My Response on Why Docs Should Profit

The blog post: "Why Doctors Should Profit From Dispensing Medications" Yes. You did enter dangerous territory in regards to physicians dispensing medications. Immediately as a pharmacist my first thought is the idea of checks and balances going to pot. Even the federal government knows that having three branches of government decreases the chance for one particular party or worse, person, taking over thus changing our whole democracy.

Why do you feel so strong about making things easier for the patient and sacrifice the safety of what is being prescribed? I cannot tell you how many times I've discovered the wrong drug written for a patient. The wrong strength. The wrong frequency.

PHARMACISTS are not just workers at McDonald's filling your order for a number four supersized value meal. We actually are saving lives.

It is quite humorous to me that 90% of your blog post were the reasons why NOT to do it. You answered your own question.

Does your idea include hiring a pharmacist to actually do the job?

I personally would not go to a physician who had this setup. It does scream profit, and better... would insurance companies reimburse you for that $300/day that you are looking for?

Why dangerous? For a number of reasons.

One, physicians still grapple with the perception that it is improper for a physician to make money from the delivery of care from business ventures.

Two, profit-making from prescription writing might induce physicians to write unnecessary prescriptions.

Three, prescriptions for profit might lead to conflict with pharmacists.

Four, Some states prohibit physician office dispensing, and more dispensing might lead to other states prohibiting the practice.

Five, there is also a fear that such a physician business venture carry significant risk relative to government regulation.

Then, there’s the other side of the issue. Writing prescriptions and ordering their refills takes a lot of physicians’ time. It also takes knowledge. It carries some malpractice risk, should the patient suffer an adverse reaction. Dispensing from the office would be convenient for patients. Since 30% of patients never fill their prescriptions, office dispensing is more likely to assure compliance. And prescriptions dispensed at the office are generally significantly less expensive than those filled at the local pharmacy.

I especially like "It also takes knowledge." Really? At first I was thinking this was approaching the concept with the ease of the fast food model in mind. Shouldn't patients at least take a little bit of responsibility for their own healthcare? Some malpractice risk? Look at the pharmacist that is in a jail for making one mistake on filling a chemo for a child who died as a result. Pharmacists carry a lot of risk, and the majority of complaining you hear is because the retail pharmacy model has catered to the patient's ease to make more money and putting patients at higher risk.

I will always stand by the banking model... a quiet environment where you expect to wait patiently with no other distractions like selling beer, cigarettes, food, etc... A pharmacy should be a place where health is FIRST and respect demanded just like in a bank. Doctors' offices are like this too though yes, the phone rings off the hook and people are waiting for long periods of time (I've personally waited 90 minutes before!!!).

I really believe adding the dispensing portion to the physicians' practice will turn it into a very unprofessional madhouse.

Good luck with that.

Dreaming

I would LOVE to hear if you are a pharmacist out there what you would do if you could do it all over again. Would you be a pharmacist? Would you be a physician? I'm super curious. My own journey was a flukey one. I had every intention of going into medicine. My entire childhood was filled with whispers from my over-achieving parents. "You will be a physician." Yes, I sort of failed them, but I'm quite alright with it. When I see tweets about having to tell a patient they have cancer or hearing about my OB missing a lot of days with her kids due to births, I relish in the fact that when I sign off for the day, I've signed off for the DAY. There are exceptions to taking the job home with you - when I was in home health and carried the dreaded black pager - but for the most part, I've enjoyed my six figure salary and even overtime stints where I've made $100/hr. Not too bad. What would YOU be? If you had the opportunity to never have to work pharmacy again... what would you do?

The Best iPod and iTouch Apps for Pharmacists

Per request... passing along the link.

Morality and Ethics in the Pharmacy

Should a pharmacist be allowed to exercise their own beliefs and ethics while at work?  This question is part of a big debate in our country in regards to abortion vs. a woman’s right to choose and how it could pertain to a pharmacists’ right to not dispense a medication, specifically the morning after pill.

It is ironic that the same liberal and feminist groups have defended other people in their choice to exercise their own beliefs.  A soldier has been backed by these same groups when they have not wanted to go to war.  The man or woman smoking marijuana to ease pain, although illegal in most states, has been backed by the same.  However, exercising your own beliefs or morals about abortion and the debate of when life begins ends when it comes to the morning after pill.  These groups want to make it mandatory that all pharmacists must dispense Plan B when requested regardless.

On the other hand, a female wanting to exercise her right to choose could be met with resistance from a pharmacist whose morals including viewing life beginning at conception.  There is no clear winner on either side.

By law, a pharmacist can refuse to fill a prescription for any reason they see fit.  Should that reason include their own morals?  Why do you believe yes or no in this debate?

You Lucky Pharmacist You

How are you doing out there fellow pharmacists in an economy that is slowing down? Are your jobs secure? Do you have any fear of being laid-off or losing your job? Do you feel content where you are? On the plus side, it's easy to see how pharmacists and other medical personnel will more than likely be in demand. People continue to age and grow sick. People still need us. Perhaps they'll need us more? However, I am reading from fellow classmates that retail pharmacy is taking a bit of a hit as far as hours the stores are open. I hear that even Walgreens is shortening their hours and therefore not offering as much hours to their current staff. I'm not for sure if this is true, but things are slowing and slowing.

How slow will the grow and how much will it affect us? I'm not so sure that we couldn't find something else if we HAD to versus my husband who could not. That in itself is a good reason to sit and consider how lucky we are to be pharmacists right now. People need us. Even in bad times.

Update:  Three Years Later

I have always wanted to do this and spend the time to tell you how the pharmacy market has changed over time.  Yes, we were right.  Now there are so many pharmacy schools and pharmacy students graduating that the jobs have all but dried up.  You can't find a job.

How sad is that?

How to Make the Transition from Retail to ANYTHING Else

You've finally reached the end of the line in retail.  You've had enough of the rude public, the non-pharmacist managers, and the corporate cuts.  You are ready to have an hour lunch (maybe) and normal bathroom breaks.  You are ready to feel a little more professional.  Sorry, retail pharmacists, you know it's true.  Yes, you probably make more money than me, but at least I'm not worried about my health.  (I was working retail in a terrible part of town.  All of the good areas were full with waiting lists of pharmacists ready to transfer out just like me.  I just chose a quicker path). The first thing that is entering your mind as I'm noticing on a couple of comments here is that you think a special amount of training is required.  Let's first think about hospital pharmacy.  You can transfer from retail to hospital pharmacy fairly easily.  Hospitals can train you.  There is a lot to learn, yes, but I was up-to-speed in two months.  I worked five years in retail, if that helps at all.

You will have to learn about the hospital's formulary, allergy list, and perhaps coumadin and pharmacokinetic dosing again.  You will certainly have a lot of pharmacists willing to help.  There will be no more jerks in line waiting on you to hand them their papersack with drugs; you will merely have a function to be a part of the team that helps to heal the acutely and chronically ill.  You will revisit sterile technique to mix IVs, chemo, and TPN. (I hope, though it seems the hospitals I worked in didn't observe this at all!)

And most importantly... you will have a life back.  No more driving home from work in retail and a customer follow you home.  No more jerks waiting until 3 minutes before close to get 10 prescriptions filled... all new.

I don't regret leaving retail at all.  I do regret losing the knowledge of some of the new drugs since graduation, but it's worth it for peace of mind and life.

I hope that helps.

Pharmacists

Every once in awhile someone will find my blog and decide to once again attack pharmacists on what we do and what we get paid for what we do. "Order entry and some allergy checking, how much do you get paid?"

Seriously?  It's almost as if I were to sit here and sum up the current economic crisis to the fault of the Democrats or Republicans alone based on something I heard on TV.  I have NO idea about the economy and I'll be the first to raise my hand and say so.

Since I have some readers that have no idea about what we do... I thought I would elaborate:

Pharmacists enter your order into a computer.  We make sure that everything written makes sense.  It's a first check kind of thing.  We make sure that all the legal components of a prescription are there regardless if a hospital order or a retail order.  Sometimes we cannot do this step and we hire a technician to do it.  Sometimes we have to check several hundred per day and many times companies find it a better use of our six figure incomes to put us checking and having other people enter.  Usually there is a ratio of 3-6 techs per one pharmacist.  Imagine how much we check at that point?

We check the drug against your profile.  Usually based on other drugs you are on (should you not disclose to the pharmacy other illnesses or conditions you have) we can tell what is going on.  Oh so your doctor has written for Levaquin 750 mg daily.  Oh snap!  You have kidney failure.  That isn't good.  Wow.  We're going to pick up the phone and call.  Oh snap!  This drug interacts with another drug on your profile.  Oh wow!  This drug is subtherapeutic.  Oh!  He wrote for 650 mg.  It doesn't come in that strength.

We check the directions.  Once daily, twice daily, three times daily, every 48 hours, every odd day, every even day.  Every single day we check to make sure this is correct.

We check the tablet to make sure the tech put the right one in there.  They all look alike.

Many times GASP! we get a phone call from a prescriber who wants our opinion about how to dose a particular drug.  Here in the hospital I'll get a call on how to dose different meds.  You mean the doctor doesn't know everything?  Nope, they have to look things up as well.

In essence:

Pharmacists serve patients and the community by providing information and advice on health, providing medications and associated services, and by referring patients to other sources of help and care, such as physicians, when necessary. Likewise, advances in the use of computers in pharmacy practice now allow pharmacists to spend more time educating patients and maintaining and monitoring patient records. As a result, patients have come to depend on the pharmacist as a health care and information resource of the highest caliber.

Pharmacists, in and out of the community pharmacy, are specialists in the science and clinical use of medications. They must be knowledgeable about the composition of drugs, their chemical and physical properties, and their manufacture and uses, as well as how products are tested for purity and strength. Additionally, a pharmacist needs to understand the activity of a drug and how it will work within the body. More and more prescribers rely on pharmacists for information about various drugs, their availability, and their activity, just as patrons do when they ask about nonprescription medications.

So before you go comparing me to a tech earning $8.00/hr, try to learn a little bit why I have a degree in chemistry and then a Doctor of Pharmacy (8 years) and what we do...

Just because Walgreens, Eckerd, Rite Aid, CVS, and your numerous grocery chains are hell bent on making their pharmacies look like a McDonalds drive thru... doesn't mean the person in charge back there doesn't deserve the pay they are earning.

Geeze.

Two Pharmacists Convicted

My question is this:  How did they get away with it for so long???

By Nick Madigan

Sun reporter

August 1, 2008

After a seven-week trial, two pharmacists accused of selling almost 10 million addictive painkillers illegally over the Internet were convicted yesterday in federal court in Baltimore of that offense and several others.

Steven Abiodun Sodipo, 51, of Forest Hill and Callixtus Onigbo Nwaehiri, 49, of Jarrettsville were found guilty of selling 9,936,075 units of hydrocodone online using phony prescriptions; conspiracy to launder money; engaging in transactions involving the proceeds of drug sales; and filing false tax returns.

Sodipo and Nwaehiri, who face maximum sentences of 70 years in prison, owned and operated Newcare Pharmacy in the 400 block of Sinclair Lane in Baltimore, a business they founded in 1993 that initially specialized in delivering medications and medical supplies to nursing homes and other assisted-living facilities. There was no walk-in service as in traditional, drugstore-based pharmacies.

Prosecutors said that beginning in 2004, the defendants joined a "nationwide conspiracy" to illegally sell hydrocodone over the Internet to anyone with a valid credit card. They engaged in agreements with Web site operators to fill prescriptions e-mailed to them that were signed by a small group of doctors. The doctors, who never saw or spoke to customers, routinely authorized the prescriptions, which were then wired to Newcare for filling and shipment, prosecutors said. In return, Newcare was paid $20 for each prescription it filled and shipped.

"Prescription drug abuse is a growing crisis in Maryland and throughout the nation, and it is one of our most important drug enforcement challenges," Maryland U.S. Attorney Rod J. Rosenstein said after the verdicts. "Many people wrongly assume that prescription drugs are safe. The truth is that using any drugs without proper medical supervision can result in addiction, injury or death."

Carl J. Kotowski, an assistant special agent in charge of the Drug Enforcement Administration's Baltimore office, said the investigation of Newcare "sends an instant message to cybercriminals that the Internet is not their safe house."

Evidence presented at trial showed that Sodipo and Nwaehiri continued to sell large quantities of hydrocodone even while aware that some of their customers were addicts.

The government is seeking the forfeiture of $20 million, the gross proceeds of the sales of hydrocodone from January 2005 to October 2006, when DEA agents raided Newcare's 55,000-square-foot facility and arrested its owners. More than 50 employees of the pharmacy lost their jobs. The government also intends to seize the Newcare facility and its contents, and the homes, bank accounts and motor vehicles of the defendants.

Chief U.S. District Judge Benson E. Legg set sentencing of the two men for Oct. 21.

A co-defendant, Ahmed Alhaji Abdulrazaaq, 49, of Forest Hill was charged with conspiracy to defraud the IRS and is scheduled to go to trial Sept. 2.

nick.madigan@baltsun.com

Copyright © 2008, The Baltimore Sun

Are You Kidding Me?

My mouth just dropped open.  It's obvious to me that physicians do NOT read medication reconciliation forms for home meds at all.  The ones that do, kudos, but the ones that don't make my job more interesting and at times really get to me. Case-in-point:  50-something presenting to the hospital with lower GI bleed.

The doctor signed off to CONTINUE HER HOME MED OF PHENTERMINE FOR WEIGHT LOSS.  Are you kidding me?

I guess the nurse could have written "Purina Dog Chow - take one cup by mouth daily" and the physician would have signed off on it.

Way to go Joint Commission on putting in a requirement with no means of adhering to any sort of THINKING for anyone involved.

Except for the pharmacist of course to wade through the BS and find what is really needed.

I really like the one where the physician wanted to continue the patient's viagra while in the hospital.  THAT should keep the nurses on the floor on their toes running from a man who is looking for some fun.  Not good.

Medication reconciliation forms.  The bane of my existence.

Some pharmacists give us all a bad name...

There's nothing worse that grates under my skin as a pharmacist than to drive to a retail pharmacy and find a pharmacist digging in the trenches with a sourpuss expression and basically giving us ALL a bad name.  We're not ALL miserable. Here's a post about waking a retail pharmacist up only to find out she had the wrong drug.

Not that we cannot make mistakes... but please.