Hi Pharmacist

Tuesday, March 17, 2009

Pharmacist Generosity

I read recently that there is such a thing as a “generosity gene” The study suggested that certain ethnic groups are apparently genetically endowed to give some of their time, knowledge, expertise and treasure to other people. It went on to identify Americans of European lineage as being like this.

I have been a generous person for my entire life. I remember giving a Rocky Colavito, Cleveland Indians baseball card to an 8 year old boy whose parents did not think that baseball cards were wholesome. He had his secret stash of cards, but no Indians and that was the home team for boys in northeast Ohio.

I guess that family does not count, but V and I are both haunted with this gene. She has given Vancouver, BC to Houston plane tickets to her sister for the last three Christmases. I have been especially generous with V’s kids. The dad, who was absent for almost all of V’s youngest son’s life, refused to co-sign for the first round of student loans. S, I did it. He needed a laptop for law school, so I gave him one worth $3000.00 with kick ass programs like Office.

I am buying an “AS IS” house in the heavily Hurricane Ike flooded Bayou Vista neighborhood for V’s oldest son, wife and baby to live in. The son is going to do all of the recovery, repair and renewal work. I provide the down and closing costs and Frosty pays the mortgage, property taxes and insurance (not a small thing on the coast of the Gulf of Mexico). Someday, we’ll settle up. When UTMB announced that it will rebuild in Galveston rather than move much of the institution to the Mainland, the house appreciated substantially.

I am certainly not a rich man, but I can do things for the kids.

What a good boy I am. Gandhi Plagakis. Family does not count.

I am thinking of Drug Store generosity. My co-workers have always gotten little things from me. Food mostly. I helped a drug store clerk with grocery money way back in the early 1970s. Her husband stole the money from her purse and bought dope with it. This was the 70s. The magic flame of love and peace of the 60s had been snuffed. I think this was the beginning of the “Me” decade.

I have paid for prescriptions for patients/customers. I have a thing about earaches. More than once, I have paid for the Auralgan-type ear drop because the mother had only enough dough for the antibiotic. I mean, the kid is all runny nose and whining, holding her ear. I can’t say, “Sorry. Money on the barrel-head or, like the soup Nazi, ‘You get no ear drops today.’”

My sister in donating gene, SOSP, out in Washington State buys big ticket things for her patients, occasionally. The last I heard was a small, office-size refrigerator for the bedroom of an older woman who shared a place with a “roommate” who stole her food from the fridge that they shared. SOSP most definitely has this gene.

Awhile back, a young woman wearing the work outfit of Popeye’s Chicken had the money to pay for the prescriptions for one of her children. She had two with her. A toddler and a child in her arms. The problem was that she would not have the $20.00 she had planned on using for milk & bread and the like to fill in until pay day.

“I guess it will be Ramen noodles,” she said. “Or chicken”.

I asked her if she had insurance from work.

She shook her head, “I’m not salary yet. When I am an assistant, I’ll have benefits.” Sounded like an opportunist company. Work them in a hot, greasy kitchen and provide no benefits.

This was a young African American woman in Texas City, Texas, a town where a significant percentage of the population is working the system. A town that I am happy to just forget. This girl was working. She was not on Texas Medicaid and this was before CHIPS money was loosened up.

I told her, “You are trying hard.” I took twenty dollars from my wallet and told her to go to the grocery store. She tried to refuse, but I insisted. She got a little choked up, remarked that a kind man had white skin. Did she know about the gene? Hardly.

What I want to know is this: Are SOSP (blonde and white) and Jay Pee anomalies or is the study accurate? Is this a white person of European lineage thing or do all pharmacists show generosity on occasion?

Monday, March 9, 2009

Calling ahead - How hard is it?

Every retail pharmacist in every pharmacy around the world have dealt with this issue.

Patient comes in to the pharmacy and wants a refill. He has 0 refills left on his medication. You tell him that you need to request refills from the doctor. He gives you a blank stare with the response "but I'm out! ". Of course he wants his seizure or di-a-beetus medication (that he cannot go without). It can't be something stupid like Zantac or Vicodin.

When it comes to refills and calling ahead, patients fucking fail every single time. I mean the number of refills you have left on the bottle isn't a secret, it says right on the damn container. However patients, being the most retarded creatures on the planet, just don't "get it" that sometimes a little planning ahead goes a long way. Even if you put a big note on the Rx that you must call ahead to get refills they still pull this stunt!

Moreover, this puts pharmacists in a very interesting situation. Technically its illegal for us to fill an Rx that has no refills remaining without a doctors approval. The patient obviously doesn't have his bottles (you think he's going to make it easy for you?) with him, so you can't just put a few in there to last him. You have the following choices:
  • Use a typical TAP Response: "Tough shit. I warned you the last 5 times you pulled this shit that you need to call ahead. A lack of planning on your part does not constitute an emergency on my part. Maybe after you seize or end up in the hospital you'll get the simple concept of calling ahead when you have 0 refills remaining. Quit crying, I don't care!"
  • Waste the money on your labor, yet another vial, and another label for a whopping 4 tablets to advance him (since you obviously just cant dump tablets in his hands) until you get the OK from the Dr
  • Fill the Rx anyways and deal with the doctor if he denies/changes it.
  • Run and hide and let your tech deal with it.
Can't say what the right answer is. Obviously for controlled stuff (vicodin, etc) the backlash of filling it without an OK is greater than shit you can justify (BP, diabetes, seizure, etc). I mean really, if a patient has been on the same Tegretol dose for the last 5 years, there is a good chance that the doctor will okay it, however, that's illegal by the letter of the law, but allowing someone to seize because they are a dumbass is ethically not-right.

Breaking the law vs caring for your patient, where do you draw the line?