The "lawyer" drinking game!

Yesterday was a good day for the most part. The fact that it was a ten hour shift was rubbish and that I had the makings of a sinus infection trying to rip itself out of my sinus cavity did little to tarnish the overall goodness of yesterday.

We have a patient that regularly comes in. He's a workers compensation patient, who doesn't really know what he's taking or why. Each time he comes in he says to me "What do I have on file to fill?" to which I respond "Depends, what do you need filled?" Well today, it was the same routine, and this time he picks that he needs Dolgic Plus, Fioricet, and Acular LS. It doesn't matter how many times I tell this patient that Dolgic Plus and Fioricet are the same active ingredients.Today, I noticed his workers comp information is missing from our system, both claims [one for his pain medication and a separate one for his eyes]. I ask him if his information changed.

This is when the drinking game begins. Every time he says 'lawyer', you drink. You have to be prepared, because he can squeeze lawyer into the tightest of sentences. I wish I could remember word for word what was said. In essence, he has been in touch with his lawyer and had sent his lawyer the records showing how much money he's paid out of pocket because the workers comp stopped covering his medications, and that his lawyer is getting really tired of having to fight with them over this. The workers comp will work for a few months then refuse to pay for a couple months till his lawyer gets onto them about it. He and his lawyer are so tired of this that his lawyer are going to petition for the company to give him a big payout or his lawyer will make sure they cover his medications without the hassle.

I don't do it justice, he must of used the word lawyer twice as much, but I can't figure out how to work it in. I called his old workers comp processor, they told me the case wasn't closed but that it was changed to a different processor. So I got the info for his workers comp adjuster and left her a message. I explained that they changed who was handling your workers comp, and he went on about his lawyer some more.

I guess I shouldn't be so amused at the blatant attempt to abuse the system to get a big payout but I can't help but see the lighter side of things.

An endless stream of silly antics.

In the retail pharmacy industry, there is one term that has the power to send all within ear shout into a frenzy, contorting their face into a knot while chills shudder down their spine. Something so evil and unholy that it would cause a religious man to curse. Customers abuse it, pharmacy employees loath it, and the entire industry's professional image has been scrubbed off and replaced with the intelligence of a high school drop out because of it.

Drive-thru.

I had a woman yesterday act in utter disgust when I asked her to come back in 30 minutes. In her best valley girl voice said "I'm not going to wait her for 30 minutes" which I promptly said "no, that's why you have to come back because you can't wait in the drive-thru". Of course she began to question me, saying "Go ask the pharmacist if he can speed it up" as if I were a dirty liar. I countered by saying "It's not up to the pharmacist, we have patients ahead of you." I almost though she was done, and ready to go. Then she surprised me again. She asks me "how do you know it'll take 30 minutes?" I know I had probably the look on my face that said "am I freaking dreaming?" because I've never been questioned as to how I know it'll take that long.

I leaned forward and said "I know based off of the workflow over the last 2 hours and the number of people ahead of you that it will take roughly 30 minutes to complete your order." She had this holier-than-thou smile creep up on her face, as if she enjoyed the hell out of vexing me. She said that was "bullsh*t" and that she would be back.

I prayed she got lost on the way back...

Not so lucky, she showed up 10 minutes later inside our pickup window. Time is apparently a lost concept to her. Long story short, she waited another 15 minutes and picked up her RX and then asked to speak to the pharmacist. She then goes on to tell the pharmacist that they need pharmacists really bad at a local independant pharmacy just down the street from us. The pharmacists said ok to get rid of her. She didn't say who she was or what she did, for all we know she could of been a cleaning lady.


Ah well, got to head to work...

What's that buzzzing noise?

Oh wait. That buzzing noise would be the fatigue, boredom, and annoyance in the back of my head. As they grow in intensity, so does the buzzing noise. It's sorta like a florescent light in an office just as it begins to go out [if I remember right, this is caused by a failing power inverter]. As it starts to go out, it begins to buzz slightly and you might even notice a slight flicker. As it continues to expire, you really notice it more as the buzzing becomes more prominent and the flickering more distracting. Typically I have an episode of "blank stare" syndrome when I get like this, which I've avoided so far tonight, but is a great indicator that I need to relax and get some sleep.

So, I sorta disappeared for a little while there. I wonder if there were any fanciful stories made up as to how I did on the PTCB Exam?! Did I do so horridly on the test, that I quite my job and ran for the hills? Oh! Maybe I did so amazing, that I found a new found sense of belonging and forgot about blogging! Na, I think I passed it but I won't find out my score until the 1st of December. Three weeks.

At first, I couldn't see why I have to wait three weeks for my results, since the exam was done on a computer! I know it KNOWS how well I did! Yet, after reading the PTCB Scoring procedures it makes much more sense, given that it appears to be more than a CORRECT = 10 points and NO = 0 points. With that said, I will venture to guess how well I did on it, and lean towards a score of 670 [650 is passing]. I didn't study much at all, maybe an hour or two, and felt the affects of that when I came accross some of the non-retail questions, more specifically the ones that asked about air flow hoods and various functions, as I have never used one.

After staring at my mouse for about 3 minutes without a single thought crossing my mind, I take notice and head to bed. Good night!

Tick. Tock. Tick. Tock.

Well, I've only 19 hours before I take my PTCB Exam. I'm a little nervous.

I've been told by many pharmacists and techs alike that I'll do fine, but I've barely studied and didn't attend any of the workshops that my job provides, had I the free time to actually attend.

If I don't pass, I think I can retake the class in the same exam window. Which is why I chose the first day of exams, plus if I pass that's a month of pay that I'll get with the subsequent raise!

I've asked around about what MIGHT be on the test, since my study books and workbooks seem to be a bit outdated in some regards. I think my biggest worry will be SPECIFICS. Like, which ACT regulates THIS law, or something mundane like that. As long as I know it's a law, I don't see why I need to remember what legislation or act made it so. I'll be sure to make a good assessment of how the exam is here in Florida for those techs looking for a little insight. I've been told there are sample scripts, and obviously conversion and mathematics, but I guess I should of taken this more seriously and done my homework. That would cut out the need to guesstimate everything, but in all honesty, I LIVE like that everyday and it makes things just a little more exciting.

Wish me luck!

"It's only Vicodin..."

We have this patient who is a regular, he apparently provides hospice care of an older gentleman and frequently picks up both his patient as well as his own prescriptions at our pharmacy.

The other day, he comes to drop off a prescription via our drive thru window. His wife/gf/babys' momma is driving while he rides shotgun.

He passes the RX to her and she barely sticks the corner of the paper out of her car window, she was apparently expecting me to finesse my arm completely out of the drive thru drawer opening and practically into her van just to grab it. Maybe she just thought I had a hidden mechanical arm that would do the work for us both. After a moment, I notice her blank stare at me so I motion for her to put it in the drawer, she goes to entire effort of straightening her arm out, and almost let the RX fall to the ground.

I anticipate this, because the fatter the patient is the less likely they are to lean for anything other than pastries or fixin's. The fatter the patient is, the more of a fit they will throw for having to get out of their car, all because they didn't put enough effort into putting the small piece of paper under the little weight that we conveniently place in the drawer to prevent the wind from stealing your happy pills. As I lean forward and snatched the paper just as it feel past the edge of the drawer, she looked unfazed. As I reel in my arm from the drawer opening, she has the nerve to throw her credit card on the drawer and utters the sweetest words that every pharmacy employee loves to hear, "It's only Vicodin, can we get it right now?"

I say "Sure, give us 30 minutes and we'll have it ready." I lay her credit card on the edge of the drawer so it's easy to grab and shove it all the way out. I watched as she reluctantly grabbed her credit card. The guy who is the regular smiles and says "Thanks Lowly!" and they drive off.

Quote of the day? "It's only Vicodin." Apparently C3 drugs should be OTC.

Sorting out the idiocy...

Common Misconceptions about the Retail Pharmacy

1) You charged me too much for my copay! - Sadly, we at the pharmacy level do not control how much your copay is, we electronically submit the medication, quantities, cost, and day supply to your insurance. Their computers check it against what is called a Formulary. The insurance then returns APPROVAL or DENIAL of your coverage to us, if approved they also send amount the patient must pay [your co-pay] as well as the few spare pennies they pay the pharmacy over the cost of the medication. This means your copay will always be dependant on the insurance company, what tier your medication falls into, and other variables tied into your money-hording insurance company.

There ARE indeed cases where the prescription is written in a way that we have to guess on the day supply. An example, lets say it's the first time at our chain and you drop off your prescription for Lantus which clearly says "Use as directed" and dispense #3 vials. Unfortunately we can't calculate day supply off of information we don't know, such as your A1C levels or your weight or anything else for that matter. So we assume a vial should last a month, run it for 90 days supply and get on with the other 250-300 scripts needing to be filled that day. You come in, we ring it it up and "HEY! why is this 3x my normal co-pay for a one month supply!?" We will inquire as to the dosing, and adjust the RX accordingly.

Lesson to be learned? Don't drop off a script for any new medication and expect to come back and pay $5.00 and be on your marry way. Ask about the typical pricing of medication if you don't know anything about it, we pharmacy techs LOVE to share information that WE actually know and aren't just parroting from what we overheard [sorry fellow techs, deep down you agree with this]. For example, as a pharmacy technician, I KNOW that Valtrex is not cheap and I KNOW that there isn't a generic option available and that most insurance companies require either prior authorization, a low discount [10-20%], or it falls into your tier 3 or non-formulary category with the insurance company which is your
highest co-pay possible. Just 21 of these puppies go for about $280 without insurance, so I can at least give them a heads up.

2) Why will it take xxx minutes to throw some pills in a bottle? - The process of filling a prescription isn't a complex one, nor is it really all that time consuming. The delay normally lies in the fact that there are people ahead of you which, to be fair, should be filled before yours. Granted, we do understand the difference between someone waiting in the lobby on a script and someone dropping it off to pick it up at a later time, and we actually note if a patient is waiting when we enter the script into the computer and we try to push it ahead, assuming there are no issues with deciphering the chicken scratch your doctor calls 'penmanship', billing your penny-pinching insurance company, or being out of stock of the medication. In addition to adhering to the first-come-first-serve policy, we have to answer phones, sell already filled prescriptions [believe it or not, they have been waiting longer than you for their perscription], correct insurance problems [which more often than not involve calling the insurance company directly as a service], general resupply of consumables, file reports, place out-of-stock orders, and so on.

3) The more obnoxious I am, the better/quicker the service! - If that's the case, just imagine the service you'd receive if you were a little more pleasant and understanding? Read on for a much more detailed explanation of how this REALLY works.

In this profession, it's a complete given that people will be agitated. As a patient, you're either short-term sick, got-some-serious-bad-news sick, or a life-long-ailment sick. In any case, people are sick [starting to see a pattern are we?] or are representing someone who is sick when they come to the pharmacy. I don't know how you feel when you're ill or uncomfortable or in pain, but the majority of people will feel like crap, are irritable, and very often are already upset from a bad doctor/hospital/clinical experience or wait. This usually results in a WIDE variety of people to interact with when they finally reach the pharmacy counter. Each person can be completely different from the next. This makes being on top of Customer Service slightly difficult, but it is completely manageable with a set of guidelines [for a later post].

Lets say we have a patient that is genuinely nice, accommodating, and understanding. These can be common enough to keep us from going insane, which goes to show that, in general, people are good and capable of a little flexibility even when not feeling well. Obviously this type of patient is much easier to make happy, but from a customer service standpoint, we want you to come back and we want you to bring your positive and uplifting attitude with you. We, as an industry, NEED people like this to make the day worth the snaggle-toothed remarks and sly jabs at our intelligence by those who aren't so pleasant to deal with. So we innately, end up putting a little extra effort into making sure your process goes as smooth, or at least trouble free on your end as possible. Drop-off, pick-up, feel better!

Next, we have another patient who is slightly irritated at the wait experienced in just dropping off the prescription, which is understandable but often unavoidable. The patient is rushed, short with you, and simply wants to get the medication and leave. These are also the ones who sometimes come off as being unable to cope with the reality that there is a wait between dropping off the prescription and picking it up. You can tell the patient you'll have it ready in half an hour, they'll come back at you asking "is there any way it can be done sooner" to which you can only reply saying "We'll get it done as soon as we can". I often wonder If I had initially said 45 minutes and upon being asked "if you can have it any sooner" and then tell them it'll be ready in 30 minutes, if it would make them any happier about our mutual plight. I say mutual plight because the patient is not the only one who doesn't want you waiting around, from a service standpoint. Not only does it annoy us to no end that you hover around the pick-up counter, or stare at us and make me feel guilty about that sip of water I had while waiting for the next person in drive-thru to pull forward, it also creates unhappy customers if the wait time gets too extensive, and unhappy customers may not come back [in some cases this is a good thing for us, but too often I feel really bad about the next pharmacy victimized by the truly rotten customers].

Everyone: Patients personalities extend well beyond these two types, and are affected by countless variables. Too often the blame is easily shifted between patient, doctor, and pharmacy. The important thing to note is that in the end, we all want the same thing, and that is the well being and comfort of the patient. It's also important to keep a healthy level of respect for each other, because in all honesty, we each depend on each other in far more ways than one.

Patients: Be aware. Nothing is final until you walk out that door with the medication in hand, if you suspect something doesn't make sense or add up then mention it immediately [with respect]! It's our job to make sure everything makes sense to you and if we can't answer something we'll direct you to your doctor. Once it leaves our pharmacy, by law we can't take it back except in the ultra rare case you are affected by a manufacturer recall or a misfill.