I just read this again and it is a downer.  So, I removed the picture and may find a more sanitized inage, but I took the “Sticky” off it so it will get soon buried.  However, what do you think about this before it is lost? 

 

This morning, I was reading an article published by The New York Times on nightmares.  I came upon some disturbing statements.  They indicated that patients who are terrorized by repeated traumatic nightmares are usually victims of PTSD, not necessarily associated with wartime events, but usually from childhood sexual abuse.

 

The results of a randomized controlled trial were published in a 2001 paper in JAMA, of the subjects:

95% had moderate to severe PTSD

97% had experienced rape or other sexual assault

77% reported life-threatening sexual assault

58% reported repeated exposure to sexual assault in childhood

 

Reading that article got me to do some research.

 

The statistics are shocking

• 1 in 4 girls is sexually abused before the age of 18.
• 1 in 6 boys is sexually abused before the age of 18.  
• 1 in 5 children are solicited sexually while on the internet.
• Nearly 70% of all reported sexual assaults (including assaults on adults) occur to children ages 17 and under.
• An estimated 39 million survivors of childhood sexual abuse exist in America today.

Some of you have read about my first marriage.  I stuck it out for 9 years even though it started to go bad right after the honeymoon.  My wife was an alcoholic. She abused every drug she could get and got her doctors to write for drugs like Doriden, Quaalude, Librium, Fiorinal and others.  Donna was a victim of incest.  Her father used her and her sister as sex partners for years.  At one point of her middle teens, she ballooned to 175 pounds.  She was five foot tall.  She hoped to make herself unattractive.  Donna had serious sleep issues and episodes of traumatic nightmares.

Most of you are from backgrounds in which this is not a possibility.  It certainly was not in my paradigm.  That was why it took me so long to get it, even though she tried to tell me after marriage counseling one evening. 

My point is that we all have patients with sleeping issues.  If there are 39 million Americans in this group, how many of them get their Ambien from you?

Most pharmacists are not from the socio-economic group where this is prevalent, but there are plenty of us counseling patients who have been victims ourselves.

Paul Rogers was a brilliant psychologist who always looked at what got his patients where they are.  He gave the example of seeing a potato in the root cellar as a boy.  The potato got no sunlight, but it still tried to grow.  It had white, plastic-looking shoots, all curled and malignant-looking.

Rogers said that the same thing happens to people who get no light.  Some of them have been sexually abused.  Many of them have nightmares and can’t sleep.  They end up with us at the bottom of the funnel.  How do you counsel them now?

You First. 

I know what I’m going to say.  How about you?  Let’s check your creativity.  Write something that no one else will write.  Then I’ll write mine.  C’mon.  Have some fun.  For those of you who object to ADULT LANGUAGE.  Beware!

 

“Hey you, Pharmist.  I toad you I wand my Vicodans.”……… “Whad you mean No REFILL?”…… She holds up the vial. 

The fat woman yelps, “It sez ride on the bottle.  Two refills, you frikkin asshole.”…. mutter, mutter.  She takes a drag on her cigarette and then a chug from a bottle in a paper bag.   “Frikkin damned pharmacist.”  Suck from the cigarette, a plume of blue smoke.  A chug from the bottle.  It dribbles down her chin.

 ”Hey, you.  Pharmist, you listening to me?  I got refills.  You ain’t no doctor, girly.  You just a goddamn pharmist.”……

 You say, “That is an old vial.  You have used up all of the refills.”  …….

 The obese woman screams, “You give me my refills or I’m gonna come in there and kick your skinny white girl ass.” 

 That’s enough for you.  It is 8:30 PM and these people could be in the parking lot when you leave.   The Assistant Store Manager tells you to relax your skinny white girl ass.  You call the police.  They tell you that they can do nothing about threats.  After you get your skinny white girl  ass kicked, then they can do something.

Your husband sounds worried, but he is at home with the kids.  They are in bed.  It is a half hour drive.  You tell him that you are calmed down, but that is BS, you are almost panicky. 

At 9:00 PM, you leave the store and the tension is released when you see a police car at the curb.

“Do you see the person who threatened you?”  The cops get out of the squad car and go to both windows of the creeps’ car.  They read her the riot act.  You do not stay around.  You never see her again.  Tax dollars at work.

Which of these three giants is separating from the others?

Last week one of these three companies made a major announcement about the kind of pharmacy that will be practiced in their stores.   This company publicized that they would be officially moving from TASK CENTRIC to PATIENT CENTRIC pharmacy practice.

TASK CENTRIC, of course, is the workings of the “Prescription Mill” and keeping up and doing it according to the timers.  In TASK CENTRIC pharmacy, the R.Ph. is chained to the “Mill” and more interested in satisfying her handlers need for the timers to stay green and not red so that their handlers don’t get pissed off and can their asses.

The pharmacist who cannot break away from the “Mill” will be relegated to the status of “Glorified Technician”.  The question is how long can he expect to make a professional’s wage when he is not doing a professional’s work?

An interesting question is:  Will there be a discrimination made someday soon between the “Tech Pharmacist” and the “Professional Pharmacist”?  Those of you who whine and complain that the burden of the “Mill” will not allow you to counsel make me believe that you like it that way.

PATIENT CENTRIC practice is the kind of pharmacy that I have really tried to practice for 30 years.  It has not been easy.  I have had non-pharmacist managers jump me because I was WASTING TIME when I went out front to help a patient with her worry that her children had lice.  That is PATIENT-CENTRIC practice, as is counseling on prescriptions. 

The mother with the lice problem sees the R.Ph. as her Primary Care Provider if she is poor and has no insurance. 

The company I’m talking about put out this statement:  “Patient counseling (is) an important part of the process, but there wasn’t time to have in-depth conversations about lifestyle and other factors that patient expect from pharmacists.  That’s a problem for the industry and (company name) will lead the industry to fix it.”

This company wants the public to recognize their pharmacists as the healthcare providers that they are.

It takes a TRIMTAB on the rudder to change the course of a huge ship.  This pronouncement is the TRIMTAB.

Look for this company to go to state boards to get Tech-Check-Tech authorized.  That would be a good start to free up the R.Ph. to practice in a professional manner.  (Peon, you need to re-evaluate.  Perhaps a change in scenery would give you reason to keep on keepin’ on)

Which Company is it?

Friday closing Stock Prices.

WAG     $28.40   UP

CVS      $29.90   UP

RAD      $  0.97    ??  $0.52 less than a 20 ounce Coca-Cola at Walgreens

 

This is a letter that I will fax to my Senators and Congressman.  This bill can only make it better for us, enhance our professional standing and help ensure that we continue to get a professional’s wage.  I don’t think that you will get extra pay YET.  But, you will.  There is a sea change happening.  Either get on the ship or be left behind.  I am older and worn out compared to most of you, but I don’t want to go out as a “Glorified Tech”.  I want to ride this horse as hard as I can until I can’t anymore.  None of you have an excuse other than ignorance and incompetence.  There are pharmacists (like some doctors or lawyers) who are just warm bodies with licenses.  They are not reading this, however, so we won’t be hurting their feelings.

Feel Free To Use My Letter.  Just edit it to customize it for our own style.

 Senator Kay Hagan (NC) and Senator Al Franken have introduced legislation that improves the Medication Therapy Management (MTM) benefit in Medicare Part D by making more Seniors eligible.  Like the House bill (HR 3108), the Senate bill will help insure that Seniors properly take medications.  This can save billions of dollars.

 

The Senate Bill ensures that Seniors can receive MTM services from the pharmacy of their choice and creates a payment structure that assures that pharmacists are appropriately paid for providing MTM services.

 

I urge you to do everything in your power to see to it that this bill passes.  The pharmacist represents a “bargain” compared to other health professionals.  We are at the bottom of the funnel.

 By education, the law and tradition, we are there to serve and to make a difference in the drug therapy of every single patient that receives prescription medication.  

 

We could speculate that 90% of all office visits result in one or more prescriptions being dispensed.  I know of a holistic doctor who plays the flute for his patients, but, in reality, drug therapy is medicine in the 21^st Century. The pharmacist is alone with the patient at that point.  The pharmacist is uniquely positioned to assure that positive outcomes are achieved.  The pharmacist is the “finisher”.  Passage of this legislation will benefit the patient and will also save billions of dollars.

 

 

Jim Plagakis

 

 

 

 

Right now, getting paid extra for MTM is not the question.

DOING IT is the question.  As long as we do the work of glorified technician, we are doomed and will be relegated to a lower class of pharmacist.  Right now, as I see it, the job is to DO a professional’s work to continue to get the $10,000.00 a month PROFESSIONAL’S salary.  Later, after we have shown the companies that we are causing a very satisfying return on investment, we can negotiate for a sliver of the pie.

The CVS-Caremark vs. Walgreens battle was only the most visible case in point of Walgreens intention to separate from the other “Bigs”.  While CVS & Rite-Aid and Wal-Mart are figuring out how they can avoid counseling (as one example) WAG is stepping up.

This is worth watching.

This letter was written on 6-10-2010 by David Kliff, Publisher of Diabetic Investor

  

 

Walgreens had announced it was dropping out of CVS Caremark’s drug-benefits network, citing CVS’s promotion of prescription plans that require patients with chronic conditions to use either CVS stores or the Caremark mail-order pharmacy.

 

This cat fight between these two retail pharmacy heavyweights is just the latest in series of blows between the companies. Both CVS and Walgreens are fighting tooth and nail to capture customers with chronic conditions and diabetes is at the centerof this fight. According to industry the customer with diabetes is the golden child for retail pharmacies.

 

These patients spend on average $4.500 per year. visit stores more frequently and tend to buy products that carry a higher margin for the retailers.  This is also why both CVS and Walgreens are making a major push to capture the valuable diabetic consumer.

 

Recently CVS announced a rather lame attempt to capture the patient with diabetes with their Diabetes Advantage program. A program that merely rewards CVS customers with double ExtraCare card points for buying  products that they would buy anyway.

 

Walgreens for their part is taken a far different and more encouraging approach as they are getting set to adopt the successful Asheville protocol in their stores. Using this health coaching approach Walgreens intends that  patients will remain loyal to their pharmacy as the pharmacy will no longer be viewed just as place to pick up their prescriptions but become a valuable part of their diabetes management. Or put another way, Walgreens believes patient education will not only translate into better patient outcomes but increased sales as well. Seems to Diabetic Investor that we’ve heard that somewhere before.

 

We have known for years that education works but until Walgreens came along education was treated as a second class citizen. This is what makes CVS’s efforts so transparent. Rather than put education ahead of product sales, the company somehow believes that by rewarding patients for buying products they already use will magically help them achieve better outcomes. Frankly the CVS approach is nothing more than frequent buyer program that everyone has and will do nothing to enhance customer loyalty or improve outcomes.

 

For years Diabetic Investor has noted that 80% of patients with diabetes are treated by primary care physicians who lack the time and infrastructure to adequately educate their patients with diabetes; and let’s not forget they are given littIe Incentive to provide this education as reimbursement is either nonexistent or inadequate.

 

We also know that while Certified Diabetes Educators are a dedicated group of individuals there just isn’t enough CDE’s

available to meet the demand created by the epidemic growth rate of diabetes.

 

Finally Diabetic Investor has noted on numerous occasions patient education would never gain traction until someone actually understood they could profit from providing this education.

 

To their credit Walgreens understands that educated patients are more compliant with their daily therapy regimen, monitor their glucose levels more frequently and achieve better overall outcomes.

 

Just as important for Walgreens is that they also understand that they can profit from patients who better manage their diabetes as they will fill their prescriptions more frequently and visit their stores more often.

 

Simply put Walgreens understands that patient education is a win-win scenario, Patients achieve better outcomes and Walgreens experiences greater sales.

 

While Diabetic Investor  has no .idea how this latest cat fight between Walgreens and CVS will turn out, we can say that when it comes to getting it right with patient education Walgreens is light years ahead of the competition. Imagine that a company that actually understands that patient education works, who would have thunk it.

You can view the email alert online by logging into your account at http:/Iwww.diabeticinvestor.com

David Kliff

Publisher

Diabetic Investor ,

www.diabeticinvestor.com

6/11/