S – Straight Face

Theres a skill that should be taught in pharmacy school, but isn’t. Its learning how to hold a straight face.
All pharmacists, techs, clerks have been in this situation:
You are working along, typical day, when a well endowed (not in the good way) woman comes in obviously not wearing a bra. You think to yourself “oh please, not today” but fate drew your unlucky number. She quickly walks up to the counter, and asks if she could see you. You don’t even have a chance to mentally prepare yourself before she horks up her shirt to show you her two very red and very angry mommy-bags right there in the middle of the store for all to see. She asks “Is there any cream I can put on these to make the rash go away?” You think “Holy crap are they really laying on the counter?” as your clerks make a bee-line to the break room.
Now a seasoned retail pharmacist wouldn’t even bat an eye. Been there, done that, heres your miconazole, thanks for coming. Now we shall share our secrets.
There are some main types of straight-face holding. Lets review them.

  • Laughing: You mostly get this when the patient says something really stupid and you don’t wish to make them feel bad. However there are times when it takes all your will not to laugh at the patient. A prime example of this is watching an old man bend down to pick up his dropped cane only to rip the loudest, wettest, juiciest fart you have ever heard. Now to some, farts aren’t funny, but to 99.999% of the people who are actually living, farts are a joke that never get old. Other examples include “oh god” moments like having someone shout from the isles if they can use a Fleets Enema up their vagina, or asking for the “large tampons” because they have an “especially large cooter”. This takes practice. If the other pharmacists in the store are jokers, then this is a skill you must learn as soon as possible.
  • Disgusting: The yeast infection under the breasts is a prime example of this. Now the goal of this face is to not visibly show that you have been mentally (or sexually) scarred from this experience. You will be shown stuff that you don’t want to see. You will have to talk to people who have the worse BO/Breath/Cat piss/etc stank known to man. Boobs really aren’t /that/ bad, however add on the smell of BO and you have some serious face-restraint going on. This face can also be used when looking at boils, draining wounds, the use of laxatives and pill hunting in poop.
  • Embarrassing: This one usually involves teenage girls and personal questions. Pretty easy to keep a straight face if you know what you are talking about (or are a female and speaking to a female). You’ll be asked how to properly put on a condom, how to take Plan-B, or how to insert a tampon. It can be embarrassing at first, but if you’re professional about the whole event, it’ll go smoothly. Like wild animals, they are more afraid of you than you are of them. Remember, its okay to think the “You’re pregnant at 12!?!?!” thoughts, just not the face.
  • Anger and Disgust at Humanity: You use this face when some welfare baby-factory brings in her 10 children (who are tearing apart your store) and yells at you because her Protonix has a $3 copay /and/ she cant get her vicodin/soma filled 2 weeks early. Similarly, when a 11 year old comes in for prenatal vitamins and her parents are so proud of their little girl even though her life is pretty much put on hold. Welfare recipients who drive $60k SUV’s (and frequent the ER to get more OTC Tylenol/Pediacare/Pedialyte for their crotch-fruit) also fall in this category. You must suppress the face of disgust and be neutral. Keep on telling yourself that living a lifestyle off of the working class’ dime is extremely hard and we should feel sorry for these people. …..Then think what a load of bullshit that last sentence was and why these bastards cant go out and get a goddamn job and quit talking on their goddamn cellphones while you’re telling them how to give medication to their goddamn bastard children. Am I bit bitter on this subject? Nah.
  • Pity: You use this face when you are explaining (for the 40th time) a simple concept to an elderly (or just an idiot) patient. Its suppressing the face of “How did you get through life being this stupid”. Mostly seen when people (mostly elderly) do things that you cant comprehend how they thought that could be a good idea. Such as dumping all of their medication into a candy dish. Or deciding that if 1 is good, then 5 is better. Fortunately most elderly are hard of hearing, so that long sigh of “kill me now” you let out wont be noticed the first time.
    So whats the secret? Experience, plain and simple. Having a stroke will help 1/2 of your face, but usually people don’t care for that solution. Ive given you a primer as to what to expect, its up to you to practice at home in front of a mirror.

  • Humana

    Who here wants to drop Humana? Seriously. 2 friggin buck profit from each Rx. Where does Humana get off paying us this?
    See, this is the inherit problem with the system(tm). Our best customers, the cash paying ones, have to subsidize the losses we take from taking retarded insurance plans like Humana. So who does this punish? Not Humana, they are reporting high profits this year (gee, wonder why). Not the patients, they pay their $3 copays while bitching the entire time. Its us and the private pay patients.
    When are we going to put our foot down and say “I cant operate making $2/rx!” and stop taking Humana? Humana needs a good kick in the teeth to realize that if nobody takes their shitty plan, they are boned. Seriously. I hope Humana reps actually read this to realize that they are costing pharmacists their businesses. They need to get with the program. Their exec’s dont work for minimum wage, so neither should we.
    Now I know you all may be saying “ho-hum, we’re used to it, same shit different day” but is it really? There are a bazillion Medicare part D plans out there, and the MediCare/MedicAid patients can change monthly! No excuse for them to switch to a similar plan that isn’t going to bend you over without lube! We aren’t dealing with the private insurance patients (obtained through their work) that are pretty much unchangeable. I realize that the non-Medicaid patients are pretty much screwed until November, well, cant win them all.
    Send a comment if your pharmacy terminated their Humana contract. We’ve sent ours a bunch of times to their contract department, but so far no confirmation. Lets give Humana the bitch-slap they deserve for being the flithy whore of the Plan-D’s.

    Told ya I’d get hate mail

    There seems to be a common theme among my hate mail:

    well. You’ve hit my hot button.
    There are people who are allergic to generic drugs Not the active
    ingredient but the binders dye, glycerin, etc.
    So are you going to stop counting pills and make up generics yourself?

    Hate to break it to you, but 75-90% of the oral tablets are made up of the same binders. The only difference might be the dye, but how many generic lisinoprils are there? How many generic metformins are there? How many generic drug companies are there that all make the same product (Watson, Teva, QT, Endo, Ranbaxy, Roxane, Upsher, etc). If someone has a true allergy to a “binder”, then most likely they are going to have a problem with the trade name medication. Getting an “upset stomach with everything except brand name” sounds pretty psychosomatic to me.

    did you ever stop to think about the patients who have trouble with certain
    generics? Please don’t give that crap about how all generics are the same
    as brand name. We in the medical community know that some generics don’t
    work as well. It’s a good thing you aren’t running the world because if
    you were someone would have already shot you.

    Problems such as with the binders? The same binders that all other tablet manufacturers use? Plain (non XR/ER) tablet making really isnt rocket science. They all pretty much are done the same way for the lowest dollar. Clinically, how would you determine if a generic isn’t working as well as a brand name? Maybe the patient skipped days (you dont know that, you dont have their refill records). Maybe the patient doesn’t take his/her medication just so they can get you to write a DAW-1 on their next Rx. With the exception of drugs with a narrow therapeutic index, how can you really tell that Lisinopril isnt doing its job (or the patient just wants trade name and refuses to take the generic). If you find a generic that doesnt agree with the patient for some reason, switch to another one by another company. When it comes right down to it, and the cards are laid out on the table, the reasons why generics “dont work” is because “the doctor said so” (fueled by drug rep kickbacks) or purely psychosomatic reasons. Ive seen it with every single brand -> generic switch to date.
    Amazing how generics magically work when insurance companies stop paying for the brand name and the patient is slapped with a $300 bill for the trade name medication they so eagerly bitch for.

    Entitlement and Old Folk

    You know what pisses me off? When older people want some sort of “Senior Discount”. You heard me, I’m ragging on grandpa here! Nobody is safe from the wrath of The Angry Pharmacist!
    I am totally against senior discounts. Why? We have to make up that ‘discount’ somewhere else, so we are going to charge YOU more for YOUR children’s Rx’s because some old chump didn’t save his money while he was young. Why should we treat senior citizens different than “normal” (read: not old) people/kids? I know people well in their 70’s who still work day in and day out because “it makes them feel young, and gives them something to do”. When someone asks for a ‘senior discount’ I tell them “I’ll ask your doc to change your Lipitor to a generic -statin, there is your discount”.
    The worst thing this country did was introduce MediCare. The stupid ‘safety net’ for seniors thats being funded by us working folk who will never see a cent that we put into the system. We’re paying for the debt of the elderly. What about us when we retire? Oh… no safety net, well shit, guess we’re on our own.
    Now you may be saying “Oh, the cost of medication is soooo high! Seniors cant afford this on their ‘Fixed Income’!”. One word: Generics. Yes, Generics. Why take Flomax when Hytrin and Cardura have been the mainstay for ages. Why take Levaquin when you can take Keflex or Cipro. Why take Lipitor when Simvastatin is now $5 for 30 tablets. Does someone who is in their 80’s really need that prostate exam? If you find cancer, you cant do chemo or operate, so why waste money? Oh, because its the governments money, not your money.
    Nothing pisses me off more than to see this 85 year old woman waltz in with an Rx for Lipitor. Why? Think about it. Why treat someone in their mid 80’s for cholesterol? Whats the point? Hell, I think laws shouldn’t apply to someone in their 80’s. They can get life in prison for shoplifting a 40oz of Mickeys! If they want to do lines off coke off of the thighs of a 13 year old Thai hooker more power to them!
    If I ran the world (oh god help us all), Medicare/aid would be mandatory generics (unless there isn’t a generic in that class). These people aren’t paying for their medications, we are; so why should they get expensive trade name drugs for free (or $3) when the people footing the bill have to pay out the ass via their private insurance? Oh, thats right, because they are poor and/or old. They “deserve” this. Right. Play that little violin for your pity party for me.
    What gets me even more; is when seniors bitch and moan about Medicare part D and the “Doughnut Hole” when they were paying out of pocket for all of their medications prior to Medicare part D! Oh cry some more! If it wasnt for Medicare part D you’d be out MORE money. Does it ever end? Can I get one person that doesn’t bitch and moan about something?
    Wait, it gets better. I had a woman come in complaining and bitching about the cost of her medication. I ask her “Did you sign up with a Part D plan? They would pay for a bit of this”. She had the balls to say “No, I didn’t feel like doing the paperwork, so I didn’t sign up”. So she’s bitching at ME because she was too lazy to sign up for something that would save her money? To hell with her and the horse she rode in on. Then she asked if the prices I gave her included a “senior discount”!@#!@#! My head almost exploded.
    So we put up with this shit for what $2 per Rx profit (if we fill a Humana Rx). Gee, thanks Humana, so generous. Oh.. no; I don’t need lube when you are bending my store over to service your “patients” (read: suckers).
    I love our senior citizens.

    My Hero, Jim Plagakis

    There aren’t many people who I would call my “hero”. So this is really saying something when I write this.
    Jim Plagakis, you are my hero. Seriously.
    For those of you with your heads firmly implanted in your anus, Jim Plagakis is a writer for my favorite pharmacy-shitter magazine, Drug Topics. I’ve birthed many brown children while white-knuckle gripping the glossy colorful pages of Drug Topics. Jim works retail, and from what it sounds like, a fellow independant.
    Jim recently wrote an article here where he.. well.. you have to go read it. Its a classic. Not only does it totally shut a doctor down in the name of common sense, but he gives Humana a well deserved backhand across the face. Damn Humana, why havent we all dropped it yet?
    He has taken the essence of my anger here with retail pharmacy, distilled it down and removed all the swearing, cussing, sexual references, and other things that make my mother blush (yes, she does read this), and publish it in a nationwide magazine.
    Jim, if you catch wind of this; I would love for you to guest write on here! Please Jim, write on angrypharmacist! You’re angry! People love you! You, like me, tell it how it is! We are the patron saints of retail pharmacy! My email is druglord@theangrypharmacist.com. Yes, i’m plugging your site http://jimplagakis.com/ and being a total pharmacy fan-boy over this. If I’m ever in Texas, we need to go DRINKING (not drinking, but DRINKING).
    Yes, this entry isn’t all that angry, but I’m prepping you all for my rant on entitlement. This one will insure me a firm E-Ticket in Hell for ragging on the elderly.

    The F in Farmacy stands for Free

    Why do patients always expect medication to be free? I’m not talking about something that costs kilo-bucks, but stuff that has like a $3 copay?
    Person comes in for their monthly HIV medications. Has the balls to stand there and bitch to me how he has to pay a $3.10 copay for each of his Rx’s (when we are getting a whopping $10 dispensing fee for a $700 Rx). Now I can see all you retail folk out there sighing and nodding your heads. I politely say to him how much the cash price would be if he had to pay out of pocket for all of those medications (which ended up to be over $2k/month). He had the balls to tell me “Well, I’m HIV positive, so I shouldn’t have to pay those copays!”. What.. The.. Fuck..
    I swear I got so pissed that I almost blacked out. I just smiled, bit a hole through my tounge, and dropped the conversation right there. I almost asked him if he wanted a medal for being HIV positive, it being quite an accomplishment in life. Seriously, where do people get the notion that they deserve something for free based upon their condition? Yes, I am going to hell, yes I am getting hatemail over this one, and no I dont feel this way about everyone who’s HIV positive.
    What is with people and expecting everything they pick up in a pharmacy to be free? Why did I go to college do deal with this?

    Dos and Donts when asking for Copies/Transfers

    Usually my rants are about patients, doctors, the system, etc. This one is about other pharmacies and other pharmacists.
    We all get copy requests from other pharmacies. For those of you who are playing along at home, when you want your Rx filled at one pharmacy transfered to another pharmacy, there is an unwritten procedure that assures that your Rx gets safely transfered to your pharmacy of choice.
    Now as easy as this sounds, there are some real assholes out there who just grind my gears. Let me elaborate.

  • The biggest unwritten rule is that the pharmacy that is getting the copy (the one who is going to fill it) initiates the phone call. That means that if your Rx was filled at Rite-Aid, and you want to get it filled this month at Bob’s Discount Drug, then Bob’s would have to call Rite-Aid.
  • The proper way to ask for a copy is: “Hello, this is NAME from PHARMACY, wondering if I could get a couple copies please.” The incorrect way is: “Hello, this is NAME from PHARMACY, I need these Rx’s transfered over”. Usually when someone is really blunt and demanding, I tell them to go fuck themselves. You are ASKING another pharmacy to give up business so you can fill this Rx. Ask don’t assume or demand.
  • If you are calling another store that you are on good terms with, demand to speak with your pharmacist friend, then say “Gimme a copy you fucker”. Don’t be sad if they hang up on you.
  • If the pharmacist asks you if you wish to have it verbally, or via fax; the correct answer (if the patient isn’t waiting) is via fax. Hard copies beat hand-scribbled copies any day. This is especially true for narcotics. Make sure when you request fax, you follow with “when you get a free moment”. Now if you are calling an independent pharmacy, a “free moment” may be within the next 15 min. If you are calling Walgreens, a “free moment” may be a week from next Tuesday.
  • If you want a copy via phone, have your pharmacist make the call and wait on hold. Nothing pisses me off more than when a dumbass tech calls me for a copy, then has ME wait on hold for THEIR pharmacist. That usually ends up in me hanging up the phone. If I have to take my time out of my day to transfer an Rx to you, then you can take some time out of your day to make the phone call.
  • If you want your copy via fax, then don’t call up in 5 min asking where it is. It’ll get to you when it gets to you. Obviously you were not in a hurry, or else you would of asked for it to be over the phone.
  • If you fax something over, make sure it has the least amount of writing on it. Don’t be like Walgreens and take a computer screenshot that takes 20 min and all of my fax toner to recieve and print out. All I need are words, I could care less how pretty your pharmacy software screen is. In fact, doing so after I specifically tell you not to usually ends up with your fax machine receiving 100 pages of pure black pages overnight.
  • When talking with your patients about transfering your Rx over, inform them that if the other pharmacy has already filled it, they may not want to transfer it over. I get really annoyed when a dipshit patient calls in their refill to me, I fill it, then they want it transfered to some place down the road. I spent the time and money to fill your Rx, so you can get it here. Unless you are in another city or state, if you call in the refill, you’re getting it here. Im not backing out or RTS’ing anything.
  • “Hi! I need for you to back out something” is asking for trouble. Some tech said this to me this week and I responded with “Well, I need a blow job, a steak dinner, and a back rub” then hung up. You don’t call up pharmacies and demand they back out something. You ask. This also goes true for Prior Auth Numbers for Medicaid. You ask for the prior auth number, not demand it. If the pharmacy says “No”, then you just tell the patient and deal.
  • Always ask if there are any patient notes before you get the copy. You have no idea how many headaches I have saved by refusing copies from known crackheads. If the transferring pharmacist thanks you and offers to buy you a beer, you just got fucked.
    I’m sure there are more of these. Feel free to comment and i’ll add them to the list.

  • The A-Z of Retail Pharmacy

    So I had this idea. I read this book called ‘A-Z of Manliness’ written by Maddox. What if I wrote a book called ‘The A-Z of Retail Pharmacy’. Seriously! Get it published, and get professors to make their students buy it! I mean I can explain retail pharmacy a whole lot better than some professor who hasn’t been yelled at in 10 years!
    So heres the table of contents. Feel free to add or suggest things:

  • A – Anger, Addiction
  • B – Babies
  • C – Chains, Chronic Pain, Copays
  • D – Doctors, Drug Reps, DAW-1
  • E – Exaggeration, Ensure, Egos
  • F – Fakers, Fake Rx
  • G –
  • H – Hold Times
  • I – Independants
  • J – Jackasses
  • K – Kickbacks
  • L – Lunches (ha!)
  • M – Mail Order, Medicare
  • N – Narcotics
  • O – Overprescribed
  • P – PBM, Prior Auth, Public
  • Q – Questions
  • R – Reimbursements
  • S – Stupidity, Showers
  • T – Transfers
  • U – Ungrateful
  • V – Vaginal Questions
  • W – Welfare
  • X – XXX
  • Y – Yelling
  • Z –
  • Albuterol HFA – What the hell?

    As you all probably know, good old albuterol (with CFC’s) are no longer being made. No longer can we get an Albuterol MDI by Warrick for 9.95. Now we get “environmental friendly” pieces of shit for $20/each.
    I recieved a phone call from a friend of mine who works in the People Republic of California. He told me that the state Mediaid (Medi-Cal) program decided (with their infinite wisdom) to take every albuterol MDI off of formulary. Thats right, he said no Ventolin HFA, no Proventil HVA, no ProAir HFA, nada.
    You know whats covered? Xopenex HFA. 29.99 a pop too. What makes it even better? The company cant supply them fast enough to meet up with the demand of California! I laugh at him! Ha Ha! Oh, get this, they wont accept prior auths for albuterol either! Ha Ha^2! Guess patients are screwed there! Ha Ha^3! Who needs ‘clinical data’ or ‘efficacy’ or ‘studies’ when you put on your formulary the product that will give you the biggest kickback, er.. rebate. California (like Camelot) is a looney place!
    So the FDA is saying that you cannot switch a patient from a CFC MDI to an HFA MDI without a new Rx. They are not equivalent and require a doctors OK to switch. They also say that all of the different HFA MDI’s arent interchangeable. I laugh at that too! You know how much bitching we would get if we faxed every doctor saying “Is it okay if we switch this CFC MDI to HFA MDI?” They’ll say “Are you retarded?”. I mean think about it; what doctor is going to say “NO! I DEMAND A CFC MDI! I KNOW THEY AREN’T BEING MADE! COMPOUND IT PUNY PHARMACIST!” Pretty retarded if you ask me.
    But what do I know, I only have to hear the complaints.