What comes out of patients mouths starts with B and ends in T

Sometimes I wonder why we even listen to what patients have to say.

How many times a day are you lied to by a patient.  A patient who on the phone will tell you they “lost” their medication, but when they magically show up at the store they say they are going to Mexico for 2 months. A patient who cried how his pain pills were stolen 2 days ago, yet is in the paper today for selling his prescriptions to an undercover officer.

Heres a colorful metaphor.  You have two sparkling clean containers (the doctor and the pharmacist).  One is filled with clean pure drinking water (the message) and must be moved to the other container.  How we join them? A piece of uncleaned retired sewage pipe (the patient).  Sure, water is going to get from one container to the other, but its going to pick up a whole lot of shit along the way.  However heres the kicker, some doctors listen to what these patients have to say as the absolute truth.

Example:  Doctor calls up the pharmacy pissed as hell because the patient said that the “bad pharmacist wouldn’t fill my pain pills”.  Doctor gives the pharmacist both barrels before being fed some humble pie by learning that his beloved patient got a month supply a week ago from another doctor.

Patients are horrible translators, historians, and message carriers.  How many times has a patient told you a message they recieved from the doctor (like to stop a medication), only to have it be horribly wrong?  How many times have you had patients spout medical jargon they learned from their doctor about their condition only to have it be sorta right in a ignore-the-big-picture sort of way?  Yet doctors and pharmacists use the patient to carry messages to each other.

“Contact myself or your doctor if your lisinopril gives you a bothersome cough” turns into “My pharmacist told me to stop my lisinopril because I coughed” and “Maybe you should ask your doctor about a pain management referral” turns into  “My pharmacist said that you should send me to a pain management doctor because you don’t know what you are doing”.  The shit that patients twist and fabricate with a single grain of truth just boggles my mind, and just makes bad blood between the doctors and the pharmacists.

What kills my soul (which a lot of things do, this being one of them), is when patients have a tiny-yet-dangerous bit of medical knowledge gained through the internet or one nursing class 15 years ago.  Then the bullshit they spout actually sounds like it really did come from the doctor or pharmacist even though its completely wrong.

So how to handle this?  Easy, treat the child like he’s a fucking 5 year old, and pin a note to his/her shirt to give to the doctor/pharmacist.

74 thoughts on “What comes out of patients mouths starts with B and ends in T”

  1. Isn’t that note supposed to be prescription…why the hell wouldn’t they write diagnose on it. If you are treating someone with Augmentin then just write sinusitis or Otitis or whatever…if you are gonna be taking 2 different strengths…why cant you say write there on the prescription in parenthesis…simple as that…


    1. /flame on

      Wow. I could barely navigate your 5th grade writing level. Please re-take 4th grade Engrish class. I can’t even determine if you formed a complete thought in that entire post. I really hope your not a health-care “professional”

      /flamesuit off

      ps: word verification = vironment clayiest? wtf?

        1. “I really hope YOU’RE not a healthcare professional.”

          If you’re going to “flame” someone for their poor grammar, at least get it right yourself.

          1. Idiots. “Engrish” is a term for mangled english, usually because of poor translation. PutOnYourFlameSuit is suggesting that this guy’s english doesn’t even meet “Engrish” standards.

            Don’t you know your freakin’ memes?

      1. People like you need there butt whooped… Beat the brakes off your a$$. You know what the issue is
        There’s dumbass Dr’s are writing oxy pain meds to people who don’t need them. ( walking around rehab like he is in his own world. And jogging. But someone like me. They kick you out and call you an addict. This is to all the dr’s. Kiss my Fn a$$.. I hope each and everyone of you experience just a little of the pain I go through. I pray y’all do cause I talked to a nurse in vs and she said. I look at patients differently now… Damn Dr’s grow some balls. If you can’t spot a fake then get into something else. Cause when your on floor for four days trying to call for help both your legs are dislocated and Dr says no. You just wanna whip his azz Dr’s are cowards and idiotsd

  2. You are so right! Oftentimes I wonder just how what I say to a patient is going to be reiterated to the doc. It’s amazing how quickly the real truth comes out when the doc’s office and pharmacy go over the patient’s head. You would think the patients would tell the same lie to the doc and the pharmacist, but apparently they don’t think we’re smart enough.

  3. Nothing like getting yelled at by a patient because I had the nerve to call their doctor’s office when they bring in a sparkling new oxycodone prescription (from their PCP, an ARNP, who was not surprisingly on vacation) one day after they got Norco and lorazepam from an ARNP 75 miles away. Suddenly it’s my fault the supervising MD said no.

    It’s b.s. that we have to be the intermediaries between the doctors and these clowns. Oh, and by the way, if I had filled the oxycodone without calling the doctor and something negative had happened to the patient – lawsuit.

  4. priceless. I do love how patients pick out only the stuff they want to hear with the medication.

    I answered the phone at work yesterday with a lady calling from a doctor’s office for the pharmacist. I said, “I’m an intern here, is there anything I can help you with?” and she was like nope, the doctor would like to speak to the pharmacist. so I hand it over and the doctor proceeds to chew out our pharmacist for telling a patient that meloxicam is for arthritis. apparently the patient had picked up a zpak or something similar with the meloxicam and read that it could be used for arthritis. so the patient calls the doctor in a frenzy like “I have arthritis?!?” so MD calls like, “why would you say that? I prescribe this to help with the aches and pains.” so pharmacist then says we didn’t tell them that. they had to have read it in the patient education leaflet that comes with every single prescription. he then asks if we can stop giving them out. ….okay.

    my first thought was that maybe you, doctor, should do a better job counseling your patient instead of just sending them out the door with new prescriptions. I know someone could have counseled them better on our end, but how about not putting all the blame on us. just a thought, dingleberry.

  5. The one I love is the “Oh, if that is too expensive/does not come that way/anything opposite of what the doctor ordered” the patient tells me that the doc said just to give them a call.

    Are you F*#&ing kidding me? Why didn’t the doc pick up the phone and call me. I don’t have a pharmacist’s line that I can call them on, nope I have to call and wait on hold just like everyone else, then I do not talk to the doc I talk to the nurse, and then she hangs up and goes and talks to the doc and then has a bagel, and a cup of coffee, and then takes her break after that, and then comes back and picks up the phone and tells me that “no, just keep it the way it was” or some other complete waste of my time.

  6. Come now, where’s your sense of empathy and trust?

    **snicker, giggle**

    Trusting what patients say is a lawsuit / death / general error waiting to happen.

  7. It is amazing that patients who are taking controlled substances are so well traveled. They need their pain pills early because they are going to Hawaii or their uncle in Italy died.
    Amox is seldom dropped in the sink or thrown away by the housekeeper. Only Norco and Vicodin are left behind in the hotel room on Las Vegas. Sure,,,,,

    We, in our pharmacy, are fortunate to have a great working relationship with the mds in the area. It is rare that an “early refill” request is granted.

    What aggravates me most is a patient who blames the increase in copay or deductible or PA requirement on us. If I start my own blog, it will be titled: “That can’t be my copay!”
    I did not read the notice that the patient got from Bx/Bs or the employer about the new drug formulary. We are not aware until we process the claim that only 2 fills are allowed at retail or that the mail order Rx was sent out yesterday. And we neglected to use our mind reading ability to know that the pt really does need a vacation “override”…
    I am sure this is common in all pharmacies. Please give us more proactive patients!!!

    1. I work with a woman whose dog ate her Evista. Really! Chewed the bottle open and ate the pills.

      No, she didn’t ask for an early refill because she knew she could go without it for a couple weeks.

    2. I HOPE that you Bcmigal , are never dealt with the chronic pain card, you will then be eating your words. I Am well traveled, I go to Europe , The Islands and the Americas on a timeshare 4 times per year. You decided to spent your money becoming GOD, I like to spent mine seeing the world, Not in paIN cause I have my Opiates!!! Who takes Amox everyday? Dumb comparison.

      And Because we take a certain medication EVERYDAY , things happen to them. I have dropped some down the sink, I have washed some in my pants pocket. I have lost some in a hole in my pockets, I have left my prescription at my Summer cabin so far away I could not retreive it till Next time..

      Anyway, drug addicts or not those of us on opiates KEEP YOU IN BUSINESS……….JERK!

      Why dont you ALL spent you money on an education where you can clean up this opiate abuse like clinical psychology with substance abuser rather than just randomly picking on the minority that make it bad for people who are in REAL pain, if YA have such an opinion of it?

      1. Opiates are cheaper than chewing gum. I doubt they’re keeping anyone in business chief.

        Also, see ENGRISH post above.

      2. RE: Ally Says

        I’m always interested at how people who have such severe pain that they require opiates are able and willing to travel and indulge in life’s pleasures. Oddly enough, when I have pain I want only to be as quiet as possible and have zero interest in going to a restaurant, having guests, or going to a movie – much less traveling! Pain is exhausting, focuses one’s mind on it and only it, and is debilitating.

        Wow. I’m impressed. Or maybe, just maybe, what I call discomfort someone else might call intolerable pain that requires narcotics. Maybe?

        1. That is the whole point of pain treatment, to allow people who are stuck in the quiet not moving spot to function and hopefully move forward to getting better. And if you knew anything about why pain treatment is used you’d read your own post and shake your head at the exacting stupidity of what you are asserting as an opinion.
          Although most people in such a position don’t have the money to take vacations to summer houses because that not moving thing hits the pocketbook pretty hard.

  8. Good assessment of patient….they are a 5 year old kid! They whine, complain, and pitch tantrums. Our pharmacies are becoming kindergartens. These kids want to be pampered and treated special. What they need is a good paddling. 🙂

      1. Yep…me too.. I swear, this guy should either be a website designer ( this is a pretty cool layout..I will assume he didn’t have this page designed by a dope fiend that he’s popping pills with)..or he should go work for the PENAL SYSTEM. I think if “KARMA” really exists…I would NOT STAND NEAR THIS Jerk off in a white coat. Lightening is aimed squarely where he vents.

        I think I’m going to move my pharmacy account today…but first, I’m going to INTERVIEW the Pharmacist..and find out their attitude toward customers. If they flunk, I move on…and there goes a LOT of business. I’m asthmatic, a chronic pain pt., have hypertension, and am getting old and crotchety myself.. I’m a walking profit for these white coat buggers…and I’m NOT going to be treated like a “leppo”.

        1. Interview the pharmacist ? Hahahahahah, go off your high horse, like the pharmacist is going to personally care if you leave.

          You really think we spend 10 years in school/residency training earning doctorate degrees and spending 200 k on our education so we could be interviewed by idiot patients ?

          1. if it there own personal business………..yes they will care!!! especially in this economy and chain stores putting family run businesses out of ..

            1. Agree with SFPharmD. And good luck finding that dream family business with giant profit margins off you and no awesome buyout deal from the “chain stores”. If you wanna bitch about this then research the laws and why pharmacists are liable when pts fuck up or OD or get caught shopping. but yeah–the interview comment made me laugh:) ty

          2. No, we think you spent 10 years in school earning a docotrate in order to wield it as a weapon of elitism and condescension. “Idiot patients”? Really? In all those years of school, you were never made aware that they call it “healthcare” for a reason. It is really a shame that you (or someone..parents, fafsa, etc) spent all that money on school for you to be such an asshole. I am in “healthcare” myself, and listening to you talk makes me think you would be more suited towards “criminal justice”-perhaps a prison guard. That way you can continue to be a pompous fuckwad, and you MIGHT be correct about some of the pre-jugdements you make on people you dont even know personally.

          3. A pharmacist who is a decent person would understand and wouldn’t mind talking to a new customer about their concerns.
            A pharmacist who feels entitled to blow people off and not do their job because they chose to spend 200k for a degree, chose the wrong profession, is a part of the problem, and should do everyone a favor and find something to do that doesn’t include people’s health.

  9. wife is an RN and me RPh; we both know if the patient says, “My doctor said…. ” they are Lying, Lying, Lying!!

  10. I usually find alot of your posts profanely clever in detailing how retail pharmacy works. In this post however, everything you state is the very reason why you have a job.

    Maybe the pharmacist is the unnecessary middleman in the equation. Lets entrust the doctors, give scripts indiscriminately to patients and let them navigate the intricate maze of pharmaceuticals. The dumb ones you site here will be naturally selected and cease to exist. The remaining population will be savvy enough to get along without pharmacists.

      1. Greetings, That is the current plan. The Escript is the last part of the equation. The Rx will go straight from your doctor’s PDA to the Escript to the Kiosk at the Mall or WallyWorld or whereever.
        As always, good luck with those student loans.

  11. I have Kaiser Insurance, and I never even have to SPEAK to a pharmacist. In fact, speaking is NOT encouraged there. You are to have ready your picture I.D. and Kaiser card, hand it to the pharmacist, and wait for your meds. Then you give them 20.00, walk away. Never even have to make eyecontact. Beautiful. Once my husband took me because I was in a wheelchair, and he said hello to the pharmacist, and the guy looked at him like he was crazy. Reminds me of the Soup Nazi on Seinfeld, but it seems to be a smooth system.

  12. The way things have been, maybe since the 80’s, when the money went out of medicine and independent pharmacies both, thanks to insurance companies, is that patients think they have lots more power… which they do, unfortunately. As a result, the class has run amok, no one is in charge setting the rules- except big brother corporate- from an eerie distance. It’s like a class room where the student can yell and scream, and no one backs the teacher. CVF and Walblues just tell the pharmacist, and tech, and clerk, to make the customer happy, even if it means gritting your teeth through their invectives ( or their requests for fake vacation overrides.)

  13. Hmmm. While I agree with most of what you say here, I cannot simply standby and agree with the idea that all patients are idiots. Yes, most are. Yes, as a medical professional myself, I understand exactly where you are coming from. However, this is partly in due to the fact that the pharmacist and/or doctor does not take the time to educate their patient about their diagnosis, and why they should call them if they have progressive coughing while on Lisinopril. 🙂 If we took more time to educate our patients, they might spend a little less time looking up their diagnoses on the internet, thereby spending less time creating undue anxiety about their conditions.

    If you google leukocytosis, a patient can easily within a matter of half an hour, believe he or she has leukemia because they have had fatigue with weakness and fevers in the past two weeks. Gee, could this possibly be a flu? But no.

    As a patient, I have had doctors ignore my questions, and statements regarding my diagnoses, until I tell them I have an extensive medical background. I am not a doctor, and I am not a pharmacist, but I am a very educated patient with a long work history in the medical field. I, unlike most patients, have taken the time to educate myself and ask questions. If I have a doctor who will not answer my questions, I will change my doctor.

    Unfortunately, the attitude towards patients displayed above only adds to the problem and does nothing to alleviate it. In fact, it just frustrates the patient more. Don’t get me wrong, I am not talking about the guy who gets upset because you wont fill his pain meds from one doc when another doc wrote him for it the week prior. I’m talking about the elderly folk, or the legitimate pain patients who have doctors who refuse to send them to pain management or write them a higher dose of medication to prevent overuse of the inadequate supply they were originally given because they minimize the amount of pain the patient is actually in. I’d like to see an M.D. with a slipped disc who says he doesn’t need anything for the pain, or one who has had physical therapy actually help. I’d like to see an M.D. who has a congenital spinal condition be told that, oh, its just muscular. Yes these things have happened, and happen daily. Sometimes it is the M.D.’s fault for not taking the time with his/her patient, sometimes it is due to lack of compassion or sympathy.

    I agree the pharmacist gets the brunt of this B.S. however, because you can’t write the Rx. You can’t give the patient anything without a physician’s order. Yet, you have to face these patients who have been left out in the cold about what is going on with them because their doctor refuses to inform them. For that, I am sorry.

    What a twisted world we live in.

  14. “Extensive work experience in medical field” usually means being a hospital janitor. Usually these people assume an honorary MD and request lots of useless tests and medications.

  15. I dont tell my new doctor what my job is because i want to be treated like an idiot sometimes. In my old surgery as soon as my GP found out I was a pharmacist he changed instantly, and started giving me no counselling at all. Now I know I am clinically trained, but I specialise in drugs, not diagnosis, that’s why I went to the doctor in the first place. Does mean I cant just go in and ask for the medicine i want if I have already self diagnosed, so maybe I will tell him eventually.

  16. i don’t want to make you guys feel bad about complaining about being pharmacists.. all me and my friends do is complain about how hard organic chemistry is on facebook,so i don’t mean the question to come off wrong, but i really do want to know how much you enjoy your jobs. do you reccomend pharmacy as a profession ? do you wish you had done something else?

    1. To Pharm Studnet: It’s a living. It pays ok and I can look myself in the mirror every morning. Would I recommend it to others? Well, let’s just say that I will not recommend it to my children.

    2. Pharm Student:

      I’m almost done with school, and from what I’ve seen and experienced so far, Watson349 pretty much hit it square on the head. You won’t die or retire ( whichever comes first ) a millionaire, but you’ll live comfortably, and not really have to worry about being out of work.

      Good luck in school! 🙂

    3. If you are going to be a retail pharmacist, i would recommend you think hundred of times.. We get paid a lot that we deal with a lot of BS every single day. Sometimes i feel respected by some few honest and educated people. The real challenge in a retail setting is the insurance. They would yell at you for a copay that they won’t agree to pay…..

      If i would tell my kids about my profession, i would say i did it to pay bills. Other than that, everything is not pleasant.

      1. Oh c’mon. Working in a pharmacy is not all that of a drag. Yeah sure a lot of our customers treat us like we’re just the next venting machine or drive through Starbucks bikini barista down the street, but they’re not all like that. I spent a half an hour with a customer in the drive through one morning. She was having a break down and had no one to tell her worries to. Yeah so our job mainly entitles throwing some pills at a customer and moving onto the next, but just listening to that customer built a relationship with all of our pharmacy staff. She moved 2 hours away and still drives to our pharmacy just to pick up her prescriptions passing nearly 50+ pharmacies on her way. I know the next time there’s an issue with a prescription, or an insurance has changed her plan, but didn’t bother to send her the letter until 3 months after the fact, she’ll be willing to listen, rather than just rant and complain. Another customer visits our pharmacy with her dog and every time we give him a treat. She says that if she came home with her prescription bag and no scoobie snack, she’d be in deep trouble. I had another customer tell me that we’d informed her more of the medications she was taking and insurance coverage she had in the last 2 months since she’d recently been filling at our pharmacy than her doctor or insurance company had let her know in the previous two years. Yeah it’s hard work. Yeah most days are full of ungrateful crabby individuals, but THOSE customers who we do make a difference for, are the reasons to love our jobs.

    4. Well…..

      Spending 50 years or so of a career dealing directly with the public is not the kind of thing that is placed front and center when the clowns at the pharmacy schools are trying to sell kids on a pharmacy career.

      There is a lot of mumbo jumbo about what a big medical clinical professional one is going to be and this is kept up all the way through pharmacy school. That was true when I was in school 30ya and remains true today. About 5% of pharmacy employment involves actual clinical practice. A substantial portion of this involves LTC Consulting which is Mandated by the Feds, but not paid for. (MANDATED, BUT NOT PAID FOR) It is a free give-away that LTC pharmacies are willing to pay people to do just to get the Rx’s.

      The actual job involves dealing directly with the public, whoever wanders in, which has its moments. Somthing NO OTHER PROFESSION really has to do. No Doctor/Lawyer/Accountant/Dentist/ is routinely interrupted by whoever wanders in off the street. No one has to put up with that kind of thing but pharmacists and other sorts of store clerks.

      True that the pay is OK and the job market is currently pretty good. However, the minute the PBM’s and Chains purchase enough politicians they are going to find a way to whack the RPh licensing requirement. All Rx’s are going to be filled by Techs and Robots, and soon. That will collectively save the PBM’s/Chain stores/Govt about Twenty Billion Annually (yes, with a Capital B).

      The forces are currently becoming aligned; automation, certified techs, chain store domination of the market. The last piece of the puzzle is the EScript. There is going to be a few years where Pharmacists will be trouble shooting and fine tuning the EScript system, then it will be, “So long, Suckers. ”

      Try paying off your six figure student loan with the $12.00 an hour you will make when you are reclassified as a pharmacy tech.

      Good Luck,


      PS: If you are smart enough to actually make it through pharmacy school and are willing to put up with the six (or more) years of gratuitous abuse at the hands of your pharmacy professors, you could be a REAL doctor with very little more effort and expense.

      1. I agree Oz completely. For those of us dispensing in the retail setting for $120,000 per year, enjoy it while it lasts. The retail setting is a horrible working environment, so most pharmacists think they earn that paycheck. Don’t our techs work in the same environment and put up with the same crap/stress? They do it, and they make squat in comparison. The only thing we get paid for is to hold a license. For now, the pharmacy boards protect us by saying only an RPh can conduct certain tasks in the pharmacy. The day they ease the restrictions, easily half of us are out of a job (or doing the same thing for 30-40 grand a year. My advice to all the students and young pharmacists — live way below your means, save and invest at least half your salary, and cross your fingers. I work for huge pharmacy mega-chain, and Oz is correct. The suits at the top start orgasming every time they think of some way to eliminate RPhs. After all, we are the company’s biggest expense.

    5. I’m going to go the opposite route from the other relpies so far. I’ve worked at a retail pharmacy for four years now and am in my third year of pharmacy school. I know that’s not as long as some people, but I enjoy my job. sure, there are times when it’s stressful and people are stupid, but there are also times when patients truly appreciate all the work you do. there’s no better feeling than talking to someone who cares about their health and will listen to you and take your advice. I recommend it as long as you can shake off the crappy people (that you’ll find at EVERY job out there) and if you think it’s meant for you. I enjoy my job.

  17. I love the patient who hands you a rx for a 90 day supply of a med they are getting from mail order MONTHLY and “for some reason it hasn’t come in the mail yet.” so when i take 45 minutes to get through all the teleprompts (while pushing 30 cars through the drive thru) just to find out the medication is on its 5th of 11 refills and the patient has been getting it regularly for months. of course this is news to the patient because “i just started taking this medication” so after 20 more minutes of profile scanning and a sideways glance from your pharmacist you fill it for the full 90 days then patient who is now standing in front of me with a half eaten candy bar (which is dripping onto the counter AND PLAYING DARTH VADER WITH MY OCD)is confused as to why it costs one of two amounts: if the rx is on time; the triple tag because its a 3 month supply so its all your copays combined “what is this simple math of which you speak” or what usually happens: its too soon (go figure) so the insurance wont cover the cost. then the patient miraculously remembers they are taking said medication “twice a day because thats what works for me and that is why i am out” even though the sticky refill bottle from the mail order pharmacy they “haven’t been recieving anything from” clearly says once a day. so it is now my single handed responsibility to call the doctors office to get them to change the directions that he wrote at 9am to reflect what the patient is taking (wait who’s the medical professional in this equation) and as i look at my watch and inform the patient they may have to come back tomorrow because it is now 6:50pm and most offices close at 5 but silly me i was totally aware that “Crackhead McRefillearly” is out of thier medication what am i supposed to do now? well you have to make him change it call him right now. hes still there you can call him now someone will pick up” so after leaving a message of the new directions. you look over to see you now disgruntled pharmacist holding a one month supply of said medication (sorry leslie)…And the patient says oh my gosh i didnt know it was gonna be so much trouble i’ll just take it somewhere else…..”Smithers, release the hounds!”

  18. Thanks for the reply watson, I really appreciate any input I can get. I have plans to start working in a retail pharmacy over Christmas break, so I guess that will be what makes my decision of whether or not to sontinue to pursue the Pharm.D

  19. At this point in my life (too many decades to count), I would not recommend becoming a pharmacist to anyone. I can’t say that I really regret my career choice because it has helped me pay the bills as a single parent. My own children have seen what retail pharmacy is like and they have moved as far away from it as possible. In our town, we have only 3 choices for work: CVS, WAG, and RAD. I believe that the days when we did not have to worry about being out of work are fading quickly. One of my friends quit his job in July and is still out of work. He could drive about 50-60 miles each way, I guess. We will see more and more call centers and central fill and there will not be a need for a full staff at the retail level. Ou ancillary staff has already been cut by 50% and the suits are talking about cutting the pharmacist”s hours as well. So much for “living comfortably”.
    I would caution those considering pharmacy to keep that in mind. Find something that you will love and enjoy and go for that.

    1. With the attitudes you pharmacists have, it will be a god send to have e-scripts and call centers, Just to get rid of the inconsiderate arrogant judgmental apathetic uncompassionate assholes that are churning out of school these day.

      What has this world come to. I am disgusted that I surfed onto this site. That there are “people” (if I can even consider some of the folks that post here) in a business that Need empathic understanding compassionate people and behind the doors of the internet you can spew your actual feelings about the people that you spent 6 years and 140K trying to help.

  20. Ok, I agree with your post…BUT…I’m on the other end. I am the patient, put on a drug my doctor didn’t fully explain to me when he put me on it. By the time I had a chance to research it, I was on it (for a day) – and the doc said he didn’t “want” to take me off. (Nope, not making this up.) Since that situation, I was moved to another doctor (because that didn’t sit well with me, so I “forced” a change with insurance).

    However, I’m still on a medication usually taken for “heroin withdrawal” – and the few times I’ve gotten it filled at a different pharmacy, the tech looks at me like they’re trying to scope out what sort of heroin user I was, and how long I’ve been off it. Fact is, I’ve never touched an illegal drug – but my stomach doesn’t agree with most pain medications, and when the whole oxycontin debacle reared it’s ugly head in the public, I didn’t want to continue taking it. (Along with the “pure” vicodin I had to have filled at a special pharmacy, dilaudid, AND a Duragesic patch.) I thought I was doing a good thing by wanting off all those meds and on something “safer”. Is suboxone safer? I don’t know…but I’ve come to this conclusion…it may be safer for ME – but I’m not sure it’s safer for the pharmacy tech who’s judging me.

    It would be easier if the dr put the condition on the script – in a way. In another way, and I mean this most respectfully, is it really the pharmacists business WHY a patient takes a drug? That’s like the bank requiring customers to explain where they got the money (or why) every time one makes a deposit or cashes a check.

    One more quick point: My uncle has been a pharmacist for 30+ years and we’ve had this conversation several times. I can see your point clearly. Then again, in the 15 years since my accident, I’ve never once lost my meds, had them stolen, blah, blah, blah. Those people make it hard for everyone – including the honest patient who just wants to get their meds filled so they can get out of bed in the morning.

    Awesome blog!

    1. Sorry this is so long – but as an aside (and before my “medical field work history” is referred to as being a “hospital janitor”, I injured my back – 2 herniations and 1 bulging disk – while working as a paramedic. I also was half-way through becoming an RN. Then again, I don’t pretend to know all about medical diagnoses, and I would sooner stick bamboo under my nails before I had to know all the chemistry/equations/math/etc a pharmacist needs to know…about a gazillion drugs. I figure I have a medical background – IF you’re in some traumatic emergent situation. Then I can take care of you (or drive lol) while transporting you to the hospital. It’s been an experience being on the other side of this whole medical thing – but I know one thing. I am the PATIENT. I go to the DOCTOR for help and a diagnosis. I then go to a PHARMACIST for medication, if necessary. If I have questions about my diagnosis I contact the aforementioned DOCTOR (not one of 6 that I see, but one of 2 – since a PCP isn’t prepared to direct pain management and a pain doc isn’t the one to call when I have a sinus infection). If I have a medication question – not why I’m taking the med, but about interactions – I call the aforementioned pharmacist. Regardless of the situation, I am the PATIENT. The other two involved in this equation went to school for a long time, interned for a long time, carry expensive malpractice insurance (or the company does…I’m assuming pharmacists have some sort of malpractice insurance), and have the general work experience, and I don’t. So why pretend I know “everything” or make up my own medication schedule??

      Maybe I suffer from common sense (??) – but I figure if I’m advised to take meds by a trained doc, and a qualified pharmacist fills the meds the way they should be filled (while knowing the other meds I’m on and my allergies), why take a chance?

      I’ll shut up now. I just want it to be known (which I’m sure it is) that not everyone on pain meds (or any other kind of meds) is a lying clown. Some of us do have a small brain – that we use. Occasionally. 🙂

    2. Here’s why you get those suspicious looks. The pharmacy has laws we have to follow according to the DEA. Here’s what they state.

      Your Responsibilities

      The abuse of prescription drugs– especially controlled substances–is a serious social and health problem in the United States. As a healthcare professional, you share responsibility for solving the prescription drug abuse and diversion problem.

      * You have a legal responsibility to acquaint yourself with the state and federal requirements for dispensing controlled substances. You also have a legal and ethical responsibility to uphold these laws and to help protect society from drug abuse.

      * You have a personal responsibility to protect your practice from becoming an easy target for drug diversion. You must become aware of the potential situations where drug diversion can occur and safeguards that can be enacted to prevent this diversion.

      The dispensing pharmacist must maintain constant vigilance against forged or altered prescriptions. The law holds the pharmacist responsible for knowingly dispensing a prescription that was not issued in the usual course of professional treatment.

      This guide will help you meet these responsibilities.

      The DEA states that a pharmacist who knowingly dispenses a prescription that is used for drug abuse, EVEN! weather it is a legit prescription from a doctor is just as responsible and will pay for fines and lose his/her license as the prescribing doctor.

      That technician doesn’t know you personally. Even if you were an ex heroin addict, that’s not really of his/her concern. She/he is mostly trying to do her job to make sure that your prescription is legit, and they’re not going to lose their job, by filling it.

    3. Thank you Katherine: that was well-put and summarized my viewpoint and experiences nicely.

      I concur that the Pharmacist’s job is not to judge the patient, but rather, to dispense a medication, to explain the med to the patient as such may require, and to be the special “confidant” of ye olden days. Well..so much for the esteemed “go to” guy…as you and I both know that we get judged by the white coats that fill our Rx’s …and we get nothing but snide looks, comments and attitude. I’m patently resentful of the attitude I get, from the kids in the white coats. I’m going to change my pharmacy over some rude comments I got from one of those clowns only recently..it had something to do with a break-in and the Pharmacist said “….it was some crackhead like YOU..” Despite the two rods in my back, the herniated discs up and down my spine, I swear I could risk them all and go for a round or two on the canvas with young TWIDDLEY and make him ingest his words…but I won’t. What I WILL do, however, is INTERVIEW my next pharmacist…I will explain to him what I have endured, and what a typical morning is for me..when I am awakened by the sheer burning/stabbing agony that fills my back..each and every morning..and then, what it’s like to come home from working at a construction job…that I can BARELY PULL OFF…but I am self employed and I have no choice…despite my active search for more sedentary occupations within my degree fields….this is a TOUGH TIME to be looking for work..and I’m getting no younger nor more healthy. I just wish for a modicum of respect when I present a refill for MS and Norco. I have never lost, had stolen, had a vacation over-ride or had anything untoward happen to my script. I have been “suprise” tested by my pain doctor and I have passed with the urine of a saint. Yet I get the “crack head” comment from a mal-contented, holier-than-thou white coat Furbie. I lifted a car off of a dying teenager. I got a hernia and a twisted/broken vertebrae. But what I got most was, a continual raft of SHIT from the local pharmacy. Had I know it was to be this way, I would have driven right by that accident, and have been the ilk of this pharma-cyst that hosts this site…a real rock crawler. Thanks for speaking your mind.

  21. Not all patient’s are liar’s. I had a gentleman come in yesterday at 4am to get insulin needles for his mother. 1″ 29 gauge. While this didn’t seem out of the normal for me. The manager came back because the guy looked suspicious. I’m sure they must have had a late dinner and she needed her shot.

    Seriously, In 4 years I’ve been wrong about one patient that I know of. He got extra scripts from the ER and early refills for 6 months. He was in 2-3 times a week. Now I see him every 6 months or so for a cold or something random.

    I try to give every one the benefit of the doubt until they prove otherwise.

    1. Hey Ed….late dinner or early breakfast? I am not aware of too many Insulin dependant patients who run out of needles at 4am…maybe some going on vacation and need some cause their flight leaves in 45 minutes and the pharmacy is the only thing keeping them from complete happiness. (as usual) Like someone mentioned earlier if i go with my gut i am usually right….usually. we are all human and entitled to mistakes but if someone demonstrates “drug seeking behavior” then they shouldnt be offended by my prejudice. but i will keep my judging eyes to myself….or a nice low cut top 😉

    1. CM: I am here for my medication. oh but i dont have enough for both so im going to come back for the antibiotics later.
      CI: Cracky you must pick up your pain meds with your antibiotics….or come back for the pain meds if you dont have enough for beer and medicine (wait you can take percocet and beer together).
      CM: But it hurts so much i need my pain medication, why wont you give it to me.
      CI: guess why it hurts because the infection is killing you when you cure the infection the pain will stop.
      CM: But i dont have an infection it went away because i picked up my antibiotics at another pharmacy already but the pain is still there.
      CI: what you dont have an infection? well then you shouldnt be taking this medication; but why does your doctor write 2 rx’s for the same thing? i am so confused. i have an idea since the rx’s are less than the beer, and more important, get them; then come back for the beer.

  22. Right now…I’m going to assume \real\ doctor means a PhD. Yeah…I’m going by the classical title instead of the modern title of all the all \D’s\ out there. PharmD, MD, JD, Ed.D…all doctors within the field.

  23. I am still very curious as to why you have not ever responded to my posts in the “Deck the halls with Vicodin and Soma” thread. I suppsoe as your post suggests, you the pharmacist, are some important person in the “pipeline” between the doctor and his patient, and that is the dispenser of his medicine. Now, I understand you look wearily upon all opiate patients with disdain and as being untrusting. There are certainly a great number of pharmacists as well who have been caught with their hand in the cookie jar scraping off some Oxy or Xanax from the store’s supplies. Maybe patients should look at all pharmacists as some sort of faux hero attempting to somehow wedge their way into the healthcare system only as a front to score some Drugs! And this is just as you believe people fake injuries in an attempt to score Drugs!

    I do wish you would respond to my posts in that other thread, and hold a sensible argument.

    1. I dont reply to comments on here, I thought it was quite clear. If its something worth responding to i’ll make a whole big post out of it.

      You show me 1 pharmacist who got caught skimming from stock, and I’ll show you 10000 patients who lie, deny, and bullshit to get narcotics and early fills.

      Pharmacists have something to lose for skimming, something huge to lose. Patients? not so much.

  24. Probably not the best spot to comment but we need the Angry Pharmacist’s guidance. TriCare has changed its pharmacy benefits through Express Scripts effective 11/4/09. I’m an advocate for beneficiaries and I’m fielding scores of complaints that their pharmacy is no longer allowed by Express Scripts to dispense drugs they need for seriously ill children-only Express Script’s subsidiary, Curascript is allowed to ship drugs for chronically ill that require specialty injectables. This wasn’t transparent to beneficiaries and I wonder if TriCare meant to send every thing to this company? If so why are we eliminating competition for our preferred pharmacies that were fine before? Mothers are telling me that Curascript is telling them that due to these changes, they are overwhelmed and can not get drugs out for 2-4 weeks. What are these moms supposed to do, these are life & death drugs! I heard that Tricare Military Activity is looking into the problems but the deadline and Express Scripts not authorizing drugs is creating a stifling road block. Please help.

  25. I stumbled upon your website. Once I started reading your posts, I could’nt stop. Like morbid curiosity. Your an incredibly frustrated, burnt out snob. In the big picture, the perfect solution would be the elimination of your position. I would be interested in finding out what type of savings may be realized for the consumer/patient. I’ve got a few pharmacists as clients and it never dawned on me that this is how they may view their clients. Your doing a great disservice to your antiquated profession. With the great advances in programming and high tech solutions, I can envision a situation where pharmicists, as we understand the profession, will no longer exist. Kind of like a blacksmith or cobbler. The best thing that could happen to see your profession collapse would be if more people could become exposed to web sites like yours. I’m sure your fellow professionals find your sounding board theraputic. Misery loves company…

    1. None of us pharmacists (as far as can figure out on this site) are ‘incredibly
      frustrated burn-out snobs’, YET. We’re recognizing the signs and we’re discussing the issues.

      I can’t guess what field of work involved or how long ‘working’… ‘Pharmacists as clients’ … hmmm? Insurance, wholesale distributor, bank loans, advertising, tax auditors, building inspection, cleaning or delivery services? ANYONE in health, or works with people encounters the One-Who-Would-Be enigma, except these individuals aren’t really so ‘special’, nor an isolated entity.

      It’s a rather surprisingly ordinary occurrence to meet people that assure us pharmacists (eyes as big as saucers) that they are quoting verbatim what this or that person told them, when a lack of understanding is patently revealed as the message is passed on.

      If a person really wants to know about their condition, they first of all ask the doc who diagnosed it, then read up on the disease from reputable sources such as standard textbooks, National Institutes of Health, Mayo Clinic, etc., and their other healthcare providers. If a person wants to know about drugs, they ask questions of the pharmacist, read up on what they were told, and ask some more questions.

      I hear this attitude (“pharmacists will be replaced by ‘machines'” with binary functions) by those that don’t really deal with people as fellow members of the human race, as if a human is a chemical vat and illness can be remedied by tossing another chemical into the brew.

      There is a lot of predictability in chemical reactions, but the most vital factor in recovery is the patient and an active choice to improve their lot. Patients have more choice in how they will handle their situation than they think they do. Pharmacists get fed up with patients that seem to say that they’re just carrying around their bag of bones, doing time until they’re magically whole again.

      If patients aren’t active participants in their health choices, their life doesn’t get any better.

  26. I am one of those nightmare patients. I have chronic pancreatitis (not alcoholic) and axonal neuropathy. Lots of meds required, complex diagnosic picture, no the dog never eats them and I never ask for early refills. But I go to the pharmacy to get my pancreatic digestive enzymes. The pharmacy tech assures me…that the company has QUIT making it (!!!)and I have to accept a generic. Hysterical phone call to manufacturer from idiotpatient ensues. Much Havoc and screaming. In the end, it turns out that the new pharmacy policy of *suggesting* generics had somehow mutated…

  27. I am very sorry that you are obviously unhappy with your job. I was just researching for alternate possibilities with my heart medications, and came across this vitriolic site. I have to say that I have the greatest respect for the pharmacists, interns, assistants etc at the place that I go to, and I certainly hope that pharmacists with attitudes such as yours are the minority.

    I hope you do not develop high blood pressure from your rantings. When you are finished whining about how bad your life is, count your blessings that you have a well paying job, a roof over your head, a family who loves you, that you probably don’t have to choose between which medication you can fill and which ones have to wait so that you can pay your other bills, and plenty of healthy food to eat. There are many who don’t.

    Whether you like it or not, how you present yourself as a professional (or not) pharmacist, will have an effect on how we customers–the knuckle dragging mouth-breathing troglodyte as well as the erudite latte liberal–view you and everyone else in your industry.

    Ah well, moving on to a different link in my google search…best of luck finding your peace.

  28. I believe that this blog is a necessary outlet for people of our profession. As with any health professional, we see the worst of the worst, sometimes we are forced to dispense narcs to obvious addicts, and it can really wear on our soul. We take an oath to help and heal, (not deal in the illegal drug trade), in which we are doing exactly the opposite in spite of our moral compass. But that fine line between drug seeker and legitimate pain patient is what this blog is all about. Many pharm’s become jaded. If it’s legit, I fill it and move on, and I sleep well at night.

  29. I’ve always wondered just what people are thinking when they try to creatively “edit” their prescriptions.. knowing that pharmacists have had lots of practice reading them properly!

    I got to see a seeker in action at walgreens yesterday morning while picking up my moms prescriptions, something I’ve never actually gotten to witness first hand, and I must say I was impressed!

    Not impressed by them trying to get more pills, I was impressed at how far they tried to go even though they’d been told the pharmacy couldn’t do anything.

    Never outside of the Dave and Busters game room where I used to work ahve I heard so many “what the fuck you mean I cain’ have dem now?” and “why i gotta have dat? (when asked about a police report in regards to their stolen roxycodone 30’s)”, and “dis is bullshit, i’m pose ta take fo’ a day fuh muh back pain!”

    The last one got me the most, having taken a couple of roxy’s during my own.. less than pristine stage (bless you suboxone), especailly since this person was able to wander back and forth flailing her arms wildly – truly she was more flexible and acrobatic from where I sat than most of the olympic gymnasts I saw in the last summer olympics!

    I have so much respect for you pharmacists, just for your dealings with people like her – surely if I were in your position I’d not be able to keep from laughing in their faces!

    RagewithRibeye Forums

  30. I will say that coming to practice in the States has been an eye-opener. I was raised here but never experienced our health care system per se prior to going to Ireland to take the Mark of the Beast at RCS in Dublin (then most of my post-grad training in the UK).

    The difference there is the OTC availability of opiates/opioids. Pure codeine phosphate syrupe can be had for a few quid at any high street chemist. Dihydrocodeine in combination also, allegedly for those poor souls with poor P450 2D6 activity. Of course over there we also prescribed heroin to hospice patients- not tremendously sure on the rationale but it was in vogue for a time- seems to be falling out of favor from what I hear.

    I’ve had SLE since I was 17 and I can sympathize with people who really suffer, but my sympathy as a physician has its limits. I have come up with a few rules that seems to make everything easier.

    1. All my patients have to sign a practice agreement that stipulates there are no refills beyond what is written on the prescription. There are two pharmacies in the town where I practice and both of the pharmacists are my drinking buddies. They have my complete backing when it comes to things like allegedly losing pills. Of course they know when it is really okay to ring me on my cell phone. They know my policies, I trust them completely, and all I have to say is yes. Mostly this is done after the fact. Ha! Sometimes something bizarre will come up like a lost inhaler for a child at school or something- no problem. But it is discreet. They love it and I love it. They don’t have to call and fax and we don’t have to pull charts and re-fax. If I have you on atenolol 50 mg qd and want to see you in 6 months then it will be for 30 with 5 refills. Patients know that they have to see me then. End of story.

    2. I rarely prescribe anything that has been on the market for less than two years so the drug reps hate me. Exceptions would be maintenance treatment that has been established by a consultant. Tussionex or TussiCaps? Suck it! If it warrants it, I will write for Dilaudid syrup any day before that bullshit. I like old cheap meds. A lot of them are older than I am if that says anything, but I will be damned if I have another apeshit patient go Vioxx on me.

    3. I write prescriptions as I was trained to do, mostly using apothecary notation. Then I draw a line and write everything in plain English. It is my way of letting the pharmacists know that I wrote it while still making the patient directly aware of my instructions. Hopefully between the two there are fewer opportunities for confusion or mistake.

    4. Since the drug reps hate me, I hardly get any professional samples, but patients know that they are getting the best bang for their buck to begin with. The few I do get go to the people I know need it most. 99% of my prescribing is limited to about 20 drugs so I am predictable. If it is something really out of the ordinary for me, I will usually call it in myself. Small town- no voicemail systems- gotta love it.

    5. We have gotten into this heinous ideology that every patient who walks through the door should walk out with a prescription. How stupid is that? I will write them a note saying they should get some generic Claritin and clean their damn ears. Teenagers, you don’t need Accutane, you need a damn shower!

    6. Being in a small town that is pretty far removed from colleagues of other specialties, I do a lot of chronic pain management. I don’t regret it so much. Good planning can assuage a lot of headaches in the future. They need to understand that this stuff could take hold of them even if they don’t especially like the side-effects and take it religiously as prescribed. In return I try to understand that without some of these medicines, they don’t see their lives as being worth living, and if things do get better, they don’t need to be ashamed that they are hooked on it. We will deal with that together. COMMUNICATE! Unfortunately I know what it means to really hurt, but that makes me despise those who only feign it.

    7. John and Bill have saved my ass so many times it would hurt to count. They are the two pharmacists. Of course they have a friendly rivalry but I emphasize the word friendly. They really do have my back, and I have theirs’ in any way I can. Besides just being buddies, we are colleagues. What has happened between medicine and pharmacy for chrissakes?

    8. I have a PA who just started with me and he is fan-fuckin-tastic. Former Navy SEAL and he WANTS to see the drug seekers. I will admit that there are very few of them here, but I always get a kick out of it. We are gonna add him to poker nights.

    TAP- I am sorry for you man. You have a doctoral degree dude! That is better than me! I have a couple of baccalaureates and a licentiate-in midwifery no less! HAHAHA! MB BCh LM for life, although I do use M.D. behind my name. Even though I am a general surgeon, I don’t even have a doctorate or a terminal degree from my system of education. You do! There has to be something better.

    In both Ireland and the UK, chemists have significantly more authority and I think that is a great thing. Now don’t get me wrong- I love your posts- they keep me coming back for more. But if you ever get around to it, in vernacular that doesn’t ooze quite as much sarcasm for the benefit of my rheumatologist friends, could you come up with a short list of concrete ways that we can help? I don’t practice in the same high-volume world that you do, so to speak, but I have friends that do and I would love to pass that list along.


  31. Buddy, you are brilliant, but you have got to post or be deleted from my favorites….please get with it or bow out?




  33. I am a retail pharmacist as well and I have experience at 2 retail chains and clinical/mail order pharmacy. I have only been out of pharmacy school for 5 years but I have given up all hope of finding a decent position in this profession. Coming out of pharmacy school I was a nice, friendly, willing, caring and trusting pharmacist and now I just dread going to work every day. Yes it is true that every once and awhile you will find one patient that you can relate to and help but the truth is that most people are rude, ungrateful, selfish and liars. Pharmacies are not fast food restaurants so that means you can’t demand we wait on you before the next person because you “have somewhere to be”, we can’t “whip up” your medication in 2 minutes despite looking like we just pour the pills in a bottle and throw them to you and we definitely can’t get you a food order along with your medications threw the drive-thru window. I thought this was a trusted profession but all we are now are punching bags for those of you who think you deserve everything. I work just as hard as you and I had hopes of helping people but most people don’t care about that. In this world people want things “yesterday” and don’t care if I think their disease mgmt is not being properly treated. And lets not forget those people who are too lazy to call their doctor but instead come to the pharmacy and ask us for a recommendation to treat something we have no way to diagnose or were even schooled in. And if we do give you a recommendation you don’t like my answer so why waste my time. I was taught to fill medications, monitor for drug interactions & inappropriate therapies and recommend over the counter medications for “common” ailments. Yes, monitoring for inappropriate therapy does allow us to call your MD if we think you are abusing pain medications or are exceeding the recommended duration or dose. We are there to make sure medications are used PROPERLY and to prevent adverse events. If you don’t care about your health enough to allow us to do our jobs and maybe take some time to be responsible for your own medications than don’t come to my pharmacy. Our relationship is a team effort and deserves 50/50 effort and respect. In the end each of us are responsible for our own lives!

  34. I think you’re giving yourself a tad bit too much credit, talk about unwarranted self importance. My pharmacist has never been involved in my care as a patient. Eh, well unless you consider reading a prescription correctly and counting out a few pills as patient care, I certainly don’t. I view him/her more like a waitress or a drive-thru burger joint employee, “Your order . . . I mean prescription will be ready in about 10 to 15 minutes.”

    What would be considered a generous tip for a professional pill counter, 10%, 15% of the copay? Next time I have a (usually unnecessary) medication that needs to be filled I might throw the poor bastard a bone. Especially after seeing how disgruntled some of you are.

  35. Wow. I never realized how much you guys hated us. I see you guys as mullahs, to which I take a sacred prescription, and wait to be judged. That is how little we patients with schedule 2 prescriptions understand you(at least the legit ones).

    You are an unpredictable god. Some of your places of worship grant me 2 days grace, some grant me 7 days of grace. It’s always consistent (usually) from pharmacy to pharmacy. Then some grant me no grace what so ever. Some actually loudly humiliate me (bear in mind I didn’t speak a word between handing them the script and the beginning of their humiliation… next pharmacy filled it sans yelling).

    You guys have to realize this: most of us just need a medication to function and don’t really know the rules… And you folks are crazy unpredictable from store, to store, from city to city. (I travel a lot doing consulting). It’s either 7 days, 3 days, or no days grace… (it’s 7 days grace in most of SF, same for Austin. LA is fucking horrible [who knows why], Vermont is great! Mass sucks!) I could go on, but really, we have no idea what the real rules are.

    Just try googling “how early can I get a refill in (some state).” THERE IS NO REAL ANSWER! (other than the “30 days is 30 days supply” which is rarely enforced) MUAHAHAHA!

    Personally, I never bullshit. I just hand a prescription, and they either fill, or invoke the 0,3,7 day law (whatever the real ‘law’ is…), and smile, and say thanks and go about my day. I get it. I’m just saying if 30 day supply is a 30 day supploy, than you guys need to figure out how to standardize that so patients like me can actually take stuff like that seriously.

Leave a Reply to PutOnYourFlameSuit Cancel reply