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!

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 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

All's Quiet on the Western Front

Today was a a very quiet day. After the absolute insanity of last week, which was the first week of the month, today seemed like bliss. It amazes me how packed the lower income area pharmacies get during the first week of the month. The crazier thing is how everyone acts when they come into the pharmacy. I think there is a very simple explanation for this...

Pack mentality.

No I am not calling poor people dogs! Rather, I am saying that when the first of the month comes around and the Medicaid population gets their monthly checks and other benefits they feel the need to use it (like the rest of us who await payday before making a purchase). Therefore they rush to spend them and stock up on things they need (or want). Thus with all of the craziness people get upset and frustrated with each other, thus multiplying the animosity felt towards others. So who to take it out on? Well when they come to a place to pick up something they need/want and are told it may take an hour or two to get it, it is understandable as to why they get upset.

The pharmacy counter is unfortunately a good place for this. Patients come from the doctor and waiting up to a month or more to get an appointment (some having just got their new health insurance for the month). Then they wait again to tell someone (or worse yet have the other person tell them) what is wrong with them. Then they leave and in the process of going to pick up their prescription have to wait again. Honestly, THIS is white coat agitation (Ok and maybe hypertension, too).

Anyways, it goes without saying that I am glad this monthly cycle is over. Today was a very quiet day in which all but a couple of patients were actually pretty polite and were thankful for my help. One of those days it feels good to be a retail pharmacist and realize that despite all the frustrations we regularly deal with we are the most visited and accessible healthcare for the public. Especially good when most of the patients say thank you and give you a smile before leaving!

Welcome!

Welcome and thanks for reading my blog! I decided to start this as many of my friends are amazed/dumb-founded/shocked at some of the things I deal with on a daily basis in my work as a retail pharmacist. For myself it's just another day at work with the public.

I am a little bewildered at how many pharmacists out there come off as jaded or angry. I will post daily occurrences at my pharmacy along with my reaction and thoughts about them. As I have many stories I will try to post daily. If I have a day off I will post some of my old stories or will give a daily thought about pharmacy or just the world in general.

Hopefully you will enjoy my postings and feel free to comment. I am a person who takes any sort of criticism well and love to learn what others think. Expression of thought can be a great tool to learn from.