Pharmacy. Jim Plagakis. Pharmacist

JP Enlarged

Stat means stat for gawd’s sake

Last evening, right before closing, a frantic threesome came up to the pharmacy counter. The oldest, clearly the leader, had long stringy hair, a New York Yankees cap and was using crutches. He blurted, “Did my sister’s doctor call you?” This man’s eyes were lit up. He licked his lips and bit his fingernail.
The second one, a younger man, repeated, “Did my sister’s doctor call you?”
The third one, a young woman, said, “My sister got bited by a bee.”
I looked up then. There are reasons to be concerned about a bee sting. I asked what their sister’s name was and looked for her in the computer. She was not a patient at our pharmacy.
Now is a good time to tell you about these people. They all had haunted wide eyes. Each of them had a minor speech impediment, like they had learned as children to talk this way. The technician whispered into my ear, “Inbred.” I agreed and had the thought that this bee stung sister may need help getting her Epipen.
I called the clinic across the street and asked about her. They knew who she was. They knew that she claimed to be allergic to bee stings. They knew that she had been stung. They also knew that she was not their patient and refused to order anything.
“Her doctor is in Burlington,” the nurse said. “We have already contacted them. They will call you.”
“They will call me? She needs the Epipen now.” I looked at the technician.
“Go out to the car and bring her inside.”
“She is not our patient,” the nurse repeated.
“That is bullshit,” I said. “Do you know what Epipen is for?”
Blur rip
“Of course I know what Epipen is for and you don’t need to swear.”
“Stat is the instructions. Of course you know what stat means.”
Who’s That Girl the movie
“Of course I know what stat means. Jim, what has gotten into you?”
“This woman could die. That is what has gotten into me.”
I hung up and went to the shelf for an Epipen. I took it out of the box and looked at the sister. She was already swelling up. She said, “I don’t feel good.”
“Have you ever used one of these?” I held up the Epipen.
“I can’t remember.”
I handed the Epipen to the technician. “Help her,” I said, “She pops it into her thigh.”
To the technician’s credit, she did not hesitate. The woman popped it, drew a little blood, but in seconds she said, “I feel better.” She managed a small smile. The family walked in a sort of communal limp and left the store. None of them said thank you, but that was okay. We didn’t do it for thanks. We did it because stat means stat.
Finally, 20 minutes later, the sister’s doctor’s nurse in Burlington called. She told me to give this woman an Epipen.
“I have already given the damned thing to her.” I was agitated from the situation and angry at 2 offices filled with doctors and nurses who should have known better. “She has already used it. She feels better.”
“You gave it without a prescription?”
“You are damned right I did! She could have died. The timing and order is a little off, but the patient is still alive.”
“The doctor may not like that you did not wait.”
“Do you know what Epipen is for?”
“She should have had one on hand.” Now the nurse was going to blame the patient. I suppose it would serve her right to die. She didn’t plan ahead.
“Give me a break for crissake. This woman was going into anaphylaxis and all you can do is blame her because she did not have an Epipen on hand.”
“Don’t get mad at me. We don’t do anything in this office without the doctor’s permission.”
“Even in an emergency? You’ll wait for the doctor?”
“I asked you not to get mad at me.”
“Alright. I’ll calm down.” I took a deep breath.
“I suppose it is okay that you gave it to her, but you should have waited until we talked to the doctor.”
“It is an emergency drug,” I said. “This was an emergency.”
“We have rules,” she said.
“Sometimes you have to say the hell with the rules. This was one of those times.”
“I could get in trouble. The doctor is very strict.”
“What would you have done? The woman is standing right in front of you. Her face is starting to swell. She is scared. She could die and the Epipen is just a few feet behind you on the shelf?”
“Point taken” the nurse said with a sigh. “Give her 2 Epipens with prn refills.”
“These people are not very bright,” I said, “They need to be led by the hand. She is already gone and this is not her regular drug store.”
“I’ll call her regular drug store,” the nurse said.
“They don’t have a phone.”
Right before closing, the nurse from across the street called. She asked if the woman had gotten her Epipen. I assured her that the sister was okay.
“By the way, Jim.”
“What?”
“The doctor agrees that we should never have made her wait until her own doctor called.”
“You are not forgiven,” I laughed. “Stat means stat.”

“Will you call the patient?”

Racetrack Pharmacy October 12, 2005

JP Enlarged I can’t help it. I’ve been doing it too long to change. It isn’t good for me. My health suffers. My nervous system is like a frayed electrical cord. It sparks and sizzles. My stomach needs Rolaids after a day of too much black coffee and a diet of salty snacks. I jump when the phone rings. I hate the phone. I hate it that customers think I have time to listen to their stories. They want to tell me about how well the sleeping pill worked when they were on vacation. They hate a strange bed, you see. I have to let the voice mail take some of the calls. Some call me rude because I have to cut them off. They think I am unfriendly because I won’t listen.
This is racetrack pharmacy. You dance as fast as you can. Once you get started, you can’t slow down. You still get behind. After a racetrack day, I don’t sleep very well. I’ll fill prescriptions in my sleep. I count pills. The same pills over and over again. I see the faces of the frowning, difficult customers. The impatient ones who give me a hard time because the waiting time is a half hour. I never get the pleasant customers in my dreams. I only get the wisenheimers. The ones who want action right now, but prevent me from doing my job to argue with me about the waiting time.
“There are people ahead of you,” I explain in my dream.
“Where? I don’t see them.”
I panic. They are right. There is no one there. I wake up and my heart is racing. This is not healthy. I should know better than to try to work at that pace. The day follows me around, like a dark cloud, for hours after the official shift is over.
The problem is not that I have busy, nerve-wracking days. The problem is that I actually feel proud about it. The number of prescriptions filled during a shift is still a predominant criterion for the judging of a pharmacist. If you can fill a whole bunch of prescriptions, you are a good pharmacist. If you can’t quite do so many. If you ask for help. If you insist and sitting down for a rushed lunch, you are not such a good pharmacist. By those rules, I am a terrific pharmacist. I have been a terrific pharmacist for many years. I am also a stupid pharmacist.
Okay. We all have busy days, but I don’t think that all of us feel a sense of satisfaction when it is all over. Me? I do! This is racetrack pharmacy and I am a speed horse. Store managers have loved me. They give me a smile. They pat me on the back.
They want to know how many prescriptions we have filled. You can see the calculators in their brains. $85.00 per prescription at 18% profit. Yum yum. They start to salivate. This is big money.
I know that I gotta stop it. I know that I can’t continue working at a break neck pace and thrive. Fortunately, these days are rare for me. How about you? Have you tried to slow down? Do you go to the bathroom when you need to? That is the last glimmer of failed dignity. When you don’t go to the bathroom when you have to.
I keep telling myself that I have earned the right to stay away from the racetrack.
I remind myself that a ten minute meal break is not unreasonable. The customers may bitch and complain because they have to wait. They may huff and harrumph, but they’ll get over it. But will I get over it? I doubt it. When the racetrack presents itself, I’ll hop on and run as fast as I can. I’ll fill too many prescriptions and I will feel good about it. I’ll keep on doing it because it is what I have always done and I just can’t stop.

Kinney pharmacists are trained and certified over-the-county drug advisors. That is what I hear on National Public Radio every evening on my ride home, at about ten minutes past six. Now here is what my wife, a licensed pharmacy technician, had to say about that. “That is not just misleading, it is stupid and it is an insult to somebody’s intelligence. Victoria worked as a technician for Kinney a few years back. “They are just like any pharmacist. Too rushed! Too busy! Too stressed!

“But, Victoria,” I argued, “They are certified.”

“La la la, I can’t hear you.

” “Wait a minute,” I said, “maybe they really are certified.

” “How can they be?”

“Kinney sends them to school, huh? Maybe Kinney pays for their rooms and meals. Maybe the certifiable pharmacists can order a round or two of drinks on old Kinney.”

“La la la! I don’t think so.”

“Perhaps Kinney gives them the 2005 PDR on Over The Counter Drugs and tells the pharmacists that they have to study the book to keep their jobs.”
Victoria laughed at that one. “Good old Bob would be working at Brooks within 24 hours.”
I got the dictionary out and found a treasure of certify words. There was Certificate -that is the written statement that proves that Kinney’s proclamation is true. Certification – the act of certifying. Someone had to take their metaphorical sword and touch the shoulders of the supplicant Kinney pharmacists to certify each of them. How about good old certify? To declare something true or correct by an official spoken, written or printed statement.
Well, who the hell is the official who certifies the Kinney pharmacists? Is it the guy on the radio? He said it so it has gotta be true .. Right? I don’t think so!

The radio statement implies that the Kinney pharmacists have special training that the rest of us do not have. I don’t think so about that either. Every pharmacist I know is an expert on OTC drugs and therapy. Not every single one of us is willing to leave the pharmacy and share our knowledge with the patient just because we get so damned far behind that we will never get caught up. We don’t get paid for it either. We’ll explore that some other time

. So, it is clear to me that there is no one, with authentic certifying authority, who is going around to the Kinney pharmacies and declaring that Kinney pharmacists are so special that they are better than the rest of us. They are just regular pharmacists, you guys, and, just like you and me, they know a lot about OTC remedies. I am one who loves to counsel on OTC therapy. Some of you hate it. None of us are truly certified. The word implies that something special happened. A certificate from a one hour continuing education mail-in course on OTCs is just not good enough for me. Last winter, I listened to a drug store clerk as she gave advice to a patient on cough control products. This girl was not a technician. A technician would know better. She said that the best was a product that her mother had given to her when she was a little girl. The customer kept looking at me so I finally stepped in.

“Now,” I said, “You can take the advice of a pharmacist. That’s me! Or you can take the advice of the girl who works in the greeting cards.” I stepped between them and indicated that Karen should go back to the gift shop. Later, I told Karen to never presume to give anyone her opinion on any disease or any drug when I am in the store. “I’ve done it before when Rick is working.”
I stared at her. I felt uncomfortable doing this, but I said, “I take this so seriously that I will advise that you never are scheduled to work when I am the pharmacist. Perhaps just plain never work here again at all.”
She cried.
Tough!

• Who’s That Girl dvdrip

Every pharmacist is an expert on OTC drug therapy. Most of us are not certified. Only Kinney pharmacists have that distinction. Yeah! Sure! Yuck yuck!

This elderly customer looked down at the vial of pills on the counter and said, “We can’t afford that.” She put her checkbook back into her purse and said it again, “We can’t afford that.” She was stricken. Her face had turned pale. Her hands trembled slightly. She sighed deeply. “Why so much with my AARP discount?” She gave me a mean stare.

The problem was that she had lost her pensioner’s insurance when she became eligible for Medicare and we all know about Medicare and drugs for the next few months at least. Nada! “It’s not my fault.” I held my hands out, palms up. “This drug is $125.00 for 45 tablets … after your AARP discount.” “We can’t afford it,” she said one more time.

Now, this was not a legitimate life or death drug, although some psychiatrists might disagree. It was sertraline (Zoloft) and she had been taking 150 mg a day for a couple years. Had the doctor even talked to her about depression lately? “I’m going to quit all my drugs,” she said with a snap to her tongue. “We just cannot afford this kind of money.” She stared at me. This woman could be scary. She had the elegance of a big city woman and the toughness of a farm girl. “Maybe you should not just quit all your drugs,” I said, thinking of her diltiazem, atenolol and hctz. “This one, I will quit. I will not pay that kind of money for a drug.” She gave me a look. “Why are you so expensive?” I said it again. “Don’t blame me. This store is not the one making all of the big money.”

“Well who is then?”

“Can’t you guess?”

“The drug companies?”

“Bingo! Medicare will help starting next year.”

“Well, what can I do in the meantime?”

“I will tell you,” I said and I did! I told her that her AARP discount card did very well with generics, but did not do that well with brand names. I told her that there were generic drugs similar to sertraline and she would be wise to request a drug change from her doctor. She was interested now. “What drugs? Are they just as good?”

“Probably just a good, but you are the only one who can really answer that question.” I wrote the names down for her. Citalopram and beside it I wrote generic Celexa. Fluoxetine and Prozac. “Here are two good ones.” I folded the slip of paper and handed it to her. “The generic Prozac is really cheap,” I said. “I’d guess that a month’s worth would be less than $30.00 with the AARP discount.” She thanked me and assured me that she would talk to her doctor. He is a family physician. I just can’t wrap my mind around that idea that your average family doctor can competently treat depression.

Red Dragon movie

This elegant farm woman took a metaphorical club to her doctor within an hour and he had me on the phone within 90 minutes. I had made a mistake. When I make a suggestion of this type, I usually request that the patient tell the doctor that they found the information on the Internet. Doctors just don’t like pharmacists exercising our knowledge muscles. I neglected to do that and I paid the price. He was aggressive with me. “Did you tell her to change drugs?” Oh boy. I could tell from his voice that he was pissed. It was too loud and snappy. This doctor was an older physician. Some of these guys, who have been around the race track a few times, are used to pushing pharmacists around. Not me!

“Hold up,” I said, “I did not tell her to change drugs. I told her that there are alternative drugs that are much less expensive. I told her that it was up to you and I made a couple suggestions” There! Take that, big fella! I explained the price differential to the doctor. He listened carefully, but I could hear that he was not happy with me. He was breathing hard. “I told her to discuss a generic drug with you.”

“I think Zoloft is a good drug,” he said, calming down.

“Doctor,” I said very slowly, very distinctly, “She won’t take anything if you don’t write for something cheaper than Zoloft.

“You don’t like Zoloft?”

“Zoloft is a fine drug,” I said, “And when this patient had prescription insurance and the copay was only $15.00 it was fine for her. Zoloft is not the problem, doctor. The fact that 45 tablets price out at $125.00 with the AARP discount … that is the problem.” The doctor quietly asked me which generic would be the cheapest. I told him fluoxetine. He said, “She probably doesn’t even need this anymore.” He prescribed fluoxetine and hung up without saying goodbye. This incident is at the top of the iceberg. This woman was no pushover. There are thousands of people out there who never complain. They pay huge amounts of their income on very expensive medications when there may be an alternative drug that is only a fraction of the cost. How do they know? They are unsophisticated about drug prices. They do not even know how to ask: Isn’t there something cheaper that can do the job just as well? They just pay .. and pay .. and keep on paying. You know people like this.

And you are not making a hell of a lot of profit when your investment is $110.00 and the AARP discount price is $125.00. You do much better when your investment is $5.50 and the AARP price is $27.78. It looks to me that both the patient and the pharmacy come out OK. Now, I am not suggesting that pharmacists intercede willy nilly when the prescribed drug is a very expensive brand name and there is a generic alternative in the same class. There are many people who have money and there are just as many who do not! I am suggesting that we look carefully and show some compassion when buying a prescription means draining the grocery fund. I think that were can be better human beings if we take a look and actually do something about it. On the third Friday of every month, around 5:00 PM, a seventy-something woman named Crystal comes in for her monthly prescriptions. Last winter, on an icy, blustery day below zero, I took a close look at Crystal’s cold weather jacket. It was baby blue, frayed and a weight appropriate for 30 degrees, not 10 below. Her husband’s jacket was denim. I filled her prescriptions and asked the technician to ring her out. I told her that I was embarrassed. She looked at me funny and said, “Why are you embarrassed? What have you done?” “The prices,” I said, “Look at the prices.” Three prescriptions came to almost $400.00.

“Do something then.” A twenty-something idealist.

“Like what?”

She shrugged. “I dunno!”

So, I did something. I called the doctor’s office and talked with the nurse. I explained about Crystal and $400.00. I asked if the doctor had ever thought of less expensive therapy. I told her that I felt like a criminal. “These people may not get enough to eat,” I said. “The thing that gets me the most is that they never complain.” The nurse said, “I will talk with the doctor.” She did. Crystal came in with three new prescriptions the next month. Her total came to less than $120.00. The next time I saw her and her husband, they both had new winter jackets. So, if you are going to play in this game of serving people, use your head. Have a heart. And remember the old Internet trick if you don’t think you want to have your hind end chewed up by a cranky physician.