Beginning Flu Vaccinations

Since certified pharmacists have been able to give flu shots for a few weeks now in Ontario, my pharmacy has been giving out tons of flu shots. With this expanded scope of practice, we have been receiving a million questions. There have been excellent questions like "What is the difference between the cold and the flu?" and there have been questions that seem like their aim is to bait us into an argument.

These people who seem to want to pick a fight mostly ask about the fact that two of the available types of flu vaccines have been voluntarily recalled recently due to floating particles in the vials. People ask questions about the quality of the service that we are giving as well as whether or not we are giving "dangerous" shots because of these particles. So far from my knowledge, the voluntary recall is probably to prevent people from freaking out. The manufacturer has stated that these particles contain bits of influenza virus (not the intact virus) which is not uncommon in vaccines of this nature, and that noone has felt any adverse effects so far. In addition, it helps to know that the vaccine we are distributing is not the one that is being recalled.

Today I had a woman of this nature who seemed like she wanted to pick a fight and I would not let her. THEN, she asked a question which took me by surprise (and she couldn't even pronounce it correctly).

Me: *after a bit of conversation* Is there any other question I can answer?
Woman: Does your flu vaccine cover AJSKQWIORJKKER? (She mumbled something and I was waiting for her to ask H2N3 or something like that.)
Me: Sorry I could not understand you. Do you mind repeating yourself?
Woman: DOES YOUR FLU VACCINE cover UIOQWEUIERKLJDSFJK?
Me: Sorry?? I really do not understand.
Woman: You know...the flesh eating thing.
Me: Uh...necrotizing fasciitis? Flesh eating bacteria?
Woman: YEAH!
Me: This is the FLU VACCINE. It covers the FLU.
Woman: Oh. *hangs up*

I didn't even get to ask her why she thought that or wanted to know. Why would you routinely vaccinate against flesh-eating bacteria? lol.

Can You Read This?

This isn't that bad because you can probably make out every drug name and can confirm if you ask the patient what kind of drugs they are on...but the handwriting is so unclear that you probably would never be 100% sure every letter, which is why I'm posting this.

Problem Prescriptions

After going to a pharmacy conference I was pooped and was too tired to post. Today I have an assortment of problem prescriptions discovered only THIS WEEK. I define "problem" as: requiring clarification/extra-work-that-shouldn't-be-necessary, erroneous, disgusting, etc.

1. This reads "1000/cc Mitte: 10cc". This lovely doctor decided to omit the drug name on the prescription. (Note: More experienced pharmacists would probably take a guess that this could possibly be the Vitamin B12 injection, but really you can't assume.) I had to type up and fax a note to the doctor then wait for a response. Another classic example of WHY it takes so long to fill your prescription (or the next person's).

2. This only makes you go "OMG" when you've checked the patient's file and realize that he was previously taking 5 tablets TOTAL per day of the Levocarb 100/25mg. This doctor decided to write "4.5 tablets FOUR TIMES daily", totalling 18 tablets per day, which is 3.6 times the patient's previous dose. Even if the patient's Parkinson's disease had worsened significantly I'm not sure they would've made such a huge jump in dose. 

3. This prescription is not the worst that I've seen (I've seen some miscellaneous red/brown droplets/fingerprints), but this is ranked as the most disgusting prescription I have dispensed this week. Unfortunately the photo doesn't really display very well the depth of colour on the prescription indicating its pure filthiness. Even though I have lots of things in my purse, I don't think any of my papers in there have ever turned colour or gone this wrinkly...did the prescription get stored in an armpit or crotch? How did it get so brown and dirty? As soon as my assistant brought this prescription to me to ask me a question about it, I immediately used a thick roll of tape and taped the surfaces of both sides to prevent ourselves from catching the plague. People, please be respectful of your prescriptions AND your pharmacy team.

(For whatever reason, blogger will not align these photos! So annoying...lol.)

About Cold Medications and What Happened to Neo-Citran

I've had a million people ask me about Neo-Citran in the last few weeks and about where they might find it because it hasn't been found on the shelves in a while. According to a Toronto Star news report , it is because the parent company Novartis had voluntarily closed their manufacturing plant down because of issues with drug mix-ups and needing to improve their manufacturing standards. (http://www.thestar.com/news/gta/article/1201516--the-gta-runs-out-of-maalox)

For whatever reason, people believe that Neo-Citran is a magic drug that "makes their cold get better", and that drives me crazy; I'm not sure if other pharmacists are feeling the same way. As you should know, the cold is caused by a virus, and there's nothing to really kill it except your immune system.

Most packages of Neo-Citran contain a first-generation antihistamine which is normally used for drying up a runny nose, and THIS is the medication that makes people pass out. I think that if people DO feel better it's probably because this drug knocked them out with drowsiness and made the person actually have a good night's rest which in turn made their immune system more effective at fighting off the cold virus. The other ingredients in your box of Neo-Citran probably also helped with a stuffy nose, and headache/pain so you feel much better with these floating in your system - it may not have been that you actually got much better...you just FEEL better.

To prevent you Neo-Citran fans from freaking out because this product might still be off the shelves for a while, as long as you can read labels, the next section of this post will be beneficial to you. NOTE that these medications are pretty much the same thing that's in Neo-Citran.

How to figure out which cold medicine to get, pharmacist-style: 
Rules:
1. Understand that the cold is caused by a virus. You DO NOT need antibiotics (they kill bacteria which are a different germ).
2. Understand that the cold usually lasts around 7 days. You will feel the WORST around day 3-4 and you will slowly get better after that.
3. Understand that these will make you feel more comfortable and WILL NOT CURE YOU. You will cure yourself.
3. Treat ONLY the symptoms you have, and you will not be taking unnecessary medication.
4. Don't read the front of the box - read the medicinal ingredients in the tiny print on the side.

What ingredients to look for if you have certain symptoms : 
- This is what's usually found in your cold medicine...find the ones that are applicable to you...that's why there are SO MANY COMBINATIONS of cold medications (every brand almost carries some of the same thing, so you can't go by brand!)

1. Pain and Fever: something with acetaminophen or ibuprofen
2. Cough: cough suppressant like dextromethophan
3. Stuffiness: decongestant like pseudoephedrine or phenylephrine
4. Runniness (nose/eyes): first-generation antihistamine like chlorpheniramine, brompheniramine, diphenhydramine
5. Phlegm (aka mucus): guaifenesin. *note: this doesn't have much evidence for efficacy. You might as well drink tons of fluids to loosen phlegm up or use a humidifier*

If you have certain allergies or medical conditions and you're not sure if these ingredients are safe to take, then go ask your pharmacist! Note though, that there are pretty much only 5 types of cold medications and they just come in different pretty colours and packaging. I've just memorized which boxes contain which ingredients, lol. I hope this helps - I would be more efficient in the pharmacy if I answered only 10 questions per day on colds rather than 50. Thanks. =P

Overly Sensitive People

The pharmacy was really busy today. While busy checking prescriptions in the dispensary, this young guy (late 20s, early 30s?) decided to come up to the counter to ask a question. Maybe I didn't choose the best words, but seriously, anyone would've understood the intent. All I have to say is that this guy needs to remove the stick from up his behind or he is going to suffer a stroke before he's 40. 

Guy: Where are your Band-Aids? 

Assistant: Over in Aisle 8. *guy goes to aisle 8 and comes back*

Guy: I'm looking for something that you tape to the back of your heel to protect it from forming blisters. 

-----

STOP. What do you think of when you think of shoes and blisters and protection? Most of the time when I deal with this in the store the majority of people are looking for protection from their pretty high-heels. 

-----

Maybe I stopped thinking for a second, but I blurted something out. 

Me: Is this for high-heels? 

Guy: No, it's for leather shoes. 

Me: OHh...*understood* okay, there's something called moleskin that you can use. *I look up from checking my prescription and see that the guy looks like he could murder me. Holy crap*.

Guy: THAT WAS ***NOT*** FUNNY. *deathstare* That was REALLY NOT FUNNY. 

At this point I'm kind of shocked that I've managed to offend someone in such a short period of time. 

Me: Oh, sorry, usually people who often ask are asking about high heels and I thought maybe you were asking for a friend. 

Guy: THAT WAS ***NOT*** FUNNY. (No one was laughing.) WHAT IS YOUR NAME?!?! TELL ME YOUR NAME NOW. 

Me: *I tell the guy his name while he stomps off*

So apparently this guy was really pissed and I was shocked that I managed to imply something horrible in his eyes...that he was a drag queen? ...Liked women's shoes? ...WORE women's heels? 

I looked at my assistant who was there and asked "Did I say something REALLY wrong? I am kinda shocked" and he was like "Oh Man. That guy was overly sensitive, lol."

I've been thinking about this conversation all night feeling quite bothered, and now I have to really work on modifying my future behaviour so that the 1% of the population that will get seriously offended will not be as likely to get seriously offended. I should've probably asked "Is this for you? What kind of problem with shoes are you having?". Being that I already feel like I talk too much, this is going to be an extra 9 words compared to asking "is this for high-heels?".  

Being Clueless

In the past I have had many husbands who pick up medications for their wives and have no idea what illness she is experiencing or what she went to see the doctor for. I also have had fathers not know their child's illness or what they went to see the doctor for. Also a lot of the time I get "let me ask my wife" when I ask for their child's weight or problem but usually I don't have this problem when I ask the woman of the family. I wonder if it is just in the woman's nature to know. =P

Anyway, in my family, everyone always knows what is happening with everyone else, so situations like these are surprising, or at least I wonder what the family dynamics are at home. But I guess being a pharmacist, my husband does not do anything regarding illness without asking me first. =P

A dad brought in a prescription for his daughter for Zithromax (azithromycin) and Alupent (orciprenaline). It's their first time at our pharmacy, so I had to make a new profile. Sometimes I wonder when people are very clueless about their children.

Selective parts of our conversation while processing the prescription:
Me: Last name? First name?
Dad: ______ s-i-n-e. (*blanked out the beginning part of the name for confidentiality*)
Daughter: No, it's _____ s-i-n-i!
Dad: OH.
Me: Birthday?
Dad: Um...July.
Me: What date?
Dad: 21st? 25th? ... Uh...25th.
Me: Year?
Dad: Um...well...*speaks to daughter* you're 6 right? So...2006.
Me: What's your address?
Dad: Um...hold on. Let me give you my driver's license. (This is where I noticed that the street name was spelled incorrectly on the license and I told the dad he should probably get it fixed because it's an official ID).
Me: Phone number?
Dad: Um...*starts scrolling through his cell phone*...Uh...can I give you my cell phone number? It's ____.
Me: Because these are medications for a child I need to verify her weight. How much does she weigh?
Dad: 16kg I think.
Me: *calculates dose and realizes it's high - should be around 10mg/kg/day, and it was around 16*. Hm. This antibiotic dose looks high then if that is her weight. Are you sure?
Dad: Let me call my wife. *wife says it's 13kg making the dose even more high (making it around 19mg/kg/day)*
Me: Hm. The dose is even higher then which isn't good.
Dad: *lifts up his child* well, it seems like it should be 13-16kg.
Me: I guess I have to call the doctor to verify then.

Worst part is that the doctor's office kept giving excuses for why they did not fax back after I sent them a note. The dad decided to take his prescription back with my note indicating the improper dosing, and take it to his old pharmacy which is beside the doctor's office. I wish we got paid for this stuff. I caught a drug-related problem and spent over 5 minutes explaining to the dad what was happening, and then did a bunch of work writing up a letter to fax, calling the doctor's office and holding for quite a while sometimes, only to have the business leave the store. Oh, and this was for an Ontario Drug Benefit patient for which we would've gotten a reduced fee if I HAD filled the prescription.

I'm a Mother, So I Know!

A get a lot of questions in the pharmacy, and most people tend to take the advice, or at least listen without an argument and then do whatever they wanted in the first place.

A few days ago, a mother came to the dispensary with her son who was about 1.5 years old, asking if there was a medication she could give him for his runny nose. After a bunch of questioning, she had come to Canada recently from somewhere-that-I-will-not-mention, and she was worried because her son seemed sick. He recently had had an ear infection and she had just finished a course of antibiotics. He recovered from that, but he was now presenting with "lots and lots of runny nose". After asking more questions, I found out that he had a "very very runny nose" for two days, but had no fever, and the nasal discharge was not colourful. He also was acting normally, eating well, and in the pharmacy while mom was speaking to me, all I saw was her son picking up bottles of drugs off the shelves and moving them around – very energetic!

Mom wanted a drug "to cure her son". I told her that given the symptoms presented, it's possible that he had caught a cold. Because of their change in location, or even because her child was young, it was very possible that he had never been  exposed to these germs and was sick again. I then said that there was no medication for her son that would cure him. I explained that here in Canada, all cough and cold medications were for children older than 6 years old due to the safety of the drug, or even just its lack of effectiveness in younger kids. Also, even if her child were over 6 years old, this medication just comforted the child, rather than curing them. If she needed a medication, she could perhaps use some saline solution to help with stuffy nose.

Maybe that was offensive.

Mom: What do you MEAN there is no medication for my son?! He has a very, very runny nose! It's runny every few minutes! (Note that she never wiped her son's nose the entire time we were talking.)

Me: Well, your son seems to just be having a cold, and there isn't really medication for younger children, especially since he doesn't have a fever. You can just wipe the runny nose gently with a tissue.

Mom: Well, last time he got sick, he had minor symptoms then he got worse! I need a drug to give him RIGHT NOW so that he doesn't get worse!

Me:  There's no way of telling right now if he will get worse, but it looks like he just has a cold right now, and there isn't really medication that will cure him.

Mom: YOU ARE CRAZY. THIS IS CRAZY! How can there be NO medication?! I'M A MOTHER, AND I AM SAYING THAT MY SON NEEDS MEDICINE! At the other pharmacy, someone said that there was something "0 to 9" that would help.

Me: Oh, you're probably talking about the homeopathic medication. That stuff isn't well studied, and the science behind it doesn't make any sense. If you want to try giving that medication to him you can, but it probably won't do very much. It's likely that your son will get better with or without the medication. (Despite not believing in homeopathic remedies, I showed the bottle to the mother.)

Mom: I GAVE this already and IT DOESN'T WORK! I'M A MOTHER AND I KNOW MY SON NEEDS MEDICATION!

Me: Well, you could just wait a few days and monitor your son. Colds usually last about a week. If he develops fever or starts losing his energy then maybe you can do something about that, but he looks perfectly fine right now.

Mom: YOU ARE CRAZY! YOU have NO medication?! THIS IS RIDICULOUS! YOU ARE CRAZY! I CAN'T BELIEVE THIS! *and…she stomps away….*

I don't think I've been called crazy by a customer before for giving perfectly sound advice, although I've received some other rude comments. I also have never heard anyone use the reasoning "I'm a mother, so I know" (but I'm sure this happens more than I am aware). I find it funny that people think that just because they carried a baby for a few months and gave birth to them makes them more educated than a health professional. I really wonder what kind of health education this person from an unmentioned country has received and I feel really bad for these kids who are shoved medicine every time they have a sniffle or a runny nose.

Really, parents are doing a disservice to their kids when they MUST get them medication. It's better to let your kid (or yourself) be sick once in a while to give your immune system a work-out. I work in the pharmacy exposed to sick people all the time, and I probably get sick at most twice a year (generally it's a very mild cold). I think the last time I took antibiotics was 2 years ago, but that was for an infected mosquito bite, haha.

What were they thinking? (This is why it takes "forever" to fill your prescription)

The last few days I was away on a small trip so I was unable to post anything. As soon as I got back to the pharmacy, my boss informed me that she had a "dumb prescription" to contribute to my blog. My boss is hilarious. I then received a prescription also which was dosed incorrectly, so I will post that too. As pharmacists, we know what the dosing SHOULD be which is how we catch these problems, but we do not have the authority to correct the prescriptions. This leads us to have to contact the doctors to verify and clarify, and therefore waste everybody's time (and sometimes get yelled at by patients).

RX #1:

Apparently a seasoned doctor wrote this, and not just a new one who hasn't figured out the art of prescription-writing. So in this image, the doctor wrote: cloxacillin 500mg every 6 to 8 hours for 5 days. This is an antibiotic. How do you ask the patient to take it every 6 to 8 hours? Which one is it? Every 6 hours or every 8 hours? What would the quantity be then if it's 5 days? Is it 20 capsules or 15 capsules? Haha. SO DUMB! Wasting the pharmacy's time to clarify with the hospital. 

RX #2:

The above prescription is for Biaxin 500mg 2 tablets once daily for 7 days.

So anyway, there are two kinds of Biaxin: Biaxin regular-release tablets are dosed twice daily in 250mg and 500mg strengths, and Biaxin XL 500mg extended release tablets are dosed once daily. 

In the above prescription, because no "XL" was written, it indicates the usage of regular-release tablets. If the patient takes the two tablets together, they are getting a huge dose right away which only lasts for about 12 hours, and then once the medication starts to excrete out of the body, they will have a large number of hours where there is no medication in their system and bacteria starts developing resistance. HM. To correct this rx, either, the doctor could write XL behind the Biaxin, or change the directions to BID (twice daily). 

The annoying part is that it's after office hours, and the patient is sick. I cannot NOT dispense this medication, but to change it would be against the law. It's so annoying that even though I know the correct rx, I still need to clarify with the doctor tomorrow. THIS is why it takes "FOREVER" to fill your prescription. (For those curious people, I just gave the patient regular 500mg tablets and told her to disregard directions on the label and take it twice daily.) 

Scientifically Unproven Things That People Do

I have decided to compile a list of scientifically unproven things that people do, just beacuse of their interesting or amusing nature. Note that all of these events are true.

1. Some of our Asian customers like to give their newborns/infants dextrose powder. I have stressed that this is pure sugar with no nutritional value, but yet they often cannot be convinced otherwise and continue this activity.

I would imagine that this would probably predispose the child to diabetes in the future as well, due to the lack of maturity of their organs to process this sugar, but noone wants to listen.

2. Some of our Asian customers also ask for rubbing alcohol to help reduce fever. This is to be wiped over specific parts of the child's body (eg. underarms and forehead, I think), and this is to "evaporate away" the heat.

I have stressed that this isn't very effective, and is quite drying to a baby's sensitive skin. Rather, a lukewarm towel wet with a bit of water would do the trick to cool down their baby too, but ultimately fever-reducing medication like acetaminophen/ibuprofen would be best.

3. Some of our Asian customers also ask for rubbing alcohol for any skin ailment that you can think of. If it hurts, itches, burns, weeps, it's an infection, and they must put alcohol on it to disinfect it.

A lot of the time, when you put alchol on eczema it gets worse due to the drying nature of the alcohol. Strong products like alcohol and hydrogen peroxide can also impair wound healing.

4. Some of our Asian customers request for these "cool patches" to reduce fever that you stick to the forehead of their child. Apparently these are quite common overseas.

We have similar patches in the store, but they say clearly on the box that it is for "soothing" the child, rather than for fever reducing. I don't think a tiny patch on the forehead would be effective at reducing the internal temperature of a child.

5. I have had customers request for Dettol liquid. This can be used as a disinfectant for floors, bathrooms, etc. THESE people are using it for various ailments, including itchy or stinky feet.

I reminded them that there's a poison symbol on the bottle for a reason; it's quite possible that this is getting absorbed through the skin, and to just be cautious when using these products. Perhaps a better-studied Western medicine product would be more effective for their skin problem.

6. I had a 20-something year old female customer ask me for a refillable/reusable enema. After I asked a bunch of questions, I realized that she was not constipated. She actually wanted to refill this enema with organic coffee. I wondered what in the world for, and she told me that apparently it made your skin beautiful. LOL. I should've taken down her information and asked her if she ended up being successful.

7. I have a bunch of customers who have cold symptoms for 1 day like runny nose, stuffy nose, sneezing, and perhaps a sore throat and they immediately go to their doctor for antibiotics. They don't understand (or refuse to) that colds are caused by viruses which are not killed by antibiotics. The first doctor (hopefully) tells them that they don't need any drugs. After wasting the government's money to see the doctor the first time, they continue to have symptoms for another 2 days, which is normal, as colds usually last around a week, and are worst around the 3rd to 4th day. They then waste more of the government's money going to another doctor to get a second opinion. At this point in time, perhaps they have gone to a doctor who easily prescribes antibiotics, even when the patient has a dry non-productive (non-chunky/phlegmy) cough, and the sore throat has gone away.Now the patient will come to the pharmacy gloating about their first doctor being wrong and not giving them drugs in the first place, because look, the second doctor thought they needed drugs.

This is what I say to myself and my loved ones:
A) ***SUCK IT UP***. It's a cold. Fighting it will make you stronger.
B) If you take antibiotics at the start of a cold, by the time you're almost done your 5-7 days of antibiotics, even if you did NOT take them in the first place, your cold symptoms will have still typically resolved. Now you have created some bacterial resistance. Good job.

The worst part is that some doctors WILL prescribe antibiotics for patients who have been sick for two days! Often these symptoms have partially resolved by the time the patient gets to the pharmacy, lol.

8. Lots of Asian customers believe that it is bad for you to "take so many days of antibiotics". The more you take the worse it will be for your body, thus, only taking them until you feel better ie. 2-3 days is the best! I had a guy come to the pharmacy asking for something to treat his tooth pain. I found out from him that he had already taken some clindamycin from his previous bout of tooth pain, about.2 days worth until he got better. THEN, the tooth pain returned, and he had been taking another two days of clindamycin, but now it was not working.

HELLO bacterial resistance. The duration of treatment has been studied to be whatever it's supposed to be, in order to kill all/most of the bacteria causing that particular bacterial infection. When you only take 2-3 days of antibiotics, you end up killing the bacteria that are easily killed, leaving behind all the strong ones that survived. These strong bacteria now end up reproducing and you have an infection that returns, and the antibiotics you just used is ineffective. Oh wait, so are all the OTHER antibiotics that are related to that one.


More and more of these scenarios occur daily. I hope you enjoyed this post. =)

What is Worse? Newbie Doctor or Annoying Patient?

A patient of mine came in during a busy time and said "I know that the newest Bayer blood glucose machine is out, so I want it now. I brought in a prescription last month and it's on my file". For those who don't know, some of the blood glucose machines are free with a purchase of 100 strips, and some have a cost regardless of whether you buy strips.

I told this customer "Because this machine is very new, I don't think the rep has come by to show me anything about the machine yet. I also do not know if it's free with a strip purchase, so let me call him and ask". I make the phone call and the rep tells me that it is in fact free with purchase. He also informs me that he hasn't been by any stores yet because he himself had only received the demo kit the week before. I asked him what the differences between this one and the old one were. Apparently this machine is more accurate compared to the other ones, and eventually all the meters will be upgraded to these new test strips. I told the customer that I had located this information and that the machine was free and I would now process his test strips. I also mentioned that because these strips were so new, there was no entry in my computer system so I had to manually enter this into the system and figure out how to bill it. I then entered it and had to call his insurance company for a pseudodin # in order to bill the strips, and finally I got it working.

The man also asked to see another blood glucose machine by the same company and started asking more questions like "what is the difference"? (My response: They're practically the same...the newest one that you're getting is supposed to be more accurate.) He then keeps looking at the other machine. I asked him "So which machine do you want? If I give you this one and I open it, you cannot change your mind. I cannot give an open one to someone else". He goes "Okay, I'll take the newest one." I said "Are you 150% sure?" and he says "Yes." After a few more minutes, he's STILL looking at the other machine and I ask him the same thing again. Then this happens one more time, and he looks VERY indecisive. Finally I said "Look sir...are you getting the newest one or not? You need to be 200% sure because once I do it, I'm not changing it. Decide right NOW. If you decide on the newest one, stop looking at the old one." He decided he wanted the newest one. Finally.

At this point in time, it was quite busy, but the most pressing matter on hand was the prescription for an elderly gentleman who had just come out of surgery to remove a lung, for which his daughter had already waited a while. He had a prescription for docusate sodium and Tylenol #3. As soon as I saw the prescription I was like "OMG. This doctor does not know how to write prescriptions." See the following:

What was a huge pain?
1) Any prescription (especially narcotic prescriptions) require a definite quantity if the direction is "as needed". If the patient takes max 2 tablets every 4 hours around the clock for 30 days, assuming his pain is not reduced, then "30 days/1month supply" = 360 tablets which is a pretty huge quantity
2) Narcotic prescriptions cannot be repeated (you must do a part fill - ie. write a large quantity and say to dispense a smaller quantity every X number of days). This means that the repeats are void.
3) This is coming out of a frickin' hospital where you can barely get a response from a doctor especially if they're a resident, or not on call, don't answer pages, or no longer works on the unit that they were on when they wrote that prescription. If you get a call back, it also frequently is not on the same day within a reasonable time. This doctor had the newest license number I'd ever seen. Oh no.

I decided to call the hospital to page the doctor. Thank God they called back within 15 mins. I asked the doctor if they were familiar with writing narcotic prescriptions, and the answer I get was "Well, I guess I'm learning how to do that today!" WHAT. I then proceeded to teach the doctor how to write a prescription, and then to change my prescription. Okay then. I get the quantity verified...so apparently this doctor didn't really care and 360 was fine, haha. I counted and double-counted it by hand. The patient's daughter is pacing like crazy and is saying that she's going to leave soon because she needs to take care of her dad, but she also really needs his medicine as he just got cut open. I run the prescription to the counter. She goes "OMG, why are there SO MANY PILLS?! Last time he got a small amount he threw them out because he was mad at his cancer!". Okay then...now I had to change the number of pills into half.

Cut back into scene 1 with glucometer patient. He apparently walked away and walked back with the merchandiser from the front store after making a huge complaint! So now I was informed that I was mistreating this guy. WHAT?!
Man: You are supposed to be helping me! I GOT HERE FIRST. Why are you helping this woman?! How can you just start helping me and then switch over to someone else?
Me: This woman was here way before you...I think it's possible that she has been waiting for an hour.
Man: She was NOT here for an hour!
Me: Were YOU here for an hour? How would you know?
Man: Well, you should be helping me!
Me: Look, this woman has been waiting for much longer than you, and her father just came out of the hospital after getting cut open and removing an organ and she needs to get this medication to him as soon as possible. I am helping you with your things now.
Man: You're being ridiculous! How can you say you've been helping me when you're wasting your time doing this here and that there and talking to this person on the phone and that person on the phone? You should be working on MY prescription. I SWEAR THAT YOU'RE MAKING ME WAIT ON PURPOSE!
Me: Sir, you have to understand that I WAS working on your prescription! ONE phone call was to the manufacturer of your blood glucose machine to make sure I can give it to you, and to get you the proper details because it's so new that nobody knows. The OTHER phone call was to YOUR insurance company to make sure that it would go through your insurance so that you don't have to pay! I was calling people for YOUR sake! (Thinking: Shouldn't talk to me like that.)
Man: Oh.

Responsibility

Is it just me or are people nowadays babied through life?

When I grew up, my parents always stressed the importance of school and education, of working hard to achieve our goals and dreams in life. The more effort you put into something, the greater the output, usually. While I was enrolled in many extra-curricular activities throughout the school year and the summers in-between and was signed up for lessons in various things, there were other kids who got to "go outside and play" all the time. Generally if I talk to most of my friends of my age (or older), they had similar upbringings. It was just a normal part of life to work hard to earn something.

Now we hear in the news that it's demeaning to kids and impairing their ability to "fit in" if they don't finish an assignment on time and a teacher gives them a poor grade in school. The answer to this is apparently to be extremely lenient, give the student an extension, and encourage them. If they don't do an assignment, it's fine, just mark them on the work that they have done. All students should pass their grade; how much trauma would it be if they got held back in school and all of their friends graduated?!

Seriously, real life does NOT work that way and I have no idea what the education system is thinking. If you're in the real-world and you're consistently late for your job, your boss will find someone else to do it. If you were supposed to do an "assignment" for a large construction company and you were slacking off and no work was done, you just cost someone thousands of dollars, so they'll find someone else to do it.

In the pharmacy, we see these poor attitudes trickling in year after year, consistently getting worse, and people are feeling an increased sense of entitlement. It's not even just in the young people anymore! We have older people (with grey hair) who are doing the same thing!

Conversation #1
Lady: I need to refill my birth control
Me: Oh, unfortunately you don't have any more repeats on it.
Lady: That is ridiculous! How can I NOT have any more repeats?
Me: You are just out of repeats because you used up everything the doctor gave you.
Lady: WHY DID YOU NOT CALL ME TO TELL ME I HAD NO MORE REPEATS? YOU ALSO DID NOT CALL ME TO TELL ME TO REFILL MY MEDICATION!!
Me: YOU are responsible for your own medication. You can see on your label how many repeats are remaining, and also you can see EVERY DAY when you take your pill how many pills are remaining. If you realize that you're coming down to only 1 week left of pills you should have either checked with the pharmacy to see if you had any more repeats, or made an appointment with your doctor.
Lady: Well, what am I supposed to do now, I have no more medication! You HAVE to give me more medication!
Me: Well, I could try to fax your doctor for repeats, you can make an appointment with them, or you can go to a walk in clinic.
Lady: That is ridiculous!
Me: Sorry, those are your only options. (In my mind I'm thinking that SHE is ridiculous!)

Conversation #2
Lady: I need my pills, but I have no more repeats. You need to fax my doctor as soon as possible. I AM LEAVING FOR VACATION TOMORROW. I HAVE to have my pills and you MUST give them to me.
Pharmacy team member: We will try our best to fax the doctor and ensure you get everything in the original bottles, with expiry dates on them, and in brand names after being specific to the doctor to write "no substitution" on the renewal. Hopefully they reply.
Lady: Well, I don't care how you do it, just make sure I get my pills!!

Why is it that people always come last minute to the pharmacy to get their things? You take your pills every day. You see how many pills are remaining. EVERY DAY. Every day the number decreases so the urgency increases! WHY WAIT UNTIL THERE IS ONE LEFT?!

Frosty Reception

Surprisingly the last few days have been pretty short on ridiculous incidences at work. It makes it so much more relaxing, but that means I have less to post, so I'm posting about an incident that occurred a few weeks ago.

I was checking a prescription prepared for a patient, and I noticed that it read as follows:

Estrace 1gm - 1 tablet daily

Prometrium 100 - 1 capsule twice daily

For those non-pharmacy people, these are hormone medications (an estrogen and a progesterone). 

Knowing that the doctor probably meant 1mg (1/1000th of 1gram), I signed it and hoped that the patient wouldn't show up until the next day so at least all the documentation would be proper, and faxed the doctor's office with a quick note asking for clarification. When I asked "Do you mean Estrace 1mg instead of 1gm" I pretty much expected the doctor to just write "YES!" and fax back, making it completely easy for them. 

Instead, if you see the attached document, I received a fax in return where the doctor clarified it to be 1gm. I think this was one of the rare times I had to clarify a clarification because I knew that I was probably right. 

I called the doctor's office only to be greeted with the frosty receptionist. Our conversation in summary:

Me: Hello! I just received a fax back from your office and I just wanted to clarify the dose again. 

Reception: Well, if the doctor WROTE 1 gram, then it IS 1 gram. WHAT is the problem? 

Me: Well, it's just that the product Estrace only comes in 0.5mg, 1mg, and 2mg, so 1 gram is a pretty huge dose. Can you please ask him to look at it again? 

Reception: WHY? The doctor ALREADY wrote the answer, and we ALREADY faxed back. It IS what it IS. 

Me: Look, if the direction is 1 gram per day, and each tablet is 1mg, then the patient should be taking 1000 tablets per day, or 10 full bottles of 100 tablets per day. Do you understand why I am asking? (ie. Please use your brain and think about it...)

Reception: Oh. Okay, then fax your request again. 

I faxed the request again, making it even clearer and finally I got the answer that I wanted. Thankfully the doctor was courteous and wrote "sorry" on his response; there have been other doctors who have been quite rude in return (I now only WISH I had kept copies of those responses, hahaha). I have also dealt with many types of receptionists in the past and some have also been quite rude for no reason. I hope that this incident showed that sometimes we're not calling just to be annoying and that people should wake up and think for a second before they speak! 

PS. I was just thinking that there's no way that one of those automatic dispensing machines would've been able to do the amount of work/thinking it took to fix this problem.

PPS. This is another reason why it takes "THAT LONG" to fill your prescription. If this incident didn't happen during YOUR prescription, it happened to the person before you. =)

Unnecessary Work

A man came to pick up his prescription today. which came to $9.99. I scanned in the barcode and said "That'll be $9.99 please". He opens his wallet, so the pretty fat stack of bills inside is quite visible, and he hands me a twenty-dollar bill. I ring it in and give him $10.01 change.

Man: Um, can I pay with card?
Me: You just finished paying.
Man: I mean...can I pay with my credit card?
Me: You just paid and I already gave you change. You mean you want me to do a REFUND for you so you can PAY AGAIN with your credit card?
Man: Yeah.
Me: You seriously want me to do a refund so you can pay again with a credit card?
Man: Yes.
Me: WHY?!
Man: Because I want to.

I contemplated the other worse things in life and decided that things could've been a lot worse. At least in this scenario I did not get yelled at for something stupid and not my fault.

I processed this man's refund, asked for a penny, and gave him back change, and then charged his card. What an unnecessary amount of work for something so simple. Craziness.

That's What I Meant!

Customer: I have a pretty stuffy and runny nose. I used Claritin and it didn't work. Can you recommend something else for me?
Me: How long have you been experiencing symptoms?
Customer: It has been maybe 2 weeks I've been trying the Claritin and I haven't  found it very effective for me. Is there anything better than Claritin?
Me: Let me ask you a few questions then. Do you have any allergies to medications, any medical conditions, or are you using any other medications? Have you tried any other medications?
Customer: No to all of the above.
Me: Which symptoms are bothering you the most? The runny nose, stuffy nose, or both?
Customer: All of them.
Me: So you're itchy and sneezy? Any colourful discharge?
Customer: Yes, itchy and sneezy. No discharge.
Me: There's no list of what really works better, but there are quite similar allergy meds and some people find one works better for them than other drugs. It takes trial and error.
Customer: What is that?
Me: Trying it to see if it works better. Let me show you something. *walks to the aisle and selects Aerius Sinus 12 hour*
Customer: WAIT, THAT is what I've been using the whole time!!
Me: You told me that you've been using CLARITIN all along!
Customer: Well, I MEANT that.
Me: So you've been taking AERIUS and NOT CLARITIN?!
Customer: Yes.
Me: Okay, so try Claritin Sinus 12 hour, or you can use Claritin Sinus 24 hour. Keep in mind though, that the decongestant that helps with extra stuffy nose in these can keep you awake maybe.
Customer: Okay, I don't want something so strong, I have trouble sleeping.
Me: Okay, maybe try plain Claritin. It still works for allergy symptoms, just not as well for super stuffy nose, but it won't affect sleeping as much.
Customer: Okay, give me the 12 hour one.
Me: Plain Claritin pills are ALL 24 hours.
Customer: I only want something that's 12 hours.
Me: They're the SAME allergy medication. Claritin in the usual dose lasts 24 hours. When you get Claritin SINUS they cut the dose in half and add another drug, so then you need to take it twice a day, because IT'S ONLY HALF the amount.
Customer: What?! I only want 12 hours, so forget the sleeping. I'll take the Claritin Sinus 12 hours.
Me: Whatever you want. (By this point I had had enough.)

A Conversation on Being Specific

Recent Conversation

Man: I have this rash on my arms and the thing that the doctor gave me doesn't work. (Note that the rash doesn't look like hives.)

Me: How long have you had the rash? 

Man: 2-3 weeks. The doctor also said that there was something I could take OTC but I cannot remember what it is.

Me: Do you know what medication was initially prescribed to you? Did the doctor tell you what this rash was caused by?

Man: No, I don't remember the name of the medication, and I do not have it with me. I also don't know what this rash is caused by. It's just a rash that's itchy. 

Me: Well, it's hard to help tell you what to do next if a prescription medication wasn't useful, because lots of prescription medications are much stronger than OTC medications, so anything I suggest might not work anyway. 

Man: Well, the doctor said I could use something OTC that was very good. 

Me: Was the rash due to an allergy according to the doctor, and is it spreading?

Man: I don't know. It was just a rash and it is getting worse. 

Me: Unfortunately you aren't giving me enough information about the cream that you used or what caused this rash, so I cannot really recommend something that might be effective for you unless I get more information. If in fact your prescription medication is stronger than anything OTC, then you might have to go back to your doctor for follow-up. Can you call maybe try to call someone at home and ask them the name of this cream?

Man: No, no one is at home. UGH. Nevermind! You are so useless!! 

Me: LOL. Ridiculous.

What does that say?

Reposting some old, but good stuff.

When you first try to read this prescription I think most people are a little dumbfounded. Once you know what it says it's just really obvious. This is from a pediatrician...I am quite concerned that there have been mistakes made elsewhere due to his poor quality handwriting!

The Journey Begins

I've now been a pharmacist for four years. At work we talk about drugs, medical conditions, and patients; at home we talk about what work was like, and whenever we have a chance to step out of our busy lives for a second and can enjoy some time with friends, what do we talk about? We talk about work, drugs, medical conditions and patients.

My husband has always said to his other friends that when I get together with my pharmacist friends it always ends up being a gabfest about the worst patients,  students, and more patients...To tell you the truth, I think that my colleagues and I will never get enough. Nobody understands what the pharmacist has to tolerate except other pharmacists so when there's a giant group of us or even just two of us, it's just everyone letting off steam. "I cannot believe that so and so said and did THAT!" Or, "The doctor really wrote THAT?"

Over the years there have been some pretty good stories in which sharing them elicits some minor sympathy from "outside people" (ie. those who don't spend hundreds of hours behund the counter) but they have slowly faded from my memory. This blog will be the new place to keep my pharmacy "exposures" remembered, and hopefully I will be able to convince you, the reader, that next time you see your pharmacist, be NICE to them - they aren't just pill-counters and free question-answerers (although we do that too). We have lots to offer, and we want to help...just appreciate what we do and don't take us for granted.

With that said, this place is also going to be a place where I and potentially some future guest posters will be letting off steam. Enjoy the stories, laugh, and don't seriously wonder "OMG, did that REALLY happen?" Of course they did. In a not so literal sense, we are kind of like nurses, your other favorite profession - we deal with crap on a daily basis.