One of my favorite things!

Quick Post - One of my favorite things just happened today.  I will recount the conversation on the phone.

Customer (on crappy cell phone): Jason, it's John (doesn't tell me his last name, I mean, how many John's could there be). I need my two blood pressure pills filled and my Crestor.  I have the Crestor prescription with me so you get it ready and I will drop it off because I'm in a hurry.

Me:  Who wrote your prescription, what is the strength and how many refills did they give you (and yes, I realized at the time I was asking him to read while he was driving).

Customer: It was Dr. Smith (name changed for HIPA reasons), and it's for Crestor, 90 tablets.

Me: Alright then.


Now then, I used to be a real hardass in the past when people do this.  The general public, contrary to what they seem to believe, are not qualified medical professionals, and I cannot accept verbal orders.  Shit, sometimes I cannot read physician orders.  In any event, I've gotten some what tired and concussed due to repeatedly smashing my head against a wall when people want to do this and then get pissy with me when they drop it off.  In any event, it was a renewal, and John's usual (note I said usual, this is a bit of foreshadowing) physician uses a computer generated prescription system so I figured (ie hoped) that it would be the same.

Soooooo, John comes in and drops of his script (I was able to recognize his voice so I figured out who it was) and low and behold, different doctor, different dose than last time.  Anways, after I woke up from smashing my head against the wall I told him that this is why we do not let customers call in prescriptions, now I will have to correct your prescription and redo it, which is going to take me longer than it would have if you had just dropped it off in the first place and waited.

To which he responded: I'm kind of in a hurry.

sigh.

J

The New Motto for Pharmacy

So I've been reflecting of late of the direction that we have allowed our profession to take over the past 30 or so years.  Pharmacists have slowly but surely failed to unite, consistenely stabbed each other in the back, and basically whored ourselves out to corporations to the point that we are little more than... um, well the whores of the health care world.  If that language is too strong for you then how about the fast food dealers of health care, everything cheap, fast and with a free toy.

Now we are scrambling.  You see, as we have failed to consistenly stand up for ourselves and each other, worrying too much about stealing business instead of being good pharmacists, we have in effect failed ourselves.  The problem is, the people who pay for our services, namely insurance companies and government figure that since we apparently don't give a shit about our profession, neither should they.  Basically, we are getting what we deserve.

So, following that string of thought, I have come up with a new managment strategy for my pharmacy:

At Grumpy Pharmacy you pick how you get your prescription filled.  You can have your prescription filled in any two of the three ways listed below, however, choosing two autmatically negates the third:

1.  Fast
2.  Cheap
3.  Correct

So, if you want it fast and cheap, it may not be correct.

If you want it fast and correct, it won't be cheap.

And if you want it cheap and correct it won't be fast.


They say giving your customers choice keeps them happy.  I hope this works

J

The Pleasures of Small Town Living

I grew up in a small town, the same small town which I now call home.  I often remark that my 5 year pharmacy degree was the best 8 years of my life and following graduation I moved in with some University friends for a couple of years to continue the fun.  During this stint I met my wife and got married.  My wife and I continued the fun life for a couple of years, but after we decided we wanted to start a family I decided that it was time to grow up.  I had to be a father figure and partying like Van Wilder just isn’t acceptable. 

After we had our son we decided that we would move back to our home town so that we could be close to family to help.  Our son has a great relationship with both sets of his grandparents.  He spends a lot of time with them and this has helped him to become the wonderful and caring boy he is.

About 6 months ago I developed a slight tinge in my hip.  This tinge gradually migrated to my lower back and down my left leg.  It affects me to the point now that I have difficulty walking more than one block.  For those people who know me and know of my love of recreational sports you can imagine how much this bothers me.  I have been diagnosed with severe sciatica.  Tests with my pain management specialist show that I have a high tolerance for pain, which is a good thing, because if I did not I would not be able to continue working.  I cannot take any type of pain killers for this pain as sciatica is basically fake pain.  The only thing wrong is a pinched sciatic nerve which tricks my body into thinking there is something wrong with my hip, leg and foot.

For the past two months I have been having regular physio therapy, as well as having a series of intra-spinal steroid injections (which are a real treat I might add, and make me once again thankful that I have a high tolerance for pain and have also given me a true appreciation for pregnant women who have epidurals).  I have slowly been improving.  My goal is to get better without having surgery.  I occasionally have a setback in therapy but this is to be expected.  This chronic pain has also given me a greater respect for patients who are dealing with chronic pain.  There are times when I just wish it would go away so I could go to the park and play with my son.  I can understand now why individuals with chronic pain can develop depression, can become hooked on meds.

I will get better.  Of this I have no doubt, but it will take time.

So how does this relate to the title of this post, you may be asking.  Well allow me to elaborate.  A couple of blogs ago I ranted about people who complain about the fact that I do not open my pharmacy in the evenings or on weekends.  How dare I put my family first when I should be working 80 hours a week to provide service to ungrateful sheep who can’t get their shit together.  The thing is, I could really give a shit about people who bitch about the fact that I choose to spend time with my family versus being in the pharmacy.  Complain all you want about me.

Also, when I took over my pharmacy I came into an environment where a previous pharmacist seemed to believe that Bylaws and Ethics were secondary to profit.  Who gives a shit if you haven’t seen your doctor in 3 years, here’s another 3 month refill.  What’s that, you have a sore throat, here’s some amoxil!  The list of unethical and outright illegal shit is long.  Unfortunately, all these things which made people think this pharmacist was a good pharmacist were the reason the pharmacist was a bad one.  People, unfortunately, do not realize that we often need to protect them from their own stupidity and so once again they bitch about me being an awful pharmacist because I’m not willing to go down that road.  Fuck ‘em, go somewhere else then, I’m not losing my license for you, and go ahead and spread rumours about the awful pharmacist who makes you go see your physician early or who won’t just give you drugs because you think you have a sore throat.  That shit doesn’t bother me.

Ultimately, I am a father and husband first, a son and brother to my family second, a friend to my friends third, and a pharmacist last.  A pharmacist is part of who I am but it is not who I am.

So you can imagine my utter outrage and disgust when I find out that there are rumours circulating in my town that the long-term pain issue with which I am dealing is merely a cover for the fact that I am having an affair on my wife.  Secondarily, I have chosen this issue so that I can have fake physio therapy appoinments so I can go spend time with the woman I am having an affair with.

If there was ever one time I wish my blog was not anonymous this is it.  I use this blog to rant and rave in an attempt to maintain sanity.  To protect the personal health information of individual (which I think is important) I blog anonymously.  But there comes a time when I am utterly disgusted with individuals in a small town.  Some people are obviously not happy unless others are miserable.  There is only one thing that pushes me over the edge, and that is when people would imply that I am an unfaithful husband or bad father.  You can bitch about me being an asshole pharmacist.  You can think I’m a bad person because I’m an atheist and not an indoctrinated Christian sheep.  None of these things matter to me.

But if you dare imply or spread rumours that I am a bad father or husband and you will feel my full wrath.  I struggle to convince my wife who grew up in a city that living in a small town is great for raising a child. I try to have her understand that you need to have thick skin and just ignore the rumours.  People wonder why we cannot attract young medical professionals to live in a small town, or to have them stay once they are here, but I must confess when this type of thing happens I often question this myself.  Maybe moving back to the city and becoming a corporate whore pharmacist who works 40 hours a week just to collect a cheque is where it’s at.

J

More of your questions answered.

Due to the overwhelming response to my previous post regarding my post on everyday questions for pharmacists I have decided to answer more of your questions.  To see my previous post go here: http://twogrumpypharmacists.blogspot.com/2011/10/collection-of-questions.html

In any event, as promised I will continue to educate, as is my calling.  Enjoy.

1.       Q: I have a new prescription for my medications, but I left it at home.  Do you actually need it or can you refill my prescriptions without it?

A: Absolutely Not.  Realistically, as per my previous blog-post listed above, you didn’t actually need to see a doctor ever to have refills.  The fact that you did is actually rather bazaar.  In any event, I have the ability to telepathically read your prescription from afar.  In pharmacy school we have a class called: ESP 110.  This class teaches pharmacists several important skills:

-         Mind Reading:  This skill enables us to know that you need your refills without you having to phone us and actually request them.  If you go to your pharmacy and your refills are not done even if you didn’t phone ahead it is safe to assume that your pharmacist failed this class and isn’t really a pharmacist at all.

-         The ability to see into the future.  A subset of this class teaches us how to build a time machine, but that class is optional.  This allows pharmacists to see into the future and make sure we contact your physician well in advance when you need refills so that you do not have to bother.

As you can see, Pharmacists do not actually need the prescriptions.  By simply rubbing our temples and slamming our heads against the pharmacy counter we are able to read your prescription from afar using our mind’s eye.

2.     Q: My Doctor gave me a new prescription, but I am too busy watching “The Price is Right” to bring it in.  Can I just read it to you over the phone and then come pick it up later?  I’m in a bit of a hurry because after TPIR I’m taking a nap and Bingo starts at 2:00.

A: Of Course.  As I have previously said once you have been diagnosed with a medical condition you are automatically as qualified as your doctor to identify issues with your own health.  Secondarily, this translates into the ability to read and write prescriptions properly. As well, pharmacists can decipher mispronounced drug names and directions thanks to our ESP class stated above.  Here is an example.

Patient: the prescription says Lasec 2mg (could be a 20), take 1 tablet oddly.

Pharmacist: ahh, Lasix 20mg one tablet daily, gotcha.

Patient: Yep, the pink ones for my stomach.

3.     Q: I have a new prescription for my Narcotics.  I’m too busy to bring it in today.  Can I just fax it to you and have my brother pick it up?  I promise I will shred it.

A: Of Course.  You see, the bylaws of the Saskatchewan College of Pharmacists are not actually bylaws at all.  We are currently having them renamed “By-Suggestions” meaning that they are a rough outline as to what we are required to do.  The government also has this crazy and ridiculous program called “The Prescription Review Program” which oversees Narcotic and Controlled drugs.  It is a particular pain in the ass, as it requires silly things like the correct patient name as well as an actually quantity of drug to be dispensed as well as a bunch of other nonsensical B.S. for filling Narcotic prescriptions.

Apparently, in some places, people have attempted to fax their Narcotic and Controlled prescriptions to several pharmacies in an attempt to get more than what their doctor prescribed for them.  Weird, I don’t actually believe anyone would do that, so fax away.

4.     Q: Does this look like Herpes to you?

A: Eww, gross.

J

What Defines a Good Pharmacist?

I made the mistake a couple of months back of doing a customer survey and focus group.  “What a great way to improve my business” I thought.  I could really get at the meat of the issues as to what customers expect from me and find areas where I could improve myself as a pharmacist and what I offer to my patients.

Well, let me tell you, my fellow pharmacists, if you ever want to get totally shit on as a professional have one of these.  They are great for upping your personal rage level.  Following the survey I have decided to compile a “What we think is important to our patients” versus “What our customers want” essay.

First off, my essay as to what I would expect from my pharmacy.  This is based on several things.  Naturally, my knowledge of pharmacy (being a pharmacist and all) and what I would expect as a patient receiving a prescription.  Tied into this is a little bit of what we are taught in pharmacy school as to what we should expect as professionals.

Things that define a good pharmacy/pharmacist

Most importantly, focused patient care.  My pharmacist should be attentive to my needs with respect to helping me understand how to properly use my medications as well as educating me about what I can and cannot do as a result of this medication.  Follow-up phone calls to ensure I am taking my medications properly would also be a bonus.  I would also find it beneficial if my pharmacy offered patient Education and Clinical days.  My pharmacy should be involved in the community by offering community education events about various health related topics.  This includes, but is not limited to, medications.  As these types of services have value, I believe it is reasonable to charge a fee to attend them.  Finally I want to be treated like a member of the health care team.  I would hope to have a good working relationship with my community pharmacist and the rest of the health care team, including my physician to optimize my health outcomes.  A relationship built on mutual understanding and respect by all members of the team.

So there it was.  Short and sweet.  I could have droned on and on, but basically that was a flowery (ie boring) look at community pharmacy, and realistically I know you are all waiting for the other one. So, following the survey and focus group, here is what I have generated from the public’s perspective:

Things that define a good pharmacy/pharmacist

                Most importantly, fast and cheap (just like a good whore).  I could really give a shit about side effects or other medications I can and cannot use.  Just hurry the fuck up and it better be free.  And if it’s not free then I’m not taking it, I need to buy smokes.  Oh, and you better be open about 27 hours a day, 8 days a week, because I’ve got shit to do and I need you to be open when I finally remember to pick up my  medication, which I cannot go without, but which I ordered 12 days ago and have been without for 7 days.  And those little artsy farsty health fairs had better be free and you damn well better have free coffee and doughnuts too.  Don’t dare offer me carrot sticks and water you tofu farting tree hugger.  Oh, and when I call you at midnight to come down and fill the emergency Amoxil script I received 4 days ago but was too busy to fill (I’m retired, I’m busy) you had better be prompt and fucking happier than a kid in a candy store because without me you would be out of business.  By the way, I don’t need you to counsel me on drugs, that’s what my doctor is for.  Can you please, however, be sure you know what’s going to be on sale on next week’s flyer, because I’m getting low on Cheezies. Oh, and when I run out of refills you had goddam better automatically fax my doctor for refills.  I’m too busy to go and see him (Bingo starts at 7:00pm you know, and you close at 6:00pm).  Oh, and finally, I want airmiles with the full co-pay on my prescription (it is afterall about as important to me as a loaf of bread) and you better act like you are happy to see me whenever I come in because I’m your only customer and my prescription pays your bills.  Shit, I own half your store.

Well, ok, it’s not really that bad.  Realistically, it’s only a small percentage of patients who are like this (I could say it’s about 10% but like 80% of stats that’s just a guess).  Realistically, everyonce in a while I get to help someone with their medications and truly make a difference.  It is these rare moments that make me glad I became a pharmacist.  It is difficult, however, because most of the time it mainly just feels like I’m in the fast food department of Health Care, getting shit on all day.

I recently tweeted to another pharmacist friend, that I only drink alcohol on weekends and if I’ve had a shitty day at work.  I’m down to 6 and a half days a week.

J

Why is it that...?

Just some quick pharmacist’s questions for this weeks blog:

1.        Why is it that the guy who refuses to pay $5.00 for his meds, because that’s too expensive, can afford $30.00 in lottery tickets?

2.       Why is it that people bitch about having to see their physician for a new prescription regularly, but have no problem making sure they get the oil changed in their car regularly?

3.       Why is it that the only people who whine about reduced pharmacy hours are retired old ladies who have nothing to do but drink coffee all day?  Oh wait, because they need something to complain about when they are having coffee of course, my bad.

4.       Why is it that when  it takes any more than 5 minutes to fill a prescription some people get totally unreasonable, but standing in line at Tim Horton’s for 20 minutes for a fresh Double-Double makes total sense?

5.   Why is it that George Lucas would rather spend money making updates to the original Star Wars Trilogy instead of just making epidsodes VII, VIII and IX?

6.       Why is it that Narkies always open their Oxycontin bottles over the toilet and accidentally dump them all in to said toilet, but this never happens with their Ramipril?

7.       Why is it that these same Narcies always fill their Oxycontin on time, but forget to take their diabetes medications regularly?

8.       Why is it that when some patient’s would rather take advice regarding the proper use of OTC medications from some random person with no medical training instead of their pharmacist?

9.       Why is it that J, The Grumpy Pharmacist, is such an @$$Hole?

10.   Why is it that the single mom who is on social assistance and has 4 kids from 5 different men can afford a nicer car than I can?

11.  Why is it that old people are always in a hurry, but drive ridiculously slow?  Oh wait, that's why they're in a hurry, it's going to take them a long fucking time to get home.

12.  Why is it that I can't get the goddam spacing to work right on this week's blog (thus making it look like, ie: revealing, that I have no idea what the hell I'm doing)

And finally

13.    Why is it that J, The Grumpy Pharmacist, couldn’t come up with anything good to write this week so he whipped this off in 2 minutes and hope you wouldn’t notice?

Have a great week everyone!

J

A collection of questions.

Here is a collection of fun questions I have been asked over my career, some (like the first one) are on a daily basis, some only once a week or so.  To save time and to help inform both of our faitful readers I have provided the answer as well.  Enjoy!

1.        Q: It says here on my bottle that I have no refills remaining.  Does that mean I have no refills remaining?

A: Nope, I’m just messing with you, you busted me.  In fact you will never have to see your doctor ever again for refills.  I merely put that on the bottle as to stimulate conversation and make my otherwise dreary life bearable.

2.       Q: I had a sore throat a couple of years ago (hands me bottle of antibiotics dated March 3^rd, 2004) and the doctor prescribed these.  Can I have a refill or do I have to go see a physician.

A: Absolutely.  Actually, you will never have to see a physician for this problem ever again.  Once you have experienced symptoms for any kind of disease you immediately become a certified medical specialist in the field as it relates to that particular disease or condition.  This means that although you have no previous medical training there is absolutely no chance you have misdiagnosed yourself and as such are qualified to prescribe yourself antibiotics.

                For the same reason, and for future reference, lets say you have a heart condition requiring open heart surgery.  As a result of a heart-attack and subsequent surgery you are immediately qualified to do open heart surgery on yourself the next time you have a heart attack.  This is how we save money in the medical system.

3.       Q: I hear pharmacists in Saskatchewan can now write prescriptions.  Does this mean I don’t ever have to see my physician for refills and I can just continue coming to you instead?

A: Yes, you are correct.  Interestingly enough, now that pharmacists have prescribing rights the Province of Saskatchewan has realized they can cancel any and all pre-existing contracts they may have with physicians as they are no longer needed.  The Province feels that the average Joe is more than qualified to regularly assess their own medical status and can tell when things such as a new condition might come up, or if their current medical condition has changed in anyway.

                For example, let’s say that 10 years ago you were diagnosed by your physician with hypertension (high blood pressure).  Well thankfully, because your body never changes over time, and especially not over a 10 year window, you will never have to see the doctor for refills.  We can safely assume that the dose of medication you were initially prescribed 10 years ago will never change.  Similarly many other medications “require” regular blood tests to ensure that the dose is correct.  In reality this “requirement” is just put in place to ensure lab techs (who pay a lot for their schooling) are able to secure a job.  To simply tell if your dose needs to be changed all you have to do is lick your forearm and tell me if it seems ok to you.  If you think it is normal you are good to go.

4.       Q: I need my medications filled today, but I don’t have the money for it.  Can you just give them to me and I will come pay you in two weeks?

A: For sure.  Once again you have stumbled upon a well-kept secret.  While other businesses expect to be paid for providing goods or services, pharmacies have magical money trees growing in our back rooms.  You see, the government developed these trees to ensure pharmacies get paid.  As you all know Canadian Health care is supposed to be free.  This means drugs are supposed to be free as well.  In fact, it extends to everything in the store, so go ahead and pick up some pop, chips and a couple of lottery tickets on the house.

                By the way, would you like me to call ahead to the grocery store so you can fill a cart full of groceries and walk out without paying for them as well?

5.       Q: My friend and I were chatting.  Her symptoms seem awfully like mine.  Can I get some of this medication she is taking from you, or do I have to go see a doctor?

A: Well, that’s a tough one, you see it all depends on your personal confidence with both your and your friend’s combined diagnostic abilities.  You see, as per numbers 3 and 4 above your friend could request this medication for themselves; however they cannot request them for you unless one of the following criteria is met:

a)      They are your best friend (or at least a very close friend).  The closer your friend is to you the less likely they are to make a judgment error as it comes to medical issues.

b)      It is your mom (or primary caregiver when you were growing up).  Your mom would never do anything to hurt you.

c)       The person was wearing glasses – glasses make you smarter

d)      They are a doctor (pfft whatever).

6.       Q: Can you lend me $20.00, I will pay you back when my welfare cheque comes in?

A: I’m surprised you haven’t asked me before.  You see, pharmacists are able to expense random amounts of money to their patients.  It’s the “born yesterday” pharmacy legislation clause.  We may also co-sign loans, buy you a case of the finest wine, and even provide you with our first born child.

I will keep collecting questions as I go and look forward to answering more of your pharmacy related queries in the future.

J