Operation Baby Ejection has Begun!

If you're reading this post, it means that little Mason (yes that is his name) has decided to claw his way out of the wife.

I have no idea if I'll be gone from this site for a week or a month. As you read this I am stepping into the great unknown, only without my trusty flask this time.

Wish me luck.

The Real Point of Pharmacy School

Time is elusive... an almost mythical component of life. Often it seems as if it is plentiful, yet quickly it evaporates. Confused, you scramble around attempting to make up for it, but often it is too late.

Such is the life of a pharmacy student. Walls routinely collapse around you and part of the test is being able to survive and climb out of it. All the while you chase time... more and more time.

It seems as if we're being tested on our mental toughness as much as the material. And this makes sense, in the real world you do not work within nicely defined borders. Being adaptive and able to cope with stress in the face of adversity is one of the best skills you can develop.

Often I tell people the best thing you can ever learn is that you are can be wrong. For many it is a hard fact to accept as in order to reach this level of education you have to be egotistical and believe, to an extent, that you are mentally infallible.

Yet the opposite is true, we're all mentally infallible and in fact we may be more prone to it. Over confidence is predominate among myself and many of my classmates as a byproduct of the process in arriving here.

This makes it very, very hard to look yourself in the mirror and admit your faults.

I argued during my interviews that I was apt to not only be an excellent pharmacy student, but an excellent pharmacist because I have failed numerous times. Due to those experiences, I know how to control my emotions and develop a train of rational thought to overcome that failure. It is, at least in my mind, one of the best skills I possess.

Pharmacy school is about failure, whether they want to admit that or not. It's about not having enough time or struggling with material or actually failing an exam. We are not only learning mountains of material, but we are developing a mental toughness and agility which will be essential in our daily professional lives.

I wish there was someway to adequately explain this to many of my classmates. I know, and see, so many who are overly stressed out to the point where I wonder sometimes if they'll survive the next few years. Ironically enough I am almost certain one of my classmates regularly reads this little blog, so at least one person may be aware of it.

One test does not make a person any more than it breaks one. The light at the end of the tunnel, however faint, will eventually arrive, probably more quickly than we imagine.

So to all of you fellow first year pharmacy students who find them struggling throughout this initial year, heed this advice. Learn from your mistakes, but don't dwell on them.

Lastly you're not alone. We're all struggling in our own ways, even if we don't outwardly show it.

I will gladly crack a beer for anyone who needs to have a drink after this semester. Trust me on that.

Breathing, Peeing and Pooping, Oh My!

Depressing notion for the week... Walked into the library today and the librarian who's working the desk looks at me and goes:

Well hello! So nice to see you again!

I think that's a bad a sign. Or a good sign. Or... I don't know what the hell it means.

Alas, this is the fifth straight night I have been in this wretched little library. Tonight I am learning the intricacies of breathing, peeing and pooping.

Who said there's no glory in studying the human body?

Three more days and freedom awaits me... at least until the little bugger makes his initial appearance. As I sit in the study at night going over material, every time I here her move in the bedroom my blood pressure shoots up as I prepare for her to walk in and say, "It's time."

It's like a game of Russian Roulette, only instead of a bullet it's a small child.

Before one of our finals on Friday, a classmate of mind was bitching to me about how 'stressful' it has been studying for the exams this week.

Really? My wife is about to eject a watermelon from an area which seems like it does not have the space to eject a watermelon. Every time my BlackBerry flashes the LED colors signifying I have a message from her (BTW: if you have a BB, look up the app BerryBuzz. You'll thank me later) my heart flutters a little bit.

Pretty sure when it actually does happen, I will either hyperventilate, piss or shit my pants. Maybe all three, who knows.

At least I know now how precisely each process works. Although we never did cover birthing...

Because God Said So

I'm man enough to admit not only do I not know everything, but that I continually learn new things almost every day. About a week ago there was a note on a patient's prescription asking if she had new insurance coverage for her birth control prescription.

Her response was that since she worked for a 'really religious' organization they had decided that certain medical treatments defied the will of God and that they would not pay for these items. In this case, one of these 'treatments' was birth control. There were also other 'treatments' that were not allowed, but she didn't really wish to discus them.

And no, the organization was not a church or anything similar to that.

In my mind there is no point to delve into a debate on personal beliefs because we each have our own. Mine is no more superior to yours than yours is to mine. We believe what we believe and leave it at that.

This, however, I do have a problem with. How can you deprive someone, specifically an employee, medical coverage for something because of someone else's belief? How is that fair to others?

Furthermore, how is that deemed acceptable in modern health care? What's to keep the CEO of company from deciding, "Ya know what, I don't believe in warfarin therapy because of my God the Flying Spaghetti Monster and I don't want our health insurance to cover it anymore."

Ridiculous? Sure it is, but the scary thing is that that instance really isn't terribly far from what has happened to this poor woman. She seemed like a well educated and well adjusted married adult woman who simply does not want to have children at this time. And yet she is being punished, in a way, for being responsible.

Sure she could just leave her job, but who is really willing to do that in this economy?

I'm all for expecting and honoring every one's beliefs. But when your beliefs deprive an innocent person medical coverage, then I have a bone to pick with you. Push your beliefs through pamphlets, mass emails, televisions ads, whatever pleases you.

But for the love of God, don't deprive people of their right to health care.

Pun most definately intended.

Big Fish in a Huge Pond

Pharmacy school, much like starting any new school, is all about adjustment. For the most part, you roll with the punches until you find your new equilibrium. It's a struggle at times, but eventually you come to peace with the new situation.

Only after that do you realize you see the elephant in the room and discover what is, for most, the biggest struggle to cope with.

Let's face it, if you're in pharmacy school you're highly intelligent. Chances are you did very well in grade school, very well in high school and very well during undergrad. You were the proverbial "big fish in a small pond."

Some people relish this fact and will consistently remind you of how smart they are on a regular basis. These are the people who came very near death during many of my undergrad courses. And I say that with utter and complete certainty.

In pharmacy school it's different. Everyone here is intelligent. For many the pond has grown so huge that not only are you not the big fish, but you very well may be completely insignificant. It's a fact which sneaks up on as you are completely unaware of this change.

In actuality, this alone may explain so many of the frustrations we feel during this first semester. When you're used to getting high As and being the prized jewel of the class, but instead you're fighting tooth and nail merely to get a C... well it's a sobering experience.

I imagine for some this new hierarchy will be exceeding difficult to follow. Already I have noticed some personalities within my class changing ever so slightly. Whether this is attributed to the Big Fish Syndrome or whether it's related to something entirely different I do not know. Yet it is there, clear as day.

So I sit here in the medical library and proudly exclaim that I am a big fish in a huge pond. Except I'm not just a fish... I'm a shark. And I'm gonna come back and bite some ass in the future.

Something To Read

Blogging is such an intimate endeavor. Many people bare the inner workings of their soul to complete strangers on a daily basis. I cannot ever describe how immensely therapeutic it is to have a site like this.

That being said, occasionally you stumble upon something that is rather powerful. I'm not a huge fan of posting things from other sites, but this is something worth a read. I highly doubt I could ever share something of this nature, and to say what I respect what is written here may be the understatement of the month.

Enjoy.

Edit: When I originally composed this post, there were no recent posts other than the last link I've posted. If anyone has any words of encouragement or anything of solace to offer, I encourage you to leave it.

My Life Exploded - Part I
My Life Exploded - Part II
My Life Exploded - Part III
My Life Exploded - Part IV

The Man With the Itch

It's dusk in the pharmacy, as the last commuter comes through the drive thru. As the last rays of sunlight streak through the window, a man steps up the counter.

"Hey," he half-whispers, "I can I ask you a question?"

I stroll over to the counter and he leans in, "I have an itching problem. Do you have anything I can... put on it?" Half-exhausted from the mid-afternoon rush, I bring home over to the first aid aisle and show him the Hydrocortisone products.

"Hey... does this stuff like... stay on?" he inquires.

I assure him that it does and depending on where he's applying it dictates whether or not the cream or the ointment would be best suited.

"Well... what about for like under clothes?"

I then tell him that in that case a cream is usually best as it doesn't leave the oily residue on clothing that so many have a disdain for.

"Well... can you... I mean would you.. have sex with it?"

For the first time in months I am held speechless. I inform him that you shouldn't be using it as any type of lubricant for intercourse.

"I've got this like.. like a rash on my johnson... and it itches and burns real bad."

Then to kick it up a notch.... "Do you want to see it?"

It is at this point, I pull the student pharmacist card and mention that I will have to get the pharmacist to help him further. As I stroll back to the pharmacy, suppressing a grin, I kindly tell our pharmacist a gentleman in aisle 4 needs help.

He asks which mean and I point and say, "The man with the itch.."

No One Can Change How You Practice But You

Today a woman in her mid-70s made her way to the out-window of which I was manning. As I brought her name up on the work queue, she started by saying that she recently transferred to us from Walmart due to "those swarmy bastards."

I liked her already.

Since she was a new patient, I went through the usual round of intel gathering to update her file. It was when I arrived at the question regarding insurance that things became interesting.

She initially stated she would be paying cash for her prescriptions. I asked her if she was sure because her prescriptions totaled nearly $900 at the cash price. She was taken aback at first, but reiterated that she was paying the cash price.

After a minute she pointed at one of the scripts and said, "This isn't right, Walmart's been selling this one to me for just $373, not what you have listed there."

Now one of the drawbacks of WAGs system is that you cannot override cash prices, at least from what I've been told. The price we had was, to say the least, ridiculous in it's own right and I wasn't going to make this elderly woman fork over hundreds of dollars extra because of it.

I turned to my pharmacist and said I was going to take her over to our consultation area so I could work with her and see if I can find some way to fix this. He looked a bit perplexed at first, but allowed me to continue on.

I begin to try various filling combos to fix the price. There was changing it to two different prescription strengths, halving tablets, taking more of a smaller dose, etc. I had gotten it knocked down to just a shade over $400, and she was content with that.

It was then that she began fumbling around in her wallet for her credit card when I noticed her Medicare card. And it dawned on me; she has to have Part D coverage and, if she doesn't, she has to have some sort of supplement.

I ask her if she's enrolled in Medicare Part D and she replied yes. Next I ask her why she didn't mention she had any coverage at first and she said it was because she had lost the card several weeks ago so she didn't know how to get us the information. Naturally she was surprised when I said I could look up her information simply by using her Medicare number.

As she hands me her Medicare card she then states, "I don't know how much good this insurance stuff is gonna do me." I ask why and she goes, "Well they don't cover that spendy one right there cause I've been paying cash for it all year. And I'm in the donut hole so Walmart told me it's better to just pay cash for everything."

Are the alarm bells going off in your head? Because they were going off in mind.

First, I explained to her that I would be very surprised if they did not cover the drug in question. It's not an uncommon generic drug and I'm not sure if I've ever seen someone not pay for it since it went generic.

Second, I then explained to her that when you're in the donut hole you don't really pay the 'true cash' price. The price given, if you will, is more of a discounted cash price and is usually less than what WAGs or Walmart can match.

Of course she asked why her Walmart pharmacy had never explained to her, of which I had no answer.

I proceeded to input her Part D information and rebill. Suddenly that almost $400 medication she had been paying for at Walmart was now just $40.

She was shocked. Utterly and completely shocked. By the time I re-ran everything, the total bill was around $280, down from the $900+ originally. She thanked me several times for helping her as she left, while I sat wondering how in the world another pharmacy could be so inept at helping a patient.

Then I remembered that Walmart employs more of a profits before patients policy, similar to what I alluded to in my last post. Their pharmacies are often overworked and understaffed. A corollary to this is they have a tendency to hire 'cheap' techs who may not know as much as they could otherwise.

To make things even more interesting, my pharmacy manager pulled me aside and said he hadn't seen anyone do anything like that here in the eight years he's been working at WAGs. It reminded him of working in his pharmacy back home.

I told him there's no reason you can't practice like that, even in a WAGs-type setting. It's how I decided to practice long ago and where I work won't change that.

Ultimately, I think this is the moral to the entire story. It doesn't matter where you work, what you do on a daily basis or what corporate wants you to do. We still have an opportunity to take some time with our patients to help them.

We choose how we want to practice, no corporate decree can change that. It doesn't matter how busy or how swamped you are, I did this entire exchange during the 5pm rush on a Friday afternoon.

And if I can do it, so can you. All I ask is that you try...

One Semester (Almost) Down

I sit here plotting out my schedule for the next fourteen days. Finals are approaching and I need to develop a battle plan to not just survive, but conquer my upcoming finals. It's hard to believe the the first semester has almost come and gone. The excitement of being in pharmacy school wore off weeks ago, and now I find myself aching for finals to end.

To everyone who said I couldn't do all of this this semester, I have but one phrase for you: Go to hell. This includes my school's Academic Office and our class adviser.

My schedule for the vast majority of this semester consisted of:

7:20am - Crawl out of bed
7:50am - Drive to campus
8:20am - Hop on the campus bus
8:50am - Class
11:45pm - 20 minute break for lunch
2:25pm (5pm on Tuesdays, 6pm on Thursdays) - Class ends
3pm (5:30 on T, 6:30 on R) - Go to work
11:30pm - Get off work
11:45 - Get home, say hi to the wife
12:00am - Burst of studying
2:00am - Bedtime

And this doesn't include the 9am to 11:30pm shifts I would work on the occasional Saturday. Yes, for the first two and a half months of pharmacy school I averaged working 50+ hours a week.

Did it suck? Damn straight it did. Did my grades suffer? Not really. Am I glad it's over? Hell yes I am.

This semester has been hell. Luckily my wife has been awesome throughout this, which I mentioned a few weeks ago, and we have everything ready for the arrival of Phathead Jr in about a month.

I have cut back to a mere 33 hours a week, which is roughly what I'll be maintaining next spring. I've tested out of one class, possibly two, so my schedule will be a little lighter. There will be no rest during winter break with a newborn in the house, but I like a challenge.

People in my class and online ask me all the time how in the world I do all of this. Truly, I do not know. I think I've conditioned my body to get used to this sort of thing over the past few years. I'm probably one of the least stressed out students in my class namely because I've been through much worse.

In 2-3 weeks time, this semester will end and I can prepare for the spring. I will be a much, much better student than I was this time around, namely because I know what to expect.

Plus, look at it this way, only 1255 days to go!

Taking On Walmart: Lawsuit Style

Over the top post title? Perhaps, but hear me out.

Every one within the pharmacy world agrees that Walmart pharmacies are the cancer of the profession. They are mostly detrimental to the profession, to the point that something needs to be done about it.

In the Walmart I recently worked at, my store manager told me the pharmacy is responsible for 4% of the yearly revenue of the store. Think about that, just 4% of the entire store. In the great scheme of things, the total profit brought in by the pharmacy does not have a high priority. What a pharmacy does accomplish, though, is to drive more people into the store. And that's where the problems arise.

It's not difficult to imagine that twenty years from now we will see the final death blow for true small town, rural, independent pharmacies as the four dollar generic program that Walmart began a few years ago. The effects from this program will begin to become more evident as the years wear on (I personally believe it will, or maybe already has, trickle over to the reimbursement side of things). It's a program which is great for consumers, but utterly terrible for pharmacies and pharmacists.

Previously I have covered how we are routinely underpaid by insurers for the services we provide. Here is how Walmart, in its revenue based mindset, gouges the profession using poor, and unethical, business practices.

In the state I am in at the moment, the average cost of a prescription, prior to the addition of the cost of drug, was $10.28 as of 2006. This is the most recent data we have and does not take into effect the legal changes since then which have significantly increased overhead labor costs. If you consider that the most of the drugs listed under the $4 generic program actually cost roughly $1 per 30-day refill, we're looking at a total cost (in this state) of $11.28 per 30-day supply.

Using a bit of simple math, we can see that Walmart is selling these $4 generics at 64.6% below true cost. Sure they're making a "300%" return on the cost of the drug, but we're a service based profession and you cannot quantify cost in that manner.

Here is where the lawsuit would come into effect; there are laws in place to prevent businesses from undercutting competition by ensuring that they cannot price their products and/or services below a price floor, namely the cost of the product/service. It a byproduct of the monopolistic tendencies of big business at the turn of the 20th century and the anti-trust laws that followed.

This is called predatory pricing, and it is usually intended to drive competition out of business. In Walmart's case, they are doing so to drive more consumers into their store and not so much to rid them of competition.

However, one of the key components of predatory pricing is a high market entry barrier. By pricing their prescriptions so low, and under cost, they are in effect presenting a high market entry barrier. It is one thing for a new, or small, pharmacy to be unable to offer all of the insurance plans offered. It is a completely different problem when they cannot come close matching the cash-pricing policy of Walmart.

Under the Sherman Antitrust Act, this is considered monopolistic business practices and is unhealthy for both the market and the consumer. And, at least legally, you could file a class action lawsuit claiming as such.

The thing is, you would lose the lawsuit. Walmart is far too big, far too powerful and with far too many attorneys. Also, it has proven difficult to adequately argue for monopolistic business practices, although I concede we could develop at least a moderately successful argument.

But here's the best part... we wouldn't have to win the lawsuit.

Really what we need is consumer awareness of what is happening within our profession. It's been shown time and time again, especially when it comes to Walmart, that when the public is presented with an injustice they will move on their own to attempt to right it. People like a good deal, but only to a point.

We have the data, we have the facts, we have the manpower, so why not? What's stopping a group of us from standing up and actually doing this? It isn't about increasing pharmacy profits, about maintaining the integrity of one of the most important health care professions in existence. We an argue convincingly that we have been put on a dangerous path and, if it is not righted, in a few years we will be presented with a very serious problem.

Cost/revenue cannot be the sole driving force for the profession, yet Walmart, and to a lesser extent the other large corporations, have decided to take that route. It will continue to harm us, the market and, ultimately, the patients. The last part of that statement is what we have to proclaim most loudly.

Let's rile up the consumers, let them see how big business is harming one of the essential health care services in this country. It can only go up from here, right?

How You Can Touch A Life In A Pharmacy

It's hard to imagine that I have been in pharmacy for nearly ten years now. When I was started I was a bright-eyed fifteen year old, fresh off his first year in high school. Now I sit here awaiting the birth of my child and stressing over the possibility of pharmacy residencies and MBA programs.

I'm not sure if you can quantify one particular point in my life that drove me to pharmacy. Rather it is more a collection of experiences spread over the first handful of years working in a pharmacy.

In the past I've written about the steps I have gone to help a patient and what it's like dealing with the death of a patient. But the first time a patient I had known well died is really what sticks out in my mind.

I was seventeen at the time, still young enough to be oblivious to the actualities of the real world. The patient was a captain in a branch of the military, which one though has forever escaped my memory.

He was a rather fun guy to be around. A doting husband and father, he always had a legitimately funny story to tell when he came into the store. One of the few patients who makes your day a little better when you see them walk through the front door.

At this point, I was seriously mulling pharmacy as a career and he kept encouraging me to go that route. His thing was to always challenge yourself and to not become overly lax in your daily life. It's a motto I have since adapted as my own.

One day while preparing to fly out for an assignment he was stricken with a massive headache. He was taken to the hospital on his base and after a serious of tests they determined that had a brain tumor.

A terminal brain tumor.

He was then discharged to begin treatments and to spend time with his family. Over the next several months this kind and gentle man devolved into a bitter and angry one. He would come in, snap at his wife, yell at us and say things that I do not wish to repeat here.

It was difficult at the time to process. I had never dealt with something like that and wasn't sure how to think, yet alone respond to it.

Just a few months after that initial headache he passed. A few weeks after that his wife, came in to pick up something for herself. As she was leaving she put her hand on mine and said that her husband began to revert to himself during his final days. He wanted to apologize for all he said and had done to us during that time.

And that he wanted her to make sure that 'pharmacy kid' stuck with pharmacy as a career as communities need people 'like him' in that sort of position.

I never saw her much after that. I suppose she really didn't have much of a reason to visit us anymore. A year later I went off to college and the rest, as they say, is history.

It's something that's stuck with me over the years though. The fact that even when a patient is near death, their thoughts can turn to us and what we have done for them. Whenever I crawl into my personal pit of despair, that memory usually acts as my ladder to climb out of it.

I guess in some way I'll always be that 'pharmacy kid.' And I'm perfectly okay with that.

Presenting the 2010 Medicaid Mother of the Year

My work day after Thanksgiving in this new city proved to be vastly different than what I am accustomed to. Whereas I am used to being completely swamped on Black Friday, here the pharmacies are a wasteland. So imagine my surprise when midway through the day I realized I was in the presence of greatness.

I had met the Medicaid Mother of the Year. Shocking, I concede, that she would choose to visit our little pharmacy on this day, but alas here she stood.

Chatting on her iPhone 4, bedazzled of course, with her Coach purse and fancy manicured nails, she presented to prescriptions for her 18 month old son. And she presented her, and her son's, Medicaid card.

One of the prescriptions was written for Amoxil and the other for Orapred, nothing out of the ordinary. As she loudly chatted with one of her baby's daddies, I took the scripts to the counter and began to input them. It was then that I noticed both scripts had the DAW box checked.

Perplexed, I dialed up the urgent care doc who had written the scripts and asked the nurse on call if she could verify the DAW. Often a slip of the finger can slap DAWs on scripts when they are unintended. When the nurse returned to the phone she informed me that it was the patient that had insisted on the DAW and that they were written correctly.

Cute.

We call her to the counter and the pharmacist asks her why she's insisting on the name brand version of these medications. Her reply was that, "Generics don't work that good and she wants the best for her bab-ah."

We both calmly explain that in order to fill each of these prescriptions we would have to order the drug in. The likelihood that a store in our area would have either one of these drugs in stock was negligible. And, since it was a Friday, we informed her the soonest we could get the medication would be Monday morning.

"That's ok," she replies.

Next we inform her that in order for Medicaid to pay for these medications we're going to have to get a prior auth on both drugs. That, in itself, meant that we wouldn't be able to bill the insurance for payment until Wednesday at the absolute earliest.

"I'll just wait, he can tough it out until then, he's a strong lil dude like his daddy. I just want him to get the best meds, I don't want none of that cheap shit."

Let's get her tiara and flowers ready, because this woman just kicked the rest of the competition to the freakin' curb.

Yes, let's deprive your ill child of the medication he needs simply because you have some sort of righteous belief that you deserve the best even though it is those like myself who will pay for it. Never mind your suffering child, hold tight to that notion.

Because when child services show up, it's the only thing you're going to have left.

African American Friday

I can never adequately explain the kindness people showed me while I worked one of my last shifts at Walmart on Thanksgiving. The sheer number of people who would stop and merely thank me for working was astounding.

Except for one person. Below is her almost verbatim response to my simple of question of how she was for the day.

"I'll tell ya how I'm doin', I'm damned pissed. All this talk about 'Black Friday' this and 'Black Friday' that... everyone's all racist up in that shit. They need to call it 'African American Friday' and stop puttin' down black people. We've been through enough with all the slaves and ghettos and shit and now they have to name some day after us to have sales? Well fuck that shit."

Well then...

My How Things Change In A Year

Roughly one year ago today I received notice from the first school I interviewed at that I was waitlisted. It was a crushing blow for me at the time, especially when the wife and I were hoping to have some idea of where we would be living a year from now.

To say I was unsure of myself would be a vast understatement. I said to myself, at the time, that if I did finally get accepted to a school that I would finally believe that I was destined to be a pharmacist.

One year later and I'm still unsure.

But think of all that's changed for me in the past year. I had a spat with the company I worked with for 6+ years ultimately resulting in me resigning and being unemployed for five weeks. I ended up being accepted to four schools all across the country and shortly thereafter I found out I'd be a father for the first time. And we got the cutest puppy the world has ever seen.

We moved to a completely new area for us, devoid of everything we know in the hopes of starting a new life here. A little over a month ago I suddenly lost one of the best friends I'll ever have. And here I sit, the day before Thanksgiving, scrambling to get in studying in case the baby decides to arrive early.

That's a helluva lot of change in one year.

Pharmacy school is what I expected and is not what I expected. I have yet to decide if it is something specific to differences in how they are doing things this year or if it has something to do with myself. In the last two months I have questioned if this is something I truly want to do more than at any other point in my life.

Yet, despite all of the change and all of the hardships, I still find myself proclaiming "Hell yes this is what I want to do!" It's more that this proclamation comes far and few in-between as of late.

And it's only going to get worse.

T-minus three years and six months to go...

Walgreen's, Sucking the 'Phun' Out of Pharmacy

I am coming near to my three month anniversary with the empire that is Walgreen's. During this time I have moved around to a couple different stores now which has helped me gather a more rounded view of their day to day operations. Recently, I have come to a singular conclusion.

Walgreen's has sucked the fun out of pharmacy.

In the past, I have worked in stores that were a blast to work in to the point that when you saw you were scheduled there, you smiled. The co-workers were great, the pharmacists were great, the patient population was great... it made for an awesome daily work experience.

With Walgreen's you still have that, yet you do not have the same experience. I'm not saying that work should always be fun, but more that you should be able to enjoy it at some point. After three months, I have yet to find a day that comes even remotely close to that.

Part of it, as I alluded to when I started working there, deals with their work flow. It's one of those ideas that looks beautiful on paper, but doesn't work as well as it should. The better stores I have worked in have just a straight pharmacy (to me, the sexiest pharmacies have a straight counter about six miles long), but the pharmacies based in the corner of a store are just terrible.

To top it off, there is virtually no patient interaction. I miss the days of an open pharmacy. When my favorite customers would come up to the counter, wave me over and ask me if "I got lucky on Saturday night." Or the customers who would randomly bring treats or show pictures of their grandson at his most recent soccer game.

When I started, the manager told me I would fit in really well because this store had a really close knit community. From what I have seen this far, it does not meet my past experience of a close knit community.

Working in a Walgreen's is very cold and methodical. Each worker is only really well versed in their specific tasks and the pharmacists, no offense to them, are very one dimensional. That, of course, is a byproduct of the Walgreen's system, but I still would put up a pharmacist from one of the indie stores I worked with up against a Walgreen's pharmacist any day.

Have I mentioned I despise their robots and the lack of record keeping/information they hold?

I'm not trying to be a negative Nancy, but I miss enjoying going to work. Moving around to different stores the last few weeks, I have learned that this is probably not going to change any time soon. How depressing of a thought is that?

No wonder so many of you are so bitter.

Why Does Breast Cancer Have a Whole Month?

Not to put down one of the most prevalent cancers out there, but can someone explain to me what makes breast cancer so special that it has its own month? I mean there are countless diseases and conditions out there which are much more tragic than breast cancer.

Now it seems as if it has become its own marketing machine, akin to how Christmas has become overly commercialized in recent years. Sometimes it seems with all of the 'special' items out there for Breast Cancer Awareness Month that it may be more about pushing a product than an actual cause.

It's great to see so many people get behind a specific cause, but why this particular one? Is it due to the male fascination with breasts? Is it because of the inherit connections we feel towards our mother and, as such, are deeply effected to what may happen to her? Is it because we all secretly enjoy the color pink?

Each year this month grows to be even more grandiose than the year before. For several years in my sport of choice, NASCAR, it was not uncommon to see one or two cars run a special pink paint scheme for a race or two. Now there are multiple teams who do this for the entire month.

The NFL was chalk full of players covering themselves with pink in whatever way they could. I wouldn't be surprised if there was a push for pink uniforms in another few seasons.

So what is the fascination with this month and the associated cause? I'm not attempting to be callous in anyway towards breast cancer survivors and those currently battling the disease, but I truly don't get it.

It's like we get TaTas-fever for one month out of the year, but in a respectable manner. It's like an ethical Hooters if there is such a thing. And if that's the case, why isn't there more support for male breast cancer and the associated chest-ticles?

Anyone have any ideas?

The Quandary of Clinical Pharmacy

Quick, in one brief sentence describe the role of a clinical pharmacist.

Tick Tock. Tick Tock. Tick Tock. Tick Tock.

And your answer... is probably correct even though it differs from the twenty other responses given. Actually it may not even be remotely similar to half of the other responses given.

This is precisely the reason I dislike the term 'clinical pharmacist' because it truly does not mean anything. It is a blanket description to cover the roles of a pharmacist that currently lack an accurate description. In fact, I'd say roughly a third of the 'clinical pharmacists' I meet are really ambulatory pharmacists.

Yet even they are unaware of this fact.

No one person is to blame for this facade. It's simply a byproduct of an ever evolving profession, but it is something that we must address at some point. The 'roles' of a clinical pharmacist are incredibly varied that any lay person would question if they really fell under the same umbrella.

Honestly, it may sound petty to begin to discuss what to call ourselves, but in reality is it so petty? We already have a problem with the public and our patients over a misconceived notion of what a pharmacist is. Do we really need to compound the problem by the repeated use of such a vague description of a role?

Naturally this is not something which will change over the night. In fact, in fifteen years I would not be surprised if pharmacy schools were producing pharmacists with specific specialty titles, akin to the current medical school practice, so it may eventually correct itself.

Where do we start? Well if you consider yourself a 'clinical pharmacist' start thinking about what it is you truly do.

Do you call yourself one because you're not sure what the actual title of the role is? Do you call yourself one because you like the sound of it? Do you call yourself one because no one has ever told you otherwise?

I'm sure some use the phrase clinical pharmacy as a bridge between the past hierarchical gap between pharmacists and medical doctors. That is completely understandable, but that bridge cannot stand unless we reenforce the legs upon which it stands.

Let clinical pharmacy remain the general term for the professions specialists. But remember that this is, indeed, merely a general term. An oncologist does not introduce himself as a medical specialist, but simply as an oncologist.

Seems logical enough, wouldn't you agree?

Pharmacy School: Supporting SSRIs!

In one corner sits a person ashen faced, staring into nothingness. Perhaps a slight streak of drool traces their chin, but they are dead to the world.

In another someone sits face in hand, sobbing uncontrollably. Their body shudders with each stifled wail as on-lookers stare.

Yet another person is merely wondering aimlessly about the room. Mumbling incoherently, a kind passerby offers a consolation of candy and is greeted by an indifferent stare.

What is the connection between these three individuals? They're all pharmacy students!

If you want to discuss an up and down roller coaster of emotions, talk to your nearest pharmacy students. For every high you there is a stunning low which is soon to follow.

At no point do you catch your breath and often you find new depths to your own personal despair. It's like being punched repeatedly in the balls, helped back up, and then be hit in the same balls with a jackhammer.

And then be pissed on by a bunch of angry elderly women.

Truly, it's amazing. If I were in any other situation, I would think there is something mentally wrong with myself. Eventually, such as days like today, you reach this insanity driven breaking point when you incessantly giggle. As if nothing in the world matters and everything is hilarious.

And here's the best part... this isn't the worst of it. Not by a long shot. That threshold is still a year or so away.

No time to wallow in the depression tonight, yet another exam awaits a mere 38 hours away. And let me tell ya, I truly am excited... and by excited I mean three seconds away from bashing my head repeatedly into a wall.

Good times.

Am I Too Cynical?

One of the greatest realizations a person can have is that you are not always right. In fact, you're probably wrong more often than you may think.

That statement is the precise reason why I won't enter politics; I'm too open to the ideas of others in place of my own if they are better. I fully concede there are times when I am completely wrong or have an illogical train of thought. I do my best to think things through in a logical manner, devoid of emotional input, but we're human and at times that is simply not possible.

It goes without saying that I probably have more intimate knowledge about the profession of pharmacy than 99% of my classmates right now. I do not state this as an ego-booster (although I have been told that others would disagree), but as a statement of fact.

I think we can agree that most of the material published on the pharmacy blogs, this one included, has an overtly negative tone. Sometimes I justify this as merely being realistic about the profession, an idea which is grounded in some logic. Recently I've been debating if this collection of negativity has clouded not only my judgment, but my attitude.

In more concise terms, I have become too cynical.

All we hear about, or talk about, in this type of medium is the negative. View any major news publication and the stories that receive the most, and most consistent, play are negative in nature. Call it a byproduct of our society if you will, but because of this we have become colluded into viewing the world in negative lights.

For instance we all argue about the adverse effects of mail order pharmacy on the profession and the care of the patient. It's something that has been beaten into my head from various sources over the years so much so that any 'good' news regarding mail order pharmacy is met with a sneer on my face.

Imagine my surprise last week when I went to a presentation and was introduced to a mail order system that actually works. A system which is producing better outcomes than the traditional retail setting. A system which solves the majority of the problems we associate with mail order pharmacy.

I sat, jaw agape, for much of the presentation. "How can this be?" I thought.

Over the years I had grown so use what everyone else had been saying about mail order that I neglected the fact that it could possibly work. Something which I had written off as a death blow to the profession in fact has a very helpful place within it.

In essence, I had not followed my own mantra of being open to the ideas of others.

There is no particular blame to be placed. What is said, for the most part, needs to be said. The context of what is being said, at least in my mind, needs to remain forefront

After all, I don't wanna grow up to be Scrooge. Or do I....

What's a HIPAA violation?

Let's play with a hypothetical example today.

Say you and some classmates are given the assignment of tracking the health of an individual in a retirement community over the course of several months. There is a school website, with greatly restricted access of course, in which you participate in discussions about the overall project and complete assignments.

Then let's say that there is another sub-section of that same site where only you, your group members, and your professors can read what you post.

Now one day you're discussing with your classmates on this site about the next visit and you inadvertently use the first name of the individual you're tracking in the discussion.

Is this considered a HIPAA violation?

I ask because I was told, and corrected, by a professor that it was indeed a violation. For the life of me, I cannot seem to figure out how this would be and said prof has yet to respond to my email.

It's on a non-public webpage so restricted only six people can view it. It is a part of the pharmacy school, which is in turn part of a health care facility. No other relatable information was disclosed in the discussion, merely the slippage of the individual's name.

In all of the HIPAA training I have received over the years, I cannot see how that would be a violation of the law.

Am I missing something here?

Health Care Reform

We all struggle to relate complex items, such as the current health care reform, to friends, family and even patients. We were shown this video in class from Kaiser Permanente and found it to be humorous while educational.

I though it best to share it to help defuse the confusion that is so often found when discussing current reform.

My Wife Rocks

Never underestimate your support system. Seriously, its slightly surprising how much stuff they cram into your schedule each week. Tie in working and maintaining a family... And you can gather some idea the organized chaos that I deal with on a daily basis.

Immediately you are initially concerned on how you are going to balance things. Some areas are going to have to be sacrificed, there is no denying that, but where to do so becomes problematic.

This is where my awesome wife comes in. Some days I leave the house at 7:30 am and do not end up back home until midnight.

Yet she never complains. She's always happy and jovial when I get home, if she's still awake that is. Sometimes she'll have dinner ready for me, even though it may be excessively late.

And even when I am home, I'm often holed up in my study for hours at a time. I'm not sure if we've gone to bed at the same time since school started.

Still no complaints. And did I mention she's pregnant?

Often I have people ask how I'm able to do all of this on a daily basis. My wife is the biggest reason for this. Without her, and my beloved BlackBerry whom keeps me uber organized, I woulda sunk a long time ago.

My wife rocks.

You should all be jealous now.

The Tale of the Rogue Shitter

“Do you have a tissue?”

A seemingly innocuous question, especially considering the time of the year.

“No,” I replied. “Walmart generally doesn’t let us keep tissues here for public use.”

She nodded, I finished checking her out, and she calmly walked away.

Looking up to the next woman in line, I notice an expression of confusion and slight terror in her eyes.

“Can I help you?” I ask.

She stammers, “Is that… is that shit?”

Perplexed I leaned over the counter to see what she was pointing at. There, on the normally sparking white floor, was a smeared brown mass leading away from the register. Trailing away from the smear proper were clear footprints with a small Nike symbol emblazoned upon them.

Quickly, I begin to analyze my encounter with the previous customer. There was a hint of tequila on her breath… did she stammer? What else did she buy? Was she wearing a dress?... Yes she was, a black and white floral print dress.

Why did she ask for a tissue? Oh wait…

The woman in line quickly steers her cart to another line while I block off my lane. I beckon for the CSMs to come to my area. Needless to say we are taught how to handle all sorts of spills, but human feces is not one of them.

“What… is that chocolate ice cream?” asks my perplexed CSM. When I state what I believe it to be she quickly asks, “Should we smell it?”

Should we smell it? You didn’t need to smell it. There was the typical corn kernel present, the ultimate calling card of feces on the floor.

If there even is such a thing.

How you can casually walk away from such an event I will never know. And to knowingly track it all the way out the door on top of it. In some twisted way, I'm impressed she maintained her composure, although now I know why she was exceptionally polite to me.

It’s also a good thing for her she chose to go commando that day. It was, however, not a good thing for us that she chose to go commando that day.

Moral of the story is when you gotta go, just go on the floor. Everyone likes a surprise.

One Last Time...

Can't send you out of this world without one last listen to our favorite KoRn song.

Crank it up bud.

...Because I'm A Scientist!

Note: This is one of the hardest things I have ever written on here. I'm not normally the type to outwardly speak of things like this, but it's something that I personally need to do.

How can you quantify one's life in a simple sentence? Is it an impossible endeavor? Or merely a monumentally difficult task?

I sit here tonight, jaw still agape from the day, trying to decide if this idea is possible. If there is a concise way to explain the entire being of one particular person.

Throughout high school I was luckily enough to find someone who not only shared in my unique sense of humor, but thrived in it. While others discussed the most recent football game or newest video game at lunch, we would launch off into philosophical discussions ranging from the intricacies of the newest KoRn album to the current world economic situation.

And when you're fifteen years old, that's a helluva strange topic span.

We survived two semester of Spanish together by plotting our eventual 'takeover' of the country. For instance we decided to sell Maine to Canada for a case of Labatt Blue, build a wall around Iowa and declare it a biohazard zone, and build matching old English style castles in the hills of San Francisco.

Once during a biology field trip we unwittingly toppled over a 20+ foot tree in the middle of the woods. The first concert either one of us went to found us wondering the side streets of the city, stumbling upon sights our young eyes had never quite imagined.

Throughout high school we had this plan of constructing a trebuchet designed to launch ourselves into a lake. Our physics professor at the time declined to help us, seeing as we were underage, but periodically over the years we would figure out the mechanics behind the overall design.

As high school ended, our trebuchet plans were put on hold due to time and money constraints. When I talked to him this past summer, he quipped that we had the time, he just needed for me to finish pharmacy school so we'd have the money to finally build the damn thing.

We jokingly discussed renting and arriving to our ten year reunion in a jet black helicopter, just to make people talk.

Now we will never finish our trebuchet... never shock our class by arriving in our jet black helicopter.

Hell we were supposed to retire to the same nursing home and proceed to blow it up via experiments from Bill Nye and Mythbusters. Assuming we survived from launching ourselves in our trebuchet that is.

From now on, each day is now a little dimmer, little less joyous,

Which comes back to my original question, how do you condense one person's life to a simple sentence? The thing is, for every person that sentence will be different.

I'll never forget the pride he showed after receiving his first job after graduating college. His new line, whenever someone asked why he did something, always ended "...because I'm a damned scientist."

And for me, that's about as concise as you need to get.

Godspeed Roy.

You were one of the best friends I have ever had and we had more fun than two people should ever have together. My life will never be quite as complete as it once was.

Should I Take an Elective in the Spring?

You guys want a small part in the path of my becoming a pharmacist? Well now's your chance.

For various reasons, I do not have to take one of our required courses in the spring which leaves me with an open block. I now have the opportunity to take an elective class or simply not replace that class at all.

Why the question then? Well there's two main outcomes.

Do not take an elective and have more free time this upcoming semester with the new baby. I know the first six months, roughly, are going to be the toughest and not having to take a class would make things just a tiny bit easier.

Take an elective, and I finish up my total electives more quickly. This will allow me to take off a block during my fourth year rotations, something which is rather entertaining to me.

So what would you do? Go for short term or long term gain?

Poll is on the top right of the page

Advice For My Generation

As cheesy as it sounds, my generation of pharmacists is the future of the profession. Most are not as well versed in the field as I and it is something I am aiming to change over the coming years.

Right now the sole sources of information about pharmacy to us students come from the school and the organizations affiliated with the school. That information may, or may not, be applicable to every day pharmacy life.

My question to you is what would you tell someone in my generation about the world of pharmacy? It could be advice about school itself or about the real pharmacy world.

What would you have wished you were made aware of when you were in our shoes? How would you have liked to have been better prepared?

Feel free to leave your respective field and length of time in the profession if you wish. My goal is to collect these and use the replies to educate the rest of my generation.

We all have differing experiences and, as I've mentioned before, it is extremely beneficial to see all sides of the coin.

So be honest. Don't hold back.

I know I will.

Public Service Announcement: Check Cessation

Hi there, Phathead here for a helpful public service announcement.

Did you know we live in 21st century America? That we have such fantastical gadgets like the cellular phone and mobile computer. There is also this thing invented by former Vice-President Al Gore called the Inter-Net.

It is truly a wondrous time to be alive, wouldn't you agree?

Seeing as we have such wondrous technology to better our daily lives, why do we not use it more? There is no sense in using inferior technology like vacuum-tube computers, the phonograph or anything made in Canada.

Really, it comes to one simple sentence, and I want you to say it aloud with me.

Are you ready?

Stop fucking writing checks at the check-out line.

You see, with these new technologies, the ancient skill of writing checks is now obsolete. Much like we ditched the stone table and chisel for an Apple iPad, you too can ditch that lowly checkbook.

Did you know that at most retailers your check is processed just like a credit card? If you did not know this fact and/or your mind is blown, well the rest of this announcement is for you!

Did you know that you don't even have to write the check the majority of the time. Those little fancy robotic printer machines will do it for you!

And there is an even simpler way to conduct yourself at a check-out line. Don't whip out the checkbook at all! Leave it at home where it belongs writing checks for your mortgage, health insurance and pornography subscriptions.

There is a reason you have that little plastic card in your wallet called a Debit Card. And I'll let ya in on a little secret, it does the exact same thing as your check!

Amazing!

So next time there is a line of ten people behind you and you being to carefully write out a check, stop, step back and remember:

Stop fucking writing checks at the check-out line.

Let's make the world a better place, one non-check at a time!

This public service announcement has been paid for, and endorsed, by Phathead, Pharm.D. Candiate, Class of 2014. All rights reserved. ©

Pharmacy Junior High

Remember the days of middle school when your biggest worry was who you were going to sit next to a lunch or walk home with at the end of the day? It was a more simple time in many ways, but also extremely childish in others.

For instance, do you remember when someone would be upset with you and you'd get the shoulder slam while walking down the hallway? And after ending high school you are left with the assumption that those days are over?

Wrong.

Those who follow my every Tweet with abated breath, yes I am stoking my own ego, read about my attempt to become class president a few weeks ago. It was a failed attempt, namely because I focused on real world logic and a promise to not focus simply on social gatherings but on preparing us for the challenges ahead.

Naturally they are no where near concerned with that as of yet, so I lost. Personally, it's not too big of a deal as I will be back next year to try and convince them once again.

What has happened since has been nothing short of perplexing. You see, the gentleman I ran against is... well I'm not sure what he is. He conducts himself like a politician, literally having a checklist with him during the first week in order to meet everyone.

To most he comes across as someone through and polite. To me he comes across as someone with some sort of personal agenda.

He's not a bad person by any means, just not someone I overtly trust. A few times he stated what he wanted to do as president or what he thought of the profession and, being the kind person I am, I sat and listened as he described something not even touching on the realm of reality.

Afterward I offered him my counterpoint, to which those around us stared slack-jawed. As someone told me at the bar the other night, I've "owned his ass" several times this year.

What has happened since that election? Well I'm now blocked from his Facebook profile. That's right, he didn't defriend me, but merely restricted the hell out of what I can see.

When he talks to a group of people, of which I am included, I am ignored. Or if I am acknowledged, I am quickly dismissed. It's like I'm invisible but without the actual benefits of being invisible (i.e. sneaking into the girls locker room).

Really, we're just a shoulder slam away from having a rumble during the recess after lunch.

Obviously he feels threatened by me, which I find immensely humorous. It's also disturbing because I would have thought by now that we could be adults about matters like this. I wasn't bitter about the whole election situation, I was gracious and offered any support I could give over the next year.

Now I'm left with the options of being a royal dick and undermining him during the year, or coming back on the offensive next fall. Clearly, the latter is the best choice, but the former would be so much more fun.

Decisions, decisions...

Thank God for Advil Congestion Relief

With the winter season quickly approaching, all are in the opening stages of prepping for the onslaught of the winter cold season. With the exception of the occasional sadist, no one in enjoys the sneezing, hacking and congestion the arrives with our yearly cooling.

But wait.... What's this? Could it be a savior for all of our cold symptom woes?!?


Contains Ibuprofen AND Phenylephrine? Genius!

1 Pill Dosing? Spectacular!

And at just $8.98 for 20 tablets it's a steal!

Hooray, the upcoming cold season is already defeated! Let that pesky rhinovirus burn in hell!

Wait a minute... 200 mg of ibuprofen... 10 mg of phenylephrine? How can this be? You could by the separate components for a mere fraction of a cost... but then again why would you to begin with?

With that sort of dosing you might as well just eat the box. Maybe drizzle some Nyquil on it for added effect and flavor.

Oh Pfizer, you never cease to amaze me in how you can squeeze money of the unknowing consumer. Bravo to you and your creative marketing product. Hope you can sleep well at night in your giant mansions.

Congestion free of course.

Anal Raping with a side of Tequila

Hi everyone. How are you? Pretty good I'm sure.

How am I you ask? Why what an interesting question. There is a mental countdown in my head right now as in four hours the skies will open and the tequila will rain down.

And I cannot wait.

School for the first month had been peddling along in first gear. They weren't shoving information in our face and all of the professors appeared to be kind, understanding and non-threatening.

It was a false sense of security.

Today will be my third test in seven days. Normally not too tall of an order... except for the nature of the tests. The week has steadily grown worse and in two short hours I will take my final exam of this retched stretch.

You see, they lulled us into thinking the exams themselves were not to be too bad. The practice questions were easy. The lectures were easy. The study guide was easy. The exams.... not so much.

It was like being in a prison cell with a lonely guy named Bubba and not an ounce of KY present.

In the last week I have studied more than my entire undergrad career combined. It became quite apparent that our profs were not as easy-going as they made themselves out to be. These exams have been the most demented, head-throbbing exams I have ever experienced. And the worst is yet to come.

For the first time in my life, I truly felt utterly and completely stupid.

And really I cannot blame the profs for this. I underestimated, along with the majority of my classmates, what would be required for each exam. Obviously that little tangent in biochem may ultimately be related to a problem worth 10% of your score on the exam.

As I sit here, bruised and bleeding, a new plan of attack for the rest of the semester has been formulated. These SOBs aren't gonna keep me down, and I'm going guns blazing for the rest of the semester.

First thing is first however... where the hell is that tequila?

Thinking on a Macro-Level

Our society thrives on instant satisfaction. It is a theme which I have covered numerous times over the years, but there is a related problem that proves to be just as frustrating.

That being an inability to view things on a macro level... to see the big picture if you will.

I have an often unique perspective on the pharmacy world because I have contacts not only across this country, but across the world. Due to this, I often see individuals deriving conclusions about a situation solely from their own experiences. For example, if they are having difficulty finding employment, that must mean that it is difficult to find employment everywhere ergo, the profession is screwed!

Except that is not the case and, in fact, the severity of that particular situation tends to be highly localized.

As the world has grown smaller and we have become more blended society, many have regressed and begun to view their world in a local manner. Perhaps it is an attempt to hold onto times gone by, but it is an odd observation as much as it is distressing.

And it's something which must be negated sooner rather than later.

One of the reasons I enjoy chemistry, and happen to be good at it, is that you are forced to see the big picture in order to understand a topic. For instance, we've been covering enzyme kinetics the last few lectures and the discussion drifted over confusion over why a specific amino acid, Serine-195, was so important in the action of chymotrypsin.

The screen at the front of the hall displayed the related sequence and shape of the molecule. Many around me sat trying to figure out what made that particular site special. It took me all of ten seconds to realize that it had to do with the residues surrounding it... i.e. looking at the larger picture.

Sure enough, there is a triad effect with the surrounding residues that explains why this site is preferred.

In class we will be continually taught to look beyond the obvious. We are but a very small subset of the overall population and cannot speak for the majority.

Individuals flock to shows with hosts like Dr. Oz, Glenn Beck or Oprah because of the over-the-top, sensational set of advice or story they present. Most people take that at face value and move on with their life without ever truly thinking about what, or why, something was said.

That particular example is one of the reasons working retail pharmacy is so difficult. No matter how calmly and effectively we explain something, as soon as Dr. Phil goes off on a well worded rant (and lets face it, he's a pretty good orator) what we have said is immediately forgotten. Suddenly whatever has the most pop, if you will, becomes fact.

I believe the clinical term is "A Deficiency of Analytical Thought Processes."

That's why I respect a man like Jon Stewart, even if I do not always agree with his ideals. He is one of the few individuals who is trying to curb precisely what I am describing here.

Opening one person's eyes to the entirety that is the world is but one small victory. It is something that I try to do on a daily basis. If I had a personal soundboard, that would be one of the most well worn switches.

So do me a favor, the next time you're getting worked up or enveloped in an idea or situation, take step back and try and view things for what they really are. The world will be a slightly better place.

Trust me.

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.