But I’m Just a Tech!!

After almost a year of being patronized by mostly neighborhood people, we have finally been uncovered by the local junkie population. Up until a couple weeks ago, we went through a modest amount of Gravol, T1s and 10 packs of syringes. Amounts that would be regular people with the flu, a sore back from weekend landscaping and the occasional person getting some weekly vitamin or iron injections.

Yup, they’ve discovered us. They are starting to come in droves. The Gravol seemed to pick up first. Then the T1’s (store brand, of course!) I don’t understand what the thrill of downing 47 T1s and 30 Gravols (store brand again, cheap buggers!). We don’t have many regular customers as of yet, so we DO remember your face when you come back for the 10th time in a month and give us a different name each time you come for your 200 pack of “acetaphemimen with codeine”. Don’t think we don’t know when we send you away because you just got some 5 days ago and your buddy/neighbor/girlfriend who happens to live in the same town (that’s not this town) comes in 5 minutes later for the exact same thing, that you’re partying it up tonight. Spelling your last name with a different letter combination isn’t going to fool us for long. Thank goodness for laws recently passed that mandates that we have an entire patient profile including health care numbers for selling NPA medications. Welcome to liver damage!

As for the syringes… I think this week was only the second or third time that we had someone come in for “a 10 pack of 1cc diabetic syringes”

“have you been here before?” “nope”

“name, address, phone number, birthdate?” “John Smith, uhhhh 1234 uhhhh elm street, uhhhhhh555uhhhh5555, uhhhhhh 12 uhhh April uhhh 1976. Yeah, that’s it”

“What length would you like them, sir?” “uhhhh.. the long ones”

Not once, but TWICE today. The second ones disappeared into the public washroom right beside the pharmacy about 30 seconds after paying. Gross!

From now on… I am going to demand a prescription for insulin. Legally we don’t have to, but I don’t like it. The moral dilemma with syringes is… do we let the junkies have clean syringes so they don’t infect themselves and others with who knows what? Or do we let natural selection work and let them do whatever they want to themselves??

I am glad the pharmacists that I work with take a pretty tough stance on abuse/misuse of these kind of non prescription meds and have no problems turning obvious abusers away empty handed.

Drop an antibiotic on the floor… are all the bacteria on it going to die???

Had the weekend off.. no pharmacy shenanigans.

My boss made an observation that every time we have an RN come in to the pharmacy to pick something up, either for themselves or for a family member, they have to mention the fact that they are an RN. I guess that statement is exaggerating a bit, because if they didn’t mention it.. we wouldn’t know, right? It seems, though, that RNs have a habit of letting us at the pharmacy know that they are also in the medical field and hence don’t need any counselling on any of the meds we give them. They are also the first to call up with dumb questions about the medications that are given out to them, that they would have discovered had they accepted the couselling offered to them instead of saying “I’m a retired RN, I know all about this.”

They are also the ones to come back for early refills on their children’s asthma meds that “aren’t working right” because they are using improper techniques, or bringing in their glooked up blood glucose monitors and don’t know why they aren’t working. They’re RNs!! They don’t need a lowly tech like me (who has advanced meter training courses under my belt and a name tag and certificate that proudly declares this) to tell them how to use it!! Even this lowly tech knows that if your child had an aerochamber that was being used properly and an inhaled corticosteroid that was used on a regular basis, your child might not be going through 3 Ventolins a month (although I would always refer to our resident asthma expert). Even I know that all you need to do is change your battery and make sure the code on your strips match the code in your meter. But.. I am not an RN. I don’t know everything!

It even extends to children and spouses of RNs. They will announce proudly “my wife/mother is an RN, she knows what this is all about. They used to give these out at the hospital!” Don’t get me wrong here. I have a lot of respect for nurses of all types. RNs, LPNs, heck! even nurses’ aides get my respect. They do an incredible job dealing with patients and doctors all day. They bust their butts in a field where there is a huge shortage of qualified employees. They are the experts in their field(s) of medicine. But… they don’t know everything there is to know about medications. That is what the pharmacist is there for.

Ladies and gents in the nursing field. Lend us your ear…. for the 2 minutes it will take a pharmacist to counsel you properly on your medications. And you don’t need to tell us you are an RN. We will treat you equally no matter what your profession. I don’t go to my car dealership to get an oilchange and tell the mechanic “my significant other sells cars, so I don’t need you to tell me what you’re doing… he knows”

I’m done now.

After a gorgeous, hot summer, the recent turn of the weather to drab, gray and rainy must have made people cranky. Summer brings the typical things like people asking endlessly where to find the sunscreen (turn around and check out the HUGE DISPLAY of sun care products, Skippy); bug spray (that one is a little harder to find, but still right out in the open); or the “best thing for a sunburn” (right beside the sunscreen you should have asked about a few hours ago).

This rain has turned our thoughts to fall. We have to dig our jackets out of the closet. There are large selections of school supplies everywhere (I need an EASY button, dammit). People get cranky.

For example, the gentleman (I use that term lightly) who came in on Thursday wanting “the other half of my medication that YOU PEOPLE wouldn’t give me the last time I was here”. So I check the will-call thinking that we owed him something, and nope, nothing there. I check his file and, of course, the refill was there. I try to fill it and get a rejection from his insurance that it’s too early to fill. I explain to him that his insurance won’t let me bill it, at which point he gets incredibly irate, yelling that we are incompetent and the last time he was here (2 months ago) we wouldn’t give it to him either. He is going away, you see, in a week, and needs his medicine. By our estimation, he should still have at least 40 tablets at home, so.. trying to be pleasant I tell him that it has nothing to do with ME, but the automated computer system at his insurance company that won’t let us do it. Unless you want to pay and submit…

Nope, that isn’t what he wanted to hear. He starts cursing again about how we don’t know what he wants and that he will never fill a prescription at our company again… blah blah blah. I offer to call the plan saying that if he were to give us his vacation dates, we could perhaps get an early release authorized, to which he vehemently declines. Finally, the pharmacy manager comes over after overhearing the whole scenario and offers the same thing to which he also declines in the rudest manner possible. He then declares that we don’t know what we are doing and that 2 months ago when he came with a fresh RX for 6 months worth, we wouldn’t give it to him. No, we can only bill 3 months at a time… according to your insurance.

Anyways.. he came back Friday (my day off) to pick up the pills… I don’t know how the manager got them to go through.. she probably called anyways, or it was 70% through the last fill, but Mr. Grumpy got his meds. Hopefully he DOES take his business elsewhere and someone else can tell him the same thing next time.

Today we had a MISS Grumpy. She called and asked me if, by chance did she have an RX on file for something for her bladder infection. Her doctor ALWAYS gives her a back up because they are recurring. I check the file… no refill on the RX for Cipro we filled for her in May. I offered to pull the original to see if we overlooked the refill. No refill. (we are perfect, afterall…LOL). I put her on hold to speak to the pharmacist, perhaps she can offer another solution. The pharmacist listens.. confirms that no, there was no refill, no she isn’t able to provide an emergency refill on an antiinfective, and maybe Miss Grumpy should stop into a local drop-in clinic.

“But I don’t want to wait 6 hours in a clinic, ” she says. HANGS UP. The pharmacist, thinking she was inadvertently disconnected, tries to call back. No answer. In the meantime, Miss Grumpy has called the store general office and spoken to the Assistant Manager in a very abusive and foul way, who basically tells her that while the pharmacy is part of the company, the pharmacy has it’s own rules , regulations and legislation that it has to follow, which he has no power to override. I love that guy… did I mention that, yet?

We discussed this afterwards… the pharmacist was dead set against giving someone an antibiotic when there are plenty of doctors available on a Saturday afternoon. She is not comfortable with that being outside the scope of her practice. What if it WASN’T a bladder infection? What if the medication made her really sick or masked the symptoms of something more serious (or gave the lady the thought that she didn’t have to go get checked out in case it was something else). Symptoms for bladder infections don’t come on from one minute to the next… if it was that serious.. why didn’t she call yesterday when it was possible for us to contact her physician?

(edit added Aug20/07) Miss Grumpy came back the same night after I had left and had a 2 month old prescription in her hand for the same med (lower dose, longer duration). I guess that was the back up she was talking about her doctor having given her. No apology to either the pharmacist whom she hung up on, nor the Assistant store manager. Today with a new rx for more antibiotics and she was as pleasant as punch. No cursing, rudeness or anything of the like. I guess she realized she screwed up, and hoped we would forgive her faux pas. Forgive maybe, she was probably in pain and irrational, but forget? Not likely. (end edit)

I hope we get a nice Indian summer so people will be happy and joyful again.

Today I answered a phone call from a very nice sounding person, who explained to me that she had a dilemma. She was out of her medication, an antidepressant, and her doctor was out of town until the end of the month. She couldn’t get in to see any other doctors in the same office because they had no openings, so could we please extend her prescription until the end of the month until her regular doctor was back in town.

I consulted with the pharmacist working, who agreed that we could do this for the person. We filled the prescription. and faxed the doctor’s office with the details as we are required to do. The medication was picked up with no further issues.

That is….. until the doctor’s office called us to inform us that this very nice lady had seen the locum doctor the previous day and was issued a prescription the previous day for the very medication she was out of this morning. And her regular doctor will be back Monday, and NOT at the end of the month. We were basically speechless.

I could understand someone trying to scam us if it were a narcotic (which we wouldn’t do in any case) or something with abuse potential… or even maybe if they were trying to off themselves with prescription medications, but this wasn’t the case. Perhaps she was going away and needed extra amounts to get her through until she came back.. but, then why wouldn’t she have let us bill the rx for 100 to her insurance or asked the locum doctor for a bigger supply? Maybe she lost the rx and was too embarrassed to tell us.

Who knows what the real circumstance was, but it was incredibly bizarre. It also gave us a little wake up call. Don’t trust very nice people. Always double check their stories. Even when they seem really nice…. especially when they seem really nice.

Added later:–it turns out she just lost the rx… was too ashamed to tell us that after having gone through all the trouble of going to a different doc. If she had just been honest with us, we would have faxed or called and had them verify that she had been there and fax us a new one.

As Bill Engvall once said, “stupid people should have to wear signs” just so we know they’re stupid before they open their mouths. I think this would be a wonderful thing to implement in our business. It would definitely save us a LOT of time. Now don’t get me wrong… it’s not always the customers who do stupid things… sometimes it’s people working with us.

Take , for example the tech student we got from a local tech training program. He had recently finished all his courses and exams and was doing a practicum to finish off his training. You would suspect that having recently finished his schooling, he would have some sort of clue about the basic workings of a pharmacy. Now, I am not saying I knew how to do every single thing in the pharmacy within the first few days, but I picked it up pretty quickly. This guy also claimed he had a one point in his previous career been a commercial pilot, so there have to be some brains in that head somewhere, right? WRONG!

Simply understanding that working in a pharmacy, we have to project a trustworthy, professional image was beyond him. His mode of dress was ridiculous, and his personal hygiene left a lot to be desired. Being able to figure out simple things, like putting an order away with supervision… impossible and very time consuming(3 hours for 2 boxes???).

As we didn’t want to let this person anywhere near our computers just yet, we had him doing menial tasks and tried to introduce a few more prescription related duties one by one. First assignment–decipher this RX.

I handed him a very clearly written prescription that said “Biaxin 500mg bid X 7d” and asked him “which medication would you choose, and why?” He turned to the shelf, selected a Biaxin XL 500mg and handed it to me and said “this one”

I said to him “Read the rx.. what does it say?” “It says Biaxin 500 mg bid (twice daily) for 7 days.”

“So,” I say, “What are the directions on the Biaxin XL bottle?” “Hmmmmmmm” long pause, “it says’2 tablets once daily for 7-14 days’ ” he replies.

“And what does this one say?” I ask, handing him the Biaxin BID bottle.

“Take 1 tablet twice daily for 7-14 days.” is the answer.

“So which would you pick?” I lead. “This one!” he smiles, handing me the Biaxin XL bottle.

Here’s your sign.

Needless to say.. he was told not to come back.

If you want the reference for the title

http://www.youtube.com/watch?v=upXayzBPuzM