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!

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!

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