Monday, April 25, 2011

I Have A Question… A Lesson for the Profession

It is not very often that my mind is blown while working a pharmacy. After doing this for as long as I have, even the unexpected, to a certain degree, has become expected.

So yesterday when a patient turned to me and said as they were leaving, “I have a question before I go…” I thought little of it. The cynic me expect some inane question devoid of common sense, as typically that is the question you receive in this stage of a pharmacy visit.

Instead what followed damn near caused my jaw to hit the pharmacy floor.
“I was reading up on health care legislation and kept coming across something called therapy services by pharmacists and how helpful it was for the patient. Wouldn’t it make sense for you guys to help out with my drug management instead of just my doctor?”
After pinching myself and realizing that the patient, indeed, had said what she had just said, I quickly began to formulate a concise way to explain what she was talking about.

First, I mentioned that the majority of what she was talking about would be covered under the term MTM. I went over how it works and how it is integrated into current health care. We then glanced over some general cost savings associated with it that could be had, to which she replied,
“So, what you’re saying is that everyone could save money from doing this simply by catching problems before they get worse and making things more efficient? And patient's health could be better? Why aren’t we doing this already?”
I then mentioned some of the studies that had attempt to do this sort of thing, and she wrote down information about The Asheville Project to do a little more research on her own. Lastly, I explained the difficulties we are facing in wide spread implementation of MTM services from the patient, provider and insurer prospective.

It was a conversation which lasted a mere 15 minutes or so, but nonetheless provided a wealth of information for her.

By the end of the conversation, I realized that she was just a typical patient who had stumbled upon what we are all striving for. Inquiring with the normal pharmacy staff, to find out if she was someone with extensive education and/or health care experience, they confirmed that she was none of the above.

And it was the closing statement she made that offered the most telling benefit of our conversation.
“Well pharmacists need to start getting more involved with this. I’m going to talk to someone at my insurer to see why they don’t insist on something like this for everyone because it seems stupid we’re not doing it already.”
The patient gets it. A simple conversation explaining MTMs and the future role of pharmacy, and the patient gets it. And all it took was a little conversation during a slow afternoon in the pharmacy.

Are you listening APhA? This is exactly what I have been saying for the last year. If you want to proliferate the next generation of pharmacy services, don’t go after providers or insurers. Go straight to the source and start educating patients to the benefits of them.

It's a simple supply and demand problem. You can't create something without showing the demand for it. Recently I discussed with the Director of Pharmacy for a, somewhat, rural hospital on how they were implementing MTMs into their patient care for employees. Her, and the hospitals CFO's, idea was to force employees to use MTMs services combined with their own PBM. The plan then was to show the benefits of said program to local employers and attempt to show them the benefits that could be had.

Naturally this will work in their area, due to the small population size. On a larger scale, we need more grand ideas to challenge the status quo.

This little story could prove to be the catalyst that finally gets the proverbial ball moving. If this patient is as interested in MTMs as we are, why aren't we more vocal about it? Why aren't we casually mentioning it to patients who are waiting on slow days? Why aren't we pushing fliers and educational materials to show them what we can accomplish?

Why aren't we standing up for the profession on a daily basis to ensure that we reach our full potential?

APhA, are you listening?

Monday, April 18, 2011

Need Some Medicaid for your Escalade?

A lively Twitter debate has sparked a collection of data, formulated into a highly non-scientific study. The results are as follows.

Note: To curb some of the hate mail I've been receiving, I encourage you to check out this link. It may prove useful before getting one's panties in a bunch.


There is a direct correlation between the drivers of Cadillac Escalades, especially when they are black and possessing rims, and their reliance upon state sponsored Medicaid when visiting a pharmacy. That correlation provides an example of not only the faults of the system, but the manner in which discretionary income is disproportionately spent on frivolous purchases, like an Escalade, over supporting their family.

An example of the type of vehicle in question


First, we must clarify some otherwise stereotypical notions regarding individuals on Medicaid. This is not intended to judge those who use the system as it was designed. Individuals who are disabled, in the midst of transitional phase in their life or simply hard on their luck are not sought by this study.

Additionally, this does not seek to single out the Medicaid patient who may have given themselves the rare gift of a nice manicure or any other small piece of joy in an otherwise stressful life. Every person is entitled to spoil themselves at least occasionally.

No, this study seeks to identify those patients who appear to be abusing the system. Those who come to the pharmacy in repeatedly extravagant purchases, often times owning items beyond the means of the people who work in the pharmacy.

Data was collected across a six day period over two separate pharmacy locations. Each location possesses a high percentage of Medicaid based clientele and a propensity for playing extremely shitty music overhead.

As such, fourteen (n =14) Escalades were either noticed at the pharmacy’s drive-thru or were noticed as being the patients vehicle at the pharmacy. A careful analysis of this number of data points combined with noted actions while in the store, including their insurance, provided the following results.
  • Number of Patients meeting criteria: 14
  • Number of said patients driving Escalades: 14
  • Number of non-Medicaid patients driving Escalades: 0
Further analysis concluded that there is indeed a 100% probability of a patient being insured by Medicaid if they drive an Escalade, even truer if it is black in color with blinged out rims.

Every study needs a complicated graph. Look at the pretty colors!


In noting these patients it became abundantly clear that there were other useful bits of information to be gathered. On average, the patient would bring three unruly children into the store. There was almost always an excessively jeweled up iPhone in their hand, the majority of which they had pressed firmly to their ear while at the counter.

In three instances the phrase, “My baby’s daddy…” was heard uttered during the conversation. The phrase, “I ain’t got my check for the month,” was used twice as a reasoning for not wanting to pay the one dollar copay.

While it is impossible to delve into the specifics of each individual’s personal and financial situation, it is possible to derive a perhaps improper spending of funds based upon their visible purchases. Not having a dollar for your son’s asthma medication could easily have been avoided if you were not driving around in a vehicle which most likely costs twice what you earn in a year.

Other high priced vehicles, Lincoln Navigators, BMWs, etc, were noted but did not meet any of the criteria sought in this study.


This non-scientific study has confirmed that if a patient arrives at a pharmacy in an Escalade, they will be an irresponsible Medicaid patient. Little can be done with this knowledge other than to provide an example as to how to not use the system. In addition, pharmacists and pharmacy technicians can use this visual cue to prepare for the highly probable flood of bullshit that will gush from the patients month.

One of the god fathers of the blinged out Cadillac Escalade phenomenon

Sunday, April 17, 2011

A Collection of Disdain

Oh woe is me.

That simple statement is the underlying theme of pharmacy school, at least if you ask people who are either in it or have recently escaped it. Little variation exists from person to person as while the verbiage may change, the tone does not.

As I slowly begin to rediscover my pharmacy mojo and climb out of this funk from the last few months I am discovering just how truly unhappy the vast majority of students here are. It is such a collection of disdain and frustration that at times it is almost overwhelming.

Even those who put on the most stoic of faces, are internally crumbling. Many are too proud to admit their struggles or to admit their frustrations. After years of being used to academic success, it is a bitter realization that one may be forced to struggle to earn merely average grades.

Nor will it become any easier. At least not yet.

And one has to wonder when this feeling will ever end. Honestly, I think the majority of success one has in this program is learning how to mitigate these feelings. Despite the pamphlets and the emails and the meetings, they never tell you one of the important tests you'll be faced with over the next four years. That is the fact that you will be mentally broken down and slowly rebuilt as the curriculum wears on.

It's the equivalent of academic boot camp.

But we mustn't feel sorry for ourselves. We mustn't drown ourselves in the almost sweltering pressure that at times seems unending.

For we are not alone. No matter what the surface may show, beneath it there is little difference. We're all in this hell-hole together, and we're going to be buried under it for a few more years.

So to hell with it I say. To hell with being overly stressed to the point of exhaustion. To hell with trick exams and impossible objectives. To hell with letting an academic program attempt to break me.

The worst may be yet to come, but I say bring it on. Because I'm taking this bitch on head on from this moment forward.

Who's with me?

Thursday, April 7, 2011

When False Facts Are Factually False

As I walked into the pharmacy school building on the first day of classes, I was keenly aware that the next four years would be difficult. I knew that it would test every ounce of mental and emotional fortitude that I housed in my geeky little body. In the end, I would be challenged to grow beyond myself into something, hopefully, resembling a health care professional.
Heading to the first day of pharmacy school, I knew that the next four years would be difficult.

What I did not expect was for this road to be made so astonishingly difficult, almost in a sadistic manner.

You see, no one had informed us that professors routinely trick students in lectures and/or exams. That they'll present something as fact, but carefully phrase it in a way that means it is actually false.

Kind of like using a triple-negative to explain something.

When you use said fact and are told you are incorrect, they reply back that we must be acutely aware of how and what it is they say. Phrasing this way is to help develop a higher sense of thinking on our part.

Now how in the hell is that supposed to work? I busted my ass for six years only to be forced to endure another four years of deceptive learning? Leading up to a recent exam, our professor routinely exclaimed that we were over-analyzing material and that, "it will be incredibly straightforward, not requiring overly analytical techniques."

I'll let you guess what the exam was truly like.

And I don't get it. How are we supposed to adequately learn for patients if some of the professors derive some sort of sick pleasure from tricking us? Granted not all of the material is presented in this manner, but enough of it is to make you wonder how we can be taught in such an environment.

Now maybe I feel this way because I am an ardent believer in equality or maybe because I'm still young and relatively un-jaded about the world

Or maybe it's just because it's a steaming pile of bullshit.

I think I like that explanation better.