Pharmacy Translation Manual

Patients are constantly in need of attention, help, validation and more validation.  I have concocted a translation guide for employees of pharmacies everywhere.  I'm confident this will be universal in nature.

Question from Patient:  Do you know how much that's gonna be?

Translation: I'm not spending more than 5 dollars on this goddamn thing.  Also, I don't plan on waiting more than 7 seconds for a valid answer.  That valid answer had better be less than 5 dollars or I'm going to throw my arms in the air and mutter 'forget it then' and storm off like you just insulted my mother. Way to go, a-hole.

Q: A confused person is wandering near the pharmacy looking in every nook and cranny.

T: I have no idea where your bathroom is and don't know what one looks like.  I do know how to read, but refuse to out of principle.  My back teeth are floating over here, and NOBODY will stop with their "work" and lead me to the restroom.  I will continue to look for holes in the merchandise that is in now way a door and look amazed that there is not a bathroom there.  I may just pee in the next door-like opening I see.

Q: Is this good?

T: I have a medical condition of some sort, but want you to guess what it is.  I refuse to answer your direct questions about the runny-ness of my nose or if I feel congested.  I will tell you a story about somebody I know and how they said this product should work for my supposed condition.  When probed about the medical background of the recommender, I will be vague and make them sound sophisticated.  They are not.

Q: How do I go about transferring my prescriptions?

T:  I have no intention of doing any work in this process.  I hate my other pharmacy and will soon hate you also.  After 2 or 3 or even 4 pharmacies, I will still blame the staff, insurance, doctor and possibly my dog.  He keeps burying my controlled substances in the backyard.  I am in no way responsible for my own actions and I find it offensive when you ask if I have my insurance card with me.  You people are all the same, don't you know that information without any guidance?

Q: How long will this take?

T: I have errand(s) to run and will be back when they are done.  I will give you no certain times, as I have no idea things take to complete (throughout life).  The answer should be "whenever you return, sir/ma'am. It will appear as if magic has entered the building.

Commentary:  I've just about had it with Landmark Time(TM).  That is when people will give you a time based upon the interpretation of their lives instead of using the clock.  (It's like when giving directions, instead of using road names or route numbers, they use landmarks.  How do I get to Carnegie Hall?  Oh, simple.  Just go to the Texaco station, turn right and then turn left at the Denny's.  The restaurant? No, the other Denny's.)  Most of society has used the clock to differentiate amounts of time for thousands of years.  Not anymore.  Nowadays, it's "after I go to Wal-Mart or "after I go to the bank" or "after I pick up my kids" or "after my vasectomy" or something like that.  I can't stands me anymore of it, I tells ya!  People often puts 's' at the end of words, too.  Like 'yous' or 'guys' or 'yous guys'.  I don't follow. Sorry.

Q: What's good for sinus?

T: I WANT MUCINEX.  You could recommend anything and give a detailed, well thought-out explanation using non-jargon and evidence-based medicine.  No good, Jose.  I WANT MUCINEX.  If what you are recommending does not have mucus carrying luggage, count me out.  You and your fancy medicines....why do I bother asking?

Pharmacy FAQ

Many of you may have basic or not-so-basic questions regarding pharmacy etiquette. I've compiled a list of Frequently Asked Questions to alleviate concerns in the community.

Question: Do I need to bring my insurance card to the pharmacy when intending to fill a prescription?

Answer: No. It is widely known that ALL pharmacies have a global list of all people and their current corresponding prescription coverage. Often times, we don't even need to know your name. We have a billing algorithm shenanigans system (BASS) that allows us to automatically know whom and where to bill.

Q: Will the pharmacy know my copay before I divulge any information about myself or my insurance plan?

A: Yes. Thanks to our previously mentioned billing algorithm shenanigans system (BASS as it will be referred to from here on out), we can identify a copay immediately. Our system allows us to circumvent the prior auth process and tell you the copay amount within seconds of looking at a prescription.

Q: Will I be satisfied with the copay?

A: Yes. All copays are exactly the price you were thinking or less. No medical condition, regardless of severity or complexity will yield an excessive copay for needed therapy. Examples of covered items include, but are not limited to:

• Pravastatin, Lisinopril, Clopidogrel, and all prescription drugs
• Chocolate or Vanilla pudding (Lemon no longer formulary)
• Biologic agents
• Bug spray
• Herbal products
• Shampoo
• Any OTC product*

*This will ALWAYS be covered by FSA cards without prescription. Governmental legislation, like you thought, is arbitrary and depends upon the view of the patient. There is not a specific set of rules that govern this process, nor does anybody have to follow them.

Q: After dropping off a prescription, may I stand at the drop-off window or other window I've incorrectly used to drop off the prescription?

A: Yes. While staring at people when they are working is traditionally considered rude and creepy, it does not apply to the world of pharmacy. You may stand and stare, tap, drop keys, hum to the muzac, whistle, talk incessantly about the weather, complain about your doctor, ask repetitious interrupting questions, ask where the bathroom is or simply ask what time it is. The clock in front of you is analog, so we're glad to read it for you.

Q: Is there a threshold to how many times I may ask the same question in order to induce the pharmacist to agree with my initial self-assessment of my medical concern?

A: No. The more times we are able to answer the same question, the better we feel our time is used. Feel free to phrase it differently if you feel it's appropriate.

Q: Is there a situation that is too outlandish to request a controlled substance to be filled early?

A: No. It is widely known that the ratio of controlled substances taken is directly proportional to the amount of:

• Vacations taken
• Funerals attended
• Times medication has been lost
• Strange places to drop medication
• Doctors visited to treat the same condition
• Insurances that will cover multiple prescriptions for the same exact therapies

Q: Is it necessary to ring the drive-through 'call button' as soon as I pull up?

A: Yes. It is a shame that large corporations don't put in any type of loud, piercing, or obnoxious buzzer to signal a driver's arrival. It is most helpful and boosts employee moral to signal us the very second you arrive.

Q: What behaviors are acceptable in the drive-through?

A: Acceptable behaviors include, but are not limited to: Arguing, smoking, having a loud engine that you refuse to shut off, allowing children to scream, parking too far away and complaining the drawer is not long enough or your arms are too short, spitting, talking on your cell phone, text messaging, eating, drinking, talking too softly, refusing to come in if the parcel is too large to fit through the drawer, swearing and masturbation.

Q: Does the magnetic strip on my credit or debit card need to be operational?

A: No. It can be scratched, cracked, split in half, covered in wallet scum of unknown origins, or be missing the strip all together. Not your problem.

Q: Do I really have to show my driver's license or other legal photo I.D. when purchasing a pseudoephedrine product?

A: No. Federal regulations put in place since 2004 do not apply to you. Everybody else, however, will still be required to oblige the Combat Meth Act.

This is not a complete list, keep in mind. I hope this takes care of some concerns among pharmacy patrons and will make patient relations smoother in the future.

Pharmacy Hat Trick

I don't know if there is an official "Hat Trick" for pharmacy, but I think tonight would be pretty close to a dictionary or Wikipedia entry. In one hour, and consequently, the last hour of my shift, I experienced a Twilight Zone episode. I checked the lunar cycle for answers, but alas, it mocked me. I've written about the off-lunar cycles in the past, and this experience is only adding to my ever-growing pile of data. I intend to fully disprove the "full moon brings out the crazies" notion.

Chapter One
"Excuse me," she started. "Do you have a copy of last week's ad?" she rudely and interruptively queried. "I want to see what I missed," she went on to postulate.
(As I write this, I'm listening to "No Shelter" by Rage Against the Machine. I think you know why.)
"They must have one up front," she rattled on. "I'll go see what going on up there," she yammered.
Now, needless to say, I'm not sure what she was angling at, but it was pure evil. I couldn't get a word in edge-wise and just let her go.
(The song just changed to "Bullet In the Head," also by Rage; how appropriate.)

Chapter Two
"What do you think?" asked the scary woman whom appeared out of absolutely nowhere. I craned my neck quickly out of shock and fright. She was holding what looked like a retainer with one tooth dangling from it. "Which of these is better?" she wondered aloud while still holding the contraption that was just in her mouth a couple of seconds ago. She was pertaining to the dental repair kits she had wrangled. "I don't know," I replied. "They both seem to have the same basic constituents," was my final answer. (People of the Sun now playing - this is scary) She took the cheaper one and put that thing back in her mouth and was on her way. She was nice enough to leave the more expensive dental repair kit on my counter for us to re-shop, thought. Thanks, toothy.

Chapter Three
At last, a phone call. Take me away from the madness, please. Wait, the phone. Shit. The phone has fucked me repeatedly for my entire career. It did not disappoint tonight:

Caller: "Can I start, well, that is, if I'm on ciplox, ciprox, ciplofloracin, cipr-"
Me: "Ciprofloxacin?" I interrupted, putting her out of her misery.
Caller: "Yeah, that's the one," she stated. Long pause........"HELLO?!?"
Me: "I'm still with ya, just waiting for your question"
Caller: "Oh, yeah, well I might have an infection and well I just got um.....ahhhh...Zypr....Zyprella....Zyp-
Me: "Zyprexa?"
Caller: Yeah. That's it. Can I start, er, well, restart, well I was on it but then I stopped and then the doctor gave it to me and I need to well can I take it with the Ciprofunacin?
Me: There are no interactions between the two, to the best of my knowledge and resources available to me.
Caller: Well, I was readin' and I saw it can cause infections or sumtin and I don't wanna die.

This was the gist of about 15 minutes and a call back with a belligerent not-so-significant other in the background.

I wonder why it takes "15 minutes" for a waiting prescription?

He shoots, He scores. A natural hat-trick.

Did you really just ask that?

Upon being witness to the pharmacy's goings-on, she was intrigued. Her mind was formulating a money saving scenario, of which, this generation has never seen. In the meantime, a busy technician rang out the veritable endless train of cars utilizing the drive-through.

The young lady noticed something.

Something of monument.

Her interpretation of what was transpiring couldn't be more accurate.

Finally, upon being rung out herself, she had to ask.

"So, if you go through the drive-through thingy, like, you don't have to pay? It's free?"



The technician looked at me, with a smile running away from her face. She looked to me, the Pharmacist, to take this one. I did what any mature, competent, and compassionate professional would do. I asked a question in return.

"Are you serious right now?"

I didn't hear the rest of the conversation, as Earth beckoned me. This exchange did, however, give me hope. If the drive-through was paying for itself, then maybe, just maybe, my phone would answer itself.

It just keeps ringing. Shit.

Cutting out the middle man?

Doctors don't like patients and patients don't like anybody. Patients think they know what's best and doctors are sure they know what's best. When it comes to prescriptions, both are completely in the dark. I have had some doozy conversations during my career, but this "on-call" "doctor" took the cake.

Long story short: Trying to clarify the old "use as directed" for Coumadin 5 mg, #60. Called the office twice during the day to no avail. They can't pull this off. It's not in the chart, written on the wall, on crib sheets in the doctor's pocket, in the bloodwork history, on the roof or anywhere. Nobody at the office can tell me this guy's dose. Meanwhile, if I try to be the "good guy," I will have not 1, but 2 insurances (medicaid secondary) fucking me in audits in years to come. What's a boy to do? I know. I'll page the "doctor on call."

Let's just say I've had better ideas. These better ideas include:

• reading a pamphlet in high school about the rewards of a pharmacy career
• riding a bike while utterly intoxicated
• punching myself in the face
• heckling grizzly bears
• taunting badgers
• kissing a possum
• answering the phone at work
• giving policemen driving the opposite way the middle finger

The "on call" "doctor" then tells me she has no idea what the dose is. First, she says to talk to the patient's Mom. I told her this was not a very good practice; letting the Mom prescribe Coumadin, that is. After bantering back and forth she then capitulates and says: "well, just give him 1 pill daily.....30 pills." Well that is some sound and thoughtful advice, "doctor." So, Mom is now the MD, is she? What. The. Fuck. You know what I did? I called Mom.

I went with Mom's dosing, it actually made more sense. I notated the prescription: 2 daily, per Mom. Come get me insurances, I don't care.

The next lady was a patient on Lipitor. She was on 40mg, a usual dose, but the "Physician's Assistant" wanted to jack her up to 60mg. This is not a usual dose. Why? Let's get schooled, shall we? There is a "rule of 6s" with statin drugs - for every doubling of the dose, there is a 6 percent response (roughly). So zippy the "PA" is going to deduct a whopping 3% from this lady's LDL. Nice work Sherlock. Oh, did I mention the patient thinks she's a doctor? According to her, the dose of 60 mg is too high. I think she said:

"Now, tell me, really, this Lipitor, this 60 mg, tell me, that's a high dose, 60 is too much?"

First, that's not a question, it's just a feeble attempt to put words in my mouth. My opinion must count for something, because people are always trying to form it for me. I can hear them now, "my pharmacist says that smoking crack is just fine when you're pregnant." Look, if 60 was too much, I'd tell you. Stop trying to trick me into saying it is. It's not. It's retarded, but not too high.

"Well, I'm going to stay on the 40mg. I can do that, can't I?"

I told her that it was a free country and up to her doctor and her.

"I can't get through to my doctor, just this physician's assistant."

I told her the last time I got through to a doctor that she said to do what the patient's Mom thought was best. I guess getting the doctor is not always a winner.

Good luck out there. Let us RPHs handle the drugs. Please? Pretty Please?

I Wish I Was Lying.

People do say and think the darnedest things. That's a pretty blunt and bland statement to say the least. My creativity has been drained. Countless hours trying to dispel the same myths and thoughts of folks not trained in the pharmaceutical sciences has taken it's toll. I'm not trying to sound mightier than thou or as if I'm God's gift to the world. That said, I definitely am smarter than at least two people I've encountered the last two days.

It was a Friday and the masses were huddling and jockeying for their weekend controlled substances. It's as if a gumball rally had marked my pharmacy as it's destination. Mired in prescriptions and phone calls, there she appeared. She was docile this day, but her words were confusing.

"I have a bagel of prescriptions to drop off," she said.

Now, I was working with 2 techs at the time and one heard "bagel" and the other didn't want to think he heard "bagel," but ultimately did. I can only assume she meant to say gaggle, but she said "bagel." Much like the boiled then baked traditionally Jewish delight, the ribbing would be delicious. I didn't know what direction to take this one. I took the high road and made analogies of other baked goods in ratio to large amounts of things.

• I have a knish of phone calls to make
• I just rang out a pastry heart of people at the counter
• We are selling a cookie of silly-bands
• That is a danish of Lortab for one person to take
• I have to fill a donut of refills for him
• That is a muffin of money for so few tablets
• Feel free to add your own baked good analogy in the comments

The second person asked me for diabetic socks. Yep. So I asked if he was looking for support stockings? No. Socks, but for diabetics. I asked what they were made of. He said "socks." I then told him I was not aware of such a product. I did tell him to check in "SkyMall." They have everything; even the "arthritis gloves" some lunatic was looking for last month. Boy, was my face red. I am going to market a line of cotton socks (breathable) and have the word "DIABETIC" stitched across the toeline and at the top of the crew. Then, I'll be a millionaire, as the rate of diabetics is exponentially soaring and they all need socks.

I've lost my mind. Carry on, carry on.

"The Call"

I think every member of pharmacy personnel has received "the call." You know, the dreaded one. I'm going to paint a picture; you may want to put on a smock. Remember in second grade and the art teacher had you bring in your Dad's old shirt to put on backwards? Well, the following scenario is a little less comfortable, but equally as frustrating as trying to keep on an oversized backwards oxford.

The time: always 4:59 p.m.

The person: almost always the bored housewife or retired housewife (sorry ladies)

The task: obtain (insert drug that could wait until tomorrow but really can't because everything is an emergency when you stare at the wall all day or watch grass grow or wash the same dish repetitively) a refill

The problem: there is always more than one problem at that given time

If you've been to a doctor's office, then you probably realize they close at 5 p.m. (for the most part). The "nurses" or "employees" that work there obviously have no fucking idea about the posted hours on their glass doors. If they did, I wouldn't want to beat somebody with my phone receiver after I get "the call."

You know what "the call" is if you're in the profession. In fact, you're probably trembling with anticipation. You know I'm gonna light this fucker up and send it into the clouds. We'd all like to blow something up when we get "the call." With out further delay, here is "the call" :

Me: PharmacymayIhelpyou? (I'm so busy it's all one word)

Bored Housewife: Uhhhhh, yeahhhh, uhhhh I've been on hold, ugh for 10 minutes.....

I'm going to interrupt the "conversation" here. First, "bored housewife" will be shortened to B-HO for the remainder of this "conversation." Secondly, why is the universal amount of time that somebody lies about always 10 minutes. It's without fail, always, always, always 10 minutes. In the drive-thru, behind the old lady, on the phone, wandering the cough/cold section, no matter. "I've been doing such-and-such for 10 minutes!" No you haven't and stop lying. I'm putting this out as an edict to squelch the 10 minute rule. Just suck it up, life is a wait.

Me: What can I help you with, I am juggling many phone calls/questions/waiting prescriptions/drivers-thru all at the same time?

B-HO: What? Anyway, MY doctor says you HAVE to call him...
Me: You mean they'd LIKE me to call them?
B-HO: What? No. He says, well not him, but his nurse says you have to call.
Me: Well, that was quite kind of them to lend my time and services. I'd be glad to call them, but aren't they closing in a few minutes?
B-HO: Oh, yes. They said to call RIGHT AWAY, because they're going home.
Me: Well, I'll do the best I can, I have many things in front of your call on the docket right now. Hopefully they won't go home just yet.
B-HO: Oh, no. You have to call them IMMEDIATELY. They said you have to.
Me: Okay, ma'am. I don't HAVE to call anybody. I will call them, but if they are too lazy to pick up the phone, then beggars can't be choosers. I, as a chooser, however, am begging you to let me go so I may call the office and tend to the business at hand.
B-HO: When can I pick it up? It better not be too long, I've got a roast in the.....
Me: I'll call you when it's ready (click).

That's the gist of the exchange, you've all lived it. There are a few variances, but that is the basic ebb and flow to "the call." As we all know, however, "the call" has many layers of piss-me-off flavors.

Upon calling the doctor's office, you talk to "Peggy" or "Kathy." They, in turn, have no fucking clue why you are calling. Questions like: Who's the patient? What do they need? What's the date of birth again? pervade the conversation. It typically ends up with them calling you back. The irony is hauntingly reflective of the health care industry. One hand doesn't know what the other is doing and truly doesn't care.

In the meantime (meantime = within 15 minutes) B-HO calls back.

B-HO: So'd ya get it??????
Me: No, your doctors...
*Interrupting* B-HO: What do you mean?????
Me: They said they have to call me back.
B-HO: Why? They said to just have you call......

I'd like to personally thank every doctor's office that has ever pulled this shenanigan. I do hope that your giant, block-like fingers will undergo successful surgery one day that will allow you to properly dial a phone. They do make phones with enormous numbers on them, look into it. I also pray your taxing form of dyslexia will be overcome by the years of therapy, allowing you to call me. Then again, maybe you are just the laziest thing on the planet. It's not hard. Just call me when you know what you're calling in. Better yet: it's 2010. There's these things called computers, like the one I'm using now, that can assist you. I know that you are not reading this, for rotary phones don't have screens. What you could do is e-scribe, fax, or even give the patient a written rx at their appointment. You've already been put on notice, don't make me do it again.