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Wednesday, October 28, 2009

Smart-Ass Comment of the Week

I work on Friday, but I don't think I'll get a better chance to be a smart-ass than I did on Tuesday.

A mother comes in with a prescription for her daughter. I ask if we've filled for her before.


Awesome. I pull up the profile and see we haven't filled for her since 2007. I then ask if she got new insurance since then.

"No, it's the same."

Awesome. I enter in the prescription, it gets rejected by insurance claiming "FILLED AFTER COVERAGE TERMINATED."

Ok, the patient obviously has new insurance information. I ask to see her card. She hands me a card from a different state than her old one was from. I give her a look that I hope conveys my feelings toward her. It was my "You're a fucking idiot," look.

I'm about to enter in the information when the woman pipes up and says:

"In the past, most pharmacies have found that it only works when you don't put the letters in for the ID number."

Oh holy shit, by the time she was half finished with that sentence I was smiling my sarcastic I-want-you-to-be-hurt-by-what-I'm-going-to-say-next smile. I said:

"Oh, really? Huh, because -"
"Yeah we know all those little tricks," the pharmacist bursts out, completely interrupting me, which is probably a good thing.

I was planning on finishing the sentence with something like, "I've been working in this pharmacy for a while now, and I've never seen that. Weird."

Of course, the patient might still have thought that I was being serious. Oh well. Maybe I'll get another chance to ridicule a patient on Friday.

One can only hope.

The Filling Process

For those of you out there that are unfamiliar with the process that happens behind the counter at the pharmacy (although I doubt anyone but pharmacy people read this), I'm going to go through a step by step guide to how it works.

1. You hand me the prescription. This is pretty simple stuff that 99% of people understand.

2. I look at the name on the prescription and ask "Have we filled for (name) before?" There are only two answers to this question.
1) "Yes." 2) "No."
A third possible answer, "I don't know," is not what I am looking for, but I can understand if you really do not know. That's ok.

If you answered "Yes," or "I don't know," skip down to #4

3. I will ask, "Do you have insurance?" This is always a tricky question, because some people will just say "Yes," and about 90% of the time it's "Yes, we have MA." They then stare at me until I say, "Well, can I see the card?"

This is when you have your first opportunity to either be a pain-in-the-ass customer or a good customer.

If you say, "No, I don't have the card on me, don't you have the number from when we checked in?" I will want to punch you. No, we do not have the number. My computer system is completely different than the clinic's system. I will then direct you out to the clinic to obtain the number from the receptionist. She will not be happy.

Of course, if it isn't my state's or any neighboring state's MA or BCBS number, you're fucked. There are too many different processors and BIN numbers and especially group numbers to keep track of them all. Go find your card and come back.

If you say "Yes," and hand me a card, I will not dislike you.

Skip to #5.

4. I will pull up the patient's profile; if I see we haven't filled anything for that person this year, I will ask if your insurance information has changed since then. If it has, you better hand me that card.

5. Once I have the profile all set up, I will ask if there are any allergies to medications. Do not tell me "pollen." We do not dispense pollen in my pharmacy.

6. This is all the information I need. I will tell you it will be a few minutes. Take a step back, sit in a chair, and wait. Do not hover around the drop-off area. I will be able to feel your eyes on me, and while it does not make me nervous like it did when I first started working in a pharmacy, it does make me want to choke you.

7. Once the prescription is entered and successfully made it through insurance, I will then fill the prescription while the pharmacist checks to make sure it is correct.

8. If everything is peachy-keen, the pharmacist or I will ring you up, get you through HIPPA, insurance signatures, and about 1/3 of OBRA 90 (maybe 1/4). You are then free to leave. Please do so.

Sunday, October 25, 2009

Too Mean To Publish

I wrote this article for my school newspaper, but I decided not to submit it. Mostly because it would just piss people off and I really don't need an extra source of stress in my life. Another reason is that the more I think about the entire subject I'm not even sure I agree with what I wrote. Red flags started popping up when I wrote "This is as Republican as I get, folks."

Of course, if we had universal healthcare this wouldn't be a problem...

It looks like the hospitals in this country are following the lead of the airline industry and charging obese people more for their services. Instead of charging them for an extra seat, hospitals are charging more for an ambulance ride. This really shouldn’t surprise anyone, considering an ambulance ride for an obese person is often double the cost of what the Associated Press calls “normal-weight” people.

I felt the need to quote the Associated Press on normal-weight because I am not sure it is fair to classify people with a healthy BMI as “normal,” knowing the fact that over 60 percent of this nation is overweight, according to the CDC. Actually, if someone described me as “normal American weight,” I would be offended.

The reason costs are so high to get obese people to the hospital is that many stretchers and ambulances just cannot hold the weight, and special equipment must be used. Equipment such as forklifts, flatbed trucks, and Sawzalls to cut open the obese person’s house because they just can’t squeeze out a normal doorway.

These are extreme, although real, examples, but the cost to purchase new stretchers and ambulances that can support an obese person will double in the coming years, which will contribute to the total cost of health care. We all know that the cost of health care really hasn’t been a big issue lately, but we should still address this issue as soon as possible. I bet Congress will get around to it in a couple years.

Of course, the obese of this nation think that charging more to haul their extra weight is a form of discrimination. Joseph Nadglowski, president of the Obesity Action Coalition, stated that "Ambulance services are a critical public service and should accommodate the needs of all of those who require them at a fair cost.”

I know what you are thinking: “There’s an Obesity Action Coalition?” I am here to tell you that yes, yes there is. Obese people have become so prevalent that they need a coalition to speak for them, presumably because they are too busy using their mouths for breathing instead of speaking.

The coalition states on their website that one of their proudest moments was when they organized 3,000 people on a “Walk From Obesity” march on the Capitol. According to my calculations, that is about .029 percent of all obese people in this nation. I’ll let you decide where the rest of them were. My guess is on the couch.

And here I was, thinking it was funny when my friend made fun of the Greek community for only getting 200 people to their pep rally. My calculations indicate that that is about 1.4 percent of the entire campus, so if his estimation was correct, Greek life is way better at organizing events than obese people. Now that is what I call an accomplishment.

I do agree with Nadglowski though; I believe we should accommodate the obese at a fair price. It would be fair to charge them more, right? If I need to get my car towed, and I have a strange model that requires a different, more expensive hitch, I should have to pay more to get my car towed. If I need to send a heavy package, I should have to pay more to cover the extra cost to transport it.

I would not be saying these things if people could not control their weight, but they can. An obese person has essential chosen their lifestyle by not staying fit, and they should have to pay for the costs that are directly increased by their choice. I don’t see how that is discrimination. I just see it as fair.

This is as Republican as I get, folks.

I understand that some people cannot control their weight. Genetic defects and certain medications can cause weight gain, and these irregularities should always be taken into consideration.

If someone does not want to put in the effort to overcome obesity, I do not have a problem with it. However, I think it is completely fair that they pay for the increased health care costs based on their decision.

If an obese person wants to roll up to the drive-thru pharmacy for their Lipitor, Benicar and NovoLog prescriptions, I honestly do not have a problem with that, just as long as they don’t complain about the co-pays.

So yeah, that's my article that decided not to publish in the newspaper. I figure the relative anonymity that blogger provides protects me from getting flamed by my campus.

Saturday, October 24, 2009

How Do I Do It?

I'm a busy fucking person. Between work and school, I was occupied 58 hours this week. That is just the hours I had to be in class, at the pharmacy, and at my other job. I also write for my school newspaper.

I also take labs that require extra studying and writing lab reports. My life is fucking hectic. I wonder why I accepted a TA job. I wonder why I said I'd write for my school newspaper (well, that was for the money).

My friends ask me how I do it.

To be honest, I'm not, I'm not doing it. I'm coasting by on my relatively intelligent brain, but in pharmacy school it just isn't enough. At least not for the A's that I'm used to. Yeah, I can squeak by with B's and the occasional C, but I'm not OK with that.

It's come to the big decision. Do I keep up my grades by studying all the time or do I keep blowing off steam by getting hammered 2-3 times a week? I think a comprimise is in order. I need to study more often, but just drink to forget the pain once a week... I think that's the solution.

That's a terrible solution.

I Hate School

For the first time in my life, I'm struggling with school. Pharmacy school is fucking hard. The worst part of it all is I'm not doing well in classes that don't matter. At all. It's so hard to actually try in a class where I know I will never need the information ever again in my life. For instance, how many pharmacists know the pKa of the imidazole group on the histadine amino acid in the body? None? One?

Is it relevant?

Fuck pharmacy school.

Fuck it.

Wednesday, October 14, 2009

Tamiflu (You can too!)

This week has been bonkers. I was working in the children's clinic pharmacy and I have never run around like that in my life. I spent about 3 of the 4 hours I worked on Monday doing one thing: compounding Tamiflu for oral suspension. I opened around 8 or 9 boxes of Tamiflu capsules just to make all the suspension we needed. The worst part about working in the only children's pharmacy in town is that every other pharmacy in town just assumes we have the Tamiflu suspension.

Newsflash people: there's a shortage everywhere, and our pharmacy is no different. To be fair though, my pharmacy probably stocks more solution than yours does. However, does anyone consider that our pharmacy goes through more Tamiflu solution in 3 hours than most will go through in 3 days. Luckily, we got in 72 bottles of the solution on Tuesday from our state's emergency stash. We ran out early Wednesday morning.

This is absolutely crazy, and on Tuesday night, I finally snapped. We filled 60 prescriptions in 3 hours. While you may think that's not too bad, remember that it's just me and the pharmacist at the pharmacy. That's an average of 1 prescription every 3 minutes, and we have to enter those, fill those, and then counsel them. Oh, and put them through the cash register. A 3 minute average under these circumstances is insane. We were working at break neck speed, all while being completely accurate and making zero mistakes.

At the end of the big rush, we had a father come in with 2 prescriptions, one for Tamiflu suspension (surprise!) and one for a cough medication (I don't remember what one, as I had never filled it before). Well, turns out Medicaid didn't cover it, so this is the conversation that ensued:

"Sir, I tried to bill the cough medication, but the insurance won't cover it."

"Cough medication?" the father asked, confused. "What's that for?"

"Probably for the cough," I replied. I immediately realized that that wasn't the most polite way to go about things, but after 3 hours I wasn't in the mood to be polite.

I thought I was going to be reprimanded for the my comment, the pharmacist later told me she was trying her hardest not to laugh when I had said that, which just goes to show I work with one of the most awesome pharmacist ever.

As a result of all this compounding and crazy days at the pharmacy, I've been drinking heavily, and I think it shows in the lack of continuity in this post...

I think all-in-all though, this just goes to show that I'm probably not going to be a good pharmacist. I really can't hold back my sarcasm when I'm stressed out, seeing as it's the only way I know how to deal with the stress. Oh well, I'm already on the path, and I'll finish up my education, and become a jaded pharmacist. Awesome.

I'm already looking forward to it.

Tuesday, October 6, 2009

Sometimes I Hate The Pharmacist

Yeah, I said it. I get sick and tired of pharmacist that decides to check to make sure everything is done according to "the law" while she forces me to count benzonatate.

I'm sick of watching them check the prescription while I push little marbles around, trying count by five and hold on to my sanity at the same time. That isn't easy, and one of these days I'm going to snap. I don't care what you think your "job" entails, making me count out every single prescription for benzonatate is cruel, and one day you'll pay.

I can just imagine it, forcing a bottle's worth of pearls into the pharmacist's mouth and making her bite down on them. Oh, that would be sweet, sweet justice.

Friday, October 2, 2009

Finding Jesus

I was talking to a friend of mine who has found Jesus. He told me he's never been happier since he's found Him, and that life is beautiful. At first I sort of just ignored my friend; I don't push my beliefs on him, he shouldn't push his beliefs on me. After a while though, I started to think about it. My friend has been happier lately, and much more fun to be around. The best part is that he doesn't have any Bible versus memorized so I don't have to listen to those all the time. But after hanging around him lately I've decided to see if I could find Jesus.

At first, I looked in the obvious places. I went to all the churches, but didn't feel His presence or encounter Him. I then went to the local prison, because I've heard a lot of criminals find Jesus in prison. Apparently, you need to actually be incarcerated to find Jesus in prison, because I didn't sense Him there either, although a couple of the inmates asked me if I wanted to "sense" them, and yes, they air-quoted when they said it.

After a long day of trying to find Jesus I had given up. Perhaps some other day I would see the light, and it would guide me toward Him. It was a little chilly, and I had worn a jacket, and as I opened the closet door to put my jacket away I heard, "Fuck! I'm so bad at this game!"

Startled, I jumped back. "Who are you?! What game?!" I shouted.

"I am the Alpha and the Omega. Hide and go Seek is the game," said the man walking out of my coat closet. There seemed to be a spotlight behind him.

"Wait, whoa, Jesus?! I've been looking for you today! You were here the whole time? Wait, did you just say 'Fuck?'"

"Ah yes, I did say 'Fuck,' didn't I? But what sin is committed in swearing?"

Jesus had a point. I couldn't think of a single reason why swearing would be a sin.

"Would you like some wine?" He asked, as he tapped the kitchen faucet. I watched, breathless, as red wine flowed out in to the sink.

"Uh, sure," I choked out, "Hide and Seek? You play Hide and Seek?"

"Duh, dude," he replied, "Why do you think people are always trying to 'find' me? I thought it was pretty obvious."

I was beginning to feel pretty stupid, and as I took a sip of wine it just got worse. "This tastes like iron!" I exclaimed as I spit the wine all over my hands.

"Well come on dude, this is my blood; I need oxygen too, you know."

His logic was overwhelming, I could see why people pray to Him. "I'm sorry, but who exactly do you play Hide and Seek with? I mean, if it's just me and you wouldn't you win all the time? Because you're always the last one to be found?"

"Ah, another common misconception," he said. I began to wonder how many times He's had this conversation. I began to feel ashamed of all the times I've gotten annoyed with someone who called to see what time we closed. "I play with the Easter Bunny and Santa Clause, but those fuckers cheat because they only come out once a year, where I have to be out all year round. It's bullshit."

"Wait, the Easter Bunny is real? And Santa?" My disbelief was palpable.

"Oh for My sake, of course they are. Me," Jesus said, obviously annoyed.

"Did you just use your name in vain?"

"Technically, no, asshole," Jesus spat back.

"Whoa sorry dude," I replied as I went to the sink to wash the wine off my hands. "Hey! This is still wine! Can you change it back to water?" I asked.

"I just performed a miracle, and you want me to undo it? Fuck you dude. I'm out."

And then He was gone.