Thursday, March 25, 2010

The Latest Diabolical Plot By CVS To Destroy The Profession.

From the latest issue of the trade mag Drug Store News, which for some inexplicable reason gets mailed to my house every month, or maybe every 2 weeks. I don't know. I try not to pay much attention to Drug Store News:

WOONSOCKET, R.I. ( Mar. 15) —Serving as yet one more indicator of the vital role that pharmacists play in the U.S. healthcare system is a program implemented by CVS Caremark and Polk County, Fla., that clearly illustrates how clinical pharmacist interventions can improve diabetes outcomes for patients.



Clearly. That's why the opening paragraph of this story, in its entirety, is one giant 45 word sentence that doesn't say a goddamn thing. Because it's so clear. That sentence hurts my eyes. It's obvious what the real problem is here though, and it doesn't have anything to do with whatever this program is.

That pharmacist is touching a diabetic. The day I have to touch a diabetic will be my last one in the profession.

"We've been figuratively pimping out our pharmacists for years" CVS Charmain and CEO Thomas Ryan said in a fictional interview. "So we thought actually employing our professional staff as prostitutes was the next logical step. It not only allows us to meet the needs of this large segment of our customer base, which, let's face it, is quite often extremely unattractive and lacking in social skills, but also to elevate the status of the world's oldest profession by creating an association in people's minds with the healing sciences."

Ryan fictionally went on to say that CVS pharmacists would be instructed to create an emotional bond with program clients, and to never charge extra for a happy ending. Any tips will be 100% property of the corporation. "Just like in our immunization program" Ryan said in my mind.

I don't know what the deal is with the actual program. I gave up after I got three paragraphs into the story and they still hadn't spit it out, but I can't take that first sentence anymore. Here:

A joint program implemented by CVS Caremark and Polk County, Florida, clearly illustrates how clinical pharmacist interventions can improve diabetes outcomes for patients, according to a case study recently published in the American Journal of Health-Systems Pharmacists. 

First sentence is free Drug Store News. Anything more and you gotta pay me. I'm sure the people at Drug Topics will tell you I'm worth it.

Unless you want me to hold a diabetic's hand. Not enough money in the world to get me to touch a diabetic.

Tuesday, March 23, 2010

Day 1 In Socialist America. A Report From Behind The Front Lines.

I awoke before dawn and opened my wallet. I hesitated for a second. I wanted to hold onto the past for just a second or two longer.

The past where 17 year olds could be dropped from their health insurance plan the minute they contract HIV, and thereby be uninsurable for the rest of their lives. The freedom to be left to die by the health insurance company to which I had been paying premiums would be one I would never have again.   

I took out my Blue Cross card and wept. Wept for the lost profits. Wept for those with pre-existing conditions and their lost liberty. Wept for myself and my soon to be lost ability to pay for the emergency care of the uninsured through my higher insurance premiums. The uninsured  would have their own premiums now, and I wept because I would no longer would be subsidizing them through my Blue Cross plan, which made me less free somehow. 

Even though I am not currently uninsured, or low income, or burdened with any health condition other than essential hypertension managed with medication, I wept for my country, for I knew now that my life would never be the same for some reason. 

The sun rose as normal.

I looked to the east and onto this new era, and I wept some more. Like a little pansy. Or Glenn Beck. And even though the Constitution says within its first 30 words that it was written by we the people in part to promote our general welfare, and never once uses the word "corporation," I wept at this blatantly unconstitutional act.

The thought of perhaps serving on a death panel cheered me up a little. It would be fun to be on a death panel. Until I remembered that that was a fucking teabagger lie.

I called Blue Cross. They backed up their assurance that my call was important to them by not answering it. Just like yesterday. The crackly classical music that filled my earpiece over the next 10 minutes was the flint that ignited my spark of hope. The socialists had not yet conquered Blue Cross. 

The insurance companies were not yet defeated. Liberty lived. 



Saturday, March 13, 2010

But It Was The New Very Berry Flavor. Surely That Works Better.

The purps knew exactly what they were doing. The lighting in the video was dark and foreboding, yet the two days worth of facial stubble on the face of the hostage came through just as clearly as the desperation contained behind his fearful eyes.

"I am a fraud, and I'm sorry it ever came to this," the voice softly cracked into the camera. "I just want to say I miss my wife and family very much, and I hope you listen to the requests of my captors"

The knife pressed against his throat as the screen went dark.

A week ago it had all seemed so easy. A week ago he was making a routine presentation to another health department strapped for cash and feeling overwhelmed and overstressed. He knew their budget had been cut. He knew health departments did not like the expense of fighting off infections. A full-scale deployment of the immune system was not cheap. And he knew most health departments were run by the brain cells that were not exactly the sharpest knives in the drawer.

He was Airborne,™ and he had made a pretty good living off people who can't understand the words "there is no cure for the common cold"

This time, however, he was up against Pneumococcal pneumonia.

He knew something was wrong as soon as he merged into the bloodstream. His plan was to check into the hotel and lay low for a week, then emerge and claim all credit and a fat paycheck when the cold had resolved itself, the way it always does. The blood was warm though. Too warm. Broken white blood cells were lying in the median, some crying, some too exhausted to move, some on the verge of death. "The doxycycline......oh God....the doxycycline is here....we might have a chance" muttered the shell-shocked white blood cell lieutenant. Airborne had no idea what he was talking about and slowly drove past. He heard the unique laughter that marks the mentally broken as he pulled away, but he knew it was too late to turn back.

That night 5 members of the streptococcus pneumoniae militia broke into his hotel room, and they did terrible things to Airborne. They found orifices he had no idea were there. They created new orifices. They gave him pain like he never experienced in his wildest nightmares. They made him say it as they chopped off one of his fingers:

The Airborne health formula helps to support your immune system through its blend of vitamins and minerals. Airborne’s unique combination of vitamins, nutrients and proprietary blend of herbal extracts all work together to create the formula people swear by.

They laughed and made him say it again and chugged more tequila. Then they cut off another one of his fingers and made the video where he begged for his life.

Doxycycline found what was left of Airborne's corpse as soon as he emerged through the duodenum. He winced, but did not weep. In the end, no one wept for Airborne. The wife he claimed to miss so much spent the life insurance settlement on breast enhancement surgery, and Airborne was buried in an unmarked grave, along with the hopes of a million or so suckers, who thought there was a cure for the common cold.

Friday, March 12, 2010

An Ode To My Old Pharmacy Glass.

You stood strong and true. A barrier, and today they say a barrier is bad for our profession.

What they mean is if customers shout to me questions about the location of shoelaces from the other side of the store, they can schedule two less clerk hours, for I will be doing extra clerk duties amongst those for which I went to college.

The barrier is gone, yet I talked more to patients about drugs back in the time of the barrier.

Today I talk to customers about where in the mall they can buy stamps. And where the Subway is.

I abused the barrier, I admit. I used it to keep a radio playing in the background they could not hear.

I would say things like "Good morning you dumb son of a bitch" out loud as I waved as they walked by.

But I talked to them more about drugs back then than I ever have a chance to now.

Sometimes customers come up and put their hand in front of them, expecting a barrier to still be there, they'll usually ask a drug type question. The guy looking for the motor oil never expects a barrier.

It would be very unprofessional for me to walk to a private area to talk to a patient evidently, according to the people who designed my store. Or it would cut into my ability to multitask, I'll let you decide which was the more likely driver of the design. God forbid I would have had a door to close behind me today while the lady told me she was scared because her prior auth for suboxone had been denied. She was saying it in the most private area we offered, and if you were at the cash register and it was quiet you probably could have heard every word.

You can also hear every word I say on the phone all day long. Oh how I yearn to clean the glass just one more time. And be HIPAA compliant.

But I appear more accessible today, and appearances matter far more than reality.

I talked far more about drugs when I had a barrier.

Wednesday, March 10, 2010

Sometimes The Joke Is Right In Front Of Your Face, And You Just Pluck It. Like A Low-Hanging Fruit.

From today's Yahoo business news wire:


DEERFIELD, Ill--Walgreens (NYSE: WAG)  is launching a pilot program in the Dallas/Fort Worth area to broaden its workforce and disability inclusion initiatives. The program aims to hire people with disabilities for 10 percent of service clerk openings at stores in the area. On average, Walgreens hires more than 1,600 service clerks a year in this area alone.
“We’ve designed facilities and training for people with disabilities to help drive opportunity, efficiency and productivity at our distribution centers,” said Walgreens senior vice president of supply chain and logistics Randy Lewis, who spearheaded the company’s decision to create an integrated and inclusive workplace. “Now, we’re taking those tools and bringing them to the store level to help create and maintain a diversified workforce. Emphasizing people’s abilities is our strength that will help everyone succeed.”

"While this will be a major change in the composition of our workforce, we are committed to do this reorganization in a way that will be as painless as possible for our current employees" Mr. Lewis didn't add. Using the 1,600 hire-a-year formula, he speculated it would take 2 to 3 years to bring the percentage of Walgreen's employees in the Dallas/Fort Worth area with disabilities down to the target of 10 percent, from the current estimated 60 to 70 percent chainwide.

"We deliberately picked this market because we knew it would be the biggest challenge to find non-disabled applicants, as the Texas employee pool has a far higher rate of disability than any other region of the country."

While it is generally assumed that the leading disability of a current Walgreen's employee is Down's Syndrome, or trisomy 21, in fact, an internal company document shows a wide and diverse number of disabilities among its workers, including disorders of specific genes, cutoff of oxygen to the brain during childbirth, metal plates in the head, lead poisoning, club foot, and scurvy. CEO Gregory Wasson, abandoned by his father as a child and a resultant sociopath, is perhaps the company's most successful employee with a disability.

Reaction among customers was generally positive.

"You mean next time I go into a Walgreen's and ask a clerk where the Afrin is I might get back something besides a blank stare?" said fictional Seattle area shopper Jennifer Downey. "Yeah, that would make me more likely to shop there."

Reached for comment by telephone, a Walgreen's cashier sat silent for 15 seconds before offering to transfer the call to the store manager, then accidentally hung up.

Monday, March 08, 2010

I Solve The Nation's Gang Problem.

The first thing we have to do is issue every gangster a set of white gloves. Maybe not every gangster, but as many as we can.

Hang with me until you see where I'm going here.

We also need to give them a pistol. We might have to go to ebay or something to find the right ones.

K, you ready? I'm kinda excited about this.

Duels. We bring back the concept of the duel. Norteños and Sureños facing off at 20 paces. One set at a time. We could make a few adjustments to fit in with the times of course. I think maybe the traditional glove slap to signal "game on" could be called "the bitch slap" for instance.

This may be my most awesome idea ever. The end of the innocent victim caught in the crossfire. Entertainment value. Teaching lessons to our nation's youth about how to resolve disputes like a man. Granted, the type of man who wore girly clothes and wigs, but it's definitely a step up in courage from shooting a few rounds into a house in the dark of night and then speeding away in a stolen Honda.

I mean, it was good enough for Alexander Hamilton, and he ended up on the ten dollar bill. From what I understand, many gang members like money. Perhaps the story of Alexander Hamilton could be the key to promoting this.

I really don't see any losers here. Except for maybe the guy who gets shot. Odds are pretty good this wouldn't be a change in how he would have died anyway though.

Think about this the next time you drop a ten.

Sunday, March 07, 2010

How Do I Get On Medi-Cal? The Board That Is. That Decides What Drugs Are Covered.

So, I used to be a Medi-Cal expert. Medi-Cal, for those of you in the inferior 49 states, is our name for the medicaid program. Take out the hyphen. We're clever like that here. At any rate, you can't not work in the ghetto and avoid becoming adept in the intricacies of  getting a Medi-Cal claim to go through. Bizzare stuff some of it. My favorite was the requirement that a documented diagnosis of HIV be on the face of any prescription for AIDS meds. Like doctors otherwise would go around giving protease inhibitors to people with the common cold I guess. I also remember that Medi-Cal would only cover Ortho's birth control pills. Send a claim for a generic and you'd get yourself a big fat rejection with an explanation that wouldn't make any sense. That always threw the newbies in our store, who would always say the same thing:

"Why the ^%$! would they pay for the brand name and not the generic?"

Then there would almost always be some sort of joke about kickbacks.

Ha ha ha.

At least, I always thought it was a joke. From the San Francisco Chronicle:

Three California officials who oversee billions of dollars in Medi-Cal prescription drug spending have failed to disclose free flights, hotel rooms and meals paid for by nonprofit groups funded by drugmakers, records and interviews show.
One of those officials, Pilar Williams, accepted free travel even though she has a direct role in negotiating rebates with drugmakers. Williams, the pharmacy division chief at the Department of Health Care Services, also helped decide which drugs were among the $8.5 billion worth of medications the state dispensed to low-income patients in the past three years.
The three officials' travel was paid for by several nonprofit business groups that exist for the sole purpose of funding conferences and meetings, according to a chairman of one of the groups. The business groups raise money by charging registration fees up to $2,000 per person to drug company representatives and other executives who do business with Medicaid programs.
Since 2005, those corporate executives contributed about $1.8 million to the business groups to pay for conventions - including the costs of travel, lodging and entertainment for the state Medicaid pharmacy directors, California Watch has found.


Actually, there is a joke in this story. Here it is:

Norman Williams said officials will report future trips to conventions...He described the conferences as great idea-sharing forums.
Pharmaceutical executives "do not try to influence (our) decisions in any way," he said. "And we would not attend those conferences if that were the case."


"As a corporate executive I couldn't agree more" Pfizer Chairman and CEO Jeffrey B. Kindler didn't say. "Every time I bring up the prospect of using a large sum of company money to get absolutely nothing in return our stockholders applaud and say nice things about me. They realize, after all, that the foundation of American capitalism is that the corporation has a duty to spend money that would otherwise be added to our quarterly profits, for no reason other than to make the world a better place. For a few people who may have the power to give us more business. Not that we've noticed whether they do or not."

"I thought we put these ethical type issues behind us when we stopped giving out the free pens." He didn't add, with a puzzled look on his face.

"Jesus you are one cynical bastard Drugmonkey" I can hear you saying. "Can't you at least entertain the possibility that these people are professionals who went to these meetings to enhance their on the job performance?"

Sure I can. Oh, speaking of entertainment:

The agenda showed that officials from at least 22 states attended sessions. But it also showed there was ample free time. On one day, sessions ended by 11 a.m. Networking and entertainment was scheduled until midnight at the resort, which featured an indoor theme park and water park.

Before 11 a.m the meetings probably stressed things like how important it was to document that AIDS meds weren't being used to treat the sniffles. I have a feeling the reason those Ortho products were covered... might have something to do with what went on later that afternoon.

I wish real life would stop stealing my jokes.

Thanks to the alert reader who tipped me to the story.

Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/02/28/MN4A1C80TR.DTL#ixzz0hZBuwwBR

Wednesday, March 03, 2010

Highlights From Friday's Pill Counting Action.

Maybe the memories don't really gel into my head until I get back to work after a weekend off. Maybe that's why I don't write about them for awhile.

Or maybe it's just because I'm lazy. Maybe a dedicated funding source for my little blog garden would go a long way towards me getting the Friday pill counting highlights up faster, and you should seriously consider approaching me to inquire about my advertising rates. 

The first highlight from last Friday happened before I even got to to work, A man was standing beside the street undoing his pants as I drove by. He wasn't really making any effort to hide what he was doing, which made him visible long before I actually got to where he was standing. His pants were totally off by the time I got to him. He was obese.

It's definitely the blockout thing. Don't worry about buying an ad.

There was someone waiting for me to open the gate as usual and my keystone tech was late as usual and I was beginning to think this might end up just being a boring kinda day. That's when I heard "a hunk a hunka burnin' love." It was foreshadowing. My employer's in-store radio plays the same 20 songs 24/7 ad nauseam, and the Fat Elvis classic was not one of those 20. This was significant. Fat Elvis was trying to warn me.

I looked down and saw the phone lines were blinking, but not ringing. This had been a problem for two days now, and for two days we had been waiting for someone from my employer's techno-geek squad to come down and make an attempt to fix it. Basically, if you look at the phone and happen to notice it ringing, you can answer it, but the phone doesn't make any sound or any other real effort to let you know someone is there. I picked up to start the day.

"Hi, this is Nurse Dumbass calling, we have a patient who is being discharged from our not-quite hospital, not-quite nursing home tomorrow and I need to know what to do to make sure he gets his discharge meds."

"Give me a prescription"

"Is that all"

"That's all"

"OK, can I fax it?"

I gave her our fax number and figured she could knock herself out. Ten minutes later the fax machine spat out ten pages of the guy's chart. Only one of which had anything to do with meds. It was just kind of a list of random drug names.

"Yeah, um I got your fax" I told Nurse Dumbass after being on hold for 5 minutes. "It wasn't real helpful in letting me know what I'm supposed to give the patient. Why don't you try sending over some proper prescriptions."

"Um.......OK"

The next caller asked if she really had to fill her diuretic prescription to lower her blood pressure or if she could just drink a lot of water. Her question really made all the extra effort I was making to stay on top of the phone calls worthwhile.

"Hi this is CVS......you just called"

"No....I didn't"

"Really?"

Yeah. It was a lot of extra work, but I could really feel good about the service I was providing the public with my phone skills.

In the waiting area, a customer screaming into their cellphone was joined by another customer....screaming into his cellphone. They both stood there, screaming, loud enough that each of them was interfering with the other being able to hear the person they were talking to. They gave dirty looks to each other, and screamed, and said things like "I didn't get what you just said" while giving more dirty looks to the other one.

Neither one of them showed any intention of moving. They screamed some more and I composed a heartfelt eulogy to the phone booth in my head.  

A lady asked for a counsel and then walked away mid-sentence. Not in anger I don't think, she just kinda drifted away like something shiny had grabbed her attention. Maybe I need to add some jokes or a live band or something to my counselling routine.

Three prescriptions came out of the fax from the not-quite hospital not-quite nursing home. One said, in its entirety, "Coumadin 3 and 4 milligrams for two weeks." Back to the phone to complete what should have been a 20 second process at most.

"Yes, how is the patient taking this Coumadin?"

"By mouth"

There was a man out there somewhere dependent on these people for his care, and my heart broke for him. I think my head exploded as I tried to beat a prescription out of Nurse Dumbass. There were reports my face was beet red and that I may have called her stupid. I'm not sorry if I did.

Do you know what the difference is between a successful organization and a not so successful one? A successful organization sends a technician to fix your phone problem who fixes your phone problem. The technician from the not-so-successful organization goes home at 5:00 and leaves you with a fucked up phone all weekend because he isn't authorized for any overtime.

Last prescription of the day was for Septra suspension. Couldn't be the tablets. Had to be the liquid. It was from a pediatrician's office, not unusual stuff. Nurse said the Mom wanted to know if we could make it orange flavor. Mild pain in the ass, but doable if your little shit is a bit contrary. I told the nurse sure and asked for the kid's date of birth.

1992.

Somewhere out there is an 18 year old  who can't swallow a tablet. He's allowed to join the army and wants his liquid orange flavored so it's not all icky when it goes down. He can register to vote and buy cigarettes and has his Mommy make sure he doesn't get yucky medicine. That's the difference between where I work now and the ghetto from which I came. No 18 year old in my old ghetto store would do this. And live.

I miss the ghetto sometimes. And phone booths. And nurses who could communicate prescription orders in less than a day and parents who could communicate to their offspring they were being a wuss. And Fat Elvis. As I pulled the gate closed I imagined I was opening up a portal into a time when there was less technology and more brainpower. I pretended I was stepping out into the parking lot of 1978. Then, I swear to God, I saw a man playing with his belt, and I subconsciously blocked it all out. Until now.

I'm going to go dust off my 8-track player. 

Monday, March 01, 2010

It Would Be Too Easy For Me To Write A Post About How Much I Want To Punch This Kid.

First off, there's just the way he looks. This kid looks like some sort of wayward child of that dude from Air Supply. And whether we like it or not, all of humanity has an obligation to stop the members of Air Supply from reproducing. By violence of necessary. Here's his picture:


I almost punched my computer monitor just now. There are so many reasons to want to punch this kid though. His name is McKay Hatch, and evidently he has a taste for politics:


SACRAMENTO, Calif. -- Californians had better start watching their mouths.
The state Assembly passed a resolution Thursday that would establish the first week of March as "Cuss Free Week" throughout the state. If approved by the Senate next week, the measure would take effect immediately.
The resolution was inspired by a South Pasadena teenager, McKay Hatch, who started a No Cussing Club at his junior high school in 2007. Similar clubs have since cropped up in every state and 20 countries.
Hatch, who traveled to the Capitol with his family to support the resolution, said he sees a link between foul-mouthed incivility and other forms of problem behavior, such as drug use and bullying.
Next up for the 16-year-old? Promoting no-cussing measures in other states and internationally.
"Next year I want to do a world tour," he said. "Cussing is a hard habit to break, but anyone can do it."
California lawmakers will now test Hatch's theory. Portantino and his staff have supplied each of them with a "cuss jar." Those who let a foul word slip are encouraged to deposit money into the jar as penance.

My first thought upon reading this, of course, was how much I wanted to punch this kid.  The more I thought about it though, the more I realized the cuss jar thing was a more constructive proposal to deal with California's budget crisis than anything I've heard come out of the mouths of Assembly Republicans. And cutting out the cussing to stop drug abuse can't be any less effective than anything our legislators have come up with to date. Perhaps The Little Pansy Boy wasn't wasting our lawmaker's time. Perhaps... he was on to something. I decided to take a trip to a meeting of his No Cuss Club in my imagination to see what I could learn.

As I entered the meeting room the no cuss crowd was in the midst of a heated debate.

"I love my mummy more!!"

"NO!! I LOVE MY MUMMY THE MOST!!!"

"Can't we all just agree to love our mummy's as much as we can?"

"Yes!! Everybody wins!! Yay!"

"McKay, I have a question"

"Yes Bartholomew"

"People keep calling me a puss. Is puss a bad word?"

"Well, according to the dictionary I keep in my pocket at all times, 'puss' is another word for 'cat.' They must be calling you a cat."

"Yay!! I like kitties!"

"Let's talk about our favorite book now" said McKay, to which everyone in the room responded in unison:

"LITTLE WOMEN!!!!! YAY!"

"All the sisters really loved each other" said Bartholomew "And my brother said Theodore was a big puss, which means he was a giant kitty!! Yay!!"

"YAY!!!!! Shouted the entire room.

This was more than I could take. Start a lame campaign to stop people from cussing if you'd like, but Little Women is the worst book ever. At this point in my imagination, I walked to the front of the room holding a glass jar, sat it on a desk, put in a ten dollar bill, then told all those little fucking cocksuckers that I would see them on the fourth floor of hell.

Because getting through this post without a cuss word would have been exactly what McKay Hatch would have wanted.

I am going back to the real world now. I suspect if McKay Hatch stays in his he may grow up to be president of APhA.

Fucking puss.