Are You Still A Pharmacist?

When I tell people I am a pharmacist many people picture me working behind the counter of a local retail pharmacy working at a computer station while on the phone and maybe counting pills too. Some people consider this to be a cushy job. Retail pharmacy has no real physical demands and a good salary. Heck, another health care professional writes a prescription and the pharmacist reads it and fills it.

This perception is partially true but there is much more to it.

Many patients don't fully understand the amount of interactions that pharmacists perform on a daily basis. I counted myself how many interactions I made in one 40 hour work week, there are as follows: 22 refill too soon interactions (10 were due to patients wanting controlled medications early and 12 due to patients getting refills on medications they did not know how to take properly), 26 drug changes (10 due to drug interactions that could result in serious side effects, 10 due to cost concerns for the patient and 6 to provide more optimal drug therapy) and 11 prescriptions where changed due to dosage/frequency concerns.

These changes did not include issues that insurance companies prompted me to correct. These where changes I made as a pharmacist. These where changes that helped improve health care for my patients.

With all of this contact amongst other professionals including mostly physicians and nurses you would think they would realize what retail pharmacists can do? Realize the importance of having that final set of knowledge, training and eyes brings to the table, right?

Many of them do, then there are stories like this...

My intern came to work one as usual since he is now a a month break in between rotations. After I got done explaining to a nurse why the physician needed to switch medications for a patient, I hung up the phone, turned to my intern and said, "Sometimes I am amazed and that I have to explain myself in such detail to other people in health care."

The intern looks and me and says, "Well, on my last rotation I told a nurse I wanted to do retail. She then asked me if I'd still be a pharmacist. I explained to her yes I would still be a pharmacist, I'd fill prescriptions and make drug interactions and give patients their medications while counseling them too. She didn't get what retail pharmacists do. She honestly thought we just threw pills into a bottle and that was it. She didn't get why I needed a doctorate to dispense medication. She had no idea what pharmacists do or that we actually did anything. I got kinda mad at her and no matter what I said she just had this close minded idea about pharmacists:"

I can almost see a construction worker thinking this. I can almost see a pastor thinking this. I can almost see the normal little old lady (an L.O.L.) thinking this.

I can NOT see a nurse thinking this!

How can another health care professional be so ignorant to what a whole class of medical professional does!

This is the equivalent to me talking to a nurse and saying, "I thought all you did was walk around in scrubs, jot down my blood pressure and gossip with other nurses in the hallway. Any knuckle-dragger can do that, right?"

Now before the nurses I know jump down my throat, I know all that you do. I know you usually double check even my work as a pharmacist, help physicians by describing what the patient has been up to and reacting to, all while taking care of the patients basic needs and address their many concerns. I know you do even more than that. Just like pharmacists do many little things that are in the best interests of their patients that are also too numerous to list.

Just today I had a patient who was very concerned about their mental health. He was a diagnosed manic-depressive who was on Zyprexa and Seroquel but has been getting more depressed recently. I asked him a few questions before getting out of him that he hadn't been on his prescribed Celexa as well. He mentioned that he must have forgot to get it refilled and when asking a few more questions it became apparent that his depression had been increasing for over 4 months, the same time frame he had been off his Celexa. I suggested he refill it then let myself and his physician know how he was doing in a month or so. He was more than thankful for my time and was certain that this would help. Now I can't say if it did or didn't help as it is too soon to tell but by explaining what I knew and understood this man was appreciative and understanding. What else could I do as a pharmacist?

This is why I make sure to do my best to fully explain to everyone what it is I am doing or did for them. This includes physicians, nurses and especially patients. The degree of explanation varies with who I am talking to but nonetheless I still explain. I feel this helps instill confidence in both myself and my profession. Every pharmacist should do the same to the best of their ability. It is part of the reason pharmacists were the #1 trusted profession for so many years. As the most accessible health care professional it is part of our duties. It is what will help patients and other professionals recognize the importance of our role and realize that we are not simply robots dispensing medications. We are needed professionals who bring a different perspective and knowledge base that can help ensure optimal medical treatments as well as keep costs down. Good pharmacists are always in need even if we are in retail we can still make a big difference, as much as any other health care professional. Without us patients wouldn't get their medications, there would be more medication errors and the health care system would be far worse than it is even now.

This is why I am a pharmacist!

Sorry!

Sorry I haven't posted lately! Been extremely busy with extracurriculars. I will be posting more since the weather is poor. Here they come...

A Pharmacist's Day Depends On If They Get Their Coffee

When a pharmacist doesn't get their daily morning fix of coffee it's usually a bad sign of how the rest of their day is going to go.

Not only did I not get my morning coffee the other day, but I got a whole lot more than I was asking for.

The other day, I woke up a bit late. Not really a big deal, this just meant I would have to skip my morning excursion to get my coffee at the usual place. I could just stop at the Starbucks across from where I work since it was my way, despite the fact that I try to support my local independent businesses at least I would get my morning fix. As I park and walk in to the coffee giant and get into the unusually long line, I begin to debate whether the wait will be worth it. Remembering that it was the first of the month, I figured that the wait was a small price to pay for the sake of my sanity or at least what I could salvage of it. As I go to the front of the line to place my order the barista said to me, "How can I help you?" I responded that I would like a hot vanilla latte (especially since it has been cold in the late fall mornings here). "I'm sorry but we can't make hot drinks because our machine is broke."

This should have been a sign of how my bad was going to go.

Rather than get something I wasn't in the mood for I said that's OK and left. Figured I might as well make it in a little bit early and try to get ahead as much as I could. In retail pharmacy you can never truly get ahead because all it takes is a couple of problems and next thing you know you are backed up horribly. I went about work as normal and opened the store with a few patients already waiting to pick up their medication. Several more people came and next thing I knew it was 9:30 before my first technician came in. She was scheduled for 9:00, therefore causing me to start out my day a little behind because I had less time to catch up on things like physician calls and other pharmacist tasks.

I head back to work on my pharmacist tasks and realize as I am working my way through the prescriptions that are in the Trouble queue, that may partner (who is the pharmacy manager) had put off solving most of the previous days problems and they had fallen on me. It took over 2 hours to solve almost all of these problems, while making phone calls and filling prescriptions at the same time. The phone ringing off of the hook did not help any as I only had one technician until 11:00, thus forcing the other technician to deal with people while I played pharmacy secretary, filling tech, and pharmacist.

By the time 11:00 did roll around and the second tech came in, I was pretty backed up. She got to work and helped shorten my wait time back down to a normal wait time. Then I got a phone call that would put my work day into a perpetual state of being behind. "Hi, I am calling from another pharmacy and have 18 prescriptions to transfer to you, should I just save us both a huge headache and fax them?"

CRAP!

I agreed faxing would be easier and less time consuming for us and told the other pharmacist to fax them over. After a few minutes they came through filling up my printer. I walked them down to the prescription drop off window and put them there for a tech to scan in when they had time. Thank God, this was not an urgent matter but one that had to be done eventually anyways.

My third technician came in around 12:00, as is usual, and helped us get fully caught up. We still had quite a bit of patients coming in and getting prescription but luckily for me they had the foresight to call them in the day before or earlier in the day. Sometime around 1:00 it got really quiet for about 15 minutes. We still had some things to do but no people came in or called to interrupt or activities. Just as the saying goes, it's always quiet before the storm.

I just didn't know that this applied to hurricanes too.

Right about 1:30, ironically the same time the bus stops in front of my pharmacy, we had a swarm of people come in, all with at least 3-4 prescriptions. This combined with their entitlement attitude (which is common among Medicaid patients), lack of patience and other patients using the drive thru, we became extremely backed up. My usually respectable wait times turned into 1 hour and 1 1/2 hour wait times. This lead people to become short-fused with me and start to yell, "All you have to do is throw it in the bottle and in the bag, what takes an hour and half?" I have a slight problem with this sort of attitude towards pharmacies, so I am always glad to explain that we do more than that and unlike McDonalds we don't just throw it in the bag and hope it's the right order. This trend continued for a few hours, leading to quite a few headaches and backups in the pharmacy.

While dealing with this huge influx of new prescriptions, now we had to do everything we could to get them out of them pharmacy. This may sound simple, but never is. Many of these patients had issues with their insurances. Lots of prior authorizations, a few drug interactions that required calls to physician offices, old prescriptions that were out of refills thus requiring faxes to physician offices and a few prescriptions that were cancelled once a chart review realized that the patient was an abuser. Again, pharmacies do not operate on the same level as McDonalds with a guy in a white coat behind the counter. Pharmacists and the techs do tons to make sure medication is dispensed safely in a manner that patients can benefit from it and make sure the medication gets to the correct people. All of this in a relatively short amount of time considering one mix up or person being lazy can cause serious issues in health for a person.

Then came the phone calls.

While working on the multitude of prescriptions that were brought in, I noticed my voicemail had rang several times. When I saw a break in the action, I checked it (yes I did check it earlier in the day a few times as well). "There are 13 messages"

CRAP!

It took me around 20 minutes to transcribe all of the messages that had been called and get them ready to be scanned into the system. Now my wait time was at almost 2 hours. I thought to myself most district managers would scream blasphemy at me if I told them this wait time. Then my district manager stopped in and made the mistake of asking how everything was going. I am not sure whether it was when I asked if he wanted to wait on people, fill prescriptions, answer the phone or start to type prescriptions but something made him leave pretty quickly.

The phone still kept ringing. Finally a lot of the physician offices were calling back on the earlier prescriptions. Several irate customers also decided to call, just to mix things up for me . One patient called with the opening line that will give any pharmacist chills, "You filled my prescription wrong!" After addressing the patient and looking into the prescription was actually filled correctly. This conversation took way too long to explain to the patient since apparently the physician decided to change the prescription from when he had talked to the patient to when he sent it over electronically, especially since the prescription was adjusted due to the patients poor kidney function. The patient then went into a tirade about how I am always right and am not listening to them. I was in no mood now to listen to somebody, who I had just fully explained why the prescription was right and that I even called their physician over the odd dose and had it clarified, and reinforced what I had done for the patient to ensure it was correct. The patient kept explaining how the whole thing was wrong and would not let up. I kept re-explaining myself until I finally told the patient there was nothing more I could do for them and that if they had nothing else I was getting off the phone. It always amazes me how many people don't actually trust medical professionals despite our best efforts to be transparent and explain things to them.

All of these problems finally starting subsiding around 7:30 PM. That's when apparently the store management decided that since it was the first of the month and the pharmacy didn't have a long line they would send store customers to the pharmacy to be rung out with their full shopping carts. My techs and I tried to explain, while on working on prescriptions, that we only ring out 5 items or less. Two customers did not want to hear this, so they decided to embark on a four letter laden tirade because they had to wait in line like everybody else in the front of the store. Some people just feel they should always be the exception, I guess.

The first of the month brings out the best in people. It makes for an extremely busy day in the pharmacy, especially if you are in a low income area like myself. This was a quick synopsis (yes I left many things out that added a great deal of other smaller issues) of my work day the other day. Some people, even other pharmacists view retail pharmacy as being an easy job. They do not realize the many things that we actually do for our patients and put up with from others. Retail pharmacy is what I like to call the front lines of health care. We see and deal with many things that people and other health care providers do not have to. Without retail pharmacists where would patients get their medication and how would a patient on several medications and seeing several physicians be assured that they are getting their medication safely? Retail pharmacists are essential and perform a critical job, including dealing with irate patients.

Next time you are in a local pharmacy be sure to say hello to the pharmacist and if you feel the urge let them and the techs know they are appreciated. This is the one thing that puts a highlight in their day, despite all of the grief they deal with. Heck, maybe get them a gift card to their favorite coffee place so a few of their days can start off well, trust me they will make sure you are taken care of for then on out!

When A Medical Professional Turns Into The Patient...

I woke up the other morning with pretty badly irritated eye. Apparently I forgot to take my contacts out before going to bed. WHOOPS! I walked into the bathroom and looked into the mirror just to see how seriously red my eye was. I decided to take my contacts out, not sure whether it would make the situation worse or not. It made it worse, much worse! My eyes had a sharp stabbing pain whether it was open or shut. I continued to cover and wipe my eyes of drainage and decided to lay down and see if it passed. This did not help very much so I got the idea to put some contact solution into my eye in hopes it would bring some relief. It only stung more.

I guess I had to go to the pharmacy to see if something like Clear eyes or Visine would help. I figured that if this didn't do the trick, I might have to get some further medical attention that was above my own skill as a pharmacist.

The pharmacy I went to was the one I currently work at. I called a friend and he went with me in case my eye really bugged me. I made it to the pharmacy, picked out the eye drops I had in mind and left. My friend drove me home and stuck around to make sure I was alright. Thank God for good friends. The eye drops burned and did not seem to help much. I waited awhile and tried them again still to no avail. It was time to seek further care.

My friend drove me to an Urgicare which I used to know some nurses at. When we got there I had to fill out 4 forms and give them my insurance and identification. Filling out forms with one hand over your eye is not the most fun, especially after a 20 minute car ride which simply looking out the window makes you nauseated. I turn in the forms and waited to be seen. I waited about an hour and fifteen minutes in the waiting room before being called back to an exam room. Finally!

Once in the exam room the nurses came and asked some basic history and pain questions. They also took my blood pressure and they took it wrong. They raised my arm just over shoulder height and took it. Blood pressure readings should be done at heart level, at least that's what they taught me. I then continued to wait 45 minutes for the physicians to come into the room. He explained what he thought it was (since I gave a very detailed explanation he probably could have diagnosed it without even seeing me) and what he was going to do to examine it. Overall, he was very professional and I was pleased with his work. He then explained he did not see anything serious but was going to give me and antibiotic just to be safe. I then told him I was a pharmacist and wondered what he was thinking for an antibiotic. He said I should have mentioned it earlier and said he was going to write for Vigamox.

Wrong answer.

I knew Vigamox is over $100 a bottle and requires a prior authorization for every insurance I have every dealt with including my own. I suggested tobramycin and explained to him what I knew. He agreed and appreciated my knowledge then left to write the prescription. He came back and gave me follow up instructions if needed, including an ophthalmologist he knew personally, as well as the prescription for tobramycin eye drops, then showed me out to the nursing staff to sign one more item.

When I saw the nurses and signed their document, I asked them to call my prescription into a pharmacy near by that was part of the chain I work for. They were hesitant and said they do not do that.

Wrong asnwer.

I told them I am a pharmacist and that I knew the pharmacist they would be calling it into. They checked with the physician who literally said, "Ya, why wouldn't we call it in?" They agreed and I left with my friend to go to the pharmacy.

We got to the pharmacy 30 minutes prior to close and to no surprise my prescription was not ready. I asked how long and the intern, who I knew, said that the pharmacist did not take it because they were out of stock of it. Personally, I would have still taken it and then offered the patient to transfer it, but to each their own. The pharmacist said the Urgicare was going to call me to call another pharmacy with it or to preferably to pick it up. One problem, my cell phone was dead. Thankfully, my friend let me use his phone to call the Urgicare and call it into the exact pharmacy I work at, to which the Urgicare nurse obliged.

We drove to my pharmacy, speeding a little since we know we would be getting there with in 5 minutes of closing. I called ahead as we pulled off the highway and my pharmacist partner said it was ready and he would stay open until I got there and that he rushed it since he knew it was mine. Again, I am thankful I know how the medical system works and some people in it, which allowed me to get my prescription in a fairly timely manner.

As I was rung out by my cashier, I thought to myself, "What if I wasn't a pharmacist?" This would have meant that the doctor would have written for an expensive prescription which my insurance wouldn't have covered. I would have gotten to the first pharmacy and been pretty frustrated since I had spent 2 hours plus at the Urgicare and still had a sore eye. If the pharmacist would have called the Urgicare to change the prescription, she would than have not had the antibiotic in stock. I then would have to go to another pharmacy to get my prescription. I also would not even be able to stay with the same chain to get my prescription that night since they all would have been closed. I may have even not gotten my prescription that night. On top of all of this the antibiotic I did receive needs to be applied every 3 hours while awake. This is fine by me, since it was $4 instead of over $100, but even as a medical professional applying an eye drop every 3 hours is hard to remember. Imagine if I were a patient again, I would probably be annoyed and not understand why the drop needs to be used so often.

This whole experience really did make me think differently about patients who come in last minute. Ironically enough I had a patient about my age come in with an antibiotic 5 minutes prior to close while I was already busy the night prior to my eye injury. I told him to stick around as I would make sure he got it before he left. The man was grateful for my services and that I took care of him despite being busy. I now fully appreciate his appreciation for me taking care of him despite the fact that I was closing really soon. Thankfully, karma must have paid off and taken care of me when I needed it. I can definitely say I look at the last minute patient with a little bit more respect considering what they might have just been through. If a last minute patient just hurried to make it in, I will definitely take care of them as long as they are in a true urgent need and not just filling a prescription they had for 2 weeks. This is especially true if a patient has an antibiotic or is from an Urgicare!

Pain Management For Sale

This picture was sent to me by a reader. This scares me. This is what is wrong on so many levels. If I had seen this, I think I might have stolen it to help fight abuse.

Why Herbals Are So Popular

"Is there anything over the counter I can take for my menopause?"

"Where's your glucosamine at?"

"Can you recommend something natural?"

These are some very common phrases around most retail pharmacies these days. Many consumers are turning to herbal supplements to help them improve their health or to aid them in other ways. This boom in herbal remedies is due in large part to the amount of information available on the internet and the ease of access it provides now more than ever.

On a daily basis I have handfuls of patients that ask me question pertaining to a variety of health issues and remedies for them that they have researched on the internet. In many cases, these patients come to me asking what I think about specific products and "do they work" or "how well do they work". With the availability of information many of my patients can filter out their symptoms and essentially find their "diagnosis". I use that word loosely since only limited medical professionals can actually make a diagnosis.

To be fair to lay people, I put myself in their shoes...

I am sitting at home with knee pain and wondering what I should take? Should I take the Celebrex (celecoxib) the physician prescribed for me? I just saw a commercial of which half it was the risk of side effects including possible heart issues (by law 1/2 of all prescriptions advertising must be focused on things such as side effects, just look at the next printed medication ad you see in a magazine). Well that seems a little bit serious. I remember there was a commercial for Osteo-Bi-Flex when I was watching the price is right and it didn't list any side effects. No side effects must mean that it's safer, right? There was also a commercial for One-A-Day Energy which said it would give me that little kick I needed. I am going to go the the drug store...

After arriving at the drug store, I grab a generic pain reliever (that is similar to Celebrex but cheaper as my pharmacist said) and what appears to be a generic for Osteo-Bi-Flex. I look at the labels...

First the herbal supplement...

Just like I thought, there aren't very many warnings. Now let's look at the over the counter (OTC) pain reliever...

WHOA!! That's a lot of information on a bottle about the same size. I think I am going to try the herbal instead. Let's look at the energy vitamin. It looks like the rest except it has guarana with an asterisk by it. It's probably alright...

Now this is in now way an all encompassing example. Many of my patients will actually listen to what I recommend for them, especially if I tell them it's what I would take if I were them. However, there are also several patients a day that now matter what I say they believe that the natural is better. I do what I can to help all but sometimes, they will not simply listen.

With such strong FDA restrictions on prescription and some OTC medications while have little to no regulation over herbals it is no wonder why advertising and the billion dollar herbal industry has lead consumers to think they are much safer than FDA tested and regulated medications. Many patients, even when they look up herbals on the internet, are not aware of the side effects or drug interactions of many herbal medications or that many of the herbal products are not tested and in many cases are not regulated for quality.

Just to highlight a few common areas I see in a daily basis I will keep this herbal review short. VERY SHORT. Here are some herbal basics:

1. ALWAYS consult a pharmacist/physician before taking them. At the very least do some homework and look up possible indications and directions for use as well as potential side effects.

General Rule: Beware of the G's - Ginseng, Guarana, and Garlic. These have the most interactions and the first two can increase blood pressure signigicantly. Glucosamine is generally safe but may interact with Coumadin (warfarin)

2. If it makes some cure all or miraculous claim, it's garbage and will not live up to the hype

This includes: most weight loss remedies (Alli will work but with proper diet and exercise only minimally), male enhancement or erectile dysfunction (ED) herbals (some with yohimbe or horny goat weed may work but all of them I have seen have ingredients that will raise blood pressure which may worsen ED), and colon cleansing products to name a few.

3. A lot of the herbals have some basis as to why they work. However, many may only work mildly if at all. They are not replacements for prescription medications.

4. Look for the USP or ISO certification stamps. These mean these herbals where tested by an independent third party and actually have what they claim in them. Thus these are safer than most.

5. Do not ask advice at a store that strictly sells these products. Many of the employees have numbers they need to reach and will sell you a variety of things to meet THEIR NEEDS, not yours. Instead ask a health care provider, like a pharmacist. We must be able to legally back up what we recommend. Would you trust someone who must back up their recommendation in a court of law or someone who was hired last week and is still in high school?

With all of that being said herbals are not always a bad thing and can actually help many people live better lives. They are not cure alls but should be used with the same discretion as prescription medications. Everything has side effects even foods. If a person eats too much fat, they gain weight. BOOM! Side effect! Always ask advice of a professional. Yes, they may make a little bit off of selling you something but they are held accountable for what they tell you. That's why they are PROFESSIONALS!

15 Pharmacy Rules for Patients

Pharmacy Rule #1: If your name looks like a set of Scrabbles tiles don't yell at me if I butcher it.

Pharmacy Rule #2: I can only explain your insurance only covers 30 days worth of medication instead of 90 in so many ways before I give up. I am not bad at dumbing things down, you may just not be that intelligent.

Pharmacy Rule #3: If you don't know the date of birth or address for the prescription you are picking up, I do not know how to sell it to you. Double checks are there for a reason.

Pharmacy Rule #4: If I tell you your refill is too soon and you try to have it transferred to a different pharmacy, I will make sure the other pharmacist knows it's too soon and that you are a current problem for me. Therefore they won't fill it either.

Pharmacy Rule #5: If you try to get you pain medication filled too early repeatedly you will get a nice note in your profile that will let other pharmacists know this.

Pharmacy Rule #6: Respect. Respect the pharmacist and the technicians. Respect is mutual and if you don't respect us, we will not respect you.

Pharmacy Rule #7: If you do not think something is correct please feel free to ask. If you do I will look into it and try to correct and problem willingly. If you yell and make a scene, I probably will not go out of my way (unless it's truly bad).

Pharmacy Rule #8: If you simply say thanks or show that you appreciate my work, I will bust my hump for your gratitude and take care of you.

Pharmacy Rule #9: If I can't read it, I can't fill it. I will try to clarify any issue, unless you act indignant towards the fact that my effort and care may take a few more minutes to ensure YOU get what YOU need.

Pharmacy Rule #10: Your physician isn't always right. Neither am I and neither are you. Everyone's human, so there is no reason to go crazy about something if it's small. If it's big bring to my attention as politely as possible and it WILL be resolved.

Pharmacy Rule #11: Controlled medications are controlled for a reason. This is why I can not fill them early. Drug abuse is real and very serious. No early controls. Period.

Pharmacy Rule #12: I see more patients than any other medical professional and do it fast and accurate. If I need extra time to ensure something is correct, please allow it. It is YOUR health.

Pharmacy Rule #13: If you think my hold time sucks, feel free to call your own insurance company. I do it all the time for YOUR gain, not mine. Trust me it sucks 5 times worse.

Pharmacy Rule #14: There are many pharmacies and pharmacists out there. If you and I don't get along or see eye to eye, feel free to venture elsewhere for BOTH of our sanities.

Pharmacy Rule #15: I became a pharmacist to help people. I did not go through 6 years or more of college, stay up countless hours studying and busting my hump to be a pain in your side or to play God as some may accuse me of. I use knowledge, legalities and logic to ensure what I am doing is the best for my patients and others. This is why I am a pharmacist.

That is all of my pharmacy rules for patients.

Until I can think of more.

8 Quick Rules All District Managers Need to Remember

I decided to send my district manager an email of pharmacy rules. They are as follows:

Rule #1: If I am not the store manager, do NOT call me on my days off. I earned them by working on my days ON.

Rule #2: When you pay me real overtime, then I may not mind working 60 hours a week. An extra $3 an hour isn't gonna make much difference in my pay check, it just increases my taxes.

Rule #3: I can actually affect how much your bonus is, so treat all of us pharmacists better. Or else there may be an "accidental" order for some high end medications just to throw off you days supply and inventory demographics

Rule #4: If you won't fill in for me or my technicians, do NOT tell me that I am NOT understaffed.

Rule #5: Don't tell me to improve my numbers when all pharmacists should focus on patient care FIRST and foremost.

Rule #6: I stand all day and take heat from patients, physicians, technicians, random others and you. When complaint calls make there way to you get my side first before doling out a gift card. This will only infuriate me more and reinforce the patient's entitlement complex.

Rule #7: All pharmacists have some anger inside (see Theangrypharmacist.com). Remember this when you think how we might react to something!

Rule #8: I have mastered the skills and many uses for the spatula. Again, remember this!

That is all.

For now...

Blondie Gets Plan B

Fried Chicken with a Side of Diabetes

Any time I see a patient in motorized cart headed towards my pharmacy, I can usually see some sort of odd problem on the horizon. When the patients pulls up in a motorized cart, is over 100 pounds overweight and eating fried chicken straight off the bone (grease all over the prescriptions of course), I know it's going to somehow cause me a headache!

A morbidly obese patient slowly heads to my pharmacy in a motorized scooter because they are probably too large to walk any distance. They hand my technician several prescriptions with one hand while eating a few pieces of fried chicken in the other. My first thought is that that all of these prescriptions are probably for diabetes and hypertension and of course they were. Clearly this patient is not trying hard to control either by eating fried chicken for a snack (it was mid afternoon and I am sure she does not miss many meals) and not even trying to do simple exercise like walking.

The technician tells the patient that it will be just under an hour to get their prescriptions ready because there are so many of them and it is the first week of the month, so we are swamped. The patient scolds the tech with, "I can't believe this I need my medicine and I have to wait and hour!?! I am gonna go over there and I'll be back in half an hour they better be ready!" The tech tells the patient that she is welcome to come back but it will be closer to an hour. The patients scoots aways with the drumstick still in her hand.

Twenty minutes later, I finally am able to initially check the prescription before the techs fill it. I do so and then my computer tells me that her insurance won't cover the medication because the physician did not put clear and precise directions or a diagnosis code on the prescription. Although forgetting this legal bit of info to bill a government insurance, which the physician knows the patient is on, she did put her hemoglobin A1c which is 11.0. This measure is explained here. Despite being on high doses of every medication possible this patient's diabetes is still through the roof! Again, reinforcing my previous opinion that she really does not care but is rather riding this for what she can get out of the government.

Like any good pharmacist, I pass the task of calling the physician's office on to my intern. My intern calls and actually gets a hold of the physician. Odd, why can I never reach anyone of knowledge when I call that office? He explains to her the situation and the response by the physician is appalling. "This has happened before and your pharmacy always prevents my patients from filling their medications! It's only you guys! Just give her the damn medicine and don't bother calling me back! I have other patients who need help too and I am sick of you calling me on technicalities!" My intern looks at me with a look of disbelief, he knows I heard the whole conversation because it was that loud.

Now I am angry. People don't like me when I am angry...

I call back and get the office secretary and ask for the physician while explaining where I was calling from. "She's in with patients can I take a message for you?" I explain that I can hold it's that important. After several minutes on hold the physician picks up the phone. "How can I help you?" It's go time! "Hi, is this Dr. (protected so I don't get sued over slander)? It is? Good, I have to tell you to NEVER treat an intern, or pharmacist for that matter, like that again! We called you because you did not fill out a prescription in the correct and LEGAL way so we can help one our mutual patients! I heard what you said to my intern and am tempted to report this further to the institution you practice under. Are we clear? GOOD! Now can you get me the diagnosis code and the precise way she is taking her medicine so I can give her the DAMN medicine you prescribed? Uh, huh. OK. Thanks! I appreciate you giving me that LEGAL information. I hope when or if I have to call your office again your are more appreciative of what I do. Without my knowledge and skills your patient would not get their medicine and good medical care could not be provided. Have a great day!" **CLICK**

At this point my ears are red and my intern is in hysterics. It is sad how some people, particularly in medicine, have such a God complex. Now the patient is at the counter and asking why her medicine isn't ready. My intern quickly walks over and informs the patient who promptly starts into a fit of yelling. My intern is calmly explaining the situation to the patient but the patient is not listening. I don't expect patients to fully understand everything but I do expect that they listen to me or trust what I am doing is correct. They can even question me but there is never any reason to yell unless something is really messed up.

I scurry over to bail out my intern. As I start to tell the patient what all we had to go through to ensure that they get their medicine they shouts this, "I don't care! My doctor gave me those scripts and there is always some problem! I ain't waitin'! Let God figure it out! If he wants me, he'll take me! If he wants me to live he'll fix my diabetes!" Now I am fuming! For better or worse I was "blessed" with a sharp tongue and quickly state to the patient, "God only helps those who help themselves." The patient continues to raise a scene and putts away in her scooter (which is now leaning to one side as she has been rocking back and forth in it). My intern looks at me with disbelief, I tell him "Some people just don't care."

This was an extreme case of ignorance on multiple ends. However, this could be avoided by one simple way. Put a pharmacist in a physician's office. I understand this has some high costs with it as most pharmacists in my area get paid right around $100,000 a year. With the cutbacks by government programs, which are the biggest payer of health care, this can really strap physicians and their practices.

Here's my justification and solution.

If it takes me 10 minutes to get a hold of someone at an office who can help me, that's $10. Include the office help time and the nurse or physician's, that number jumps to ~$25-$30. This is assuming an office person spends 10 minutes at $20-$25/hr and that the physician only gets paid double what I do and spends 5 minutes on the problem. Multiply this by the number of calls I make daily for things like this, about 10-15, that's easily $250-$450. Extrapolate that number to all of the pharmacies in the metro area in which I work in, according to Google is 2,676, that number booms to $669,00 - $1,204,200. This number represents wasted time for pharmacists, physicians and office staff. The scary part is this number is probably low since most office staff have to hunt for answers after I leave them a message. Physicians have to go and look up more info and spend more time, which is more money. This number may also be low because my pharmacy is slightly below average for volume as well.

So what could reduce this cost?

If a pharmacist was to work one day a week in a physician office and work for 5 offices, that would only cost and each office ~$20,000 a year, which is less than they pay most, if not all, of there staff. Most practices have multiple physicians so they have higher patient volumes. A pharmacist could work with the staff and physician to review charts and ensure patients are getting correct prescriptions that can be filled by pharmacies easier thus resulting in less money being spent on wasted time. This would also result in the staff and physician being better educated on what it is pharmacies need to get patients their medications easier and possibly cheaper. I have no way of measuring the statistics of how much this could save patients and thus insurance companies as well as government programs but with my experience, I am sure it could easily be millions in just the one metro area I work in. This could be another benefit and cost savings which a pharmacist could help greatly reduce. Maybe the government would be willing to pay a little bit more to physicians if they saw a decrease in the back end of prescription costs. They may argue this is what their prior authorization process is for but, honestly, that just costs physician's offices and pharmacies more time. Most patients have more time untreated and end up frustrated or not getting their medicine. This problem can from here just snowball, but could have been prevented with a pharmacist on the physician staff. With the loose math above, this means that roughly 12 pharmacists could cover 60 physician offices! If you had several head pharmacists and made a residency program out of it you could cover even more!

Maybe I am aiming to pie in the sky, but to me this make to much sense financially and medically. Why not try to save money, decrease government spending and improve medical care. Many studies out there already back these claims up, so why are we not seeing more of this? I wish I knew, but until that day I feel that it is too many times we are, figuratively, just giving the fried chicken to the diabetics and only creating a worse situation for everyone involved.

Quotes of the Day: August 2010

This is a new section I decided to add since we all know that sometimes the best one liners come in retail pharmacy!

Patient: What's that do? (pointing to image below)

Patient: I didn't have this transferred I had it filled at another pharmacy!

Patient: What does script 2 of 2 mean?

Me: It means the ER gave you two prescriptions. Do you have the other?

Patient: No I just want the tramadol not the antibiotic.

Me: I never said you had an antiobiotic, ma'am.

Patient: Well they only gave me one prescription!

Patient: Where do you find bed bugs? In bed?

Patient: You have a drive thru? That's just like McDonalds!

Me: Ya, except we don't spill your pills all over your bag.

Patient: Do you have Plan B?

Me: Yes we do and it's around $55.

Patient: Thank God, my mom got me this gift card!

Me: Ma'am, we need to call your physician to clarify your prescription.

Patient: Which doctor are you calling over there?

Me: Dr. Phuc Nguyen (last name said Win, no joke this is a REAL name!)

Patient: What did you say to me?

Patient: Which of these makes it, uh, smoother? (spoken in broken English, and simulating a penis and vagina with his hands)

Me: Well I think the medicine for your wife's yeast infection will help and so will the rash cream for you.

Patient: Really?

Me: Sir, may I have your date of birth?

Patient (who's in the clergy): Hell no! I don't want one of these cougars knowing my age! (while staring at the woman behind him)

Me: Well can I check your address?

Patient gives address

Me: Well, now they know where you live.

Patient: Aw damn! Now I gotta go stock up on my cougar killing ammo! Where's your condoms?

Lastly...

Patient: Thanks for your time/help!

Despite all the funny things that happen in retail, its all the people its the people who appreciate what I do that make me glad I worked my butt off to be come a pharmacist!

Medcaid Fraud May Be Legal, As Long As You Get Their Permission

Medicaid fraud totaled around 12.9 million dollars in 2007 according to the U.S. Office of Department and Management. Medicare fraud was slightly less at $10.8 billion. Though this number may sounds shocking a fair amount of this may actually be due to the Medicaid and Medicare itself.

Near the close of business today I had a phone call come in from a patient's parent asking us to refill her son's necessary medication. I obliged and went about my regular duties while my technician filled prescriptions and did other small tasks. Withing 30 minutes of calling a woman showed up to pick up the prescription that was phoned in for a refill. I looked up the desired prescription and saw it was in troubleshoot due to an insurance problem. This is where it the government based programs ALWAYS get something wrong.

I opened the prescription on and saw that the problem was that Medicaid claimed the prescription was not properly billed to the child's correct primary insurance. To clarify his parent were divorced and his mother had custody BUT his father had insurance that still covered him and therefore must, by law, be billed previously before billing Medicaid. I double check with the patient and I had all of the correct information in the system. I fiddled with some rejection issues for billing 2 different insurances that I have picked up along the way. Still to no avail.

This means I have to face every pharmacists nightmare. The dreaded insurance call...

I got through amazingly quick (probably because who the hell is filling prescriptions on a Friday nigtht that isn't a pain med or possibly birth control). When I get through I am connected with Gino who was surprisingly pleasant throughout the call, unlike most people who I reach when calling Medicaid. I explain to him the problem, that the insurance is being billed correctly yet I can not get Medicaid to cover the rest. Gino gives me several more options that I did not previously try but all are futile.

Then it dawns on me.

I can go back and see how the prescription was billed previously. As I pull up how this prescription was previously billed I mention it aloud to Gino. Gino says, "Well that makes sense since that was the billing number that kept coming up on my screen." There is one major problem though. With the way I am billing this rather expensive prescription I am telling medicaid that I am actually billing a different insurance company than I am and I am also saying that I did not collect payment from the primary insurance. Basically I am telling Medicaid that I am not getting paid for this and they need to pay it in full.

This is Medicaid fraud by the book!

"Wow, you're right! My system is saying that's the only way we can cover this prescription but they are literally telling me to falsely file this claim!" I ask Gino to leave a detailed message for his supervisor and he gladly obliges. I can actually he him scuttering around papers and pens to start writing. I stated to him the only reason I am doing this is because 1. it's in the best interest of the patient and 2. he told me to. He agrees and says he will send the tapes on to his superiors as well. We exchange goodbyes and hang up.

The woman who was sent to pick up the child's prescription is staring at me now with her mouth agape. "Wait, so Medicaid told you to committ fraud? What the hell?" "My sentiments exactly," I replied. The woman then went on a tirade and starting laughing about how she couldn't believe it but was not about to complain since the child definitely needs the medication. I agreed with her but what was I to do since I was instructed by Medicaid?

As I go to ring the woman out I ask for the patient's date of birth. "I think it's... I don't know we all have too many kids," states the man she is with. Seriously, now Medicaid patients are admitting they have too many kids!?!?! I can't believe my ears! After hearing this I half expected some hell spawn to appear from behind the pharmacy counter but thankfully it did not. The woman gave me the correct info and was glad I could help and planned on contacting her social worker.

This child had several prescription, all costing in the hundreds of dollars, that had been filled for over 6 months like this! The only way this could have happened is if somebody called Medicaid to get the override and repeatedly billed it that way. I can only imagine how many times Medicaid has told other pharmacies to fraudulently bill them in similar situations. With that being said it is now wonder why so many government programs are in the red or that Medicaid fraud is around $12.9 million. When an average guy from a small town with a little common sense can prove how there is a major loophole in a system designed by "well educated" politicians who make careers out of setting up these programs it is no wonder our medical system is "broken". Maybe if somebody high up in the Medicaid or government reads this I can get a consulting job in which they will pay me millions once I prove I can save them billions.

Mr. President Obama, I think I just got you a few more bailouts so how about...

When Trying Hard Bites You In The Butt... You Must Be A Pharmacist!

As a pharmacist there are many, MANY times that you can see a problem coming. One of those moments is when someone comes in with a stack of prescriptions. This is especially true when the said patient brings in the stack after 5pm, in which case if there is a problem you are usually stuck with nobody who knows what is going on to talk to in case there is an issue. This can leave you in quite a precarious point, do what is legal or do what is best for the patient. Rarely can you do both in retail pharmacy. This is the stuff they DON'T teach in pharmacy school!

A patient comes in with a rather panicky look on her face at ~1 1/2 hours before my pharmacy closes. The patient states to the technician that she is worried if we have enough of one medication in stock. She nervously says, "I wanna know if you have this medication 'cause most other pharmacies haven't had it in! He just got out of the hospital and really needs it!" From this I have determined that my actual patient is this person's father, who is just stabilized enough to leave a major hospital (at the point in which he has been there too long for their tastes and must be discharge ASAP so they can quit bleeding money away on him). This is not a rip on hospitals but the unfortunate truth of how insurance and mainly the Medicare system reimburses these hospitals, which is another story in and of itself.

I read the main prescription of concern and see it is for Lovenox 50mg inject one syringeful subcutaneously twice daily. Two glaring problems here: 1. Lovenox is expensive and 2. It does not come in 50mg! Or for that matter, Lovenox comes in no combination that can equal 50mg. This forces me to call the hospital which the patient just left and try to get a clarification of the prescription. Since one of the many residents at this facility wrote the prescription it is very well possible that the dose is wrong, the resident has no clue what strengths are available or somehow there is serious communications error since it is obviously written for 50mg.

So I inform the patient's daughter and call...

I get a hold of the hospital operator and briefly explain to her the situation. She says no problem let me page the physician.

5 minutes of elevator music interrupted by boastful statements about the hospital later...

"Hi, you were holding?" Obviously she has forgotten who I was or why I was holding. I repeat my problem to her. "Oh, you need the floor. Paging won't help you!" I thought to myself, well you suggested it and seemed certain I could reach the said physician.

5 more minutes of elevator music interrupted by boastful statements about the hospital later...

"Hi this (blank), how can I help you?" Again, I explain my situation and that I need someone who can clarify this. "OK, let me get you someone."

5 MORE minutes of elevator music interrupted by boastful statements about the hospital later...

"Hi this (blank), I am a nurse. What can I do for you?" Yet again, I explain the problem with the way the prescription is written. This time I explain all I need is someone to confirm that the dose is 50mg and that I can go ahead and dispense the 60mg syringe with an explanation to only inject 5/6ths of it. The nurse says, "I don't know can you do that?" I explain that is simple they can just push out the first 10mg and then inject the rest and that I had talked with the patient's daughter who understands. "Well, how does that work?" asked the nurse. I repeat my previous statement with more depth to how injecting with the style of syringe works. "Well are you sure?" she asked again. "Yes ma'am, this is a simple syringe it is not an auto-injector and is VERY simple." "Oh, well as long as it's not an auto-injector that's fine," she states. "OK, ma'am, can I get your name to put on this?" "Oh, I can't authorize that let me get you the physician on the floor."

SLAP! I could not help but slap my forehead at this point. I have now explained my problem in one form or another 3 times and no one knows what to do or how to go about approving this. Mind you this is considered a good hospital by the accrediting bodies.

3 MORE minutes of elevator music interrupted by boastful statements about the hospital later...

"Hello, this is Dr. (blank), I hear you have a problem with a patients Lovenox dose." Finally, someone who I think can help me solve my problem (which at this point I think I should have taken the easy route and just filled it with what I knew the physician wanted but in accordance with company policy have called to ensure that the prescription is written correctly). I explain my situation and the physician pulls up patient's profile and says sure no problem and that I can fill it that way. "Thanks doctor, the patient was getting worried they might not get this after they watched me talk to so many other people in your hospital who had no idea who I needed to talk to."

I then scan in the prescription and attempt to fill it. There's a problem. The insurance will not cover this medication because the physician who wrote the prescription (and the one I called to authorize it) are both residents and do not have active NPI numbers. I look online through the national NPI sites. Nothing. I then inform the patient's daughter of this problem. She then says, "Oh, that's OK. Just give them a call tomorrow we have enough to cover us through Friday!"

WHAT!

Apparently, this woman thought it was fine if she decided to make this situation and emergency and she needed it now. After watching me talk to multiple people on the phone and bust my tail to get her the medication for her father, THEN she decides it is no longer urgent. People like this are a serious problem. They have such an entitlement complex that they feel it is acceptable to act like only they matter and their problems trump everybody what everybody else is dealing with. They cause delays in the process and are really a big reason why many pharmacies, that are not terribly busy, can have longer than expected wait times.

With that being said I have no regrets for doing what I did. I did my best for what I thought was a paitent in need. Many other pharmacists would have done a similar job. I know I made others have longer wait times for what is essentially a self serving person but I did not know that at the time. This is what makes pharmacists a different breed. We are the connecting point for solving medication problems amongst multiple doctors and getting the patient what they truly need. The necessary medication. Sometimes we go above and beyond, this is our professional touch that machines will never be able to replicate

"May I Speak to the Pharmist?"

"May I speak to the pharmist about my ascription?"

Phrases like this are all too common where I work. The one good thing is that this is where a pharmacist can make some of the biggest impact. Educating and empowering patients is where I feel pharmacists can make as big of impact as actually getting patients their medication. With a estimated 9 million hospitalizations due to taking medications incorrectly (per the Institute of Safe Medication Practices) there is a lot of room to for pharmacists to help.

Some of my personal favorite moments, and a few of my least, in pharmacy come from talking to patients about there medication. I had one patient come in to my pharmacy about a month ago with 24 prescriptions all from the same medical facility. While working on his medications and doing a profile check I realized that he had just recently received a lot of these very same medication from another doctor at the same facility. To makes things even worse a lot of the prescriptions he brought in where for the same medication from different doctors. If these prescriptions would have been filled, possibly by one of the other pharmacies he also goes to, he would have been taking over 700mg of metoprolol, 120mg of lisinopril and over 400mg of furosemide to name a few.

When I approached the patient about his medications he said he didn't realize what he was taking or that he had duplicates. I quickly asked him a few more questions then explained the situation to him, needless to say he looked shocked at what I was telling him. When I got all of his medication ready I grabbed the gentleman a large pill organizer and explained to him how to take all of his medications and what they were for. I didn't want to confuse or scare him more by explaining side effects since he again, was part of the largely uneducated masses when it comes to medicine. He seemed pleased but still a little confused. I tried a little more but figured at least now he would be taking his medicine correctly if nothing else.

This was one small moment when I could definitely say I probably saved someone from one of the 9 million hospitalizations. Educating the masses can be tough and unfortunately will probably never be done fully. Although if they all were fully educated on these things I guess I would have to find a new line of work, so I shouldn't complain but rather do what I can to help.

I think sites like http://www.familydrugguide.com are a great idea. It also provides pharmacists a new place to direct patients to in times where they may be too busy to counsel. With all of the cut backs that have happened with more on the horizon this may only get worse. Sites like these can really help dumb down things and actually work as a good thing to help tie together what a pharmacist knows with what a patients wants/needs to know. This website even has smartphone apps which might be a good reference for caretakers of patients with complex drug regimens.

I can't say that a fully educated public will happen but as a pharmacist I and many others do our best to help those who need it. I am actually in the process of writing my congressman to push reimbursement for these issues and to show how bad some dispensing fees are. Every little bit helps to further pharmacy so patients can be better taken care while still providing a less stressful workplace for pharmacists

Although they may still say "askritshun", "pa-scription", "pharmist", and "that guy in the coat". Somethings just don't change!

The Dark Side of The Moon

This is just great!

Canadian Physicians? Not As Arrogant As American Physicians!

Today was Friday the 13th. Thank the pharmacy Gods its over! Patients where crazy today arguing and losing it over every little thing! Of course tons of abusers came in too. Ironically enough the minute I put in the order for C-II medications into the system 8 prescriptions for Percocet magically showed up in 30 minutes! Again, glad today is behind me.

One thing that I thought was very different today was the two drastically different experiences I had with two physicians. One was originally from and trained in Canada (she told me this) and the other was a typical American trained physician. Both physicians worked at the same institution, both are residents and since there is only one medical school in town that pretty much supplies all the residents to the hospitals in the area I assume they are both enrolled or affiliated with that university.

The first physician actually called me to make sure that her patient had a prior authorization taken care of for his prescription. This about floored me that a physician would actually call to make sure a prescription was covered for their patient before being prompted by a pharmacist or patient. She was very polite and explained that being from Canada she did not fully understand the American insurance system. WHOA! A physician admitting they don't know everything? They exist? I then checked and sure enough she was right, this patient needed a prior authorization for their Diovan. I explained what they wanted to use (a generic ACE inhibitor over and ARB) and what I would substitute for it based on what I saw in the patients profile. She explained to me that apparently the patient had a ACE-I induced cough issues several years back, which was never filled by my pharmacy. I then explained to her how to go about getting a prior authorization for the patient. The physician thanked me. Let me repeat that... THE PHYSICIAN THANKED ME! One of the few times a month this actually happens and was definitely sincere.

A few hours later the same physician personally called back to tell me it went the prior authorization went through and it indeed had. She then asked me to explain some things about American insurance to her. I explained it pretty quickly but basically they do everything they can to keep costs down and therefore increasing their profits. I went in more detail but don't want to drag on here. She was glad that I was the first pharmacist she had a good experience with and took the time to listen to her and explain a little about how I see things. I was hands down amazed at how passionate and genuine this physician was. Definitely one of the best physicians I have EVER come across.

A few hours later...

A patient came in with 5 prescriptions all for very expensive medications relating to HIV. The physician who wrote the prescriptions was a resident which in itself isn't too big of a problem considering the prescriptions actually made sense. It is very common for residents to write for medications that doses are either A. Made up, B. Way out of normal range or C. Don't make any sense to what they are treating the patient for. The one problem that occurred was that this resident was not on file and did not have an NPI number (which is quite essential these days to bill most medications to insurance companies). I called and had the doctor paged to get his NPI number since I could not find it with a few websites online.

20 minutes later...

The paged physician calls me, on his way home of all things, and tells me that he has an NPI number. I then ask him what it is. His response was, "Look it up." I explain that I tried and that nothing came up. He then spelled his name to me slowly like I was in middle school. I then told him that was exactly how I had it spelled and still nothing. The physician then said, "Well I know I have one! The paperwork has been mailed in and I got something back it just isn't on me at the moment. It HAS to be online SOMEWHERE!" How about this "doc", since you have it and I don't (and neither does the whole freaking internet!) why don't you look for it and when you find it give me a call? He agrees to this and hangs up.

An hour later...

The fairly grumpy physician calls back and repeats to me his NPI. He also gave me a website to look up his NPI and said he knew it was there. This was the same website I had previously used and explained it to him. He then decided that while he had me on the phone he was going to look it up to prove me wrong. He looked it up. Nothing. Just like I has said. The physician then said, "Well it should be there I don't know what's wrong with this site!" I decided to cut my losses and close the discussion since I had proven to him that he was indeed wrong and that I was a competent pharmacist. No need in causing more hostilities amongst our professions.

These two very different experiences made me wonder. Is the arrogance of most doctors a result of the American system and the pedestal that physicians are placed on? Is it an Americanized attitude? Are Canadians raised that much differently in how they interact and work together with other healthcare professionals? I am not a fan of the Canadian healthcare system but this physician has left me scratching my head a little. Would it actually be better for the patient to change to a system like this? I must say that despite all the craziness of Friday the 13th, this was quite a comparison of how physicians act and has really got me thinking. I wonder if there is a way for more physicians to act like the Canadian while still maintaining some of the benefits of the American health system.

Dating and Retail Pharmacy

While watching television today I saw one of the many commercials for online dating services. I know many people who use these and several people who have had successful relationships from using these sites. One major problem I can see with these would occur with people who work with the public, like retail pharmacists.

This may seem like an innocent and effective way of meeting people who are also interested in a relationship. However, when working with the public this puts a bit of a twist on things. Consider that anyone can sign up for a dating website and most of these sites let people limit the geographical area in which people can search for other singles. Thus if a retail pharmacist was to sign up for one of these sites there is a decent chance that they may see some of their patients on the dating site. Also, the patient may see their pharmacist on the site as well.

Seeing a patients profile could actually work for the pharmacist since they will see what medications a patient is on before they decide to wink, poke or talk to the patient/dating interest. However, this may also put the pharmacist in a predicament, what if they are not interested in the patient but the patient has a thing for them. Trust me, people have no fear getting flirty with their pharmacist either. They already trust their pharmacist with to handle and check things that they are going to put into or on their body. With trust already being there, the pharmacist is also a well respected and decently paying profession. Don't those sound like good qualities in a person for someone looking for a person to date?

Now, I am not saying that these websites are forbidden for pharmacists, but rather use caution when using these sites. Also, if something like this does occur, be sure to weigh all options before making a decision, for personal sanity NOT the business end of things! Besides we all know those patients who get flirtatious with the pharmacist, kind of adds some flavor to the day really. Heck, many pharmacists (who are hopefully single or in an open relationship) have gotten flirty with patients as well. One of the many perks of the job. The key and hardest part is to make sure that a line or multiple lines are not crossed. Show respect for the patient and their rights (even though they may not do the same for the pharmacist), remain professional while at work and be certain that whatever you put out on the dating site is nothing that can come back to you in the work environment. Admitting to having a leather fetish and enjoy multiple partners may not be what a supervisor or patient would like to know about but they can both read it if it's put out there.

That being said pharmacists should still do what they want but occasionally listen to that little voice in the back of their head before posting things on the internet!

Cialis... Ta-da!

Cialis is hands down the most aptly named of all the erectile dysfunction medications. This works several ways...

The generic name is tadalafil. It literally included the words Ta-da. As in, "Ta-da! It works I can now get an erection!"

I am also assuming the person who was the head researcher for it gave some insight to the marketing guy for the brand name. Taking another assumption here that the head researcher is probably male (because what woman would want to give a man another reason to have an erection) and had a wife or female significant other. Hence after he helped find the medication he probably snuck a little bit out of the lab to it home looked at his wife and said, " See Alice, it does work!"