Notes from a Pharmacy

I don't know why anyone decides to be a pharmacy technician, because I think they should be paid much more than they do make, but I am so glad some people do. My first days as a new practitioner I came close to the record of prescriptions per day that this location held. The only thing that pulled me through was my joy to finally be in the driver's seat, and the wonderful trio of staff I am currently working with. They solve insurance problems more quickly than I can at this point. The crazier the environment became, the more confident I felt because of those wonderful, smart and dedicated techs. I am sure they wish I would stop singing, but that's not going to happen.
I love that the company I am with values my time as a professional and provides enough help so that I CAN counsel on new prescriptions, help people choose the appropriate OTC product and answer questions. Yesterday I worked alone for the first time due to a huge snow storm, and I could feel the difference: I filled fewer prescriptions, and it felt like more work.
I believe people don't understand how much work goes into filling a prescription and they get angry if we say it's going to be fifteen minutes. We take in the hardcopy and ask for your birthdate; are you in our computer system? (No, our computer system does NOT take your information from all the other pharmacies and magically put it in ours!) Any change in insurance? Let us see if we have this in stock (somehow people get offended when I say this- how do we know what to stock until a patient orders it?). We need your drivers license. No we cannot fill without it, it's required by law for drugs in class II like Ritalin and Percocet. The Rx goes to the tech to type- what is this drug? Does it say Zocor or Zoloft? Call the doctor for clarification. He is in with a patient, the nurse will call back. Sometimes the doctor has the nurse collect all messages and he calls back once a day; this means that we can't fill in 15 minutes, and it's NOT our fault even if you choose for us to be the ones to yell at. Yes, we know it's a pain in the butt to have to come here twice. We get the call and now we know the correct drug, so we proceed, Choose the correct drug and put a basket together. Locate you in the computer, or type in all your info. Yes it IS important for us to know your allergies. You say you are allergic to codeine but the drug you want us to fill is Vicodin, which contains a product that belongs in the codeine family. What happens when you take codeine? You get constipated. Does your throat close, or do you have trouble breathing, or do you get a rash? No. But since you have never had Vicodin before, we have to call the doctor and confirm your allergy status. It's not going to be fifteen minutes. Doc says no you are not allergic and have had other codeine products in the past according to his records. We fill the prescription, choosing the correct NDC number for the drug. We bottle and label it and it comes to me. I ensure this is correct patient, correct drug, correct amount, and verify that the drug in the bottle is the drug from the stock bottle in the basket, and the NDC, name, strength and dose form match. If new, I check all the directions off from the original hardcopy, and we file it. Then we dispense it to you. Why does it cost so much? We asked you if there was any change in insurance and you said no. It was rejected by the insurance so we put it through for cash. You have another insurance card? That's why we asked. We send it back to enter all the new information, and we run it through again. It costs more than it did last time? Maybe that's because you have new insurance and the last time you filled with the old insurance. Why is their co-pay higher? You need to talk to your HR person at work.
Most of the time these wonderful techs are dashing about handling all this craziness while I am checking, answering questions and running out to help choose a product outside the pharmacy. I'd say 95% of the customers are pleasant, but the 5% left over can go a long way in raising the energy level for keeping a pleasant environment. The toughest are people who hate to wait, and who call in their prescriptions, then never get around to picking them up. It's considered insurance fraud to keep a prescription on the shelf more than 14 days. Technically, the insurance has paid for a product that the patient they cover has NOT got possession of. So we return to stock, but then in comes the patient the very next day and now the patient is mad that it's going to take 15 minutes for us to locate, fill and dispense. The patient doesn't care that we wasted time filling it then returning it then filling it again. All he cares about is he didn't want to wait- didn't he say that in the first place?
In the middle of all this, we had a few problems, some got solved, others must wait until the manager has time to give me guidance.
I like the tasks, especially when the work is flowing nicely. I like the challenges, and solving problems. No two days are alike. I like when the situation requires creativity, and I like when I turn an unhappy person into one whose situation is resolved. I like when people stop by to say they feel better. A mom came to thank me for taking the time to show her daughter how to use and care for her new asthma inhaler. The patient who thanked me for giving her a list of prices so her doctor could choose medications she could afford. The guy who didn't know he could get better control of his cholesterol by taking his med at a different time of day until I mentioned it while ringing him out. And the man with the very sick wife came in to say she was better and to thank me for my prayers.
But best of all, I like my techs.

Career On Hold

Apparently, a professor in the state of Georgia has been paying students to reconstruct questions and answers to the NAPLEX pharmacy exam. Then he turned around and "taught" a board review class and sold study packets containing real Q&A. This prompted the National Association of Boards of Pharmacy to shut down the exam and re-write it. Anyone who had an appointment after August 25 had his/her appointment cancelled and no new appointments will be issued until early November.

What does this mean? It means the HUNDREDS of graduates who hadn't yet stood the exam, or whose states required 500 hours of graduate intern experience now are left in the limbo of grad internland. Unable to be licensed, we cannot do the actual jobs for which we were hired. Our student loans are due and Sallie Mae is knocking at our financial doors, yet we are not collecting the full salaries we would have if this suspension never happened. Some of us have relocated and floated moving expenses, anticipating the full salary tied to the completion of the licensing procedure. Some of us are being told that contracts required being licensed within a certain time period, even though that contractual obligation would have been met except for this.
Pharmacy chains are scrambling to cover positions that new hires should be working.

If I need to look at the positives, well, it gives me some more time to study. But I am definitely not a happy camper about this.

Counting to thirty

Last Monday was my first day as a pharmacist. As usual in my life, a post-it note with a message "a graduate pharmacist is starting Monday" was my introduction in the new job. The computer system is one I have used before (and hated), but the float pharmacist working with me gave me a mnemonic that made the system "click" and now I am negotiating it so much better.
MT FEET HURT. Really hurt. Of all the things I could have inherited from my Dad, I got his varicose veins and crappy circulation (but thank you God for omitting the nose). Considering all the things that pharmacy entails, it's frustrating that I am so focused on my feet. But I am.
My favorite problem was a lady who wanted a refill on a prescription; we looked in her record and in the system, but no luck. "Did you have this filled somewhere else? "Canada." Apparently the psychic pharmacy crystal ball is supposed to be able to find any prescription previously filled anywhere else in the world and magically transfer it and fill it yesterday. I give it about three weeks til I get that good:)

One Flew Over

I am doing a rotation at a psych facility, and the intricacies of the
human mind are mesmerizing. I am in a group of students for the first
time, and I am so enjoying the different perspectives they bring. The
opportunities for learning something new have been myriad, and being
able to bounce this stuff off other students is so cool. We do a lot of
presentations, which I do enjoy, and go to a lot of meetings like
Pharmacy & Therapeutics, and Team meetings.
Today I had to lead
a group discussion and one person had to leave because the social
worker came, but I heard the patient comment to her "It's ok, that was a sucky group!" Yeah, just try to lead a bunch of people with varying cognitive function into agreement that taking your meds is a good thing- especially when the meds wreak havoc on your systems and make you fat, dopey, and sleepy (and the staff has no problem with this!).
I am pretty sure it was a sucky group, but we all really tried.

It is so cold here. I had to warm up my little buckwheat pillow and I am toasting my feet before getting back to work. More research, more writing. Eight weeks of clinicals left- the light is at the end of the tunnel!
I got a letter from the college and didn't open it right away becasue I thought it was a non-bill again. Apparently, I made the Dean's List for fall semester. I wasn't even thinking about that! Woo Hoo! Ditto pointed out that after struggling my way through all the sciences, I am getting excellent grades in the part where you have to act like a pharmacist. Add my Phi Sigma Lambda induction to that and I guess it's been a good start to the final year. If I can only keep my nose clean until NAPLEX I'll be ok, but I won't relax til the NAPLEX score is in hand.
Two solid job offers and a few good leads...What a great field pharmacy is!

Poster Presentation

It's OVER!!! Thank God.
The graduation poster is a mandatory presentation done be P3's (that's senior in the accelerated program) and is worth one whole grade point. You choose a drug, find primary literature (that's clinical trials to you non-science folk) and write up a presentation. Normally people do this drug vs that drug and illustrate one's superiority (efficacy) with studies.
Part one is search. Part two is bibliography. Part three is writing an abstract. Part four is creating a poster- you get a threefold presentation board and have one title and 12 slides.
Of course, I can't adapt to herd mentality and I chose a drug that works with rare cancers, and did my presentation on its effects on a cancer so rare it's 7 in one million. I get totally sucked in to research and spent hours reading and interpreting studies. I did a progression of efficacy, use in advanced cancer, resistance to the drug and how histological DNA tissue typing is critical for prognosis and dose selection. I was pretty happy plugging along with the written work- I do love that kind of stuff. Week of presentation, I started having huge anxiety about it- my blood pressure was up, I wasn't sleeping well. And Wednesday was P-Day.
I got into Worcester early and met some of my friends. My place was moved- I was Number One which was scary- thought I'd be first. I was in a corner in a big hall. The guy next to me, it turned out, was going to do a rotation in Manchester and was moving in with my pal Ryan- small world, eh? Bonnie, my former preceptor, decided to come scope it out and offer support. It was so encouraging to have her and another pharmacist pop in, and I ran thru my spiel no problem. Another college employee came down and asked some questions- same deal. Everyone else was being judged and done. Finally, my judges came, and they wanted to read it first and ask questions. Thrown off a bit, I began stuttering like an idiot (say Platelet-Derived Growth Factor five times fast and see how you do!). I didn't say half the things I wanted, I didn't articulate well, and the one question they asked- "How much does it cost?" I could not answer at all. ($461.99 for 30 tablets, and the dose is four or eight a day!) We won't get our grades til March, so it's nerve wracking. They have been known to flunk people on their posters.
The school and alumni association threw us a party afterward- I figured it was cru d'etes and cheese but it was a full buffet and open bar. I had oranges in my purse and had wine- wish I had asked for a GF meal! The line was funny- one of the deans and a pharmacology prof were in front of us and we had a good time hanging with them. Most of the profs were there, and nearly all my class stayed. It was so nice to see everyone- we've had a wedding and a baby since last we got together. It was the last time we'd all be together before graduation, and not all of us will be there.
It took such a huge chunk of emotional energy all told. I had another presentation the next day at my rotation- it went well. It was a lot more low-key delivering to techs than to professors.
Friday was the last day of 3rd rotation- we are more than half-done with clinical year, and we are 100 days to graduation. My preceptor let me go early, and a bunch of us got together up in Manchester for dinner and drinks. We helped Tran & Michelle move out, then headed off to party. Two of the group have already signed contracts. Several of them move to their home states today. It was bittersweet to know this was it for the group and it was hard to leave. I didn't get home til 12:30.
I slept til 1:30 this afternoon- it was so good to sleep. By 6 pm I was ready to go back to bed. I am taking this day to just ready and putter. back to the real world Monday.
Poster is Done!!!

Postscript- I got a 98! I was in the elevator en route to a meeting and bumped into one of the women who graded me, so I thanked her for the grade. "You're the one who earned it," she said as she stepped off.
YES!!!