Returning Medication

I hate to RTS (Return To Stock) medication. Plain and simple. Its just a fact that I really dont like to fill something, then have to undo my work because you’re an idiot and didn’t want it (yet called it in to be refilled). Yes, surprisingly enough it does cost the store money to fill your Rx even if you don’t pick it up.
If your child gets an antibiotic, and I ask you “Can he/she take a pill?” while showing you (and your child) what it looks like, and you both say “yes”; I don’t want you to return said prescription 30 min later and want liquid. When I warn you that its a lot of liquid (because your child is a pussy overweight 16 year old who can swallow mcdonalds but not an amoxicillin capsule) and it tastes bad, I really do mean it. The stuff tastes like shit, and its a lot easier to take 1 tablet than 2 teaspoons three to 4 times a day. I told you this straight out.
Then you wonder why I go postal when you come BACK the next day and want tablets again because your douche of a child doesn’t like the taste/quanity of the liquid THAT I WARNED YOU ABOUT THE PREVIOUS DAY! If I made it Big Mac flavored, then your child would drink the whole damn bottle!
Oh, this gets even better.
Then you have the BALLS to get angry at me because I charged you ANOTHER copay. I’m sorry, but I cant suddenly remove the water out of that amoxicillin suspension. Its yours to keep as a reminder of not-listening to what I’m saying.
I’m sorry if you’re just not a good listener. Obviously you didn’t listen when the whole topic of ‘condoms’ or ‘contraception’ came up while you were 13 years old. You did however listen to that deadbeat baby-daddy of yours when he said that he ‘loved you’ and ‘raise this child together’. I don’t care about your pity party, I only care that I lost all the money I made out of this Rx by redoing it yet again.
Yes, I did go there and I am going to hell.
Oh, and to our other customers who don’t listen:
When you call in a refill on your medication and are 3 weeks early; then have the balls to argue with me on the phone and swear up and down that you didn’t receive them (even though you signed for them). When you find them at home, just shut your mouth, and eat the cost of the early refill. Don’t come waltzing back in and demand a refund on the extra fill that I did for you.
People wonder why pharmacists drink….

Amgen: Fucking over the little guys one wholesaler at a time.

Got a call from a fellow classmate of mine. He had quite a large bitch that he wanted me to make “public”.
Turns out Amgen is not shipping any of their dropship items (Enbrel, etc) to pharmacies UNLESS the pharmacy orders it through one of their “approved” (read bribed) wholesalers. His independent wholesaler was not on the list. I got in contact with said wholesaler and they told me that Amgen basically told them to go piss up a rope, and for the pharmacy to switch wholesalers.
Now for those of you not in pharmacy, Enbrel is a drop-shipped item. Meaning you order it through your wholesaler, and Amgen ships the medication directly to the pharmacy. The wholesaler does not stock the medication. It goes from Amgen -> Pharmacy. All the wholesaler does is handle the billing aspect and money exchange, thats it. Has nothing to do with this ‘pedigree’ mutual masturbation clusterfuck.
I have no idea if this applies to other Amgen that wholesalers stock (like Epogen).
So, the small independent pharmacies, wanting to stick to their loyal independent wholesalers, cannot order any Amgen products any longer. All because some motherfucking douche decided to get some bribes from McKesson, Kinray, and HD Smith. Fuck Amgen.
I’ll let you know how this turns out. He’s got every independent phoning, emailing, and threatening to cut off Amgen completely unless their wholesaler gets added. Of course i’m not helping Amgen either.. ๐Ÿ™‚

NPI – Someone needs to get a real job

Who thought this NPI (National Provider Identifier) would be a good idea? What bored non-working bureaucrat with too much time on their hands (and has never held a ‘real’ job) decided to bring hell down upon us hard working pharmacists? Oh wait:

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of a standard unique identifier for health care providers. The National Plan and Provider Enumeration System (NPPES) collects identifying information on health care providers and assigns each a unique National Provider Identifier (NPI).

Thanks Hillary, you fucking twat. DrugNazi set me straight (for once). Hillary is still a twat for reasons not gotten into here (this is a pharmacy blog, not a place to voice my political opinions).
For those of you not in pharmacy, currently Providers are identified by insurance companies as so:
Pharmacies: NABP/NCPDP number. Its 7 digits long.
Doctors: DEA Number. Its 2 letters and 7 digits long. Or a Tax ID Number.
Easy isnt it. Short, sweet, and has been effective for the last 100 years.
Now everyone has to apply for a NPI number. Thats right, a NEW number that we all know ALL insurance companies will have installed flawlessly in their software so there will be NO slowdowns in processing. Right, until you get that doctor who has not gotten his yet, and refuses to give it to you. So for this to work, EVERYONE needs to get an NPI number, swap it amongst each other like Garbage Pail Kids cards and assume that the insurance companies have their shit together and everyone added.
So lets take a solution, and run madly around finding a problem. Sounds like HIPAA

ePrescribing

I’m probably the only person here who is going to feel this way, but I think this whole ePrescribing shit is bad juju.
Sure, doctors obviously lack some gene to write well, but ePrescribing is going to end up killing more people than saving.
Why? Take your typical doctor. Brilliant medical mind, but can barely point-and-click. Now throw that doctor in front of a computer with a tiny little drop-down box that has such winners as:
Hydralazine
Hydroxyzine
and
Lamisil
Lamictal
and
Topamax
Toprol
In tiny tiny font all right next to each other in the drop-down drug selection menu. Ever click on the wrong thing on the screen? Yeah, I think you can see where i’m going with this. Uh-oh! Here comes hydralazine 25mg 1 q8 prn itching come racing into our fax machine. Uh-oh! That patient just died! Uh-oh! That pharmacist was a major dumbass (*ahemwalgreensahem*) ๐Ÿ™‚
To make matters worse, the doctor probably has someone talking to them while they are trying to place that little mouse pointer on exactly the right drug in the huge huge list thats scrolling down past the bottom of their screen. Click on the wrong drug, type in their magical password so it prints their signature on the dotted line, and blam-o, your pharmacist just saved you from lawsuit city. Now if this doctor has a 21″ flatpanel that drop-down box is pretty damn big, and the click-space between similar sounding drugs is pretty big too, but what about PDAs? Now that big screen is a tiny tiny little screen with a tiny tiny little stylus that you select the drug from a tiny tiny little list. Fun shit technology is.
Now I know you all are probably thinking; “Gee! This happens with paper-and-pad Rx’s all the time too!”. However, using a mouse does not involve 20+ years of muscle memory. Ever drive on autopilot to the office and wonder “why did I come here?”. Any schmo doctor can write out Amoxicillin 500 tid x10d #30 while talking, doing surgery, and taking a dump. They have been writing Drug X with Sig X and Quanity X for 20 years. Drug matches Strength matches Quanity. If they error, they error (you hope) on the side of just writing the wrong drug and a safe sig to go with that drug. Sure, the patient is getting the wrong drug but I’d rather have him get the wrong drug and a correct sig for that wrong drug than the wrong drug and an overdose sig intended for the correct drug. Make sense? Confusing isnt it.
What about forgeries? We all know Windows is a exploit riddled piece of crap operating system, but 99.999% of ePrescribing is written for it. Send an office staff a little happy email with a virus, and you have an endless supply of vicodin and soma that you can send to ANY pharmacy and have it be “legit”. You think a minimum wage front-end office staff girl is going to question Norco 10/325 #240 1 q4 prn pain with 5 refills when it clearly shows that on their computer screen? Hell, I bet the software even helps them with the sig and everything! At least with phone-ins you get a gut feeling when its a phony by the way they call it in (or its a voice you dont recognize) or the red flags with a stolen Rx pad.
To make matters worse – patients come waltzing into your store expecting their Rx to be ready (because doctor was typing it in while they were at the office an hour ago) only to have it NOT be at your store because their ePrescribing auto-fax software screwed the pooch (or they have your fax number in wrong). So it takes a phone call from you to a dumbass at the doctors to get a verbal. All when 2 extra seconds and a hard-copy Rx is all thats needed. Horrible, absolutely horrible.
Now I know all the doctors at home will say “But it makes reviewing my patients medication SO much easier”. Thats great, but does your software talk with the patients cardiologists software? How about the patients neurologist who prescribes Tegretol 1600mg/day and you’re giving them Nizoral 200mg qd (I caught that one today, +1 for me!). ePrescribing is all fine and dandy, but if your records are going to be electronic, at least interlink them with other doctors offices (oh, I can see the HIPAA police frothing at that one). Of course the same could be said about independant pharmacies as well, but at least we talk to each other on a regular basis.. ๐Ÿ™‚

Angry Doctor II

So a few months back I got into a bit of a Pharmacist vs Doctor war (I think it was involving drugbuyers.com, narcotics, and the bit). I wrote a very heated response to a hate-mail that I got, and never published it hoping that the whole situation would just die (which it did). Yanno, taking the high road, etc.
Since I just got back from vacation, the angry-pumps arent quite primed for a new entry, so you get one that I wrote when that stuff was going on (but I didnt publish it).
Oh, as before, I am /not/ anti-doctor (a bunch of my friends are very nice doctors). However what I say below is how I feel on most issues when doctors get uppity. Lets not start another war here. Its sad that I have to put a disclaimer as to not to piss off a bunch of my MD readers.. bleh!
Onward!

There are many differences between pharmacists and physicians: your post
and your comments highlight the big ones.
Physicians work as hard as they can to not judge our patients based on
race, income, gender, sexual orientation or sexual preferences. We learn
NOT to make rash assumptions. We know that the superficial appearance
doesn’t always tell the whole story.

We dont initally judge either. However, since we spend more than 5 mins with these patients more often than once or twice a month, we have a better understanding as to who they are. Regardless on how they look when they walk in the door, I treat them with the same respect and kindness I do everyone else who walks in. However after the 5th phone call in 2 days asking if their Vicodin is due yet, I tend to get a bit irritated and annoyed. You have a front-end staff to deal with that crap, I dont. They can just walk in and start yelling anytime they want. I dont have the luxury of setting appointments.

You’ve now gone and made pharmacists look like every other whiny, catty,
self-rightous, ignorant retail clerk. Congratulations. The more that the
general public reads work like this, the faster you’ll lose the title of
“Most Trusted Profession”. I’d never set foot in your pharmacy knowing
that you’re review prescription histories and make fun of patients this
way.

Im sorry for reviewing patient histories, I thought that was part of my job. I’m sure the front-end girls in YOUR office have their share of chuckles and eye-rolls when they find out that patient-X is coming in at 2:30 to get his Rx’s refilled. Im sure you yourself have written an Rx or approved an early refill just to get a troublesome patient out of your hair. See, we dont have that luxury. We cant just fill vicodin 4 weeks early just to get them out of the store, its unethical and grounds for having men in suits come and look at our records. We dont have the luxury of setting appointments, or closing for lunch for 2 hours, or taking off at 5pm on friday. We dont have an officestaff to say that you are busy, or with a patient so you dont have to deal with these folk. We take the heat from your patients so you dont have to. We are the last line of defense in preventing truckloads of vicodin and soma and other crap from hitting the streets. I have no problem telling a patient that his pain pills are due on this date. What does the doctor say when the patient bitches to him/her? “Well, I wrote for them, its up to the pharmacist if he wants to fill them”. Not “You’re getting them too early, NO”. So he/she absolved himself of any blame. We’re the bad guy, you’re the good guy. Its hard to be nice when you’re getting lied to by the patients, and used as the scapegoat by the doctor.
So if I look like a “whiny, catty, self-rightous, ignorant retail clerk.” Then you really need to walk out of your little office, with your cushy chair and big computer monitor and start spending more than 5 min with the patients that I see and talk to all month long.
So yes, we still we be the “most trusted profession”, because the people who I poke fun at will just choose another pharmacy in a month. However that 80 year old patient of yours (a patient of mine of over 25 years by the way) who is seeing 4 other specialists (and you all cant be bothered to talk to each other to formulate a drug game-plan) is coming in holding Rx’s for 3 different ACE-I, a few beta-blockers, some warfarin + amioderone, a smile on her face and a story to tell us about what happened at church last week. You paint that picture on why we are trusted and why your patient isnt dead.

Shame on you.

No, shame on you for making a blanket assumption about pharmacists based upon a blog who’s humor obviously eludes you. When is the last time you found out what pharmacy your patients were mostly going to, and paid them a visit to say hi and thanks for all they do? Try it sometime, oh wait, you’re too busy going to free CE dinners by drug reps to learn what new drugs are out rather than reading non-paid-advertisements like us pharmacists do. God knows you arent approving refill requests that have been sitting on your desk for the past month (while I advance the patient some to keep them out of the hospital).