Saturday, July 26, 2008

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

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!
Posted by oleapothecary at 20:35:49 | Permanent Link | Comments (0) |

Friday, July 25, 2008

PHARMACY WORKERS ARE AMONG THE TOUGHEST WORKERS OF ALL

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.
Posted by oleapothecary at 21:30:41 | Permanent Link | Comments (0) |

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) |