The Battle of the PPIs

The remains of the fallen solders from the Prevacid tribe

In the annals of historic battles there are Gettysburg and D-Day, but never before has there been a battle as epic, or as dramatic, as the Battle of the Proton Pump Inhibitors this past evening.

On one side sat the old guard, the Tribe of Prilosec led by General Astra Zenica. As one of the oldest tribes in the PPI realm, Prilosec had felt the increasing pressure of the Prevacid Tribe as they first encroached on the Prescription Peninsula and then eventually OTC Island. Using shimmery, metallic purple colors they attempted to outshine Prevacid Tribe, but in recent months had continued to be besieged by the upstart tribe. Now they felt their livelyhood was immediately threatened by its racemic counterpart.

Prevacid Tribe, led by the venerable General Takeda, had surpassed all expectations and supplanted themselves as a force on PPI isle. A more multi-racial tribe composed of equally mixed pinks and aquas, Prevacidians found themselves ambitious and eager as they attempted to topple the mighty Tribe of Prilosec.

At 7:04 PM on Tuesday the 31st of May, the General Zenica gave the order which would alter the history of the PPI isle. A surprise attack on the capital of Prevacid Tribe, Novartis, sought to finally rid the world of the too-similar Prevacidians.

Using intimate pharmacologic knowledge, Prilosec leaders used optical attacks from the left and right to decimate the Tribe of Prilosec. Capsule and capsule parts lie strewn across the land, with the innards of Prevacidians coating the counter-side.

By the end of the battle, the Tribe of Prilosec stood victorious over their nemesis, and found themselves the reaffirmed King of PPIs... for now.

Realistic Professionalism in Health Care Practice

Inspired by the following post over at 33 charts

Barely an hour into the first day of orientation for pharmacy school we were given the first, of what would be many, lectures on professionalism. We were told how our daily actions, both during and after work/school, would reflect both the image of the school and of the profession. Due to this, we were to maintain professional decorum at all times.

There was also some insinuation that our actions outside of school could be used as a reason for dismissal.

Think about it though, how realistic is it to expect an individual to maintain professional standards at every waking moment? Am I not allowed to see movies with an R-rating in case a patient sees that I may be viewing something inappropriate? Am I not allowed to consume a beer at a restaurant for fear of a patient judging me?

Where precisely is the line?

For whatever reason, too many people today expect perfection. In the mind of the public, there can be absolutely no errors in dispensing or prescribing or diagnosing without an immense amount of retribution. Life is, of course, immensely precious and people feel wronged when something goes wrong. So-called 'News' shows such as Dateline NBC feed off this fact and help propagate the incessant need for perfection.

However as Alexander Pope once said, "To Err is to be human." We are not machines designed for perfection, we are human beings. We have faults, we make mistakes even though we may strive to mitigate them as much as possible. It's one of the reasons why I repeatedly say here that failure is our greatest strength. Perfection is a wondrous illusion, namely because of the impracticality of it.

Humans, well most humans, cannot restrain their emotions every hour of every day behind a professional facade. In fact, it has been shown in numerous studies that bottling up one's emotions has negative consequences. Health care professionals have one of the most mentally taxing daily jobs, yet we are all expected to maintain professional composure at all times.

Due to this, many choose to vent their frustrations not only for their own mental sanity, but to be able to continue to effectively practice. We all have to let that facade crumble at some point or another, and the majority choose to do so outside of the public realm. Whether it is through a blog, Twitter or even a friend, it is where we are able to let our guard down and shed our concerns, fears and worries.

The evolution of devices like blogs and Twitter may prove to be one of the most beneficial outlets for health professionals in their history. It now only spurs new and creative ideas, but let's professionals bond across state and even national boundaries if only to reassure all that they are not alone in your frustrations. Pharmacy blogs like Your Pharmacist May Hate You and The Angry Pharmacist have quite literally helped to relieve the immense amount of stress felt in pharmacies across the country.

For those of us who may be shy when discussing our most personal problems, professional or otherwise, the fact these devices exist is a godsend.

While those popular blogs exist as a source of venting for the profession, it has lead to the creation of other blogs with slightly different focuses such as Eric, RPh and The Redheaded Pharmacist that exist to help better the profession. And this example is just describing the pharmacy blogosphere, not even considering the countless medical blogs in existence.

Yes, some of these blogs and Twitter accounts are crass, using language that would never be used in an actual professional setting. Yet they speak more truth than any professional document you may see coming out of organizations like APhA or AMA.

Why is this?

Because professionalism is self-limiting in that we are all expected to maintain the same methodologies and persona to standardize patient care. In itself, there is nothing wrong with this, but outside of a professional setting how else are we to spur innovation? How are we to explore the good, and bad, of our profession? How else are we to relieve the stress we all feel and actually enjoy life?

We all carefully consider federal and state laws, often artfully crafting responses to ensure the innocent are protected. Every work place has similar gossip-style discussions, and yet similar health care professional discussions are draped in anonymity in comparison. This is a fact even more impressive when considering the amount of venting we all do.

And venting is just that, an outpouring of frustration. What is said during this time should not be construed as a representative of who they are as a person and a professional. The majority of the time if someone stubs their big toe, their first reaction is to spout off a slew of words that would make a sailor blush. Does this mean that we should judge their response and formulate that they are crass and unprofessional?

Of course not.

Expectations are a wonderful device when used properly, but only when they are based in reality. Today the expectations for not only health care professionals, but for individuals as a whole are unrealistically high. Before you decry what and how they say something, consider the benefits they earn from doing so.

Would you rather have a practitioner who is constantly uptight, concerned with ensuring that they abide by all expectations and standards while they treat you? Or would you rather have the practitioner who is able to release their frustrations outside of work and remains relaxed and clear headed?

Before you judge and before you point fingers remember that you are not speaking about a device spouting off medical advice, but a person with a personality and emotions. They have the same needs and desires as anyone else in the world.

If anything it's a good thing others can see these frustrations under the premise that they realize we are not as infallible as they assume us to be. Because of they see that we are not infallible perhaps, just perhaps, they will no longer operate under the guise of perfection.

One can dream, can they not?

10 Year Anniversary

My first day of work in a pharmacy was June 1st, 2001. It was my first job, and the ultimate goal was to make enough money to buy some bitchin' clothes for my sophomore year in high school.

Fascination grew while learning terms like "Stool Softner" and the fact there were medications that made you pee. In fact, the "pee pills", HCTZ and Furosemide, were the very first drugs I learned. By the end of the summer I found myself enjoying what I was doing, but still had no idea that it would transform into my lifelong profession.

Now, I'm staring down at my ten year pharmacy anniversary. Changes over those ten years are too numerous to count, and too minute to elaborate upon. There has been different cities, different schools, different states, and yet I ultimately have not wavered in what I want to do.

Well, until actually starting pharmacy school.

I remember the Bextra and Vioxx recalls, the birth (if you want to call it that) of Medicare Part D, the proliferation of e-Rxs and the rise of $4 generics. I have seen way more than I ever intended to and sometimes I feel like I have more knowledge and experience than I deserve.

The question now becomes, do I celebrate this milestone? Do I look upon it with befuddled curiosity and continue on with my day? Does it even matter in the grand scheme of things?

I am 25 years old and have spent nearly half of my life in this profession. I venture that there are very few others out there who can lay claim to such a fact.

Who knows what will happen in the next ten years? Who knows if I'll even still be optimistic after another ten years.

If one thing is evident, I feel I should at least raise a beer when June 1st arises. And then hunker down a prepare for a day of work in the battlefield that is pharmacy.

Because right now, that's what pharmacy is, a battle. A battle between the desires of the profession, between PBMs, between what our current health care system says what pharmacy is compared to what it should be, and between our own shreds of sanity.

And at least I'm young enough to still have my sanity.

For now.

Year One: Complete

First year has been over for about a week and it's only been in the last day or two where my mind is finally able to unlock from the "Study All The F'n Time" gear. Hell it wasn't until the third day after my last final before I was finally began to feel as if the stress of school was subsiding.

Funny how that works.

To say I am ecstatic for this year to be over may, in fact, be the understatement of the year. I have neglected this site for the same reason I have neglected everything else the last six months, I felt I had to. Without going into too many details, my school managed to completely rip apart who I am as a person and how I conduct myself both academically and personally.

It wasn't until very recently that I was able to shake off the scratches from that meeting prior to the start of the spring semester and finally be able to feel comfortable once again. Only time in my life I have ever truly doubted it and it frustrates me all to hell that it was induced by others.

So to those deans and profs who said I was unprofessional and would never survive pharmacy school, you can take my As and Bs from this semester and shove them up your ass.

As bad as it sounds, I have resorted to steering people away from my school on the basis of how I, and others, were treated in the past years. Call it my first taste of reality in dealing with egos if you will.

That being said, this place should become a bit more lively in the coming weeks. With rediscovered confidence comes a new-found desire to post nonsensical ramblings. Because honestly, that's what everyone comes here for right?

It's going to be one helluva a summer. And I can't fucking wait.