The Pharmacy Chick

Flying the coup in retail

Got up and went! ( a non pharmacy post)

Filed under: Uncategorized — pharmacychick at 10:14 pm on Wednesday, June 30, 2010

It takes a lot tick off the Pharmacy Chick, I will say that from the start.  I have been a retailer for WAY to long to have every little thing bother me.  However, tonight Mr Chick and I did something we have never done before….Walk out of a restaurant.

We had decided to meet a friend of ours for dinner after we had played golf (and she had finished work).  We chose a mexican restaurant (and while I won’t name names, lets just say that it happens to share the same name as an American car company..heh heh)

We arrived, and was promptly seated.  Our server Tina (fake name) brought us the big bowl of chips and some salsa…Our friend arrived about 10 minutes later and we placed our order.   Tina brought more drinks, more chips and more salsa.  We had ordered some Guac as an appetizer……and Tina brought us more drinks, more chips and more salsa.  We asked about the guac and she said it was coming. (tick tick tick)  So we kept eating chips and salsa and drinking soda.  Pretty soon I saw Tina coming with a tray! Hurray, our guacamole!…NOPE…two more bowls of salsa.  (we had been waiting now for over a 1/2 hour)

Mr Chick flagged Tina down and asked to cancel our Guac, and she somehow finagled us to keep the order because it was going to be “right up”. tick…tick…tick…By now we had 45 minutes under our belt and all we had before us was an empty tray of chips, 6 bowls of salsa, and enough soda inside of me to float a ship.  This time I flagged Tina down and told her we were CANCELLING the Guac and it was to be taken off the bill. She apologized and said it was very busy and our food would be out “in a few minutes”….but half the tables were empty so I wasn’t buying this.

(an aside)  Pharmacy Chick was a waitress in her early days…I will warn all my readers, that when a server tells you that your food will be ready in “only a few minutes”, its server-speak for “we just got it started cuz we forgot your order and we trying to buy time”.

Tick …..tick….tick. 

I checked my watch. The 3 of us had been there for 55 minutes, and all we had eaten was chips and salsa.  In that entire time we had seen NO actual meals come from the kitchen.  It was nearly 8 o’clock,  we still had a 45 minute drive home, and I had enough!

I told Mr C,  “Dear, put $5 on the table for the drinks,   I have waited long enough, we are leaving..and we are leaving NOW”.  The 3 of us got up, and without a word, left the restaurant.

We went to the hamburger joint across the street and had a burger and a shake.

I may write a letter.

Ok. Lets let the Doctor speak about the subject…

Filed under: Uncategorized — pharmacychick at 5:14 pm on Tuesday, June 29, 2010

So, Pharmacy chick wrote a post about legit narcotics users being treated like second class citizens because their drug seeker counterparts make them look bad.  Because I implied that Doctors contribute to the problem by continuing to give narcs to seekers (cant seem to see thru their lame stories), one commenter added that it “wasn’t that easy” to deal with them.

I countered that a few phone calls to pharmacies around would garner enough info to determine the status on a sketchy patient.  Most would be more than helpful to provide dispensing information for the MD to make informed choices about servicing certain patients.

I don’t know how many PROVIDERS read my blog, but I am inviting you to comment.  Tell us why you give narcotics to people you suspect are scamming or lying to you and how  you stop,  when you finally have had enough, and finally, how often do you call pharmacies or other providers to see if the (said patient) is popping up there too.

Because…Pharmacy Chick really wants to know both sides!

Second Class Citizens?

Filed under: Uncategorized — pharmacychick at 9:46 pm on Sunday, June 27, 2010

Recently, PC had the opportunity to have an email string with a person who had some questions about being a better pharmacy customer despite her many needs including high dose narcotics.  She felt frustrated at the treatment she received at certain pharmacies when she filled her prescriptions, and tho she said she prefers to use the same pharmacy each month, they have suffered supply issues and occasionally has to find it elsewhere.  She took pains to remind me that she uses ONE doctor for all her meds and she she has never lost/stolen/ or otherwise needs “early fills”.  Never the less, she is often treated with disdain. 

In her opinion she is doing everything by the book….ordering early enough to get the stock(but not TOO early to be inappropriate), using one doctor, being polite and friendly..you know..playing by the rules that we pharmacists like our customers to play by.  And yet, she described a story where she was berated by a pharmacist as being a f’n drug addict and to get the f**k out of the store.

Wow, strong words.  All things being said, I have not met her, seen her, and my only communication as been thru email.  She could be blowing smoke..but I am not thinking so.

Pharmacy Chick has a pain clinic near by so we dispense a lot of narc’s.  Ive had my own share of scum in and out of the store.  You know the kind, the ones that leave a trail of slime as they leave the counter.  They are good at working the system to their advantage and are so good at it, they could probably teach a class.  Why the doctors dont see thru this act is beyond me.

However, I also have  a sizeable client list of people who are on high dose narcotics from a lifetime of illness or injury. Henry was in a car accident…I guess you could call it that.  He was working on a car and it fell on top of him. He was broken in a lot of places and most of them aren’t fixable.  Not that the doctors haven’t tried, but he is so full of pins and screws that his insides look like a toolbox.

Ralph lost his leg at work.   It confuses him because he takes pain meds for pain in a leg that isn’t there anymore.  I told him that his BRAIN doesn’t know the leg is gone.

Steven was a police officer shot in the line of duty. 

Tim had a kidney transplant and it didn’t go every well. He has so much scar tissue pulling on stuff he was going thru 2000 oxycodone 5 per month.  Everytime they did surgery to remove the scar tissue, more came back in its place.   Eventually he was managed on Oxycontin 80mg, twice daily.  Dunno how he managed that, but he is.

Linda has bone cancer…she is fighting it like her life depends on it…because it does.  She takes a lot of pain meds to control the suffering.  She knows she is going to lose this battle by years end likely, but she isn’t giving up.

Everybody you just met, are nice people.  They use 1 doctor.  They come to me each month for a prescription.  They  never lose it. They never have it stolen.  They never ask for early refills for suspicious reasons.  They treat their meds like blood pressure/diabetes/asthma meds, like clockwork.

If there is one thing I have learned in this life is that not all boo-boos can be fixed…and some only LOOK fixed..  If you remember in school,  there is no ceiling to narcotic doses.  You dose to pain control.  What would kill me, barely holds another. 

Its wrong to treat pain management patients as second class citizens.  Now granted, there are WAY more that deserve to have the book thrown at them when they resort to sneaky ways to get their stuff.  I’m not writing about them and I don’t go out of my way for any of them.  But I also haven’t called anybody a f’n drug addict to their face, which is inappropriate on every level.  When you wear the white coat,  you can at least hold some professionalism.

At the very least, you could be wrong about the patient..and get hauled into corporate to explain your behavior…at the very worst, you could get your butt shot off in the parking lot by somebody who took exception of your tirade.

We bloggers write frequently about drug seekers and the trash that they are…lets just remember not to paint all our patients with the same brush.

How to find (and keep) a pharmacy per reader request

Filed under: Uncategorized — pharmacychick at 1:35 pm on Thursday, June 10, 2010

One of my readers/commenters asked if I might write a post on how to select a pharmacy.  I had to think about that one for a while because it seemed rather “elementary” of a question to be honest.  My initial response was “pick one near your home”.  But I think that a better post might be “how to get the best experience out of the pharmacy of your choice”.  And THAT is how I think I will answer this reader’s question.

When you choose your pharmacy initially, CONVENIENCE is king.  REALLY.  You want to pick a pharmacy that is near your home or someplace you go regularly..like the grocery store.  If the pharmacy is in the back of the store, even better, you are in the grocery already, no extra steps are involved to take care of your pharmacy needs.  If its in the same complex,  thats fine also, you don’t have to get into your car and make a separate stop.  Whether you really need a 24-7 pharmacy is debatable. I am an organized and efficient person and  I really dont see the need personally to have a pharmacy THAT accessible to me but then again, I am a pharmaCIST 24-7 anyway and I posess the keys…(tho I have never needed to open the pharmacy for myself…and its probably not a good idea anyway). 

Therefore since that question is easy enough to answer, lets work on the EXPERIENCE of  using a pharmacy.

First off, it is important that you develop a friendly relationship with your pharmacist.  He or She is a human being foremost and coming into the pharmacy on your first visit with a chip on your shoulder or an adversarial attitude because of whatever experience you had at your LAST pharmacy is not going to endear you to anybody at THIS pharmacy ok?  Once you establish a postive realtionship with the staff, it goes a LONG WAY, but likewise, if you start out bad, it will take a long time before you will get into their good graces.  I love the saying “you get what you give” and it applies well here.  There are a lot of little things that we do that are purely optional that can make your life easier.

Have all of your information at the ready, and at the BEGINNING of the transaction, not at the end. That means be prepared to present all of your bio data, and have your CURRENT insurance cards at the onset.  If there is anything quirky about your plan, dont keep it a secret.  an aside:  I had one guy that I absolutely tore my hair out over his insurance and he admitted that he had been a “she” and his insurance had him as a female.  He knew this but didn’t bother to inform me. The less we have to fuss over, the quicker we achieve what you want…the finished product.

Decide what you want your pharmacy to be…a health care service or a cost cutting device.  If all you want out of a pharmacy is “CHEAP” then shop at stores that only really focus on cheap and advertise their $4 stuff.  I’ll be frank with you,  we dont like to be asked if we price match. Not all pharmacies do the $4 thing.  We may price match  because our company tells us to, but its a hassle to keep track of and we think its a little cheesy and tactless.  Likewise, if all you care about it cheap, don’t expect special services from that pharmacy. They likely don’t do them.

Help us with your initial transfers.  If you have moved to a new area and need to transfer prescriptions, we are happy to accomodate. Just give us the proper information and some TIME to do it.  Be sure to tell us all pertinent information like IF YOU HAVE A NEW DR.

Special needs:  If you have special needs or some really expensive drugs,  please order ahead of time. Most pharmacies would prefer not to keep (and hold) a drug for you for 29 days of each month so you can order and pick it up the same day.  At Pharmacy Chick pharmacy, we make it a rule to call patients on rx’s that we are short on.  We value your time as much as you do and dont want you to make more trips to the pharmacy than necessary. Likewise, understand that we aren’t a warehouse.  We don’t stock EVERYTHING on the planet, and since we do 200-500 scripts a day, what we may have had at 9 am might be out of stock by 7pm..

Learn a bit about the biz.  We are the middle man between your doctor and your prescription, and your insurer and you…  Understand that we may  have to ASK to refill your prescription. If el-doctoro hasn’t oked the rx, its not going to be done and getting mad at the pharmacist isn’t going to make that rx magically appear.  Likewise, if your insurer rejects a prescription, we may not have the ability to fix that.  When your insurance company sends you new cards, information, etc…read it all.  Be informed about your choices, your limitations and your benefits.

The worst day of the week to  want something fast is Monday. Its the pharmacy’s busiest day.   The worst day of the week to need a call to the doctor is Friday.   Also, beating the door down at opening time isn’t the ideal time of the day to need special favors any more than racing to the counter at 1 minute before closing is.

“How long is this gonna take?”  and “When should I return for this?”  are basically asking the same thing but #2 is going to elicit a much nicer response than #1..trust me.   If you want your pharmacist to love you, say “I’ll be back for this in a day or so”.  He/She will throw rose petals at your feet.

Planning 1-3 days ahead isn’t just a favor for us.  It is really to your advantage, resulting in less trips to the pharmacy and leaving empty handed. I have never met a pharmacist who scolded a patient for calling ahead to see if a prescription is ready.  What IS frustrating is to see the same faces over and over at the counter bemoaning the fact that something hasn’t been authorized yet “man, dont you have a phone? Call before you come down!”

Changes:  Tell the staff when you have : 1) changed a dose  2) stopped taking a medicine 3) changed physicians 4) changed addresses 5) changed your name, or 6) developed an allergy to something.

Poly Pharmacy. We advocate using one and ONLY one pharmacy.  We understand its your right to chase the deal.  And if you want to have profiles at every pharmacy in the county chasing the gift cards, understand you are forfeiting the advantages of having your entire profile at one pharmacy. You will not have proper drug interaction checks and it will be up to you to keep track of it all.

Please, No whining.  We all know drugs are expensive.  We aren’t big fans of expensive copays either. We are only charging you what we have to. If you dont like what you have to pay for a prescription, there are contact numbers on the back of every insurance card out there. We also know you think your time is more valuable than the guy sitting next to you.  We, however, think that getting a prescription filled accurately trumps both of you.   (and you might mysteriously find that the nicer you are, the sooner things might be done)

Ive been doing this for 23 years, and I can pretty much sum a person up after 1-2 visits.  I can usually sniff out  “high maintenance” from the get-go, and I can almost always single out the jerks.  That being said, I am also pretty good and recognizing a really neat person too.

Remember:  You get what you give….

Ready and waiting..please

Filed under: Uncategorized — pharmacychick at 12:16 pm on Thursday, June 10, 2010

My most recent lisence renewal had a fee in it for initiating a database check on controlled substance use.  We dont have it yet but I am hoppin’ ready for it to be instituted.  No more phony stories, lies, and deception.  Can I get some feed back from you readers on this subject IF you have this database in your state..and if you use it…and how it has changed how you fill narcotics??

Self Fulfilling Prophecy

Filed under: Uncategorized — pharmacychick at 10:16 pm on Tuesday, June 8, 2010

My favorite (unexpressed) thought of the day was this lady who came in and said…

“My doctor just called something in for me..its probably  not ready”.

me, in my head:  Correctamundo!

It was not on the recorder, and not faxed in til way later in the day.

Inappropriate SIG’s

Filed under: Uncategorized — pharmacychick at 10:05 pm on Sunday, June 6, 2010

I always bristle when the FIRST thing out of a patients mouth is one (or both) of the following statements: “How long is this going to take?” or “How much is this?”, without even so much of a “Hello” preceding it.  I bristle even more if I am treated like an afterthought by the so-called customer whose attentions are diverted by the cellphone fused to his/her ear ” Hold on hunney, the pharmacist wants something”.  ( EXCUSE ME? YOU ARE THE ONE WHO WALKED TO MY COUNTER..YOU WANT SOMETHING..NOT ME.) Honestly, can you imagine getting away with that in a doctors office?

I got the call before I saw her face.  Barely understood because of her crappy Bluetooth device she wanted to know if we had 120 Oxycontin 40 mg.  5 minutes later she was standing before me with the prescription.  The only words out of her mouth (to ME anyway) was “How long will this take. I got a plane to catch”.  One look and I knew we were going to have a problem.  Oxycontin 40mg # 120,  1 QID. 

Maybe if I knew her..maybe if she had been filling the same rx her for the past year…but that was not the case.  New patient… and I hate those kinds of sigs.  Its the same moron who writes Tussionex  1tsp q 4-6 hours… or  Proair HFA 4 puffs every2 hours.  Give me a break. I told her I needed to verify the directions on the blank.  They were not standard or appropriate for the dosage form…it wasn’t  2 tabs bid, something completely different.

First call to the office: Voice mail.  Second call to the office (asking for a humanoid)  :  voice mail.   Third call was made by the customer getting irate.  She handed me HER cell phone to talk to the office “they are getting  Kristin” …I handed it back:  Voice mail. I guess Kristin is a machine.  She was getting livid. 

I had her naked over a barrel, not by design but by necessity.  I needed to verify the sig…and wasn’t budging.  This script was only signed by the doctor. it was written in somebody elses hand.

It happens all the time.  We get some of the weirdest crap written, faxed and emailed to us every day.

We are a nation of people in pain apparently, and we are all about quantity and not quality.  I got some nutcase whose Oxycontin 80 script reads “take 5 tabs daily”.  Based on patient interview, he does at least take 3 am and 2 hs. That (while a HUGE dose) is at least prescribing within reasonable limits based on the drug itself.

I got a script for Fentanyl patches.  Apply 1 patch every 24 hours. No notes added or explainations offered.  Even after I verified it, I didn’t like it much. Neither did the insurance who even after PRIOR authorizing it, still audits my claims about once a year.  Stick it  Mr PBM, I have every I dotted and every T crossed.

I receive quite regularily a script (from the same Dr who  just doesn’t get it) ” Oxycontin 5mg  1-3 every 4-6 hours…etc etc”.  Granted, I know what he means, but it still is not written correctly or appropriately.

OR, the E-script I got last week for Azithromycin 250mg #30.. 1qd with prn refills.  I got it after office hours which meant I had to page him. He called us back. ” We got this escripted to us..Were you intending on prescribing Mr. X  Zithromax daily  for a year?”  He decided to be funny and replied ” No, I am intending on giving it to him the REST OF HIS LIFE”.  Well alrighty then. Thanks for  your help…( the patient never picked it up..I guess his life was pretty short)

It gets kinda old doing the call-back thing.  There are too many layers between me and the Dr, and “voicemail” is the lousiest of them all. Its the professionals version of the brush off.  Its the 21 century version of “have your people call my people” …only there aren’t any people.

What would really help (and I know this is a real stretch for prescribers)…is if when you write a script that is weird by intent or design…how about elaborating on it so we know you INTENDED on prescribing it like this?  A little help here perhaps?

I recently got a script for Cymbalta 60mg  4 caps qd.  That normally would necessitate a call to the office. But the kind dr included a tag at the bottom of the fax “Patient is a heavy metabolizer and requires excessive dose”.  End of story. Now was that so difficult?

“Kristin” finally called back and was just a bit put out that I called into question the sig on the Oxy. I said ” Look Kristin,  I have never seen this lady before and likely never will again. She is just stopping by on the way to the airport (her story not mine) and Oxycontin is 12 hour release, not 4 hour release.  I want YOUR name on this RX blank assuming responsibilty for this sig…..yada yada yada”

Every time I sign off on a prescription I am putting my stamp of approval on the contents of it, including the sig.  If I dont like the sig, even if its “correct as written” I am not going to fill it. “correct as written” does not make it “CORRECT”.

For every one I have verified as correct, I have found sigs that were unintentionally wrong.  We are humans. We make mistakes.  So if you are a patient reading this and the pharmacist wants to verify your prescription,  don’t take it as an afront to your personage. And, if you are a Dr reading, help us out a bit. If your script is over the top, leave us some indication that it was intentional.

Oh, and what about Ms Bluetooth?  “kristen” said “well, if you dont like the sig, change it to 2 tabs BID”. 

What the….?