to the ER.  If she were a male would this be an issue? Of course not.  @BurbDoc doesn’t get thrown under the bus for the outrageous things he says, but her being a female the rules were obviously changed.  How unprofessional.

This is the same sort of shit that Scrubs is made of.  Do the masses think doctors are “unprofessional” after watching Scrubs?  Do they think that House is unprofessional?  No!  If the doctor is anonymous, and writes a few crude humor lines on a medical condition that could happen to say, ANYONE, whats the harm?  The poor gal was probably on call, stressed out, and wanted to get some sort of outside reaction from a case that us, anonymous internet medical people, would get a chuckle about.  Do I feverishly check all of twitter about the patient with a horrible case of hemorrhoids the moment I leave the doctors office? Of course not!  The humor on twitter could happen ANYWHERE, yet the MD population thinks that it can be narrowed down to ONE office out of 10000000 in the United States (if she is from there) instantly.

I’ll be blunt here.  Voicing your frustration means you care. Your patients aren’t perfect, their conditions aren’t perfect, and sooner or later you are going to have to blow off some steam and vent to those who are in the trenches with you.  If you just saw patients, collected your paycheck, and went home without a care in the world, you dont care about your patients because they didn’t have a personal impact on your life.  The world is far from perfect, and yes, I bitch about crackwhores/welfare/shitty state of pharmacy because I do care.  I do care about those abusing the system or the crackwhore mother who obviously cares more about her early norco refill than her child who is ignored.  I can’t solve the worlds problems and that gives me frustrations.  I bleed the relief valve on twitter and on here to keep myself from going insane.  Burnout is huge in the medical world, and if we; the faceless medical community from all races, specialties, locations, etc, are unable to joke, laugh, and support each other then thats just going to separate US from our patients.  All of us have been the butt of jokes, all of us are patients in one form or another but as long as nobody is singled out and no harm is done (intentional or unintentional), whats the harm?

But what do I know, to these MD’s im just a fucking pill counter who gets yelled at because Solodyn is 500 bucks and the patient cant afford it.

Oh, and to close this off, heres an awesome twitter quote: If I had a 36hr priapism and Dr. V was attending, one thing’s for sure: There’d be two prominent dicks in the room.

I’ve always wanted to speak at a pharmacy school graduation.  Give my thoughtful insight of my many years in the trenches of a profession that is going down the shitter faster than that burrito I had on cinco-de-mayo.  If I ever received the privilege of talking to a classroom full of new graduates and their parents, it would go something like this (before the school snipers took me out).

—–

Fellow graduates, family members, and friends.  We are gathered here today to celebrate a special person in your life and their accomplishments in recieving their Doctorate of Pharmacy degree from this wonderful instution.  Before you, in their regal cap and gowns, are your professors, who have worked day and night to mold the clay that you came in as into something that will help people.  Well ladies and gentlemen, let me tell you how this shit is going to go down once you enter the real world.

Look around you.  Go ahead, look around you.  Those smiling faces will be bitching at you as to why you are taking so long to fill their fucking prescription.  They will pester you on the phone about stupid shit like the price of condoms as your tech is texting his fucking girlfriend about the parking-lot blowjob he just received (nod to BKBJ, sorry I made your vagina sandy at work, pussy) while the backlog is out the fucking door.  See grandma over there? Shes proud of you now, but will demand you cater to every one of her fucking drug needs at this very moment, want free delivery after you have been on your feet for 10 hours, and make you special order the blue ones instead of the pink ones.  Oh, and she’ll say “I never paid last month” when she has; EVERY FUCKING MONTH.  Your uncle will be too stupid to have the Rx numbers, but will gladly call in “the pink ones, and the capsules that help him pee”.  Oh, and your parents? They will want “all my regular meds” and make you RTS all but the pain pills.

Your professors smugly sitting over there haven’t work a retail job since Lozol was trade name only.  Sure they can recite the pages from Lexi, but throw an angry patient in front of them and they cry to administration.  Maybe one day you can fill the heads of students with knowledge and not any practical retail skills.  Get working on that.

The “hard work” that you have accomplished with your royal sash of dark green is worth $1.50/Rx to the insurance companies.  Its worth even less to your employer that demand you fill 500 a day by yourself without the luxury of a lunch.  Oh, sure, they say you can take a lunch, if you want to get dinged on your metrics and be out of a job.  From here on out you go from student to the bitch of your employer, and the bitch of your patients.

You, in the back, stop your sniveling.  Yes, I know you just wasted $100k on an education, but its not MY fucking fault you haven’t stepped foot in a pharmacy until you graduated.  Moving on.

To those uppity students smugly smiling that you got a ‘residency’, prepare to be a doctors bitch.  Yeah, they will treat you like an ‘equal’ to your face, but you’ll just be their walking drug reference book and get made fun of in the lounge.  You’ll run the clinics that they don’t want to deal with and think you’re getting a good deal.  You’ll be walked all over by attendings and residents because you’re just a PharmD and they are an MD.  You’ll go to sleep at night with the feeling of “at least I’m not in retail, but I should of went to med school.”  You will live life as a “should have”.

Lets all cut the bullshit.  You didn’t go into pharmacy because you want to “help people” like those smiling idiots in APhA magazines, you did it for the fucking $100k/year salary.  Well I’m sorry to say, but a lot of professions make $100k a year, and that ship sailed without you about 3 years ago when you stepped foot on this campus.  Looking down on all of you, it reminds me of that time I visited the slaughterhouse.  All those cows walking in a single line unknowing that their life was about to get really shitty really quickly.

In closing, I would like to take a second to reflect on all the hard work you have done to further your career, and cheerfully remind you that I am at least 10 years ahead of you to retiring, if you make it to retirement age, with the MI you’ll have in 15 years.  Pray its a stroke, one that kills you quickly, at work, in front of a crowd, so your employer can get sued.  You’ll laugh and think I’m wrong now, but in about 10 years you’ll be singing my praises.  Don’t say I didn’t warn you.  Thanks.

—–

All joking aside, I really do with our new grads the best of luck as you enter into our profession (you’ll need it).  Its good to have you in the family, because misery LOVES company.

A wise man (OK, its my employer, fine) told me that the smartest investment a business can make is in its employees.  That’s right, happy employees mean productive employees which are good for the customer, business, everyone.

I sure as shit wouldn’t be happy if my employer rewarded complete dickhead patient behavior with gift-cards.  In fact, I’d feel like my employer feels that a shitty patient attitude is more of an asset than the feelings of its employees.  A feeling that my professional opinion/ethics is worth less than a $10 STFU gift-card.  Chain pharmacists, I don’t know why you put up with it.  Oh, its because they blew a bunch of smoke up your ass when you were in school (when you thought you knew everything), offered you a fat sign-on bonus in return for years of slavery, and now you’re stuck with a tech who paid $20k in schooling but asks you daily what the trade name of hydroxyzine is.  Lame.

So I hope Walgreens, Rite-Aid (15 mins!), CVS and the like need to listen the fuck up, because I’ll tell you why the profession is going down the shitter (and why we are treated so).  The mighty bribe..er..gift cards.  CorpoChains are shitting in their own beds for the sake of ‘loyalty’.

At my store, we have no gift-cards.  You treat me (or my staff) like shit and we politely ask what pharmacy you would like your Rx’s transferred to.  If you continue, you get the front door opened with your face.  We don’t reward asshat behavior (unless we REALLY REALLY FUCKED UP, then we deserve it), most (if not all) independents operate the same.  Its just common business sense!  If the pharmacy fucked up – sure, throw them a gift card to say that we’re sorry.  However word from the trenches is that they are throwing gift cards away to people who have complaints that are in no way the fault/responsibility of the pharmacist nor the pharmacy itself!  Chains, grow a pair of nuts and realize that the customer is usually dead-fucking-wrong!

Hey, if you are pissy because your doctor hasn’t responded to your vicodin request then you are FREE to go get a new Rx directly.  Upset because you have 0 refills? Your bottle clearly stated that fact when you picked it up, try reading it for once.  Don’t like this whole novel concept called “responsibility” and “planning ahead”? Go get your own MD license and you can write your own prescriptions.

Unhappy that we didn’t have all 120 of your Xeloda?  Are you unhappy that the pharmacy TOLD you that this was a special order and to call a week ahead (which you promptly forgot/ignored)?  I’d be happy to order you a year supply if you want to foot the $20,000+ tab and I’ll keep it safe for you.  Maybe a little inconvenience will pound into your thick skull to do what we tell you next month.

Pissed that we didn’t have the full amount of a trade-name item that only YOU take (and you didn’t call ahead like we asked)?  Well, I’m unhappy that my grocery store doesn’t have a certain brand of salad dressing in stock, yet you don’t see me raising a stink and demanding compensation via gift-cards.  Call ahead.

Pitching a shit-fit that you drove “all the way across town (2 miles)” to find that we’re still waiting for the refill authorization on your pain pills (even though the 10 maintenance meds are ready to go)?  Its called a phone, you have one in your pocket, its nicer than mine.  Amazing how you can know everything that your baby-daddy is doing behind your back yet you are unable to make a phone call to the pharmacy to see if your crack got approved.

Whats the solution to all of these scenarios?  Gift-cards to the loud-mouth crackhead by some ignorant store manager who couldn’t be a pharmacy tech if his/her life depended on it.

The chains are doing nothing but demoting the profession (if you still want to call it that) of pharmacy by rewarding patient complaints.  If your dog pissed on the carpet do you give him a treat?  The chain stores do! Rewarding such piss-poor behavior just breeds more bad behavior.  Shit-hole patient chainitude (that’s chain attitude, I’m so clever!) behavior spills over to independents, and god dammit we don’t give out fucking gift cards nor do we want your douche-canoe “Eye wanna gyft carrrd” patients!

So my in at the Low-Stock-Price-Leader says that Rite-Aid has this 15 min guarantee for when your vicodinprescription will be done.  If you don’t get your Rx in 15 mins you get a $5 gift card (insurance problems don’t count, some restrictions apply, see your friendly Rite-Aid associate for details, blah blah blah).  Now considering how short staffed most chain stores are, I’d rather them keep the $5 (the going rate for almost 5 shares of stock, no bullshit), have them take as long as needed, and have my Rx be correct (ie: not killing me).  In fact, this whole 15 min bullshit really pisses me off.  Who cares if your Rx wasn’t done in 15 mins or less (sounds like pizza delivery).  Guess what Rite-Aid; people die due to medication errors, people don’t die from a cold pizza. If you want to hold your pharmacists to the same standards as a pizza-worker, then expect the same quality of service of a pizza-worker.  Hope the impending lawsuits don’t push your stock to the point where you need to PAY people to claim ownership of it.  Oh wait, its $1.11 a share, strike that last statement.

In all honesty, I really do feel bad for the pharmacists, tech, and clerks who have to deal with their employer who puts the opinion of the public over their own employees.  Its one thing to offer something to a patient as compensation for a mistake, an oversight, or just plain forgetting (nobody shit smells better in this regard), but for a 15 min guarantee?  Way to value patient safety at a whopping $5.

By the time you read this, the Vaccine = Autism published by the BJM will be old news (Yes, I do write a bunch of rants at once and have them post at a later date).  However lets take a closer look at this whole situation.

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:

Part 2:

Everyone has heard that Pharmacists are one of the most “trusted” professions.  Sure nurses yanked that out from under us a number of years ago, but the fact that we are still on the “trusted” scoreboard started to make me wonder what exactly about what we do makes us so “trusted”?

Patients dont trust us.  They yell at us over their copays thinking that we are making a HUGE profit from that measly $50 copay when in fact we are barely breaking even.  They whine and bitch and think we are lying to them when we say that their pain pills are too early.  How many times have we caught a possible serious interaction only to have the patient demand that we fill it anyways because they don’t wish to wait the extra day for us to confer with their doctor (then transfer it out when we refuse)?  How many of us have suggested an OTC product only to have the patient pick the one with the shiny packaging that won’t do a damn thing for them (but Airbone was created by a SCHOOL TEACHER!).  How many times have you told mothers they cannot use a decongestant elixir on their 2 month old baby only to have them grab it after your back is turned?  How many times have we given them medications so they won’t have to sit in the ER only to have all of their Rx’s transferred to a chain for the coupons/gift certificates the very next day?  Someone who is “trusted” doesn’t get yelled at for non-covered drugs or for insurance-company doughnut holes, they should accept what we say (its not like we do this for a living or anything) and go on their way.  How many times have you seen a patient dump all of their pills right there on the counter only to count them (and proceed to dump them on the floor and demand new ones).  How many times has your drug knowledge been called into question because of “my friend said” or “I read on the internet”?  I guess we are trusted enough to know what isle the paper towels are on or to count the blue Lortabs vs the pink ones.

Doctors dont trust us.  95% of them won’t allow us to switch to a covered drug in the same class without going through 10 fax backs that involves their non-medically trained front end staff relaying incorrect messages and completely wrong information.  They dont ever get on the phone to speak to us because they are “too-busy” seeing patients and cant spare the 10 min’s to discuss an interaction that may kill someone (yet they take an hour lunch break every day.  When is the last time YOU got an hour lunch break?)  Yeah, sure they may be “reviewing paperwork” during that hour, but how many times have you gotten mindless “OK’s” when a valid question is written on the refill request in black sharpie?  How many doctors will allow you to use your knowledge over being their human shield/proxy when they piss a patient off?  How many doctors will stand with you against narcotic diversion rather than just rolling over and demand we fill narcs early when the patient starts to whine?  How many times have you gotten a call from a doctor wanting to discuss the narcotic use of a patient and what WE can do to help the patient (I can count the number of times this has happened on one hand, minus a few fingers)  Yeah yeah, doctors are busy, excuse me while I take care of your patient’s issue while I fill the other 1000 Rx’s that your other patients are screaming at me about because they aren’t ready 30 seconds after they call them in.

Insurance companies don’t trust us.  They make us go through mindless audits where they nit-pick /everything/ just so they can yank that drug cost right out of our checks.  We cannot call them for a prior auth even though we have a complete Rx history for the last 10 years AND have doctorates of pharmacy (or 20+ experience in the field) but rather hear some high-school dropout or some community college graduate tell them the exact same information read from a chart.  Our services and education are worth a dispensing fee that is less than the pizza boy who delivers in 30 mins or less.

State Boards/FDA don’t trust us.  They are the first to nail us to the cross and pull our ticket at the slightest word that someone has gone wrong.  They won’t stand up for us against the PBM’s even though THEIR fate is directly tied with ours.  Ever been inspected by the state board?  Ever gotten some minor-ass infraction just because they needed SOMETHING to ding us on to justify their jobs?  “Your fridge is 1 degree above the USP published standard, ignore the fact that I had the door open for the last 5 min’s looking for outdated insulin”.  They make us cram so much information on our Rx labels that it takes a masters degree to sort through all the tiny (and BIG) print to find when a drug was last filled.  We have to hand out STUPID medguides (more on this on another post) that list every side effect known to man that just scare the patient into not taking the drug.  To hell with actually US TELLING them what they need to know!

In fact, the only people who trust pharmacists are other pharmacists SOLELY because we are in the same trench.  Sure patients that you KNOW and have cared for will trust you, but its mostly out of professional friendship gained via feats that you have gone completely out of your way to do for THEM (illegally most likely) vs the inherit trust earned through a pharmacy degree and license.  Oh, don’t piss them off or they will drop you in a hot second for that chain giving out coupons and gift cards.

Not to belittle or devalue the hard work that nurses do, but what do they do that makes them number one in the “trusted” list?  The ones I know follow the doctors orders and care for them while they are in the hospital.  Their “trustworthiness” is not plugging the wrong IV (that has been scanned 100 times through a bar-code system and prepared BY A PHARMACIST) into the IV tube.  They make the patient comfortable and act as proxies to the doctors (the times that I or my family have been hospitalized this is what I’ve seen.  Sure its important, but #1 on the trusted list).  Dont we do the exact same thing?  I mean really, in a hospital setting you’re at the mercy of the nurse since you obviously cant walk around shouting and demanding stuff like they do when they walk into a pharmacy.  Nurses have a little light and call button to summon them, we have a phone and a pissed off patient storming in through the front doors demanding to know why their copays are “so high this month” (when they paid the SAME last month).

Pharmacists are like the kickers of a football team, we either save the day in a pinch or cost the team the game; in both cases we obviously didn’t win/lose fast or cheap enough.  Our shit doesn’t smell better or worse than ANYONE in medicine, yet we’re the human shield.

Oh hell, what do I know.  I just put vicodin and soma in little bottles not fast enough to keep the unwashed masses from bitching and moaning.  Yeah yeah, it’ll be ready in 10, your ride is impatient.

This is taken from Apothecary Tales.  Its too well written and too funny to have me just skip over it:

Here are a few things that I have written to celebrate the overly-medicated holiday season:

The 12 days of Crackmas:

The night before Crackmas:

Merry Christmas to All!  May all your early refill wishes come true!

Im leaving town right now, will it be ready in 10?

Pharmacy tech schools/programs are cropping up around here in California like herpes after the prom.  I, for one, am sick and tired of these schools duping young ignorant students into handing over their hard-earned money to get some half-assed education when they can avoid it all together.  Thats why my friends, I am going to tell you how you can get your pharmacy tech license WITHOUT setting one foot in some useless program that costs 20k bucks.

Back before 1/1/2004, one could work in a pharmacy as a tech-apprentice and get a license after completing 1500 (or something like that) hours of real-life work.  Personally, I think this is the BEST way one could be a tech since you are being taught exactly what you need to know, what you can and cant do, and all of the things that you will be doing on a daily basis.   These were the glory days when men were men and the generic quinine flowed like cheap booze!  All of this is different now, read on.

Now this is California specific and information that the schools do NOT want you to know.  Here we go.

According to the Calfornia Board of Pharmacy tech license requirements.

Effective January 1, 2004, there are only four ways to qualify for pharmacy technician registration (California Business and Professions Code section 4202). California law now requires that an applicant for a pharmacy technician permit must meet one of the following criteria:

1. Have obtained an associate of arts degree in pharmacy technology.
2. Have completed a course of training specified by the board (typically provided by employers under requirements of California Code of Regulations Section 1793.6 (provided below)).
3. Have graduated from a school of pharmacy approved by the American Council on Pharmaceutical Education or recognized by the board.
4. Be certified by the Pharmacy Technician Certification Board.

California Code of Regulations section 1793.6 describes the training courses acceptable to the board (item 2 above)

This training is:

1. Any pharmacy technician training program accredited by the American Society of Health–System Pharmacists,
2. Any pharmacy technician training program provided by a branch of the federal armed services for which the applicant possesses a certificate of completion, or
3. Any other course that provides a training period of at least 240 hours of theoretical and practical instruction, provided that at least 120 of these hours are in theoretical instruction in a curriculum that provides:
   1. Knowledge and understanding of different pharmacy practice settings.
   2. Knowledge and understanding of the duties and responsibilities of a pharmacy technician in relationship to other pharmacy personnel and knowledge of standards and ethics, laws and regulations governing the practice of pharmacy.
   3. Knowledge and ability to identify and employ pharmaceutical and medical terms, abbreviations and symbols commonly used in prescribing, dispensing and record keeping of medications.
   4. Knowledge of and the ability to carry out calculations required for common dosage determination, employing both the metric and apothecary systems.
   5. Knowledge and understanding of the identification of drugs, drug dosages, routes of administration, dosage forms and storage requirements.
   6. Knowledge of and ability to perform the manipulative and record-keeping functions involved in and related to dispensing prescriptions.
   7. Knowledge of and ability to perform procedures and techniques relating to manufacturing, packaging, and labeling of drug products.

Laws are stupid and boring.  Lets go through the possible avenues you can be on to become a Tech in California.

1. Get an AA degree in Pharmacy Technology.  What the fuck is Pharmacy Technology and why is it even an AA program?  It requires school and thereby money, moving on.

2. Have completed a course of training specified by the board (you can read the boring law as to what “Training” is).  Here is where all of the pharmacy tech “programs” come into play (along with #1 above).  They dupe you into thinking that you need to take their class to become a pharmacy tech.  Most schools tuition range from 15 to 20k bucks and will suck up a good 6 months of your precious life.  All to work in a retail pharmacy counting by 5′s.  Go you.

3. Have graduated from a school of pharmacy approved by the American Council on Pharmaceutical Education or recognized by the board. Translation: “You graduated from pharmacy school with a PharmD but you can’t pass the boards to save your life”.  Congratulations, you are the most overqualified pharmacy tech on the planet, here is your certificate on waterproof paper so your tears don’t smudge the ink.

4. Be certified by the Pharmacy Technician Certification Board.  Wait, whats this?  What is this strange PTCB you speak of?  Well, its a test.  Its a 90 question multiple choice test given at a hochillion testing centers around the state year-round.  Here is their online application to apply for this test.  Their requirements to take the test?

• High school diploma or its equivalent (e.g., a GED or foreign diploma).
• No felony conviction.
• No drug or pharmacy related convictions, including misdemeanors. These violations must be
disclosed to PTCB.
• No denial, suspension, revocation, or restriction of registration or licensure, consent order or
other restriction by any State Board of Pharmacy.
• No admission of misconduct or violation of regulations of any State Board of Pharmacy.

So, pay 15k and have information spoon-fed to you, or spend $200 bucks (the test is $129 of that) to get a PTCB study-guide from Boarders/B&N (search for PTCB exam), read it at home, take the practice test, then go to a testing center and get THE EXACT SAME THING.  PLUS if you pass the test you get a fancy CPhT after your name!  Just that information alone is worth it for you to buy Drugmonkey’s book with all the money you saved!

That’s it!  That is all you need to do!  Take a 90 question test and you’ll have your license!  No teachers! No books! No $20k financial-aid’s dirty looks!

Why am I doing this?  This is why; the pharmacy tech market in California is saturated to hell.  I get at least 2 applications a month from people looking for pharmacy tech jobs.  I feel horrible for some idiot who spent 20k bucks to have some washed up pharmacy-tech yap at them in a classroom to get a license that there isn’t any job demand for.  Its that simple.  These schools are swindling these students out of their money with promises to “get in on the pharmacy action” when there are already TOO many techs LOOKING for jobs.  I don’t think its right because the schools make it sound like their program is the only way to get a tech license, and that’s an outrageous lie.

I’ve worked with CPhT’s that just took the test, and externs who are close to finishing these ‘wonder-schools’.  I’ll be honest, both of them are shit-worthless walking in the door, with the CPhT’s a bit more useful than the externs solely because they have the ambition to study on their own.  I spend more god-damned time doing brand-generic translations, telling them they pulled the WRONG drug, and fixing their mistakes for them to be any worth to me.  What the fuck are these schools teaching these externs?  If you studied at home, I can sorta give you some lee-way.  But if you spent 6 months in a CLASS getting LECTURED on shit, you should damn well know what Keflex and Vicodin’s generic names are.  It’s gotten to the point where I refuse to take any tech-school externs because they end up COSTING me more time than SAVING me time by having them be there.  Yes, they are there to learn, but I am there to work.  Teaching time was in the classroom, “you should of learned this there”.

Now granted, some people learn better by having the information spoon-fed to them via a talking-head and homework than reading a book on their own, but is it worth 15-20k?  Honestly I want a tech that can read, understand, internalize, and apply on their own rather than asking me the same pointless questions every day.  I don’t have TIME to be a talking-head explaining them shit they should of learned at these fancy programs! I have work I need to do; and although these externs aren’t getting paid, they are preventing ME from doing what I need to get done with their should-of-learned-”How many mL’s are in a teaspoon?”-in-school questions.  At least intern pharmacists can take new prescriptions!

I’m waiting for the “Well, we all have to start somewhere!” excuses.  My preemptive response to your bogus statement: “You went to a SCHOOL to LEARN how to do this and you are SHIT-WORTHLESS.  You have FORMAL INSTRUCTION in this field and you don’t know your ASSHOLE from a 30 DRAM VIAL.  If I have to tell you one more time why HYDRALAZINE is not the same as HYDROXYZINE I am going to shove Drugmonkey’s Book (Go buy it) UP YOUR ASS.”  That’s right, his book up your turd-cutter.  Harsh, I know.

Another unrelated point on my refusal to take externs is a trust thing.  With a CPhT licensed tech, he/she is an employee.  We have paperwork on them.  We know where they live.  With an extern, its just a name from the school.  What prevents them from pocketing a handful (or a bottle) of vicodin during their X-hour externship stay at my store?  I don’t have the time to watch him/her like a hawk, and its my license on the line if something comes up missing. I’m not going to do a narc inventory after EVERY extern rotates out, so one of 12 externs/year could nab a bottle of vicodin and nobody could pin it on exactly who did it.  So I choose to just not deal with the situation at all.  Yeah, its a shitty outlook that really isn’t justified, but at the same time its my ass.