Merry Christmas!

The truth

You know. No matter how angry I get, no matter how cynical I can be.... There is nothing compared to the Good Lord in the world. No matter how we perceive him, and now matter how He chooses to reveal Himsel, there is just nothing like him in this world. Put that in your record books. know what I'm saying?

Update on Techs

I was looking around the "blogosphere" and noticed a really good blog about requirements to be a technician in California.  Read it here on the Angry Pharmacist's site.

First things first... Seek wise counsel

  Has anyone out there had any success with MTM or any other clinical practice?  Are there any tips or tricks to get started?  There is one good article that outlines the process to get started.  The main question is, how do you get paid?  From what I can tell, I need to get my NPI number, so that I can start billing. Then I need to contract with the insurance providers in my area to become a provider for their patients.  From what I can tell, though, these companies don't have very many eligible patients to keep a practice going. 

  Does this mean that I need to get hooked up with a nursing home?  Do I need to complete a residency, or do I need to get some certification? Like CDE or Geriatrics certification?  I don't know. I'm thinking out loud I guess.  I think there are some pay for service opportunities out there, and possibly an immunization niche, but can we make this happen in a way that will sustain our livelihood?  I guess we will find out.  Is anyone else interested?  If so I will keep you informed.  Please give me suggestions as I go along, and ask questions if you think of anything. 

Long hours

Is anyone else out there required to work 14 hours a day with no relief? I will have my third 14 hour shift this week. How do they expect me to accurately dispense medications and care anything about customer service when I have to listen to everyone's sob story about their pain meds for 14 hours straight, multiple times a week? How does the board expect the drugs to be monitored all of those hours, when there is no one to relieve me to at least use the restroom? I mean do they really expect me not to drop duece in a whole day? Sometimes I need to do that like three times a day. Am I the only one?

Did I really go to pharmacy school for this?

  So tonight was extremely busy after about 4 o'clock. No surprise there. I just wonder, how is it that things can be almost normal when all of a sudden everything collapses?  Tonight everyone wanted to wait, and of course my tech complies with 15 minute wait times for everyone.  Then a medicaid patient comes in for his 20 day Lortab supply that he gets every month with a prescription written for 30 days.  So I am forced to talk to his doctor who says, "well I changed the sig... Man that is a lot of meds, I wonder why he is getting so many...." WOW!  I couldn't make this up if I wanted to.  Then, to top it all off, he says "he is supposed to be going through rehab or something." Yet you continue to supply him, and wonder why he is getting so many Lortabs.  I don't know..... maybe because you keep giving them to him. Just a guess.
  
   All the while I hear everyone that checks out saying, "no this is supposed to be a 90 day..." or "this isn't what the doctor called in..." or "wasn't there another prescription with this.." as my techs scramble to answer their questions.
 
   Needless to say, I was stressed.  Then 3 people show up to get flu shots.  Now I have a policy that we don't give flu shots during our peak hours of 4 pm to 8 pm.  Somehow, one of our employees told them that we give them until 7pm.  Or at least that was their understanding, or so I found out as they stormed off saying that they will never come back. The cherry on top of the sundae came from a patient that is a frequenter of the establishment.  She asked about her prescriptions, but made her true intentions clear by saying "is one of those hydrocodone?"

I am really going to lose it one day.  I mean I already say things that I shouldn't when people are around, and I feel myself getting closer and closer to losing my cool with some innocent old lady (or whoever happens to be there at the right time).  So I truly think that this begs the question.... "Did I really go to pharmacy school for this?"

What a horrible, horrible state this profession is in.  Now I truly think that God has a reason for me to be here, and that things will all work out eventually, but I can't help to wonder what I would have done differently if I had read all of the blogs of the disgruntled pharmacists out there.  Actually I know what I would have done differently, I wouldn't have gone into this career. It's too much, and not in the good way that you think of when someone asks "how would you like a career that challenges you. 

As a former bright-eyed, ambitious young person with delusions of grandeur, I implore all of you seeking to enter the field of pharmacy to reconsider.  At least, at least, do not let yourself be roped into this maniacal world that we call retail pharmacy.  It will suck the life out of you.  Seriously, just knowing that I went out and got a doctorate degree to be the keeper of pills is enough to drive me crazy.  Especially when I can hardly get away with telling some pill-head that they can't have their medications, just to have their doctor call and make it legal somehow.

Anyway, happy studying.

Why does it take 30 minutes to get 30 pills? - Thats like a pill a minute

   Ever wonder why it takes so long to get your prescription filled at a busy retail pharmacy.  I mean all they have to do is take the pills from the big bottle and put it in the little bottle - right?  Well, if you really want to know the answer to that question, you must first ask yourself, "Do I really care?"  Honestly from my experience, most people don't care because this is a fast paced world where we can answer phone calls, emails, text messaging, and write on our blog all while sitting in a McDonalds eating fast food, drinking coffee, surfing the internet all inside the Wal-Mart that we just bought our groceries, clothes, toiletries, garden supplies, and electronics from. 
    In the world of fast paced customer service where the customer must "have it their way," do people really care what it takes for "the help" to do what it is that they need to do in order to provide the customer the service that they desire.  The answer is a BIG FAT NO! 

I have decided that the people in the very small suburb where I serve as a pharmacist must live in the new Rome of the world, because they are the busiest people with the most demands on their lives compared to anyone else out there. Now, occasionally you will get the nice elderly man or woman who has all the time in the world, but the others must be out making decisions that will make or break the revival of our economy.

They are in that big of a hurry.  They will call ahead and say, "will you just fill what I tell you is on the prescription, so that when I get there you will have it ready?"  WHAT?!! I'm sure that the moment I say yes, they will spout off some ridiculous order for Lortab 10mg #360.  So no, that is not possible. 

Okay back to the main question - why does it take 30 minutes for 30 pills?

1. We have to type in the information into our system.  It has to be correct or we will not get paid by the insurance and we may possibly be fined by the state board.
2. We have to try to decipher the doctor's horrible handwriting everyone (including people that can hardly read at all) complains about
3. We have to bill the insurance, and handle any issue that may arise including when they have an incorrect birthday in their system, and it is up to us to figure out which is the right one.
4. We have to correctly fill the medication and troubleshoot any technical errors that may arise with the printer/fax machine/computer.
5. The pharmacist has to verify that everything that was previously done was done correctly, aaaannnddd determine whether or not the medication is appropriate for the patient based on
1. drug interactions
2. drug class duplications
3. strenght, dose, and duration
4. patients age
5. diagnosis
6. whether or not the patient recently received this medication (for narcotics and controlled substances)
7. Drug allergies
8. Etc......
6. All the while we have to answer the phone, call the insurance company for problems, the pharmacist has to counsel the patients on new medications and answer any and all drug questions that arise, as well as receive new prescriptions over the phone
7. We also have to try to answer the questions like "Hey where is the Loreal eye makeup?" or "Now isn't this on sale?" when the pharmacy and the front store are two separate entities yet one company. SO we don't know the answer to those questions nor do we care.  And another favorite is "do you have this?" -my response-  "No I don't think so..."-your response- "Well, why not?"  Again, don't know and I don't care.
8. And the main reason why it takes so long..... We are completing these steps for the other 50 people that came in before you and said, "Can I get this right now????"

Don't get me wrong, pharmacists get paid a lot to do this, but it still sucks. However, if you ever asked the question, now you have the answer.  So don't come up and ask if I know about the daily special on the pens and pencils up front, I slang pills not merchandise,  don't get it twisted.

A guide to OTC's - Over the counter medications

  Let me tell you what the big pharmaceutical corporations hope you don't find out..... When it comes to over the counter cold remedies, there are really only 5 main categories of medications that you can get.  No matter how many different brands, combinations, or brands of combinations there are; the medications are all the same.  Lets compare it to milk.  Milk is milk.  There is chocolate milk, strawberry milk, whole milk, 2%, etc...  No matter what kind of milk, milk is milk.  Okay, so the brands may taste different, but that is irrelevant to medications (unless you prefer the taste of one syrup/cough drop to another).

 The 5 main classes are.... (brand followed by generic in parenthesis)

1. Pain relievers - Tylenol (Acetaminophen or APAP), Motrin/Advil (Ibuprofen), Aleve (Naproxen), and Aspirin (Acetyl-Salicylic Acid or ASA). 

  - Brand name Tylenol is the same as the generic and so on and so forth.  All generic medications are put through extensive testing to ensure that the active ingredient (e.g. acetaminophen) is the same as what is in the brand.  So it doesn't matter which one you get, it will work the same.  And please do not come into a pharmacy and ask for  "name your pain reliever for arthritis" - it is the same drug but dispensed in a higher strength. For example, Tylenol Arthritis is acetaminophen 650 milligrams(mg) per pill where regular strength is 500mg.  This will be the same among all the different types of pain relievers.

  - Baby Aspirin is 81 mg ASA, no matter if it is Bayer, Ecotrin, or any other brand
       - EC is enteric coated - meaning that it will release the drugs in the intestines instead of your stomach -
             thus relieving some of the discomfort usually felt in the stomach after taking ASA (for more 
             information ask in the comments section and I will reply).

 - Do not give children under 18 ASA (aspirin) do to risk of Reye's Syndrome (you will have to look that one up).  The tricky thing is that Pepto Bismol contains salicylates that are related to ASA, so you would avoid this in children as well (except for infants brand Pepto which has the same ingredient as Tum's but labeled Pepto - isn't it ridiculous?)

- Tylenol is hard on your liver and the others are hard on your kidneys.

2. Antihistamines- These medications will stop the action of histamine in your body. When you are allergic or develop an allergy to something, your body responds to it.  This reaction is actually beneficial if you are infected with some kind of virus or bacteria.  However sometimes the allergen (what you are allergic to) is benign like ragweed or pollen. This can result in a runny nose, itchy/watery eyes, sneezing, itchy throat, etc...
Enter antihistamines.  These can help reduce the discomfort felt by allergies (especially seasonal ones). The major difference is this

    - Claritin will not make you drowsy.  Zyrtec is less likely to cause drowsiness. All the others (benadryl, chlorpheniramine, brompheniramine,doxylamine, etcc...) will probably have you dozing off soon.  This fact is not true in young children.  Benadryl (etc..) can actually cause a 2 year old to bounce off of the walls.

From there it is basically trial and error. What works for you. Some swear by one and think the other is garbage.

3.  Cough Suppresant.  There is only one - Dextromethorphan.  This is in Brand name Delsym and Coricidin.  Sadly this is why kids buy "Triple C's" and take 30 at a time (my friends in high school did that), because it can affect the brain at high doses.  Also, please avoid buying Coricidin anything or anything else that says its for people with high blood pressure - THE ONLY DIFFERENCE IS THAT IT LACKS A DECONGESTANT WHICH CAN RAISE YOUR BLOOD PRESSURE.

4.  Nasal Decongestants - Pseudophedrine and Phenylephrine are the only two.  Pseudoephedrine is kept behind the counter and requires a drivers license to purchase thanks to the meth heads in the world, and phenylephrine is over the counter.  From what I hear, phenylephrine is worthless, so you might consider pseudoephederine (Brand name sudafed). These can raise your blood pressure, but how high is your blood pressure?  Is it controlled? If it doesn't run very high, than it might be worth taking.  This medication is by far the best solution for symptom management in my experience. It takes away clogged sinuses, relieves sinus pressure, prevents post nasal drip (which in turn decreases cough) all by shrinking the blood vessels in your body especially your head.  If the theory is correct, it should also decrease headache pain because most headaches occur from dilated vessels in your head.

5. Expectorant - Guaifenesin or brand name Mucinex.  Don't forget that the generic is the SAME as the brand.  This medication will loosen secretions in your chest and help you get them out. Which can help prevent an infection by eliminating a favorable environment in which virus' and bacteria to tend to thrive. 

  So if it is important to cough that stuff up, then why do manufactures produce medications that are combination expectorants and cough suppressants?  Money money money money......money.  Dummy men aka crooked crooks.

Also, I have heard on multiple occasions that mucinex (guaifenesin) is no better than drinking plenty of water. Because water will ultimately work the same way.  So if you want to save money, then drink good ol' fashioned water. Of course I haven't read any studies, so I am not fully prepared to back this 100%.  I will have to say that I have felt a lot better after taking mucinex and coughing all that crap up.

Ultimately this post is to show you that when it comes to colds, there are only 5 main ingredients out there. So why then are there so many products? The answer is always money.  With money comes marketing.  Did you know that all sleep aids are anti-histamines with the exception of melatonin (which is questionable as to how well it works). So why not buy some benadryl and use it for all its purposes.  Also, anti-nausea medications are also anti-histamines (except emetrol, whose ingredients are very comparable to a soda). Anyway, lets stop making this harder than it is.  READ the ingredients, please, READ them.  A spade is a spade.

My recommendation is to buy a big box of each single ingredient and keep it on hand. Then treat the person based on the symptom, but be sure to read the dosing.  I would keep one box of benadryl (diphenhydramine) and one box of claritin/zyrtec (due to the drowsiness factor).

  Also, moms, you can get dye free, alcohol free, sugar free (diabetics as well) medications. Just look at the box.  And stop coming up to me and telling me how old your kid is and how much they weigh.  If their age/weight is not on the box, or says consult physician, or do not use...... that is my recommendation. The only thing out there for your precious little one's cold is childrens zyrtec/claritin and vicks baby rub - Unless the dr prescribes something else---

  The pediatrician has more experience with those meds than I do, so stop asking. I am new. Some old fogee pharmacists out there with kids or grandkids may tell you otherwise but not me. I really do love you and your child, so I don't want to have to get gangster on you okay.  I really feel that you come up to me and say, well can't I just give them half, and decide that you won't leave until I say yes.  Seriously, how many times do I have to say call the doctor before you will leave. That's right, you won't leave until I tell you what you want to hear, even if it isn't right.  When that happens I feel like a crip/blood who tells an opposing gang rival to leave my turf before I have to do something I regret.  Then I do something I regret and say, "it might be okay, just be sure to call your dr."

Anyway, these aren't the only OTC's out there, just the ones dealing with colds. Post with your questions if you want to know more.

I'm out.  Know what I'm sayin?

PS to see more of what I am talking about  go to http://www.theangrypharmacist.com/, but be sure to come back here!

To be or not to be - should I go to pharmacy technician school?

  So let me tell you a little about pharmacy techs.  Techs do everything the pharmacist does minus a few tasks such as taking new prescriptions over the phone, final verification of a prescription, counseling, and a few other things.  They, however, do this at a much much much lower wage.  Technicians are at a disadvantage in that they get to share in the daily stress of a pharmacist without sharing in the pay that makes the pharmacists job almost worth it.  To top it all off people are being tempted daily by schools out there claiming to give them the edge that they need to become a tech, if they are willing to attend class and pay tuition (of course).

  First of all, technicians can start out as cashiers in a pharmacy.  They can work as a cashier and do everything that a tech does except fill prescriptions. While they do this, they are getting the training that is needed as well as GETTING PAID to do receive this training.  States differ in their requirements, but in my state, you can work and become a tech without going to school (GED or high school diploma is needed though).  "Tech school" is not required.  So why do it?  Well if you are sitting at home and you are unhappy with your job/life, and see a commercial that promises all the great things in life if you would just finish a program that their trade school has to offer, you would get pretty motivated to do look into it.  So people do.  If they are like one of my friends, they will enroll, realize its actually tough, and not finish.  Thus owing a school money for a trade never learned.  Furthermore, the information that is taught in those schools is more than is needed to work as a tech.  Trust me, you do not want to be an "expert" pharmacy tech.  The pharmacist will always know more, and there is a ceiling to how far you can go (in regards to pay and status).

  These schools remind me of what Bone Thugs-n-Harmony like to call "Dummy Men."  The guys that sell dope that ain't dope.  You know crooked crooks.  (Did I mention I'm from the streets?) They sell an education that can easily be learned on the job while being paid.  Also, a technician would need to learn the system and work flow of a company before he or she would be proficient at their job.  In other words, they may start a job after getting out of school and be lower on the totem pole than a person who didn't go to school (or even a cashier for that matter). 

  So take my advice.  Stay away from pharmacy unless you find a slow job where people don't try to rip your head off everyday.  Secondly, DO NOT go to a pharmacy technician trade school UNLESS your state requires it.  Pharmacy isn't for the faint of heart, you can't be any geek off the street, you got to earn your keep. You got to be a Regulator.

PS to see more of what I am talking about  go to http://www.theangrypharmacist.com/, but be sure to come back here!

My first test...

  In the world of pharmacy, a common theme is "Professionalism." This concept is fed to you during your entire stay at a school of pharmacy. Its just that, pharmacy is changing.  I believe that pharmacy was originally filled with smart businessmen. What sells better than what people can't do without? Pills are now apparently one of those commodities. Now the profession wants to evolve into a clinical one, that will help people with their conditions and actually help them get healthier instead of just better.  Very admirable I think.  So we first have to maintain the trust of the people and get on the physicians' good side.  The physicians "own" the rights to prescribe or authorize others to prescribe.  Pharmacists now go through a doctorial coursework that not only deals with medications, but also disease states, so we want a piece of the action!!!!

  To get there, we have to maintain respect and be professional.  There is just one problem with that.  I'm ghetto. I am.....always have been.  Don't get me wrong, I am respectful, but I'm from the the streets. I was raised mostly in a small town, but I did time in the ghetto and that always changes you.  Grew up on food stamps and section 8.  I even hung around with thugs, even though they sold drugs, they showed a young brotha love (Tupac).  So when someone comes in and demands something from me, my instincts are to get hood with em. 

  I work in retail ( a large chain pharmacy). So one day, this guy comes in on workers comp (where you get hurt on the job and now the employer foots the bill).  Now I don't care who pays.  I just want to make sure everyone gets the right medication and good care. But he gets a med that has to be compounded (mixed) and wants it on workman's comp (same as above).  So, we spend an hour on the phone and get it to go through, but our company adds a $1.20 compounding fee and he throws a fit.  Again over $1.20.  Now I am new, but I know that workman's comp has limitations, and I figure that compounding fees are one of them.  So we call workers comp, but they say they covered the cost. So my company must have added the fee.

 I tell him that $1.20 is what he owes.  He says "NO they pay it all, have you EVER done a workers comp claim before, I work there so I know how it works!" 

 Now my first thought is....... I'm about to stomp this dude out.  Little skinny buster, you think your gonna come in here and talk to me like I'm some sort of punk.  NOT UP IN HERE YOU AIN'T! But the professional side comes out and I say... "yeah, every day. I know that there are some things they don't cover."  He says "NO they cover everything." ----- Well apparently not. He starts to insist that one of my staff added the charge on there. Now I work for a chain, I don't care if they get their money. They are gonna get their money to regardless, even if it means calling their customers everyday and begging (like they already do!).  Anyway, I took the charge off, and have now I have to every time he comes in for a refill.

Now pharmacy is lucrative, but this is the kind of stuff you deal with everyday and multiple times a day. Not to mention the volume of medication you deal with and all the struggles that brings. Is it worth it? Time will tell I guess. My main question for now is why are people so worried about everything that goes on in a pharmacy and why are they so demanding and rude.  When did a pharmacy become like a fast food restaurant?  Do you really want your pills as fast as you want your fries?  What do you think?

PS to see more of what I am talking about  go to http://www.theangrypharmacist.com/, but be sure to come back here!

First of all....

  Okay.  Let me start by letting you know that I am a young pharmacist.  I am in my mid twenties, and have recently had the pleasure of completing my coursework in the field of pharmacy.  Let me just sat that the profession itself is a very dynamic profession that will challenge you and allow you some autonomy to be all that you can be (if you will).  However, the point of this blog is to let everyone in on a day in the life of a young pharmacist. This blog is not intended to inflate the egos of those that are pharmacists, in fact it may do the opposite. This blog will however give you an idea of what it is like to wear the white smock and feel like a schmuck.
  Like I said I am young.  I like to have fun, be goofy, and enjoy life.  I have come to realize that being a pharmacist does not allow you to do any of those things.  Instead, being a pharmacist allows you to be stressed out, get yelled at while being "professional", at feel like you could have a heart attack at any moment.  So, if you are interested, I will take you through many scenarios that may make you rethink what pharmacy is as a whole.  At the same time, you may rethink your decision to use certain pharmacies.  anyway lets begin.....