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Saturday, April 26, 2008

When you stand...

at the counter ready to pay, fiddling around with you purse or jamming your hands in your pocket fumbling for change...we hate that! Can you possibly think that we have nothing better to do than wait patiently for you to add your change up? Just give us the bill and deal with it. I have 20 prescriptions waiting, ten people behind you waiting for their medicine, two calls on hold, and reports to do.

And while we're at it...

throw all your checks in the shredder. Checks are bogus and a waste of every one's time. Why do we still have checks? I haven't made out a check in a very long time. I pay with my debit card or my credit card. I don't need to stuff bills in my wallet and have loose change jangling in my pockets. I wish I knew how many lost hours have gone by standing there at the register waiting for someone to fill out their check. There is one good thing about checks: I can tell when someone is beginning Alzheimer's. A wonderful lady who would come in monthly for years, jotting down the information on the check, flipping it to us, then turns into someone who takes five minutes to arduously, meticulously filling it out like some exam she took sixty years ago. That tells us that something is wrong. But that is about the only good thing with checks. Throw the things out or at least leave them home.

And just give us the bills and let us get back to work.

Saturday, April 19, 2008

Ugh, the abortion question...
just wont go away. Pharmacists everywhere have been forced to make a moral decision regarding Plan B: Sell or don't sell. Which really means, sell or refer the sale to someone else thus bypassing you.

When the product came out (just an expensive high dosed birth control pill) I opted out. I felt that I just did not want to be involved in the possible aborting of some innocent kid. I know, I know--there are many of you who don't want to think of a fetus as a kid but "it" is and you'd know it if you ever cracked a biology text book--at least before they were rewritten by liberal fascists. Anyway that is how I felt: let someone else sell it and my conscience would be clear.

Well,I now sell it. It is going to be sold anyway so why put some girl through the embarrassment? I don't want to make her feel bad; she probably feels bad enough already. But the real kicker came when I thought through the entire process. What was going on in the girl's womb? Sperm meets egg (maybe), fertilization occurs (maybe), embryo attaches to lining (maybe). If the girl takes the Plan B maybe the developing baby is sloughed off like so much dead skin (which it decidedly is not: it is a miracle, plain and simply said) or it never gets the chance to become anyone at all, as the fertilization might be prevented.

A lot of maybe's and might's. I'm letting God do the deciding. The girl thinks she is in charge, but she is not. That baby will be born if God wants it to be. The decision is not hers and it certainly is not mine. God's in charge, whether we know it or not.
National Health Insurance...
is the only answer to the morass we find ourselves in. Unfortunately, none--none!--of the three major presidential candidates offer even the hope for a national program. Incredible. Even Clinton has shied away.

Why should your health insurance be tied to your job?

Why should we pay profits to some insurance company?

Why do we need ten thousand plans in this country? What waste.

The national plan could be expanded Medicare (guess what? we already have a national health insurance and it works pretty good: Medicare--so just expand it!) or some variation on the existing system, but with restrictions.

A Pharmacist friend once gave me his take on this: Why not divide the country into five or six regions. Let each region take bids from health insurance corporations to contract out benefits for a few years. That forces prices down and still gives people a measure of choice: heck, we could even vote on our plans. That way we wouldn't have ten thousand plans, but only five. Simple. Cheaper.

Only one problem: less profit for insurance companies means less money in the politicians pockets.

Back to square one, I guess.

Friday, April 18, 2008

I've read that the vast majority of seniors are satisfied with their Medicare D plans. U.S. News reports [The National Interest, April 21, 2008]:

But even the elderly, who grew up in an America where big institutions--the U.S. military, big corporations, giant labor unions--made choices for them, turned out to be satisfied with the choices they had under Medicare Part D.

Who are these people? The customers I see hate Medicare part D. Hate it. Every December they get these letters saying how they may need to switch to a different plan, or they may be switched unless they do such-and-such and call so-and-so. And then they find out their drugs are no long covered and they need to switch or get prior authorizations. Who could blame them for hating this system? I certainly hate it.

But the reports are saying that everything is all hunky-dory. Are they daft? Maybe it depends on how the questions are written. Maybe more people respond who simply aren't on that many medications and so they just don't see the worst cases.

All I know is that I hate it. I hate it good.

Thursday, April 17, 2008

No prescription for you! Back of the line!

The soup Nazi has now come to the drug store. If you make me work all the way through a prescription (or worse, several) only to tell me at the register that you are sorry but you have a prescription card and can you "just run that through"?

No, actually, I can't. We need to start over...from the stinkin' beginning. And you are now at the end of a very long line of people. I don't care if you are standing at the register like your about to set up a campsite, I don't care how pretty you are, I don't care how rude and obnoxious you are--I don't even care how nice you are about it...you're going to wait. A long time. No soup for you!

Saturday, April 12, 2008

A young woman, I'd say she was around 23 years old, recently filled a prescription for Adipex, an amphetamine derived appetite suppressor. Adipex--or rather phentermine, the generic, as nobody gets the brand anymore--is a fairly powerful suppressant of the appetite, and isn't bad for starting a diet. [An aside: phentermine was FDA approved in 1959...my birthday!!] The problem is that after several months of use it doesn't do much; there isn't any study that I know of that shows successful weight loss with the drug for longer periods of time. It used to be hugely popular in the early nineties, as part of the Fenfluramine-Phentermine combo (Phen-Fen), taken off the market because of valvular heart ailments. Even with the combination, long term weight loss was iffy. Phentermine is now somtimes used off-label with Prozac (or one of the many "me-too" Prozacs like Celexa, Effexor, Zoloft, Lexapro).

Anyway, there seems to be a resurgence in Phentermine use, as our script count for the drug is rising, at least in southwestern Vermont. Why? Well, why would it become more popular? Either it really works--which no one can prove, as the studies show--or it benefits the prescriber. One of the two has to be true, does it not? Either the one receiving the prescription benefits, the practitioner benefits, or no one does, which we can eliminate, since at the very least the prescriber gets paid.

So...since the patient doesn't benefit--studies prove that--then how does the prescriber benefit? I'd say in the following ways:
  • returning patient office visits
  • perceived caring on the part of the prescriber (if the patient doesn't get a piece of paper after a half hour office visit for which she pays dearly for...unhappy patient)
  • sometimes it is just easier to hand a prescription for a stimulant anorexiant than to counsel weight loss in a responsible manner: faster patient visits mean more $$'s for practitioner.
Now, am I being too cynical? The young woman I just gave that phentermine to, do you know what she looked like? A model. Beautiful woman, wonderful figure.

And it wasn't because of the phentermine she was taking. She just wanted a drug to assure herself that she wouldn't look fat in front of her boyfriend/husband. She didn't need any drug--heck, she didn't need to be on a diet. Period. But this doctor felt it was necessary to give her this stimulant, take her money, and book someone else for the same half hour fee. Nice.

Friday, April 04, 2008

Got the flu...
probably not the real influenza flu, but pseudoinfluenza. The aches aren't as bad, you can still get around and do stuff. Just don't feel well, is all.

So what do pharmacists take for the flu? Usually either some favorite pain reliever like tylenol or naproxen or ibuprofen. I personally like to use a nasal wash like Alkalol. It has mucus solvents that can clear the sinuses. There is an instructional video on the use of nasal saline washes (Alkolol has oils and saline, but the concept is the same: go to instructables.com).

Don't be taken in by all the marketing for cough and cold and flu meds. There really is only a few drugs out there used for these illnesses: a decongestant, an antihistamine, dextromethorphan, and some pain reliever. And all of them are weak. Some, like phenylephrine and dextromethorphan, are so weak you might as well call them useless. So don't waste your time and money on them.

Make some chicken soup instead. Maybe some vitamins too; not they actually help, but no harm no foul.