A Doggone Dilema

This is how it went down. In my first 20 minutes of an 8 hour shift at work today, I was faced with unhappy customers. Look, I get it. You're in a hurry, and the last place you want to be held up is at the pharmacy. Guess, what? It's the last place I want you to get held up, too. "Not good for you" pretty much translates to "not good for me". So, let me tell you about one of the interactions from as neutral a position as I can muster.

First, let me preface by saying, before I arrive at work, I have NO IDEA what has happened in your dealings with the pharmacy. I'm starting at square one. Whatever difficulty you've had, or think you've had, is news to me, but I'm always motivated to try to solve the problem.

With that said, let me tell you about Ms. Doggone. Unbeknownst to me, she has been waiting in our waiting room for 15 minutes for us to fill a prescription for syringes for her pet. She's a bit miffed that her name hasn't been called yet. So, she just walks right up and hovers behind the customer I'm currently waiting on. Ok, not really kosher to begin with, but we'll let that slide and get right on to the main attraction. She gives me her name and the name of her pet. I call up the patient profile on the computer. Next to her pet's name and the prescription she's waiting on is the dreaded RED "Call Prescriber". As a pharmacy tech, I mentally cringe at those red words. It means there is an issue with the prescription, and we've had to contact the prescriber for clarification. In Mrs. Doggone's case, the issue was the prescription had been written without information regarding the size (in mL) of the syringes required. We needed the veterinarian to get back to us (phone, fax) with the size syringes they wanted for the patient. We CANNOT move the prescription forward until the veterinarian contacts us and clarifies their prescription (which THEY WROTE). So, I try to explain the issue to Mrs. Doggone, but she's not having any of that. She knows what size it's supposed to be. I respect that she is that aware of what her pet requires, but she's not the veterinarian, so, as knowledgeable as she might be, it's not sufficient enough to fill the prescription. It really does require the veterinarian....the one that failed to put the necessary information on the script in the first place. Now, don't get me wrong. I'm not angry with the vet. We all make mistakes. I'm just a bit peeved that we're the ones Mrs. Doggone was "less than respectful" with when we did not cause the delay and were actually trying to help her understand the issue, but I also understand that's part of the job territory. Mrs. Doggone wanted her script back. Apparently, she was going to take it to another pharmacy (one that knows what they're doing). No problem. I got the script, had a pharmacist cancel it out, and handed it back to Mrs. Doggone. She left my register tossing a few more choice words over her shoulder.

Not a great start to my day. More importantly, not a great start for Mrs. Doggone. She was about to find out that the next pharmacy wouldn't be able to fill the prescription without getting clarification from the veterinarian either. I can only hope the next pharmacy was able to get a faster response from the veterinarian than we were.

The lesson of this story is this..... sometimes, your doctor (or vet) fails to write a complete prescription. They might accidently leave off information that is necessary for a pharmacy to process your prescription. Any legit, responsible, trustworthy pharmacy MUST get the missing information STRAIGHT FROM THE PRESCRIBER. We cannot make it up. We cannot take an educated guess. And, we cannot take your word for it. It may feel like we're the people delaying your plans, but, truly, we are not. We are just the bearers of the bad news when your prescriber has written a script with missing or inaccurate information. We don't really enjoy waiting on them to get back to us any more than you do. But, we'll work as hard as we can to get the information as quickly as possible. This requires cooperation and promptness on the part of the prescriber. In the meantime, we'll treat you with courtesy. I hope, when you know more about how the pharmacy works, that you'll extend the same courtesy to us.  

Don't forget to take your happy pill!

P. S. My day got better :)

Dear Pharmacy Customer,

Let’s talk about the pharmacy “Drive-Thru”.  We can all admit that, in a perfect world, the convenience of picking up your prescriptions without having to exit your car is an amazing notion.  Unfortunately, we’d also have to admit that we’re not living in a perfect world.  Let’s take a look at what can happen (and, this isn’t even an exhaustive list).

First, you must acknowledge that once you have entered the line at the drive thru, you’re pretty much trapped, and you did it willingly.  There aren’t too many places I’d enjoy being trapped.  Maybe a loving embrace would work.  Personally, I’d opt for a craft store.  But, never would I willingly trap myself in a line of cars at a pharmacy drive thru if I were limited on time or the type of person to get frustrated by unanticipated/unexpected delays.  I’d have to eat my high blood pressure meds while I waited.

Each interaction at the pharmacy is unique.  Many times, people have questions for the pharmacist, or the pharmacist must speak to them before a medication can be purchased.  This can take time as the professionals relay important medication information to the customer.  Mrs. Smith is entitled to ask her questions, and the pharmacist is always willing to answer and clarify Mrs. Smith’s concerns.  If you’re bothered by Mrs. Smith’s desire to understand what she’s taking, how to take it, what it will do to her, and side effects she might experience…maybe you shouldn’t have pulled in behind her.  I mean, she did get there first, right?

Sometimes, there are insurance issues with someone’s prescription.  Mr. Jones didn’t update his new prescription plan the last time he was in, now he wants to do it at the drive thru while picking up his maintenance medications.  It will take a few moment’s to update his info, a few more to rebill his prescription,  a few more to take his meds to the pharmacist and have them rechecked and the new bill attached (and we’re not even sure if the pharmacist is in the middle of something at the moment), then we can finally complete the transactions.  All those “few moments” can add up.  Plus, in Mr. Jones’ scenario, we didn’t even consider the added time if his insurance would reject the claim!  Maybe the meds aren’t covered or only covered in a smaller quantity which isn’t what his doctor prescribed.  Maybe the prescription refill is “too soon”.  Maybe he needed a generic instead of a brand name.  Mr. Jones came to take care of his business.  He didn’t force you to pull in behind him. 

Then, we have sweet Ms Little.  Her child is ill and the pediatrician has prescribed a liquid antibiotic.  Ms Little sits in her car (possibly her child is screaming from discomfort in the back seat) while the medication is mixed for use.  This means water is measured, checked by the pharmacist, added to the powdered antibiotic, mixed, rechecked by the pharmacist and finally delivered to the drive thru window.  We haven’t even considered the possibility that Ms Little wants flavoring added so Baby Little will not fight taking it too much.  This will add several more minutes of waiting while the flavoring recipe is looked up and added to the medication.  1 minute.  2 minutes.  3 minutes.  4 minutes.  It’s hard to predict how long Ms Little’s transaction will take. 

Next, Mr. Big stops by to “drop off” his prescription.  You know…he’s just come from the doctor’s office.  The pharmacy will need some mandatory information before he can drive on his merry way.  Usually, this is quite simple.  As long as Mr. Big has previously picked up prescriptions at the pharmacy and has his current prescription insurance on file, we’re good to go in a couple minutes.  But, what if he hasn’t been to the pharmacy before, and doesn’t have his insurance in the system?  Or, what if he’s been prescribed a drug which is controlled and has to be checked on before the pharmacy can even commit to filling the prescription.  You’ll be sitting in your car behind him while we handle his needs. 

So there you sit.  The convenience of not having to get out of your car and walk into the store doesn’t seem so convenient any more.  You’re frustrated.  You’re agitated.  You’re running behind schedule now.  You’re itching to yell at whoever stands on the other side of the glass when you finally get there.  And, you know who that is?  Possibly me.  I’ve just helped Mrs. Smith, Mr. Jones, Ms Little and her baby, and Mr. Big.  And, I did it as quickly as possible in the constraints and requirements of my job.  I also planned to give you the same personal attention I’d given them.  But, my smile and greeting are met with your frustration.  I suppose there was no way for you to tell my previous customers how they ruined your drive thru experience, so I’m the only option you have.  Guess what?  I’ll stand there and take it.  Heck, I’ll even apologies for your inconvenience.  But, I’ll know (and so will you) that you put the blame on me when you made the decision to not come into the store. 

Sure, there might be a line in the store, but there are also several registers that can be running at the same time.  In my particular case, there are 3 registers inside….and only 1 at the drive thru.  If there is another Mrs. Smith inside, she can be handled at one register while you are handled at another.  You don’t have to wait for her to finish before the rest of the line can move forward.  In the drive thru, you are trapped behind her.  If, for some unknown reason, you find you must leave before you’ve been taken care of, you can easily do so from inside the store.  Not so easy when your stuck between cars in the drive thru.

There are many reasons the drive thru is appealing.  There are also as many, if not more, reasons that it can be more time consuming than parking and coming inside.  In either situation, I’ll still greet you with a smile and ask how I can help you.  The ball is in your court at that point.

Remember to take your happy pill :)

It Makes Imperfect Sense

An Interesting Encounter

Let’s be real.  Really real.  At some point, you have to take responsibility for your own life, health care, too.  It only takes one customer to drive a point home and remind you to practice patience…because you can’t always say what comes to mind first.  Take this “exchange” as a prime example.

A customer comes to the drive-thru.  She’s just planning to pick up a refill of a prescription she called in the previous morning, so it makes sense that it would take very little time to complete her transaction, but, it just doesn’t work that way every time.  Here, I’ll break it down for you.

*I’ll make up the names as we go along.  You know, HIPAA is a real thing.

Ms. Sharon calls the pharmacy.  She has just recently transferred all her prescriptions to us.  She tells the tech she would like to get a refill on HER Vitamin D.  This is a medication she always gets in a 90 day supply, so it’s been 3 months since her last pick up.  The tech brings up her patient profile on the computer screen, locates HER Vitamin D prescription, and notes that she does not have any refills left on that prescription.  Standard practice for the pharmacy is to send an electronic request; this is done automatically by the system, to the prescribing doctor of record.  So, the tech tells Ms. Sharon that an automatic electronic request will be sent to HER prescriber to ask for refills of the HER Vitamin D, and the prescription will be filled when the refill request is granted.  Now, Ms. Sharon wants to know if she will be able to pick up the prescription the following day.  That’s a tough question since there is no way to know when/if the doctor will get back to the pharmacy with his answer, but, as any good tech would do, Ms. Sharon is given this information and, most likely, told she can call in before stopping by to see what progress the pharmacy has made with her order. 

Ms. Sharon chooses to skip the phone call and head to the pharmacy directly.  This is where the lesson begins.

Upon arriving at the pharmacy drive-thru window, Ms. Sharon gives her name and lets the tech (ok, it was me) know what she has come to pick up a refill.  Side note, I am not the tech who took the refill order, but that doesn’t really matter in this scenario.  Procedure is procedure, so it would have played out in a similar fashion no matter which tech was working the drive-thru when she arrived.  Her name is entered into the system, and her file is retrieved.  No refill is found.  HER Vitamin D is not waiting for her.  How has this happened?  As it turns out, Ms. Sharon didn’t mention, when calling in her refill, that the prescribing doctor of record was NO LONGER HER DOCTOR, and, in fact, lived in another state.  Ms Sharon hadn’t seen her previous doctor since moving to her new home in PA.  It would seem realistic to most people that a doctor (who is no longer YOUR doctor) would not authorize a refill for a patient who is NO LONGER HIS PATIENT, but it didn’t make sense to Ms Sharon.  Let’s imagine a 5 minute scenario where Ms Sharon lets me know how unhappy she is that we (I) did not get her refill authorized.

Now, Ms Sharon, who is building up a head of steam, informs me that she has 2 new local doctors, and had the pharmacy called her to let her know her request had been rejected by her old doctor; she’d have given us the info for her new doctors.  We had just wasted HER time by contacting her old doctor, the doctor of record, to get her refill.  The problem with Ms Sharon’s solution is that neither of her new doctors had ever prescribed Vitamin D for her.  There was no prescription on record from either of them, therefore, there is nothing for us to call in to refill.  Her situation would require HER to call her new doctors and ask them to send a NEW prescription for HER Vitamin D to the pharmacy.  Note to self, to make it a less stressful situation for herself, it might have been best for Ms Sharon to make those arrangements before taking the last Vitamin D from her previous prescription and putting herself in a situation where she was without any medication as this issue was being resolved.  But, Ms Sharon is convinced that the pharmacy is responsible for the situation she now finds herself in.  Truly convinced.  And, absolutely determined to make me understand how the pharmacy is responsible.

We’ll skip the lengthy conversation that followed.  Suffice it to say, Ms Sharon truly sees this as a failing on the part of the pharmacy.  There is nothing I can say at this moment to make her understand that it would make perfect sense that her old doctor would not grant the refill request, that calling in before arriving at the pharmacy would have saved her the trip (and made her aware of the situation she needed to resolve), and that the pharmacy wouldn’t be able to contact either of her new doctors to ask them to write a new prescription for her.  There is no way to convince her that things would have gone smoothly if she’d have contacted one of her new doctors, before swallowing her last pill, to request they send a NEW prescription for Vitamin D to the pharmacy, because she was running low.  Ms Sharon was dead set on laying full blame on the pharmacy.  She even let me know that she was going to write a note about the situation so there would be a record of what transpired should she die in her sleep because we did not have her prescription for her.   I must take a moment to note that: 

            1:  Her medication was not life saving.

            2:  Her medication could be purchased over-the-counter.

            3:  I offered to get a pharmacist for her to speak with to see

                 if there was a temporary solution to her problem.

After chastising me one last time, Ms Sharon left in a huff.  

I don’t know what Ms Sharon decided to do once she left the pharmacy.  She might have made a note to call one of her new doctors to get a new prescription.  She might have written a complaint to the corporation.  She might have realized it was ultimately her responsibility to have her ducks in a row when it comes to the timely refill of her medication.  Maybe I’ll find out eventually.  Maybe I won’t.  In either case, it’s a learning experience for me.  One that I hope will lead me to better resolutions in the future. 

Main point: YOUR healthcare is YOUR responsibility first. 

Second point:  I DO want you to be satisfied when you leave the pharmacy, but there are only so many things I am able to do to make that happen. 

Third point:  Figure out a way to prevent this in the future if possible. 

Fourth and Final Point:  Tomorrow is another day.

Don’t forget to take your Happy Pill.