I hope all doctors don’t write this horrible.

So some ignorant horrible spelling doctors decided to harass the *Angriest* Pharmacist over a rant I made about some idiot with 4 degrees who couldn’t write coherently to save his life.
Now I may rag on the Angriest Pharmacist for stealing my idea and stuff, but I got his back when some uppity fuck decides to give him both barrels.

for all you uninforned assholes,first notice this is not in caps!!my parnter and best friends wife is a pharmacist at a major grocery store ad she will admit it is the easiest job and when i read last week i was actually published i got a dictionalry and learned how to spell vicoden and even lortab which is hydrocodone which in the 33 years i have been practicing i have never prescribed the frug and refuse to,when i do surgery they get ultram and or darvocett. then i can count on a pharmacist callinf and asking if i realized i gave 2 pain meds an always when i give anti biotics its for 7-10 days and then a 25 year old dr. want to be pharmacist will call and ask why 10 days the book says no more than a week. we also have a system for fraud which we rarely get taken and i do press charges, ill write 38 in 2008 and 39 in 2009 never with refills and pharmacys know if it is mine, we get a few “losts” scripts but we handle individually and if its stolen we need a police report to take to pharmacy and i still get calls. all replacements must have notorised letter to be replaced and controlled drugs are only replaced once. on major surgeries i might prescribe 18 oxycontin,6 times in 2007 all over 65 years old. i explain all medications as well as side effects and how the medications react with any other current meds.then the nurse brings in the rx and goes over questions,so by the time they see the pharmacist all needed is count the pills and run through insurance unless patient has questions and in our area its the tech the pharmacist doesnt have time.most pharmacists earn thier money and do have responsiblity its the young ones that i have to pay for 2 extra phone lines and they still want to tell me how to prescribe.we do recommend mail order to low income if it is long term usage on our internal medicine practice as long as they keep thier appointments or we give them samples but i keep no controlled. in 33 years i have had 4 malpractice cases, 3 dismissed and the 1982 casse was settled out of court in 1988 for a medicaid person who had no injuries just wanted to never work again,so my dea number is last of my concerns. so the assholes who say i have no degrees and speak 6 languages, does that mean i am smarter or above you i think not, i make mistakes like should have retired in 1996 when i was making 450k instead of 6 day work weeks 10-12 hour days for 125k, but i would do it for free. anyone want to put up something about my credentilals? I COULD BE A LYING DRUGGY WANTING ATTENTION. sorry i got carried away with the caps. glad i could raise your rating for your website, i thought it was a joke. maybe ill send a couple movie clips youve probably seen me before even though i am not a house hold name but bottom line the world needs to hear all sides before making a judgement. im not a dr. because i dont proof read and use large and small letters, i can live with it. t. elway,md facs
scripts

Wait, this guy doesn’t know how to spell Vicodin or Lortab however in his 33 years just prescribed Darvocet and Ultram? Uh, isn’t Vicodin and Lortab a generation older than Ultram? This post is like a brain-dump with no sort of flow or break. It makes my brain burn.
If that wasn’t enough:

Sorry, address must include host name. (#5.1.3)
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From:
To: “‘prescription’”
Subject: RE: Dr “4 Degrees” and the Caps-Lock key eludes him – The Angry
Pharmacist
Date: Thu, 31 Jan 2008 18:42:09 -0500
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Did you get the email today from dr.e and his numbers as well as dea to
prove you and your readers that you can be wrong?? For something that was
toungue in cheek it sure got you a lot of readers we all read it 1/25/08 and
it was a good laugh enough that we have it hanging in our waiting room and
after blocking our 3 of every 10 words out of the 95 patients a day at least
15 make a comment that it must be a real pharmacist that is disgruntled and
hates his job.tried not to use caps or bad grammer or caps in an informal
note,had no idea what your site was but have started reading it as we
phycians get a good laugh after double shifts and watching the pharmacist at
Albertson asleep, like I said my wife is a pharmacist and that doesn’t make
her dumb or lazy she knows how well she has it plus benefits and
retirement,she is way up the ladder as well as most pharmacists versus the
audiologists we put up with dailey, one of our specialities is otology, that
is ear infections,hearing and aids as well as stapedectomy surgerys invented
by dr. shea in Memphis tn, say for not proof reading this also but I think
you can read it if a couple words are turned around you are a phd,and
thankfully not an md with that language that you use. God bless you and we
pray for your soul and that you find happiness. C.r.shultz,md f.a.s
_____
From: hoover [cut]
Sent: Friday, February 01, 2008 8:20 AM
To: hoover
Subject: Dr “4 Degrees” and the Caps-Lock key eludes him – The Angry
Pharmacist
http://www.theangrypharmacist.com/archives/2007/12/dr_4_degrees_and_the_capslock.html

Well, first of all I’m glad people read my site. I have no idea how the TA’estP got the email bounce. If you want this dillhole’s email address go to TA’estP site and look it up. I’m a big vagina and took out his email address.
All I have to say about this is:
i sure hope this doctor treats his patients more than he treats proper puncutation and grammar i know that i dont ever, use proper grammar but at least i know that the keys,on the keyboard are used to signify when sentences stop and start and i dont place,commas in places where they dont belong i have letters after my name like f.a.s and other crap that makes people think,that i am smart but really i dont know what i am doing because i like to type with only the letters because all of the other key,scare me like chicken.
DrugNazi was right, these websites just write themselves.

Tinfoil hats for everyone!

I saw this comment on Kevin MD’s blog about a rant of mine. The url is: http://www.kevinmd.com/blog/2008/01/paying-cash-for-narcotic-prescription.html#comments

The attitudes shown on the referenced blog also show why there is no confidentiality once a RX is filled.
I had a doc who needed an antidepressant as a patient. The big clinic/hospital that he worked for also owned the insurance company, and he was in a political struggle within the administration. Given a history of personal destruction as a political tool, he didn’t trust them to not use his medical care history against them.

Okay, right there screams that we aren’t getting the entire story. I fill Rx’s for Doctors all the time for stuff like this, and to be honest nobody gives it a second thought or look.

So he paid privately in cash for the treatment, and then went to a different pharmacy than his usual one, gave them no insurance information and paid cash for the prescription.
The pharmacy somehow uploaded the information to the insurance company anyway, where it was tapped by administration.

Something obviously isn’t right there. I can’t fill an Rx for an Insurance company 99% of the time WITH the card, what makes you think that we can just ‘transmit’ and have it magically go through? Gimme a break, now this story either screams exaggerated or made up. The chances that some pharmacy can just ‘guess’ the information from a private insurance patient who did not provide any card/info is on the same playing field as us getting U&C for Rx’s.

His investigation uncovered all this after he was beat over the head and insulted with his “mental disability” as evidenced by taking prozac during a contentious meeting with his medical director.

Prozac for a ‘mental disability’? Right. I wonder where the HIPAA police were during all of this? Oh, they were paid off by the ‘administration’ to keep their mouths shut.

Stopping drug addicts is all well and good, but the patient’s right to privacy and need for it is not obviated by the “war on drugs”—and he shouldn’t have to give that up to stop addicts from gleefully killing themsleves. I understand where the pharmacist is comming from. The state puts him in the position of policeman. But it shouldn’t be like that. We shouldn’t have to go to a policeman for our medical care.

You’re right, we should just make Vicodin over the counter, and when a doped up addict comes crashing through your front door looking for more cash for his dope and murders/rapes your family you can rest assured that his privacy was protected. Give me a fucking break and come back from bizarro-land. Addicts dont just kill themselves, they hurt other people in the process of their dope. Those that don’t end up on the state system that US working folk have to pay for over something that THEY did to themselves. I dont know about you, but I don’t want to pay for a liver transplant for someone who has never worked an honest day in his life, and who’s only accomplishment is how much vicodin he can pop before passing out.

Regarding these databases to catch pill poppers—anyone who doesn’t think that is going to be used sometimes by snoops to personally or politically destroy enemies fell off the turnip truck yesterday. It’s very existence creates a barrier to legitimate medical care for some.

Let me get some more tinfoil for your hat.

Anyone thinks that Rush Limbaugh wasn’t a political target? Notice how they used search warrants rather than supoenas to get his records? Remember the viagra incident–cleary a deliberate ploy to use his (non-controled) med use to embarass him.
Any number of public and not so public characters have legitimate reason to fear filling something so benign as Prozac, viagra, or a properly used opiate RX in the information juggernaut that the pharmacy industry has created.

Uh, a supoena is a form of search warrant. If the police come with a search warrant and want Rx records, then by all means I need to provide them just as if they came with a subpoena. Just a search warrant is “Dont get up, i’ll get those myself” vs “fax these over when you get a free moment”. Rush was getting a huge amounts of oxycontin, a C-2 narcotic. A tad bit different than the person who gets his vicodin 2 weeks early.
That being said, here is some more tinfoil for your hat.

What? Medwatch? I’m confused

You state: Now I went to college for 7 years, got my PharmD, yadda yadda
yadda. I know about drugs. I am trained in drugs. Ask me about a drug
and I will tell you everything you need to know about it.
Okay–I’m asking about a drug: INSULIN. Tell me everything I need to know
about insulin . . . about older OTC natural animal insulins versus the rDNA
synthetic human insulin that is “just like the human body makes.”

What do you want to know about it? How its more consistent than animal derived Insulin? Less prone to allergic reactions? Longer shelf life (if kept in fridge)? Less shit from animal-rights groups (god save the pork?). Or should I go into the long tyrade about how EVERYONE can use this product without being forced not to get treatment due to religious beliefs of not using pork products? When I said “I will tell you everything you need to know about it” with Insulin its going to be how to store it, proper aseptic technique to inject it, when to notify your doctor, confusion about sliding scales, mixing, etc etc etc. Basic stuff they tell you in school. However you are a “50+-year insulin user” (See lilly rant) so I think you’re going to tell me that my 7 years of school + millions of bottles of insulin dispensed is completely wrong and I’m an idiot.

And while you are at it, I would like to know why pharmacists–whose years
of education supremely qualify them to serve as an intermediary between
patients and the FDA–have NOT stepped up to amerliorate the dysfunctional
adverse events reporting. It has been shown that patients talk to their
pharmacists 7 times more frequently than to their doctors. Ergo, you hear
more tales, more quickly, about adverse events; and yet you obviously have
opted to stay out of the mix, count your little pills, place them in
bottles, and ask patients, “Do you have any questions?” Your education and
position qualify you to do much more. Why don’t you?

If I reported every damn ‘side effect’ and ‘allergic reaction’ that I get on a daily basis, I would fill up medwatch’s books on “headache”, “upset stomach”, “dizziness”, “gives me gas”, etc etc etc. We filter out a /ton/ of bogus already-reported side effects from Medwatch. Now have I ever reported something to Medwatch? Yes. Woman had such a bad allergic reaction to the adhesive to Vivelle dots that it made a bleeding rash that spread. We arent “staying out the mix”, we are just nodding our heads and telling Mrs. Jones who calls you 100 times a day that YES, it is common to get lightheadedness when changing blood pressure medications, and if she wasn’t being such an uppity bitch about her copays she might of heard me warn her of that during the consultation. People hear what they want to hear, and the moment their copays change by anything more than $0.05 anything of value I tell them goes right out the window as they scream at me about their fucking copay.
I dont see where you are getting with this whole bitch to be honest. We ask the patient if they have any questions, yet don’t submit every side effect to Medwatch? Do you call the police about a missing person when your child cannot be found for 10 seconds because they are in the restroom? You’re probably one of those patients who has an “allergy” to codeine and tells us to record it as “upset stomach”, then argues with us when we say that its a common side effect.

In other words, what YOU perceive as your STELLAR qualifications could–and
perhaps will–be supplanted by a comprehensive PDR software program,
automatic pill-counter/dispenser, and voice-activated computer that can
spit out prescription inserts “on demand.”

Yeah, and who’s going to program said PDR software program that can turn medical speak into plain-person speak? How are you going to get around the Drug-Drug-Interactions/Dosing Mixups that aren’t picked up in the software but are picked up via experience (Morphine ER/IR mixups or a good starting dose for the elderly). We aren’t going to be replaced by machines because people like us, we talk to them.
Doctors have more of a chance of being replaced. They see patients for 10 seconds, take a quick look at them, and just leave giving them an Rx on the front counter. They could be replaced by an automated blood-pressure/DM/etc diagnostic machine, then patients can use a touch screen for their symptoms which spits out a diagnosis that then gets sent to the pharmacy where we pick out the proper drug and dose.

It sounds to me like you should be working at a mail-order pharmacy where
patient contact is minimum. That should take care of your ‘anger’ issues.
Then, of course, without those stupid, sick, suffering patients–and yes,
sometimes thoughtless or clueless patients–you wouldn’t have a job.

Do you realize that you are on the website “THE ANGRY PHARMACIST”? What part of “Angry” do you not understand? Have you ever read this site before? Do you realize that the whole reason /WHY/ I get angry is because I’m out there associating with everyone who walks into my store? This includes the village idiot, the whiny uppity rich bitch, and the 99.9% of the /normal/ people whom I don’t get angry with (hence not bitch about here). Did you read how I /hate/ mail-order pharmacies because they give substandard patient care and make /me/ do all of their shit work (when I dont get paid for it)?

Translated Drug Rep Speak

You will only find this here at “The Angry Pharmacist(tm)”.  It is a smuggled document from the headquarters of a training facuilty (the drug company shall remain nameless) about how to train drug-reps.  This is the secret code! Lets take a look:

  • Doctor, can I speak with you for a min about a new product?
    • Translation: Our patent has ran out on our best selling drug, so I’m going to tell you how much the generic will suck and how our NEWER and BESTER product (which is the same shit just XR after the name) beats the living hoo-hah out of the stuff I was pimping to you as the latest and bestest just 2 weeks prior.
  • Here are some studies for you to read.
    • Translation: You wont read this shit, and we paid for them so what do you think they’ll say you idiot.
  • You know that our new product has 500% better bioavailability and the AUC is 15% higher big-word big-word.
    • Translation: You have no idea what the fuck these numbers mean, and neither do I!  I just memorize them and spit them out to sound smart.
  • I’m going to leave some coupons here so you can trial your patients.
    • Translation: We’re gonna fuck over pharmacies so they’ll have to buy a $500 bottle of 100 to get a whole 7 tablets out for the fucking coupon.  The rest will just rot and outdate on them.
  • All major insurance companies cover this.  Its Tier-4 on their formularies
    • Translation: Which means its not covered without a prior auth.  I know you’re too ‘busy’ to do PA’s so we’ll just fuck over your patients by feeding them samples until they run out, then force them to pay $200/month to continue therapy.  Wait, I think the coke dealer did that same thing to me when I was in college.
  • Do you have any questions?
    • Please don’t be an ex-pharmacist.  Please dont be an ex-pharmacist! SHIT! I NEED A DISTRACTION! IT LOOKS LIKE HE’S GOING TO ASK ME SOMETHING!
  • Oh, I dropped my pens.  Dont worry, i’ll get them.
      • Translation: Yes, they are real. I can make them bounce into each other.  Look into my mind control device doctor.. Loooooook.
  • Here are some pens and notepads for you doctor.  I hope you have a wonderful day!
    • Translation: Sucker!!!! HAHAHA!

I really do dislike drug reps.  However I dislike Medicare Part D salesmen even more!  More on that later!

Lilly – Get with the program

As I have (and we all have) learned in school, a bottle of Humulin R or N is good for 1 month if kept at room temperature or if refrigerated good until the expiration date on the bottle.  Right?

Not according to the Lilly Reps.

They are telling doctors and other retarded janitor-types who can write Rx’s that once a bottle of insulin has been opened, it is good for 28 days upon which it must be trashed.  That really great for the cash customer who is on about 10 units a day and gets to shell out the 40+ bucks a month for a new bottle (as they toss out a 3/4 full one).

This bullshit started about 4 years go.  The formula for Humulin R and N have not changed since god was a boy.  What the hell caused this?

Heres the kicker.  There are no studies to back this data up.  Thats straight from the Lilly mothership.  Turns out that Europe (thanks assholes) have this law that states that all injectables must have an expiration date of one month from the time of penetration (har har har).  HOWEVER if the product was made before 1990 this law does not apply.  Thats why Humalog and Lantus have the warning in the package insert to discard after 28 days.  Humulin R and N do not have this warning (also stated directly from the mothership).  The good ole USA just decided to adopt this standard without any studies to show that its even half way legit.  Yeah, lets just do what Europe does, it worked so well for thalomide didn’t it?

Does this stop Lilly reps from spreading the gospel of ‘discard R & N after 1 month’ to every doctor and nurse out there?  Hell no.  Higher sales for Lilly!  Fancier pens!  Lower tops!  Higher heels!

Lilly, you are fucking retarded.  I hope all of you become cash paying diabetics who are forced to sleep in your own shit.

Everything is my problem

A really frustrating part about retail pharmacy is that everything seems to be “my problem”.  Now I went to college for 7 years, got my PharmD, yadda yadda yadda.  I know about drugs.  I am trained in drugs.  Ask me about a drug and I will tell you everything you need to know about it.

However:

  • I am not your fucking insurance agent.  I don’t know how much your fucking deductible is because ITS NOT MY INSURANCE.  I can guess, but its only that, a guess.  Its YOUR job to know about your insurance, not MINE.  If YOU dont understand something, talk to your insurance company; not your pharmacist.
  • I am not the keeper of your insurance card.  If you go to the store and want to buy something but don’t have your credit card, do you ask the salesperson to call VISA and ask for your credit card number so they can finish the transaction?  NO.  Keep your fucking card on you, and when you get a new one don’t make me fucking ask you 100 times for it before you say “Oh! Yeah! I got this new insurance card last month”.
  • I am not the welfare office.  If you bitch about your $3.10 copay and whine how the government hates the poor, let me charge you the fucking cash price of $150 and see how much you fucking whine.  All the welfare programs have done is create a bunch of fucking ungrateful bastards who think the F in Pharmacy stands for FREE.
  • I’m not your mother.  If your medication got lost/stolen/etc its YOUR job to call the doctor to explain how you are not a fucking addict, not MINE.  If I call I’m going to say “Yeah, he/she lost his medicine.  He told me a story but to be honest I wasn’t paying attention.”  Keep your pills where you can find them, and if you lose them expect to pay cash for the replacements.  Insurance companies do not pay the copay on stupidity.
  • I am not a drug company rep.  You can whine to me day in and day out how pricey the medication is in this country, then turn right around and ask me to sign something on a class action lawsuit over Avandia or Vioxx or something.  You know why medication costs so much in this country? Stupid bastards who sue over side effects inflicted from taking a controlled poison.  Lets sue Clorox because my kid drank bleach and died.
  • And last but not least.  I am not your fucking personal bitch.  I am here to help you, and will do so with a smile on my face, but I am not your bitch.  I am your pharmacist, and if you treat me like your child or someone you think you can just boss around I am going to pee in your promethazine with codeine and shit on your Soma.  Treat me with respect and you will get the same in return.  Treat me like shit and you’ll be waiting 4 hours for your Rx’s at the Walgreens down the road.

DEA with their thumbs up their asses

Crusty RPh writes,

DEA, DEA, DEA, Bullshit. Everyone worries about the DEA. The DEA has bigger fish to fry then worrying about me dispensing a Vicodin prescription to some jackass who got it down the street at another pharmacy 5 days ago. If I beleive the lost story, it is my decision. Fuck the DEA. If I say no,it is my decision with absolutely no concern about the DEA. The DEA is trying to find prescription mills, not the occasional poor judgment of a legit pharmacy. They currently get transmissions from the pharmacies — these transmissions include the Patient info, Dr. info, and drug info including the quantity prescribed. The DEA gets transmissions from the drug wholesalers which have the purchase information for each pharmacy for Schedule meds. In essence, all the information needed to audit each pharmacy, Dr and patient each month. With all this information, their answer to the problem is to limit the number of bottles of Vicodin I can order. Bullshit, if they have a problem with the amount of Vicodin I order, audit my store’s usage, don’t limit my supply. I am very strict with Schedule Rxs –I feel 99.9% totally legit, but I have high volume business and I don’t need any fuckin government agency telling I can’t order the meds necessary to fill these prescriptions.
I have requested reports from the DEA on patients, which show overusage and over prescribing. Why do I have to request this information–it should be forwarded to me as matter of record. That’s why I call BULLSHIT on the DEA. A letter to the Dr, patient, and pharmacy should generated automatically when there is a history of “repeated” abuse.

I’ve emailed back and forth with him, and it turns out California is required to send all controlled Rx info to the feds weekly. There have been reports of wholesalers limiting how much Vicodin/Soma you can buy under orders from the DEA.
DEA, get your head out of your ass. You can tell if a pharmacy is a drug-mill just by looking at the data that you force them to send to you! Here, let me help you.
1. The wholesalers transmit to you how many vicodin they sell to a store in a month.
2. The pharmacies transmit to you how many vicodin they dispense in a month along with patient and doctor information.
Look at the two, if the pharmacy is 10,000 tablets off, they either have a huge stock in the store, or something is fishy. Pharmacies should get notices (along with the doctors) when say 100 vicodin are filled at 2 different pharmacies within an unreasonable period of time (say, 5 days). If the doctor auth’d the early refill (due to loss, stolen, etc) then the notice is just trashed and everyone moves on. This shit is all electronic now, so why cant they just generate reports to send to pharmacies about potential doctor shoppers? What the fuck is the DEA doing with all of that data that they require pharmacies to send to them? I’m sure it would be extremely easy to take all the data and give each pharmacy a weekly report on usage. At least then it would make the poor pharmacists who have to transmit this shit feel like they are actually doing something!
DEA is like the Highway Patrol. Useless unless you have your head up your ass and screw up once. Then they are all over you like flies on shit.