Angry Tweets for 2010-09-30

  • I dont care about your sob story. I cant pay my staff or eat on sob-stories. #
  • I'm the wrong person to talk to about "Is pharmacy a good profession" What? Am I bit too jaded and realistic? #
  • I wonder if Miralax would go well with Gin. #
  • 18, dressed like a skank with your tounge pierced? Let me start the PA on your Valtrex now. #
  • Let me also slap the shit out of your parents for letting you look like a whore in public. #
  • Heh, some guy just threatened to do a robbery here. Bad move bucko, go find another store to put up with your shit. #
  • My tech: "If those titties hung any lower they would be called knees!" #

Angry Tweets for 2010-09-29

  • Dentist wrote DAW-1 on a Luride Rx. My opinion of dentists writing Rxs is upheld. #
  • Heres a novel thought. Maybe if you TOOK your meds you would be on LESS meds! #
  • Heh, big procrit recall. Its nothing big, only tiny glass flakes 1 micron in size that BRING DEATH TO YOU! #
  • Name your favorite Pen. You know you have a brand you like! Mine is Pilot G2 7mm. #
  • People with the same first and last name crack me up. I usually call them Firstname^2 #
  • I've had a stiff neck for 2 days. I'm praying for meningitis. #
  • As you can see, im just having a STELLAR day.. 🙁 #
  • Lidoderm? From the ER? Come on ER docs, dont try for fancy shit. #
  • Saw little old asian lady lift a leg and rip one on the plastic waiting area chairs. So loud, so very loud #
  • A fart is a joke that never ever gets old. #
  • Pt: "Is this medication returnable" Me: "Would you want meds that went to randoms persons house then returned?" Pt: "Uh, ew, no". #
  • Just got an Rx for Clozeril. Clozeril, who the shit still uses Clozeril? #

Angry Tweets for 2010-09-28

  • Now we wait for when my day explodes into yelling and whining. #
  • Bleh, this ER doc must of been rummy when he wrote this Rx at 3am. :\ #
  • Oh no no, you "know your body" so go ahead and take your lasix the way your body tells you. #asshat #
  • If a patient is adamant about not listening to the MD or RPh who am I to stand in the way of Darwin? #asshat #
  • You say that you "dont know how drugs work" yet refuse to listen to ppl who's job is to KNOW how "drugs work" #asshat #
  • Now why on Gods green earth would you think the state would pay for Clomid so you can have MORE children? #
  • A lot of YOUR problems are just that, YOUR problems, not MINE. #
  • Man, @kevinmd posted a pharmacy asshat today. Must be a slow news day. #
  • The asshat is strong in this one. #
  • HAHAHA Rx: Depakote ER DR 250 #
  • asshat: "My husband didnt pick my meds up" Me:"Well, he signed for them and we have him on video." asshat: "HE DID NOOOOOT!! *freakout*" #
  • I want to see a TV show about Rx Hoarders. You know, the people who stockpile medicine. #
  • I would love to see the social services stripped from these ungrateful fucks so they have a reason to treat me like shit. #
  • As well as appreciate what the so openly bitch at me about. #
  • Dear Doctor. Since you think Celexa 20 = Lexapro 20, we cannot be BFF anymore. Im sorry </3 #
  • Why are the "caregivers" of asshats usually a larger, more ignorant asshat? #
  • Doctor: If you ignore the big sharpie note requesting a drug change (and just write OK x 6), im going to switch it for you #
  • Ah, kevinmd.com got a few barrels of good ole me regarding that pharmacy post. Lets see if he approves my comments.. 🙂 #
  • Post that has me and @phathead pissed off: http://www.kevinmd.com/blog/2010/09/pharmacy-profit-gouging-patients-insurance.html #
  • Any patient who thinks a fax is a reliable communication medium between Dr <-> Pharmacy is a complete idiot. Most faxes dont redial > twice #

Angry Tweets for 2010-09-26

  • Get that sour look off your face idiot, I'm at work and you're not. #
  • The ASSHAT page is almost complete! Will post URL when done #asshat #
  • Amazing how people think the excuse "Well he has cancer pain" absolves them from taking meds correctly. #
  • Cancer pain? Seriously? This is 40 vicodin from the ER, try again. #
  • The first revision of the ASSHAT page is up for public consumption: http://www.theangrypharmacist.com/asshat #
  • I have a pretty sad heart-felt blog post that I've been keeping under my hat for a while. Wondering if I should make it public. #
  • If you dont follow @BurbDoc you really should. He's like the medicine version of me (only without a nifty website) #
  • Drinking Jim Beam right out of the bottle. I can smell the class in the air! #

Angry Tweets for 2010-09-25

  • Managed to work both 'asshat' and 'douchecanoe' into my post last night. @BurbDoc would be proud. #
  • Coffee too hot to drink is giving my energy levels blueballs. Might deal with the partial thickness burns in my mouth to drink it now. #
  • The couple that takes Methadone and Percocet together passes out in the hallway together #
  • Hallmark Card: "Sorry to hear your Vicodin was denied. You are in our thoughts and prayers in your time of need" #
  • Woman, stop crying on my counter. Dr wrote your Rx can be filled on <date>. Unless your crackhead tears can bend space/time you're screwed #
  • Still undecided what I should send to @docgrumpy for Grand Rounds. Suggestions? #
  • Pharmacists who call themselves "Doctor" annoy the shit out of me. Maybe if you did a residency I could see, but in retail? Gimme a break. #
  • Wow, why did nobody tell me Klor-Con 8 went from $40/#500 to $200/#500? #
  • "Differin is awesome but its not a miracle-worker" #TypicalTAP #
  • Pt asking about Viagra: "Can i get it over the counter?" Me: "Maybe if you take 2 or 3 of them" #TypicalTAP #BadJoke #ImHereAllNight #
  • I'm going to start: American Social Society of Healthcare Anger Therapy (ASSHAT) #
  • To be an ASSHAT member, you must demonstrate anger in a funny amusing way. Then you get ASSHAT certified and put on the ASSHAT page. #
  • If we had @BurbDoc @nursekris99 and myself in one office, we'd be the trifecta of health-care bitterness/funniest office #
  • People who are on state-assistance programs take THE MOST vacations out of everyone i know that works. #
  • Giving this guy a deal on Viagra because he pays cash for 30/month. Thats some big pimpin there. #
  • For how much trazodone I dish out, I have never heard of someone getting priapism. #
  • OH GOD pt left their used vag app and life-sucked-out-of-tube of premarin vag in the box I was handed. IM CALLING A CODE METFORMIN! #
  • Going drinking with a local PA from the hospital tonight. #
  • I have replaced our "waiter" bell with a remote-controlled fart machine. Lets see if the store notices. #

XL, ER, and SR (Oh My!)

How many of those at home have gotten an Rx that looks something like this:

Wellbutrin 150 QD

or

Depakote 250 QD

or

Effexor 75 BID

Now how many of those at home after getting these prescriptions felt the urge to slam their face into the counter.  For those not in pharmacy (or for those douche-canoe asshat prescribers out there who are stuck in 1990) all of these drugs come in different formulations BUT in the same mg strength.  The regular-release is the SAME strength as the extended-release.  Its not like Coreg or Paxil which the extended-release dosage form has a different strength than the non-XR form. Hell, in that case its easy.  Dr writes for Coreg 20, and we know that he wants the once-daily CR caps (unless he wants the patient to start shaving the IR tablets, which would be rather funny).

Does the MD want Wellbutrin 150 SR given once daily? Or did he/she mean to write the once-daily XL?  Depakote comes in a 250 DR and a once-daily 250 ER, but depending on the patient they may want the DR given once daily.  I’ve seen Effexor plain given BID as well as the XR given BID.  Should I just guess?

Its shitty at best and outright dangerous at worse, and there is absolutely nothing that we can do to prevent this.  The only thing that we can do is to call the Dr, be left on hold while the patient gives us the “Why cant you fill it? It says the drug on the prescription!!” face, and be at the mercy of the *sigh* wonderful doctors staff to give us a call back saying “Doctor wants the extended release Wellbutrin” *headdesk* “IT COMES IN 2 WAYS!”.  What makes matters worse, is that ALL of these drugs are relatively new (compared to like Theophylline, Cardizem, or Verapamil) thereby removing all shred of hope that we could “guess” what the doctor wanted (since some doctors are stuck in 1990).  It requires a phone call/fax, which is just balls for everyone involved because 2 little letters could have solved this.  This isn’t something that the insurance doesn’t cover, this is just sloppy Rx writing!

Is there a good solution to this problem?  The one time we guess as to the release-mechanism it’ll be wrong, so there is no point doing that.  Of all of the examples regarding sloppy Rx writing, this has to be the most annoying for pharmacists.  I can deal with not having a quantity.  In some cases I can deal with not having a sig if I can tell from the quantity (I mean how many ways can a dentist give 28 amoxicillin caps?).  I can deal if you didn’t sign the damn prescription.  No IR/ER/XL/WTF designation? Boned-every-time.  Saving 2 seconds on your end just cost me (and the patient) 15 to 45 mins.

Just go give us one more kick in the balls, the patient wont understand what the problem is.  They see a drug, a strength, and some T’s with dots over them with some letters.  They don’t care about the IR/ER/XL/OMFG  dosage form, they want the drug on the prescription and they wanted it filled before they handed you the Rx.  Short of yelling at the doctor for omitting probably the second-most important piece of information on the Rx (yeah, that’ll teach him! *sigh*), all we can do is just bend over and accept the 30 min phone-call and hateful glares from ungrateful patients.