THREE AND A HALF MONTHS LEFT!!!!!!
Oh, and I got a job at the same hospital so yay for me!
Thursday, March 19, 2009
Tuesday, September 23, 2008
Residency
Well its been a while since I've written. I've started the residency - liking it ok. Of course there is a lot of work. I guess I thought something magical would happen when I had PharmD behind my name and doctors would listen to me, but its the same ole same ole. They feel as if you are stepping on those toes if you suggest something to them. Example: I'm currently following in the pediatric dept, the PICU, and the NICU. In the NICU I suggested to the NP that we order an amikacin level since one had not been drawn and the baby's BUN and SrCr were elevated. "We don't normally do that unless the cultures show something and we decide to keep treating," she snapped rather rudely. Ok fine - but what if it were YOUR 25 wk premie's kidneys. She ordered trough after the MD said so. I suggested we increase the dose of Zyvox on a baby with VRE in the CSF - didn't think we would want to play around with that infection. She just didn't know about that one and had to ask the MD - he agreeded with me. Not saying I'm a genious, but here's another example. Lets see if non-pharmacy or even non-medical person can get this one. It's not rocket science. Amikacin #mg q 24 hours. You hang amikacin at 10 PM. The trough should be between 3 -5. You order a random level (I hate random levels...seriously, don't do it unless you have a good reason) to be drawn at 3 AM (that would be 5 hours after the dose) and it comes back as 2.9. Hmm....so what do you think about the dose? Remember, you are giving it every 24 hours and after only 5 hours the level is at 2.9 - what do you think its gonna be at 930 pm before the next dose (the "real" trough)??? Do you think it will be between 3 and 5? No...I didn't think so. The NP gave me the dumbest look ever when i suggested she order an actual trough with the next dose. I don't know - I didn't think it was that hard to understand myself. So I guess its like having to start over - you have to gain their trust. Its just annoying when they don't listen!!! I don't try and diagnose - I just try to help out with the drugs - my area of expertise (I use that term lightly!).
So anyway...I LOVE LOVE the teaching atmosphere. and I get to work at Coumadin Clinic and just started seeing patients on my own - love that too! It still makes me a nervous wreck and I always check with the veterans before I make a change, but I know I will get good at it.
Oh and I'm engaged......yay!
So anyway...I LOVE LOVE the teaching atmosphere. and I get to work at Coumadin Clinic and just started seeing patients on my own - love that too! It still makes me a nervous wreck and I always check with the veterans before I make a change, but I know I will get good at it.
Oh and I'm engaged......yay!
Tuesday, July 1, 2008
A Customer Apology and STUPID IDIOT GUY
I was reading some fellow bloggers' sites about rude customers (some of the Angriest's top 20 blogs) and remembered when a customer actually apologized to me. Here's what happened:
She comes in with a bottle fill a couple of days ago for generic Dilaudid. She tells me that she doesn't think we gave her the right strength. This is only 4 mg. This can't be what the doctor prescribed. It's not working for her mom's pain.
I always give the patient the benefit of the doubt. I look up the prescription and tell her that the doctor did write for 4mg of dilaudid. She wanted to see the script. I turn the computer screen towards her to see the scanned image.
"Are you sure that 4mg is right?" She then compared it to some other drug, I think morphine 60mg or something, and said 4mg is apparently too low. I told her that you can't compare different drugs on a mg-per-mg basis and 4mg is actually the higher of the 2 doses available.
"Well why did you give me hydromorphone - is this the right thing?"
"Yes mam, that's the generic."
"Well I don't remember anyone asking me if I wanted generic. You filled this wrong."
Granted, in most states you are suppose to offer the generic and get consent from the patient, but in every pharmacy I work in we automatically substitute generic if the doctor allows and if the patient doesn't specifically say they want the brand when dropping it off. If they complain when they come to pick it up, we fill it for the brand - BEFORE it leaves the pharmacy.
I tried explaining that the doctor had indicated that we could substitute.
"Well maybe this is expired. Could you check."
I explained that we check for expired drugs and remove them from stock.
"Could you just check."
So I got the lock box keys, checked the date (I'm assuming this was the same bottle we filled her script from, but who knows). It expired in like 2011. We go through some CIIs where I work so I'm sure no matter if this was the exact bottle, it was in date.
Then she wanted to give me the generic pills, which already had pills taken from the bottle, and switch for the brand. I told her we couldn't take meds back once they left the pharmacy and especially if some had been taken...and this was also a controlled substance.
I'm sure other pharmacists might have handled this differently, but our manager wasn't there (because it was 9:00 PM) and I was working with a pharmacist who was about to retire, and thus did not deal with people. He would either referred them to me (oddly enough - an intern at the time - he did this all this time) or have just told them to come back the next day.
Anyway, back to the customer. She was very angry, sighed and me, snatched up her bottle and left before I could say anything else. I felt bad, but there was nothing I personally do could. I was a lowly intern, I'm certainly not going to tell her we'll take back her CII three days after it was dispensed. Her mother's pain probably wasn't controlled. I did not doubt that.
An hour later she came back in tears - IN TEARS! - and apologized for being so rude to me. I honestly didn't even think she was that rude. I've had MUCH worse.
Then she poured her heart out to me about how her mother is sick and hurting and she can't do anything to make it better. She kept saying "I'm normally not like this and I'm so sorry for being rude to you." I told her she didn't have to apologize. I told her that maybe this medicine wasn't working for her mother and she could call her doctor to see if he wanted to prescribe something else. I honestly felt bad for the lady.
It just goes to show that sometimes - and I do mean sometimes - you get that nice customer. This is the only time I can remember a patient apologizing to me. I've worked in pharmacy for about 8 years. That's pretty sad considering all the rude people we come into contact with.
Of course the very next week we had some stupid guy - I want to point out that it was a GUY because it seems like only a girl would do something like this - decide to call the store manager (not the pharmacy manager) and tell him that "it wouldn't hurt me to smile once in a while."
Seriously. Ok. Well how about I had just walked in, the pharmacist was on the phone, we were backed up like crazy. I started verifying scripts, then had to check-in and put up the narcotic order, and then tend to the register (because all the techs were having a cake and pizza party for a tech that was leaving and were too busy eating to do any work - don't get me started) where said STUPID IDIOT GUY was picking up a script. The reason I am so freaking mad about this is because he - who is a full grown man by the way, who should have more important things to worry about than if the girl in the pharmacy smiles at him - is with his little friend trying to see himself on our video surveillance TV at the front of the pharmacy. I stood at the register for like 2 minutes waiting on him to stop acting like a child and walk over to the register and tell me what he was picking up. Two minutes that I could have used doing something more important.
There was mass confusion finding it as well, because of course he spat out like 4 names and the addresses at once and expected me to retrieve them all in the blink of an eye. I think he actually had to come back because he didn't get them all (well, that's what he gets for being retarded in a place of business).
I wasn't at all rude to him (he even told the manager, when asked, "No, she wasn't rude. She just didn't smile"). Maybe he got pissed because he was trying to crack jokes and I didn't laugh (they weren't funny). I don't know.
Why are people so trivial. Seriously? What if something really bad had happened to me earlier in the day, or what if I was sick. Am I still suppose to be a freakin bubble/giggle machine. (by the way, I don't get paid to smile. I get paid to be sure you get the right medicine and your doctor doesn't kill you) And, would STUPID IDIOT GUY had complained if the male pharmacist (who never EVER smiles) rang him up, or any guy for that matter. I'm not a one of those "i am woman, hear me roar" types, but seriously. I doubt if a guy didn't smile at this dude, nothing would have been said. He probably wouldn't have cared. It made me sooo mad. The manager came back to the pharmacy (where I was trying to verify scripts and call MDs) and told me to look more friendly and smile at customers. I told him (and I can't believe I did) that maybe if all the techs weren't eating cake at the same time and/or mysteriously disappear from the pharmacy when I showed up, maybe I wouldn't be so stressed from trying to do the pharmacist's AND technician's AND cashier's job.
And that was my last day at my part-time job at Chain A. Of course, apparently I'm a glutton for punishment. I contacted the district manager for this area and asked about PRN work (since I already know the system). Hey - I gotta supplement the lousy resident salary somehow.
She comes in with a bottle fill a couple of days ago for generic Dilaudid. She tells me that she doesn't think we gave her the right strength. This is only 4 mg. This can't be what the doctor prescribed. It's not working for her mom's pain.
I always give the patient the benefit of the doubt. I look up the prescription and tell her that the doctor did write for 4mg of dilaudid. She wanted to see the script. I turn the computer screen towards her to see the scanned image.
"Are you sure that 4mg is right?" She then compared it to some other drug, I think morphine 60mg or something, and said 4mg is apparently too low. I told her that you can't compare different drugs on a mg-per-mg basis and 4mg is actually the higher of the 2 doses available.
"Well why did you give me hydromorphone - is this the right thing?"
"Yes mam, that's the generic."
"Well I don't remember anyone asking me if I wanted generic. You filled this wrong."
Granted, in most states you are suppose to offer the generic and get consent from the patient, but in every pharmacy I work in we automatically substitute generic if the doctor allows and if the patient doesn't specifically say they want the brand when dropping it off. If they complain when they come to pick it up, we fill it for the brand - BEFORE it leaves the pharmacy.
I tried explaining that the doctor had indicated that we could substitute.
"Well maybe this is expired. Could you check."
I explained that we check for expired drugs and remove them from stock.
"Could you just check."
So I got the lock box keys, checked the date (I'm assuming this was the same bottle we filled her script from, but who knows). It expired in like 2011. We go through some CIIs where I work so I'm sure no matter if this was the exact bottle, it was in date.
Then she wanted to give me the generic pills, which already had pills taken from the bottle, and switch for the brand. I told her we couldn't take meds back once they left the pharmacy and especially if some had been taken...and this was also a controlled substance.
I'm sure other pharmacists might have handled this differently, but our manager wasn't there (because it was 9:00 PM) and I was working with a pharmacist who was about to retire, and thus did not deal with people. He would either referred them to me (oddly enough - an intern at the time - he did this all this time) or have just told them to come back the next day.
Anyway, back to the customer. She was very angry, sighed and me, snatched up her bottle and left before I could say anything else. I felt bad, but there was nothing I personally do could. I was a lowly intern, I'm certainly not going to tell her we'll take back her CII three days after it was dispensed. Her mother's pain probably wasn't controlled. I did not doubt that.
An hour later she came back in tears - IN TEARS! - and apologized for being so rude to me. I honestly didn't even think she was that rude. I've had MUCH worse.
Then she poured her heart out to me about how her mother is sick and hurting and she can't do anything to make it better. She kept saying "I'm normally not like this and I'm so sorry for being rude to you." I told her she didn't have to apologize. I told her that maybe this medicine wasn't working for her mother and she could call her doctor to see if he wanted to prescribe something else. I honestly felt bad for the lady.
It just goes to show that sometimes - and I do mean sometimes - you get that nice customer. This is the only time I can remember a patient apologizing to me. I've worked in pharmacy for about 8 years. That's pretty sad considering all the rude people we come into contact with.
Of course the very next week we had some stupid guy - I want to point out that it was a GUY because it seems like only a girl would do something like this - decide to call the store manager (not the pharmacy manager) and tell him that "it wouldn't hurt me to smile once in a while."
Seriously. Ok. Well how about I had just walked in, the pharmacist was on the phone, we were backed up like crazy. I started verifying scripts, then had to check-in and put up the narcotic order, and then tend to the register (because all the techs were having a cake and pizza party for a tech that was leaving and were too busy eating to do any work - don't get me started) where said STUPID IDIOT GUY was picking up a script. The reason I am so freaking mad about this is because he - who is a full grown man by the way, who should have more important things to worry about than if the girl in the pharmacy smiles at him - is with his little friend trying to see himself on our video surveillance TV at the front of the pharmacy. I stood at the register for like 2 minutes waiting on him to stop acting like a child and walk over to the register and tell me what he was picking up. Two minutes that I could have used doing something more important.
There was mass confusion finding it as well, because of course he spat out like 4 names and the addresses at once and expected me to retrieve them all in the blink of an eye. I think he actually had to come back because he didn't get them all (well, that's what he gets for being retarded in a place of business).
I wasn't at all rude to him (he even told the manager, when asked, "No, she wasn't rude. She just didn't smile"). Maybe he got pissed because he was trying to crack jokes and I didn't laugh (they weren't funny). I don't know.
Why are people so trivial. Seriously? What if something really bad had happened to me earlier in the day, or what if I was sick. Am I still suppose to be a freakin bubble/giggle machine. (by the way, I don't get paid to smile. I get paid to be sure you get the right medicine and your doctor doesn't kill you) And, would STUPID IDIOT GUY had complained if the male pharmacist (who never EVER smiles) rang him up, or any guy for that matter. I'm not a one of those "i am woman, hear me roar" types, but seriously. I doubt if a guy didn't smile at this dude, nothing would have been said. He probably wouldn't have cared. It made me sooo mad. The manager came back to the pharmacy (where I was trying to verify scripts and call MDs) and told me to look more friendly and smile at customers. I told him (and I can't believe I did) that maybe if all the techs weren't eating cake at the same time and/or mysteriously disappear from the pharmacy when I showed up, maybe I wouldn't be so stressed from trying to do the pharmacist's AND technician's AND cashier's job.
And that was my last day at my part-time job at Chain A. Of course, apparently I'm a glutton for punishment. I contacted the district manager for this area and asked about PRN work (since I already know the system). Hey - I gotta supplement the lousy resident salary somehow.
Saturday, June 28, 2008
WHEW!
Oh my gosh. Today I found out that I passed that freakin MPJE. Seriously guys I thought I had failed. I was already trying to think of what I was gonna do (the residency I'm at said I have to be licensed by the first week or I would be "dismissed" [harsh, i know!], so if I had failed, well.....I wouldn't have been licensed by the first week. though I'm not gonna be licensed by the first week anyway because some lazy person decided to wait 5 weeks to tell me my fingerprints weren't accepted so..anyway that's another story.) Yeah, I've been developing my own ulcer for the past 5 days waiting on these results. You'd think they would post them online or something. No - had to use snail mail.
anyway - I don't know exactly how it happened but I think God started clicking the mouse button for me because I had no idea. Thank you LORD!
Now - whew - I can start the residency. The biggest burden has been lifted. Ready to get this party started. And get a paycheck [albeit small paycheck, a paycheck nonetheless].
anyway - I don't know exactly how it happened but I think God started clicking the mouse button for me because I had no idea. Thank you LORD!
Now - whew - I can start the residency. The biggest burden has been lifted. Ready to get this party started. And get a paycheck [albeit small paycheck, a paycheck nonetheless].
Saturday, June 21, 2008
Naplex down, MPJE to go
I took the Naplex about a week ago and found out I passed. Yay! My exam was actually kinda difficult. I had a lot of statistics (apparently because I kept missing them - isn't that the way it works). I mean, I didn't really think to study over ANOVA and Chi square the night before my exam. However, I was pleasantly surprised to find it fairly straight-forward. I did get asked about some drugs that I had never heard of (maybe those were the "tester" questions). Oh well, it doesn't matter. It's over with.
Pray for me on the MPJE - I take in Tuesday. I'm so sick of looking at law right now.
Pray for me on the MPJE - I take in Tuesday. I'm so sick of looking at law right now.
Monday, June 9, 2008
Bad Timing
Here's a story for you....I move to my new location. My parents leave me where I do not know a soul and - I have a wreck and total my car. Yeah. perfect timing. No health insurance, haven't started my job yet, no pay check, don't know anyone. My sweet parents had to drive 6 hours one way in the middle of the night to come get me b/c I have the Naplex in a week and am taking it at home. So instead of studying for the boards and MPJE I am dealing with this. I have been a total wreck, no pun intended. Rough start to my new life. If only my parents were millionaires! But they are not - so the car situation is still up in the air....dang it! Should've taken that $52/hour job at Walgreens and I wouldn't be worried about the money.
Monday, May 19, 2008
LONG time, no write
Well, it has been a minute since I last wrote on here. I've graduated (yay for me) - I thought things would be fun now -WRONG. now I have to study for the naplex and the DREADED MPJE. My state doesn't require the MPJE (yet) but the state I got my residency in (oh yeah, forget to tell y'all I got a residency!) does. I would rather write 10 treatment plans than read the law book. There are too many "except's" and "unless's" and "but's" etc., etc. I fear the MPJE MORE than I fear the Naplex. Go figure. If anyone has any input - please leave a comment. I greatly appreciate any help! I'm getting ready to move in the next 2 weeks, so I have a lot of changes going on in my life right now. Just wanted to touch base - I've been trying to keep up with reading everyone else's blog when I get a chance.
By the way - I read somewhere that a pharmacy forgot to mix a recon and the mother gave the child a teaspoon of the un-reconstituted POWDER - can you believe that? So we really can't depend on common sense any more, can we? oh dear...it's gonna be a Loooooooong career!
By the way - I read somewhere that a pharmacy forgot to mix a recon and the mother gave the child a teaspoon of the un-reconstituted POWDER - can you believe that? So we really can't depend on common sense any more, can we? oh dear...it's gonna be a Loooooooong career!
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