For a friday, work was pretty slow today. However there was one aspect of it that really made me angry.
Turns out this family immigrated here from Thailand last month. Now i’m not one bit against immigration (being eldest of a 3rd generation immigrant family), however I am against people just using the good american nature to help others without giving back.
Now this family waltz’s in here, and gives me their prescriptions. Oh, about 15 of them for their 15 children. Thats right, 15 children.. Come one come all to the land of milk and honey, where you and your 15 children can not work, and live for free! I know its in your right to have as many children as you want, but if you cannot afford 1 or 2, why have 15? Thats just stupid!
Now those 15 children, how many of them are going to have children in a year? Probably 2 or 3? Yes, they are all on the state system already.. Its like they landed here, and the first thing they recieved was their welfare cards and check.
Now you may be wondering why i’m bitter about this. Well my great-grandfather came here from overseas, and he had to work his ass off (including learning english) to make a living. There was no welfare system; you worked, or starved.. During the depression, he farmed so his family would have food to eat.. They didnt have free medications, free housing, and a steady check every month. He made something for himself because he had to survive.
If I immigrated to an eastern country, the very first thing on my list would be to learn the local language, and to find work; this is because I know damn well that nobody is going to give a flying fuck about some american immigrant over there…. I guess thats why America is different and so great, yet people have the balls to badmouth it while mooching off its generosity..
Its common knowledge that a prescription can only get to a pharmacy to be filled 3 different ways:
Now lets focus on the third one, telephone.
State law allows prescriptions to be phoned in by a doctor or a doctor’s agent. “Doctors Agent” pretty much means anyone with a pulse. It does not specify the education needed, nor any requirements short of working with the Doctor.
State law only allows pharmacists to recieve the verbal prescription over the phone. Tech’s cant do it, clerks cant do it, janitors cant do it. Only a licensed pharmacist can accept a verbal from the phone.
Whoever wrote this law must either hate pharmacists, or have not stepped one foot in a pharmacy in their life; because now every doctor’s office has some minimum wage making minority who can barely speak english calling in medications for YOUR mother. Thats right! Someone who has zero medical knowledge and has no clue what they are saying are calling in medication for YOUR LOVED ONES! HU-FUCKING-ZZA!
Bah, so they got hydralazine and hydroxyzine mixed up, or Lamictal and Lamisil confused. Or Lamictal and lomotil, no biggie! Your loved one only ended up in the hospital, and a big fat lawsuit pending on yours truly.
Now dont get me wrong, there are lots of doctors offices out there who employ nurses and other very qualified (meaning they speak english) personel to call in prescriptions. Its just that one cheap-ass doctor who gets some phillipino or chinese fresh off of the boat for $4.50/hr to phone in prescriptions to pharmacies which are blaring loud already, they cant pronounce the drug, and to make it worse they speak super super quietly on the phone!
It just pisses me off to no end as well when they get offended when you ask them to repeat it about 10 times, then spell the damn drug. Its not my fault you cant speak english clearly. Its not my fault you cant pronounce the drug. Its not my fault you dont know any medical shorthand so you have to waste my time and ask what ‘po tid uf’ means.
So please, for the sake of your patients, your liability insurance, and my sanity get someone who can speak clear english on the line when you need prescriptons called in. Your pharmacist will <3 you for it.
Its amazing how the medical community has ‘evolved’ in the past few years. Back when I started this profession, only Doctors (MD/DO/DDS/DVM/etc) and Nurse Practioners/PA’s could write prescriptions. Everyone was happy, and the world was at peace.
Well some idiot decides to allow Certified Nurse Midwifes and Holistic Medicine (or some bullshit like that) to write prescriptions. Head, meet table.
When is the madness going to stop? Are janitors going to be the next ones to have prescriptive authority?
I went to college for 7 years, and I only have the ability to prescribe the morning after pill. Some idiot goes to a Career College, pops out a CNM in 5 months, and can write for anything (yes, I know they are under protocol, but thats not my point).
It makes my blood boil when I see these idiots churn out Rx’s that look like this:
Amoxicillin suspension, 234.3 mg three times a day for 10 days.
Now that may look good to you, but any pharmacist will say “Hey! Amoxicillin suspension only comes in 125mg/tsp, 250mg/tsp and 400mg/tsp!”.. Are we to have some mother who can barely wipe her own ass (but can pop out a kid) measure out 4.7372143 mL’s? Hell no! Its fucking amoxicillin! You round up to the nearest strength! Its not rocket science! You could give the kid 2 grams of this shit three times a day and nothing will happen.
If you dont work in the profession, you may wonder where im going with this. Well its a fact of book learning vs common sense. Obvously a “real” doctor would use common sense and just dose said amoxicillin 250mg/tsp three times a day for 10 days and make it easy for everyone. However some CNM looks up in her little drug book (which is probably wrong) and uses her little calculator to do 20mg/kg/day (or something like that) and just blindly writes for whatever number appears as the result. Use your fucking head!
It doesnt end there, oh no!
I’ve seen them write Hydralazine for itching (supposed to be Hydroxyzine, whoops, you just killed someone). As well as give strengths for drugs that they obvously pulled out of their ass (Ultram 100mg when it only comes in 50’s) as well as write for the latest and greatest shit not knowing that it costs 1000 bucks (Zyvox)..
Blah is all I have to say.. But of course because of them us pharmacists can never be replaced by machines.
Talk to any pharmacist and mention the word “Prior Authorization” to watch him/her instantly have a hemmoragic stroke.
Prior authorizations (PA, or TAR to some) are a way insurance companies say “Sure, we’ll cover this medication if you sing us a little song, dance us a little dance, and fill out these 100000 forms”. They are of course a huge topic for venting.
Most insurances (some state ran welfare programs for examples) are kind enough to let pharmacists handle all prior auth stuff. We get to fill out the paperwork, and we sign it and send it in for review. Now you may be thinking “Why is letting you do all the work ‘kind of them’?”. Well, when the patient is calling every 20 min asking if the insurance has covered their $2000 herpes cream, you want to have control of the situation; and delegating the paperwork task to some mininimum wage twat in the doctors office doesnt really put you in control of anything; so you are at the mercy of someone who can barely hold a conversation (let alone speak english clearly). Sad, i know, but 99% of doctor submitted prior auths are from the staff, not the doctor him/herself. Which leads into my bitch for the day:
One piss-poor aspect of some private insurance’s prior auth policies is that they demand that the doctor (or their representive) submit the prior auth.. I got the pleasure of talking to an insurance rep from one of the more well-known insurance plans this last week. Heres how the conversation sorta went:
Me: “Hi! Im The Angry Pharmacist from Drugstore Z, I wish to get a prior auth for patient John Doe for some ExpensiveDrug”.
Her: “Im sorry, but the doctors office or their staff have to call”
M: “But I have the diagnosis right here, its all faxed to me, I can send you a copy if you wish”
H: “Im sorry, but we do not accept prior auths from pharmacies”
(at this point im thinking that i’ll have a good story for this website)
M: “So it can be anyone at the doctors office”
M: “Even the Janitor if he/she wishes”
H: “Uhh, I suppose so, as long as they work for the doctor”
M: “So you’ll take a prior auth from someone with zero medical experience, who is just reading scribble from the chart and has no clue what the misprounounced words coming out of their mouth mean, yet you will NOT take the same information from someone with a Doctorate of Pharmacy who went to college for 7 years who has a medical history here of all medications tried and failed, as well as the necessary diagnosis information”
M: “May I ask what qualifications do you (meaning the prior auth team, not you personally) have to take this information”
H: “We are all licensed pharmacy technicians”
M: “So, if I am not qualified to give this information, and I am a licensed pharmacist, then obvously you all are not qualified to recieve this information because you are a technician. Do you have any high-schoolers there that are qualified to take this information?”
(I actually got a chuckle out of her with that one)
H: “Is there anything else I can help you with?”
M: “You never helped me in the first place”
Now I do know of a handful of doctors offices who have competant people doing prior auth stuff, so this rant doesnt really apply to you all. Its just the 2% that take up 99% of your day that make your blood boil. Ugh.
What you are to read may offend and
Off-color remarks about ones race, creed, religion, sexual preference, handicapped, or anything else that you find on those equal opportunity handouts.
Lots of swearing
Lots of bitching about things you may hold dear, such as your insurance company!
Stuff you disagree with, and some stuff you may agree with
Some misc pharmacy knowledge that you can impress your friends with over dinner, like how to dose Zyvox
Spelling mistakes, lots of spelling mistakes!
even will piss you off. Its the daily ramblings and venting of a young pharmacist who works in a not-so-great part of town. If you are offended easily, then please, just turn off your computer and dont log into the internet ever again. We already have too many uppity people who have sticks up their asses on here already, we dont need another one.
If this doesn’t apply to you, then I have some further warnings. What you may find here may include:
Note that my opinions and feelings here do NOT represent the feeling of whom I work for, nor my profession as a whole. I wont say where I work, nor will I give any specifics that will reveal who I work for, or anything that Mrs Clinton can sick the HIPPA gustapo after me about.
What you will NOT find here:
Anything your cyberslut 14 year old can rub one out to. (This aint MySpace folks!) (that was harsh, even for me, woah)
A little about me:
I’m young compared to the age average in my profession.
I work in a pharmacy as a pharmacist (duh)
I went to college for 7 years to recieve a Doctorate in Pharmacy
I have a license by the state for which i reside to sell narcotics.
I’m one of those republicans who hates psycho-religious republicans
I’m typing this in my boxers
I have a very crazy sense of humor.
If you wish to get a hold of me, you may do so at firstname.lastname@example.org