JP at Large Up to Date. A compilation of Jay Pee columns from January, 1989. For ordering information, see “A Section For Pharmacy Matters” in right hand column.
Click on "Pharmacy Matters" in right column for order information
More than 50% of the people I serve at my two shifts a week job are medical or nursing students, residents, faculty members, regular doctors or scientists at one or the other laboratories at the University of Texas Medical Branch. The Galveston National Laboratory is one of two in the USA that have air locks and shower rooms and high security. They study bad “germs” like Ebola.
My favorite GNL scientist gets her Allegra and Yaz from me, every fourth Friday night. Her name is Evgeniya Volkova. A six foot two Russian thirty-something beauty who, if she became unemployed, could make a living on the midnight to six in the morning shift at the San Luis Resort. Sexist? Yes. Could she? Oh, man. Absolutely! You gotta see Evgeniya to appreciate Evgeniya.
I have hesitated to say this, but I have been convinced for awhile that a good, seasoned pharmacist is a better primary care provider, in many cases, than a resident.
Friday night, around 8:30 PM, a very pleasant Bengali woman with an American accent told me that she was born and raised in New Jersey. She is a resident at UTMB. With her, were a toddler and her sister-in-law who had an Indian accent. I had been trying to get a pharmacist at a grocery store in Austin for a transfer of the child’s prescription.
The two women showed consternation when I said that I had been put on hold three times and that I refused to wait longer than two minutes.
The mother, maintaining a patient face when she really was impatient, said, “But two minutes is not that long.”
“Only 120 seconds,” I answered. “121 seconds is too long.”
“Can’t you try again?” the resident asked.
“My technician just left,” I said, “I’m all alone and two minutes is my limit.”
It was almost hilarious how they studied their watches as I held the phone to my ear. At two minutes, the mother squealed and the doctor sighed.
I walked back to the counter. “Doctor, what is the problem? You are a Texas licensed physician. You can write the prescription yourself.” I put an Rx pad on the counter.
“What do I write?”
The mother said, “Write this” and she handed her sister-in-law a bottle. The doctor handed it to me.
“Well, you can’t write this,” I said, “It’s a compounded Protonix prescription.” There was no hope at 8:45 PM. “But you can write for Prevacid 15mg Solu-Tabs.”
“Is it the same?” the mother moaned, “My child can’t eat. Please help us.”
I waved my hand at the mother and showed her an extended palm. I was done with her. It was now time to instruct this young doctor. I gave her the quick version of Protonix vs. Prevacid and the value of a dissolve on the tongue tablet.
The doctor started with the questions and I showed her the palm. “Trust me,” I said.
Then she showed me something. “I’m sorry. You know more about this than I do. Please dictate what I should write.” That done, she asked, “Where is the Blistex? Her little mouth is terribly chapped.”
“You don’t want Blistex,” I advised. “It is a runny mess with too much of the volatile oils. If you use Blistex, her terribly chapped little mouth will stay terribly chapped until she is sixteen.”
There was a homeless looking guy standing behind them. He had a bottle of store brand Maalox and tipped it over to show me that it was empty. He shrugged his shoulders.
“Really!” I said to the doctor. “Trust me.” Then the homeless guy (who was very clean by the way), I told him where to find the Maalox. He smiled.
“Is that why I have had chapped lips forever? Blistex is what I use.” Her eyes were wide. Her smile was brilliant. She had found a valuable resource. The pharmacist at the neighborhood drug store.
“That’s probably why,” I said. I told her that the best for chapped lips was the original, black tube Chapstick. “It has more wax than any of the others. The wax will protect.”
While In was doing the computer work, the mother asked what would be good for the cold sores in the child’s mouth. “I can’t get her to eat.”
I looked at the doctor. “They are canker sores if they are in the mouth. Kanka is over the counter and pretty good, but, since you can prescribe, write for lidocaine viscous. Your sister-in-law can put a little on her clean finger and apply it that way. You don’t want the kid (I used the child’s name) to have a numb mouth.”
Ten minutes later, they had two tubes of Chapstick, Prevacid Solu-Tabs and lidocaine viscous and were on their way.
That was only one incident, but it was so over-the-top and the doctor was very willing to listen to me that I had to report. I am also convinced that I deal with plenty of residents who let me take the lead, but fake it.
This girl was terrific. She was ignorant and did not care that I knew it.
OTC. I don’t even show respect anymore. It doesn’t matter if they are students, residents or faculty,
I treat them as if they know nothing. That is more often than not the case. A faculty member recently was going to buy Pepto-Bismol for stat use for gastric hyperacidity. I handed him a pack of Rolaids. He showed a skeptical eyebrow raise and expressed doubt.
“You want magnesium hydroxide,” I told him. When he asked “Why?”, I told him to either trust me or not, but that I knew what I was talking about. I smiled and turned my back on him and walked back to the pharmacy. He bought both.
A resident Friday night asked me why I recommended guaifenesin 400mg, diphenhydramine 25 mg and pseudoephedrine 30 mg separately when she could buy a combo product.
“The combo is what I call a ‘dirty formula’. In order for you to get enough guaifenesin to help, you’d be getting way too much antihistamine and pseudoephedrine.” I had to repeat three times that Benadryl is more likely to stop the post-nasal drainage that was gagging her (her description) than Clarinex or Zyrtec.
That’s enough. I’m out for today. Doubt me if you dare. What you know, what you are conversant in, what you are an authority on is not what doctors are experts on. Period. Watch out. Especially if you are the patient. 90% of the time, you are much better off if you allow the doctor to diagnose, but you choose the drugs she writes for.
Have to give credit to GRAVY. Months ago, commenting “Her ass was grass and she knew it”, Gravy suggested the Solu-Tabs.
Is this subject a curve ball? I never know what subject you guys will jump on, but I am very discouraged that you won’t comment on this. I’ve been away from the classroom for plenty of years and I do what I do. Is it a matter of timidity? Courage? Laziness? Many years ago, at a meeting of the California Board of Pharmacy in San Francisco, I got up to talk. They were discussing technicians. Two representative and an attorney from the Retail Clerks Internation Association (the union representing pharmacists) hollered that allowing technicians to do “clerical” work in the pharmacy would lead to sub standard pharmacy care and would endanger the citizens of California. They also said that pharmacists would litter the roadside, put out of work by technicians. In the early 1970s, matchbooks were still used for advertising, often they were employment ads for technical jobs. My statement was off-the-cuff. I said that technicians were essential. We had to have them. I stated further, “If the profession does not move beyond clerical work, we can advertise on matchbooks.” That’s how I feel about you people yawning over this subject. I have a BS from 1964 (the last 4 year class) and I keep on practicing pharmacy as I think it should be practiced. What the hell is wrong with you PharmDs? Can you honestly justify your tunnel-vision focus on the prescription mill? Hey, wake up! The Mill is clerical work. In an 8 hour shift, you can spend a split up hour actually serving your patients. 4 minutes here, 2 minutes there. It actually will make your day. You’ll do some good. You whine about the Mill. Sometimes, you guys irritate me.
Oklahoma RPh, eventually guys like me will get off our legs and there will be more guys like you who CAN wow the system and will be WILLING to wow the system. My knowledge is limited. I do what I can with what I know and I am not the least bit reluctant. Oklahoma, you are my hero.