Friday, May 28, 2010

Memorial Day... let us remember

a recently fallen soldier is escorted to Arlington National Cemetary

Thursday, May 27, 2010

It made me smile

Sometimes, when a label prints, I wonder what the heck the people who put together the database were thinking when they assign auxiliary labels to particular prescription medications.

You know, things like "may cause drowsiness" on zolpidem or temazepam. I know that it is because some idiot, somewhere in the past, filed a lawsuit because they took a sleeping pill before driving to work, fell asleep at the wheel and wrecked, then decided to hire our buddies over at 1-800-BAD-DRUG because "I didn't know my sleeping pills might make me tired".

It's the way of modern medicine in the United States. Eighty percent of what we do is in one way or another designed to reduce our liability from a legal standpoint.

So it made me smile today when the following prescription came to the pharmacy today:

Visicol tablets
take as directed prior to procedure

And the auxiliary label that printed was:

Caution: this medication may impair your ability to drive or operate machinery

I dare anybody to take that medication and drive any distance longer than the length of their driveway.

Wednesday, May 19, 2010


The weekend at the pharmacy. The prescription side of the business usually revolves around birth control pills and ER scripts. An occasional hospital discharge order for that once-a-year medication that you just sent back as outdated. Usually there's not a whole lot of excitement behind the counter.

But in front of the counter it's a different ballgame. People are coming in left and right looking for an over the counter item to fix them. Doesn't matter if it can be treated with medication, the people are wanting a pill or syrup that will cure their ailment.

So a better portion of my weekends are spent consulting on OTC medications. Most the time I can find something to help out. There are times when I have to tell the people that a product doesn't exist to treat their symptoms. Other times I tell them to call their physician or go to either the urgent care center or the emergency department, based on the severity of their situation. Basically the pharmacy serves as a triage location during the weekend. It's a role pharmacists are used to playing since we are the most accessible members of the health care team.

This past weekend I got to see how it works for another component of the health care team, at least partially. One of my daughter's friends had a birthday party on Sunday. I wasn't sure if I was going to go, but the weather wasn't nice enough to go golfing with my boys so we showed up at the party a little late.

When I arrived, all of the men were sitting out on the front porch consuming some adult beverages. It just so happened that all of them are physicians in the area. One is an ENT, another an OB/GYN, and the third is an ER doc.

We didn't talk work at all. The host had recently built his house and all of us were giving our input as to how he should landscape the gigantic hill in front of his house and where he should locate his vineyard.

After moving inside for cake and ice cream, we went to the backyard to play wiffle ball with the kids. That's when OB/GYN dad's phone rang.

It was a young lady, pregnant in her first trimester, freaking out over some spotting. After fifteen minutes on the phone attempting to reassure her, OB/GYN dad told her that she could always go to the ER to be evaluated. That's when a wiffle ball came flying from ER dad towards OB/GYN dad.

"Why the hell did you tell her that?" ER dad yelled. "All you are going to do is occupy one of our beds for three hours when there's nothing we can do."

"I know," said OB/GYN, "but she's not listening to me. If she sits in a bed for a few hours, she will at least feel better until she comes into the office tomorrow."

OB/GYN dad had a few more calls from patients freaking out about nothing. That led to a discussion of the how patients expect to have all of their problems fixed, even things that don't have a fix. We shared stories of some of the more interesting calls that we have received and patients that we have dealt with.

I thought I had the upper hand because I can always refer the patient to their primary care provider or the ER. OB/GYN dad thought he was in control because he can refer the patient to the ER. ER dad said he could always get back at OB/GYN because he could claim lack of expertise for the patient's specific gynecological issue and call OB/GYN back to the ER for an expert consult.

After a few laughs I realized that in the end, I'm the one getting the shaft.

After my referring the patient to the doctors, they let the patient sit and stew in the emergency department for hours and hours. Releasing them 30 minutes before the pharmacy closes on Saturday.

Which makes my last 10 minutes at the pharmacy not a lot of fun.


Next birthday party is in three weeks. Looking forward to it.

Wednesday, May 12, 2010

Pharmacist Organizations

A month or so ago I set up a poll on this blog's sidebar to see how active local pharmacist organizations were. To my surprise, 30 percent of respondents said that they had active local associations. I expected the number to be much lower.

In my own community, we had an organization that disbanded over 10 years ago. When we were active, we were able to meet every couple months at 9:30 or 10 at night. The meetings consisted of a small presentation from a drug rep, a decent meal, and drinks. Lots of drinks. Since just about everybody was coming from work we needed to blow off a little steam.

Why don't we meet any longer? I don't know. Maybe it's due to our geographic region. I practice in a rural area. There are 90,000 residents in the entire county. There are about 15 pharmacies in the county, plus two hospitals with pharmacies. To get everybody together means that some people will be driving 40 minutes to the meeting. Since half of us would be working the opening shift the next morning, we never really had a huge turnout.

The local organization did help us connect with each other. No matter who we worked for, we were able to share our experiences and be heard by our peers.

Take note of that last part.

Heard by our peers.

I think that there is a tremendous disconnect between your local pharmacists and the state and national pharmacy organizations. The issues that are being discussed at the state and national levels seem so far removed from what those of us in the community and hospital pharmacies are facing.

If I were in academia, maybe the issues would resonate with me. But for me and my peers, the state and national organizations just don't practice pharmacy in the same world that we do.

Back in August or September I joined the American Pharmacists Association. Mostly to get access to their medication therapy management resources. For that aspect of my practice, the APhA is a valuable resource. But when it comes to workplace issues, third-party issues, legal issues...we are not in the same ballpark.

I understand that the APhA represents all aspects of the profession, but I think the APhA needs to look at where most pharmacists practice and address the issues based on where the pharmacist are. That's a major part of the disconnect.

Another part of the disconnect (and one that infuriates me) is the lack of reply to communications from the organizations. After joining the APhA, I looked at joining the Ohio Pharmacists Association. Before sending in a check to cover membership for a year, I sent an email to the OPA to see what issues they were focusing on, to see if their vision of pharmacy jived with mine. I didn't get a response. I sent a second email. Again, no response. If an organization can't take the time to respond to a simple email from somebody wanting to join, are they really going to listen to my opinions or will they simply continue to attempt to advance their agenda?

The same thing has happened to me with the APhA. Three different times I have used their webform to send questions to them, including two this past month. No response to any of the emails. This really pisses me off because I am a dues paying member and the courtesy of a reply has been non-existent. Way to connect with your members APhA. Again, I feel like my thoughts and opinions are not going to be heard. I do have the email addresses for specific people who would be able to answer my questions, but I wanted to test how well the organization replied to my questions and comments. They failed.

Two organizations of my peers have failed to even reply to information requests. I believe that the failure of the Ohio Pharmacists Association and the American Pharmacists Association has led to such apathy on the part of the local pharmacists that we will never be able have an active local association. This is not good for the profession.

There are many smart pharmacists out there with ideas that can advance the profession beyond your wildest expectations. These pharmacists need to be heard. It's up to the larger organizations to listen to the individual pharmacists who are practicing pharmacy. We are trying to be heard. The organizations need to listen.

As always, if anybody wants to speak to a real pharmacist they can email me at to set up a time when we can talk on the phone.

Tuesday, May 11, 2010

Birth control pill turns 50

In case you missed it, the oral contraceptive pill has reached a milestone. We are in the midst of celebrating 50 years of the birth control pill.

The National Museum of American History at the Smithsonian has a small display in one of its wings honoring this anniversary.

I was in Washington DC last week with my son's eighth-grade class and was able to see the display. Rather than go into a long discussion on reproductive rights, I thought that I would just share a few pictures that I took with my BlackBerry (can you believe that we left our good camera behind?).

This is how birth control pills used to be packaged.

An editorial cartoon from the era.

And what would be a politically incorrect cartoon by today's standards.

Just a bit of pharmaceutical history from the Smithsonian.

Monday, May 3, 2010

New APhA president.... Dee Snider?

A visit to the home pages for the American Medical Association (AMA) and American Pharmacists Association (APhA) might make your tummy turn if you are a community pharmacist.

Why, you ask.

Look at the AMA page and you will see, front and center, three big stories that show how the new health care will affect the practice of medicine. Not surprisingly the stories revolve around the financial impact that AMA members will see. The actual stories are:

  • Congress delays Medicare cuts
  • How will health reform affect you
  • AMA launches national managed care contract

Seem like pretty relevant topics. Now let's compare to the lead stories over at the APhA:

  • Tylenol/Zyrtec recall
  • New drug approval
  • Article on TNF inhibitors
  • New USP president
  • Article on aspirin

Not a damn thing about the financial side of pharmacy. Doesn't seem like the APhA pays any attention to that side of pharmacy, you know, the side that pays the bills.

Those of us in community practice settings (aka retail) have felt the disconnect for years. Mention the APhA and you see eyes roll and get a little chuckle. Either that or you see the pharmacist's face turn all sorts of red as the blood pressure elevates.

So when I received an email about how I want to receive my election ballot I wondered how I would vote. I've been an APhA member for about eight months. This is my first election.

Will the candidates/issues be relevant to my practice of pharmacy? Will the election results have any impact on the financial side of pharmacy?

I already know the answers to my questions. So no matter what the issues on the ballot are, I'm going to write-in a candidate for APhA president. My choice....

Dee Snider.

With him as president of the APhA we could then adopt a new slogan for American Pharmacists Month. It would be based on several issues that relate to issues that pharmacists see.

Things like insurance contracts.

Staffing requirements.

Hours of operation.

Break periods.

You already know the new slogan for the APhA.... We're Not Gonna Take It

Just think how nice pharmacy would be if the organization that "represents" us took as active a role in the financial side of the profession as their counterparts over at the AMA.