The Ten Commandants to getting optimal drug therapy.

I was interviewed by a medical journalist who is working on a book for a major publisher.  A comprehensive guide to the wise and safe use of Rx and non-Rx drugs.  What your PHARMACIST wants you to know.  NOT what your doctor wants you to know.   That is interesting.  There is a sea change taking place.  Let’s help him out.  By tradition and law, we deliver all Rx drugs to the final user.  That is power.  C’mon, help this guy out.  You can do better.

The publisher suggests a list of “Ten Commandments to assure you get the optimal outcomes from Drug Therapy”. I will take #1,  You guys list your in comments.

1.  Make sure that you insist on being counseled by your pharmacist and then trust your pharmacist.

I go ballistic when a nurse says, “That’s on the $4.00 list, isn’t it” and she’s talking about a $100.00 drug.  We need to get this stopped.  Nurses need to mind THEIR OWN BUSINESS and leave us to do ours.  Yesterday, it was a Tricare rep who advised about the $4.00 Rx.  She and I had a talk.  At the end, she refused to tell me her name and, under a withering barrage, she chickened out and hung up on me.  So, I am going to start a list of bullet points that all of us can use when the $4.00 subject comes up.  I’ll list mine and also list yours.  Politicians do this all the time. When the subject comes up, you can refer to this list.  PUT YOUR “BULLET POINTS” IN COMMENTS AND I’LL CUT AND PASTE THEM HERE.  I’ll give you credit.  Once the list is complete, I will ask Keith to put them on the main page of The Pharmacy Alliance (aka The American Pharmacist Alliance TAPhA) website.

#1 .  Pharmacists provide a very valuable professional service.  What we do is worth a lot more than $4.00.  Plenty more.  (This is Jay Pee’s biggest gripe.  Giving away antibiotics or selling Rxs for $4.00 diminishes the perception that a valuable professional service has been provided)

#2. ” Doctor, I don’t tell your patients that the fee for an office visit at your clinic is $19.99 just because THERE IS A DOCTOR IN EAST HOLLOW WHO DOES CHARGE $19.99.  How does that feel, Buddy?”

#3 From the man who coined the appelation GALLEY SLAVES in reference to INSTITUTIONALIZED pharmacists.  The Ole Apothecary.

PATIENT POINT: “My doctor said it would be all ready for me when I got here.”

PHARMACIST: What time was your appointment this morning?

PATIENT: Nine o’clock.

PHARMACIST: And, what time was it when you finally got in to see your doctor?

PATIENT: Eleven O’Clock.

PHARMACIST Why do you think he didn’t see you at your appointed time and you had to wait two hours?

PATIENT: Because he was busy taking care of other patients.

PHARMACIST COUNTERPOINT: Tell you doctor that it’s the same situation here.

Davey

Davey, along with MrSeyer, is a pharmacy student who administers the FORUM here at www.jimplagakis.com.  That particular project is slowly gaining speed. 

I WANT TO SHARE WITH YOU WHAT A STUDENT CAN DO TO MAKE A DIFFERENCE FOR ALL OF US.  These kids have 50+ years ahead of them working as a pharmacist.  Davey was proactive.  If we can just get One in Ten students to do what Davey did, the pressure on the “Trimtab” will be enormous and the ship WILL change direction.  Jay Pee

P.S.  I believe that students can run their own ship.  They will have long careers.  50, 60 years.  They must start now.  There will be no time later.   THE PHARMACY ALLIANCE,  also known as  THE AMERICAN PHARMACIST ALLIANCE can be the source . TPhA (Alliance) has the network and the know how to start a grass roots initiative.  If any student would like to explore the possibility of a student chapter, contact TAPhA (TPA) President, Myron Bryant to present your possibilities.  tmyronb@comcast.net

GOOD FOR YOU, DAVEY. 

From Jay Pee… Yesterday, I wrote Davey and asked, “What did Perez say?  How did he answer your question?

Thanks, Jim…I just tried to edit and the site timed out on me. It could have been written better. Still though, the assemblyman said that something needs to be done about the business model that pharmacy chains operate with currently. He also reiterated that the California legislative process is a huge hindrance to that right now and that he’d like to change how that works. I think he was agreeing with me without stepping on corporate toes in the room. He said he knows the value of pharmacy services, and what they do for their community and that it’s unacceptable for pharmacists to be seen as second rate practitioners.

Jay Pee..Moe from Davey.

Guys, thank you so much for the feedback. I consider you frequent posters on this website to be pharmacy’s few who see the light, and those people I look up to and support and feel support from. I did this for us. And so that pharmacy students whose heads are in academic lala land from the zillions of blood pressure screenings and pages of Koda-Kimble they’ve done could bear witness to the ugly question about what will soon be their inescapable reality. Hopefully, they’ll ask themselves if they’re willing to put up with the status quo or just deal with it for the sake of a reliable buck. Drug Monkey, if you’ll condescend to show up to the next APhA mid year meeting, you’ll see me raising hell in the ASP forums as per usual, and mark my word that I’d stand next to you if you decided to do the equivalent in the House. While most students mirror current pharmacists by trying to target issues that keep the focus off themselves (like pharmacogenomics, direct-to-consumer ads, and what I’ve discerned as being the great distractant, MTM), I stand up and ask students to look at themselves, and question whether we are denying our basic needs as professional human beings in this profession in order to avoid confrontation.
Without laboring the topic too much, I was required to write a reflection paper to my professor since I missed class that day. He told me, in true pharmacist fashion, that I should take a less confrontational approach to advocacy, and be more constructive. While he makes a good point about how being well-behaved might get me some invites to the bargaining table someday, I couldn’t respond back to him because I wanted to ask him, an academic clinician for life, where the obsequious, polite, people-pleasing attitude of the modern pharmacist has gotten this profession. I mean, really—we need to get way bolder, way more vocal, and can the idea of traditional conflict resolution; to me, it’s a truth in any part of life that when you show resolve and an unwillingness to back down from what you stand and have passion for, things go your way.
Exposure of the issues is needed now, with some measure of balls. And you know what Ben Franklin said so I needn’t repeat: we will continue hanging separately with but the opportunity to frantically type responses on JP’s site if we don’t choose to hang together. I’m starting to like the TPA more and more. I wonder what kind of recruitment I could get with a chapter established at my school…hmmm

Start the Chapter, man.   One student at a time.  You first.  Mister Seyer first at Creighton.  TPA. The Pharmacy Alliance aka The American Pharmacist Alliance.  TAPhA.  Student dues are $15.00. 

Jay Pee is just “Steam Release”. You visit “Angry”, “Angriest”, “Drug Monkey”, plenty of others and Jim Plagakis and you get the same thing in context: How Bad It Is! The particles may be different, but the messages are the same: There is trouble in pharmacyville.

The Internet seems to be a wonderful thing. Instant answers. Music. Videos. Full length movies and “Steam Release”.

Two types of “Steam Release” come to mind. Porno and Pharmacy Blogs. The Internet IS a wonderful thing if you are able to control yourself and insist that you maintain objectivity. But that is not going to happen much.

The Internet lets us wallow in subjectivity. I tell you about the $4.00 Rx. I tell you that it is a disgrace and you say, “That’s what I’m talking about, Plagakis, you tell what’s really going on. The bastards”. Screw them all and their $4.00 prescription. “Steam Release”.

Angriest points at the famous Pharmacy Benefits Manager (as only he/she can point with colorful language squared) as the asshole of the prescription drug delivery. You love that stuff. You love it because Angriest has a knack for belittling and demeaning the subject (PBMs). It makes you feel so good. You turn off the computer and go to bed. Spent. Like you had just been in a tough street fight and came out on top.
“Steam Release”.

Is it that much fun when your team always wins. I do not think that Angry is looking at writing a piece about the difficult situation the chain drug store got themselves into when some minor functionary signed the last PBM contracts. The idiot took another 1.5% hit and that means that you are just trading dollars on most brand name, mid-priced prescriptions. That means that the company is not making any money on 30% of the prescriptions you fill and is actually losing money on another 10%. The only Rxs that you make money on this group of PBM contracts are generics.

That same group of idiot middle managers look to save money where they always look so they can save their own asses. Pharmacist overlap and technician hours. This has not changed in four decades, you guys. It is the easy place to look. It is the loser’s place to look. It is the quick fix so that the idiot can report to the upper management that money is being saved by cutting what they say are superfluous, redundant hours. WTF? Redundant? Superfluous?

How about those upper managers coming and talking to you? The idiots would be out on their asses.

Can you feel the Steam starting to build up? After 7:00 PM the steam is about to blow your head off. You go home and read what Drug Monkey has to say and, Ohmygawd, David is talking about my store, about me. Dammit, David, you are so right about this. It is customer service that suffers. It is me who suffers. My language, man You are talking to me. STEAM RELEASE!

The two wars that our kids are fighting in Iraq and Afghanistan have millions of us outraged. There were millions outraged 40 years ago and we took to the streets. We demonstrated. The stream built up to such a critical pressure that we had to do something. We were active and vocal. We did stupid things, but we had a lot to do with the end of the Vietnam War. We had to vent some of the steam pressure. There was no Internet. There were no anti-war blogs were we could go.

What if there was no Jay Pee, no Drug Monkey, no pharmacy blogs. What would you do with the hissing of the superheated steam then? Some of you might troop up to the district office, go find your pharmacy DM and tell her, “You get me 16 more hours a day of tech help and a relief pharmacist on Tuesday and Wednesday or I am giving you my nametag and store keys right now.

NOW, THERE’S SOME STEAM RELEASE.

“But, but Terry, you do not want to do that.”

“Oh yes I do, Mildred. Yes, I do.” That first rush of epinephrine and cortisol is abating and you feel worried. You’ve worked for this company for 15 years.

“Terry, let’s talk about this.” Mildred has a look. Devious eyes. “Terry, I’m asking the secretary to come in and take notes.”

The bitch wants a witness to cover her own ass. You take off your nametag and start fishing for your keys. “By the way, Mildred, I’m riding this horse as far up the pike as he’ll take me. Right to the CEO’s office at a gallop. I’m not stopping until everyone knows that it is not the pharmacies who have screwed up.”

Now that is some bona fide STEAM RELEASE.

What does Terry do in real life? He goes to some pretend life on the Internet to find some ranting to make him feel better.

“When you coming to bed, Terry?”

“Damnit, Betty,” Terry says to his wife, “This Angriest Pharmacist is right on target and he calls them, oh hell, Betty, you don’t like that kind of language, but, baby, he hits them right where they live.” Haw Haw Haw. “This cracks me up.”

Steam release. Me too. So, I am included in the group that comes to the pharmacy blogs basically to masturbate rather than have real sex in the manager’s office.

If I am even close, this is very dangerous. Not just for pharmacists, but for everybody in our culture, perhaps the world. First, we read only what we agree with and second we read rather than actually doing something about it. Brrrrr. Where is George Orwell when we need him?

Instead of whining about the state of retail pharmacy, how many of you are engaged in a written, face to face or telephone conversation with your state board trying to get the board to acknowledge that a tired pharmacist is a dangerous pharmacist?

The wars, health care, taxes, pharmacy schedule budget cuts. What’s the difference?

]THE SEVEN PAGES UP ABOVE ARE BRAND NEW. 4-5-10. Doctors are OTC IGNORANT
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NEW PAGE “Girls Beware of the Bad Boy” published Wednesday 4-8-2010

NEW 4-9-10 “That’s not my Job. That’s the Technician’s Job.”