Old Folks and Their Poopies.

All pharmacy staff has seen this before:
Old man/lady comes in weekly (or even three times weekly), picks up a bottle (or 4) of the familiar green bottle of Magnesium Citrate, and happily does god only knows with it. Rinse and repeat for the next 10 years. For those non-pharmacy types: Mag Citrate is a yucky tasting laxative that comes in a very distinctive green bottle. Its best shotgunned all at once while very cold (so it tastes like buttcrack instead of ass). In school we wanted to do the “Mag Citrate Challenge” where contestants each chug a bottle of mag citrate, and the last one to crap themselves loses.
Moving on,
What is the issue with old people being obsessed with their poop? Does being old make very simple things magical? “Martha! Come look at this! I’m growing a brown tail! Loo-… awww.. It fell off onto the floor”.
I cant explain it. I mean, I enjoy taking a good dump (its when I get to sit and relax during work!), but i’m not going to run into my pharmacist in a panic if my brown babies arent birthed at the same time each day. Here are some horror stories from the pharmacy:

  • Lady calls up to tell us she’s shit down the back of her legs, and now her shoes are filled with shit. She asked what do to, so I tell her to take her shoes off and get a mop.
  • Man gets a bottle of Mag Citrate to tell us he hasnt pooped all day, and he feels something but its too far up there for him to reach with his fingers. Please dont touch anything sir, you have problems.
  • Man comes in the store in a panic because he hasnt pooped in 2 days. When I ask him if he’s eaten anything in 2 days, he said “No. Why do you ask?”. I politely inform him of the not-so-known fact that poop is indeed (believe it or not) made of food, and if you dont eat any food, you wont make any poop. He had a look of complete surprise. Yes, you and I are paying for his MediCare benefits.
  • Bermuda-Triangle lady who says “what have you got to take a shit, i’m backed up to my lungs”
  • Person who pooped his pants in the store was enjoyable. Im just glad it didnt roll down his leg and onto the floor. The look on his face was priceless.
  • Person who hadnt pooped for 2 weeks, and wondered what over the counter medication they could use to relieve the cramping that he had. I wanted to say “A rubber spoon, some lube, and a whole lotta teeth-grittin” but alas we told him he needed to go to the hospital.
    Its mind boggling. You would think that older folks would have something else to focus their mind on. Like watching Dallas or Jag reruns. Hell, watching Golden Girls reruns is better than dreaming of your next bowel movement (not by much though). I guess I wont understand until I hit that magical age of 90.
    Just as a side note, I pointed my dear parents to this blog some time ago. They loved the last rant involving poop so much they printed it out and hung it on their fridge. I swear, they never put my report card on the fridge, but the’ll put some poorly worded banter on how people dig through their poop looking for things on their friggin fridge. Guess the apple doesnt fall far from the tree.

  • Express Scripts, Zocor, and taking it in the butt.

    Express Scripts gets the gold medal for screwing over pharmacists across the country (shocking! I know!).
    If you’re filling Zocor (trade or generic) for an Express Scripts patient, take a look at your reimbursement rates. I have a dollar that says its about 33% below your cost. If you didnt notice the big flashy red signs that say “YO DUMBASS! THEY ARE REIMBURSING BELOW OUR COST!” then you need to take more pride in your work and stop working for Walgreens.
    Well, here at the store of The Angry Pharmacist decided to confront Express Scripts on this issue.
    The first call resulted in some talking head saying “We have done extensive market research to show that the reimbursement rates are correct”. This is completely beside the point that Generic Zocor is only made by a company called Dr Reddy, which is in part owned by Merck Medco (surprise surprise) so its a single source generic. This is also beside the point that they are reimbursing 33% below cost on both the Trade and the Generic product. I can see a company getting kickbacks from Merck so they wouldnt cover the Generic, but below cost on the Trade name?
    The second call resulted in some very interesting information. The person on the other end said that “Since our reimbursement rates are so high on our other products, we feel that you (pharmacists) can take the financial loss on Generic/Trade Zocor”. They also admited that they have recieved calls from all over the country complaining about this issue!
    Is this an attempt by Express Scripts to move people to their shitty Mail Order Pharmacy where they get substandard service (and expect me to bail their asses out when they fuck up the mailings)? Hard for me to feel sorry for them when their stock is through the roof this year.
    If you must know, we’re switching everyone over to Crestor. There arent any real good generic statins out that are “covered”, and contrary to what Express Scripts thinks we actually do care about our patients. Plus Crestor is the most expensive one out there, and despite the kickbacks that Express Scripts is getting I think this will do more damage to them than just eating the loss of Trade/Generic Zocor. Or maybe this is a plot by Merck to force people to move to Vytorin.
    Regardless, fuck Express Scripts. I’d be happy to take back this bitch if some talking head from Express Scripts can provide some documentation as to where they are getting Trade/Generic Zocor at 33% cheaper than what I am getting at it. They can email me and i’ll send them my fax number.
    So look at your Zocor scripts and let me know if Express Scripts is bending you over as well. You can comment here and ill add you to a list. Or better yet, comment here and then call Express Scripts (800)235-4357 and tell me what the talking head tells you.

    Yes! More hate mail!

    Heres a hatemail response to my Indian Customer Service Rant a while ago. I’ll put my comments in.
    Oh, this was also posted by someone at an IP that resolves to internet.walgreens.com. Someone is surfing my website at your local walgreens! Naughty Naughty!
    I understand the anger in outsource but come on grow up! I can understand being upset at the insurance company but why be upset with the help desk person.
    Because if the help desk person says to their manager: “Gee, we’re getting a ton of complaints about X, maybe X will change” Change has to start somewhere, and unfortunally in the customer service industry the shit rolls downhill. If they give me their managers direct line, or better yet the CEO, then the customer service reps wont get as much flak.
    They are doing their job!
    And I am doing mine, so their customers can get drugs so they (and I) can get paid and their patients dont take a trip to the ER.
    They work for a living and can not help that they have accents, try getting people in the phillipines or brazil!
    You’re right. They cant help they have accents. You have me there.
    Just grow up and don’t blame people who work for the f’d up companies. Yes, in case you are wondering, Yes, I am Indian. If you knew anything you would realize why companies outsource. The conversion rate for $1 is to 50 Rupees. Do you understand that?
    Uh, why not blame the people who work for the fucked up companies. I dont think they are being forced to work at these places. I’m sure they damn well understood when they took the job that they would be the human shield against the pharmacist -> insurance war. I know damn well why these countries are outsourcing. Unlike some people who surf websites that openly bash their employer while at work (i assume you work for Walgreens, coming from internet.walgreens.com), I do have two cents in my noggin. And you’re Indian, congratulations, heres a cookie for your life accomplishments. Why should I give special treatment to an Indian who cant speak english vs a Chinese who cant speak english; an African American who speaks ebonics, or a Shit-Kickin Oakie who speaks in er.. Okie? If I cant understand whats coming out of their mouth, then theres a problem.
    If you had a business how else would you save money?
    Stop taking insurances administered by Walgreens Health Initative.. 🙂 These insurance companies are saving money by paying me cost + 1.50 on all Rx’s, changing info on the cards without issuing new cards, then hiring bargan basement help. Pretty shitty move for everyone involved except them (who are reporting record high profits this (and last) quarter). Eh, you wouldnt understand, you probably just sit there, drink coffee, and check off Rx’s coming from a Script-Pro belt while your Techs do all the work.
    Forget that, my defense is b/c of how your reaction is to the help desk person. So what if they are somewhere else and so what if they have an accent. Grow up and do your job. And if you don’t like what you do, leave the stores, go work as a drug rep since you have such a wonderful accent and wonderful way of talking to people.
    I’m pissed because I have to deal with them, and their accents are so horrible that it takes 20 times repeating for me to understand what the hell they are saying. Its a waste of time for me, the rep, and our employers. I’d work as a drug-rep, but I absolutely hate drug reps. I rate them as one step below a used car salesman, because thats pretty much what they are. I used to be tolerable when they gave out free pens and stuff, but a ton of them stopped doing that.
    For the record, when I get a rep in India, I dont fly off the handle saying “You dirty foreigner stealing our jobs! I dont want to talk to you”. Im usually pissed off because I need to call the insurance company over something thats completely out of my control (and 99% of the time their fuckup) for a whole 3 bucks (I tip my pizza boy more), and then have to deal with the frustration of not being able to understand the person on the other end on the phone. I shouldnt have to repeat myself 1000 times or ask them to repeat themselves. The shit should be done right the first time. That means correct info on the cards, correct published formulary, and for petes sake better hold music!

    CNM/PA/NP, Home Health Nurses, and Stupidty

    I love getting hate mail from people who try to defend what I bitch about. Here is a good one:
    Most CNMs have Master’s Degrees…hardly career college.
    My response to that:
    Then learn your shit so I dont have to correct your errors. If you have a “masters” degree, then obvously you should have some brain cells in your noggin so I dont have to waste my time correcting your fatal fuckups. I get my shit in order before I speak with a doctor about a medication, so you should have your shit together before you speak with me about medication.
    Lets rehash the whole CNM/PA/NP issue shall we? For those of you who arent in the medical profession, heres a quick breakdown:
    CNM: Certified Nurse Midwife – Basically someone there when you have a baby. Why they gave these people the ability to write prescriptions is beyond me. Their scope of practice is about a half dozen drugs.
    NP: Nurse Practioner – At one time could prescribe everything a doctor could except C-2 narcotics (Morphine, Ritalin, etc). Thats changed.
    PA: Physicans Assistant – A NP but could write triplicate Rx’s for Morphine, etc.
    Now PA/NP’s are interchangeable.
    Back to the rant:
    How many pharmacists in the crowd have saved a CNM/PA/NP/Whoever-they-are-allowing-to-write-Rx’s-now-days/etc asses from something severe. Say like confusing hydroxyzine with hydralazine, or my favorite lamictal with lomotil.
    I had a NP sit there and argue with me that hydralazine was for itching. This was a white chick too, so there wasnt any accent (dont get me started) or language issues. She was dead set that hydralazine was for itching. Well, I guess if you take enough of it you wont have an itch anymore.
    Now this isnt a bash on all NP/PA’s, because i’ve met some of them that really know more than the Dr they work under. This is just a bash to all the stupid ones with the ego of a doctor, but without the schooling or balls to back it up.
    Lets move on now to Home Health Nurses. I had a nice call day before yesterday from a Home Health Nurse that went something like this:
    Her: “We have a problem here”
    Me: *sigh*
    Her: “I am supposed to give this person 10mg of methadone twice daily, but you dispensed the 5mg tablets”
    Me: “What does it say on the label”
    Her: “Take 2 tablets (10mg) twice daily”
    Me: “So whats the problem”
    Her: “These are 5mg tablets!”
    Me: “Yeah, you give 2. 5 + 5 = 10”
    Her: “Oh”
    Me: !@#!$!@#!@#!$!
    I swear, thats how the conversation went. When I hung up, I walked into the back room, sat down, and sobbed for the medical profession.
    Another fun story involves a tube of Regranex. Now most pharmacists out there are rolling their eyes at this point, because Regranex comes in a 15gm tube (small), and costs about 500 bucks a pop. Its used for chronic wound healing, and has a mathmatical formula to specfiy how much to squeeze out based upon the wound dimensions. Its like width x length x 0.6 = inches to squeeze out.
    So I managed to jump through the hoops to get this covered for this poor lady. Spent a few hours on the phone, and the insurance company decided to auth a few months of treatment to see if it’ll work. I call up the patient, and talk to the home health nurse:
    Me: “You know how to apply this right?”
    Her: “Yes”
    Me: “Its width x length x 0.6 = inches to apply – change with saline dressing after 12 hours”
    Her: “Ive done this before”
    Her: “Okay, just making sure”
    Drug goes out, and I get a call a day-and-a-half later. Its the home health nurse:
    Her: “I need another tube of Regranex”
    Me: “uh, why? This should last you for 2 weeks”
    Her: “I used it all up”
    Me: “But the wound is . You would need like 0.75″ of cream”
    Her: “I used it all up”
    Me: “You realize thats 500 bucks a tube right?”
    Her: “Will another tube be sent out today?”
    Now at this point I get the patient on the phone (who is very kind and sweet). She tells me the dumb twat was just latering it on like neosporin and used up the whole tube. I come unglued. I speak with her manager, and proceed to give her both barrels. It took me an act of God to get this shit covered, and a fucking dumb ignorant twat just blew what small chance I had. What burns me up even more is that I asked the dumb hoe if she knew how to apply it, and she blew me off.
    Ive been scarred by home health nurses ever since. The real pushy and demanding ones are the worst. When they start off the conversation with “You need to do…” my brain shuts off, and I just lay into them. I’m not their bitch and i’m not going to do their job for them.