Pharmacy. Jim Plagakis. Pharmacist

A few weeks ago, I learned a brand new imperative about pharmacy practice. It was an ah ha moment and my job has been made much easier knowing this. My entire relationship with the patients I counsel has been redecorated. I have either broadened my archetype or I have created a brand new paradigm for my practice of pharmacy. Either way, I am better off for it and I can now walk away from a patient and not feel that I am inadequate. It is not me. It is them.

I have been faced with all of the evidence for a transformation for decades, but I just did not get it until I was counseling a boomer on the youngish side on the warnings and side effects of his medicine. He had wrenched his back lifting a truck tire with his knees locked and his back bent.

This guy professed to hate doctors and that he had not seen one until that day. He had listened to his wife for the first time in over 30 years about doctors. He had to. He works for a tire company. Hauling around monster truck tires is his job.

The prescriptions were for hydrocodone/APAP and tizanidine. Simple right?

Two drugs. He takes nothing else since he hates doctors and has not been a patient until now. Just take a quick detour on your way to go to the bathroom.

“Spike,” you say hello and he struggles slowly to stand up from the chair. He is bent over and, when he raises his face, you think, this guy is hurting. He sits down suddenly. His face screws up tightly.

“I can’t get up.” He tries again.

“No, sit sit. Don’t get up.”

“I hope you made me some damned good medicine.”

“Are you driving home?”

“No, I am gonna go to my mother’s. I always go to my mother’s when I don’t feel good. She’s better than any doctor.”

“No, Spike, I mean are you the one driving the car?

“Well, yah, I am. Why?”

“You shouldn’t be driving, Spike?”
“Why not?”

“You can’t even stand up, man.”

“I’ll be okay.” His eyes dimmed. “I’ll take some of my medicine and then I can drive.” He looked at me. “It’s good medicine right? Norcos?”

“No, you can’t drive. Trust me.” I answered his question. “They are generic Lorcet. Don’t take more than 6 a day. It could harm your liver.”

“How can I tell?”

“Tell what?”

“If my liver is hurt? Can I feel it?”

“Trust me on this,” I said. I made him promise to have his wife come and get him, to take him to his mother’s I guess. Then we got down to the routine counseling about his prescriptions. I gave him the quick, standard rap. This is a narcotic. It can impair your ability to drive or work with dangerous equipment. No chain saws tonight. Hardy har har har. It is my standard little joke when I counsel on pain medicine. For a female it is No electric carving knife with the roast beef tonight. Oh, yuck yuck yuck. You are such a card, Plagakis.

Spike had a blank gaze. I had lost him somewhere.

“Tonight is bowling night,” he said.

“How the hell are you going to bowl when you can’t even get out of the chair?”

“I can still go if the medicine is good enough. I can still be one of the team, have a few beers.” He sort of smiled. “You ever had that chili cheese nachos bowl at the bowling alley?”

I told him that I had never been so lucky. As I was looking down at him, I had the awakening.

This guy was a lot dumber than I was and I believe that this is a general rule. Pharmacists are simply a lot smarter than most of the people they see in a work day. Of course there are people we deal with who are just as intelligent as we are. I was going along thinking that everyone could understand what I was saying. Not so!

Let that settle for 30 seconds. Take a deep breath. Now listen. You are a highly educated professional. Just getting through pharmacy schools says this about you: A smart cookie, this one is. The is a good chance that many of the people you deal with on a daily basis are just not as smart as you are!

Many of the people you deal with on a daily basis just do not get it when you are trying to connect. Some of the girls at the doctor’s office likely can’t get it. There are people who will never get it no matter how hard you try.

So, what should you do? Try this. I sat down beside Spike and buoyed by the realization that I was not connecting, we pared down the counseling to the core. I limited it to no alcohol, no driving, possible drowsiness and don’t take it if you don’t need it.

My paradigm before Spike did not include the notion that I deal daily with people who have no idea of what I am talking about. If you look carefully, you can see in their eyes that they have gone away. What you have said is so impossible for them to understand that they just check out. They go away. They say things like okay and Yes I will and I understand when all they want to do is get the hell away from you.

As I was returning to the pharmacy, Spike said to my back, “If I let my mother drive me to the bowling alley, then I can have a few beers, right?”

I did not even turn around. I had done my job

I can see buckets of tears flowing in the offices of pharmacy middle mangers in Camp Hill, Deerfield and Woonsocket and buckets of money is not going to help. Imagine this scenario. The pharmacy district manager returns a call to the PIC in a store in rural Alabama. He has not been told about his most recent IMMIGRATION PROBLEMS. He has a couple foreign pharmacists working in his pharmacies. The chain has them everywhere. They do an adequate job. They have adequate English. But their biggest value is that they are better than adequate when asked to pick up the slack when there is a crunch. If you throw enough money at them, they will drive all night
to open the pharmacy at 9:00 AM in an emergency.

So, when Fouad tells his PIC that he will not be able to work, the buckets of tears start welling up in the district man’s eyes.
“What do you mean? Fouad is on track for his Green Card.”
“Not anymore,” the PIC reports. “Last week the State Department withdrew
tens of thousands of job-based visas they had offered last month to foreign professionals
who were on track to become permanent residents in the United States.”
OHMIGOD, the district manager feels sweat on his forehead. If the government refuses Fouad’s visa, what is going to happen to Rajinder’s visa? And the other
three foreign pharmacists? Dieter from South Africa, Phillip from the UK and Maria from the Philippines? They are aching to work in the USA.

He tells the Vice-President boss and there are additional buckets of tears. “They can’t do this. We have followed all of the rules. We paid for their mandatory physicals. We have officially sponsored them. I’m putting in a call to legal.”

To make a long story short, the State Department had expected to offer 60,000 visas for highly skilled professionals starting July 2nd. This was announced on June 13th.
Middle managers in Rhode Island, Illinois and Pennsylvania celebrated. They needed, at the very minimum, warm bodies with licenses to put in the hours. Well. Not so fast. This offer of visas has been withdrawn. Period!

I do not think it is much of a stretch to agree that there are a number of foreign pharmacists who had been counting on one of the 60,000 visas. Goodness knows that
we need people with their feet on the floor behind the counter. These foreign pharmacists
are gutsy, I believe. How many of us born-in-America pharmacists could dig up the courage to move to a place with a distinctly different culture, a difficult new language
and no friends, no relatives? The best we can do is move from Long Island to Los Angeles.

I cannot guess why the State Department has pulled these 60,000 visas. I hate to be Chicken Little and say that the sky is falling, but THE SKY IS FALLING. We, as a profession, are already stretched to the limit. We need pharmacists desperately. The profession needs foreign pharmacists. Period! I know, this is the second little article
about immigration, foreign pharmacists and visas in the last couple months.

I am writing this for the people who hire pharmacists at CVS, Walgreens,
Rite-Aid, Kroger and Wal-Mart, among others. You may not have Abdul or
Tejinder or Zoe to throw money at. The visas that they counted on are kaput.

Your born-in-America pharmacists aren’t as impressed at the buckets of money you throw around anymore. They want you to address working conditions. They want to work in a dignified atmosphere. They want respect. These people who were born in the homeland don’t have as much patience as they used to have. They are willing to work hard, but, frankly, guys, there are issues like getting the promised vacation when the kids
are out of school and going to the bathroom any time they want. The first major company to take in hand the issues that pharmacists want addressed will not have any recruiting problems. American-made pharmacists will be impressed. Throwing money at them goes only so far. Think about it!

Second dip. Today…………….

A middle-aged woman stands looking at me. I made the mistake of making eye contact. “Sir, will you look at the list of my father’s heart medicine… he just had a heart attack.. …and tell me if he can take this sleeping medicine with his heart medicines.”
“Sure. What is your dad’s name. I’ll look and see what he is taking.”
“Well, he didn’t get his prescriptions here.”
Now, this is something that really gripes me. They call us because we answer the phone. They don’t have to wait. This woman came in and was standing in front of me.
“Where did your father get his prescriptions?”

My Bloody Valentine psp

“CVS.”
“I think it would be best to consult with the pharmacist at CVS.” I was done with her. CVS was 5 minutes away when the traffic is bad. How dare she come and want me to give my time and knowledge to her when we hadn’t even filled the prescriptions?

Well, Mister Tough Guy Plagakis got ambushed. She started to cry. She mumbled
something about MY DADDY and the tears came in gushes. She found a weak point in my façade. I was putty.
“I have already been to CVS.” Boo Hoo.
I handed her a handful of tissues. “What did they say?” This was a mystery.
“They didn’t have the time to talk with me.” She wiped her eyes and handed me a typewritten note. It had the names of her father’s medicines listed. She handed me a package of Tylenol PM. “My father wants to try this, but I said not until it was
okayed by the pharmacist.”
I looked at the list and said, “It’s okay.” And that was that.

Come on, you TOO BUSY pharmacists. Taking care of this woman is YOUR JOB. Especially when you filled the prescriptions. Enough is enough, you guys. You can never be too busy for this.