RANT 1
I'm not going to grovel at your feet when you threaten to 'never get your prescriptions filled here again.' I don't want your business if you can't respect me. The I in IVR (filling your prescriptions via the phone) doesn't stand for immediate/instant. If you refill your prescription via IVR, please allow at least 24 hours to have it filled. It's not going to be ready if you come in 10 minutes after you IVR'd.
I have no problems apologizing to you if it's my fault. However, if you're just going to come in looking all pissy at me because you used the IVR while you were driving down to the pharmacy I'm not at fault, and I am not going to beg for your forgiveness when it's not filled yet. When I'm the only person working in the pharmacy (with no assistant on Sunday mornings), I can't fill your prescription in FIVE minutes when I have to answer the phones, enter in prescriptions, make recommendations, count, check and COUNSEL on prescriptions. I only have 2 hands and 1 mouth, I'm not Bodhissattva (thousand hand Buddha).
RANT 2
Are doctors in hospitals completely oblivious to the concept of LU (Limited Use) codes? I called St. Mike's today and the nurse I spoke with thought I was speaking alien. "What is this code you speak of? Why does this patient need this code? If I figure out the code can I tell you what it is?" She probably doesn't really care whether the drug is covered by the patient's drug plan or not.
Later, when a doctor was finally reached they called back and said the patient did not qualify for any of these LU codes in order for the Fragmin to be covered by ODB. Lucky the patient didn't mind paying cash for it. But what about those 80 or 90 year old patients who can't afford that specific medication? I wish people in the hospital would be more considerate and didn't write the first drug that popped into their head. They should think about the patient's economic status as well as put that into consideration. Fragmin is used very frequently in hospitals, but community pharmacies do not regularly stock this medication.
=====
Can I see myself doing this for the rest of my life? I dunno man.... but I'm sure it's better to be the pharmacist than to be the pharmacy assistant. They deal with a ton more crap than I do. Man, I'm only in my 2nd month working as a full time pharmacist and I'm already getting bitter... it's not a good sign.
Sunday, November 9, 2008
Thursday, October 9, 2008
What your pharmacist does
A lot of people don't really know exactly what a pharmacist does, and I think everyone in my profession feels my frustration when I tell them 'No, we do not (just) count your pills!' If that's all we did, why don't they just hire chimps instead??
Under the Pharmacy Act, a pharmacist's scope of practice "is the custody, compounding and dispensing of drugs, the provision of non-prescription drugs, health care aids and devices and the provision of information related to drug use." Simply put, a pharmacist needs to there at your Shoppers/Pharmaplus/Pharmasave/etc in order for it to be open! You will notice that in Dominions, Loblaws, etc, they will have a "Lock & Leave" pharmacy where the drugs are sealed off so that the public can't access it when the pharmacy is closed (usually after 9 pm).
What pharmacists learn in school
I think different faculties may teach the courses in a different order, but the courses itself are generally the same. Human Anatomy and Histology, Micriobiology of Infectious Diseases, Statistics (so that we can analyze the evidence about the efficacy of drugs), Basic Human Physiology, Medicinal Chemistry, Biochemistry and Molecular Biology, Pharmaceutics, Pharmacology, Pharmacokinetics (how the drug is absorbed, distributed, metabolized, excreted through the body, Toxicology, Pharmaceutical Care (aka Therapeutics - where we learn important information about the drugs we give you), etc are just a few of the MANY courses that we learn during our 4 years in school.
While most students take five 1.0 credit courses during an academic school year, we as pharmacy students take up to 8 or 9 courses/semester that vary from 0.25, 0.5 and 1.0 credits. Tuition is MUCH more expensive (double that of regular arts&sci students) and we graduate with a BSc.Phm (Bachelors of Science in Pharmacy).
What pharmacists (would ideally) do at work
Unfortunately, doctors are not perfect and they make mistakes too! Luckily, we are there to catch them (most, if not all of the time). We also make sure that the drug you're getting is the appropriate one for the right condition. When you come in with a script, we will know the many uses for that drug, as well as appropriate dosing. This is why sometimes we confirm what you're taking it for and what the doctor has already told you. Ideally, we would follow up with you to see if there are any undesirable side effects due to the medication and if the medication is working (eg. has blood sugar, or blood pressure gone down).
If you get a new prescription, we are SUPPOSED to counsel you on its use! If it's a repeat prescription (you've had it before), we're usually ask if you have any questions regarding the medication. When you come in with a question about colds/allergies/rashes/burns/lice/pinworms/scabies/multivitamins/herbals etc, we can answer your questions and make a recommendation about which product would be best for you.
Here is a common example of a pharmacist intervention:
Mrs. X comes in with a prescription for one of her maintenance medications. Usually, she gets HCTZ (water pill) 12.5 mg daily. HCTZ is available as 25 mg strength. Instead of writing, ss (1/2) tab daily, doctor Y has written it as 1 tablet daily. I confirm with Mrs. X to see if she is aware that her dose has increased. She is unaware that there were changes to her medication regime. I call doctor Y and confirm that she is to stay on 1/2 tablet daily.
Pharmacy technician DNE Pharmacist
It always amuses me when patients/clients come up to the counter and start talking about their cold/allergies/rash to the first person they see at the dispensary. After the patient goes on for 2 minutes, the technician usually says "Hold on, I'll get you the pharmacist," and then the patient has to repeat their case to me. Most people do not realize that there is usually ONE pharmacist and one or more pharmacy assistants/technicians, and that legally, only the pharmacist can legally provide recommendations on over-the-counter medications. Usually, person wearing WHITE labcoat = PHARMACIST.
The technician(s) can make or break the pharmacist. I can't tell you how important they are. They can either make the workflow go very smoothly, or slow the pharmacy down tenfold. They can enter in prescriptions, deal with billing issues, count/prepare the medications, answer the phone that rings incessantly, as well as answer certain patient questions (eg regarding billing, location of products). I really really really appreciate my technicians!
Ontario set up a program last year called MedsCheck, which I think highlights the importance of a pharmacist and what they can do for patients! It allows patients who are taking 3 or more chronic medications to set up an appointment with his/her pharmacist and go over their medications thoroughly. During a MedsCheck appointment, patients can ask any questions regarding the use/storage of their medications, and it provides pharmacists with the opportunity to identify and resolve any drug therapy problems. Best of all, it's free for patients (all they need to bring is their health card) and is paid for by the Ontario government! The patient leaves the pharmacy with a complete list of all the medications they are taking (prescription, OTC, herbals), and sometimes the doctor is usually notified of a MedsCheck being performed.
Wow, that was a lot of typing in one day! I hope you enjoyed this special edition of "What your pharmacist does". I like comments (positive more so than negative). Thanks for making it this far
Under the Pharmacy Act, a pharmacist's scope of practice "is the custody, compounding and dispensing of drugs, the provision of non-prescription drugs, health care aids and devices and the provision of information related to drug use." Simply put, a pharmacist needs to there at your Shoppers/Pharmaplus/Pharmasave/etc in order for it to be open! You will notice that in Dominions, Loblaws, etc, they will have a "Lock & Leave" pharmacy where the drugs are sealed off so that the public can't access it when the pharmacy is closed (usually after 9 pm).
What pharmacists learn in school
I think different faculties may teach the courses in a different order, but the courses itself are generally the same. Human Anatomy and Histology, Micriobiology of Infectious Diseases, Statistics (so that we can analyze the evidence about the efficacy of drugs), Basic Human Physiology, Medicinal Chemistry, Biochemistry and Molecular Biology, Pharmaceutics, Pharmacology, Pharmacokinetics (how the drug is absorbed, distributed, metabolized, excreted through the body, Toxicology, Pharmaceutical Care (aka Therapeutics - where we learn important information about the drugs we give you), etc are just a few of the MANY courses that we learn during our 4 years in school.
While most students take five 1.0 credit courses during an academic school year, we as pharmacy students take up to 8 or 9 courses/semester that vary from 0.25, 0.5 and 1.0 credits. Tuition is MUCH more expensive (double that of regular arts&sci students) and we graduate with a BSc.Phm (Bachelors of Science in Pharmacy).
What pharmacists (would ideally) do at work
Unfortunately, doctors are not perfect and they make mistakes too! Luckily, we are there to catch them (most, if not all of the time). We also make sure that the drug you're getting is the appropriate one for the right condition. When you come in with a script, we will know the many uses for that drug, as well as appropriate dosing. This is why sometimes we confirm what you're taking it for and what the doctor has already told you. Ideally, we would follow up with you to see if there are any undesirable side effects due to the medication and if the medication is working (eg. has blood sugar, or blood pressure gone down).
If you get a new prescription, we are SUPPOSED to counsel you on its use! If it's a repeat prescription (you've had it before), we're usually ask if you have any questions regarding the medication. When you come in with a question about colds/allergies/rashes/burns/lice/pinworms/scabies/multivitamins/herbals etc, we can answer your questions and make a recommendation about which product would be best for you.
Here is a common example of a pharmacist intervention:
Mrs. X comes in with a prescription for one of her maintenance medications. Usually, she gets HCTZ (water pill) 12.5 mg daily. HCTZ is available as 25 mg strength. Instead of writing, ss (1/2) tab daily, doctor Y has written it as 1 tablet daily. I confirm with Mrs. X to see if she is aware that her dose has increased. She is unaware that there were changes to her medication regime. I call doctor Y and confirm that she is to stay on 1/2 tablet daily.
Pharmacy technician DNE Pharmacist
It always amuses me when patients/clients come up to the counter and start talking about their cold/allergies/rash to the first person they see at the dispensary. After the patient goes on for 2 minutes, the technician usually says "Hold on, I'll get you the pharmacist," and then the patient has to repeat their case to me. Most people do not realize that there is usually ONE pharmacist and one or more pharmacy assistants/technicians, and that legally, only the pharmacist can legally provide recommendations on over-the-counter medications. Usually, person wearing WHITE labcoat = PHARMACIST.
The technician(s) can make or break the pharmacist. I can't tell you how important they are. They can either make the workflow go very smoothly, or slow the pharmacy down tenfold. They can enter in prescriptions, deal with billing issues, count/prepare the medications, answer the phone that rings incessantly, as well as answer certain patient questions (eg regarding billing, location of products). I really really really appreciate my technicians!
Ontario set up a program last year called MedsCheck, which I think highlights the importance of a pharmacist and what they can do for patients! It allows patients who are taking 3 or more chronic medications to set up an appointment with his/her pharmacist and go over their medications thoroughly. During a MedsCheck appointment, patients can ask any questions regarding the use/storage of their medications, and it provides pharmacists with the opportunity to identify and resolve any drug therapy problems. Best of all, it's free for patients (all they need to bring is their health card) and is paid for by the Ontario government! The patient leaves the pharmacy with a complete list of all the medications they are taking (prescription, OTC, herbals), and sometimes the doctor is usually notified of a MedsCheck being performed.
Wow, that was a lot of typing in one day! I hope you enjoyed this special edition of "What your pharmacist does". I like comments (positive more so than negative). Thanks for making it this far
Thursday, September 18, 2008
OTC Questions - Part I
Stupid Customers and OTC Questions:
Dialogue 1:
B: Hi, I'm wondering if there's anything that I can take to detox my body.
Me:What do you mean detox? Like.. a laxative to make you go?
B: No, not exactly. I'm trying to get in the army and so they need to do a blood test. Do you have anything that can clear marijuana?
Me: (upon asking my preceptor) Um, just drink lots of water.
Dialogue 2:
G: Hi, where are your epsom salts?
Me: Oh, they're just right here. *points to big bags of epsom salts*
G: Oh, do you have the ones in a small bottle? I usually put a bit of epsom salt in my water and drink it
Me: *confused look* Err... I can ask a merchandiser for you. But epsom salts are usually not for drinking.
Dialogue 3:
B: *man with thick thick incomprehensible accent* How mooch arrre you vi-taaaa-meeen D, won taw-zand you-neets? How meh-nee pills in the smallest bot-tel and wat iz dee price? (the tech gave the phone to me as she couldn't understand a word this man was saying)
Me: *after going out in the aisle* It's 2.99 and it contains 100 tablets.
B: 100 tablets? No smaller?
Me: No.
B *hangs up and doesn't even say bye*
Ugh, why didn't he just come in and take a look for himself! Geez -_-
Grrrrr... customers are soooo rude! I'm so glad I have a week left of work, then I get a little break before I start at my new store! Has anyone else found that they were picked on because they were an intern?
Dialogue 1:
B: Hi, I'm wondering if there's anything that I can take to detox my body.
Me:What do you mean detox? Like.. a laxative to make you go?
B: No, not exactly. I'm trying to get in the army and so they need to do a blood test. Do you have anything that can clear marijuana?
Me: (upon asking my preceptor) Um, just drink lots of water.
Dialogue 2:
G: Hi, where are your epsom salts?
Me: Oh, they're just right here. *points to big bags of epsom salts*
G: Oh, do you have the ones in a small bottle? I usually put a bit of epsom salt in my water and drink it
Me: *confused look* Err... I can ask a merchandiser for you. But epsom salts are usually not for drinking.
Dialogue 3:
B: *man with thick thick incomprehensible accent* How mooch arrre you vi-taaaa-meeen D, won taw-zand you-neets? How meh-nee pills in the smallest bot-tel and wat iz dee price? (the tech gave the phone to me as she couldn't understand a word this man was saying)
Me: *after going out in the aisle* It's 2.99 and it contains 100 tablets.
B: 100 tablets? No smaller?
Me: No.
B *hangs up and doesn't even say bye*
Ugh, why didn't he just come in and take a look for himself! Geez -_-
Grrrrr... customers are soooo rude! I'm so glad I have a week left of work, then I get a little break before I start at my new store! Has anyone else found that they were picked on because they were an intern?
Thursday, September 11, 2008
The customers I encounter/Almost done internship
1) Rude ones who throw their Credit card/Cash on the counter. I swear, you get better customers at McDonalds. At least they're willing to wait in line and don't scream at you.
2a) Crazy ones that call 3 billion times a day to see if their doctor has OK'd their T3s.
2b) Annoying customers that have to speak to the pharmacist to refill a stupid prescription.
3) Customers on ODB who will never remember that come August 1st, they'll have to pay a deductible, and swear that they have never paid a deductible before in their life.
4) Those who stare you down while you're working because they think it'll magically make the process go faster.
And countless other patients/customers.
Honestly, in school you learn about how wonderful it is to be a pharmacist. We can solve DRP's, provide pharmaceutical care, improve the life of our patients and establish a therapeutic relationship with them. We are the "#1 Trusted Health Professionals" and so we should be love what we do.
Well, I guess for some people it can be true.
What hinders community pharmacists from providing the best pharmaceutical care is the fact that we have to do so many other things, especially at a busy store. Do you think you simply 'check prescriptions' to make sure it's okay? Heck no! I am constantly answering phones, going out in the aisle to make recommendations, calling doctors' offices for clarifcations that sometimes I can't even check a prescription without interruption. If you're at a busy store, you're also entering in prescriptions or cashing people out if the technicians are busy. You're not just a pharmacist, you do EVERYTHING.
Another big obstacle is time. Community pharmacy is essentially a business. Your boss/manager is not going to be happy if customers are upset because you are slow. Hence, you won't spend 5 minutes like you do in PPL labs to talk about every single thing about the medication. Meds Checks, Call Backs.. pretty hard unless you have EXCELLENT time management and a store that isn't too busy.
My internship store has taught me a lot. They're nicknamed me the "Machine" because I've pretty much been able to work independently since week 4. It's still pretty overwhelming as I feel as though there's still so much I don't know. Honestly, everything comes with experience though. I wish there was a computer chip that contains all OTC/Rx info and insert it in my brain. Sometimes I've encountered situations where I'm like... *ugh, hmm...*... then I'm scratching my head as to where to find the answer.
I've seen some pretty interesting things so far, but only a couple stick out right now.. the first being 0.2% nitroglycerin ointment and Cialis 5mg/day.
Thank God it's Friday tomorrow!!
I got a full time staff pharmacist position at a store 5 minutes away from my house! Awesomeness :)
2a) Crazy ones that call 3 billion times a day to see if their doctor has OK'd their T3s.
2b) Annoying customers that have to speak to the pharmacist to refill a stupid prescription.
3) Customers on ODB who will never remember that come August 1st, they'll have to pay a deductible, and swear that they have never paid a deductible before in their life.
4) Those who stare you down while you're working because they think it'll magically make the process go faster.
And countless other patients/customers.
Honestly, in school you learn about how wonderful it is to be a pharmacist. We can solve DRP's, provide pharmaceutical care, improve the life of our patients and establish a therapeutic relationship with them. We are the "#1 Trusted Health Professionals" and so we should be love what we do.
Well, I guess for some people it can be true.
What hinders community pharmacists from providing the best pharmaceutical care is the fact that we have to do so many other things, especially at a busy store. Do you think you simply 'check prescriptions' to make sure it's okay? Heck no! I am constantly answering phones, going out in the aisle to make recommendations, calling doctors' offices for clarifcations that sometimes I can't even check a prescription without interruption. If you're at a busy store, you're also entering in prescriptions or cashing people out if the technicians are busy. You're not just a pharmacist, you do EVERYTHING.
Another big obstacle is time. Community pharmacy is essentially a business. Your boss/manager is not going to be happy if customers are upset because you are slow. Hence, you won't spend 5 minutes like you do in PPL labs to talk about every single thing about the medication. Meds Checks, Call Backs.. pretty hard unless you have EXCELLENT time management and a store that isn't too busy.
My internship store has taught me a lot. They're nicknamed me the "Machine" because I've pretty much been able to work independently since week 4. It's still pretty overwhelming as I feel as though there's still so much I don't know. Honestly, everything comes with experience though. I wish there was a computer chip that contains all OTC/Rx info and insert it in my brain. Sometimes I've encountered situations where I'm like... *ugh, hmm...*... then I'm scratching my head as to where to find the answer.
I've seen some pretty interesting things so far, but only a couple stick out right now.. the first being 0.2% nitroglycerin ointment and Cialis 5mg/day.
Thank God it's Friday tomorrow!!
I got a full time staff pharmacist position at a store 5 minutes away from my house! Awesomeness :)
Tuesday, January 1, 2008
Time to look forward
"It’s time –
Let go of the past
Hold on to the present
And build the future
For our past may determine who we are, but not what we can become." J.C.
What better way to start off the new year by becoming an active blogger again? Maybe I can revive the blogging spirit amongst my friends, but I somehow doubt it =P. People often make New Year's Resolutions and they can range from just one to perhaps even dozens of them. I can see that with a New Year people have a desire to try to change something about themselves, but why wait until a new year approaches to instill change in your life? Every day is a new day, so there really is no need to wait =)
One of the most popular New Year's resolutions is 'to lose weight/exercise more'. I know because when I go to Hart House in January it's a LOT more busy than it usually is during the rest of the year. Bad habits are hard to change, and I guess it depends on what your priorities are.
Here are a list of my resolutions (but not necessarily for New Year's):
Read more (though I've already been reading more these past few years)
Exercise more (I've been pretty good, although last semester was terrible... recruitment dinners and residency events just sucked up all my time)
Develop my talents (take up drawing again, dance classes, etc)
Become more educated (about politics, sports, etc)
Get my G2 >_<
Improve my Cantonese/Mandarin (I even bought a book at Pacific Mall today =))
What are some (New Year's) resolutions you have?
HAPPY NEW YEAR'S EVERYONE! I wish you all the best in all aspects of life!
I promise I'll blog about something more interesting next time.
Let go of the past
Hold on to the present
And build the future
For our past may determine who we are, but not what we can become." J.C.
What better way to start off the new year by becoming an active blogger again? Maybe I can revive the blogging spirit amongst my friends, but I somehow doubt it =P. People often make New Year's Resolutions and they can range from just one to perhaps even dozens of them. I can see that with a New Year people have a desire to try to change something about themselves, but why wait until a new year approaches to instill change in your life? Every day is a new day, so there really is no need to wait =)
One of the most popular New Year's resolutions is 'to lose weight/exercise more'. I know because when I go to Hart House in January it's a LOT more busy than it usually is during the rest of the year. Bad habits are hard to change, and I guess it depends on what your priorities are.
Here are a list of my resolutions (but not necessarily for New Year's):
Read more (though I've already been reading more these past few years)
Exercise more (I've been pretty good, although last semester was terrible... recruitment dinners and residency events just sucked up all my time)
Develop my talents (take up drawing again, dance classes, etc)
Become more educated (about politics, sports, etc)
Get my G2 >_<
Improve my Cantonese/Mandarin (I even bought a book at Pacific Mall today =))
What are some (New Year's) resolutions you have?
HAPPY NEW YEAR'S EVERYONE! I wish you all the best in all aspects of life!
I promise I'll blog about something more interesting next time.
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