strong>Jay Pee 9/2/09 All of your comments have been thoughtful. Some are “Can Do.” Some are hopeful. Some are “Doom & Gloom”. I have noticed that the majority of people want to be right more than anything. You who predict that robots, high school educated techs and cashiers will run us out of a job, I contend just want to be right. What the hell is the difference? It will be what it is. My take is that we better get our asses away from the “Prescription Mill” and do some counseling. You know what a “High Value Opportunity” looks like. That’s not Valtrex. That is zolpidem. “Be careful. You may sleepwalk. You may even sleepdrive. Please read this literature and call with questions.” The best way to continue earning $10,000.00 a month for a long time is to do your job properly. If you do not, CVS SHOULD finger you as the first to go.

< Next thought. There is NO pharmacy organization with a large membership and therefore some clout that will assist us. The big ones are letting us twist in the wind. There is an organization that is geared up and ready to help. The officers and members are committed to making a difference FOR YOU. The problem is that the membership is still tiny. You guys are so frikkin cheap that you won’t shell out $110.00 for a membership. You are so institutionalized that you won’t even help. My friend Paul has you pegged. GALLEY SLAVES. $110.00 is 0.0009% of the average pharmacist’s annual wage. Dues for students and techs is cheaper than a good pizza and a few beers for you and your boy toy on Friday night.
Visit www.thepharmacyalliance.com

It is my thought that we, pharmacists and our profession, have one chance to get pharmacy back for pharmacists. Everything is in place for it to happen. The conditions are perfect. Once the snowball starts rolling, there will be an avalanche.

APhA is not a practitioner’s organization. No matter what they say. I cannot see the APhA even noticing the opportunity. It is old. 1852. Feet in cement. APhA is too high minded. Improving Medication Use. Advancing Patient Care. It is interesting that the opportunity I see is a chance for this old organization to be to pharmacy what the AMA is to medicine. I’d certainly join back up if they took a strong and active position on this prospect.

NCPA is an organization in which only pharmacy owners and their managers can hold a voting membership. I can see NCPA helping a lot if they took a good look.

The entire pharmacy universe has its head in the sand. We have a duty to warn. Not warning is the rule. The road to a professional status that removes us from a profit on a product mentality is the fact that all 50 states (plus federal laws) require counseling.

I know. Here he goes again with an Airy Fairy Jay Pee vision. Just listen for awhile.

We do not counsel. We do not even think about counseling. My counseling is restricted to what I call “High Value Counseling Opportunities”. I was having lunch with a Dean of a college of pharmacy a couple months ago. Nice lunch in a fish restaurant in Houston. We talked about college football (his subject) and the awkward situation in the JOB of a pharmacist (my subject).

I told him that I rarely counseled. He gave me a look and took a sip of his iced tea. “Really?”

“Really,” I said, “I counsel only when there is a High Value opportunity.”

His eyes sort of glazed over. Too much information. He liked believing the myth passed around in the ivy covered halls. Counseling defines a pharmacist where he works.

My “High Value”, by the way, is not necessarily your “High Value Opportunity”.

Pharmacy state boards exist only to regulate the profession of pharmacy in order to protect the people of the state from dangerous pharmaceutical care. It is my contention that the common practice of pharmacists neglecting to counsel is dangerous.

The moment one pharmacy board decides that non-counseling is unsafe to the citizens and starts doing something about it is when things change.

I think it will take more than just a “write-up”. When a pharmacy board cites, suspends for one week and fines a pharmacist for non-counseling, that will be the crack in the dyke. The crack will widen when pharmacists find out that a citation means having to sit for the MPJE. The flood will be a deluge when the drug store has the pharmacy license suspended for one week, the game will change nationwide.

Can you imagine: A suspension of just one week for the pharmacist means a loss of pay. Close up the pharmacy for one whole week. How many patients will have to go through the inconvenience of getting their doctors to call in Rxs to a new pharmacy? When they find out the reason, most will never come back to the dangerous pharmacy. A game changer.

Every state would have to follow the precedent. Trust me. The state boards themselves could be sued. A patient harmed because they were not warned could ask a judge, “Why does not our state board MAKE them live up to the law?” A good attorney could take precedent from Wisconsin and use it in Kentucky if the pharmacist did not warn the patient of dangers in the Rx and the patient was damaged.

We have a duty to warn. We are really up a tree, aren’t we!

I do not know if pharmacists can bring enough pressure to bear, but I know that when citizens complain to a state board about getting Four Rxs filled and never seeing the pharmacist, the board will have to investigate. How about 100 complaints in Vermont and Wyoming. 1000 in California and New York.

There are millions of patients/customers/patrons who commonly say, “I trust the pharmacist more than I trust the doctor.” About drug therapy, that’s smart. They like pharmacists and they like it when the pharmacist comes and talks. Often, they make me a little uncomfortable with expressions of gratitude for my counseling.

Recently, I told a young woman, a second year medical student, that her ARNP was wrong about Midol being good for menstrual cramps. She bought the naproxen sodium I suggested and was back the next day gushing, “You were right. I have put up with unbearable cramps since I was twelve. Finally, I listened to the right person.”

What would happen if just 100,000 of them, even 10,000 of them, got a little pissed off when they find out that pharmacists are mandated to counsel and we don’t do it because we do not have the time?

What if just 1,000 of them complained to the board?

What if only 10 pharmacists were suspended for a week? What if only one chain pharmacy had to lock up the pharmacy for 7 full days and pay a hefty fine?

What if all the pharmacist middle managers of the chain in that state had to take the MPJE?

I’d like you to answer these questions. I know you guys. Many of you will find this scenario appealing, but will not comment. There are a few of you who always ask, “What is Jay Pee smoking?” There are others who will write a thoughtful comment. Come on, can this picture actually be worth putting juju into the ethers?

This can happen. Conditions are perfect. AARP could be dynamite in the dam. Citizens are becoming more sophisticated. They are educated medical consumers. Once they spot the wart on pharmacy’s nose, look out. This can happen, you guys.

All it will take is one pharmacy board to say, “Enough is enough”. I have practiced in five states. I’m looking at Washington State nailing this thing.

Dogma film

Dragnet Druggist was a terrific movie. I saw it when I switched on the TV in the middle of the night. Black and white and really racy. It had to be from the 1930s. Before films were rated. Today, it would be an NC-17. It starred no “A List” actors, cheap sets and a laughable script. It must have been written by a pharmacist who had screenwriting aspirations. This was probably his first try. It would have not been the least bit compelling to me if it was not about a druggist and his life.

Bungalow Broadway Beauty was pulp fiction. I found it on the rack at the corner store. There was a picture of a bespectacled balding man in a starched barber style white smock. He was pouring from a pint bottle into a graduate. I was already in the drug store business as a cleaner-upper and stock boy. I had the money so I bought it.

The Beauty was a cosmetician in a drug store. I was hoping for a pharmacist that was portrayed in a good light. What I found out was that the pharmacist was having his way with the Beauty. Her boyfriend, a long haul trucker in the days before the Interstate highway system, confronted the drug store owner and ended up kicking the crap out of the druggist. I was a teenager and the idea that pharmacists could have sex with the employees was an original idea. I watched the owner’s wife, Ella, and I still think that she and Frank, the employee pharmacist, had their fling. Why did they go downstairs into the basement alone so often? There was nothing down there, but cases of Rexall products.

We all know about Mister Gower in It’s a Wonderful Life. He was drunk, made a huge mistake on an Rx and the stock/delivery boy caught the error. Mister Gower had just gotten a telegram telling him that his son had died of influenza, at college. Every Christmas, I watch this classic and I feel bad for Mister Gower, Registered Man.

The main character in Kurt Vonnegut’s Deadeye Dick is a pharmacist from Ohio. I know something about Vonnegut and his relationship with a certain pharmacist. Kurt had good reason to portray the pharmacist as a bit flaky.

On the brilliant Fox TV drama House, the writers consistently portray the pharmacist as a doofus. When asked a drug question, one asshole says, “Well, I am just a pharmacist. How do I know?” I really enjoy House, but I cringe when there is a pharmacist in the story.

These examples of pharmacist portrayals can’t even be lumped together. They are so different.

However, each of them is full of the same suffering and pathos. Dragnet Druggist starred a guy with slicked back dark hair and a pencil-thin mustache. This was way before the Durham-Humphrey Amendment. Slick was getting customers addicted to a “health drink” that he called “Whiz”. He was a wealthy man. His wife was left at home and he lived the high life. How could a pharmacist in LA in the 1930s afford to drive a Cord. The scene I remember well is at a night club. His mistress was pestering him to dance. Finally, he grabs her face with his right hand and hisses, “I’m on my feet all day. Leave me alone about dancing.”

The pharmacist in Bunglaow Broadway Beauty is not a main character, but he worked long hours and apparently believed that he was entitled to use the good-looking female clerks any way his appetites desired. It was a hunger of male flesh for female flesh. After the beating, the movie never visited the drug store again. I will speculate that in 2009, there are plenty of pharmacists taking advantage of their power. That goes for female pharmacists also.

In these works of fiction, you have a fictionalized view of a pharmacist. What I see as a huge difference in these old examples is that the pharmacist was a real person, not just a stereotype. The scene I will always recall was in Dragnet Druggist. The pharmacist store owner did three things. He compounded. He drank coffee with a doctor almost every day and he made terrific ice cream sodas.

How could the movies or a novelist find a pharmacist to be a compelling character in the 21st Century.

Two years ago, the Cleveland Clinic stopped hiring smokers as one part of a “wellness initiative.”  The Clinic has offered smoking cessation classes for the surrounding community.  The Clinic has a farmers’ market on its main campus.  The “wellness initiative” is a good story, I think.  Refusing to hire smokers seems to be a bold move, but somebody had to be the first.  Smokers are being marginalized socially and now economically.

 

The CEO of the Clinic, a heart surgeon named Delos Cosgrove, said that if it was up to him, if there were no legal issues, he would also stop hiring obese people.  Cosgrove was accused of being unfair.

 

“Why?” he asked.  “People’s weight is a reflection on how much they eat and how active they are.   The USA has grown fat because it is consuming more calories and burning fewer.”

 

Cosgrove went on to state that our national “fat” problem has huge costs, both medical and economic.

He wondered why we did not present an anti-obesity agenda with the same urgency that we have gone after smoking. 

 

Doctor Cosgrove summarized his feelings, “We should declare obesity a disease and say we are going to help you get over it.”

 

In 2008, $147,000,000,000.00 of the health care expenditures went to treat diseases caused by and associated with obesity.  That is $50,000,000,000.00 more than we spent to treat cancer.  It is about 3:1

Obesity over cancer.

 

Every single one of you has patients whose Type II diabetes would disappear if they lost 100 pounds.  You frequently review a treacherous delivery of a dozen or so prescriptions for one obese person.  I did it yesterday.  Fourteen prescriptions.  Hypertension.  Diabetes.  That should be enough, but the doctor wrote for a steroid nasal spray and an Rx-Only antihistamine for allergic rhinitis.  He wrote for an albuterol HFA inhaler and another steroid for her to huff.  She showed attitude when I told her that the multiple vitamin and Vitamin C were not covered by her insurance.

 

I could smell that she smoked so I bit the bullet and took my shot.  If Delos Cosgrove, MD could do it on an international scale, I could do it locally.

 

“You know, Maam, your weight and your smoking could take years off your life.”  That was a pretty bland comment, I thought. 

 

“I’m a healthy woman,” she claimed. 

“I just need some medicine temporarily.”

 

How do you answer that?  I chickened out.  “I hope so,” I said.

 

In 2008, the treatment of diseases associated with obesity came to $477.00 for each American.   $159.00 per person for cancer.  In 2008, the average American in their fifties is 20 pounds heavier than we were in the late 1970s. 

 

Since we are having the national debate about health care, I ll ask this.  “Should obese people be charged higher premiums for their health insurance?”

 

I will admit that I am prejudiced.  At the pharmacy, I do not act the same with a fat person as I do with a person who is fit.  The difference is the light-hearted banter that I engage in when counseling a person who takes care of themselves.  I am all business with an obese person.  I don’t look at a fat woman the same way I look at a woman who is in shape or even a woman who is packing a few extra pounds but is pleasantly round and soft in the right places.   

 

I’ll remind you that pharmacists are at the bottom of the funnel.  We are the last chance for the medical system to make a difference.  What can we, as individual pharmacists, do to help?  I’m leaving it up to the individual pharmacists because our pharmacy organizations seem to have other things to do rather than make a difference in society. 

 

The drive-through.  There are times on Fridays late when I have to wear all the hats.  Pharmacist, Technician, Counselor, Cashier and also be the caretaker of the drive-through.  It is interesting that a very high percentage of drive-through patrons are obese.   Galveston is hot and humid in the summer.  Some of these obese people sit and sweat.  No air conditioning in the car of they choose not to use it.  Some of them can barely get in behind the steering wheel.   They can’t reach the drawer to get the prescriptions and their change.   They are often surly, mean and demanding.  

 

There are many obvious reasons for my drive-through fat prejudice.  The one I am not proud of is the little voice that repeats, “Just stop eating.  You are weak and not worthy of more than my perfunctory attention.”

 

I treat walk-ins differently, I just realized.  I am polite to everyone who comes to the pharmacy counter.   Fat or not.  Why do I often feel that drive-through fat people are substandard human beings?

 

I can’t imagine pharmacy taking the lead on the “War against Obesity”, but we are perfectly positioned to do it.

 

By the way, I have never seen an obese pharmacist.  Twenty pounds is like lugging around a car tire.  I don’t see how anyone who is carrying five car tires could be on their feet all day.

 

Some guy who calls himself CHIP is fixated on making me wrong.  Others have defended me.  Chip has managed to distract some of you.  The conversation has been diluted.  My purpose in using material from the Wall Street Journal was to illustrate that there is an important discussion taking place and that we should be interested.  I have done something for the first time.  This site has been up since 2005.  I did not ban CHIP, but I have deleted the distractions.  After all, it’s my site.  I have invested a lot of money, attention and time.  I don’t have to put up with snipers.

Please, my friends, notice that it is The Democratic Party lawmakers who are scrutinizing the PBMs. You would not find a GOP rep doing this in 100 years. I know that many of you are conservative, but all of us need to get modern. The GOP will not do shit for you. It is the party of the Big Guys. In this area, at least, the little guys, like RxJoe or Ray Jay Rx, just might get some help. Can anyone say, “Third Political Party”? Like in “The Honest Party.” I voted for Goldwater. I voted for Reagan and Bush One. Bush Two was so transparently governing for the rich that my eyes were opened. Worse yet, his majority Congress just followed his lead lemming-like. The GOP was actually Conservative when I voted for Goldwater. It is now some weird mutant of what was once a terrific ideology.

From the Wall Street Journal. 8-19-09

Some Democratic lawmakers looking for ways to overhaul the nation’s health-care system are targeting the companies that handle drug benefits for more than 210 million Americans, setting off a lobbying battle over how much pricing information the companies should disclose.

One version of the health legislation passed by the House Energy and Commerce Committee last month includes provisions that could overhaul how pharmacy-benefit managers — middlemen hired by insurers to administer prescription-drug benefits — operate. It would require them to inform the government or federally approved health plans about differences between the average cost of drugs to the PBM and what the PBM charges insurers. It would also require PBMs to disclose rebates they receive from drug makers for pushing certain pills and say whether those rebates are passed on to insurers.

The goal of the provisions is to drive into the open any cases in which PBMs are earning improper profit margins or rebates, said Rep. Anthony Weiner (D., N.Y.), the lead sponsor of the provisions. He said his legislation will “cut down on inside deals that benefit only the PBMs and the drug companies.”

PBMs use their buying power to wring lower prices from drug makers and say they save money for employers, the government and others who pay for health care. Most health-insurance companies, including those running Medicare’s drug plans, hire PBMs to manage drug benefits.

Typically, pharmacy-benefit managers have carried out pricing negotiations behind closed doors, leaving insurers and other outsiders little idea of the actual prices PBMs negotiate for drugs or their profit margin.

The PBMs argue such secrecy is necessary to negotiate lower prices, but critics say it only helps PBMs pocket more money at the expense of others.

The president of the pharmacy-benefit managers’ trade group called the provisions a bad idea. “One of the great services PBMs provide is to play drug companies off one another and get big discounts on drugs,” said Mark Merritt of the Pharmaceutical Care Management Association. “The thing that drives prices down is competition, not this kind of transparency which tends to help suppliers keep prices higher.”

Greater transparency could result in drug makers giving smaller discounts to PBMs, which could lead to higher drug costs for insurers and consumers, according to analyses by the Congressional Budget Office of previous legislative proposals.

The Weiner provisions aren’t in versions of the health-care bill passed by other House committees. In the Senate, Maria Cantwell (D., Wash.), a member of the Finance Committee, said she wanted her committee’s health-care bill to include similar disclosure requirements for PBMs.

Some companies that offer drug benefits to employees are taking action on their own. Nearly 60 large employers accounting for more than $4.9 billion in annual drug spending, including McDonald’s Corp. and International Business Machines Corp., have banded together to demand greater transparency from pharmacy-benefit managers.

They have signed on 15 PBMs, including industry leaders Medco Health Solutions Inc. and CVS Caremark Corp., that are willing to disclose to the companies their acquisition costs for drugs and pass along any additional discounts they get.

One of the companies, Caterpillar Co., also negotiated prices for the drugs its employees buy from Wal-Mart Stores Inc., although it still uses a PBM to handle claims.

Troy Filipek, an actuary at consulting firm Milliman Inc., predicted that more companies will seek alternatives to traditional PBMs. “I think in general, plans just want to have an understanding of where PBMs are making their money,” he said.

Independent pharmacies, which have lost money as PBMs expanded into Medicare’s drug benefit in recent years, said secretive pricing techniques benefit PBMs more than employers and consumers. A prescription, for example, costs the pharmacies more under a PBM system because they often have to hire other middlemen to make sure PBMs aren’t underpaying them.

The National Community Pharmacists Association, an industry group, has beefed up lobbying against PBMs, hiring outside lawyers and increasing political contributions, said spokesman Kevin Schweers.

The group’s lobbyists are talking to Sen. Cantwell and are trying to persuade leading Democrats to include the PBM provision in the House’s final health-care legislation, said John Coster, the group’s senior vice president for government affairs.

Write to Jane Zhang at Jane.Zhang@wsj.com

Printed in The Wall Street Journal, page A6

No comments in two days when the “problem” of PBMs is the most vital issue in our industry. Haven’t you thought about it? RXJOE & Ray Jay Rx. You guys are in your own shops and are on your feet. What’s up? You two tell me why no one wants to talk about this issue. Are pharmacists so disinterested that they will just keep on taking a good screwing silently?

How hard is it to get laid in Vegas? What was Nevada Senator John Ensign thinking? Okay, be satisfied. That’s the SEX part.

Most people know that a vulture is a bird of prey, with a bald head and bare neck that can dig deep into the body of something dead. A carrion eater. In a human picture, a vulture is somebody who waits for the chance to exploit somebody else when that person is vulnerable. The medical insurance companies get that chance to the tune of billions of dollars. They are profiteers. They provide absolutely NO medical care whatsoever. They are vultures!

Of course, the PBMs are the quintessential example of the vulture for us. They have been bullying us for more than 20 years. Big Insujrance has been bullying doctors, labs, physical therapists and pharmacists. Many specialties that I’m not going to list have been taking 60 cents on the dollar for payment while patients without insurance have to pay usual and customary. The full dollar. This goes on in the richest country in the world.

How did we let this happen? It was an insidious downward fall. In 1967, I filled out PCS and Paid Prescriptions claims for full 100% of AWP + $3.60. How is it possible that our reimbursements from the PBMs have gone down spectacularly in the last three decades? In the beginning, when there were only the two. Paid & PCS. A pharmacist could make a living filling 3rd party prescriptions.

I know that it is the fault of the pharmacy industry that we are in such a calamitous state. But, how did we let it get out of hand? How did the doctors screw the goose? The dentists? All of us? Is the entire $2.6 trillion medical industry the private piggy bank for the stockholders of Aetna and Humana?

We have to have health care reform. We do not need health insurance reform. I am not particularly fond of a Public Option, but I am really concerned that we are doomed if we allow Big Insurance, PBMs to stay in the game. They are vultures, remember? They are profiteers. They are the same as Cincinnati Millicron supplying precision equipment to the Nazis before we entered WWII. It may not be ethical. It may not benefit the average American, but it sure is profitable.

Medicare Part D is what happens when the Big Insurance, along with Big Pharma, write the bill. The Donut hole. What a joke. Have you taken a look at how they determine the prices? They pay cents for a generic drug, calculate the price using AWP and charge that amount against the donut hole. (They call it the coverage gap). I don’t know what the net net cost for a 90 day supply of omeprazole 20 mg is to my Medicare D provider, but I know that they want me to the donut hole as fast as I can get there because they say that they paid $112.10 on my behalf. You and I know that $112.10 is ridiculous. I’ll never get to the donut hole, by the way. Any older pharmacist who is not seriously ill should be able to manage his/her prescription drugs to make Part D work. The public does not know how to navigate the waters as we do.

Makes me sick. Makes me sick because prescription drugs are our business and we are just a poorly paid conduit for Big Pharma and Big Insurance to eat all the flesh they can from everyone they can eat it from.

This is too important for us to ignore. Big Insurance is NOT our friend. Health Care Reform may not even include prescriptions. In Canada, Rxs are not part of the national plan. This may be the only chance in this generation to send Big Insurance back to insuring houses and motorcycles.

I am to the point that I will urge Barack Obama to veto any bill that keeps Big Insurance in the picture. Veto it and start over. This is our chance. It doesn’t come up very often.

By the way, watch carefully in the next few weeks, Big Pharma has made a deal with the administration, I believe. You will see ads paid by Big Pharma that back the administration. I read that Pharma has earmarked $150 million. They know that they will still be in the game if they just make some concessions. Big concessions like allowing Medicare to negotiate price. I think what they will get is the patent protection they have been enjoying extended.

• Telstar rip

Last Spring, the Nobel Prize winning economist Paul Krugman wrote a column on health care reform in The New York Times. He advised the Congress of the United States on two points.

1. Never trust the insurance industry.

2. Never trust the insurance industry.

Anderson Cooper CNN shows you the video and also the view of a couple talking heads.  I want to know what you guys think.

Justifiable homicide?  First Degree Murder?

You may want to see this look, put up by the Associated Press

Okay, here is the view from the O’Reilly Factor. 5 minutes.

My right ear is still a little plugged after a lot of swimming early this summer.  I use the left ear for the phone.  Now these ears were damaged by 1960s rock ‘n roll when I lived in San Francisco.  Lots of concerts.  Lots of bad groups, but it was worth sifting for the good ones.  Jefferson Airplane, Creedence, The Dead.  War Protest songs.  The spectrum from “Where have all the flowers gone?” to Jimi Hendrix “All Along the Watchtower”.  I listened to Hendrix too much.  One Saturday night at the Carousel Ballroom, it was “The Holding Company.”  Janis Joplin didn’t even get billing.  She was just the “chick singer”.  That night, she took over and it is a sad history. 

When Janis sang, “Piece of my heart”, the audience started whispering, “Who is she?”

Yesterday, a pharmacist from Iowa called for a transfer.  I had to help her, “Will you please put your mouth closer to the phone and talk louder.”  Honestly, I expected her to tell me her name was “Tinkerbelle”.

It was if I had told her to pull down her pants and admit that her children are ugly.  She refused to talk louder.  I made the request three times.  Halloween 4: The Return of Michael Myers movie full I told her about my ears.  I told her that we could get the transfer done quickly if she would just cooperate.

She said, “You’re just having a bad day.”  I heard it clearly.  It was to make a point.  I can talk louder, but not when you ask me to.

It was 10:30 AM,  So, I just said, “You better call after 2:00 PM when the pharmacist with young ears is here.

Essentially, she was stubborn and rude.  We were certainly not colleagues.

 

February, 2008. Pathetic legs. Chilly morning. Long sleeves, short pants.

There is significant muscular atrophy from the late effects of polio. I should apologize to my legs.

“You have done a very good job of getting me through my career. You are good legs, faithful legs, hard working legs and I have let you down.”

Pharmacists brutalize their legs by standing on them for up to twelve hours straight day after day after day. The only relief for some is to go home at 10:00 PM and wash down three Aleve with a beer or cocktail and let themselves be entertained by some mindless distraction about the best slam dunks of the day or shots at some cute penguins in Antarctica.

Suffer in secret. Is that what we do? I know that is what I have done. For over forty years, I rarely said a word to anyone when my legs hurt. The discomfort affected my mood at times. I tried to keep it hush-hush. There was a concealed guiltiness to allowing anyone to know about my legs. Telling would make me a lower-grade pharmacist.

I guess that I have been fortunate. Essentially, I am a small man. At five ten, the heaviest I have ever been is 180 pounds. The load that my legs have had to carry has been a relatively light one. I can’t imagine the problems if I was overweight.

I had an appointment with a neurologist a couple weeks ago. I stopped by the outpatient pharmacy to say hello. The pharmacist who came to the window was carrying some weight. She limped.

I asked her, “Your legs bothering you?”

She smiled. “Not my legs, man, my hips.” She gave me a doleful look. “I don’t need one side done, I need both hips replaced.” She shook her head and gave me a gallows grin. “I am only freaking 43 years old.”

Legs are not the only body parts that seem to go after many years on your feet. You can look in the mirror and see hunched over shoulders from bending over the counter all day. Your heart space gets squeezed and constricted. That can’t be good. Your poor heart has a big job to do. Give it room. I have worked with pharmacists, mostly women, who constantly have their hands on the small of their backs. None of them have been complainers, but, when asked, they admit that their backs hurt. Does this happen to men? My back, I am grateful, is good.

I do not know if all of this discomfort is necessary. It’s our own damn fault, I believe. I could have saved my legs if I had told Thrifty Drugs in 1965, “I’m not standing up from 9:AM to 10:PM. Get me a stool.” It was a union. I could have gotten away with it. It could have sent my whole career along a take-care-of-myself fath.

I do not know if our jobs will ever change. Your new car, nice house and all of the private lessons for the kids come right out of your hide. What we do is not a job for sissies.

Tell me what you think about this. Especially if your body is thriving.

Another amazing example of being “Clueless”.

More than a week ago, let’s say, July 15^th, 2009, a mother brought in an Rx for Concerta with the date June 15^th, 2009.

“Maam,” I said, “This prescription is no good anymore.  It is a month old.”  It was one of those written by a nurse with the doctor signing, but never really reviewing the Rx.

Big eyes.  “A month old?  That isn’t right.  I just went to Houston to pick it up this morning.”

I sighed.  I could see what was coming.   There is absolutely nothing I could do for her.  Schedule II prescriptions are now good for 21 days in Texas, up from 7 days.  With the new, expanded window for filling, it is now forbidden to call the doctor and write in a change in the date.

“My hands are tied,” I said and explained the new rules to the Mom.

“What should I do.  My son has to have his Concerta.”  She actually stamped her foot.  “I will not drive back to Houston just because the damned doctor was not paying attention.”

“I don’t blame you.”  I was just treading water and grateful that she was not blaming the pharmacist, as is often the case.  It flow downhill, you guys, and we are at the bottom.

“But, I don’t know what to do.”  She slammed her purse on the counter.

“When does your boy need the Concerta?”  She had always seemed to be responsible so I surmised that the kid probably had some tablets left.

“He has two pills.”  She frowned.  “I mean it.  I will not make that trip again for a month.  It is over two hours round trip.”  She mutter the words, bitch, doctor and stupid but not in that order.

“That’s why there is Fed Ex or UPS,”   I said.

“What do you mean?”  I think she knew what I meant, but was too timid to demand that from the doctor.

“Overnight,” I said, “Have the doctor overnight a new prescription with the right date.

“Do you think she would?”

“I’d say that she better.  You do not have to pay for her negligence.  It is her job to solve this problem.”

That was it.  I had forgotten the incident until the technician told me that the doctor was on the line.  I was ready for her.  I had the ammunition thoughtless, inappropriate, inconsiderate, inattentive, careless and sloppy in my six shooter……but I didn’t need them.

“Thanks,” the doctor said, “For saving my bottom.  I would have had one of my staff drive the prescription to Galveston.”  She chuckled.  “I wouldn’t have thought of Fed Ex Overnight.”

“Doctor,” I said, “You are welcome.  May I make a suggestion?”

“Sure.”

“Read the prescriptions before you sign them.”

“Especially the date.  Point taken”