Category Archives: The Wonderful Public

Careastatin, 0 refills remaining.

Anyone who has been in a relationship (professional – personal, it doesn’t matter) knows that it takes two to tango.  Your patients come in, put their life in your good judgement, and in return you may have to do things that are ethically sound, yet legally grey at best.

I’m talking about the dreaded ‘0 refills remaining’ with the patient being out for 2 days.  This phenomenon is so prevalent in pharmacy that we should have received a class on how to handle it.  Since pharmacy schools give two-shits about retail, here is your class on the subject.  Pay attention!

This is how 99% of the cases take place:

  • The patient will call you over every little change on the label (expiration date, change in manufacturer, quantity, doctor) yet will gloss over how many refills remaining until they are out for exactly 2 days.
  • The patient will let you know they are out of refills in person…. On a Friday… Before a 4 day holiday…. At 2 min’s to closing…
  • The mediation won’t be Vicodin, Valium or any narcs.  It’ll be something awesome like insulin.  You know, the kind of shit that you ethically can’t tell them to go fuck themselves over.
  • They won’t be out of something simple that you can drop a few tablets in their bottle, it’ll be something that comes in a unit-of-use bottle, like Januvia, Actos or Nexium.
  • In the event that they are out of something simple and stupid, they will forget their old bottle despite you telling them 10 times “MAKE SURE YOU BRING YOUR OLD FUCKING BOTTLE”.  This leaves you out the cost of ANOTHER bottle and ANOTHER label.  Regardless of how shady this all is already, dispensing drugs into their open unwashed hands is just crossing the line.
  • The patient will use the phrase “BUT I NEED THIS MEDICATION” or “CANT YOU JUST FILL IT”.

Here is where the legal waters get the product of Go-Lytely dumped into it.  What do you do?

  • Legally (sorta), you can only give a 3 day supply without authorization.  Its insulin.  Are you going to suck out a 3 day supply?  If you are, I hope your employer fires you for being a dumbshit.  Are you going to break open that box of Humalog Flexpens to dispense just 1?  To make this worse, if the MD finds out (usually patient taddling) he/she could file a complaint against your license with the state board of pharmacy for filling without authorization.  If you billed the insurance company, they can ding you for filling a fraudulent Rx and pull your contract.  This is all worse case mind you.
  • Realistically, you know you won’t get the OK from the MD for at least 5 or 6 days.  A week to 10 days if the patient goes to a county-ran clinic at the local hospital.
  • Ethically, you know that if you don’t dispense this insulin, the patient will have to go to the ER (or worse) thereby costing the taxpaying citizens a few thousand.

Pretty fucked situation all around?  Yes, yes it is.  For those of you at home, we deal with shit like this about 20 times a day.  Now this is how I would handle it:

If it’s a regular patient (regular in the term that we have a professional relationship, not that they can poop fine), then I take the potential legal hit to my license (and to the store) and give them the insulin without the authorization.  I figure the patient will stand with me against the state board (and their doctor) to justify my actions as being in their best interest.  I politely tell them to bring me a new Rx before this amount runs out, and all is happy.  Wait, can you hear the collective jaws of every MD out there dropping as I spill the beans that yes, we do dispense medication without your authorization in certain cases.  Here’s a fucking reality check, your patients are dipshits.  They can program their phones to play the most obnoxious ghetto rap-song ring-tone at 1000db while waiting for their drugs, yet they can’t program a simple alarm to remind them to call in their refills a week early so we can get the authorization.  If you are unable to grasp this concept, then actually listen to the ‘blah blah blah’ that comes out of their mouth when they visit you and you’ll realize that you’re dealing with someone that’s half-step above my dog on the evolutionary chain.

If its Joe-Crackhead who treats me like utter shit, bitches at me about EVERY-FUCKING-THING and looks for things to argue about; fuck him.  Let him sit in the ER for 10 hours.  If he paid as much attention to his medication refills as he does his fucking cigarettes, we wouldn’t be in this mess.

Harsh? Yes.

Surprised? No.

Agree with me? Probably.  Here is my rationale.

Personal responsibility is something isn’t to be taught by your Pharmacist.  Sure, everyone has a brain-fart and forgets to call their medications in.  However why should I legally put MY license on the line for someone who has no respect for me, doesn’t treat me like an equal, or always tries to pick a fight for me?  This kind of bullshit patient would be the first one to throw me under the bus to not only the MD but the state board if the shit goes south.  I’m not going to put my livelihood on the line for someone who doesn’t give me an ounce of respect, and doesn’t realize that I’m doing him/her a huge favor.  Unprofessional? Sure, if you want to look at it that way, but you also need to look at the irresponsibility of the patient who put him/herself in that situation and expect me to put my ass on the line to remedy a situation that he/she put themselves in.

The easy solution is for everyone to have a little bit of self-awareness and personal responsibility regarding their own health.  Yeah, I’ll get right on that after I finish filtering all the piss out of the ocean.

The dreaded RTS

What is the public enemy number 1 of any pharmacy?  No, its not the patients.

Its the dreaded RTS bin.

Thats right! The Return To Stock bin.  The glorious bin of drugs that patients called in to have refilled “RIGHT NOW” yet never got off their lazy asses to come and pick up.  You know, all the simvastatin and lisinopril that the patient pitched an absolute fit right in the store because they “were out” and didn’t have any refills remaining yet never bothered to pick up 2 weeks later.

RTS’s absolutely kill pharmacies.  Here’s why (to those at home who don’t work in a pharmacy).

It takes money to fill a prescription (gasp!) other than the raw cost of the drug.  Everything from the vial, to the label, to the computer system/printer/toner that spits out the label (that you fucking don’t read) to the tech that fills it, to the pharmacist that checks it, to the clerk that puts it in a little bag and takes your whiny phone calls.  All of those steps cost money.  Thats not even counting the electricity, insurance, employee taxes, etc.

We get a dispensing fee paid for by YOUR insurance to cover these fixed costs.  Why are they fixed? Because the dispensing cost is the same if the drug costs $1 to $5000 kerzillion dollars.  When you pick up and sign for the medication, we have proof to your insurance company that you in fact received the medication and their piddly $2 dispensing fee was in fact put to its intended use.

Now say that drug filled vial with your name on it just sits out front for a few weeks.  It starts to get lonely sitting by itself in the pharmacy because contrary to what you read on the internet, just ordering your medication doesn’t make it magically work, you need to TAKE the fucking medication.  Eventually, we need that space to store medications for people who give a fuck about their health.  Your vial then gets RTS’d.  Since we didn’t dispense that medication, we legally cannot accept the money that your insurance company paid us for the drug + dispensing fee.  So now, we “back out” the prescription (meaning we give the money your insurance company paid us BACK to them, all of it), and now must PAY someone to put the drug back into the big stock bottles.  We have to throw away the vial and the label as well.

Your laziness now has cost the pharmacy double the labor + the cost of the vial/label  for which we are getting paid a whopping $0.00 for.  All because you called in a refill and didn’t get off your ass to pick it up.  My store has a policy that we call people once their medications have sat for a week, then we give them a second call 5 days later.  Yes, we PAY someone to call you to remind you that the prescriptions that YOU CALLED IN have sat here for a week.  This is after we told you when you called in your refills that they will be ready later on that day.   Ask me how this can be any more straightforward!  Oh, I guess its as straightforward as paying your fucking phone bill because every time you come in you give us ANOTHER phone number (thats disconnected 2 days later).

After about the second time I RTS a prescription for a patient, I put a big note in their profile to make sure they are told that we will fill their prescriptions when they are IN the store due to us always putting back into stock what they order.  What do I get? A bunch of swearing at me from over the counter by some idiot unwashed mouth-breather to the tune of “I called these in a week ago, why aren’t they ready yet!”  This is after they were EXPLAINED why they must be here for me to fill their “diabeetus and list-o-pril” pills.  I swear I can’t fucking win.

This shit really pisses me off.  Its a waste of my fucking time and a waste of the stores money.  Since my store doesn’t do auto-fills, if you’re not going to take your fucking medication, then save us all the headache and don’t call it in.

Oh, and a cool pharmacy fun-fact, is that controlled prescriptions are a good chunk of what I fill everyday, yet less than 1% of the drugs I RTS.  Big fucking surprise.

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.

Vaccines, Autism, and Dipshit Jenny McCarthy

By the time you read this, the Vaccine = Autism published by the BJM will be old news (Yes, I do write a bunch of rants at once and have them post at a later date).  However lets take a closer look at this whole situation.

Lets keep in mind that I don’t belittle Autism or think its “not important”.  I’m hoping to not only find out what the cause is, but how to prevent it.  Autism, like Down Syndrome, happens and we aren’t sure exactly why or how.   Take a look at how many drugs are out there (that kill people no less) that the mechanism of action is “Undetermined”.  Are you throwing a shit-fest over those? No.  Is some random dipshit actor standing on his/her soapbox about that? Nope.

First off, Jenny McCarthy.  The woman who is best known for her blond hair and big fake tits speaks the gospel about how vaccines contribute to autism. The whole fact that people LISTEN and BELIEVE her shit makes me want to blow the brains out of 99% of society.  She should stick to what she does best, being being eye-candy.  We don’t need “actors” to be the voice of medicine, politics, or anything else that they know jack and shit about.  Lets be realistic, if you listen (and believe) any non-medically trained person’s bullshit about medicine, you are an idiot. Do I ask the random homeless guy on the street how to fix the breaker box in my house?  No. Do people come into my store and ask me how to replace the water-pump in their Escalade?  No. However some random dipshit actor “speaks out” on a topic and people run and proclaim the word like it was given by Oprah herself.  Yes, it sucks that her child is autistic.  It sucks that /any/ child is autistic.  However it sucks MORE that kids need to suffer a preventable diseases because their mom listens to such propaganda given by a non-medically trained person.  I’m sorry Jenny, but I am no longer fapping to pictures of you out of sheer disappointment.  I hope we can still be friends.

Second on the chopping block, the Lancet.  I had somewhat high regard for the Lancet, having used their studies while I was in school.  How in the hell could they let such a bullshit study be published? A study group of 12?  A high school science project has more people in their study group!  But oh-no, its the whole “think of the children” mentality that got this clusterfuck of a study published vs good logical science.  Good going Lancet, now you can “think of the children” as the unwashed idiots don’t immunize their children and they die a preventable death.  I’m planning on releasing a study showing how Vicodin and Soma use cause laziness and stupidity.  My sample size is 20, I hope you publish my study.

Third, and most favorite: Andrew Wakefield.  Dude, when you publish a study with a sample group of 12 on a medication that MILLIONS and MILLIONS of people have received without incident, didn’t you take a step back and think to yourself “Man, maybe something is a bit wrong”.  No, you didn’t.  You published your bullshit to the Lancet, got your 20 seconds of fame, freaked the fuck out of a bunch of ignorant dipshits because you are were a licensed Doctor and thereby had the inherit trust that goes along with the degree.  If you were selling penis pumps (because thats really all you can do now), I wouldn’t even buy one of those from you because your study group would be 12 men who used it!  You did a huge disservice to the profession of medicine.  Your fellow colleagues hate you, nurses and pharmacists hate you, and to be completely blunt you and the Lancet should be brought up on criminal charges for the damage you have done.  You should go have sex with Jenny McCarthy so maybe the common sense recessive trait could be expressed in your children.

Fourth (and finally) the parents who refuse to immunize because of Autism:  I’m a parent – so this hits close to home. To be completely honest its not the job of the government nor any governmental authority to make you vaccinate your child.  Its your child, you can do whatever you want.  However, that being said, if your child develops any preventable disease because you decided to listen to an ACTOR via the INTERNET vs listening to your DOCTOR (I can see how you can confuse the two, they end in -CTOR) YOU should receive zero state aid while the CHILD gets the treatment he/she deserves on our dime (its not the child’s fault their parents are dipshits, so why should they get shafted out of treatment?).  That’s right, no welfare or any public assistance for YOU because YOU decided to not listen to someone who deals medicine for a living.  You can sleep soundly in bed listening to your child squeal with pertussis knowing full well they won’t get the evil Autism because of your good judgment. Right after that, please stick a road-flare up your vagina, because we don’t need more idiots like you breeding.

I will commend BJM to putting an end to this madness, unfortunately its too little too late.  The damage has been done, the lines have been drawn, and you aren’t going to change the opinion of the uneducated idiots.  After all, you are just a “propaganda machine for big Pharma”.  Oh, and calling Jenny McCarthy an actor is a stretch, even in my book.

But wait! Theres more!  For your enjoyment, straight from YouTube, I present my heros Penn (he should have been a Pharmacist!) and Teller’s episode of Bullshit about this very subject:

Part 1:

httpv://www.youtube.com/watch?v=Xo97VouL0ls

Part 2:

httpv://www.youtube.com/watch?v=X_nYMEO82mo

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.

Why help those who refuse to help themselves?

There is a common saying that goes “You cannot help someone who will not help themselves”.  Pharmacists deal with patients like these day in and day out.  Patients who get prescriptions from their doctor only to have them sit unused on the shelves to be brought to you for refills months after months.  These are the patients who give you a bottle to refill that has 28 out of 30 tablets left in it (but the vicodin bottle is stone empty).  These are the patients who you see the drug dosages increase and increase then switched to something thats expensive (and not covered) only to sit there and expire on them.  We do the prior auths, we go through the filling procedure to RTS them a month later, we send refill requests to the doctors to have them waste money paying office staff to respond to them.  Its a big waste of time and money for everyone involved EXCEPT the patient.

What does a pharmacist do at this point?  Does he try to have a “Come to Jesus” meeting with someone who obviously has no regard for their health?  After all, healthcare is “free” to them, they can just take an ambulance ride to a cushy ER at some paid-for-by-tax-dollar establishment.  Or does he/she see the writing on the wall and just fill the Rx knowing full well it won’t be taken.  We all know that the moment you refuse to fill that Rx they are going to die and you’re livelihood is in jeopardy in some civil suit.

What does an MD do at this point?  Does he/she shit-can the patient only to have him/her die of some complication and get his life ruined by a suit brought upon by the family?  Does he/she write for more medication just to cover his/her ass knowing full well it won’t be taken?  Does he/she waste his/her time filtering the piss out of the ocean when there are other patients out there who need the help?

What does a healthcare professional do when the patient really doesn’t give two shits about his/her own health?  Tough question, no real cut-and-dry answer.  If the patient dies, someone is getting sued; be it me, the doctor, the hospital, someone.  Even if the patient’s family loses the suit, you still have to deal with the mental/financial bullshit that goes along getting sued.  After all, its everyone’s fault but the patient.

A big contributor to this problem is that the patient really isn’t forced to care about his/her health.  Like I said before, the medication is free, hospital visits are free, and the proverbial “You can’t get blood out of a rock” comes true when the bill arrives for services rendered for their irresponsibility.  These patients have nothing but what the state gives them, and have nothing to lose.  So what if I’m 500 lbs and my HbA1c is around what my IQ is, I know that if the shit hits the fan I can go to the ER and get treated for “free”.  Theres no burden/penality on the patients to take care of themselves, and (much like everything in life) the responsible people end up paying the price.  People in other countries would cut their testicles off for just a smidgen of wasted care that is taken for granted here.

I hate to say it, but I think know the healthcare system is going to implode on itself in the next 15 years (if that).  There are way too many irresponsible people sapping the resources that the responsible people produce.  Nobody cares about their health anymore, and the people that do are the ones paying out the ass for services that cost a truckload to compensate for the loss accrued by the irresponsible.

You may think that I’m blowing smoke out up your ass, but take a look around next time you are in a public place at the amount of morbidly obese people are mouth-breathing around.  Look at their kids and the crap they stuff into their face at an alarming rate.  Its not ignorance thats fueling this, its the simple fact that when push comes to shove they will get treatment without payment.  We are afraid to say “You did this to yourself, you deal with it” because of some bullshit excuse like “its not their fault”.  You may think that sounds uncaring and callous, but take a second out of your candyland outlook and look around you at the people who are pissing their health down the toilet on your dime just because they can.

Healthcare is a business, All of us; doctors, pharmacists, nurses, PAs, NPs, and the staff that help us all have bills to pay and families to provide for.  Charity won’t put food on the table, and the sooner you realize this the better off you are.  If you want charity and “helping those in need” then work for free and see how far that gets you.

I hope you link this jaded-yet-true article on your website/forums/whatever, because I’d really like to know how this problem can be fixed/should be fixed or what we can do short of just making as much money as we can before the entire system explodes and we’re all out of work.