Things that make my blood boil

You know, things were going somewhat okay recently, save for some front store drama reaching back and pulling me unwillingly into it. The pharmacy staff was finally, for the most part, getting along together, Terry included.

So I decided to take advantage of the good vibes and try to talk to Terry about a few things that needed fixed around the pharmacy.

There are two main things that have been making me very angry about Terry. The first is the way Terry staples our labels. It may sound trivial and stupid, but Terry puts TWO staples through the patient's information AND the drug name. Always has. I asked Terry to follow our previous protocol (two staples going down the side in the blank spaces). Terry asked why the other method didn't work, and I explained that it was difficult to tell the patient what medication they were getting, let alone to see that it's the correct patient to begin with. We'd talked to Terry about this a few months after Terry came to us, and Terry seemed receptive to this change back then. Terry seemed receptive this time, too, but Terry didn't even attempt to do it right this time. So, I got a staple remover, and every label that Terry put together (which was probably 90% or more, because I was running back and forth between the drive-thru and drop-off) I dismantled and put together the correct way. It slowed us down significantly, but it proved the point that it's much easier to read the information when the staples aren't in the wrong place. If Terry can't fix it next week, I'll be doing the same thing all week.

The second thing that really makes me angry about Terry is the refusal to clean up after themself. Terry has this problem with dirtying dishes, littering drawers with crumbs, refusing to vaccum, and refusing to empty the trash. The trash can next to Terry's station is Terry's favorite place to throw milk jugs with spoiling milk that wasn't emptied out, half-eaten food, etc, and when I went to change the bag the other day, I thought I was going to have to put my head between my knees to stave off the nausea. The stench from something Terry had left to rot had managed to penetrate the plastic bag and make a nice little home inside the trash can. I had to take all the bags out back then go in search of Lysol disenfectant spray. I created mushroom clouds inside the can, around the can, and around Terry's station, repeatedly. I think there were at least 3 actual clouds in that part of the pharmacy. Yesterday, when I changed the can after yet another quart of milk was haphazardly thrown into it, I could smell the stench back again. I don't know if maybe I'm more sensitive to it, because I'm the one who had to clean it up, but nobody else could smell it as bad. I'm going to have to go in search of a new can this next week.

This makes me even more angry, because when I talked to Terry about the stapling issue, I also discussed the reluctance to touch the trash. Terry promised to take care of it, but obviously, Terry didn't. Terry has family members at home who basically take care of Terry's needs, but there's no reason that Terry, a grown adult, can't do these things themself. It's ridiculous for me to have to spend more than half my week, let alone more than half my day, cleaning up messes Terry has conveniently decided to ignore. It's getting pretty upsetting to have to bring in my own cleaning supplies from home. I'm no way a neatnik or a neat freak, but at least I know how to clean up a mess I make. I just think that in a confined environment such as work, there should be no excuses for things being filthy.

So that's the latest update from CPhT's pharmacy. We'll see if next week when I get really strict with Terry, and I do mean REALLY strict, if Terry finally gets a clue.

Very quick

I find it extremely funny that the only people who complain and tell us it's false advertising/scamming/anything else in that vein when we refuse to honor gift card coupon offers are the ones on Medicare who read the fine print on EVERYTHING but the coupon, and upon telling them WHY we can't offer it to them (federal law, if you're not familiar with pharmacy workings), INSIST that their Medicare part D plan is NOT a Medicare plan. Just a(n) Aetna/Blue Cross/AARP/etc plan. Quit bitching, you're already getting $4 (sometimes less!) generics.

Interesting.

I was looking through my Site Meter, and I decided to look at the stats, referrers, etc. I thought I'd share some of the Google/Yahoo!/other search engine results that were interesting.

Months down the line, I am STILL getting a ton of hits from my posts about the Actavis Totowa recalls from digoxin. There are Actavis, Actavis Totowa, Actav, and digoxin referrals all through there

There were also a fair amount of referrals from an entry I wrote about a Factive coupon I wasn't even thanked for using. Funny.

"Lose your pharmacy tech license" via Google. Oddly enough, this has never been discussed here to the best of my recollection.

There were a TON of referrals, almost as many as the Actavis Totowa ones, asking the pros & cons of e-prescribing. I wonder if it's medical professionals, or just patients, looking into it. Hopefully, a mixture of both! I like promoting e-prescribing, as long as the doc looks into it and knows what they're doing.

"Why does the pharmacy tech look at me strange when I fill Lorcet?" via Google. Easy answer - we've been taught to scrutinize controlled drug scripts, and sometimes when you get large quantities, it sets off warning bells in our heads. Not saying you're an addict, but we deal with them every day, and sometimes, it's hard to shake the thought of the possibility.

"Pharmacy tech pin" via Google via Microsoft. Again, never discussed. Haha.

"Sorry works pharmacist" via Google. Weird.

"Pros and cons of pharmacy drive through" via Google. It's just a big con, folks!

"I hate my job procter & gamble" via Google. Another weird one.

"Nursing sucks pharmacy tech is better" via Google. I'll have to ask my tech in nursing school if this is true, and I'll let you know what she says.

"Pharmacy technician anecdote" via Google. This one just appeals to me! I don't know why, but I really like it.

"I hate being a pharmacy technician" via Google. Don't we all hate it at some point or another?

So that's my list. Some of them are funny, and some of them are just odd. I'm just happy for the traffic, any way they get here.

As for pharmacy life, we are still experiencing trouble with Terry. Terry came in last week and asked myself, my intern Madison, and another intern, Tom, to clean up the pharmacy in case our supervisors stopped by. Uhhh, what?? Terry worked with two technicians, Mark and Kaya, this weekend, and they had no time between filling all of 175-ish scripts to do it? The pharmacy was a disaster! I spent the entire evening cleaning up, and as soon as I did, Terry messed it all back up again. I was ready to kill Terry for it. I had to leave the pharmacy area and just go for a walk in the store because I was afraid I was going to lash out. I tried not to say very much because I knew it would be bitchy and spiteful. I just can't see how if *I* work the weekend, no matter who with, I can get everything done, clean, and make calls for our various CorpoPharm programs.

I just don't know how much longer I'll be able to deal with this. I've talked to our supervisor, Alex, at length about the issues. Problem is, he and Terry are old friends, and he won't see how miserable we all are, and trust me -- every single person in the pharmacy is miserable. I guess the next step is Alex's boss, Stephen, then possibly their boss, Ethan. Something has gotta give, and if it doesn't, I'll start looking for jobs. I truly don't want to leave CorpoPharm, because I love everyone there, excluding Terry. We were a tight-knit, great group before Terry. We are still a tight-knit, great group excluding Terry, because Terry isn't interested in the same things the rest of us are. It's just getting harder and harder to find a reason to get up and go into work every day.

Don't lost trust in your doctor

At CPhT's pharmacy, we are experiencing a problem.

Terry (surprise surprise!!) is basically telling people they don't agree with what the doctor is prescribing, and what they would have prescribed. There are a few issues there. I'll list them out.

1) Terry does not have a doctorate of medicine/CRNP license/prescriptive authority/ANYTHING, so no matter what he thinks, the doctors' opinion is the one that matters.

And yeah, the doctors are wrong on occasion. There are times that Mr. Smith is getting x drug from Dr. Stupid and Dr. Worse tries to hand him drug y, which is a Level 1 Interaction. But, we're talking about average patients here, getting average medications for illnesses. It's not usually chronic patients whose doctors are having their medications questioned. Although, it has happened with chronic patients.

2) Terry does know a lot about the drugs, but Terry does NOT know WHY the doctor selected the chosen drug.

Maybe the patient has neglected to tell us of their penicillin allergy, therefore rendering Terry's choice of Augmentin useless. Maybe a few weeks ago, they went to XYZCHEAP Pharmacy with their $4 generics, and got a bottle of cephalexin, and it just didn't work as well as the doctor had hoped, and they are choosing something else.

... Sorry, I ran out of steam/am running out of time before I have to get ready to leave for work, so I'm going to cut to the main story.

Go back a few weeks ago. We had a child come in with bronchitis. The nurse practicioner did pick a suboptimal drug regimen (a drug not technically indicated for bronchitis), and Terry told the parents that the drug was not a good one. Terry called back, and they told Terry that they'd really chosen another family member. That drug had some issues, according to Terry, so they called the office AGAIN, who said it was REALLY supposed to be drug #1 called in. Following so far? Drug #1 called in, then they said no, it was #2, then they said, no, it was really #1.

As I could imagine, the mother of the child was getting pretty upset at this point. They had some of drug #1 at home, and Terry said to use that, and in the meantime, Terry would try the doctor again, and if they refused to see it as Terry thought it should be, the mother could have her cousin's sister's dogwalkers' fiance (herein known as C/S/D/F) call us, and Terry would tell the C/S/D/F what to prescribe. Terry did not receive a call back from the doctors' office, nor the C/S/D/F, and the mother calls, after Terry leaves. It's me, my favorite pharmacy, and my 6th year intern who's filling in while she's on her off block on her rotation. Terry did not leave a note, and I was helping a customer elsewhere, when I hear Meg (pharmacist) and Diana (intern) freaking out. I caught a few snippets of the talk, and I finished with my customer, and rushed over. I told them the story, as far as I knew, and Diana related what I told her to the patient's mother. She was still PISSED (don't blame her) that nothing has been resolved, but she doesn't know if she can get the C/S/D/F to call at this point. I had to go call Terry and ask what the dose of Terry's favorite drug would be, and I had to call the pediatrician back. The nurse checked the chart and told me that drug #1 is what they ordered and wanted. She also told me that the doctor that was in that night was going to call the mom as soon as he was done with his visits, because the mom flat-out refused to speak to any practitioners ever again. I then proceeded to tell her what Terry had done, because it wasn't fair for them not to know why this mom was making crazy demands and freaking out. I think I was right to do that, because I wanted the doctor to have the full knowledge that their knowledge was being questioned. Basically, they picked a dose, and went with it, of drug #1. A few days later, they did the max. adult level for drug #1. For an 8 year old.

Fast-forward to yesterday. The 8 year old's sister has now caught the bronchitis. The doctor wisely selected a drug that is indicated for bronchitis. However, the patient has developed enough airway constriction that they decided that the OTC meds mom & dad were giving her is just not cutting it, and they needed to give her a corticosteroid. The patient's mom wanted to talk to Terry, but she wasn't home, so she had to call back. The dad decided not to pick up the corticosteroid because they just weren't comfortable with it. Finally, when Mom called Terry back, she was convinced enough (I believe) to pick it up.

Our intern and I were debating when Terry was not yet in yesterday (Terry had a half-day for a doctors' appointment) what kind of parenting it takes to stop trusting the doctor. I know Terry did not instill anything positive about the doctors' office and staff to these parents, but when your kid can't BREATHE?? You're just going to let them go?? Seriously?? I'd almost go as far to call that negligent parenting. The drug is safe, the doctor even prescribed a little below the dose for mg/kg/day as they wrote it out on the script for the parent, and yet, mom & dad don't trust it, because Terry doesn't trust their office. At some point, you have to trust the doctor and just bite the bullet. We told Dad it was a safe dose for that patient's age, and everything that we could to alleviate fears. But no, daughter is going to suffer until Mom can discuss the pros & cons of the corticosteroid. Just suck it up and be a good parent.

Was it wrong of Terry to do this? We all think yes. I don't think that it's exaggeration to say that none of us are happy about the way Terry is going on. At the rate Terry is questioning prescriptions from doctors, soon enough, NONE of them are going to want to deal with us.

Phew

It's been nearly an entire month. One day short of it. I feel like so much has gone on within that month, yet it's hard to put into words, because I don't want to give too much away towards showing who I am. The PIC DOES surf the net and read some of these type of blogs, after all.

So, what's happened? First things first, Donna finally had enough and quit. She didn't give us two weeks to replace her, more like two days. I've been working by myself with the pharmacist until late in the afternoon, whenever we can snag an intern after classes end. It's been difficult, but so far, we've managed with just slight issues about being too busy and understaffed.

Also, my intern that does not get along with the rest of us gave up a shift to work for another store in the chain. It's not a big loss, because we had a few people who were coveting that time slot, and it's working out for the better, because there's less snarky comments being made.

We finally got an application that was viable for us for a new hire to replace Donna. We started Kaya last week, and she's catching on quickly, which I'm really excited about. I actually know Kaya outside of work, and was surprised when she applied. I was happy, because she and I had always gotten along, and it looks like she will be joining this CPhT's team until she graduates school.

We've had our share of weird customers over the past month, and there were really no exceptions. We've had people coming in to ask if we have those round Percocet 10/325 generics or the long ones, because the round ones just don't work as good as the long ones. Or so they say. Needless to say, those people are ones we aren't going to be thrilled to see if they keep coming back. We've had a lot of people angry about some new company policies, and the local doctors' still don't understand that the OTHER new policy is not our idea, and they keep getting angry with us.

It's just been weird lately. I've been feeling pretty crappy towards work at all. Kaya's going to be making a similar wage as me in a few months, and this is after 4 years of service on my part. I like Kaya, but I don't think I should be making what a first year is making. I feel like we are in a rut, and we can't get out. Terry is causing a lot of this rut, because ALL of us are feeling it.

Maybe next time, I will have more good news. We'll see.

Update

So, let's call my PIC Terry from now on.

Terry brought up to me the other day that my other technician has been showing less and less interest in working in my pharmacy. I told Terry that it was true; and that since my tech has been skipping shifts back with us to work for my front store manager, that I was going to have a talk with her. Terry said maybe they should have a discussion, so Terry could try to iron out their differences, as they still do not work together when not absolutely necessary.

This opened up a great hole for me to stick in my 10 cents about how Terry has been behaving towards not just my tech, but myself. I felt like I got some of the things that needed said out of the way.

However, Terry proceeded to tell me my tech had been lying to our Pharmacy Supervisor. I got a little angry(angrier maybe?) inside, because I know exactly what Donna (my tech) said to the supervisor. I dialed the phone for Donna. I heard what Donna said to the supervisor, and I can vouch for the things Donna said happened, because I have witnessed them.

For the sake of working in a non-hostile environment, I have been trying to be nicer to Terry, since I did get a quasai-apology for some of the hot-button issues, but it doesn't seem like that's enough anymore.

This weekend almost completely ruined any of the new dentente we'd reached. I was off, but I came in to cover for someone yesterday who couldn't make their shift. It seems that this weekend, Terry managed to make all hell break loose, and Terry wasn't even there.

On Thursday, we got in a special order for someone. Instead of giving them the full quantity, Terry inexplicably shorted them close to half of the order. I asked the patient if they had received a holdover supply, since we'd had a few in stock. They said yes, and they could not tell me how many they got. I tried to call the patient's wife at home, and she was not there. The patient called me back when they got home and had me speak to their wife, who just had not answered the phone. They came back a short time later for the rest of the order, and the patient screamed at me, and told me they would be talking to my boss. Problem is, Terry is my boss, and is also the one responsible for the shorting. The patient blatantly lied to me and the pharmacist, claiming that we had not asked if they had received any. The pharmacist laughed at the patient, and said that she'd witnessed it, but the patient kept insisting he was right, and we were wrong, and he'd be talking to my supervisors. I finally told him to go ahead, because that supervisor is the one who was responsible for the shorting.

About an hour or so later, a patient came through the drive-thru, and asked for his son's prescription. Guess what! Terry had filled the narcotic script under the mothers' name. We took about 10 minutes to fix it.

A little while later, we started the CII monthly inventory. We didn't bother to stop and figure out why everything seemed to be off. We left about 8 flags in the book as to things we need to go back to and investigate why we are over/under on those.

These things did not happen before Terry came into our pharmacy. Terry is very knowledgeable, to the point of knowing very random tidbits off the top of their head. However, seemingly simple things, such as accuracy, get lost in the process of trying to live up to CorpoPharm's policy of getting the patient out as quickly as possible, even if they are not present at the time. It's very difficult to clean up Terry's messes, and we are thinking it is going to be time to have Terry dig themself out of their mistakes. It's getting a little ridiculous to keep explaining to people that they can still rely on us, but some things may take a little more time. There are people who absolutely refuse to come in under Terry's watch, and Terry is now blaming some of the errors being committed on some of our techs/interns. It's not fair, and it's going to have to stop.

So, that's life in this CPhT's pharmacy lately. Hopefully, I'll be able to post again soon. It's just been one thing after another, and I come home ready to curl up at the end of every shift. It put a strain on my life away from the pharmacy for awhile, but that is even slowly coming back. We will see what happens with Terry. We have all come to the point where we are going to let it go back to Terry.

Sorry for the neglect

Let's get honest here. It's hard to come up with a bunch of rants and post them all the time, although I do get quite a bit of good fodder daily at work. But there's a reason I haven't been posting. If people I work with see this, they may or may not be able to identify me. That's fine. I think it's more important to come out with the truth and at least have a sounding board for it, rather than spending every day silently pissed off.

See, a few months ago, Corporate decided to replace a pharmacist with a new one. Corporate has been doing this all over in our chain, and it's getting ridiculous. For the first month, our new pharmacist was great -- a charmer, funny, nice, and great with the customers. But after the first month, things went absolutely downhill. The new pharmacist became some sort of monster. For the first time in my years at my store, things weren't good at all. There are fights, requests to keep employees apart, and a lot of drama. This pharmacist has also brought taboo subjects (such as sex, religion, poltics, etc.) into our workplace, and this is something that we frown upon, and our ethics department in human resources would have a huge issue with if we decided to pursue calling them and letting them in on just how hostile a work environment it is becoming.

I have front store employees expressing disgust for this pharmacist, I have customers calling ahead to ask what pharmacist is there so they can specifically avoid the new pharmacist, and I have coworkers expressing fear that their jobs could very well be on the line. I have been told to watch my back by my other pharmacists. The new pharmacist has no say in whether I stay or go, for the most part, and I am not really that afraid, but I will say this -- we have made a pact that if one of our Core Group goes, and it fucks things up for the rest of us, that we will leave, too. There are about 10 of us (give or take; I'm not positive anymore since people are in an out) that work in our pharmacy, and there's a good 5 or 6 of us that have agreed to seek other employment should one of us be tossed.

It's funny, because one of our pharmacists, and a close friend of mine, has been having trouble sleeping because of all the issues in the pharmacy, and lately, I notice myself having more and more trouble. I'm unable to sleep, I wake up in a bad mood when it's the new pharmacist's day to work, and I spend my day wishing I'd've taken a vacation day rather than drag myself out of bed.

Our main supervisor has been informed of some of these issues, and there's a tentative sit-down meeting planned between a few of my coworkers, myself, and our supervisor to really discuss some of the major issues at hand. I'm not opposed to bringing other higher-ups into this. Everyone tells us that this new pharmacist is one of Corporate's Sweethearts, but if they could see what a week in the lives of any of us is like, they'd quickly rethink that proclamation they've seemed to make.

I truly love the pharmacy profession, and I know I want to spend my life in retail pharmacy practice. But I can't do my job under the conditions we're under right now. I've been offered a job in our front store by the managers for my hard work, but it's not worth it to me. I want to be in the pharmacy helping people, and I get a teensy bit more respect back there than I ever did in our front store. But it's becoming more and more enticing as things keep deteriorating.

So, to anyone reading this particular rant -- any ideas? We all are struggling, and it looks less likely every day that Corporate will do anything about this. I don't want to have to leave, because it was our home long before it was this pharmacist's. But we are all sick and tired of being miserable. So, help!

Why pay $60 instead of $6? Hiding something?

A woman came into the pharmacy yesterday (one of my first back since my extended-long weekend vacation) and my pharmacist waited on her because I was stuck in insurance-hold hell. She told us she had an insurance plan we did not accept and told us she didn't think anyone who accepted it would fill her script. She was fairly nice, but even from IHH, I could tell she was bad news. Just the tone of her voice screamed it out. She kept herself together while Marie added her into our system and processed her script. It was for Lorcet 10/650. 30 day supply from a fairly new doctor in town. It came out to nearly $60, and her copay would have been, if I am not mistaken, between $6 and $12 on the insurance. Her male friend paid for it. While we were filling it, the act started. She started moaning and groaning and whining and complaining that she was in pain. She even started to hobble after it was done. She walked straight up with a smile on her face and no complaints when she approached Marie. It's a safe bet that if I could have gotten on the phone with her insurance company and asked when she'd last had it filled, it would have been within the past 30 days.

Needless to say, we have a flag on her file that says she has prescription coverage, and to be careful when filling for her. She said, as she was leaving, that she just didn't think anyone would fill her rx. Wouldn't fill it, or would see it had been previously filled, is what Marie and I asked ourselves. It's sad to say, but we are seeing more and more cases like this woman sauntering into our pharmacy. There are a lot of people who are not telling us their primary insurance, and when we stumble upon it somehow (usually by a competitor calling us to inquire about them), finding out their game. We had a doctors' office call us about a suspicious patient last night, one who I remembered playing games with us before. Saying that he'd left his 100+ rx of Percocet on the front seat of his car and it had been stolen, et cetera, et cetera. Asked me to fill it again, and I refused, because he told me he didn't want to pay cash, and there was no way his insurance would pay a day later. He has only been back sporadically since.

I wish there was a way for these people to realize they need to get some help. It's just a shame they will never find out until it is almost too late, if they ever do find out, whether it be jail or worse.

Dear Woman at my Drive-Thru

Yes. I saw you there. I even heard the announcement from the speaker when you pressed the button for service. But, as YOU could see inside, I was busy reconstituting a gel for someone who was standing at my counter tapping her foot as my pharmacist, Jenny, went over the instructions for her cream, which was mis-dosed by the doctor's office. When you pressed the fucking button AGAIN, as soon as the announcement turned itself off, I STILL SAW YOU.

When I visibly dropped (literally) what I was doing to wait on you, and make Poor Mrs. Oldlady have to wait even longer at my register with Jenny still trying to explain some confusing directions, you just got ruder. Don't shove shit into my face when I'm in the process of opening the window. When I tell you with a noteably bummed look, because seriously, on slow Mondays, I want work to do, that we do not accept your new insurance, DON'T BE A BITCH AND DRIVE OFF BITCHING AT ME. If I could magically force CorpoPharm to sign an agreement with your insurance, I'd've done it when we first had this issue.

Yours in spite,
CPhT

(PS - to the readers that I have accumulated -- sorry I'm not posting very often. There's a lot of internal drama in the store, and it's not something I could even assimilate into a post that was fabricated, because it's so fucking ridiculous. Thank God my vacation is in 2 weeks. I may not post until after then. Sorry for this short post.)

Quickies, since there's downtime in 10 minutes.

Seriously, I am starting to wonder if people were born in barns.

I cannot count how many times a day people interrupt myself or one of my fellow staff members while waiting on another patient. It pisses me off to no extent. You are all important. Stop being an asshole and interrupting while we give these patients (potentially) vital information, and go away. Thanks.

Also, if you're planning to transfer your stupid freaking prescriptions in and out of a zillion fucking pharmacies, EXPECT that at some point the refills are going to be incorrect. You've fucking transferred in and out and in and out EVERY MONTH. I can see this in your profile. I can pin down where it most likely happened. Stop being an ass and bitching me out. Figure out who you had originally fill your script, and go bitch at them. Thanks.

Sometimes I hate work

I've been in this funk lately. I've had all these things happen that make me think "Hey, this would be a GREAT experience to blog about!", but then 5 minutes later I'm in a stupor because Mr. So and So can't understand WHY his Viagra is too soon, when he just got 8 pills 3 days ago, and his insurance limits him to 8 per month.

I'm going to try to sum up some of the best stories now, and try to start writing down some ideas for here.

This guy came into my pharmacy at night one night. He had a script for Vicodin HP. For 300 of them. It was a legit script, despite the fact that the doc didn't sign it. I called the office, spoke to the doc in question, had him speak to the RPh on duty as well, and we gave the guy a partial. When we got the full amount in, we discovered that he'd had it filled somewhere else the week before. I called that opposing Chain Pharmacy, and spoke to a friendly RPh who told me he'd personally filled her script -- first as a partial, then as a completion, FOR THE SAME DRUG AND QUANTITY, A WEEK BEFORE. How you could blow through 300 Vicodin HP's in a week blew every single one of our minds. I spent that day on a crusade. Between the insurance company (WHO I HATE), the doctor (who apparently is doing a drug test on the patient, which I applaud!), and the other pharmacy, we found out that this guy really isn't trustworthy, and needless to say, our PIC told him that we won't be stocking that drug anymore. He was pissed, but he knows he's been caught. He does not know that the doc is waiting on drug test results. A little more digging turned up that he's been on Suboxone and Naltrexone before. Clearly those drugs didn't work for him.

A lady came in who insists we order her Percocet brand. We know, from one of our RPh's being friends with people in other pharmacies who deal with her, that she sells these drugs. We have finally had it with her, and we are finally pushing her out the door. I am just thrilled we don't have to stock brand Percocet anymore!

The week preceding the full moon was a disaster. We had floaters in and out because we got a sick pharmacist. We had new patients transfering lists and lists of drugs in, many of which were too soon. Then, even though the pharmacists at the other stores said nothing was in their bins waiting, the patients insisted that they were, and they were right. I spent half a day rebilling for someone.

We discovered after a week that our Vicodin HP patient's doctor had previously had rx pads stolen off of him. Not the best news to hear, but at least that person is done with.

It's been a crazy time in the Pharmacy, but all these good stories that I know I was planning to write up have fallen out of my mind. I'm bummed.

One last thought:

I've got another two fuck you's to issue: number one, to our dear friends at Actavis Totowa again, because all of their freaking drugs are being recalled, and my shelves are rapidly becoming devoid of drugs I have cranky old people on. Fuck you number two goes to my dear friends at Procter & Gamble. I am so fucking TIRED of your drug reps coming in and wasting all our fucking time with all your new fucking ACTONEL PRODUCTS!! If it wasn't enough to have the once weekly Actonel 35, and the Actonel plus Calcium, now you give us twice a month Actonel 75, and, the best news yet ... ONCE MONTHLY ACTONEL 150!! I forgot to mention the 30 mg Actonel and the 5 mg Actonel as well. These drug reps come in and interrupt me as we're dealing with an onslaught of waiters, always without fail. Do me a favor, and just fucking quit bugging me. I'm not going to tell people to go beg their doctor for a drug that's likely a higher tiered copay, and I'm not going to waste my time giving out the millions of coupons you'll give me for a drug that probably won't catch on at my pharmacy. Nobody wastes their time with Boniva due to the price. Everybody loves Fosamax now, since there's generic alendronate. So stop bugging me. I'm busy.

Wondering

I've been checking in with my SiteMeter every once in awhile, and I've noticed I've actually got what seems to be some fairly regular visitors. I know I don't post nearly enough -- in fact, I'll probably have to start bringing a small notebook into work so I can keep track of things to work on, just so I can update more. But I want to know who's reading me, especially those regulars.

So, if you could -- please leave me a comment and let me know you're reading. It appears some of my regulars are actually from my home state, so it's nice to see that some of my audience lives nearish to me.

If you have anything you want me to write about, too -- feel free to ask. There are a lot of subjects you can touch opon while writing about pharmacy life and such. I know I could never touch all of them.

I'll have a real post probably tomorrow. I've got major plans involving a certain place I like to call my Second Home, and a big event there.

Crossing the Line

There are fine lines with ethics, rules ... basically, most things that can go on in a pharmacy have lines you may find people crossing.

Lately, our PIC, John, has been wayyyy overstepping his boundaries. John is a Catholic man. Many of us at our store have different religious beliefs, and for some reason, lately, it seems that they are not good enough. John has asked many of us to question our beliefs, and to even welcome his into our lives. He has crossed the line there.

One of my technicians has very different values, and for some reason, John has specifically marked her as one to work on. My tech has not spoken very much at work lately, and when I finally got her to talk, she told me her family is not very comfortable with John's religious talk. They are not the only ones. We have had countless discussions on how to handle this. After conferring with Pharmacy Chick, it seems like we finally have options. There has to be a clearer line than the one we have been drawing, but he is going to have to save his opinions for at home.

Also, I found out John has been lying to my face. I'm not going to get into specifics, but it does deal with some of our coworkers, and some of them have been angry with me over things he has apparently "forgotten" to discuss with them. I feel like crap, physically and mentally. Here I was, laboring under the opinion that he's sorted out these workplace issues, then I find out that nothing's been solved! Some of my staff wants to leave over this issue. I am alongside them in that one. It is disappointing to find out that someone you are supposed to trust is lying to your face. You rely on your pharmacists ... or at least, we do. We have always had a great relationship at our store, but it almost feels like that's falling apart.

I've given applying to another chain a lot of thought, yet in the past week, I've never had the guts to actually fill out the application and send it in. Maybe in the next week I will find the cajones, and do it. For now, though, we will see how the next week goes.

Quick hello

I haven't written very much lately. For the past week and a half or so, I've been contemplating job moves.

For the past 3 years of my life, I've worked for the same Chain Pharmacy. The supervisors have pushed me to become the best I could, to take the top jobs I could take, and I've done everything they've asked of me. Last year, I took my PTCE, and passed with flying colors. I was promised a substantial raise, and they also promised me that, once I took the top technician position available, they'd give me a great raise there, too.

The head honcho locally came in a week and a half ago, and crunched the numbers. My "substantial raise"? That was supposed to bump me up two whole dollars?

84 freaking cents. A mere 3 cents short of the next whole dollar amount. And "we tried to round it, but they wouldn't let us."

BULL. SHIT.

50 cents of that raise was also my "CPhT" raise. Another crock of shit, if you ask me. My new job title did not get me a single penny in the raise.

I jumped into overdrive -- there's more chains opening up near me, and if I could apply for one of their jobs, that'd solve all my problems! I'm sure!

But as reality set in, I thought about it. I WANT to be a pharmacist one day. I WANT to reap the benefits of forcing my way through 6 years of school, busting my ass, and when I come out, dictating to THEM what they will pay for my services, not them dictating that I'm just not good enough. Chances are that I wouldn't even work for this chain when I was done, because of the piss-poor treatment they give to techs like myself. I want to get myself to become a pharmacist, and when our (non-pharmacist) supervisors come in for raise time, I'm going to give them hell until they begin to understand that my techs are absolutely important in the everyday business of my pharmacy.

It's ridiculous that my chain pays 6th year interns $17 an hour, yet I make WAY under $10. My newest employee is almost through with his 6th year, and we just hired him 3 months ago. So, he's making $17/hr, and after 3 years, I'm still below $9/hr. That doesn't pay the bills for me. And, he only works a few days a week. They should be more concerned with keeping ME around, since he's free to go anywhere that's willing to pay for his services in just a few short months.

So, my new plan will go into action. Starting as soon as possible, I'll follow the model of what classes you need undergrad, and I'll take them online or at a community college, bust my ass doing so, and transfer into one of the major local universities. I'll fight my way through 4 more years, and when I come out, sure, I'll still be cynical, but I'll be fighting for those who aren't going to do what I'm going to do, or those who just can't.

Busy month

You know, in January, we were hugely busy. February, pretty busy still. March, starting to settle down. And April, fairly slow. I don't know WHAT has happened, because school won't let out for a few more weeks around here, but all of a sudden, we're totally busy with not enough help. I've been working long days with no chance to run to the restroom, and no chance to eat half of the time.

We've been fortunate enough to get some rotation students, though, since colleges are letting out. It's been different, teaching them our chain's computer systems, and teaching them all kinds of different things, but our PIC has been doing pretty good acclimating them to the job.

Interestingly enough, I've got to say, things have been fairly smooth overall. With the exception of me always seeming to pick the wrong thing, whether it be go to the registers instead of the phone, or the drive-thru instead of the register, or something, of course.

Today was kind of weird, though. It felt like every person had a problem when they came in. There was a girl who had just gotten 3 months of birth control 3 or so days ago, yet said she left them at her house less than an hour drive away, and still wanted me to transfer them until she realized she'd have to pay about $60 for one pack. Then, one of our little old ladies came in and complained about something or other. Then, someone needed me to go point out eye care, right under the sign that says 'eye care', where it always is. On top of that, today was the day we write up our order for the next week, so that took some time. After that, we found out that our relief tech was sick. I had an appointment, so I could not stay. She did us a huge favor and sent in a friend, after we found out that our intern was sick as well.

I guess what I have to say, is that I don't have all that much to really say right now. Hopefully June rolls us back into our typical Summer Sloth mode. As much as being busy is nice, there is something to be said about kicking back, eating some snack food, and doing your CE's on company time if there is nothing left to do elsewise.

A big FUCK YOU! to Actavis Totowa

Those jerks are the ones responsible for the recall of Bertek and UDL's Digitek. Digitek has historically been the cheaper of the two brands of digoxin we've carried (Lannett and Bertek were our choice), so we let the Lannett expire. Plus, it WAS a good $3 cheaper, and at my CorpoPharm, we like to be nice to the old people for the most part. So, we got the cheap one, let the old Lannett 125's expire, and rolled on. Until just a few days ago, when we received notice of the Class 1 Recall. In my career, I've never seen a Class 1 Recall. My PIC (who, granted, is fairly young) could not recall a Class 1 before. So, we had to spend yesterday calling patients, and ask them to please return to us their Digitek, so we could give them our Digoxin stock, which, our wholesaler was out of. Yes, our wholesaler fucked up big time and RAN OUT of Digixon. They told me they won't have any until at least next week. We had some Lannett 250's that are expiring in August. The problem is that we only have about 6 patients taking 250's, and about 30 who are taking the 125's. I managed to procure 300 off of other stores, and I'm going to have to go on a mission to get more today. We already owe 2 people 90 day supplies. If worse comes to worse, we will have to partial them out until we can get SOMETHING next week.

If you're a patient and reading this -- chances are that your pills were NOT in the affected batch(es). You'd probably have some sort of sign of problem if they were double the thickness. There's a lot of fairly obvious signs of digitalis toxicity. You'd probably see at least one. I can't guarantee you would, but I think you're okay for now. See your doc if you're concerned. The docs we talked to yesterday said they're not too worried, and that they're going to do the blood tests as a precaution at their patient's next check-ups. They don't feel that a rush to get blood tests by their patients is warranted.

We had a ton of people come in and tie us up for over an hour, extremely concerned about the fact that they had a recalled medicine. I know it's scary, but TRUST US. It's our job to know what's going on. We also don't have any FDA info, nor an information sheet from Actavis Totowa with the specifics of HOW much % the affected pills were off from what they should be and technicalities like that. Stop asking us these things, and CALL the freakin' 800 number for the jerks at Actavis Totowa who are doing their job being proactive, but not releasing enough information to satiate the public's fear.

Like I said. JUST TRUST US. We're going to get you through this. Worse things have happened.

Slow times

Sorry for a lack of updates. CorpoPharm has been pleasantly slow, after a huge boom for the first quarter of the year.

This has made me reflect quite a bit on our day-to-day operation. I spend a good bit of time actually doing work -- receiving orders, doing miscellaneous pill counting, pulling outdates, data entry, ringing register, the likes -- but it seems a lot of time lately has been spent on two things:

1) Answering questions pertaining to the restroom
and
2) Answering questions pertaining to "extra" services

I can't even tell you what percentile of my day is spent playing GPS and pointing people to our bathroom. I've frequently questioned if people purposely drink a gallon of water/tea/soda/WHATEVER when they leave their houses, and say "Oh look, there's CorpoPharm. Potty break!". Now, I can understand the service workers who help us out, like our vendors that bring in orders, and our UPS men who spend all day in their trucks, and people such as that. But, I can't even begin to count how many regular people start out at the front door and make a beeline for our front registers, asking how to get to the bathroom. The directions are simple -- go all the way to the back, just after beauty. However, somehow they confuse "beauty" with "pharmacy counter". Yeah, you caught me. I'm hiding the toilet between Tekturna and Trileptal. I repeat the simple directions, and throw in a few hand motions to demonstrate down and right. We've remarked quite a few times that we'd like a tape player with a continuous loop, so we could just hit "play", let it roll all day, and go back to work. It's pathetic.

Part two -- "extra" services. No, not those kind of services. People frequently call up CorpoPharm and ask if we have delivery, if we can bring them a quart of milk with their delivery, and if we will keep their credit card on file so they could call us and have their photos and prescriptions and their laxatives and maybe some eyeshadow waiting, all paid for, as they run through the drive-thru. This is part of what is wrong with pharmacy. I've ranted on the drive-thru before -- I think it's great for disabled elderly people, people with SMALL children (read: NEWBORN to MAYBE 2, to be generous. If they can walk and hold your hand, GET OUT OF THE CAR!), and people who have just completed surgery and are still puking all over themselves from the anesthesia. So, when Joe Schmo pulls through, and says "Hey, can I get my photos here? Oh, and a pack of batteries for my camera, thanks!", I shut my window on them, after explaining that this is the PHARMACY department, and we don't do photos in the PHARMACY. You have to go to the photo counter. I don't hand my prescriptions to Susie up front, and ask her if she can just fill them and hand them to me right then. I wouldn't hand my film to my pharmacist, and tell them to step on it, that I have places to go. It's ridiculous, and people are truly trying to make us into less of professionals than we already feel like when people just dump a cartload of stuff at our counter, and say "The girl up front has one person in line, and I didn't feel like waiting for them to finish. I'm sure you don't mind ringing this all up! You're not busy." Don't even go there.

As for the delivery stuff. CorpoPharm offers delivery at SELECT locations. We are not one. We have not been one. If we had enough hours for a delivery driver, and we had an actual viable amount of people who needed delivery, I'm sure we could appeal to CorpoPharmacy to change this. However, most of our clients don't ask for delivery, so we are all too happy not to start a big fight to get a driver. Plus, it is not the delivery driver's job to get you your triple-a batteries, and maybe some pink lipstick (coral, not baby!) to boot. Their job is to bring your prescription to you, have you sign for it, and pay for it. The end. That's all it takes. That's all they're expected to do. If you have a serious reason you can't get something, and are nice to us, maybe, we can bring you a container of milk. But that lipstick isn't something you should expect the driver to want to grab you. You know we'd never get it right, anyway.

I don't know. It feels like we're almost becoming a joke back there. Between being the BDB (Bathroom Direction Booth) and fielding these ridiculous requests at the drive-thru and on the phone, it makes me shake my head much more often than I should at work. We are pharmacy PROFESSIONALS. We are not cashiers, so please do not bring us your entire cart. We're more than happy to help you with your medicine. Just stop asking these ridiculous things of us.

E-Prescribing ... pros/cons?

Pharmer Jane's blog gave me a good topic to talk about tonight -- e-prescribing.

I'll admit it -- at the very beginning, I was totally drinking the Kool-Aid, believing this to be the answer to life's problems in the pharmacy. Finally! The doctor has to make the prescription clear and concise. The joke's on them! We will have our jobs done even more quickly and efficiently, PLUS, there's no hard copy for your typical Absentminded Abbie-type patient to misplace!

That was the beginning. It was quickly after e-prescribing started to filter through some of our regular doctors' offices that we realized what a headache it can be.

Sure, the e-scripting cuts down on a lot of errors. But, seriously? The local dermatology practices are huge on these systems, and change which one they prefer practically every 2 weeks. If I had even just a penny for every single issue with their rx's (no quantities, malformed sigs, typos, dosage forms being written for that don't exist, and so on), I could probably retire for at least a few years before I'd have to get back into the swing of things. But, when they write for "Plexion", how do we know if it's the cloths, the wash, or whatever else some pharmaceutical company churns out for another brand name zillion dollar "copay rape", as we've termed it at our store? They always write "as Directed in the qAM" or something just as ridiculous in the free-form text field that appears on their screens. It's also cute when the quantity field says "QS", and there's no duration specified. Just "as Directed". That's all they ever write.

And what about the doctors' office who can't even get their patient's chart correctly? Patient John McFarlander has been taking Diovan HCT for two years now, at least, and Dr. Idiot still thinks he's taking 80/12.5. Mr. McFarlander's been taking 160/25 for the two years. In fact, for the first 6 months, he took 2 80/12.5's a day. 2 tabs qd was what Dr. Idiot's nurse, Kathi, called into our pharmacist. We pulled all the 5 hard copies we had -- all phone-in's -- and they all said the same thing. "Per Kathi, please dispense at 160/25. Dr. Idiot states dose is correct at 160/25." Yet, it's always incorrect. Can you imagine an e-script from Dr. Idiot? Either he or his staff are desperately behind with their reading skills. In fact, Mrs. McFarlander sighed sympathetically with us as we frantically tried to get her husband's problem straightened out before he had to go to work. "They always do this, don't they? They can't keep it straight, can they? I can't believe this!"

E-prescribing was supposed to make it so much easier for someone to look at a patient's chart, and to find out where the problem lay. It was supposed to be fool proof! What happened to this dream world we were in with our Kool-Aid glasses held aloft to toast to this new technology?

I will be the first to say that I agree with e-prescribing, don't get me wrong. I'd rather sit and call Dr. Stupid's nurse 3 times a day to correct his malformed sig of "per Day or as Needed" on Peter Pan's amoxicillin than sit and try to decide if it says Duricef or Omnicef, let alone what strength it says for his wife. But, until humans are perfect, e-prescribing can't be. So, yes. There's a lot of issues. But, if it will help Mrs. Smith just once on her way out of the hospital and back home after contracting community-acquired pneumonia and bronchitis and needing to get some Augmentin, than I'm all for it. Just don't hit me with a retarded sig. Typically, these systems have some form of an input field for a sig. Don't fuck it up. It's simple.

I see the future moving towards e-prescribing as the only acceptable form of maintaining medication records for doctors and pharmacies, and even possibly, a system where we can share information easily from doctor to patient to see their previous history of medications, and any allergies known to either party, so when their Celebrex is denied, we can help the doctor figure out if it's easier to try some Anaprox DS, or maybe even meloxicam, if either are appropriate. Something like short-term antibiotics, and of course, controls/narcotics, should require tamper-proof, original hardcopies as many states require/request as it is, but hopefully the e-prescribing business continues to head in the right direction.

Sorry this isn't a 100% perfect entry, and that it sort of rambles a little. This is a big weekend at Casa CPhT, and it's not even here yet. There's still so much planning to do that this pharmacy tech is wondering how things will ever get done before the big start to the weekend tomorrow. What are your thoughts on e-scripting? I'm interested to see if anyone else is behind my thoughts on this one.

Fun times

I haven't been able to think of good stories lately, mostly because I have to change things in them now. But, I think I have at least one now.

Last week, this guy stopped into our store. He was rather interesting. When I got to the register, where he was pacing, he looked me dead-on. "Do you know anything about cuts?" he asked me. "Well, what ABOUT cuts?" I answered. "Cuts! Like this one."

He rolls up his pant leg. There's an obviously infected cut across his leg. "I got this cut a few weeks ago. How do I make it better? I've been using homeopathic cream to fix it, and it isn't getting better. HOW DO I GET IT TO GO AWAY?"

I called John, my pharmacist, over. John sees the cut, and tells the guy to see the doctor, because it looks like it could be an infection. "Listen, John," the guy starts. "This isn't infected. It's looked like this for a few weeks. It's not a cut. You know how when you drink too much and your liver gets hurt, but after awhile, gets better? It's sorta like that. I cut it too hard and it won't heal very fast. I just want to speed it up. It's not infected. Really. I know."

This man was no doctor. Both John and I could plainly see this man's need for a good dose of some type of antibacterial agent, but this guy was too full of himself to be able to listen to our medical advice.

I just don't understand why, if they don't want our honest to God opinion, these people bother to waste our valuable time, when there were about 20 prescriptions waiting for both John and my attention that we could have done if it was not for this idiot. But he was sure it was just like hurting your liver drinking. Whatever.

Also, I got a customer complaint given to my PIC, John, the other day. Apparently, this lady asked for a refill on her skin cream (I think it was Vaniqa), and when I told her she had no refills, and that the doctor would need contacted, she told me fine. Well, apparently after the doctor called her at home and told her she needed a follow-up appointment to get more refills, since she'd been using that tube for about a year and a half (and I believe she actually got the tube shortly after it came onto the market), she decided she told us not to call (not true). So, John got an earful of how I was incredibly rude. Now, this lady is a whiner -- she has complained to us many times about how mean her doctor is because he requires her to show her face for an appointment every once in awhile to check her Synthroid dose, and all kinds of similar things -- so, I didn't get into trouble. But it was a good laugh, especially considering that she told me it was important for her to refill her Vaniqa. I guess she was afraid her ladystache would come back overnight.

Hitting the big-time

I got my first reader e-mail:

"Hi,
I was wondering if you could go on a rant about Accutane and the stupidity of the IPLEDGE system. So many more babies are born with fetal alcohol syndrome, yet the FDA does nothing about that. Unbelievable...I guess it all comes down to politics. In a way, I can understand why the FDA is concerned, because yeah it does screw up babies...but don't you think something is wrong with this picture when it's easier to buy a gun or get an abortion than go on accutane.

Thanks,
Susan"

I spent the day yesterday contemplating this, and I came to a conclusion -- I can a gree with some points in Susan's e-mail. I agree that there's nothing the FDA does about FAS, but what CAN they do, besides the warning on the alcohol bottles? I can also agree it's easier to get an abortion, but I agree with the iPledge system for the most part.

See, for those of you who aren't in pharmacy, and don't know how iPledge works, here's a brief rundown, to the best of my knowledge (some things may be a little off, since I'm only in the business of dispensing, but they're all in the ballpark) -- you have to make an appointment monthly with your doctor to get a script -- no refills are valid. To START on Accutane, both genders need to be signed up for the program by their physician, who has to be a member of the program as well. A woman of childbearing age has to wait a month to start their medication, as they have strict regulations about said woman taking pregnancy tests and/or blood tests every month. They are also required to use 2 forms of birth control, abstinence being allowed as one of them. This lasts for a month after the treatment ends, too. Males and females who cannot get pregnant just have to go to the doctor monthly for their prescriptions, and possibly some blood work.

Here's the main reason why I DON'T agree with the e-mail I received --

There's a serious NEED for the program to be so strict. Harming unborn babies with serious birth defects is no joke, and I'm not saying FAS is a joke, but these babies are born deformed and mentally challenged. According to the March of Dimes website, these are some of the most common Accutane-induced defects - "hydrocephaly (enlargement of the fluid-filled spaces in the brain); microcephaly (small head and brain); mental retardation; heart defects; ear and eye abnormalities; cleft lip and palate; and other facial abnormalities.". I don't know about you, but I'd much rather a woman have to take a urine test every month, and be on birth control, then see a baby born with these issues that WE have to support on their welfare plans, when these issues were so easily preventable in the first place. Yeah, it can be a pain in the ass for these people to go to the doctor every month and be tested, but in the end, it saves them from terrible acne, and any potential babies from these terrible defects.

So, unfortunately, I can't really agree on this rant, but it was good fodder for a blog. Thanks Susan.

Real-life do-over

I've seen the blogging community through a lot of things, both on Blogger and on different servers. This was something new -- an anonymous blog, where no one would know who I was!

But. Over the past month or so, I realized just how much I was giving away. If I was a coworker of mine at CorpoPharm, I could identify who this was in a heartbeat. So, this morning, I went through, and kept posts where things were fairly vague. From now on, I'll be making up names for my pharmacists, and my coworkers. I've said some things that, while never crossing the line, may not look favorable to certain people in CorpoPharm. So, beginning now, it's a fresh start, basically. I guess Pharmacy Mike sort of inspired the 2nd half of this change -- rather than always use actual stories that happen at CorpoPharm, I may change some details, too, just so it's harder to figure out who I am.

I'm looking forward to this new start. Some of my readers know my real identity, since I've told them who I am. I trust that they'll keep my identity secret. We are fellow TPA dues-paid members, and we will look out for each other.

There will be a real post at some point tonight, if I don't get the call to help out a friend at their house with a moving project.

And Hilarity Ensues!!

One of the absolutely funniest things, ever, happened to us today --

Patient comes in. I don't know how old he was, but obviously old enough to go to a geriatric center to see a doctor. Let's just call him JB Dumbass, for lack of a better name.

Mr. Dumbass comes to drop-off. I was up to my ass in rejection, so Part Time RPh takes the prescription, after he told me he would not talk to me anyway.

Seems that good ol' Dumbass left his hard copy at his house, but he wanted us to call the geriatrician to get them to phone in the prescription, since he didn't feel like going home for it. He lived 5 minutes away, maximum, in traffic.

RPh calls, and gets transferred to a voice mail. He INSISTS she calls back! She does, gets a person, and they tell her they'll try to get a nurse, but if one doesn't pick up, she has to leave a message. Two minutes pass, and she's dropped into voicemail. She leaves the message. She then offers him a few pills to get through. "Well, I haven't taken any in a week! I need a few!" This is for his amlodipine.

We give him a few, and he goes to our drinking fountain by our restrooms. He comes back. He then proceeds to take a seat in our waiting area for the next THREE HOURS before finally conceding defeat in that they won't be calling back anytime soon. I'm not exaggerating when I say 3 hours. Seriously. It was the most ridiculous thing ever.

We had another crappy day, but thoughts of TPA and how hilarious a blog this could make helped us pull through.

Also, I'd like to thank Mr. and Mrs. Shithead, for taking a big dump on our company, once each, for dragging competitor coupons for gift cards to us. Five dollars total on each RX, $30 coupons for each. A $25 profit for each. Sick. I hate coupons. I'd like to see them try again, because I do mark in patient's profiles when they are allowed their next coupons, because if they're gonna use them, I'm gonna do what my supervisors said, and force upon them the limitations the originating pharmacy making the coupon forces. It's nice that most of them say ONE COUPON PER 6 MONTHS. It really makes my job a bit easier, and I take pride in forcing these people to try again somewhere else. I'm sick of my company being shat on be cause they want their free gifts for coming. I can't wait until TPA gets this practice outlawed. I'll do anything to help!

Also, lastly, I may or may not end up buying a domain name of my very own for this blog, now that I've got a renewed interest in posting. We'll see.

Edit: I forgot the moral of the story -- when the office called back, at 4:30, we explained that he had the prescription at home, and they were flabbergasted when we told them he'd sat there for 3 hours. They told us they would not encourage bad behavior on his part, and that he had to bring the script in. Vindication was never quite so sweet as this.

If last week wasn't a full moon week, then we're fucked

Honestly. Remember that post I made Thursday morning? The one right below this one? Yeahhhh. The rest of the week went just as bad, in fact, Thursday had me on the verge of tears most of the day. I'm going to forget everything and just let go, because if I don't, I may quit that job I need, even as underpaid as I am.

On that note, too, I want to add that I'll be mailing my dues check for The Pharmacy Alliance shortly. TPA has me truly stoked for my profession. If we all take a stand, we may be able to make our profession what it's supposed to be -- a PROFESSIONAL business -- and take it back from the brink of us being the glorified cashiers we are currently becoming. If I could afford it, you KNOW I'd be in Galveston at those meetings, putting my 10 cents into 'the bowl'. I'm going to spread the word -- my hope is that others do so, and continue to do so, if they already are. I haven't been this excited for something like this in a very, very long time.

We were so screwed yesterday

You know how every time you have your day planned, and it seems to go your way, then it blows up RIGHT before you have to leave? Yeah. That happens a lot to me.

Yesterday morning, my longtime part-time pharmacist's new buddy who came in and bugged the piss out of her about prenatals came in AGAIN, and made us show her every damn bottle so she could pick a brand she wanted to take. She says she's allergic to fish oil, and miscellaneous other things, so she was going over every single ingredient, and tying both me and New RPh up all damn morning. After that, I got a new customer via phone whose insurance card had not arrived, so he wanted to call in his insurance along with the rest of his info, but he did not have his BIN, and just said 23*. Tried the typical condor code, and no go. Tried the other regular processor, and no go. Told him I'd have to call the other processor, since he said he was pretty sure it was under that one.

He told me I had to call him when I got it through to tell him the copay. Uhhh, generic Ambien is always covered; never seen it NOT covered by any 23* plans, so I'm sure it will be, but NO! You must call me! So, I waited on hold for 10 minutes for the lady to tell me, like my previous rant, that since I did not know his social or his 10 other addresses, I could not get his correct info. I was resigned to call him for his social security number. When I got another rep, they tried to get me to verify his addresses anyway. I was starting to get angry, so I read off the social, and finally got all his information. $10 copay. Call the guy back (btw - he was born in the 40's, I believe, so the New RPh and my intern that came in a little while later teased me and told me I was being Mommy for him, and I said not only did I not want that old of a child, but he should be able to do this himself at his age and provide me with the correct insurance information! But they do lie, and that is a whole other can of worms). He told me he'd like it ready by 4, but he didn't plan to come in until later that evening, or possibly the next day. Uhhhhh, okay?? We got it ready, whatever.

After THAT, a Suboxone representative, with some asenine title, came in and handed me all this information, after I told her I don't carry it. Then, she handed me a package of pamphlets, and here's what made me so mad at her -- she tells me to just 'slip these in someone's bag if you think they need help with their problems'. Yeah, oh-fucking-kay. I'm gonna piss off one of my customers, because you want me to sell more of your drug that I DON'T CARRY! The doctors that are allowed to prescribe it DON'T send their patients to my store! Seriously, what the fuck does this woman want me to do, just say, "Well, Mr. Doe, you buy an awful lot of hydrocodone and oxycodone, and it tends to get stolen quite often; I think you should go find a doctor that can prescribe you this wonderful drug, and maybe get a little help." Seriously. The people who come to my store that have issues KNOW they have issues, but they refuse to get help for it. I'm not going to piss them off, because they do pay good cash for their legit rx's, even if I question the doctors' sanities for writing for so many damned controls. Not to mention, something like that has to be approved and distributed by CorpoPharmacy. I restrained myself, after giving her the dirtiest look, from throwing her out of my pharmacy for even suggesting something so asenine. New RPh, Floater RPh, Injured RPh, and My Oldest & Favorite Intern all agreed that this was an absolutely ridiculous request on her behalf, and applauded me throwing those damn packets right into the trash, where they belonged.

It also just made me laugh, because I spent the last 20 minutes of my shift on hold for a Welfare prescription, where the 5 day old child hadn't been added on for an OTC product, SURPRISE, SURPRISE. Then, I got stuck, because someone whose call I took that morning came in to get 5 prescriptions and wanted me to do them for her.

I was supposed to leave a little early yesterday, because I had somewhere to be. Instead, I left 20 minutes late, and cancelled my plans.

* - after reading Pharmacy Mike's site, I decided since I was complaning about The Other Processor's reps, I might as well just blank out the plans that guy had, and such, so the 23 is actually a veiled way of saying **** *****/**** ******* (a popular insurance plan, that you may now be able to figure out). Not saying anything mean about "23"; because I like 23, and had them as a child, and now have them again as a CorpoPharmacy employee. I just wish their prescriptions help desk (who is luckily not my help desk for my prescriptions) would get their shit together, and not make life difficult for me on an already shitty day.

A Few Things Today

1) Yesterday was my first day back at work since being hit with the dreaded influenza. It's going around our chain's local area right now, apparently. One of the first things I had to deal with was a woman who was so impatient, she told the pharmacist on duty (who got the drive-thru for me yesterday out of pity, since I was barely able to stand up, a week after my flu) everything she needed was written SOMEWHERE on the blank from the local emergency clinic. We got her name, address, date of birth, allergies, insurance ... no phone number.

Pharmacist on duty enters the insurance info. No go. It says there's a problem with the cardholder id. I take over. It's entered correctly, but in pharmacy, you usually need to drop the 3 alphabet characters at the beginning of the ID. I drop 'em, and still, no go. I do everything I can think of before I call Anthem for help. What happens when I finally get through, after a possibly 10 minute hold? My new Mexican friend at Anthem tells me he won't give me the date of birth (which is apparently the problem -- NOT the ID, as their rejection told me it was) for my patient, because she's recently moved, and I don't have her old addresses, nor her phone number. She had a very unique last name, and I'm sure she was the only one, since he told me she was, but since I couldn't give him anything else, he told me it was a violation of HIPAA to tell me any information without verifying where she lived or her number. I told him she'd recently moved here (true story), yet he wasn't having any of it. I'm not racist, in any way, but you have to think -- with outsourcing and everything, do these people REALLY know the US laws? I mean, we have to follow them to the letter every single day. When they leave their job, they don't have to think about it at all, nor is it relevant. My point was that I'm a healthcare provider, and it's not a violation of HIPAA to tell me her information. When the patient's mom came in later, I asked for any old addresses, and got a handful, and got a recent phone number, too. I call Anthem back, sit on hold for an agent, pass the mom's insurance problem (different carrier and everything) to the pharmacist on duty as I'm working on the daughter's, and when I get a lady (still slightly foreign), and give her all the precious information, she said if I'd've called right back, she was sure anyone else would've cooperated with me, without needing all that extra information. My patient's care got delayed, and I was really irritated that I'd spent a good 20 or so minutes on hold between the two calls. If I would have been feeling better, I would have asked for the first guy's supervisor and had it taken care of on that specific call, but I was feeling like crap and just didn't feel up to fighting.

2) A patient got mad at us today, because she called a prescription in for us to phone her doctor on Friday. We sent an electronic request, as that's the doctor's preferred method of receiving refill requests, and we sent another one yesterday. The lady neglected to tell us she also had a new prescription on file. She comes in and tears me a new one, and I just filled her new prescription from on file. She had the worst attitude I've seen in a long time, and she said we should've called to tell her the doctor wasn't responding quickly enough for her liking. They were out of the office by the time she'd sent the request in Friday, and that doctor doesn't work weekends. Is it my fault we waited an appropriate time for a non-essential medication to be sent back to us? No. It was not fun.

3) A regular came in today. He's not been around too much since his wife sadly passed away, but he's still a regular. He hands me 3 prescriptions, and tells me he wants them submitted for 5 month supplies. First problem -- 2 of them, cholesterol and blood pressure meds, are written for just 3 months at a time, and the 3rd, a sleep aid, was just one month at a time (with 11 refills for a C4 ... when will they learn?!). I explain these restrictions if I'm billing his insurance, then I see in his file he has Caremark. Anyone who's dealt with insurance knows Caremark's stringent 30 days only rule. I run them, and of course, it comes up 30 days only. I tell the man, and he freaks out, and tells me he always gets 90, then realizes he's been doing mail order, then changes his mind and insists to me that they'll pay for 90 at retail. I explain the situation, and he gets mad and takes all 3 prescriptions back, even the sleep aid. I explained that his sleep aid needs to be re-written for #90 with 1 refill if he wants to be able to use it through mail, but he brushed me off since I guess my answer of Caremark only allowing 30 days at retail was not good enough for him.

FYI to Patients

As a somewhat veteran of the pharmaceutical distribution industry, at the retail level, I feel it's necessary to remind all patients of the following few things:

1) Do not stick your credit card in your mouth while digging through your purse, then hand it to us. That's disgusting, and can make us sick.

2) If you're sick, and getting an antibiotic or something, please attempt to not cough all over the pharmacy, the registers, or us.

3) Most important!! - When you're sick, and you are hesitant to hand over your prescription that you've coughed over, you should hesitate a little more in shoving the money we've watched you cough all over at us. Not only is that also disgusting, but it can make your resident technicians get ill with the flu, and not be allowed to work for a week.

Thank you for your time. Your regularly (or not) scheduled updates from the CPhT Extraordinare will resume whenever this tech is allowed back to work.

It Never Ends

Sometimes, I just can't imagine the days I have at work.

Two days ago, a regular, let's call her Amy Irrirating, drops off a prescription for her kid. Now, she literally takes 100 mg of Paxil a day, in tandem with a few other similar drugs at equally high doses, and it's a wonder she can even have any type of feelings at this point. So, she came through my drive-thru, chatting a mile a minute on her cell phone, and just thrust her kid's prescription at me through the window. I know the patient's in my computer, so I didn't bother to get any other info, and since she was practically yelling (people over 40 never seem to realize you don't have to yell to be heard on a cell phone, no offense to anyone over 40 who is sane and realizes this), I wanted her out, so I asked when she was going to pick it up. She ignores me. I ask again, and she puts on a pained expression, holds her phone up by her shoulder, and flashes me a "2-0" with her fingers. How rude! She drove off before I could say anything else. When I glance down at the rx -- cefdinir. 1 & 1/2 tsp qd x 10 days. NO STRENGTH. Argh. I give her a call -- no answer. Leave a message. She comes back in about a half hour. It's been lunch at the doctors' since she dropped off, so we couldn't get ahold of them. She gives my co-tech a terrible time at the window. Is it our fault you stopped us from correctly serving you by ignoring us? Finally, we got it taken care of, and she ambles down about 2 hours later. My pharmacist in charge told me we no longer have to wait on people if they're going to do that -- we'll just tell them we'll be happy to help them once they've ended their call -- and her two bosses already told us before that that's more than appropriate.

Yesterday, I answer a call from a local SuperChain. It's like a Walmart-type of store, but on a slightly smaller scale. The pharmacist tells me he wants to transfer me a prescription in, so I pass it to my pharmacist. Turns out, the patient lived near us, but had never been to us. Okay, we get all the info we need off them, including insurance, and we process the Factive-5 prescription. For starters, who writes for Factive?! It's never covered for less than $40. That price is exactly this patient's total. As I ruminated over the debate to order vs. not to order (since I basically do inventory at work, too), it hit me -- that irritating rep who stops in every 2 or so months that didn't leave us alone until I got the box in and showed him we'd given in and ordered his stupid drug, yeah, he gave me a few coupons. With just a moment or two in our coupon drawer, I found what I was looking for -- a Factive coupon for $50 off, still in date until April. I reprocessed his claim, and BAM! No copay. $0. SuperCPhT* saves him 40 bucks.

The guy comes in about an hour later. The other tech waited on him. He was very weirded out that we had his Cigna information on file. She politely explains that the SuperStore pharmacist wanted us to have it ready, since he didn't think it would take very long for this patient to come in. Then, she explains that the $0 copay was due to me finding a coupon and saving him $40, and instead of him being grateful, he started freaking out. "I've NEVER had a copay for $40. Something MUST be wrong!" We told him, "It doesn't matter. Nobody prescribes this drug for that reason, but we saved you $40, and you get it for FREE!" "Oh. Cool," he replies. No thank you's, no sorry's for his outburst. Nothing. I'm a nice person who, contrary to complaints to my supervisors over following the law and not giving out new/transferred rx giftcards to seniors on Medicare that I'm "scamming them", isn't out to screw the patient. I try to go above and beyond -- not because the CorpoPharmacy suits want me to do it, but because I'd want somebody to do that for me. These kind of things kind of make me scratch my head, and wonder why I try sometimes. It prompted me to clean out my coupons, at least. We only have a singular Factive coupon, and some Akurza Lotion/Cream coupons that we'll never use, left over. Hopefully, next time I decide to be nice and use these things, the patients will be a little more appreciative. I mean, hey -- I could've easily charged the guy $40.

I Live!

An update! Finally! I've been busy absorbing my greatness at gaining the CPhT title, as well as taking a well-deserved vacation. In the past 2 weeks, I've worked a total of 5 out of 14 days. Not shabby!

The beginning of the year has gone fairly smooth. I've not had too many expired insurance policies popping up. I also haven't seen too many insurance lines going down yet. My single complaint is that it appears that approximately a quarter of my patients who have coverage through plans served by Medco have varied from the 1000000000001-style ID numbers, and now have ID numbers starting with 600, and some weird group number that ends in PDP, and they aren't even Medicare plans. None of these Medco plans with these weird ID numbers and group numbers have sent out their new cards, it appears, because everyone we dealt with in the past 2 days said they'd received such cards. All I have to say, though, is that the Medco hotline has a great automated system to deal with this.

Honestly, as I've been out of the game for so long, I really don't have much to say. I'm sure the next few weeks will garner many more amusing anecdotes to post, but for now, I guess I'm done.