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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Julie on March 5, 2000, at 12:47:46
In reply to Pharmacists - Problems or Praise, posted by Cam W. on March 4, 2000, at 23:35:04
The annoyances I've had with pharmacists here in the US mostly seem linked to insurance. For example, recently I was going out of town for 2 weeks and was due to run out of Effexor while gone. My pharmacy-the local Eckerd, a big chain- wouldn't give me a refill before I left because according to "the insurance," they couldn't give it early. (I was going to visit family in a little town across the country, with no Eckerds or other big pharmacies nearby.) One pharm tech did whisper to me that I had his sympathy, he'd gone cold-turkey off Effexor once and knew how uncomfortable it was!
My pharmacy has also called "Julie, your Effexor is ready!" with other customers standing around. Not info I want everyone to know.
They seem over-worked and harried. Then again, so do many of their customers.
It's strange ... I've worked with pharmacy students at the university where I teach, and they seem really sharp-- dedicated and sympathetic. I wonder if these students will end up in big retail chains, or doing something less draining.
Posted by Janice on March 5, 2000, at 23:44:44
In reply to Pharmacists - Problems or Praise, posted by Cam W. on March 4, 2000, at 23:35:04
Hi Cam,
I think I'm the only other Canadian on babbleland.
I've had only good experiences with pharmacists, both in Toronto and here in Calgary. Most times, I've found them to be extremely helpful. One pharmacist recently spent about 15 minutes with me one evening explaining how my medication was working, and he managed to do this in layman's language.One suggestion for the students would be to never say the name of psychiatrict medications outloud - even when they are doing the consultation with the client. I used to get my medications in a drugstore by my office, and would sometimes run into my collegues there. Although, I can never remember any pharmacist saying the name of the drug, I often felt concerned that they may.
One time, I came to pick up my medication earlier than I said I would. The medication wasn't ready yet and I was unable to wait for it, as I had an all afternoon meeting. Since I couldn't pick up the medication that afternoon and was going away for the week-end, the pharmacy had someone bring it to my office. I really appreciated it, especially since it wasn't their fault...and them, they got my loyalty.
Good luck, and thanks for educating these people. I don't like the sounds of those 'Walmart style pharmacies' - I hope they don't make it up here!
Janice
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Posted by Cam W. on March 5, 2000, at 23:48:00
In reply to Re: Pharmacists - Online?, posted by Dr. Bob on March 5, 2000, at 22:20:52
Dr.Bob - Speaking for most community pharmacists I know, we really don't care about mail-order pharmacies (we don't like them, but because of their nature, they really aren't a threat). We don't like it when someone gets their drugs from a mail-order company and then comes in or phones us for counseling and advise.Some Problems With Mail Order Pharmacies (off the top of my head)
1) Even if the have a counseling line the operators (presumably pharmacists) do not see the patient. I find it very tough to counsel over the phone. I need to see the patient's reaction to what I say. Does this person really understand what I am telling them? Do I have to modify my explanation? I need to see their body language when they are asking me a question (eg do they look like they have something more to ask me, but are afraid that the question may be stupid - Impossible to ask a stupid pharmacy question. All are relevant).
2) Further to being able to see my patient. I need to be able to judge whether this person will need a follow-up phone call. I can get a gut reaction or feeling (vibes) by seeing a person.
3) Usually you don't have to wait a day for your prescriptions at a community pharmacy.
4) Prescription filling errors are harder to deal with. If a pharmacist says they've never made a mistake, it is either their first day or they are lying.
5) Will a mail-order pharmacy blister pack complicated drug regimens?
6) Will mail-order pharmacies do periodic med file reviews? They can't, really. They do not know if their customer is getting prn meds (needed ASAP) from a community store. This is also why I stress to people to use one pharmacy for all their drug needs (incl. OTC & herbals)(doesn't necessarily need to be my pharamcy either.) That way drug/drug interactions can be minimized. This is especially important for people who go to 2 or more doctors for different conditions (eg psychiatrist, general practitioner and cardiac specialist). These docs will probably all be writing prescriptions and changing them periodically. These docs are not usually in contact with each other, so if the patient does not remember to tell one doctor about the medication change another doctor did, toxicity or drug interactions could result. In my pharmacy I make sure that all docs, therapists, group home operators and other relevant caregivers get a new medication regimen chart with every med change. I was surprised to see how many potential interactions and mistakes I have caught in the past couple of years since instituting the medication regimen sheets.
7) Will a mail-order pharmacy shoot the breeze with you during slow times or even acknowledge your existence apart from filling your prescription? I have caught some food/drug and herbal/drug interactions this way. Caring about your 'patient' (customers buy pop and chips) makes this job rewarding.I could go on, but this is too long now. I will ask the 3rd-year students their opinion on this. I assume that they will spew the "party line"; what they have heard their professors tell them. When was the last time a pharmacy professor filled a prescription? (Actually I don't know what the party line is - stay tuned)
Sorry Dr.Bob, I think I just spouted MY views, not pharmacists as a whole. Any other pharmacists out their want to add or subtract to this list? Any mail-order companies care to refute anything I have said? Come on Babblers, bring on your opinions as well. Your idealistic pharmacist - Cam W.
Posted by Dr. Bob on March 6, 2000, at 0:34:46
In reply to Re: Cam Gets On His Soapbox, posted by Cam W. on March 5, 2000, at 23:48:00
> 1) Even if the have a counseling line the operators (presumably pharmacists) do not see the patient. I find it very tough to counsel over the phone. I need to see the patient's reaction to what I say.
This is certainly an issue, whether online communication would be adequate. How's it been for you, not "seeing" the reactions of those you discuss things with here?
> 3) Usually you don't have to wait a day for your prescriptions at a community pharmacy.
> 4) Prescription filling errors are harder to deal with.Those are good points. An online pharmacy would be better for medications someone's continuing on than for ones they're just starting.
> 5) Will a mail-order pharmacy blister pack complicated drug regimens?
You mean put combinations of medications into different blisters? If a community pharmacy can, why not? I suppose they might charge extra...
> 6) Will mail-order pharmacies do periodic med file reviews? They can't, really. They do not know if their customer is getting prn meds (needed ASAP) from a community store. This is also why I stress to people to use one pharmacy for all their drug needs
That's an issue, but as you point out, that's an issue even at a community pharmacy.
> 7) Will a mail-order pharmacy shoot the breeze with you during slow times or even acknowledge your existence apart from filling your prescription?
I guess it would if it wanted to develop a relationship with its customers...
I'm not saying online pharmacies are the way to go, but I do think they're an interesting possibility...
Bob
Posted by medlib on March 6, 2000, at 1:59:30
In reply to Re: Pharmacists - Online?, posted by Dr. Bob on March 6, 2000, at 0:34:46
Cam-
You stress the value of non-verbal communication for the practitioner, but would you look at the "face-to-face" versus "once removed" (telephone or online) issue from the patient's point of view? If you can imagine yourself as a patient (who couldn't answer his own questions as you can) how would you prefer to ask sensitive questions? Why? What do you think other patients prefer?Babblers--anyone else care to comment? Me--I'd rather handle it ALL over the phone--and yeah, I'd pay my pdoc for telephone consultation at the same rate as in-person. But that preference may well be as "ab"normal as the rest of me. Wonder if babblers and pharm students differ or agree on this point? Just wonderin'...
medlib
Posted by ChrisK on March 6, 2000, at 6:11:26
In reply to Pharmacists - Problems or Praise, posted by Cam W. on March 4, 2000, at 23:35:04
Hi Cam,
I feel lucky that I have a couple of good pharmacists where I am now. I live in a relatively small town so they don't seem to be overworked when I go in. They are always busy but not busy enough to take the extra minutes to answer any questions.
I think that the biggest thing to stress to a group of students is the issue of privacy. I personally don't care if anyone knows what meds I'm taking but I realize that I am in the minority. My pharmacy has counters on both ends of the work spce. If someone has sensitive questions they can go to the end without the cash register and get some privacy. I think that works well for most people.
The other nice part of my pharmacy is that the pharmacists (2) know be by face and name. I get 5 scrips filled each month and they are on two differnt dates. Whenever I come in they ask about side effects or how the meds are working (even if I'm just there to buy toothpaste). I feel good about the personal aspect of the service I get. I know it isn't easy in the bigger stores but it is a nice touch.
BTW, my pharmacy is a CVS which is one of the larger chains in NY state.
Posted by Cam W. on March 6, 2000, at 6:49:49
In reply to Re: Pharmacists - Online?, posted by Dr. Bob on March 6, 2000, at 0:34:46
Dr. Bob -
1) Not seeing people's reactions on this board has left me wondering, at times. At least once already I have misread a post and lashed out where I shouldn't have. I guess you can misread people face-to-face as well, but I doubt as often. Although I can feel some of the warmth and humanity in this room, it's original intent may become skewed from the time the original intent of that warmth leaves the brain (amygdala?) to the time it comes out the fingers.3)&4) - Many on the board are in an almost seemingly constant flux with their meds. Ordering from a mail-order house (ususally in large quantities to make it cost effective) would lead to a lot of left over meds and thus much waste. Only the drug companies (and the mail-order houses) would like this. Someone would have to be very stable on medication to use mail-order pharmacies.
5) Blister packing - Damn, I gave them another idea, but as above, people on many medications tend to change medications more frequently than those taking less (I can't prove this).
6) Med reviews - yes, I agree not many community pharmacies will routinely do them, even for the most unstable of patients. But, as there are psychiatrists that are egocentric (in it for the money), there are pharmacists who see their job only as a way to get a better house (P.S. I am still underpaid! - haha). In every profession there are people who do not put the customer first.
7) The telephone (or the computer screen - even with video - lacks the warmth of a face-to-face encounter.
In general, mail-order pharmacies make many pharmacist-owners worried, especially in small town. The large chains, with there "no dispensing fee" policies also make the small independent nervous. I guess it's a dog-eat-dog world out there. This is why I'd rather stick to the business of educating people, rather than owning a store and possibly retiring more comfortably (I'd like to pay off my mortgage faster, but I guess I'll just have to wait).Good points Dr.B. I believe mail-order pharmacy will pick up once we are entrenched in using the computer for everything (Amazon.drugs.com - sigh!). - Cam W,
Posted by Cam W. on March 6, 2000, at 6:59:29
In reply to Re: Pharmacist/patient interaction?, posted by medlib on March 6, 2000, at 1:59:30
medlib - good point med. I agree with you that sensitive issues can be dealt with more easily over the phone or computer, but still many people will not divulge this information. A well placed question, in a face-to-face encounter elicits unmistakeable body language and gets a problem out into the open without pussy-footing around it for months. P.S. Come on you docs out there, ask about sexual dysfunction with meds (eg SSRIs). 15% sexual dysfunction with Zoloft - that's crap - more like 70-80% clinically (at least). Sincerely - Cam W.
Posted by JanetR on March 6, 2000, at 22:05:33
In reply to Re: Pharmacist/patient interaction? - medlib, posted by Cam W. on March 6, 2000, at 6:59:29
>
> medlib - good point med. I agree with you that sensitive issues can be dealt with more easily over the phone or computer, but still many people will not divulge this information. A well placed question, in a face-to-face encounter elicits unmistakeable body language and gets a problem out into the open without pussy-footing around it for months. P.S. Come on you docs out there, ask about sexual dysfunction with meds (eg SSRIs). 15% sexual dysfunction with Zoloft - that's crap - more like 70-80% clinically (at least). Sincerely - Cam W.I agree with medlib. Just look at your relationship with us on the board. From reading your posts I've come to trust you more than my own doctor. And body language works both ways. If I feel that my doc is tired or distracted I immediately clam up and I often don't ask the questions I want to ask . Also, by writing things down I tend to clarify them for myself. Sometimes when I ask my doc. things he misinterprets my meaning and I am reluctant to repeat the same question. Also, having 24 hr access is wonderful .When I have a query I send it off at once and I don't have to wait till the next day to phone or for the next appt. If all on-line pharmacists were of your calibre it would be marvelous and you do it for nothing! God Bless you Jan
Posted by Chris A. on March 6, 2000, at 22:44:43
In reply to Pharmacists - Problems or Praise, posted by Cam W. on March 4, 2000, at 23:35:04
Cam,
I just wish they'd take the initiative to talk to me some time. I figure that they probably have some knowledge that could be quite helpful. I sense some stigma around my diagnosis and some of the meds I take (probably self-imposed).
It doesn't help that this is a relatively small community, my surname is unique and that my spouse is in the public eye. I have some avoidant personality characteristics, which don't help. My main plea would be for conveyance of respect and caring. I'm sure the students have been taught that, but a review never hurts.Chris A.
Posted by judy on March 6, 2000, at 23:00:50
In reply to Re: Pharmacists - Online?, posted by Dr. Bob on March 6, 2000, at 0:34:46
Having had experiences with both, there is no doubt in my mind that my local pharmacist wins hands down over the internet co. I've used. My pharmacist has literally saved my life- by calling my pdoc when I came to pick up a prescription that was dangerous to me at that time; he saw the mood change and knew I couldn't be trusted with a large quantity of drugs. The on-line pharmacist would have sent my 3 month supply (it would have been cheaper but I could have been dead). Just my experience.
Posted by AprilA. on March 7, 2000, at 8:15:22
In reply to Re: Pharmacist/patient interaction?, posted by medlib on March 6, 2000, at 1:59:30
> Cam-
> You stress the value of non-verbal communication for the practitioner, but would you look at the "face-to-face" versus "once removed" (telephone or online) issue from the patient's point of view? If you can imagine yourself as a patient (who couldn't answer his own questions as you can) how would you prefer to ask sensitive questions? Why? What do you think other patients prefer?
>
> Babblers--anyone else care to comment? Me--I'd rather handle it ALL over the phone--and yeah, I'd pay my pdoc for telephone consultation at the same rate as in-person. But that preference may well be as "ab"normal as the rest of me. Wonder if babblers and pharm students differ or agree on this point? Just wonderin'...
> medlib
>
>
I agree. I have severe fear of interpersonal interactions and going to the pharmacist is a nightmare. There are times I've stopped medications rather than face the pharmacist. I am so nervous I couldn't remember what he said anyway no matter how useful. The idea of him scrutinizing and interpreting my body language is not comforting!!
I'm a big Cam fan but I don't think he would have been nearly as much help to me standing behind a counter instead of online. A.
Posted by Kim on March 9, 2000, at 11:33:32
In reply to Pharmacists - Problems or Praise, posted by Cam W. on March 4, 2000, at 23:35:04
Cam--two stories re: pharmacists and psychiatric medications. Sorry it's kind of long; I've tried to keep the extraneous to a minimum.
(Just as background I've had treatment-resistant major depression off and on for the past 15 years; tried pretty much every AD there is. My "best" drug combo has been Parnate, dexedrine, Visken, and temazepam for sleep.)
STORY ONE
My pdoc in Utah prescribed dexedrine as an adjunct to Parnate, to which I had a partial response. The first time I went to fill the prescription, the pharmacy (a major chain which I always used) refused to fill the RX without first talking to the doctor to be sure he was aware of the theortetical problems of the combination. I assured them he had discussed the risks with me thoroughly. I was slightly annoyed at the delay, although appreciative that they were looking out for me. After talking to the doc, they filled the RX without any problems from then on.I moved to Washington (state). I didn't change pdocs immediately since I was still in Utah at least once a month and continued to see my pdoc there. The first time I submitted my RX to the Washington pharmacy (also a large chain) they, too, insisted on calling my doctor in Utah. I explained that I had been on this combination over a year, etc, but they still insisted on consulting him. My annoyance this time was not at the fact they insisted on calling the doctor, but that they had left me sitting in a plastic chair for an hour waiting for my RX before telling me they were trying to call the doctor. After the initial consultation, they had no problems filling the RX.
STORY TWO
My Washington pdoc was appalled at my parnate/dexedrine combo. He took me off first the dexedrine and then the parnate, with a 3-week washout.Tuesday, he started me on Effexor XR (I've been on Effexor with no response previously, but he says the XR is different and still might work--I'm dubious since the only partial responses I've had are with MAOIs and really think I should try reboxetine, but hey--he's the doctor, right? Sorry, that's a whole other story).
He left me on the temazepam, which he told me I could take up to 3 times a day if I needed to and that it shouldn't make me drowsy; inspite of my telling him at least twice I'd only been taking one or two capsules at night to help me sleep.
He wrote the RX for temazepam 3x daily, but told me I didn't have to take it all 3 times if I didn't need to. When I took it to my usual (chain) pharmacy, they said they'd need to call him because my previous prescription had been for only one per day, and the 3 per day was "unusual." I was annoyed at the inconvenience when I went back the 2nd time and they still hadn't talked to him. (Luckily I'm too passive at the moment to be hostile.)
I'd no sooner gotten home from the pharmacy then I got a call from my pdoc, he "wasn't thinking clearly" when he told me to take the temazepam 3 times daily, since it's supposed to be a sleeping pill (DUH!)
So this time the pharmacy averted what could have been DANGEROUS. I consider myself to be well-informed on my meds (psycho-babble, etc). When he told me I could take the temazepam not just at night, I thought it was odd but figured that maybe the only reason it was working as a sleeping pill was that I was taking it with parnate and no parnate=no drowsiness.
SUMMARY
I'm glad both chains had computer systems which alerted them to the potential problems with my meds.Kim
This is the end of the thread.
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