Angry Tweets for 2011-05-30

  • Alcohol management should be taught in pharmacy school. Beer before liquor, all that jazz. #
  • Think 300mg of trazodone is enough to give me a pripiasm? I need something to admire tonight. #
  • I think if @Burbdoc wrote a guest post on my website, we'd bring angry pharmacy and angry medicine together as one. #
  • Fuck, I could use some bacon now. I have Gin. Gin glazed bacon? Holy fuck. #
  • If I made bacostatin I could make a food that has a net-0 effect on your body. #
  • Having Gin for dinner was a good thought, but poor execution. #

Angry Tweets for 2011-05-29

  • I wonder if I can get a little "Verified" checkmark on my twitter account. Am I famous enough? #
  • Just FYI. Im not a real pharmacist, I just play one in a pharmacy for a paycheck.. 9 hours a day. #
  • This latest post is to answer the question asked by @BurbDoc and @mommy_doctor why they have such a devote pharmacy following. #
  • Spicy food should be a therapeutic alternative to Reglan. Oh man, the police should stop my GI tract for speeding. #

The true story about Retail Pharmacists and Twitter Doctors

Ive been asked on more than one occasion (by MDs), why the ‘Angry Doctors’ on Twitter have such a strong Pharmacist following.  Since I have undertaken the task of being the official spokesperson of Pharmacy on twitter, I decided to turn this answer into a well though out response vs a 120 character tweet.

If you’re looking for profanity, slurs against the downtrodden, just skip over this whole post.  This is a post to generate discussion about a real issue that us retail Pharmacists have with our MD counterparts.  Yes yes, I know that the past few posts I have been quite uppity and boring about some issues going around, but fear not, the poop-talk is coming.

What I shall grace before you is from my own experiences only.  Although I represent a voice of pharmacy, I cannot speak for every pharmacist (although I do damn near get all of them to agree with me).  I want the MD’s in the audience to think about this article, because its not meant to inflict harm, just bring to light exactly how us in retail feel we are perceived by you.

  • Whenever we call for a clarification, you are “in the room with a patient”.  We are unable to speak with you directly.  Even if its about issues that can get you in serious trouble, like forgeries/stolen pads or narcotic shoppers.  We speak with your “nurse” who gives the message to you.  While we are waiting for your “Nurse” we have a line out the door and the hospital on the other line calling in discharge medications, yet we patiently wait.  Your “Nurse” then gives us a response which is totally different than the original question, obviously there was a miscommunication between us and your translator which wastes both of our time.  We feel that your time is worth FAR FAR greater than ours since you can’t spare 30 seconds to have a conversation with us even though we are treating the same patient.  We feel like our concerns about OUR patients (which if we are calling you, its a concern, we dont have time to just piss away) take a backseat to everything else in your office.
  • On your answering machine or answering service, you give a option for doctors or hospitals to get an express route to you.  Yet you do not give pharmacists an option.  Since we respect you (and aren’t a hospital or doctor), we are thrown into the call pool with your patients to be answered by a staff, who transfers to another staff, to transfers us to your nurses voicemail box, all while your patient is feeling ill and just wants to get the antibiotics (thats not covered) and go home.  All of our IVR systems give you an express hotline to us, yet the courtesy is not returned.
  • When we see you at the CE dinners, we introduce ourselves only to be shunned by you chatting with your MD friends.  When you do actually talk to us, you don’t ask us how we’re doing; you ask us to pass the wine, or to fetch you something.  We introduce you to our fellow pharmacists, yet you dont even extent the common courtesy to introduce us to the other doctors.  We treat the same patients, we are on the same team.
  • When is the last time you spoke with a pharmacist that you do a lot of business with.  Not just call in prescriptions or yell, but actually ask how they are doing.  Have you ever offered to have a cocktail after work with them? We would gladly treat you to cocktails after work, yet we never get the chance to speak with you to extend the offer.  Do you even know what their name is? I guarantee that your local pharmacist knows what your first name is, shouldn’t you respect him/her and do the same?  You do treat the same patients.
  • Pharmacists, on the other hand, talk to each other.  We ask how we are doing when giving transfers.  We go out for cocktails after work.  We warn each other about forgeries.  Even ones who are in direct competition have a fraternal-like bond regarding reimbursement rates and looking out for each other.
  • Pharmacists have a closer relationship with your front end staff than we do the MD that employs them.  We know your nurses, they know us.  We laugh and crack snide jokes about our patients who want yet another refill for that prometh w/ codeine.

Notice a trend here?  Retail pharmacists get scooted to the side by MD’s in all aspects of our job.  Now compare this with the angry doctors on twitter, who openly joke, converse, and treat pharmacists there as equals.  Do you see why they have such a huge following? Do you see WHY pharmacist jumped to the defense of a faceless, nameless anesthesiologist who was bullied by an MD who seems like he fits the above description?  The doctors on twitter are the doctors that pharmacist love.  They don’t put us on hold or communicate to us via a 3rd party, they speak directly to us.  They are approachable and friendly.  I can send one a message and not wonder if they will ever get back to me because they will.  I don’t need to watch what I say around them for fear of getting the “oh he’s just a pharmacist” eye-roll and subsequent ignoring.  They are people, real people, like us.  If you, the stereotypical MD, treat a fellow professional like us this way, how are you treating your patients?

I regularly go drinking with a NP and an MD friend of mine from a hospital nearby, and we discussed this whole issue about retail pharmacy and the local docs.  They, working in solely a hospital setting, had no idea that this huge gap between us existed.  They thought that all the docs in the area called up their local pharmacist and ask questions as basic as whats covered, to a suggestion for suitable beta-blocker for a patient with a low CrCl.  They wondered how you can practice medicine safely without asking advice from someone who is knowledgeable about medication.

I find it interesting, that pharmacists; most if not all have doctorates, who went to school, studied, and work with drugs for a living, are ignored in general by your average MD (except when the patient bitches the “pharmacy wouldn’t fill what you wrote”, only to be yelled at by the MD because the drug wasn’t covered and costs $400).  We are on the opposite side of the same coin, and ultimately the person who suffers the most is the person who is generating the revenue so we both can eat.

Part of this is the fault of pharmacists in general.  Most of us really don’t have the time/balls to stand up for ourselves when push comes to shove regarding MD’s and medication therapies.  We have allowed ourselves to be walked upon for decades.  Ask a pharmacist who graduated in the 70’s what doctors were like back then (shout the orders, slam down the phone, “just fill the fucking prescription”).  However the tides are turning.  Residents are being taught to ask us for advice.  There are too many drugs and conditions now for one profession to master every small aspect of both fields.

I’m really not bitching per-se, just letting you all know what your image is like on the other side of the fence.  Do I expect this to magically change with one blog post? No.  Behavior that has been refined over the past 100 years can’t change overnight.  I hope this brings some insight on why the docs on twitter have such a strong pharmacy following.

Angry Tweets for 2011-05-28

  • Who's got 2 thumbs and reppin pharmacy? http://t-rav.es/ah Bob Kelso. #
  • Oh jesus, now @kevinmd is jumping on the bandwagon? Oh well, got some fight still left in me. #
  • Heres a hint, why dont worry about how YOU act on twitter, and not how other people act on twitter. #
  • The group gchat last night was so funny I think i popped a rhoid. You all missed out #
  • Holy shit this fucking bitch better stop shouting on her cell phone or Im going to shove it up her ass. #
  • Listen, crackhead, I dont give a shit about who your baby daddy is fucking, and neither do the neighbors. STFU. #
  • I'm the posterchild of #unprofessional today. #
  • We have switched Mrs Crackheads' Fentanyl patches with NEW Folgers Nicotine Patches, lets see if she notices! #
  • Really peeps, in order to use #unprofessional you must either BE a professional or have a job where you are expected to BE professional. #
  • Im waiting for a patient to pick a fight with me so I can throw a full glass prometh plain bottle at their face. #
  • I stand for 10hrs/day with constant LBP and these whiny fucks cant have a hangnail without an ER rx for vicodin? Fucking pussies. #
  • I wish I could wear scrubs to work, but then I'd have to deal with the infamous pee-blot in front. #
  • Shit, some patient just thanked me for helping them. Day isnt so bad after all. #
  • If you cared as much about getting a job as you do your "Oxykawtin" Rx maybe I'd like you better #UNPROFESSIONAL #
  • Im so fucking done today. #
  • I think im going to eat japanese food and drink enough soy sauce to blow my kidneys straight out through my back. #
  • Seriously, why do all the FUCKED UP (oh i have no ins but i NEED lovenox) happen 15 min to closing? #
  • ok, who's on the fucking weekly gchat bitchline? #
  • Ok bitches, im on gchat theangryrph@gmail.com #

Angry Tweets for 2011-05-27

  • "Docusate 100, 1 bid hold for lose stools" MAN! I hate it when I lose my stools! #
  • It makes me happy that a rag-tag group of random medical peeps can pull together to defend our own. #
  • Clerk "You want something from burger king" @TheAngryPharm + @TheAngryBKBJ *look at each other, look at clerk* Clerk: "NO, NO BLOWJOB". #
  • Makes my day when I get a stressed med resident on the phone and I crack some off-color joke about the patient & the whole conv lightens up #
  • Why do I get a feeling if there was a big medical tweetup, most of us would be playing D&D in the corner. #
  • Medtweep D&D session: You see a pt, BMI of 40 smoking eating mcdonalds, refuses to take DM meds, attacks you with stinking cloud, initative! #
  • If you make ME redo all of your Rx's because YOU fucked up, your wait time is now 1 hour. #
  • gchat party line: theangryrph@gmail.com. @ApothecaryTales is on too (busting my balls). #
  • Thinking of making some fish for dinner, but I dont want to stink my house up like what the pharmacy smells like. #
  • so what, its only 3 dudes in a group gmail chat? theangryrph@gmail.com #

Angry Tweets for 2011-05-26

  • Soo… Im getting blueballs waiting for @Burbdoc response to @mommy_doctors 'drama'. #
  • Wait, YOU are spending $6/day for a habit that is costing US $400/month in asthma meds. Pay up chump! #
  • Uh oh, here goes @BurbDoc. #
  • Shit, I wish I could be on the state dime so I can go to a foreign country for 2 months (and get a check at home). #
  • Fuck, I think the rapture did happen. Nothing but idiots and morons in the store today. #
  • You ever fart into an empty Depakote bottle? I think its going to be the next big perfume smell. #
  • WTF is this @mommy_doctor bullshit still going on? Why do we not have this shit in pharmacy. Oh wait, because we dont care. #
  • Lets see, I wonder if I can beat the south park movie for my UNPROFESSIONAL use of the word FUCK in this rant im making. #
  • Maybe thats the nail in the cross of pharmacists in the MD vs PharmD war, we are people just like our patients. We drink, smoke, cuss #
  • We rant, we bitch about work, we are like your common working class. We aren't held on a higher standard. #
  • This also explains why people TRUST us and involve us in their lives, not because they HAVE to, but because they WANT to. #
  • The public isnt intimidated by us, they aren't afraid to ask questions (OH BOY IS THAT RIGHT). #
  • Sure, all of us rant and bitch about the public, but thats just human nature, that prevents burnout. Look at the suicide rate of MD vs us. #
  • If my personal MD bitches about me on twitter, who cares? As long as its CASES not INDIVIDUALS then whats the harm? #
  • The paradigm of medicine is changing. You can hold onto your god complex all you want, but you'll be replaced by residents just like us. #
  • If you dont rant about your frustrations, you obviously dont CARE about your profession or your patients. The world isn't perfect, accept it #
  • Misery loves company. Embrace the FREE social help of the internet and twitter that yes, you are not alone in your frustrations #
  • Im saddened that I have more followers (by a ton) than our PROFESSIONAL org. What does that say about pharmacy? #
  • If anyone wants to voice their anonymous rant about the @mommy_doctor fiasco on my site, DM me. #
  • Im dreading work tomorrow. End of the months are full of MY COVERAGE EXPIRES IN A WEEK I LOST ALL MY MEDS. #

EXTREME UNPROFESSIONAL MAKEOVER -or- PIMP MY UNPROFESSIONALISM

I’m taking a break from my usual silence (I think i’ve flogged the welfare crackwhore/dumbshit patient enough) to comment on a few important points.  Social sites and you.

Thats right, Facebook, Twitter, etc and the drama/flak they cause (as well as the laughs).

I want to start with a story.  When I was a lowly intern, I was at a very large hospital being the beating-boy for the medical team comprised of a few residents, an attending, myself (go pharmacy!) and a dietitian (wtf?).  We were examining a scrotal hydrocele case that was admitted.  The attending flings back the curtain, and the guy is laying there with his legs spread, and what looked like 2 large grapefruit between his legs.  The attending said “HOLY SHIT THOSE ARE THE BIGGEST BALLS I HAVE EVER SEEN”.  I laughed, the other residents were stone-faced.  The patient looked at me and the attending laughing, got a sense of pride in his crotch-fruit, and laughed.  He completed the exam (including one of the residents who really wanted to stick a needle in them) and left.  The most senior resident said as we were walking the halls “THAT WAS THE MOST UNPROFESSIONAL EXAM I HAVE EVER SEEN”.  The attending, in true Dr Cox style, said “Listen, you need to laugh or you’ll go crazy, sure it was off-color, but thats what makes us relate to the patient in a way that makes them feel not like they are some rat on an exam table”.  The patient, after his nuts drained and looked like prunes again, personally gave his thanks to the attending to making him feel like ‘one of the gang’.  Word got around the hospital about the nut-of-the-year award, and although no names were dropped and not personal information was given out, it was something that pharmacy and medicine could open dialog about.

Thats one of those lessons that you can’t be taught in a classroom.

The second part of this rant is some Twitter drama involving @mommy_doctor and (although a valid point) a bullshit article written by DrV.  Realize that I follow a lot of MD’s, mostly from the ER who say some pretty damn funny things regarding their profession. Much like myself, they give an insiders look at really goes on in the world of medicine.  In fact, I view these angry doctors with a ton of respect, mostly because they make us in pharmacy realize that we’re not alone in dealing with idiots; and their sense of humor/rants about their job makes them (in my eyes) someone who you can hang out and have a beer with.

Before I go further, let me explain about @mommy_doctor (herein known as m_d).  I’ve been following her for a few years now. Shes an anesthesiologist (obviously she is a female, hence mommy).  Her job is rough.  She puts her ass on the line day in and day out to save people.  She deals with surgeons, scared patients, and is a really really stand-up woman.  Her tweets are funny, usually clean, and show how much she cares.  She gives us an inside look at the crazy mixed up hybrid of pharmacy and medicine.  I view her with a huge heaping of respect and admiration for doing what she does on a daily basis.

Anyways, I got a major case of blue-balls when I saw that link, because I immediately thought that ole @BurbDoc was under fire for one of his many hilarious (and totally true) tirades about the unwashed masses.  However reading the holier-than-thou rant just got me pissed off.  I really wasn’t pissed off at the whole concept, but at the bullshit cliquish high-school drama that took place in the realm of Doctors.

First off, DrV, in an article about the lack of ethics, decided to copy/paste screen-captures of the tweets of @mommy_doctor treating a priapism case, one that she obviously felt empathy and sorrow for.  The tweets weren’t crass, funny, or even note-worthy.  However the MD fanboy population decided to textually masturbate themselves about how unprofessional this was.  Mind you these seem like the MD types who will DAW-1 everything, not give you the benefit of a clarification, and refuse to speak with pharmacists.  You know, the MD’s that us as pharmacists HATE dealing with.

Rather than using the text as an example (and blurring out the name), he unethically decided to just drive the bus over her and publish the tweets unedited.  Ironic that in an article about unprofessional behavior, he commits an unprofessional act by doing something that she obviously had the moral-high ground to not do.  Pin something to an individual vs a concept/idea.  In the comments he stated “Regarding outreach, I don’t engage anonymous people.”  So wait, you dont engage anonymous behavior except when it benefits your argument?  How does that work?

Second: This whole clusterfuck over something absolutely stupid makes me realize how much MD’s are gunning at each other.  How quick and petty they are to nail someone on the cross over something that (in the grand scope of whats out there) a non-issue.  Yes, she made a joke about pripiasm, but I’m sorry, dicks are funny, and a 36 hour boner (although a medical emergency) is going to get SOME reaction.  If I had a boner for 36 hours, after the 10 tubes of KY jelly and the absolute destruction of my wifes vagina, I’d painfully tweet about it on my way to the ER.  If she were a male would this be an issue? Of course not.  @BurbDoc doesn’t get thrown under the bus for the outrageous things he says, but her being a female the rules were obviously changed.  How unprofessional.

This is the same sort of shit that Scrubs is made of.  Do the masses think doctors are “unprofessional” after watching Scrubs?  Do they think that House is unprofessional?  No!  If the doctor is anonymous, and writes a few crude humor lines on a medical condition that could happen to say, ANYONE, whats the harm?  The poor gal was probably on call, stressed out, and wanted to get some sort of outside reaction from a case that us, anonymous internet medical people, would get a chuckle about.  Do I feverishly check all of twitter about the patient with a horrible case of hemorrhoids the moment I leave the doctors office? Of course not!  The humor on twitter could happen ANYWHERE, yet the MD population thinks that it can be narrowed down to ONE office out of 10000000 in the United States (if she is from there) instantly.

I’ll be blunt here.  Voicing your frustration means you care. Your patients aren’t perfect, their conditions aren’t perfect, and sooner or later you are going to have to blow off some steam and vent to those who are in the trenches with you.  If you just saw patients, collected your paycheck, and went home without a care in the world, you dont care about your patients because they didn’t have a personal impact on your life.  The world is far from perfect, and yes, I bitch about crackwhores/welfare/shitty state of pharmacy because I do care.  I do care about those abusing the system or the crackwhore mother who obviously cares more about her early norco refill than her child who is ignored.  I can’t solve the worlds problems and that gives me frustrations.  I bleed the relief valve on twitter and on here to keep myself from going insane.  Burnout is huge in the medical world, and if we; the faceless medical community from all races, specialties, locations, etc, are unable to joke, laugh, and support each other then thats just going to separate US from our patients.  All of us have been the butt of jokes, all of us are patients in one form or another but as long as nobody is singled out and no harm is done (intentional or unintentional), whats the harm?

But what do I know, to these MD’s im just a fucking pill counter who gets yelled at because Solodyn is 500 bucks and the patient cant afford it.

Oh, and to close this off, heres an awesome twitter quote: If I had a 36hr priapism and Dr. V was attending, one thing’s for sure: There’d be two prominent dicks in the room.