How can you be that stupid?

I saw this happen twice today, so I figure that I had better make the issue known.  Plus it really really pissed me off.

Both patients came in within the past 2 weeks with new Rx’s in hand.  One was for a change in Lantus (dose cut in half), the other was for a change in Atenolol from twice to once daily.

The both “knew” that there were changes, they spoke with the doctor and got a new Rx issued.  However, 15 days later now they both come and want a refill.  Turns out that even though I TOLD THEM there was a direction change, I made a HUGE HIGHLIGHTED REMARK on their Rx receipt (which they saw, it had their copays on it) and their DOCTOR TOLD THEM THERE WAS CHANGES, they (of course) ran out early because they were taking the OLD directions and not the NEW directions which are STARING THEM IN THE FUCKING FACE.

Seriously, Lantus I can see, you don’t look at the label, you just open the box, inject, and dont notice the change.  However the moron with the atenolol is another story.  She obviously had to look at the label to find out WHAT THE PILLS WERE and didn’t notice the huge change in direction note? It would take a fucking neon sign, and me standing next to her saying “Uh, its once a day now” to have her fucking take her medication right. 

I wish being dumb caused pain instead of more children.

A retrospective look at 3 years, 200+ entries, and a whole lot of booze & tears

Once in a while I’ll do these retrospective posts after reading some of the old entries that I have made.  Think of it as a “Final Thoughts” like Jerry Springer does (only this is FAR from my final thought).  This isn’t a space filler so the site will have new content for you to read when I’m short on rants *ahem* but some deep thoughts from yours truly.

I have painted a colorful picture of Pharmacy.  I have exposed all of the crap, the drama, and the daily pain that pharmacy schools pretend don’t exist or your pharmacist cant talk about while in the store.  Despite how much of an asshole you think I am, or wonder how or why I’m even a pharmacist, you too have gotten a clear idea of what goes on behind that counter.  You have realized that we are more than just pill counters and the ignorant bitches of doctors.  Other pharmacists realize that they are not alone in the sea of stupidity with sparse slowly-sinking lifeboats littered about that we all tightly clench onto.

But what really makes doing this whole blogging thing worth while (along with keeping my sanity, god knows its not the ad revenue check – $1 menu here I come) is that some of you out there will look at your pharmacist with a new light.  I hope its a positive light (and not think that we’re all a bunch of raging assholes).  I hope you’ll be more understanding when things don’t go correctly or smoothly and once in a while give us a thanks (or a box of candy, we love candy.  Booze also works well too).

I’ve been reading the Raging Server (http://www.ragingserver.com), and doing so has given me a whole new respect to Waiters/Waitresses/Waitripeople.  They deal with the same shit that I deal with, so I tip better because of it.  I wish other people in other professions would write what their day is /really/ like so we can get an understanding of how their jobs are similar to ours and would give us just a tiny bit more restraint before we blow up at them for doing something that we don’t like.

Just a thought.  Fuck Perdue and Liberty Medical.

Ethics and the lazy

Contrary to popular belief, there is a ton of ethical crap that goes along with being a Pharmacist.

Prime Example:
Family comes in who are on welfare.  They bring you Rx’s for 2 bottles of amoxicillin (one for each kid) and for some OTC tylenol liquid.  You run their Medicaid through and they were terminated.  You obviously know that they cannot be terminated because its the first of the month, and everyone gets all screwed up towards the first.  Plus it helps that this family has been on Medicaid for the past (all) generations, so the chances of them being actually terminated is nil.  The Amoxicillin runs about $9/each.  You know that they don’t have the cash on them.  Do you charge them; Do you fill and not charge them; or do you give them their Rx back with a huge “See ya!” wave.

The correct answer (as almost all if not all Pharmacists will agree, except Mail Order douches) is you give them the Amoxicillin, and tell them to get a hold of their social worker to get their insurance settled.  You tell them you’ll try to process the Rx’s in a few days.  Witholding antibiotics from a sick kid when it costs $9 each is pretty hard-ass (even for me).  Now if it were a screaming crackhead who wanted Zyvox, to hell with her.  Kids should be taught that your Pharmacist is your friend, not the man who gives mommy those white pills that make her sleep all the time.

A few days go by, and you try to process those Rx’s.  Of course they won’t go through.  A week goes by, nothing.  10 days go by, nothing.  You call the parents to ask, and they tell you they did not call their worker, and really have no intention of coming into your pharmacy to pay the $18 they owe because they have no money.  Good deed? Punishment? Thanks for playing!  Be happy it was only $18 and not more.

I got bitched out for being too PC, so i’ll lay it out plain and simple.  When advancing medication to a Medicaid patient, you must be fully prepared that you will eat the cost of said medication.  Think about it, these are the patients that have their asses wiped by the government because they are unable/unwilling to work.  What makes you think they will take the initiative to actually CALL someone when they already got the rewards in-hand.  Sure, they will get shafted next time they try to get stuff filled at your store, but they’ll just go somewhere else and do the same thing.  Its not until someone stands up and says “NO” to them that they will get off of their ass and make the call to get reinstated.

So this is where the ethical question comes in.  At what point do you withhold medication to FORCE the patient to make that call (because you sure as shit don’t have time to call HIS worker for HIM) so you not only will save other pharmacies what you went through, but also save his OWN ass when pharmacies refuse to refill drugs that will save his life.  Tough issues, and having a “come to Jesus” meeting with him will just get result in him/her agreeing with you and not following through.

Perdue, Thai Hookers, and rolled up Benjamins

As you all have heard/read; Perdue, the maker Oxycontin (AKA: Hillbilly Heroin), decided to sue the shit out of all of the generic Oxycontin manufacturers and cease production (or some patent shit.  I really doubt Teva would make a generic knowing full well the patent is still legit).  Not only that, but they are bringing out NEW strengths for easy pharmacy shafting…er..patient dosing!

Hooray for Perdue! Only brand name Oxycontin in pharmacies everywhere!  Addicts Rejoice!  Pharmacists rejoice! Now we get to stock a bottle that costs $600 vs $300! Hooray! I could piss myself from all of the HAPPINESS that is going on right now.  Oh wait, I cant afford a change of pants because I have a fucking rainbow of gun-in-face magnet pills sitting on my shelf costing me a house payment.  Perdue is probably trying to recoup that $634 million in false “oh, this isn’t addicting.. Hey, it worked with Heroin” marketing, why else would they lawyer-up and magically get FDA approval for new strengths as their patent dwindled.  Some Perdue Exec is probably using wet-naps right now after her visit to the FDA office (ha ha!)

So Perdue, in an attempt to line its own pockets full of gold, have just shafted not the addicts (who just raise their prices when they sell this stuff) but the legit pain management patients.  Thats right, chronic pain patients now have to deal with trade name copays instead of generic copays.  Your grandfather have cancer? Perdue pretty much is saying “hm, that sucks, so sorry!” as they swim in their lakes of gold and snort their products off of the thighs of 17 year old Thai hookers with rolled up 100 dollar bills.  Thats right, I went there.

I’m all for free enterprise, making money, and selling a good product.  However its not cool when there is indian giving with the generics (like Plavix).  I guess 10+ years of “record high profits” with Oxycontin wasn’t enough.

Perdue Pharma Execs, I hope you never get cancer and have to deal with the same assholes that you have become.

Paging Doctor Sandy Pants…

The original post is here. TAestP didn’t want to field this one, so hell, its my duty to stand up for my loyal readers.
http://dinosaurmusings.blogspot.com/2008/05/rant-alert-attention-pharmacists.html

To the friendly, trusted neighborhood pharmacist who told my 74-year-old diabetic patient with coronary artery disease and arthritis to stop his Zocor because maybe that’s what was making his knees and hips hurt:
You fucking moron! Do you have any idea how hard I worked to get this guy to take this stuff in the first place? Do you know how long it took, how many visits over how many months of teaching, explaining, describing, convincing, persuading, cajoling and begging to get him to agree to even try this medication in the first place? Are you even aware of evidence-based guidelines that recommend statins for patients with diabetes and CAD? I assume you’re aware he has these conditions BECAUSE YOU FILL HIS FUCKING Avandaryl, Diovan and Procardia!
And guess what, asshole: his knees and hips still hurt. Think it might be osteoarthritis? You think you’d never seen that in a septuagenarian before.
So thanks for nothing, fucktard. No matter how hard I work my ass off trying to educate my patients about the need for their various medications, you go and undo it all — why? Because you can? Just to prove to yourself that patients hold you in higher regard than they do me? Think I can get you named as a co-defendant when he has a stroke and the wife sues because I wasn’t following the guidelines? No, of course not. You’ll just keep smirking there behind your counter, saving poor patients like him from us arrogant docs whom you claim don’t know one tenth as much about drugs as you do. Well guess what, you cum-burbling trout-fucker [thanks, CrankyProf!]: you may think you know all about drugs, but you don’t know the first motherfucking thing about using them in people.
So why don’t you go down a bottle or two of tylenol and chase it with a quart of vodka for good measure. Your basal metabolism is contributing to global warming, and there are slime molds who’d make better use of the oxygen you consume.
End Rant.

Are you mad because we undid your work with one statement what took you a while to accomplish? A bit bitter because your patients listen to US over you? Its okay, heres your ID card; Join the club. Not my fault that we spend more time with your patients than you do. Maybe if you didn’t take appointments and allowed them to just walk in to pester you they would think the sun rose and set on the crack of your ass like they do their pharmacist.
Now, after you have washed the sand out of your neither-regions, should you also maybe take what your patient says with a grain of salt? Say, like when YOUR patient comes to us and said “Doctor said I can have my Soma early”? Because we /all/ know that the PATIENT never gets what you say wrong. NEVER EVER.
Since the patient said that their knees and hips hurt, they probably pointed to their legs and said “It hurts me here”. I’m sure the pharmacist said “Talk to your doctor, the pain could be because of your Zocor” and the patient took that as “Stop Zocor”. Hell, the pharmacist could of said “Your Zocor is no longer covered, I’m faxing your doctor” as “Doctor told me to stop”. Old people don’t hear things correctly, you know this and I know this. I don’t care if another person “heard them say it”. If a doctor called me over something as stupid as this I would just say “yeah, whatever *click* ” just so you would stop wasting my fucking time. You don’t see us calling you to bitch you out for having a bunch of morons phone in your prescriptions and all of the retarded errors they make.
If the patient initially didn’t want to take Zocor (which you said that he didn’t) then don’t you think that MAYBE he was looking for the tiniest reason to stop taking it even if it meant taking things completely out of context? If your patient refuses to take it and dies, its not your problem. You said he should be on it, he doesn’t want to, end of story. Your patent could just be getting it filled and NOT taking it. Ever think that? Happens all the time. Just decided to rant on poor pharmacists over something stupid that your patient did.
Oh, and to shit in your punchbowl some more – if a 74 year old dies, I doubt they will sue you for not following guidelines considering HE’S FUCKING 74! Why doesn’t his wife sue God while she is at it. You should of made your story involve a 45 year old to make this point a bit.. uhh.. less retarded.
Heres an idea, Maybe you should have the Avandryl and Diovan reps talk with your patient, we all know that you’ll do whatever they say – maybe your patient will do the same.

Friday + start of the month = very angry pharmacist

The first of the month is always super stressful for pharmacists.  Not only are we usually busy, but it seems like everyone saves their shit/drama to explode on us.  If you think that I’m a callous asshole (and obviously are not a pharmacist because if you were you’d understand) then read on and maybe it’ll give you a bit of insight as to why not only myself but all pharmacists either drink or are on antipsychotics.

First thing in the morning, I have to do the backlog of call-ins from the answering mac-

Phone rings.. Pharmacist on line 1.  Mrs Jones needs all of her regular medications refilled.  She wont give any of the numbers to any of the clerks, will not give you the numbers, says “you know what I normally get” and she wants them delivered.  She mumbles like she has marbles in her mouth as the answering machine is blaring in the background because you forgot to pause it when you grabbed the phone.

-hine.  There are about 15 Rx’s on the machine, and after playing each about 4 times you think you can understand what they want.  You write down everything and start to fill them as people start to mosy around the store.  Vicodin, Soma, Vicodin, Soma, Valium, Vicodin, Soma you fill and fill and-

Pharmacist line 3.. Dr Dumbfuck’s high school dropout receptionist is trying to sound out amitryptline but it sounds like amultryptillyinyling.  She cant make out the strength so she has to-

Pharmacist out front for a question.  Some woman is bawling in front of you asking for her somas early because her grandbaby died and she has to leave for texas RIGHT NOW.  You tell her that you’ll be right with her as she gets pissy and yells and says that she has to leave RIGHT NOW.  You pull up her profile to see a nice array of Vicodin/Valium/Soma with a huge note that says “NO EARLY REFILLS PER MD”.  You tell her that you really can’t refill it early as she throws a fit that would make 2 year old proud right in a store full of people making you look like a complete asshole because HER COUSIN DIED AND YOU WONT FILL HER NARCOTICS EARLY.  You’re the only one who caught that her story changed half way through.

-ask the doctor for clarification.  You wait on hold trying to hold back the urge to scream at this ignorant non-english speaking twat but the Doctor is one of your heavy writers so you just bite your toung-

Pharmacist on line 4.  Dr Smith is on the line.  You tell your clerk to hang on line 3 while you talk to Dr Smith on Line-4.  He wants Wellbutrin XR 75 and manages to hang up before you can tell him that strength doesn’t exist. 

The phone gets thrown at you from your tech who is waiting on line 3 from you with Dr Dumbfuck giving you both barrels because you didnt understand his fucking daughter who must of just gotten off of the boat from India.  You make some backhanded smart-ass remark about being sorry for caring for patient safety and the horrendous idea of filling the correct medication and hang up on him.

-fill. (still with me? Good!)  You wonder if any of your patients are on any blood pressure medications or just narcotics.  You put the calendar you have right by your workstation in front of your monitor so you can count the days to see if people are due for their refills.  Notes such as “Wants to see if she can get early” or “Requesting early fill going out of town” litter your stacks of refill call-in requests that your clerks relentlessly place up for you to process.  Obviously you know the answers to these early fill questions already, but you pull up the numbers just so you dont put your foot in your mouth later on.

The more you process, the more the stack grows.  Your techs are a flurry of counting awesomeness as the printer churns out the labels like they are going out of style.  Wellpoint goes down, and your entire pill churning operation decides to start to nosedive as you make a stack of Rx’s to bill later when Wellpoint comes back up.

You take a few deep breaths to try to keep the wave of panic from destroying your day as your tech scratches your back in a half-ass comforting way-

Pharmacist Line 2…. Its Mrs Jones..  Mrs Jones got her delivery, and WHY IN THE HELL DID YOU SEND HER LISINOPRIL.  HER DOCTOR TOOK HER OFF OF THIS LAST WEEK AND LIKE HELL SHE IS PAYING THE $1 COPAY FOR THIS.  YOU TAKE THIS BACK RIGHT NOW AND SHE CANT BELIEVE YOU SENT THIS OUT *click*.   Life just got a little bit worse, you didn’t even get to yell at her to call in the Rx’s numbers next time and this shit wouldn’t of happened.

Pharmacist requested out front rings throughout the pharmacy.  A mother does not know what 1.0mL means on the TriVitFlor (for those who are NOT pharmacist/techs, TVF has a dropper that has 1 mark on it.  1.0mL).  You are walking back to your station as your tech screams at you to check off the counter-full of Rx’s filled so they can be put-

Pharmacist Line 3!  Its Mrs Jones again, she wants to know why her copays went up from last month.  You balance the phone on your ear as you try to check off the Rx’s on the counter so your techs can continue to work.  Mrs Jones is screaming at you like you are some sort of monkey at the zoo flinging poo at her.  You run to the computer to find her copays have not changed in 2 years.  You pray for either your death or hers.

You try to work on things throughout the day to have customers scream at you from across the counter as if it is their personal pharmacy.  They get pissy because they are going “on vacation” and need their shit RIGHT NOW.  You feel less and less like a professional and more and more like a fucking vicodin dealing slave.

You’ll feel anger towards your fellow man, that how someone that stupid can continue to pop out kids as if they have no idea how they are being generated.  You’ll feel disgusted at the healthcare system and allowing people who contribute nothing continue to further their own genetic legacy.  You bust your ass and are treated like shit so these people can live a “good life” without having to work one honest day, and they have no problem cracking the whip over your head for not counting out their valium faster.

The day goes on, you almost have a breakdown.  You dont feel like eating lunch because you are so stressed out.  Your techs try to give you some comfort and your clerks try to handle the brunt of the insanity of the public coming in but eventually the walls crumble.  After your day is done, you sit there alone in the empty pharmacy wondering why in the hell you went into this profession, where we went wrong, and how you can do this again.  You stand up, knees aching and back tingling and make your way to your car.  You sit at home and prepare yourself to do the same thing in the morning.

Ask any pharmacist out there who works retail, and they will agree that its EXACTLY like this.  Pharmacy is a interruption based profession.  You have no time to actually concentrate and work on something from start to finish in an environment that fosters good thinking.  You have people screaming at you, demanding things, bitching and blaming you for stuff that you have no control over (like copays and not-covered drugs).  You went to school to learn really complex shit to use in an environment where the only 5 min’s of peace is spent sitting on the toilet.

However, take heart that there are others like you.  Others that are in the same boat and feel the same way about work.  I, for one, take some comfort in that.

Fibromyalgia is the new Low Back Pain

This post is due to an educational grant from The Raging Server.  Blame him that I’m ripping on all of the FibroFakers(tm, ie: TAestP dont steal this).

Usually when I write stuff like this which pisses off a ton of people, there is an implied concept that I’m bitching about one small subclass of people.  Unfortunately, some of my readers here just got off the short bus.  Example: I made a rant recently about Type-2 diabetics stupidly testing 5 times a day, and got tons of comments by a bunch of well educated Type-1 folks on insulin pumps (obviously well educated, low in common sense).  So I have to make the following statement:

This post is about the joke diagnosis known as Fibromyalgia.  If, in fact, you do have Fibromyalgia and are on Lyrica, Neurontin, TCA’s, Ibuprofen, and everything BUT SOLELY Vicodin/Valium/Soma, then disregard the rest of this post.  I am not talking about you.  Unless you want to be publicly made fun of on here, do not write me a 10 page comment bitching me out about your life story, how you are on ALL of these drugs to treat this “condition”, how much of an asshole I am, wah wah wah.  I repeat, I am NOT TALKING ABOUT YOU.  Other readers of this website will be quick to point out the error of your way.

There are two types of people who have “Fibromyalgia” – Those who actually have something wrong with them, and those who just use it an an excuse to get narcotics.  I must say that I have seen a whole lot more of the latter than the former.  From just my own experience, it effects the poor more than the rich, and only Vicodin/Valium/Soma combination will ease their pain.  To hell with Lyrica or anything else like Ibuprofen.

For those of you NOT in the medical profession.  Fibromyalgia is one of those diagnosis which amounts to “You say you are in pain, yet we have no idea what is wrong with you”.  Its a crap diagnosis which even the inventor of it says it does not exist.  Basically what this comes down to is that it is indeed the new “low back pain” that people use to get narcotics.  It indeed is the “low back pain” for the 00’s.

I do a ton of prior auths for patients to get their Norco/”Somas”/”Vico-DAN 7.5’s” covered. Its gotten to the point now that when the patient or doctor responds with “Diagnosis: Fibromyalgia” and I see nothing but narcotics on the patients profile for the last 10 years I want to put down on the prior auth “Diagnosis: Patient has a shitty life and just wants to get high”.  For an Incidence of 2% of the general population there has to be something big that ALL of my patients seem to have acquired this condition.  Maybe its transmitted by toilet seats or welfare folk having sex with unicorns or leprechauns.  Or heres a novel idea, maybe they are just FAKING IT.

I see patients who have something obviously wrong with them, be it Fibro or something.  They usually are all crippled up, walk with a cane, are on Depakote/Lyrica/Neurontin/Ibuprofen/other than solely Vicodin/Valium/Soma and get their 30 norco filled every month for breakthrough pain.  They don’t bitch about early refills and actually take an active part on their healthcare.

Then I see the very vocal patient who has “Fibromyalgia”.  I see them stroll through the parking lot to have the hand of God suddenly inflict them the most unbearable pain once they hit the front doors.  They use phrases like “Good Lord Jesus save me from my pain” as they stumble to the counter.  Johnny Depp, eat your heart out, these folk have you beat in the acting department.  They act like the world is going to end until you say that the doctor denied their pain pills.  At that time they stand STRAIGHT UP and YELL about how they have FIBROMYALGIA and are IN PAIN as they march straight out that door on their cell phone.  Yeah.. I know.. See why I’m jaded?

The wikipedia article linked above has a lot of great tidbits about Fibro.  My absolute favorite is:

“In addition, many patients experience cognitive dysfunction (known as
“brain fog” or “fibrofog”), which may be characterized by impaired
concentration and short-term memory consolidation, impaired speed of
performance, inability to multi-task, and cognitive overload.”

Yeah, brain fog/fibrofog.  Gee, do you think its because of the condition, or the fucking truckload of dope these people get from their doctors to treat this “condition”.  The jury is still out on that one.

Wait, wait, the NYT article (on page 2) has another gem:

“The potential for weight gain is a special concern because many
fibromyalgia patients are already overweight: the average fibromyalgia
patient in the 2007 survey reported weighing 180 pounds and standing 5
feet 4 inches.”

I wonder if carrying all of that excess weight around has anything to do with your chronic muscle pain?  Nothing a little soma and valium wont fix!  Oh wait, we should feel sorry for them because they have fibromyalgia.  Lets just rename the disease FATSOmyalgia and stop with the candy-coating.

So yes, I do think Fibromyalgia is a fucking joke.  I am not disputing that people have actual legit problems that require medication, but its really hard to take this as a real condition when people are just using this to get tons of free narcotics from the state program.  Now I need to prepare for all of the people who didn’t read the disclaimer to send me their life stories and call me an asshole.