Saturday, November 28, 2009

Dude Sounds Like A Lady

Now I understand we are one day removed from the only time period during the year when seemingly everyone in the country shits out their brain. I am referring to the masses who get up at 3am to buy a toaster for $5... the oh-so-wonderful Black Friday.

I realize it takes people a few days to recover from this spectacular day. Go ahead, take the weekend to dig your brain out of the toilet, I'm ok with that.

But if you are male, do not call the pharmacy claiming to be Jill Johnson and ask if your hydrocodones are ready.

You see here's the thing, and I know because your brain is still floating in some port-o-potty out there, but men and women generally don't sound alike on the phone. And when you have a Barry White-esq voice, as you did, I find it very hard to believe that you are in fact a female named Jill.

This is especially problematic when I know who this woman is and, unless her testicles distended this week, I am pretty sure she still sounds like a sweet young women... even though I know she's a raging meth head.

So next time, pinch your scrotum a bit and raise your voice... maybe I'll find it a tinsy bit more believable.

Friday, November 27, 2009

Something That Bothers Me

One of the things, among many, that really bothers me about pharmacy is how students become interns. In all the states I have worked in (there are several) the interns are virtually allowed to do everything a pharmacist does under a licensed RPh's discretion.

I have no problem with this at all, it can be rather helpful.

What I do have a problem with is how some states decide who should be classified as an intern. One state's laws stated that a pharmacy student cannot be called an intern, or perform intern duties, until starting their second year of pharmacy school.

This seems perfectly reasonable to me. For the majority of pharmacy schools across the nation, the first year of pharmacy school is essentially review and groundwork knowledge before delving into the fun stuff. After one year of school, you really don't know a whole lot more than you do during your undergrad.

Disclaimer: I know I am not in pharmacy school, but this is what I have gathered from talking to people over the years.

Now what scares me is that some states allow an individual to claim intern status as soon as they are accepted to a program.

Think about it, individuals who haven't even started a program are now considered an intern. Consider the fact that a big chunk of incoming pharmacy students have virtually no pharmacy experience, and you may begin to see where this fear is arising from.

I have watched too many 'interns' struggle to take down new prescriptions or 'check' refills. One in particular would get Lipitor and Lisinopril or Hydroxyzine and Hydralazine mixed around all the time. The latter is at least close in spelling, but anyone with experience can tell one from another just from looking at the directions.

What further scares me is the 'white coat ceremony'. So you've been in school a month, learned how to spell the word pharmacy, and now you deserve a white coat to reward you for your hard work.


Again, you don't know shit at this point. Why should you be christened with, what I consider, the honor of being rewarded with a white coat. You're not pharmacists, you haven't even started learning anything about pharmacy, so why should you be able to wear the professional badge of a white coat?

If anything, they should wait until the P2 year or, even better, until you graduate. I am not saying that you cannot wear a coat at work or for labs or whatnot. What I'm saying is don't have a ceremony glorifying an accomplishment you have not yet earned.

Tie those two together and you have the creation of the ultimate clusterfuck.

And I simply do not understand it. You think someone would be at least a little cognoscente of this fact and perhaps find a remedy.

Then again I may be the only one who has a problem with this...

Thursday, November 26, 2009

Happy Turkey Day

Perhaps the greatest joy of Thanksgiving is that for many of us the pharmacy is closed today.

That means no druggies yelling at you for the hydrocodone refill even though you stand a fat chance in hell of getting an authorization today. No fifty phone calls asking if you're open. No lame turkey sandwiches.

Enjoy the day.... because its back to pharmacy hell tomorrow!

I'm such a damned optimist I make myself giggle.

Wednesday, November 25, 2009

I Have Pharmacy Superpowers

Anyone any pharmacy is aware of the thrill of a perfect pour. For the uninitiated, this happens when you pour the precise amount of mediation on the tray that you need to fill a particular prescription. I realize this sounds completely trivial, but honestly its the small things like this which make otherwise hectic days terrible.

In some stores if you have a perfect pour, and it is verifiable, you've earned yourself a ten minute break out of the pharmacy or perhaps the pharmacist on duty will by you a soda or something.

I have one upped the perfect pour.

This actually occurred a couple weeks back and I had forgotten about it until flipping through the photos on my phone last night. I will leave you to guess what medication it was, but you first must marvel in the handiwork.

Have you witnessed anything so beautiful? The contents were evenly stacked like this all the way around. I have never had something stack to efficiently on its own before. It's almost as if I was touched by the hands of the pharmacy gods that day.

And now you know my powers... and I hope you all are insanely jealous.

Saturday, November 21, 2009

This is a classy pharmacy...

I write this on a short break I am taking at work today. As I have stated many times, I work for a classy pharmacy.

A few minutes ago we were presented at our window a Rx for compression stockings for an elderly woman with severe edema. The pharmacist handed them the tape measure and told them to measure her in the car and give us the numbers.

Anyone who has regularly worked with these is screaming at their monitor right now.

Earlier the same pharmacist filled someone's Fentanyl prescription even though we won't receive the actual hard copy until Monday at the earliest (and no, that is not legal in this state under any circumstances).

And to think, we have kids from high school job shadowing here all the time.

Sigh, if only people would listen to me here...

Tuesday, November 17, 2009

At Least Put Some Effort Into It

This semester, for reasons I still do not fully understand, I decided to TA for my ex-Finance professor. Actually it was mainly because he is a really good guy who is one of the few professors I have never seemed stumped by a question. Seems rather out of place in our otherwise anemic business department.

Now realize I'm a science guy at heart. I have learned over the last three years that I look at and tackle problems in a completely different manner than my classmates. Usually we end up at the same point, so it doesn't matter.

But the shit I'm seeing grading these assignments is unreal.

First Finance is not an overly difficult course. If you could handle stats or pre-calc, you can do a Finance course. Actually I recommend you take one as an undergrad as it is easily one of the most useful courses I have ever taken.

One of the things this prof does is post the answers for the assignment, but provide that you must show your work to get full credit. It kind of makes sense because a lot of these people are terrible with numbers. When I took the class, many of the students were thankful as it helped them learn various concepts for the test. Since a lot of it is done in excel, you can see where the work is done.

Thus, my grading is usually pretty generous in this respect.

Except since I've been doing this I have had several assignments that are mere copies of the answer sheets. I'm talking word for word, letter for letter, formatting for formatting IDENTICAL.

First, if you're going to copy something, don't be that fucking lazy. I mean honestly, change the font to Arial or some shit like that. You'd at least get one point for effort.

Second, this is a junior level course and you're resorting to copying? What. The. Fuck?

I would say I have had a dozen homework assignments, from various students, turned in in this manner. Another two dozen more were probably copied, but changed just enough to where you can't really tell.

If I were to pull that shit in my Biochem class or Genetics, I would instantly be thrown out of the course. That is something that as an upper level class-man you simply do not do.

So far the professor has been light on these students. I've decided tonight that I will not stand for that. Three out of the last four assignments I have graded have been blatant copies.

If these are the people who are our future business leaders of America, just what fucking message are we sending them? It's ok to skirt on by, doing as little of work as possible?

Screw that shit, I won't stand for it. Tomorrow oughta be fun...

Saturday, November 14, 2009

What More Do I Have To Do?

Today I found out I was waitlisted from the other school I had an interview with this past month. That makes one deferral and one waitlist for those counting at home.

I know what some of you are thinking. I'm not out of it yet and it's better than being reject, which I wholeheartedly concede.

My question is what more do I have to do though? I know my grades from my first two years sucked. I have been spending every waking moment since then trying to make up for it. And ya know what, I am utterly exhausted. I cringed at the fact that I will now, for certain, have to come back in the spring after I graduated to take a class for another school's pre-req. I was immensely looking forward to a nine month break from studying, but alas that is not the case.

They asked me to bring my grades up to show an upward trend. I'd think a GPA of 3.5 over the last 60 credits would do that.

They asked me to have volunteer work on my application. I'd think volunteering at a hospital pharmacy a couple hours per week for six months would have done that.

They asked me to ace the PCAT. I think a 94 is a pretty damn good score if you ask me.

They asked me to do research. I think a year's worth of research that not only will be published, but has shed a new angle on the field it was in, would be enough.

They were worried I may not be able to handle the stress and amount of work involved in pharmacy school? How about the fact that since September 2007 I have either been in class nearly all year and/or studying for the PCAT? Oh and I got married during that period as well.

On top of all of this I have had at least 16 credits per semester, worked 35 hours a week, tutored a person or two on chemistry, and done every other damn thing they wanted. My experience is probably unlike 99% of the other applicants out there. Seriously, what person redesigns a pharmacy when they're 22 years old? I know where the profession has been, where it is, and where it is going.

And yet here I am, awaiting a decision for another five months. Yes I have started growing bitter about the whole situation. The last several years I have sat idly by as my friends went out for the night or on trips while I had to stay behind to focus either on school or paying for school.

Would you think I've sacrificed enough during that period? My wife is probably the only thing that's kept me sane the past few years.

I know this is not the end of the road, but these two schools were my most likely to get into schools. To say this is a kick in the nuts may be the understatement of the year.

I get kicked down, I get back up and go even harder. Kicked down again, bounce back even higher. Its gotten to the point where there's not much to bounce back too.

So I ask, just what the hell more do I have to do?

Friday, November 13, 2009

Rx America has Enlightened Me

It was the last script of a the day. Instead of the typical stressful hectic day, this one had been exceedingly slow. I swear, running 30 scripts during a day is just as bad, if not worse, than running 400.

In any case I was filling one last script before scampering home for the night. I made a dyslexic mistake and build for the wrong days supply. It was for Ibuprofen 800mg so I was not overly concerned when I saw the reject pop up. I moseyed on over to my rejection screen and saw this:

Drug Overdose... Max Daily Dose = 4.5123144
Really? I mean we dispense 0.5123144 tablets ALL THE FUCKING TIME. It reminds me of when a PA sends us a script for Amoxicillin 713.6mg. I understand they need to be somewhat specific, but this is just ridiculous.

And no, it was not an Rx number or some other piece of information posted near the dose. I had three other people look at it, to make sure I wasn't losing my freakin' mind, and they all came to the same conclusion.

So on this lovely Friday evening, I feel I must thank you Rx America for enlightening me on the proper dosage for Ibuprofen 800mg. I know I will truly never make this mistake again.

Tuesday, November 10, 2009

They're Watching Me...

A bit of insomnia recently had me diggin' through the visitor stats of this lovely little site. I stumbled upon something that made me giggle like a school girl.

One of the regular readers of this blog works in the admissions office of a school I applied to.

Seriously what are the odds of that? And before this person gets any ideas, there are about 600 or so what I would refer to as 'regular readers' and many of them are from various institutions. Hell a more recent visitor comes from the office of the Dean of one of the more prestigious schools in the nation.

So to all of you reading from the various pharmacy schools across the nation... would you please let me in? Pretty pretty please? With sugar on top?

Monday, November 9, 2009

A Setback

Today I received via snail mail my admissions status from my second interview. I thought it was the better of two interviews, especially with some comments I recieved from the interviewers, so I had thought the entire experience went quite well.

I was wrong though. I have been told that I will have a second review once all other applications have been reviewed in April. No acceptance, no waitlist at this time. From what I have read this effectively corresponds to a Dear John letter.

Really, this shouldn't come as a surprise. One cannot expect to be accepted in all the schools that have been applied to.

I suppose the bigger thing is that I thought this had gone really well. Makes you doubt your first interview ya know?

Only thing to do is keep pluggin' away like I have been for the last couple years and keepin' the fingers crossed. I do think, however, it is time for a beer.

Sunday, November 8, 2009

A New Method to Getting What You Want

I shit you not, there is no exaggeration in this story what-so-ever. This was an actual conversation that I was blessed with this past Friday.

Lawyer: Hi my name is Jack Meoff and I'm calling from the law firm of Larry, Moe and Curly about a client of ours

Me: Ok what can I do for you

Lawyer: Well our client is stating that you are illegally preventing him from obtaining the medication that was prescribed for him. As such we are looking into the legal ramifications of your actions

Me: Ok... What's the patient's name?

He gives me the name and I look up his profile and see the problem

Me: I'm assuming he is talking about the Claritin-D correct?

Lawyer: That is correct

Me: Well let me fill you in on the story a bit more than you are probably aware of. The patient came into our store at 10am this past Wednesday drunk. Yes, he was drunk at 10am on a Wednesday. (Mad props for this) He brought in this prescription and demanded we fill it under his insurance

Lawyer: Ok...

Me: First off, Claritin-D is an over the counter item. His Medicare Part D coverage does not cover OTC items. He has secondary coverage through the state which covers most OTC items. The problem with this prescription is that he was insisting on getting the name brand Claritin-D rather than the generic

Lawyer: So why didn't you give it to him?

Me: We would dispense to him, but he would have to pay the cash price.

Lawyer: I see... so if we got a court order, could you bill it under his insurance?

*** This is the point where I bash my head on the counter seventeen to eighteen times ***

Me: Well if you wanted to stand up to one of the largest insurers in the country, I won't stop you. I can tell you that it most likely won't get you anywhere.

Lawyer: I see... well I'll talk to my client and get back to you.

*** Click ***

My. Fucking. God.

One can infer that the patient called his lawyer right after leaving our pharmacy... you know, when he was drunk at mid-morning. And yet the lawyer decided to stiff hand us into complying.

I have seen and heard a lot of strange things over the years, but this one is definitely in the top ten now.

Saturday, November 7, 2009

Pooping Is Deadly

"But she's gonna die with out themmmmmmmmmmmmm!"

"Ma'am, I'm sorry, but there is nothing I can do. I can get something close to it, but our hands are tied until Monday."

"It has to be the kind she always gets otherwise she could die!"

"Ma'am, your daughter will not die if I have to give her a different brand of diapers for the weekend"

Yes, that was an actual exchange I had this morning with a customer. This particular customer, who's daughter has cerebral palsy, always comes in on Saturday mornings to order her daughters diapers. No matter how many times I tell her to give us a one day lead time (it's really improbable to keep four and a half cases of diapers on hand at all times) she always comes on the weekend when we have no way of getting anything until Monday.

Today, however, she moved into the realm of a toddler's tantrum. Very easily we could have simply given them a pack of a similar product that would work for at least two days free of charge. Honestly, it's not the young girl's fault her mother can't plan ahead and she should not suffer for it.

Alas, it appears we were trying to kill her daughter this morning. That's what pharmacy is all about, killing patients. And we all know how incredibly deadly pooping your pants can be.

If I'm ever the head of Pampers and, less face it, stranger things have happened in my life, perhaps I shall devise a marketing plan around this idea.

"Pampers... or your baby will die!" - And then cut to a shot of Christopher Walken cackling.

At least I know I have a future in another field if need be.

Tuesday, November 3, 2009

The Future of Pharmacy

One of the things I have noticed while surfing through the various pharmacy and pre-pharmacy forums is a frustration with the of changing pre-reqs over the last couple years. The majority seem to think that it is unfair to change requirements and that changes lack an overall point.

Thus I decided to dedicate this blog post to explain precisely why this changing to those who may be unfamiliar with the state of the field. This was spured by a lengthy tangent one of my interviewers and I delved into last week about where the field is heading and the changes that are coming. We both agreed that the current pharmacy school curriculum has to change in the coming years, but no one is quite sure where to start.

Before we dive into that, consider this fact. The classes they teach in medical school have remained relatively unchanged for many years. Sure new topics have been added and new methods of teaching used, but, for example, there hasn't been a new system discovered in the body during this period.

Why is this?

Because medical schools have all the essential information they need to train a doctor today, tomorrow and twenty years from now. Yes there will be some slight variations over the years, but I can guarantee that there will not be a massive change in med school curriculum during that time frame.

Now let's look at pharmacy schools. I consider myself fairly well versed in the history and current events of the field, probably more so than others my age. What few people realize, especially those who are new to pharmacy, is that the field is extremely volatile. There may be no other medical field that is evolving as rapidly as pharmacy is.

Think about how much has changed in the past fifteen years. The number of drugs on the market has exploded. Programs such as MTMs were nothing but the imagination of an innovative few. The term preventive health care was in its infancy.

Yet look where we are today. Pharmacists have never had such a vital role in patient care. The kicker is that this role will continue to increase in the coming years. As pharmacy school's accreditation come due for renewal, many are scrambling to meet the new patient care requirements.

Perhaps the biggest change to come will be the new classes of drugs which are currently in development. It has become apparent that the field has tapped out the available simple chemical compounds that have been the foundation of pharmacy since its inception. It is very unlikely that a new collection of blockbuster drugs will be found under these methods. Granted there is always the possibility, but one will not see blockbuster drugs appear with the frequency that they did at the turn of the century.

Where the future lies, however, are in proteins. Already researchers are toying with the idea of creating unique proteins to act in the same manner as drugs in the body. The evolution of insulin over the past several years is what has opened the door for this new area. Some estimates state that we are less than ten years away from the first protein-based drug hitting the market.

Now lets go back to the schools and their curriculum again. They now have to start adding patient care classes, if they haven't already, and at some point in the future they will have to consider those aforementioned protein based drugs.

The problem is, you simply cannot add more time to the pharmacy school curriculum. Three years in a classroom is the most they will have to work with. In order to squeeze in new classes, to fulfill future requirements, more pre-reqs are going to be required.

In reality, this is not a terrible idea. The first year of many programs are just review of courses that most have already taken. Freeing up credits by making biochemistry and stats pre-reqs is simply a good idea.

Yet another area that will be changing, I would expect by the end of the next decade, is the requirement of some sort of residency program. The field is growing to the point where there is almost too many details for one person to retain in their heads. Pharmacy will most likely take a chapter out of the medical school curriculum and pushing for residency training.

And really, would this be such a bad thing? A pharmacist focused in say, pediatric oncology, working with a doctor with a similar focus could accomplish amazing things together. Sure, people will still go to retail, but how nice would it be to have a retail pharmacy who specialized in diabetes or something of that nature?

To often I work with pharmacists who mumble, or yell depending on their mood, "This is not what I went to pharmacy school for!"

Ya know what, they are right. Yet it all comes back to how quickly the field is evolving and how we must all be prepared to adapt to it in the coming years.

I cringe every time I hear of people jumping into pharmacy without truly knowing what it is all about. Last week one of the interviewees stated that he decided to go to pharmacy school just a month ago and hadn't looked much into it. That alone scared the bejesus out of me.

So those of you who are aspiring to become a pharmacy, heed this message. Your role as a pharmacist in twenty years may be something that no one has imagined yet. This is not even including the Armageddon which is coming with both PBMs (well all know the shit will hit the fan sometime in the next few years) and/or public health care.

Just don't be caught off guard by it.