The dreaded old patient

I’ve seen a lot of things come through my workplace.  Crackheads, addicts, people with guns, seekers, screaming children, teenage mothers, people who should be in a care home rather than on the street, etc.

However you know what really makes my asshole pucker when I see them walk through the glass doors? You know what makes me want to run and hide the moment they come into my sight?

Old people, with a baggie full of medication.

I know right then and there that if I get suckered into talking with them, there goes about 45 min of my day and the remainder of my patience.  Why do the elderly have to be so stupid and so difficult to deal with.

You tell a crackhead that they can’t have their vicodin, and although they may pitch a fit and threaten you, eventually they get the hint and leave.  Tell an old person they got their lisinopril filled 2 days ago, and they just stare at you expecting god-knows-what to magically appear in front of them.

Here are some signs and symptoms of oldfartitis:

Females: Usually they will give you the infamous blank stare (AKA: Cow Eyes) and expect you to know exactly what they are thinking.  After about 45 seconds of silence and her staring at you, she will finally throw some random curveball at you like requesting refunds for drugs she picked up at another pharmacy.  No matter how long you explain to her about Medicare Part D deductibles or how she received 30 atenolol just 2 days prior, it will appear that you are just talking to yourself.  The same “Cow Eyes” just stare at you devoid of any sort of knowledge or common sense.  Its quite frustrating.  Eventually, you’ll use every technique in the english language to say “Okay, you’re done, you can go now” without outright booting her.  She’ll pick up her baggie, walk out, and in 30 mins will call you and ASK YOU THE SAME FUCKING QUESTIONS YOU JUST WENT OVER WITH HER!!!  Im surprised she doesn’t trip over her cordless phone (and you’re surprised you don’t hang yourself with your phone cord)

Males: Everything is your fucking fault.  You are the reason why Hitler killed those jews, why Jag got canceled from channel 12 and why Hometown Buffet and Cracker Barrel was closed last Saturday so they can repaint.  In their mind, you have screwed the pooch big time, and the only solution is to sit there and express their confusion via yelling at you.  No cow-eyes for them, they just blab their frustration with why they cannot pee and why they have not pooped today right over that counter all over your little white coat.  You can show them the video tapes of them coming into your store 2 days ago and picking up their pills and they will STILL yell at you and call you a liar and demand their refills.  They squack about their $1 copays each time every time, and you wonder how Mrs Cow Eyes can live with Mr Poopy Pants.

Both of them share one thing: The inability to grasp and understand simple concepts.  I’m not talking about people who are on 10 different medications here, I’m talking about 2 pills both taken at bedtime.  At what point do you draw the line and say “Hey, listen.  No offense, but I don’t think you are mentally capable of taking this lisinopril once daily.  Let me put corks on the end of your forks and give you the rounded scissors so you don’t harm yourself”.  These patients are super high maintenance, and to be honest I’d rather deal with the scummiest crackhead off the street who can understand what I’m saying.

Its sad that I have to rag on the aging population, however they are pissing away all of my Medicare money that I pay into and will never see, so since I’m footing the bill for their lives I can rag on them all I want.

An addicts point of view – ie: A lesson in personal responsibility (lack thereof)

Hi TAP I know I have called you an ass hole and a dick, but… well… there is a topic I have never seen your opinion on.

Thats a great way to start an email. “I want your opinion on something, and I’ve called you names before.” Hm… I guess I already know what my opinion is going to be.

You talk about addicts who refill their vicodin 2 weeks early, and are frequenting many pharmacies using their insurance, and doctor shopping and ER hopping. I know all about this, I am one of those addicts, or I should say WAS one of those people. I have been clean 2 years and counting.

Reading that right there sorta offsets you calling me an asshole and a dick in the past. Being clean for 2 years after something like this is nothing to scoff at.

I would like to explain some stuff to you from the addicts point of view. It’s a growing problem, prescription pain killer addiction. I blame everyone for this. It’s not 100% the addicts fault.

Oh, here we go. Its not the addicts fault that the pills fall into their mouths or they are FORCED to lie. Lets see if this email gets any better.

Maybe put some blame on the MD’s who get the person addicted by giving high doses of the pain meds, and give refills and believe the crap about them losing their script, and losing their meds and so on, vacation refills. Blame should be placed on the ER who treats the seeker with more morphine/demoral/dilaudid, they know he/she is an addict, their there 3 x a week with a migraine, but yet they give the pain meds. The insurance company who keeps authorizing the refills.

Yes yes yes, its everyones fault but your own. Hate to tell you sweety, but in today’s sue-happy day and age, if you go into the ER complaining of pain (ie: lying to them to get a fix. Something that they are not forcing you to do) and they refuse to treat you; and for some strange reason you stroke out and die, the hospital gets to pay your loser family a buttload of money. ER’s cannot refuse treatment. Morphine/Demerol/Dilaudid are fast acting, cheap, and get you in and out.
As far as doctors go, most do not have a good bullshit-o-meter to tell when you are lying. Most will just give you what you want just to keep you from pitching a fucking crying fit there in the office and wasting time. Doctors dont just look at you and say “Yup, you’re in pain, here are some norco 10’s” and send you on your way. It doesn’t work like that. YOU bitch that you are in pain. YOU bitch that the vicodin are not helping. YOU call in for an early refill. YOU LIE to US then have the balls to put the partial blame on us for not calling your bullshit (Upon which then you pitch a fit like a fucking child?) Catch a trend here? All of this STARTS WITH YOU MAKING UP SHIT. Since when are health care professionals your mommy and daddy to make sure you don’t cut yourself on that knife or poke yourself with that fork? If you want the government/someone to wipe your ass for you then move to China.
It makes me sick that you even consider us to be part of the problem when this is something that YOU start, YOU continue, and YOU pitch a fit when things don’t go some way.

I had been addicted for 11 years to vicodin, dilaudid, morphine, norco, vicoprofin, and many other narcs. I had aid and they paid for everything including the frequent er visits, different doctors, 10 refills of vicodin in 1 week. No BS!!

Yeah, 10 refills of vicodin seems like a lot when you are hitting every ER in town and paying cash for those 14 tablets the ER gives you before giving you the boot. I hope you have a thick skin, because I feel the readers of this blog are going to skin you alive and hang your bleeding body from the nearest overpass.

The crappy thing for you pharmacists you get caught in the cluster fuck, stuff that is no fault of yours gets taken out on you. I can imagine the names you have been called. I have done my share of bitching on pharmacists. I know I was pushed to the brink of calling in my own scripts. I could not function without the meds. Iwas sick and mean and a total wreck “tore up” without those meds. That’s probably why these people are so demanding and so nasty. You have to feel for them, while the blame is theirs you also have to think of who contributes to this persons problem. It’s scary to run out of your medicine, very scary. That’s the whole reason I quit, I was tired of being scared. I am sure you know all of the withdrawal symptoms. The vomiting, the shits, the sweats, the lethargy, the depression, even as far as suicide. I have been there. I use to go to the ER 3x per week, now it’s maybe 1x per year if that!. I have only 1 problem, as a recovering addict if I do go to the ER for a migraine I am thought of as a frequent flyer, it’s a double edge sword, if I tell them about my past and say I am a recovering addict I may not get the meds that will kill the headache. If I say nothing they’ll think I am fulla shit and not give the meds. Once an addict always an addict!! I’ve bitched out my MD about this. I still get narcs, but I am carefully monitored, it started out with 2 vicodins now I am up to 20 unmonitored per month. I take them cautiously, and only for severe headaches. When I do need to go to the ER it’s the same one I went to, to detox. They know my history, they test me and then give the meds. They know I am on vicodin. They also call the area hospitals to see if I have been a pt in the last few months. Not a problem, I have nothing to hide. 🙂 Sorry this is so long but I wanted you to hear the addicts side of thestory.

The quote “You shit in your bed, you sleep in it” really rings true here. I’m sorry (actually, im sorta not) that you did not receive the pain control that you require. However thats 100% all you right there. Its called personal responsibility and being an active part of your healthcare and well-being. You can ask to be referred to a pain management clinic. Morphine/Vicodin/Opium-products aren’t the only thing to relieve migraines. TCA’s? Neurontin? Depakote? Tegretol? Oh, those don’t give you the buzz that you look for. Sorry.
So no, I don’t “feel” for these people, much like people wouldn’t “feel” for me if I pissed all my money away on toys and couldn’t pay my bills (or you all don’t give 2 flying fucks about my feelings as you scream at me in the store). Until we put a gun to your head and make you take 1000 Norco (then lie to everyone on the planet as to why you need more) the only person that you can blame for your “condition” is yourself. Personal responsibility and accountability. Big words, learn them.
Thanks for letting all of us know the “addicts” perspective where we are viewed as just another person to try some sob story before hitting up the doctor or ER for more dope. Cue the addicts from http://www.drugbuyers.com now to tell me how much of an asshole I am.

DEA is useful as tits on a boar

I hope the DEA is reading this, because they are not only a burden, but a tax drain on pharmacies and on the public in general.  Thats right DEA, I’m talking to you.  Lets show the whole world why you are as useful as tits on a boar.

In California, every pharmacy must transmit weekly a log of its controlled Rx’s that it has dispensed.  These are transmitted directly to the state as part of its CURES program.  Good idea right? Sorta.

Whats nice about this is that I can fill out some paperwork, fax it in, and in 1-2 weeks I get a nice printout via mail of all the narcs a certain patient is getting.  Of course this is after I can do absolutely nothing about it, but hey, its better than nothing.  To be honest these reports are downright useful. I would give lapdances if they would have an online system where I
could query in real-time my patients who might be narc-shopping.  It
wouldn’t even be hard, just limit it to patients that have gotten
something filled under the pharmacy’s DEA number in the past.  No HIPAA
problems there.

You should SEE the look on a patients face when you slide the report in front of them after they have given you both barrels about how you wont refill their vicodin early.  It makes it even sweeter when you say that you have faxed EVERY doctor on the list this report.  One woman even cried in front of me.  I almost felt sorry for her if she wasn’t a raging bossy commanding bitch who would go from calm to insane if you told her no.  See what happens when you lie to your pharmacist and doctors about pain pills?  Don’t give me this “She was in pain and it wasn’t controlled” sob-story bullshit.  If she took what the report said she received, her liver would of been blown out long by now.  Guess the Escalade is going to be repo’d now.  Pity.

Now, you may be asking why I think the DEA are useless with regards to the profession of pharmacy.  Well, they collect this information, but do absolutely nothing with it other than collect it.

In the past, when I was out of school and ‘Out to Change the World(tm)’, I would call the DEA when I saw doctors with “funny” prescribing habits.  Say like a month’s worth of vicodin written out every 10 days.  You know, stuff that your pharmacy will blacklist a doctor for (not piddly stuff like an oncologist giving an early fill once in a while).  I call the DEA and the Bureau of Narcotic Enforcement to get some ignorant dillhole who had no idea why I was calling.  5 transfers later, still nobody who had any CLUE as to why I was calling or who I should talk to.  Wonderful.  Fuck you DEA, I tried to help so now you can do your own fucking job.

To make matters worse, they are cracking down on the wholesalers.  Did you know that I can order 80 bottles of concentrated oxycodone solution with no problems, but the DEA is forcing my wholesaler to only allow me to buy 2 x 1000 count of soma and 2 x 500 count vicodin per working day?  They say its to prevent pharmacy diversion, but lets take a closer look at this.

1. The wholesaler knows how many I buy (obviously).
2. The DEA gets weekly reports as to how many I dispense.

so

Per month/year/whatever, they take the quantity from the stuff I transmit (#2) + whatever stock I have on hand (my vico-dans, let me sho u demz) and that SHOULD be ballpark to what my wholesaler sells me (#1).  Since we have to do stock-on-hand estimates every 2 years, that can be the ballpark starting inventory before the tally takes place.

However the DEA, in their infinite wisdom, is mandating my wholesaler take PICTURES of the pharmacies (to which my boss promptly flipped off, there were patients in the store so I couldn’t hang my bare ass at them) as well as sign a quadzilloin pieces of paper that say “I AM NOT AN INTERNET PHARMACY”.  They punish the wholesalers and the pharmacies because they are too stupid and/or lazy to use the information that THEY MANDATE WE GIVE THEM to determine who’s selling under the table and who’s not.  In a high volume pharmacy, 1000 vicodin is what, 10 rx’s?  Soma is 20 rx’s? Oh, did I mention that Soma isn’t a controlled drug? Tell me how that works and tell me why the DEA is sticking their noses into what I can and cannot stock and how much of it I want to stock.  What if there is a rumored price increase for soma and I want to buy a 6 month supply? Too bad.  Guilty until proven innocent.

So day in and day out we are the vicodin police living in fear of the dreaded DEA audit.  Those aren’t fun, when hell freezes over and the agents get off their asses and actually do one.  Do they care about phonies? Nope.  Does anyone care about phonies? Nope.  Even the doctors don’t care when the patient decided to give themselves 3 refills on their Vico-Dan ES prescription; “Oh, the’re in pain, fill it anyways – no refills”.  Yeah, write me out a check for $100 and after I add about 4 zero’s behind it you can tell the bank “Oh, he’s just poor, cash it.”

Don’t get me started at the whole logging Sudafed transactions.  What roomful of non-medical politicians decided to jerk each other off and pass such a shitty hole-ridden law such as this is beyond me.  Yay, I have a book that has every Claritin-D Rx in it.  So does every other pharmacy out there.  Doesn’t prevent the 18-wheeler full of sudafed thats being trucked in from MEXICO that the crank-cookers use.  Again, we can check our little books and realize that Juan Jose Carlos Maragariga VIII has been to every store in town to buy sudafed.  Will work really great after he’s arrested (or dead) after his lab blows up; BUT HEY WE HAVE THE LOGS TO SHOW HE BOUGHT SUDAFED (as if busted in a lab wasn’t enough).  The FDA shot themselves in the foot by pulling PPA off of the market because fatties were OD’ing on the stuff to lose weight – did they somehow not see this coming?

So DEA, after you are done subpoenaing me, auditing my store, ruining my life and wasting your time to find I’ve done NOTHING wrong, realize that pharmacists all over the country think that you pretty much suck and should stick your nose out of our business unless we call you.  We went to school to deal with this shit, you didn’t.  Oh, and give us a web-interface for all of the HIPAA violating data that you collect on a weekly basis. We can do *your* job a whole lot better if we can get the information NOW rather than after the patient has shopped every pharmacy in town (as if you will do anything about it anways).

The Pharmacy Union Address

Take a step back for a second and look at retail life.

We went to school to learn about drugs, the human body, a little bit about diagnosing stuff, interactions, CYP450, Kreb’s Cycle, Chemistry, Biology, Kinetics, blah blah blah.  Most of us spend 3 to 4 years in classes, then went out on rotations for 9 to 18 months working for free, etc.

However what do we do for 9 hours a day?  Do we actively use this knowledge to further better our patient’s lives?  Do we use all of the crap that they force-fed us in pharmacy school to do the things that they promised us we’d do?  Do we get to spend an hour talking with little old white ladies while wearing our pristine white coat (gotten at the UOP White Coat Ceremony, die UOP) while we laugh and talk and go over her disease states and medications with smiles on our faces like the chains portray pharmacists in their ads?

No.

We are the babysitters, the nannys, the ass-wipers and the caregivers of the general public.  When there is a problem, we have to deal with it (even if it had nothing to do with us).  Patient loses their medication or takes it wrong? We have to deal with it.  Patient flushes her Percodan down the toilet its OUR job to put the call in.  We are the common sense of the public and the bearer/invoker of their personal responsibility.  Doing this makes us a doormat, not doing it makes us no better than fucking McDonalds or Burger King.  Fuck, some stores are already no better than fast food chains with drive-through windows.

We went to school to end up using our deep pharmacological knowledge so we can apply it via AARP covers Zocor and not Lipitor or that nicotine patches are a DAW-1.  Lyrica is only covered if Neurontin is failed and nobody covers fucking Adipex-P or Xenical.  We wait on hold to speak with some dillhole in India who speaks like a robot because the ID card has the wrong information or PCN printed on it.  See that AWP -%30 + 1.50? Take it and like it; you don’t have a fucking choice anymore.

We try to decipher handwriting that looks like shit-covered toilet paper as office staff who cant speak a fucking clear word of English try to sound words like atenolol while using phrases like “Well this *looks* like….”.  We are a slave to the machine known as a “Fax” and the 2 doctors in town who still think that its a HIPAA violation to use one.  Our jobs revolve around the public whining at us because they waited until they were out (typical idiots) to have us send the fax over to the doctor for the refill request.  Did I mention that its also Friday night and the doctor turns his fax machine OFF when he’s not there?  Doctors think that we are nothing but fucking pill counters and treat us like some ignorant plebe who knows nothing about medications (or anything for that matter).

We are the vicodin police to a completely inept and retarded DEA (Fuck you DEA, more on you later) who collects data from us yet does absolutely nothing with it.  We live in fear of inspections from the only professional licensing agency that is AGAINST us.  You fuck up, the state board wants your head.  They aren’t there to protect you, they are there to protect the public FROM you.  Tell me how that works and why I send them money every 2 years for a green piece of paper with my name on it.

We go through this day in and day out so we can live a good life.  We put in our 30 years to hopefully have some sort of retirement (since Medicare will be long broke when I retire), and after those long days, 2 heart attacks, refills upon refills of the Buspar and Wellbutrin you take to keep your sanity, and the dumpsters full of alcohol bottles to make the pain go away, you can look back at your career and really ask yourself was it really worth it.

You’ll think.. You’ll think some more.. You’ll drink.. You’ll drink some more…  Days will run into weeks will run into paydays will run into months into years.

You’ll remember this post, and say to yourself “yeah, it was worth it”.  For all the shit that we deal with, for all the frustrations, the hold times, the yelling, the swearing, the hugs your techs give you when you’re about to have a breakdown, the throwing of pens and dumping of Alpharma’s (now Activis) insanely sticky Prometh with Codeine on the counter (as you scream “SHIT!” and hope your patients didnt hear you) you’ll have those handful of patients who’s life you really did make a difference.  You’ll have the metaphorical little white ladies in the chain commercials who you *did* help out and *did* make life just a bit better.  You will be someones hero and a person that people look to for nothing more than a smile, hello and acknowledgment that they exist.  You’ll walk through the parking-lot wearing that beat-up white coat that you got in school 20+ years ago like a badge of fucking honor and respect as your patients know you by name and will drive across town to come into *your* pharmacy to say nothing more that what you suggested to them OTC worked like a charm.

From this post you must get the idea that retail pharmacy sucks, that I hate it, that I wish that lightning would strike me down and put me out of my misery.  Certain days there is nothing more in life I would wish for, however everyone is like that with their job. When its a really shitty day and nothing is going right, yeah, I hate it.  However those days are few and far between.  Thats why its called work, not fun (“How was fun today dear? Oh, tiring”).

I wrote this because retail pharmacy is changing and I really don’t feel like pharmacy students are getting the proper picture that retail paints.  This isn’t designed to scare people away, but to let them know exactly what they are getting themselves into.  After spending tens of thousands of dollars and all that time in school, wouldn’t it be a waste if you learned you couldn’t take getting yelled at for an early soma refill your very first day as a pharmacist?  That on the first day working alone you realized that retail life was in fact nothing like what your school had prepared you for?

I really wish that Drug Topics or somewhere else would publish some of what I write, but I think that I use too many bad words are too “real” for most magazines out there.  I wish they would grow up and realize that people swear, and that medicine/life isn’t one big hugfest.

Loaded lancet devices for everyone!

When people bring in their blood glucose monitor to me for help (which I don’t mind really, as long as it was filled here and not Liberty Medical (fuck you)) there are a few things that are consistent as the sun rising in the morning and white bread/Velveeta cheese at a redneck BBQ.

  • The machine, strip container, lancet device, everything will be smeared in blood
  • The lancet device will have a loaded, used lancet in there cocked and ready to stick yourself with

Lets look at point one first:  Why can’t people keep their fucking blood glucose machine half-way clean?  Most machines I see look like they have been used to cave someones head in, or was used as a tampon.  Dried blood all over the place, on the buttons, on the screen, everywhere!  I have seen less blood at a murder scene than on some of these machines.  Am I the only person who finds this utterly disgusting?  Let me shit all over something and have YOU deal with it.

This brings me to my second point: People love to have a loaded lancet device there waiting for you.  It never fails, I look at a machine, and I pop the top off of their lancet device to see if its working to find a used lancet needle staring me straight in the face.  Why can’t people use a lancet once, safely recap it, and throw it in a fucking sharps container?  How hard is that?  We give them the fucking sharps container for free!  Now fortunately both myself and the other pharmacists treat a lancet device like a loaded gun and stay safely away from the business end, but seriously, if its going to go off, have it be a loaded gun so it can just end my life quickly vs me having HIV or Hep C by some ghetto dirty ass whore who couldn’t take the two seconds to properly dispose of her used lancet.  The last thing I need it so accidentally stick myself and have to miss work because I’m out having every test to man done.  I can just see the Work Comp bill for that little fiasco.

So please, if you are one of those type-2 diabetics who test 30 times a day just to waste money, please make my life a bit easier and use a bit of common sense (HAHAHA) and unload your lancet device before you bring it in.  My safety and general sanity really do depend on it.

ATAP: Medication changes and how I deal with them

I received this question from a doctor who frequents the site:

I have a question regarding changes in medication. I am a physician.
The way I usually handle it is that I tell the patient the new dose and
then write a prescription to reflect that dose. I then tell them that
they’ll have to go in earlier than usual to get a refill and to use the
new prescription to let the pharmacist know that the dose has been
changed. Is that the best way to handle it?

This is an excellent question. I far far too often have patients tell me (when they are out of medication) that doctor has changed the dose. Usually this is on a Friday night about 10 min before closing.
In the case above, you, Dr, are doing the correct thing. Seriously, I cannot express this enough that writing a new Rx for the patient to bring in (or fax over from your office) is the absolutely best thing to do. Telling the patient about the new dose is like talking to the sky (or filtering piss out of the ocean). I have seen more mistakes with patients getting their pills mixed up and taking double on something they shouldn’t have. Usually things turn alright, but when they get instructions to double up on their HCTZ and instead double up on warfarin, things turn sour really quick. If doctors always assume that their patients cannot wipe their own asses without written instructions, the world would be a better place.
This is what I do with a sig/dose change for which the MD has done “The right thing(tm)”:
When the patient comes in, I get the new Rx in hand, and right then I have verification that the dose has indeed been changed which I input into the computer and fill the Rx (if they are out). If the patient comes in and still has some medication at home I put the changed Rx on file, and if the drug & strength are the same I print out a new label and tell the patient to apply it to their old bottle (I write the Rx number down which to apply the label to). Usually the patient is smart enough to match 2 numbers together and apply a stupid sticker. However this is a huge judgment call, and on more than one occation I have told them to come back with all of their medications so I can do it myself. I instruct the patient to come in when they are out upon which I fill the Rx that was put on file and everything is happy in pharmacyland.
So if you are an MD/NP/PA/DO/CNM/Janitor who is reading this, here is a few tips on how to make your pharmacist love you.

  • Any changes in dosage or sig, write the patient a new Rx. Using a sharpie on my pharmacy label is just going to waste both of our times with a fax over confirming what you wrote.
  • If any medications are DC’d, let us know. Nothing annoys us more than to have to wait for a fax-back asking if the patients Lotensin needs to be DC’d because you wrote an Rx for Diovan. Its not that its a waste of our time, but the patient obviously has no clue what’s going on, and the terms “possible therapy duplication” is like speaking chinese to them. They have to come back to the pharmacy, or wait an unknown period of time until we get an answer.
  • Write down any and all information on the Rx that might save a phone call or fax when switching to formulary alternatives. Unless you really want Protonix for some god-forsaken reason (like the reps are giving you lapdances), writing “or equiv” will save us both a ton of time. A PPI is a PPI for gods sake.
  • If you have any questions about whats covered, a rule of thumb is that if its cheap and generic; its covered. Prilosec vs Aciphex, Lotensin vs Aceon, etc etc etc. Have you tried generic Mobic vs Celebrex? You should! If you don’t really care what NSAID the patient gets, then state “Feldene, but whatever is covered, therapeutic sig”. Any pharmacist worth his salt will take care of your patient and not bother you. We may fax you what we gave so you can keep your records updated, but we’re not going to ask you a bazillion questions if its okay. Remember, we went to school to learn about drugs; have a bit of trust in us.
  • Hate to tell you, but most NEW drugs now days are just knock-off me-too’s that are out because their replacement is going off of patent soon and will be dirt cheap. Look at Paxil CR, Coreg CR, Adderall XR, Lexapro. All came out shortly after Paxil/Coreg/Adderall/Celexa went off patent. You have been using these agents for 10-15 years, and all of a sudden they suck because something new came out? Think of it this way, if they were so “new” and “breakthrough” and “revolutionary”, then why weren’t they out when there was 5 years left on the patent on the drug they are meant to replace?
  • If you have any questions about pricing, call us. Seriously. Nothing makes me happier than churning my workflow to a grinding halt to answer a phone call from a local doctor wanting information vs some crackhead asking for their vicodin a week early. Believe it or not, we’re in the same boat, and we cant exist without each other, so lets actually talk once in a while.

Telling someone they are stupid

Its a fine, (if not lost) art to get the point across to a patient that they are too stupid to manage their medication without sounding like an asshole.  Unfortunately this skill is not taught in school (but really should).  We all know the types of patients that really have no clue what they are doing.  They still have bottles from 5 years ago (and call in those numbers when they want refills).  You insist that they did sign for some pickup (which they deny) only to magically “find it” once you already have the replacement refill done.  Patients like this really do gum up pharmacies all over the nation and are a source of not only stress for the pharmacist and their staff, but themselves as well.  Sometimes they are so stupid that they don’t realize how much danger they are putting themselves in, which is why Mommy/Daddy pharmacist needs to have a “time out” and tell the lady who’s ship should of sailed 10 years ago why they are so confused.

So how do you break the news that taking a pill twice a day is beyond their mental capacity?  To be honest, there is no easy way.  Well, I take that back; there is an easy way, but “You’re too stupid to do this by yourself” tends to drive patients away. 

Some pharmacists take the “confusion” route.  By saying they are “confused” instead of “stupid”, it takes the blame away from them, and puts it towards their age.  Old people are confused, its a fact of life.  You have a car engine that has 600,000 miles under its belt and see how well it runs.  Confusion is always a safe bet that won’t make the patient feel that they should be wearing a helmet and winning a medal at the Special Olympics.

Another avenue you can try is by telling the diaper-wearing drooling patient that you want them to bring all of their bottles in so you can “Make it so they all get filled during the same time of the month”.  Uh huh, right.  This is translated pharmacy speak for “Throw away all of the 10 year old bottles so you’ll call in recent numbers” or “Seeing if you are actually taking your Aricept and Haldol”.  The retard thinks you are doing him/her a favor, so they will have no idea that you are mentally murdering them as they bring in their shoe box full of empty vials.

Speaking of retards:

What really makes my blood boil are people who live in these “assisted living” joints.  These people aren’t old, they are just truly borderline retarded and are too well to be in a 100% ass-wiped-by-Filipinos nursing home, but too mentally challenged/retarded/handicapped/etc to live on their own.  Whats truly retarded about this whole thing is that the “caregivers” allow the patient to manage their own medication to give them a sense of independence.   Trusting someone with a IQ thats my shoe size to manage medication so they feel independent is a REALLY dumb thing to do.  If you want them to feel independent, then let them use the shitter by themselves, or don’t clap when they do a somersault without help.  I know that I’m going to hell for making fun of retards here, but we need to draw the line at how mushy-political-correct-huggy we are willing to take without having common sense step in.  If you think I’m an asshole, then you try correcting their blister-packed medication 4-5 times a month because they thought it would be a good idea to make little pill piles sorted by color.