The Ole' Apothecary

WHEN A FELLER NEEDS A FRIEND: THAT"S BECAUSE THE BUSINESS WORLD DOESN"T GIVE AN AIRBORNE INTERCOURSE*

oleapothecary — Thu, 21 Aug 2008 10:43:55 +0200

Followup to A Million Little Girls:

Want to fight back? Get personal! Make live telephone calls, or better yet, show up at the person's desk! They'll quake in their boots if they have to talk to you. God forbid that these people should have to get off their greedy asses and communicate with their clients! The entire business world is able to hide behind telephone trees or Web sites, and does not give a *flying fuck about you, me, or anything human or personal, except perhaps minus signs. Yes, if they see that money isn't coming in, they might communicate, but, of course, not directly. They'll send you a canned letter in the mail, and then, the boss doesn't care personally; he or she sends his or her minions out to do the communicating. Sorry, bosses, you better check up on these little girls. They are just not doing a man's job of communicating. Sorry, girls, there is such a thing as a man's job of communicating, but to quote my old science teacher's wise bad grammar, you don't know from nothin".

Here is an example. My pain management doctor simply skipped town, and the physical therapist he hooked me up with runs a McDonald's type operation run by--you guessed it, little girls, who apply the electronic stimulators and exercise plans for me, but do no follow-up. They never even asked me if I wanted fries with that. Well, today I gave Mr. P.T. a taste of his own communication style, and also a minus sign. I withdrew from his therapy (which, incidentally, is not helping), by e-mail, and didn't bother to call in to the little girls. The office manager, a lady like Cyd Charisse, was the only one who would even listen to me.

Somehow, I believe that if the pharmacist talks to his or her patients and shows communicative concern, the whole problem of adverse customer relations would be solved. In my day, I had no telephone tree or refill line to hide behind. When the phone rang back in 1978, I answered it (there was nobody else, not even a pharmacy "aide," as the company called technicians then). Yes, it was time-consuming to just take refill numbers over the phone, but I do recall the pride, the customer craftsmanship, and the patient-pharmacist relationships, that I had. I think I may have been among the last of the pharmacists called "Doc," the honorable nickname of the concerned drugstore druggist. Provided it looks safe to do so, go out in front of the pharmacy next time and, look the angry customer in the eye, and talk to the person. Just show you care, even if you show anger. Just show that you care. That's the missing ingredient. That is what makes people mad, that you don't seem to care about them.

I have a friend who hates the term "druggist," but now that term rings musically to me. "Druggist" meant "friend." Wasn't there a tobacco product whose slogan read, "When a feller needs a friend?" In this gimme-money-or-I-don't care world, he or she who is a friendly pharmacist has got to win! Same goes for doctors and physical therapists.

MILLIONS OF LITTLE GIRLS

oleapothecary — Wed, 20 Aug 2008 11:16:57 +0200

This is my Ole' Apothecary male gut reaction. Do not expect reason, egalitarianism, equal opportunity, or tolerance from my gut, or, for that matter, anybody's gut. Guts are not brains. They move chyme, bile, and feces, and the smell there must be awful.

I sense that the world is being taken over by little girls.

They are in adult form, age 20 to 50, but somebody, or some thing, is training them to look and act like undisciplined elementary school girls. They are pharmacy colleagues, they are people who answer the telephone, they are Megyn Kelly of Fox News, shouting, "Wait'll ya see this!" (is this supposed to be a journalist talking to me?) but I do not see them acting as poised, and yes, elegantly restrained, ladies. And, to boot, they insist upon chewing gum in my ear.

An armada of these junior-high-like females is conducting the world's business right now. They are behind most checkouts, most counters, and most telephones. At some time in this planet's past, there were finishing schools for women. What happened to Princess Diana's Institut Alpin Videmanette? Maybe the makers of Orbit Sugarless Gum got Diana out of the way so that the gum-chewing swarm of matured baby girls could take over.

If you are such an inchoate young woman, I tend to keep my distance from you. Go ahead, get out your bottle of Murphy's Oil Soap and clean up this issuance from my gut, but I warned you. Perhaps it is no coincidence that I am writing this in the year of the death of Cyd Charisse. Now, there was a complete woman! If you have to go to Wikipedia et al. to find out who she was, you are probably a 21st-century little girl.

Maybe if I was born in 1992 instead of 1952, I wouldn't notice this, and maybe my Mom and Dad saw these puerile features in me as I reached my adulthood. But, over the past 10 years, I have sensed a serious decline in adult features in adult women. Cyd may have taken her treasure to her grave. Rest in your rewards, beautiful dancer!

So, go ahead, tell me to get lost my top hat and tails and "put on the Ritz." I would if I could dance like that.

SOUL-SEARCHING FOR PHARMACY'S SURVIVAL

oleapothecary — Sat, 16 Aug 2008 17:04:05 +0200

In 1981, Tracy Kidder wrote The Soul Of A New Machine, a non-fiction account of young computer designers working for the achievement of it all. The book title has run through my head for decades as I worked in pharmacy. Over and over again, I asked the ceiling or the sky, where is the soul of this work? If I am in the tunnel, is there supposed to be a light? Where is the newness proclaimed by my early clinical professors? Where is the changeover from product orientation to patient orientation?

Often times, I think that the clinical soul of pharmacy is to be found only in the writings of journalists and brochure authors. It is only advertising, not practice. Perhaps I could be so bold as to follow the American College of Clinical Pharmacy's forecast about the need for 165,000 independent pharmacy practitioners by 2020, hang out a shingle that reads, "Ole' Apothecary, R.Ph., Pharmacotherapy Management" and open an office to seek people to come in and hand over their medication profiles for redesign. I should market such a thing; I practically know that others have done this, and I have probably read about their success very anecdotally (that is, reading U.S. Pharmacist while groaning on the porcelain throne). Perhaps this kind of intense entrepreneurship is necessary to shine in pharmacy. Or, group entrepreneurship, i.e., a group practice? Something's got to give, because otherwise, I feel that the practice of pharmacy is doomed to extinction.

Do not go off roaring at me for this statement, brandishing your CVs in my face, telling me about your anticoagulation clinics, demonstration projects, informatics conquests, storyboards, and process improvement teams. I am sure that you have received well-deserved accolades for your documented performances. But, do your patients talk about them as much as your medical records do?

I do not yet hear a pharmacy parade. I do not see a pharmacy parade. To the public, where is it? As R. Lee Ermey shouted in Full Metal Jacket, "Sound off like you've got a pair...I can't hear you!" How can a profession blossom in silence? How do we flourish anectodally? Where else but on product labels do we hear the phrase, "Consult your pharmacist?" Do a couple of girlfriends, appointment card in hand, talk about this with a pillow between them? Is there a calendar anywhere marked with the note, "Pharmacist's Office, 9:00 A.M.?" Where is our practice philosophy? Where is our genuinely best public image? Who would play pharmacists on TV---Brad Pitt and Angelina Jolie, or Mr. Whipple and Lily Tomlin?

The public chases pharmacists only anecdotally, too. I sense that need for pharmacy services briefly, when hard-pressed citizens call my inpatient hospital pharmacy to get drug information. What am I, the high priest of medication advice just because I work in a hospital? I ask them why they are calling me rather than their own pharmacist, and it is usually because they see their community pharmacists as being unavailable to talk to them. I don't think they can even conceive of having "their own pharmacist." What is sad about this is that they seem to call the hospital as if they have to steal the advice they are ethically and legally entitled to have.

I had thought this was going to be a pathologically gloom-and-doom post. Before writing and posting this, I even discussed it with a respected colleague, tried to write it, and gave up because it was so hopeless in its tone. He warned me, "Leave us with hope." Hope? There is every reason to hope for pharmacy.We have the highest practice standards ever. We have a cohort of young people infinitely eager to don those white coats and flesh out the tenets of clinical performance that have been established. And, if only anecdotally (grin), we are respected and valued by many. My complaint is that our professional marketability is on the slab. We cannot continue to justify a living by mass repackaging. The Big Box-ers are champing at the bit to replace us with machines; the generation that knew us as "Doc," the respected family friend and advisor, has been consumed, and their successors, for all they care about the value of drug advice, would gladly get their drugs from a smart ATM instead. I don't know when the replacement process will begin, but I am confident that where there's a will to change laws, there's a way.

Still another respected peer listened to me say, a few days ago, "If new pharmacists cannot find a clinical role in chain drug store pharmacy, they should move on." He retorted, appropriately, "But, Ole' Apothecary, where? Where are these kids gonna move on to?" I have no clear answer, except to offer the risk of new, independent practice, or some kind of pharmacy without the drugs on hand, but with the drug therapy on hand and the authority to revise drug treatment plans. Isn't this what the Doctor of Pharmacy degree is all about? According to the clinical soothsayers, There are supposed to be 165,000 of us doing this 12 years from now.

The strain of the ache in every pharmacist's soul is the soullessness of the work that come right after years of being pumped up with the "soul" of a pharmacy education. Will that education end up sounding like a threnody, or like an anthem? I sure don't know, and that's what is bugging the shit out of me.

MY OVER-THE-COUNTER VIEW

oleapothecary — Sun, 10 Aug 2008 00:36:28 +0200

There was one dividend I earned from the travail of community pharmacy: catching people in the act of being themselves.

Often, I felt like Sol Nazerman, the pawnbroker, played brilliantly by Rod Steiger in the 1965 role (The Pawnbroker) that should have won him, and not Lee Marvin (Cat Ballou) the Best Actor Academy Award that year. Nazerman stood in his frowsy little cage and was greeted by the whole parade of cash-seeking humanity: the abandoned pregnant lady with the glass "diamond," the lonely man who just wanted some "good talk," the charity worker, the pauper lady with the candlesticks. Turn these quests into prescriptions for drugs, and you have my story as the pawnbroker of healthcare. What a view!

It was usually painful, but sometimes rewarding, such as the day when a frightened elderly gentleman hustled me into the back room of the chain outlet where I worked, and silently took out a note for me to read. The note was typed neatly on an old manual typewriter, and read:

"MY WIFE AND I ARE HAVING DIFFICULTY
WITH THE SEX ACT DUE TO DRYNESS. CAN YOU SUGGEST A
SOLUTION TO THIS?"

I never found out if the K-Y Jelly helped, but that was what I showed him. He left delighted.

I would always enjoy demystifying OTC medications for people by explaining them beyond the packaging and going straight to the active ingredients. Sometimes they preferred to believe the manufacturer's game playing, but when they listened to me instead, I felt as if my knowledge had gone somewhere. Excedrin Migraine came out after I left community practice, so I never got to see the look on their faces when I would show them that it and Excedrin have identical formulas.

The satisfaction I found in those retail days had more to do with helping people in a general way, and less to do with helping people in a pharmacy way. Very often, the answers to questions were so simple that it was really a friend they needed, not a pharmacist. But, I was honored to be both. Pharmacies are healthcare stations and also common sense stations. We dispense drug information, life information, and, as often as possible, the best of all medicines, the smile.

THIS PHARMACIST SALUTES AND PRAISES FLIGHT ATTENDANTS

oleapothecary — Thu, 07 Aug 2008 10:43:27 +0200

On Fox News this morning, I happened upon a story about a major-airline flight attendant's encounter with a "celebritess." It seemed that, upon boarding the aircraft, Ms. Royalty found liquid in her seat. But, let the Washington Post save me time by telling the tale:

The misunderstanding occurred when the [passenger] boarded the first-class cabin and [she] noticed a liquid spill on her seat. She asked one flight attendant to clean it, but the attendant was unable to do so at the time because passengers were boarding. [She] then asked another flight attendant. That attendant was also busy and instead gave [her] napkins to clean it herself.

What happened next differs depending on who's telling the tale. According to two written complaints filed by the attendants to union officials, [The woman] became angry and barged toward the cockpit saying that she "wanted to speak to someone in charge." One attendant tried to stop her and she pushed the attendant aside, according to the reports. A second attendant stepped forward and Osteen grabbed that attendant by the wrist and engaged in an argument outside of the cockpit.

Touching a flight attendant is a federal offense, according to the Federal Aviation Administration. [a witness] said that he didn't know if [the woman] had touched the attendant.

-Keith L. Alexander, Washington Post, Tuesday, December 27, 2005; Page D01

Let's get the defense of the customer out of the way first (I can hardly wait to do that!). First-class passage is expensive (I think I priced my 2007 round trip flight to Australia as being $10,000 first-class, but it's hard to be humble, so I went coach) . Passengers in this class are entitled to be pampered. So, to some extent, I see where Ms. Royalty is coming from. However, I would never have gone the rest of the way with her on her perversely egoistic journey.

The incident seems to me to be a matter of the need for paid pampering versus the need for common sense. To me, common sense wins every time. I know I can expect to be spoiled in first class, but I think in practical terms a lot of the time, and I also like to be independent. I would never have asked the flight attendant to mop up the spill; I would have asked for a paper towel myself, and the thought of barging forward to demand some kind of official action on this piddling matter of a puddle would never have entered my mind. I would even have been grateful that she would interrupt her boarding activities to get me the towel. With my attitude, she might even give me the pampering I'd be secretly yearning for, and I would get was Ms. Legree did not.

The lady's performance on the flight reminds me of Kris Kristofferson's performance as Sheriff Charlie Wade in the film Lone Star, when he imperiously asks the barman to pour his beer from the bottle into a glass. We who serve the public are eager to take on a service role, but service does not mean subservience, and in that struggle, pharmacy personnel and flight attendants have this in common: both professions agree that slavery in the United States was abolished in 1865. Customers are entitled to pampering, but not genuflexion.

To flight attendants, wheresoever dispersed in the skies: this pharmacist salutes you. Most of you are hard-working, helpful, highly trained professional men and women, and you do not deserve one glimpse of the sorry sights that the members of the flying public present to you every day. Shame on us if we, especially those of us in community pharmacy, should even think about abusing you! I watch you when you serve refreshments. Okay, never mind that the refreshments are meager. That is not just service; to me, that is a ballet. You make it look easy. I detect a supreme amount of coordination in you as you go down the aisles asking people what they want. There is a lot of hard work there that the public neither recognizes or appreciates. And, otherwise, how about the simple strain of spending your life in the air?

If you, or someone close to you, is a flight attendant, I urge you to read some of the pharmacy blogs in my blogroll at the top right at this blogsite. Based upon what you read there, you can see why we often think that we fly with you.

HOW WOULD LIFE BE IF PHARMACISTS ALWAYS WORKED FACE-TO-FACE WITH PHYSICIANS AND NURSES?

oleapothecary — Sat, 02 Aug 2008 14:40:24 +0200

If we pharmacists had no telephone barrier, if we usually worked eyeball to eyeball with the other healthcare professionals we deal with every day, I am convinced that our angst level would be reduced substantially.

In the spring of 2000, my hospital sent its daytime pharmacists to be stationed on the patient care areas. Blind telephone conversations between nurses, physicians, and pharmacists came to an end. The attitudes people take when they look you in the eye are far more respectful than the ones blurted into a telephone handset. Before them stands a white-coated professional with a voice, a smile, and a spirit, who is no longer a drug room turnkey.

Even though I worked in retail pharmacies in far-northern, rural New England, I still got the bum's rush on the telephone by some medical offices. However, when these people dropped by the pharmacy, we mutually charmed each other. Future telephone transactions were cheery, and remained so.

Try this experiment: seize any opportunity to visit the medical office bearing the one nurse or secretary that is the bane of your existence. Monitor carefully the reaction you get. I think both of you will be pleasantly surprised, and all subsequent times you speak on the phone will be very much nicer.

Yes, it can't work in the world of kiloprescriptions per day, but I believe that eliminating the telephone barrier---or adding video to every electronic voice communication---would improve our emotional and professional lives by many orders of magnitude.

ONE MAN'S TRASH IS ANOTHER MAN'S TRASH AND TREASURE

oleapothecary — Sat, 26 Jul 2008 21:35:49 +0200

Try something for me: start throwing away other people's trash.

"Who, me?" you say? "I've got enough to do for myself. Why should I clean up after others?" Well, because you could help maintain a counterrevolution in manners I have started.

We talk much on these pharmacy blogs about the lack of etiquette on the part of our prescription patients. We find some of these people butting in while we are in the act of advising others, or talking on their cell phones while we are trying to quietly save their lives with pharmaceutical care counseling. But, that lack of etiquette also shows up outside the pharmacy, in the form of escalating sloth when it comes to personal sanitation. I find people choosing to be pigs. What else does it mean when someone takes a half-full beverage container and deliberately sets it on top of a trash receptacle? Hey! Yo! Why not lower your hand by 10 centimeters, then move the hand forward, so that the object drops into the trash can? It means that the person is stating out loud, "I don't care about anybody or anything." How seriously do I take this? Well, if you did this, and I was engaged to you, what part of "The wedding is off" wouldn't you understand?

Turn the tide of untidiness. Set an example for the at-large porcine sluggards: deprive them morally of their assumed right to oink. If you see a piece of refuse such as a beverage container perched at a place where is was obviously set down in spite of someone's better judgement (if they had any to begin with), take the 10 to 15 seconds required to dispose of it properly. Heads will turn and compliments may flow. I was pulling into a parking space at a restaurant last week when I saw a soda cup sitting abandoned on a picnic table. I got out of my car, reached for it, and shoved it into a nearby trash stand. A man entering the restaurant to my right was totally confused. He asked me, "Was that your soda?" I replied, "No, it's just that I can no longer stand idle littering." He answered, "Well, thank you! I just couldn't figure out why someone would get out of his car to throw a cup away."

Consider your selective street cleaning to be a blow against the barbarianism you face on the bench. Just maybe, because of the spark generated by your example, Emily Post will eventually make her way back to the prescription counter, and then spread to the restaurant, the movie theater, the dinner table, and, who knows, maybe even among motorists, turning road rage into road love!

PHARMACY WORKERS ARE AMONG THE TOUGHEST WORKERS OF ALL

oleapothecary — Fri, 25 Jul 2008 22:30:41 +0200

Pharmacy workers: pharmacists, pharmacy technicians, pharmacy interns, and pharmacy checkout-counter associates, I love you and I salute you!

We have waged campaigns as a team over the years that have to be unmatched in the annals of labor. It reminds me of that keychain that reads "I have PMS and a gun," for that is the unspoken mantra of our adversaries. We deal with people every day on the often loaded issues of livesaving medication, the clarification of the orders for same, its proper use, and who or what will pay for it. We have to wade through rapid-fire assaults of information, diplomacy opportunities, shipment logistics, and the human tendency toward chaos. Sometimes we even risk actual small arms fire in the form of armed robbery.

But, the toughness really comes in the constancy of all this: we are seldom, if ever, found standing around shooting the breeze. Often to our own detriment, we drive ourselves to the bitter end of the day without a break, and this is brutally unfair to us, but we do it anyway. We are not office workers who stand in the doorway of their cubicles chatting lightly while holding coffee cups with elevated pinkies and sighing at pleasant thoughts we have time to share. As Jim Plagakis observed recently, pharmacy is not for sissies. That small section of store behind the plexiglass is one of healthcare's most intense battlefields.

Fellow pharmacy workers, I credit you with more spiritual strength than you might ascribe to yourself. There may be no atheists in the foxholes, but I also believe that there are no faithless on the bench.

I MISS SOME OF YOU PHARMACY BLOGGERS

oleapothecary — Tue, 22 Jul 2008 18:13:41 +0200

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!

PHARMACISTS SHOULD NOT GIVE THEIR STORE OF KNOWLEDGE AWAY

oleapothecary — Sun, 20 Jul 2008 21:33:52 +0200

"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!