I Need A Life

Wandering around the strip last night, saw this and immedately snapped a pic of it with my phone.

That is the nicest looking Walgreens I have ever seen... and I am such a damn pharmacy nerd I can't even act normal while on vacation... Oh well

But you're so young!

I can't wait until I'm old. No, seriously. Maybe people will actually stop questioning me when I give suggestions or make a statement.

Let's clear the air here, in nice big bold letters.

I am 24 years old and I have almost 10 years of pharmacy experience.

There we go, much better. Maybe I should have this tattooed on my forehead.

You see everywhere I go, people question my ideas on various pharmacy related items. This can be at work, talking to other students, or inane message boards where everyone is an expert (I'm looking at you SDN).

Yes I'm young, but I probably have twice the experience of half of the students graduating pharmacy school this year.

I mean I have worked in retail, hospital, compounding, nursing service and dabbled in home infusion pharmacy. I have worked as a pharmacy consultant and received over 150 hours of additional specialized training.

I have become involved in numerous business decisions and have been preparing for pharmacy school nearly since I started working in one.

Yet people question me when they ask my advice because of my age.

Look, I know I'm young. I realize I do not know anything. But I know the industry of pharmacy better than half of the pharmacists who work in our company. I have discussed with several deans and countless pharmacist on where the profession is going and how it will change.

Yet people question me when they ask my advice because of my age.

Well ya know what, buzz off. Find me someone else who's my age who knows the shit I do. No longer will I let you talk down to me just because of my age. If you don't want my advice or my views, that's fine. Just don't ask and dismiss them in the same breath.

Whew, I feel better now.

Where's Phathead?

I will be traveling around the country for the next two weeks or so. Prior to having to go back to school for that one motherfuc... I mean that one class, I had made plans to spend a week in Vegas.

Two weeks ago I received notice of my fourth and fifth interviews... at roughly the same time.

So this week I find myself in Vegas where as next week I am traveling to two different parts of the country for two different interviews.

Ole Phatty is gonna rack up some frequent flyer miles!

Posts will probably be short and sweet during that time and, as creepily as it sounds, I could be sitting next to some of you during the interview process... and you would never know!

*Cue evil laugh*

If, for whatever reason, one of my many flights crashes, I leave this blog to our fellow medical blogging brethren. Maybe Dr. Grumpy can divvy the site up for me.

I'm such a positive thinker!

Until then, booze and sight seeing awaits me!

The Patient Formally Known as Josh

*Phone rings*

Phathead: "Good afternoon, Shittiest Pharmacy in the World"

"Hey how's it goin bud, its Josh! Is my Adderall ready?"

Phathead: "Um... ok, what's your last name Josh?"

"You don't know my last name? If you don't know my last name then, why should I give it to you?"

Phathead: "If you want to know if your prescription is ready, I have to know your last name"

"Since you don't know who I am, I'm not comfortable giving you my last name."

Phathead: "Ok...."

"Fine I'm taking my business elsewhere."

*Click*

I am such a grade A asshole for asking for the patients last name...

I Drink to Coco

Normally I don't comment on my personal preferences on this blog outside of quips about society and pharmacy. I like to keep the blog somewhat focused, call it anal retentive if you will.

Last night though, Mrs Phathead and I sat down to watch the final Tonight Show with Conan O'brien. I have followed the story quite closely the last few weeks as Conan has been part of my weekly schedule for almost a decade now. To say I am upset at the notion that it will be several months, if at all, until I am able to end my night watching Conan and Andy exchange barbs is an understatement.

Curiously, when the topic comes up on message boards I frequent or conversations I have, there are numerous individuals who claim, "Who cares, he's getting paid millions to leave a show while there are much more important things going on in life right now."

And I do agree with that. To a point.

But they are missing the much larger picture. One of things that I noticed about Conan, and that several are now picking up are, is that he is a micro chasm of my generation.

Insecure, but confident. Goofy, but serious. Self-depreciating, yet self-aware.

This, generally, is what my generation is all about. That is why the majority of fans of his are my age, we can identify with a nearly 50 year old comedian better than most celebrities. He is able to laugh about his faults and we realize that it is okay to laugh at our own.

It is not surprising that his type of show did not transition well immediately to the Tonight Show. In some ways, he is an acquired taste and I understand that.

And during the sparing that went back and forth on his show these past two weeks, he always reminded the viewers that there is a larger world out there, and events like the earthquake in Haiti serve as a reminder of that.

Because of that, I understand how minuscule these squabbles have been compared to real life. Sure he is getting millions of dollars to leave a television show. But remember that not only he, but 200 of his staff moved across the country for their dream job. A job they would thought would last them for years and years, not seven months.

Is a tragic? You bet it is. Is it in the same scale as the situation in Haiti? Of course not.

But you have to respect who he is as a person and what he means to many of us. His closing speech, and accompanying musical number, was one of the most classy moments of TV I have seen in a long time. He then made a statement which I think far too many people do not take to heart. It is the statement which spawned this deviation from my normal postings.

To all the people watching, I can never thank you enough for your kindness to me and I'll think about it for the rest of my life. All I ask of you is one thing: please don't be cynical. I hate cynicism- it's my least favorite quality and it doesn't lead anywhere.

Nobody in life gets exactly what they thought they were going to get. But if you work really hard and you're kind, amazing things will happen.

And with that statement, I raised my glass and had a drink in his honor. Because it says a lot of a man in his situation, and in the job that he is in, to make a statement like that.

Life is not about the money, or about the job, but what you do with it. Perhaps more people need to be reminded of that fact.

Here's Something for APhA To Do

If you get bored some time, run a little experiment with the general public. Ask them what a doctor, dentist, optometrist and pharmacist do on a regular basis. I bet all could describe the first three quite accurately. Furthermore, I would wager that roughly 9 out of 10 would describe pharmacists as ‘The person who puts my medication in a bottle.”

Is this an incorrect statement? No, generally it is not, but it describes only one small facet of the life of a pharmacist. In fact, I do not think it is farfetched to say that the public generally has no idea what a pharmacist does and/or what they are capable of.

If the APhA and other organizations really want to make a difference in the profession, why not address this fact? In twenty-first century medicine, pharmacists have become an integral part in patient care. That is not to say they were not so in the past, but they are much more dynamically involved than ever before.

Patients simply do not know what pharmacists can do on a daily basis. They are not robots who merely count by five all day. Nor are they able to only give suggestions on the best type of cold medication for a patient. Pharmacists are a fountain of information that is often not used to its full potential.

Do patients really know how many times we fix prescribing mistakes their doctors make? Do they realize that it is the pharmacist who is often correcting a dose or inputting suggestions on different, yet similar, treatment options based upon side effects or contraindications they see? Or that a pharmacist plays a key role in the treatment of whatever ailment they possess in a hospital?

How about pharmacists who save patients money by finding less expensive alternatives to their current drug therapy? Or the pharmacists who can relay complex medical conditions into laymans terms, something many doctors struggle with. Or the pharmacists who can more closely monitor your diabetes or blood pressure problems simply because they see you on a regular basis.

If you ask those ten people will they mention any of those facts? I venture that maybe one of them will hit one or two, but no more than that.

So why isn’t this being addressed? Why are there not ads, if that’s what needs to be done, showing what the profession is really about?

What sparked this thought was in my last interview there was a session involving some of the professors of the school who described what they did. While they did this I scanned the room at the other people there and, not so much to my surprise, the vast majority (I would venture 85% or higher) sat with their mouths slightly awry. One of the professors, noticing this fact, quipped, “Pharmacy is not really what you thought it is, isn’t it?”

And that is entirely truthful. During all of my interviews I have been rather surprised at how little the other applicants know of the profession. Sure you could attribute that to their inability to research their future job, but when looking in a larger scope you notice that really very few people know what a pharmacist does.

That is something that truly must be addressed. Of course I am not the person to lead such a charge, nor am I sure what should be done, but I realize that it is a problem. If we want pharmacy to realize its true potential, people have to realize what we have to offer.

Or am I completely off base here?

More Adventures With Nurses

A new patient of ours brought in a script for azathioprine and her insurance requires a PA on it. We slapped the PA phone number and patient's ID on a fax and sent it off to the doc's office.

Simple right?

Not when there's one of nursings finest involved.

First she calls us and, with an attitude a 14 year old would be proud of, states they 'just got a PA in September that was good indefinitely and they don't need to do another one.' I kindly explained that she was new to use and that often PAs do not transfer from pharmacy to pharmacy. I asked her if she had any new insurance info and she stated the patient didn't bring new info in this past week so her insurance must be the same.

*Click*

Then she calls back saying that the insurance hasn't seen a claim for this drug since September so we must be billing it incorrectly. She gave me a PA number to try and when it failed she said she would call them back. Of course she cut me off before I could inquire anymore.

*Click*

She calls back again saying that Humana confirms that the PA is still valid and we are not billing it correctly. I then, with a slight grin on my face, inform her that her Humana plan ended at the start of the year. I pointed out that in, a very noticeable box, I put her current insurance, their PA number and her ID number.

The only reply I get? 'Oh'.

*Click*

Reading is so terribly hard. Its much easier just to blame someone else isn't it?

Nurses Know All

A lovely discussion with a nurse at giant hospital on a Friday afternoon. Names have been changed to protect the inept.

Phat: "Hello, I have a question about the Effexor XR prescription you just sent us on patient John Q."

Super Nurse: "Okay go ahead."

Phat: "Well I sent you a fax saying the patients insurance prefers generic IR Effexor. The patient is okay with this, so I asked for a new prescription for that instead to avoid the PA paperwork."

Super Nurse: "Okay."

Phat: "Well you sent me a fax back for Effexor XR."

Super Nurse: "Okay."

Phat: "So... this is not what I asked for nor what the patient wants."

Super Nurse: "Ohhhh so you want a prescription for the regular Effexor"

Phat: *smacks head on counter* "Yes, that's what I'm saying"

Super Nurse: "Okay, I'll have the doc sign off on it and fax it back to you"

Phat: "Great. Can I make one other suggestion?"

Super Nurse: "Sure"

Phat: "Well you wrote this for Effexor XR 225mg 1CQD, but that dosage does not exist in a single capsule. Thought I would let you know in case you try to do a PA on that."

Super Nurse: "But it's listed in our software as existing"

Phat: "I realize it is listed there, but it doesn't really exist"

Super Nurse: "But if its in the database it has to exist. Are you sure?"

Phat: *Head now smashes through countertop* "Yes I'm sure it doesn't exist"

Super Nurse: "I don't understand though, its in our database so you must be able to get it"

Phat: "Right... databases can be wrong. I can assure you that it does not exist"

Super Nurse: "Huh. That's weird, our databases are always right. I'll google it later and double check. Thanks!"

*** Click ***

My freakin' God... And you guys wonder why we bitch about nurses sometimes. That woman coulda used a 2x4 upside the head a few times.

I mean its shocking, fucking shocking, that their database could be wrong.

Anyone miss the days when they actually had to write things out and not rely on drop down menus?

The Economics of Pharmacy

Imagine you are a furniture maker. You possess skills that takes many years to learn and have knowledge that few laymen possess. Because of this, you operate your own furniture store to sell your work to local consumers and businesses. You have to compete with the big box retailers, but because all of your furniture is hand made, and made quite well, you have a loyal customer base. You generally manage to keep your prices competitive and, at times, you can match prices of the larger retailers.

In essence you are a respected member of the community providing needed goods and services to the area.

For humor's sake, lets look at the actual cost of materials of the building of a rocking chair.

Wood for Chair - $150
Hardware - $20
Time & Labor - $30
Total Cost - $200

Thus you need to sell this particular chair for over $200 to procure a profit. Being a fiscally responsible businessman, you decide to sell the chair for $250, a 25% markup. This is generally in line with the pricing of similar items at other retailers. As the years go by, you enjoy modest success with this pricing method and remain able to compete with the big box retailers.

Suddenly one day, Walmart attempts to under cut you. They start selling identical chairs for $210. Knowing both you and Walmart have roughly the same cost involved in procuring the chairs, you realize that there is only a very marginal profit made.

Customers start complaining about your now 'over priced' chairs and you are forced to price your chairs at the $210 price point. It doesn't appear to matter that you offer services that Walmart can in no way compete with. You are now making only 5% on this chair, but this pricing method begins to spread to other items in your.

When you voice your displeasure with the situation, the majority of the replies are:

"Well you drive a nice car, live in a nice house and have a stable job, you don't need to be making that much on your products."

Because not all of your customers are demanding meeting this price point, you are able to stay afloat. Your cash flows are altered, but big orders from regional hotels and businesses are supplementing the lost income.

One day you are approached by one of your largest hotel clients. They want one of your rocking chairs in everyone of their thousands of hotel rooms. Naturally, you are excited at this proposal until they start listing their contract demands.

Namely they will pay you $150 for each chair.

"That is unfair," you state. "The cost for each chair alone is $200 and I have to be able to make some kind of profit on it in order to pay my employees and my bills."

"Ah," starts the hotel representative, "but you have operated successfully selling your chairs at $210 and we know the cost of wood in each of these chairs is only $150. Thus you can absorb another reduction in price. So we're willing to pay that amount, and that amount only."

"But you're misunderstanding the situation," you cry back. "The only reason my prices are so low is because I have to compete with the likes of Walmart and other retailers. I'm barely making a profit as it is. And the cost of each chair is not $150, but $200. Your missing the associated costs of actually constructing each chair!"

"Irrelevant!" replies the representative. "The cost of the wood is $150, so that must be the cost of the chair. We will not pay you a dime more for your chairs. Either you accept this agreement or we will take all of our business elsewhere."

Reluctantly you agree. You cannot afford to lose such a large client, even if the deal is rubbish. So you go along, making all of these chairs but never seeing any profit come from it.

Then another of your clients hears of the deal you signed and wants the same pricing. And then another. And then another. Soon a large percentage of your big buyers are purchasing your goods at cost. Tie in the purchases by single consumers for a price barely above cost, and you find yourself leaking money in multiple directions.

Finally, after decades of loyal service to your community, you are forced to close your business. The big box retailers and greedy large clients have bled you dry.

This is exactly how the economics of pharmacy work today. Walmart prices its $4 generics to the point where there is virtually no money made on it (actually the average cost of a prescription, before adding the drug cost, is around $10 per prescription). The large buyers in the story are the PBMs of the nation. Too many of these actually expect us to fill prescriptions for cost.

It is a sad sad fact that very few people are actively aware of. No one seems to care that pharmacies, specifically independent pharmacies, find themselves scrambling for other sources of income. It is the sort of thing that would have its own Dateline special if it were more well known. I highly doubt the public would stand for this type of thing if the majority were aware of it.

Of course this example is overly simplified and there are several other factors that contribute to this problem. I've thought for the last several years that pharmacies and PBMs are going to reach a breaking point some day soon. With two more prominent insurances this year telling us that they will not pay over cost, I feel that day is creeping ever closer.

And it's gonna be one helluva fight.

Five-for-five

Don't worry oh loyal readers, I am still alive. My main computer took a crap on me about three weeks ago and I have been trying to identify the problem ever since. Thus I have not been around to entertain you with my exquisite rantings.

In other news, I received noticed that I have two more interviews in the next three weeks. That makes me five for five on interviews thus far. I do believe its time I can start relaxing a bit over whether or not I'll be going to school in the fall. Kind of an odd feeling if you ask me.

So, ole Phatty will be boppin around the country for the next few weeks. Who knows, maybe I'll be sitting next to some of you in some random city and you'll never even know it.

Spooky, isn't it?

Interview... Round Three

I'm starting to enjoy going to these interview just to people watch. I mentioned on Twitter the guy in khakis and a green sweater. A rather odd combination for an interview, but he fit in with the guy in a polo and cargo pants.

Probably the best part of it is how serious some of the interviewees are. I mean seriously, there were sticks shoved so far up some peoples asses that they had splinters in their eyes. While the Dean gave the opening welcome I scanned the room and was astounded with how many people held their unblinking gaze with chin up in the area at the Dean.

It reminded me of a dog begging for a treat. I actually have to stifle a laugh.

A few times I attempted to chat with people, but most of them had the personality of a wet rag. Or at least they did at this particular time. I make a joke about something, and yes it was a decent joke, and you can hear crickets as the other people look at me.

Laugh people, they aren't going to like to interview a statue.

All in all I think it went rather well. I was very impressed with the program and the faculty members I met. It appears they know exactly where the profession is going and are more than willing to adequately train students for that. Much better than school number two whose sole focus was on research for some odd reason.

Now the waiting game begins once again as I will not here from this school for a couple months. The only thing I'm left wondering is how others felt when they finally did remove that stick from their ass. I bet they'll be shittin' pancakes for a week.

Prescribing, So Easy A Caveman Can Do It!

This appeared on my fax machine earlier today from a dentist office. I've seen a lot of strange form prescriptions before, but this one takes the cake. Really, all its missing is a bingo dauber for maximum effect.


Now I know what some of you are thinking. First, it is nice that it is legible to read. Second, I recognize that it is probably an easy way to prescribe common prescriptions.

But seriously? The kicker is you can tell they screwed up the refills to start out with judging by the marks. They had to make an X, the number 15 and the number 1. And they screwed up one of them.

Bravo, bravo.

Who new little old ladies in a bingo parlor on Saturday night had so much in common with prescribing prescriptions!

The Dark Side of Pharmacy

As the sun covered the ground with its rays in an attempt to perpetrate the first warm day of the year, we sat plugging along in the pharmacy. It was a typical day, nothing out of the ordinary.

Lunch came and went. The order came and went. Soon it was about three o'clock and we successfully filled over 200 prescriptions. For the time being, there was nothing in the queue so we all took a chance to relax and enjoy the peace and quiet.

Out of the corner of my eye I saw the young girl in the hoodie come through the back door of the pharmacy. It was nothing unusual for this time of year and I paid no attention to it. In the midst of discussing the some random fact I heard a voice murmur,

"I'm so sorry."

I looked towards the direction of that voice, which just so happened to be directly in front of our consultation window. There stood the girl in the hoodie with my manager. And a knife pressed to her neck.

"Here," she said and handed me a piece of paper. Hastfully scribbled in blue ink on that crumpled piece of paper said the following words:

Give me all of your Oxycontin and no one gets hurt. Do not call the police.

I looked up to our pharmacist, our eyes locked and he immediately knew what was wanted. Sadly, this was not his first time in this situation.

Together we walked over to our controls cabinet, unlocked it, and began emptying the requested bottles into a white sack. No words were spoken. No words needed to be spoken.

He stayed back to relock the cabinet as I carried the sack towards the window. The girl still stood there, her hands shaking. As I gave her the bag she slowly walked backwards, my manager still in hand. A few feet back from the counter she pushed her away and darted out the door.

Out of instinct I flew out of the pharmacy after her. I wasn't thinking of what I would do, it was just a reaction. By the time I ran out the door she was in a car speeding away.

Walking back into the pharmacy everyone was frozen. I stepped back into the pharmacy and hit our silent alarm. From some direction, to this day I do not know who said it, came the phrase,

"What the fuck."

The whole experience was slightly surreal, almost as if you have stepped back and are watching a movie of yourself. Adrenaline kicks in and saves you from completely breaking down... at least at that moment.

Why do I share this?

So often we share stories about addicts and crazy customers and do so in humorous tone. The thing is, some of them are really not all that humorous. It's merely a way to cope with what we see on a daily basis.

As cliche as it may sound, that day a part of me died. The innocent part that still believed things of that nature did not really occur. It was almost as if part of the joy I see in the world died a little bit that day.

Now when ever I see someone with a hoodie pulled up over their head, the hairs on the back of my neck stand up. It's almost an innate response now. Little quirks that previously were ignored are now highlighted with the possibility of a repeat occurrence.

It is really funny how something like that can change you. It's one of the few experiences that I really do not find any humor at all.

Why haven't I told this story after having this blog for well over two years and over 300 posts? I really have no idea. Why do I share this story now? In prepping for an upcoming interview one of the questions asked, "Name a moment in which you excelled in a difficult situation."

Honestly the only answer I can think of is that day. After the event I spent the next three hours defusing various aspects of the situation. That included driving to the location where the police eventually found them and identifying them.

There is something insanely sobering about sitting in the back of a police car when they remove another person, with guns drawn, in order for you to identify them. Especially when you considered what you just witnessed mere hours ago.

It was the only time in my life I have ever felt truly proud of how I conducted myself. And its the only time that completely answers that question.

I guess the real reason I've decided to finally share this is so that those of you who do visit this blog realize that it is not always fun and games behind the pharmacy counter. Sure we can joke about situations, but in the end not everything is truly as humorous as it seems.

That kind of goes against everything I believe in as a person. Ironic is it not?

Happy New Year... Minus the Happy

There shall be no year in review from this blogger. Why? Because I think they're gay, that's why.

What I have been pondering during the first work day of the new year is how paranoid I have become during this time of the year. It used to be that New Years signified a chance to start over and to better yourself. Now I wake up the next morning in cold sweats dreading heading into work even though I typically have New Years day off.

And who do I blame? Medicare Part D, that's who.

Even though it has been a couple years I still fear the clusterfuck that was Year 1 of Part D. We all walked into the store today with a bit of trepidation and reluctantly logged onto our terminals. This was before checking the faxes, before checking the phones, before even powering up the robot.

Of course the day has not been anywhere near as bad as that fateful first week in 2006. I have not witness a pharmacist punch his computer monitor today, which is still one of the most humorous things I have seen at this horrid place.

Sure I have about a dozen patients that I cannot fill anything for until they mosey on in with their new cards. Sure some Caremark plans aren't allowing refills until 85% utilization and some Medica plans aren't allowing refills until 100% utilization.

Note to Caremark and Medica VPs. Next time you pull a major switch like this, let us know next time. That way I can resist the urge to donkey punch you after being on hold for 20 minutes.

In all, it's not that bad. Yet still, in the back of our minds, there is this innate fear that it could all go down hill at any moment. It's almost as if we have a touch of PTSD regarding it. Funny how that works.

And perhaps the greatest joy is that we can no longer say Happy New Years because there is nothing happy about the new year anymore. CMS stole my joy, those bastards. Maybe I should donkey punch them instead.