I was at this concert.  It was in an upstairs ballroom on Market Street in San Franciso.  I think the Carousel Ballroom.  Around 1967.  Donna and I were dressed like a pharmacist and his wife.  She wore a dress and heels.  I was wearing a blue blazer with a white turtleneck.  If I remember, this was my last presentation of this type.  There wasa big crowd.  A whole bunch of hippies and a handful of people like me and Donna.  After that night, I gave up with the professional man act and enjoyed myself much more.

Two new acts.  The Holding Company with janis Joplin and Ritchie Havens.  They played until almost 5:00 am.  I was drinking Scotch Whiskey until the bar closed.  After that, I just breathed the air.  It was poisonous with resin.  By morning, I was loaded and never put a joint to my lips. 

This was not my secret life.  This was just what I did with the big pharmacist money.  California was a brain drain state.  The money was big.

How about you guys?   Life cannot be just your feet on the floor behind a pharmacy counter from day one until now.    

The adult part of this story was my wife’s behavior.  Don’t read this if you have fantasies about everything is good when you are married.

 ”The Pill” was fairly new.  It contributed greatly to the sexual liberation of women.  Those who were so disposed became very active and the devil be damned.  Donna was so disposed.  The only defense I can present on her behalf is that she was an incest survivor/willing participant.  She never told me which.  I can’t ask her because she is dead.  She killed herself on Christmas Eve in 1978 or thereabouts.  Her father, who was either the rapist or her partner had to go over to her apartment in El Cajon to find out why she hadn’t shown up to open presents.

Around midnight at the concert, Donna disappeared.  She was gone for three hours.  I suspected that she was getting laid with some hippie guy, but the only evidence I had was that she came back with her clothes rumpled and her usually carefully coiffed sixties hairdo messed up.  She smelled funny too.. or was that the marijuana smoke.

I read your comments and think, “Are these people really so perfect that none of them have ever acted like a human being being stupid?”  You mean to tell me that not one of you have had sex in the pharmacy.  I know better than that.   None of you girls have had a serious appetite for that hunky intern with the great sense of humor?  I write about the base human appetite of the organs for one another because that is real!  Perhaps you are bothered by what you did.  Share it,  “The Truth Will Set You Free.”  Your brain cannot tell the difference between an overt confession or a covert confession.  It just klnows that you shared and you will be healed.  Be anonymous!

Piecemeal: In separate parts or fragments.  Done in a disorganized or fragmentary way.

I have watched pharmacists take their vacation with a string of long weekends.  I have listened to them complain.  I cannot imagine getting renewed and refreshed taking vacations that way.

You have earned three weeks of vacation, but you aren’t able to schedule even two weeks off in the summer when the kids are out of school.  Look at vacations at a different time of the year.  There are some terrific winter spots.  My favorite is San Diego.  My second wife and I took the two girls for two weeks around Thanksgiving.  If I remember correctly, we had our dinner at a pizza place in Mission Valley.

San Diego is family friendly.  I rented a suite on Mission Bay.

We had two bedrooms, sitting room and a small kitchen and bath.  It was a garden hotel with two pools and a giant hot tub.  There were tennis courts and sand volleyball courts.

We spent time at Sea World, The San Diego Zoo and The Wild Animal Park in Escondido.  We made multiple visits to Old Town.  We did not even think about Tijuana.  Two weeks was too long.  Seven days would have been better.  Live and learn.

I came back to work fully refreshed and ready to go with a clear head and energy.

Even in the winter Seattle is a great place for a family vacation.  Florida has plenty of spots, but can get crowded in the winter.  Why not Puerto Rico?

The following is most of Rule #12 from JP’s 20 Simple Rules for the Successful & Satisfying Practice of PHARMACY

They promised you the generous vacations, but no one told you how hard it would be to get the time off.  You are a new hire.  The idea of getting to take your vacation during the summer months when the kids are out of school makes the company veterans laugh so hard they hurt themselves.

The vacation coordinator at the head office suggest that you take a winter vacation.  “San Diego is really nice no matter what month you go.  The San Diego Zoo.  Have you heard of it?”

“Of course, I have.”  You try to chill her out, but she is good at this.

“Your kids will love Sea World and there are bargains to be had at the best Mission Bay resorts.  The beaches are to die for.”

Hmm.  Not a bad idea.  “Put me down for December.  Two weeks on both ends of Christmas.”

This is a helluva good idea.  Peggy will love getting sun in December.  A little Christmas tree in the hotel suite, all decorated.  Breakfast from room service for Christmas morning. Huevos Ranchero.  This is San Diego not Milwaukee. Oatmeal and a bagel will not do.

The kids will be overjoyed to hear this.  A swim in the pool before opening presents.  This is a terrific idea.  Julie may be 15, but she is not wearing…. Why is this woman laughing?
“Oh, Tony, I am so sorry”.  She is still chuckling.

“My name is Anthony.  No one has called me Tony for 20 years.”

“I’m sorry,  Anthony, but December is out.   Company policy.  No vacations in December.”

A long silence.  Is she asking me to settle?  I was told that they would offer me money to just forget all about the vacation.

They encourage taking your vacation in short sips.  A four day weekend.  It is good for them and lousy for you.  Nobody can decompress from this job in four days.

“I don’t care about a policy that says no vacations in December.  I am going home today and I am lighting up Orbitz.  I will have reservations for flights and a hotel in San Diego at Christmas before I eat my dinner.”

“But..But.. you can’t do that.  Vacations are not allowed in December.  It’s company policy.  It’s just not done.”

“Maybe I should look elsewhere for work.  Maybe I made a mistake agreeing to work for CostLess Drug Stores.  Perhaps I need to take a second look at the promises CostLess made.”

“Uh.. Anthony.. uh. I will have to talk with Mister Jones to see if….”

“No Ifs.  It is a done deal.  Christmas in San Diego this year for me and my family.  You have six months to find my replacement.  Goodbye, Harriet.”

Now, how good did that feel?  It is your vacation.  You earned it.  They made promises.  Take it when it works for you and your family.  An inflexible company may not be where you want to spend your entire career.

A note:  JP’s 20 Simple Rules are, by design, sometimes over the top.  Use your head, but don’t allow them to push you around.  No vacations in December rules are not for the pharmacy.   Those rules are meant to assure that everyone works at Christmas time.

Frances Oldham Kelsey

A renowned pharmacology professor at the University of Chicago hired her sight unseen.   He mistook Frances for Francis, a man’s name.  Frtancis Oldham and Dr. Eugene Geiling established the toxicity of sulfamilamide, a medicine that killed scores of patients.   This led Congress to strengthen drug regulations.  Frances Oldham Kesley had a hand in two of the three most important events in FDA’s history.

Dr. Kelsey joined the FDA in 1960 as a member of a group of scientists that insisted that drugs show clear evidence of effectiveness as a condition of approval.

Fifty years ago, Doctor Kelsey was a new medical officer at the FDA.  She found an application on her desk to consider.  William S, Merrell Company had applied to sell a sedative named Kevadon.  It was widely prescribe in Europe for morning sickness.

The generic name is thalidomide.

Phocomelia.  Seal-Like Symptoms

Doctor Oldham Kelsey said, “No, you don’t get no soup” to Merrell and the thalidomide disaster with patients who were pregnant in Europe, took the drug, and returned to America to give birth.   Doctor Kelsey’;s work led Congress to pass legislation giving the FDA authority to demand that drug makers prove their products safe and effective.  It seems impossible that there was a time,  when I was a practicing pharmacist, that they DID NOT have to prove that their drugs were safe.   They are still skating on the edges.  Vioxx.  Avandia.

Doctor Kelsey said this about her dealings with executives of Merrell, “I had the feeling that they were at no time being wholly frank with me about this drug (thalidomide).  Merrell argued that she was personally depriving women of this marvelous drug.

Merrell officials complained to FDA officials about her.  FDA supported her.  When Dr. Kelsey presented irrefutable evidence that Kevadon causes horrendous birth defects, Merrell quietly withdrew its application.

Last week, Frances Oldham Kelsey was awarded the first “Kelsey Award”.   After thalidomide, the FDA was given far more power over the drug companies.  Dr. Kelsey set about with others at the agency to write the modern rules for the testing of drugs.  These rules have been adopted world-wide.

A historian (Carpenter) said, “:Dr. Kelsey and the FDA had a huge role in determining the terms and sequence of what is now modern medical science.

For you strong women, she was born and  raised in Canada.   Her parents sent her to private boys’ schools because that was where she would actually get a good education.  She knew that Dr. Geiling believed that she was a man so she asked her mentor at McGill University if she should take the job.

“Don’t be stupid,” he said, “Accept the job, sign your name and put (Miss) afterward.

The Five Biggest Lies The Chains Tell About Their Pharmacists

 

Our Pharmacists Are Our Most Valued And Honored Employees

 

We Respect Our Pharmacists As Highly Trained Medical Professionals

 

Our Pharmacists Are Encouraged And Empowered To Always Put The Patient’s Needs First

 

Our Pharmacists Are Given All The Tools Needed To Practice Pharmacy In A Legal And Ethical Manner

 

Our Pharmacists Enjoy The Most Supportive Professional Environment In The Industry

 

How about those cowboys?

 

The five statements above are common pharmacist fodder among upper management.  They spout and publish statements like that everywhere you look.  The CEO, the President and the board room people who light-up-the-big-cigars and pop-the –corks would never tell the truth.

 

They may even be sincere, but there is a disconnect between upper management and the middle managers.

 

The middle managers are institutionalized, just like you and me.  Their job is to produce numbers.  They couldn’t care less about the single mother who can’t read.  You are wasting your time when you spend twenty minutes counseling her

on her baby’s dose of Prednisolone.

 

Here is how the middle managers hold you as a valuable employee.

 

“Listen, Buster, we pay you enough .  So just do your goddam job.  Nobody waits more than five minutes and you take coupons and give away antibiotics with a big smile.”

 

“What?  You want a meal break in a 14 hours day?  You have a nice roof over your children’s heads.  They eat good food.  They go to good schools.  You can afford Disneyland every year.  You have friends who think you are hot shit because you drive a Lexus.  Bitch, bitch, bitch.  What more do you want?”

 

“You make me laugh, asshole.  Self respect?  You think I go home at night and feel proud of myself?  You think my job is dignified?  I gotta produce numbers and you gotta cooperate so I get those numbers or your ass is grass.”

 

“You run the worst pharmacy in the district.  You have the longest wait time.  I don’t care that that heart transplant patient wrote to The New York Times about how you saved her life.  You either get acceptable wait times or I’ll find somebody else to do the job.”

 

“You want self-actualization?  Where did you get that term?  In Psych 101 at your Junior College?  You are a pharmacist, Judy.  We give you money and that should make you happy.”

 

Is that enough about the Big Lies?    

 

There has been talk on this site about how to enhance the pharmacist’s image with the public. 

 

I think you should start acting like the pharmacist that the upper management aims at with the five talking points.  Start acting like you are what the CEO says you are.

 

You are an idiot if you want to enhance your image and still refuse to counsel according to legal requirements. 

 

I counsel on 85% to  90% of all new prescriptions.  This is not a big damn deal with most prescriptions, but often, when I scan the bar code that I wear around my neck, the patient will occasionally ask,

 

“Is this something new?”   

 

I explain that the scan is just a legal record that I counseled on their Rx.

 

Trust me.. My professional image is enhanced.

 

The route to being seen as a “Highly Educated Medical Professional” is through counseling.  The price of the Rx is not a consideration when I tell a patient something they really need to know and they recognize that I have provided a valuable professional service.

 

Click on the Screen to fit the video to this page.

Those of you who have followed me know that I have strong feelings about the inappropriateness of Monistat and the others being OTC. Watch this video. Not once does this “Hired Gun” mention the indications of a bacterial infection. Colored discharge and odor. Not once does she warn about the dangers of misidiagnosis and the use of Monistat with a bacterial infection. Not once does she even hint that very bad things can happen if a bacterial infection is treated with Monistat. Not once does she mention that a yeast infection is indicated by a odorless, white like-cottage cheese discharge. A good pharmacist can handle this in 30 seconds.
The makers of Monistat care only about profits.
These products rightly belong in a BEHIND THE COUNTER class if the goal is patient health.

This little girl’s voice says, “I want to call in a prescription.”

 

“Okay,” I say, “You want to order a refill?”

 

“No,” she said with a Valley Girl inflection, drawing out the Nooo.  “I want a prescription for a patient.”

 

“Okay,” I say, “What is the patient’s name and birthday?”  It took a good 30 seconds to get the DOB.

 

“Augmentin,” she said, “80 mg…..”

 

I stopped her right there.  “There is no 80 mg.”

 

“Well, what do you have?”

 

“Are you a nurse?”

 

“No, I am not a nurse.”  She sounded offended.

 

“250mg, 500 mg, 875 mg tablets.”

 

“Do you have an 875mg liquid?”

 

“No, the largest dose in liquid is 600mg.  How long have you been calling in prescriptions?”

 

She did not answer my question.  “Let’s go with 250mg…..”

 

“We’re not going with anything,” I said, “You have been too ambiguous.   I do not trust that you know what you are doing.  Go back to the doctor and get it straight and call me back.”

 

“You are rude.”

 

“I am concerned about the patient.  I want him to get the right drug, in the right dose at the right time and I am not confident after talking to you.”

 

I hung up.  All of us have had to deal with ill-prepared employees trying to call in

prescriptions.   Just one more for the Champion of the patient to deal with.

 

Two hours later, the same small voice.  This time she was more assertive. 

 

I asked her, “Are you the doctor?”

 

“Yes, I am!”  A new resident.  “And I know what I want.”

Why isn’t there a 15 minute lesson on how to call in prescriptions?  First, they need to identify themselves.   Then, we pharmacists can pat their fannies and guide them through the process.

 

This resident had clearly been given a pep talk by her faculty member supervisor.  She was aggressive.

 

“What is your name?”

 

I told her, including P L A G A K I S.  Then she wanted to know the name of my District Manager.

 

“Do you really want to do this?”  I asked.

 

“What do you mean?”

 

“The only result would be to embarrass both of us.  You would look like an idiot and I would look like a bully.

 

“I am not an idiot.”

 

“I did not claim that you are.  You have not been properly taught in how to call in prescriptions.  What’s your Mail Stop?  I’ll write you an outline and send it to you.

 

We who reside at the bottom of the funnel put up with a lot.  All she had to do was lead with, “This is Doctor Saraswati” and I’d have made it easy for her.

 

 

 

Powered by Cafe Press

At CafePress you can find hooded sweatshirts, personalized gifts and even a calendar for 2011!

Here are some of the logos on the shirts and caps.  Designed to make a difference.

Stomp out Billy Bill’s (A metaphor for any company that gives away prescriptions)

Art representing The Pharmacy Alliance Initiative

Find this art work on Tees and caps at Jay Pee’s New On-Line Store by clicking on the link in the right hand column.  Mountain, Come on and stretch your latent, not-often-used youth muscles.  You may be getting older and are certainly institutionalized (like most of us), but they can’t kill you.  Take a chance.  Come and play.  Let’s get something viral going.   Billy Bill’s has got to go down.  “Stirring it Up” has to start happening.

Young people have decades ahead of them, with their feet on the floor. Stir it up!

THE PHARMACY ALLIANCE is holding on.  The indifference of working pharmacists is staggering.  I was an idiot.  I believed that all of that complaining and whining about working conditions meant that pharmacists were ready to do something.  I was wrong.  For the most part, they wanted to stay back and WATCH ME, PAUL AND A SMALL GROUP DO SOMETHING.  If TPA is going to be a force for getting DINGITY, SELF-RESPECT and INTEGRITY to the workplace, the organization will have to get young.  Here are two new logos that are meant to appeal to young pharmacists and students.  I have opened an on-line store where you can get shirts and caps with these logos.  Click on the link to your right.  Please express your opinions on the new art work.  JP

  

Read Davey’s comments.  He is our leader.  He is a student and is looking at 60 years behind the counter.  Maybe longer.  In 1964, I expected to do this until I was 60 years old.  Modern medicine has me doing it at 69 and doing it well, two days a week.  Davey and his fellows should not allow you nay-sayers to discourage them.  It is their profession, not mine.  I just stir it up when I can.  Kids like Davey, who have both feet into it and are using their youth and energy to make pharmacy the best it can be need to be encouraged, not put down.  Shame on you guys who are so beaten down and institutionalized that you can’t even imagine anything better.  9-4-2010  

If we neglect to counsel, we will sacrifice our professional standing.

I am a strong believer that our salvation as professionals is counseling.  If we follow our personal professional standards, ethics and the law, we will counsel.  We will counsel with new prescriptions and we will counsel on OTCs. 

 

I can hear some of you whine, “But, Jay Pee, the timers.  The DM nails us when the timers look bad.  I DON’T HAVE TIME.”

You can be a slave to the Prescription Mill, a glorified technician or you can be a pharmacist.  Your choice!

Counseling does not have to take a lot of time.  Thirty seconds to hit the high points.  Beyond that, most patients won’t listen.  Some drugs may take five minutes.  I had a woman the other day who did not want to listen.  I had to repeat the warnings.  Finally, I grabbed her hand and made her look at me.  I asked her, “Do you want to decline this counseling?”

“No, why would I do that?”

“Because you are not listening to me.”

“After that, it took 30 seconds.”

I want to examine pharmacist prescribing.   Either defacto when the doctor screws up and asks what you would choose or when the pharmacist is the primary prescriber.

We need to bring this to light.  We need to bring this out into the world because it is only reasonable that the drug expert would prescribe the drugs.

Please send me your thoughts at jpgakis@hotmail.com.

Tell me about your prescribing.  I’d like to hand over a ton of evidence to the editors at the magazine to influence a cover story.

I have corresponded with a psychiatric pharmacist in California who prescribes for every patient in the hospital.

A hospital pharmacist in the Midwest reported that he was captive in the ER because the foreign ER doctors had no clue when the emergency was a real emergency.  The stress got to the RPh.  He used CIII drugs illicitly to take the edge off.  He now works for a retail chain and considers it to be paradise.

I know that many of you prescribe.  Please tell us about it and send me your thoughts privately. 

There is a matter of respect here.  Big Pharma has been ignoring us for over a decade.  If we are going to be prescribers, and it is inevitable, I want Big Pharma to come back home and court us a little.  We are the drug experts and they aren’t even advertising in our magazines anymore.  That is disrespect.

Jay Pee

Great job on the comments, you guys.  Remember this.. Nothing is perfect.  Most doctors know about only that handful of drugs they use often.  Most of them know what they know from Big Pharma.  How many are prescribing Lexapro?  Pristiq?  They didn’t just pull those names out of their asses.  YOU KNOW BETTER. Their job is diagnosis.  For optimal patient care at the most reasonable cost, you should be the prescriber.

 

 

Every night, I hope and pray a Dream Patient will come my way

 

“My insurance plan requires me to fill certain prescriptions by mail order, but I’d rather you fill them even if I have to pay more.  You take good care of me.”

 

“We do our best, Jane.”

 

Jane laughs, “It is more money, but I like it that my pharmacist knows every pill that I am swallowing and why I am taking it.  You even gave me a few pills to hold me over while waiting for an okay from the doctor.”

 

“You can’t just quit clonidine cold turkey.   The doctor should know that.  That is a warning in the literature and that makes it ‘the law’”.

 

“Remember when you gave me that cream when I had poison ivy?”

 

“I remember, Jane.  The mail order pharmacist can’t do that.”

 

“I’m a sophisticated medical consumer, Ron and what I like most is that you have conferred with my doctors to make sure that I am getting the right drugs.  The doctors, clearly not know-it-alls have followed your advice.”

 

“I like being a pharmacist.  That’s my job.”

 

“Your store, Ron.  You have spiffed it up and have added supplements and health food s and herbs.  Your new cosmetic line is all natural.  I love the old-fashioned ice cream counter.  Your fruit smoothies are the best in town and they are chock full of nutrition.

And you mix prescriptions by hand.. what is that called?”

 

“It’s called compounding.”

 

“That’s it.  Your glassed-in lab is impressive.”

 

A grumbly voice jumped in.   He was an older man.  “I am semi-retired and do not have a regular paycheck,” he says, “I’d love to bring all of my prescriptions here, but I can’t.  I can only bring you the one-shot prescriptions, like this one for my pink eye.”

 

“I understand, Tony.” 

Ron knows that the days of making his living filling prescriptions are long gone.  There is more profit in what you call your “Hi-Protein, Omega-6, fiber strawberry smoothie” than there is in one prescription for Lipitor.  The Smoothie only costs you $1.23 and sells for $3.95.  Betty Jill, a high school graduate, manages the smoothie counter.  She gets $15.00 an hour plus benefits plus bonus.

 

Tony speaks up, “Ron, I feel guilty that I get my recurring prescriptions from Medco and you still advise me on my prescriptions.”

 

“It’s my pleasure, Tony.  You buy your supplements from me and you love that special Vanilla Chocolate Smoothie that Betty Jill makes for you.”

 

“I love that Smoothie.  I think it helps me keep muscle.”

 

Jane is interested.  “Can she make me a carob butterscotch smoothie?”

 

“I can make any smoothie you want,” Betty Jill says, “but, Jane, butterscotch will add calories.”

 

Paul McCartney comes on the music loop,

 

 “Jojo was a man who thought he was a loner, but he knew it couldn’t last.”

 

All three sigh.   They are mature.  The music is emotional.  Ron remembers the day when 150 prescriptions paid for a good life.

 

“Jojo left his home in Tucson, Arizona for some California grass.

 

“Goddamit, Ron,” Tony says, “I hate frikkin’ mail order.  It makes me feel cheap when I call you for advice on medicine I get from them.”

 

“Get back, Get back where you belong.”

 

“Ron, Tony, I love this song,” Jane smiles.  “Don’t tell my husband, but it reminds me of some very horny days when I was single.”

 

“Yeah, Ron.  You’re the pharmacist, what is up with Loretta?”

 

“Sweet Loretta Martin thought she was a woman,

But she was another man.

 

“Premarin, probably.  Give a guy enough of that and he will be a woman.”

 

“All the girls around her says she’s got it comin’,

But she gets it while she can.”

 

“Jane, what do you think?”  Ron is looking at her with interest.

 

“Premarin for sure,” she laughs.  “How about three smoothies.

I’m buying.  Are you ready for us, Betty Jean.

 

Three smoothies.  $8.28 profit. 

 

There is a way, you guys.  You are never going to provide for your family by filling prescriptions.  Those days are in the rear view mirror.  It will take a paradigm shift, some lateral thinking.  Some daring and courage.