Category Archives: The Wonderful Public

The right and wrong reasons to give your pharmacist both barrels

I admit, my shit is far from smelling like I rose.  I fuck up as much as any pharmacist out there (yes, we do fuck up, more than you think and a lot more than we want).

However, you must choose your battles with your pharmacist carefully.

Its sorta okay for you to give me both barrels when you call in “all my regular monthly meds” and I miss that albuterol MDI that you filled 9 months ago because (silly me) I didnt realize it was part of your “regular monthly meds”.  I mean in my world, meaning common-fucking-sense-land, the world ‘regular monthly’ means the shit you take every month; like your vicodin, soma, and the other unimportant non-narcotic shit that you take to keep your sorry ass alive.  Usually I’ll send my apologies (and raise the price on your narcs for next month) and kindly ask that next time you tell me if you need anything that you dont pick up every month.  Oh, and I’ll be sure to remind you of this conversation next month when I fill your albuterol and you scream at me that you don’t need it, and ask why did I fill it.

Fuck I hate not having the power to read minds… Or blow people up with a thought.  I’d be the shittiest X-Men around.

However dont you ever, fucking EVER give me both barrels because your lazy sorry ass didnt realize that you had 0 refills remaining and I haven’t heard back from the doctor (and of course you’re out).  Thats your fucking fault, not mine.  If you want me to hold your hand like your mother, then I reserve the right to slap the living shit out of you for being fucking stupid like your mother should have.

Don’t ever make me drop everything Im doing because you need your hospital discharge meds filled RIGHT NOW that were written a fucking week ago.  You waited a week to get them filled? You obviously can wait for me to get to them after I finish the Rx’s of the people patiently waiting who do have their shit together.

Don’t ever put me in the middle of your fucked up family issues because your ‘caregiver daughter’ (who has picked up your narcs for the last year) decided to sell them to get that new tattoo and you want me to get the drugs from her.  Don’t even get me started with your daughters crackhead boyfriend who ‘stole’ your oxy 30’s.

Don’t ever give me both barrels and throw down the race/poverty/etc card as an excuse on why I wont fill your narcotics early.  Oh, and by early, I dont mean like a day or two, I mean like 2 weeks early.  Race/poverty/etc isn’t a excuse card for being stupid and not taking responsibility for your actions.

Going on vacation? See 0 refills on your bottle? Obviously you planned enough ahead to get plane tickets for your 3 month trip to a far away land yet were mentally incapable of at least giving me a week’s notice to try to get auths for your medications that (you know) you need to survive.  Must be nice to go on vacation for 3 months.

Fuck, I need a drink after writing this.

Im dreaming of a Crackhead Christmas.

I hate the holidays.

There, I said it.  We should take the Christ out of Christmas and throw in Crack.  Call it Crackmas from here on out, because that is the kind of shit myself and other retail pharmacists need to deal with on a daily basis this time of the year.  Soma and Norco are the reason for the season, and when you can’t take your fucking life or family any more, you need your pills.

The holidays, to me, are a really shitty time of the year.  Let me sing you the song of my people and whine about why I wish tomorrow was Valentines day.

  • Christmas started well before Thanksgiving this year.  My co-workers, full of holiday fucking cheer, demanded we put on the 24/7 Xmas radio station for the “holiday season”.  I’ve been listening to “holiday music” for 9 hours a day, 5 (sometimes 6) days a week, SINCE THANKSGIVING.  I’m no longer dreaming of a White Christmas; I’m dreaming of a hot-tub, some fentanyl patches, some cocaine, some Viagra, and a bunch of fucking Thai hookers.  I’m dreaming of tossing that fucking radio into a wood-chipper and doing a fucking victory dance as the parts rain down on my head (knowing my luck the speaker magnet would crack my skull).  I’m dreaming of an ice-cold bottle of vodka and Simply Orange (no pulp) sitting in front of a roaring fire.  I have grown to hate the 5 fucking Xmas songs that are remixed 100 times each and played on a gigantic fucking loop.  Grandma got ran over by a reindeer because she put on Xmas music before Thanksgiving, thats why.  Bitch had it coming.
  • It gets dark early here, and for those of us who work behind the counter (and have access to the narcotic safe) that means it gets really scary once the sun goes down.  You see, there are 2 ways to get a prescription medication filled in this country.  With a prescription, or with a gun.  Unfortunately, with the GunRx ™ there’s no quantity limit, no refill limit, everything is covered with 0 copay, and you get to self-serve.  Most of the Indy’s (and a few of the chains) have already been hit in the last few months.  Fortunately nobody has been hurt, only nerves rattled and holidays shattered by having a gun shoved in their face for a handful of narcotics.  People want money this time of year, and oxycodone makes good stocking stuffers.  Keep your local Pharmacist in your thoughts when it gets dark, because for some of us, we put our personal safety on the line to make ourselves accessible.
  • On a lighter note; when it gets cold here, people (read: old people) decide that since they don’t sweat, they don’t need to shower.  The smells range from cat-piss (because cat’s aren’t going to fucking piss outside in the cold, fuck that!) to what resembles like an onion wrapped in gauze and baking in the cavity of a chicken that’s been sitting in a car for about 2 months.  I have no fucking idea what twisted part of my brain that description came from; but I must say, I’m pretty proud.  People just don’t fucking shower, and its ALWAYS the little old confused lady with the dull cow-eyes who has to ask for the 10th month in a row what her hydrochlorothiazide is for.  Ignore the simple fact she has been taking this since it was brand-name only.  At this point you pull rank and make the new pharmacists go, or better yet send an Intern so they can have a “learning experience”.
  • People, as a whole, have their asshole-dial set to 11 this time of the year.  Yes, I get you are stressed from all that christmas shopping.  However don’t complain that I am taking too long to fill your 20 Rxs (that you need RIGHT NOW) as you bitch to the crackhead next to you about waiting in front of Walmart 5 hours before they open so you can get $10 off a fucking TV.  Then have the fucking balls to whine at me about why your copays are so high because you’re in the Medicare coverage gap.  Everyone in retail is busy this time of year, I get it.  Be part of the solution and shut your fucking face and stop being part of the problem.  Usually these assholes get the price of their Soma raised.  Merry fucking Xmas.
  • Staffing can be a real issue this time of year.  My coworkers deserve days off to be with their families (or take trips).  Hell, they work with me for a living, they deserve a fucking medal and a parade once a year.  This leads to short-staffing, which means the gaps need to be filled.  This really isn’t a whine, just an observation, because I will gladly be a clerk for a day (or even come in on my day off) to give a hard-working employee some much needed time off with their family during the holidays (awwww).
  • However, I am NOT a fan of stupid game shit like Secret Santa.  Every fucking year we all draw names to play this stupid fucking game that just drips awkwardness and poor gift selection.  This year the queen of festivities (ie: my tech) decided that we shall have no gift cards, and everyone needs to write what they want on a fucking secret santa list.  My exact words to her were “What the fuck, why do you hate me and my fellow male coworkers, fuck this noise!”.   THEN I was forced to write what I wanted.  Well fuck, guess putting down “blowjobs” would be a bit out of line, so I left it blank.  Then the smart-asses come out of the woodwork and put down “A life”, “A personality”, “A sense of humor” next to my name.  When I am eventually forced to write something, I put something really vague down so someone asks me about it.  That person, in 100% of the cases, drew me for secret santa.

Sitting here in my half-drunk state writing this, I can think of some reasons why I put up with this shit.  It’s the little old ladies who come in just to bring you a Xmas card thanking you for all you did for them.  It’s for the families who drop off a box of candy, or make you cookies.  It’s the kids who made you something at school saying “thanks for making me better”.  It’s the smiles and the thank-you and the Merry Christmas that make all the above seem sorta pointless and petty (except Secret fucking Santa, I fucking loathe that game).

So from my cold bitter angry heart to yours, I wish you the merriest of Crackmas and fuck Secret Santa.

A pharmacist example for non-pharmacists.

Holy shit, its almost been a year.

No, Im not dead.  Just took a small vacation from the site.  Family, work, etc.  It happens.

Ive been going through the (years worth) of comments posted to this site, and from what I can see, they seem to follow a common trend:

  1. Im an asshole, and all pharmacists are assholes.  All of them, but when its time to refill your Norco they are your savior and best friend.
  2. Fibromyalgia is real, I’m an asshole for thinking otherwise.  Santa is also real.  Ever notice how spell-checkers always get hung up on fibromyalgia like its a word that doesn’t exist?  Interesting. (OH COME ON, LET ME POKE SOME FUN)
  3. Tell me your entire life story to justify your usage of pain pills to try to convince yourself that you’re not a crackhead.  If you don’t think you are a crackhead, then you probably aren’t. Convincing the internet with some 10 page paper on how you got hurt, and SSI denied you, and you’re on ALL THESE MEDICATIONS and the mean pharmacist wont refill them early because your crackhead kid’s friend “stole them”, blah blah blah isn’t going to help your issue.

That pretty much sums it up.  Im sad for humanity.

On a lighter note, I want to put something into perspective for those non-pharmacists out there who think we just stand there, drink coffee, and deny your pain pills while laughing manically.  Just bare with me.

Imagine you own a small cell-phone dealership.  You carry all sorts of cell-phones, from the latest Android, to the iPhone, to the big bricks in the bag from back when we all had mullets.  So many fucking cell phones people come in and go “holy fuck! you have a lot of cell phones”.  You also have a big button to make them all ring at once just because you are that much of a badass.  Is your dick hard from cell-phone envy? Mine is; I’m typing this one handed actually.

Anyway, a customer comes in with a letter from T-Mobile.  The letter says “Dear badass cell-phone dealer, please allow my member to purchase ONE iPHONE”.  You happily take the letter, and give your customer a shiny new iPhone.  Your customer is so fucking happy because his baby-momma keeps on calling, and his old phone just isn’t working as well as it should be.  You go to the cash register;

“That’ll be $200 for the phone please” you ask with a smile.

“What the fuck! I don’t have any money! This is supposed to be free! I have a VISA card” the customer yells rudely like you insulted his mother

“Okay, do you have the card so I can process it through VISA?” you respond.

“No.  Call up VISA and get the number for me” as the caresses his new

Let me pause the exercise right here.  Would you, as a customer who goes ANYWHERE make the store clerk/cashier/etc CALL YOUR CREDIT CARD COMPANY for your credit card number?  Am I the only one who thinks if you asked this you would be laughed all the way out the front door?  No? Good.  Lets continue.

After 20 mins, you finally get the VISA number of your BELOVED customer.  You punch it into your little device and an error spits out:


Oh shit, looks like Google is fucking Visa.  You gingerly tell the customer that his card will not pay for his nice iPhone because his credit card company wants him to use an Android phone.


You kindly explain that if he wants an iPhone, that he would either have to pay for it, or you can contact T-Mobile to see which Android phone would be the best fit for you so Visa will cover the cost.

The customer throws the iPhone at you, and storms out mumbling that the cell-phone shop down the street will get him his iPhone.  You restock the iPhone and proceed to repeat this same conversation about 4 times before you get to go home.

So the story ends.  That customer was a dick right? I mean it wasn’t the store owner’s fault that his insur-….credit card company didnt cover his iPho..damn…medications!  I mean what kind of asshole would blow up at someone who is doing their best to help them out?

One word answers this question: EVERYONE.  EVERY-FUCKING-SINGLE-ONE.  Welcome to retail pharmacy, here is your tough skin and alcohol habit.

It sucks to get yelled at, and it sucks even more when you are getting yelled at over something that is 100% out of your control.  If you are one of those “Oh, well they make 100k a year to get yelled at” idiots go fuck yourself.  Any decent human-fucking-being with a soul doesn’t like to be yelled at day in and day out while doing their job of helping people.  Especially when you are getting yelled at while you are trying to HELP them.  The money is there for our knowledge to keep you from doing something stupid and dying, not to be your own personal fucking punching bag.

Its good to be back bitches.

Trying to not kill your patients.

Yeah yeah, I havent been posting.  Lets get the fuck over that and go into how I almost ended a patient’s life today with nothing more than a counting tray, and a glass pint bottle of prometh with codeine (dont even start to tell me you haven’t thought of doing it).

There is a little known fact that when you, the patient, call in your prescription numbers we usually get started on filling them.  Oh, by ‘little known fact’ I really mean common fucking sense.

So when you, the patient, call in 10 rx numbers, you can probably safely assume that we are going to start filling them.  We are going to fill them with staff that the store pays for to fill prescriptions.  The store gets to pay for their employees with money gained from filling your prescriptions.  Again, I realize this is fucking rocket science to some people, but to the majority of the non-paste eaters out there this is as surprising as not-winning when you play the Lotto.

Therefore, when you the patient come in to pick up your 10 rx’s (which if you didnt think they would be filled why the fuck would you come in), and decide to tell ME (of all people) “Oh, well these are a bit expensive can you transfer them to Walmart”  why in the fuck would you would be shocked when I say “No”.  I mean its not like you paid THE EXACT SAME FUCKING COPAYS LAST MONTH.  So this month copays shouldn’t be any surprise you dim-witted sack of shit.  Did the medication-fairy magically make the drugs free? Did we have a bumper crop on the Soma tree so we’re just giving it away now?  Fucking shit I was two seconds away from taking those drug bottles and shoving them up their ass sideways.

Not only that, you have the nerve to glare at me when I say “You know, its pretty rude when you called all these in, we spent all this time filling these, and now you want them to be transferred to a Walmart.  Its like ordering food at a place then sending it back once it gets put on the table saying ‘I’m going to another restaurant because their steak is cheaper’.”  I realize that the concept of analogy is hard to understand with your two brain cells, but the point I’m trying to get through your thick skull is that its a pretty dickish mood to have me do all this work to undo it an hour later.  I don’t give a fuck about your “limited income” excuse that you throw around to get what you want.  Being on a limited income isn’t a license to be a fucking twat and waste the stores “limited income” and my time when I could be helping patients who actually have their shit together.

FUCK.  I feel better now.  Really, no bullshit, I really do feel better.

So to answer the question you all may be asking; yes, I did transfer the prescription.  However I called Walmart and warned them about this dillhole’s antics.  The pharmacist said “Oh I absolutely hate it when they do that, i’ll make them stand here before we even think about starting them.”  Problem solved.  Although pharmacy as a whole is going down the shitter, I’m glad that us, as Pharmacists, are willing to stand up and get even on behalf of each other, especially for uncalled for bullshit like this.


An open letter to my patients.

Dear patient standing in front of me.

Yes, I mean you.  You standing at the counter eye-fucking my forehead.  Listen, I’m sorry its taking so long to fill your prescription.  I mean you’ve been standing there for a whopping 5 mins not including the time it took my girls to verify that all of the information is correct in our computer system.  I’m very sorry that its taking so long to bill your insurance, be it that you left your card at home a whole 5 min drive away and refuse to get it.  I really wish I could make your day happier, but regrettably I can’t stay in business if I dispense $400 worth of medication to you without some sort of guarantee of payment, and I can probably safely guess that your credit-card won’t be able to take that hit (if you even brought it with you).  Yeah, I hear your sighing as if its some huge inconvenience we are putting you through by actually making sure we get paid for this drug, not to mention checking to see if they will actually kill you or not.  Whats your rush? The 5 other patients that you managed to cut in front of don’t act the way that you do.  In fact, I’m sure your actions have brightened their day as much as you have brightened mine.

I really wish you could see it from my perspective, getting paid $5 over the cost of the medication only to be screamed at because you don’t feel you should have to pay your share of the cost that equates to about a 97% discount for you.  I wish you could see yourself acting like a spoiled child who didn’t get brand name frosted flakes because your mother is on a tight budget.  In fact, I wish your mother slapped some manners and common courtesy into you growing up.

When you snatch that bag out of my clerks hands and storm off like we just pissed in your cornflakes it sucks, not for you but for us.  We work hard to help you, and to be quite honest, we can only do the best we can with what we are given.  In your case you gave us nothing to work on, no information, no help.  Im sorry my crystal ball isn’t working properly today so your prescription took a bit longer than expected.  Your attitude ruined our day, because we have that feeling that we could have done something different to make you less angry, like rub your feet or give you a lapdance.

So I’m sorry patient who is screeching his tires as you leave the parking lot in anger, Im sorry we took so long to fill your prescription.  I hope we can do it better next time.

Oh, and go fuck yourself you worthless sack of shit.


Your Pharmacist.

Cleanup on aisle 4.. now 5… oh damn.

So life has been slow around the Angry Pharmacy.  Same crackheads, same rants, same bullshit.  Hence why the posts have been really slowing down.  I’m going to throw in a funny post in the midst of bitching how pharmacy is going to be ruined by Express Scripts and MediCal for your enjoyment.

Now there is something really unique about me.  I have an uncanny supernatural ability to keep a straight face.  Doesn’t matter how loud someone blows a fart, or if I’m consulting on how far up your vagoo you need to shove that monistat 7 applicator (Uh, to the hilt baby, fish that fucker out with your fingertips!) I wont crack a smile, or laugh, or do anything but be Mr Professional.

In fact, its a rite of passage in the Angry Pharmacy for new employees that while they are helping a patient, I rip the loudest, rumblest, most wet sounding fart I can muster with the pot of coffee in me, then stand there looking over the very top of my monitor to what happens out front.  Ive learned that if you pretend you didn’t hear it, they patients don’t think you did it (or they are hearing things).  The seasoned employees quickly turn around to “check on the bags” or to do something while they laugh to themselves while the newbie sits there staring the patient in the face wondering what the fuck just happened.  I don’t care if its fucking unprofessional, coffee makes you fart and its better to let it rip than to hold it in and end up blowing ass-chowder later on during the day when you’re up to your armpits in new prescriptions.  A few times this has backfired on me and I actually shit my pants in the store, but even the best have a bad day.


It was winter, cold, damp, winter.  The day previous I stayed late with a few of my clerks to mop the floor out front.  I was pretty proud about how clean we got the floors.  That was karma warning me my day was about to get a whole lot worse.

There had been a bug going around town that caused a sudden urge to puke your guts out.  Some call it the stomach flu, I call it CHA-CHING the price of compazine just went up!  The store was absolutely full of idiots with Z-Pak prescriptions for their colds.  Im not sure why I decided to look up from my usual 1000 yard stare into my monitor trying to decypher a stupid insurance reject, but I remember the guy plain as day.  The glazed over look in his eyes, and the urgency that he must cut everyone off and march up to the front of the line.  He ran to the front, and waved the prescription in my clerk’s face like it was a winning lotto ticket.


For a second, time stopped as I saw pancake batter consistancy vomit erupt from the mans face, and plop down onto the counter.  The clerk jumped back like a snake was going to bite her vagina and threw me the prescription as the vomit was making a perfect large pancake pattern on top of the counter in front of him.  I scanned the room as the chatter of pharmacy died down to an eery silence.  Vomiting is contagious, and I looked with almost childlike glee to see who would start to dry heave.  To my dismay, everyone covered their faces and eyes and no chain-puking took place.  I was disappointed.

I looked at the prescription that had been clutched so tightly that it was nothing more than a ball of clumped moist paper.  Compazine tablets.  I decide to take matters into my own hands and change the tablets to suppositories, since I’m sure the floor doesn’t need any Compazine, and thats where these tablets were headed if he put them in his pancake-batter dispenser.

The poor man got a free garbage can and was on his way sitting down when another wave of heaves took their toll.  The sound I heard after that (over the heaving) I can replay it in my head 1000 times, but its hard to put into words.  The closest thing I can say is that if you percolated air through thick chocolate pudding and muffled it with a pillow.  Thats what I heard.  Oh, and I used chocolate pudding for a reason, because thats the consistancy of what now filled the poor mans pants.

At that point the entire store was in horror.  Me, being a compassionate caring pharmacist, was sorta pissed off that my ingenious suppository switch was in vain.  Tablets go in, tablets go out.  Suppository goes in, suppository gets shot out.  I seriously couldn’t win.

The poor man eventually left with suppositories in hand, and 2 free garbage bags to take with him on his journey home.  The bucket, gloves, mop, and squeegee came out to clean up the mess, and life went on as usual.

If you work retail, this will eventually happen to you.  Mark my words, your floor will be a magnet for vomit and poop.  Not just any poop, usually old people poop or little kid poop (that they like to step in afterwards and track all over the pharmacy while the mother ignores them while texting her baby-daddy).

It always happens after you stay late to mop the floor.  Every. Single. Fucking. Time.

All in the same boat

Before I continue on my usual tirade of broad stereotypes, foul language, and shit that makes Drug Topics avoid me like a crackhead the night before a holiday weekend; this post is dedicated to the brave men and women who risk their sanity day in and day out so the ungrateful masses can focus on your petty first-world problems.

I’m talking about people who work with the public.  Hair dressers, Pharmacists, Doctors, cashiers. The kid who bags your groceries to the checkout line clerk to the nice lady who takes your order at the fast food joint.  You know who they are, they greet you with a smile and a silent anxious look in their eyes that you won’t rip their head off over something that is completely out of their control.

What sparked this?  A visit to the supermarket.  They were having problems with their ATM/Credit Card thingy.  The cashier said outright “Im sorry, but we’re having system problems processing ATM/Credit/EBT cards, it make take a try or two for it to go through”.  The ungrateful waste of skin proceeded to give her both barrels about how this was unacceptable, that they should have their system fixed, they should have a system in place to fix this, should have, should have, should have (notice I didn’t say ‘should of”? Be proud Mr Woo).

I was the next in line, and by the time this douchecanoe actually got his 6 pack of natural-ice with a carton of cigs ran through the one out of 3 credit cards that were not maxed out (after getting pissed that their food-stamp card can’t be used for that/it was tapped out), the poor checkout clerk nerves had been totally fried.  It only takes one asshole to ruin your day.  I gave her a smile as she rambled through the warning that the checkout computers were going in and out, blah blah blah, to which I said that there was no problem.  I realized the look in her eyes was the same look that I probably have when I miss filling a prescription that was buried in a profile and expect both barrels from the patient when they have to drive back to the store because I overlooked something.  I was kind and patient, and she gave me a sincere thank you.  I told her that I work with the public too and its like she knew that I understood her pain.

I’ll be upfront.  I have never sent back food anywhere because it wasn’t up to my standards.  Even if its the absolutely wrong thing I just eat it.  I tip the person who cuts my hair the same even if its a horrible job or the best job they ever did.  Someone fucks up putting the price in wrong at the grocery store and I don’t get that $0.50 discount I don’t say a word.  People say that I just reinforce the mediocre half-ass-is-okay work-skill that plagues our working class.  I say that I don’t want to be ‘that guy’ that makes people drink as heavily as retail pharmacists do.

You ever stop and realize that the assholes of the public will gladly wait in line for 15 mins for a seat at a restaurant, but can’t be bothered to wait 15 mins for their 5 (free) prescriptions?  Interesting isn’t it.

During the supermarket incident, I realized that all of us who work with the public are in the same boat.  We deal with the same assholes, the same impatient fucks, the same douches who bitch that their prescription isn’t ready yet when the power is obviously out and I’m trying to keep the pharmacy systems up while a generator is obviously screaming behind the store.  I can always tell when a patient of mine works with the public.  They are pretty nice, easy going, and realize that sometimes shit happens.  They patiently wait for their prescription, and use the foreign words we never hear like “please” and “thank you”.  They are mindful of our time and actually show appreciation to the service that we give them.  How foreign is that in a pharmacy?

Its ironic that the most important aspect of retail pharmacy isn’t all the drug-drug interactions, the kinetics (learned for the test, then quickly forgotten; never to be used again), knowing the pharmacology of benzodiazepines, or even the rationale behind giving someone an ACE-I in CHF; its dealing with the unwashed masses.  The most important aspect (and the #1 cause of burnout) that is just blatantly ignored in pharmacy school.  “You’ll just learn it on the job” they say as your day is shattered by someone yelling at you who have never worked a day in their life.  Thats like teaching you how to swim by throwing you into the deep end and yelling “You learn by doing” as you slowly sink to the bottom.

Pharmacy school should have a class that is like a boot camp, you get yelled at each class so you’re used to dealing with idiots who give you both barrels over the most stupid things. You learn how to defuse situations.  Ah shit, who am I kidding.  Pharmacy schools would probably teach you to use fruity ‘touchy phrases’ like:  “You know by saying that, you hurt my feelings and make me feel less about myself” to which the patient would reply “Good, you’re fucking stupid, my vicodin is due now, not next week”.  Color me surprised that pharmacy schools are so out of touch with the ‘real world’ that they wouldn’t know their poop-chute from a hole in the ground.

I realize that this post isn’t your usual swear word ridden bitchfest, but fear not, I take care of my readers (sorta).  If you want to re-post this article, this would be a good time to stop copy/pasting.

So to all of you ungrateful fucking assholes out there who decide to ruin the day of us who get our asses up every fucking morning so we can serve you, heres a fucking tip from the guy who double-counts your fucking dope so you don’t come back and say that I shorted you.  Get a fucking job, work with the fucking public, see what its like to deal with your own fucking kind.  Get your day shot to shit because you had to serve a fucking asshole like yourself with the social skills of a fucking steaming turd baking in the afternoon sun.  Get a dose of your own fucking medicine.  The world owes you shit.  Be thankful you live in a fucking world that we accept you for the shit you do to us day in and day out and don’t take you out back and shove our boots in your fucking yappy twatty mouths.  If you think you can take your bad day out on us, feel fucking free; but beware, theres nothing I can really do to you in pharmacy, but I’m sure the server would be more than happy to let your fucking food you sent back 3 times because your steak “wasn’t cooked enough” fall on the floor a few fucking times when you’re not looking.

I hope I filled your use of the fucking word ‘fucking’ per post requirement.

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.