Pharmacy. Jim Plagakis. Pharmacist

I get a lot from simply asking questions. Listen to this.

I called for a transfer recently. It was a chain and the young pharmacist answered my question, “How do you like working for a chain?”

“I hate it,” he said. “I work too damn hard. The fuckers expect me to get the drive up
between prescriptions now.”

“Well, why not work for an independent?” I should have asked that question to myself in the 1980s and 90s when I was toiling as a pharmacy manager for a chain. They expected
me to work 12 hour shifts.. (I had already been diagnosed with Progressive Post Polio
Muscular Atrophy) .. on my feet all day long, gobbling salty snacks and too much coffee
for my meals, running to the bathroom, literally, with my underpants slightly wet because I dribbled from waiting too long. You get it? You do the same thing.

“Money! I can’t get the same money from an independent.”

Wild at Heart ipod

This didn’t sound right. “Most independents will pay chain wages.”

“It isn’t the wages. It’s the extras. I have my 401k maxed out. I have an IRA that is maxed out. I don’t have to make car payments. The chain does that for me. They will pay me a new sign on bonus every 3 years when the contract expires. I get a bonus based on performance. I’m still single. I have made good investments. I’m getting out early.
Maybe at 50.”

“Goodness, man. What would the profession do if everyone got out at 50? The shortage is bad enough.”

“Fuck the profession.”

I was thunderstruck. This is my profession that he was talking about. Like many of us, I have a love/hate thing going on with pharmacy, but the love always wins out. Not this young guy, just starting out.

What is this FUCK THE PROFESSION? How many of you early career pharmacists are concerned only about the $100 grand a year, the benefits and the extras? How many of you simply do not give a shit about the profession?

I am getting benefit from the shortage too. I’m an older guy and work only two 10 hour shifts a week. Thursday & Friday. I make a good wage. I love working. If I quit completely it would be like taking the clown out of the circus. I have been doing it for 40 years. I love it and I hate it. At the worst time, I have never even thought FUCK THE PROFESSION.

In the twenty first century, we need to be watchful. This is our profession, not the non-pharmacist middle-management at CVS. I have heard the bloated wage referred to as “hush money.” (Paul T) Is he right? Are they buying you off? Are you not fighting
for pharmacy because you are too damned comfortable?

This is a time for focus. This is a time for stubbornness. For resolve. The profession needs for all of you to take a stand on the little things that matter. A goddam 30 minute

• Not Forgotten psp

lunch break, for crissake.

I’m too old and tired to take a job where I need to fight for my rights. My boss is good to me. I am too beat up to join a struggle to the death. You’re not. THIS IS YOUR PROFESSION. You are the DECIDERS. You just don’t know it yet. You have the power. You just haven’t used it yet. You can have it any way you want it. I predict that the first chain to treat pharmacists in a dignified manner will not have recruiting problems anymore. Trust me on that. IT IS YOURS FOR THE TAKING. Fuck the guys who say Fuck the Profession.

Some guy actually called me “Al Capone” and said that he would fire me in 5 seconds. He said that I should be turned in to the state board. He did not day, “string you up”, but
he certainly made his point that he does not like me writing things he disagrees with.
THIS GUY GAVE ME A REAL GOOD HOSING.

This was about a JP at Large column that appeared in the February 5, 2007 edition of Drug Topics magazine. It was entitled “How wrong could I be?” It was a narrative
about a protracted telephone transaction between me and a doctor from Michigan around 6:30 PM on a Friday. He wanted me to get Diastat & Keppra for his brother and wanted to start the road trip for his brother’s home as soon as possible. I am not going to re-write the piece here. If you do not have a copy of the magazine, go to the Drug Topics Main Page. You can find it there. If you do not have a subscription to Drug Topics, you can order one there. That would be a good idea since Drug Topics is the premier glossy magazine aimed right at you.

Anyway, it was around 1994 that Ralph Thurlow, the editor of Drug Topics, told me that all mail is good mail. That includes U.S. Mail, e-mails and telephone calls. I learned to easily weather most criticism. Of course, I did not like negative comments, but ALL MAIL IS GOOD MAIL.

“How Wrong Could I Be?” has gathered comments from both sides. Strong, icy, malignant comments came from the disapproving side. Warm huggys from the other side.

There were comments that included words like AL CAPONE, DOPE, UNPROFESSIONAL, GOD THE PHARMACIST, FIRED YOU IN 5 SECONDS.
These stung, I will admit. I have exposed nerves about what I write.

Then there were the ones who approved of what I wrote: BIGGEST FAN, ABOUT TIME
SOMEONE SPOKE OUT, SAY IT LIKE IT IS, THANK YOU.. JP.

First, I would never, ever suggest that a pharmacy owner or an employee should LOSE
MONEY in the process of giving services and providing a product. What do these people
who dragged me through the fire think? Who do they work for? Are their pharmacies really successfully profitable if this is their attitude? Or was this an opportunity to work JP at Large over? What do you think?

The rest of the story. I write my column to a 650 word model. There is a lot that I often have to leave out. Believe me, I do not leave out the good stuff to include the boring words.

The doctor and I were on a first name basis. He called me Jim and that was the end of it. He was Michael from then on. Tough, strident? You bet! He had started his search for his brother’s medicine in Clear Lake, Texas, about 25 miles from Texas City. There are a lot of pharmacies between the parking lot of the medical center pharmacy where he sat in his car calling pharmacies and Texas City. He was impatient when he got to me. CVS had put him on hold and not returned. The pharmacist at Walgreens laughed and said, “Diastat? You are dreaming.” Wal-Mart hung up on him with, “We are too busy”.
What he really wanted was to find a pharmacy that would bill his brother’s PBM so he would have to pay just the copay for these very expensive drugs. At his first stop, the medical center pharmacy, the claims were rejected. Like many of our ignorant customers, he thought that trying a different pharmacy would mean a different outcome.

I know this story because I called his cell phone at 7:00 PM after we closed. I wanted to help if I could and STILL NOT COST MY OWNER THE LOSS OF HER INVESTMENT. Dollars sitting on the shelf until they go out-dated IS A LOSS.

Michael was curt and he actually said, “You pharmacists are not helpful.” He told me that he pulled out his credit card at the medical center pharmacy and paid for the prescriptions. He said that his brother would self-submit. Then he hung up on me.

Any comments? Go ahead, work me over. I can take it.

I have been shamelessly indulging myself in a BLEEDING HEART period for the last year. Perhaps personal issues have made me more sensitive, but I have been very observant of the difficulties that some people face in life and the trouble they have
just following the map of living and keeping on the road.

Many of them just give up and go to marijuana, cheap vodka, wine or Vicodin, Xanax and Soma. Life is just so damned desperate for them. These people have to be monitored, but just remember what got them there. I fully acknowledge that there are others who are just bums.

But some of them are courageous and downright inspirational. Especially, the single mothers who are trying so hard to raise their kids without a daddy who will contribute even the basic, minimal child support.

Yesterday, an attractive, diminutive young woman, twenty-something, wearing a red Popeye’s Chicken ball cap and a Popeye’s Restaurant polo shirt stood and waited for me. She had a small child, maybe five, beside her. The kid had one of those everything-is-alright-I-am-so-happy smiles on her face.

“Do you sell Gening Violet?”

“We do sell Gentian Violet,” I said and had her follow me to the shelf. “There are better things if you go to the doctor,” I said. “They won’t make such a mess.”

She shrugged. “This is good,” she said, “I don’t want to go to the doctor.” She
looked at me. “Do you have a medicine for worms. My mother said that my youngest child has worms because she can’t sleep.”

I told her that I didn’t think that insomnia was an indication of worms. “Have you looked at your child’s stool. There should be tiny white threads if it is pinworms.”

“I just want the medicine.”

Pin-X is OTC. It is old-fashioned. Parke Davis called it Povan 3 decades ago. Multiple doses are needed. I didn’t want her to spend the money if it was not needed. “Is your child scratching his bottom?”

“Oh yes. He has an itch.” This girl spoke very good English. She had a calm about her than I admired and she was going to take care of her child no matter what.

“You’d be better off going to the doctor. It would be just one pill then. What I can sell you takes multiple doses over a period of days. “

“I can’t go to the doctor. It is too much money.”

“Don’t you have Medicaid?”
“I make twelve hundred dollars a month. They say I make too much. I am an assistant manager but I don’t get benefits until I make manager, which I hope is soon. Then I will be on a salary.” She gave me a hopeful smile.

“How many kids?”

“Two…. five and three.”

I ordered the Pin-X. $20.00 for 12 tablets. Somebody was making a good buck. “It will be $15.00,” I said. “It will be here by eleven tomorrow morning.”

“Can I pay for it now?” She took a ten and a five from her thin wallet.

“You can pay for it when you pick it up.”

“I’m afraid that I won’t have the money in the morning.”

“You don’t have to pay for it at all.” I put my hand on her arm. “I am paying
it for you. You are a wonderful mother, Joi. I am ashamed of our society that you,
someone who is trying so hard, cannot get help. I want to help you a little.”

She gave me a wide eyed look and smiled. “Oprah,” she said.

“Oprah,” I answered and leaned over and kissed her forehead. “A Valentine’s present from an old white guy.”

“Thank you, Mister Jim.” I liked it that she knew my name.

Help! I need to be de-programmed. I need for Krag & Paul T. & RxJoe to kidnap me and take me to a Holiday Inn and lock me up for a week and talk me down, like families did for their children when they got brainwashed by the Moonies 20 years ago. Victoria, I am certain, would be complicit in this venture. She could be counted to lead me to the rendezvous. She has wanted me to cut back my hours ever since I started to work in Texas.

Annpharm, on the Message Board, has thanked me numerous times for my advice to quit with the grinder and cut back to 20 hours a week. It was a better choice, than throwing away an education and a career that can get her more than $50.00 an hour because she was worn out. Instead of going to work for the zoo, Annpharm works her 20 hours, brings home a pharmacist’s paycheck and can still volunteer at the zoo 5 days a week if she wants. Annpharm is a bright woman. She knows good advice when she hears it.

So what the hell is wrong with me? Why can’t I manage to take my own advice? I have been working at least 27 hours a week for the last year. I have never said NO when asked to fill in for an emergency or just because the boss decided she wanted the day off. I have made myself available to be on call for the hospice we service and have found myself at the pharmacy at 2:30 in the morning. If you have ever been 65 years old, you will know that getting back to sleep is not an easy thing. I want to know if I am a loyal employee or just stupid.

“Stupid” just doesn’t work. Definition: Showing a lack of intelligence. “Loyal” doesn’t work either. Definition: Remaining faithful to a government, a person or an establishment. It does not add … to the detriment of one’s own health, peace and enjoyment of life. I have been doing that. Giving up some of the harmony of my life to be a good soldier and work more than I really want to.

I don’t want to be an asshole about it. If I am needed in a real emergency, they can count on me. It has always been that way.

I am “institutionalized”. Definition: To make something an established custom. They often use the term to describe the state of prisoners. People who have been in jail so long that it is all they know. I knew a college physics professor from Eastern Europe. He was a holocaust survivor. He would walk across campus with his hands clasped behind his back, his gaze on the sidewalk, his head bowed. You could say, “Hello, Professor Povich.” He would sort of winch and mutter, “Hello.” He would never look up for fear of being noticed. He was “institutionalized”.

In pharmacy, that looks like feeling guilty when you ask for a few days off. It is cancelling plans and agreeing to work extra even when you don’t want to. It is working 12 hour shifts with no meal breaks. It is working 9 days in a row to get 2 days off in succession. It is taking a vacation in October because there is no relief help in July when the kids are not in school. It is holding it until you almost pee your pants and actually thinking there is nothing wrong with that. It is thinking that having your work timed is okay and normal. If you put up with these, you are INSTITUTIONALIZED. What did I leave out?

For me, it is working 27 hours a week when I want a 20 hour work week. I do not know how to get out of this “trap”. I have mentioned it once to them at work. Then, I left the ball in their court. Very bad move. Of course, they have said nothing.

So, help me. Please! Those among you who are not institutionalized, tell me what I gotta do. Are all of you women? How do you women get away with it guilt free? You, as a group, seem to have no problem arranging strict part time schedules. You even get away with demanding no weekends and no nights. How do you do this without feeling guilty? Do you consider that your “Loyalty Meter” is less sensitive than us men’s?

Or am I the only male so afflicted? Tell me. I can take it. Don’t be gentle with your answers. Give it to me rough. I can exercise my manly man muscles and stand tall and listen, really listen to what you have to say. Remember, I need deprogramming. All of you. Help me. The Holiday Inn is out. Victoria said so. So, this forum is it.

I work in a pharmacy that does not have a whatever-you-call-it telephone answering system. You know, “Press one to leave refill requests. Press two if you are a doctor.”
So, often, I am the one answering the telephone at work. There are stores where pharmacists actually do that.

Today, I wanted to have a little fun. So, when a pharmacist identified herself as from CVS and that she wanted a transfer, I said, “Did you notice how long you had to wait for a pharmacist?”

“Pardon me?”

“Did you notice that I answered the phone and that I did not ask you to wait on hold?”

“Well, yes. What are you getting at?” Here we go. I had a smile on my face. I could hear that her face was firmly set, no hint of a grin. I had not accused her of anything and here she was acting like she was guilty of something.

“I just wanted you to notice that you did not have to wait at all. Of course, it is an easy jump to the many times that I have called CVS for a transfer and have had to wait on hold for minutes.”

“Do you use the doctor function, press two?”

“Always.”

“The pharmacist is always the one to answer the doctor line.”

“Oh!” This was not my experience. Perhaps she was referring only to herself, not the pharmacists who have the tech answer the doctor line and put me on hold. “Every pharmacist? Always?”

“Always,” she repeated.

“Okay. What do you need?” I had the damndest strong urge to put her on hold. Just for fun. I would only make her wait ten seconds. Ah, devil, get off my shoulder. I fought down that base impulse, but I want you know that there was a day, in my unseasoned years, when I would have put her on hold. Not for just ten seconds either.

Two Weeks Notice on dvd

“I just want some transfers.” She told me the patient’s name and then was silent.

“Prescription numbers.”

“I don’t have numbers. She said to get everything.”

Come on. You can’t be that ambiguous with me. That is what went through my head.
What I said was, “You are going to have to do better than that. I need the names of the drugs, at the very least. I’m not guessing and you shouldn’t either.”

“I beg your pardon.”

“Beg anything you want, but I don’t have the time at 3:15 PM on a Monday to act as a surrogate for the patient. How about if I fax you her entire record? You decide what drugs you want and be the patient’s proxy and call me back.”

“Better yet. I’ll get the names of the drugs and maybe even the numbers.”

“That’s a good idea.”

When she called back, I noticed that the drugs were three controlled drugs and carisoprodol. We had refused to fill them earlier in the day. Way too soon. I told this to the CVS pharmacist and suggested that the patient was trying to work the system.

“Well bullshit!” she said, “He will not get anything here.”

We could have saved a lot of time. Just the basics, maam. The prescription number certainly greases the transfer chute.

We have a lot of trouble getting information, it seems. Our patch of the medical care garden is information rich. We need definite facts about our patients and precise data about prescribers. Numbers are big with us and they need to be accurate. We need group numbers, cardholder ID numbers, relationship code numbers and birthdates. We have to accurately record DEA numbers, license numbers and, depending on state, more numbers. Those are just a start.

For both the patient and the prescriber, we must have addresses, number and street and suite and zip code + four. We need telephone numbers. Area code first. Then we need ten digit fax numbers. Actually e-mail addresses would be nice too. Did I leave anything out?

Two days ago, this transaction transpired. It was around 3:00 PM. I had a sheaf of prescriptions I had just taken over the phone from a hospice nurse. These Rx, 12 of them for a new admit, had to be prepared quickly for the delivery man. I like to pull all of the drugs for the technicians. There is less of a clog in the tube if I do this, I think. This conversation WAS a clog in the delivery tube.

“How do you spell the doctor’s name. With an Mc or an Mac?” This was a Houston doctor. He was not in the computer. With an unfamiliar name, I always check before I hang up the phone. I hate having to back track in these days when fewer phones are actually answered by a human being. She had already, with a deep sigh, given me the complete address and telephone number.

“His name is MacIntosh. Didn’t you listen?”

“I know. You have told me that. With an Mc or an Mac?”

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She solved that puzzle so we moved on. “How about his DEA number.”

“This drug is not a narcotic. Why do you need his DEA?”

I explained to her why I needed his DEA and then moved on. “I need the doctor’s DPS number and his state license number.”

“What is the DPS number and why do you need his state number?”

“The DPS is a Texas state number that he has to have to write for narcotics. If the patient is Medicaid, his license number is the identifier.”

“This is not a narcotic,” she whined. “And it’s not Medicaid.”

“Just get it for me.” I am proud that my attitude did not bleed into the conversation……yet!

“Are you a pharmacist?”

“I AM a pharmacist. Only pharmacists can transcribe new prescriptions. Didn’t you know that?”

“You just seemed confused.”

With that, she ripped open an artery and there was blood all over the place.

“Here is the deal,” I started to lecture. My voice was pitched a little higher and she was not going to get out of this conversation until I had a piece of flesh firmly between my teeth.

“We have never filled a prescription for Doctor MacIntosh before. If we get all of the numbers we might ever need the first time, we will never have to call and bother you again. We will not have to delay the patient. This woman has been sitting here patiently.
You have already delayed her a half hour because you were not timely in returning my call.”

“Well, let me give you the drugs then. You are delaying her now.”

“Get your thinking cap on,” I said, “Write all of these numbers down and put them where you can find them for the next pharmacist who asks. They will love you if you are prepared.” Have you noticed that that is true? When a doctor’s office employee actually
can give you the numbers you need without hunting for them, you want to give her a big hug and a kiss.

It took at least 5 minutes, but I got every single number I demanded. Had she been less of a bitch, I would have given her a pass on the DPS number, fax number and state license number. She was right. I did not need any of them and since it was not a narcotic, I could have passed on the DEA if there was no insurance. Chance are that MacIntosh of Houston would not be calling in prescriptions for a citizen of Texas City ever again.

At the end, I said this. “Now that you know that I am a pharmacist, are you a nurse?”

“I don’t have to be a nurse,” she said. She knew the drill. She knew that I had to be a pharmacist and she told me that she was not a nurse, but was authorized by MacIntosh to call in prescriptions.

What is wrong with that picture?

How many of you have had authorized people say something like this. “It is a funny zee with an extra loop on it and three lines with three dots on top of them.” Your turn. Give me more examples. I remember this, “Is that Seldane or Feldene?” The answer I got was, “Yeah.”