Stole Our Hearts

 

Today’s story is a sad and difficult one.

One of our pharmacy’s favorite patients stopped by today. He’s a man in his nineties and loves to make us laugh. He didn’t have a prescription, but he said he had some other shopping to do. He stopped by and said hi to everyone. We all smiled and were glad to see him, as always.

Our smiles quickly faded, though, because we were informed by our store manager that she caught him stealing candy and a few other items. We didn’t want to believe it. We asked if it was just forgetfulness or senility, and we were told it wasn’t, as he had stuff shoved in his pants and jacket pockets and began walking out the doors without purchasing anything else. It made us wonder how many times he had done this before. =(

This is probably once of the most difficult things I have come across at this pharmacy. Luckily, I was not the one who had to approach him about it. Now, our trust in him as a patient and a person is gone. I wonder if he was stealing due to a lack of money, but still, none of the items he attempted to steal were necessities. Overall, it’s just so disheartening.

 

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Puffy Eyes

 

So, I had an interesting phone call today. A woman who isn’t a patient of ours called to ask about her eyes. She told me they were red, puffy, and almost swollen shut. I asked if both side were equally swollen, and she told me they were. She also told me the few medications she was on, but stated that she had been on them for a while. At this point, I had come to the conclusion that is was either really bad seasonal allergies or that she had consume or used something that she was allergic to without knowing it.

I asked if she had eaten anything out of the ordinary or new recently and if she had switched soaps or detergents in her house. She answered no. I started telling her that she should take some diphenhydramine and call her doctor first thing in the morning. She interrupted me, asking if there were any interactions with that and her other medications. I told her no, and she replied back to me:  “Well, that’s good. I just wanted to make sure, since these medications are all sort of new to me.” Whoa. Back up. Rewind. Didn’t she just tell me she had been on them for a while? I asked her when she began taking the medications. She told me she started them a week ago. *facepalm*

So now, the tables have turned. Now, I’m leaning more towards a drug allergy being the cause of this. But, the question is, which one is causing the problem? She started each of them on the same day. I told her this and let her know the only way to know for sure which drug would be the cause is to discontinue all of them and restart each individually. Again, I told her to take the diphenhydramine and call the doctor first thing in the morning. I also told her if she experienced any throat tightening or trouble breathing to go to the emergency department of the nearest hospital. She agreed to do so if needed, thanked me, and hung up.

The take home point of this story is to always ask questions. Lots of questions. Ask the same thing in different ways. Use open-ended questions (when did you start these medications vs. have you been taking these medications for a while). It’s important for us to ask these questions and get to the root cause of why the patient is speaking with us. It’s how we screen them and determine what action needs to be taken next, whether it be self-treatment, a call to the doctor, or even a hospital visit. Never be afraid to ask the same thing again if you need to. When patients seek out your help and advice, they usually don’t mind the questions. Most times, they appreciate how much effort we put in to helping them. This is one of our duties to our patients. It falls under the “Do No Harm” portion of the Hippocratic and/or Pharmacist’s Oaths. And, it can make all the difference in a person’s life.

 

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Excited!

 

Quick, off topic post today. I am very excited tonight. A few other pharmacists and I have just submitted a paper for review to the Journal of the American Pharmacists Association (JAPhA). The project it entailed actually began when I was a student. A then fellow classmate (now fellow graduate) of mine has piloted a lot of the study. We’re all very eager to hear if it’s accepted or not. I’ll let you guys know if it’s published! ^_^

 

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Rambling on and on and on and on…

 

Both the entry’s title and the words in the picture above are things my techs have said jokingly about one of our now regular patients. It makes me angry when I hear those things. The man has severe bipolar disorder, for which he just recently started getting treatment. Whenever he calls the pharmacy, he is manic and very anxious. His phone calls can last for a long time, especially if he is worried about one of his medications. It seems like I’m the only one in the pharmacy who doesn’t mind speaking with him, though. The rambling does not bother me like it does with everyone else. In fact, I feel very bad for him. He didn’t ask for the problems he has. I am sure if he could hit a button and get rid of them, he would without hesitation. His rambling is not intentional, nor is he deliberately trying to annoy or irritate others. He is simply trying to ask questions that he, as a patient, has a right to have answered. The saddest part of it all is that he knows people don’t like when he calls–that they dread hearing his voice. Except me.

So, things have gotten to the point where he will only speak to me. Though it’s nice that he trusts me, he shouldn’t have to rely on one person to answer simple questions, such as whether his prescription is ready for pick up. I can’t understand why people get so frustrated with him. Yes, he rambles. He rambles a lot. But, all you have to do is just let him talk. I continue doing other things while I’m on the phone with him because I know most of what he’s saying is repetitive or just him thinking out loud. But, if his rambling to me for a few minutes can quiet his racing thoughts for a bit, that’s great. I don’t let it interfere with the rest of my duties more than it has to. Neither should my other techs or the other pharmacists who work there. He knows he rambles, and so he only calls on the weekends or after 6 PM on weeknights. He knows he has a problem, and he does his best to keep it from taking up our time. I couldn’t ask for anything more from this guy. He’s as good as patients come. It’s sad to me that no one else thinks so.

I think part of the problem is that other people write him off as “crazy”. They figure they’re allowed to be annoyed with him. They probably also figure he has little grip on reality. I HATE the social stigma on mental disorders. People like this man suffer every day because the people who are supposed to help them don’t. It’s not that they purposely don’t help; it’s that they write things off as part of the patients’ disorders, even when they’re not. A schizophrenic with a UTI should still be treated the same as “sane” people with UTIs. Yes, there are emotional and knowledge barriers many times, especially with the more severely mentally ill. But, you do your best to overcome them with the patient together–as a team. You don’t ignore the barrier because of the diagnosis code in their chart. If you can build a trusting relationship with your patients (“crazy” or not), you will overcome barriers much easier than if you just tell them what to do. If you can empathize with them, they will notice and appreciate it many times. Now, this isn’t fool proof. There are always people who will ignore your advice. There are always people that will be nasty. But, more often than not, being kind or empathetic leads to kindness and gratitude in return. You catch more flies with honey than vinegar.

Going back to my original story, the man called today, and I was happy to hear that he sounded much less anxious than I have ever heard him . Still a bit edgy and talking fast, but markedly better than before. I hope the pattern continues for him. I know he wants to be more level and even-toned. Maybe, someday, he will be what society deems “normal”. I couldn’t help but smile when I got off the phone with him. =)

 

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Flu Shot Season Has Sprung!

 

So, flu shot season has arrived at all the big name retail pharmacies. I personally think August is too early, but oh well. As a general rule, I love giving flu shots. It’s a break in the monotony of the day and gives me one-on-one time with patients. It’s actually how I got to know a lot of my regular patients last year when I was new to my current pharmacy.

Today, I had a mother and two girls come in for their annual flu shots. I had given the mother hers last year, and she remembered me, so it was a great experience right from the start. The younger of the two daughters has autism. Though the girl is 21, her mental capacity is that of a 9-11 year old. The mother also informed me the pharmacist who immunized her last year made her scream, so she was very nervous. I knew it would be a challenge, but I decided to administer it anyway because I believe everyone who wants to should be vaccinated.

The older sister went first, which helped ease the younger girl a bit. Both girls and the mother were very sweet and friendly. When it was the younger girl’s turn, she got very nervous and was almost in tears. The mother, older girl, and I all talked her down and got her to relax her arm. The older girl held her hand. I assured her it was a tiny needle, and it would be over before she knew it. We got her to take a deep breath, and I injected her as she exhaled. I braced myself for flinching and screaming.

But, the screaming never came. The girl said she couldn’t feel the needle at all! She thanked me and gave me a big hug after I put a band aid over the injection site. It made my day! ^_^

That was probably my most gratifying and unique flu shot experience yet. What was yours?

 

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“Every Day is a Holiday!”

 

I have been neglecting my blog a bit, and I apologize. It has been so very busy at the pharmacy as of late. I have been getting home late after work most days and am usually exhausted. Again, sorry for not posting much this month.

Today’s story is about one of our regular patients. Out of everyone, he is probably the most cheerful person to enter the building. He’s always got a grin on his face and seems to make everyone, employees and patients alike, laugh and smile. I look forward to his visits. They always break up the monotony of the day. The picture above is the perfect way to describe him.

He came in with his characteristic, happy demeanor, walking toward the pharmacy and whistling a happy tune. He always takes his hat off and bows, stating, “Good morning, my fine ladies and gents! How are you all on this wonderful day?” He makes conversation with those around him and just generally lifts all of our spirits. I asked him how he keeps such a happy attitude every time he visits us, and he answered me with the title line: “Every day is a holiday!” Then, he started singing the tune from Mary Poppins (“Every Day’s a Holiday with You, Burt”), inserting his and our names in place of the word “Burt” in the song.

His visits are usually very quick, but he always thinks of something witty to say on his way out. We’re always sad to see him go. If he were to get a pharmacy report card, in the comments section I would write: “[patient name] is a joy to have in the pharmacy.” =)

I hope your days are all going swell!

 

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Health Insurance…My Other Specialty?

 

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I am apologizing ahead of time to my non-US readers for the confusion you will probably feel after reading this entry. Our health insurance situation in the States is screwy a lot of the time.

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Working in a community pharmacy in the US means having to deal with insurance companies about 1/3 of the day. This is true of both techs and pharmacists. We both need to know how to handle phone calls about rejected claims. My story for today is about how tiresome it can be.

I received a call from a woman in the early afternoon asking me if I remembered her situation. After talking to her, I realized I did, in fact, recall dealing with her last month. Her story was complicated, so I was glad I was able to recall the details. This woman’s insurance provider changed their plan details at the beginning of June. Same company, same representatives, but a different plan. This isn’t exactly unusual here in the States. Patients will have everything on their ends stay the same, but things on the insurance carriers’ ends change dramatically. For this woman, this not only meant that she was forced to only come to our pharmacy for prescriptions, but that the amount of pills she could get when first transferring would be different as well. She had always been allowed to get a 90 day supply of her maintenance medications before June. Now, the regulations state any time she gets a new medication that she’s never had before, she must pay her full copay for a 30 day supply first and then in subsequent refills, she can get 90 days’ worth. This wouldn’t be that bad, except that every time she goes to get her pre-existing prescriptions filled for the first time since June, they view it as the first time she’s ever had it ever filled and denies a 90 day supply. It always leads to both the pharmacy and the patient having to call and argue with the insurance provider.

Well, she called and told me she had two other prescriptions that were due to be filled. I told her I would handle the situation like last time, and she thanked me. The prescriptions were put through and (no surprise) they rejected a 90 day supply. I called and got a hold of a representative with a god complex, who told me that this override didn’t exist and that it had never been done in the past. I argued with her, trying to get her to see that it had been done last month with other medications. She basically told me it was a fluke and refused to provide any assistance. I had to call the patient, who then called the insurance provider herself. She returned my phone call a bit later and gave me a specific number to call. I called this number and was transferred to three different departments before someone was finally able to help with the situation. The actual override took about 30 seconds and consisted of a couple keystrokes and computer mouse clicks. The total time I spent dealing with this problem (which really shouldn’t be a problem) was about 45-50 minutes. I was so backed up afterwards that I had to stay an extra half hour after closing to finish checking the rest of the filled prescriptions for the day.

These kind of things are so beyond confusing and take up so much time that should be spent doing ACTUAL pharmacist duties. Because of some error in that insurance provider’s system, not only was time taken away from me, but it caused so much unnecessary stress on the patient. She shouldn’t have to call them in order to get them to listen. That middle man step should not be necessary. But, this is always the case with her medications. I’ll be happy when everything is finally all transferred over from her old pharmacy once and for all. The worst part is that her situation isn’t the most unusual thing I see. There’s a set of quadruplets that when they need medications always require a phone call to the insurance company because they are unable to provide them with their own identification numbers, so any activity appears fraudulent to the provider at first glance. Why they can’t have their own ID numbers is beyond me, but all I know is it causes four children to wait an hour and a half or longer for antibiotics when they all get sick when it should take no more than fifteen minutes.

All I can say to really sum everything up is this:  I wish my pharmacy would institute a call center like they’ve been talking about for years now. It would cut down on a lot of this unnecessary stuff and allow more time for patient contact. It would allow more time for me and every other US community pharmacy to actually practice pharmacy.

 

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