Saturday, August 27, 2011

If You Listen Closely, You May Detect The Sound Of A State Board Growing A Pair.

"I thought I was too jaded to get excited by something like this, but I've got to admit it lights a fire under my balls to think a state board might have the cajones to step into the ring with any of the big retail chains." So says the alert reader who forwarded this copy of a survey sent out by the Iowa Board of Pharmacy. We shall see.........

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Please take a few minutes to fill out this opinion survey on pharmacy closing rules. The Iowa Board of Pharmacy welcomes your feedback and your answers will be kept confidential. Thank you for your participation.

All responses will remain anonymous and will only be reported in the aggregate.

Do certain pharmacy business practices (such as 15-minute prescription guarantees, incentive coupons to transfer prescriptions, quotas on # of prescriptions dispensed and time to complete DUR, and pharmacist/ technician staff cuts) interfere with the pharmacist's ability to serve as the safety net in the medication use process?

Should boards of pharmacy set a rate for maximum average number of prescriptions dispensed per pharmacist per hour?

Should boards of pharmacy require that individual pharmacies/pharmacists-in-charge determine and document, in policy, a pharmacy-specific maximum average number of prescriptions dispensed per pharmacist per hour?

If yes, should the pharmacy/PIC be required to regularly monitor that rate and make staffing adjustments as needed to comply with their own policy?

Should pharmacy companies be allowed to offer incentives (such as coupons and other promotions) to encourage customers to transfer prescriptions?

Should pharmacy companies be allowed to advertise guarantees on the amount of time in which prescriptions will be dispensed?

Should pharmacy companies be allowed to set quotas or time limits on the amount of time it takes a pharmacist to perform patient care responsibilities, such as DUR and patient counseling?

Agree/Disagree

Advertising or soliciting for patronage is not in the public interest and is a grounds for discipline if it offers bonuses or inducements in any form other than a discount or reduction in an established fee or price for a professional service or product.

Agree/Disagree

A pharmacy shall not guarantee, promise, advertise, or in any way promote the dispensing of a prescription within a specified time limit or period that would jeopardize the health, safety, and welfare of the patient or the ability of the pharmacist to complete the pharmacist's professional responsibilities including, but not limited to, drug use review, patient counseling, and verification of the accuracy of the prescription.

Describe your typical workload in the pharmacy:

Do working conditions adversely impact your ability to practice pharmacy safely?

How long is your typical work shift? Indicate time period in hours:

Do you receive a break during your shift? If yes, indicate length of break in minutes:

Should pharmacies have a required meal break for pharmacy staff?

Should pharmacies have policies regarding workload?

Should pharmacies have policies regarding working conditions?

Should pharmacies have policies regarding maximum work shifts? If yes, should pharmacies have a specified maximum shift for pharmacists?

What type of practice setting do you work in?

Mail (or fax) completed surveys to: Iowa Board of Pharmacy 400 SW Eighth Street, Suite E Des Moines, IA 50309-4688 FAX: 515-281-4609 http://www.iowa.gov/ibpe/index.htm

Thursday, August 25, 2011

Today's Flu Shot Follies

The conference call. I don't have to explain to a good chunk of you the futility of the pharmacy conference call. A unique opportunity to touch base with the corporate mothership and cover important business issues of the day. A chance to listen and share with colleagues. To communicate and learn.

While filling your normal amount of prescriptions of course.

And fielding customer questions.

And taking phone calls. On the other line. While the conference call is going on. You get the picture now if you didn't before. Under the best of circumstances, you'll get about half of what is said on a conference call.

Now is the point where I would play you a sample of my District Manager's voice if I could. She has a very strong and unique accent the like of which I have never heard before. I have wondered at times if it isn't actually a speech impediment, but it would probably be rude to ask your boss if she's had a stroke or something. Anyway, under ideal conditions, I can understand about 70% of what this woman says, put her on a conference call, and that'll easily go to under half.

Which means, at best, I'll get about 25% of the information that goes out on a conference call. I'm just very lucky to work for a company that never says anything important.

Today's conference call started with something to do about trash I think. Sorting the right trash into the right containers or something. We've had to make sure any trash with anyone's name on it is separated from the regular trash for over 5 years now, so I'm not sure what might have changed. Good thing I don't care very much or I probably would have been upset I missed out on the whole trash conversation while trying to explain to a moron how they were to take their prednisone. The moron's doctor was really asking a lot of the moron with the instructions he came up with, but I think I got the moron straightened out. When I got back to within speakerphone range the subject had changed to flu shots.

And the flu shot quota, which I've noticed has changed three times since originally imposed.

"So when you're asking your customers if they'd like a flu shot, what kind of reasons to they give when they say no?" Asked my district manager.

I decided that she kinda sounds like a pirate.

"Some people are saying they're worried it's too early in the season." Piped up a pharmacist somewhere who was taking this way too seriously.

"A lot of people are telling me they've already got it at their doctor's office." said another.

"OK then" said the pirate. "Pharmacist Nerd, you've given out the most shots in the district so far, so you must have a lot of experience dealing with people's concerns. What do you say to your customers that say it's too early in the season?"

"I just tell them that we've checked with corporate and they say it's fine" said Pharmacist Nerd, giving us all some goddamn valuable insight.

I noticed now that my Supertech was starting the paperwork so we could actually give a flu shot to a customer while these numbnuts sat around and talked about it.

"Very well" goes the pirate. "And Pharmacist Nerd, what do you say to your customers who tell you they already got it at their doctors?"

Which was the point where I hung up. Which I regret. Because I would have loved to have heard Pharmacist Nerd's answer as to how we can sell a flu shot to someone who's already had one.

Only seven months of flu season to go.......

Tuesday, August 23, 2011

Of Puppies And Rainbows And Consequences And Reality

I remember the moment like it was only yesterday. It's not often you get the feeling that you're living in a world where things are breaking your way, especially if you're me, especially when I'm dealing in things work related. But there I was in a momentary place where every child has a puppy and rides around on a unicorn that shits out rainbows. Representatives of my employer were actually giving positive encouragement to rank and file employees. They had given them both a challenge and the tools to meet it, and most disorienting of all, had acted pleased when the challenge had been met. I had just graduated with the absolute last class of immunizing pharmacists in my company, and while there were smiles and back slaps all around, I knew what would be coming next.

I remember that moment like it was yesterday because it almost was. In less than three months the positive encouragement has morphed into business as usual. THE FLU SHOT NUMBERS SENT OUT IN LAST MEMO WERE NOT A GOAL, THEY WERE A MINIMUM!! ALL STORES ARE REQUIRED TO MEET THESE NUMBERS AND THERE WILL BE CONSEQUENCES FOR THOSE THAT DO NOT!!! I was genuinely shocked....that it took them this long to return to normal. I rolled my eyes, deleted the message, then walked over to the shelf and broke the seal on a bottle of Jalyn that had been gathering dust and was ready to be sent back to our wholesaler. A little harmless Lordstown syndrome is good for the soul when you work in retail pharmacy.

Thing is, it takes awhile to realize that being a retail pharmacy manager in turn of 21st century America is a setup for failure. That taking your corporate office seriously is a recipe for insanity. The game of unreasonable expectations is one that is played in every major chain, but it takes a few years of browbeating before it usually sinks in. My pharmacy manager isn't there yet, and I can see the stress on her face, aggravated by the fact she's here on a work visa. She's fired and she's also deported. So she's desperately toeing the company line, practically begging everyone who sets foot in the store to get a flu shot. I'm passive about the whole thing, if you want a flu shot, I'll make sure you don't leave without one, but I'm not about to bug your life to talk you into it. I've got plenty of other shit to do.

So far this week I have given 10 more shots than my stressed out, desperate pharmacy manager.

Because she also doesn't realize that the bullies from above, like most bullies, aren't very smart. That their suggested way of doing things rarely matches with what works in the real world. That if you really do want to give more flu shots, their MANDATORY PROCEDURE probably isn't the most effective way to do it.

So the pressure will build and the stress will rise, not only for my manager, but for like minded de-professionalized professionals throughout the company. We've had pharmacists crack under their pressure before, committing fraud regarding some sort of customer service survey and having to write a letter of apology in the company newsletter. Others that got fired over bending the rules when the frequent shopper card came out. If the bullies from above were able to break people over unimportant crap such as that, you know what's going to happen when the type of dollars to be made giving flu shots is on the line.

Someone, somewhere, is going to start making up false flu shot prescriptions to get the bullies from above off their back. I'm calling it right now. And if those false flu shots involve Medicare, which would be the easiest to do since Medicare flu shots have a zero co-pay, whoever does it will be aqua-fucked. Because that person will have just defrauded the federal government. That person will face fines and banishment from the Medicare program, making them unhirable, while the corporation that broke them with prescriptions on a time clock, lists of phone calls that MUST be made, staff cuts and sheets of unobtainable goals will at most, get a slap on the wrist.

It's not worth it. Learn to ignore them my friends, or at the very least, accidentally knock a few Lipitor tablets into the trash with every memo.

Wednesday, August 17, 2011

One More Reason I Am An Al Franken Groupie.

I think it's around a minute 30 I start to swoon. Oh to have an entire Democratic party of Al Frankens.....




 

Wednesday, August 10, 2011

A Random Speed Dating Story From Long Ago.

Those of you on the market know what it's like out there, and those of you who aren't probably aren't anxious to be reminded. The hard work, the constant pressure to perform, the degradation and humiliation, not to mention the expense. Trying to get laid my friends, is the hardest job you'll ever love. Kinda like being in sales with occasional orgasms.

The humiliation part was well in evidence as I walked into the kiddie club. The speed dating event was being held in a place that normally attracted a crowd that needed to be well versed in ways to trick a bartender into miscalculating the number 21, so it was incredibly obvious when one of us approached. "Upstairs and to the left" the bouncer said without looking up or so much as a word from myself. I shuffled up to the geriatric corner and hoped it wouldn't be as bad as I feared.

It was. Fat, old, weird, ugly and stupid filled the room. Everyone in this place had an obvious defect and I started to wonder to which category I belonged until I looked into the far corner and saw the exception. Long blond hair and the most elegant air about her you could imagine. Older, yes, but in a way that made you think classy. Worldly. Wise. And experienced in ways that would surely rock my world. The long sleek evening dress cried out to the world that she was the prize this night, and as I looked around at my male competition, a good portion of which was huddled in the opposite corner talking among themselves like this was a junior high dance, I was confident the prize was mine for the taking. I walked over and made a little small talk before the event officially started. It went well.

For those of you not familiar with how these speed dating things work, I'll give you a quick primer. Every lady sits at a table and every guy is assigned a number, guy number one goes to table number one, two to two, and so on. A bell is rung, and for five minutes each couple makes a little small talk until the bell is rung again, at which point the guys move along to the next table in line. It soon acquires the feel of a boxing match. My prize was to be the last lady I would talk to that evening, which would be perfect. I would look positively stunning after she sat through the other 12 numbnuts in the room, and the setup would be perfect for me to suggest we round out the evening by going to the grown up bar down the street. I don't have to tell the single among you what the dry spells are like, but when they break like a welcome drenching thunderstorm in the heat of July, I also don't have to tell you the feeling is among the most ego-gratifying in the universe.

I worked my way through the lesser women with the required subtle politeness. No use burning my bridges, even with the 280 pound redneck with eight... yes eight, children. Hope springs eternal, and she could lose custody of them and have a gastric bypass one day. The anticipation built as the night went on though, to the point where I admit it was hard to concentrate on the woman before the prize. I think she said she raced cars in her spare time, which under normal circumstances would have been pretty interesting. Tonight though, I was meant for more. The bell rang and my heart quickened.

I swear she looked even better than a mere hour ago. I hadn't noticed her smile and her perfect teeth. I realized that smile might be a sign she was glad to see me as I sat down. I was starting to feel something I hadn't in a long time. Happy.

The conversation started with the usual stuff. "So, where do you work?" naturally came up, and I told her about my exciting career in the happy pill room.

"Oh, I was in there once, I asked the pharmacist where the Q-Tips were and he was kinda rude"

"What were you doing asking the pharmacist about Q-Tips?" I instinctively shot back. I will mention here that I am the only man that works behind the pharmacy counter in my store.

The rest of the five minutes passed by in silence, and I went home alone and content.

An Ode To Darvocet, We Knew You Far Too Long.

I've never filled your space on my shelf, dear Darvocet. For so many years I knew that I could reach behind me, to my left and slightly above my head, and you would be there, ready to step into the battle against mild to moderate pain.

Not that you would do particularly well in that battle, but if they gave out grades for effort my darling Darvocet, we all know you'd get an A+

Maybe that's why people liked you so much. Kinda like Pete Rose, you took the limited talent you were given and mixed it with an oversized work ethic, jumping into the fray day after day to improve your skills and gain a competitive edge. Except Pete Rose was successful, eventually becoming baseball's all time hit leader, and you worked just a little better than Tylenol alone. Now that I think of it, your addictive properties probably had more to do with why you were so popular.

Habit forming as you were though, I always loved your sense of humor. The way you would change from white to pink periodically. I'm pretty sure you did that just to fuck with the amateur drug dealers, more than one of which I witnessed trying to scrape off your pink coating in an effort to convince their customers nothing had changed. With every change of color we would get a spike of phone calls on Friday night from people who "found some pills" and wanted to know if we could verify what they were. You mischievous little narcotic you. You'll be happy to know Norco picked up on that trick of yours and continues to pull it off to this very day.

I'll also admit the adverse safety profile that eventually did you in was like a security blanket to me. For the better part of two decades, I knew that if things got too tough, that if the absurdity of the general public or the pressures of life in general became too much to bear, I could always just reach behind me, to my left and slightly above my head, take a couple handfuls of you, and be at hell's front door in about 40 minutes. I always make a note of where the phenobarbital is these days for just that reason, but it's not the same. I don't know why. Maybe because the phenobarbital isn't pink.

I hope you're doing well wherever you are these days dear Darvocet, and that  retirement is as good to you as you were to my profit margins. Who knows, maybe if the teabaggers continue their rise to power it may be decided that the right to have a slightly effective, cardiotoxic pain reliever on the market is a matter of personal freedom, and that banning you from my shelves is akin to pissing on the grave of John Adams himself. Maybe that's why I've kept your spot open, because I wouldn't piss on the grave of John Adams.

I would recommend that people just use the Tylenol #3 though, or maybe some tramadol.

Wednesday, August 03, 2011

Highlights From Friday's Pill Counting Action.

Asking me where the reading glasses are at work is the stupidest goddamn thing you can do. I don't say that because I don't think you should read. After all, the more people who make a commitment to getting some of their entertainment through the written word, the more copies of my book I will possibly sell. And it's not that I don't applaud you for making a positive change in your life in order to improve your vision. It's just that.....when I'm at work, I'm about 5 feet away from a reading glass display that is taller than I am, and I'm a taller than average kinda guy, and since you're probably between me and the reading glasses while you're asking....well....you get my point here?

"WHERE ARE THE READING GLASSES?" Said the first customer of the day. This happens about three or four times a week.

I also noticed we were starting off the workday at a relatively toasty 73 degrees. I've written before about our store's air conditioning troubles. They've been going on for well over five years now, but things had seemed stable of late, and I was almost ready to declare the long running situation resolved. Half an hour later it was 73.5 and I realized five years of air conditioning repair has gotten my employer nothing. I also noticed that our wholesaler's order had not shown up yet. We're very lucky in that we are one of the first stops on our wholesaler's delivery route, which means when we tell people something will be in tomorrow, we'll usually have it taken care of by 10 AM. It was now 10:30. You know what came next.

YOU GUYS SAID MY SUGAR MED WOULD BE HERE TODAY!!!

It was gonna be a long hot day. 74 degrees and rising.

At lunchtime I walked by the soon to be vacant Border's Express and thought about my last purchase there. I had been horrified to see the latest book by Philip Roth on the 50% off rack, and bought it mostly to save the poor book the embarrassment of being featured next to the latest work by Marie Osmond. I wanted to say something to the clerk about how we are lucky that Philip Roth consents to allow us to read his words at any price, but as I watched her struggle to count back my correct change and pop her gum at the same time I knew what that would get me. I remembered lamenting the state of literature in our culture back then, and I realized soon even bookstores manned by bubble headed bleach blondes will be gone. I resolved to be kinder to people seeking reading glasses.

I came back from lunch and found a man who had been waiting for me the entire time I had been gone. He asked for an emergency filling of his Cialis. This was the second time this week. A request for an emergency filling of a med for erectile dysfunction. I thought back to my recent CPR training and tried to remember if there was a part where I was supposed to have a boner.

We were now past the 75 degree mark and I got a warning from the computer that a prescription for temazepam, a habit-forming sleep aid, was being filled 15 days late. Makes me happy to know that Drug Utilization Review software is in there keeping my license safe.

I DON'T UNDERSTAND WHERE MY SUGAR MED IS!!!!!! This was the third time the lady waiting for our wholesalers order had called. She would call twice more, and when I phoned her to tell her it was finally here she said "Oh I'll just get it tomorrow." The temperature went from 75 to 78 very quickly, and it was now evening. The only possible explanation was that the goddamn HEATER was now on. I saw the assistant manager walk by wearing a jacket and realized I was on my own on this one. I called the air conditioner contractor and explained the definition of "controlled room temperature" that is on each and every pill bottle on my shelf. I explained it to their voicemail. I hung up and felt all hope melting away. Just like the polar icecaps.

"Where are the reading.....oh, never mind, they're right behind me!"

"At the end of every hard earned day", Bruce Springsteen once sang, "people find some reason to believe." I closed the gate and retained some small spark of hope for humanity.