Introducing AngryTV

This isn’t new to people who follow me on Twitter or on Facebook, however I’d like to share with you something that I have made:

httpv://www.youtube.com/watch?v=AGwQzBLjOZI

Stay tuned for more AngryTV (since the site that makes this is AWESOME) as well as some user submitted gems.  If you make one, comment with the link and I’ll post them if they are good.

Angry Tweets for 2010-09-09

  • What?!? Mail order pharmacy missed a Warfarin+Amioderone interaction and the pt is in the hospital? Color me shocked! #
  • By you writing for Diovan when I say only ACE-I's are covered proves you shouldn't be prescribing. #
  • Wasting a pharmacists time should be an event in the Ghetto Olympics. #
  • I guess a mail order pharmacy doesnt count as a "pharmacy" when asked if going elsewhere. #
  • Website is offline for a bit. Where the server lives exploded (so I'm told) #
  • Website is offline for a bit. W #
  • Uh, turns out exploded = went out of business. 🙁 Told server is being moved tonight to new home #
  • Site should work for some, not for others. Internet needs to learn of new home. #
  • Ah, the infamous "Girl at the doctors office" strikes again. #
  • Im amazed but never surpised how ppl with so little and get so much for free can be so rude and demanding. #
  • May your stockings be stuffed with Vicodin and Soma. Merry Xmas from TAP. #
  • Anyone else notice how HealthNet Part-D plan no longer covers vicodin 5/500? Looks like 2012 came early. #
  • Health Net Medicare Part D needs to get their shit together #
  • Real sig from a real SureScript Rx: take 2 teaspoonful (20ML) by ORAL route every 12 hours #
  • Me: Doctor changed your strength. Pt: WHY DO MY TABLETS LOOK DIFFERENT??? *sigh* #
  • Why do nursing students always comment on my site like someone gives a shit what they say? #
  • Its like the pharmacy has become a "Bitch about something thats not my problem" zone #
  • Planning ahead must be a super-advanced skill that not many people have #
  • Planning ahead must be a super-advanced skill that not many people have #
  • Whilst taking a dump and reading Drug Topics, @drugmonkey stared at me. I feel violated. #
  • American Healthcare Slogan: Its okay to abuse your body because the government will foot the bill! #
  • Wait, complain about $3.10 for nexium, but drop $90 for trade name Vicodin ES no problems? Gee, somethings fishy here. #
  • Some uppity bitchy tech doing the Blue Cross MediCal prior auths has stolen my heart <3 #
  • Not really, Im going to email blue cross to complain about her. #
  • On a RESTAT WorkComp card: "Paid without Predjudice". Anyone else find the irony (as I wait on hold to get OK from adjuster) #
  • Oh look, another patient begging for medication because Liberty Medical (fuck you) messed up. #
  • Me: This Rx is for eye glasses // Pt: I know, how much is my copay // I cant win even on fridays. #
  • God, another Avandia news warning. Cue 1000000 calls of "should I stop taking this" #
  • If you're going to go to 2 docs/pharmacies for narcotics, THINK before you demand I fill something. I might get onto your little game. #
  • For only knowing 5 to 6 drugs, Dentists sure can fuck up a lot of prescriptions. #
  • For only knowing 5 to 6 drugs, Dentists sure can fuck up a lot of prescriptions. #
  • Hm, thanks for barfing on me twitter! 🙁 #
  • CURES report shows a patient getting 120 vicodin rx's in last 9 months. Busy busy little crackhead. #
  • Dear Low Income Population of the USA: USE CONDOMS! THEY ARE FREE! SERIOUSLY STOP HAVING KIDS! #
  • OBRA'90 is a joke. Patients dont listen to us. They only hear the price, and if they can get their dope early. #
  • MAC + $1.50.. HAHAHAHAHAH OH GOD, PBM's crack me up in that sad fuck-me-in-the-ass sorta way #
  • "I cant be keep on paying $15 a month for my Nexium!" *sigh* Pay cash you ungrateful fuck! #
  • You mouthed off to your part-D and they turned you off, HAHAHA! #
  • "This happened saturday, Im getting plan B today (Wednesday), will it still work?" Oh its just another kid, no biggie. #
  • Are you really that stupid or am I on Candid Camera/Punked? #
  • Vicodin 500mg. Remind me why Dentists can write Rx's again? #
  • With all of the palm/iphone/whatever drug lookups, why do medical residents insist on making drug strengths up? #
  • Yes, when the counter on your Ventolin reads 193 it means you get a refill (with $0 copay, go figure) #
  • I wish @docgrumpy worked closer to me. I could use a new drinking/ranting buddy. #
  • Oh look, CURES is online now, time for the crackhead jihad. #
  • It makes me sad that a Dr wants a prior for Symbicort when last Qvar Rx was over a year ago. #
  • Getting pills in tissues with a note "Please refill these" make me sad. A lot of things make me sad. #
  • Notice im silent on the health care bill passing? You know damn well how I feel about it, no need to whine and moan. #
  • "Why the fuck aint my drugs be free?" The mind boggles. #
  • Few emails about San joaquin general hospital pharmacy and walmart. Email me if you have info/rants #
  • Today I slammed my head against the counter in disgust. It actually helped a bit. #
  • QOTD: I know my card is expired! So why aren't they covering my drugs! #
  • Think haldol infused coffee would be a good seller for pharmacists? #
  • Livalo? Really? A new statin? I think this is an idiot-doctor-detector! #
  • The lower your copays the more medication you are on. Its as constant as the sun rising every morning. #
  • If @drugmonkey writes a book, I think I might have to pimp it out on my website (but only if he puts 'TAP IS AWESOME-SAUCE' in it). #
  • You know you are getting a winning transfer when the patients name is John PIC-ID-NO-EXCEPTIONS Doe. #
  • So I've decided to follow some pharmacy peeps. If I followed you, feel honored. #
  • Its amazing how the phrase "Im a nurse" nullifies all of my college education. Its been a bad day today. 🙁 #
  • My follow-up to "Im a nurse" was "Then i'll use small words for you". ZING!!@ #
  • Any TAP fan ER Docs/Residents willing to give me their opinion on something ER/Trauma related? Email me: druglord@theangrypharmacist.com #
  • Patient: "Why cant I read you the Rx over the phone so it'll be ready for me" – Me: "Because you cant read scribble" – Pt: "Good point" #
  • Depakote smells like jordan almonds. Giving those out as wedding favors would make the party interesting (and boring). #
  • My tech almost FALCON PAWNCHED some woman who demanded trade name Lidex cream for the generic price. #
  • Im so congested. I'd slam my nuts in a drawer for some Entex LA right now. Curse the asshats who took it off the market! #
  • I love you Afrin. I hope you dont turn on me in about 5 days though. #
  • Someone just paid me a compliment. I think I dreamt it in the Afrin/Sudafed haze I'm in now. #
  • Patients who decide to up their insulin doses on their own should just die and save the MD/me the trouble of early fills/sig changes. #
  • Anyone who doesnt follow the directions on the bottle (because they KNOW their bodies) should just die and save us the time/trouble. #
  • So next post about people who "know their bodies"? Any requests? #

The MD’s guide to an RPh

Lets face it, part of our jobs is dealing with Doctors of all shapes, sizes and colors.  As you can see from this website, Pharmacists are a unique and special bunch.  I hope this guide helps our MD readers out there (you cant hide from us!) understand and interact with us a bit easier.  If some MD makes an “RPh’s guide to an MD” let me know and I’ll link it here.

Both MD’s and RPh’s need to drop the egos: Face the facts, MD’s aren’t the proverbial God of medicine anymore.  The whole concept of a pharmacist being an MD’s bitch died when Lanoxin went generic (no, I wasn’t around for that).  We both need to look at each other as allies against “to better the health of” the patient.  Fortunately the doctors who pull the “This is Dr OldFart, I need this for the patient, I don’t care if its not covered do what I say *click*” are either close to retiring or already dead.  Doctors can’t afford to stock their offices with $100k worth of expensive trade-name drugs, and pharmacists can’t prescribe stuff.  Its mutual destruction if one of us goes under, so lets stick together and drop the egos. (me, the biggest pharmacy ego on the internet saying to drop the egos.  I’m talking about at work, not on the internet!)

MD’s need to stamp their prescriptions: If you don’t have a stamp (and your pads don’t pre-print your name) , print your name and DEA/NPI on every prescription.  Then spend the $4 and get a stamp after your pen explodes after the 4th Rx of the day.  Having the correct doctors name on the Rx saves a ton of time for refill requests, and prevents us from playing “guess the signature” as the patient sits there staring at us.  Oh, and you think the patient knows your name?  Unless your name is “that Indian doctor”, “the doctor who I cant understand”, or “that cute doctor on 4th street with the huge tits” (no, I’m not joking); get a stamp.

Allow us to substitute in the same class: Unless there is some HUGE issue with dispensing Aciphex instead of Protonix, please write “OK to substitute per formulary” on Rx’s that you write.  We went to school to dose drugs in the same class into ballpark ranges.  This is what we are taught to do.  Trust in our judgment!  If this doesn’t convince you, lets look at the time savings:

Drug isn’t covered.  We make a copy of the Rx and write down whats covered.  We fax it to your office where someone that you pay stops answering phone calls to take the fax and put it on your desk.  You need to look at the fax, roll your eyes at the bullshit that the insurance companies make us go through and write “OK”.  Your staff then faxes it back to us where one of our clerks pulls out the original (in case the fax was lost in transmission) and gives it to us.  All of this happens while the patient is cursing your name as to why you wrote for a drug that costs $150 when her copay should be only $15 (or $0, most likely $0) as if you know her shitty insurance formulary by heart.  By spending 10 seconds to give us permission to substitute, look at how much time everyone saves and makes you (and us) look like rock-stars to the patient.  The “Its not covered” speech turns into “What doctor wrote for isn’t covered, but he/she gave me permission to switch it to what is covered”.  I’m no longer the bearer of bad news, but your wonder-twin counterpart.

Obviously this wouldn’t apply to tweaky drugs, we (I hope) know when something is over our heads and wont try to wing a Depakote dose because Lamictal isn’t covered.  If this bothers you, we can even FAX you what we switched it to.  Trust us, seriously.  Trusting the insurance company (who is telling you what to write regardless of what you say) over us is pretty shitty.

Nobody’s shit smells any better than the other: Sometimes pharmacists fuck up.  Benazepril gets dispensed instead of lisinopril, a 4 turns into a 1, I misread your lamisil for lamictal, anything can happen.  We both make mistakes, and having a doctor throw me under the bus to the patient (or having him/her call me up and just give me both barrels) makes me more shitty than how I already feel when I make an error.  When you write for something that has a life-threatening interaction, we “fax you for clarification” not throw you under the bus and tell the patient that you almost killed him/her.  We are both busy, we both make mistakes.  Lets not finger point, because in reality when that happens we both lose.

We need to talk more: No, this isn’t a chapter in some relationship self-help book.  We need to stop using our minimum-wage staff’s as proxies and just call each other directly.  This is going to sound sappy, but I love it when a doctor call me and asks me if something is covered, or how much something costs.  Hell, even to bitch about this patient and what to give him/her to get them off of our backs.  This makes us feel like part of the “team” than just pill-pushing human shields to the medicine side of health care.  Yeah, we both are swamped all the time.  A 30 second phone call as to whats covered will save us 20 min’s (and lots of bitching) later on down the road.  You want to know the real scoop on a new drug that some big-titted rep is pushing?  Give us a call, we’ll tell you how the drug she was pushing a year ago is going generic soon so she’s pushing the “new version” to keep the sale.  Hell, even a simple “thanks” for informing you of a narc-shopper makes us feel like we did something good.  Remember, pharmacists are the underestimated fat-kid of the football team of medicine.

Show us you care by giving us lots of refills: Mrs Jones has been on Atenolol 50 since the day it first same out.  Why not give us 12 refills on that new Rx that you wrote for her?  Help us save time (and thereby saving you and your staff time) by giving a bunch of refills on drugs that the patient has been on for years (and you have no plans to change).  Obviously I don’t mean stuff that you need labs to monitor!

Med dosage/sig change? Write a new Rx: Telling the patient to take a medication differently without writing a new Rx is about as effective as giving a stripper $100 and asking for change (uh, don’t ask me how I know this).  Save us both a fax and just write/call in a new Rx for any dosing changes.  Our computer systems can put new Rxs on file for future fillings, so it just makes sense to make both of our lives easier.  Spend 30 seconds now or 20 mins (and lots of phone calls by the patient) later.

Want to know the scoop on a patient? Ask us! Patients will tell you what you want to hear so you’ll give them an Rx.  However we see when they are getting their refills, who they go to, and how they act.  The patient that complains of a 10/10 low back pain to you may waltz into the pharmacy like nothing is wrong.  You may not see how your patients act outside of your office, but we do.  We usually see your patients enough to get a good gut feeling if something fishy is going on with them.  If we don’t know, then their insurance company computers can tell us if they have been naughty or nice (like Santa!).

Hope this helps.  I’m sure other pharmacists will comment on points that I missed.