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ATAP: What exactly do you do?

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Welcome to another installment of Ask The Angry Pharmacist, where the most famous pharmacist on the planet (heh) answers YOUR questions and concerns in a not-so-nice (usually) way!
This is a genuine question, so I won’t be burning her at the stake (much) 🙂 For those of you new here, mail [email protected] with your questions and I’ll answer them on here. Be warned that the answer may end up making fun of you, but I wont publish who you are.. 🙂

Dear Angry Pharmacist,
My husband and I, (physician and nurse practitioner, respectfully) recently found and subscribe to your blog. Wow. You really are one angry guy.
Before you go hating on us, if you knew us or worked with us peripherally, you would most likely put us in the category of “good guys”. We genuinely appreciate pharmacists who check dosages and allergies, and sincerely thank you if you catch a mistake on our part.
But humor me for just a minute and allow me to ask you something that Hubby and I have always wondered about. Please recognize this question comes from a combined total of over 18 years of higher education, and is meant with absolute respect and sincerity:
Just what is it that pharmacists DO?
We know you guys are smart…colleges don’t go around passing out Pharm D’s based on your looks. And from our own painful experience, we know there is more paperwork and red tape involved in your work than should be allowed by law. But I gotta tell you, from John Q. Public’s perspective, it appears that you guys have these huge bottles of pills in the back, count a few out, put them in a bottle, and put a label on it. Why does that require a doctorate and 7 years of college?
I’m being dead serious, not disrespectful. Oversimplifying it, yes, being jocular, yes, but I really am serious. Hubby and I are above average in intelligence. If we don’t know…and we actually WANT to know…then I am sure the docs with whom you regularly engage in sparring matches don’t have a clue. Even the ones with God complexes.
So, would you take the time to explain to us, and to your readers, what all you guys do? What you studied for 7 years? Maybe it would help them have a better appreciation for your intelligence and get that huge chip off of their shoulder.
(Who am I kidding? That chip is soldiered firmly onto said shoulder. But maybe some people would appreciate it…and you…more. We would.)
Thanks, TAP. Keep ranting.
Just The Nurse Practitioner

Well Nurse Practitioner, you partially answered your own question. How do you think we catch said mistakes and dosing errors and allergies without the 7 years of college? Most pharmacy computers marginally handle this (or go overboard with the interactions part) but almost all the time we do it off the cuff. Amazing isn’t it with all the drugs that are out there.
Let me run down for you what a typical Rx filling process goes like in retail:

  1. Patient comes in with an Rx. We get the insurance information, personal information, allergies, etc.
  2. Patient has 400 questions about OTC products, we answer those so they don’t bug you about if Tylenol will help their arthritis vs Ibuprofen.
  3. We start to input the Rx into the computer. The computer, being a computer, spits back at us 900 drug interactions (99% which are theoretical and drug-food and drug-alcohol interactions) to which we blaze through sorting out the true interactions (warfarin and Codorone, Flagyl and Alcohol, etc) from the ones that are in the system because one idiot in Nebraska had it 30 years ago once. Knowing what is crap and what is a legit concern comes from the 7 years of college (however mostly experience).
  4. We learn to find that the Rx is not covered. So we select the next best alternative that the insurance will cover and ask you to change.
  5. We bill the insurance (to watch them reimburse us $3 over cost for all this work).
  6. We tell the patient how to take it, as well as handle another 400 questions about if it will cause headache, diarrhea, anal seepage, hemorrhoids, when the next shipment of cards will be in, etc.
  7. We send the patient on his/her way after a long discussion about how high the $1.05 copay is, and why he/she has to pay it.
  8. We spend the next week getting phone-call after phone call from this patient about every little side effect that he/she is having claiming them to be ‘allergies’.
    Now, this is if 1 person is bringing in an Rx. Most pharmacies have at least 3-5 (or more) of these processes going on at the same time with only 2 or 3 pharmacists to handle this. Add this with Dr’s and NP/PA’s calling at random times (which causes us to drop what we are doing and get the phone) and you have yourself quite a mess. We don’t get to shove people in rooms to wait and come around to them and work one on one. Imagine if you were seeing a patient in a big room, and someone just came in and tapped you on the shoulder derailing your train of thought. We shovel medical advice out the front door as the money is being spooned in through the window.
    This doesn’t even touch on the clinical folks at the hospital who need to know what a patients renal or hepatic status is when selecting drugs. Try to give atenolol to someone with a GFR < 20 and you’ll have quite a mess on your hands (hint: use metoprolol instead). Unless you’re a specialty doc, we know as much (if not more) about drugs as you guys know about diagnosing stuff. Sure, any pharmacist can diagnose heart-failure, or diabetes, or hypertension just like any MD/NP/PA/etc knows the basic drugs to give, however when someone has no kidneys, or is in hepatic failure, or their insurance doesnt cover it, or how much Tylenol to give to a 4 month old baby, we don’t have to look these up. Retail guys don’t carry around PDA’s or Tarascon (which is full of mistakes, be warned). Sure, we have Lexicomp or a Facts around for the weird stuff, but all the things that you have to look up we know off the cuff. Plus retail folk don’t get their heads polluted with drug-company shit from the reps (which reminds me, I need to rag on the reps some more). Finally, (this is a big one), most (if not all) pharmacists have a uncanny ability to translate medical -> commoner. Doctors are notorious for using medical-speak to patients (which sound scary and just confuses them). We are the ones who get the “what does this word mean” when patients get the warning from their doctors about rabdo with statins. We are good at bridging the gap between a very precise big-latin-word based language to the language that is used by people with annoying song ring-tones on their cell phones.
    I hope this answers your question, I’m sure that the commenters out there will add on what I leave out.

Comments #

Comment by Google Account on 2008-07-31 09:44:40 -0700 #

I get that same question too! I was at a party awhile back with dentists, dr’s and drug reps and I was introduced to a lady. The first thing she said when I told her I was a pharmacist was, “Oh yes, counting by 5’s I see!”. haha. Well what can you do.
I would say that 90% of our time is dedicated to patching up the problems of the “least-inteligent” and “majorly disorganized” patients. It’s a shame when you could spend hours in a day helping the people who really want to learn more about their meds, but instead you have to cut their questions short because so-and-so left all 7 of their meds at the cottage and they need everything now, or one of your most complex (36 meds) dossette patient shows up with a new RX from last week that involves changing their dossette that was already made…AND it’s out on delivery!
So if we seem inefficient because of prescription wait times.. remember that we aren’t only dealing with your basic prescriptions, we are dealing with every possible thing that can go wrong (and does go wrong)with prescriptions!

Comment by countbyfive on 2008-07-31 10:20:50 -0700 #

Let us not forget that retail is just one potential career path for pharmacy school graduates. Students learn a great deal that will serve them in all of the many other areas of pharmacy that are not outpatient and retail.

Comment by on 2008-07-31 10:39:41 -0700 #

At-a-Boy to you my favorite pharmacist I have ever only read about!!! Can I have a job? I got 19 years of experience with every little thing there is to know about retail pharmacy. I’m the one who got fired by a unfair, treat the dedicated tech like shit cause I’m intimidated by her knowledge and I suck as a manager and she just might file a grievance and…..get me fired. Poor baby, like the chances of that are so far and few between. Soooo, lets dump my best tech than we all dont have to worry about it. Ok, my tantrum is over. haha
Mr Angry, hats off to you dude. I would love to work with you as you truly are one in a million. In my 19 years of working with all the relief guys that filled in for my 13 year lazy ass boss who gave me the college education I never had. God, he had it made. I am thankful, yet I can see where Dr./NP are coming from too. Mr Angry there are a lot of Rph. out there, or coming down the pike that seem to think they dont have to do any of the things you or I do. I had a intern who did’nt want to answer calls, talk to customers, run a computer, take care of a rejection (you know, ins.shit) he just wanted to count the pills (lil shit wouldnt even pull the drug) he says to me; hhm! What do I have a tech for? Little bastard!!!!! Needless to say, once his 5-6 weeks were up he was thankful for all the knowledge I gave him and had more respect for techs and was going to treat them right. He saw a true dedication to our customers/patients and he learned it from a technician. My pussy boss, who fired me and his staff ph. were to fucking lazy to show this to-be rph the ropes. So to the Dr/NP you have a point, to a point. Mr. Angry, remember all Rph aren’t like you anymore. I understand that these little bastards go into pharmacy for the money and prestige. Christ! Wonder if they remember their oath 2 minutes after they vow it. Also authority, which is bullshit! So I get the AX! I who LOVED MY JOB, AND CUSTOMERS. I WORKED FOR THEM!
Compassion, care, accuracy,yes even techs know alot about the horrors of interactions, I could go on and on just like Mr. Angry on what we do. Well for me, did. It’s all for the wellbeing of the patient or customer. One thing some of us seem to forget at times……… ASK YOURSELF; WHO IS PAYING YOUR SALARY?

Comment by Mrs. Linus Larrabee on 2008-07-31 17:35:02 -0700 #

Wow…..that is really sad (to me) that an N.P. and an M.D. (non-layman, medically trained individuals) are wondering what we as pharmacists (also medically trained, but in a pharmacy-based curriculum) actually do in any practice setting. I would also encourage them to visit any U.S. pharmacy school website and lookup the entrance & degree requirements and required course descriptions. Pharm.D.’s (the current entry level degree to pharmacy practice) have to earn more credit hours than a Masters of P.A. or an N.P. Does that mean every course taken and every fact learned will get used up in actual pharmacy practice, surely not. But the same can be said for any professional degree, including nursing and medicine. I find the laughable description of we pharmacists as glorified pill counters highly misrepresentative and ignorant (lady at the Drug Rep party). By the way, I surely do not mean to come off sounding elitest. And don’t call me Shirley 🙂

Comment by Google Account on 2008-07-31 19:02:22 -0700 #

TAP, great description of what we do, but I think you left something out – TRIAGE.
For example…
The guy that comes in and says “I’ve got this rash, what can I put on it?” I ask a few questions – what does it look like, where is it, does it itch, can I see it? Then I take one look and say “Sir, it looks to me like you may have shingles. That’s when the virus that causes chicken pox lives in your body for a while doing no harm, then something stresses your body so your immune system can’t keep the virus in check any longer, and it breaks out in a rash that looks a lot like what you’ve got. Since you’re from out of town, here’s directions to the closest urgent care. Dr X works there, and he’s really nice. Have him take a look, because if it is shingles, you need oral prescription medicine, not just an OTC cream” Patient comes back 2 hours later and says “You were right – thank you. Can I have this prescription filled?”
Or the multiple phone calls from various patients asking what cough syrup they can take with their prescriptions. Look up the profile and peruse it while asking them to describe the cough. Is it dry? Productive? Worse when lying down? I see that they’re on an ACEI – hmmm – send them off to the doctor, see about switching to an ARB. Or, they’re on furosemide, digoxin, possibly carvedilol – they haven’t filled it in over a month. “Maybe you’re having a worsening of your CHF. It could be fluid in your lungs causing the cough. Check with your doctor, they might want to increase your furosemide dose. But don’t just take a cough medicine.”
THAT’s what we really do….

Comment by CardioNP on 2008-07-31 19:06:41 -0700 #

I can’t believe that that this MD and NP don’t know what pharmacists do. Perhaps they have not worked in academic settings in a while.
I’ve pretty much always worked in tertiary care settings and am very aware how helpful a pharmacist can be. When I was a new NP I relied very heavily on our clinic pharmacist to help with exactly the things you cite – dosing in the elderly, drug-drug interactions, figuring out exactly which of those EMR interaction alerts were bull*hit and which were real.
I still call our coumadin clinic pharmacists quite often when I see that one of my pt’s has had a quinolone or TMP-SMZ prescribed by the clueless urgi-care docs and no anticoag clinic f/u or INR testing has been arranged.

Comment by ADHD CPhT on 2008-07-31 19:49:32 -0700 #

Also, the general frustrations of the patient usually gets thrown at us; after all, the pharmacy is the last stop. If there are problems (legal or otherwise) with the presciption, the interpretation of the patient isn’t “Hey that pharmacist is trying to help me by verifying that dose/drug/chickenscratch.” It’s usually “THAT BASTARD WON’T GIVE ME MA SOMASz!!1”

Comment by Doreen on 2008-07-31 19:53:31 -0700 #

You forgot the Techs in process. I work in one of the big retail chains.
At least where I work…
Techs enter in the script into the computer and deal with insurance issues.
Techs count and label everything but narcs.
Techs call customer’s/patient’s house to tell them of any issues (refill too soon, drug not covered, ect).
Techs inform the patient of issues with their scripts at the register and if a more educated explanation is need, they call over the RPh.
Techs keep the pharmacy stocked.
Techs put away the drugs after they’re used.
Techs pull outdated drugs.
Techs clean the pharmacy.
Techs are in charge of scheduling the pharmacy staff.
RPhs check to make sure a prescription was filled correctly.
RPhs look for drug interactions and allergies.
RPhs fill narcs.
RPhs take phone-in scripts from doctor’s offices.
RPhs answer the customer’s/patient’s questions.
RPhs do a ton of paperwork.
RPhs are who the techs look to when they can’t work out an issue.
The point: techs do the bulk of the work, but it’s the RPhs that do the tasks that need the education. RPhs do get stuck with tech tasks, though, especially when corporate keeps cutting back RPhs overlaps and tech hours.

Comment by Google Account on 2008-07-31 20:05:16 -0700 #

Don’t forget that our job is not just about catching mistakes Dr’s make and finding drug interactions, but also identifying all drug-related problems and looking for a solution. So just because a combination of medications won’t kill someone doesn’t mean it is the best choice for the patient. We must aim also to do good. So if a therapy is necessary but absent, having a discussion with the patient and/or provider is important. Also, I believe education, to patients, providers, and the public is a huge part of our role. And like you said, we are well placed to be translators of information between providers and patients. But most of all, I think we work well as system navigators, helping patients to find their way in what can be a confusing mess of a healthcare system (be it down in the US or up here in Canada), acting as a readily available resource for patients, and taking stress off other parts of the system in order to improve care and reduce costs. Great response by the way!

Comment by Lipstick on 2008-07-31 20:25:37 -0700 #

Oh TAP, you are so very fabulous…I heart you.

Comment by UrbanRxTech on 2008-07-31 20:30:18 -0700 #

**clapping**Well said TAP!

Comment by Google Account on 2008-07-31 22:05:31 -0700 #

Thank you, Angry Pharmacist, and others, for taking the time to post and teach us. I sincerely appreciate it, and hope everyone learns from it. (PS…thanks for the tip about Tarascon.)
It won’t surprise you to know that the same patients that schlep into your pharmacy just left our office asking the same barrage of questions (we’ve already answered them), demanding *certain* brand drugs (we’ve already addressed that), livid about the $20 co-pay (we’ve already explained that). Sigh. But I won’t blog-jack…Hubby has his own blog, and I can whine about this on his time. But we feel your pain, just in a somewhat different venue. Medicine would be a lot more fun if it weren’t for the patients. 🙂
Mrs. LL, even as a physician/NP team, my husband and I were trained so completely differently, I sometimes wonder if our professions are from the same discipline of science. Pharmacology may as well be from a different galaxy.
But again, we are among the few who will thank you for calling us if you catch a mistake, and NEVER mind you asking us if a dosage looks goofy. We try to work WITH our colleagues, not form adversarial relationships.
Kudos to you for doing what you do so well.
-Just the NP

Comment by erik on 2008-08-01 00:27:29 -0700 #

What do we do???? We answer stupid questions like the 65 year old man who asks “does this razor blade fit my norelco shaver?” I’ve had it for 40 fucking years and have never changed the blade before!?!, or “where is the abreva? and why is it with the lip care stuff and not the toothpaste stuff?” or my new favorite that happened today…”is vitamin c the same thing as calcium???????” What the fuck? Who are these idiots?? We deal with Joe Public that has at best a 3rd grade education and we don’t see them one on one in a tiny room, we see them in hordes all coming to the counseling window looking for advice on this stupid shit and wasting our time while there another 20 people wondering why it takes 30 minutes to fill there fucking prescriptions. Meanwhile, we have 2 different fat-ass state-assistance customers in the drive-thru wanting their rx’s now, even though they are getting insulin syringes which clearly don’t fit through the drive-thru but they are too fucking lazy to come in and get them (heaven forbid they have to get up and walk a little bit), 3 phones ringing for customers to call and place refill orders, (because they’re too stupid to use the automated line) doctors calling in new rx’s (ever heard of a fax machine????) and cashiers asking why so-and-so’s rx is in troubleshoot for hydrocodone (yes its too soon to refill because you just got a 30 day supply 5 days ago!!). All this and still we have to call your office and get transferred 3 times to some nurses voicemail because you forgot to write the quantity/strength/directions/date/etc… on an rx because you are in such a hurry to get to the next pt thats been waiting in some tiny little room to complain that they have a runny nose and cough that you think requires a z-pak prescription, or to verify who the fuck you are that wrote a rx and can’t sign (or print?) your name legibly. (How about a DEA number?!?!) Newsflash, you’re not so important that everyone knows who you are by your scribble!!!!! It would be nice if we in the medical field could work as a team to get the best possible outcome for our patients, but because of ignorant people like you who think we just “count by 5’s”, the pharmacist role will continue to be hell while the MD/PAC role will continue to be over-sensationalized!!!! The most frustrating part is that the RPh is accessible to the public and can’t hide behind nurses and receptionists. We are put out there all day every day for the constant torture that the public applies to us. Until people in our own medical profession give us respect, how can we get it from the general public???

Comment by Google Account on 2008-08-01 02:35:44 -0700 #

My usual response to the pill counting comments (or the ‘why do pharmacists get paid so much’ idiots):

  1. “Yep, that’s all I do… Count by 5’s.. Until I accidentally kill your kid. Then I guess you’ll think I should have known better, right?!”
  2. “Well…. That’s what we do, count by fives…. in between your doctors trying to kill you all despite our best efforts to prevent it…. Some days I even get up to 30 before the first error.”
  3. “The reason we have to know so much (or get paid so much) is that we’re ultimately responsible if your doctor is successful at killing you. So I need to know my job, and most of his.”
    Then I sit back and watch the deer in the headlights try to swallow their tongues.

Comment by Google Account on 2008-08-01 04:59:12 -0700 #

Picture this its 9 am Monday morning. Pharmacist and Pharmacy Tech open the pharmacy. There are already 3 people at the gates either waiting to pick up or drop off prescriptions. You have 15 or so Dr Calls (Call the Doc for more refills or needs prior auth and such) and about 30+ scripts to refill in your computer queue. So while locking up all three computer screens trying to process those refills your on hold with the Doc (if they are open yet) and trying to get the lady in front of you to dig out her current insurance card for kid 3 of 4, no not the one that we had on file for you 5 years ago. She then upturns her whole purse, the size of a house, on your counter because she can’t find anything in that black hole called a purse. At the same time your store manager has come up to the counter to yell at you because you had one minute of over time yesterday and you have to fill out a statement as to why you had overtime and what you can do to prevent that in the future. And the fact that you were trying to help out because at the register the line has grown to 16 deep is not an acceptable answer. He/she also has comments on your superior customer service scores. BTW this drives me nuts, I don’t think of my patients as customers they are patients or clients. Of course I sell a product and service but it is much more than that to me and I hope to my patient. He/she wants to know why you didn’t recommend some extra product (Benifiber or toothpicks for all they care they just want the sale) to the customer who turns out was a secret shopper. The secret shopper has the wonderful job of rating you on if you greeted them with a 1000 watt smile, tried to sell them something else (this is why we have pushy sales people), and told them thank you and have a great day. At the other end of the counter the poor tech is just trying to help they guy now throwing the stapler at him/her. The tech is trying to explain why the insurance won’t pay for their script that they have been on for years. On top of that one of your major insurance companies is down because they thought Monday morning would be a fabulous time to update their computer systems. Then when things start to smooth out for you both you get a phone call from Dr. Dave Douche yelling at you because you don’t know anything, he didn’t go to school for 20 years just to be told by some glorified cashier that he doesn’t know what the hell he (Dr. Douche) is doing. I’m right you’re wrong… In the background you can hear the printer doing this weird squeaking grinding death sound, you turn in time to see your tech digging around trying to figure out what the problem is because a call to your tech support will mean hours of down time (which sounds great now, but when go time comes around again your back in hell x10). Oh ya, and to top it off the supper chains are having a pissing contest so that for every new prescription you bring to the pharmacy (transfer or a brand spanking new script) you get a $10 off coupon on your groceries next time you shop. So you have floods of transfers back and forth between pharmacies for $10 off, transfers btw are a pain in the ass, so it increases your phone time by 200% easily. So basically we are caught between the patient, doctor’s office, insurance and have to kiss the store managers ass every now and again because they have a complex because the pharmacist makes more money but they (the store manager for Gods sake) work harder blah, blah, blah. This all in addition to what TAP has covered already.
Don’t forget the little things that get taken away from pharmacy staff that most people take for granted. Such as being able to take a lunch or when your food does arrive and it’s supposed to be hot and you don’t get to it till it’s roughly the temp of an ice burg or vice versa. And finally getting 2 seconds to run out of the pharmacy to go to the bathroom which you needed to do about 3 hours ago (now doing the bathroom cha-cha, and have to go so bad your eyes are watering) only to be stopped in some isle on the way to be asked where the red wine vinegar is. Not that any of this is really important. However a Pharmacist (or Intern/Tech) with an exceptionally full bladder who has been on there feet for 8+ hours and two bites of ice cold food doesn’t put him/her in a very good mood. But it is however been the excepted standard in pharmacy, and does occur in the everyday life of most pharmacy personnel. Thankfully some chain pharmacies have become a little better about some of this stuff, like putting a bathroom in the pharmacy it’s self. This however is the exception rather than the rule.
Let me just say I’m glad I made the switch to hospital a few years ago, we still have our trials and tribulations but they aren’t so bad some how. I still work in the outpatient side that also serves the ER, OR, and L&D departments so we get to see some interesting things every now and again. I’ve gone from the pharmacy that does 250-300 scripts in 12 hours to a pharmacy that does if it’s busy 65 scripts in 24 hours.
On to other things. I’ve heard of Pharmacists doing with their degrees. This is very far and few between, however there are supposedly a small percentage of pharmacists that actually are employed in the doctors office. They are there so that when the doc has come up with a diagnosis they are handed the information who then comes up with the appropriate medication for that diagnosis, make sure there are no interactions with current medications, allergies, supplements, herbals, and may even be able to take into account personal life style (are they the busy CEO who barely remembers to eat every day? are they fairly active? do they have the money for those glucose strips for 5 times a day testing? are they fairly compliant with their medication? you get the idea). I do hope that they have some retail experience so they know what insurance is likely to cover, and for example if X drug in a class is $200 and drug Y in the same class is $25 dollars with approximately the same efficacy for both drugs that they try drug Y first. They could go as far as counseling the patient in the office as they are training PharmDs to do now a days. Can you believe that they have counseling competitions?

Comment by on 2008-08-01 11:59:04 -0700 #

What does a N.P. do? I know!!! Instead of cleaning just pee out of the bed pans, they get to clean the shit out too. A BIG FUCK YOU!!

Comment by A Bonillo on 2008-08-01 18:28:41 -0700 #

Thanks for the well-described function of pharmacists, as this prescriber clearly needed some education on what we do.
Don’t forget how much time we spend on calling back or faxing back doctors to clarify dosing problems, lacking strengths on rx’s, etc.
I thought your image of their sure bewilderment at helping all their patients in a big room was excellent.
Portland, OR

Comment by amandarogers on 2008-08-01 20:44:28 -0700 #

I just want to put my input into this. It has already been said a few times but the thing that pisses me off more than anything in this entire world is having to tell a pt to come back later because I got transferred 5 times just to hear the same Stupid nurses voicemail…..and have to leave a message because she or the MD forgot to put something SO SIMPLE….dose/quaintity whatever!!!!! Then have to call back for the next three days because they can’t take three seconds out of there chat sessions to call us back!!! Like it’s that hard ladies and gentleman. We are the ones getting reamed because you have not called us back and heaven forbid if the pt calls you themselves because they are just as tired of the same STUPID voicemails. And IF YOUR CALLING IN SCRIPTS don’t talk like your on SPEED I can’t write as fast as your squeaky voice can go and it is such a waste of freakin time when I have to listen to it 50 times to get the message then have to call back anyway because you forgot the pt DOB. Come on people what makes YOUR TIME SO MUCH MORE VALUABLE!!!!!! And don’t be a bitch to me cause a PT is yelling at me and I have to call you to see where there script is just to find out they JUST LEFT the office and you have not had two seconds to call it in. I understand that but if I have you on the phone the pt is standing there staring at me wanting an explanation. So we look like idiots because you can’t answer the stupid phone for 1 min.

Comment by Google Account on 2008-08-01 21:00:32 -0700 # Author Profile Page said:
What does a N.P. do? I know!!! Instead of cleaning just pee out of the bed pans, they get to clean the shit out too. A BIG FUCK YOU!!
August 1, 2008 11:59 AM
Awesome!! That’s the stuff and then we can have a dialogue. You are so right about the poop though. As a nurse I play with a lot of shitza. Kinda sucks. Funny, I gave someone a blood transfusion today, and I don’t even know what blood is! Nursing is the best cash scam of all time!! I’m rich bitch!!

Comment by Nasty on 2008-08-02 08:40:46 -0700 #

I find this very funny b/c where I live in Canada pharmacists are getting the ability to prescribe certain drugs. All the talking heads are saying how great it will be for pharmacists and MD to work together. In my experience most people, MD included, have no idea what we do and don’t care, so I have a hard time imagining how we are all going to work together and ride off into the sunset together. I am tired of justifying my job and my salary to people who haven’t got a sweet clue what I do. I am just gonna stop ringing in their fucking toilet paper, I am going to ask them to wait while I have to go eat my lunch and tell them to call their own fucking insurance and ask why it isn’t covered. T

Comment by Pam on 2008-08-02 16:23:19 -0700 #

Twice in my adult lifetime, pharmacists, (two different ones) have helped me with correct dx’s which had been wrong by MD’s. The pharmacists also were able to prescribe the CORRECT meds.
I had a relative (an old-school RN) tell me long ago that pharmacists have way more knowledge when it comes to meds. than an MD EVER could; so she told me if ever in a quandry after an intial ov with an MD and not happy with results,(and perhaps before going for a 2nd opinion MD), to seek advice from a pharmacist as they could also “prescribe” from “behind the counter” and have me “sign” for meds. that they could prescribe for me.
Both times I did that; once for my child and once for myself….hello….the pharmacists’ made correct dx’s and had me sign for different type of med. and both were 100% correct as it worked!
These episodes were yrs. apart, but I did thank each pharmacist profusely AND let the MD’s know WHO correctly dx’d and rx’d in both instances!!
p.s. I love your site.

Comment by Sara on 2008-08-02 17:00:42 -0700 #

In addition to all the valid points TAP and other commenters said.. you did forget a few important things:

  1. You get to direct people to the location of the nearest bathroom.
  2. You have the honor of answering tough questions, such as
    “Where are the paper plates?”
    “Is the 24 pack beer that is on sale in your backroom, too? Cuz there aint any in the aisle..”
    “What do you mean, NOT COVERED? Cant you call my benefits office and take care of it for me?”
    “Why do I have to show an ID for Sudafeds?!”
  3. You also need to be aware of EVERYONE’S expected co-pay, be able to have their prescription ready in 5 minutes, and especially know what IS and ISN’T on their formulary, and if it costs too much, furthermore, know WHY it costs too much, and what WON’T cost too much.
    But this is only what TECHS are expected to know.
    I can’t answer for pharmacists. They have their own shit to deal with.
    I can say I have had one patient ask the pharmacist if she would mind checking her head for lice.
    We appreciate you, TAP, and other hard-working pharamcists. And when I go pee, I think of you.. standing there, wishing you had depends.

Comment by on 2008-08-02 19:30:57 -0700 #

We are your receptionist, scheduler, office manager, billing department, your nurses assistant, nurse, and sometimes you when we say, “Now I’m not a physician, I can’t diagnose you, but based on what you’re telling me, sounds like _____ and I’d have that checked out if I were you.” We work for the DEA, FDA, DHEC, Home Infusion pharmacy, Retail(counter jockie), Hospital(round with teams of MD’s,social workers, med students, pharmacy students, nursing students, head nurse on that floor) or we are inpatient pharmacists, Nursing home pharmacies, Consultants, Drug Reps(Lilly is huge on hiring pharmacists), Independent Pharmacy owners, work for the prison system or the State, Mail order pharmacy, work at VA’s(usually same as hospital duties), we run our own coumadin clinics and check INR’s and adjust doses, we hold brown bag forums for pts at local centers so they can ask us about their meds and we can check for polypharmacy and that’s all I have to say about that.
Also, a big majority of my day is spent catching the dishonest pt with the polypharmcy or altered control substance/I pay cash combo and trying to get the usually soft hearted MD to kick their butt in jail, but what gets me off is that it’s not the MD that makes the descision, it’s ME! I get to make that call and those people get off the streets and get help!

Comment by The Ole’ Apothecary on 2008-08-02 20:50:21 -0700 #

MD and NP,
If you have questions about a drug’s name, approximate cost, strength, dosage, administration route, regimen, commercial availability, refills, indications, contraindications, pharmacology, interactions, absorption, distribution, metabolism, excretion, pharmacokinetics, insurance coverage, legal status, toxicity, patient profiling, and stability, your pharmacist can get you this information very quickly. Practitioners with prescriptive authority rely upon us heavily for this instant information service, which I agree is not apparent to those who are standing in front of the pharmacy window watching us work. Like any great power, knowledge is invisible until it is summoned. Try us. You’ll like us!

Comment by KDUBZ on 2008-08-03 06:31:16 -0700 #

This question really just goes to illustrate what a piss poor job we pharmacists do in terms of promoting both the services we provide and what we are ultimately capable of providing. I will say I am happy that the people who generally are angry/misunderstanding towards pharmacists are generally ignorant of our responsibilities (and indeed ignorant in general), whereas I have found that more educated and accomplished people I know tend to think very highly of pharmacists.
I kind of blame our professional organizations for not doing a better job stepping up to bat for us. Hell the AMA has got to be one of the bitchiest organizations ever, they fight for the rights of physicians…even with regards to sometimes stupid issues. But they get the job done (don’t hang me if you are a physician and feel otherwise.) The APhA seriously needs to grow a pair and start fighting for us, since CVS and Walgreens sure as hell are not going to promote the profession.

Comment by RJS on 2008-08-03 08:33:12 -0700 #

There’s actually no disulfiram reaction between Flagyl and alcohol.
That’s an old wives’ tale with absolutely no peer-reviewed evidence to back it up. In fact, there are a number of not-well-publicized studies that have refuted this claim.
You can get started here, if you really want to know.
It’s about time they stopped teaching that particular bit of nonsense in pharmacy and medical schools.

Comment by RJS on 2008-08-03 08:37:55 -0700 #

It is my opinion that every person in the medical profession should do someone else’s job for a short time. That means a 3-6 week rotation in a retail pharmacy for every medical and nursing student. I would say the same for pharmacy students, but they already do rotations with the MD/DO types, so it’s less relevant.
I think it would go a long way towards breaking down the idiotic barriers that exist between the various sub-fields.

Comment by Shalom (R.Ph.) on 2008-08-03 08:47:46 -0700 #

My stock answer to the “count by fives” question (or “taking pills out of big bottles and putting them in little bottles”, fsck you Jerry Seinfeld) is, “Nah, that’s the easy part. What we get paid the big bucks for is figuring out how to fit the bottles into the typewriter.”
(OK, I’m dating myself here. How many of today’s grads have ever even seen a typewriter? I remember when I started in this business as an intern back in ’94, every store still had a typewriter stashed under the counter as a backup to the computer, in case it went down. And a Bates machine…)

Comment by The angry CPHT on 2008-08-03 11:25:02 -0700 #

you want to know what we do??
Let’s start with the first script of the day, written on a blank ER pad, with no letterhead, Doctor Who!!
I know you must have spent hours perfecting your ‘rockstar’ signature…but really, all I see is a capital “looks like an O” followed by a squiggly line…and ending with what could be a G…possibly a Y”
and THIS is what i have to tell the ER nurse, right before i get ‘attitude” for interrupting HER busy day! ( I love the library full of well-worn Harliquen Romance novels i saw last time in there, btw)
And THAT is if we’re LUCKY enough to GET a signature on that Class 2 Narcotic!! I know it probably isn’t too much trouble for you to rescrawl on it, when the patient has to bring it back, but I just lost 5 pounds off my backside over the situation!!
Yes, customers do not yell at Drs often..but it’s a daily occurance in a pharmacy. They stand there in front of everyone and SCREAM at us, for each and every little mistake you make.
Oh, and FYI…at any given time of any day We have Inspectors walk through the door, pull our files, and examine each and every one of those Rxs that you’ve maimed and we’ve corrected. Federal ones…State ones…Retail Inhouse ones.
God help us if we just type what you’ve written, and passed it out…because THAT would be OUR licence!! You don’t have to be responsible for it…we take that bullet for the team.
Cookies at Christmastime, and telling your nurses to “lose the tude” would be an appropriate beginning to a “thank you’

Comment by WAGslave on 2008-08-03 15:00:36 -0700 #

I couldn’t agree more with KDUBZ!!! When are our professional organizations going to REALLY stand up for us! I’ve been to meetings with mixed health care pofessionals, and I have to say, hands down, the physicians always impress me with their ability to stand up for themselves and get their views addressed. Is it just me, or does the pharmacy profession attract way to many bright people who don’t possess a backbone? Too many pharmacists cave when the shit hits the fan.
We do a terrible job of standing up for ourselves … the big pharma chains aren’t going to do it (they’re more concerned with keeping investors happy than their staff), the boards of pharmacy aren’t going to do (they are very clear that they are there for the public at large, and not the profession itself… try calling them and seeing how much help you get other than them reminding you of which law you are at risk of breaking), and trying to unionize doesn’t work (thanks Walgreen’s in Illinois … when you guys broke the union, you essentially sold the rest of us out. Fuck you.)
Who’s left? The public? Yeah, not likely. They want cheap and fast service like everyone else. If they don’t get it, they comlain about us, and not for us.
We need to find some advocacy that really stands up for us. If someone has a good idea, sign me up!

Comment by Google Account on 2008-08-03 19:46:19 -0700 #

Yup, I was filling in at a long-term care facility (ususally I do retail) and got a call from a bradn-new intern. Client in the nursing home had a cold. The nurse has told her that perhaps a DM would be good. Do we have it? What dose? (Really? The baby-doc didn’t know what dose on DM???WTF) Then baby-doc goes on to ask what decongestant we have. Um, phenylephrine. Then baby-doc asked me what dose for that too! I mean, I know she was new (clearly) but she was damn lucky she got me and not the usual long-term care guy because he hasn’t worked retaoil in 30 years and doesn’t care either. aHe would probably have told her to screw off and look up the dose herself.
THEN I had to write up the order for her because writing up an order is not covered in school apparently. Weird.
But that is another thing we do. suggest doses and drugs.

Comment by Google Account on 2008-08-03 19:50:57 -0700 #

Oh, funny story, I forgot to mention. I was filling in at a large chain retail store and rang through a client’s meds, took payment and sent them on their way. 17 year old assistant manager was going by and came over to ream me out for not “celebrating the sale”. Leaving aside the fact that I wasn’t actually a company employee, I was filling in for a sick friend and don’t work there,and thus they have no authority over me, I looked at the teenager blankly and asked what the hell that meant. asst mgr said,”for example, if you are selling a pack of gum, you would say,”enjoy the gum, sir!”” So I said,”so I should have said something like,”Enjoy your meds for that sexually transmitted disease””? Asst mgr got red and left me alone in a hurry after that!

Comment by nurse guy on 2008-08-04 00:07:43 -0700 #

I am a Registered Nurse on a tele floor in a community hospital (meaning we don’t have resident physicians on the floor, I have to deal with attending physicians directly – usually via pagers and phones since I work PM shift). I can see how physicians have no clue what Pharmacists do. Where I work there is a cadre of docs who allow the Pharmacists to dose warfarin and a different cadre of docs who would rather drink bleach than let a Pharmacist dose warfarin. Hospital Pharmacists have to prep lots-o-IV-meds which I administer. I call them often on proper infusion rates. I have a lot of geriatrics who have to take their pills crushed in applesauce since they have aphasia – once again I call a pharmacist and find out if I can or I can’t crush meds. I got grannies with G-Tubes <> I call the pharmacist to ‘please can I get KCl liquid instead of tablets?’ cuz the crushed tabs are clogging the G-Tube. I had a doc write for ‘Domeboro’s solution 1:20’ last week. Pharmacy called me and said it was archaic, do I really need it? I said yes, and they mixed some up and the tech hand delivered it to me. I had an order last week to change IV Lasix to PO with a patient who was being discharged to an ECF. I called to have it changed stat – I could sense stress in the Pharmacists voice. I sent a thank you note to the Pharmacist – (using our CIWA-scale flow sheet) included some candy and sent it to her via our pneumatic tube system. An hour later I received a call from Pharmacist – she was almost in tears with gratitude and she told me how many times she was getting yelled at that night. BE NICE TO YOUR PHARMACISTS/TECHS – THEY HAVE YOUR BACK. I love to read The Angry Pharmacist when I get home from my grueling shifts repositioning Norco-addled obese patients with “back-spasms”

Comment by chemoqueenrph on 2008-08-04 05:40:25 -0700 #

The number one thing that frustrates me about my job is that sometimes it is hard to ‘do’ anything because of the CONSTANT interruptions. The phone is constantly ringing. You get interrupted with lots of questions because you are a walking reference source. Anytime you call a pharmacy for any reason, remember that there are 100 other people out there that have called that same phamacy that same day for a similar reason. Meanwhile, you are supposed to be thinking about whether the dose ordered is appropriate. Is it a duplication of therapy another doc has already prescribed? But God forbid you make a mistake, even though you were interrupted 5 times trying to get a script or order into the computer. Then the stress level ratchets up from problem after problem that can bog you down & keep you from getting stuff checked & out the door. Then your clients start getting pissed & scream ‘Why does it take so long? All you have to do is count some pills!!’ Problems such as a script or drug order that has a missing piece of info, or info that is plain wrong like a fictitious strengths or 10 fold overdose. If it’s a topical, I cannot tell you how often we have to call and ask cream or ointment? Do you want Glucophage? Or Glucophage XR? We get orders in the hospital to resume what the patient was taking at home, and there is always a problem because people can’t seem to copy information off a prescription bottle correctly to save their life! Then half the stuff they take at home is not on hospital formulary, so you have to look up the substitution. No substitution? You have to call & see if the patient can have their own brought in. Or you make the substitution and the patient says ‘Oh, I can only take Brand X’ so now you are back to can they have their own brought in. And how many times a day do you go to get something off the shelf and it’s not there. Because someone forgot to order it. Or it’s on national backorder. And it’s Saturday evening so you are calling all over town trying to find someone who can loan it to you.
Or my personal favorite, you have a patient on Friday evening (of a 3 day holiday) who starts going through your Levophed supply like water, and you are calling all over town to get more because if you run out, they will be dead in 5 minutes.
Is it any wonder we all drink when we get home from work?

Comment by James on 2008-08-04 17:42:10 -0700 #

I’ve always been told that it’s not what the pharmacist “does” — it’s what he knows that’s important. And that’s what I tell people.

Comment by Google Account on 2008-08-06 12:15:14 -0700 #

I’m just another PharmD, and I just found this site. Quite interesting…I’m sure to visit again. Anyway, I read the first post and here I am commenting.
In response to angryRPh, np/md, and all the commenter’s…I think the following needs to be said.
An MD and NP don’t have a clue what we do…it is sad, but don’t you see? Here in lies the true problem of today’s fast-food paced pharmacy world. If an MD and NP don’t know what goes on behind the counter, the general population sure as shit doesn’t have a clue either. When people don’t understand, it makes it a whole lot easier to get angry, because ignorance takes over and they feel justified. I am of course talking about patients getting angry about a 15-25 minute wait. In general, its simply because they DON’T UNDERSTAND what could possibly take so long. On top of that they also are usually dealing with some sort of illness as well and don’t have the patience to want to understand either. Sure..WE know that we’re dealing with 30 other things at the same time, but patients really believe everyone back there behind the counter is tending to THEIR scripts they just dropped off… not the 15 others before them, along with md errors/insurance problems. I read an article some time ago in Drug Topics or Pharmacy Times that stated 40% of prescriptions dropped off to a pharmacy have some sort of error whether large or small. If patients new this!, maybe they would have a little more respect for what we do and would focus on what is important… that being getting their medication correctly, not in 5 minutes. I’ve had a wide range of compliments working as a retail pharmacist, and some of the most genuine have been in regards to important interventions that I�ve made, but sadly the most common compliment is how fast they got their medicine. “He’s good, he’s really fast”. What the F does that have to do with good healthcare?! We are healthcare professionals, not vending machines. As such, we are the LAST LINE in the healthcare system before the patient receives their treatment. There are a lot of errors that can occur along the way, and that’s a whole lot of responsibility to make sure its right when the patient walks out the door. I don’t know when and where pharmacists started bending over, but for some reason the respect is lost from the Dr’s office/hospital on the way to the pharmacy. A patient won’t complain about a doctor wait because in general there is a higher level of respect for their responsibilities. Its pathetic what the common perception of a pharmacists job has become to the average joe on the street, let alone a MD and a NP. What is even more sad is that we don’t even have time to explain ourselves, not that we should have to either. In a 400+ script count day with one pharmacist, it would take too long to explain to a patient that they had to wait longer than normal because their doctor wrote for a medicine that was discontinued a year ago and we had to wait for him to call back before we could get authorization to make a change, then he made a change and left it on the doctor message line, but that rx wasn’t covered by the insurance, so we had to determine what would be covered and call the physician back, then waited again for a return phone call. And when it comes to counseling we have to make it short and sweet because there are 5 other people staring at you waiting for their meds. If I had the time I would not only like to counsel longer but become more social with patients and establish better personal relations. I guess this luxury exists in a smaller setting, but i have yet to experience anything other than a short staffed busy as hell pharmacy. About a year ago I started talking with friends in the healthcare community about how a nationally televised special should air to help educate the general population about how complicated it can get behind the counter in most busy pharmacies. I thought it would be interesting to those that don’t know and also do a great justice for our profession. It wasn’t but months later that 60 minutes aired a special that did the exact opposite. Whoever was behind that program should kill themselves. No, i’m serious. It wasn’t close to what really goes on, and to top it off they paid off a couple old grumpy RPh’s to back their findings. It gave the public the ridiculous idea that high school teenagers could have any part in making decisions about their medicine, and that we make life threatening mistakes on a regular basis. Leave it to classic media, ruling with fear. But this armed the naive public with the right to accuse and question our methods, slowing us down even more. If I have to go on Opera and jump on her couches I will but something has to change or this profession is going to get ugly.
Cheers to a new day-RxMAN

Comment by Eric In California (but from Melbourne via London). on 2008-08-06 17:06:25 -0700 #

Chemists and pharmacists provide considerably more services than simply counting by fives. I appreciate what most chemists/pharmacists do, and it is important to realize that they are a vital part of the primary health care team. The average Pharmacy have many things to offer patients – the advent of the Pharm.D. helps describe the work of the chemist much more completely than R. Ph. does.
Good pharmacists are worth their weight in gold (or Jennifer Connelly in lingere’, stockings and garters depending on one’s perspective). Keep up the great blog mate! And you also provided a very good answer!

Comment by CPhTechbabs on 2008-08-06 18:49:42 -0700 #

Lets not forget:
Those patients who just want us to “fill the little white one” or “the green one”. And thats a few minutes to cruise their profile to find exactly which of the 3 “white ones” they want. Nope they are not sure what they are for the Dr just told them they had to take 1 every day.
Not only do patients yell at us and become out of control, they like to spit and toss things at us too, when those xanies are a bit to soon and no you cant pay cash, please come back in 10 days (and yet manage to call back in a few hours, just in case a different tech is working and they can pull a hardship story to get them xanies filled early.)
Prescribing drugs that dont exist(usually Mg issues), or havent been on a shelf for years.
My personal favorite: Yes nurse, this script has been altered (which is a felony….right?) would the Dr persue said alterer? Why no Doc just said fill it with no refills, he will speak with said alterer on next visit….WTF??!!!
Yes, lukewarm lunches and potty breaks (called “code b” by the way) are few and far between. And yet, I love my job!!! I have great apprication for RPh’s and what they do.
Thanks Tim the Rph for sending me this link!!
I would love to work with you AP!! love the blog!

Comment by fyre93 on 2008-08-06 20:03:01 -0700 #

As as example from a new grad PharmD in a specialty setting:

  1. “So, could you show me where exactly, on my BUTT, that I’m supposed to inject this progesterone? Could you actually mark an X on my butt with a Sharpie, so my husband can see it?” (fertility patient)
  2. Recently diagnosed HIV patient, starting HIV meds for the first time. No problem, right? Some moderate counseling over side effects, importance of adherence…oh! right! He’s also being treated for TB, so he’s on rifampin, isoniazid and ethambutol. Oh! And WARFARIN, d/t having mechanical heart valves! Seriously, let’s throw in some cimetidine and digoxin and phenytoin and have a big party! Lovely!
  3. “Yessir, gas prices are hurting us all. But a $25 copay for $7900 worth of Remicade does not qualify as ‘rape’. Have you considered trading in the Hummer? Just a thought.”
  4. IVIG. Enough said.
    We all have our battles!

Comment by Rxdoc on 2008-08-07 15:25:39 -0700 #

Like a previous poster said, we do a poor job of promoting what value we really bring to healthcare. Working in both hospital and retail, I enjoy a very collaborative relationship with physicians and other professionals when practicing in the hospital, but too often it seems that the retail environment is much more adversarial.
Our profession also is a house divided. ASHP members don’t necessarily care about what APhA members want, yet we are all pharmacists. The practice environments are very different – I don’t have to reiterate what so many before me have said. Perhaps some day technology will truly free us from the routine and thankless parts of our jobs so that we can spend more face-time with patients, and then they’ll iknow that its more than just counting by 5’s or mixing IV’s.

Comment by Google Account on 2008-08-08 00:02:39 -0700 #

As someone who has multiple health issues and takes some 15 different medications every day, my pharmacist is an integral part of my health management. I recently switched pharmacies after a decade because of staffing changes. The new guy was rude and kind of nasty, and since I’m in and out of there pretty much every week, I really need someone I can work with.
I usually give my pharmacy staff cupcakes.

Comment by Pharmacist on 2008-08-09 05:52:12 -0700 #

I once was asked, “How many weeks training does it take to be a pharmacist?”. Ha.

Comment by on 2008-08-10 01:57:54 -0700 #

I can’t believe these two. “What does a pharmacist do?” about keep the doc from fucking up big time because when he was still a rosy-cheeked kid in medical school he slept through pharmacology? Probably because he knew that the RPh in the hospital basement would save his bacon if he happened to make a lethal dosing error.
I saw this happen a couple of weeks ago. Pharmacist says: “You can always tell when the kiddies get out of the med school and start work over here(teaching hospital).
That’s when the lethal dose errors start showing up on the computer. Happens every summer.”
Pretty damn scary.

Comment by Dave Leeson on 2008-08-13 09:28:32 -0700 #

Thank you!
One big annoyance of mine (I’m a hospital pharmacist) is doctors & residents writing med orders “patient may take own meds” or “pharmacy to clarify medications and doses.” Come on! That’s just plain lazy, not to mention dangerous. This is fine during the day when the pharmacy is open, but what about overnight when the pharmacy is closed or the weekend when staff and hours are shorter? Most patients don’t know the name of the drugs they’re taking or what they may interact with. Short cuts like this may save an overworked resident time, but could ultimately cause pain, suffering or even death.

Comment by chilihead on 2008-08-14 12:07:35 -0700 #

Almost a year ago, I passed my pharmacy technician certification exam with flying colors. I could not get a job right away, unfortunately, because I was the sole caretaker for my newborn infant and a husband undergoing preventative chemotherapy for a colon (pre)cancer.
My husband is all better and I had been trying to find work, which seems impossible right now in Orlando. Well, the experts recommend against a career change. (I have no pharmacy experience; I have a diverse work experience, but the closest to pharmacy is my work years ago as a veterinary assistant, when I would count the pills for dogs and cats.)
I stumbled upon this blog almost a week ago. After reading some of the nightmarish articles here, I wonder whether or not this has been a blessing in disguise… That I should not walk, but run away from this field as fast as I can, and go back to my data entry temp jobs for a while longer until I can better brace myself.
In any case, The Angry Pharmacist is hysterical. He reminds me of my husband on a bad day… or even a good day back before he had to struggle with chemotherapy.

Comment by CPhT on 2008-08-17 09:59:34 -0700 #

As a tech, I have much respect for the RPh. The crap our RPh’s go through, it’s amazing they are still IN the profession! Put a DR in the RPh’s shoes for ONE WEEK! THEN They will understand “counting in 5’s”! I truly don’t think the doctor could HANDLE it! They’d be flying back to the comfort of the office/hospital so fast your head would be spinning!

Comment by EG on 2008-08-25 09:52:24 -0700 #

My only question for all of you NP/PA’s out there is why in the great state of SC do you think you can write prescriptions for controls without a DEA number AND a state license number?! What do we do!?…well, in addition to all the duties listed above, we educate all of you fools who think that after 6 years of higher education prescibing rights mean you can write anything for anyone without the proper licensing. Do they teach you in those 6 years what you can and can’t prescribe and where to apply to obtain the correct licensing? Because in my 8 years of higher education (yes, a BS and a PharmD) I learned the LAW!

Comment by Rosanna on 2008-08-26 15:25:57 -0700 #

Let’s not forget the SHIT RpH’s deal with

  1. Conceited rich bitches who do not notice the big red sticker on their birth control RX that reads ‘no refills’ and as a result are having twins.
  2. Schizophrenics who eat lays and chips without paying for them all while demanding free klonopin because their $4 copay is far too much.
  3. Agitated, sweaty, crack heads who cannot bear to wait in line only to ask for their ’10 cc’ ‘diatetic’ needles. STFU and just admit you need to shoot up.
  4. 25 year olds that have their parents bitch and moan how i HAVE TO punch in a manual credit card (against store policy) for an URGENT medication. No no, not cipro, YAZMIN.

Comment by Google Account on 2008-08-28 17:14:45 -0700 #

Well, I can’t say that I know what a pharmacist does as far as what they use to compound what medicine, etc., but I know my pharmacist was able to basically tell me what to ask my doc for when I went to him with a heartburn prescription script that was just far too expensive. He explained the pros and cons and told me to discuss it with my doc. Turns out, his suggestion has worked as well or better than the original medicine.

Comment by RPH One on 2008-08-29 15:40:38 -0700 #

Hey Dude, as long as they are paying us 130k/year to start, I don’t care enough to “advance the profession” because when things do go south in the pharmacy profession (and you all know it is coming!!) we’ll be sitting pretty on a nice nest egg laughing at the MD’s/NPs who want to get into dispensing, then we might get some respect, lol

Comment by lasbelindi on 2008-09-05 18:43:43 -0700 #

Well, Mrs. NP… If you and your “hubby” honestly don’t know what a pharmacist does, I doubt your capacities as health care professionals. If you really want someone to explain it to you, here; I’ll be sure to use layman’s terms to be absolutely sure you understand. I’M THE LAST BLAST BETWEEN YOU AND A MALPRACTICE LAWSUIT!!! There. Get it? You might want to keep that in mind when you have your snotty, unqualified receptionist try to call in a prescription for Adderall. (Yup. I’ve seen it done.)

Comment by Fired up MD on 2008-09-06 08:22:07 -0700 #

“”…Sure, any pharmacist can diagnose heart-failure, or diabetes, or hypertension just like any MD/NP/PA/etc knows the basic drugs to give…””
Before I toot my own horn, let me say that

  1. CHF is a complex diagnosis. If a patient comes in to the ER with SOB, I’d like to ask a “PharmD” what to order AFTER they have examined the patient from head to toe (If you hear crackles in the lungs but not pitting edema, is it left or right sided heart failure?… Is it an S3 or S4 gallop? What is the JVD? If this is the 75 year old patients 3rd of 4th CHF exacerbation, what is the liklihood they might die in this exacerbation?)
    WITH ALL DO RESPECT, I APPRECIATE PHARMACISTS WHO PAGE ME AND TELL ME I MADE A MISTAKE ORDERING A MEDICATION. HOWEVER, with 2 years of TRUE DIAGNOSIS COURSES (aside from pathophys class, cardiology, etc etc etc), 3 years of residency, PHARMACISTS ARE NOT TRAINED TO DIAGNOSE. Sure, you learn many symptoms in school. Great. Diagnosis is a COMPLEXXXXXXXX way of thinking. Back to shortness of breath in the ER. So what do you do? What do you do FIRST before anything else? HOW DO YOU RULE OUT OTHER CAUSES? (Is it pulmonary, cardiac, heme, infectious, etc etc in origin?) What tests? **JUST LIKE YOUR “DRUGS”, INSURANCE COMPANIES WONT PAY FOR RANDOM TESTS… SO YOU HAVE TO HAVE A TRUE INDICATION FOR IT**…THEN, when do you call a consult?
    With all due respect, again, PharmD and MD are not equivocal. Be glad that we DONT know everything or else you wouldnt have JOBS!!!! Our brains are full of many many many things. If I studied 4 years of just drugs, I’d be proud too.
    PS- My PA catches things that I miss. I’d like to see you try to run circles around any PA. These kids work harder than MDs because they function essentially as residents

Comment by Fatima on 2008-10-02 15:33:37 -0700 #

“8. We spend the next week getting phone-call after phone call from this patient about every little side effect that he/she is having claiming them to be ‘allergies’.”
Whenever I had a question about a prescription med I was on, I called the doctor who prescribed it! Until reading your post, the bugging-the-pharmacist option never occured to me.
“4. 25 year olds that have their parents bitch and moan how i HAVE TO punch in a manual credit card (against store policy) for an URGENT medication. No no, not cipro, YAZMIN.”
Lemme guess, it’s urgent because she’s taking it for hirsutism (like I do, since I don’t have *hours* to shave and pluck my face every morning) and has a job interview coming up very soon. As for those bitching and moaning parents, I bet that 25 years ago they knew damn well that (a) for centuries everyone in the family has sprouted beards and moustaches since puberty, women and girls included and (b) “bearded lady” is a bad reputation to have in the West but still decided to risk having a biological daughter in the U.S. (like my parents did).

Comment by Pissed off PharmD on 2008-10-02 19:09:30 -0700 #

Are you fucking kidding me? Seriously? What does a pharmacist do?? If you would pull your heads out of your asses you would see that not only are we the ones who cover your ass in the real world, we are also the ones that make sure Grandma & Grandpa shoved off in the nursing home and forgotten about get meds appropriate for their age/condition since you’re too fucking busy to come out and see them your damn self. We keep them from being “chemically restrained” for all you doctors who think the best starting dose of Seroquel for Aunt Betty, who is 88 years old, confused and delusional who also happens to be on broad spectrum antibiotics for a UTI for which the C&S is still out on, is 100 mg hs!! We cover your asses so state surveyors don’t “bother” you with pesky issues such as why so and so is still receiving FeSO4 TID when his last 5 CBC’s have all been well WNL. Or Mr. Yada had heartburn 6 years ago but is still receiving omeprazole 20 mg BID. Ooops…you forgot. No shit. I have to say that my favorite dumbass doctor mistake is when someone with hepatic encephalopathy who is, as they should be, receiving Lactulose multiple times a day develops diarrhea (duh!) so the doctor changes it to PRN constipation and adds routine Colace. And you wonder why their ammonia level shoots through the roof. I’ve seen this more than once by different MDs. So what does a pharmacist do? If you’re too friggin’ ignorant to see, then you need to question whether you’re truly intelligent enough to “diagnose” someone who is dependent on you for their life. This isn’t a game moron.

Comment by screeb on 2008-10-07 19:14:05 -0700 #

“Hmm, count by fives.”
Yes, and earn by the hundreds, you idjit skank.

Comment by cathy cpht on 2008-10-08 09:16:40 -0700 #

Just want to say. I’ve been a cpht for 20 years.
I have had questions like”Why is my hamster shaking? and Can I give my dog tylenol?” I use half my day working out financial issues for people who cannot afford the high-priced drugs that the docs prescribe, sometimes because the drug rep has been pushing that drug lately (When cipro would work) or deciphering the latest garbage on the new “fool-proof” electronic scripts eg Take 1 tablet daily for 30 days. Dispense #10 or the change from metformin xr to metformin because …….who knows why. Was it intentional? Oooops better call. Then we get to deal with Dr. hopping druggies and the stories that go with it. And I wont even go into the requirements that CMS is saddling us with now to give a customer glucose testing strips. It is NOT as easy as it looks , chickie. Follow me around for a day and you’ll be glad to go back to your 2 hour lunch break.

Comment by man52fold on 2008-11-22 13:31:10 -0800 #

What do pharmacists do? All you had to tell the NP was that they now have to dispense, compound, and keep records of patients refills, insurance and all the other bullshit we do. Then she would have an appreciation of what we do. We are not drug experts, I do not know how anyone can say that. We are here to assist the physician in their drug selection. Do you want to tell a cardiologist that you know more about amiodarone than he does? I didnt think so. We are the drug accountants and police of the hospital. We are here to make everyone’s jobs easier. plain and simple. I feel sorry for the NP because she really showed what an idiot she is. There are other things going on in the world that are a little more important than her doing hernia exams. IMO (which counts more than the NP’s)

Comment by Meagan on 2009-02-18 19:34:17 -0800 #

The problem is…health care professionals do not have a mutual respect for other health care professionals. I mean its easy to say nurses do nothing when your a doctor or pharmacists push pills when your a PA because we don’t see the difficult days each of these professionals experience. If the pharmacist spent a day in the ER watching nurses run around stopping bleeding and saving people from circling the drain without having a second to go to the bathroom they might hesitate to say that we just put people in rooms and let them sit there. And if the PA spent time in the retail end of things listening to the ridiculous questions about the diarrhea they got from taking antibiotics we might hesitate to say what exactly do pharmacists do. So in the end Pharmacists would be unemployed without physicians and PAs and physicians and PAs would not be able to do half of what they do without a pharmacist there for guidance and help. Think of all those phone calls you would have to make at the end of the night about every single medication you wrote that day…you wouldn’t sleep.

Comment by Terri on 2009-09-17 15:54:34 -0700 #

I have a question that maybe someone could answer for me. I work in a Psych clinic that is run by a NP I will call him “Joe” Joe writes scripts for coworkers i.e. antibiotics for the coworker and or child that is at home sick. Xanax for the nervous friend, gives free samples to friends and coworkers. Mind you now, these are not patients and I wonder about the legality of writing scripts to people that are not seen in the office let alone in a Psychiatric setting when the scripts are sometimes not related to Joes specialty.
I am just a paperpusher but even I can smell a rat? Joe is very quick to tell the office staff when we call refills in what morons Pharmacists are etc, but I am wondering here if he is in need of help himself.
Any ideas?

Comment by Madeline on 2009-09-29 20:37:03 -0700 #

Hi Angry Pharmacist,
How do you feel about pharmacy surveyors/auditors? You know those assholes who parade through the hospital sniffing for trouble and questioning everything from our policies to what we throw in the goddamn trash. Some of it is acceptable within reason and may actually be helpful for the department, but there are those that take it too far. What’s surprising is that the surveyors who are actually pharmacists themselves (i.e. one of our own) are the ones with the longest, widest sticks up their frickin’ butts. They are the ones who create the most trouble. You would think that pharmacists as a group would stick together, but it’s these fags that work the hardest to create dissension among us. I absolutely detest them. I often wonder if they had preceptor pharmacists slap them around when they were students and are thus are out for some kind of sick revenge against other pharmacists in general. It just seems they want the power trip that they didn’t have when they were in school. Sorry, just had to rant.
I’m interested to hear your thoughts. Thanks.

Comment by J.W. Sprague on 2009-12-18 15:20:08 -0800 #

so then my little friend ..who would fill ur script…when a love one is dying oc cancer or ur fishing buddy comes to the Pharmacy counter screaming “I’ve got a fishing lure in my eyebrow” can u get it out?? or “Ms. I need a tube of lipstick” rolls up to the drop off window at the Pharmacy…I could write a sit-com on all that has to be tolerated by a Pharmacist working in a “MacPharmacy” and it would far exceed the rating of “Grays anatomy” or “ER”. Believe u me I bet not one active Retail Pharmacist had any idea what he was in for. Good Gravy..have u ever reviewed the course of studies…the old Pharmacist use to compound and was highly respected…It is the laws and more restrictions and red tape on and on… AND retail giants that have robbed them of their dignity and real aspirations to help people. Maybe the Doctors, Lawyers and CEO’s should trade jobs for a week.

Comment by Andrew on 2010-01-03 00:47:42 -0800 #

Pharmacists are the drug expert of Healthcare Professionals.

Fired up MD
That’s it you don’t know everything and you continue to need us.
Also, what you said is retarded – it’s like me saying well you’re lucky I don’t go to med school and take away your job.

Comment by Christie on 2010-07-19 09:22:01 -0700 #

I work for one of the big 2 and we were in the process of hiring a technician. An older woman comes in and inquires about a job for her neighbor…who does that?…Anyway she says “What experience do you need to be a pharmacist?” And I say “the position is for a technician not a pharmacist”. So she says….wait for it….”What’s the difference?” All I could say is WTF!

Comment by TargPHarmD on 2010-08-28 11:12:33 -0700 #

Holly Cow, apparently this NP is not very knowledgeable regardless of how much education she and her Husband have. It’s amazing to me how NP and PA’s have the biggest Napoleon complexes when it comes to their professions. We all have our Niche. Pharmacists have more pharmacology, physiology and biology than any prescriber. The NP should hope and pray that if she ever ends up in a hospital that it is a Pharmacist reviewing her med rec or dosing her med. Not handed down to a 1st year surgical resident (cephalexin) or phone nurse. Furthermore, in most countries, it is the pharmacist that picks the drug. The Physician diagnosis and the patient goes to the pharmacy and the pharmacist determines the best drug based on other med’s etc… Prescribing is not that big of a deal unless you attach it some false sense of authority. Pharmacist prescribe all day every day. Who does she think makes all the calls and gets the drugs changed. Hell I can’t tell you how many times an ER doc or Hospitalist has called me and asked me to recommend something. Maybe she and her husband should stop worrying about what we do and just be thankful we still do it inspite of her ignorance.

Comment by pharmstudent on 2012-03-20 02:53:07 -0700 #

Hello there.

I am currently a 2nd year pharmacy student.
im taking pharmacoeconomics which i have to write a paper for. And the question is…. Do pharmacists get paid too little or too much?

I would really like your input on this.

Thank you!

Comment by Eddie Lederer on 2012-10-17 01:14:22 -0700 #

I have a question. I have been on suboxone for five years. One of the things that I take seriously in my life is not straying from my program. I have been picking my meds up 3-4 day’s prior to running out. Most of the time in the past they would just fill it and send me on my way. Lately they’re hassling me and refusing to refill it until the day before! I don’t drive and I have to depend on people for rides or pay a cab, because we have a useless bus system in Kona, Hawaii. Do I have rights as a patient who is trying to make sure I have my meds? I don’t know how many times they have run out, were short… I can’t afford to wait until the day before. My sobriety (which is literally my life) is at stake. Please help?
Mahalo for your patients with pain and addiction patients… Forgive us! We are an ungrateful lot.
Eddy L.

Comment by Barb on 2012-10-20 10:38:01 -0700 #

As a cancer patient of nearly four years, I want you to know that I appreciate the knowledge and input my pharmacist contributes to my care. I am Stage 4 and can tell you, there isn’t anything quite like the pain of bone cancer. My pharmacist is truly my partner in the fight for my life.