Yay, moral hate mail!

The entire tirade about retail pharmacy is here

My last comment…the one I’m sure will draw fire, is regarding the
Birth Control Pill argument…. I am on your side that moral and
religious believes should play no role in pharmacy dispensing…
Refusal to dispense based upon those things goes against everything the
healthcare industry stands for (do no harm, yada, yada)… But I must
have read 15 comments you’ve posted over the past number of months that
all relate some story of a ‘vicodin addict or loser’ trying to get an
early refill or pull one over on you… Let me ask you…. What
percentage of vicodin (or pick your drug…I won’t go the route of
mentioning your personal favorite) prescriptions do you fill? Of 10
that you get, how many are legit in your view and you agree to
dispense? Does someone’s appearance play a role in determining that
script’s validity in your eyes? Some of your comments on the person’s
smell, clothing, hygiene all seem to imply that you do…. Is that a
‘moral judgement you’re making’? One person’s street drug is another
person’s morning coffee and cigarrette. The only difference is that one
is illicit and therefore hard to get, and the other is has entire store
chains devoted to it….(Starbucks…?)

First off, comparing a moral objection to dispense birth control vs refusing to dispense vicodin thats a week too early isn’t even an argument.  Its even stupid to even start to compare them.  How can you even start to equate “You know, God says that abortion is wrong so I refuse to fill your pills.. MURDERER” to “Uh, you just got 120 vicodin from another doctor 4 days ago, I’m not filling this until you are due”?  One is a 100% your own personal opinion and the other is doing what the DEA mandated our job to be (not to mention a huge safety/health/do-no-harm issue).  To answer your question, of those 10 Rx’s I have a pretty good assumption that at least 7 or 8 are being diverted (does everyone need Vicodin, Valium, AND Soma?).  However can I do anything about it? No. Why? I have no proof that there is, and there is that chance that they aren’t being diverted and actually used. So if they are on time, I dispense it without question.

So would you call someone who “loses/gets stolen” their vicodin Rx at least 3 times a month, always calls in 10 days early, doctor shops and is on every ER’s “do not dispense” list an addict?  Is that a call of morals like refusing to dispense Plan-B or a good statement of fact that you need to keep an eye on this person.  Its not even a moral call but a ‘get-you-head-out-of-your-ass’ call.

The personal appearance argument is vague at best.  I look at every Rx with a huge grain of salt especially if they are a new patient or an out of town patient/doctor.  I’m just as quick to call out doctor shoppers if they are a long-term patient or someone i’ve never seen before.  You know why? Its my job. 

Never in my career have I ever said “you know what, you look strung out and I think you are on way too much of this.  I am going to refuse it for no good reason other than my own”.  It doesn’t work that way.  I have however refused to refill based upon “Uh, if you take this how you are taking it, you are going to blow out your liver from 10 grams of tylenol a day, let me call the doctor”.  Thats a safety issue, not a “moral judgement”.

Judging by the rest of your comment, I doubt that you work retail.

An interesting tidbit of real-life info for those pharmacy students out there… One of the sucky part of my job is having to monitor diversion in a large setting… We use many tools to do this in order to track patterns.

Ah, I was right.

Real Life Retail 101

Pharmacy schools are notorious for filling their students heads with tales of wonderfulness and gummi-bears when they work in a retail setting.  This is due to a few factors:

  • Pharmacy school professors have not worked in retail for 10+ years.
  • Pharmacy school professors could not cut it as retail pharmacists, hence why they teach.
  • If pharmacy school told it as it is, nobody would become pharmacists.

Thats where I come in.  I want all the students to print out this entry and hang it on the bulletin board of their school, because this is ‘Real Life Retail 101’.

First some common smoke that is blown up the ass of students:

Pharmacy School: You will have a working relationship with the doctors of your patients so you can both provide the best possible care.
Real Life: The only interaction you will have with a doctor (in the rare event) is when he calls up and whines like a little bitch about how his precious medication that he prescribed isn’t covered.  He’ll bitch and moan about how he wants Altace over any of the generic ACE-I out there (or the new Soma 250 vs Generic Soma 350) and just ramble off whatever the big titted drug rep told him.  He will blame you for the insurance not covering it as if you had something to do with it.  If and when you catch an error, he/she wont even thank you.

Pharmacy School: You will be treated as an equal by a Doctor and any NP/PA
Real Life: “Just fill the damn vicodin script early, I dont have time to tell you whats going on”

Pharmacy School: You will make a difference in your patients life.
Real Life: There is some truth to that statement, for your regular patients you will have a small (if not a large) impact on their lives.  Be it getting something changed to a less-costly generic, or just dealing with the bullshit of MediCare-D.  The rest of the time you will just be the vicodin police and pissing off the crackheads who doctor shop.

Pharmacy School: You will use your deep pharmacology knowledge to the best of patient health.
Real Life: If you replace ‘pharmacology’ with ‘whats on formulary this month’  then yes, this statement is true.  You will use your pharmacy school knowledge to some extent, but to actually use it as pharmacy school’s preach it is just a fart in the wind.

That being said, here are some survival tips when working in retail:

  • Have a sense of humor – If you dont laugh at your patients or at least poke a little fun when they are not there, you will crack and go insane.  Thats why this site exists.  Make sure they aren’t standing in the store when you poke fun at how bad they stink though. πŸ™‚
  • Know your patients – Say ‘hello’ to them as they walk in the front door.  Know their names, be involved in their lives if they decide to tell you about their kids.  Remember that their kids will be your patients too.  You have techs and clerks for a reason, to do the grunt work while you build a reputation with your patients.  You’d be surprised as to how much people trust what you say over the doctor.
  • Choose your battles – You’ll burnout really quick if you decide to battle every little shit that gets flung at you.  Its easier to just ignore the fact that the old nurse out there is spouting out drug information thats completely wrong than to try to tell her how the Renin-Angiotensin System works.
  • Speak English, not medicine – When you get out of school, you’ll have all these big words that make you sound smart.  Remember that your average patient can barely wipe his/her ass and doesnt really comprehend medical stuff.  Its “blood pressure pill” vs “Beta-Blocker or ACE-I” and “Water Pill” vs “Loop Diuretic”
  • Be vague when asked what a medicine is for – For BP stuff its pretty clear cut.  But sometimes doctors give medication for off-label use.  Be careful with the anti-psychotics.  Call them “mood pills/mood stablizers” not “anti-psychotics”.  Just what you need is to have both barrels of insanity being blown at you when you infer that your patient is on anti-psychotic medication.  Even be vague with the TCA/SSRI’s.  I always say “They are used for mood, for headaches, for nerve pain, etc”.  If they don’t have any of those, they need to talk to their doctor.  You’ll only make that mistake once when a doctor gives a TCA for neuropathy or migraines and then calls you bitching as to how come you told your patient that they had depression.
  • DON’T GUESS! – If you dont know the answer, look it up.  If you have any doubts on a dosage or a medication then look it up.  Don’t guess!
  • Learn from the Doctors – Look at the pediatric Rx’s you get and get a ballpark idea on the OTC cough/cold medication as to how much to give to a patient of x age and y weight.  You will be asked questions when parents come in to buy OTC pediacare drops and how much to give.  If you give what the local pediatricians give you’ll always be okay.
  • Build a tough skin – You’ll be cursed at, sworn to, etc.  Usually it’ll be by crackheads wanting their pain pills early.  Look at the source before deciding to take something personally.
  • Be patient – If you are an impatient person, then dont go into pharmacy.  Spending 15 min explaining to some 85 year old patient as she gives you the cow-stare about her medication will be frustrating.  Especially if shes too dense to realize what “once daily” means.
  • Know when to cut bait – Think of the bottom line of the store you are working at.  If a patient is making you jump through 30 min worth of hoops for an Rx that will net you $5, then its not worth it.  Give more slack to the regular patients (or ones that have been going there for 10 years).  Remember, its costing your employer $1/min for everything you do.  Know when to pull the plug and go do something that earns the store money.  Remember, filling Rx’s puts food on the table, not patient care.  Patient care will earn you money by filling Rx’s and drawing people to your store; but at the end of the day all your talking and helping earned you zero if you did not fill one Rx for that person who just wanted free advice (and will never get something filled there again).  Yeah, it sounds unprofessional, but doctors get paid to talk, we get paid to fill Rx’s.
  • Respect your techs – They are your equal, not your bitches.  Not heeding this can make the difference between them doing their “job description” vs covering for you while you go put your skills to work.  A good tech (AKA ‘Keystone Tech’ as DrugNazi puts it) is extremely hard to find, be nice to them.
  • Respect your elders – Waltzing in with your fancy PharmD and showing up all of the BS’s with 30+ years of experience is a good way to piss people off.  Be humble towards people who have been practicing pharmacy for longer than you have been alive.  You may know more book-learned material than they do, but they know what does and doesnt fly with the patients and doctors.  You cant teach experience, remember that.
  • Be nice to the Doctors Staff – They get the shit done in the office, not the doctor.  Being nice to even the most dumbass office staff can save you from waiting 4 days for that refill request.  They can push you to the top of the request stack in a pinch, and can save your ass when you screw up.
  • Shut up and do your job – There are some time where you just need to bite your lip, and just do your job.  Letting your moral/religious beliefs (AKA refusing to dispense birth control) run your job makes you a pothole in the road of medicine.  You have a job to do, just do it.  People don’t want to hear how you feel about religion, politics, etc.  They come for you for medical help so give it to them in an unbiased way.  Obviously if you have a legitimate health concern (blood clots with
    BCP, etc) then by all means, speak up, thats your job.  Refuse to fill if you feel that the medication will cause documented immediate or long-term harm to the patient, not because of how you personally feel.

I’m sure that there are more, but this is a good starting point. πŸ™‚

Beware of the dreaded shart!

I am going to give you all a very serious warning to a very serious condition that pharmacists (and techs) are prone to.

The condition is called Shit-Fart, or Shart.  ICD9: 457.44

You see, Pharmacists/Techs are very prone to catching the dreaded shart due to the following risk factors:

  • Long periods of time standing up
  • Huge sums of coffee
  • Inability to sit down to take a poop in peace

Symptoms include:

  • Urge to release gas
  • Moist feeling in pants
  • Embarrassment
  • Putrid smell

Case Study:
A male 33 years of age is a Pharmacist assistant at a local independent pharmacy.  The patient has had an increased intake of coffee to offset the 500 rx day that he is having.  For lunch, he has woofed down nothing but dried fruit and coffee.  Whilst working, he feels an urge to release some built up colonic pressure.  He walks over to the back of the pharmacy (where all the creams are) and proceeds to let one fly as gingerly as possible.  The sound resembles something between a juicy floorboard squeek and a coffee percolator.  Immediately the patient experiences a warm humid sensation in his bottom region quickly followed by a cooling down sensation and moistness.  The patient quickly hurries to the restroom where he has confirmed the differential diagnosis of crapping his pants (AKA Shart).

Guidelines for the treatment of ‘Shart’:

  • You will know, because your butt-area will get very warm, then very cold and wet.
  • DONT PANIC!  Initially, nobody will know that you have crapped your drawers.  Shouting “OH FUCK I THINK I JUST SHIT MY PANTS” will just draw attention to your butt-leakage and result in humiliation and an influx of phone calls to prolong treatment.
  • Proceed immedately to the nearest restroom after finishing Rx or patient consultation.
  • If you have confirmed Sharting yourself (either by seeing the butt-paste run down your legs, or the evidence of a tractor-trailer doing doughnuts in your tighty-whities):
    • If you are wearing briefs, remove said briefs (they would have contained the episode) and dispose in nearest trash receptor.  Be a good citizen and take said trash receptacle out for the sake of your coworkers.
    • If you are wearing boxers
      • If force of anal explosion has spackled only the back of your boxers, jump for joy and proceed as outlined above with briefs
      • If force of anal explosion has not spackled the back of your boxers, yet allowed poo to run down the backs of your legs, contain the spillage as best as possible.  Absolute worst case is stainage of nice slacks with poo-poo-juice upon which you must leave work to change.
        • If you have a white coat, pray that the butt-juice did not stain it.  UOP would be angry that you sharted all over the white coat that so many alumni gifted to you yet could not be there for the ceremony.
    • If you have a phone call waiting and cannot fully clean up
      • Abort the undergarments as fast as you can in the trash
      • Create a ‘male tampon’ or Manpon
        • Take 6 to 7 squares (but no more than 10) of toilet tissue
        • Fold neatly in half
        • Place between buttcheeks
        • Smile at the ingenious way to catch butt-moisture
  • Emerge from the restroom with the appearance that nothing is wrong.  Say you are “taking out the trash”.  If employees question your sudden act of kindness, remind them that you are a pharmacist and have taken classes in patient care and cultural competency.
  • If your fellow employees mention that you have just shit your pants
    • Deny it.
    • Check back of pants for butt-leakage runoff marks
    • Deny it again
    • Go home for lunch
    • Ignore the comment that you have changed pants after lunch and insist they were just unobservant.
    • Point at nearest tech and said “SHE DID IT”
    • Hide the fact that you just took 2 Lomotil

Together, we can help education and put an end to this terrible, terrible condition.

Site Changes, Announcements, etc

Hi Pharmacists/Doctors/Students/General Public

As you can see, the site has changed a bit to add some new features.

  • You can actually create an account/login to the site for commenting.  Doing so will (or should) make your comments appear automatically (vs me having to approve them).  If you are a frequent commenter, this should make your life a ton easier.  If spammers hijack this i’ll turn it off though. πŸ™  Sign-in page link is in upper right sidebar.
  • Site search works again (hooray!).
  • Soon you will be able to subscribe to individual entries, so you will get email notification when someone else comments (vs having to check a bunch to see if there are any new comments).
  • As always, you can get email notification when a new post is made via the usual menu —> that way.

Other things:

  • I have a bunch of questions mailed to me for “Ask the Angry Pharmacist”.  Be patient and i’ll get to them.  About 50 of you emailed me the first day.
  • If you have a topic you wish for me to bitch about, feel free to email me (druglord@theangrypharmacist.com) and i’ll see what I can do.  I always like to trash on Pharmacy School classes.
  • I’ve been contemplating putting ads on the site to help pay for the hosting (or a “buy me booze” paypal button to donate to the site), but I’m still sorta mulling this over.  Suggestions?

Be on the lookout for a nice hefty rant about how we are all going to get screwed over the first of the year.

Oh, that gosh darn UOP is at it again!

From The Angry Intern, a student of UOP (who is just an Angry Pharmacist in Training) on a “Cultural Competency” class that is given for $55k/yr

Why this is part of our curriculum still puzzles me. Yes we should be aware of other cultures; but that’s also saying we should sterotype people to some extent as well. Why do I bring this up now? Mostly because the professor teaching us how to be culturally competent is in fact the least culturally competent person I’ve met.

A class to teach how to become culturally competent? Oh, it gets better!

Speaking to the class on monday before Thankgiving Day break, she so proudly stated
“Some people think we have Thanksgiving to celebrate the arrival of Christopher Columbus to Plymouth Rock. His journey on the Nina, Pinta, and Santa Maria” ….”Oh yeah, thats right…..are you smarter than a fifth grader?” (in that “damn right I know my shit” tone)

Uh… Yeah… Now I think classes like this for pharmacists are just outright stupid. For doctors I can sorta see having something like this, because you are at least touching and examining the patient and dont want to offend her by not bowing a certain direction before you stick your hand up her hoo-hah for that annual. What the hell are we to use one of these classes for? To bow before we give out vicodin and soma to a certain class of patient? Or maybe face all of the tablets East or South or maybe North?

“Stereotyping (or racial profiling) didn’t exist until after 9/11” (I don’t know the exact words but this is pretty close)

Thats right, no pharmacist thought to themselves “Oh god, I wonder if I have norco by qualitest in stock” when they see a crackhead of a certain race/color/creed/religion/disability waltz in the front door. Nope, never happened before 9/11 or even before 9:11am for that matter. “No maam, would of never of guessed you wanted trade-name Vicodin judging by all that fake mall-island bling you are wearing and that just-about-repo’d escalade with the 1 spinner rim taking up 2 parking spots in the lot”.
Someone needs to give me some dirt other than UOP. Come on hoards of STLCOP students out there!