When you lose your job at CVS because you did not answer the phone in 20 seconds because the young patient you just dispensed Methergine to was bleeding all over the floor, here’s job for you.

Last night, around midnight, the telephone rang.  Victoria and I are early to rise and early to bed.  We had been asleep for around 2 hours.  When the phone rings in the “middle of the night”, we immediately have that knee-jerk, “Oh No, who died?” or “Oh No, is one of the kids hurt or in trouble?”

I picked up the phone and there was silence.  I said, “Hello, who is this?” My heart was racing.  ”Hello, is there someone there?”

The person cleared his throat and then said, “Is this Jim Pal-Ah-Gis?”

“Plah-Ga-Kiss”, I said, “This is JIm Plagakis.”

“You are a disgrace.”

“What?  Who is this?”

“It doesn’t matter who it is.  You are a disgrace to pharmacy and you are going to rot in hell.”

Victoria touched my forearm, “Who is it?”  She was clearly concerned.  Late night calls are rarely good.”

“Somebody from California.”

“How do you know I am in California?”

“Because it’s midnight here.  It’s ten o’clock there.  I just took a shot.  Reasonable people don’t call at midnight, even if the purpose is to issue a scolding.   Who do you work for?  I trust that you are a fellow pharmacist, a colleague.”

“I am a pharmacist, but I am not your colleague.  You are a disgrace to the profession.”

“Pray, tell me why I am a disgrace to pharmacy?.” I said, yawning.  V was wide awake now.  She had a scowl on her face.  I waved my palm, facing downward, telling her to relax.  Trouble is the fuel for most of what I write.   I enjoy the fluff, but you guys like the down and dirty.  I play the devil’s advocate a lot.  In the recent post about Walgreens, I played the role of advocate.  I don’t know what WAG is up to so I trust what they say.  I took my shot and that post got more comments than any other in about a year.  It seems that you are passionate about the future and you should be.  Who said, “If we don’t hang together we shall surely hang separately”?  A spirited discussion is important before change is possible.  Without trouble, David Stanley, The Red Head and Jay Pee would be three weak sisters writing about the Certified Technicians Annual Meeting in Keokuk, Iowa.

“All you write about is the negativity.   You don’t have any pride.  Pharmacy is a profession and you treat it like a job.  You should be ashamed.  You are a disgrace.”

“Do you work for a big company?”

“I don’t have to tell you who I work for.”

What an idiot.  By not saying NO definitively he just told me YES that he worked for a big company.  ”Have you been drinking?”

“Shut up,” he demanded.  ”How dare you?”

“He’s been drinking”, I said to Victoria.

“SHUT UP.  I have not been drinking.  How dare you?”

“Let’s calm down,” I said, “What do I write that pisses you off so much?”

“You write about 14 hour days, no lunch, pharmacists being dangerous when they are tired.  You can’t do that.  People who are not pharmacists use the Internet too.  And…. you sell the morning after pill.  That guarantees you a trip to hell.”

“What should I write about?  If I see a turd in the punch bowl, I’m gonna tell everyone.”

A very long pause.  ”I don’t know why anyone would want to read what you write.”

“You read it don’t you?”

Another long pause.

“Please don’t call again,” I said. “I know that it is hard when someone points at the wart at the end of your nose, but I’m gonna keep on doing it.”

This Pharmacist is From Kenya. If the pharmacist shortage is over, would he have this job?  Check out the shelves behind him. With that much stock, he is very busy, indeed.

If the pharmacist shortage is over, it will show first in metropolitan areas.  There will still be a shortage in rural areas for a long time.  Young people want to be where the action is.  The CVS is Sandman, Alabama will still be difficult to staff.

Our industry has been employing anyone with a pharmacist license for twenty years.   The new boutique, for-profit pharmacy schools are causing a problem.  The competence of their graduates is questionable.  I have worked with only one of them so I shouldn’t generalize, but I will.  This guy has no experience or training in compounding.  What the?  That is still our quintessential skill.  Pharmacists are the only ones who compound and they aren’t teaching it?

Remember when the military liberated the medical students in Grenada?  I am in the habit of referring to these for-profit schools as Grenada-like Pharmacy Schools.

The following categories may not get jobs if the shortage is over.  Pharmacy will be like all other professions.  The cream will rise to the top.

There may be no jobs for:

Warm Bodies With Licenses

The Disabled

Too Young and Inexperienced

Too Old and Tired

Cranky Pharmacists

Mean Pharmacists

Pharmacists who cannot multi-task

Dumb Pharmacists

Slow Pharmacists

Grenada-like Graduates?

Boys who bother the girls

Girls who bother the boys

Obese Pharmacists

Inexperienced Pharmacists

Foreign Pharmacists

Minority Pharmacists (There are still red neck areas in the US of A)

I’m sure there are others.  We are like any other job.  Experienced is valued.  The new graduate from Toledo who worked for Walgreens for five years will be a more desirable hire as an RPh than the new grad who did one slam bam rotation in retail.

If you are good, you will get a good job.  If you are incompetent, you won’t.

Oh, an addition, they will not lower wages.  If you are good, you will have a job.  If they tried to lower wages, too many of you will say, “Kiss my ass”, got to the Small Business Administration, get a loan for 3.2% and open your own store, probably close to the CVS you worked in because the patients love you.   These chains, big box stores and grocery stores still need you.  Without you, they close the pharmacy.  I lived in a town where the K-Mart could not get a pharmacist for months (Oak Harbor, WA).  I reported K-Mart to the board.  They did not have a pharmacist, so they did not have a pharmacy license.  The board wrote K-Mart up and made them remove two big “Pharmacy” signs on the outside of the building and made them remove all references to the pharmacy inside the store.

You have to have figured out that I love what Walgreens is saying.  The following is word for word from a New York Times Article from Yesterday. 10-21-11  I believe as WAG continues to separate from the Bozos, there will be a sea change.  Will the best pharmacists gravitate to WAG?

October 21, 2011

Out From Behind the Counter

By BRUCE JAPSEN

CHICAGO — As the Walgreen Company pushes its army of pharmacists into the role of medical care provider, it is bringing them out from their decades-old post behind the pharmacy counter and onto the sales floor.

The pharmacy chain, based in Deerfield, Ill., and the nation’s largest, has renovated 20 stores in the Chicago area and is converting more than 40 in Indianapolis to get the pharmacist closer to patients. Pharmacists in the revamped stores are being kept away from the telephone, where dealing with insurance coverage questions and other administrative tasks occupy 25 percent of their time, Walgreen says.

“What we are seeing now is pharmacists should be using their knowledge to help consumers manage their medications appropriately,” said Nimesh Jhaveri, executive director of pharmacy and health care experience at Walgreen. “It’s not about the product but the care we give.”

The reinvention of the pharmacist’s role comes at a critical time for Walgreen, as it vies to keep its customer base. The company has so far been unable to reach a new contract with the pharmacy benefit giant, Express Scripts. At the same time, Greg Wasson, the chief executive, is trying to remake the company into a national provider of health care services.

This last summer, Walgreen sold its own pharmacy benefit management company for more than $500 million to a Maryland firm in a deal that Mr. Wasson said would help the company focus on becoming the consumer’s “most convenient choice for health and daily living needs.”

Walgreen braced investors last month for the potential loss next year of more than $3 billion in sales in 2012 if it lost the customers whose prescription coverage was managed by Express Scripts. In the most recent fiscal year for the company, it filled about 90 million prescriptions managed by Express Scripts. The two are parting ways effective Jan. 1 over payment issues, leaving Walgreen scrambling to contract with major employers directly in hopes that they will want to opt out of Express Scripts’ pharmacy network. Walgreen’s new model resembles the type of service that CVS and other major drugstore chains are trying to achieve by developing deeper relationships with customers and their doctors. Big pharmacy companies are hoping to increase reimbursements from insurers and employers as they become more integral in managing customers’ medical care.

At the newly converted Walgreen stores, one of the ways pharmacists hope to develop longstanding relationships with customers is through private or semi-private consulting areas away from the busy pharmacy counter.

On Chicago’s North Side, Walgreen has a pharmacy in the Andersonville neighborhood on North Clark Street that dispenses a substantial amount of medications to patients with the AIDS virus, so privacy for patients was critical and figured in the overall idea behind the new store model, company executives said.

Behind the pharmacy counter, the familiar bags of medications are tagged and labeled alphabetically in plastic containers, but they cannot be seen from in front of the pharmacy counter. “Customers want privacy,” Mr. Jhaveri said.

The Andersonville neighborhood store includes a 50-square-foot room behind sliding doors where a pharmacist, James Wu, can sit and counsel patients, who sit on a padded bench that has enough room for the patient and a family member or two. Mr. Wu’s desk is steps to the right of the private room.

Mr. Wu said he could now spend more time talking to patients or out in the store aisles, and rarely is distracted now by the orders being placed for prescriptions.

“I would take calls, asking ‘Is it ready?’ ‘Is it covered?’ ” Mr. Wu said. “The phone doesn’t ring anymore.”

Walgreen said it would route routine questions about insurance coverage and co-payment issues to a call center in Orlando, Fla., that is staffed around the clock by pharmacists and pharmacy technicians. Another new feature is a “health guide,” a concierge of sorts who answers questions, markets new services and triages patients who may need other health care services, like treatment at a Walgreen Take Care retail clinic. At 354 of the chain’s more than 7,700 stores, nurse practitioners at such clinics are available to handle routine maladies.

There are financial incentives for the more personal approach; some private and government insurers have programs that reward health care providers if they can prove that their services improve the quality of care and save money.

Moreover, insurance companies and the federal government are moving to models that encourage better coordination of medical care service, putting all providers on the same page.

Federal Medicare drug laws allow for payment to pharmacists for “medication therapy management,” when patients have multiple chronic diseases like hypertension, diabetes and asthma and are taking multiple medications. In recent years, Walgreen and other pharmacy chains have lobbied aggressively for reimbursement and changes to rules that allow pharmacists to do more and to get paid for these additional services.

Walgreen already has aggressive lobbying efforts under way to get pharmacists the ability under state rules to administer more vaccines in the pharmacy. And the company is working with doctors and hospitals to develop relationships that include having a pharmacist involved in patient consultations and management of their diseases.

“As we start to prove better outcomes, our reimbursement is going to be more based on how we do that,” Mr. Jhaveri said.

Employers are open to Walgreen’s idea, citing national studies showing large numbers of Americans, particularly among the elderly, who do not adhere to their treatment regimens or forget to take their medicines.

For example, 2009 research from the New England Healthcare Institute showed that patients who did not take medications as prescribed cost the health system $290 billion in “avoidable medical spending every year.”

“There are a variety of reasons why the current medical system is failing to help people stay on their medications,” said Larry Boress, president and chief executive of the Midwest Business Group on Health, a coalition of large employers that purchases more than $3 billion in medical care services annually. Among the members are Boeing, Ford Motor and Kraft Foods.

“On filling the script, the pharmacist or pharmacy tech doesn’t do much more than ask: ‘Do you have any questions?’ And then they give you the bag,” Mr. Boress said



Here is a tease from the first draft of “The Comfort Demands.  Occupy Pharmacy” You can buy it from Lulu.com, then Amazon.com for $26.99 plus shipping sometime in January.  You can buy it directly from Jay Pee for $23.50 including shipping via WePay.  I’ll alert you to the link.  This book sill be around 180 pages.  The following, I wrote yesterday.  If you are young and single, you can do this.  If youare young and married, you still can do this.  If you are married with a child, this is not impossible.  We are talking about your life.

Stay out of debt.  Drive a used Corolla instead of a Lexus.  Rent a one bedroom apartment.  You are a pharmacist.  There will be plenty of time for the house.  Work awhile, save money and then, when you have the money, bail and go live your life for awhile.  You won’t need that much.  Eastern Europe, the non EU countries will welcome your dollars.  Talking about doing it will get you from “I’d like to” to “I will.”  When you come back, there will be a job.  Trust me.

History Tour

I am giving you this pharmacy history tour from my viewpoint because I believe that it will be helpful for all of us to recognize how we got to where we are.  I believe that the modern era of pharmacy began when pharmacy work became computerized.  We entered pharmacy’s epoch of darkness when non-pharmacist manager types discovered that they could spy on pharmacists with productivity programs.  We will get to that.  I will talk in depth about all of the darkness that is prevalent in the job of working in a retail pharmacy.  First, I want to take you through what were the best years of my career.

This is me on the island of Mykonos in the Aegean Sea in December of 1976.  I had quit my job working as a store manager/pharmacist for All-Med International after seven good years.  My first marriage had been a disaster.  For a year, I drove to South Shore Lake Tahoe and played Blackjack every single weekend.  I won a lot of money, paid off all of my first wife’s bills and had a substantial wad of cash. So much that I did not have to take a full time job for over five years.

Mykonos was a brilliant experience.  I was so far away from working in a pharmacy that I felt like I was a different person.  I won’t indulge you with the titillating stories.  You can find them on my blog.

I am going to give you some advice.  If you are young and single and have avoided debt, take some of the money you have saved and go live some life.  Quit and go live.  You are a pharmacist for goodness sake.  You will find a job when you come back.

I am acquainted with a young couple from Sandy, Utah.  Colin and Sarah are married.  They are both pharmacists.  For years, they lived their lives to the fullest.  They would work six months and then travel in Europe for six months.  They always found jobs when they returned.  I asked Colin about their peripatetic lifestyle a year ago.  He told me that he and Sarah were staying with jobs longer because the shortage wasn’t as acute in Utah as it was.  I did notice, however, that he and Sarah participated in a medical mission to Haiti, I believe.

I believe, learned from experience, that there is nothing that will sustain your spirit better through long years behind the pharmacy counter than a brief love affair in an exotic place.  For me it was a young Irish girl who was looking for an experience impossible in Dublin.

I do not believe that you will find a five dollar a night hotel room with a shower on Mykonos in 2012.  I visited in the winter, the off season, and I was among only a handful of visitors.  I have been told that there is no off-season on Mykonos anymore.

I would go with another American down to the dock every day to welcome that daily ship and to see if there were any Americans onboard.  We would sit in the sun, drinking a beer or a coffee and smoking acrid Greek cigarettes watching the boat come in.  It was too big to enter the harbor, so they offloaded the passengers onto smaller boats that brought them to the quay.

There never were any Americans.  I suppose that that was why I eventually decided to return to the United States.  That and because the Irish girl had decided to return to her parents’ home in Dublin.  She gave me a last kiss and said that it had been brilliant, but she had a serious need for confession and absolution.

The Unbearable Lightness of Being is a novel written by Milan Kundera.  It is a thoughtful, sometimes painful, but always brilliant story.  The movie was very good, but the book could not be matched.  I found myself on Mykonos living this unbearable lightness.  I was not entangled with anyone, anywhere.  I did not have to be anywhere at any given time.  Nobody cared that I was spending my days walking around a white-washed village on a Greeks island.  The island had 365 tiny chapels, one for the Saint of every day in the year.  Every day, I walked to the chapel of the day and watched the visitors come and recite their brief prayers.  My mother would have been upset if she never heard from me again, but no one else.  I felt that detached and that light.

I had spent my first 36 years being bombarded by stimulus from all sides, at every moment of the day.  My relationships with women up until them were meaningless connections.  My first attempt at marriage drained me of my life force.  Mykonos was my chance to empty the hurt and start again.  I was a pharmacist.  Pharmacists made a professional wage in California.  I had made the money honestly or at the Blackjack table.  I had enough money for years on Mykonos. My problem was my need to be needed.  I seriously needed to serve a woman.  That is how I was trained.  Alone, I was frozen with want.

Don’t get me wrong.  I truly enjoyed not being attached to my old, regular way of life when I was working. I found something that Milan Kundera wrote in The Unbearable Lightness of Being.

Two people in love, alone, isolated

from the world, that’s beautiful

Heather and I found respite with each other.  I didn’t know then quite how damaged I was.  I suspect that she had some demons also, but we wanted nothing from each other.  We held each other and we slept together and we spent every moment together for a week or ten days.  I am embarrassed.  I only think that her name was Heather.  I honestly cannot remember for sure.  When she was gone, she was gone.  A sweet memory with no regrets.  We did not share addresses.  She gave me a Roman Catholic Saint medal that I misplaced years ago.  I gave her a set of dice that I had bought at the casino in Monte Carlo.

I took her down to the quay one morning and held her hand as she climbed down into the small boat that would take her out to the ship.  It was a sunny morning in December.  Probably in the 70s.  I was wearing a red, long sleeve cotton Tee shirt and a wool Greek fisherman’s cap.  Heather was wearing a jacket and had a bandanna covering her red hair.  I didn’t cry, but she did and it was like a stake in my heart.   I wanted to leap into the small boat and to beg her to stay with me, but I didn’t.  The fist in my abdomen gripped my insides and squeezed.

I walked to a small Taverna overlooking the harbor.  I could watch as the ship sailed out of sight.  I ordered a glass of ouzo and made it milky with some water.  The bartender brought me some slices of sausage, some wedges of cheese and some crusted white bread.  I sat there for awhile, feeling empty.  Then a person I knew came into the bar.  Andrew, an archeologist from New Zealand.  Andrew was working on the sacred island of Delos.  You could see the peaks of the island in the distance, from the Mykonos harbor.

Andrew and I became drinking buddies every night, at the taverna.  An ouzo hangover is memorable, my friends.  You wake up with an insane thirst.  The first long drink of ice water somehow makes you drunk all over again.

Those nights of ouzo fog did not last very long.  The lightness was so excruciatingly sharp that I had to become back engaged again.  There rarely were Anericans on the daily ship.   When there were, they were the quintessential tourists.  They wanted Greek dancers and young, sexy widows dressed in black from Zorba The Greek.

They always asked me what I did all day on Mykonos.  They asked me if I was a writer.  I told them that I went to the chapel every day, waited for the ship and drank ouzo at night.  They looked at me funny and that made me more resolute.  I was going to stay on Mykonos forever.

But, eventually, the lightness got to me and I returned to California because I was in love.  I had fallen in love with a three year old girl named Christy.  I married her mother so I could be her step-father.  I raised Christy

We learned when we were children that a game is only worth playing if there was a chance that we could win.  If the team made up of older boys got 4 outs and your team only got two outs, you went and played something else.  If your gym teacher demanded that you do a perfect cartwheel and yours was far from perfect, you stood near the back of the group of girls and hoped that the teacher did not single you out.  When there was no hope of ever winning, you gave up.

I remember the years directly after I was released from the hospital with polio.  I wore a brace knee to heel on my left leg.  My mother (what was she thinking?) thought that dance lessons would do wonders for me.  I ended up with a dread of dancing.  I took disco dance lessons in the 70s just to confront my fear.  I believe that I hurt myself trying to look like Travolta.  I am still terrified of being seen dancing, but I will take Salsa dancing lessons if I have a chance.

I have played the drug store/ pharmacy game a lot in the last 40+ years.  In the 1970s, it was all about winning.  There were no computers to keep track of metrics.  There were no productivity programs.  All-Med International (Los Angeles) graded me at the All-Med Drugs in Pacheco, California by the amount of money we rang up compared to all expenses.  We made money and that was all that counted.  The game was winnable and I won.

I ran a cult of personality.  I have a terrific memory for names.  I would see a patient enter the store and think:  Marie Sanchez, Dimetapp and Hydrodiuril.  I could hear the voice on the phone and the name would come to mind.  I learned how to be a good businessman from my father and he learned from his Greek immigrant father.  The rules of the game I played was: Get them to like you and they will buy their prescriptions from you.  A simple game.  I was good at it and I won.

Pharmacy computer programs became the enemy ten or 15 years ago.  Some assholes who are not pharmacists, but enamored with technology, decided that the computer could be made to spy on the pharmacists.  Oh, what a great idea, said the executives.  What an insult.  Take your most important employees and allow a frikkin’ machine running a faulty algorithm to determine what good pharmacy is based solely on time.

You can either satisfy the monster or practice pharmacy.  In two companies, you can’t do both.  Rite-Aid and CVS are downright draconian.  There are punishments for not making the numbers.  I honestly believe that they are selective.  They only punish pharmacists they want to get rid of.  In many cases, older pharmacists who get a month and a half of vacation and other expensive benefits.  This is an example of making the most critical employees pay for the errors of signing ridiculous PBM contracts.  I contend that pharmacists are not involved in the decision and that is pathetic.  The profession is called Pharmacy, after all.

The rules of the game as they are designed by CVS and Rite-Aid make the game unwinnable unless you are going to operate as a glorified technician.  It must be downright painful for pharmacists with high personal standards and respect for professional ethics.  I can understand the bitterness.  I can understand the feelings of despair.  I can see the anger.  Just don’t forget:

It’s the JOB, Stupid.  There is nothing wrong with the PROFESSION.

I welcome your thoughts.

A disclaimer.  Many of you know who I work for, part time.  This company has metrics, but they are gentle as practiced in Southeast Texas.  There are no red warnings or buzzers.  The company respects the patient-centric practice of pharmacy.   I get the idea that they’d like to make huge changes, but are worried about a competitive disadvantage.

I just started writing:

“The Comfort Demands  Occupy Pharmacy“

I am aiming for December or January.  I am at page 25 of 160-200 pages

Foreward

This is the logical conclusion of the “Comfort” messages.  It follows “The Comfort Trilogy” and details how we got to the soul-crushing conditions that predominate in retail pharmacy in the 21^st Century.

I will conclude this book by outlining reasonable and uncomplicated demands that will benefit both the institutionalized pharmacist and the institution that suffers right along with us.  A happy pharmacist is a more productive employee and that means more profits.

Jim Plagakis, January, 2012

Evan Worth, my web designer in Boston, set me up with Google Analytics.  When I check it and I don’t look very often, I see that this thing gets around 4,000 unique visitors a month.  When I look closer, I see that the visitors are from all over the world.  One of these days, I will compile some numbers for you.  You can see who your audience is.  And make no mistake that the visitors come to read what you have to say.  I often just put stuff out there like red meat, so you will pounce on it and rip it apart.  I don’t expect you to agree with me.  I am disappointed if you do agree.

So, for that international audience, here is a little entertainment.

The propaganda that the medical insurance companies and PBMs are there to help the patient livea good, clean healthy life is just so much bullshit.  They are for profit engines.  They are classic “middle men”. They just move money, take a good chunk for themselves and provide absolutely no medical care.  Medicare Part D is a government program.  How did these private insurers even get into the game?  That’s an easy one.  Who was President?  Who wrote the law?

In 1980, Tempest Storm was 52 years old.  Amazing.  Here, she reminds me of Jan, the 19 year old Brazilian.

This May Be Too Adult For You.  Time for some fun.

I feel good about my life.  I don’t have regrets and, believe me, there are plenty of reasons to whine.  Three wives. One good one.  Too many women who were not my wives.  One very dubious one, but oh, my friends, she generated excitement that I can’t tell you about.  She was a pharmacy clerk in San Diego.  I was the pharmacy manager.  She would come up behind me as I typed, slip her knee between my legs and put her arms around me and rub my chest.  She was an accomplished siren.  It was difficult to get away from her.  A girl who turned 18 showed up at the pharmacy and showed me her driver’s license.  It was closing time and we escaped to the comfort mat behind the pharmacy counter.  I believe that the “Cigarette Love Affair” was the most memorable.  The 19 year old (I was 31) who refused to sleep with me until I took a few tokes on her doobie was the most gorgeous of them all.  Tall and dark.  An English father and a Brazilian mother.  I never cheated on the wife.  My first two wives made me a cuckhold.  The first wife, many times.  I had my affairs when we were separated and we were separated a lot.  This paragraph is a tease for “Too Adult For You”.  I will take down the videos up above and activate a few adult posts that have proved the test of time.  This is for Tom, a 50 something tech who just found this site.

That being said, what follows is NOT too adult for you.

My best advice to you is:  Don’t waste your time living someone else’s choices.  You are a medical professional, make your own choices.

Don’t let the Yama Yama of others’ opinions drown out your own inner voice.  You have goals and dreams.  Live them, go for them.  Have the courage to follow your heart and your intuition.

Think of your company:  People (Managers, Executives) do not take power.  It is given to them by you.

July 28th.  McNeil (J & J) announced that the new safe dose for acetaminophen is 3.0 Grams per day.  Two years ago an FDA panel suggested that combos like Vicodin, Percocet, Norco be banned totally.  What they got was a ruling that all formulations containing more than 325 mg APAP be banned as of 1/1/2012.  Have any of you heard about that? Did it get stalled by the big money generic companies that made hydrocodone products?

Two years ago, the FDA panel also wanted a new OTC dose of 675 mg (No more than 4 per day) to replace the 500 mg (No more than 8 a day).

I talked to a doctor last week.  She had prescribed hydrocodone/APAP 10/660.  Her Sig was 2 qid.  I asked her about it.  ”That’s way too much acetaminophen,” I said.

“She is in too much pain,” the doctor said.  She was young and aggressive.

“That’s close to 6.0 Gms of APAP a day.”

“Well, what do you suggest I do?”  I could almost hear a disinterested yawn.

“I suggest that you prescribe Norco 10/325 with a max of no more than 8 tablets a day.”

“Tell me.. what medical school did you go to?”

I stopped, then answered, “Tell me, doctor… what pharmacy school did you go to?  Let’s cut the crap.  If this patient took more than your dose she could end up in a coma and needing a liver transplant.  You have prescribed enough for a month.  If you insist on that particular product with those instructions, I will decline to fill the prescription and I will have to tell the patient why.”

“You wouldn’t.”

“Oh yes, I would.  I would also have to report to your faculty advisor”  I then told her all about J & J, the FDA panel and the outlawing of dosage forms above 325.

“I didn’t know any of that.”

“You don’t have to, I guess.  That is what the pharmacist is for.”

“I’m sorry.”

“No need to apologize.  Trust the pharmacist, doctor, and be safe.”