typical conversation

Me: Hi, I was hoping to change this patient's prescription from Diovan to losartan or irbesartan because his Diovan copay is $150 and his losartan copay would be $7.
Nurse: Well, I don't know why the Diovan would be so expensive
Me: Diovan is a brand name drug and losartan is generic. They are in the same class and he has never tried losartan, so I feel it would be a good option.
Nurse: But Diovan is available as a generic
Me: No it's not
Nurse: Yes it is
Me: No it is not
Nurse: Yes it is.
Me: Diovan is not generic yet
Nurse: Um yeah it is.
Me: No.
Nurse: I could have sworn valsartan was generic Diovan
Me: That's it's generic name, but it is not available as a generic drug
Nurse: Well, I'll just have to talk to the doctor then
Me: (Sends fax to office stating the exact date Diovan will be available as a generic which is not for another several months)
Nurse: (3 days later, faxes me prescription for losartan)

Diagnosing the Joker

The first time I saw The Dark Knight, I was with a friend who is now entering pharmacy school. I believe I was in either my first or second year at the time. About half-way through the movie, I turn to him and say "the Joker has tardive dyskinesia" and then try to explain what that means through the rest of the movie. It actually gives him a pretty sweet back story. The Joker is certifiably insane. My best guess would be severe Bipolar I disorder, anti-social personality disorder, and ADHD. At any rate, he was heavily medicated with typical antipsychotics to the point of developing TD. So, he breaks out, is obviously no longer medicated, but the TD remains as evidence of his former treatment. Tardive dyskinesia is made up of involuntary facial/body movements that become present when neuroleptic drugs are used for an extended period of time, and remain even after the medication is removed. Whenever the Joker is particularly psychotic or in high stress situations, like when he's telling people "how I got these scars," his tongue flicks in and out of his mouth, obvious dyskinetic behavior. Pretty cool huh?

Suboxone continuing education

from a pharmacy CE... Characteristics of forged prescriptions include: Handwriting that is unrepresentative of the prescriber or appears too legible

Never in All My Life!

So, Jillian was helping a patient who was having an insurance issue, and it was taking quite some time. Amber had been chatting with the woman behind her about her day, and she mentioned she had ice cream melting in her car, so Amber decided to ring up the woman at our other cash register. As she finished the transaction, the first woman yelled, "Did she really just cut in front of me? Never in my life have I had someone cut in front of me in line like that. I don't care if she has ice cream in the car. Who doesn't go to the grocery store without a cooler in the back of her vehicle, seriously?" We all kind of stared at her for a minute, thinking she was joking, but she was seriously upset. Jillian said, "I'm sorry, I am still helping you, Amber was not helping you." But the lady still looked really mad and stormed out of the store as soon as Jillian resolved the insurance issue. It is like if you go to Walmart and one check out line moves faster than yours, really? Is that cutting in line? And um, I don't go to the grocery store with a cooler in the back of my car, do you?

Verbals

"Hi this is So And So from Dr. Jones' office, this prescription is for Jane Doe. Progesterone suppository 200mg. One suppository per vagina each night at bedtime" Wait, what?

New Rule

NO ONE is allowed to prescribe ANYTHING that they cannot spell. Seriously, if you don't know how it is spelled, how do I know you know what it does? Sometimes, I think they just can't remember the name of a drug, so they scribble down nonsense and just assume I'll pick what they mean. I laugh a bit when I hear patients or MAs say levo-thy-ro-sin-een or om-a-pro-zol-ee, but if you have a frickin' MD and can't spell guanfacine, I'm sorry, you don't get to prescribe it. The end.

Spring Fever

We had a recent rash of men coming in with erectile dysfunction medication prescriptions. These are some of my favorite phrases they have used to describe the med, without mentioning its name or purpose: Passion pills Plumbing pills That one pill, you know... I would actually rather have men be discreet about it though, however humorous it may be. I have had more than one of my patients tell me EVERYTHING else they had tried before resorting to Viagra. Wow. I am so professional until they leave...