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)?