The Worst Terms in Retail Pharmacy

A few months ago I stepped back into the world of retail pharmacy, taking a management position with a large chain company and resuming my life as a full time retail pharmacist.  I have been working retail since 2006 and have worked my way up from tech, intern, staff pharmacist, and now pharmacy manager.  Along the way I have worked for several large chains, big box, and independent pharmacies and learned that no matter who you are working for there is always some terminology that everyone in the field uses.  In my opinion these are some of the worst terms in the field of retail pharmacy.

Floater

  • What it means: A pharmacist who does not have a home store, and covers shifts throughout a district when people need time off.
  • Why I hate it: It seriously sounds like a turd.  Couldn’t we as a profession filled with learned doctors put our heads together to find a better term?  Sometimes that description is fitting though because the floater pool is often filled with people who are either too inexperienced to be placed in a store or are unable to handle the rigors of working in a store consistently, which is a shame.  I personally love floating to different stores and enjoy the challenge of working with a new staff and an unfamiliar patient base every day, and have used that position to be a boots on the ground resource for my district managers.  Whenever field leadership is in the store people are on their best behavior, it is best to observe how they treat strangers, and after a few days in the store I can find the best aspects of each pharmacy and identify opportunities for improvement, but unfortunately most floaters are just there trying to survive the day before getting the paycheck.

Partner

  • What It means: The other pharmacist who works in the store.  Generally works opposite shifts resulting in 2 pharmacists who technically work together but mostly know each other from hastily scribbled notes left on scrap paper.
  • Why I hate it: Partner is a good term, but it can be confusing explaining it to strangers.  I once was covering a store and said “My partner is going to Disney next week so I am picking up a lot of overtime” and the tech said “That is so sad that he is not taking you with him.”  I then had to explain that it was my work partner, not a man who I was in a relationship with.  I have no problem with people thinking that I am gay, but I have a serious issue with the fact that she would think that I would ever date the type of monster who would go on vacation to Disney without me.

Prior Authorization

  • What it means: The insurance required the doctor to call them in order to approve payment for a medication that is not on their formulary because it is over a certain price threshold or has a cheaper alternative
  • Why I hate it: The number one thing I get when I try to explain it to a patient is “But my doctor already approved it, that is why he wrote the prescription.”  The patient doesn’t realize that the doctor is ignorant of what medications are covered, and even the most on the ball prescribers can’t stay up to date on the changes to thousands of insurance formularies.  But because the patient is ignorant of what the doctor is ignorant of the pharmacy staff becomes the people who are sworn at because all the patient wants is to be handed a medication and we can’t do that.  When people tend to shoot the messenger it sucks to be the messenger, the least that the insurance can do is come up with a term that is less confusing.

CBTs/CBLs/PPLs

  • What it means: Computer training
  • Why I hate it: Every company has to have their own set of nifty terminology in order to feel special.  Since we already work in a world awash in acronyms they need to further confuse some of the basic company issued training that everyone is supposed to do.  It is hard enough to keep on top of the situation where “HW is as 84YO M with HTN, DM, and BPH and allergies to PCN and MTX.  He presents to the pharmacy with complaints of HA and a dry cough possibly due to ACEI use that he has been treating with DXM,” but then once you get done you have to do your CBT or else your PDM will yell at you, since as PIC you need to set an example for the rest of your staff.

Community Pharmacy

  • What it means: Retail pharmacy
  • Why I hate it:  Just 10 years ago it was respectable to work retail pharmacy.  Back before mandatory doctorates and expanded residency training people could work retail and be an important part of the field, but all of a sudden things changed.  Schools started developing a clinical focus which turns out higher quality pharmacists and helps to further the profession, but it left retail behind.  Despite the changing clinical outcomes that many chains are promoting it is still a numbers game where you are expected to fill more scripts in less time with less staff.  In order to combat the language of students saying that they were going to work “Just retail” some do gooder professor who had clearly never worked in a retail pharmacy coined the term “Community pharmacy.”  It is an overly aggrandized term intended to shine shit in order for everyone to feel more accomplished no matter what branch of the profession they work in.  Unfortunately we are all pretty smart people, and we see community pharmacy for the BS term that it is, especially since there are very few pharmacies or pharmacists who live up to the standard of serving their community.  I have worked retail pharmacy for most of the past decade, mostly in small towns in rural areas and I don’t feel that I have ever been able to serve the community in the way that a true community pharmacist would.  This term is actually insulting because it says “You are doing the same thing that you have always done, but I think that we should call you something different because it looks better” and it is endemic of many of the problems found in the profession of pharmacy.  As a whole we are like the kid wearing his dad’s suit, we are puffed up and trying to act like we belong but since we spend so much time trying to project an image there is no substance behind it and all the other medical professions are laughing at us.  We as a profession will never grow if we are more worried about image than about substance.

While I have been negative about many of these terms I would like to leave you with my favorite pharmacy term.

Secundum Artum

  • What it means: Latin signa that translates to “By the Arts”
  • Why I love it: Who doesn’t love latin sayings, dead languages make everything more fun.  This was originally a sig used for compounded medications that allowed the pharmacist to use extra emulsifiers or tricks of the trade when compounding.  It in essence means, do what you need to do via the methods that only your profession knows.  This was the original license to step outside the lick stick and fill dispensing model that any trained monkey can do.  Having special knowledge and skills in compounding lead to immunizations, MTM, and the many opportunities that we have today. Beyond that I think that it takes a certain type of person with certain skills to become a pharmacist, and secundum artum is a good way to describe many of the things that we deal with every day.  From working long shifts, to making clinical decisions, to dealing with irate patients, to placating doctors, to compounding medications we can do that all based on the important skills that we have learned along our journey, and we can do it all by the arts.
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The Dark Side of Comedy

Comedy is fun, and it is something that I truly enjoy, but sometimes it brings out the worst in people.  They say that comedy is tragedy plus time, and many comics get up there and recount some of the worst things that have ever happened to them night after night constantly picking at that scab and trying to wring as much laughter out of a terrible situation as they can.  Long after normal people have put things to rest in the back of their minds a comic will continue to examine those issues under a literal spotlight.  After just a few months of doing comedy it is very clear to me that one of the hardest aspects of being a comedian is dealing with your own issues and trying to stay positive.

Think of how many time you have heard about a comedian passing from suicide or drugs and thought “what a shame.”  Mitch Hedberg, John Belushi, Chris Farley, Robin Williams and many others, people who made us laugh and raised our spirits, who succumbed to their own demons.  They worked hard to build on their natural talents and became recognizable faces and names only to lose everything, in part because of what they did for a living.  Every day they got on stage and tried to make people laugh, often at their own expense, and sometimes playing the clown that makes others laugh can be the loneliest position of all.  Beyond the trapping of fame and the perils of celebrity there are thousands of unknown comics like myself who deal with many issues off the stage.

Maybe it is the type of person who is attracted to doing comedy that is the root of the problem.  Most comics are not the most well adjusted people in the world, which is part of what makes comics funny.  Nobody wants to go to a show and hear  someone brag about all the great things that are going on in their life, we want to hear about their fuckups and failures and insecurities so that we can forget our problems for just a few minutes.  Luckily most of the people drawn to performing comedy, myself included, have plenty of that material to work with.  I have heard the line “Deep down all comics are pieces of shit” and I really don’t agree with that since I have met some really great people who happen to be comedians.  I think that the type of people who like to make people laugh tend to be those who know what it is like to be hurt.  I developed my sense of humor as a way to deflect bullies and to make myself more acceptable when I was a very unpopular nerdy fat kid, many others draw from the darker pools of addiction, family problems, and mental health issues.

It takes balls to stand in front of a crowd of strangers and admit some of the bad things in your life, and it takes something special to take those things and find the humor in them.  We are hardwired to avoid that and to keep things secret and put on a good face, especially in today’s social media fueled society.  While most of my jokes focus on bad dates, or struggles with my weight, or the stupid things that I do when online shopping it still sometimes hurts to pick at some of those scars.  I can’t imagine what it is like for people who have suffered real tragedies and have come out the other side.

They say that a runners high is bullshit made up by people who have never been high.  I haven’t personally experienced a runners high but I have felt the stage high.  You do a set where everything clicks, one of those transcendent nights when everything goes the way you plan, time fades away, and you can have an almost out of body experience.  You leave the stage and strangers are congratulating you, other comics go out of their way to tell you what a good set you had, and you are king of the world… and then the crash begins.  All of a sudden everyone is paying attention to someone else, someone who may not being doing as good of a job as you had just done, and you fade back into obscurity.  Chasing that stage high is a part of why many comedians keep getting up there.  Those few minutes of glory are what motivates us to push through bad sets, inattentive crowds, grueling open mics, and the other rigors of the daily grind.  Good sets tend to push you to be more creative and ride that wave to better jokes and hopefully more good sets, it also makes you want to continue that high through other means if necessary.

Nothing tastes as good at that first sip of beer after a good set, you have done your job and made people laugh and now it is time to kick back and reward yourself.  This is where some comics can go too far, trying to prolong that stage high through seeking out other highs.  Even worse than coming off a stage high is dealing with bombing.  All you want to do is crawl up in a ball and medicate the crushing pain that comes from putting yourself out there and failing hard.   Beyond the ups and downs on stage comics tend to work late nights and can easily fall out of sync with the rest of the world.  If you add in the travel schedule that many successful comics have to endure it can make for an exhausted and lonely existence. I know that some of my most depressive moments of the past 8 months have come during the long drive back from a show either coming down off a stage high or doubting everything about myself that could have made me fail.  Living on this roller coaster is enthralling but it also takes you to places that you never thought that you would go in both a good and a bad way.

I have found that when doing comedy it is very easy to fall into jealous patterns.  I am generally not a jealous person, but sometimes when I hear about other people getting booked for shows, even shows that I can’t make it to or that I wouldn’t want to do I feel extremely jealous.  When several comedians who I have worked with a bunch and consider myself close to formed their own group I felt jealous and left out at first before realizing that my work schedule wouldn’t let me participate anyway and would hold the entire group back.  When I see people who don’t work hard enough to live up to their potential, or comics who make excuses or use qualifiers it makes me incredibly angry.  I realize that some people aren’t hard wired to work the way that I do but it still pisses me off that after working a 12 hour shift and driving an hour to a show I have to hear someone bitch about how they mismanaged their time and didn’t put in the basic effort necessary to do what they are there to do.  I also feel a good deal of schadenfreude wanting other people to fail, which is pretty tough to admit.  Vermont is a relatively crowded scene with not a lot of shows going on, and with the exception of a dozen or so comics who are talented, hardworking, and likable enough that I respect them no matter what they do I kind of hope that some of them fail and I can work my way up the totem pole.

No matter how angry and jaded this post has made me sound becoming a comedian has been of the the best things that I have done in years.  It has allowed me to meet new people, have new experiences, earn some praise, and define me better as a person, but it has also brought on crippling self doubt, extreme anxiety, brushes with alcohol abuse, and has forced me to look at some of the worst things about my life on a nearly daily basis.  Everything in the world has good and bad sides to it, the trick is to latch on to the things that have more upside.  I believe that comedy is a good thing for me, it helps to keep me sane and allows me to have fun, but there will always be those long and lonely drives home where I will fall into the darker parts of my thought pattern.  The key is to keep those visits to the dark side of comedy short and to realize that there is a light at the end of the tunnel before becoming just another name lost to history.

June Challenge Recap and Issuing the July Challenge

For my June Challenge I wanted to try some self exploration and gave up gluten.  No beer, no pizza, no pretzels, no sammiches, it started out just as terrible as it sounds.  For the first few days I just wanted all of the glutens, like right then and there.  For the first few days I would wake up wanting a pizza made out of cornbread and topped with spaghetti-Os, which is an idea that I am thinking about pitching to Pizza Hut, they will probably be interested.  As with any changes in diet the first 3 days are the hardest and then the cravings start to wane.  By the second week I had found a lot of replacements and had started to move on.

The hardest thing about trying a gluten free lifestyle is not knowing what things you can and can’t eat.  While many products are now marketing themselves at GF (like Twizzlers do) you actually need to know what is in your food before you consume it, which is a big change from how I normally consume things.  I am lucky that I have no dietary allergies, so I may look over the nutrition label but I don’t pay much attention to the ingredients.  I found that scouring the ingredients lead me to spend more time looking at the label and estimating portion sizes and being more mindful about the things that I put in my body.  While I found a lot of very good snacks I found that most of them contained a lot of the same processed crap that most other snacks contain.  I found myself drawn to more natural and unprocessed things, and since I cook most of my own meals and follow a standard meat+veg=yum plan I didn’t really have to adjust as much as I thought. Giving up beer was a bit of a challenge, but luckily I live in the land of Citizen Cider and was able to make that swap, and I also had the chance to try some new whiskeys.

The biggest change that I had versus previous challenges is that I programmed in a cheat day.  My friends were getting married and I didn’t want to cheapen the experience by having to avoid things.  I started things off the night before with some light beers, then had pizza on the way out, and had pasta salad, croutons, and cake at the wedding.  I also slipped up and had a sandwich when I went to my parents’ place for lunch the following day, it was easier to break my gluten vow than to explain to my mother why I was just eating plain cold cuts.  As expected having this cheat day nearly derailed me for a few days afterwards.  I had tasted the gluten and I wanted more.  Eventually I was able to get over it and get back on track.

This month’s challenge made me open my eyes a bit and take in more information about food than I normally would.  I suppose that I was secretly hoping that taking a gluten out of my diet would make me feel awesome and immediately solve some problems that I didn’t even know about.  I did find that without gluten in my diet I was losing weight at a pretty rapid pace despite not changing my activity level.  I am not sure if it was the food that I was consuming was healthier, or that I wasn’t drinking as much, or the fact that I wasn’t snacking as much, or that my go to unhealthy meals like subs and pizza were out of the picture.  I am glad that I had the chance to try something new, and even though I no longer have to I think that I will be checking more nutrition labels in the future.

July Challenge

The Challenge: Write at least 500 words every single day.  It doesn’t have to be great, in fact it doesn’t have to be good, it just has to be something on paper.  If something isn’t good then either edit it or delete it completely, but get some words on a page and create something

  • Why: This blog was supposed to be an outlet for me, a way to express my feelings and put some things out there.  I had planned on writing at least one post each week, but shortly after I started the blog my comedy schedule picked right up and now I find myself with a method of expression and less free time than I expected.
  • The Benefits: I really enjoy writing but it is hard to do and rather time consuming.  I was thinking recently about what I would do if I ever won the lottery, because I would have to do something to keep myself busy or else I would go insane, and I came up with becoming a writer.  I enjoy writing and am able to do it pretty well, plus I can do it anywhere and on my own time table, it is basically the perfect job.  But in order to become a writer you need to write, and like anything the more you do it the better you get at it.  I find writing to be extremely cathartic and whenever something big goes on in my life I enjoy being able to put it down on paper or on a computer screen before literally turning the page and moving on with my life.
  • The System: The system is pretty straightforward with this one, just sit down and do it.  I prefer not to write at home, but when I get home from work it will probably be a good way to switch out of professional mode to home mode.  I recently bought a new computer so I will be dedicating to writing, comedy materials, and the website so it should be easy not to fall into netflix or facebook when working on writing.  If what I come up with is crap then I will just delete it, which will help me to let go of other things in my life that are not up to par.

I think that this month’s challenge will help to push me as a writer and maybe help me think through some of the things going on in my life.  I have a few ideas that I have been kicking around, and it should be a decent month for introspection, but worst case scenario it is an opportunity for me to seek out new muses and inspiration.