A store manager and his favorite pharmacist, Oh Yeah!

 

This is a segue to my new book: “The Prisoners of Comfort”.

The Bully OnThe Block is too often the non-pharmacist store manager.  You must be ever watchful and arm yourself, but first you have to understand the dynamic.

Here is the truth in most cases when the store manager bullies pharmacists.   He/she resents the hell out of you because you do not work as hard as he/she does.  You do not work as many hours as he/she does.  It appears that you are a favored employee and that you are coddled by the middle management.  But, the thing that really kills them is that YOU MAKE MORE MONEY THAN THEY DO.  Some of these managers downright hate you and that is the seed of the bullying.

What allows you to be bullied is your inexperience and, for most of you, your youth.  Also, being a woman makes you a prime target.  We all know that female managers are the toughest on women.  Add the dynamics from the “truth” paragraph and on-my-gosh, look out. 

With male manager bullies there is a very real and distinct sexual component.  Put boy and girl together and there is usually a sexual component.  Add resentment and the behavior becomes toxic.  Always be watchful for harassment.  Communicate very clearly to the bully that harassing behavior is not wanted.  Document every single thing.  Dates.  Times.  Names.  Even quote exactly what was said.  If there is unwanted touching, write it down.  Be smart.  Remember this: E.E.O.C. 

Experienced bullies know the game.  The can belittle you, isolate you, intimidate you and sabotage you.  Some managers will scream at you, but these are idiots and they won’t last.  The best (worst) bullies are more subtle.  They can purposely leave you out of the communications loop and then reprimand you because your performance is not up to expectations.  They can mock you in front of other employees, effectively draining you of confidence and power over your own practicing of pharmacy.  The can spread gossip about you.  All of these are malicious and, if you could prove it, constitutes very sophisticated harassment.

Young people, especially, just do not have the thick skins of veterans.  You can feel anxious and depressed, can’t sleep and are likely to have health issues such as insomnia or distraction.  You may worry about your job and generally feel impotent.  I’m sure that there have been, at worst, suicides and, at best, people who have quit jobs where they had spent a lot of time and energy into a career with a certain company.

What is bullying?  It is when a manager has an ongoing pattern of intimidating or demeaning behavior that can affect an employee’s health and welfare.

It is one thing to have a tough boss, and it is another thing to have a manager who makes you feel sick.  Psychologically, physically and emotionally sick.

Even when it is very clear that your manager is a bully, nothing will be done because:

Victims Keep Quiet. 

Many pharmacists are embarrassed at being bullied, so they don’t report the persecution to human resources.  In addition, many victims feel like they will be punished. 

I worked at a drug store where the store manager was the quintessential bully.   He was 50-something and very savvy and talented at what he did.  He bullied me.  He bullied the staff pharmacist.  We cringed every time, but we liked our jobs so we were quiet.  He also bullied the female staff.  There was sexual harassment and he was good at this.  So good that he enjoyed frequent sex with three of the girls.  The guy was a monster, but we were all institutionalized and we kept quiet.  Enter a brand new female employee.  She was a woman in her late 30s.  She observed what was happening, got the other girls to tell her their stories.  She called human resources and lit it up.  Within two weeks, the manager was escorted from the store by two members of company security.  He carried a box with his personal belongings and was warned to never come in the store again.  Do NOT be silent if you are bullied.

Unfortunately, intervention  can take time. 

If the company does not take action in a timely manner, do not give up.  Remind them of the bullying.  At this point, send copies of all correspondence to an attorney.  If it is clear that the company is hopeless, send your file to the E.E.O.C.

Witnesses are scared to come forward.

It is simple, people who observe bullying are afraid to come forward because they are afraid they will be singled out for punishment, including losing her job.

Savvy manager know how to work the system.

Manipulative managers are kissing the asses of their bosses so they can kick your ass with impunity.

Statistics are that 60% of the bullies are men.  Get this: 58% of their targets are women.  When a woman is the bully, she picks on other women 80% of the time.

Bullying is more likely to take place in health care, education and manufacturing.  That put you in the first group.   Bullying is more tolerated in industries that focus on sales goals.  Who is that?

A huge complication:  99% of bullies don’t even acknowledge that they bully others. 

To exacerbate the situation, a pharmacist who tolerates bullies do not do as well on duties that take mental acuity. 

Many of you do not get bonuses anymore because of cost-cutting.  The manager resorts to bullying to get results.

The biggest problem is that a bullied pharmacist feels trapped.  Because the job is good, they think.  Is it really.

“The Prisoners of Comfort”.  It is the most important thing I have ever written for pharmacists and deals with the psychology of being institutionalized.

Visit Lulu.com  to purchase.   Jay Pee

 

Now, this is my kind of Pharmacy Manager.

For those of you who missed McPharmacy

You Better Watch Out, You better Not Cry, You Beter Not Pout, I'm Telling You Why. The Flu Shot Can KillYou.

Lessons for Doctors

Listen to me, Doctor.  Listen, Please.

Prescriptions 101

Class Time for Idiots

Those are four possible titles for a book directed to physicians, written by pharmacists.

The idea for this book came when I was writing yet another post that outlined an issue that I have with prescribers.  It went like this:

“Doctor, you know and I know that Princess Tiny will need to use insulin twice a day until she either dies or loses one hundred pounds.”

“So, what’s the problem?  Of course you can refill her prescription for Lantus.  You just said it.  She is never going to lose one hundred pounds.  Why are you calling and bothering me about this?”  An exasperated sigh.  “Man, don’t you have anything better to do?”

This irritates you.  Does this goon think that I have waited on the phone for twenty minutes just to bother him?

“You did not put refills on the prescription.”

“Of course, I did.”

“You did not.  I’m holding the prescription in my hand.”

“So, what is the problem?  You said it.  She can’t go without insulin.”

“The problem, man, is that if I get audited by Blue Cross and they see that I have refilled this prescription multiple times without any refills ordered by you, my ass is grass.  The catch word is FRAUD.”

That is where I stopped and said, “JP, there are hundreds of stories like this and you don’t know them all.”

So, in an effort to educate the prescribing masses.  Let’s write a book.  Tell your best bitches in the comments and I will copy and paste them into a manuscript, download the book to Lulu.com and publish it.

There are no rules, but the less profane and vulgar the better.  You may want to give copies to your doctor acquaintances. 

I would rather use you real name, but will take a “handle”. 

Your location would be good.

Your background and why you feel compelled to contribute.

Your vote for a title.

Let’s see what we can do.

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I have not hidden my feelings about doctors who “Paint By The Numbers”. There are many doctors out there who were “C” students. There are plenty of doctors who are held as can-do-know-wrong practitioners because our culture has lionized doctors for generations with no real evidence that they deserve such status. Up until recently, the doctor was the medical professional who escaped criticism because of their standing at the tippy top of the pyramid.
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Lately, however, that is changing. The demands on the medical system are becoming so heavy that the smart doctor jumps off that spot up on top, does his/her job and has a good life. Doctors are choosing to be employees. The idea of a fee for service practice does not appeal to them. Having to deal with medical insurance and liability issues are only two reasons.
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Recently, I dealt with two doctors who don’t get it. Here is one story.
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One called from Houston and wanted to know if I could compound a lidocaine/diclofenac topical preparation. I told her that it was conceivable; but that I would have to order the ingredients and that the finished product would cost the patient an arm and a leg. (Parenthetically-I would not order the ingredients. There are compounding pharmacies)
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“Why expensive? There are two places in Houston who will do it for $40.00.”
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I didn’t like that. Any pharmacist who gives away a skill that only a pharmacist can do is an idiot.
So, I said, “Doctor, you can’t expect a pharmacist who has invested years in his education and thousands of dollars in an inventory and facilities and equipment to see his product for $40.00. When did you last charge $40.00 for a comprehensive office visit?”
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“It can’t be that hard to make.”
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“If I had the ingredients, I could make you a lidocaine/diclofenac ointment that would be worthless. I could just slap it together in Vaseline and charge you the cost of ingredients plus $40.00 and your patient would have a greasy mess that would do no good.”
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Silence.
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“Why don’t you use Voltaren Gel and slap on a Lidoderm on top of it?”
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“I want the compound, but it should not be expensive.”
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“I trust that you want the lidocaine and the diclofenac to be absorbed through the skin.”
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“Yes, of course.”
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“When you write the prescription, do you specify the base you want to be used?”
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“I don’t think I have to do that.”
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“How about Aquaphor? It is good base for ointments.”
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“Whatever. Why are we having this conversation? Can you or can’t you?”
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“Lidocaine/diclofenac in Aquaphor would be worthless. It would just make the skin greasy.”
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“Why are you telling me this?”
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“Because the pharmacist who makes this knows what vehicle to use to assure that the medicine is actually absorbed into the skin of the knees or hands.”
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“How did you know that my patient has osteoarthritis of his hands?”
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“Educated guess. My point, doctor, is that $40.00 is chump change for a product this specialized and the pharmacist who makes it for that cheap is an idiot.”
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“Well, I’m not going to tell him that.” She actually laughed.
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“Hell no, suck it up.”

.After that, why do pharmacists continue to sell themselves so cheaply. Do we have an inferiority complex? Why do we act like frikkin’ beggars all the time?
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A bunch of frikkin’ medical professional gypsies.

Here is the advice that I would give to someone who asked how to find a good pharmacist. 

First, ask the pharmacist for his/her help with an over the counter medicine.  Even if you aren’t in the market to buy.  This is a test.  Go to the pharmacy counter and ask, “Where are the Bonine Tablets?”  Pick anything, but make it something that is not easy to find.

If the pharmacist depends on the Technician to tell you or if they say something amorphous like, “Aisle Eight” that is enough.  This pharmacist is not your girl/boy.  Go elsewhere. 

If the pharmacist leaves The Prescription Mill and actually walks out front and shows you where the Bonine Tablets are, they have passed Test Number One.  That is one point on a scale of ten.

If the pharmacist asks why you think you need Bonine, that is another point. 

If she listens to you, that is a third point. 

If she tells you that Bonine is not a good choice for you no matter what your Aunt Bertha says and recommends an alternative, point number four.

The next set of criteria is when you have a prescription filled.  If the pharmacist does not even leave the Prescription Mill and offer to counsel on the prescription, this is not your boy.  Go elsewhere.  There is no dispensation given just because the Technician asks if you have questions.

If you have questions and the pharmacist gives you perfunctory answers and is impatient with you, go elsewhere.  No points for this.

If the pharmacist looks you in the eye as she counsels you and asks you to repeat what she just said, that is good.  She gets a point. 

If she doesn’t insult you and treat you like a child, that’s a point.  Some people are like children and need to be treated like children, but not you. One point.

We have now hit the minimum points to qualify to be your pharmacist.

For those of you who have Medicare Part D and consistently find yourself in the donut hole, the pharmacist you want is the one who will help you avoid the donut hole longer by suggesting which generic drugs you should pay cash for and not submit to your insurance company.  For you, a pharmacist who will not work with you on this is not your girl, even if they qualify on all of those above.

If you are a parent and have questions about your child’s medicine, the pharmacist you want is one who will stick with you until you understand how to use the inhaler before he walks away.  If you still do not understand, call the pharmacist back.  If he resists or show impatience, he is not your boy.

There are other criteria, but these are enough for now.  I trust that with a little help from my friends, this list will be expanded on.

One note, I have spent most of my career in chain pharmacy.  I don’t like telling this secret, but the small drug store pharmacist is more likely to give you superior pharmacy services and superior professional services.  By the way, how fast the pharmacist gets the prescription to you is not part of the criteria.  The longer, the better.  You don’t want her to rush when your life is at stake.

“You know that I am a physician, don’t you. You don’t have to talk to me about my prescriptions.”

“Well, doctor, you can officially decline the consultation, but I am required by law to tell you all about this drug.”

“Required? Isn’t that redundant? A doctor wrote the prescription. He told me all about it. Do you talk with every patient about their drugs?”

“That’s the law, doctor. We are required to counsel on every new prescription. This drug has dangers. You are an older man. I sincerely hope you know what they are.”

“I certainly do know. I told you I am a physician.”

“Ted, listen to the man. He is the pharmacist. He knows more than you do about drugs.” The wife gave me a quick look. This was a couple in their early sixties. The doctor was still in the-doctor-knows-everything-era.

Ted sighed, “Okay, what do you know that I don’t know.” I could tell that he wanted to add something like Smarty Pants.

I wanted to say a lot, but I controlled myself. “Temazepam is a long acting drug,” I said and then he pissed me off.

“Well, so what?”

“So what is that you will probably have a hangover in the morning. I think that 30 mg is too large a dose for a man your age. From your appearance, your lean body mass can’t be more than 150 pounds. That means you do not need 30 mg.”

“He does have a hangover. Every single morning, he complains of being lowggy. Don’t you Ted? Admit it.”

“Be quiet, Mildred.” He looked at me. “What else?” Hmm, he was listening to me now.

“My job is to warn you that you better be careful when you get up out of bed to go to the bathroom in the middle of the night. You don’t need a fall. You could be a bit woozy at three in the morning. It is okay to keep you hand on the wall when you walk down the hallway.”

“He has already fallen once.”

“Mildred! Be quiet.”

“Well, you have. Listen to this man.”

“I am not a doctor, doctor, but I am a pharmacist and I know about temazepam. If you are going to take it for sleep, you don’t need to be drinking.”

“See, Ted.” Mildred had stepped closer to the counter.

“Mildred!”

“I like a toddy before bed and I’m not giving it up.”

“Just one toddy?”

“That’s true,” said Mildred. He only has one.

“How long have you been taking temazepam, doctor?”

“Why do you ask that?”

“Doctor, it is my job. You don’t have to answer.” I looked at Mildred. “He isn’t a cooperative patient.”

“He has been taking it for years.” She looked at Ted. “I want you to quit taking it.”

“That may not be a good idea,” I said, “At least not cold turkey.” I smiled at Ted. “Doctor, if you quit taking temazepam today, in about four days you would begin an orgy of nightmares, plus after years of taking it I’d expect autonomic effects that would scare the hell out of you.”

Ted was interested now. “Like what?”

“From cold sweats to cardiac arrhythmias.” Talk to your doctor. It’s time for him to step up and help you get off this stuff. It’s been much too long.”

Ted told me that he is an oncologist. “Thanks,” he said when he left. “I didn’t know that pharmacist did this kind of thing.”

“We are at the bottom of the funnel, doctor. If we don’t, nobody will.”

Working at a pharmacy just a few blocks from UTMB makes the chances of the patient being a medical professional higher than most. We see more doctors as patients in a day than most of you see in a month. With doctors, I choose my opportunities carefully.

I like counseling. I enjoy it. I especially like it when the drug is an old one like temazepam. My counseling on those babies is first class.

When the doctor is the patient, it is often no different from when the patient is a factory worker. They just don’t know.

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