Tuesday, December 1, 2009

Rite Aid

I don't work for this company. But I currently finished doing an IPPE here about 2 hours ago. For such a well known name in chain pharmacy, I'd have to say the experience was eye-opening. So, I work for Walgreens as an intern. Everybody there complains about Walgreens. I interned with Target. Everybody there complains about Target. Rite Aid people complain too. However, they have a signicantly less sophisticated computer system and their counseling point stickies are among the most aggravating labels I've ever worked with.

My preceptor, a barbie, soft-spoken, under-intellectual woman of 35 years, on three seperate occasions, has attempted to teach me how to properly apply these counseling point labels to no success. Just so you know, the main label and counseling point labels all print out on the same sticky. The stickies are 5 different colored perforations with different counseling points for each color.

Around halfway through my internship, my preceptor switched my role from that of a thinking practitioner-in-the-making to that of a lick-and-stick subway sandwich artist. She obsessed and supervised my use of scotch tape to press down on the labels, pull them off the sticky backbone, fold them in half and still stick them onto the vial perfectly symmetrical. She admonished me for not being "pharmaceutically elegant" enough, and her economy of me as a robot intern filler dropped to about an eighth of original productivity from before just because of how tricky this was for me. For example, I'd pull the labels off of the backbone and suddenly the tape would stick to the sig label or to another part of the tape and just cause chaos; sometimes the paint from the colored parts of the sig label would bleed off onto the tape and 9n98ybg98d7ufng98d7fng987n9sd8fg7uns...it'd just be a mess. I'd have to reprint labels, take more mild verbal abuse for being too much of an idiot to do this as adeptly as her and so on. So, to avoid getting yelled at as often, I'd put only one or two of the counseling points (leaving off inane points like "Call your doctor if your symptoms don't improve") in hopes that she'd like "pharmaceutical elegance" as it pertains to counseling points that are actually useful to the patient. But unfortunately her staff pharmacist, who is 4 years younger than me, started bitching about "picking and choosing how to consult", wasting even more precious time that could have been used to fill their prescriptions uncompensated. So, today, I kind of perfected my skill by first prying off the labels by hand, THEN adding the tape on top, folding and THEN attaching the labels as straightly as possible on the side of the vial. In other words, I added the tape to the labels after they were detached and not before. The princess micromanager that she is, my preceptor noticed this and got ticked off. HAHAHA. The same outcome was achieved but she didn't like my means.

So does this label fable shed light on the types of pharmacists Rite Aid hires, or on the company as a whole? Was it a personal thing she had with me, such as a power trip? I do not know. I factored what fraction of my tuition, credit-hours wise, does to my IPPE. Basically, I paid $2,278 to be harassed by Barbie regarding how to apply a horribly designed set of counseling labels. I also learned that ALL retail pharmacists, doesn't matter what you work, work to avoid: their practice isn't guided by common sense or their particular circumstances, but by doing exactly how they were told from middle management to do things...I shall dubb it Conflict Aversion Pharmacy Practice. All in the name of avoiding reprimanding, correction and general visits from upper management.

Ugh. If just I had a word that started with R between "Conflict" and "Aversion", this acronym could be a self description. Am I destined to become this kind of pharmacist?

Thursday, November 5, 2009

Who did Obama "appeal" to?

Look, APhA, you are sad.

I talked with a classmate today who doesn't seem to understand that pharmacists, just because they are capable of taking on the workload for certain physician/nurse tasks, may not ever do the things they were trained to do, or call the shots in how they're compensated for it. She was certified by APhA to give flu shots but the unfortunate truth is that she doesn't get paid to do it. Think about it: yes you are giving flu shots at your pharmacy, and having some role doing a task that is considered novel in pharmacy. Just because pharmacists are largely paid hourly, does this still mean we are being compensated for it, or that we're just passing on the buck to our employer? I don't believe pharmacists get paid more for this, it just adds to their headache since the work that was already yours to begin with has not necessarily gone away.

Stop and think for a moment, if you are an intern or licensed pharmacist: do you have any say whatsoever in your practice? I don't know the answer to this. Everytime I'm in the den of my employer who will remain nameless, I see pharmacists working registers, taking out the trash, being told when to take a break and what to do, filling out unnecessary forms...just doing a lot of bullshit tasks that no professional in law, accounting, or even medicine would ever deal with. But what makes pharmacists so different? Why were they so easy to take advantage of with money? All these professionals make a good deal of money---hell, I think lawyers have the potential to make much more me thinks. But how do pharmacists put up with this?

So does it make sense to say we as pharmacists are controlled by multiple other professions by virtue of our minority population? 500,000 nurses and maybe over 150,000 physicians in the state of California...how many pharmacists? 23,000. APhA vs. the AMA: what president in his right mind is going to address David as WELL as Goliath?

Is it better for my mental well-being to be as pie-in-the-sky as my classmate about things? That it's just going to "happen" when the time comes that our scope of practice is going to increase just because there is increased pressure on physicians? Yes, indeed we have petty immunization rights and freakish hoops to get through to prescribe, at the mercy of a physician in some cases. As per another blog I read by Jim Plagakis, the AMA has "bigger fish to fry" such as improving the state of affairs for PHYSICIANS.

The problem is, the APhA doesn't do the same for the professionals it represents: while heralding the old news issues of immunizing patients and screening for disease states, etc., the ugly, red-headed and freckled truth is that the average pharmacist just merely wants more humane working conditions, more help behind the counter, and more time with their patients. It seems like pharmacists will only be confrontational with an entity more faceless than their employers: big pharma, but they will never criticize or stand up to their employer for denying them a vacation time during summer (when the kids are actually out of school), or for making life hell by cutting staff, making it even more impossible to fulfill their professional duties to consult and monitor patients. APhA-ers will decry direct-to-consumer advertising like it's such a great cause and because EVERYBODY ELSE does it. They'll simply state "Biologic drugs need to be made into generics immediately so that these life-saving meds may reach the hands of patients who need them!" Come on, Profession-of-Pharmacy! Are we really this naive? Do we have no sense to actually think outside of the box for once about how our health care system works, and how, in this country, inventors are awarded and given incentives for developing ingenius things because they get to patent it? Unfortunately this all boils down to who and what APhA is all about: reinforcing Papa Physician as supreme and Mama Pharmacist as the domesticated, subservient housewife. If you're still reading, are you angry yet? Do you feel a fire to cut the crap and have a spine and actually take pride in the work you do?

It is for this reason that I am going to join the AMA for a year or so and assess why there is such a difference between them and the APhA even though both physicians and pharmacists become doctors. I'm not going to watch my future profession be squandered like this. Nobody is doing this to us: we are doing it to ourselves by obeying the status quo and letting people less knowledgeable than us be in the driver's seat.

Let's face it: only pharmacists can take responsibility for the shitty state of the profession. So I ask you: what common ground do we have that will unite us to actually make a difference? Cause it ain't the APhA...although they do have fun conferences.

Monday, October 12, 2009

The Cycles of Abuse in Pharmacy

It goes like this in any family: father beats and belittles son. Son beats and belittles his son. That son will do the same.

Pharmacy is a small family. Numbering 220,000 nationwide, the pharmacy family is an unhappy, dysfunctional one with a few success stories. You've got your grandparents, the old-timey BS in Pharm that were taught to memorize what the pills look like in school---the most gentile and, unfortunately, useless folk. Then you have the various aunts and uncles you never see, the ones that work retail, or maybe part-time or maybe nevertime, and they pretty much represent the profession of hard laborers. Then there are the varieties and varieties of children, us. New pharmacists and soon-to-be pharmacists.

The soon-to-be pharmacists have been cracked on the head with humiliation by their preceptors and bosses throughout school. It might be wide-spread in health care in general, as I always hear horror stories about what medical interns and residents deal with for actually, much longer than pharmacy students. Pharm interns have had their souls suckled on by chain pharmacies, paying them a technician's pittance to basically do everything but electronically verify the actual prescription, while taking a confidence beating by patients and especially middle and upper management. Maybe it's just my experience of it?

This is where the dichotomy begins: all the pharmacy children of the family are sent off to the "real world". You've got the ones that become massively successful, that is, making a living off of something other than retail, and they are seen as the avuncular successful cool family members that bring a fun demeanor to your Thanksgiving dinner, and buy the best presents for you at Christmas. Then you have straight-ahead domestic types, the ones that somehow adjust their personality properly to survive, and they present at your family reunions as blending in, not loud or full of life or anything. Is there a third type? I think you're either a have (non-retail pharmacist) or a have-not (retail).

I pity my peers who have their sights set on retail. Hey, maybe I'm someone who is an easy target because my damn mouth is just open too much, but the retail life is that of a corporation holding against you that you're a pharmacist. They despise paying you what they pay you, they micro-manage your every move, dish drain the professionalism out of you, and nit pick the fucking daylights out of any remnant of a personality or soul you may have. My DM, for example, has typecasted me as a dumbass. He is a douche. Although he's an approximately 40 year old Vietnamese pharmacist, I'd classify him as the old timey style pharmacist, the "do as I say not as I do" type. He'd come into whatever store I'm working in, not say hi, and just instantly start complaining about something I'm doing or would go up to a computer and say "blah blah blah, we need to schedule you for such and such a thing...by the way I got a complaint about blah blah blah. And i heard you've been taking your paid breaks and lunches together to study...but you only work one day a week, so if you're needing to study on the one day a week you work, there might be some other problem we're dealing with here.." How about I just want to use my time alotted to me toward putting a dent in whatever work I need to get done for school since I'm still a student?

And, so the cycle goes. Preceptors are unpaid, but they get free labor. How do you get a preceptor to take your school's students? You say "Hey we'd like to place a student at your store...look at this this way, you get to have someone help you with your workflow! Work 'em however you want." How does this NOT encourage them to dump any resentful feelings they have about pharmacy onto this student? Here (the intern) is a shining example of what they used to be, and look, you get to exploit them for 60 hours per semester, and infect them with all the humiliation and negative reinforcement THEY dealt with as a student. A psychological change will occur in this student through their studies, becoming more callous and beastial to resemble their preceptor. They will see the cause and effect of trying to be "smart", of trying to bond more personally with their preceptor, and of thinking that pharmacy can be anything other than one of the least respected professions this side of Timbuktu.

I had a preceptor in a specialty internship (paid) that I did over the summer who is 2 years out of pharmacy school. He started out as the goofiest, friendliest preceptor I've ever had. Naturally, I felt very at ease to be goofy myself, and I clung on to his warped sense of humor as a sign that maybe normal people with a free spirit sometimes inhabit the pharmacy profession. However, my comfort was soon squandered when it seemed to irk him when I recounted that I was talking about going to the ocean and mountains during my weekends while he was working overnighters (a mistake in hindsight on my part). With the dramatic and cliquey atmosphere at work, and me not understanding the politics at play, he soon started showing some signs of wanting to keep me at bay. Instead of challenging me with intellectual questions and allowing me the freedom to explore the specialty in books, on the internet, and by visiting hospitals to see radioactive medicines being utilized, he tried to get me to do more routine tasks such as cleaning. He tried making filling out a routine form look really interesting, and I feigned interest at first, but became really bored, and I began to crack. The shit hit the fan when I asked him if I could make a slide show about the specialty, and he took me aside and said, if he could, he'd fail me because I don't do what I'm told, and this was in response to his boss saying that it would be ok to make that slide show because then the company wouldn't have to solicit students to work for them at my school, I could do it. He said he wasn't satisfied that I was doing enough work flow stuff---indeed preceptors don't like idle interns, but really it was because I asked his boss directly if I could because I needed some challenge, and that surprised him. Such a shameless, controlling baby he turned out to be. Funny how preceptors will say "how you act reflects on me"...no it fucking doesn't.

So, in pharmacy, management shits on pharmacists, patients shit on pharmacists, and pharmacists shit on pharmacists. Isn't there something wrong if schools are admitting students who buy into this? I have vowed to never belittle a pharmacy intern if I become a preceptor, but can I really promise that without having actually experienced what it feels like to work 40 hours a week living off the profession and dealing with the pressures of managing technicians and being the person who deals with complicated complaints?

Saturday, October 3, 2009

American Pharmacists Month

There's a certain brainlessness widespread among pharmacy students---indicative of what they think they'll have to be like as an actual practicing pharmacist. This is at the crux of why things won't change at all in this profession.

Enter American Pharmacists Month:

There is an incredibly annoying facebook campaign going on right now spearheaded by UOP in which a new daily fact is copy and pasted from a list about pharmacists into facebook stati. Lots of my FB friends, many of whom I thought were smarter than this, all have the same picture posted (which says Know Your Medicine. Know Your Pharmacist.) and in tandem are posting the same thing as everyone else. Here's the thing: I've never subscribed to the "strength in numbers" tenet, but what is it about this portion of the population that makes them want to be just like each other? Do you guys really feel as empty as you act?

Don't get me wrong. I am proud of what line of work I'll be going into. I'm proud of the high earnings, and....um....the pay...Ok, maybe I'm a sellout. Because all I see is negativity. Horrible working conditions. Unnecessary stress. No rights to defend yourself from rude, ghetto customers. And an expectation that you won't ask for what you want, you will take what they give.

My friends, this is why pharmacy is the way it is: people who aspire to be pharmacists value money over thinking. Am I really to believe that these facebook status posters will still want to provide 'optimal patient care and oversee the patient's maximal therapeutic outcomes" after they actually learn what the reality is? Do they know the realities yet or are they really as naive as they act?

Sunday, September 27, 2009

The overachieving, meeting attending, point missing pharmacy student.

Let me introduce you to an annoyance of mine: the do-all pharmacy student that joins 4 million clubs and a fraternity (biggest waste of money), but never goes to conferences, never gets the point. They have 2 meetings on Monday, 3 on Tuesday and Wednesday, one on Thursday, and none on Friday. But at these meetings, they are on their cells the whole time, texting and whining that they have a fraternity event to worry about and that they don't know what they're going to wear.

It's a continuation of high school, a continuation of college, and now, they just don't get the point. A PharmD is pretty much the end all degree of pharmacy; grades-mongering is pointless unless you're planning on applying to a residency without ever using networking. Going that route, they'll have to tell their patients "I'm a perfect A student so I am going to manage your pharmacotherapy and health care delivery in an A like manner, and I'm going to be successful". Is this the wrong approach to health care? Actually, come to think of it, is the health care problem in America also related to the demographic of students being admitted into programs and eventually spat out?

Thursday, September 24, 2009

Periscope:Genesis

Hello, I'm a pharmacy student.

Yes. Pharmacists have to go to school. And it's all science, like medical school, and massively expensive, like medical school, and you earn a doctorate eventually, like medical school. However, we are eventually pooped out the other end hirable for a job that puts us immediately at the pinnacle of our earning power, usually around 100-120K per year. Medical doctors instead go into residencies or other education, and are paid half their worth for an additional 3-5 years.

Who am I? I'm a rocker, I'm a punk, an artist, a very opinionated and very willful 2nd year pharmacy student. I don't fit in my surroundings. I am outraged about the abuses that go unreported at pharmacy student internship rotations. I've been accused of being "unprofessional" when speaking out. I nurse my non-conformism. I am a lover of women.

I deplore middle management bullies, yet I work for the largest retail pharmacy chain in the country. In 3 short years in the pharmacy business, 1 of those as an intern, I've gotten a glimpse into who has been at the wheel of this pharmacy bus for so long: MBAs and lawyers. I see the surrendering of pharmacists in the retail setting, dealing with the load of condescending treatment and busy work bullshit piled on them daily. I also see how they make no remarks of protest over it, even though they are sought after due to their paucity in the market. I've seen a pharmacist accept $30,000 to stay with the company after complaining about not having enough tech coverage and putting patients at risk. The pharmacist took the money and nothing changed.

Right now, I don't know what a pharmacist is. Is a pharmacist a domesticated scientist? Drug manufacturer clerk? A respected practitioner who can take your blood pressure and skillfully switch your Zocor to simvastatin and save you a lot of money? Do pharmacists even consider themselves professionals?

Pharmacy is the most trusted profession, but far from the most respected.

I should disclaim that this blog has been long in the works. What has stopped me is the extreme, almost fascist negative reinforcement I have experienced people higher and sometimes even lower on the totem pole---showing any kind of resistance or hesitation to being abused raises corticosteroid levels of people responsible for crushing or shutting down your free will.

The fear of being discovered for who I am keeps me at bay, since I'm still budding and already fight an uphill battle due to opening my big mouth. In this profession, I have learned about the repercussions to be felt for bad-mouthing anybody, and how they can smite you down if they have any leverage or connections anywhere. I have learned how conservative the powers that be are: they don't care about your bright ideas nor about your hardships. I have learned from few examples that you have to bite your tongue, smile and prove yourself little by little. So I write this ready to go to distant lengths to protect my identity. I will respect HIPAA laws. I will be as honest and raw as possible without stooping to insults (I'll try).

Godspeed, and congratulations to myself on my new written baby.