Wednesday, July 29, 2009

The California Pharmacists Association Proves Its Worth.

This is a story about the California Pharmacist's Association. About going to bat for all the pharmacists who spend their workday stressed-out, starving, needing to take a piss for the last 6 hours of a 12 hour shift while trying to evaluate the potential for development of serotonin syndrome in a patient taking Nardil who wants to buy some Robitussin DM.

I bet the California Pharmacists Association goes to bat for us. I mean, it says right on their website they are dedicated to advocating for all pharmacists in the State of California in the Legislature. That's really cool. We could use an organization that will advocate for the interests of both the profession and our patients in Sacramento. They even have a Political Action Committee, which says its goal is to "promote good government, which enables the pharmacy community to provide quality pharmaceutical care for Californians."

That's awesome. Because you know what kept me from providing quality pharmaceutical care to the Californians who came to my counter today? The fact there are 5 phone lines in my pharmacy, a voicemail, a fax, 2 customer service windows as well as a wide-open area in the middle people see as an invitation to ask the location of potato chips and the bathroom, and that my employer saw fit to give me one other person today to take care of all this.

How many of you out there see the biggest barrier to providing quality pharmaceutical care to your customers as the working conditions your employer forces upon you? I'm looking through my magical Internet screen and seeing about 90% of your hands going up.

So I'm sure The California Pharmacist's Association was all over Assemblymember Bill Monning's hearing back in April exploring how working conditions in retail pharmacy are destroying the profession. I mean, they said they were dedicated to advocating for pharmacists in the legislature. They wouldn't lie.

Some of you can imagine where I'm going with this. Here's a little cut and paste from an email exchange between myself and Monning regarding the hearing:

Me: Were any professional organizations, such as the American or California Pharmacists Association involved? Was their input solicited?

Monning: We invited the California Pharmacists Association to attend and testify, but they declined our invitation.
Back to California Pharmacists Association's website:

Through our lobbyist, we play an active and crucial role at the Capitol in protecting the interests of the profession of pharmacy. We help to educate the Legislators on the importance of the role that pharmacists play in the overall health care of patients.

Huh. So I guess in The California Pharmacists Association's world....."active" and "crucial" are synonymous with "not bothering to show up," and "helping to educate legislators" means "not attending hearings where legislators are gathering information about pharmacy issues."

That is one kick-ass lobbyist you got there California Pharmacists Association. And by kick-ass I mean useless.

Yet somehow the California Pharmacists Association thinks it would be worth it for me to send them $365 a year to join their little club. Plus more for their Political Action Commttee. If you're a member of The California Pharmacists Association, I have a better idea. Cancel your membership, send half the amount you would have spent on dues this year to support the one person who has shown any leadership on the issues we care about, and buy yourself something nice with the rest. Everyone wins.

If, however, you choose to maintain your membership in The California Pharmacists Association after this, I am issuing a direct challenge to you to justify why.

For the love of God tell me why.

Tuesday, July 28, 2009

Bill O'Reilly Demonstrates The Effect Of Cuts To Education Funding.

Another reason my TV isn't turned on much these days. Because when they don't expect us to be entertained by people losing weight, they give us this when we look for informed commentary on the day's events:



We have 10 times as many people, and millions who instead of laughing this man off the air when he decisively proves his unfamiliarity with basic mathematical concepts, will tune in to watch him the next day.

Not me.

It's lonely not being dumb sometimes.

This Month's Drug Topics Blog Fodder.

The nation's leading trade magazine this month covers the latest in diabetes care:


The caption to the left says, in part:

Erik Chopin (center) winner of Season Three of "The Biggest Loser," recently joined executives from Novo Nordisk, Bayer, and Health Mart in San Diego to announce a new campaign called Health Across America: Pharmacists Partnering in Diabetes Care......

"I've worked with my community pharmacist for years to help manage my diabetes," Choplin said. "I encourage others with diabetes or chronic conditions to engage in healthy conversations with pharmacists"

OK Erik, let's have a healthy conversation.

Now, I don't watch a lot of TV, almost none really, so bear with me here, but I understand "The Biggest Loser" is some sort of televised competition, the object of which is to lose weight. We televise people losing weight in this country, which pretty much explains why my set is never on. Anyway Erik, I see you evidently won the third edition of this show. So....um....how do I say this.....

Are we supposed to be pretending you're not a fatass then? Because you have man-boobies. Total man-boobies. You could lose as much as I weigh and still probably not be the lightest person in that picture.

Which wouldn't be that big a deal except that you are being held up as some sort of example to the diabetics of the world. Maybe the new diabetes treatment paradigm involves just making the patient feel good about their body as opposed to getting them to do something to help themselves. Preserve self esteem over necrotic foot tissue.

You gotta hand it to the corporate stooges in that pic though. Look how they're soldering on like their little PR stunt isn't being made a mockery of. "Yes, the beached whale here among us is a prime example of the commitment Erik and Norvo Nordisk share to being in control of your health."

Put down the Ho-Ho Erik, or give back the endorsement money. That's my healthy advice to you.

You're Welcome.

Thursday, July 23, 2009

So My Pee Forked Today.

I'm not kidding you. My bladder was about ready to burst in the happy pill room and I ran to the back and closed my eyes and desperately started the flow.

For some reason when you really really have to go it seems to help if you close your eyes when you start.

When I opened them and looked down at Mr. Pedro, what I saw was a stream of urine that looked pretty normal for the first 2 or 3 centimeters, but then split into two. I swear. Just like it was some sort of liquid fork in the road or something.

I usually don't make a habit of looking at my pee stream. Maybe I should start. How long has it been like this? How is it even possible? Is some sort of microscopic engineering corps working on a Hoover Dam kinda thing at the end of my urethra? Some sort of hydroelectric project maybe?

It reassured me on some level though, to know that according to the double slit experiment, this pee forking was evidence my urine was a stream of matter, and not a wave. I never thought of my urine as particularly energetic. Unless of course the act of observing had itself changed my urine into matter. Like in the double slit experiment. This is what goes through my mind as I eliminate my bodily wastes.

I kinda wanted to take a picture. I even started to fish around in my pocket for my cell, but then realized I just started a new wireless contract, and I really wouldn't put it past Verizon to be less than sympathetic if I ended up with a urine soaked phone.

I haven't peed since though. If it happens again I'll let you know.

Sunday, July 19, 2009

I Am A Political Genius.

In my mailbox this morning:

Bill Monning to me:

I was pleasantly surprised this week to receive notice of ActBlue and PayPal contributions from around the country. I then learned that an email from pharmacists prompted the generous outreach and further determined that you are the one responsible for this wonderful pulse of contributions.

...thank you for your efforts to reach out to your colleagues and for sharing your confidence in my work with fellow (men and women) pharmacists...I do want to thank you for your work and networking.

I look forward to seeing you soon and ask you to please convey my thanks to members of your network....

Mil gracias!
Salud y Paz,
Bill

There you go my friends. I promised you he'd notice and he did. We have now drawn the attention of the chair of The California State Assembly Committee on Labor and Employment, who I'm sure now realizes has touched a nerve with that hearing of his.

Not a bad thing at all. Everyone involved give yourself a nice big congratulatory pat on the ass.

$435 more dollars and you get a week's worth of pill counting highlights.



Friday, July 17, 2009

Only One Highlight From Today's Pill Counting Action Really.

And it didn't come until almost the end. About a quarter 'till closing I hear the "rustle rustle rustle....." of a dude fighting with his backpack in the customer waiting area. The island of affluence where I sling the pills these days long ago ceded a beachhead to a homeless encampment. Usually however, they don't cross over the line to the land of the moneyed unless they're stealing booze. I figured the guy would have to have some pretty big cajones to not at least go to the back if he was swiping something, so I didn't give him a second thought. Besides, I had shit to do before closing.

Phone rang. I heard more "rustle rustle rustle...." while I advised an old woman if she could have a glass of wine with her Benadryl. I looked up and the homeless dude was at the counter. Ten till closing now. Goddamn it.

"Can you tell me how much these would be to just fill half of 'em?" He asked, and handed over three prescriptions. "I have this" and added a prescription savings card from my employer.

Missing more than a few teeth, stunk to high hell, a prescription for spironolactone and a big 'ol belly that made him look pregnant. Those of you in the professions know those last two things meant he was just about ready to finish drinking himself to death.

To which I can hear the chorus of voices saying "who cares." Fuck you. There's not a person reading this who hasn't made choices that could have turned around and bitten them in the ass at some point. This guy got bit in the ass by alcoholism. There but for the grace of God go I. And you.

A middle aged potbellied man came to pick up his daughter's acne antibiotic. Potbelly from fat, not liver ascites. He bitched about the $7 copay until past closing. That's how the twelvers usually end. Some fatass bitching about his copay. Today I had three more prescriptions to do.

They were cheap. Each of them right at my employers minimum charge. I went ahead and filled the prescriptions in their entirety because I'm not supposed to go below my employer's minimum charge.

Not cheap enough for the homeless dude though. "I've only got $20 with me. I guess I'll check back with you later"

Fifteen past closing now and I got another look at that belly that looked like it was gonna pop.

"Sir did you say you just came from Target?"

A look of confusion.

"Because we'll match prescription prices if you can find a lower one. So they just told you these were on their $4 generic list, huh?"

I was nodding my head yes.

He gave me a smile.

Lucky me had to delete the prescriptions and fill them over form the beginning. Because my employer has the most non kick-ass prescription filling software in the world. I realized what I was doing probably wouldn't put them in a position to update it anytime soon. Half an hour past closing and I got a death glare from the assistant manager who wanted to go home and a "you're very kind" from the man who had none.

I don't have to tell those of you in the profession we are the doormat of healthcare. That the fatasses bitching about their $7 copay usually come after twelve hours of other assorted cretin customers, dickhead doctors, and numbskull nurses bitching and moaning about something over which we have no control. All the responsibility, none of the control. I always said that should be the official motto of pharmacy.

I've also always said though, that every once in a while, me and the Cincinnati Bengals can win one. This night ended with a win, meaning tonight's rum will be celebratory, and not dulling the workday memories as usual. The reason it's rum and not scotch is a reason to celebrate in itself.

Holy shit I just realized I'm on a winning streak.



Wednesday, July 15, 2009

I Keep My End Of The Bill Monning Bargain. Highlights From Wednesday's Pill Counting Action.

Once again I was looking down the barrel of a twelve hour workday, but once again this day started as one of hope. Those of you in the profession are well aware that in any pharmacy anywhere on the planet, there are always various pieces of electronic equipment that are non-functional. You may spend 6 years in college learning drugs my friends, but when you get out you'll learn to how to hold hardware together with paper clips, rubber bands, and duct tape. You'll learn how to jiggle power cords and exactly where on the outer casing to give the machine a good smack to get it to work. Or you'll learn how to bypass the goddamn thing altogether and still get your work done. This morning, however, as I struggled to hear the overnight voicemail through the telephone line that had a short circuit, I looked across the store and saw the entrance of our corporation's electronic repairman. When he left two hours later it was the beginning of a new era of Pax Technologica. For the first time that I can remember in my career, every machine in the pharmacy was fully functional. The people? Not so much.

"I take aspirin for my heart. Is this OK?" said the befuddled old man. "This" was clearly labeled as aspirin. I told him for the love of God to never put one of those in his mouth. Not really. I did wonder what these people will do when mail-order pharmacy takes over the entire universe. Because there seems to be more and more of these type of people around.

Right on cue with these thoughts, the next woman asked where the castor oil was. She came back a few minutes later with a bottle clearly labeled "Magnesium Citrate" and asked if it was castor oil. She was pregnant. I wondered what she would do when mail order pharmacy takes over the entire universe and who could have possibly have stuck his pecker in that.

I was also feeling not so good about the 5 years and all the dollars I spent to go to college until the computer made me feel better by trying to warn me that thyroid replacement therapy was contraindicated in patients with hypertension. Not that thyroid replacement should be used cautiously mind you, but that it was contraindicated. So evidently it is now best medical practice to let the thyroid glands of those with high blood pressure run amok. Who knew. I let it slide though, because I was living in the age of Pax Technologica.

"So the paper I brought in today said I have 6 refills, that means I have 2 coming to me, right?" I swear that's exactly what he said, and I could think of absolutely no reason why this man would think he had anything other than 6 refills coming to him. It was a competition this day between the machines and the humans to see who could make the least sense, and try as the machines might, the humans seemed to be winning.

The machines responded by ending Pax Technologica. The label printer started making farting noises. I swear. It was like the printer had just finished off a whole plate of beans and I made lemonade out of this lemon by taking the opportunity to release a little pressure from lunch myself. The ugliest woman in the world walked by carrying a bag from Victoria's Secret and I almost lost some lunch out the other end.

A lady came up to the counter right at the height of the after work rush and said she needed the loratadine "without all the sneezy and watery eye stuff in it." There seems to be at least one customer like this at the height of every after work rush. I put in a good effort to explain it to her. Really I did. That loratadine by its very nature treats sneezing and watery eyes. I opened up with every bit of 5 years worth of college drug learnin' firepower, but after a good 5 minutes with the phone ringing, the fax machine whirring, the printer farting, and the people backing up at the counter, she was having none of it. I finally gave up and told her it was at CVS, which may have confirmed my reservation in hell. The humans had trounced the machines in the clueless competition this day, as they do most. I started to wonder if maybe the Unabomber wasn't as crazy as he is portrayed, and pledged to track down a copy of his manifesto when this workday was done.

Thanks for coming through for Bill Monning, the one person in any position of leadership who has ever stood up for you. My pledge to chronicle the entire workweek after we reach $2000 in "Highlights From Today's Pill Counting Action" form still stands. I have no fear I will lack material.

Monday, July 13, 2009

Well That Didn't Take Long. The Bill Monning Chronicles Continue.

I wrote less than 24 hours ago that I would match the next $250 in contributions to my personal Bill Monning fund drive dollar for dollar, and you guys proceeded to blow through my money faster than anyone since my ex-wife. Unlike my ex-wife though, you have my sincere thanks. Despite what The Angry Pharmacist says about you, you've proven what I've known all along. I have the most kick-ass set of blog readers in the world.

I'm kidding about The Angry Pharmacist, but not about my thanks, or about the fact there is a bit of a crimp in my scotch budget now. So I will ask the most kick-ass set of blog readers in the world this. Do you have any ideas for what to do with rum? Because a bottle of rum is all I have in the kitchen right now, and it's looking like I'm gonna have to make do with it this week. And rum is gross.

So now that my matching contribution ploy has me on a date with Bacardi, I'm going back into the NPR bag of tricks and offering a gift incentive for your donation. Not a coffee mug or a tote bag my friends, but something far better. I know how much you like the "Highlights From Today's Pill Counting Action" posts. I don't blame you. I like them myself. So I'll tell you what. When we get that thermometer on the right hand side of the page up to $1500, you will get a "Highlights From Last Wednesday's Pill Counting Action." Last Wednesday sucked penis in the happy little pill room. Trust me, it'll be worth it. And if we get it up (get it up.....huh huh) to $2000, I will chronicle each day of the following workweek in "Highlights From Today's Pill Counting Action" form.


Yes, this means I am whoring out my writing skills, but if you're in the profession I don't have to tell you why. Did you get to take a piss at work today when you needed to? Get some lunch did ya? Do all your state-mandated OBRA counselling with each new prescription? I mean, the law says you have to offer to counsel with each new prescription, so I'm sure your employer is providing you with all the tools you need to comply, yes?

If you're in the profession you know damn well what the answers to those questions are, but if you're a member of the general public, you probably don't. Which is why the work Bill Monning did to expose our working conditions was so important. Because if the general public knew, they wouldn't tolerate it.

The way APhA does. The more I think about this the more pissed I become at APhA.


By the way, the original goal for the next "Highlights" post was going to be $1000, but as I was writing this, two contributions came in that raised our total to $960.

You guys really do rock. Now make me do some writing.

I Put My Money Where My Mouth Is On Bill Monning. Wait. That Sounds Gross.

Yeah, as I read that headline again that definitely sounds kinda bad. I should work on that. Because as my friend Billy Watson (Link not safe for work) would say; "No Way Am I Gay"

As Jerry Seinfeld would say; "Not that there's anything wrong with that"

But this post isn't about some guy who shoots porn and writes a blog I read nor is it about my favorite sitcom that I miss dearly. This post is about the answer to the question "What the hell has a politician ever done for me?"

Because if you work in retail pharmacy, Bill Monning has most certainly done something for you.

I wrote in my last post, how Monning, a California State Assemblymember and chair of its committee on Labor and Employment, held a hearing in April entitled "Working Conditions of Retail Pharmacists: Are Workers and Consumers Being Harmed?"

Monning isn't a pharmacist. As far as I know, he isn't a member of any of the healthcare professions, but with that one hearing he assumed a leadership position in addressing the crisis that threatens to destroy our profession. Yes. Workers and consumers are being harmed. And I don't see much of anyone else doing anything about it.

Which is why I want Monning to continue his work.

Which is why I created a fundraising page on ActBlue to support his next campaign for State Assembly. Trust me, if he sees campaign contributions start to roll in from random pharmacists, technicians and other fans of pharmacy around the country, he'll notice, and he'll know why. Having dollars flow in in the political off season will also serve to scare off anyone thinking of running against him next year.

I kicked off things with a few dollars of my own and a trick I'm going to borrow from NPR. I will match whatever you choose to contribute, dollar for dollar, until the amount of my seed money is doubled. That gives you two times the punch for your contribution dollar and will take us to $750 when you stand up for the man who has stood up for your profession.

When your employer has remained seated.

When APhA is nowhere to be found.

When your state board does nothing but take your licensing fee.

It's time for us to do something, and I am prepared to dip into my scotch fund to get this off the ground.


Look, I've never asked you to do anything like this before. As much as I wanted Al Franken in the U.S. Senate, I never bothered you to ask you to part with some of your hard earned dollars. Because frankly (ha ha, get it? Frankly) Al Franken's never done anything for my direct benefit. Bill Monning has.

And your's as well. At least if you work in an understaffed retail pharmacy that puts dollars ahead of your well being and your customers safety. Which is pretty much everyone toiling for one of the chains.


It doesn't have to be a lot, Politicians love to brag about the number of contributions they get, especially if they are from regular people. Five bucks is great, and it'll be matched with five of mine.

That hearing was a gift horse the likes of which we may never see again if we don't follow up. Let's make something happen.

Monday, July 06, 2009

Why California Assemblyman Bill Monning Is The Coolest Member Of Any State Legislature In The History Of The Republic.

Bill Monning is chair of the California State Assembly Committee on Labor and Employment, which held an informational hearing back in April entitled "Working Conditions of Retail Pharmacists: Are Workers and Consumers Being Harmed?"

Does the sun rise in the east? From the post-hearing report:

One retail pharmacist testified anonymously to protect his identity. He stated that he had been employed as a pharmacist in charge for 20 years and had been employed by CVS Pharmacy as a "pharmacist in charge"

He expressed three main concerns. First, he stated that there are inadequate staffing levels. Retail pharmacists have additional responsibilities and that some company policies discourage breaks.

Second, he testified that there is lack of time for proper patient counseling. There is simply not enough time to provide proper counseling and there is a lack of proper space for patient confidentiality.

Finally, he expressed concern about certain prescription quotas that were linked to employee bonuses and created pressure on pharmacists to work faster.

Least surprising legislative hearing testimony ever. Unlike the vast majority of people in the profession getting and allowing their patients to get screwed however, someone is doing something about it. His name is Bill Monning. And he evidently cares more about you and the safety of your patients than your employer. I want you to think about that the next time you're tying your penis in a knot because you're drowning in prescriptions and don't have time to let the urine flow.

Wanna read something funny? This is from the testimony of Bill Dombrowski, President and CEO of the California Retailers Association:

Mr. Dombrowski stated that there is a need to address the following issues. First, there needs to be an effort to free pharmacist time to deal with core pharmacist issues.....

When questioned whether he favored a "prescription capping" proposal, Mr. Dombrowski stated that he did not favor such a proposal in statue. He testified that a better approach is for chains to utilize their own internal standards and controls, and indicated that is essentially a management problem that the chains have to handle themselves.

Uh-huh. So....there's a problem, but instead of getting behind concrete proposals to solve the problem, or offering any solutions of their own, The California Retailers Association says we should just assume that the people who created the problem will magically solve it. When they have absolutely no financial incentive to do so. Remember that as well the next time you're tying your penis in a knot. How the California Retailers Association totally went to bat for you.

Funny thing is, Bill Monning probably isn't your State Assemblyman. But again, he's doing more for you than your employer ever will. Good thing we don't have a government run health care system though. Because Bill Monning seems to be the only person not behind a pharmacy counter who gives a rats ass that the profession is being torn apart.

Your employer doesn't care.


The American Pharmacists Association? BBBBBWWWWWAAAAAAHHHHHHAAAAHHHAAAAHHAAAA!!!! Oh God....can't breathe....laughing so hard at the thought of APhA actually doing something for the benefit of pharmacists. My diaphragm is sore now.

I'm sure I don't have to tell you the likes of Aetna and United Health don't give a shit.

So the only player in all this who's on your side if you dispense or receive a prescription is a member of the California Legislature. I want you to think about that as the health care reform debate unfolds over these next few months.

I also think it might not be a bad idea for you to thank Bill Monning.

It's Easy To Forget This, But Michael Jackson Was Also A Musician.

And not one without talent. I put my pirated copy of Thriller into the stereo the other day and was reminded of this. The music never really connected with me. At the time I took it off The Napster I would have said it was barely worth stealing, but I put in the stereo the other day and was reminded that when Michael Jackson was on, if he was hitting on all cylinders and you did not have a desire to start shaking your booty just a little bit, then there was something seriously wrong with your ass.

There are two different ways of explaining Michael Jackson's commercial success. The safe way would be that he borrowed just enough from traditional rock and roll to make his music a comfortable bridge to carry mainstream music fans over to the world of funky soul. The way I prefer to say it is that he tricked white ears into not realizing they were listening to black music. However you phrase it though it was a formula for tapping into a geyser of money. You can look at the results of his life and decide if that was a good thing.

Yes, he was a weirdo. So was Elvis Presley, and Pablo Picasso, and pretty much every other creative soul with any talent. My advice to anyone who aspires to develop a taste for the arts would be to quickly develop the ability to separate the artist from their work. When you do this and put a copy of Thriller into your ears you'll hear....a joyous album. Probably why it never connected with me. I don't do happy music well.

You'll also hear a time capsule into a more naive world. Listen to the lyrics to Wanna be Starting Somethin' and Billie Jean. Who can even remember a time when teen pregnancy carried a stigma? Keep listening and you'll hear this description of what happens when you get on the wrong side of a street gang:

You're Playin' With Your Life, This Ain't No Truth Or Dare
They'll Kick You, Then They Beat You,
Then They'll Tell You It's Fair

Was there ever a time when street gangs were man enough to actually fight you face to face? I dunno, but I like the idea way better than some sort of pussy drive by.

You'll also hear Michael Jackson tell Paul McCartney that he's a lover, not a fighter, and be reminded that a duet with Paul McCartney was at one time considered a career booster....for Michael Jackson. I also couldn't help but think that I really would have liked to have seen a fight between Michael Jackson and Paul McCartney.

And I can't help but to wonder, as the sounds of Thriller drift into my ears probably for the last time voluntarily, if maybe there was a time, back when Michael Jackson was merely a famous person working in the studio on his next album, before that tape was turned in to Epic records and unleashed forces of the type that could break almost any human being, forces that left him begging for a general anesthetic so he could get some sleep at night, when Michael Jackson might have been a happy person.

I hope so. We all deserve to be happy, even if for a little while.