Thursday, June 25, 2009

Mom of the year

I know it's been a while, work and life have gotten in the way of blogging.
But this lady yesterday was just SOOOOOOO stupid, I had to make time to tell you all about it.

Lat night, about 8pm, a woman and her two daughters come to my pharmacy to ask advice about hydrocortisone cream. "The doctor said to put this on my daughter's burn, and I don't know which one to get." Hydrocortisone on a burn? I had to ask questions...
"Is that your daughter? (looking at a 7 or 8 year old)" Mom picks up the smaller child and sits her on my drop off counter "No, it's this one" Child looks to be about 3 years old, and the skin on her face, mainly around her eyes, is all red and puffy. "What happened? Do you know what caused this burn?" It didn't look much like a burn to me, so I had to know details. Then the mom of the year story came out...
"Well, she got into my makeup. So, I used hot soapy water to try to wash it off, and it wouldn't all come off, so then I tried nail polish remover" Alrighty then....
Who on God's green Earth would take makeup off with nail polish remover???? Come ON lady, would you put it on your OWN face? No? Then why did you put it on your CHILD'S face??? Around her EYES no less???
I picked out a hydrocortisone product for her, told her not to use it more than a couple of days, and to follow up with the doctor again if it didn't improve by then. Then, I hoped that the kid didn't ever get into makeup again...

Tuesday, June 2, 2009

What rock have you been living under?

I had a really stupid question from a patient yesterday... One that made me question which planet she'd been living on recently.
This lady approaches the counseling window, so I walk over and said "Do you have a question?" She replied "Yes. I haven't been feeling well, and was wondering... Is the flu going around?" I almost laughed out loud! Seriously - what media outlet HASN'T talked about the dreaded swine flu? Apparently she doesn't get TV signals or the newspaper delivered to that rock she's been living under...

Thursday, May 28, 2009

I am in control....

Of all the insurance companies, apparently.
The other day, I had a couple of patients call me names just because I wouldn't make their insurances cover the prescriptions for them.
Patient one - Insurance coverage through a union. I work for a non-union company, and occasionally, union insurances will cancel their contracts just to prove a point (what point, I'm not sure - that they are asses who enjoy making their members drive all over town looking for a place to get their meds?) So, I'm explaining to the patient that it appears that the contract with their insurance has not been renewed, and suggest that they call the insurance and ask which pharmacies are included in the plan. "But it worked last month!" Yeah. You're right. But that was last month... As the patient stomped off, his wife tells him that we (the pharmacy employees) are a bunch of dimwits. Why can't people wait to get around the corner before badmouthing us rather than spouting off in front of the drop off window? Do they think that tech doesn't work for us?
Patient two - secondary coverage through state medicaid (aka welfare for all you non-pharmacy readers). Medicaid rejects claim with a message that patient is no longer covered. "But it worked last month!" Yeah - everybody's insurance worked last month, what's new? I suggest to the patient that he contact his case manager to ask about it. "OH! So now it's someone ELSE'S fault?" How do I answer a stupid question like that??? "Yup. See, I'm not sitting in that office where I can click the covered/not covered button on your profile. All I do is submit the claim - they decide if you're covered. Not me." Patient two calls me a dumb bitch (in front of the drop off window) as he stomps off. I just smile and wave...

Friday, April 24, 2009

It ALL costs money, honey...

Yesterday, I got a call from a doctor. No, not his office assistant, receptionist, or nurse - the doctor himself called. My tech tells me the doctor wants to talk to me so I pick up the phone and say "Thanks for holding, how can I help you?"
"For starters, you can quit sending refill requests to me for John Doe. I already denied them twice!" So I launch into the standard explanation (usually given to a nurse) about our system being automated. When the patient uses the automated system, a fax automatically - hence the term automated - goes to the doctor. When we get denials, we attempt to contact the patient and let them know, but it doesn't always sink in, and they call again.
"It costs MONEY to get someone to pull the chart every time you send me a fax!" I suggest to the doctor that, since the patient obviously doesn't believe that his refills have been denied, maybe one of his staff should call the patient and say "Your refills have been denied until you have an appointment - would you like to schedule one now?" The doctor, whom I will now refer to as jackass, tells me "We don't have time for that. That's why I faxed you a note to tell him!" WTF? Since when did I become his messenger??? And we fill more than 400 scripts a day - we don't have time either! I started wondering if he sees 400 patients a day...
I pull up the profile, and - lo and behold - there are scripts already filled! I look at the scripts and say "Well, Julia authorized these last week. Do you have a Julia at your office?" Jackass pauses and says "Um, I don't know. Maybe. But I didn't approve those, so cancel them." OK. Done. We cordially end our conversation.
Five minutes later, the phone rings, and my tech tells me Dr Jackass is on the phone again. "Uh, yeah.... I just got my message from Julia. Go ahead and let John Doe have those, but remind him he needs an appointment" Here we go with the messenger service again... "I already returned those to stock. Now I have to re-enter them from scratch. That costs MONEY, you know..." I'm chuckling and seething all at once.
So, I process them, and include on the labels "Needs appointment for further refills". I print extra labels, attach them to a fax cover sheet and jot a note to jackass... "This is how we notify patients that they need appointments. If the patient fails to make one and asks for more refills, YOUR staff will have to contact him. I've done my part. Sincerely, SOSP, pharmacy manager"
It made me feel better to send that fax (even though it cost me more MONEY), but Dr Jackass made me pissy the whole day...

Monday, April 6, 2009

What a great idea!

Last night, my husband and I were watching television when a preview of the new sitcom, Parks and Rec, came on. It's made by the producers of The Office, and stars Amy Poehler. My husband works for a city parks and rec department, so he's interested to see it. All of a sudden, he blurts out "They should make a show about pharmacy!" I agreed wholeheartedly - it would be funny, but give the public an education at the same time.
Now if only I knew a screenwriter and a big TV producer...

Friday, March 20, 2009

Think you know so much???

Don't you just hate people who think they know EVERYTHING???
I had one of those as a customer recently...
A prescription had been faxed to us from the doctor for some antibiotic eye drops. The directions said "Apply to affected area 4 times a day" and it said to dispense seven. Most people might think, "OK, the affected area is the eye" Ahhhh! Not necessarily so! Many podiatrists prescribe eye or ear drops to be applied to ingrown toenails. This doctor was not a podiatrist, however, so we jotted a note asking for clarification, and faxed it back to the doctor.
Fast forward a few hours. The patient (actually the patient's mom, I think - it MIGHT be the same little gal that thinks she's not a minor just because she had a baby) shows up. We tell her we need to clarify the prescription, we faxed the doctor, but haven't heard back yet. What's wrong with it, she asks, and we tell her about the unclear directions.
"Well, DUUHH! They're eye drops! What are you, stupid?" I'm in shock that anyone would speak to me this way, but I try to remain professional. "No, we're not stupid, we know what they're usually used for, but in our experience, that's not always the case." "My daughter has pinkeye! DUH! They're EYE drops!" "Yes, they are, usually, and we had no way of knowing about pinkeye from this fax..." She interrupts me and goes on about how stupid I am...
I hand the fax to her and say "If you are going to treat us that way, you can go somewhere else. Goodbye."
Hopefully, sometime in the not-so-distant future, I hope she tries to treat her toenail by putting eye drops in her eye... It would serve the little brat right to get gangrene...

Monday, March 9, 2009

A Hard Pill to Swallow...

The other day, we had a script come in for prenatal vitamins for a 15 year-old girl. OK, I get it, kids are having sex and getting pregnant younger and younger these days. But, on the script, the doctor wrote "Patient needs chewable tablets" - and the really stupid thing is that they exist! Yes, some companies make chewable prenatal vitamins...
Maybe the doctor and parents should have thought ahead and gotten the girl chewable birth control pills. Yeah, they make those too...

Thursday, March 5, 2009

Does it LOOK like we're open???

I worked a late shift today. My pharmacy closes at 9pm. We shut down 2 of our 3 registers between 8:30 and 9, and all but 1 or 2 of our 7 computers around the same time. We close promptly at 9.
Tonight, after closing, I was helping my cashier straighten out some shelves in our OTC area for a few minutes. About 9:10pm, a lady and her 2 kids come dashing around the corner, and when faced with closed gates, turned to us and said "Is the pharmacy closed?"
Hello? What do you think? When I was kind enough to talk to her a few minutes, she said "But is only, like, four minutes after nine." No, it's 10 after, and the sign doesn't say the pharmacy closes at 9:12pm, it says it closes at 9pm.
No, I didn't say it out loud, though I wanted to... And, I was kind enough to go back into the pharmacy and get her kids prescription to give back to her so she could go to a 24-hr place (our stock of the drug just expired, so it wasn't filled yet)
Come ON people! PLAN ahead! Get to us on time, and we'll help you. Come late, and you have a 50/50 chance that I'll be a bitch instead of nice!

Saturday, February 28, 2009

Weirdest. Day. Ever.

Yesterday was so strange. I hope we never have a day like that again, even though it was mildly entertaining.
Paramedics were called to the store 3 times. A kid fell out of a cart and hit his head on the floor. A lady had what we think was a heart attack. The 3rd person, I don't know the story, but when I saw the medics, they were getting a backboard ready.
We spent most of the day trying to find out if someone was dead or alive. Yup, you read that right. We had faxed a request to a doctor to change a prescription for a product we couldn't get. The doctor's office called us and said that the patient had passed away on January 7th. Looking at the profile, we knew something was fishy, because all of her prescriptions had been picked up regularly since then. One was a controlled substance (which sent up red flags), but none of the others were. She was on Medicare, which made us think of Medicare fraud - but what were these people doing with her insulin? So, we started making phone calls... Back to the doctor - "How do you know she died?" "Hospice notified us" OK. Call hospice, using the phone number the doctor's office provided. They never heard of her, but apparently, there are multiple home health branches of that company. Leave a message at one. Call the person who signed for the scripts (but try not to let on we think she's dead, in case there is some sort of fraud going on) - she is the patient's caregiver, and she speaks of the patient in the present tense. Call the local AND state health departments, check to see if there's a death certificate on record. No such luck, but converting from paper to computer records can be delayed. Back to the doctor - "Are you sure hospice told you she died?" "Yes. We even sent a sympathy card to the family. They never called us to say it was wrong." Odd, you would think if she didn't die, the family would ask why the doctor sent a card. FINALLY, nearly 6 hours later, we hear back from the hospice company. The patient was released from hospice to an adult family home. Call that number... "She's not dead. She's sitting right here, want to talk to her?"
Alrighty then... Call the doctor's office back. They're happy to hear she's alive, agreed to change the script.
So. How did this happen? We figure that hospice told the doctor that the patient was no longer on hospice, and the office just ASSUMED (we all know what that makes us!) that it meant she died. You know, sometimes people do get better. What I still can't figure out is why on Earth the family didn't question a sympathy card sent from the doctor's office....

Saturday, February 14, 2009

Handicapped

I can appreciate the need to accommodate the needs of people with physical limitations, within reason. But, I hate it when people expect things without any explanation, or worse yet, a stupid explanation...
Take the case of a woman who comes to my pharmacy. We have been receiving, from the manufacturers, drugs that come in unit dose packages - you know, those little blister packs that you have to punch each pill out of. A lot of people bitch about those, including me - they take up too much space in the pharmacy, they're a pain for people who don't get their prescriptions in multiples of 30, and they all look the same so if patients have more than one product packaged like that they run the risk of mixing them up. A couple of weeks ago, this woman comes in to pick up her scripts. The cashier hollers across the room to me that this lady wants us to punch out all the tablets into a vial for her. No reason. I say no - if I said yes to every request like that, we would spend half of every day punching tablets out! Seriously - I get at least a dozen requests for that every day! So - I said no, and the lady starts throwing a fit. The cashier sends her over to where I am so I can get yelled at too (share the wealth, I guess). So, the tirade gets launched "You have to punch them out! I'm handicapped! I have NO THUMBS!" She thrusts both hands in my face, and they clearly each have 5 digits... I try to hold back a mouthful of foul language, and in my attempt to cover my frustration with a phony smile, a "give me a fucking break" look comes across my face. Then she threatens to sue me for discrimination...
Now, had she told me she couldn't use her thumbs, or that she had no movement of her thumbs, or even said "my thumbs are un-opposable", I may have reacted differently. But, as each of the 5 patients behind her said to me as they came to the window - SHE HAD THUMBS!
So - if any of you readers have a disability that needs me or any other business you frequent to do something special to accommodate you, listen up.... Don't assume I know your disability by looking at you. Don't communicate your disability in a false way - if you can't walk, say "I can't walk" not "I have no legs". And finally, I can't discriminate against you if I don't know about your handicap - you can't sue me for something I had no knowledge of...
Oh, and from now on, I plan to punch out the tablets for my "thumbless" patient. Maybe I'll do it in front of her, and use my index finger just to piss her off...

Friday, January 16, 2009

Copays

I could probably write a story every single day about some patient bitching about their copays. It's too much, it's not the same as last time, it should be zero, whatever - I hear it every day. But, today, I heard a new one.
A gal comes in to pick up her Topamax. She's on a dosing regimen that requires combining two different strengths. Sixty tablets of 100mg, and 180 tablets of 50mg. Each prescription had a $25 copay. She insisted that the 50mg tablets should only be half the copay of the 100mg tablets... Get real lady, the 50mg tablets have a cash price of nearly $1000, and you're griping about a $25 copay?
When are people going to realize that pharmacists don't set the amounts of the copays and quit bitching at us???? It's getting old...

Friday, January 9, 2009

Makin' 'em love ya

I usually post about stupid shit in pharmacy, including mean people. I've noticed that many of my fellow pharmacy bloggers write about the mean people they experience, too. In a comment to a recent post on my friend JP's blog, one technician estimated 98 of 100 customers were nasty. Some days it certainly feels like that, but I've tried to change that by befriending my nastiest patients, and I thought I'd share some stories about how I did that.
The first patient I'll call GS - for gunnery sergeant. I don't know if that was really his rank in the Marines, but he seems like a "Gunny" to me. GS is a crusty ol' Vietnam Vet - loud, obnoxious, and foul-mouthed. He's diabetic, and when I first met him, he had horrible neuropathy and persistent lower extremity infections. I'm sure his pain is what made him such an ass. But, he reminded me a bit of my dad, so I decided he was OK, even though my techs would practically run and hide when he'd show up, knowing he would pound his fists on the counter. I have some background in pain management, so I helped him with his meds, called the doctors with suggestions, and made sure he was never out. I think what changed our relationship was a hospital stay he had for a post-op infection shortly after having his leg amputated. I was still working on call at the hospital, and saw orders for him cross my desk. I went up to his room to see how he was doing. GS recognized me, knew where he recognized me from, but didn't know my name. I told him, and also told him that I had clarified some of his drug doses that the admitting doctor had gotten wrong. Now, GS says the amputation was the best thing that has happened to him, because he's in less pain and has fewer infections - and, he's one of my favorite patients. Sure, he's still loud and obnoxious, but when I hear fists pounding on my drop off counter and a "Get to work, girls!", it brings a smile to my face, and takes me out from behind the counter to get the biggest bear hug you've ever seen. GS got upset when I didn't invite him to my wedding, but forgave me and even offered to marry me if I was left at the altar (I told him his wife may not appreciate that). Even though I declined on that offer, I still get a loud shout of "I love you!" when he rolls his wheelchair out of the pharmacy.
Next, I'll tell you about TW - for train wreck. "Train wreck" is a term used in many hospitals to describe a patient who has MANY medical problems. TW is a woman, younger than me, who takes 30+ maintenance prescriptions. Having so many problems at such a young age, a lot of pharmacists assumed she was just a hypochondriac. It couldn't be farther from the truth - she had a pacemaker by her early 30's. When I first met her, the experiences she had with other pharmacies had jaded her. She refused to be counseled ("I know more about my diseases and meds than YOU ever could"), demanded brand name only ("I'm allergic to all generics"), and would demand that one person always be the one to help her. Over the first couple of years, she transferred her prescriptions around, mainly in response to my demand that she be counseled on new things. After 4 or 5 experiences with other pharmacies treating her like a freak, refusing to jump through insurance hoops to get her brand name drugs, and even having her scripts bagged in a garbage bag (the regular bags are too small), she came back, realizing that we really did treat her with respect. It was then that she realized she could trust me. TW not only lets me counsel her, she calls for questions before her doctor's appointments, so she can be prepared to make suggestions to the doctor herself. She now takes generic meds, after following my suggestion to be tested for allergies to dyes. Turns out the generics she was allergic to all had one thing in common - blue dye. I call TW my bread and butter patient (and she knows this) - when she picks up her scripts every 3 months, my sales for the day are boosted by about $10k - it paid off to make her love me...
Then, there's CP - for "crankypants". That's what I call him - right to his face. When CP first came in my store with a stack of new prescriptions, he immediately launched into a tirade. Threatening to sue us if we treated him the way his previous pharmacy did. He was yelling at my tech, who shot a "help me" look my way, so I walked up to the window and said "I'll make you a deal. We will treat you with respect if you treat us with respect. You have never been here before, we haven't even started on your scripts, and you're already yelling. So - you be nice, and we'll be nice. Deal?" He agreed. It's still pretty obvious to most people that CP is just a cranky old man in general, but he grins ear to ear when I say "Morning, crankypants! How are you today?"
Lastly, I'll tell you about AA - for addiction and Alzheimer's. That's not a good combination to have. For the first few years in my pharmacy, I mainly dealt with AA's husband. He would come in, looking defeated, telling me how AA was taking his meds, would physically fight him if he wouldn't give her more of her own, and asking if I could help by not filling stuff she called in. One time, AA called me and screamed at me because I had told her doctor she was taking her husband's drugs because she had used up her month's worth in 5 days. Her doctor was putting her on a short leash. I probably spent 30 minutes talking to her, explaining that she was putting her life at risk, that I couldn't let her do that, and that it was my job to work with her doctor to be sure she was taking her meds right. I finally convinced her that I do care. Her husband passed away a little over a year ago, so I have tried to work closely with AA, her caregiver, and her doctors to keep her on an even keel. Just before Christmas, AA's caregiver came in, and in our chit chat, I found out that AA's roomie had been stealing her food. I told the caregiver to go pick out a small refrigerator, and I'd buy it for AA as a Christmas gift, so she could keep some food in her room. AA came in a few days later, full of tearful thank yous. It made me feel so good - not just for the gift, but also for standing up to her when she was at her worst, to provide good care - she's doing so well now!

So - all you pharmacists, interns, and techs - next time a really obnoxious person comes through your doors, make it your mission to make' 'em love you. Not only does it reduce the nastiness in your waiting area, it will make you feel like you've accomplished something - you've done the right thing. Not all jackasses can be befriended, of course, but you won't know who can if you don't try...

Wednesday, January 7, 2009

Rules, rules, and more rules...

There are a hell of a lot of rules and regulations in pharmacy. As there should be. Most of them are intended to protect the patient. But one rule has me all worked up lately...
As of October 1, 2008, CMS (the group that makes the rules for Medicare and Medicaid) requires that all prescriptions be on security paper. Three security features are required - and the list of options for which security features a prescriber can use is quite long. I have been audited by my company's internal audit team twice in the past month.
The thing that really pisses me off about this rule is that the weight of it falls squarely on my shoulders. If the doctor doesn't comply with this rule, nothing happens to him. Just yesterday, I had to call one office 4 times, and send 5 patients back to the office to get new prescriptions. I know this doctor knows the requirements - I've seen scripts come from him on security paper. But, for some inexcusable reason (they 'forgot' to order more paper), every person who came from that office to my pharmacy had plain old white paper. The first 2 calls I made, I was pleasant, then I got progressively nastier as the day went on. I finally said "If this continues, I will refuse to take any prescriptions from your office." But who gets hurt there? Me, and the patient. Now, my techs have to take extra time when taking in a script at the drop-off window to see which insurance the patient has before they can accept a new one - that adds about a minutes to each drop off, and when we're doing 500 scripts a day, that really adds up! I have three options when presented with these kind of prescriptions: 1) Call the doctor and get a verbal order - not allowed if it's a schedule II controlled substance - which wastes MY time; 2) Send the patient back to the office for a new script - in the case of the CII's - which wastes the PATIENT's time; or 3) Fill them as they are, which puts me at risk of getting fined if I'm audited. Did you notice that none of these options creates a hardship for the doctor???
When are these rule makers going to come up with something that impacts the doctor if the rule isn't followed?