Should We Educate Patients More?

One of the aspects of the pharmacy profession is to educate patients. Educate them on the drugs they take, the interactions they cause and to offer advice when needed. The first two portions are followed religiously, but that can also be attributed to the legal aspects. The last portion, to offer advice when needed, is a highly gray area. It is an area of which I personally would like to explore.

As of late, especially with our current economic troubles, I have been wondering if it is time that we educate our patients on more than just the side effects of their drugs. I have been seeing patient after patient paying ridiculous copays for Nexium and I then ask them if they have ever tried Omeprazole. Most say no, some even say they've never heard of it.

The question then becomes, do I explain the connection between Nexium and Omeprazole? Granted on a chemical level they will not understand it, but it can be easily explained in layman's terms. They could easily save a hundred bucks a month just from that one drug. There's countless other similar situations that this could be applied to.

In my marketing class we have been taught that it is best to educate the company into today's competitive environment. To give them choices, show them all their options and let them make informed decisions. Now I am not suggesting that we let patients decide their medication therapies, but they should be at least be aware of these cost effective options, especially if they are on a fixed-income. So why can't we do that? Why can't we tell the patient paying cash for Lexapro that Citalopram is much less expensive, but will most likely work just as well? That they don't need to pay the $50 copay on Coreg CR when generic Coreg will be covered for a much lower copay.

I think the first hurdle would be to get over the 'MD is god' mentality that a lot of patients have. To me, it appears, that hurdle is eroding under its own weight as it is. Often we are asked second opinions on drugs despite what their doc may tell them.

We all know the Big Pharm is in bed with PBMs. We also all know that it is nearly impossible to bring them down at this moment. Perhaps, though, we could use this to chip away at that formidable facade. Perhaps it would educate the public to the point that maybe a majority will start to speak up for more equality. Then again this is highly idealistic.

Our jobs are to help ensure the health and well being of our patients. If we can help them save money so they can afford their insulin or blood pressure meds, why shouldn't we help them? I know I will be from now on.

A Bunch of Hens

Ever heard that phrase before? Often in class there is a section of students whom are always talking. Always kissing up to the prof. Always being an annoyance to the class. To me, that is a bunch of hens. It annoys the hell out of me.

I switched from a science related major to a business major because, in the long run, I know it will suit me better. The problem with that notion is that I generally cannot stand the classmates in my major. The vast majority of the them, to me, are nothing more than a bunch of hens.

Do you know what it's like to sit in an upper level business course? Generally people talk all the time, interrupt the prof and ask so many questions that little progress is actually made. It is mindless, it is tedious and it drives me nuts. And these are the upper level courses.

I am used to science courses where the students pay attention and take notes. Yes there is random discussion and fun involved, but everyone is respectful and much is accomplished. That does not happen in my business courses. Do you know that in three years not once, not ONCE, have I been intellectually challenged? That used to happen weekly in microbiology, biochemistry and the likes. I'm not trying to brag about intelligence, I'm referring to how little is accomplished in these classes.

Earlier today, prior to my finance class, I was chatting with the person sitting next to me. I asked him what he was going to do after his B.S. (he is an accounting major) and he goes "I'm gonna make lots of money!" When he asked me and I responded he had a dumbfounded look on his face. "You mean you're going to go to school for at least another four years? Why?" I mentioned that I found it interesting and that it is my passion to which he responded "... but don't you want to make money now? I mean you'll be almost 30 by the time you're done!"

Perhaps that is my problem with the department. Everyone is so set on making money yesterday. I like learning, no scratch that, I love learning. I love having my mind challenged. And I am especially fond of learning about the human body and chemistry. And, on many levels, I really want to have an impact on my field. Sure I want to make money, but I want much more than that.

I'm not any older than most of my classmates, but I feel as if I'm on another level from them. It's awkward at times, especially when I see how much harder I am working for something while they coast their way to a C. I cannot comprehend living like that.

What sparked this? A post by the Old Md Girl discussing her age difference from her classmates.

I thoroughly look forward to the day when I can sit in class with my peers. Perhaps then I won't be so tempted to smack the hell outta all of them.

Something Pharmacy Folk Should Be Thankful For

For as much as we all bitch about job, talk about how much we hate it and how unbearable it may be at times, at some point we must step back and look at a simple fact that not many can say today. Our jobs are relatively secure. That nature of the business dictates this facet. And if you are a pharmacist, you have quite literally little worry about applying for unemployment. It is one of the perks, if you wish to call it that, of the profession.

That being said one must wonder just where on Earth are we headed. We have become a society that is wasteful and selfish. Pharmacy is perhaps the epitome of this fact. Can someone explain to me why our state's medicaid will only pay for brand name Risperdal and Imitrex? How about only Xopenex being formulary? Do we really need Nexium when we have Omeprazole? Should they not be the first to jump on the lower cost bandwagon? I cannot fathom how they can be so wasteful with taxpayers money. Personally I am glad I am not a resident of this particular state and that my money does not go to such money pits. Yet this is what happens in numerous aspects of our cultures. We were blessed with many years of economic prosperity and seem to have forgotten that steps that brought us to that prosperity. We've taken it for granted and, in essence, have become lazy.

One of the reasons I voted for Obama was not that he was a democrat. It wasn't because I believed in his views 100%. It wasn't because he was African American. It wasn't because I was completely certain he was the better candidate. I voted for Obama because, to me, he appears to be the beacon of change. Whether or not it is for the good, I do not know. I am sure that we could not stay on the path we ride at the moment and expect to recover from our current situation. I believe massive changes are on the horizon and I am waiting rather impatiently for them.

Now what does this mean for us in pharmacy? I think it's time to start standing up to some of the bullshit we see on a daily basis. I know several pharmacists who call the state almost daily to ask them what the hell their problem is with their decision on Xopenex. Daily I hear of patients who are foregoing insulin and other needed meds just to save a few bucks.

This is more of a rambling post and I apologize for that. I have just become frustrated with our way of life and expectations. If I take solace in anything it is that this too shall pass. And when those changes finally do come... I'll be one of the first goddamn people on the front lines fighting for them.

I survived the PCAT

Never before, in all of my schooling years, have I finished a test and been physically exhausted. Not to mention I enjoyed a splitting headache once I was done. One of my review books called the PCAT, "a test of endurance as much as it is a test of your knowledge." Ain't that the fuckin' truth?

All in all it went pretty well. Everyone I talked to was in agreement that the chemistry portion was by far the hardest. Otherwise I breezed through everything else.

One note for those who are going to take it. It is good to practice under timed conditions so you learn how to budget your time. When you take the actual test, however, you do not get to see the clock. You also are only given a 5 minute warning. There is no one minute morning. Which means when I found that out I had two blank answers I was debating over and quickly had to fill them in. Just a word of advice for future takers.

In any case I feel much better today, like I have this elephant that's been removed from my shoulders. Tis a damn good feeling.

The Last Test

Five years of sleepless nights, five years of endless studying, five years of brutal classes is leading up to my PCAT this coming Saturday. After this test, providing I do well enough, the rest of college will be smooth sailing. No more microbiologies or organic chemistries to keep me on my toes 24/7 studying.

The problem with that thought is, it's a lot of fuckin stress. I am having to go over material I haven't seen in four years in some cases. I don't really remember too much about calculus, but I have to become proficient in it in six days. I have been studying off and on all throughout break, only to discover the practice book I have been using is one of the worst. Go figure.

So for the next six days (including the start of a new semester) I shall probably be the only one engrossed in textbooks in the library. The only thing I keep telling myself is that this is the last test. Goddamn does that sound like a good thought...

Oh E1 Screens, How I Love Thee

Perhaps the one jewel that has come out of the clusterfuck that is Medicare Part D is the E1 screen. I have no idea what others call it, but every place I have worked it's been known as the E1 screen (probably because that's what CMS calls it). It is easily the most brilliant thing ever created for pharmacy use.

Now those of you outside of the business are probably goin, what the hell is he talkin' about? You've seen myself and many others in the field bitch about how patients show up with new insurance, but no cards and no idea what they have. In that case you are up shit's creek, with no paddle and, in my case, a shitload of bats are chasing you.

With the E1 screen, that is not the case. Simply input the patients Medicare number, hit submit and viola, it gives you the current prescription plan for the Medicare Part D member. Thus you do not have to hassle with the elderly who barely know their own name, yet alone which plan they are under. Sure it has it's hiccups occasionally, but its far better than nothing.

Which begs the question, why can't this be brought nationwide? Why can't BCBS or Caremark or any of the other insurances procure a similar database. Maybe it doesn't have to be connected directly to our computer system, but surely they could create some sort of secure website? Medicaid in our area has a similar setup which works wonderfully. Think of all the headaches it would save!

Then again that's the precise reason we shall never see such a system devised. Oh well, it was a good idea while it lasted.

Why I Want To Be A Pharmacist

Lately as I lie in bed unable to sleep I plot in my head what pharmacy school interviews will be like. I am not attempting to be cocky in that I'll get there, but it's something I like to think about at night. One of the questions I hear so often from other students whom have gone for the process is the question of why you want to be in pharmacy. There's the recurring answer of "I want to help people" and "I want to make money!" (ok, they don't actually say that, but that's their goal).

You want to know what my answer will be? Because someone needs to finally step in and bring some stability to the senselessness that is the field of pharmacy. Reading a post by the TAestP, found here, reaffirms my belief. Many are shocked when I say I'm getting a business degree prior to applying to pharmacy school. Often I ask why I am not getting a biology or chemistry degree which would more effectively relate to pharmacy. And in truth I am quite close to both a chemistry and biology degree from all the electives I have taken, but I have stuck with the business degree for one simple purpose. No one in the industry has any business sense.

I don't mean this in a derogatory way, but the industry is being drove directly into a giant pile of shit. In TAestP's post, he describes a pharmacy's new 'Free Antibiotic" prescription plan. At my place of employment the hours of the technicians are cut consistently and while the pharmacist is expected to do more. The schools push MTMs left and right, yet upper management does not allot the time for such a beneficial, and profitable, endeavor.

And really it makes no fucking sense. Why give out free medication? That completely devalues the product you are trying to sell. It tells the consumer that this is a cheap good, one which should be taken for granted. Is that really the impression we want to give the public? That we're nothing more than a convenience store for their medication? Sure you move more product and get more consumers in the door, but at what cost?

On top of that pharmacists are being forced to do far more than they should have to. You want your pharmacists to do proper consulting and conduct MTMs? Well schedule some extra help for christs sake! I mean honestly, you have to spend money at times to make money. Sure, you may have increased tech hours by 20 hours a week one store, but how much more money are you going to make off of MTMs? How many more loyal patients are you going to be getting because the pharmacist was able to relate to them?

Pharmacy is a health care service. So often this is forgotten with upper management. As I tell new co-workers when I'm training them, you have to take this job seriously. It's not stocking shelves at Wal-Mart, you make a mistake and you can kill a person. There's really no other way to get around it.

I want to go to pharmacy school because I do want to help people and I do find it interesting as all hell how the body reacts to various effectors. I also want to go into a pharmacy to help remedy the mistakes made on the business side of the field. I am not insinuating that I will solve problems industry wide, but I want to start bringing respect and dignity back to the profession. If that is only within the small chain I plan to own some day, so be it. It;s time someone's had the balls to say no more bullshit.

This has to stop, sooner rather than later. I want to be a pharmacist to better the lives of the patients and to better the lives of my colleagues. Is that really so much to ask?

Good End to a Bad Day

You know when you're having a real shitty day? Like you would love nothing more than to plant a small nuclear warhead in the corner of a drug bay before you leave? And then watch gleefully as it explodes into a beautiful mushroom cloud? I had one of those days today. Then I was blessed with having to visit the local grocery store for some dinner. I was truly and utterly thrilled with that proposition as well. Perhaps they would receive their own warhead in produce. Until I saw something which completely changed my mood and made my day....



Nothing like a new variation of Leinie's to turn a shitty day and into a glorious one. Now if only the Titans hadn't choked this weekend...

Types of Patients

I alluded in an earlier post about a ranking system I have devised in recent weeks to describe customers. When you float between stores as I do, it's often hard to describe one's relationship to a patient when discussing a story. As such I have devised the following list to help facilitate this clarity:

First-Tier Patients
These are the people who come in and immediately know you're name, as do you. Often you discus personal aspects of your lives together and you know one another on a more intimate basis. If you were to pass said patient in a store, you would stop and chat with them for a minute or two.

Second-Tier Patients
This type of patient is one whom recognizes you when they enter the store, but may not know your specific name. You recognize them by name as they enter the store, but may not know much about them outside of their medical life. You are friendly with them and have general conversation while in the store. No specifics are generally discussed under normal circumstances. If you were to pass said patient in a store, you would say hi to them using their first name.

Third-Tier Patients
This is the type of patient who recognizes you, but usually does not know your name. You do not recognize them until a name is stated. You are merely their pharmacist and they are merely your patient. If you were to pass said patient in a store, you would smile as you past them seeing as you would recognize them, but be unable to ascertain from where.

Fourth-Tier Patients
These are patients whom you simply do not recognize when they are in the store. They may be one time patients or irregular patients. If you were to pass said patient in a store, you would walk right pass them without a second thought.

Fifth-Tier Patients
You recognize this patient in an instant, although they may pretend not to know you are. They have caused problems in the store either via violence, confrontations and/or issues with drugs. Immediately your finger my hover over the panic button, but most likely your senses will be raised you deal with them. If you were to pass said patient in a store, you would make a wide arc around them fore they may attempt to steal your wallet.


There, now we can all relate stories to each other much more easily. Perhaps this is my contribution to the pharmacy industry. Feel free to print the list and hang it up in your respective pharmacies, copyright free. I'm just that nice!

For those midnight readers

I present something to you which shall kill hours upon hours of slow pharmacy time. A few weeks back Google uploaded the entire photo archive of Life magazine. Trust me you'll spend so much time just flipping through it you'll forget you're even at work!

Life Magazine Photo Archives

Caught this in the Obits today

Albuterol CFC MDI

[1969-2008]

Born as Salbutamol to the family β2-adrenergic receptor agonist in the United Kingdom in 1969, immigrated to the United States in 1980 and changed its name to Albuterol CFC MDI.

Albuterol had a long and wonderous life span and took pride in helping millions of people with acute asthma. Along with its twin, Albuterhol Inhalation Solution, Albuterol has redefined the lives of such peoples. Despite problems with the law, including tachycardia, wheezing and chest pain, Albuterol overcame these obstacles to retain its good name.

Albuterol is survived by its twin, Albuterol Inhalation Solution, Step-Brother Levalbuterol, children Proventil, Ventolin and Proair and grandchildren Proventil HFA, Ventolin HFA and ProAir HFA.

A not so happy new years..

Days in a pharmacy typically go by in blurs. Often you remember items, but you may not recall details. I suppose that's the mind's way of dealing with a flood of information all day long. Usually, with some thought, you can gather specific details about an item when you start to think about it.

We had a patient die on New Years Eve. That, in itself, is not too much of a newsworthy item on a daily basis. We lose patients all the time, its just a fact of the job and you become somewhat accustomed to it. Except this patient died right after leaving the pharmacy. We were his last stop.. well ever.

I know who the man is. He would get a little antsy for some of his drugs, notably his Ambien, but generally he was a nice guy. One of the faces you would recognize once he came in. He was probably what I call a second-tier customer (that explanation is coming in a later post).

And I was, for all intensive purposes, the last person he ever talked to. I remembered him coming in because I had worked all day to get the okay on his Ambien for him, which we had faxed on over a week ago. I remember him picking it up. I remember seeing him go. But for the life of me I cannot remember anything else about that moment.

Was I nice to him? Did I ask him about his Christmas? Did I wish him a Happy New Years? Or was I in such a rush that I more or less blew him off to get back to other scripts. I really don't know.

I would like to think his last interaction with a human was a pleasant one, but I honestly don't know. I've been racking my brain all day trying to remember, but I just can't. Weird how that works eh?

I suppose I could chalk it up to another facet of the profession, but it's one of the few times over the years that I have actually been bothered by something. Guess I'm not as made of stone at work as I thought.