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
    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. πŸ™‚
    Actually it’s like that for your enjoyment πŸ™‚ 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.. πŸ™‚
    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

    Thanks! πŸ™‚ 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.