Why us retail folk are hard core.

Somedays I stand there at work and wonder why I went to college. Why did I spend 7 years of my life learning all there is about drugs to have some crackhead bitch at me about an early vicodin refill or being the narcotic police. Why do I need to cover the ass of some mail-order douche who’s medication got lost and I’m taking the heat for something thats 100% not my fault nor problem?
Its because pharmacists who work retail are bad-asses.
I dont care if you work for a chain or independent. Retail Pharmacists need to plop their gigantic pharmacy testicles on the counter and say “suck it, we rule”. Elitist? You’re damn fucking right we are, and here is the reasons.

  • We don’t have the luxury of getting our hands on a patients chart for the latest labs. We need to piece together whats going on with little/no information.
  • We dont have the luxury of having coffee with the doctors, or being able to walk out of a patients room after talking with them.
  • We dont have the luxury of sitting behind a locked door just filling orders as they come in via the fax.
  • We get yelled at, swore to, blamed for everything. We somehow take the blame for stuff that nurses/children/insurance/hospital/doctors/anyone does.
  • We are the front line of medicine. You hospital/closed door type may think you get idiots and problem patients, but ask any retail folk worth his salt and your worst patient is our best one.
  • We get shown boobs, rashes, wounds, etc. We are pseudo street-doctors, the triage before the ER.
  • We are insurance salesmen, computer techs, printer repair people, floor sweepers, coffee makers and everything else.
  • We have to stand there and keep a straight face when someone yells in the store that their penis doesnt work anymore and needs Cialis. Or they have an itchy cooter and needs some cream to ‘shove’ up there.
    When you say the word “pharmacist” people think of us. That is why our testicles are the largest of them all.

  • I hate Movable Type

    Decided to change the layout on the site to something with less pictures. Turns out my hosting bill was through the roof because of all the nice background pictures on the site. Plus people were getting errors from the search and a bunch of other stuff didnt work right.
    I managed to screw everything up. The main site looks fine, but the individual pages are all messed up style wise. Computers ranks up there with whiny crackheads in my book. I cant win.

    Why do people still think Marijuana can be prescribed?

    As a pharmacist what type of medical marijuana abuse do you see?

    I see tons of abuse, and zero Rx’s. MJ is a C-1 narcotic like Heroin, LSD, and PCP. It cannot be “prescribed” or “dispensed” legally in the good ole USA.

    I’m in college and I always hear of Doctors illegally prescribing Marijuana to kids who pay a couple hundred bucks. Is this just talk or does it actually happen? How big of a problem is this and how can it effect your pharmacy?

    Doctors cant prescribe a C-1 narcotic nor do pharmacies stock C-1 narcotics (research facilities excluded). Regardless of what those fruity fucks in California say, MJ is illegal, and always will be illegal. States cannot make a less-strict law to override federal law (however they can make a state law more strict than federal).
    DEA has the final word, and the only reason why there is this MJ Rx bullshit floating around is that they have bigger things to worry about like inspecting pharmacies for vicodin use and making our lives hell than to bust some broke stoned pothead.
    So the “Doctor” that is “prescribing” this MJ is just a glorified pusher who should have his license revoked and publically strung up by his peers by propagating this stereotype. The “kids” who are buying this shit for a few hundred bucks are getting ripped off and should just visit their local stoner for a better deal.
    MJ is not an Rx drug, and the people who are getting “Rx’s” for it are just rationalizing their abuse and pulling the wool over the retarded eyes of the local law enforcement. If I were a cop, and some douchebag showed me an Rx for MJ, i’d laugh at him and arrest him (if he had some on him). I’d win in court every time.

    Paging Dr. Blackmail, Dr. Blackmail

    This is a topic that I know everyone in pharmacy knows about. Every pharmacist has dealt with it, yet like the floating turd in the punchbowl of medicine, everyone just looks the other way and pretends it doesn’t exist. So thats where I come in. I’m scooping out the turd and asking how it got in here.
    I hope Doctors (MD’s, not you uppity PharmD asses) from all over reply to this post, because I want to know if this actually happens or are we just delusional. You know that all comments are anonymous, so you have no reason to not post for fear of angry lynching (at least in real life).
    Say you are a doctor, and you fuck up on a patient bad. Not like “to error is human forgive me” error, but “sue me for lots of money” error; and the patient is fully aware that he/she has you by the balls. Is it practiced to just bribe the patient with lots of narcotics so they won’t turn you in/sue you?

    Example 1:
    Patient comes in with an Rx for Vicodin ES #180, 1 q4 prn pain **must last 1 month** x 4 refills. I start to get a huge pharmacy boner because I think this is a dead set forgery. I run to the back room as giddy as a schoolgirl who gets her period after the prom, and call the doctor. Its legit. I tell the doctor (or his minimum wage staff) about the limit on Tylenol, and at 6 a day this woman is going to blow out her liver. He tells me its only for prn and to not worry about it. I document everything and fill the Rx.
    15 days pass (the Rx was for a 30 day supply for those a bit slow on the pickup). Patient wants a refill. I tell him to (politely) take a flying leap because the Rx says that it must last 30 days. He says to call the Doctors office, so I (feeling as if i’m trying to filter piss out of the ocean) send over a call tag requesting an early fill and expect a huge NO on it. Patient must call about 20 times during the hour asking if its ready or not. Totally pissing off my frontend staff and myself. Tag comes back that its approved. I call the office and ask why the put the “must last 1 month” if they aren’t going to abide by it. They blow me some bullshit excuse and just say to fill it. I document everything and fill it (which in hindsight I shouldnt have done). Then I fill one, and 18 days pass, he wants another refill. I get on the horn with the Doctors office and ask what the deal is. I tell him that unless he makes the sig 1-2 q4 there is no way that I’m going to fill it (even then he’s really going to blow out his liver). He refused to change the sig and says that its ok to fill. I suggest Norco to lower the APAP, nada, he wants this filled (everyone knows that VicodinES by Watson Labs has a huge black-market value). I plain out ask what the deal is. He says “Doctor-Patient” confidentiality. I tell him thats great, but I dont want to ride my license on his “confidentiality” and hang up on him. I boot the patient from our place (haw haw, Walgreens got him) and blacklist the doctor. I run the sheets on the Dr, and there isn’t anything really strange about him. Handful of patients, not a big writer in our store, but blood pressure, diabetes, the usual. Just this ONE patient is a huge red flag out of the sea of normality.
    Example 2:
    Patient comes in with an Rx for Fentanyl Patches and some Norco. I don’t give this a second thought and fill it. Everything is cool, patient comes back on time and gets them filled, no problems.
    A week passes…
    His wife comes in, Fentanyl Patches and Norco. I start to wonder if something is up.
    A week passes…
    His DAUGHTER comes in with an Rx for Norco. Something is going on.
    I fill the Rx’s with a watchful eye. They aren’t early, they aren’t assholes about it. Just having all 3 family members on exactly the same drug (when he is clearly the one with any sort of ailment) raises a huge red flag with me.

    So what’s the deal here? In example 1 we have a doctor who will not budge from changing an Rx when its CLEARLY too early (and he put down that it must last 30 days) and CLEARLY too much Tylenol. Example 2 we have everyone and their family on some pretty high caliber narcotics.
    Does this problem exist? Yes or No. I don’t want to hear whiners about how the patient in Example-1 was obviously mis-dosed and in chronic pain, blah blah blah. No, it wasn’t that. He was on Mars every time he called, and he doesn’t remember calling our store or even coming in. There was something that was obviously wrong that you cannot put into writing, and every pharmacist knows what that feeling is like.
    If it is true, the Dr’s are putting the pharmacies in a really shitty position. We have to stand up to the patients when you wont over something that /you/ did and /we/ didnt. Plus, when the shit hits the fan and this person gets caught for selling, who’s going to be put under the gun first.
    If you’re a doctor, put some sort of explanation in the comments, if you’re a pharmacist who obviously is as paranoid as I am, put your story in the comments.

    Can’t feed me that info and expect a serious answer!

    This is an honest question.
    Every month I call the computer at Walgreens to have my monthly
    prescription refilled.
    I always give the computer a pickup time that is hopelessly optimistic. I
    usually don’t really pick it up until 12 to 36 hours after the time I
    entered.
    Am I a bad person?

    You go to walgreens, so yes, you are a bad person (Come on! How can I pass up a line like that)!
    Honestly, I really dont think it matters. They just sit in a drawer waiting for you. Now if you ordered a bunch of expensive stuff then sat on it for a month or two (so the pharmacy had to Return-To-Stock it), THEN came and wanted it (so they had to fill the Rx twice), you are a doubly bad person.
    Oh! If you want to ask me questions, please email questions@theangrypharmacist.com. I miss questions in the comments, etc.

    ATAP (Ask the Angry Pharmacist): Imitrex packaging

    Here is my question, though it’s unrelated to today’s post, and it’s not my
    pharmacist’s fault in the slightest. Why does Imitrex come in those big,
    folding card packages?

    Because God and GSK hate you. 🙂
    Actually it’s like that for your enjoyment 🙂 I love the Imitrex packaging, because it gives me a damn good excuse to just overrule whatever the doctor writes for in the quantity (#30? gimme a break) and just slap the label on the thing and give it out. Saves me the cost for a bottle, labor for a tech to count, and I can prepare and send it on its way while the techs are busy counting vicodin. Plus I think the pills are really brittle or sensitive to ambient air moisture, so it makes sense to individuality blister pack them.

    I can’t easily carry those packages in my purse.
    They are also a pain in the ass to open. I use a tweezers to get the first
    layer open (try doing that with a migraine). When I pop it through the
    next layer, it often breaks and a piece ends up in my carpet.

    Get a bigger purse.. 🙂
    Or you can just cut out the foil bubbles and keep them in a plastic baggie. You can also rip off the top layer of the bi-fold packaging so you just have the cardboard part that houses the little foil blisters. As long as the tablets stay in the little foil blisters you can do whatever you want. Personally I’d want to keep a copy of the pharmacy label in the plastic baggy so paramedics or other medical personnel can tell what they are if you are found in a ditch somewhere.
    For your opening question, its like that to make them ‘childproof’ since they are not in a childproof pharmacy vial. Personally I think childproof caps are bullshit since a kid can get them off anyways, and if you keep your medication where a toddler can get it you shouldn’t be having/taking care of children.
    You can also carefully cut the blisters open, but make sure you feel where the pill is first before you go hacking like Conan.

    Anyway, I enjoy your blog, and now I understand why it takes time to fill a
    prescription.

    Thanks! 🙂 I enjoy it when people send me legit questions that I can answer on here.

    Black Monday after Thanksgiving

    For as long as Pharmacy has been in existance, there has always been the Black Monday after Thanksgiving. For those not in the profession, since Thanksgiving is always on a Thursday, that weekend (for the doctors and some smaller pharmacies) is always a 4 day weekend that always ends on a Monday.
    This means that you have about 3 days of Rx’s that have been stacking up while the doctor has been away (or the pharmacy has been closed) that are just waiting to explode all over your face the following Monday.
    As I write this, black monday is over (at least for me). I hope you all have a vice filled night.
    Just for shits and giggles, post your average and how many you did today in the comment. Our average is about 375 and we did over 500 today.

    Dosing Amoxicillin is not Rocket Science

    All retail pharmacists see this on a daily basis.
    A 1 year old get an Rx for some Amoxicillin 250/5. Standard issue. However the sig is “3.4mL tid x10d”.
    Now what mother with half a fucking brain is going to know how to measure out 3.4mL? Its Amoxicillin for gods sake, not digoxin or something with a super narrow therapeutic index. 99% of the time these are from a NP or PA.
    Let me spell it out for you. Round up or down in 1/2 teaspoon measurements. Why? Its because its what our dosing spoons/droppers have HUGE markings for, and there is a less chance of some dumbass mother giving her crotchfruit 4 teaspoonfuls instead of 4mL.
    I know exactly how they get these weird doses. Rather than KNOW the drug or use common sense, they have a little book that says that the ‘dosing for amoxicillin is 22mg/kg/day (or some bullshit like that)’. With calculator in hand (and huge erection in pants) they determine that the proper dose is 3.4534mL of the 250mg/5 solution. They write this magical number down, and send their patients away with a medical hard-on the size of Florida.
    I take one look at this, and round up to 1 teaspoonful. Seriously, its Amoxicillin. Its like the douches who write an actual sig for pedialyte. As if you are going to force the baby to drink pedialyte or shove a tube up its ass and dump it in that way.
    You think that when we reconstitute the Amoxicillin I count the number of drops in the graduated cylinder? Hell no, I just eyeball it, dump it in, shake, and send it to the mother who’s child is either screaming his/her head off or running around tearing shit off of my shelves (Amoxicillin reconstituted with choral hydrate would be interesting). So your magical 5 digit significant figure dose just got horked out the window by a $4 graduated cylinder.
    Reminds me of the time I had my intern calculate a Flagyl compound. She was so proud when she told me that she needed to crush 5.4 tablets of the 500mg Flagyl and mix it with x amount of OraPlus/Choclate Syrup (Flagyl has an ass after-taste. Gotta mask it with Hershey Syrup). I look her square in the eyes, and say “I’ll let you make it if you tell me how the fuck you are going to get 0.4 of a tablet”. InternEgo, meet AngryFist. “Round up to the nearest tablet, and recalculate how much solution to add based upon that “. And who says that I don’t teach anyone anything.
    Much like during your crusades in retail, you need to choose your battles. You are exact on the things that count, and you roll your eyes and swear at the NP/PA/CNM/Janitor when they write a stupid sig for a drug that it really doesn’t matter with.

    White Coat Ceremony – Part Duex

    Well well well…
    Turns out my rant about the White Coat Creremony got mixed reviews according to my mole at the University of the Pacific (from where I heard, is where it all started).
    Lets take a look at the breakdown:

  • To the professors/staff who hate me for ragging on your precious white coat ceremony:
    Seriously, why get angry at me? Because I have the balls to publically call out how stupid your ceremony is? How everyone across the nation agrees with me as to the utter waste of money this mutual-masturbation session is? Seriously, have you taken a step back and realized why I think this is stupid?
    1. Its a waste of money
    2. You go to school because you want to learn. You shouldn’t have to attend a ceremony to make you feel “special” for what you are paying an assload of cash to go there for.
    3. Its stupid, seriously. Its like a birthday party for a 2 year old, they aren’t going to remember anything and its just there to make YOU feel special.
    4. You made it so the alumni couldn’t even attend! They are the ones who are footing the bill!
    5. Some of your stupid students were actually excited about the whole thing!
    6. Pride and respect for your future profession should come from your acts and from within, not some stupid ceremony that the school puts on. If you need a $30k handjob ceremony to make you feel good about being a pharmacist, then please, go kill yourself. We don’t need you going postal on everyone in 10 years when you realize that its not all candy-canes and fruit-loops like UOP pretends it is.
    Now, I’m going to give you all a little hint as to how to make the white coat ceremony seem not as retarded. I know that almost all schools (at least mine did) had a rotation program setup where you finish classes, then go off on rotations for x months working in bum-fuck Egypt for minimum wage. When you get back, you graduate, take the boards, etc. Have the stupid white coat ceremony AFTER you are done with classes but BEFORE you go off on rotations. You know, symbolizing you are finished with classes and are off to work “in the real world” (sorta). Mini-graduation to so speak. Thats a whole lot less corky than having the ceremony before the first round of midterms (which im sure some of them failed. Go cry into your white coat you failure!)

  • To all of the UOP students who hate me, and think that I should not be a pharmacist:
    1. You have no idea what you are dealing with.
    2. Go have fun at your little association meetings pretending you are a “leader in pharmacy”. Remember me when you are begging for copies with your broken bok-bok engrish at the end of your 12 hour shift for Walgreens.
    3. Go actually work in a pharmacy before you shoot your mouth off about me.
    4. You are in for a rude awakening once you leave the comforting colon of UOP and get shat out into the ‘real world’ without anyone to wipe your ass or tell you how special you are.
    5. Mommy and Daddy can’t pay your way to making people not yell at you for their soma. The sooner you learn this the better. Dealing with the public (especially the sick public) sucks ass but it has to be done.

  • To all of the UOP students who think I am awesome:
    1. Join my facebook group.
    2. Obviously you have either worked with the public or have worked in a pharmacy.
    3. Spread the word of angry around campus. I need more moles (druglord@theangrypharmacist.com).
    4. Go kick the asses of those uppity bitches who dont like me. Obviously they are going to get screamed at eventually, mine as well have it be by their classmates.

  • To all the UOP students who failed out of pharmacy school after the first semester:
    1. Be sure to hang up that nice white coat. We don’t want the symbol of your failure to get dirty.
    2. Have fun wearing that coat around the house pretending to be something that you are not.
    3. Haw Haw. Now you see why I think the whole ceremony is stupid?

  • The Elderly need to go…

    Everyone has the stereotypical elderly patient.
    Comes in with a smile on her face, and a few flies buzzing around inside her empty head. She comes in, plunks down 10 bottles from 7 different pharmacies, then hands you a fistful of Rx’s and wants them all filled. About 3/4 of what doctor writes for isn’t covered, and she sits there an argues with you about why you need to call the doctor to get them changed.
    Medicare part D has to be the cruelest joke that anyone could ever play on the elderly. Lets take a concept that takes working in the industry to fully understand, throw it at the segment of the population who cant tie their shoes without assistance, and see what happens. Add-on salesmen offering lapdances, free geritol, and 24 hours of Jag reruns and you have yourself a real problem.
    People say “Well thats where the pharmacist comes in!”. Bullshit. We are not insurance agents, salesmen, or explainers. We do not get a fat check from AARP for helping these idiots out understanding the coverage gap or deductibles.
    Theres really only a few problems when dealing with the old folk. When I say old-folk I mean in their late 70’s to 80’s. When you bring up that patient profile, see a fat age of 85, a piece of you dies as you pick up the phone to take the call.

  • Simple concepts become complex concepts. Deductibles are easy to understand. You pay $x out of your own pocket until your insurance kicks in. Simple. You have a better chance explaining quantum physics to Mrs Jones.
  • They dont listen. They are so damn stubborn they will sit there and ask the same question over and over and over. When you answer it, they ask it again! However they will listen to some douche on TV to call Liberty Health for free test machine but not their pharmacist. When you tell them that they dont need their Avandia filled because they picked it up 3 days ago, they will sit there and argue with you until they get it. When they finally stop stroking out and find it sitting right in front of them they wont even apologize for being so retarded.
  • Gullible as all hell (except when you talk). Salesman comes up to their door promising them a piece of gold the size of a thanksgiving turd if they switch to Wellcare. Guess who’s life got a bit harder when they come in for Rx refills? Of course it takes 30 questions, 3 hours of your time, and them bitching at you that their Rx’s arent covered for them to admit that they talked with a salesman (even though you told them not to).
  • Cheap as hell. They dont want to pay those $3.10 copays because they are on a “fixed income”. Yeah, if there wasn’t Medicare part D and you had nothing, you’d still be on a “fixed income”. Stop bitching and pay your fucking copays or i’ll glue your wheelchair to the ground.
  • Talking to them is like talking to a cow. Ever see the blank look a cow gives you? Ever see the blank look someone in their 80’s gives you?
  • Needy as all hell. They call you on a monday when you are swamped to tell you that they have not pooped in one day. They want you to call the doctor RIGHT NOW to get something so their bowels will move. Completely beside the fact they have not eaten anything since yesterday, poop somehow magically gets formed from nothing in their world. When you try to explain this to them, they obviously “dont get it” and just want some magical pill that will make their bowels explode. Thats when the Mag Citrate comes in. At least they’ll be shitting so hard they wont have a chance to get to the phone to call you.
  • They think they know more than anyone. Being around for 80+ years gives you a sense of empowerment and knowledge. Knowledge that somehow replaces going to grad school for 4 years and getting a degree.
  • They always lose/misplace/eat/destroy their medication. Of course it cant be like Lisinopril or something that costs pennies, but Avandia. They lose it like its going out of style. I swear that when half of my patients die I’m going to buy their house so I can recover the 1.3 million dollars of lost medications that are scattered about. Plus they refuse to acknowledge that they lost their medication! They just call in a refill 20 days early and expect you to fill it. Oh, did I mention that they dont wish to pay for said lost medication replacement?
    I hope that if I make it to 80+ years old (highly unlikely) that I can be a burden on everyone like our current aging population is. I figure that its just proper paybacks. Lord knows that I’ll never see a dime of the fistfuls of cash I’m throwing away on the current Medicare system.
    PS: I just got an email that some of the professors at UOP are angry at me for trashing their White Coat Ceremony. Guess who’s getting another entry!!!