"Dipping into tonight's mailbag" by the way, isn't nearly as fun as it sounds. Anyway, here we go:
I worked for (corporate soul sucking chain) about 7 years before I moved and I worked for (2nd corporate soul sucking chain) about 15 years before that. Neither had unions, but I wish they had. I developed a bit of an edge from all those years of corporate aggravation.When I got home my sweet wife would let me vent, then she'd say something like: "You're over reacting, just do your best and let it go. Hey,supper is ready..let's eat" She probably saved my life by doing that for me all those years
I like hearing someone's marriage got them through the bullshit. Probably because I fairly recently found the most awesome girlfriend in the world.
But it bothers me that the corporate folks do whatever they want without much regard for the people who work for them. A lot of it is not only silly, but just dumb.
And dangerous. Let's not forget dangerous. I'm looking at you 15 minute prescription guarantee.
Here's a little example that happened last week. Might seem little to others, but I think you'll understand:
In the past, when we dispensed coumadin, we got a little auxillary label that said: "do not take with aspirin unless directed by physician".
How many of you named coumadin/aspirin when I asked you to come up with an interaction quickly? I'm betting most of you. It's probably the most common, most dangerous, drug interaction you'll find in any type of ranking of these things. Pretty basic stuff for anyone with a pharmacy education. Yes?
Read on.
It printed automatically on the peel off spot. One day that label dissappeared and was replaced by two others.One said do not take if pregnant without Dr advice, the other said do not drink alcohol with this med...but the no aspirin sticker was gone. I checked Facts and Comparisons to make sure the aspirin/coumadin thing was still legit. And I found out that they classify the coumadin/aspirin interaction as level 1. (Probable, prompt, and serious). The alcohol/coumadin interaction is classified as level 3 (unlikely, delayed, and not significant).
For those of you playing along at home, here's what the good folks at drugs.com have to say about aspirin and coumadin:
Aspirin, even in small doses, may increase the risk of bleeding in patients on oral anticoagulants by inhibiting platelet aggregation, prolonging bleeding time, and inducing gastrointestinal lesions. Analgesic/antipyretic doses of aspirin increase the risk of major bleeding more than low-dose aspirin; however bleeding has also occurred with low-dose aspirin.
And again, anyone who's spent more than a week in pharmacy school knows this. This is simple, basic stuff.
Back to the letter:
So I called one of the pharmacist who serves on the "advisory board" and she agreed that it might be a good idea to have that level 1 interaction put back on the label. She brought this up on the conference call and was told, "no we can't do that. Medispan would have to redesign our labels and all that and "so, no we can not do that".
I know it's just a little green sticker on the side of the bottle, but it's my profession.
Correction. It was your profession buddy-boy. Today my friend, you are no longer even capable of judging whether the possibility that someone might bleed to death merits a warning label. Got that?
You are at 14:30 on that waiter on the counter though. better hurry up before someone gets a gift card.
I feel powerless to address this incompetence. I would like to be able to report this to the union and have them call up corporate and say: "Hey what were you thinking? Get that changed right away. Not next week, not after lunch, NOW!"
But I don't really like unions. I would like to think that they are unnecessary for professional people. I've developed a 2 inch thick folder of gripes like the one I've outlined above, but I don't like the sharp edge that's it's developed in me. I want someone to speak for us, but I don't know who.
You got any insight into this situation?
Yes, I do. Realize that unions are not perfect, and that as it stands today, they need a lot.....a LOT....of work before they become the type of organization that is able to advocate for our control of our profession. But right now they are the only tool we have. We need to improve the tool.
"Improving the tool" by the way, won't be nearly as much fun as it sounds.
Pharmacists can't even get an aspirin/coumadin warning on the label at one of the major chains that now control pharmacy. Imagine someone had told you that would happen back in 1995 and what you would have thought.
Now imagine what might be happening in 2030. Unless we improve the tool.
7 comments:
I had this guy come to my window at the store I was at that given night (I am still floating after one year, grrr) and ask about the side effects of warfarin. Turns out his prescribing doctor and the dispensing pharmacist (at a different chain, mind you) had put this man on warfarin for his a-fib with not even a wham-bam explanation of the signs and symptoms of bleeding to monitor for, the interaction with warfarin and green veggies – nothing. He only knew about the veggies after his INR went under 2 and his daughter, a nurse, mentioned that it might be the reason.
So, I put on my pharmacist hat, printed out the microscopically tiny patient education sheet, and counseled. Pissed some people off behind him, but the guy needed the info. And he thanked me. I am now a true believer that if someone thanks me at a pharmacy, I have done something right.
That is one of the best things I have learned, DM, from reading your blog and the blogs of similar-minded pharmacists. I was taught how to counsel; honestly, that’s why I got into this gig in the first place. And, dammit, I am going to counsel. If I am expected to friggin leap over damn counters to assist someone in the cough and cold aisle, I am going to take some sweet time about possible interactions that might kill you when you take that prescription in your hands. I will teach you to use your Advair and your Ventolin and, God help me, I will reset your diabetes monitor when you screwed the pooch after changing its batteries.
And, for the longest possible PS ever, I will say that my evil retail is at least paying lip service to the whole idea of counseling. There is a new to therapy call list so that we can check on the patient after they start a new med. And, joy, someone is ‘capping’ (i.e. locking) new rxs in the system, so they can’t be sold until the pharmacist counsels the patient and documents the outcome. Now, if only they would give me more tech hours so I wouldn’t have to do this while running the drive thru, ringing up customers and getting those last 10 labels out in the 10 minutes before close – oh, shit, there is an insurance problem – never mind.
I would have thought that complaining about a necessary label wouldn't be something you'd go to the union about. I'd have put that in the hands of the state board. (Of course that would depend on the state he's practicing in and if that board has any balls to do anything productive about it.)
Do wholesalers not stock individual rolls of auxiliary labels anymore? It's been many years since I left retail due to the imminent storm of chains & PBM's, so excuse my ignorance if non-computer generated boxes of aux labels are no longer available. If still available, are you allowed to sneak an order in with a wholesaler for a couple of rolls for your personal use & peace of mind?
Hey DrugMonkey, I thought of allopurinol and theophylline as too much Xanthine oxidase inhibitors. You know, it was on my state boards. Still have not seen that interaction in reality. The previous comment about taking this to the state board would probably be the best. We do need unions, I believe. Before corporate takes over, we need some representation. Almost everything I have heard about unions has been bad, but they tend to get things done. Again, I comment on your article in july's drug topics. We do need to sharpen our tool. Maybe by using a union, it will become sharpened.
My guess is your state board will do nothing. They create and enforce regulations. In my state, at least, there are no regulations with respect to auxiliary labels. The law, of course, does require counseling.
Remedial Labor 101:
Labor is a commodity. It's price is governed by the same supply and demand forces that govern the prices of other commodities. When supply exceeds demand the price is forced downwards. If the commodity is you, your employer can get away with paying you what you are worth MINUS some amount related to the ease with which you can be replaced. This situation is known as "unfair competition" and the elimination of "unfair competition" is the fundamental reason why we have and why we need labor unions.
To beat "unfair competition", the union must be able to require that everyone employed in a job category be a member. This is called a "union shop". In opposition to the union shop, many favor so-called "right to work" laws. These are laws that restrict the unions' ability to demand membership from everybody. Watch for this trick.
In pharmacy there is a tendency to expect good treatment from a corporate employer. As long as the employer can replace you with David or me or him or her, your job is not safe and you will be subject to all sorts of abuse. The company does not work for you. It works for its stockholders. This is proper in a capitalist economy. But just as vendors, drug companies, third parties, governments, etc. put pressure on the company, we must, too. There is nothing wrong or unprofessional about that. Unions are just another feature of capitalism, which is our system. I don't understand our reluctance to use them.
Happy Labor Day!
A union is only as good as its members.
Glad to hear ya still have the girlfriend. Wishing you find a gratifying job soon.
Aspirin interacts with Warfarin? Are you sure?
(just kidding)
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