There is no pill that will cure stupidity

All pharmacies have patients like this.

  • The village idiot. 
    • Always really late or really early. 
    • Cant manage to take 3 medications (all once a day, at the same time) correctly. 
    • You think you are doing him a favor by putting all of his medications in weekly planners or blister pack, only to have a plastic baggie full of pills be returned to you because he decided to “punch them all out”. 
    • No matter how specific you make the instructions, he will always come in confused as all hell and need for you to explain it to him. 
    • Doctors think its a cruel joke to prescribe him a blood glucose monitor with insulin and defer the instruction to you.
  • The lady who’s time has long come and gone
    • Is about 100 years old
    • Gets hospitalized about twice to three times a month.  Each month she gets discharged with 4 pages of meds, all different sigs and strengths which means that you have a whole mess of stuff that needs to be sorted out with insurance companies.
    • Has no idea what shes on, what shes taking, when she takes it (see above with the joys of this)
    • Decides that arguing with you about the most retarded things (like how many refills are on her Toprol) somehow is a good thing.
  • Ms Know-It-All
    • Retired Teacher
    • Swears by Airborne no matter what you said (CREATED BY A SCHOOL TEACHER!)
    • Always asks you your opinions and then tells you how WRONG you are because she looked it up on the internet
    • Would take advice from the homeless druggie behind her than from you, because the homeless guy has “real world experience”
  • Hypochondriac
    • “Can I get gout over my whole body?”
    • “I saw Lexapro on TV, can you tell my doctor to give me some, I think I have agoraphobia!” (as he’s standing in front of you with a store full of people)
    • Any daylight savings time changes completely crushes his life
    • He keeps a log of what he has eaten for the past year (3 bites of tuna, 2 crackers) and takes his blood sugar about 10 times a day.  Did I mention that he’s not a diabetic?
    • “I drank a gallon of water and now I’m pee’ing all the time! I think I’m losing my potassium”
    • Any explanation about anything medical just leads to another 20 phone-calls that day with another 100 questions.
    • Other pharmacies have gotten restraining orders against him (no shit!)
  • The last minute filler
    • Comes at 10 min until closing wanting hospital discharge meds filled or a plastic baggie full of empty pill bottles from another store (thats closed)
    • Wants to wait
    • Insurance wont go through or they go through but were filled by another pharmacy thats closed for the day
    • Doesn’t have any cards
    • Makes you want to go home and drink.

Arg, funny entry went poof.

Alright.  I tried to lighten things up a bit by posting a funny entry that I did over a year ago but never made public.  Unfortunately I got the YEAR wrong when I set the date upon which to publish it.  Its visible, just back with entries dated around the end of 1/2007.  Go team me.

Those who are signed up for email notifications already know about it, but for the rest of you I’ll just link the post here (to keep from breaking the links in the notification emails).

Doing other people’s jobs

Now I don’t mind explaining to people how their medication works, how to take it, and what it does.  Its part of the job, and to be honest /most/ pharmacists really enjoy doing things like that (if they arent swamped to all hell).  We go to school to learn stuff to share with the general population and a more educated patient is a happier (and more dangerous) patient to both themselves, the doctor, and us.

However when you bring fucking filled Rx’s in from ANOTHER pharmacy or mail order place (fuck you Liberty Medical) and expect me to take time out of MY day to explain Rx’s that someone else made some cash off of, I start to get upset.

Mail order joints (fuck you Liberty Medical) are the absolute worst of them all.  I don’t get paid by Liberty Medical (fuck you)  to sit there and explain to you how to work your nebulizer or some proprietary piece of shit blood glucose monitor that only YOU can get the strips for.  You got it from Liberty Medical (die) so YOU can call them up and have them explain to you over the phone how to use this piece of shit.  I don’t care if you saw a TV commercial and called the fucking number, YOU deal with it, not ME.

Where in the fuck do mail order places get off thinking that I’m their bitch.  What pisses me off absolutely the most is when they TELL the patient to bring their drugs/devices/etc into their local pharmacy and receive instruction on how to use it.  You know what, FUCK YOU AND DIE.  You dispensed it, so YOU TELL THEM HOW TO FUCKING USE IT.  Oh? You’re in another state? Wait, let me bring a fucking 2L of ‘I dont give a fuck’ to your pity party.

The best is when the patient comes in with a blood glucose monitor and has no idea how to use it.  The patient gets maybe 1 Rx, 2 at the very most from you (and even then it was filled 3 months ago).  They come up with a Nation-Wide-Chain Rx label on the box the monitor came in and tell you “the pharmacist was too busy at Nation-Wide-Chain to explain to me how to use it, can you show me?”

At first glance I want to say “No, go back there and MAKE the son of a bitch cock-sucker show you how to use it.  What do I look like? His fucking lackey bitch who does the grunt work while he makes the money?”  Alas common sense and ethics kick in and I end up being a big pussy and showing him/her how to use the machine.  ALTHOUGH I do stick in the rib-jab of “You know, if you get your stuff filled here you won’t have to deal with someone who obviously doesn’t care about your well being to show you how to use it.”  TAP – 1 / Dildo Chain – 0

Really, this post makes me sound like a grade-A asshole that shouldn’t of gone into pharmacy.  However take a second and think of all the time we spend on the phone answering questions FOR FREE, how must OTC advice we give out FOR FREE, and the only concrete way to earn money that will pay for food on our table is by filling Rx’s.  Its bad enough that we’re one of the only professions that gives out tons of information FOR FREE that we went to college to exclusively learn (why cant Lawyers or Doctors be the same way?), but do we also have to deal with the lazyness factor of our own profession?  Do I have to take up the slack because someone ‘didn’t have enough time’ to explain something (and made the dispensing fee off of it) or is in some warehouse in another state?  Its not that I nor the people who agree with me don’t wish to help people, but we have our hands full with OUR patients who come to US and ONLY US  without having to deal with the overflow of shit from mail order places that dont give 2 flying fucks to Sunday about patient care.  Patients are just an ID and an Rx number to these mail order places.  There is no patient contact, no patient care.  They make pharmacy look like a fucking industry rather than a profession.  Fuck mail order joints, and fuck Liberty Medical with their fancy commercials that trick old retarded folk into getting their shit from them.

PS: Fuck Liberty Medical, the horse they rode in on, and their fucking commercials.  I’m tired of cleaning up their shit and doing their job.

Ads, bills, the usual

One of the problems with writing entries that piss off a big portion of the online community is that you draw a ton of people to your site.  That little diabetic stint along with pissing off most of the chain pharmacists pushed my web hosting bill through the roof.  Yeah, I’m a pharmacist.  Yeah, I make “a lot” of money.  However when a website starts to chip more and more away at your income, you need to stem the bleeding eventually.

I mean I love the attention and all and its sorta neat to be such a famous-yet-totally-unknown pharmacist, however love doesn’t pay the bills.  So, to keep me ranting and out of the poor house, I put google ads on the sidebar over there ——->  They are stupid, text only, and actually have things to do with pharmacy (go figure).  Click on them if you’re interested, if not then just ignore them.

I don’t rant because I want the ad money, I dont rant for the attention or the notoriety, I rant because it keeps me sane, and it shows other pharmacists (and students) out there that you’re not alone in dealing with the cesspool of stupidity known as the ‘general public’.

So I hope you don’t view this as me selling-out or cashing in.  I’m just trying to keep my head above water for something that I love doing and preventing me from becoming a raging alcoholic puppy-kicker.

Oh, and I don’t really have any control over the ads they show, so if you see any for online pharmacies or mail order places, remember that they are paying for ads while I am receiving money for ads.  I still hate online and mail-order places.

Taking responsibility for yourself

After letting that little diabetic rant stew for a few days (Oh, the uppity folk who pitched a bitch-fest came from here. Notice how almost ALL of them are on insulin and proudly display their insulin pumps and a1c score.  Now notice how the people I was bitching about probably think an insulin pump is where soda comes from at taco-bell and the a1c is a new brand of steak sauce.  Enough about that, draw your own conclusions) its time for me to talk about one of my favorite topics of all time.  Something I see almost nothing of on a daily basis, and something that ties into my diabetic rant.

Patients need to start taking an active role in their own care of whatever they have.

Foreign concept isn’t it?  Amazing how many people I see on a daily basis not only do not care that they have HTN, DM, etc that can possibly kill them, but as long as someone else is footing the bill, they do things that make the condition worse!

For those who work retail; how many grossly overweight type-2 diabetics come to pick up their meds, and as your clerk is checking them out, the plop about 5 candy bars on the counter and begin unwrapping and eating NOT one but TWO! (2!).  Now add on a few grossly fat 10 year olds on top of that and have them plop their candy on the counter as well.  Hm, is that silence I hear from the diabetic whiners (or are you going to stand up and defend the type-2 450-lb fatty eating that Baby Ruth as shes signing for $200 worth of taxpayer-paid Avandia)? Is that the collective sighs from the retail folk out there because im absolutely fucking right? Now how many of you actually say something?  I usually make a comment of “You know those have a ton of sugar in them”.  I’m usually met with a laugh and an “I know”.  Temper, meet roof.  Let me dispense to her a gun so she can just take herself out NOW and save us the billions of dollars of hospital visits, medication costs, and crotch-fruit checks.  That right there has me pissed off at the world, not the uber-compliant diabetic who is always on time and breaks a bottle of Humalog once every other year (and wants to pay out of pocket when I’m insisting that I’ll get an insurance override for them).  It makes me happy when patients come to me and brag about their a1c, it makes me angry when patients brag how high they got their glucose machine to read as they eat candy and drink pepsi.

I’m sure the diabetes police will whine about something related to this (because they ALL see this sort of stuff 9 hours a day 5 days a week for a living).  Diabetics can obviously do no wrong, and heaven forbid I bitch about them eating fucking candy-bars in the store.  Maybe they should just stick the test strips in a jar of Karo Syrup, since testing that and their blood has the same result; and in both cases the patient is able to do the same thing, just watch the meter explode.

Thats one example, another one is actually taking responsibility and planning ahead for your medication refills.  If you are leaving for Mexico and are going to run out early, you do NOT come into my store the morning that you are leaving and want 10 Rx’s refilled RIGHTNOW.  Then get all huffy and pissed off when I say that the insurance company is going have to be called and if they want to pay cash we can work something else.  The icing on the cake is when they say “Well i’ll just have to cancel my trip because of you”.  Wait a sec, back the truck up.

You know when you received your medications last.  Now I know math is hard, but if you take 1 pill twice a day, and you have 60 pills, 60/2 = 30day supply (unless its vicodin, then 60/2 = 4.5days and an escalade payment).  So right there you know if you are going to be out during your trip or not.  Now unless you just found out and planned this trip RIGHTNOW, you had a few days to call me and get this shit-storm sorted out.  Yet here you are, screaming at me and blaming me for canceling your vacation (which how welfare patients can afford to always go on so many “vacations” boggles my mind) over something that was YOUR responsibility.  Lets bitch at Cadillac because your escalade ran out of gas because you thought it was someone else’s job to check the gauge.  I just don’t get how people can bitch and blame /ME/ over something that is 100% preventable for THEM just by taking 2 seconds and a quick phone call.  Just because I have a computer that has all of your medication in it does NOT mean that it knows when you are leaving on vacation.  I don’t check every morning to see what refills are due for the thousands upon thousands of patients that I see every month.

As my boss likes to say “A lack of planning on your part does not constitute an emergency on my part”.  I’m not going to drop everything that I’m doing just because you’re an idiot.

My final point drives pharmacists up the walls from CA to NYC.  We need to be kept in the loop when your doctor changes directions.  Its a little known fact that doctors and pharmacists only talk when the doctor either whines that something expensive isn’t covered, or he thinks we fucked up.  Thats all.  When the doctor tells you to take 2 furosemide a day, and we have a record of only 1 a day, and you come in 15 days early and want more, it really puts us and you in a bind.  You see, your insurance company (along with us) thinks that because the label on your bottle says “one tablet a day”, it means you are taking “one tablet a day” not “one tablet twice a day” like your doctor told you and nobody else.  Medication changes aren’t a fucking secret.  Take some responsibility for your medication and call me and say “Hey! Doctor said for me to take Rx# 2349234 twice daily now!”.  I’ll confirm this, and get you more when you run out.  Case closed.  Coming to me on a FRIDAY night 5 min before closing when EVERYONE has gone home to tell me that you’re out of digoxin because doctor told you to take 2 a day last week really pisses me off.  Amazing how many times a day I bitch at people who do this and they STILL think that medication changes are some sort of secret and that I’ll never find out about them.

I’m not going to get into doctors telling patients who can barely wipe their asses about medication changes.  Talk about a whole messed up clusterfuck of misunderstanding.  Thats for another time though.

Oh jeezus, I pissed off the diabetics now.

Ah look, the diabetics come out of the woodwork. WATCH OUT, I HAVE CANDY AND I’M NOT AFRAID TO USE IT! I would like to point out that below I refer to diabetes as a ‘condition’ and not a ‘disease’. See, those PC/sensitivity classes are paying off. πŸ™‚
On the other hand, when I piss people off they come to the site to whine, read past entries which makes them laugh, then they keep on coming back. Just ask The *Angriest* Pharmacist (or is his case, copy me) :).

As a pharmacist it is none of your business haw many strips a patient
uses. Strips in no way can hurt a patient and one can not overdose by
using too many. If a doctor writes a prescription for an unsafe dosage
of a medication then the pharmacist is correct in questioning the
order, however this is not the case. As far the insurance company, one
should ask, are working for the insurance? are you the insurance
police? who made you in charge of determining how many times a diabetic
can test? I think you should go about your business of filling
prescriptions and leave the ordering to the doctor, and not worry about
how many strips the insurance company should allow.
Interestingly, if a person goes into a drug store and purchases 100
bottles of strips each month and pays cash for them you wouldn’t ask
those questions. You would be thankful for the business, but because
insurance is involved you feel you have a duty to limit the amount of
strips uses.

Woah, wait a second. You’re telling me that its not my business to deal with how many strips a patient uses for a condition that I fill Rx’s for? Since you obviously have no idea what goes on in a pharmacy, let me enlighten you. Every Rx you fill has a day-supply associated with it. If 50 test strips lasts you 10 days (and you aren’t on insulin), the insurance company is going to come to ME and want ME to submit documentation to justify a type-2 diabetic (who cannot control the dosage of his medication) testing 5 times a day. Do I have any? No. There goes 50 bucks from my next reimbursement check. Simple as that. If you want to pay cash for your strips thats fine, but if you want the insurance to pay for your strips then we all have to play by their rules, you dont like it then pay out of pocket for your strips. You want someone to pay for your life then deal with it.

Where in heaven’s name did you go to Pharmacy School? Didn’t they
teach you that a non insulin-dependent diabetic also needs to know how
their diet and stress are affecting them?
Every bite they put in their mouth will raise the blood sugar. To
avoid the complications of diabetes (yes, all diabetics are susceptible
to them, insulin-dependent or not) these people must know exactly where
their blood sugar level is at all times.
Another factor that can cause the blood sugar to rise is stress. When
the liver senses release of stress hormones, it releases sugar into the
bloodstream to fuel energy for the “fight or flight” response.
All of these things must be learned and then checked and rechecked.
Can you imagine someone wanting to make themselves bleed for the fun of
it? Being a diabetic is no fun, especially with people like yourselves
imagining how simple it all is.
Shame on you.

Yeah, thats great, the patient knows that eating a ton of candy raises their sugar into the 400’s. Thats maybe 2 or 3 tests at the absolute most to confirm that. What can they do about it? They can’t adjust their medications to compensate for this so why bother testing. If you eat something and it boosts your sugar sky-high twice, then obviously you know what NOT to eat. Is there justification for testing 5 or 6 times a day everyday for months upon months for something that you have NO control over? I mean how many months does it take for someone to learn what they CAN and CANNOT eat. After 6 months of trial and error of what works and does not work what excuse do you really have to test that often?
You say that they must know exactly where their blood sugar is at all times. Yeah, thats great, if they are insulin and can do something about it. What are you saying? That they should skip meals if their blood sugar is through the roof? Thats not healthy either. “Oh look, I ate birthday cake and my sugar is up to 400, guess I can do nothing about it since I already took my 2 glyburide bid and 1 metformin bid today.” At least the folks on insulin can compensate, oral meds not so much. Lets look at the gas gauge every 3 miles but not stop for gas when we’re at empty. Oh, and lets throw away $1 every time we look.
Oh, and guess who gets to suffer if the payer of your test-strips doesn’t like how much you are testing. Its me. Not you, but me. If you want to test 100 times a day and pay cash for your test strips, thats fine, more power to you. However when insurance companies are paying the bill then YOU need to abide by what rules they set up, and trying to get doctors to provide justification for a type-2 diabetic who burns through 5 strips a day for 9 months and is noncompliant as fuck on their medication isn’t my idea of a good time. In fact, it has cost me on more than one occation a filling or 20. Do the math at a little over $1 a test and tell me why i’m a bit pissed. Plus this puts me into a bind. The “diabetic” (I use that term loosely since they obviously don’t take any initiative in their care) needs their strips, but there is a good chance that the insurance company wont cover it. The patient can’t afford $100/month in test strips. Do I chance it and cost the store money or do I do what you all think is “right” and possibly eat $100/month x 20 patients/month.
My argument was that testing 5 times a day is an absolute waste if you can do absolutely nothing about it like most uncompliant type-2 diabetics. I know plenty of very compliant type-1 diabetics on insulin pumps or rock-solid awesome Lantus/Humalog setups and some very compliant type-2 diabetics who test once or twice a day and have A1c’s in the 5 range. I have patients who come to me (rather than their doctor) and say “Listen, I’ve been running in the 140’s every morning for the past week, nothing has change, can you talk with my Dr about increasing my medication?” As you all know, diabetes is one of those conditions that requires the patient to be an active part of their care and management, and I’d rather see the funds be used to paying for test strips for the complaint patients who actually /care/ about their sugar and test smartly than the non-compliant patient who throws tests away just so they wont get yelled at by the doctor during their next visit. Pissing away 5 tests a day does nothing unless you are doing something about it (and after 6 months when the insurance companies catch on, you should of done something about it).
Let me tell you a little secret. The reason why diabetes kills a ton of people is because the people who have it really don’t give a shit what happens to them and really want someone else to deal with their condition. Obviously there are people out there (ie: you) who *gasp* take an active part in their condition. If the insurance company audits me for test-strip usage and you get your meds filled every month as well as a blood sugar log printed out thats 20 pages I will gladly throw that back into the insurance companies face with a hard-on the size of the empire state building. However patients who actively manage their disease are few and far between. Most of my patients just take the pills, eat whatever the hell they want to eat, and just pretend that everything is okay no matter how many times I scream at them for having a 300 reading first thing in the morning. They dont feel pain, they dont really feel much of anything (other than peeing a lot) and life goes on. I can consult them until I am blue in the face, but until something BAD happens to them they will just pull the smile-and-nod game. Thats okay if they are paying for their stupidity, unfortunately they are on the system, so I tend to get a bit pissed since the taxpayers are footing the bill.
I know this sounds crass and crude, but I’m really surprised diabetes doesn’t kill more people than it does for the sheer lack of common sense and responsibility that I see on a daily basis, especially from “diabetics”.
Its sad really, but no matter how much you say they are going to die/go blind/renal failure/amputation most diabetics really dont give a rats ass about their condition.
Plus we need a token comment from someone who obviously arrived to the game LATE and with their shirt on inside-out:

You need to find a new occupation. This obviously is not your expertise or passion. While you are at it, go to school and learn how to use the English language to express yourself. If you can only use foul language, obviously you need some serious help in learning to express yourself intelligently.
oh….. have a nice day! πŸ˜›

Uh, what site is this again? I’m sorry, last I checked I was the ANGRY pharmacist. Obviously you need to go to school and learn to realize the obvious: that a site that has the word ANGRY in it is going to have some swearing and other ANGRY things in it.

Glucose testing for fun and profit

Why must people be obsessed with testing their blood sugar?  Its about 3 times a week where I run into the typical uncompliant patient who needs a refill on 100 test strips they picked up 2 weeks earlier.  A quick scan of their profile shows only oral meds, no insulin, and uncompliance.  So then the 20 questions starts:

  • Are you on insulin? “No”
  • Do you adjust your oral medications based on your readings? “No”
  • Do you have any problems working your machine? “No, it works fine”
  • Do you waste strips or get errors which make you waste strips? “No, this machine is easy to use”
  • Do you bring your doctor your machine to look at? “No”
  • Do you do anything with the readings other than just collect them? “No”
  • Why do you test that often then? “Doctor told me to”
  • So if the doctor told you to wipe your ass 20 times a day even though you dont need to, you would do it? (alright, so I didn’t ask this question.. πŸ™‚ )
  • Its been a month and a half since your glyburide refill, did doctor change the directions? “No”
  • Then why do you test this often even though you don’t do anything with the results? “Doctor told me to, I dont know.  Is my vicodin due yet?”

At this point my head explodes as I fight the urge to say “Your doctor is an idiot”.  What doctor worth any sort of medical degree will tell their patients whom are solely on oral meds to test 5 times a day?  They aren’t adjusting insulin nor are they adding additional doses of glyburide or anything like that.  Does the doctor realize that test strips average about $1/test?  Oh, wait, $ + MD = ???

Patients on insulin is another issue because these patients are expected to adjust their dosage based upon readings (sliding scale) or will call the doctor for dosage adjustments (Take as Directed as sig).  So I very simply put that if they are on ORAL MEDS then they only need to test once maybe twice a day. 

Hell, I have patients who after getting 10 test results of 112 every morning they pretty much assume that the next one is going to be around 112 and test every other day or every 3rd day (These are the patients who pay cash for the strips, go figure).  But of course, being on Medicaid/Medicare with your FREE/Low copay test strips means that you can just waste them as you wish, because they are in fact “FREE” and the nanny government will in fact supply you with more because you are too fucking stupid to use some common sense.

Best dialogue I ever had:
Me:  “The F in Pharmacy stands for Free” 
Them: “But TAP, there is no F in pharmacy”
Me: “Exactly!”