Taking responsibility for yourself

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.

Comments #

Comment by Christine on 2008-03-18 11:37:58 -0700 #

Nope, no whining from me on this one. In fact, I couldn’t agree more and you got a few laughs out of me on this one. Which is why I’m a regular.
“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.”
Now that got me laughing.
I’m not in pharmacy, but I am in nursing. I worked renal over the summer, which is non-compliant diabetic fest floor. Seriously, I also got a lot of transplant patients and I got patients s/p pancreas transplant who couldn’t tell me what types of insulins they were on before the transplant. Yes sir, get that person a new pancreas, they’re obviously incapable of managing their diabetes. I still get blank stares from a lot of patients when I ask what meds they’re on, and not just from 80 year olds who take 20 meds. Also from 30 year olds who take 2 meds. It amazes me.
I had a patient in renal who’s a1c clocked in at 15 or something and had already had a kidney transplant (on the tax payer’s dollar, of course). Why was he in? Why, to get a biopsy to see if he was rejecting. Because he hadn’t taken his tacrolimus in 2 weeks and had an FK506 of 0. He ended up getting admitted because while he was there, they noticed his feet were rotting off (hmmm, wonder why). When I asked him how long he had been diabetic he told me he wasn’t.
In case you’re wondering, that’s not the only place they came from…you were mentioned on a few of the boards.
I know those are the type of patients you’re referring too, and they drive me crazy too.

Comment by Gail on 2008-03-18 11:41:01 -0700 #

This reminded me of the time I stopped at the pharmacy to buy a box of syringes for my diabetic cat. I had already gone through most of the store shopping, and run into the Hostess sale. (It was a very good sale.) And I stocked up a bit more than was probably reasonable.
So I roll up, my cart full of hostess and ask for the syringes. They looked at me, at my cart, and I thought they were going to kill me. I quickly added the “for my cat” bit, and all was well with the world.

Comment by pharmd2bee on 2008-03-18 13:39:25 -0700 #

“Patients need to start taking an active role in their own care of whatever they have.”
that about sums it up right there.

Comment by http://openid.aol.com/blastoff2them00n on 2008-03-18 14:56:03 -0700 #

amen

Comment by Kathleen Weaver on 2008-03-18 15:49:55 -0700 #

If I walked into your pharmacy today, you would like I am one of your non-compliant patients.
I’m almost 300 pounds, late 40s, and yes, diabetic.
HOWEVER, I am an insulin pump, knows my last A1C (well, actually the doctor forgot to tell me that one, but I know everyone BUT that one). Oh, and I wear a CGMS (Dexoom to be exact). I also run dog agility (yes, I said run).
I understand you are a small business, and you operate on a small profit margin.
However, there are some things you don’t understand about diabetics and being diabetic. I don’t live in the real world, and you don’t quite get the real world.
Oh, by the way, my mother joined the real world of diabetes a year ago, and she’s just starting to understand that world AND the world I’ve been living in, so don’t feel bad.
The real world of diabetes is that the doctor doesn’t make a big deal out of it. You might get sent to a diabetes educator, but at the time you do, you are so freaked out over the diagnosis you don’t absorb much. Besides, the usual format is set up so that you DON’T learn (I’m a teacher, I know how to set up a class so you can learn and so you don’t. These are set up so you don’t). See the Little People, Big World episode filmed last year where the father got diagnosed with diabetes if you don’t believe me. His experience is typical.
So the patient is set up to fail, and hasn’t a clue on how to be compliant, and sadly the doctors and the insurance companies don’t care.
Here’s the REAL secret though, and the insidious thing about diabetes. The less your blood sugar is controlled the more you are driven to eat. YES, high blood sugar makes you crave more sugar and not only that, that craving is nothing you can control.
Here’s the next secret. Most of the diabetes drugs, especially insulin make you hungry! Metforim and Byette are some of the few drugs that don’t make you hungry.
So here you have a patient who doesn’t know what is going on, the doctor is throwing a pill at that patient once a day, AND both the condition and the drugs make the patient want to eat and eat the worst possible thing.
Yeah, I understand where you are coming from on the test strip thing — you’d be amazed at the number I go through on a good controlled day. Not because I want to, but that in the long run I feel better.
So why don’t I believe to that world? I watched my father go through this crap long before the test strip was invented, and it was a nasty way to die. I’m trying for a different way.

Comment by EE on 2008-03-18 17:58:58 -0700 #

My fave. part:
“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).”
LMAO!

Comment by OzPharmStudent on 2008-03-18 18:05:37 -0700 #

Kathleen Weaver / Anybody with chronic condition
How often do you ask your pharmacist to explain what is going on with your medication, general disease or non pharm measures to help. Nothing make our (mine at least) day better then having a patient who is genuinely interested in their condition and wants to learn as much as possible. We may not be allowed to diagnose but but treatment is our field.
You can talk to us when you are ready to, not when the doctor decides you should be talked at. We can point you in the right direct for further help and will bend over backwards to ensure your questions and worries about the condition are fulfilled.
The sooner patients and doctors stop thinking of pharmacists as useless box labellers that ruin people holidays the better healthcare will improve for individuals and nations.

Comment by GC on 2008-03-18 19:15:36 -0700 #

haha great stuff there TAP. I was checking that link you posted to the diabetic forums. I love how they are ranting and bitch about the rants. Clearly people failed to notice that you are the ANGRY pharmacist and write rants about everyone not only diabetics.
“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.” lol

Comment by jmerph on 2008-03-18 19:51:06 -0700 #

I ALWAYS say that phrase “A lack of planning on your part does not constitute an emergency on my part”. If anyone from my pharmacy reads this post, they will laugh because they hear that all the time.

Comment by indietech on 2008-03-18 22:01:20 -0700 #

wow TAP. i sure picked a bad time to go on vacation. i missed all of this! anyway, i actually have a perspective from BOTH sides of the argument! yes, i am prediabetic, although we are treating it as seriously as diabetes in order to reverse it or at least prevent it from progressing. i do test daily, once or twice. occasionally i will test extra if i want to know how a particular meal affected me. i haven’t had anyone teach me about carb-counting or bad/good sugars. but guess what. instead of complaining about what a bad doctor i had (as she is wonderful) or what a bad pharmacy staff i had (as that is me) i took the initiative. i researched prediabetes online, through ADA and i actually read BOOKS as i know not everything online is 100% accurate. i don’t know everything and i’m still learning but i’m probably one of a handful of prediabetic 21-year-old college student who has actually CHANGED her diet, CHANGED the way her family eats and DONE something about her condition! but it’s something EVERYONE can do. nothing pisses me off more than seeing a 300 lb 53-year-old patient come into the pharmacy and refill their strips for the first time in a year. and yes, they DO buy candy bars. so diabetics, cool it. don’t blame your pharmacy staff. yes, we’re not all perfect and we don’t know everything about diabetes always. sometimes there are real life angry pharmacists who have just had some druggie come and get an oxycontin prescription filled 20 days too early and now don’t really want to deal with any one else’s crap. and pharmacists/techs, realize that this IS a scary disease. if you have a patient who is a type-2 and maybe doesn’t need to be testing as much, sit down and talk with them. if that doesn’t work, talk to the doctor. if nothing changes, at least you tried.
oh and everyone just learn to laugh at yourselves once and a while. not everything that’s being said is being said about YOU so don’t take it personally!

Comment by pharmy on 2008-03-19 00:15:19 -0700 #

Impossible not to eat when you are hungry???? No point of arguing with you on that onem you may BITE my head off.

Comment by CO on 2008-03-19 02:48:10 -0700 #

“Taking responsibility for yourself,” what a novel idea? Sometimes I really wish I can say that to people; especially those who pulls the whole “my plane leaves in an hour, can I have my pills,” crap at least once a year. I also love those people who fills a RX, doesn’t come in for two weeks to pick it up so the fill was RTS’d and then complain they have to wait twenty minute while the pharmacist refills it again. Clearly, one week is not enough time for someone to drag their lazy ass down to the pharmacy to pick their meds. Personal responsibility is too high of a concept for most people.
BTW, I actually put up a sign that reads “A lack of planning on your part does not constitute an emergency on my part,” in my pharmacy. Out of pts’ sights, of course. Heaven forbid I offend someone.

Comment by Laura S D on 2008-03-19 04:30:13 -0700 #

I am a pharmacist in Scotland-and get all the abuse just like yourselves from patients who get their meds for FREE!!!
Count yourselves lucky-at least you hold some cards, we are “duty bound” to process any prescription that is presented to us by law..
That is the NHS for you-its all crap!!
Why is it that doctors get all the respect and us none? Because we are the gunnies in the front line….Sempre Fi!!! to all my pharmacist buddies!!

Comment by http://openid.aol.com/blastoff2them00n on 2008-03-19 05:00:08 -0700 #

Ms. Weaver,
To put it plainly, I would estimate (liberally) that only 5% of the people who come into the pharmacy are actually pains in the side to deal with, or irritate me, or are otherwise upsetting.
As far as I can tell, you are not those people.
The AP is venting b/c he probably had like 3 people in the same hour give him shit about their test strips being too soon on Medicaid. It can be really frustrating to help people spend your tax dollars.
I only have about 3 complete pieces of work who come into my pharmacy, but writing and telling stories is a lot more fun when you turn everyone into a charicature.
So, I would probably make the following disclaimer about this blog:
“CUSTOMERS IN STORIES SEEM DUMBER THAN THEY ACTUALLY ARE. IF WE DON’T MENTION YOU BY NAME AND YOU DON’T WORK FOR ARGUS, WE AREN’T ACTUALLY TALKING ABOUT YOU.”

Comment by melissa on 2008-03-19 08:07:12 -0700 #

Kudos on your site, makes my day. I work in Cardiothoracic surgery and practically every case the patient is DM II. Pretty much every one gets an insulin drip as part of a Tight Glucose Control initiative within the hospital. What kills me are the patients that come in for surgery with mulitple toe amps and are still not on insulin, just “oral” meds, and are probably non compliant with those. How many toes does one have to lose before the light bulb goes on in their noggin that “mmm, maybe I should start taking this diabetes thing seriously…”?

Comment by IReallyAmInPain on 2008-03-19 09:12:25 -0700 #

I know you’re angry and don’t post about the nice patients very often, but I must ask if you think all vicodin patients are druggies. I had a super-duper badass accident five years ago (slipped on some ice, got hit by a car…I fucking rock).
A billion surgeries later I’m always in pain. Docs want to put me on Oxycontin, morphine pumps, all sorts of shit. I’ve refused the heavier meds because I already feel like I’m sticky with vicodin. I’m not “early refill girl,” and I for SURE don’t have an escalade (I walk to the pharmacy, even though it hurts. I walk to work, too…yes, I work…and I’m not on public aide).
I want to know if you think we’re all horrible. I’m not being critical, I’m just curious. The thing is, being on vicodin for 5 years has screwed up my life in many ways. One of them being that pharmacists look at me like I’m a screw ball and the other is that I don’t know how to live in pain without the scapegoat of a pain killer. I worry constantly. What the hell am I going to do? It kills your sex drive, and a bunch of other stuff, but it also helps me walk.
Are there any “vicodin” patients you don’t think are junkies? Maybe it’s myself feeling like one because of all the weirdness I get at the pharmacy or the fact that deep inside I don’t know what to do or how to get off the stuff or if I even can deal with the pain.
Some vicodin patients are scared, feel silly, embarrassed and hate the monthly trip to the pharmacy because we, I, know the media hates us, pharmacists seem to hate us, me, and in turn, it keeps me up at night.

Comment by ndenunz on 2008-03-19 09:27:56 -0700 #

I have a question regarding changes in medication. I am a physician. The way I usually handle it is that I tell the patient the new dose and then write a prescription to reflect that dose. I then tell them that they’ll have to go in earlier than usual to get a refill and to use the new prescription to let the pharmacist know that the dose has been changed. Is that the best way to handle it?

Comment by MidwestPharmr on 2008-03-19 13:39:51 -0700 #

At the pharmacy school I went to, there was a 40 something guy who was in the class below us. He gave a speech to the class about Type 1 diabetics since he has been one since childhood… The look of horror on my classmates faces as this guy jokes about the eye surgeries, dialysis, hypoglycemic attacks, and the final pancreatic transplant is unforgettable. Now hes an overweight, balding pharmacist… If the world is fair he’ll get Type 2.
Sx of diabetes: dyspepsia, polyurea, polyphagia, bitchface.

Comment by Cpht on 2008-03-20 03:08:26 -0700 #

ndenunz,
That is a okay way to handle it. Another way would be calling the new script directly in to the pharmacy or just use the handy dandy E-rx LOL or just fax it in. Its always best if we have it on record because many times the Patient lost the script or magicly denies ever getting the script. in the end we get bitched at and have to end up calling the office.

Comment by rph3664 on 2008-03-20 07:55:03 -0700 #

Melissa, regarding the toe amputations, etc.: I think a lot of people like the attention and having people feel sorry for them. JMHO.

Comment by Shalom (R.Ph.) on 2008-03-20 12:20:36 -0700 #

@ReallyInPain: No, we don’t hate all vicodin patients. Just the ones that are always trying to get more than they are supposed to have (lost them down the sink, cat peed on the bottle, fell out of purse on the bus, going on vacation, doctor increased the dose but mysteriously forgot to document this anywhere on either his end or ours, etc.).
If you’re on heavy pain medication, but you always fill it on time (i.e. if you have enough to last 30 days as per the labeled directions, you don’t try to fill it after 10), and don’t come in early with baloney stories, then we have no problem with you at all. I had one cancer patient on enough morphine (180mg per day) to kill a horse, but he was never early for his fills, never claimed to have lost them, etc., and like you he had a job and was a productive member of society. We had no problem with him, the stuff was just something he took so he could get on with his life, no different from someone taking norvasc for his blood pressure. Now the guy who had a different (and progressively stupider) excuse each week for why he needed his meds refilled early, him we gave an invitation to the rest of the world.

Comment by Sammie on 2008-03-20 23:02:15 -0700 #

I think this entry is hilarious. One of my pharmacists also has a saying: “Your lack of planning is not my problem.”

Comment by nobody on 2008-03-21 12:15:53 -0700 #

You can’t be serious when you say you want people to take an active interest in their own physical maintenance. Can’t they just get it in a tablet?

Comment by Andrea on 2008-04-05 17:34:54 -0700 #

To patients on Vicodin, Oxycontin, benzos and other similar meds- I don’t think of any of you as bad people, unless you give me a reason. Some of my favorite patients are on some pretty strong meds. These are the patients that come in every month for their rx’s. That’s every 30 days, not every 27 or 28 days. I am a pharmacist in New York state, and by law I can only fill your prescription early by so many days, for as long as you are on the specific medication. When you come in asking for early refills on a regular basis, you put me in a bad spot. You get upset with me, when in reality I am not going to put my license on the line for someone who thinks that a max of 3 tablets a day means that you can take them whenever the hell you feel like it. If you need to take more, no matter how much pain you’re in, your doctor needs to write you a new script with new directions.
And please, don’t beg me to break the law, even just this once. It pisses me off and makes you look like a druggie.

Comment by JustAGirl on 2008-04-08 15:47:18 -0700 #

This is funny to read this now because 10 minutes ago I was on the phone with the pharmacy trying to see if i could refill my meds yet.. But when I can never get in to see my doctors- how do I talk to them about putting different directions on EVERYTIME! They will start me off with you know the 1 every 4-6 then next time its one at bedtime and now one every 6 hours… I am not trying to refill early.. if you looked at my refill log i refill the same everytime.. but because my stupid doctor changes the directions it messes me up and then now i cant work because he cant take the 2 seconds to look into my file and see what ive been doing the past 8 months!!! fucker.

Comment by Jason on 2008-08-12 05:50:26 -0700 #

Now what really bugs me is the “patients not taking responsibility for their own health care” I work in the mail order side of things and getting people their meds is hell. We have certain policies… patients call in and say, “look, I want you to get my script from my doctor and I want you to send me a bill along with my meds”…. lol really? Go to walmart and ask them to send you a bill after handing you the medications. And the part about us getting the script for you, we do that as a courtesy… if we don’t get a response the pharmacy can’t do much about it. If it’s too hard for you to talk to the doctors office than it’s probably not going to be much easier for us. It is the responsibility of YOUR DOCTOR to get the pharmacy the prescription, not the other way around. PLEASE take this into consideration when filling scripts.

Comment by Walking Pharmacy on 2008-11-28 18:15:28 -0800 #

What I’d love to see is how these diabetics would fare if they had antiphospholipid antibody ‘syndrome’ instead. Post PE and coumadin for life, when they are only 20 years old?!?!? Add on non-compliance…How would these lads last? When’s the next clot coming or when will they bleed out and how much more $$$ money would be needlessly wasted? This sounds sick and no punn intended but, it’s a way to thin out the crowd. Yes….crappy Thanksgiving but now…a bit happier. 😉