Yer Out!

Lady comes in and wants,"The rest of her Percocet". Oh and my clonazepam and Seroquel too.

Turns out the doctor wrote for her Percs every 14 days and it's been....5. Strike one.

Clonazepam and Seroquel both come back from insurance with a "duplicate pharmacy" rejection message. Strike 2.

Oh, but her Celexa come back accepted. Riiiight. The 3 drugs with a street value are too early, but the one that isn't (to my knowledge anyway) is just fine. Except, I'm not gonna fill it either. Clearly you are doing something fishy. Strike 3.

Piss off, lady.

That specific rejection message from that drug plan only comes if you filled that exact prescription TODAY at another store. If you filled it yesterday, the plan kicks back a "too soon" message.

So don't piss and moan at me, it's not my problem. Maybe you shouldn't be defrauding the system. Or should I say attempting to.

Don't tell me it's "impossible". Clearly it is not.

And I ain't playing your game.

I've Been Busy!

Like you haven't heard THAT before? Or maybe I should've called this post,"Where's my matter transmitter?"

I had a client call for a refill on her eyedrops at 10am. She had no refills, but her doctor will take faxed in requests for stuff, so I dutifully printed the form and faxed it. Client came in at 2pm wondering where her drops were. For the billionth time, she was informed that, according to her DOCTOR (not us, you will please note), it may take 48 hours for a refill request to be approved. Client whines that she has some and can't we call the doctor. It was quiet, so even though I knew what the answer would be, I played along. I called the office and recieved the information that the doctor wasn't in the office until tomorrow. So no refill till then. Client stomped off in a huff to the office. Where she sat for an hour to see the other doctor in the office. Client storms back with the prescription.

She was all het up because she is going to be on this med for "the rest of her life" and why can't they give her a bunch of repeats. I tried to point out that her condition may change over the years, or there may be a newer drug that is more appropriate, but she wasn't having none of that. As she stormed off, she was heard to be muttering,"Useless pharmacist. Can't jsut give me the meds".

This embodies the attitude that drives me crazy. I am NOT A DOCTOR. I have NO prescribing rights. Some nurses do. Don't get me started on the inequality there. But I do not. I do not have to "just give you a few" because you didn't pay attention to your supply of meds. In fact, technically, I am not allowed. I may on occasion give you a few. If it is a life-threatening condition and going off your meds would be deadly. That is it. and I don't have to do that either. I do that because I don't want my tax bill to climb even higher when you wind up in emerg because you couldn't plan ahead a couple of days and ask for a refill.

Who's the Boss?

If you are a pharmacist and will be working at a pharmacy in a medical clinic, make sure that you know who the boss is. I recently turned down a job after working relief in that situation. Although the pharmacy is owned by a pharmacist, the owner has no spine. So, when the doctors started making demands, the owner just caved.

The problem came in when the demands started impinging on me and my practice of pharmacy. I felt that clients should obey certain requirments set by law. The doctor wanted me to "make an exception". Numerous times. Then the doctor wanted the pharmacy to stay open well beyond the posted business hours for the "convenience of the patients". Turns out that some patients were complaining that when they came in late in the day, they would have to go a whole 100 metres to the next pharmacy instead of the one in the building.

I was willing to stay a bit late, but not up to 3 hours late. I also wanted to be informed when the clinic would be running late hours. They can tell. If they have appointments booked late in the day, then I wanted them to walk across the fucking hall the day before (minimum) and let me know.

Apparently that was asking for too much. I guess as a pharmacist I am classified as a "grunt' and not a professional. I guess as a human being, I have no life outside work except for what my boss, the doctor, allows me to have.

I walked. I wish them joy of the relief pharmacist who accidentally screwed up a compounded prescription-5 times- and overdosed the patient. I hope they have fun explaining to the non-english speaking pharmacist they have to stay late.

I wonder how the doctor will react when the boss can't come in and can't find anyone to work? So the pharmacy will stay closed for a day. Think the patients will complain?

Pissed

I just had a job I was going to be starting tell me that the doctors office across the hall doesn't like me. Apparently the fact that I like to have regular hours and not "just stay until the patients feel like coming in" is asking the patinets to conform to MY schedule. Umm, the posted hours are 8-3 (4 on clinic days). Not "when you feel like coming in". Fuck heads. If my almost boss doesn't get them straightened out, I'm walking. 2 weeks notice, I'm not completely unprofessional, but that's it. And the hours for the next 2 weeks will be 8-3, because that's what I feel like doing. They are lucky they had anyone, never mind a competent English speaker like myself.

good luck finding someone.

Irresponsibility

Client has been getting 1 seroquel every day. After a while, the doctor decides 1 week at a time would be okay. The very first week the client gets a week supply, the client somehow manages to go through or lose 4 days out of the 7. Of note is that the client has substance abuse problems and seroquel is occasionally used on the street to achieve an "altered mental state".

Client comes to me and insists I should give the next supply early. I reply that 1 week supply was given out and the next supply will be given out in 7 days from the first supply. Client says her drug plan allows early fills. Which is true. However, this client is not exactly a responsible member of society (did I mention her drug plan is social assistance?) and I am uncomfortable giving out a drug which is very likely being diverted.

Client goes to see doctor. Doctor decides client can have the pills early, but back on the 1 day at a time schedule.

And the client wonders why.

Nice Try. No Cigar!

Woman comes in and asks for a repeat on her clonazepam. Which her doctor will only let her haveon a weekly basis. (you can guess why) She watched me carefully count her pills-twice, put them in a vial and give them to her.

The next day she came in and said I had shorted her 6 tabs. I pulled out the hardcopy of the prescription where I had written "double counted" and pointed out that I counted them twice.

"Oh yeah" she said,"I remember watching you do that."

Buh bye

Sure I'll Break the Law just for you

Got a call the other day. From the "clinic co-ordinator" at the local hospital. Seems we filled a prescription with a generic drug when the doctor requested brand. I immediately put her on hold, got out the rx we had filled and checked.

Nope, no "no substitution" ont his rx. Hmmm, I held it up to the light. There WAS, however a preprinted phrase under the sticker with the patient name and address...yup. says "no substitution"

However, law in my region states that"no substitution must be handwritten on the prescription. Preprinted prescription forms or boxes that are checed off do not constitute a valid no substitution request"

Besides, the ass that signed the rx put a sticker over the preprinting anyway, so anyone with half a brain would figure it's not to apply to the rx, right?

I picked up the phone and smugly told the "clinic co-ordinator" the above facts. She tried to argue with me. I cut her off and said it doesn't matter what you want, this is the way it is.

What a way to start the day.

Gotcha!

Today I had a "frequent flyer" irritate me. I was covering a shift for a colleage when the man came in. I recognized him as a dsi (drug seeking individual) from previous encounters, although I couldn't quite place at what store.

The technician came over and told me that the regular pharmacist will not sell Tylenol 1's (acetaminophen with 8mg codeine) to this man anymore. I looked over and saw that he was talking on his cell phone. I told the tech that when the fool stops blabbing into his cell phone, call me over and I will give him the bad news.

Ten minutes pass. He is still standing at the counter talking to his cellphone. the tech got irritated, went over and said that the pharmacist wanted to talk to him and wouldn't if he was going to keep talking to his cellphone. Idjit hangs up.

I went over and informed him that I wasn't selling him any T1's. He started hooting and hollering about "why not, I have had 5 surgeries, I'll drop my pants right here and show you the scars" etc... I informed him I wasn't interested and he should leave now. He then freaked out about how he was going to call the Medical Board and report me yadda yadda. I was quite entertained. Especially as it's not the Medical Board he needs to complain to, it's the College of Pharmacy. And this particular complaint would get him laughed out of town. After all, I don't have to sell him a chocolate bar, never mind T1's!

He kept ranting. I repeated that I didn't care what his excuse was and walked away.

He wandered around the store for another 10 minutes and then left.

Afterwards, I realized where I had seen this fool before. At another store, in a nearby town, in a fucking wheelchair getting his Oxycontin. On the taxpayer's dime. AND he called the store after he picked up his damned Oxycontin and claimed we had shorted him. Except, of course, we had counted his pills multiple times and knew he got the right quantity. We told him too damn bad, he could get the next batch in 2 weeks, since that was what the doctor ordered.

So, I have one burning question. Since he is on welfare, how could he afford a cellphone?

another thing....

So, the computer generated prescription that makes it easy to read? It also makes it easy for the doctor to repeat mistakes. Had an rx for morphine today. Read: Morphine 30mg sr 1 tab tid. Turns out the woman takes 2 tabs tid. And she was really pissed at us because "we" made the same mistake last time. Ranted about how she never had this problem at her "old" pharmacy.

folks,t he pharmacy I was at today was a large chain discount pharmacy. If it had been a regular one, I would have offered to fix the problem after calling the doctor and deliver it. But it wasn't. she came here because it was cheap. Lady, your doctor screwed up on the last prescriptiion on the computer and then just copied it over again for the new one. Including the mistake. It is NOT us that fucked up, it was your doctor. I'm sorry it inconveniences you. But I have to dispense it as written. I can get it fixed. But it is after business hours, so it will have to wait till tomorrow. Deal with it.

Oh My!

Apparently, our counter espionage service employs drug addicted people. I had a client who is on disability (and boy is he disabled!) confide in me that "they" want him to go on medical marijuana,but he doesn't want to because it would jeopardize his security clearance at his job with the agency.

Interesting. Especially as I was talking to doctor's office staff and they told me he asked for medical marijuana.

What do you think? Secret agent? Or stupid druggie?

No wonder there are med administration errors!

Today I had a guy pickingup his wife's Fragmin. It is an injectable. One we usually order. we had 1 syringe.
We gave him that one and I told him,"here's one to get her started, the other 4 will be in tomorrow".
Him: wha??
Me: pick up the rest tomorrow.
Him:Wha?
Me: come back tomorrow
Him: Wha??
Me: get your wife to call us

Patient number 2 comes in. directions on the antibiotic say,"Take 2 tabs daily"
I bring it out to counsel the patient. (a 20 something female)
me: Take 2 pills together once a day
she:1 pill two times a day.
me: No. Take 2 pills a day. Together (I stressed that word)
she: Yeah, 1 pill twice a day.
me: NO, 2 pills at the same time, 24 hours apart.
she:okay, 1 pill every 12 hours.
me: NO. Take them together. At the same time. Once. A. Day.
she: oh, okay.

I know she is going to do it wrong. But I can't be there to hold her hand 24/7!

Patient number 3: I'd like to fill this rx for my son.
me: (looking at prescription) Hmmm, this dose dose not exist, I'll have to call the doctor.
she:okay, I have to go to the store, I'll be back.
Me: (thinking Halleluja) See you in a bit.

I called the doctor, corrected the incorrect dose the intern had written for and filled it. She came back to pick it up.
she: we are waiting on a throat swab for my son. The results won't be back till tomorrow to tell us if this is strep. Can he just start it now?
me: no. You are more likely to develop resistance..yadda..yadda(you all know the story, right?)
she: even if it is just one day?
me: yes.

patient 4:
Wife comes in to get new prescription for Crestor for her husband. I fill it, note that he had just gotten Lipitor 3 days ago.
Me:I see your husband just got some Lipitor. Is he still taking it?
she: I don't know
me: do you know if it is the same doctor?
she: Yes it is, let me call him. (whips out a cellphone) "honey are you still taking your Lipitor? ....Hmmm....here, talk to the pharmacist"
me: are you still taking Lipitor?
him: yes.
me: did the doctor tell you to take them both?
him: yes
me:that is very unusual
him:I used to take 2 different pills.
me:possibly, but it wouldn't be these particular 2. Let me call your doctor and I will call you back.

I call the doctor after reviewing his file and confirming, in fact, that it was 2 different doctors.
me: Mr. XXX is here and he tells me he is still taking Lipitor. Did you want him on Lipitor and Crestor?
dr: He told me he wasn't taking the Lipitor anymore! Tell him to not take the Lipitor!
me: thank you. good bye.

So, I saved a life (possibly) today!
but really, is it supposed to be that difficult?

Why Are We All Still Alive?

Hmm. It appears that we have been innocently poisoning our babies with..gasp..cold medication!

Come on. Does the FDA etc have nothing better to do? I mean, those of us in the know, KNOW that these medications do practically diddly, but deathly? Please. If that were the case, then all of us would have died as infants when our parents unknowingly fed us these deadly, useless medications.

Why haven't the babies been dropping like flies for 30 years? Because the medication isn't dangerous. The PARENTS who od the kids are the dangerous ones. And not many parentl do that.

Sheesh

Vote for Someone Else Then.

Awright. I have had just about enough whinging from the seniors in my practice. It seems like none of them remember the fact that once a year, for the past 14 years or so, they have a $100 deductible for the government drug plan. Hell, I had one who claimed that they didn't have a drug plan. But they did. The government one. Now if they were willing to pay cash instead of using the government plan, I would be ecstatic. That means that the pharmacy would get a decent profit AND my taxes would be able to go a little farther.

That was not to be. Idjit just didn't want to comply with government rules. It seems that all the seniors in my town think that all the pharmacies are trying to rip them off. Because we want them to pay the damned deductible. If you don't like the deductible, then vote someone into office that will repeal it. Although, I doubt you will have much luck. The government likes ways to keep my hard earned cash in it's pockets. Not to mention the fact that deductibles did not come up once in a recent election, that I heard of.

People, just pay whatever I tell you is owing. I don't have time or patience to explain for hte thousandth time something that you should know. That you do know.

Pay a Little Attention Folks

Today was the day of crappy prescription writing. There was the doctor who changed his mind about the directions midstream and scribbled on top of what he already wrote. Thereby rendering the directions illegible.

There was the doctor who prescribed controlled meds that the patient shouldn't need yet. Once contacted the doctor gave a reasonable explanation and the rx was finally filled.

Then there was the doctor who wrote for a compounded cream, but chose the wrong ingredient on their computer software drop-down menu, thus creating a prescription for a 50% hydrocortisone cream. (normal is around 1%). This office took an extra long lunch today. Left me on hold for 15 minutes when they finally got back and then took another 20 minutes to clarify the prescription. The whole time the client was staring me down. I tried suggesting to her to go do something else. (anything else!) but no, the client wanted to stand there and stare at me. I hate that.

Then a doctor faxed in a prescription for a refill for a client. With the wrong directions. Or at least, directions that were different than the last time. So I had to re-fax back the prescription with a request for dosage clarification. As it happened, I was right. The directions should not have been different.

Oh, and my local druggie called to say he was out of his Percocet and could I "just give him a few" to get him through to his next doctor appointment. I waited till I hung up the phone to laugh at him.

You want WHAT???

I got a call today. Person on the phone wanted an over-the-counter mole removal method or system. When I told him that mole removal was best done by a medical proffessional, he told me that it was "elective and I don't have $600".

I felt like telling him that the most effective method was a really sharp knife. I didn't. But I wanted to. However, professional ethics won out and I told him that there was nothing of the sort available.

A few days before that, a woman wanted to buy some hydrochloric acid because her digestion was off and she read somewhere that she needed more of the acid in her stomach.....

DIN woes

To the makers of Fragmin...you blow! It's bad enough that the boxes of the different strengths are basically the same and only have a stripe of colour to distinguish them. But every strength has the same DIN. Which completely fucks up my computerized billing system. I spent 20 minutes wrestling with my system in order to get my cost reimbursed from ODB. I wound up having to bill for 11 packs to get paid for 3! Because some other idjit has locked up the drug info screen so that I can't adjust the price. Which is locked in at the price for one of the weaker doses. In other words, cheaper.

And the client needs this today. As in actually needs it, not just wants it. I don't have 3 days to wrestle the billing into submission.

The argument for the same DIN for all pack sizes is that it is the same drug in each strength of syringe. Just the quantity varies. As I recall, we had the same problem with insulin when the penfills came out in 1.5ml and 3ml. So the government assigned the 3ml a pseudo-din so that the billing would work. Why can't we do that? All pharmacists would thank you forever.

Dear Doctor

When you fax in a prescription for a narcotic, please make sure you sign it. If you are not going to sign it AND not respond to the fax I sent you politely asking for a signature, do you think it would be possible to put the correct phone number for your office on the damn prescription pad you faxed me?

I bothered some poor woman at home TWICE because you couldn't be bothered to check the new prescription pads for printing errors. Or maybe you are just cheap and figured you'd use them anyway. Which would be fine IF you scratched out the phone number.

While I was struggling with your stupid phone number fiasco to get the damn prescription done legally, your poor patient was sitting, or should I say drooping, in my waiting room, waiting for his much-needed pain meds. That is not good patient care.

Next time, it might be you waiting for your meds. And I probably won't be rushing to fill it ahead of the other poor sods in front of you.

3 days

You should still have 3 days left of your meds, lady. If not, I suggest you call your doctor to give you a tide-me-over prescription for your morphine. Waiting until tomorrow and calling the regular guy is not going to get you another answer....

Ick

Question asked while picking up a prescription,"Do you have any water based massage oil? I don't want to clog up my pores."

Some things, I don't need to know, buddy. I pointed him at the personal lubrication section which has some massage oils and went to wash my hands. Ick.

You want WHAT?

Today I had a lady come in who wanted to buy hydrochloric acid. when asked why, she said that she had "read in a book" that the reason she was getting stomach aches was because her hydrochloric acid levels were too low. She wanted to buy a bottle and drink it!

Oh. My. Gawd.

If that isn't a Darwin Award, I don't know what is!