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

The Psychic Pharmacy Tech and Mr. Oblivious.

Well, I figure it’s time for another round of insane, hilarious, ridiculous stories of the kind of stuff that can happen in a pharmacy.  Once again, some are personal, some are second hand.   Enjoy.

Chapter 1: He can read minds. No really!

On a slower day in the pharmacy we were standing behind the counter having a chat.  It was just myself and the two technicians I was working with.  It was most likely a Friday evening.  Anyhow, the technician was in the middle of telling a story.  Just then a real beauty of a gentleman walks around the corner.

Now, I’m not a profiler, but nine times out of ten, when I see a person walking towards me with a dishevelled “I just woke up in the gutter down the street” kind of look I brace myself for what comes next, because it usually ends up with the whole “Tylenol #1 or Gravol” question.  Anyhow, the gentleman who strolled around the corner had just this look.  Just as he came around the corner the technician said, as a part of his story “and so I told the guy I could read his mind”.  Mr. Shitty pants thinks he’s really cool so he says to the technician “Ok, if you can read minds, why am I here?”

Without hesitation the technician looked at him and said “You want a bottle of 200 generic acetaminophen with codeine”.

The guys face goes white… “How did you know?”…

Needless to say I was rolling around on the floor laughing my ass off.

Chapter 2: Bad Timing

During my internship in my fourth year of pharmacy I was working a night shift with my preceptor.  At around 9:30pm or so this rather stunning young lady came stomping down the aisle with a prescription in her hands and a rather pissed off look on her face.

She slaps down the script: “Azithromycin 1 g stat”… aaaah Chlamydia, what a great disease.

Anyhow, I take the prescription from her and tell her it will be just a few minutes.  I go up and get everything ready and chat with my preceptor about what I am going to counsel the young lady on, etc.

I walk back down to the waiting are and hand her the prescription and proceed to counsel her “Take all four tablets at once… blah blah blah”.  When I’m done counselling her I ask if she has any questions, at which time she snaps.

Her: YA, I’ve got a question for you.  Why are all men dirty pigs?

Me: ummm

Her: My boyfriend was screwing around on me and now he gave me a goddam STD from that skanky whore he’s been banging.  I already chucked all his shit out of the house, it’s laying on the front lawn.  When he comes home he better not come in the house or I’ll cut his balls off

At this point she stormed off.  I stood there stunned for a second and my preceptor just had a laugh.  I was just about to step back up into the dispensary when my preceptor whispered “She’s coming back”.

I went back down to the counter and asked her if there was anything else I could help her with.  She told me she was sorry for blowing up on me and that she had just needed to vent to someone.  I told her it was ok and that I imagined it was a little stressful.  The next exchange stunned me, here is what was said next:

Her: Anyways, you’re new in town, did you just start here?

Me: Yep, last week, I’m doing my internship here.

Her: You should give me your phone number; we can go out for drinks some night.  As you probably guessed, I’m single now.

Me: (at this point I didn’t know what to say, because a woman who konws I know has an STD is asking me out) Uhhh, I’m only here for 2 more weeks doing my internship then I’m moving back to Saskatoon to finish school.

Her: Oh, well, make sure you come out to the bar on Saturday; I’ll be there with some girlfriends.  I’ll buy you a drink and make sure we show you a good time and see if we can’t convince you not to move back.

At this point she turned around and walked away and left the store.  My preceptor and I stood there stunned and then she looked at me and said “I guess she likes you, give her a week and she’s good to go”. I stayed as far away from that bar as possible.

Chapter 3: For a newspaper?  Seriously?

I was working one day in Calgary.  It was not a particularly busy day, and the technician and I were just moving things along.  At one point I was behind the counter on the phone answering a question from a patient while the technician was receiving a prescription from another customer at the drop-off counter.  As I’m talking with the patient an elderly gentleman (mid 70’s) is hurrying down the aisle waving a news paper at me with an angry look on his face.  He comes to the till and shouts at me “Get over here now!” and points at me.  I covered the receiver up on the phone and told him I would be with him as soon as I was done with the phone call.

I heard him mutter some other obscenity and he waved the newspaper at me and kept talking so I just turned my back to him, now facing my technician, and kept speaking with the person on the phone.  The technician suddenly looked at me wide eyed with this “WTF” look on her face and I wondered what was going on.  Then it happened.  I felt a very forceful tap on my right shoulder.  I turned around and was standing face to face with the little old man.  He had walked behind the till and let himself into the dispensary.  Very calmly I asked the woman on the phone to hold for just a moment.

Before I go any further I will say one thing.  I’ve only ever actually lost my mind and snapped once in my pharmacy (this was it).  I’ve gotten irked and made some snide and smart ass comments on occasion (i.e. daily) but I’m generally a very calm guy.

Anyhow, I turned around and just lost my mind on the guy, asking him what was so goddam important that he thought he had to let himself into the pharmacy, to which he replied:

“I bought that copy of the Globe and Mail at the front and I wanted the Calgary SUN and that girl at the front told me I had to come back here to get a refund.”

Now this made it worse, for some reason this ass thought a refund on a Globe and Mail was of earth shattering importance.  I reached in my pocket, took out a $2.00 coin and told him to get the Hell out of my store.  He said, very snidely “I’m sorry, I’m in a hurry” to which I replied “Don’t give me some half-assed apology, I better not every see your impatient ass in here ever again”.

I think I handled it quite well.

Chapter 4:  There’s no way he’s going to come back here… WTF, here he comes!

One night a particularly grubby looking guy plops himself in front of me and shows me  this prescription:

Oxycontin, 40mg

Take 1 tablet twice daily

Give: 120 tablets

I could immediately tell the prescription was a forgery.  This dude obviously had stolen the physician’s triplicate prescription pad.  He then says to me “Do you have this in stock because I was just at the pharmacy across the street and they don’t”.  This of course means the other pharmacist recognized the forgery as well.  Quickly I said “No, but if you like I can order them for tomorrow”.  To which he says he would try a couple of other pharmacies instead.  I told him I would order them anyhow if he liked, but to do that I would need to set him up a file.

Now, this scumbag was smarter than most.  A lot of idiots, when they forge prescriptions, get greedy and will write stupid shit like “give 1200” or write ridiculous instructions like “Take 1 tablet every 30 minutes”.  He wrote for 120 tablets, and the directions weren’t ridiculous.

Anyhow, I convinced the guy to let me set him up a file.  I got his Driver’s license number, his health number, his address and his phone number.  At that point he left.  Once he was gone my technician said to me “There’s no way that dude is coming back here tomorrow”.

The next day I did the standard call the doctor, confirmed it was forged, no I didn’t fill it and then I notified the police about what had happened.  Pretty straight forward.  At around 7pm the next night guess who comes traipsing down the aisle?  You guessed it, Mr. Scumbag.  The tech starts freaking out “Oh no, he’s back, what are we going to do”.  I just told her “don’t worry, I’ve got this.

He asked me if I had the stuff.  I said I did, but it would take 20 minutes to get it ready because we were busy.  He said no problem, handed me the prescription and left.  As soon as he was out the door I called the Police and told them to meet the store manager at the back door, and that I had told the guy it would be 20 minutes so they had better hurry.

In about 10 minutes the guy comes back and sits down in the waiting area.  Of course, it’s not busy, and now I don’t know how to stall him.  I just had the tech pour out and count tablets repeatedly from the same bottle, while I would randomly call out names for prescription pick-up and then look puzzled when the people never showed up.  All the while Mr. Scumbag sat there with a smirk on his face already counting the money he was going to make selling the stuff.  Finally the phone rang and it was the manager.  The police were in the back.  He showed them the surveillance camera so they knew what he looked like.  I saw them coming down the aisle.  Thankfully Mr. Scumbag was sitting with his back to them.  The one officer pointed at him, I nodded my head and the officer then said “Excuse me, Mr. Scumbag”.  The guy, still oblivious, turned his head.  He then turned back and just frowned.  I smiled and just looked at him as the officers asked him to stand up and they cuffed him.  I gave them the forged prescription and he was on his way to the big house.

Funny thing is, he never showed up for his court date (which of course I was summoned to) so I never got to see him again.

J