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.