Pharmacy. Jim Plagakis. Pharmacist

I don’t like it when a guy with a slicked-back pompadour and a thin mustache, driving a black BMW four door sedan encroaches into my lane so far before he takes a left turn that I have to stop dead and wait for the pimp.  Probably a stockbroker, banker or insurance company executive.

I don’t like it much when I call some independent in East Muhammed, Illinois and he acts like I am trying to rip the tattered dress off his wife’s body and dig the food out of his children’s’ mouths.  His patient is in Galveston for a vacation and they forgot to bring the kid’s Singulair. 

I hate it when a supercilious, mush-mouthed, fast talking prescriber with a thick accent thinks it is MY fault when I cannot understand one frikkin’ word she is saying.  And…. it is the WOMEN who are the problems.  “Goddam, what is wrong with your ass, girl?  How could it possibly EVER get so tight?”

I really hate it when I have filled 8 prescriptions for a person and they hand over the insurance card with a smile.  This kills me between 8:30 PM and 10:00 PM on Fridays.  My one night shift and the only time I work without a tech.  I fix it and you know that those three words do not come close to describing what I have to go through.

I hate it when a mother (who I have seen slowly shopping for a half hour) stops at the pharmacy on Friday at the stroke of 10:00 PM and hands me three prescriptions.  I always ask, with attitude,

“Madam, why did you wait until ten o’clock to give me these?  We are closed!”

“Well, I need them tonight.”  A bit of arrogance.  I don’t see stupid.

Here is what I have done.  “I am sorry.  The store is closed.” 

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I just look at her.

“I need them.”

I look.  Nothing special.  No antibiotic.  No ear pain medicine.  Stuff that can wait.  I repeat.  The Constant Gardener movie download “We are closed.”

“Well, I never…. when can you fill them?”

“They will be done first thing in the morning.  You can pick them up after 9:15 AM.”

If I see stupid, I take a deep breath, make her sit down…no more shopping… and wait while I do them.  If she walks out of my sight, I quit.

Another thing I hate will be discussed in the next post.

The American Pharmacists Association and their stated mission.  “Improving Medication Use.. Advancing Patient Care.”   What the f…..? 

 There was an editorial in this last Sunday’s edition of The New York Times (March 25, 2009).  The headline was:

“Broader Access to Morning-After Pills”

I read it with interest and wondered if smaller newspapers around the country treated it as a news story or as an editorial subject.  The New York Times did both.  The Northern Kingdom psp This issue needs to be before the public and it would be irresponsible for any new organization to refuse to not take into account the importance of this news report.

The editorial did what pharmacists MUST DO.  It educated, “Prompt access is imperative”.  The writer talked about the 72 hour rule and how the window starts closing at 24 hours.  You know the drill.  You have either counseled on the use of “Plan-B” or have washed your hands of the entire issue, turned your back and made mean faces into the mirror.  Either way, both viewpoints are being formed with a picture of a 12 year old girl scared to death.

Judge Edward Korman ordered the FDA to make the pill available to girls as young as 17.  He ordered that the FDA consider approving it for ANY age.

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Thanks to the judge, the cat is out of the bag.  The quack is whacked.  This genie will not be put back into the lamp.  Ever!

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The WHO and a slew of American health groups have urged that the pill be made available to anyone.  We are virtually the only major industrialized nation to lag behind. 

Is Alaska an industrialized “Nation”?

The Bush administration is behind keeping the good old U.S. of A. a third world country in this matter.  Bush is gone. 

Governor Blagojevich of Illinois stuck his nose into this issue on the other side a few years ago.  “The Old Apothecary” had some real good chops on the governor and his rules.  I don’t. Perhaps P.T. can bring us up to speed.  The precedent that the governor set was dangerous, if I remember correctly.

According to Judge Korman, the evidence is overwhelming that 17 year olds can use the drug safely without medical supervision.  

I expressed my opinion on this matter a few years ago.  I received a lot of mail.  People promised to keep me in their prayers.  Others were insulting.  “Idiot” was a big word.  “Christian” was bigger.  One writer was very erudite.  He expressed himself well until he said, in Bold and Italics. 

“Plastic Ass, you have already punched your ticket to hell.”

Twenty minutes ago, when I read the editorial, I asked, “Plastic Ass”, 

I’ll only say this, If this was 1996 and my 12 year old daughter came to me and said, “Daddy, Tommy Ference put his penis in my .. you know.. yesterday when we were playing in the tree house and Daddy, it hurt.”

Translate this to my daughter being 12 years old in 2009… I would be at the closest drug store in 5 minutes.   When I got back, she would take the first pill.  Then I would metaphorically get on my knees to apologize for failing to educate her.  Then, and only then, would we have a conversation. 

There would not be a lecture.  I’d ask lots of questions (The Socratic method)  That talk would be both ways and there would be lots of hugs and “I love yous”.

Oh, yes, hell ticket punching is a preposterous notion, an outrageous and absurd affront to a reasoned dialogue in a civilized culture.

3/21//09 “Union Agitator” is really good. 

I’d bet that SOSP can get behind this.

I had this conversation on Friday.

The emergency room nurse asked me why I needed to talk with the doctor.  “She is very busy.   If you do not have Cortisporin Otic, why can’t she go to another pharmacy?”

Very politely, I said, “You are too busy to worry about that.  The doctor has to make a choice here so I need to talk to her.”

I went to the patient and her mother.  I offered to buy them soft drinks, but they refused.  “This may take awhile,” I said and they nodded with smiles.

Finally, the doctor called. She actually was patient, but getting her off the notion of Cortisporin generic which we have not had in stock for weeks was a chore.

I offered Cipro HC and she argued with me.  As far as another pharmacy goes, I ambushed her.

“This mother is in a motorized wheelchair.  Going on a wild goose chase from pharmacy to pharmacy will cause hardship.  Even sitting with her cell phone calling would be a problem because she told me that she is going to need to pee soon.”

“Aren’t your bathrooms equipped for the disabled”

“Of course they are.  Have you ever tried to get your panties down and get on a toilet in a drug store bathroom?  It can’t be easy.”

I love her.  She actually chuckled.  “You are right.”  She ordered Cipro HC and changed the Sig to BID.

The she really surprised me.  “Thanks for helping this patient,” she said.  “You know, I think that this happens more often than we like.  Why don’t pharmacists call me often?”

I told her that I could not answer her question.

The truth is this:  Most pharmacists don’t give a shit.  Less work.  “We don’t have it in stock.  Try another pharmacy.”  What do you think?  Am I right?

I am not sure about unionizing.  So,  Mister “Agitator” is on his own.  I have proposed the idea that pharmacists are adults, capable of acting in their own best interest.  I am not so sure about that.

However, I was a member of the Retail Clerks Union when I worked for Thrifty Drug Stores in the late 1960s in the San Francisco Bay Area.  I was an Ohio boy agog in what the union gave me.  Time and a half over 8 in a day or 40 in a week.  Plenty of holidays.  Is eleven possible?  Good vacation line-up.   If Thrifty called me in for a sickness or other emergency, they had to pay me for 8 hours.  On and On.

Still, I knew that I was just a novelty to this union.  It was, after all, the Retail Clerks International Association.

My biggest problem is this:   The union was so strong that we had dead wood opportunists who yawned their way through a work day.  They did the minimum and to hell with Thrifty.  I think that this attitude is wrong.  It is the attitude that got American cars the reputation of being “Pieces of shit”.  

Union or not, I have always given my employer consummate value for his money.  Union members who skate their way along a sleazebags.  

That’s what I think.  How about you, SOSP? 

I read recently that there is such a thing as a “generosity gene”   The study suggested that certain ethnic groups are apparently genetically endowed to give some of  their time, knowledge, expertise and treasure to other people.  It went on to identify Americans of European lineage as being like this. 

I have been a generous person for my entire life.  I remember giving a Rocky Colavito, Cleveland Indians baseball card to an 8 year old boy whose parents did not think that baseball cards were wholesome.  He had his secret stash of cards, but no Indians and that was the home team for boys in northeast Ohio. 

I guess that family does not count, but V and I are both haunted with this gene.  She has given Vancouver, BC to Houston plane tickets to her sister for the last three Christmases.  I have been especially generous with V’s kids. 

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The dad, who was absent for almost all of V’s youngest son’s life,  

refused to co-sign for the first round of student loans.  S, I did it.   He needed a laptop for law school, so I gave him one worth $3000.00 with kick ass programs like Office. 

I am buying an “AS IS” house in the heavily Hurricane Ike flooded Bayou Vista neighborhood for V’s oldest son, wife and baby to live in.  The son is going to do all of the recovery, repair and renewal work.  I provide the down and closing costs and Frosty pays the mortgage, property taxes and insurance (not a small thing on the coast of the Gulf of Mexico).  Someday, we’ll settle up.  When UTMB announced that it will rebuild in Galveston rather than move much of the institution to the Mainland, the house appreciated substantially. 

I am certainly not a rich man, but I can do things for the kids.

What a good boy I am.  Gandhi Plagakis.  Family does not count. 20 Million Miles to Earth

I am thinking of Drug Store generosity. My co-workers have always gotten little things from me.  Food mostly.  I helped a drug store clerk with grocery money way back in the early 1970s.  Her husband stole the money from her purse and bought dope with it.  This was the 70s.  The magic flame of love and peace of the 60s had been snuffed.  I think this was the beginning of the “Me” decade. Changing Lanes dvdrip

I have paid for prescriptions for patients/customers.  I have a thing about earaches.  More than once, I have paid for the Auralgan-type ear drop because the mother had only enough dough for the antibiotic.  I mean, the kid is all runny nose and whining, holding her ear.  I can’t say, “Sorry.  Money on the barrel-head or, like the soup Nazi, ‘You get no ear drops today.’”

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My sister in donating gene, SOSP, out in Washington State buys big ticket things for her patients, occasionally.  The last I heard was a small, office-size refrigerator for the bedroom of an older woman who shared a place with a “roommate” who stole her food from the fridge that they shared.  SOSP most definitely has this gene.

Awhile back, a young woman wearing the work outfit of Popeye’s Chicken had the money to pay for the prescriptions for one of her children.  She had two with her.   A toddler and a child in her arms.  The problem was that she would not have the $20.00 she had planned on using for milk & bread and the like to fill in until pay day. 

“I guess it will be Ramen noodles,” she said. “Or chicken”. One Flew Over the Cuckoo’s Nest video

I asked her if she had insurance from work. 

She shook her head, “I’m not salary yet.  When I am an assistant, I’ll have benefits.”  Sounded like an opportunist company.  Work them in a hot, greasy kitchen and provide no benefits.

This was a young African American woman in Texas City, Texas, a town where a significant percentage of the population is working the system.  A town that I am happy to just forget.  This girl was working.  She was not on Texas Medicaid and this was before CHIPS money was loosened up.

I told her, “You are trying hard.”  I took twenty dollars from my wallet and told her to go to the grocery store.  She tried to refuse, but I insisted.  She got a little choked up, remarked that a kind man had white skin.  Did she know about the gene?  Hardly.

What I want to know is this:  Are SOSP (blonde and white) and Jay Pee anomalies or is the study accurate?  Is this a white person of European lineage thing or do all pharmacists show generosity on occasion?

Pharmacist licenses are like phantoms.  They follow you everywhere.  I have two active licenses.  Ohio, my first, and Texas, where I now live.  In between came California, Idaho, Washington state and Vermont.   They are not active.

I have a file of recruiting letters, pamphlets, booklets and even one DVD.  It is interesting to see how desperate they can get.  Rite-Aid makes incredible promises.  A grocery chain in Washington touted, “We do not have drive-through windows”.   The most interesting was a prison pharmacy.  The military is an active recruiter.

Recently, I received a nice letter telling me about a job THAT I WOULD RESPOND TO IN A MINUTE if I was only 20 years younger.  I probably would not have the chops, however.  I am an old retail guy.

California hospital/clinical pharmacists. 

This recruiter is looking to help anyone who has either prior experience in clinical/hospital setting or a residency if they’re a fresh graduate.

Specifically San Diego!  

With connections throughout California to help the right candidate.

I talked with the manager of  “Find-A-Pharmacist-Recruiter” and she told me, “Yup, she is in our network.”

I know that you are out there.  There are plenty of you who are like I was in 1965.  Sick and tired of the cold, dismal winters.  Sick and tired of a mother who thought it was her business to run my business.  Sick and tired of being sick and tired.  I got my California license and moved 3,000 miles to the west coast and stayed there for 35 good years.

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I spent part of that time in San Diego.  There is no place nicer in the USA.  The weather is perfect.   Never cold and rarely too hot.  The Zoo and Wild Animal Park.  The beaches.  Baja just minutes away.  Balboa Park.  The people are beautiful and they keep themselves that way.   

Especially if you are younger.  San Diego is a dream.  I guess I am just voicing an old man’s fantasy, but, if you are restless, have sand in your shoes, click the big baby blue banner:  “Find-A-Pharmacist-Recruiter” and take a few minutes to complete the questionnaire.  A current California license is probably a secondary issue.  You can get one.

Those of who know me well, are aware of my viewpoints on unions.  I have believed that pharmacists are professionals and that we can demand high standards and get them.  I have believed that when we have tolerated bad conditions and situations long enough, we will say, “No more!”

Recently, I played a significant role in the creation of professional pharmacy organization dedicated to the very issues of the basic human rights that we, as professionals, have a justification for demanding.  A professional has an entitlement for superior working conditions.

That organization is walking through a quicksand of pharmacists’ indifference.  Personally, I am stunned to see so many pharmacists, highly educated medical professionals, unable to look out for their own best interests.  That organization is strong and will make a difference, but talking into a condition of personal COMA takes time.

I have been waiting for pharmacists to stand up for themselves for 20 years and I see very few practitioners acting like adults.  We are institutionalized.  I once believed that just telling pharmacists of their institutionalization would be enough.  They would get mad and not take it anymore.  Under Siege 2: Dark Territory download

I never thought that we would need collective bargaining to break out of the pit and to stand up as true professionals.

I MAY HAVE BEEN WRONG!   Perhaps, we must unionize.  Nationally.

I will introduce here a friend whom I have dubbed “UNION AGITATOR”.   Unless you are so institutionalized that you are not interested in a conversation about collective bargaining, I will create page on top for ‘UNION AGITATOR” and your comments.  I am really hoping that the indifference does not prevail.

Here is something about “UNION AGITATOR”. Maid of Honor release

  I’m a recovering over-achiever.  I majored in a foreign language, because I only spoke one, and the second language of choice in Southern California is Spanish.  I was a terrific student so I applied to the premier pharmacy school in California.  The University of California, San Francisco .  Until I graduated from pharmacy school, I followed the rules, and the system rewarded me with what I wanted.  Then I got a job in retail.

    I like the pace and I like the patients.  What I don’t like has been detailed by every pharmacy website on the web.  Twelve hour shifts.  No lunch breaks.  No bathroom breaks.  Bad help that I can’t get rid of.  A lack of control over my work environment that one would hardly expect as the result of eight years of post high school education resulting in a position that, if nothing else, makes me the guardian of the country’s most illegally abused drug, hydrocodone.  It almost defies explanation.

     It used to be that a pharmacist ran his own shop.  The hours spent at work were his own, and because of that, he had freedom at work.  Then the chains came.  What independent pharmacist, unless he worked in a special niche, could compete with them?  And so the pharmacist became an hourly or salaried employee.  So much for capitalism as the engine of freedom.

     I don’t complain anymore, though.  I give my employer’s drugs out for free whenever I have a good excuse.  I am the great waiver of copays.  I’m not embarrassed to say that I do a great job, in English and in Spanish, working nights, weekends, and graveyards, so when I ask for a day off a month in advance and am not given it, I call out sick for all the times I came to work when I was sick. 

I get together with my fellow pharmacists, the good ones, and we tell our employer when we are taking our vacations, and for how long.  We collectively ask for certain wages and benefits, and if our company doesn’t deliver, we take a short vacation.  If this isn’t somebody’s idea of a professional, then they can have that title.  I’m working on getting my freedom back. 

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            I work in an institutionalized setting and I am becoming less and less institutionalized.  I am a member of the Guild for Professional Pharmacists.  Yes, it is a union, but when every member is a pharmacist, it is something else than the Retail Clerks or the Food Service unions that some pharmacists belong to.

            How do you feel about “collective bargaining”?  Let’s talk about it.

“Union Agitator”

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I have been urging people to become “aggressive medical consumers” for the last two decades.  I have advised patients, relatives and friends to educate themselves on THEMSELVES and to be prepared to demand a bargain and answers to any and all questions.  Even if they feel stupid and intimidated. 

I THINK THAT THIS IS PART OF MY JOB.

That’s just a start.  The next step to being a 21^st Century sophisticated medical consumer is to know that it is okay to DEMAND services that they (or their insurance) pay for.  I have told people that they want answers from their car mechanic.  They should never give the doctor a free pass when he/she tries to stonewall them.

I THINK THAT THIS IS PRACTICING PHARMACY.

This afternoon, V came home from the orthopedic surgeon at UTMB with a funny look.  I got tense. I was expecting terrible news.  I know that she will have to have surgery in 2009.  We had hoped that it would entail the removal of a bone chip and that would be it.  She looked concerned.

“Is everything okay?”

“Not really.”

“What’s up, babe.”

“The doctor got mad at me.”  She explained, “He wanted me to go right downstairs for X-rays and to come right back up so he could look at them.”

I was proud of her already.  I knew what was coming next.

“I told him that I had a $5,000.00 deductible and that I was not going to pay $600.00 downstairs for X-rays that I could get for less than $200.00 at Gulf Coast MRI and Diagnostics in Clear Lake.”

“What did he say?”  I was getting ready to call the UTMB ombudsman if the SOB mistreated her.

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“Not much.  He did point his finger and tell me that I had to have the X-Rays in my hand at the next appointment.”

V is a scrupulously proper woman.  Granted, living on “Island Time” (an attitude, not a chronological thing) has gotten her to “casual up” dramatically, but she is still proper.  I was proud of her.  I have been after her for ten years to be an aggressive and sophisticated medical consumer.  Finally, she was.

THERE IS NO ON ELSE TO TELL THESE PEOPLE WHAT THEIR RIGHTS ARE.

 A few weeks ago, a frantic mother was giving me a hard time because her son’s seizure medicine dosage change had not been confirmed by the neurologist.  The dose on the new Rx was way too high.  We had faxed the doctor 3 days in a row.  We tried to call, but were told that they accepted faxes only.

“Don’t look at me,” I said, “The ball has been in the doctor’s court for three days.”

“I don’t know what to do,” she shrieked.  “My son has not had his medicine for two days.”

I asked her if she really wanted my advice and the answer was, “Yes.”

I went out front and motioned for her to take a seat.  I sat beside her.  I reminded her that, as the mom, she was the doctor’s customer.  I told her that she or her insurance company was paying him good money. 

She shrugged and looked lost.

“The office is only a half mile from here.  You need to go there right away, ask to see the doctor and they will ask if you have an appointment.  Look the receptionist right in the eye and ask if she thought the doctor really wants your son to take this medicine.”

The mother was biting her lip.

“You can do this,” I said.  “Your son’s life could be at stake.”

Now she was really listening.

“You stand your ground no matter what the receptionist says.  Her job is to act like the doctor’s mother.  You act like your boy’s mother.  Talk loud if you have to.   She will want to get you quiet.  If you do not get either a new Rx with the correct instructions or a promise to call me right away, you string together the words lawyer, mal-practice and seizure all in one sentence.”

WHAT ELSE IS THE PHARMACIST TO DO?  Shrug it off?  “Sorry, maam, your doctor still hasn’t gotten back to us?”  Do you just leave this kid twisting in the wind until his feet shake?

Less than one hour later, a smiling mom handed me a new written Rx with appropriate instructions.

I haven’t talked about Wal-Mart lately because this stinking turd in pharmacy’s punchbowl is going nowhere.  The $4.00 Rx are here to stay, industry-wide.  Get used to it.  Beat your brains against this rock and you’ll just get a broken head. Star Trek: Nemesis psp

Wal-Mart may have better surprises for you.  Especially you guys out on the edges who still own your independent stores. 

Take a few minutes to go through the phone book and call the Wal-Mart Pharmacies out in the hinterlands around you.  Just listen to the message.

Last week, I called the Wal-Mart Pharmacy in a small town north of Dallas.  The message advertised the new Wal-Mart delivery service. 

That is all the work I am going to do for you.  What will be next?  After Sex on dvd

I was told by a Wal-Mart mid-level executive that they intended to be the largest pharmacy chain in the country.   This was in the mid-1990s.  What do they want now?  To be the best?  To offer the most services? 

Speaking of the “Monsters”.  An update, the little guy wins one.

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I do not see new pharmacists displaying the same pride, confidence and secure self image that I see in new doctors and I wonder why that is so.

I live in Galveston, Texas and work two days a weeks at a drug store just two blocks from the University of Texas Medical Branch.   UTMB is the premier medical school in Texas.  That neighborhood has a lot of rentals where students live.  They come to the drug store as patients/customers and I have the chance to talk with many of them one to one. 

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 Of course I compare them with young pharmacists.  I have worked with many of them during my career. 

There is a distinct difference that troubles me. 

The medical students are already confident about being doctors.  They comport themselves as highly trained medical professionals and they haven’t even graduated.   First year students show a bit of panache.

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They are groomed right from the beginning and this coaching works.  The new doctors enter practice knowing that they are at the top of the pyramid even though the pyramid is flattening drastically.

In contrast, new pharmacists take a sign-on bonus and go into a chain drug store situation that pays them very well for working in dismal conditions.  New pharmacists put up with it.  Why is there such a disconnect between how they were trained at school and life at CVS?

I contend that highly trained medical professionals do not have to put up with a paradigm that will seal the careers of these kids in mediocrity for five decades.  What is missing that allows new pharmacists to put up with no lunch and twelve hour shifts and a bullying store manager?  How do they get from the hallowed halls to unacceptable working conditions?  What happens to their pride, their ethics, their duty to themselves and the profession?  Why have they not been armored better? 

Have you noticed that getting an established twenty year veteran pharmacist to go beyond complaining and actually doing something is a really tough nut to crack?  Our new kids are not established.  They come out to a hail of money.  Why haven’t they been taught skills that will allow them to be comfortable making demands about working conditions?  Why aren’t they more like brand new doctors?