Tuesday, July 22, 2008

I MISS SOME OF YOU PHARMACY BLOGGERS

I keep checking for new posts on these blogsites, but no go, nothing new for months. I miss you guys---you were great when you were writing, but you haven't been writing in a loooong time.  Where have all of the following authors gone?

Not Another Disgruntled Pharmacist

PharmBarbie

Secundum Artem

The Politically Incorrect Pharmacist

What's That Sig?

The Apathetic Pharmacist (yeah, tell me about it!)

I hope you'll come back to your keyboards soon.  The world of pharmacy needs you to keep stirring the emulsion!
Posted by oleapothecary at 17:13:41 | Permanent Link | Comments (3) |

Sunday, July 20, 2008

PHARMACISTS SHOULD NOT GIVE THEIR STORE OF KNOWLEDGE AWAY

"Knowledge is power," said my sixth-grade teacher. "Your knowledge
can't be taken away from you." That is, of course,as long as you don't
relinquish your knowledge so freely that you might as well be condoning its theft.
Under the guise of "service"---usually in service to our employers
rather than our patients--we pharmacists have abandoned the idea of
having any kind of practice philosophy. Regardless of the situation, we oblige
every request for information presented to us. Why, oh why, have we been
doing this?

I am a client of a physical therapist with a small local empire of P.T. centers.
At my first visit, he assessed my condition and authored a treatment plan.
Today, I imagined something. What if he, knowing me to be a pharmacist, 
approached me as I lay on one of his cots, and asked me if his
medication profile (scribbled on a Starbucks napkin) contained drug interactions?

My proper response should be, "Well, Joe, I think you should route these questions to your regular pharmacist.He/she is the one with the full custody of your medication history, and can best advise you."If he persisted, I would add, "Joe, if I were not your client  in physical therapy, would you consider it good practice to advise me on the best exercise for vague pains, and would you advise me without charge? You're certainly charging for today's therapy for me." But, no! Had I not thought about what I was doing (which I usually don't in these instances), I would try being a good egg for this guy and tell him everything I know about his medications---information he might expect to pay for if he got it from his doctor!

But, you should expect my imagined, thought-out response from a physician, attorney, plumber, engineer, nurse, or any other skilled professional you try to buttonhole on the street. Pharmacists should join this club, and fast!

This approach should also apply to acquaintances, and for people you receive
cold calls from, who don't get their pharmacy services from you. Refer them to
the pharmacist who filled the prescriptions in question, or invite them to
bring their prescriptions to you. Do you think you are being cruel or selfish
by doing this? Think for a minute--you sometimes expect to pay others for information, but you are robbing yourself by giving away your own professional expertise just for the asking! 

You expect the "make an appointment" response from a physician, attorney, plumber, engineer, nurse, or any other skilled professional you buttonhole on the street and
attempt to milk for precious information. Pharmacists should join this club,
and fast!

Knowledge is not only powerful, it is valuable in coin of the realm. If we
continue to give away the knowledge we cultivated so carefully through our
costly, rigorous education and training, we will devalue our profession to the point of its extinction. Just a few legislative changes, plus a few shifts in public
opinion, and we shall be replaced by some very good automated
dispensing machines.  Wait until Walgreen and Diebold really start
talking!

Posted by oleapothecary at 20:33:52 | Permanent Link | Comments (0) |

Monday, July 14, 2008

THE OLE' APOTHECARY'S BOOK OF BABY NAMES

In eight years of working in a hospital with a nursery and a pediatrics ward, I find the given names being chosen for newborns in recent years to be extremely bland. In fact, the issuance of these dull names has been going on for about a quarter of a century. So, after considerable reflection and numerous yawns, I'd like to write my own "book of baby names."

If you wish to be certain that your child's name has not been duplicated since the Bicentennial, please consider choosing from the following lists:

FOR BOYS: David, Michael, Paul, Andrew, John, George, Philip, Henry,Christopher, Charles, Mark, Robert, Samuel, Leonard, Arthur, Harvey, Theodore,Neil, Bradley, Albert, Martin, Gary, Stanley, Steven, Gerald, James, Bruce,William.

FOR GIRLS: Mary, Jane, Linda, Angela, Cheryl, Evelyn, Ellen, Helen,Karen, Marcia, Ann, Judy, Alice, June, Nancy, Christine, Lisa, Donna, Eileen, Kathleen,Ruth, Lois, Barbara, Patricia, Margaret, Elizabeth, Joan, Pamela, Sharon, Marilyn,Shirley.

Not only will these names stand out from those in the current repetitive pack, but they have one added advantage---they will be instantly recognizable,and will only need to be spoken once in order to be understood. . .

That is, unless so much time has passed that people don't recognize them any more. This may have already happened to me. My name is one of those listed in the boys' column above, and, this year, I did have one cashier ask me to
spell my one-syllable name.


Posted by oleapothecary at 17:45:04 | Permanent Link | Comments (3) |

Saturday, July 12, 2008

WHERE DO I SEE MYSELF IN FIVE YEARS? WELL, SIR, ACTUALLY, I HOPE TO BE HELPING AN OLD TATER FARMER.

In 1976, Greyhound was offering a bicentennial deal on its bus service. For $76, one could travel any distance in the Greyhound system for seven days. They called it the 7-day Ameripass.  Thinking this plan was better than sliced bread, I bought the ticket to the magic bus to get to my grand interview at what was supposed to be the best post-graduate Doctor Of Pharmacy degree program in the Nation at the time.  I remember thinking that my great Jack Kerouac imitation was supposed to be my commitment to the holy path of clinical Nirvana. 

I am a lifelong non-smoker, and that year, smoking was still allowed on buses, but only in the first three rows: BFD! For 24 hours each way, I suffered at the hands of those constant puffers and the eternal white line of the Interstates that crossed the Midwest.  I  felt I would be justified if only I could reach that distant campus for my opportunity to bow down at the feet of the white-coated pharmacy professorial sages who held the key to the evidence-based treasure of treasures, something I could not actually name then or now.  Doesn't the Old Testament forbid worshipping a graven image? So, I was a blasphemer from the start.  

Somehow, I remember packing enough for an expedition to climb Everest. I recall hauling around this big suitcase for three lousy days' travel.  Once on the campus, I would be shuffled around to 10 different personages (what did Revelation say about those guys sitting on thrones?), one of them apparently a member of the USP (now I know how Winston Smith felt in George Orwell's 1984, when he knowingly met a member of the Thought Police).  That standard bearer asked me, "Are you religious?" Heaven knows what I must have answered. Six out of the divine ten must have asked me, "What do you see yourself doing in five years?"  There seemed to be no "now," but only the immediate building of a curriculum vitae.  The craziest moment was when I met an officer of the institutional pharmacy itself, and he asked me if I would be ready to help manage a Pharmacy and Central Sterile Supply (combined in one operation.)  I said I was.  At the time, I had not done any more as a pharmacy intern than run a cash register and repackage Motrin.  Heck, knowing what I know now, I wouldn't want to work as a housekeeper in a combined pharmacy/CSS!

Professionally, emotionally, and philosophically, I was in the wrong place making that interview visit.  The 24-year-old version of me was greener than a Maine spruce, and, two years later, Maine is where I would arrive at, and comfortably so.

I was really a lover of simplicity and peace, not academic pomp,  and the people of Maine potato country were very much to my liking. But for a few strange occurrences, I would be living and working there today.  One of my customers was a farmer who would drag himself into the store once a month or so and request "half orders" of all his prescriptions, and pay cash.   Sometimes he would drop cigarette ashes on my counter during his struggle to set down his empty drug vials.. Turns out he would die during my few years there.but I hope I provided him with some friendship and guidance during his last, stubbornly lived, days on earth. 

To the high priests and priestesses of pharmacy and philosophy who behaved like little Torquemadas toward me that day three decades ago in their attempt to determine whether or not I was worthy of a coveted place among them (thank the real God that I was not), I want you to know that I was accepted into a much better realm than yours.  By the way, are you religious? Then, I refer you to Psalm 24, which states, "The earth is the Lord's." That means it's not yours.
Posted by oleapothecary at 02:01:41 | Permanent Link | Comments (3) |

Wednesday, July 09, 2008

IF I CALL IN SICK, CALL THE CORONER

I called in sick one day in November of 1979, when I spent the entire morning puking up an Italian sandwich. The next time I called in sick was for two days in the winter of 1985, when I had a severe case of influenza.  After that, I did not use another impromptu sick day until February 2005, when I had the worst case of flu in my life: cough, congestion, fever, and no way to get comfortable. I felt like one of the characters in the film Outbreak. Finally, I had to call it a bad day in November of last year, when severe sinusitis sent me to the E.R. and not even I.V. Dilaudid could touch the pain.  Total number of days called in sick in my 32-year pharmacy career: five.

Now, read http://www.foxnews.com/story/0,2933,377901,00.html.  In Connecticut, a second-grade teacher calls in sick. What does she do? Spend the day coughing and puking in her bed? She goes on the Howard Stern television show in a bikini, with her husband! 

At my previous employer, people used sick time like vacation time.  When I would come in to work on Fridays and Mondays, I would always get especially tight in my diaphragm, because I would never know where I would end up with all the absenteeism.  The boss called the sickness "Mondayitis." I never caught it; I just do not believe in using that company benefit for other than that for which it was intended. So, being blessed with good health, I am seldom on the phone announcing my absence to my supervisor. One can assume that if I cannot come in, my death may not be a rumor. If I can think, I can work. The five days in question were days on which I could not think. Vomiting, fever, and extreme pain are not conducive to my practice of pharmacy.

But, there is another side to this philosophy, as many pharmacists will testify.  I, and we, could probably be a lot kinder to ourselves when it comes to sickness.  Having the ability to think as my criterion for coming in to work does not mean that I work comfortably.  Working with a throat on fire, or a feverish, headachy feeing in the absence of fever, or with a bad headache that Excedrin will not relieve, is unfair to me. I could use the time off, but I persevere for the sake of continuity among my co-workers and the pharmacy department.

Jim Plagakis dealt with this issue in a recent post on http://www.jimplagakis.com. In "Pharmacy Is Not For Sissies," Jim tells of the chronic wear and tear on pharmacists' bodies that is the result, not only of our stoic nature, but also of our toleration of working conditions that the rest of the working world would stage a demonstration against call out the legal eagles and the Industrial Accident Commission over.  The Pharmacy Alliance (TPA, see www.thepharmacyalliance.com; you should join!!)  wrote 14 principles to deal with our emotional and physical pain, and soon will probably be concentrating more on the physical injuries we must start addressing.

Remember the old joke, "Any employees found dead in a standing position will be sent home?"  I think of the Ole' Apothecary every time I run across that. 
Posted by oleapothecary at 00:00:41 | Permanent Link | Comments (2) |

Friday, July 04, 2008

GIVE ME THE SPACIOUS SKIES, TO BE AT LIBERTY

Call me a jingo, a chauvinist, an Archie Bunker, a nationalist, a flag-waving, love-it-or-leave-it super-patriot. I am all of those things, and proud of it.   In Afghanistan, people eat grass for breakfast.  In China, people can only have one baby per family.  In the Zaire version of the Congo, women are raped wholesale.  In much of Southwest Asia, women are the property of their husbands and must hide their faces and bodies.  Poverty and tyranny rule much of the world.  But here, despite the flaws we try to measure with a cracked ruler of political correctness, we are, nevertheless,  at liberty: to become, to grow, and to have.  The protection of our Constitution is celebrated in Franklin Roosevelt's Four Freedoms:  of speech, of religion, from want, from fear. These freedoms are on my bedroom wall, in the form of Norman Rockwell's painted representations of each.  Okay, Rockwell is no Jackson Pollack, but, to me, Pollack was no more of an artist than pollock is crabmeat.

Our government runs a lottery periodically.  No, not the lottery for mega-millions of dollars, but for something far more precious in the world and in the world's history. They hold a lottery for the right to live here. In other words, the chance to become a citizen of the United States of America is something that some people regard, literally, as a prize to be won.  Should that not move those of us who won that prize in our birthday suits to cherish it all the more?  Isn't that another truth we should hold to be  self-evident?

Go ahead and throw some P.C. muck in my face; I am expecting it.   This is my safe celebration of the fourth of July in my Texas county, where an historic drought has caused the sale of fireworks to be banned.  I launch some rockets' red glare with words, and will continue to do so.  God stand beside her and guide her!
Posted by oleapothecary at 00:54:00 | Permanent Link | Comments (1) |

TTHE WORST TIMES OF MY PHARMACY CAREER--A GLUTTON FOR PUNISHMENT

Earlier, I observed the completion of more than three decades as a pharmacist. Tonight, I contemplated that, despite the usual shortcomings of any job, my present position is the best of the lot.  I can sure tell you about the worst times, though.

They weren't in the chains, or in a busy, indifferent hospital. They were had during two part-time relief missions, one in a small indie, the other in a small-town hospital.

In the first instance, more than 20 years ago, I was doing a favor for a friend. This was a classic Rexall on the town green. I thought I would enjoy it; after all, I started my career in a small town, but the difference was that my first boss was a Mr. Chips.  This fellow turned out to be a stinking-to-high-heaven tyrant.  This was the start of the computer age, and the fellow's computer "system" was out of a Tandy kit.  It's been along time, but I remember my tapping away on the keyboard with him prompting me, "No! No!NO!" (he was there getting me ready to take over during vacations; he'd never get it). Then, he had me fill out his universal claim forms in his own way, and when I put in a number wrong, i.e., not his way, he'd bellow at me.  I hadn't had enough sleep, and had just been through my own first computer learnin' a month before. I didn't need this job. At 11:00 that morning, just two hours into the shift, I told him I had had enough, that he probably needed to get someone else. To my shock, he answered, "Sure. I understand."  He knew he was being a bastard, but I was in no mood to take it. (Maybe you could, but I couldn't. At least I admitted it after only two hours.) He reached into the cash register and paid me some money.  Never in my life was I so delighted to leave a building than I was when I left that one and drove home a free man from this tin-horned dictator to whom I had almost committed a pastime. I had a friend at the time who was a precious metals dealer, and went right to his office, put down my money from Hitler's pharmacy, and bought three troy ounces of silver. Later that day, I locked those three coins away. I still have them! I would no more part with them than part with my own scalp. I had to show something for that dumb torment I put myself through. Well, look at the price of silver today.  Turned out also that that mo-fo would be cited later for unprofessional conduct, to whit, sexual harassment.

The hospital of the second "job from hell" was a 30-bed rural institution I was supposed to cover on Christmas week.  It was only a two-day assignment,  also almost 20 years ago, and I had already been there that summer on behalf of my agency, but that turned out not paying off at all in terms of experience.  As soon as I arrived, the computer system went down!  I had to call in the health information coordinator, and it turned out that she had to stay with me four hours each of those two days to get the system up and down and up and down.  It was a crude system that you had to launch from a DOS prompt and enter several arcane DOS commands to do so.  I don't recall having a graceful moment, fielding phone calls for half-entered or un-posted orders and struggling to get the carts filled (there was no technician).  At one point, I just bellowed at the H.I.S. coordinator, acting, myself,much like the jerk in the first story. My accommodations were on a hard patient bed in a room reserved for such agency people as myself.  I wish I had bought platinum, not silver, with my salary from this gig!

In both instances, I remembered these jobs as being nightmares come true. The sense of hopelessness, frustration, and even violence reminded me of bad pharmacy dreams I had had in years past and survived by waking up from them. Each assignment gave me the sense that they were not worth the earnings.  For these jobs especially, I "shoulda stood in bed."  I'm sure that, over the years, there were other moments I took it on the chin when I shouldn't have.  Gluttons for punishment and indignity, we pharmacists are.
Posted by oleapothecary at 00:21:48 | Permanent Link | Comments (2) |

Tuesday, July 01, 2008

SIMPLICITY NO LONGER ALLOWED

I fear I have quoted Thoreau too often here, but "Our lives are frittered away by detail. Simplify, simplify." is one of the codes of my life.  Ole' Henry David could not have stood in the shoes of the Ole' Apothecary and remained sane. He would have seen so much of his beloved ease and common sense eroded rapidly. 

I recall this:

Nineteen seventy-eight. A new patient comes to my window with a handwritten prescription for ampicillin 250 mg po qid #28 from a local doctor.  I obtain his demographics and he hands me a Medicaid card. My technician rushes forward with the drug and a form. She is typing the label on our manual typewriter and counting out the capsules while I counsel the patient. I check the final product and hand it to the patient with an official receipt handwritten on the bag. There was no co-pay and no online adjudication in those days (the claim might be rejected weeks later, but usually not if I have a permanent Medicaid card and not a temporary one).  Time for this whole from arrival to departure: about 3 minutes (faster than that if it was a cash sale; the prescription would retail for about $3, and this wasn't the "generic deal" of today--the average retail price of a prescription at the time was $8). The technician would complete the Medicaid claim form later, and also later, manually post the prescription information on a paper profile card.  There were no drive-thrus or cell phones. No touch-tone phones yet, either.

Well, not every patient encounter went like that, but it was possible.  Why counseling in 1978? That state passed a counseling law in 1975. We were doing it when it wasn't cool. 

Also, the cash register was analog, not digital. If you have ever seen one of those, it was because you are as old as I am or you ran across one in an antique shop or at a swap meet.  This thing would make a lot of noise, too, almost like a machine gun.  On You Tube recently, I saw a cute video of a fellow complaining about the size and complexity of today's cash register receipts. I identify; in the day, ours was a little strip of paper with the price of each item, the total, the amount tendered, and the amount of the change, plus a date. End of story. Oh, yeah,  I think the company name was on there somewhere, too.

So, compare to our frittered-away lives of 2008.

Posted by oleapothecary at 21:02:20 | Permanent Link | Comments (0) |

Saturday, June 28, 2008

THE OLE' APOTHE-BLOG IS A YEARLING TODAY: OH, DEAR!

So, I joined the vast blogosphere on June 28, 2007, one year ago today. This has certainly been fun. I'm going to delete the whole thing right now--NOT.  Thank you very much, everyone who has commented.  This has been, and shall continue to be, a source of enormous pride, release, and insight for me. I wish I had this pharmacy blog, and the other pharmacy blogs I have read, as reference works when I was starting out; I could have used their collective wisdom, and, who knows, what I have read here might have redirected my career a long time ago.

To the likes of The Angry Pharmacist, The Angriest Pharmacist, Pharmacy Chick, Pharmacy Mike, The Drug Nazi, and the late, great Pharmacy God, I say, thank you for keeping me well informed of the nature of community pharmacy practice in the 21st century, because I left it long before the 20th century ended, and thanks to you, I am able to list the following as non-negotiable conditions for my return:

1) $100 hourly wage
2) daily, uninterrupted, external (i.e., Elvis gets to leave the building) 1-hour meal break 
3) third-party ombudsman pharmacy technicians
4) personal receipt of all MTM reimbursement I file for
5) immunity from frivolous customer complaints
6) limit drive-thru transactions to prescription-related products only
7) in-pharmacy toilet facilities

Give me another year, and I'll probably add to the list.  And, even with these, you'll have a long
wait until I make up my mind. 

On to year two!
Posted by oleapothecary at 02:05:52 | Permanent Link | Comments (1) |

Thursday, June 26, 2008

PSEUDOEPHEDRINE AGAIN: TOWARD CRIMINALIZING A STUFFY NOSE

I can't help it, but I'm coming back to this. This is the endpoint irritant of disrespect to all community pharmacy professionals, and I do not care about the presumed legalistic virtue of it: the "controlled-drug" status of pseudoephedrine.

Our national government has put this excellent over-the-counter drug, not just in the status of a potential threat to public order, but in the status of a potential threat to homeland security! The federal law governing pseudoephedrine sales is part of the USA Patriot Act. Because of Al Quaeda, you are now, in some semblance, a potential terrorist if you seek relief for a stuffy nose.

Of course, sales of pseudoephedrine (PSE) have been restricted because the drug is a precursor in the manufacture of the illicit and fiercely addictive drug methamphetamine (meth), certainly the scourge of the Nation, but now also the scource of pharmacy operations from purple mountain majesties above the fruited plain and sea to shining sea.

This isn't maudlin sentimentality, but real chagrin. I don't like the idea of a popular, effective, nonprescription medication becoming hard for ordinary, law-abiding, upper respiratorily challenged U.S. residents to get, and also having this happen in the new century. It goes totally against the grain of an Ole' Apothecary who has been the custodian of similar jurisprudence from former times. Why add to it? Have you ever heard of the so-called "exempt narcotics?" They were exempt from narcotic tax, but also exempt from prescription status. In the modern era, they are Schedule V controlled drug products which, in some states, can be bought without a prescription but must be purchased similarly to pseudoephedrine: the purchaser must be at least age 18 with proper ID, and must sign his or her name and address. Examples of these are Robitussin-AC, Tussar-SF, and Novahistine-DH codeine cough syrups, and (before they went off the market), the antidiarrheals Parepectolin (kaolin/pectin plus paregoric) and Donnagel-PG (belladonna alkaloids with paregoric). Folks bought these easily enough, and in early times, they were seldom abused. But, pseudephedrine isn't even directly abusable. Take a handful of Sudafed 12-Hour caplets, and you'll get rather agitated, sweaty, and tachycardic, and your blood pressure will crack the mercury column. So, you won't seek that feeling again.

The problem is with the illicit drug makers and dealers. Prior to the federal and state regulations, these folks were able to obtain PSE by the carload for processing into meth. Surely, the sale of the drug must be monitored: I am in total agreement with that. But, I say, why must the task be thrown to the already strapped, busy, clinical staff in the pharmacy? Front store staff are perfectly capable of checking the IDs of PSE purchasers the same way they do for tobacco, beer, wine, liquor, or firearms ammunition. We need our technicians to help us fill prescriptions without the PSE interference, so we can more efficiently handle our professional duties of drug use evaluation and counseling.

I have occasional sinusitis, so today's PSE post was inspired by my visit to the local fast-food pharmacy for measured relief. I stood in the roped off HIPAA line for a few minutes, then stepped forward with my drivers license in hand, and asked for my Sudafed 12-Hour caplets. The technician-trainee filled out his little booklet slip and had me sign it, and I received my receipt categorizing the sale as "AGE RESTRICTED - LIMIT REACHED." The pharmacy staff all looked pretty tired and nervous, but somebody must still be stuck with this behavior-control scut work, and one needed pair of hands was taken away from the practice of pharmacy and handed over to pure law enforcement.

It may now be a crime to want freedom from rhinorrhea.
Posted by oleapothecary at 00:04:52 | Permanent Link | Comments (0) |