e-Rx of the Week

This is something I've toyed around with for a while, and since I am enjoying many more curious prescriptions on a weekly basis, I figure I'll finally have the material for it.

The Rx's posted here may have a legitimate medical usage, but may still sound or humorous, or have an erroneous mistake. In all cases they caused more than a small case of laughter within the pharmacy.

The current e-Rx of the Week:

Patient Sex: Female
Drug: Viagra 50mg
Sig: Take 1/2 tablets by mouth twice daily as needed for esophageal spasms
Qty: #60
Ref: PRN

I do believe the jokes write themselves on this one...

The First Annual Angry Medical Professional Conference

Today there exists conferences for medical professionals on seemingly any topic. Yet there exists a void in the conference spectrum which could be of greater benefit than any other conference one would attend.

A conference in which medical professionals could bitch about their daily lives in their profession.

The sheer amount of booze consumed over this multiple day event, and yes it would be multiple days, would be astounding. The times we would have.... now those would be priceless.

If I have learned one thing over the last few months via conversations on Twitter, it's that we all enjoy sharing asinine stories about patients. It is a way we manage our frustration of our profession during a day.

Obviously, for HIPPA reasons, the names of the inane are never released, but the experiences can be retold in detail.

We could even have an awards ceremony for meeting various requirements of ineptitude.

"To the doctor who dealt with the foulest shit stench while in an exam room... BurbDoc!"
"To the creation of the best patient greeting card slogan... The Angry Pharmacist!"

Then we could all high five each other and take a shot of Tequlia.

We would share tears, laughter, and the occasional group singing of a Journey song. Really, this could be the greatest thing we ever contribute to the profession.

Now who's with me?

The Disconnect in Pharmacy Management

One of the disconnects in pharmacy, and truly in many jobs, are the orders which come down from the corporate side of the business. As most are aware, this time of year in pharmacy everyone is pushing for immunizations. Often the manner in which they are pushed, and promised to patients, shows a clear disconnect between what corporate wants and what is actually possible.

And truly there is a simple solution to this problem.

During my travels across the pharmacy world, I once worked for a successful, and fairly sizable, independent chain. The owner made it a point to regularly work a shift in one of his pharmacies in order to have an accurate gauge of what it was he was truly running.

It wasn't always a full day, but there was still a consistent amount of time spent in a store on a regular basis.

Wouldn't you know it, last I checked his business was thriving.

Why is it so hard to do this? Yes, we're all busy and needn't be bothered by additional work, but isn't it a good idea to have first hand knowledge of what things are like at ground level? Wouldn't many of the problems we face be mitigated if the person making decisions was actually forced to deal with them?

Would the regional manager who keeps cutting hours for technicians still do so if they were forced to work in a busy pharmacy with minimal help? Sure, it would not change the thought process of some, but I'm sure it would change it for some.

One of the things that is preached in business courses is efficiency. It is this which can bring in the most revenue over a long period of time. In order to run a business efficiently, one has to not rely merely on second-hand knowledge of processes. Obviously this is a stark change in how many upper managers conduct their business, but it seems so logical that it would be foolhardy to ignore it.

Then again, whoever said upper management was logical...

Maybe Being A Pharmacist Isn't So Bad

No words at needed for this post, but a simple warning. Do not start watching this video on full screen mode. You'll see why.

http://www.liveleak.com/view?i=f2d_1284588370&p=1

Hooked on Phonics for Prescribing

Little verbiage from me today other than a collection of some prescriptions I have seen come my way over the past two weeks.

I thought being in a much bigger city would provide at least slightly better prescription writing skills.

I was wrong.

Avelox 40mg/0.4mL
#5
Inject Daily For Five Days

Vytorin 10/40mg
#6
Take 1 tablets as needed prior to sexual intercourse

Lisinopril 20mg
#30
Take 1 tablet. Inject in right eye four times daily for diarrhea

Oxycontin 80mg
#120
Take 1 tablet by mouth four times daily
Refills: PRN

Somewhere, some place, Grumpy is rolling around in his office...

Druggie Math

Woman comes to the drive thru Saturday night, naturally, ten minutes before close. She presents a narc prescription for Opana ER, an odd drug of choice around here.

We ever so kindly explain to her that we do not have this drug and, from our files, it does not appear anyone within our area has this particular strength in stock.

Her response?

Well.. I gots this injury and they give me like mor-feen which worked kinda good and Oxy which worked kinda good at someone told me this combines da two in ta one

Alrighty here, for those playing at home this druggie formulated the following math problem.

Oxycodone + Morphine = Oxymorphone

Actually, for a collection of people who cannot seem to figure out that 30 tablets, at one per day, equals a 30 day supply, this is pretty clever.

Sadly though, we attempted to explain to her that, like many other things in her life, she failed at this math problem.

Boo hoo.

Side note: When talking to your pharmacist, do not refer to Oxycontin as Oxy. Ya know, if you actually want us to fill anything for you.

Stop Coddling People

We live in one of the most glorious times in human existence. At no other time in our time on this planet have we had such plentiful and easy access to all of life's necessities.

No, I'm not talking about the internet, or Walmart or anything of that nature. I'm talking about the new dominate form of humanity... hand holding.

All we do is coddle people in this country. Each day fewer and fewer people take responsibility for their own actions and expect others to pick up the slack for them. And, for the most part, we keep on smiling and going about our day.

How is it someone who is on state insurance, and by definition has insufficient personal funds to provide basic health services, can afford some of the things they own? Regularly you see Medicaid patients roll up in their fancy cars with shiny rims while chatting on their iPhone which is full of various paid add-ons.

"Rather spend your money on making yourself looking ghetto fabulous rather than paying your own bills? Well hell, we'll pay for it then!"

I do not believe that if you are poor that you should be forced to live in squalor. I do believe, however, that you should not be able to live a more extravagant life than I.

When calculating eligibility for welfare, why do they not take a better look at the recipients assets? If they drive up to the SSA office to pick up their check in an Escalade riding on 24 inch rims, you would think that perhaps they don't need those benefits, no?

And yet we hold their hands. Some states take it a step further and tell their medicaid recipients that pharmacies have no right to refuse their prescription if they do not have the co-pay.

Great. Way to give them even more power. It's bad enough I'm paying for their own ineptitude, but now you're giving them a reason to refuse payment so they can buy another intricate tramp stamp.

Awesome.

I won't even get into the economic aspects, considering that for many medicaid programs most of the monies received over cost come from that small copay.

The system has failed spectacularly. Social workers, and I've run into my fair share who could use a 2x4 upside the head, are some of the least paid government workers on the basis of the shit they put up with. I do not envy them in one bit.

Perhaps it would be better if instead of giving these people free will over their spending that they have some sort of proxy to determine for them if they can spend their money on said item. They should not be able to drop $200+ on a phone when they 'cannot afford' the $1 copay on their child's antibiotic.

What right do they have to be able to manage their own finances? Isn't that what partially got them in this position to begin with?

For the love of God, stop coddling people. Make them take responsibility for their actions. It's not that freakin' hard.

Don't Tell Me I Can't Do Something

If you really want to light a fire under my ass, try telling me I can't do something. For whatever reason, when someone states that I will be unable to accomplish something, it ignites this insane desire to not only succeed, but to do so at an astronomical level.

When I first started in pharmacy, back when I was a wee 15 year old, someone told me that there was no way I would last long as an employee. After that, I strove to disprove that and ultimately worked for that pharmacy for eight years, including a consultation gig, and it is part of what drove me to pharmacy.

When I made the decision to continue on to pharmacy despite my lowly GPA, several people told me it was a fruitless cause. Needless to say, it was a great thrill when I ran into one of them recently when I was able to tell them that not only was I accepted at one school, but I was accepted at four.

Normally I am not overly competitive. Most of the time I think excessive competition is fruitless for all parties involved. Yet, I make an exception in these cases.

What brings this up? I've had a couple of people tell me that there is no way I will be able to succeed in pharmacy school seeing as I need to work many more hours than a normal pharmacy student and raise a family well doing so.

Oh it's on now.

I may have said I'm not shooting for Rho Chi, or anything of that nature, but I'm sure as hell not going to roll over these next four years. My goal is to be able to bitch slap these people during my graduation with all that I have accomplished.

And it shall be glorious.

Who Cares About Rho Chi?

All anyone is talking about since we started school is Rho Chi.

Rho Chi this, Rho Chi that. Next year, I wanna be in Rho Chi so my schlong will go another six inches and/or my breasts will increase a cup size. I really hope someone doesn't answer 'and' to that question.

Ok, so maybe I made that last part up, but it's rather annoying.

So, to continue my trend of... well bucking the trend, I shall make the following proclamation.

I, Phathead, being of somewhat sound mind, body and judgment hereby declare that during my tenure in pharmacy school I will not, under any circumstance, strive for a GPA of 4.0 ~~~ Signed, Phathead - September 15th, 2010

Sure, there are some of you going "What in the hell is he smoking?" or "Dumbass."

I am a firm believer that grades, on the whole, don't matter. Fifteen years down the road, you're employer won't care if you earned a 4.0 or 3.9 or shit monkeys out of your ass on Sundays. Granted, GPA is one of the deciding factors on who gets what residency, but in case some of you have not gathered, I have no desire to go the residency route.

In one of my interviews, I was asked a question similar to this. My response was that, in the end what does it really matter? Do I want to subject my mind to even more stress and fatigue to gain an extra 0.1 GPA point? Do I want to devote time to an endeavor which ultimately is not worth it for myself?

I would rather be a well-rounded, well-learned individual who is able to think rationally, and quickly, when required.

I'm not saying that I will slack off over the next four years. What I'm saying is that if I earn a B on a test instead of an A, it's not the end of the world. I have my own personal standards that I will maintain, but needing to earn all A's is not one of them.

Some people like to set challenges for themselves, and earning a 4.0 is certainly a challenge. It simply is not a challenge I am interested in. I feel I can better spend that exertion elsewhere.

Plus I will help cease the proliferation of gray hairs that were started by my pre-pharmacy stress levels. At least that's what I'll continue to tell myself...

I Get It, I Finally Get It

For the last two weeks or so I have been becoming acclimated to working in a Walgreens pharmacy. After almost ten years at independents, I figure I would begin to develop an understanding for the other side of the retail table.

And I finally get it.

I understand why they typically cannot fill a prescription in a timely manner.

I understand why pharmacists stated they are overworked on a daily basis.

I understand why people say pharmacy is not fun on a regular basis.

Why? Because WAGs workflow sucks.

I'm all for preventing errors. I have no qualms about double checking. The number of fail safes the pharmacy has, however, is broaderline overkill.

You cannot accomplish anything in a timely manner. Enter a prescription, it has to be reviewed. Need a partial? Has to be reviewed. Want to fill something? Have to scan it and wait 20 seconds for it to register.

Don't get me wrong, they have several very cool systems. There is just not a good workflow. It's clunky and slow.

What makes it worse is the lack of patient interaction. I'm used to an open air pharmacy and being able to converse with waiting patients as you please. It is a nice change of pace and often brings a lightheartedness to a stressful day.

Not here, the most interaction I get to enjoy is telling someone how much their bill is.

Obviouslly I have been jaded. I have toured many, many pharmacies over the years, but never long enough to see the full picture. This isn't fun... It's a chore.

Of course it doesn't help that all of my co-workers are uber serious all the time, but even if they were fun, it still wouldn't solve all of the problems.

I feel for all of you, I really do now. Some of you may have never ecperienced how great working in a pharmacy can truly be.

And that is the most sad fact of all.

What's The Point?

I'm sitting in class today listening to my fellow classmates ask various questions throughout the multitude of courses we have on a daily basis. Through all of the student associations stopping by (Remember to come play beach volleyball everyone!), to the overly peppy IPPE instructors (You can really make a difference in someone's life!), I find myself ending each day with the same question.

What's the point?

I have a fairly good gauge of what at least half of the students in my class are like. For years I have had a tendency to observe people and gather an idea of who they are as a person. It's a hobby if you will.

There are some who lack a backbone, many who know nothing about the profession and more than a few who lack decent communication skills. These, are your future pharmacists.

As I head to work, I observe the interns and other undergrads who attempting to be accepted to school. There's the girl who gives a blank stare to everyone who comes to the counter, the intern who is unable to answer a simple question, the pharmacist who doesn't know the difference between Zaditor and Zyrtec eye drops.

And for the record, there is no difference.

Throughout the pharmacy blogosphere we have pharmacists, technicians and interns across the country yearning for change. Some, most notably Eric, Pharmacist, have taken it in their own hands to fight the good fight.

Good ole J.P. attempted something grand with The Pharmacy Alliance, but it has never gotten off the ground for various reasons.

And I think I have traced this fact to two many problems.

1) Obtuseness
2) Lethargy

The former is simply ignoring what is surrounding you. My classmates, thus far, seem to be quite keen on this. I would say ignorance would be a better word, but it is so clearly presented so many times that ignorance is not an excuse.

Lethargy might be the even bigger problem. Those who see the problems, but do not care enough to act on it. With older pharmacists, I can somewhat understand this because the profession has changed so drastically from what they first envisioned that it may very well be overwhelming.

A simple solution, at least in my eyes, is to start young. Get them while they're still in pharmacy school. Begin now to open the eyes and brains of my fellow classmates to what the world is truly like.

Start a revolution if you will.

Then, and only then, will we develop a point. We have excessively bright minds in this field that could be put to much better use than simply clearing a DUR. If organizations like the APhA won't do it, then perhaps students need to get involved with a new organization. One that will actually prepare people for the real world.

Until then... What's the point?

Head, Meet Wall

"Ooooh oooh oooh, I know the answer!"

I have a feeling I'll be hearing that phrase, or some variation of it, a lot over the next three years. The biggest question is whether or not there is enough alcohol in the world to keep me from strangling said persons.

Case in point, we had our first group work of the semester yesterday. Nothing overly difficult, obviously, but it was the first interaction of small groups since we've been in pharmacy school.

And it made my head hurt.

What the hell is it with people? I derive the answer to a question their asking, explain it to them and their response is, "Well I understand what you're saying, but I'd prefer to have written proof from another source before putting that down as my answer."

Huh? It's the opening lab of the first year of pharmacy school. It's just a simple question which is not going to be scored? What the fuck does it matter?

Later on we come to another question in which they were a bit stumped. It involved how a certain aspect of the human body operated. I remembered, in great detail, how this action worked and explained it to them in as remedial terms as I could.

Their response? Ask a TA who repeated, almost word for word, what I said.

Then there was a question regarding data and whether or not it would be wise to draw a linear line through the points. There were six points and they were in a row, albeit not a perfect row though.

A debate began on what was meant by 'drawing through the points'. Did it mean that it had to go directly through the points, because the answer is no since you can't do that. What if the data plateaus off in the future or becomes parabolic. Maybe that one point is an outlier (it was maybe 2mm off the other data points) and shouldn't be counted.

All on one fucking question.

It's going to be an awful long three years...

Senseless Lives Lost... While Raising A Perplexing Question

Pharmacy is a unique professional career because unlike that of a doctor or a dentist or a chiropractor, retail pharmacists often come face to face with violence. It's fact that we all must deal with whether we like it or not.

One of the quirks that is never covered in the schools or pamphlets, it is something that I covered earlier this year simply to open other's eyes.

A story mentioned in passing to me earlier today brought an interesting question as a possible response to this unpleasant facet of our profession.

NORTH HIGHLANDS, Calif. -- A shootout in the Sacramento suburbs has left a pharmacy worker dead and police hunting for two drugstore robbers.

Sacramento County Sheriff's Department spokesman Sgt. Tim Curran says two men walked into a Rexall pharmacy Thursday afternoon and demanded drugs.

Curran said the robbers and an armed employee began firing at each other in the store in a chaotic gun battle that continued into the parking lot. He said investigators are still trying to sort out who fired first.

The sheriff's department says a 27-year-old pharmacy employee died after being shot in the chest. Curran says a 37-year-old employee who was eight months pregnant was shot in the foot.

The employee involved in the shooting was not injured.

Source: http://www.washingtonpost.com/wp-dyn/content/article/2010/09/03/AR2010090305519.html

The initial thought may be to applaud the pharmacy worker for not taking the situation lying down... until you considered the lives lost.

After discussing the article, naturally the debate evolved to questioning the validity of a conceal and carry permit being employed in a pharmacy for protection.
Here I shall offer a bit of a disclaimer: I have no problem with the second amendment and all the rights it bestows. If the Constitution said that it was okay for people to walk around wearing chicken suits and flinging shit at each other, I would accept it and move on with my life.

This isn't intended to be a public service announcement.

Now some of the statements made alluded to the fact that it is too bad more places do not allow such permits to be invoked while working in a pharmacy. Obviously the logic being that the profession could be dangerous at times and we should have a chance to protect ourselves.

My initial logic is a resounding no.

First off, we are deemed professionals by the schools we intended, our peers and even by the government. We do not cover a course studying Rambo in our schooling. Additionally we have a duty to protect our patients and, I would think, a situation like this would fall under that oath. And I do not think putting their lives in harm's way anymore than they already are is a wise idea.

Second, pharmacies are usually a fairly small and confined areas. The person in question is probably already nervous and is most likely bluffing (even the most whacked out of methhead's are going to realize it will be difficult to get away with shooting someone in a public pharmacy).

By threatening back you are effectively kicking the situation up a notch and perhaps making said person panic. The vast majority of the time I hear of shootings in a pharmacy, it is due to someone trying to be a hero and antagonizing the situation.

Plus there is also the risk of giving said person the option of yet another weapon if things go even more wrong.

I've been in this situation. It's not fun and it's more stressful than most of you can imagine. With adrenalin running, you do jump into survival mode and almost run on autopilot.

I completely get the part.

What I don't get is the logic behind going this route. A woman... no, a co-worker is dead and another pregnant co-worker is injured because someone decided to fight back and one could argue that part of the reason for this is the actions of the co-worker. You have no idea if the criminal in question is merely pushing buttons or if they actually have the ability to take a life. Surprisingly, most do not have the power to do so unless pushed.

Plus, it's one thing if it's just you and the criminal, but it is another thing when you are endangering those around you.

My question is if there are any other thoughts about this? I may have completely missed the point on this or I could be completely in the right.

I honestly don't know.

A Theme Song for the Site

No I did not create this (or have anything to do with it), thus it is not me in the video. Pulled it off of SDN and figured it was clever enough to share.

So I present to you, a musical rendition of "I want to be a pharmacist..."