No iPhone For You!

"I was wondering if you could possibly spot me enough of my meds for a week cause I won't have the money for my co-pays until I get paid next week."

An innocuous question, no?

I'm sure most of you are thinking that it is a completely unreasonable request and, as pharmacists, we should see no issue with heeding her request.

Which would be true... unless you had a bit more information.

First, the total amount on her seven medication was $1. I'm pretty sure there is enough change in my couch to total a buck.

Second, she asked this while her blinged-out iPhone 4 sat on our counter. A quick glance at said phone showed numerous pages of apps and, from what I could see on the page showing, numerous paid apps.

Knowing this, does your answer change?

Apparently this person, and many others, can fork over money for a pointless app which makes a farting nose for their phone, but they don't have the dollar for the medications which help keep them alive?

Does anyone else see the issue with this?

Look, I know what it's like not to have money, I live with it every day. I put off buying new shoes for over year until I could not glue or tape them anymore. Why? Because we needed that money for bills, diapers and other necessities.

It was not absolutely required to live, so I did not purchase it. Being able to provide basic needs should supersede any other frivolous spending at all times.

I don't care if someone splurges on themselves every once in a while and, in fact, it can be a good thing. But when you do so at the expense of your basic needs which may harm you, or others, what the hell is the point?

The better question is how we can let low-income individuals, whom for various reasons the public is supporting, be allowed to sign expensive phone contracts or fill said phones of paid apps? How is that fiscally responsible? They can't pay more than a dollar for their medications, but they can pay over $100/month for their iPhone.

Too often in today we rely on others to fix our own problems. We "pass the buck" far far too often and do not take responsibility for our actions.

And it's sad to see.

Ultimately the pharmacist decided not to spot her any of her medications partially for the reasons I mentioned and partially because this is a regular occurrence with said patient. There is only so much charity and hand holding we can do before the patient needs to stand up for themselves.

Cruel? Perhaps. Unprofessional? Maybe. Except for when she came back an hour later and paid with a crisp $20 bill.

Funny how that works.

Who Am I?

For various reasons I decided it would be best to take the summer off from using my brain. This is the first thing I have written in over two months and, for the most part, I have remained as distanced from pharmacy as I can be right now.

After the last year, I felt a need to simply relax and spend time with the family. And as I look ahead to second year starting in a little over the week, I find myself asking, "Who Am I?"

One year ago I was overly ambitious, hell bent on changing the pharmacy world upon graduation. I felt as if I was here to right so many of the injustices we all live with every day in the profession.

Then class started... and work become overbearing... and the baby came.... essentially, reality set in. I'm still bitter towards my school and the profession after how the first year panned out. Honestly, I'm not sure if I'll ever get that taste out of my mouth, no matter how much I try.

And if it wasn't for the wife or Lil Man, I doubt I would have survived.

But who I am now? All I want right now is to finish school, have enough money to provide for my family and spend time with them. Whether that's as the director of pharmacy for a large hospital or as simply the RxM at Walgreen's, it truly does not matter to me at the moment.

I would love to be able to find enjoyment in pharmacy again, to find that fire that used to burn so strongly inside of me.

And to find out just precisely who I am now... because I really have no idea.

The Pharmacy School Depression

You slave through several years of undergrad, study for hours and hours for the PCAT and finally earn your pharmacy school acceptance letter. To yourself you think, "I know pharmacy school will be hard, but at last my stress will be reduced because I've finally made it, I'm a pharmacy student!"

Alas this is not the case.

Sure, for the first few weeks of class you ride the wave of accomplishment, taking pride in earning admittance to a school few others enjoy. It's a wonderful feeling and ultimately you feel pretty damn good about yourself.

Only it will not last.

By December that stretch of unbridled joy will seem but a distant memory. Replacing it will be stress-induced insomnia coated with a bitter taste of self doubt.

One of the things that your school will not tell you, nor your friends, is how emotionally and mentally taxing pharmacy school is. If not for the material, than for the expectations of the school or the manner in which courses are taught.

You find yourself sitting next to a dual Ph.D. on one side and on the other sits the wiz kid who powered into pharmacy school riding a 4.0 after two years of undergrad. Suddenly you are no longer a big fish in a small pond... and you come to the realization that there are individuals, perhaps several, in your class who could mentally wipe the floor with you.

The first round of exams come and... they're not what you expect. Maybe you do well, maybe you do not, but you quickly realize these are not the same type of exams from semesters past.

Dozens of hours of studying and sleepless nights may yield a mere sixty percent on an exam. Material you thought you knew like the back of your hand vanishes under the complexity of exam questions.

Doubt sets in.

"Do I belong here?" you begin to wonder. "Did they make a mistake? Maybe I shouldn't do this... maybe I can't do this."

You moods became more variable as your patience wains. It's not common for you to suddenly snap at someone under even mild stress. Self-doubt clouds your mind from exam to exam as you scrape together the will to continue.

At times you do not think it will get any better. Friends speak of struggling during studying and exam taking, yet they proclaim earning an "A" while you quietly mumble about your "C". Socially you distance yourself as you internally chastise your inability to maintain pace with your friends.

You have the Pharmacy School Depression. Mentally you have been broken... perhaps you are merely a shell of who you once where.

The semester draws to a close and you feel as if you are on your last bits of sanity. Suddenly the tough facade that everyone else has erected begins to crumble.

The dual Ph.D. you sat next to? Barely scraping together Cs in a class... and wondering if pharmacy is for him.

The wiz kid? Can memorize the material, yet cannot figure out how to apply it in several courses.

One friend mentions how they almost withdrew from school towards the start of a spring semester. The other mentions that they scored well below you in some exams... only never mentioned it.

You come to realization that you are not alone. No matter what someone's intellectual pedigree may be, no matter how enthusiastic or how cocky someone will be, at some point they will have to face this bout of Pharmacy School Depression.

There is no escaping it. There is no denying it. For some it becomes encompassing and they do drop out. For others it becomes even more serious requiring hospitalization.

Yes, it does happen.

For those who survive, it is almost as big of an accomplishment as being accepted into pharmacy school. And as you walk out of an exam room for the last time, you look back on what this year has brought upon you.

Are you the same person? Are you better off? Or worse off? Can you still do this?

The last question is an easy answer... Yes. For you are not alone, and actually never were alone. We all suffer for with it, but few speak out.

So upcoming first year students, when you are in the greatest depths of self-doubt and despair remember that you are truly not alone.

We've all been there... whether we want to admit it or not.

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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?