Presenting the 2010 Medicaid Mother of the Year

My work day after Thanksgiving in this new city proved to be vastly different than what I am accustomed to. Whereas I am used to being completely swamped on Black Friday, here the pharmacies are a wasteland. So imagine my surprise when midway through the day I realized I was in the presence of greatness.

I had met the Medicaid Mother of the Year. Shocking, I concede, that she would choose to visit our little pharmacy on this day, but alas here she stood.

Chatting on her iPhone 4, bedazzled of course, with her Coach purse and fancy manicured nails, she presented to prescriptions for her 18 month old son. And she presented her, and her son's, Medicaid card.

One of the prescriptions was written for Amoxil and the other for Orapred, nothing out of the ordinary. As she loudly chatted with one of her baby's daddies, I took the scripts to the counter and began to input them. It was then that I noticed both scripts had the DAW box checked.

Perplexed, I dialed up the urgent care doc who had written the scripts and asked the nurse on call if she could verify the DAW. Often a slip of the finger can slap DAWs on scripts when they are unintended. When the nurse returned to the phone she informed me that it was the patient that had insisted on the DAW and that they were written correctly.

Cute.

We call her to the counter and the pharmacist asks her why she's insisting on the name brand version of these medications. Her reply was that, "Generics don't work that good and she wants the best for her bab-ah."

We both calmly explain that in order to fill each of these prescriptions we would have to order the drug in. The likelihood that a store in our area would have either one of these drugs in stock was negligible. And, since it was a Friday, we informed her the soonest we could get the medication would be Monday morning.

"That's ok," she replies.

Next we inform her that in order for Medicaid to pay for these medications we're going to have to get a prior auth on both drugs. That, in itself, meant that we wouldn't be able to bill the insurance for payment until Wednesday at the absolute earliest.

"I'll just wait, he can tough it out until then, he's a strong lil dude like his daddy. I just want him to get the best meds, I don't want none of that cheap shit."

Let's get her tiara and flowers ready, because this woman just kicked the rest of the competition to the freakin' curb.

Yes, let's deprive your ill child of the medication he needs simply because you have some sort of righteous belief that you deserve the best even though it is those like myself who will pay for it. Never mind your suffering child, hold tight to that notion.

Because when child services show up, it's the only thing you're going to have left.

African American Friday

I can never adequately explain the kindness people showed me while I worked one of my last shifts at Walmart on Thanksgiving. The sheer number of people who would stop and merely thank me for working was astounding.

Except for one person. Below is her almost verbatim response to my simple of question of how she was for the day.

"I'll tell ya how I'm doin', I'm damned pissed. All this talk about 'Black Friday' this and 'Black Friday' that... everyone's all racist up in that shit. They need to call it 'African American Friday' and stop puttin' down black people. We've been through enough with all the slaves and ghettos and shit and now they have to name some day after us to have sales? Well fuck that shit."

Well then...

My How Things Change In A Year

Roughly one year ago today I received notice from the first school I interviewed at that I was waitlisted. It was a crushing blow for me at the time, especially when the wife and I were hoping to have some idea of where we would be living a year from now.

To say I was unsure of myself would be a vast understatement. I said to myself, at the time, that if I did finally get accepted to a school that I would finally believe that I was destined to be a pharmacist.

One year later and I'm still unsure.

But think of all that's changed for me in the past year. I had a spat with the company I worked with for 6+ years ultimately resulting in me resigning and being unemployed for five weeks. I ended up being accepted to four schools all across the country and shortly thereafter I found out I'd be a father for the first time. And we got the cutest puppy the world has ever seen.

We moved to a completely new area for us, devoid of everything we know in the hopes of starting a new life here. A little over a month ago I suddenly lost one of the best friends I'll ever have. And here I sit, the day before Thanksgiving, scrambling to get in studying in case the baby decides to arrive early.

That's a helluva lot of change in one year.

Pharmacy school is what I expected and is not what I expected. I have yet to decide if it is something specific to differences in how they are doing things this year or if it has something to do with myself. In the last two months I have questioned if this is something I truly want to do more than at any other point in my life.

Yet, despite all of the change and all of the hardships, I still find myself proclaiming "Hell yes this is what I want to do!" It's more that this proclamation comes far and few in-between as of late.

And it's only going to get worse.

T-minus three years and six months to go...

Walgreen's, Sucking the 'Phun' Out of Pharmacy

I am coming near to my three month anniversary with the empire that is Walgreen's. During this time I have moved around to a couple different stores now which has helped me gather a more rounded view of their day to day operations. Recently, I have come to a singular conclusion.

Walgreen's has sucked the fun out of pharmacy.

In the past, I have worked in stores that were a blast to work in to the point that when you saw you were scheduled there, you smiled. The co-workers were great, the pharmacists were great, the patient population was great... it made for an awesome daily work experience.

With Walgreen's you still have that, yet you do not have the same experience. I'm not saying that work should always be fun, but more that you should be able to enjoy it at some point. After three months, I have yet to find a day that comes even remotely close to that.

Part of it, as I alluded to when I started working there, deals with their work flow. It's one of those ideas that looks beautiful on paper, but doesn't work as well as it should. The better stores I have worked in have just a straight pharmacy (to me, the sexiest pharmacies have a straight counter about six miles long), but the pharmacies based in the corner of a store are just terrible.

To top it off, there is virtually no patient interaction. I miss the days of an open pharmacy. When my favorite customers would come up to the counter, wave me over and ask me if "I got lucky on Saturday night." Or the customers who would randomly bring treats or show pictures of their grandson at his most recent soccer game.

When I started, the manager told me I would fit in really well because this store had a really close knit community. From what I have seen this far, it does not meet my past experience of a close knit community.

Working in a Walgreen's is very cold and methodical. Each worker is only really well versed in their specific tasks and the pharmacists, no offense to them, are very one dimensional. That, of course, is a byproduct of the Walgreen's system, but I still would put up a pharmacist from one of the indie stores I worked with up against a Walgreen's pharmacist any day.

Have I mentioned I despise their robots and the lack of record keeping/information they hold?

I'm not trying to be a negative Nancy, but I miss enjoying going to work. Moving around to different stores the last few weeks, I have learned that this is probably not going to change any time soon. How depressing of a thought is that?

No wonder so many of you are so bitter.

Why Does Breast Cancer Have a Whole Month?

Not to put down one of the most prevalent cancers out there, but can someone explain to me what makes breast cancer so special that it has its own month? I mean there are countless diseases and conditions out there which are much more tragic than breast cancer.

Now it seems as if it has become its own marketing machine, akin to how Christmas has become overly commercialized in recent years. Sometimes it seems with all of the 'special' items out there for Breast Cancer Awareness Month that it may be more about pushing a product than an actual cause.

It's great to see so many people get behind a specific cause, but why this particular one? Is it due to the male fascination with breasts? Is it because of the inherit connections we feel towards our mother and, as such, are deeply effected to what may happen to her? Is it because we all secretly enjoy the color pink?

Each year this month grows to be even more grandiose than the year before. For several years in my sport of choice, NASCAR, it was not uncommon to see one or two cars run a special pink paint scheme for a race or two. Now there are multiple teams who do this for the entire month.

The NFL was chalk full of players covering themselves with pink in whatever way they could. I wouldn't be surprised if there was a push for pink uniforms in another few seasons.

So what is the fascination with this month and the associated cause? I'm not attempting to be callous in anyway towards breast cancer survivors and those currently battling the disease, but I truly don't get it.

It's like we get TaTas-fever for one month out of the year, but in a respectable manner. It's like an ethical Hooters if there is such a thing. And if that's the case, why isn't there more support for male breast cancer and the associated chest-ticles?

Anyone have any ideas?

The Quandary of Clinical Pharmacy

Quick, in one brief sentence describe the role of a clinical pharmacist.

Tick Tock. Tick Tock. Tick Tock. Tick Tock.

And your answer... is probably correct even though it differs from the twenty other responses given. Actually it may not even be remotely similar to half of the other responses given.

This is precisely the reason I dislike the term 'clinical pharmacist' because it truly does not mean anything. It is a blanket description to cover the roles of a pharmacist that currently lack an accurate description. In fact, I'd say roughly a third of the 'clinical pharmacists' I meet are really ambulatory pharmacists.

Yet even they are unaware of this fact.

No one person is to blame for this facade. It's simply a byproduct of an ever evolving profession, but it is something that we must address at some point. The 'roles' of a clinical pharmacist are incredibly varied that any lay person would question if they really fell under the same umbrella.

Honestly, it may sound petty to begin to discuss what to call ourselves, but in reality is it so petty? We already have a problem with the public and our patients over a misconceived notion of what a pharmacist is. Do we really need to compound the problem by the repeated use of such a vague description of a role?

Naturally this is not something which will change over the night. In fact, in fifteen years I would not be surprised if pharmacy schools were producing pharmacists with specific specialty titles, akin to the current medical school practice, so it may eventually correct itself.

Where do we start? Well if you consider yourself a 'clinical pharmacist' start thinking about what it is you truly do.

Do you call yourself one because you're not sure what the actual title of the role is? Do you call yourself one because you like the sound of it? Do you call yourself one because no one has ever told you otherwise?

I'm sure some use the phrase clinical pharmacy as a bridge between the past hierarchical gap between pharmacists and medical doctors. That is completely understandable, but that bridge cannot stand unless we reenforce the legs upon which it stands.

Let clinical pharmacy remain the general term for the professions specialists. But remember that this is, indeed, merely a general term. An oncologist does not introduce himself as a medical specialist, but simply as an oncologist.

Seems logical enough, wouldn't you agree?

Pharmacy School: Supporting SSRIs!

In one corner sits a person ashen faced, staring into nothingness. Perhaps a slight streak of drool traces their chin, but they are dead to the world.

In another someone sits face in hand, sobbing uncontrollably. Their body shudders with each stifled wail as on-lookers stare.

Yet another person is merely wondering aimlessly about the room. Mumbling incoherently, a kind passerby offers a consolation of candy and is greeted by an indifferent stare.

What is the connection between these three individuals? They're all pharmacy students!

If you want to discuss an up and down roller coaster of emotions, talk to your nearest pharmacy students. For every high you there is a stunning low which is soon to follow.

At no point do you catch your breath and often you find new depths to your own personal despair. It's like being punched repeatedly in the balls, helped back up, and then be hit in the same balls with a jackhammer.

And then be pissed on by a bunch of angry elderly women.

Truly, it's amazing. If I were in any other situation, I would think there is something mentally wrong with myself. Eventually, such as days like today, you reach this insanity driven breaking point when you incessantly giggle. As if nothing in the world matters and everything is hilarious.

And here's the best part... this isn't the worst of it. Not by a long shot. That threshold is still a year or so away.

No time to wallow in the depression tonight, yet another exam awaits a mere 38 hours away. And let me tell ya, I truly am excited... and by excited I mean three seconds away from bashing my head repeatedly into a wall.

Good times.

Am I Too Cynical?

One of the greatest realizations a person can have is that you are not always right. In fact, you're probably wrong more often than you may think.

That statement is the precise reason why I won't enter politics; I'm too open to the ideas of others in place of my own if they are better. I fully concede there are times when I am completely wrong or have an illogical train of thought. I do my best to think things through in a logical manner, devoid of emotional input, but we're human and at times that is simply not possible.

It goes without saying that I probably have more intimate knowledge about the profession of pharmacy than 99% of my classmates right now. I do not state this as an ego-booster (although I have been told that others would disagree), but as a statement of fact.

I think we can agree that most of the material published on the pharmacy blogs, this one included, has an overtly negative tone. Sometimes I justify this as merely being realistic about the profession, an idea which is grounded in some logic. Recently I've been debating if this collection of negativity has clouded not only my judgment, but my attitude.

In more concise terms, I have become too cynical.

All we hear about, or talk about, in this type of medium is the negative. View any major news publication and the stories that receive the most, and most consistent, play are negative in nature. Call it a byproduct of our society if you will, but because of this we have become colluded into viewing the world in negative lights.

For instance we all argue about the adverse effects of mail order pharmacy on the profession and the care of the patient. It's something that has been beaten into my head from various sources over the years so much so that any 'good' news regarding mail order pharmacy is met with a sneer on my face.

Imagine my surprise last week when I went to a presentation and was introduced to a mail order system that actually works. A system which is producing better outcomes than the traditional retail setting. A system which solves the majority of the problems we associate with mail order pharmacy.

I sat, jaw agape, for much of the presentation. "How can this be?" I thought.

Over the years I had grown so use what everyone else had been saying about mail order that I neglected the fact that it could possibly work. Something which I had written off as a death blow to the profession in fact has a very helpful place within it.

In essence, I had not followed my own mantra of being open to the ideas of others.

There is no particular blame to be placed. What is said, for the most part, needs to be said. The context of what is being said, at least in my mind, needs to remain forefront

After all, I don't wanna grow up to be Scrooge. Or do I....

What's a HIPAA violation?

Let's play with a hypothetical example today.

Say you and some classmates are given the assignment of tracking the health of an individual in a retirement community over the course of several months. There is a school website, with greatly restricted access of course, in which you participate in discussions about the overall project and complete assignments.

Then let's say that there is another sub-section of that same site where only you, your group members, and your professors can read what you post.

Now one day you're discussing with your classmates on this site about the next visit and you inadvertently use the first name of the individual you're tracking in the discussion.

Is this considered a HIPAA violation?

I ask because I was told, and corrected, by a professor that it was indeed a violation. For the life of me, I cannot seem to figure out how this would be and said prof has yet to respond to my email.

It's on a non-public webpage so restricted only six people can view it. It is a part of the pharmacy school, which is in turn part of a health care facility. No other relatable information was disclosed in the discussion, merely the slippage of the individual's name.

In all of the HIPAA training I have received over the years, I cannot see how that would be a violation of the law.

Am I missing something here?

Health Care Reform

We all struggle to relate complex items, such as the current health care reform, to friends, family and even patients. We were shown this video in class from Kaiser Permanente and found it to be humorous while educational.

I though it best to share it to help defuse the confusion that is so often found when discussing current reform.