Saying 'No' to Counseling

Background:

You don't have to receive a consultation from a Pharmacist when buying a prescription; you may deny consultation. However, Oregon law requires that the patient deny consultation directly to the Pharmacist for any prescription that is not a refill. This means that even though you say "no" you may have wait in line to say "no" to the pharmacist.

Complaints

Last night and tonight, I had patients that flipped out about having to wait to give me their denial. In each case, they only waited half a minute at most and spent more time yelling at my technician, trying to say that she doesn't know the law than it would have taken to talk to me. Actually, I could've given a complete consultation in the time it took tonight's nimrod to finish bitching.

Consequences

If a Pharmacy Technician is caught releasing a non-refill without having the patient speak with the pharmacist, they are assessed a $500 personal fine and the Pharmacist on duty is assessed a $1,000 personal fine. So, getting bitched at is still better than the potential fine. Yet, sometimes, I'm tempted to 'run the red light' and let my technicians just get them out.

Message to the Oregon Board of Pharmacy

Come on, if you can't trust a tech to tell the truth about a denial of consultation, why even allow them to work in the Pharmacy? Oregon (along with most other states) has decided to waste Pharmacist and patient time with an impractical, pointless rule.

Message to Patients

Just, suck it up. It's the law. Our goal is to get you out as fast as possible. Why would we hold you up, if it were not the law? Save yourself and us a huge hassle and just wait patiently and tell the Pharmacist you've had it before and have no questions when it's your turn. Every minute you spend complaining is another minute other patients have to wait.

I am not trained for that!

Pre-holiday weekends are WEIRD. You get a crazy mix of vacation supply authorizations, out of state narcotic rxs that you couldn't possibly fill because there is no way to verify them, people who don't want to make an appointment with a doctor because they have to wait a month to get in the office, people who don't want to go to the emergency room, people who swear we shorted them 20 vicodin tablets out of a 30 tablet rx (even though we double count and initial ALL controls) and are conspiratorially sharing them amongst ourselves even though she has teenage children at home (who are the biggest drug thieves in America, statistically), etc. The phone call I got at 2AM was a dandy!

A ninety-five year old man who thinks he might have a hernia above his testicles has a lot of pain and wants me to talk him through a scrotal examination. I kindly explain to him that I have no formal training in that type of physical examination. I can tell you what problem symptoms may point to but the definitive exam and diagnosis must be performed by a doctor. He is not having ANY part of that answer and is very upset so I refer him to a male colleague at another location who gives him the same explanation.

The patient calls me back about thirty minutes later. He is upset that no pharmacist was able to instruct his exam. Duh, the pharm part comes from pharmaceutical meaning drug. Maybe if my title was exapharmacist (exa for exam) I would have been trained to do such but even better would be ex-pharmacist when I decide that I can no longer bear the burden of helping those who cannot or refuse to help themselves. That is when I dive head first into a downward spiral of despair and fully embrace alcoholism while skating in the wizard suit for Grublets on Ice and having sex for money. Oh fantasy life, when wilst thou become reality?? Oh to shed this festering mortal coil we call humanity and live like the lowly street wretch....but I digress.

He wants to know if he can sleep in a jock strap because it seems to help ease his pain. I told him that was fine but he REALLY should call his doctor's office when they open and see if they can get him in before the holiday because he is in pain. He said he would call them but I know deep down in my heart that he will be calling me again tonight because I talk to him a couple of times a month whenever he feels a doctor is unnecessary.



***On another note, there was a complaint in the e-mails that we are unprofessional. I assure you we are top notch empathetic professionals on the job. We save our sarcasm, anger, frustration, etc. solely for the blog and entertainment of our readership. If we only had nice things to say no one would read us. It is the tabloid effect, we all like "dirty laundry."

***Now go stuff your face and be happy you have a job, family and friends, a roof over your head, and food to eat. Happy Thanksgiving!

Hate Mail

I wish you were my more personal pharmacists!

October 24, 2007

Dear Blogging Pharmacists,

I'm having a hard time finding boric acid, which I was able to just
walk in and buy only a few short months ago. It seems to have
disappeared from Chicago drug stores. Dissolving it in some hot water
to soak an infected finger or toe was really the best, most
successful, and most importantly, non-antibiotic, way to relieve some
pain and unbearable swelling. This treatment has worked many times
for me and my family.

So, while curiously investigating the disappearance online I happened
upon your blog. I'd like you to know that I was saddened by the
comments I found. It's clear to me from what I read, that your job is
a strain beyond words at times.

While some come to you needing some sober medical direction, or a
trustworthy source for preparing and handling their medicine, my
guess is that most, including myself on occasion, come to you for
some compassion because we are feeling confused, afraid, or are in
pain. A bunch of crabs we all are, limping and sniffling up to the
counter.

While I realize it takes a different kind of education to dispense
empathy, it is most certainly more in demand than pharmaceuticals for
relieving what truly ails people and for addressing the fears,
financial limitations, and concern for the well-being of our loved
ones, that truly exacerbate the most minor of physical discomforts.

The next time someone comes to you with a less than desirable
disposition, would you be willing to dispense with some professional
distance and see beyond the bitching to the pain and frustration
behind it? I know it's not your job, and, more often than not, it's
what's needed most.

Fan Mail

Fast Food Pharmacy---mirabile dictu, this is a religious experience I have had. Not only do I have a perfect current view of the milieu I left in 1993, I am enjoying the finest pharmacist writing I've ever read. You folks are all Dennis Miller sharp, indeed. "A vagina is not a clown car" was the best line, but there are many more.

The answer to the question you haven't asked yet is, yes, you can become a hospital pharmacist. I made the change 14 years ago, and never looked back. Would I dare? Drive-thrus, cell phones, the scholarly journal called the Internet (bet they throw that in your face, too), and quadruple the amount of drug abuse are a few of the things I wouldn't want to subject myself to.

I believe that you, more than most people in U.S. society, are looking directly into the face of our collapse as a nation. Our enemies are hungry and angry, and we are fat and happy. Whom do you think will win? I'd move to Australia, but after my visit in March, I think the Aussies have already caught the American plagues.

THANKS for the story Ms. N

This lovely story was sent in by a huge fan of FFP:


I work at a big corpo chain pharmacy in Fl. Tonight we were dead slow and just waiting for the ER across town to empty their waiting room into ours. My favorite out of the entire evening was a 45ish gentleman. Gentleman is much too nice a word actually. More along the lines of white trash addict. Now, we're talking no shoes-black holey tshirt-cut off jean shorts-unwashed hair. But even better, he has the front half of the left side of his head completely shaved. A large noticable scar that has been stapled shut. He hands me his Rx. There's just one for lortab. (SHOCKER!!) I ask him if there is more than one. He says no. Now, our hospitals in town are hardcore strict about only filling controls with a antibiotic and staple them all together. Now...immediately I'm suspicious about it and look harder at the Rx. There's a staple still attached to the hardcopy and two little pink corners of paper under the staple...hence, two more prescriptions. I ask him to go get them and he says "How'd you know that?"
I'm a genius...
So he goes out to the car and brings them in. One of the other techs types them in and we get to filling them. He is adamant about only getting the lortab because he "lost his wallet" and cant afford them. He's on Medicaid. I'm practically paying for his Rx's. He's getting all three of them whether he likes it or not.
Doxycycline, Augmentin XR, generic Augmentin 875, and the Lortab....those are the 4 Rx's. So of course we call to verify the fact that he's taking an exceedingly large amount of Augmentin. He's freaking out the whole time at the counter about how long it's taking and says he's in a hurry. The pharmacist says "Well im not going to be held liable so he's going to wait." Apparently he has a very very bad infection and must take them or he will be admitted to the hospital...or so the doctor says.
Crackhead says "Im not going to take the antibiotics anyways so i might as well just get them how they are".
He goes the the cooler down the aisle, gets a Mountain Dew, and begins to drink it. Finally the Rx's are done and everything's been taken care of. We ring him up. Tell him it's $1.50 for the Mountain Dew and the Rx's are free.
"Oh, my wallet was stolen. I dont have the money for it," says the Crazy Crackhead.
It wasnt even worth bothering with. It's not coming out of my paycheck.
I was clocking out to go home while he was being rung up. I follow him out the door...he opened the Rx bag. Takes out the lortab bottle...throws everything else in the trash can outside the front door.

I love our tax money paying for other people's stupidity.

Condom Conundrum

Father time and his younger old lady came in for condoms. She asked the manager about sizing.

"How do we know it will fit?"

The question asked since the invention of the condom. It's too tight is the excuse many men will use to try and get out of wearing one. A regular sized latex condom can be stretched to fit over an adult cranium so it should pretty much fit any wiener. If he complains it is too tight or it cuts off sensation he is either putting it on improperly or just a huge fucking baby that deserves to be left to service himself.

Well ladies, unless his wiener looks like a baby's arm holding an apple any condom should fit. Although I must say that many a time I have sold Plan B to a girl who had sex with a guy who needed "magnums" and the condom slipped off during sex......guess he wasn't as big as he said he was.....so sorry lady. That must have been a HUGE disappointment, pun intended. If it is a beanie weenie then you might want finger cots (again, they look like tiny condoms and have been incorporated in many gag items through the years). Then again, if it is that small you might just want to skip the man and get a good vibrator.....

Back to our elderly couple. The manager told her that the regular condoms should fit and we all had a good laugh. It leaves me to wonder if a little blue pill and a broken hip was in the near future for one of them.....

Tablet Identification

You know what is coming down the phone line........

"I found this pill in my daughter's backpack and I want to know what it is."

Your child is experiencing the wonderful world of chemistry by trying out every little tablet she can get her hands on. I love these calls. I can't say I feel the tiniest bit of remorse for the child. I know there will be groundings, lectures, beatings, etc. I like tears and torture. It puts a spring in my step like nothing else.

This particular call was funny because the tablet was Atenolol 50mg. That dizziness and floaty feeling she gets isn't a "high" it is actually from the "low" her blood pressure hits from it. I told her mom it was not a controlled substance, not addictive, etc. but it was dangerous in that low blood pressure can lead to organ failure, coma, death, i.e. the not so fun stuff because she had normal blood pressure and it is a prescription drug so she shouldn't have it anyway. Mom was pissed. Hahahahaha, I want to hear the fallout from that!

Another concerned parent could not wake her son up and he had some tablets that turned out to be Methadone 10mg. I told her to call 911 because he may never wake up from that one. She did and called back the next evening to thank me for saving the life of her ungrateful little bastard of a son who racked up an expensive hospital bill of gastric lavage, IV's, and critical care.

Kids are stupid when it comes to drugs. They think it is "cool" or "fun" but many times they introduce substances to their body that are lethal. Look at the news. There is always an overdose story of a teenager who didn't think before taking pills. They don't give a single thought to what anguish they can cause a concerned parent or family when the shit goes wrong or what damage they can do to themselves. I like vegetables but I don't want to live like one. Want to get high?.........

Many of the calls I field are "Is this Oxycontin/Valium/Percocet/Tylox/oxycodone/equally strong substance to fuck your shit up/etc.?" For those callers I realize you want to rocket off into oblivion and you don't want to get ripped off by some shady dealer. I can respect that you want to know you are getting all the bang for your buck. There is a recession looming for all of us, even low paid or jobless junkies. By the way, if you haven't been on any of those substances before I may never hear from you again....might not be a bad thing for the rest of society but don't you think there is a relative who dearly misses you? Maybe a puppy or something? I'm just saying, don't you have anything left to live for?

On a sad note, my tablet identification software does not list any of the designer tablets or ecstasy tablet markings. I have no idea what is in that tablet... I can't help you with that one. Until the government decides to let someone market them there will be no standard markings or monikers. It also may not be a good idea to "roll" with the whole person to person contact leading to potentially deadly MRSA infections. I know you "love" everyone and want every millimeter of your body touched or licked and every orifice filled but it may turn out to be a bad time. Vaporub and face masks are in aisle 11, blow-pops are in aisle 5, have a nice night......

Other fun calls involve the police. Bag a perp, take him/her for booking, find a few tablets in his/her pockets/purse, call the pharmacy. Do we have an illegal substance? Can I add additional charges to the bookee? Awesome! Oh, by the way, I think that guy/girl may have called earlier to see what those were he/she was buying from his/her dealer......might want to follow up on that.....

Listen to D.A.R.E. and Mr. McAfee (from South Park), "Drugs are bad, m'kay?"

ER is still worth watching

Medical dramas really comfort me after a rough day. Especially ER for some reason. I think it's because I can identify with the characters. While my job involves totally different functions, the physicians are placed in similar situations to those of my coworkers and I. Our Pharmacy is extremely busy...I rarely get a break, never get lunch, and never sit down my whole shift. In addition, I am faced with the potential for life threatening medical errors every minute of my day.

ER is the main place in television where they show realistic ambiguity about what the right decision is. In healthcare, the right answer isn't always easy to determine(e.g. Is this prescription a forgery made by a talented drug addict or is it from a stressed out doctor who got sloppy in trying to write it quickly for a patient screaming in pain). Sometimes the right answer is very complicated and unsatisfying to the patient (e.g. Sudafed PE works just as well as old Sudafed for some patients while others get nowhere near the same effect).

ER also shows just how busy things can get in healthcare and how you have to strike a difficult balance between being thorough enough to catch errors and fast enough to avoid drowning in work. This month I've had to deal with a woman who was hospitalized for an error made by another pharmacist. However, this same month, I found out that one of my technicians complained to management that I should work faster.

Finally, ER shows healthcare mistakes in perspective. No matter how good you are and how hard you try, mistakes will happen and patients will be angry. ER shows people beating themselves up over the mistakes they make and doing their best to prevent them in the future and deal with the consequences. This is exactly what happens in real life; you tell yourself there's no point in beating yourself up, but it's just what you do.

I know that ER is not realistic in many ways, but the emotions and the situations are realistic. It really comforts me to know that someone who writes for that show knows the experiences I go through.

Testing....testing....one...two.......Three?

Science has made great advances in home test kits. You can test for pregnancy, fecal blood, yeast infection, bladder infection, HIV infection, illicit and prescription substances, blood alcohol, ovulation, cholesterol, lice infestation, and blood sugar. In many ways the knowledge they impart can be helpful in managing health, but sometimes they cause great anxiety or just make you scratch your head.

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A fun "experiment" to entertain your drinking age friends: Purchase a Breathalyzer at McDruggie's and take your friends to "Happy Hour" or go to someone's house and play a drinking game like 3-Man or The Star Wars Drinking game. Damn those bad guys for wearing white and damn those dice for always hitting 3!

Yes, McDruggie's has a Breathalyzer but it warns you not to use as a sure-fire way to know you can drive after enjoying a "liquid" lunch. It also helps if you wait until the police dining at a table near you are long gone before you settle up and leave. It always happens to me so I know a few of you have experienced that fun game.

Drink, drink, drink and take turns blowing...the breathalyzer, that is, you perv. Oh, and make sure none of your friends have lip herpes before you all use it. Wouldn't that be a nasty surprise......a wicked hangover and a mouth blister.....ew...

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A woman in her late forties came to the pharmacy late last night. She can't sleep because she thinks she might be pregnant. She tried a digital test that says "pregnant" in the display. Guess what it said. So she tried a "plus" sign positive test and it came out negative. She explained to me that she may have messed up the second test so she wanted to try another one.

It gets better. After her test selection, purchase, and a dozen questions she leaves. I help the next patient and she comes back. She has a few more questions and she needs me to go as humanly far from the other patient as possible because she is embarrassed to ask these questions. I am utterly intrigued. What Jerry Springer shenanigans am I about to experience???

She already has two teenage children. She has no insurance. She is afraid that she does not know which of two men is the father. Awesome! She wants to know how early the doctor can do a DNA test and how much it would cost. I told her to take it one situation at a time. Find out for sure if you are pregnant first. If the doctor can give a close estimate of conception, that should eliminate the need for the DNA test. She left again pretty sure she would be able to sleep.

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My store manager walks up to the counter and asks me if I can pass a drug test. I said sure, why? He throws two boxes on the counter. Some super smart criminal stole the contents of two opiate drug tests. They were the tests that have to be mailed in for the results. Duh, should have stolen the one you pee in and tilt on its side that gives instant results. P.S. You are not going to pee out cocaine in time for your job interview and test tomorrow.

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A patient brought in his One Touch Ultra because he was getting weird blood sugar levels. He said it was an old machine so he probably needed a new one. I looked at the display and saw the "low battery" indicator on the screen. Gee, I wonder why it wasn't working properly....so I got him some new batteries, changed them for him, and sent him on his merry way.

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Isn't it amazing what the walking talking chem lab that is the human body can do!

Overtime in Cootie Town

Many times I get a call to work at another McDruggie's when I am off. Sometimes the lure of extra spending money with holiday shopping looming in the near future is too much to pass on. This evening was a crazy mix that went a little something like this:


1. A pregnant lady calls to get a suggestion for a yeast infection. I told her to call her OB/GYN because the OTC products we have are not recommended in pregnancy. A couple minutes later she calls back saying she "talked" to her doctor and he told her to get some of that "gyne" stuff.

How stupid did this lady think I am? There is no way she paged the doctor at 12am Saturday and got a response within 3 minutes. If she is not having the baby or in a dire emergency situation the answering service is not bothering the doc til a more reasonable hour. Itchy stinky crotch can wait til 8am. She didn't page the doctor she just wanted to weasel out a quick fix. I don't do "quick fix" for a pregnant lady.

I told her the only "safe" yeast infection cream inserted during pregnancy is a prescription item. Maybe you want to call your doctor or go to the ER like I told you the first time.


2. Scabies patrol! I get psychosomatic itching for the rest of the night, every time. This parade was luckily short but involved a bit of a Springer-esque revelation. I h.a.t.e. touching anything a scabies patient has to offer from the original prescription to the money.....ew...

The process was further complicated by the cash price of Lindane lotion. No insurance. Latino homosexual with his mom..... That could not have been an easy trip to the ER with mom. The Latinos I know do not approve of two major things: pregnancy out of wedlock and homosexuality.

I felt bad for him. Not only did he get scabies but there might have been a nuclear grade fallout at home after the pharmacy visit. Good luck! Argentina may not cry for you but maybe I will.


3. Doxy here! Come get your Doxycycline here! I felt like a carnival barker was standing outside or waving people in from the ER. I have not filled that much Doxycycline in one evening ever......I mean ever! I thought it was a fluke. The prescriptions just kept coming in and coming in and coming in. There were at least 10 prescriptions. I kind of lost count as the hilarity of the phrase "scrotal infestation" kept running through my mind.

I wondered if they were all screwing the same spirochetal funbag of doom cuz this was just crazy! Maybe they should all sit down and figure out which ho they were tapping and beat her senseless then force feed her antibiotics and maybe pee in her eye to teach her a lesson in vaginal hygiene.

I should have pointed out the condom aisle and gave my soapbox presentation on how a HAZMAT suit for your wiener is a good idea in all sexual situations.


4. Pregnancy test nightmare. How embarrassing is it when your mom picks out your pregnancy test for you based on the $9.99 price tag for the dual pack because she doesn't want you spending all her money. Even more embarrassing is that you are not old enough to hold gainful employment and dress like a boy.

It was humorous. Does dressing like a boy really get you more action? Maybe I should try that some time.

I have HAZMAT suits at the ready for any forgetful male encounter, along with an axe and a drop cloth in case there is a messy cleanup! Sometimes we mate and then we kill. I love spiders! Yeah, I stole that idea from a movie....life imitating art or something...


5. Condom conundrum. You send your lady in to buy condoms. She calls you on the cell phone to make sure she buys the ones you will use. I had to listen in on this one because it was so damn funny!

We didn't have his "brand." We didn't have his "size." I would have had her take home a pack of finger cots (they look like miniature condoms) just to piss him off.

If you want to tap some ass buy your own condoms or get them from the free clinic. Don't make her do all the spending and work because in the end you are probably a disappointment in the sack and she will have to finish off with a "rabbit."


6. The ole' bladder infection. Many times sex introduces anal bacteria in to the vaginal and urethral areas. It is not because you are nasty, the act of sex is messy, juicy, and invasive. The number one cause of bladder infections is e. coli. Yes, the same e.coli that live in your intestines, on your body, and occasionally infect slaughtered and processed meats and improperly cleaned vegetables.

Some helpful tips to prevent these bladder infections are: no anal before vaginal (the same goes for sex toys), always use a condom, wipe from front to back when using the bathroom, and bathe on a regular basis (this means wash your ass like Martin Lawrence got in trouble for saying at an awards show).

Just remember, "Cleanliness is next to Godliness." This includes your naughty parts. They aren't just for breeding anymore.