Wednesday, February 23, 2005

Sometimes I hate other pharmacists too.....

must be something in the air.....or more likely that I'm in a mood where my wrath has moved from customers to my colleagues. But I'm actually going to do something helpful to the public in this post. Keep reading and I'll tell you an easy way to see if your pharmacist knows what they're talking about.

Just go to the counter and ask what they recommend for heartburn. If they just blurt out "Prilosec OTC" without asking you any questions, their feeble little minds have been duped by the marketing machine that is the pharmaceutical industry. Here's why; Prilosec takes a few days to reach maximum effect. So if you just ate too much of grandma's spaghetti and it's mounting an after dinner attack, then Prilosec is not for you, unless said attack becomes a chronic thing. Want proof? Just look at a box of the Prilosec or go to their official site: http://www.prilosecotc.com/index.jsp They are very upfront that this med is to be used for FREQUENT heartburn. If you find yourself reaching for an antacid day after day, then you should start thinking about the Prilosec, ideally after taking to your doctor in order to rule out other conditions.

A real pharmacist would do the following: 1) Ask you if your heartburn is frequent or just an occasional thing. If it's occasional and mild, a quick acting antacid such as Maalox or Mylanta will do you just fine. If it's occasional and bad, try a combination product called Pepcid Complete (This is a product that stole an idea of mine years ago to combine a quick acting but short effect antacid with a slow onset but long lasting one. I'm still waiting for my royalty check) Only if it's CHRONIC should the word "Prilosec" come out of their mouth. We have reached the point where "shiny box syndrome", the tendency of customers to buy and doctors to prescribe whatever the TV says is new and expensive, has started to make inroads into the last holdouts, the pharmacists. I therefore give you permission to put the curse of the drugnazi on any white coated nerd who reaches for Prilosec without question.

Monday, February 21, 2005

Oh The Weather Outside Is Frightful.....

....at the end of February....snow, wind, sleet, ice, California mudslides, you name it, and the drugnazi has had to drive through it to get to his room full of pills. Not because there are poor sick people out there who need their medicine mind you, but most of the time because some damn moron with a small penis has to prove his manhood to himself by driving his SUV through whatever so he can get to the store and act like everything is normal. Last blizzard we had I payed attention to the few idiots who showed up to see what they made me put my life on the line for so they could buy. First person I saw was checking out with a copy of the National Enquirer and a bag of jellybeans. I really feel sorry for that guy's wife if his performance was that inadequate that this was the only way he could think of himself as a man. I imagined the scene as he returned home......

"Ho hum..... just another day at the office....look honey....I stopped at the store on the way home to get your favorite....jellybeans!!!! and I know how much you love reading about that wacky Michael Jackson....so I picked up this magazine as I was checking out.........what? 2 feet of snow?.......why....I didn't notice......um...no I didn't call the doctor..........I told you......I was just stressed out......it happens to every guy eventually.....I'M NOT CALLING THE DOCTOR!!!! NOW SHUT UP!!!!! He then storms out to try and drive the SUV to the nearest bar.....

For the record.....I drove a Honda Accord at the time......and nothing made me happier than the time I left a Ford Explorer in a snowbank...:)

Sunday, February 20, 2005

I miss the Romans.....

Ok, this doesn't have much to do with work, but I came across this article at lunch yesterday: http://www.inthesetimes.com/site/main/article/1915/ Can we start feeding these people to the lions again? I think it would be a win win. They'd get to act all sactimonious and holy because they'd be dying for their friggin' savior and all, and we'd get to watch them turned into animal poo. The Romans had it together man.....not to mention the orgies.....

Generally It's Considered Impolite......

....to carry on a conversation with someone in front of a third person in a language they don't understand. I, however, have forever lost my right to complain about this, but it was so worth it.

We have a mean, nasty little old lady customer who comes in regularly. Doesn't speak a word of English, which is a good thing, lest we be exposed to more of her personality. I wish I could tell you her name, but federal privacy law works against the interest of the story here. Let's just say the name is identical to a very well known 70's classic rock anthem. For real. The woman is named after a pop tune that almost every english-speaker in the country would be able to name in under 5 notes. It has a very distinctive drumbeat, which sometimes I'll start pounding on the counter when she comes in the door. Me and the clerk working the cash register will recite the lyrics as she is waiting for her prescription, totally oblivious as to why sometimes we even break out into song. If she were a nice person, I might feel bad about it..... No, I probably wouldn't, but I wouldn't think it as funny as I do now......so go ahead...... talk away in Spanish or any other language of your choice in front of my lilly-white gringo butt......I deserve it....

Thursday, February 17, 2005

My secret plan to win the Nobel Prize In Medicine....

by reading the rest of this post, you agree not to "borrow" this idea and steal the Nobel prize from underneath my feet. Especially if you're one of the world's major drug companies, as you have enough friggin' money already.

Ok....so before I spring the Nobel secret on you, I'll have to give you some background information. My little plot will end up ridding the world of turburculosis, the respiratory infection that has plagued humankind since probably close to the time people began to breathe. TB is treatable today, for the most part. The problem is, you'll have to take a combination of antibiotics every day, on time, for months on end. This is a pain in the ass as you can imagine. But if you don't take the meds as scheduled, you're helping the little bugs inside your lungs get used to the antibiotics, and you know the deal about what doesn't kill you only makes you stronger. Yup, having TB sucks in many ways. The resistance problem isn't helped by the people who were only *exposed* to the disease, but haven't developed it yet. These folks usually take an antibiotic, isoniazid, the same way, for months on end, every day, and these people feel just fine. Not a good recipe for compliance.

Now let me introduce you to #2 in my list of the 10 different types of pharmacy customers. If you would like to see one in person, just wander into any drugstore on a Friday night. They'll be explaining how they lost their pain med....maybe their dog ate it (and somehow had no side effects). They'll be coming in for a refill on a 30 day supply of their Tylenol with Codeine #3 on the 15th day, for the 4th month in a row. They'll be bringing me a 3rd prescription for the same medicine from a 3rd doctor. They'll be explaining how they had to take twice as much because one dose was for their foot pain and the next dose was for their back. Yup....meet the addict. Every drugstore has a few. Gotta be firm with them because they can sense weakness. I've been begged to, propositioned, threatened, offered money on the side, and cursed at (it's never good to curse at a drugnazi, story for another time) It comes with the territory of having a job working in a room full of narcotics. I'm used to it.

So what's this got to do with me taking a little trip to Norway to get a medal from the king you say? Simple. Four words, Isoniazid with codeine #3. Can you imagine it? People lining up at the pharmacy on Friday nights, telling me......"you don't understand!!!!!!! I NEED my TB medicine NOW!!!!!!!" The scourge that has been civilization's unwanted companion from time eternal would be banished from our planet within a year, future rap stars hustling isoniazid on the streets, to ensure it will never return.

My next plan involves Vicodin and the flu vaccine.........

Tuesday, February 15, 2005

Not To Be Solely Negative.....

.....there are parts of my job that I don't hate. Emergency Contraception for instance. I work in a state where you can get the "morning after" pill from me, as opposed to having to get a prescription from your doctor. At first, I admit it, I thought it was just gonna be a big pain in the ass to deal with. But here's the thing, when these women come to the counter, they're in a jam and need help, and if you go to the most hardened, crusty, cynical healthcare professional and strip away the years of lifeplaque that the workplace has deposited around their soul, you'll find at the core that the reason they went into this profession so long ago had at least something to do with helping people. Secondly, every time I do an emergency contraception fill, it's like sticking a finger in the eye and sending out a big 'ol F**K YOU to every right wing jihadist that runs this country today. You see, the morning after pill should by the standards applied to every other drug, already be available completely over the counter. An FDA advisory committee recommended that it's status should be switched, only to be overruled by the FDA as a whole. Tell any health care professional that. That the FDA overruled one of it's advisory committees. I'll guarentee you what they'll say......... "They never do that!!" do it to three or four people, it'll be like you're in your own little Seinfeld episode with a running gag line.

So if they "never do that" why did they this time? Simple. Politics. Because this administration hates women and would rather keep them tied down, poor and controlled with an unwanted child than by having to compete with them on the open job market. That's why I don't mind making the dmv wonders and vicodin addicts wait a little bit so I can fill out the paperwork involved in an emergency contraception filling. There are few things I can do during the workday more important than keeping a woman out from under the control of George W Bush and his ilk.

I theorize that pretty much every customer.....

That walks into a pharmacy can be put into one of no more than 10 categories. I haven't fully developed this yet, so I don't have all the categories down, however, one would be the "dmv wonder", so named because I would like to follow one of these customers some time as they attempt to register their car with the dmv. These are the customers that have no idea they are out of refills, then come in at 10 o'clock at night after they've already missed a couple of doses, the customers that have a new insurance card, are aware they have a new insurance card, but did not bring said card with them, the customer who had a "blue diabetes pill" filled through a mail order pharmacy 6 months ago and comes to the counter with nothing but this vague description. In each of these cases, although the customer has all the tools to make the transaction go smoothly, they either choose not to use them or aren't smart enough to pull it off, and I'm the one who has to make it right. Clue number 1 as to why your prescription takes so damn long to fill; I spend a lot of time doing things like tracking down mystery insurance cards and phone numbers to pharmacies far away so me and another pharmacist can put our heads together and see if there are any diabetes meds on your profile that might be blue.

So I wonder what happens to these people when they show up to register that car they drove to the store. Paperwork has to be in order or you get right back to the end of the line. The bureaucrat behind the counter is under no obligation to be nice to you as I theoretically am. Do they go to the counter and say they need to register their blue car? I wonder this sometimes as I watch them waddle out the door after I have solved their little self-created crisis for them.

Related to the "DMV wonders" would be the "life wonders"; people so out of it I seriously wonder how they get through life without hurting themselves. A few years back I read a story in the paper about a woman in a town a few miles over whose child had acquired head lice. Hearing from somewhere that an effective cure would be to pour gasoline on the little bugs, she attempted to do so.........with a lit cigarette in her mouth. Third degree burns were the result. Sometimes evidently they *don't* get through life without serious injury.

I'll bet the woman was well known to her pharmacist long before this incident.

Monday, February 14, 2005

Well Doesn't That Just Put A Damper On The Whole Weekend.....

....she said with a wink. You see, I had just explained to the nice lady customer that she would have to stay away from alcohol while she was taking her prescription for her.....um....newly acquired social disease. It was obvious what signal she was sending out, and while I guess I don't blame her, I mean, I am quite the good looking guy and all, I guess I still have enough Midwestern red state prudishness in me to be surprised by a woman who's trying to line up her next date before she's recovered from the effects of her last one. Evidently she didn't realize that the chances of scoring with someone who's seen pictures of what the end stages of her untreated condition would look like in textbooks were pretty damn low. I think I might have told her I was gay. I don't quite remember.

Saturday, February 12, 2005

There are other things I hate besides people

Dextromethorphan for instance. Check the label of your cold medicine, it's what's used as a cough suppressant. It's a distant, distant cousin of codeine and no all you teenagers out there, that does not mean you can get high off of it. As a matter of fact, you can't do much of anything with it. I have never, ever, taken a dextromethorphan based product and coughed less as a result. I have known through this anecdotal evidence for years that it is the greatest health care fraud being perpetrated on the American public today. And now, the scientific evidence is trickling in to confirm what I have known since I was 10, the stuff is worthless. http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2004/07/08/MNGNF7I1G31.DTL
Yet no one will believe this. Confronted with a shiny box, a multimedia advertising campaign, and a high price tag, my advice stands no chance. So I try to do what I can, letting people know that DM is the *only* ingredient in *any* OTC cough med (the powers that be realized diphenhydramine, an allergy med, is useless for coughs years ago and quit labeling it for that purpose) , at least trying to save them from buying 10 different products before they give up and see the doctor. This leads to many conversations such as this one:

Customer: What do you recommend for my cough?

Me: Have you tried anything yet that didn't seem to help?

Customer: Yes, I tried (fill in the name with brand A) and it didn't seem to help much

Me: Here's the thing......even though there are maybe 10, 20, different cough syrups out there, they all use the same ingredient, so if you've tried one, you've pretty much tried them all. If (brand A) didn't seem to help....you might want to get with your doctor to see if you can get something stronger.

Customer: What about (fill in the name of brand B)?

Me: It uses the same ingredient as (brand A), you'd probably be wasting your money

The customer will usually leave with (brand B), education losing the battle with multimedia advertising yet again.

Autofill from hell.......

"But I got a phone call from your computer" the customer will typically say "I must have something ready"

Just when I thought I couldn't be surprised by the ignorance and/or cavalier attitude people have about the chemicals they are putting in their bodies, came the advent of the autofill. It works like this; you ask your drugstore to have the computer automatically fill your presciptions for a maintenance med (something you'll be taking permanently, like a med for blood pressure, diabetes, etc.) when it's due for a refill. The computer will then call you when it's ready and you can then swing by the store and pick it up, no muss, no fuss. You can even put your credit card on file and it will be automatically paid for. What could be easier?

Here's how it works in the real world. A customer will be at the counter to pick up their prescription. Nothing will be ready. Customer will be adamant that something is here because they received that automated phone call. It might have been a call about someone else in the family. It might have been a call about the prescription they picked up yesterday that went out before it was sold. It might have been a call about someone who had your phone number before you moved to town and got it. These things happen. So I'll ask...."Well it doesn't look like I have anything ready for you, what was it you needed?"

And they will have no idea.....not the slightest clue. All they know is that the computer told them to come to the store and pick up some medicine. (Keep in mind that nothing gets put on autofill unless the customer specifically requests it.) If the computer told them to come into the store and quack like a duck would they do that as well? If I had a lower moral standard I would start calling customers at random, telling them to pick up their meds and have a vial of vitamins or M&M's waiting for them. I would soon be able to retire.........

Friday, February 11, 2005

There are no stupid questions......

.....only stupid people. I'm trying to think of the dumbest question ever asked to me by a customer......right now this is the one that comes to mind.

"This bottle says take 2 tablets every 6 hours, how many of these should I take?"

I would refer you sir, to the first part of your question......

He wanted some eyewash......

Elderly fellow at the counter, nothing unusual in his appearance that I saw as I wandered over to answer his question. "Do you have some sort of eyewash or something I can use....you see I had my eyes operated on by one of those VA doctors years ago....never should have trusted them.....but I was out on the golf course today and I noticed things getting a little fuzzy.....like right now I can see like a halo of light behind you but really can't make out your face....."


I wanted to grab him by the lapel at that point and scream......YOU'RE......GOING.......BLIND!!!!! THERE IS NO EYEWASH!!!!!!!! DOCTOR.......NOW!!!!! WHAT ARE YOU THINKING???!!!!


As it was I calmly explaned that he needed to see a physician. I neglected to explain however, that it might not be the best idea to drive. The last I saw of him he was getting in his Buick and heading toward the hospital. Hope he made it.

Whether Your Pharmacist Hates You or Not....

...is usually determined by the first question they'll ask you. Specifically "Have we filled presciptions for you before or will this be the first time?" Far more often then most sane people realize the answer we get is......"yes" This after more than 12 years of trying to come up with a way to phrase that question to get the answer I need. "Have you been here before?" Will prompt a lot of "yes" answers from people who have been in the store to buy a loaf of bread but never have had a presciption filled in their life. This is not useful to me when I'm trying to pull up your profile on the pharmacy computer. "Have we filled prescriptions for you before?" prompts a lot of "yes" answers from people who have been in to have something filled for their husband, child, cousin, friend, etc. again, not useful information when I'm filling for you. So the offering of choices the first question represents, I've found, is the best way to get the results I need the highest percentage of the time. And yet there are still the people who will look at you and say "yes" to a question it is impossible for "yes" to be an accurate answer for. And I hate them.

The Seinfeld soup Nazi is my hero. Oh to live in a world where the customers would step up to the counter, place their prescription on with their insurance card on top, take 2 steps to the right, then back away until their medicine is ready. They would then come to pick it up, listen to my explanation as to it's intended use and possible side effects, ask whatever relevant questions are on their mind while not interrupting my answer, then happily go away without trying to talk about their grandson in Omaha or how much better things were in 1955 or ask for the 30th time why they took a brand of foot powder off the market before I was born. Instead......well.....stay tuned to the blog to get a window on what workday life is really like at your local drugstore. I promise every story is true, and I hope they will be entertaining.