Trying not to hate on the Stupid patients...

But some days it is really, really hard not to.  It's almost as if there is an invisible "Stupid" energy force in the universe, and it's like it has its own gravitational pull that starts in the pharmacy and pulls them in...like a pharmacy black hole, sucking in all the Stupid it can find.  Once it starts in a day, it keeps rolling downhill, picking up speed, rolling up everything Stupid in its path like a Stupid Snowball from Hell.

Don't get me wrong, I have lots of patients that I just love, and I have been able to train most of my patients to call their refills in early, bring their bottles with them "just in case," etc.  I've even had a few of them stop by this morning. 

But, unfortunately, Stupid has reared its ugly head - a patient and an insurance rejection, I'm a tech down, I have a mild stomach bug, which is trying to trigger a migraine, I'm afraid it's going to be a struggle against Stupid all day, and my patience is non-existent already.  I'm only an hour and a half into my day.  I just hope I can hang on to what's left of the patience with what's left of my fingernails, not alienate anyone today, and not verbally pop off and actually call someone an idiot to their face.

Have you noticed that Stupid also goes hand-in-hand with supreme neediness?  The energy-sucking, needy, time-wasting idiots that must speak to the pharmacist and then proceed to ask what isle something is on?  That just openly revel in your attention, and ask all kinds of Stupid questions (and yes, there is such a thing, sorry to inform you!) just to keep you out front fawning over them?  Almost like a very sick, Stupid pharmacist stalker?  When I first got out of school, I thought it was kinda nice, until you learn that you are actually enabling a sick addiction.

Don't get me wrong, again.  I love to answer questions and share my knowledge with patients.  Patients who want to learn and do something better with their lives.  Not people who pull up to the pharmacy and sit in their cars until they think of something clever to ask the pharmacist, just so they can feel important.  I know it sounds mean and elitist and snotty, but I'm not here to make someone feel important.

I also understand the impact we as pharmacists can have on people's lives, so I don't mean to downplay patient interaction.  I also don't mean to downplay the compassionate side of things - I know that many of these people who are chronically ill and older may only interact with people of the health-care profession.  Many, many times we are their only social contact with the world.  So I do see that side, and have great empathy and compassion for people in that situation - I've been in that situation myself and it's a horrible place to be.

So, that would be the reason I don't call people idiots to their face and physically toss them out of the store, and spend the time out front with them, with a smile on my face and invite them back or to call with any additional questions, knowing I'll be on the phone within five minutes of their getting home, answering yet another Stupid question they thought of on the way.

But by the same token, especially when it is really Stupid, Stupid takes my valuable time away from my patients who really have a legitimate medical question and need.  Stupid also takes my time away from doing Stupid paperwork and Stupid governmental regulation-type tasks.

Most days I handle Stupid quite well.  But it's days like today when events conspire, Jupiter aligns with Mars, and the swirling pharmacy black-hole pulls Stupid into my orbit that I just hate having to be at work.

Wish me luck!  Share your Stupid stories below, so we know we're not alone, and so we can have a laugh!  I know I certainly need it!

     --T.Ph.RPh.

Thinking about what makes chains successful....

And I'm not thinking about their cut-throat, back-stabbing, loss-prevention-paranoid Zoot Suits, and other nefarious characteristics we all hate.  Nor is it their misguided sense that "convenience" and a drive-through equates awesome customer service in and of itself.  Nor is it their ability to buy en-masse, and shaft everyone else with a $4 list, and play loss-leader games.  Quite frankly, only the last item on that list helps them.  The patients hate the others as much as their employees do.

As much as I hate to admit to it, there are benefits to working for a chain store that have to do with more than mind-boggling sign-on bonuses and high salaries, or a (false) sense of job security.  That helps, but I started thinking about why, even though I had the choice to work at independents, and if I looked hard enough, could even find one that provided benefits, why did I always seem to end up back at a chain?  Especially after vowing each time I left one, no matter how decent of a store and upper management I had (and I had a couple that were awesome stores/regions), that I WAS NEVER GOING BACK TO THE BALL-AND-CHAIN WORLD.

Seriously - after the Humana contract addendum I read yesterday, I really started thinking.  What aspect of the big box makes them so successful?  Why are they able to keep stores open?  How do they pack people in that absolutely hate to do business there?  But most of all, how do they convince even the smartest of us pharmacists, who know better, to come to work for them?

I think it boils down to this.  You aren't the only one in the boat.  You aren't the only one with an oar.  If you sink, you're not going alone.  Plus, with their resources at your back, unless you just really fuck up or, gasp, rock that boat (DrugMonkey!!!  You bad, bad Monkey!!), you're gonna be ok.  And that is a comforting place to be, no matter how much crap from all sides you have to put up with.

We're herd animals, folks, and there is safety in numbers.  There is strength in numbers.  There is camaflouge in numbers - somewhere to hide, someone else to blame.  Yeah, that weak little zebra on the Savannah may have been taken down by the big bad predatory lion king, but we avert our gaze, don't make eye contact, and convince ourselves they weren't keeping up anyway, or were threatening the safety of the herd by their actions, and now that blood is spilled, we're at least all safe for a while longer.

It's much more difficult when you're stuck out there on your own, especially if you aren't in a town near anything or anyone - colleague-wise - or if you are in town that (sadly) has hostilities between the independents.  You can come to feel completely over-whelmed, alone, and abandonded by your colleagues, especially if, like myself, you never really were a social person outside of your store.

But we are all in this together, and it is only together that we will be able to turn our profession around.  As isolated as I am, and as little time as I have for myself, I have been struggling with what I can do to help, and blogging is about all I've been able to come up with.  But we can't just bitch about things, although it is cathartic, and helpful in that it can identify problems that we all share, and keeps us from feeling isolated.  But in order to fix this, we must, must, provide solid, do-able solutions, for the short and the long term.  And we ALL must take part in implementing them.

Speaking not feeling so isolated, how about some pity comments?  DrugMonkey, thanks for posting my link to the Humana addendum (thanks, I think).  My views went from 165 in about three weeks, to currently 1065 (HOLY TRAFFIC, BATMAN!) with his link post, but NOT A SINGLE PERSON COMMENTED.  Be careful what you wish for, right?  But a little feedback would be nice.  I cannot believe that not a single person out of that thousand had a thought to share about what Humana is about to do.  No "thank you for the heads up" or "wow, you stupid idiot...can't you interpret contracts?  That's not what that means."  Nada.  Nothing. 

No anger at Humana for dictating to us how we should run our stores - we all have different circumstances, and they have no right telling a store filling 500 an hour that they should be able to have a prescription ready in 20 minutes.  Sure, most of us do have them ready in 20 minutes (if management doesn't "encourage" you to sit on them while people shop), and most of us would never think about allowing a patient to go even 12 hours without a badly needed medication because we couldn't order it in "a timely manner."  Am I the only one who is outraged by this?  If so, someone please nicely tell me why I am wrong to be outraged by this.  I really would like to know.

But, before I digress....(if you've been following me, all two of you, hopefully that'll give you a chuckle.  For those who haven't, that seems to be my current fav phrase.)

Back to my point.

We have got to start having each other's backs.  We have got to start standing up for one another.  SHAME ON ALL OF DRUGMONKEY'S FELLOW EMPLOYEES WHO DIDN'T SPEAK UP WHILE THE BULLSHIT WAS GOING DOWN.  SHAME, SHAME, SHAME ON YOU!!!  YOU SHOULD HAVE BEEN ON THE PHONE, CALLING IN THE OFF-DUTY EMPLOYEES, THE RADIO STATIONS, THE TV STATIONS, FOX NEWS, THE LOCAL NEWS' I-TEAM...ANYONE AND EVERYONE WHO WOULD HAVE LISTENED!!!!!  You should have stood shoulder-to-shoulder with him, and just stared the Zoot Suits in the face.  You should have picketted outside the store on your breaks and off hours.  We all should be inundating Rite Aid's email and snail mail and Facebook and Websites with our outrage for this.

We have got to stand together and help one another.  Pharmacy has disgracefully slid from being the most trusted profession - a place that we proudly held for at least a decade.  I was proud of us during that time, but I knew if the direction pharmacy was heading wasn't stopped, that would soon go the way of the dodo, and sure enough, it did.

Folks, participate and be active with your buying groups.  If you are not successful, they are not successful, so they are there for you, and they want you to succeed.  Probably the last few people on the planet that wants you to succeed.  Help them help you.  My buying group is tiny but wonderful and provides wonderful support, but due to my location, I am the only one in my state in the buying group, and the group is out of Oklahoma, and they have had a huge fight on their hands, and may not be able to keep up with it all.  Fact is, none of us can keep up with wading through mountains of paper contracts, while also being a pharmacist, alone.  We must band together and help each other.  Nominate each pharmacist in the buying group to read a different contract and then share information.  This will work for all kinds of different tasks we do each day.

If you're getting a great price from a wholesaler, communicate with your buying group.  Found a great secondary wholesaler?  Share with your buying group.  Find a great source for laser cartridges or other supplies?  Share with your buying group.  Find a great source for labels or bottles?  Share with your buying group.  In all likelyhood, they can negotiate an even better price for the entire group!

Reach out.  It's painful for the incredibly antisocial Phrustrated Pharmacist, and if you read my post So, How Are You Feeling Today?, you'll see I've become more and more antisocial the longer I've been at this job.  I hate being on the phone.  But I'm doing it.  And if I can do it, so can you.

Gotta go - I could go on forever about this!  But I won't...

     --T.Ph.RPh.

Hate days like this -

Found out I lost one of my favorite sweet old men last night.  He passed away - he had only been out at the nursing home for about a week - not even long enough for me to get out there and check his chart, and pop in his room. 

Then saw my wonderful elderly neighbor in the store today, who has recently been diagnosed with Alzheimer's, and was shocked at how fast she has gone downhill. 

I don't need to lose any of my favorite patients - they tend to be replaced by Mr. Joe Public, and we all know how he behaves.

  --T.(sad)Ph.RPh.

We Are NOT A Bank....

SERIOUSLY.  I am SERIOUSLY sick of people asking if they can make payments.  Don't get me wrong.  I understand how expensive medication is.  But we aren't allowed to make payments when we purchase from our wholesalers, and if everyone made payments (like that would happen consistently - otherwise you wouldn't have to ask if you could make payments...but I digress), what would I use to purchase the drugs you need?  Why on earth would you think you can make payments?  Does the grocery store let you make payments on that steak you want to grill this weekend?  Would you even dare to walk into WalMart or Walgreens and ask that question?

So, the fourth person today just walked in and asked if I could hold a ticket.  The first two actually did walk in and ask if they could "make payments."  The last two asked if I could hold a ticket.  While I have put a stop to new charge accounts (see the title of the post), these last two were DENIED a charge account because they bounced checks.  And still they have the fucking nerve to ask.

Do any perishable-goods merchants allow you to make payments?  NO.

If you have to make payments, get a credit card.  Get a bank loan.

I am not a used car salesman.  I am not a bank.  Pharmacy may be a multi-million dollar business, but the pharmacy no longer "rakes it in" like most people think they do.  Pharmacies barely survive.  Yes, mind-boggling amounts of money flow through here, but unfortunately, the buck doesn't stop in my pocket.

So no, YOU CANNOT FUCKING MAKE PAYMENTS.

So, How Are You Feeling Today?

I didn’t used to be this way.  I didn’t dread coming to work.  I didn’t go home at night hating the world.  Once I got home, I didn’t used to cringe when the phone rang.  I didn’t feel like hiding inside the house and never leaving again.  I wasn’t a negative person.  I didn’t hate it when the doorbell rang, or when I had to come home, get ready, and go back out again for something social, and smile at the same people who made my life hell earlier that day.

I do now.

I didn’t cringe when the phone rang (and rang, and rang, and rang again) at work.  I didn’t cringe when I was told it was for me (every 5 minutes).  I didn’t cringe (and wonder if it is too late to duck behind the counter) when Mr. or Mrs. Needy came through the doors, knowing I was in for at least 10 minutes of my time wasted.

I do now.

I used to love being here for my people.  I loved coming to work.  I was a positive person, to the point of being a bit naive.  I smiled and laughed.  I loved the little old ladies and gentlemen who came in, trusted me, and respected me.  I loved teaching people about their medications and talking to them about their diets and nutrition.  I loved feeling like I was making a difference, albeit a small one, in the world.  When I did arrive at home, I used to have some energy left for the people and things I love.  I didn’t used to be an antisocial, ranting, soap-box standing Phrustrated Pharmacist. 

I am now. 

And it makes me very sad, not just for me and my family, but for my colleagues, the profession of pharmacy, and the healthcare profession in general.  It is a sign of the times, and a sign of just how bad it is getting in the world of pharmacy.  Over time, things have subtly changed.  Patient attitudes towards the pharmacy and pharmacist have slowly shifted, and practice of pharmacy has changed.  It’s no longer a practice of anything but futility.  Somewhere  “patients” shifted to “customers”, and “pharmacists” shifted to “glorified sales clerks”.  I find more meaning and fulfillment doing something in my spare time that would only have required an 8^th grade education, and it even involves a job that would deal with the public, and wouldn’t involve standing for 8 to 12 hours straight, with no bathroom or lunch break, or worries about liability and whether or not I missed something serious enough to kill someone during the chaos of the typical pharmacy day.  How’s that for irony?

I am pervasively sad and exhausted to my core today.  Actually have been for some time.  How are you feeling?

--T.Ph.RPh.