Category Archives: Doctors and Stuff

Paging Dr Dave… Your douche is ready..

Out of your options for refusing to help with the current (non)
cutbacks (see, that is what a court order does genius, STOPS something
from being implemented, hence NO 10% cut….oh, skip trying to explain
THIS to a pharmacist) I must take option 3 below.

Genius? Me? Did you even read the first paragraph of that last entry? You know, the one that I said “However, last Saturday the courts overturned the ruling until 8/11/08. Their computer systems still have the 10% cut, but they will let us know how they wish to deal with that ball of wax once the shit stops falling from the sky in the legal department.”
Update: Got the fax yesterday saying that the 10% cuts are here to stay. The injunction was injuncted upon by yet another injunction reversing the injunction-junction (whats your function). Yeah, I cant believe it either. This is really going to suck.

1. Lazy
2. A dick
3. Think so little of us that you don’t give two shakes of a mouses
dick what happens to us.
4. Have some ill-gotten god-complex that fell out of fad about 20 years
ago when managed care/insurance companies snipped off your scroatum and
dangled it in front of your face while saying ‘HAW HAW’
4. All of the above
Since most pharmacists I have to deal with here are 1, 2, 4 and (the
other) 4 (with THAT counting ability can you wonder why I doubt the
competence of most people in your business? 5 comes after 4 genius!). I
really think 3 is my own position. Sorry you won’t get a 150% markup on
your generics for a while, but in case you didn’t notice, the Feds
tried to do the exact same thing to us, and it fell through too. The
10% cut will also die on the vine thanks to the court order.

Yeah, I did put 4 twice. Sorry, my mistake. Thanks for pointing that out to me in the most asshole way possible. I originally had 4 be “all of the above”, but then I decided to add something in about the god-complexes that you oh-so-quaintly have shown everyone still exists.

Unless the PHARMACISTS start lobbying. When they are through WE will
have to pay the State….

Uh, we’re lobbing the hell out of the state. However lobbying does only so much when the state is 1000 trillion dollars is debt.

Here is my own quiz, based on the previous model:
Most, but not all pharmacists are:
1. Lazy
2. A dick
3. Think so little of everyone BUT themselves that they don’t give two
shakes of a mouses dick what happens to us.
4. Have some ill-gotten god-complex that fell out of fad about 20 years
ago when managed care/insurance companies snipped off your scrotum and
dangled it in front of your face while saying ‘HAW HAW’
4 (which SHOULD be 5 – leave it to a pharmacist). All of the above

Thats cute, just copy and paste what I wrote. I can see now how you got through medical school.
— Round 2 —

I am NOT a chronic pain patient, I am a practicing physician and I am
absolutely sick and tired of idiot pharmacists having a bad day calling
me to tell me what I fucked up on my scripts.

Then don’t fuck up on your scripts 🙂 Seriously, do you think we want to sit there and waste our time calling your obviously unhappy soul to tell you what you messed up on? Do you think it gets us off to be yelled at by some doctor who obviously takes his frustrations out on his office staff and the pharmacist who calls to save his ass? No.

If I wrote a particular
treatment prescription I did it for a reason. Please don’t argue with
me as you attempt to be so many amateur physicians. I realize that you
went to 5 years of school to learn pharmacology, and I respect that.
What I can NOT stand is that fact that none of you seem to respect that
I and my colleagues went to school for 10-12 years and, whether you
want to hear it or admit it, know a fuck of a lot more about medicine
and pharmacology, and more importantly how they interact and will
effect OUR patients than most of the arrogant, self absorbed, insecure
pharmacists that call to tell me I can’t prescribe A with B.

See, the fact of the matter is that if we just “fill the prescription” and the patient dies due to your arrogance and stupidity, then we are at fault just as you are. However if we call and you make our requests known (and obviously document it), then when your arrogance and “10-12 years of school” kills someone (or lands them into the hospital), we don’t get hauled into court. Well, I take that back, we do get hauled into court, and there is no doubt that you would lie and say that you didn’t talk with us about our concerns.
Now due to the condescending asshole tone of this email, I have no doubt in my mind that if we are sitting both in court, the very first thing you would do is point at me and said “THE PHARMACIST SHOULD OF CAUGHT THE MISTAKE” (even though you bitch here that we bug you too much).

Shut up
and fill the fucking scripts unless you are damn sure there is a
mistake. As I get at least two dozen calls a day between “corrective”
calls about my prescribing and suspicions about my patients that I
prescribe anything stronger than Ibuprofen, it gets ridiculous.
Pharm D? THAT is a fucking joke!

Two dozen calls a day? Okay, either this figure is way out of line, or you are prescribing some really shady shit to some shady people. “Just fill the fucking script” doesn’t quite work if the patient received 100 norco from another pharmacy yesterday.
You see Dr Dave, this whole situation really smells fishy. Most pain management clinics really have no problems with pharmacists and pharmacists don’t have a problem with them UNLESS a huge red flag comes up. If “two dozen” pharmacists are calling you about your “prescribing and suspicions” about your patients then obviously you aren’t just giving out Amioderone to a patient on Warfarin (which your ****10 YEARS OF SCHOOLING!@!@#!@$**** should tell you why that one is a biggie). So tell us Dr Dave, how many gallons of Norco do you write out on a daily basis to have all the pharmacists on alert? Have your Rx’s (and patients) been booted out of every pharmacist in town? Is that why you are so hateful?
You see, part of being a pharmacist is that you get good at sifting through the bullshit.

You’re either with us or … a huge douche!

As you have read before, California instated a 10% cut for its Medicaid Rx reimbursement.  However, last Saturday the courts overturned the ruling until 8/11/08.  Their computer systems still have the 10% cut, but they will let us know how they wish to deal with that ball of wax once the shit stops falling from the sky in the legal department.

Now, I don’t do this very often so you might want to bookmark/take a picture of this page.  The doctors have done a tremendous job in helping the local pharmacies keep their doors open and their paychecks from bouncing.  They have been more than receptive and more than helpful in switching their patients to generic drugs with little to no prior notice.  For how much shit I talk on doctors on here, they really helped us out.

However (you knew this was coming):

There seems to be a few doctors in town who did not get the memo.  You see, when we fax you a nice little note explaining the cuts and if we can switch our patients to something that cost less (so we wont lose money when we fill what the drug reps sucked you off to prescribe), and you write a big NO on it, that really upsets us.  Its not like you’re a cardiologist or writing for weird stuff like Tekturna.  Denying our request  from Nexium to OTC Prilosec isn’t rocket science, and obviously you must of slept through that class to realize how much power pharmacists have.  In fact, blanket denying everything that we send you to switch with a NO means that you are either:

1. Lazy
2. A dick
3. Think so little of us that you don’t give two shakes of a mouses dick what happens to us.
4. Have some ill-gotten god-complex that fell out of fad about 20 years ago when managed care/insurance companies snipped off your scroatum and dangled it in front of your face while saying ‘HAW HAW’
4. All of the above

Like I said before, this isn’t rocket science.  If I would of said that the insurance didn’t cover this medication you would of switched it in a hot second, but because we asked for a professional favor you decide to shit in your hand and rub it in our faces.

However, Pharmacists (believe it or not) like to take the high road.  So when your patient has a stupid medical question like what to take when they are constipated, we will not refer them to you and waste your precious doctor-time.  When potential new patients come and ask what we think of you, we won’t say that you are a flamboyant small-penis douche who hates pharmacists.  We wont make you wait an hour on hold or happen to forget to fax over that med list that one of your dropout front-end girls called and sorta-asked for in something-that-resembled-english.  I’ll look the other way when your minimum wage hired help totally fucks up.  Oh, and when you call me personally for a favor, I will (with a smile on my face), not bring up the time you totally FUCKED us when the cuts happened.  You see, we have professional courtesy, and even though you may bad-mouth us to your patients, we spend 10000x more time with them than you, so they’ll STILL come to us regardless what you say.

To all the doctors who stood up to help small pharmacies stay in business during the cuts, we love you.  We’ll refer patients to you, we’ll sing your praises from when the gates open until the gates close.  We’ll buy you drinks at the CE dinners (heh, they reps buy the drinks, but they dont know that) and run medication by your house late at night when your kids are sick.  We’ll cover for you when you write that Amoxicillin Rx to someone that you knew had a Pencillin allergy but just brain-farted.  We will drop everything to happily look up something that you just as easily could of looked up on your palm-pilot.  We’ll give you our cell phone numbers and open the store at night for those once-a-year emergencies involving a screaming grandchild, zithromax suspension and some auralgan (the original cheap one) drops.

To all the doctors who decided to not answer our pleas for help.  Eat shit.  The cards are down, and we know where you stand.  We will still treat you with respect, but excuse us always looking over our shoulder for the knife when the shit hits the fan.  We are more than just pill counters, and you are damn lucky that (unlike you) we have the moral and ethics to show you exactly how much influence over the patients we have.

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.

ATAP: Medication changes and how I deal with them

I received this question from a doctor who frequents the site:

I have a question regarding changes in medication. I am a physician.
The way I usually handle it is that I tell the patient the new dose and
then write a prescription to reflect that dose. I then tell them that
they’ll have to go in earlier than usual to get a refill and to use the
new prescription to let the pharmacist know that the dose has been
changed. Is that the best way to handle it?

This is an excellent question. I far far too often have patients tell me (when they are out of medication) that doctor has changed the dose. Usually this is on a Friday night about 10 min before closing.
In the case above, you, Dr, are doing the correct thing. Seriously, I cannot express this enough that writing a new Rx for the patient to bring in (or fax over from your office) is the absolutely best thing to do. Telling the patient about the new dose is like talking to the sky (or filtering piss out of the ocean). I have seen more mistakes with patients getting their pills mixed up and taking double on something they shouldn’t have. Usually things turn alright, but when they get instructions to double up on their HCTZ and instead double up on warfarin, things turn sour really quick. If doctors always assume that their patients cannot wipe their own asses without written instructions, the world would be a better place.
This is what I do with a sig/dose change for which the MD has done “The right thing(tm)”:
When the patient comes in, I get the new Rx in hand, and right then I have verification that the dose has indeed been changed which I input into the computer and fill the Rx (if they are out). If the patient comes in and still has some medication at home I put the changed Rx on file, and if the drug & strength are the same I print out a new label and tell the patient to apply it to their old bottle (I write the Rx number down which to apply the label to). Usually the patient is smart enough to match 2 numbers together and apply a stupid sticker. However this is a huge judgment call, and on more than one occation I have told them to come back with all of their medications so I can do it myself. I instruct the patient to come in when they are out upon which I fill the Rx that was put on file and everything is happy in pharmacyland.
So if you are an MD/NP/PA/DO/CNM/Janitor who is reading this, here is a few tips on how to make your pharmacist love you.

  • Any changes in dosage or sig, write the patient a new Rx. Using a sharpie on my pharmacy label is just going to waste both of our times with a fax over confirming what you wrote.
  • If any medications are DC’d, let us know. Nothing annoys us more than to have to wait for a fax-back asking if the patients Lotensin needs to be DC’d because you wrote an Rx for Diovan. Its not that its a waste of our time, but the patient obviously has no clue what’s going on, and the terms “possible therapy duplication” is like speaking chinese to them. They have to come back to the pharmacy, or wait an unknown period of time until we get an answer.
  • Write down any and all information on the Rx that might save a phone call or fax when switching to formulary alternatives. Unless you really want Protonix for some god-forsaken reason (like the reps are giving you lapdances), writing “or equiv” will save us both a ton of time. A PPI is a PPI for gods sake.
  • If you have any questions about whats covered, a rule of thumb is that if its cheap and generic; its covered. Prilosec vs Aciphex, Lotensin vs Aceon, etc etc etc. Have you tried generic Mobic vs Celebrex? You should! If you don’t really care what NSAID the patient gets, then state “Feldene, but whatever is covered, therapeutic sig”. Any pharmacist worth his salt will take care of your patient and not bother you. We may fax you what we gave so you can keep your records updated, but we’re not going to ask you a bazillion questions if its okay. Remember, we went to school to learn about drugs; have a bit of trust in us.
  • Hate to tell you, but most NEW drugs now days are just knock-off me-too’s that are out because their replacement is going off of patent soon and will be dirt cheap. Look at Paxil CR, Coreg CR, Adderall XR, Lexapro. All came out shortly after Paxil/Coreg/Adderall/Celexa went off patent. You have been using these agents for 10-15 years, and all of a sudden they suck because something new came out? Think of it this way, if they were so “new” and “breakthrough” and “revolutionary”, then why weren’t they out when there was 5 years left on the patent on the drug they are meant to replace?
  • If you have any questions about pricing, call us. Seriously. Nothing makes me happier than churning my workflow to a grinding halt to answer a phone call from a local doctor wanting information vs some crackhead asking for their vicodin a week early. Believe it or not, we’re in the same boat, and we cant exist without each other, so lets actually talk once in a while.

Glucose testing for fun and profit

Why must people be obsessed with testing their blood sugar?  Its about 3 times a week where I run into the typical uncompliant patient who needs a refill on 100 test strips they picked up 2 weeks earlier.  A quick scan of their profile shows only oral meds, no insulin, and uncompliance.  So then the 20 questions starts:

  • Are you on insulin? “No”
  • Do you adjust your oral medications based on your readings? “No”
  • Do you have any problems working your machine? “No, it works fine”
  • Do you waste strips or get errors which make you waste strips? “No, this machine is easy to use”
  • Do you bring your doctor your machine to look at? “No”
  • Do you do anything with the readings other than just collect them? “No”
  • Why do you test that often then? “Doctor told me to”
  • So if the doctor told you to wipe your ass 20 times a day even though you dont need to, you would do it? (alright, so I didn’t ask this question.. 🙂 )
  • Its been a month and a half since your glyburide refill, did doctor change the directions? “No”
  • Then why do you test this often even though you don’t do anything with the results? “Doctor told me to, I dont know.  Is my vicodin due yet?”

At this point my head explodes as I fight the urge to say “Your doctor is an idiot”.  What doctor worth any sort of medical degree will tell their patients whom are solely on oral meds to test 5 times a day?  They aren’t adjusting insulin nor are they adding additional doses of glyburide or anything like that.  Does the doctor realize that test strips average about $1/test?  Oh, wait, $ + MD = ???

Patients on insulin is another issue because these patients are expected to adjust their dosage based upon readings (sliding scale) or will call the doctor for dosage adjustments (Take as Directed as sig).  So I very simply put that if they are on ORAL MEDS then they only need to test once maybe twice a day. 

Hell, I have patients who after getting 10 test results of 112 every morning they pretty much assume that the next one is going to be around 112 and test every other day or every 3rd day (These are the patients who pay cash for the strips, go figure).  But of course, being on Medicaid/Medicare with your FREE/Low copay test strips means that you can just waste them as you wish, because they are in fact “FREE” and the nanny government will in fact supply you with more because you are too fucking stupid to use some common sense.

Best dialogue I ever had:
Me:  “The F in Pharmacy stands for Free” 
Them: “But TAP, there is no F in pharmacy”
Me: “Exactly!”

PA/NP/CNM/Janitors with Rx Authority

Why is it that 9 out of 10 Rx’s with a huge glaring mistake are written by NP/PA/CNM/Janitors who somehow got prescriptive authority before the people who actually went to school to learn about drugs?

Maybe its just where I’m at the PA/NP cribs are painted with lead paint, but its to the point now where when I see an Rx from one I just sigh and prepare to be frustrated.

Real life shit I deal with on a daily basis:

  • Amoxicillin 250/5 –  4.5mL q8 x10d
    • Come the fuck on, 4.5mL?  What the fuck is 25mg of amoxicilin going to do?  You can’t make it an even teaspoon?  A palm pilot is not a substitute for common sense.  Get your head out of your ass.
  • Amoxicillin – 158mg q8 x7d
  • (Just from today) Amoxicillin 648mg q8 x10d
    • This makes me want to murder people.  You get 1s, 1/2ths or 1/4ths of either 125, 250, 400.  Those are your only choices.  Choose wisely.

You know, dosing amoxicillin isn’t rocket science.  What the problem of PA/NP’s have is that their common sense is in the little electronic device that spits out a dose when you put in the patients weight.  The entire concept of having a mother who is barely able to wipe her own ass by herself is NOT going to be able to measure out anything that does not have easy to read numbers and big lines.  Thats 1/2, 3/4 and 1 teaspoon.  Case closed.  If this somehow involves fucking and having children you cannot afford, then maybe she’ll be competent enough to be okay, but dosing amoxicillin doesn’t fall into that group.

So I call the PA/NP and ask if they have a syringe they can give the patient that has readings out to the hundredth mL.  When they get the bitchy “Why would they need that?” I respond with “To measure out the amoxicillin dose that you wrote for.”  Once in a while they’ll get the idea, but usually it just goes right over their heads.  Rx authority people, this is who you are giving it to.  A fucking monkey can use a palm pilot and get a dose.  Some days I think I would have a better chance with a money.

  • Nebulizer, Ventolin HFA, Xopenex neb solution (DAW-1 of course), prednisone 60mg x5d with a huge note “DX: ASTHMA”
    • Steroid?  What the fuck good is this person going to get from all this shit with no steroid.  Lets just take care of the symptom without taking care of the cause.  I bet they would just throw vicodin at pneumonia without even thinking about antibiotics.
  • Metformin 750mg bid
    • 1.5 of the 500mg tablets? 100mg isn’t going to kill someone, just do one of the 850’s and save the patient the hassle.

The list just goes on and on and on.  Its gotten to a point now where if I see an Rx, and see that its written by a PA/NP I expect to spend about 20 min trying to sort out their fuckups.

I hope all doctors don’t write this horrible.

So some ignorant horrible spelling doctors decided to harass the *Angriest* Pharmacist over a rant I made about some idiot with 4 degrees who couldn’t write coherently to save his life.
Now I may rag on the Angriest Pharmacist for stealing my idea and stuff, but I got his back when some uppity fuck decides to give him both barrels.

for all you uninforned assholes,first notice this is not in caps!!my parnter and best friends wife is a pharmacist at a major grocery store ad she will admit it is the easiest job and when i read last week i was actually published i got a dictionalry and learned how to spell vicoden and even lortab which is hydrocodone which in the 33 years i have been practicing i have never prescribed the frug and refuse to,when i do surgery they get ultram and or darvocett. then i can count on a pharmacist callinf and asking if i realized i gave 2 pain meds an always when i give anti biotics its for 7-10 days and then a 25 year old dr. want to be pharmacist will call and ask why 10 days the book says no more than a week. we also have a system for fraud which we rarely get taken and i do press charges, ill write 38 in 2008 and 39 in 2009 never with refills and pharmacys know if it is mine, we get a few “losts” scripts but we handle individually and if its stolen we need a police report to take to pharmacy and i still get calls. all replacements must have notorised letter to be replaced and controlled drugs are only replaced once. on major surgeries i might prescribe 18 oxycontin,6 times in 2007 all over 65 years old. i explain all medications as well as side effects and how the medications react with any other current meds.then the nurse brings in the rx and goes over questions,so by the time they see the pharmacist all needed is count the pills and run through insurance unless patient has questions and in our area its the tech the pharmacist doesnt have time.most pharmacists earn thier money and do have responsiblity its the young ones that i have to pay for 2 extra phone lines and they still want to tell me how to prescribe.we do recommend mail order to low income if it is long term usage on our internal medicine practice as long as they keep thier appointments or we give them samples but i keep no controlled. in 33 years i have had 4 malpractice cases, 3 dismissed and the 1982 casse was settled out of court in 1988 for a medicaid person who had no injuries just wanted to never work again,so my dea number is last of my concerns. so the assholes who say i have no degrees and speak 6 languages, does that mean i am smarter or above you i think not, i make mistakes like should have retired in 1996 when i was making 450k instead of 6 day work weeks 10-12 hour days for 125k, but i would do it for free. anyone want to put up something about my credentilals? I COULD BE A LYING DRUGGY WANTING ATTENTION. sorry i got carried away with the caps. glad i could raise your rating for your website, i thought it was a joke. maybe ill send a couple movie clips youve probably seen me before even though i am not a house hold name but bottom line the world needs to hear all sides before making a judgement. im not a dr. because i dont proof read and use large and small letters, i can live with it. t. elway,md facs
scripts

Wait, this guy doesn’t know how to spell Vicodin or Lortab however in his 33 years just prescribed Darvocet and Ultram? Uh, isn’t Vicodin and Lortab a generation older than Ultram? This post is like a brain-dump with no sort of flow or break. It makes my brain burn.
If that wasn’t enough:

Sorry, address must include host name. (#5.1.3)
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From:
To: “‘prescription’”
Subject: RE: Dr “4 Degrees” and the Caps-Lock key eludes him – The Angry
Pharmacist
Date: Thu, 31 Jan 2008 18:42:09 -0500
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Did you get the email today from dr.e and his numbers as well as dea to
prove you and your readers that you can be wrong?? For something that was
toungue in cheek it sure got you a lot of readers we all read it 1/25/08 and
it was a good laugh enough that we have it hanging in our waiting room and
after blocking our 3 of every 10 words out of the 95 patients a day at least
15 make a comment that it must be a real pharmacist that is disgruntled and
hates his job.tried not to use caps or bad grammer or caps in an informal
note,had no idea what your site was but have started reading it as we
phycians get a good laugh after double shifts and watching the pharmacist at
Albertson asleep, like I said my wife is a pharmacist and that doesn’t make
her dumb or lazy she knows how well she has it plus benefits and
retirement,she is way up the ladder as well as most pharmacists versus the
audiologists we put up with dailey, one of our specialities is otology, that
is ear infections,hearing and aids as well as stapedectomy surgerys invented
by dr. shea in Memphis tn, say for not proof reading this also but I think
you can read it if a couple words are turned around you are a phd,and
thankfully not an md with that language that you use. God bless you and we
pray for your soul and that you find happiness. C.r.shultz,md f.a.s
_____
From: hoover [cut]
Sent: Friday, February 01, 2008 8:20 AM
To: hoover
Subject: Dr “4 Degrees” and the Caps-Lock key eludes him – The Angry
Pharmacist
http://www.theangrypharmacist.com/archives/2007/12/dr_4_degrees_and_the_capslock.html

Well, first of all I’m glad people read my site. I have no idea how the TA’estP got the email bounce. If you want this dillhole’s email address go to TA’estP site and look it up. I’m a big vagina and took out his email address.
All I have to say about this is:
i sure hope this doctor treats his patients more than he treats proper puncutation and grammar i know that i dont ever, use proper grammar but at least i know that the keys,on the keyboard are used to signify when sentences stop and start and i dont place,commas in places where they dont belong i have letters after my name like f.a.s and other crap that makes people think,that i am smart but really i dont know what i am doing because i like to type with only the letters because all of the other key,scare me like chicken.
DrugNazi was right, these websites just write themselves.

Translated Drug Rep Speak

You will only find this here at “The Angry Pharmacist(tm)”.  It is a smuggled document from the headquarters of a training facuilty (the drug company shall remain nameless) about how to train drug-reps.  This is the secret code! Lets take a look:

  • Doctor, can I speak with you for a min about a new product?
    • Translation: Our patent has ran out on our best selling drug, so I’m going to tell you how much the generic will suck and how our NEWER and BESTER product (which is the same shit just XR after the name) beats the living hoo-hah out of the stuff I was pimping to you as the latest and bestest just 2 weeks prior.
  • Here are some studies for you to read.
    • Translation: You wont read this shit, and we paid for them so what do you think they’ll say you idiot.
  • You know that our new product has 500% better bioavailability and the AUC is 15% higher big-word big-word.
    • Translation: You have no idea what the fuck these numbers mean, and neither do I!  I just memorize them and spit them out to sound smart.
  • I’m going to leave some coupons here so you can trial your patients.
    • Translation: We’re gonna fuck over pharmacies so they’ll have to buy a $500 bottle of 100 to get a whole 7 tablets out for the fucking coupon.  The rest will just rot and outdate on them.
  • All major insurance companies cover this.  Its Tier-4 on their formularies
    • Translation: Which means its not covered without a prior auth.  I know you’re too ‘busy’ to do PA’s so we’ll just fuck over your patients by feeding them samples until they run out, then force them to pay $200/month to continue therapy.  Wait, I think the coke dealer did that same thing to me when I was in college.
  • Do you have any questions?
    • Please don’t be an ex-pharmacist.  Please dont be an ex-pharmacist! SHIT! I NEED A DISTRACTION! IT LOOKS LIKE HE’S GOING TO ASK ME SOMETHING!
  • Oh, I dropped my pens.  Dont worry, i’ll get them.
      • Translation: Yes, they are real. I can make them bounce into each other.  Look into my mind control device doctor.. Loooooook.
  • Here are some pens and notepads for you doctor.  I hope you have a wonderful day!
    • Translation: Sucker!!!! HAHAHA!

I really do dislike drug reps.  However I dislike Medicare Part D salesmen even more!  More on that later!

Dr “4 Degrees” and the Caps-Lock key eludes him

Sometimes all I need to do is to just check my email for a laugh:

for the pill counting pharmisist why is he playing drr?HE ISNT THE ONE WITH
A MEDICAL DEGREE AND ITS NOT HIS DEA NUMBER AT STAKE AND THERE IS NO LEGAL
WAY HE KNOWS THE PATIENT HISTORY.TOO MANY PHARMASCIST WANT TO PLAY POLICE
AND DR, FOR THE 1 PERCENT WHO ABUSE AND THEY WONDER WHY MOST ARE GOING MAIL
ORDER TO HAVE FILLED.MOST RX PEOPLE TAKE FOR A PERIOD OF TIME ALL THEY NEED
IS PILLS COUNTED AMD REFILLED. PHARMACISTS WHO CALL DRS. MULTIPLE TIME HAVE
NOTHING TO DO AND MDS DONT HAVE THE TIME,TODAY YOU HAVE TO SEE 5 PATIENTS
VERSUS ONE TO MAKE WHAT WAS MADE IN 1995 AND DONT HAVE THE LUXURY OF 8 HR.
DAYS COUNTING DOR 100K A YEAR.THIS COMES FROM A DR, WHO HAS 15 YEARS OF
SCHOOL AND 4 DEGREES

Right, this comes from a doctor who has 15 years of school and 4 degrees. You would think a “doctor” of this caliber would know how to write in proper English or at the very least knows how to use the Caps-Lock key.
I’m not playing “dr”. I’m doing my fucking job. Obviously if you write a sig on an Rx, and that patient chooses not to follow that sig, then I can choose not to fill the Rx, plain and simple. Plus, when I’m bored with all that LOADS of free time that I have, I decide to call MD’s just to chat. Us pharmacists have a secret game that we play called “piss off the MD” where we call up a bunch of MD’s and time how long we can tie them up on the phones! Its fun! You should play! Then, after you play, you can yank your head out of your ass and realize that what you wrote above makes no sense.

WHO IS THIS ANGRY PHARMACIST WHO WONT FILL VICODEN WITH OUT BUGGING THE DR.
AND WONT FILL RITALIN OR OTHER DRUGS THAT THE DR. ORDERS IN WHICH HE CANT
KNOW IF ITS APPROPRIATE OR NOT FOR ONE THING HE HAS NO DR. DEGREE LET ALONE
MD.HE NEEDS TO FIND ANOTHER PROFESSION BECAUSE SOON THE 100K HE MAKES AND
HIS NICE CAR AND HOUSE HE OWNS IS GOING TO BE ONE OF THE PATIENTS AND HE
WONT HAVE HIS PILL COUNTING LICENCE ANYMORE. FROM THE DISGRUNTLED PHYSICIAN

I dont know if its appropriate or not because I have no doctor degree? Wait, actually I do have a doctorate, however I do not have an MD, so you’re only half wrong there buddy. It doesn’t take a degree in pharmacology to realize that if your patient is blasting through 120 vicodin in 1 week, obviously you are missing the boat entirely. How is my patient going to own my house/car/etc? Is he going to sue me for not dispensing his vicodin 3 weeks early even if the MD gives the ok for the 20th early fill in a row? Hate to tell you, but the DEA will side with me until the cows come home and will gladly plant that shiny DEA number that you covet so much right up your ass. You figure out why, you’re smart with your 4 degrees and 15 years of school.
Plus where does it even say on here that I wont fill a Ritalin Rx? Where does it say that I wont fill anything but the crackhead’s Soma thats 3 weeks early? You need to start reading the site before you fly off the handle. OH WAIT, YOU HAVE 4 DEGREES, IM SORRY.

WHEN DO THESE GET POSTED AND WHERE? IT APPEARS IT IS A PHARMACIST NETWORK AND IF IT IS CONSTRUCTIVE CRITISIM THEY DONT WANT TO HEAR IT,FROM THE MD

Ha! An MD who does not want to hear constructive ‘critisim’? Go figure! Thanks for re-enforcing every stereotype of the “I am god do what I say” MD that pharmacy students dread.
A pharmacist network? Thats right! You have stumbled upon a secret underground network of disgruntled pharmacists who’s sole purpose is to take over the medical world and make that plain-ole-stupid MD just obsolete.
Let me put it to you in a way that you will understand.
READ THE ACTUAL SITE BEFORE YOU GO OFF ON THESE TIRADES MAKING YOURSELF LOOK LIKE AN IDIOT. FURTHERMORE LEARN HOW TO USE THE GOD DAMN CAPS LOCK KEY.
Seriously, If I were an MD I’d be pretty embarrassed to have this guy in my ranks (but Im sure people say that about me. Eh, oh well).

Paging Dr. Blackmail, Dr. Blackmail

This is a topic that I know everyone in pharmacy knows about. Every pharmacist has dealt with it, yet like the floating turd in the punchbowl of medicine, everyone just looks the other way and pretends it doesn’t exist. So thats where I come in. I’m scooping out the turd and asking how it got in here.
I hope Doctors (MD’s, not you uppity PharmD asses) from all over reply to this post, because I want to know if this actually happens or are we just delusional. You know that all comments are anonymous, so you have no reason to not post for fear of angry lynching (at least in real life).
Say you are a doctor, and you fuck up on a patient bad. Not like “to error is human forgive me” error, but “sue me for lots of money” error; and the patient is fully aware that he/she has you by the balls. Is it practiced to just bribe the patient with lots of narcotics so they won’t turn you in/sue you?

Example 1:
Patient comes in with an Rx for Vicodin ES #180, 1 q4 prn pain **must last 1 month** x 4 refills. I start to get a huge pharmacy boner because I think this is a dead set forgery. I run to the back room as giddy as a schoolgirl who gets her period after the prom, and call the doctor. Its legit. I tell the doctor (or his minimum wage staff) about the limit on Tylenol, and at 6 a day this woman is going to blow out her liver. He tells me its only for prn and to not worry about it. I document everything and fill the Rx.
15 days pass (the Rx was for a 30 day supply for those a bit slow on the pickup). Patient wants a refill. I tell him to (politely) take a flying leap because the Rx says that it must last 30 days. He says to call the Doctors office, so I (feeling as if i’m trying to filter piss out of the ocean) send over a call tag requesting an early fill and expect a huge NO on it. Patient must call about 20 times during the hour asking if its ready or not. Totally pissing off my frontend staff and myself. Tag comes back that its approved. I call the office and ask why the put the “must last 1 month” if they aren’t going to abide by it. They blow me some bullshit excuse and just say to fill it. I document everything and fill it (which in hindsight I shouldnt have done). Then I fill one, and 18 days pass, he wants another refill. I get on the horn with the Doctors office and ask what the deal is. I tell him that unless he makes the sig 1-2 q4 there is no way that I’m going to fill it (even then he’s really going to blow out his liver). He refused to change the sig and says that its ok to fill. I suggest Norco to lower the APAP, nada, he wants this filled (everyone knows that VicodinES by Watson Labs has a huge black-market value). I plain out ask what the deal is. He says “Doctor-Patient” confidentiality. I tell him thats great, but I dont want to ride my license on his “confidentiality” and hang up on him. I boot the patient from our place (haw haw, Walgreens got him) and blacklist the doctor. I run the sheets on the Dr, and there isn’t anything really strange about him. Handful of patients, not a big writer in our store, but blood pressure, diabetes, the usual. Just this ONE patient is a huge red flag out of the sea of normality.
Example 2:
Patient comes in with an Rx for Fentanyl Patches and some Norco. I don’t give this a second thought and fill it. Everything is cool, patient comes back on time and gets them filled, no problems.
A week passes…
His wife comes in, Fentanyl Patches and Norco. I start to wonder if something is up.
A week passes…
His DAUGHTER comes in with an Rx for Norco. Something is going on.
I fill the Rx’s with a watchful eye. They aren’t early, they aren’t assholes about it. Just having all 3 family members on exactly the same drug (when he is clearly the one with any sort of ailment) raises a huge red flag with me.

So what’s the deal here? In example 1 we have a doctor who will not budge from changing an Rx when its CLEARLY too early (and he put down that it must last 30 days) and CLEARLY too much Tylenol. Example 2 we have everyone and their family on some pretty high caliber narcotics.
Does this problem exist? Yes or No. I don’t want to hear whiners about how the patient in Example-1 was obviously mis-dosed and in chronic pain, blah blah blah. No, it wasn’t that. He was on Mars every time he called, and he doesn’t remember calling our store or even coming in. There was something that was obviously wrong that you cannot put into writing, and every pharmacist knows what that feeling is like.
If it is true, the Dr’s are putting the pharmacies in a really shitty position. We have to stand up to the patients when you wont over something that /you/ did and /we/ didnt. Plus, when the shit hits the fan and this person gets caught for selling, who’s going to be put under the gun first.
If you’re a doctor, put some sort of explanation in the comments, if you’re a pharmacist who obviously is as paranoid as I am, put your story in the comments.