Pharmacy. Jim Plagakis. Pharmacist

Individualism has been touted as a desirable attribute for generations. The gun-toting pioneers of the west were individuals. So are soldiers even though they are not supposed to be.

The individuals of the 1960s were phonies. They made non-conforming an art of actually conforming. I lived in the San Francisco Bay Area and was laughed at in a Haight Avenue restaurant because I was wearing a blue blazer and a white turtleneck. My hair was over my ears, however. “Drop out” was never an option. I valued my profession.

Entertainers are the quintessential individuals. Pharmacists were herd animals up until the last four decades. We held on together to grow a profession under difficult circumstances, but we did hold together. Then something happened. Circumstances came about that all we had to do is look out for Number One.

In the 1960s, I was not an individual when it came to my profession. That came later. I was a “joiner”. There were ethical standards that most pharmacists lived by. At the beginning of the slam, bam 1970s when we started treating other pharmacists as the enemies (competitors), the so-called individual started showing up. It was everyone for himself.

It was easy for work-life conditions to disintegrate. Each pharmacist was on his own in almost all cases. You came in, you did your job, you put up with the conditions, you never complained when you did not agree with something. Your professionalism went into the abyss because it is very difficult for one person to make an ethical stand. That is what a profession does, not free agents like you and me.

The fabric of our profession has been torn. It is time to start repairing the stuff that we are made of.

We are in an age of individual responsibility. Accountability is the buzz word. This kind of individualism is not an “every man for himself” type of individualism. It is not a gratifying one’s desires for their own sake and to hell with everyone else. It is an ethical philosophy that elevates the individual to the standards of something bigger than themselves. THE PROFESSION.

We will then be responsible for healing our profession. Each of us must recognize that individual effort matters and that when we satisfy our ethical principles that pharmacy will gain.

It is time to pull together for the common good. Pharmacy run by pharmacists? It was run by pharmacists until the 1970s. Recent moves tell me that it is critical that we get our profession back.

Can we get it back again? What did Benjamin Franklin say Paul, “If we don’t hang together we will certainly hang separately”

Kate Gladstone conducts CE seminars for doctors on handwriting. Hospitals pay her for this because patients die because of poor handwriting. It is far less expensive for them to pay Kate than to have to pay after a law suit.

Star Wars: Episode VI – Return of the Jedi Kate and I will be collaborating on a book that will be sold as an e-book over the Internet. It can be sold for a lower price than a paper book. This will be coming up after the first of the year.

I will take my little book, WRITING PRESCRIPTIONS SO THE PHARMACIST WILL LOVE YOU (And Your Patient Will Get The Right Drug In The Right Dose At The Right Time), and will clean it up and edit it. Kate will add her Dos and Don’ts and her handwriting repair primer.

What I am requesting from you is your comments and stories about doctors and their handwriting. Hold nothing back.

You can leave them here as comments.

JP

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KATE AND I WILL BE THE JUDGES. WHAT WE CONSIDER TO BE THE COMMENT THAT BEST EXEMPLIFIES THE GROSS DISCOURTEOUSNESS OF PRESCRIPTION WRITERS WILL RECEIVE A PRIZE OF MY LITTLE BOOK,

Writing Precriptions So Your Pharmacist Wil Love You (And Your Patient Will Get The Right Drug In The Right Dose At The Right Time)

A minimum of 20 comments and the game is on.

The $4.00 prescription is here to stay. We better start riding the horse in the direction it is going.

Last evening, V and I spent a couple pleasant hours out on our neighbors’ patio, enjoying cheese & crackers and wine (Bottled H2O for JP) in the 80 degree Galveston evening. There is almost always an evening breeze. Paradise. It couldn’t be better until some tension seeped in.

These people live off their Social Security and their investments. They are doing well enough that they have booked a 2 month trip to Amsterdam, Rome, Athens, The Aegean, Istanbul, Amman, Tel Aviv & Dubai.

Out of nowhere came the subject of Wal-Mart and the blessing of the $4.00 Rx. My resistance and view that I hated it because there is no perception of a valued professional service being rendered (WHEN YOU CAN BET YOUR ASS THAT A VALUABLE PROFESSIONAL SERVICE IS, INDEED, RENDERED) fell on its face.

I swiftly and deftly changed the subject. But, I had an epiphany. THE $4.00 Rx is here to stay.

We cannot ever reverse it or change it. (Sorry, Kathy & Kay) It is now much bigger than Wal-Mart. The best we can do is implore the Wal-Mart pharmacists to be watchful of the next Wal-Mart Machiavellian move and refuse to allow it to be implemented.
You Wal-Mart pharmacists didn’t know that so much is on your shoulders. I know. All you wanted to do is WORK when you asked for the job. Never did you imagine that you might have to take an ethical stand. That is what pharmacists did in the 1950s. Not in the 21st Century. “Shit, I just work here. Yuck Yuck Yuck.”

Enough whining is enough. It is time to START RIDING THE HORSE IN THE DIRECTION IT IS GOING.

My take is that you keep your customers and give up on making money on cash generics. You must create a brand new paradigm. If you are ever in Stowe, Vermont, ask Howard at Heritage Drug what a very profitable niche business looks like. Joe, in Boston, how about sharing what you are doing. I know you have hit the peak.

Compounding is outside of the normal paradigm. Howard and Joe both do compounding.

A professional delivery service with an employee who does nothing but deliveries out 30 to 40 miles from the store WILL get you customers/patients. There are people who will be overjoyed to pay $5.00 in town, $10.00 out of town.

What I am telling you is this….. You are doomed if you think that your 1970s model Rx business, a dusty rack of sunglasses, last year’s Chinese snow gloves, two year’s old Christmas cards & Cardinal private label will keep you in business.

Sadly, once again, I am the bearer of sad news. Don’t be mad at me. All I do is observe and report.

It is really hard, but you gotta get out of the box. How about we get brave and start a discussion of what needs to be done to make WAL-MART COMPETE WITH YOU rather than you go against the windmill that is you trying to compete with Wal-Mart.

It is out there. In the ethers. Creativity takes an instant. It does not take work or time or struggle or effort. All it takes is intention. Open yourselves up. That “stupid idea” might not be so stupid.

Joe, I know that you are out there. How about starting us off.

By the way. The Publix and Meijer pharmacists WHO GIVE AWAY ANTIBIOTICS FOR FREE are a disgrace. The line has to be drawn somewhere. I will never stop denouncing the free ANYTHING Rx. How dare they take the process of cheapening us to this gutter level.

Publix and Meijer are grocery stores. Publix and Meijer pharmacist must stop the runaway truck. Or are they just throwing so much money at you that you are hiding behind the counter? Do you have enough tech help? Good techs?
Cashier help? Lunch break? If you are putting up with any shit, you are fools. They should be kissing your asses just for going along with this free bullshit. THEY WILL NOT KNOW UNLESS YOU TELL THEM. “I don’t like this. I don’t agree. I will be looking for another job. No, you won’t get 6 weeks notice.”

From now on, pharmacists must be watchful for new dangers. We must be speed bumps. We must say, “No, you can’t do this. I refuse.”

Here are some dismal figures. 3,400,000 Medicare part D clients (14% of the total) hit the dreaded “donut hole” last year.

Of course, the people who made it into the “hole” were the ones with the most serious, chronic conditions. 64% of the Alzheimer’s disease patients made it into the infamous “donut hole”. 51% of those taking oral diabetes medicine. 45% of those using antidepressants.

AN ESTIMATED 15% JUST STOPPED TAKING THEIR DRUG THERAPY. Others went on half doses or just every other day. I’m sure there are other creative schemes to make their money lost longer. Medicine or food? What a disgrace.

Many of them blame you and me. They are not sophisticated enough to understand that it was their legislatures who allowed the drug companies and the insurance companies to write the Medicare Modernization Act. We are not to blame.

As a pharmacist, what do you feel when you have to go out and tell a patient that the life-saving medicine that cost her $30.00 last month is now $230.00? Or, as some weasel pharmacists do, do you make it the technician’s job to deliver the bad news.

Just yesterday, I filled a prescription for an 80 year old woman. $273.00. I asked the husband why his wife did not have Part D. He said, “What’s part D?”

Ever After video I can’t save them all. The company I work for has a nice brochure outlining services. One of the pages is a slick presentation that outlines the process for enrolling in Part D. I handed it to him and urged him to get a relative who is Internet savvy to help get both of the enrolled.

I actually feel physical symptoms when I see how screwed over these people are. An anecdotal observation. Most of them are poor.

Statistics above are from a study by the Kaiser Family Foundation.

I have a file folder stuffed with recruiting documents. Some of them simple one page letters. Others multi-fold, slick paper, many-colored beauties that had to cost a pretty penny to produce. One of the most attractive was a six page CVS/Caremark medium meant to get me to want to pick up and move to San Antonio to work for the PBM. The cheapest was a one page, black and white letter telling me about the terrific deal I could get from PharMerica in Beaumont, Texas. They offered some really great things, but I was not interested in Beaumont and I won’t even take a gander at someone who offers a “competitive salary”. PharMerica needs to understand that everyone is throwing money at us in the 21st Century. If they are going to “throw”, then really throw.

Written recruiting pitches are just a novelty. I take a few seconds to look them over and then file them with not another thought. It is the telephone recruiters and even the face-to-face agents who can be problematical, especially when they come into the store unannounced at four in the afternoon, on Friday.

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The scatter-gun approach is the most common. They aim in every direction with the hopes that they hit someone actually interested in the hospital job in Omaha. A few years ago, a recruiter called me about a clinic job in Idaho Falls. It was a terrific job. Everything about it was primo. A scintillating wage, benefits to die for, 16 holidays a year, a month vacation the first year.

I had to ask him, “Why are you calling me?” I had been carrying on a polite conversation with him and had shamelessly led him on by telling him how good this job looked.

“We have a list of all Idaho pharmacists.”

“My Idaho license has not been active since the 1980s.”

Silence, then “Really?”

“Your list must be an old one.”

“You’re not interested then?
”
“Not in Idaho Falls. You bring that job to my neighborhood and we can talk.”

And that seems to be the biggest problem with recruiters. They want to take a cookie mold to us like we are just cookie dough. They seem to think that we are going to fall all over ourselves to get that very specific job in some town where no pharmacist wants to live.

I have had this idea that the recruiting system is backward. The pharmacist who is looking for a change should be the one to initiate the process. I recently came upon a service that seems to have gotten it right. It is called FIND-A-PHARMACIST-RECRUITER. I like what they do so much that I put up a link to the site. Look to your right. This outfit has hit the bullseye. They are not going to cold-call you like they were selling magazine subscriptions. It is up to you to go to them. You can put your pie-in-the-sky dream job out to the universe. Hell, you might get it:
www.find-a-pharmacist-recruiter.com

“CUSTOMIZE YOUR RIDE”. You get to pick your town, name your price, pick a specialty like nuclear if that moves you. Get as specific as you like. Name your vacation requirements. No scatter-gun here. Aim as tightly as you want.

If you really want to capitalize on the pharmacist shortage and have not felt comfortable in your present circumstances, there is no reason to beat your brains out looking for a change when there are professionals eager to work on your behalf. On your terms. At your pleasure.

It is perfectly okay for you to say that you want a job in which your dignity will never be compromised. Right up front, you can say that your self-respect is of paramount importance and that your integrity demands that you follow your own personal ethical standards when it comes to practicing pharmacy.

And.. just so they don’t get the wrong impression .. you’ll take the money. Of course, you will take the money and all of the rest. That’s a given. Money, money, money! Vacation, vacation, vacation! Benefits, benefit, benefits! It is the non-money stuff that matters the most. Don’t be shy. You are invited to upload a resume’.

I filled out the form yesterday. Short and to the point. I wrote a couple sentence resume’ about my writing chops and said that my dream job would be writing all things pharmacy for a big company, from my own desk on my own schedule. We’ll see if I get any bites. They asked what I wanted, so I told them.

Take a look. Put your cursor on the link to the right. Fill out the form. Write down what your dream job looks like in detail. Make sure you really mean it, because if you say you want it, you just might get it.

The voice on the other end of the phone line seemed distracted. First, she had to finish up with a prior conversation before she could talk with me. I could tell that she was not holding the phone near her mouth.

When she finally got to me, she said, “I want to call in a prescription for mumble mumble mumble.”

“I’m sorry. I do not hear you very well.” I had the phone pressed to my ear, but I still could not make out everything she was saying. My 67 year old badge has dents in it, but it is still shiny. Most of me is in pretty good shape, but there is a sizeable nick on the medal for EARS. They are 67 years old and an investment in an expensive sound system would be wasted on my ears. Saves me a bunch of money. My aural acuity is compromised.

I am not alone. There are plenty of pharmacists out there who do not hear as well as they did a few decades ago. But get us on a conversation where the information imparted is critical to a patient, we better get it right.

This is what happened when I could not understand what this doctor was trying to order for a patient named mumble mumble mumble.

“I can’t hear you,” I repeated.

She sighed a frustrated sigh. I could hear that. She tried again to get the same result. I knew what the problem was.

“Please put the phone closer to your mouth,” I said, “I can’t hear you.”

“I know how to use a telephone, honey.” Those words I heard very well. She DID put the phone closer to her mouth for the “honey” sentence, but the rest was mumble mumble mumble.

“Please, doctor. Cooperate with me. I want your patient to get exactly what you want, in the correct dose with the correct instructions. I can’t do that if I cannot understand what you are saying.”

“I’ll go slower,” she said with another sigh. “Mumble mumble mumble.”

“Slower doesn’t matter,” I squealed. “You just have to put the phone closer to your mouth.”

“I don’t HAVE to do anything. You HAVE to listen.”

“I’ll listen as best as I can. So far, I don’t even know who the patient is.”

“I told you twice.”

“But you did not have the phone near your mouth. I did not get the patient’s name.”

There was a silence. “Oh forget it,” she said and hung up.

Now, I do not know what happened next. Did she whine to the patient about the pharmacist and suggest a second pharmacy? Did she call back later WITH THE PHONE CLOSER TO HER MOUTH? Perhaps she called when I was at lunch and talked to a pharmacist with 50 something ears. Did the patient have to go without?

All of those possibilities would have caused her time and effort. All she had to do was PUT THE DAMN PHONE CLOSER TO HER MOUTH. Stubbornness is an alternative ONLY when the result is not that important. We are talking about pharmaceuticals. Controlled poisons! Put practically ANY pharmaceutical on a plate and take enough of it often enough and you are dead. We are not talking about an expensive floral display. With controlled poisons, we absolutely have to get it right. You would think that getting it right would always be the goal of the prescriber.

I got that this was a youngish doctor. Her manner was imperious. Her voice was haughty and bossy. Nothing she did made me respect her. She failed in her most important job. ACT SO THAT THE PHARMACIST WANTS TO HELP YOU.

There is enough in this little essay to keep us talking for awhile. In the end, however, it is patient care we are talking about. If the patient did not get the medicine that was needed in a timely manner, is it my fault? I know that I might have sounded impatient, but I raised two daughters and trying to get this doctor to cooperate with me was like getting my daughters to cooperate when it came to their chores.

My contention is that she exhibited gross impatience. She put her opinion of herself right at the top of the list. Her ego is what said, “Oh forget it.” I

I wonder how long it will be before she grows up a little and makes things easier for herself. They can’t be that effortless with the attitude she shows. I’d bet that the nurses make her pay. Women can do that. Men will tolerate her attitude, but nurses (mostly women) will trash her trail with glass.

I would have loved to help her out, but she never even gave me her name.