Pharmacy. Jim Plagakis. Pharmacist

You guys are still sending comments to the DATING DOWN and WRITING PRESCRIPTIONS SO THE PHARMACIST WILL LOVE YOU pieces. However, you aren’t much interested in fluff pieces like this one. I’m a smart rat. I’ll write more substantive stuff. I Promise. Happy Halloween.

Recent Conversation.
My second talk with this woman, 2 hours after the first talk.

Before I start. I am a 66 year old pharmacist who works for an independent part time. Two ten hour shifts a week, Thursday & Friday. Victoria fields the occasional call asking if I am looking for work. “Jim is satisfied right now,” is what she tells them.
I take chances because I can take chances and if my boss doesn’t like it, I’ll leave.
Right then. Just give me a minute to go pee before I walk out the door.

If you are younger and love your job and don’t want to walk out… use good judgement. Pick and choose your battles carefully, but do choose. There are so many battles to fight.

“But the doctor wrote for the Ultram ES. He doesn’t want the generic. ”

“Are you a nurse?”

Silence. “I am the office manager.”

“Then you probably won’t understand that convenience will not outweigh the hit on the patient’s pocketbook because her insurance will not pay for Ultram ES. The patient will have to pay and it is ridiculously expensive. If he wants this woman to have pain relief in a timely manner, he has to get a prior authorization or change to the generic”

“We will not get prior authorizations. We don’t do that.”

“Then get the doctor. I want to talk with him.”

“The doctor wants what he wrote for.”

“Did he tell you that about this one particular prescription? Or does your office think in terms of “the average patient”?

“The doctor has made his preferences very clear.”

“Are you challenged or something? I want to hear the doctor himself say that he insists that this patient pays over $100.00 from her own pocket when her insurance will for the generic.”

“What did you say?” Absolute ice in the voice.

Oh oh. She quit hearing me with the word CHALLENGED. “I apologize for that CHALLENGED business, but I am running out of fortitude and the patient is going without medicine.”

“The doctor is very busy this afternoon.”

“I suppose that you think I am not busy.”

Silence. More silence and I let her stew. “Well, I don’t know…..”

“I am just as busy as the doctor. I probably have more on my plate right now than he has at any one time in an entire day.”

“Well, I supposed I can leave a message on his desk.”

“When does he get to his desk?”

“After all of the patients.”

“Bingo,” I said, “You haven’t told him anything yet. I called two hours ago.”

“He wants all messages left on his desk.”

“You have not told him that the insurance won’t pay for Ultram ES and you have not told him that the insurance will pay for the generic?”

“I left the message on his desk.”

“Get him …. now.” Of course, she couldn’t do that. This guy’s office was set up like a fast food restaurant. The women who worked there became frozen if anything came up outside of their everyday way of operating.

The Rx was presented before lunch. She had been a morning patient. At around 6:00 PM, after all of the patients were long gone, the doctor called with seven words, “Use the generic 50mg. The Usual instructions.”

SLAM.

They act like Marie Antoinette. “Let them eat cake.” They don’t have a clue that the last step of the process is often FAILURE. There are a bunch of doctors out there who are not FINISHERS.

Preventive medicine. What a grand idea. The first time I came across it was when I had a complete, 3 day physical at Kaiser Permanente in Walnut Creek, California in 1978. The final step of the physical was an interview with an internist.

He presented a very impressive, even magnificent array of preventive care programs. It was the first time that I realized that stressing preventive care was a money-saver to outfits like Kaiser Permanente. This guy hit me hard on my smoking cigarettes, but I did not pay attention until years later when my mother’s doctor prescribed diltiazem for her. That did bother me. I have her genes. It bothered me a lot. I quit smoking, with the help of Nicorette, a year later, in 1990.

This essay is prompted by cleaning out a file in my cabinet. There was a note that I wrote who-knows-when. It read, 100,000 PREVENTABLE DEATHS ANNUALLY FROM IGNORING THE BIG FIVE. It took me awhile, but I finally remembered what the BIG FIVE are. The note also caused me to remember an incident when I was talking with the owner of one of the pharmacies where I worked in Vermont.

I told this guy, a pharmacist, that only $5.00 out of every $100.00 spent for medical care in the USA goes for preventive medicine. I told him that it was a shame. So much misery that could be prevented. So many unnecessary deaths.

The Da Vinci Code He laughed. “I’m in the crisis medicine business,” he said, “Preventive medicine just takes money out of my pocket. Yuck, yuck, youck.”

I liked him less after that and I really did not like him much in the first place. I had the thought, WHAT IS A PHARMACIST’S JOB IN THE MATTER OF THE BIG FIVE?

I am good at two of the Five. I always mention smoking cessation to diabetics who smell like tobacco smoke or have a pack of Marlboros sticking out, visible in the chest pocket.

I also do not fail to ask people, especially the elderly, if the have gotten their flu shot. Only 37% of Americans get the immunization when it is available everywhere, any time.
Victoria and I got ours last week at the Kroger grocery store pharmacy. We took 2 minutes to fill out the paperwork, did our shopping, returned to the pharmacy and the pharmacist gave us our shots in the counseling office, straight-away. 12,000 people die from influenza every year because they do not get the shot.

The owner in Vermont thinks that his business will be harmed if more people take preventive measures. I give him a great big raspberry. BlllaaaaaaaH.

This guy is too $$$$ focused to realize that all he has to do is own a pharmacy and he’ll do fine. There are 300,000,000 people in this country. That’s a lot of sickness, allergies,
blood pressure and the rest. To top it off, the BABY BOOMERS are gonna get him. This boom has just started. We are seeing the tip in 2007. These people are not going to age gracefully and go off into the darkness. They will insist on being youthful, vibrant and sexy for the length of the ride. I don‘t blame them. The technology exists and they have the money to pay for it. And Big Pharma is not blind and deaf. The industry is driven by the dollar in the 21st century. Curing diseases, ameliorating pain and making compromised lives tolerable is no longer the primary goal. Big Pharma will sell youth and sexiness in million dollar 15 minute ads on the Super Bowl. Making money is the king. The other is an afterthought almost. The paradigm has shifted. Too bad.

Come on back, Plagakis. The Big Five.

Little Big Man full

Smoking: One out of every five deaths in this country can be linked to smoking. I told a 45 year old diabetic with sores on his legs, “You quit smoking, my friend, or in ten years
you’re gonna lose that leg.” Three months later 2 things happened. A worthless prescription for Trental. Who is the doctor kidding? Himself or the patient? With the Trental, he bought a packet of Nicorette.

The flu vaccine: 12,000 needless deaths. People who are someone’s grandparents, or little children, end up suffocating to death. My best friend, a cancer victim, died this way. It was ugly. They always have to give a name. Sudden Acute Respiratory Distress. SARD. Or something like that.

Aspirin: 45,000 lives can be saved annually if these people would take one 81 mg Aspirin tablet daily. Think about it. How many people have died because you, the pharmacist, were too gaddam busy behind a computer terminal to inquire, “Did your doctor remember to tell you to take an Aspirin tablet every day?” Doctors are not perfect. Hardly!

Colorectal cancer screening. 14,000 people over 50 die because they did not take advantage of #4 of the Big Five. Pharmacists can do something here. You figure it out.
You graduated from an advanced program. You are smart enough.

Mammograms. I couldn’t find the statistics on the group of women who end up dying every year because they do not get mammograms. Perhaps one of you can assist us. I’m too tired to keep looking and the Red Sox / Angels just came on TV.

So, I’ll end by saying: We can make a difference. We are at the bottom of the funnel, remember? Everything falls into our lap whether we like it or not. All we have to do is ask the appropriate questions. Preventive medicine is a very good idea, not just for
managed care. For the country, all 300,000,000 of us.

May you be a source for healing in the world.