Browsing the archives for the Jp Enlarged category.

WANTED… REAL Pharmacists to Step Up Legally & Ethically. LIVE UP to your Own Personal Standards.

Jp Enlarged

After lunch at Pelican Cove around 2003

After lunch at Ferrante Winery in Grand River, Ohio around 2003

This is the 21st Century. 15 years out from Y2K, when everything run by computers would shut down at 12:59 PM. VICTORIA and I were newlyweds. We lived in Bellingham, Washington. V worked as a Level A Pharmacy Tech for Rite-Aid and I worked for Longs. We were married at noon on January 14, 1999. Lunch time. Our witnesses were the two young women who ran the business office of our apartment complex. The rent-a-minister was on the list given to us at the Whatcom County Court House Licensing office. She has a Greek name and her husband was a reporter at the Bellingham paper. That is how I made the choice.

The wedding was brief and glorious. V and I were dressed for a casual ceremony. Jacket. shirt & tie. V in a stylish dress. I bought corsages for the minister and the girls. A white carnation on my lapel. V’s Bouquet was very nice. I had a local deli deliver the food. The 5 of us ate good food. We had talked about a ceremony in the spring of 2000, but the ability to file an IRS 1040 as a married couple was too tempting.

Anyway we got a little spooked about Y2K. The media was relentless. ATM machines would jam up. Banks would not open. Credit cards
would not work. It could be dangerous with bad people looking to exploit Y2K. V and I had $1000.00 with no bills larger than a twenty. Lots of fives and ones. Y2K proved to be nothing.

Today, in 2015, my definition of a REAL pharmacist is very different than my definition in.. say… 1990 was very different. in 1990
I was most interested in keeping my good job. I loved the 10 minute commute. The job was just a PIC job. Much just floated by me. I ignored the store manager. He tried to micro-manage.

TODAY, I am looking for a few REAL pharmacists. Are there any out there? Do any of you stand up and do your job legally?

“Brenda, you are the store manager, but you are not a pharmacist. You have a bad habit of entering the pharmacy without my permission.”

“What? I do not need your permission. I’m the manager of this store.”

“But you do need my okay, Brenda. It is the law.” An icy stare. “You cannot come in the pharmacy and wander the bays, looking at the drugs. Why do you do this? Why are you so interested in handling the drugs?”

“Ah, the inventory looks too high.”

“Bullshit. You do not have a clue about the cost of the drugs.”

Don’t you trust me?”

“I do not trust anyone back there with bottles labeled Vicodin, Valium, Dilaudid (CIIs were spread out) so do not enter the pharmacy without my permission and stay at the counter when you visit. One more time, Brenda and I will write you up.”

“You can’t write me up!”

“Try me.”

Phyllis Wene is a pharmacist who is an investigator (not inspector) for the Washington State Board with police powers. She can arrest offenders. Phyllis told me this story. A store Manager at a Haggen’s Grocery Store called the board and accused the PIC of breaking the law. Phyllis agreed to meet him after the store closed. Very late, like midnight. When she got there, the store manager was in the pharmacy nosing around. Phyllis went in and listened. The guy’s accusations were nothing. The PIC was doing his job legally and ethically. She wrote her report, brief and concise. Then she asked the manager, “How did you get in the pharmacy?” He told her the key
in the safe.

Phyllis did not hesitate, she busted him. She cited the number of the law, told him that he and his boss would get a notice of the day and time to appear in Olympia. The manager was ordered to NEVER enter the pharmacy. Haggen’s had to pay a stiff fine. The board was lenient. He was told that Phyllis could have arrested him right then and there.

All of you are REAL pharmacists. Just show it once in awhile. Tell me if this piece is a dud. It is amazing what you like. I put up a letter from a Walgreens PIC during the WAG/Express dust up. She was very critical of the WAG CEO. That week, for 7 days, the number of visitors to this blog was 700+ every day. I did not expect that. The piece on the RPh must be present when an Rx is sold law has not had no comments. That is a surprise. Your life is on the line. I know that plenty of Rxs are sold with no pharmacist present. Lunch time. Before the pharmacy opens or after it closes. Sundays, holidays. I had a manager open the pharmacy because he said he heard the water running. He also used Hycodan for a persistent smoker’s cough. Yeah, water running. This guy is the grandson of the founder of the company. 400 stores. I WAS NOT a Real Pharmacist that week, that month, that year.

Are You? Just give me one shot. Write a comment. Make all of us proud.


If They (Chains, Big Box, Grocery Stores) in Collusion with the Boards try to do this, leave some Teeth and Blood on the Floor.

Jp Enlarged

No Metrics Here

This is from Washington State. I worked there for 20 years. I believed that Washington was the most progressive of the 50 states. I now believe that Oregon has earned that distinction. A couple years ago the Executive Secretary of the Oregon Board of Pharmacy commented on the fast pace, metrics and frantic pharmacists working at a Super Market pharmacy. He said, “Prescriptions are NOT Pastrami & cheese sandwiches.”

If you want to make your knees tremble with envy, visit The first article is a lengthy listing of Oregon’s pharmacist friendly (*MBA Masters of the Universe unfriendly) rules and regulations. Any Oregon pharmacist who does not take advantage of these rules is an idiot.

WAC 246-869-020 (Washington Administrative Code)
(4) Prescriptions shall be stored in the pharmacy and cannot be removed from the pharmacy unless the pharmacist is present and the removal is for the immediate delivery to the patient, person picking up the prescription for the patient, or person delivering the prescription to the patient at his residence or similar place.
I believe that all 50 states require an RPh to be present when Rxs are sold. If any board or legislature (To satisfy CVS or Rite-Aid) tries to remove this law, YOU NEED TO FIGHT FOR YOUR LIFE. If necessary, leave blood and teeth on the floor. Your life will be on the line.

How will It Be Possible to Sell One Trillion Dollars Worth Of Prescriptions Every Year? Maybe, but you have to be there.

It will not be possible if we think that the present (unexamined) model of the Prescription Mill stays in place. If we fail, if we cannot do the job, it will be the end of pharmacy at the end of the funnel. Our culture will write us off as not up to snuff.

Dollar Amount of
Prescriptions Filled
1999 compared to 2009
1999 2009
$105 Billion $250 Billion
That is an increase of $145 Billion in the decade, an increase of 138%. That is an astounding figure. In 2009, all medical care came to $2.5 Trillion. Prescriptions accounted for 10% of the total.

One Trillion Dollars by 2019?

One of you math wonks, prove it.

Exponential Growth and Decay
In many natural phenomena (such as population growth, radioactive decay, etc.), quantities
grow or decay at a rate proportional to their size (Our case # of Rx per year) In other words, they satisfy the following
differential equation
= ky; where k is a constant (1)
If k > 0; we call it the law of natural growth. If k < 0; we call it the law of natural decay.
THEOREM: The only solution of the differential equation (1) are the exponential functions
y(t) = y(0)ekt (2)
REMARK: It is easy to check that (2) satisfies (1). In fact,
= (y(0)ekt)0 = y(0)(ekt)0 = y(0)ekt  (kt)0 = y(0)ekt  k = k y(0)ekt
| {z }
= ky(t)
have fun.

You will always have a job with that kind of money ringing the registers. The MBA bean-counter MASTERS OF THE UNIVERSE would love to change it, but, as long as you must be there when a prescription is sold, they will have to pay to keep you behind the counter.

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They Are Afraid of You. You can be Very Dangerous to the MBA Masters of the Universe.

Jp Enlarged

The Poet of the Sixties

“How does it feel
To be on your own
With no direction home
Like a complete Unknown
Like a Rolling stone”

Bob Dylan

Counseling in all of its various forms is the activity that will define us in the 21st Century. Doctors will seek the counsel of some of us. We will provide MTM. There will be pharmacists who prescribe the drugs. If pharmacists want to be useful, they will counsel their retail patients on their daily prescriptions.

Pharmacists will always be the point person for triage for a certain class of patients. They will come to you because you are accessible and because you won’t charge them. You are the last medical professional standing who is still free.

I believe that it is time for pharmacists to enter the 21st Century and leave the olden days behind.

This book is not, however, about counseling. It is not about getting away from The Prescription Mill, the company’s timers and status reports. It is about acting like what you are. A highly-trained medical professional who will make a difference in your patients’ lives every single day.

The re-invention of your professional self will not be easy for anyone. There are pharmacists who have spent twenty years running The Prescription Mills for various chain drug store, big box and grocery store companies. They are institutionalized and changing the way they view themselves will not be easy.

It will take only courage for students and young pharmacists to invent themselves in the mold that the 21st Century will demand. They have been provided all of the tools needed. All they have to do is use them. All they have to do is be willing to become a Dangerous Pharmacist.

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Karen Dempsy Steps Up. Courageous! We need YOU to do something.

Jp Enlarged

It Just Cannot Be This Bad!

Dec 31, 2014 was my last day as a hospital pharmacist. I started my career in 1992 in small town independent pharmacy. It was glorious. I helped people stay healthy and I helped them get well. Over the next 8 years I watched the insurance companies compete with each other to give us the lowest reimbursement possible while the wholesalers squeezed every penny out of us they could while giving the chains the volume discounts. Frustrated, confused and desperate to practice pharmacy and move away from insurance administrator, I fled retail to become a hospital pharmacist. My brain has been doing somersaults for the last 3 years disbelieving that hospital pharmacy is following the same path as retail. So here I am a veteran pharmacists of 25 years going back to school. The health care industry needs experienced health care providers at the helm of health care reform. Layering economics on top of clinical experience just feels like the right combination. I pray other healthcare providers are having a vision that will motivate them to move on to learning new tools to combine with their clinical experience. Currently medical care is suffering from greed, and bean counter mortalities. The hospital’s cooperate consultants seem to view the pharmacist as the caboose of the health care industry. Simply because their 2+2, black and white mentalities aren’t able to wrap their brains around what a pharmacist contributes in the team. What am I going to do to help fix this problem? I don’t know right now, all I know is that I will give it my best shot. I sure hope to be accompanied by professional colleagues that have watched this all go bad over the last 25 years and are ready to stand up and make the right changes in health care reform. Seems to me we have had more than enough of this nonsense. We as health care professionals have to take our profession back from the money grubbers so that we can do what we were meant to do, Help people stay healthy and help make them well when they are ill. Jim, you have been the voice of many pharmacists. Please, through your writings, encourage everyone to contemplate the ways in which we can change health care reform to being about peoples health instead of exponentially killing off the health care professionals. How do we create a “Revolution?”

Want to help? Many hands make for light work.Contact Karen Karen Dempsy


ANGER can Ruin You or be Your Best Friend

Jp Enlarged

Fear is a Fight or Flight reaction.  Causes Cortisol and that causes Plaque

In the end, it is fear alone that keeps us acting and think like weiners.

You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, “I lived through this horror. I can take the next thing that comes along.” You must do the thing you think you cannot do”.
Eleanor Roosevelt
The situation that thousands upon thousands of pharmacist find themselves in is not hopeless. If they see themselves as victims who are powerless in their own lives, they are most likely going to be miserable. However, if they see that they have choices at every turn along the way, there will always be hope.
I have done my best to illustrate the worst pit that many of you wallow helplessly in so that I can show you that you are not helpless and that the difference is a matter of perception, pride, dignity and integrity. Pharmacy will not make you proud. Your viewpoint of yourself and how you behave is what drives your self-respect or lack of such. It is not easy to intimidate a person with confidence and self-respect. Especially, a professional. The relative intelligence and education of the average Jailer cannot compare with yours. He knows that and does everything in the book to keep you controlled.
The sense of being powerful in our own lives is largely missing with the institutionalized pharmacist. Like a disaffected teenager, we compensate for a lack of power in our professional lives by seeking power in ways that are not necessarily healthy. For every female pharmacist who finds some power by volunteering at the hospital for children with neurological disorders, there is a pharmacist who is depressed about her life and stays at home on her days off, lying on the sofa, watching soap operas. She is so used to salty snacks that she can’t stop. There is an empty large bag of chips on the floor and a half filled 2 liter bottle of soda. She has gained weight and hates herself for it.
For every male pharmacist who is on the Board of Directors of the local school board, there is a man who gets his power the way I did, from controlling my body to the point of distraction. I cross trained every single day. I spent an hour or more on the Nordic-Track machine six days a week and swam laps four times a week. I restricted calories to the point that I was so lean that I actually looked like I was ill. A friend of my brother expressed his condolences. He said, “I’m sorry about your brother.” Mark said, “Why? What’s the matter with my brother?” The friend said, “He’s got AIDS, doesn’t he?”
What I got was power over my own life. I may have been a victim at my job, but here I was in control. Nothing was more important than my physical condition and my lean appearance. I cringe when I see pictures taken back in the day because I actually believed that I looked good.
Recovery is regaining Your Power
Essentially, the miserable pharmacist is wretched because they choose to be unhappy. There is a choice every single day to be proud of what they do or to blame the job because they are not happy. They don’t even use the best tool available to them. That tool is anger!
Anger is fuel. It is not the bad thing that your parents said to suppress as mine did. “Jimmy, nobody needs to know you are angry. You should control yourself.” We feel anger and we become frustrated when we hide it because we want to do something about it. This goes against the image of the calm, in-control professional. Instead of showing the anger, we stuff it and chug Maalox and take two 20mg omeprazole every day.
How would it look if we showed that we were angry? At work, you don’t hit that someone or break that something or throw that fit. If you smash that fist against the wall, do it in the bathroom where no one can see that you are out of control.
What we do with our anger is deny it. We stuff it so far down that we forget what makes us angry. We are institutionalized and we believe that we should not get angry. We lie about being angry at the store manager. We hide our anger at the lack of technician help. We do not express our outrage to the district manager. Doesn’t he know that it is his precious customer service that pays the price?
Some of us hide it so well that we medicate the anger and filch the occasional lorazepam to hide it even better. We are professionals and professionals are nice people. We bury our anger. We block it and we hide it.
What we do best with our anger is lie about it. Unfortunately for our spouses, we lie so well that we often take our misery out on the people we love (or are supposed to love) the most. We do everything but listen to our anger.
Listen to your anger. That is what it is meant for. Anger is not a polite request. Anger is a scream. It is a command. It is a slam of the fists down on the table demanding your attention. Anger has a right to be heard. Anger should be appreciated and valued. Anger must be listened to if you are to regain your professional balance and power. Why? Because anger is an atlas or a chart or a diagram back to living the ideals you had when you were in pharmacy school.
Anger reminds you of your boundaries and limits, the areas where no one was allowed to tread without your permission. If you can set up the periphery of your professionalism in just one area, more will follow. If you list only ten serious drugs that you will counsel on no matter what, your list will be twenty in little time. If you let the store manager know in writing that his touching you at anytime, in any manner, is unwanted, you will regain enormous power and control over your own life on the job. You can gain power simply by refusing to get wet underpants because you neglect going to the bathroom when you have to go. Documenting anything at work that makes you uncomfortable will give you surprising control.
Anger shows us where we want to go. We may not know exactly what we do want on the job, but our anger tells us, without ambiguity, what we sure as hell do not want. That is a really good place to start because anger shows us where we have been and sets us on the course of recovery. Anger is not a sign of disease. It is a sign of health. If you no longer get angry at being institutionalized, stop, take a deep breath, and examine how you will find your way back. I contend that you will find that the first sign of recovering your health, well-being and pride will be anger. Welcome it. Savor it.
It is not very healthy to act out from anger. That is childish and not productive. I quit a job once out of anger. It was a good job. I was well respected in the community. The problem was that the store manager tried to micro-manage my department. I have never bent to management from a non-pharmacist. This guy was out to bring me to my knees. I fell right into the trap. I became so angry that I brought the problem to a head with some stupid brinksmanship. My district manager did not back me as fully as I wanted, so I quit. My one-way commute for that job was less than ten minutes. The one-way commute for the next job was ninety minutes. I was like a teenager having a meltdown. I turned my anger into indignation without any examination of the circumstances. I was an idiot.
Anger is there to be acted upon. Anger points the direction. Anger is the wind for our sails as our sailing ship tacks as we move on the appropriate bearing where our anger guides us. Had I used my head and had the presence to translate what the anger was telling me, I would have made better choices.
“Damn it, I could run a better pharmacy than that!” This anger says that you want to have your own pharmacy, you just need to put all of the pieces together.
“I can’t believe it. Mildred told me that she was going to demand a transfer to the suburbs and she got it. That’s what I wanted.” This anger says: Stop keeping your goals and dreams hidden. You need to express your wants and believe that you deserve your dreams to come true.
“That was my idea. This is unbelievable. I mentioned it only once and that son of a bitch took my plan and put it to work. He gets all of the credit and I get none.” This anger says that it is time to take yourself seriously and show yourself some respect. Your ideas are good enough to do something about.
Anger is the tornado that blows away all of the restrictions and hesitations and lack of self confidence of our old lives. Anger is a valuable instrument to be used productively. Anger cannot be the master, only the servant. Anger is a deep well of power, if used properly.
Apathy, laziness, misery and gloom are the enemies. Anger is not a good buddy, but anger is a friend. Not a mild-mannered friend, but a very loyal and steadfast friend. Anger will always remind us when we have been cheated or cheated upon. It will always tell us when we have been deceived or when we have betrayed ourselves. Anger will tell us that it is time, finally, to act in our own best interests. Anger is not the action itself. It is the action’s invitation.
Watch out what you ask for
You might just get what you want and then what are you going to do? It can be scary, having dreams come true. That means that you have to take responsibility for your own life. This is not comfortable, but you will feel the power. You can no longer blame the big bad store manager wolf for your lack of integrity. You can’t say that the company made you do it. You are back in your own hands, a professional making choices every day that benefit you and your patients. This is a good thing, don’t you think?
When you take responsibility, things happen that you cannot fully understand why. You are the pharmacy manager and you tell the Jailer that you are going to do what is best for your department in all business and professional matters. You tell him that you are the pharmacist, that you know best and you request that he mind his own business. You take all appropriate actions, the department thrives in all areas. Your pharmacy is suddenly the most professional and most profitable in the company and everyone wants to know why. What did you do?
Taking responsibility is not easy. You can feel very much alone. It takes courage to do the right thing. This is a difficult and slippery slope. A pharmacist who has little self-respect and has been stripped of dignity may need assistance in making the choices that are best for both their professional and personal lives. I honestly do not think that you should rush. You have been institutionalized for years. There is no hurry. You don’t want to make a rash move as I did. You probably should not try to do this alone. Talk to someone you trust before you take any significant action.
I merely took the energy it takes to pout and wrote some blues
Duke Ellington
There is a way back. Want to talk about it?

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