A pharmacist's look at the supermarket and beyond

Month: February 2016

I Read, Therefore…

I read many magazines, several pharmacy-related, also Mother Jones, The Atlantic, Time, Rolling Stone, even Entertainment Weekly, as well as the digital Arizona Republic every day. There is so much happening out there that it is hard to find time to share and comment on some very interesting developments or findings. I’m almost caught up on my reading of the latest batch of print media and must comment on some of the things I discovered.

MoJO had an article about sex ed in this country with a nifty little map diagram that shows that 25 states require that abstinence be taught as the best option and some of those don’t discuss contraception. More than half of those states have higher than average birth rates for women aged 15 through 19. To me, that seems like common sense, and another instance where a “study” is unnecessary to reach a conclusion.

Dave Gilson, in that same MoJo let me know that the FDA is allowing the formerly known as California Prune Board, to rename prunes as dried plums, saying it would be a more “female-friendly” choice. No word about raisins or figs. Did you know that there are lobbyists promoting replacing paper dollars with dollar coins? The money is coming from… wait for it… vending machine companies and copper mining companies. They claim the move would save America billions$$$.

Somewhere I saw that McDonald’s new kale salad has more calories than a Big Mac. That’s with dressing and chicken. Oh, it was Time, where I also learned that a Florida man got busted for tossing a live alligator into a Wendy’s through the drive-through window. Coming soon to Wendy’s: Gator Nuggets in an all-natural, leathery container. In other fast food news, Burger King announced that they will be aggressively going after the hot dog market. I’ll be watching for Prince Wiener. There was mention elsewhere that the wing eating winner in the Wing Bowl consumed 429 wings. Can that be right? I like wings, but, whoa!

I like the new Nature Conservancy ads that remind us that trees scrub out 1/5 of our carbon emissions. Maybe we can see some candidates planting trees!

Since 2009, under Obama’s watch, the US has manufactured, sold, and shipped over $200 billion worth of weaponry to the rest of the world, with Saudi Arabia, United Arab Emirates, Australia, Iraq, and Israel making up the top 5. In contrast, during W’s two terms the total was $60 billion. Of course, W sent a lot more of our young men and our own weapons to foreign lands while Barack seems to prefer arming our allies (hopefully) and sending fewer boots with our guys in them. This web page gives a graphic picture of weapon sales in 2013.

Time pointed out that 244 drugs were tested for Alzheimer’s since 2000 and only one was approved. Stanford’s Dr. Frank Longo is quoted as saying, “we’ve cured Alzheimer’s many times in mice. Why can’t we move that success to people?” They currently have a drug in Phase II that shows promise in eliminating the amyloid plaques seen in Alzheimer’s. With over 50 million people battling varying degrees of dementia, I am hopeful that we are near a cure. I can only hope that Big Pharma will not find a way to slow progress towards a cure while they reap billion$ from the moderately effective treatments now available.

For the first time in 21 years, the US team won the 56th International Mathematical Olympiad! The Atlantic says “something very big is happening” in math. I think it’s the new focus on STEM (Science, Technology, Engineering, and Math). The US Department of Education has many new initiatives that enable and encourage this important strategy for a bright future.

The FDA plans to hire 430 new people in the coming year as it expands its role in food safety.

The FDA has a computer app that has reviewed 380,000 electronic heath records and adverse event reporting data in FAERS and warns of potentially fatal drug interactions: ceftriaxone + lansoprazole; cefazolin + meperidine; vancomycin + meperidine; metoprolol + fosphenytoin. There have been over 9 million adverse events reported to the FDA since 1969, although summary data is provided based on the last ten years.

I learned in the Rolling Stone that the price of solar panels has dropped 80% since Obama took office. The always insightful Tim Dickinson digs into the efforts by the Koch brothers to cripple the rise of solar and how they are working at state level using “dark money” and deception. I thought things were pretty bad here in Arizona, with most of our utility-governing commission seemingly in the pocket of Arizona Public Service (APS) and its parent company, Pinnacle West. The RS article tells of even greater shenanigans in Florida where its utilities “crushed a citizen-led effort to open Florida to solar competition through the 2016 ballot.” It’s a very illuminating article and worth a read.

Thanks for reading this blog’s 100th entry! Please keep reading and sharing!

Why We Do What We Do

The tall, lanky man at the pharmacy counter dropped off Rxs for Percocet and Tincture of Opium. I was new to this location and so was he. The technicians were a bit skeptical and consulted me. As I like to do in these situations, the first thing that I did was talk to the patient. Mr. G spoke with a British accent and had good conversational skills as he presented his medical history and his current battle with colon cancer. He explained how the oxycodone somewhat managed his pain and without the tincture of opium he was visiting the restroom up to 30 times a day as his bowels were barely functional and what little food he consumed passed quickly through him. I filled his prescriptions. Mr. G was being told that he may only have six months to a year to live.

That was over six years ago. Through those years, my team and I have grown quite fond of Mr. G as he maintains a “stiff upper lip” when it comes to his battle with cancer and is always polite, friendly, and honest with us. Together, we have dealt with obstinate insurance issues (the opium Rx needs prior authorization, always), coordinated his care with multiple physicians, and probably most importantly, showed that we liked and respected him. I have always tried to improve his quality of life, whether trying various nutritional strategies, from supplements to fiber, or intervening with health plans, other providers, or state welfare agencies. Thankfully, Mr. G has been under the care of a compassionate oncologist who will even travel to a different office so that he can see and help Mr. G. This is health care as a team sport.

I enjoy talking with Mr. G, particularly about politics. Mr. G brings his worldly perspective to state and national politics and easily saw through the facades created by many of our politicians. Mr. G is an American. A proud American. He still has the accent of his homeland, but he confided to me that he long ago became an American citizen and renounced his British citizenship. Other than healthcare providers and a lady friend that is his primary caregiver, Mr. G has a small support network, so I think our impact on his quality of life is greater than with most patients.

Most recently, I set up an appointment with Mr. G to help sort through his changing insurance situation as he transitioned from Medicaid (AHCCCS, the Arizona Health Care Cost Containment System) to Medicare. After reviewing all his paperwork, which seemed to be giving him conflicting information depending on its source, I was able to determine what his new coverage would actually look like. He now has a “limited income” temporary Medicare plan which will cover his meds for February and then will be on a Medicare Part D plan starting in March. Medicaid, or AHCCCS, will still coordinate his medical coverage, but not his prescriptions. This was no easy task and I marveled that people are able to get these things sorted out. Of course, they often do not, at least, not without the help of technicians and pharmacists like my team that make the necessary phone calls and take time from their busy days to play social worker on behalf of their patients.

Once I learned the proper Rx coverage for Mr. G, I called his specialty pharmacy, Avella, with all the BINs, PCNs, etc that our computers require to properly bill for his pharmaceuticals. No doubt, the opium will need a new prior authorization, but now we have time to get that process initiated and in place when needed. Mr. G is very concerned about not being able to get the tincture of opium because without it, he his essentially a prisoner in his home, with trips to the porcelain throne required every 30 to 45 minutes. I told him that if Avella was having difficulty providing this Rx for any reason, that he must contact my team and we would make arrangements that he would not be without this medication.

It’s such a rewarding and motivation accomplishment to see our efforts have such a profound effect on a patient’s life. It is truly why we do what we do. Every day.

For his part, in addition to his positive attitude and charming personality, Mr. G brings a plate of cookies every Christmas, and often fills out the customer surveys with comments like this one:
“Carl Labbe the Pharmacy Manager and his staff always make me feel special and it shows in so many ways. I have Stage 4 cancer and they have helped me stay alive for a lot longer through their understanding and kindness.”

Twisted Metrics

I have written about pharmacy metrics and how they dehumanize a workplace previously. Well, our fiscal year just ended and one number that I keep track of really caught my attention.
If you recall, we are judged based on our “percent effective,” which is a number derived from the set of tasks and the associated labor time to complete each task. Based on business volume, a total number of hours is calculated and a “percent effective” (%Eff) of 100% would mean that exactly the correct amount of labor was used to complete all the business (tasks) in that time period. It’s suggested by management that a good %Eff is between 100 and 105, meaning that your team should be working a little above the average worker. Not made clear how we can all be above average, though, other than the trite reply of “it’s the industry standard.” Too many weeks with a %Eff below 100 and you’ll be hearing from a supervisor. My department’s %Eff for last year was 106.5% meaning that we all worked harder than we should have. The reason becomes apparent when I see that to be on target at 100% effective we should have used an additional 1,382 hours of labor!
Mind you, this is using the company metrics. Their production numbers and their task-based metrics. My team marveled at that huge number. We take pride in our performance and our ability to serve our patients and customers very well. But then we asked, “How the Hell does that happen?”
So I started playing with the math. First, that 1,382 means an average of 26 hours and 34 minutes of missing labor each week! Using our average shift length of six hours, that’s 230 uncovered shifts for the year or nearly four and a half shifts each week or about 4 hours every single day! I won’t go into the dollars saved on wages here, but feel free to use your imagination.
Of course some of those missing hours were our own damn fault. Pharmacy people get sick too. We have lives, loved ones that depend on us, and vehicles that we can’t always depend on. Briefly, shit happens. But we are hardly to blame for all 1,382 hours. More than half resulted by our company failing to provide personnel to fill the vacant shifts, leaving us scrambling and working too damned hard.
I’m sure many of you, in pharmacy or out, have seen similar business strategies. The flawed metrics, the expectation of perfection, and the lack of direct support during trying times, are things I hear from friends and family in other enterprises. We feel these practices contribute to the tepid economic recovery that we are seeing, by making existing employees bear the brunt of maintaining the business when absences and lack of hiring lead to shortfalls like we experienced.
Our team eagerly steps up to cover when of of us is sick, injured, or otherwise unavailable. However, when shortfalls are due to what appear to be the ineptitude of the organization, morale suffers. I’m giving the benefit of the doubt by saying ineptitude and hope that is not simply naked greed that causes these recurring, preventable, uncovered shifts.
I’ll be sharing these insights and others with my management and would encourage you to do the same. Silence is your enemy in this type of situation. Present facts, illustrate flaws, and suggest reasonable solutions. Most of all, work smart and keep smiling!