Angry Tweets for 2011-06-11

  • I'm in a motherfuckin comic! http://rxcomic.com Pretty good guess at what I look like, only the guy in the comic is sober. #
  • At airport, drinking gin #
  • Dear VPN. Quit being slow and sucking. Love, me. #
  • Gin just tastes better at airports. Dont know why #
  • OMFG so looking forward to stealing a skymall magazine on the plane. #
  • No fucking skymall. Seriously? Are you fucking kidding me? Holy shit this is karma for not filling soma early today. #
  • Fuck. I feel like a crackhead who is one day early for his vicodin. So disappointed. #
  • Am I really fucking drunk, or did I see a commercial for Duke Nukem Forever on the fucking TV? Holy shit. They finished it. #
  • In PDX. Watch out @DrGhaheri #
  • Wonder if DrV will rant about me if I got my scroatum botoxed by @DrGhaheri #unprofessional #HCSMgate #

Angry Tweets for 2011-06-09

  • Pt quote of the week: "Do I need to choke a bitch to get some damn xanax" – My QOTW: "What pharmacy do you want your shit xferd to?" #
  • Remember, your eRx system is connected to the rest of the world, your controlled pads are not. We know your handwriting, we dont know a eRx #
  • You know (or should) when a pad goes missing, you dont know what some 19 year old kid is eRx sending to our stores from his bedroom. #
  • Thank you eRx, for justifying my job in preventing deaths with 10cc's of lantus qhs instead of 10units. #
  • eRx isn't about safety, its about making a fuckton of cash for the makers who brib..er..lobbied congress to push it. #
  • If eRxing supposedly saved us RPh's a bunch of time and angish, why are ALL of us against it? #
  • Its not standardized, it hackish at best with our pharmacy systems, and 95% of them require a fucking call to clarify wtf some idiot wrote. #
  • If you want a system that works and has been refined over a hundred years, go with the pad. No, Rx pad, not maxi pad.. well.. FUCK TAMPONS #
  • I learned today that everything that comes out of an ER patient is a lie (3 ER's, 3 out of 4 Rx's were for narcs, 2 days time) #
  • eRx has its place, hospital, 10,000+ patients, eCharts, pt incapable of bringing Rx to pharmacy without "losing" it. #
  • eRx and Medico lobbied God to punish me, I just sat on my right nut and now I feel like I have to throw up. #
  • Insurance companies can force mail order and thats okay, but I cant discuss reimburs with another pharmacy or get nailed for antitrust. #
  • Thats right bitches, this *ahem* made up *ahem* rant was fueled by alcohol! #
  • Out of TP and a monster duce breathing down your backside? I think I found a use for the PDR. #

Pissing into the wind of medicine

This is all made up.  Uh huh.  Its a bit of a hard read to protect the identity of the stupid er.. the made up stupid… Uh huh.

It was your usual day at the Angry Pharmacy.

I got a call from a resident that I’m on fairly good terms with.  She wanted to increase the dose on a patient diabetes meds.  She wondered why the patients A1C was climbing lab after lab and thought the medication wasn’t working.

I pulled the patients profile up.

Month supply filled Jan and March.  Something wasn’t right here.  Maybe he/she was going to another store? Only one way to be sure.

I told the resident to ask the patient to bring in all of his/her meds in so I could “take a look at them”, which in pharmacy speak means “See if you are fucking taking them”.

Patient comes in with a plastic bag full of pill bottles (oh dont we just fucking LOVE it when they do that) and a new Rx.

Every single bottle of maintenance med was full.  EVERY FUCKING ONE OF THEM.  It had more fucking diabetes medication than I did on my shelf in that one plastic bag.  Most were from us, some were from a different pharmacy dating back almost a year, all were filled exactly on time.  This looked like two big scoops of not-fucking-good.  In fact, the refilling gaps in MY system were accounted for by another store’s filling.  This required a “come to Jesus meeting” by yours truly.

I asked the patient, who had almost every risk factor for diabetes in the book, why it wasn’t taking the medications.  Then the bomb was dropped.

“I know my body, and I know what its doing, I dont need this shit.  I just need my pain pills”.  Hear that needle being pulled off of the record of medicine?

Now its A1C would score a solid gold in the A1C Olympics.  I could use his/her urine to compound in place of simple syrup.  If it wasn’t the copious amounts of bullshit flowing through its veins I’m sure they would of died by now.  I asked the pushy patient if the doctor knows its not taking its medication.

“No, if I told her that, she wouldn’t give me my pain pills”.

I wanted to punch him/her in the face.  I asked if he/she had side effects, or any reason why he/she didn’t want to take the medications.  Sometimes the twice a day is too much for people, there are options that I could suggest.  This resident was an awesome one who loved pharmacists thanks to yours truly (you’re welcome) and would do whatever I suggested.  Look at me! Being all pharmacist like!

“I told you, I know my body, I dont need these, I’m fine.”  I fucking love it when they use that line.

Nothing I could say could make his/her take them.  Threats of blown out kidneys, to losing his/her sight, to not having legs, nada.  So.. Fucking.. Frustrating…  I tried to play the pain card, saying that her pain could be because of damage to nerves.  “Gabapentin doesn’t fucking work on me, neither does Vico-dan.  I need Percocet”.  This was said with a straight face as I could line the entire pharmacy an inch deep in unused gabapentin caps.  I offered to work with the patient and the doctor to help her.  I even offered to fucking blister pack the medication to improve comp-LIE-ance.  Nothing would work.  The patient had either given up, had a fucking stroke and got incredibly dumb or just really wanted to get high.  Maybe if I printed “HAVE YOU TAKEN YOUR MEDICATION TODAY” on a package of cigs or a lotto ticket it would make a difference.

The conversation turned into the “I dont want to talk with you anymore.  How long until my Percs are done” song and dance when I called it on bullshitting the doctor to get more narcotics.  Sometimes it takes being an asshole to get the point made.  My preceptor used to tell me, “TAP, never argue with an idiot, they will drag you down to their level and beat you with experience”.  If I followed that advice, I wouldn’t have any patients.  I knew that short of a diabetic complication 2×4 across its face, there was nothing I could do.

Then the blood started to boil.

This person gets FREE care and FREE medications.  It isn’t out anything but his/her own time to take care of her condition that could leave her legless, blind, and on dialysis.  Of course all care related to stupidity would be happily covered by the state.  None of that mattered to him/her.  90% of the working population would KILL to have what he/she is getting for no cost.

You know when I ranted before about how a person places no value on something that they aren’t paying for? Case in point, right in fucking front of me.

Now this person is spending, nay wasting, hundreds of taxpayer dollars a month that could be used towards someone who actually gives a shit about their health, about their care, about their body.  A person who could actually get a better quality of life while they get their life back on track.  If this douchebag wanted to just get fucking high and watch his/her health spiral down the shitter, thats great – just don’t take the resources that could be used to help someone who gives a shit.

So the question remains: at what point do we, the healthcare people, decide to cut-bait on a patient that obviously doesn’t give a shit about his/her health and is only seeing you because they are being forced to (or to get narcotics)?

Oh, and I paged the resident (I REALLY hate paging doctors, but I figured this was important) and let her know what was going on.  After a bunch of “are you fucking kidding me” she requested the patient go back to her for “clarification” on the percocet prescription.  I think someone is going to get a type-1 ass-chewing, but something makes me think its not going to make much of a difference.

I love making shit up *ahem* to prove a point.

Angry Tweets for 2011-06-05

  • Doing dishes suck. #
  • And my angry forums are… dead. Sorta glad I didnt pay 200 bucks for the software (though they have been up > 24 hours) #
  • Oh, and you need to sign up/login to get to the ranty part of the forums, google-bot insurance to prevent ppl from getting busted. #
  • And by the forums being dead, i mean nobody is posting to them, and they have been up < 24 hours. I suck today. #
  • Fuuuuuck. Converting toliet to dual-flush required unauthorized use of dremel tool and fucking testosterone #