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!