That's Rude....

You know what lady?  I'm here by myself....so yeah, I'm a little more cautious at night when it comes to opening the window.  I'm also a little busy sometimes, but I make sure you get greeted promptly.

What is it with people?  How about I come to YOUR work and bitch about you....oh wait, you are on medicaid.  That explains so much.....you've forgotten what it's like to be on the receiving end of pointless bitching because you don't have a job.  How about a little respect for the person whose taxes just bought your brand Concerta?  Too good for generic as long as I'm picking up the tab, huh?

Choke on it....

Sudafed

While I am burst out into song overjoyed that I no longer have to deal with Sudafed sales, it has spawned a whole new annoyance.

You see, when Sudafed went behind the pharmacy counter (bad meth heads!), the drug companies dug out phenylephrine, an old decongestant that had fallen out of favor....most likely because it doesn't work very well.  But it has the definite advantage of being a true over the counter product.  As in, you don't have to wait in line at the pharmacy counter or travel to another county that doesn't require a prescription.

I don't recommend phenylephrine.  It doesn't work.  At all.

So when you ask me for my recommendation, it is to drive to the next county and purchase pseudophed.  The company I work for is always happy to take your money, which is why they stock phenylephrine.  However, if that's what you are here to do, could I ask that you consider the charming, drowning in student loan debt pharmacist standing here in front of you?

And when I tell you that I don't recommend phenylephrine, could you at least pretend that you're listening?  Please?  It helps to build my self esteem and doesn't piss me off quite so much.

But I NEED it....what do you suggest I do?

Yes, I know you neeeeed it.  I guess I'd suggest that you go back to this morning, when you shook the last tablet out of your bottle.  Then, you could stop and, because you neeeeed it, you could call the pharmacy where you'd like to pick it up to have them fill it.  That way, when they tell you that they don't have your medicine in stock, you could call me and I'd be able to transfer it to my store.

Because you see, funny thing about the medicine that I dispense, I have to be in possession of your PRESCRIPTION in order to dispense it.  It's kind of a legal thing.  So when you prance off to do whatever it is that's so important and forget about your medicine until you neeeeed it, you run the risk of encountering an unsolvable problem.

If you were a regular at my pharmacy, maybe I'd be a little more trusting and I'd give you a single tablet to get you through the night.  I am nice like that.  But since I don't know you and you can't be bothered to even get out of your car to come in and talk to me like a health care professional instead of a fast food worker, I'm not sure I should put my license on the line to help you.

What do I suggest you do?  I'd suggest you grow up and take responsibility for yourself.

It's 4 AM....

And you want my input on which cough medication to give your child.  You ask, "Is Dimetapp the one that's ok to give to children with asthma?"

Who told you that?

His pediatrician.

Well, what was his concern?

Cough medicine?  With asthma?

Yea, I'm not sure what you're talking about.  I'm going to refer you back to your pediatrician.



If you want my input, don't look at me like I"m an idiot.  Also, it's 4 am....maybe I'm a little tired & slow?  Now, if the cough is due to cold, some doctors will tell you to avoid cough suppressants.  It's not that it's harmful, it's just better to get the gunk out.  Some doctors will tell you to avoid guafenasin.  Too much coughing can precipitate an attack.

So maybe if you would have wanted to talk to me, explain what you were trying to avoid instead of being an idiot bitch, I could have helped.  But as it is, I'm not touching it because I am not an asthma expert and you clearly don't want to discuss, you want an asthma expert who can read your doctor's mind.

Dumbass.

All that is necessary for the triumph of evil is for good men to do nothing...

Edmund Burke said that.  Or something like that.  It's now thought to be a paraphrase of something he wrote.  Whatever.

I was thinking about that today...

Something was off.  Her "husband" called me to fill her prescription (controlled substance, pretty fun one).  I asked that she be available at pick up.  He questioned me but I stood firm.  I need to see the patient.  At the very least.  So when he came into the drive thru, she was sitting next to him.  He asked me about it again and I explained that it was to her benefit, extra security for her, since she didn't call in the refill.  She signed for it but she never said a word.  Not one word.

I felt....weird about it, but let it go until another pharmacist called me tonight to ask me about them.  What did I think?

I can't put my finger on it.  But I thought of another girl.  Who called me early in the morning and told me, in a whisper, that her boyfriend was making her fill her prescription and taking it from her.  She wanted me, no matter what he said, to not fill it.  I promised her I wouldn't.

Later, when she called, I was on speaker.  I demanded to be taken off speaker phone.  I told her I wouldn't fill it, per her request.  I asked if she was ok.  She said she was.

He threw the fit of all fits in my drivethru but I held firm and I would have called the cops if wouldn't have left.

I wonder what happened to her.  Was this her one cry for help?  Did she manage to get away from this asshole?  Did I miss an opportunity to help someone?  What would I have done with her if she would have told me she needed help?  Should I have pushed her, offered her a safe place?  Told her she would be ok if she just got away?

Yeah, I'm kind of regretful about that one.  Maybe I could have done more....maybe not, but maybe I could have.

I thought of her after that phone call from the other pharmacist.  What if this girl is in trouble and has no one in her corner?

I wish I was working days....I might be able to do a little more behind the scenes, check out the situation a bit better.  I don't know.  I'm sure I'll meet many more like her before I'm done.  Unfortunately.  Maybe I'll actually be able to help a few along the way.  God I hope so.

The rest of the story

Remember Paul Harvey?  He had this radio show...The Rest of the Story.  He'd start out telling a story and you'd think you got it but there was always a twist at the end.  Kind of a feel good story told Law and Order style.

Let's play.

Man notices rash and swelling developing around his ankle.  Calls his doctor.  It's Friday morning and Doctor is booked all day.  Without even talking to the patient, he calls in an antibiotic for cellulitis (skin infection).

What do you think?  Is your spidey sense tingling?

What if I told you the rest of the story....patient is a diabetic....on Coumadin (a blood thinner).

If you are a medical person or just a well-informed lay person, you are probably downright squirming.  Because it COULD be something more.  We don't know...and more importantly, doctor doesn't know.  He's busy, it's Friday and the most likely diagnosis is cellulitis.  Why look for zebras when you hear hoofbeats, right?

This is why healthcare should piss you off and you should be demanding a better standard of care.  Because this patient took his antibiotic like a good boy.  And didn't think twice that the swelling didn't go down.  Or that it started to hurt.  In fact, he took his whole ten day course before he realized that it wasn't helping.  He didn't want to bother the doctor.  So he waited.  And nearly lost his leg.  He earned himself a week in the hospital because he trusted his doctor.

I told you so

There ARE people who should be glad I'm nosy and pushy.

Refill called in through the automated system.  3 tablets taken twice daily.  Insurance rejects.  I COULD just call and get an override....but I look at the refill history and he's getting it less frequently than he should...why is that?

Call the patient and it turns out, doctor put him on a high dose but he got confused and thought he was supposed to be taking 3 tablets daily.  Whoops!  But he just went in for a follow up visit and his numbers are great....he's doing great.  So I'm not going to fill it right now....we're going to call doctor to advise him and see what he wants to do.

The last two pharmacists that filled this prescription didn't stop to ask any questions....they just got the override and moved on.

I'm not that kind of girl.

There is ONE of me....

One head, two hands...one very big mouth.

I can only help one person at a time.  No matter where you are, if I am doing something else, I can't help you.  Stopping to acknowledge you isn't always possible or practical.  So be PATIENT and WAIT....two very dirty words, I know.

Hitting the drive thru button multiple times...it's just annoying.  I know you are there....the recording tells you that I know you are there.  You think it makes me move faster but truth is...I move a little slower....just for you.

I'm waiting....

I know you got into an accident.  But the lady who needs to start her birth control and the kid who wants a flu shot think they are important too.  I'll tell you what, if you can get their permission, I'll put you ahead of them.  Go on....ask.  Oh wait, you'll have to get out of your car and come in to ask.  And I know you don't want to do that.  So I guess you're stuck.

But each time you come into the drive thru, I have to stop what I'm doing and greet you.  Every interruption adds time to your wait.  So circling the building like the shark in Jaws isn't very smart if you want me to work quickly.

And, believe it or not, I am working quickly.  This is medication, not french fries.  You WANT me to take all the time I need to be safe and accurate.  Because you are going to put this into your mouth and allow it circulate through your body.  So you want it to be 100% correct.  Trust.

So howzabout you park yourself somewhere, the parking lot, the chairs, wherever is convenient and WAIT.  I know you are important and that you are hurt.  I just can't do more than I can do.  And high-pressure situations are when mistakes get made.  Neither of us wants to be the next big case on Nancy Grace.

Refill Roulette

There is a reason some medications require a prescription.

Because their use and administration should be initiated and monitored by a doctor.  Despite you knowing your body and what you need, the best thing for your health is that you diagnosed and treated by a physician.

There are many doctors who will load you up on refills....tell you to take it when you feel symptoms coming on, keep taking it as long as you need to...have a nice day, don't call us, we'll call you.

These doctors suck.

Just got a call from someone who picked up liquid Nystatin for oral thrush.  Swish & swallow.  Decided that she also had a yeast infection so she took a fluconazole tablet she had lying around.  THEN she called me to find out what to do.

Well, it's kind of too late at that point.  You are using an liquid antifungal to clear up your mouth and throat, then swallowing so it travels down the esophagus and treats the oral tract.  It will be absorbed and should also provide some coverage for the vaginal yeast infection.  It's not the drug of choice, however, so your doctor may have chosen to change your treatment for the thrush to oral fluconazole, which would treat both.

We'll never know....because your doctor loaded you up with extra tablets so you could self-diagnose and treat.

Situations like this are the reason that refills should be limited.  Especially on antibiotics.  You just think you know everything.  I guess you could be right....hey, they do it that way in Mexico.  The pharmacias don't require a prescription for anything but controlled substances.  And everybody knows that the health care system in Mexico is...well, it's great, right?  Clearly they know what they are doing.

Nobody is trying to get an extra copay out of you.  If you're sick, you're sick.  Get the proper treatment and care.  Let me ask you this....what do you spend money and time on?  Could you possibly change the order of importance so that health care topped that list?  I'm just saying...if we were talking a serious, life threatening drug interaction would you wish you had made time?  Is it really that bad to take a few minutes to call a pharmacy or your doctor or to head to the urgent care (although I think most urgent cares are only one step above the pharmacias in Mexico)?

Drive Thru Adventures: Name that Medication....

I need to know if I have any refills left...

Of what medication?

What do I have available?

Well there's....(name several medications)...

Oh, I don't know....do any of them have refills?

Well...a couple do....why are we playing this ridiculous game and do I get a prize at the end?

Well, I have this new prescription but I didn't know if I had any refills on my other one and....

Wait a minute, you have a prescription and we're playing name that medication and you have a prescription that has the name of the medication on it?

Sometimes I wish I could slam the window in their face....or on their face.  Whatever.

Just asking....

Why is it that every syringe request after dark comes from a well-tattooed diabetic?  Usually they don't know their dose or what insulin they inject.  And they are young.  Awfully young to be a type II and awfully ignorant of their disease state to be a type I.

Of course, there are the kind souls that are picking them up for grandpa....at 2:00 in the morning.

And let's not forget the all-time award winner.  The guy who was picking up syringes to administer an unknown antibiotic to his dog.  One that was suspended in sesame oil.  (NOTE:  very very very unlikely that this product exists, even more unlikely that a vet would dispense it from his office for home administration and most unlikely that he would wait until midnight on Saturday night to pick up the syringes for his beloved pet.)

Every pharmacist I know struggles with this issue.  No one thinks that sharing needles is a good idea.  But it really bothers most of us to be contributing to your problem.  We know what you are doing to yourself and it's not good.  It makes me sad.  Do me a favor...ask for what you want, politely, and if we don't have it, walk away.  Don't bother with the crazy stories.  They're irritating.  Because I have to pretend to believe you.  Then you think I'm stupid or that you're fooling me.  I'm not and you're not.

I have a question...

I'm all excited....perhaps this person who's shopping at 4 AM needs advice about the proper dosage of an herbal supplement....maybe she hasn't had a bowel movement in a week and needs some advice....maybe it's her child or her parent....

Where's the 9 count Excedrin?

Excuse me?

It's right here, in the ad, where is it?

I don't know....I'm the pharmacist.  I don't deal with inventory outside of the pharmacy.

Well, who does?

That would be the 3 front store employees that are currently at the front of the store.

Can't you go get it?

No....even if I could leave the pharmacy unattended, I wouldn't know where to look because...and this is key:  I don't stock that area!  You'll have to find a front store employee....here, I'll page one for you.

(Mutters as she walks away)

Yes, I went through 6 years of pharmacy school and earned a doctorate for this....I think of the number of times I direct someone to the bathroom or cotton balls, ring out condoms, etc every month when I write out the check for my student loan.  It's good times.

I'm going to complain!

To whom?

Your corporate office!

Why?

So they can do something.

What would you have them do?  There is a regional shortage of this drug....

Well, Wal Mart has it.

Why don't you just go to Wal Mart then?

Well....

And I'm pretty sure they are out of it to...here, let me call them....oh wait, I can't call them because it's 2 GODDAMN oclock in the morning and all of their pharmacists are snug in their beds.  But I can call 15 Walgreens and 4 other BlueBoxes who will all tell you that they are out of this drug too...




I have about had it with the shortages of Adderall.  There's no explanation, it just doesn't show up when we order it.  And then we have to deal with the crackheads and the panicked mothers who want us to "do something."  Then this asswipe shows up wanting the number for our corporate office to complain that I'm not stocking a drug that he needs and it's inconvenient for him.

Really buddy?

Here's that number -- I'll even dial it for you.  Let me know what they decide to do.

I don't have to take your shit.....

Well, actually, you do.  And you know why?

Because I had to go through six years of advanced schooling and pass a broad based knowledge test.  And that training implies that I have specialized knowledge regarding the appropriate administration of medication.  I am therefore qualified to assess the appropriateness of your treatment and whether or not that treatment is helping or harming you.

I am one more cog in the healthcare system, a check and balance that hopefully prevents you from harming yourself, despite your knowing what you need.

If you were one of the many people who I've managed to help....who have been taking medication that they didn't need, or in dosages that were harmful, you'd be grateful that I'm nosy and bossy and I take my job seriously.  But you aren't because you are an entitled bitch.

And guess what?  If people didn't have a history or the potential didn't exist for them to harm themselves with this medication, it wouldn't require a prescription.

Let's be honest here.  The potential exists for you to harm yourself with this and if you do, are you going to shrug your shoulders and say, "I thought I  knew what I was doing....oh well."  Or, are your children going to say, "Mom always did think she knew everything...."  Wait....I have to stop laughing.  Let's see...no and no.

You (if you're still alive) and your children are going to look for someone to sue....Your doctor for giving you a gagillion refills and me for not warning you about the dangers of abusing this prescription medication.  Your lawyer will argue that you didn't even finish college so how could you possibly know more than me, a doctor of pharmacy.  Your children will cry, you will stare at me ruefully....and you'll get whatever the student loan people don't.  I'll live in a cardboard box and collect tin cans....

So yea, shut your yap and use your medicine appropriately.  Or take your script somewhere else and leave me out of it.


That's what I'd say if you weren't such a bitch.  And I'm not filling it.  Sue me.

I have a bet with myself....

Most days I have funny, annoying stories about the crap people pull in the pharmacy.  Some of it is innocent, some of it is just a sign of the overall crapfest that our society is becoming.  So I thought, hey....let's see if I can come up with a story every night.  Surely there aren't THAT many idiots coming into the pharmacy late at night, right?

So far I'm losing the bet.

Umm....how long is it going to take?

Here's a tip:  if you need service, please hang up your cell phone before you step up to the counter.  Continuing to carry on what is obviously a trivial conversation while expecting me to dispense health care is absurd.  I could understand if you were oh....saving the world.  Like, "OK....well, if you can hold back the hounds of hell for a few I just need to get my Nexium...."  Or "Hey, I'll help dig out the survivors as soon as I grab my birth control."

THAT is understandable.

Then to wait until I am on the phone with ANOTHER PATIENT to ask, "How much longer?:  Well....how much longer is your stupid conversation going to be?  'Cause I can't really talk to you while you are talking to someone else.  Kinda like how I can't talk to you while I am talking with someone else.

And please refrain from making blood boiling comments like, "Well, I didn't know, there's no sign."  Really, lady?  You need a sign to tell you that it's RUDE to expect someone to help you while you are on the phone? You need a sign to tell you that it's a violation of your HIPPA rights to speak to you about medication while you are on the phone?  I think YOU need a sign.  To let me know you are an idiot.