A Conversation With a Pharmacist

[Scene opens with a loooooooong wait in the pharmacy before my number finally “pings” on the digital number-pinging thingy, as I struggle out of my chair, and hobble up to the pharmacist’s window, and hook my cane on the window ledge for emphasis as I hand over my ID and number slip, wincing in the fluorescent lighting on the other side.]

Army Medic Pharmacist: One moment.

Me: No problem, Specialist. (I am well aware that two of my three expected prescriptions require me to wait as they are counted, twice, some other fun stuff, though I no longer have to run around to get them, and have to be signed for, so I amuse myself by reading the literature he hasn’t bothered to hand me yet.)

[AMP returns with the Civilian Pharmacist]

Civilian Pharmacist: You have taken pregabalin with topamax before?

Me: Yes.

CP: What about this antacid?

Me: No. But I assume it is the same as my previous one.

CP: Yes.

[I sign for one med. CP hands me two bottles.]

Me: There should be a third script.

CP: No, only the two.

Me: There should have been a vicodin script as well.

[CP raises her eyebrows at me]

CP: You are on pregabalin.

Me: Yes.

CP: That is a time released pain medication.

Me: Yes ma’am.

CP: You don’t need vicodin with a time released pain medication.

Me: With all due respect, ma’am, I usually have both.

CP: Well, there isn’t a script for it, and I don’t think you need it.

Me: Well, ma’am, there should have been one, and I am going to ask you to call my provider about it.

[Staring contest ensues between Me and CP. I win. CP picks up phone and asks AMP for Dr. Awesome’s number. I can hear Dr. Awesome on the other end apologizing for forgetting the script, that the computer wasn’t working right when I was in her office, which it wasn’t, and that she forgot to put it in before leaving the office, and would put it in the next day she was in.]

CP: Dr. [Awesome] apologizes for your inconvenience. You can pick up the script on Monday.

Fin.

27 Comments

  1. CP: You don’t need vicodin with a time released pain medication.

    Urgh! I’ve had this too – a pharmacist – who doesn’t know me, who doesn’t know what my condition is, who hasn’t assessed my level of pain, who in fact has never seen me before – presuming to tell me I ‘don’t need’ the pain medication my DOCTOR has prescribed. (And I DID have a script.)

    I know they’re trained to double check in case the doctor has made an error, but too often that translates to policing the patient.

    I sympathise.

  2. It’s probably really unfair of me, but I started cringing the minute I saw “Army Medic” as I spent 3 years working for the Army (while being in the Navy) at the Charlotte MEPS and was not impressed with them as an organization.

    Also who the hell is the pharmacist to tell you what you do and don’t need? Jesus jumped-up Christ.

  3. Ugh, that sucks to have someone question your need for a pain medication you normally do take just because it is unusual. That pharmacist doesn’t know you, so she has no business policing what meds you do and do not need. If there were interactions to watch for, you would’ve known sinc eyou take this already (and if it’s your first time taking the drugs, she should consult with yoru doctor rather than refusing to give you the drug anyways). I’m glad it eventually worked out somewhat, and hope you had enough pain medication to bridge the waiting time.

  4. What a jackass! What is up with the judgment from pharmacists about people using pain medicine?! I’m so over it.

  5. Don’t you know, Diana Lee? Everybody getting pain medication is totally just looking to abuse it or to sell it to people who want to get high! [/snark]

    “I don’t think you need it.” Jesus Horatio Christ.

  6. Do pharmacists get any kind of soft skills/customer service skills/common courtesy skills classes taught to them? I know part of their job is to provide information to the patient and be a correction point in the system in case of prevent doctor/hospital/patient errors (and I know several people to whom serious harm was spared because of attentive pharmacists), but the assholery is not necessary!

  7. I almost giggled at the “pregabalin is a time released pain medication” part. It’s helped my range of motion a lot and removed a lot of the background pain, but when my SI joint flares up it does less than nothing – I swear the lack of distraction from the background pain makes my joints hurt even more. I can’t leave my house because of the snow and the hip pain walking on it induces, and the pregabalin is doing absolutely nothing to help that.

    I’m glad you’re getting your Vicodan. I can’t take it myself, but I understand it works wonders.

  8. Thank FSM it all worked out!

    Dr Ego holds me hostage until after the clinic closes – if I call them from within the exam room, I get the recording – so if the appt was on Friday and he’s going out of town, I’m SOL. So I’ve started examining the scrips before I let him leave.

    I’ve been on two “time released pain medications” (not at the same time!) – fentanyl patches and avinza (morphine). The patches worked long enough for me to ride my bike (in a TN summer, which made the patches wilt, d’oh) and start college, which was very important mentally. I don’t think I could have done it if I’d been like I am now, just mentally – a new thing pain free.

    Naturally, they stopped working after a while, but even while I was on them, I was still prescribed opioids for breakthrough pain. (The avinza never worked.)

    The pharmacists haven’t given me grief. They just ask if I have any questions.

    Do you have to go through this song and dance every month?

    And can I steal Dr Awesome?

  9. Hearty empathy.

    No, pregabalin is NOT a “time-release pain medication”. Pregabalin is a treatment for various disseminated pain conditions (I take it myself, bastard that it is), but that doesn’t mean it’s sufficient to cure all pain.

    I bet she doesn’t look at people with epilepsy and explain they need only one anti-seizure med. But pain — boy, howdy, you’re making that up, how dare you have a prescription for the medication known to be effective? You must be an addict.

  10. Ugh, sorry you had to go through this. Do they teach denying people’s experiences at pharmaceutical school or something?

    I recently had an encounter which went something like this:

    Pharmacist: (about a sleep medication) You shouldn’t take this every night.
    Me: But my doctor says I can and I need it every night.
    Pharmacist: But you really shouldn’t take it every night.
    Me: Why?
    Pharmacist: Because then you’ll become dependent on it and have to take a pill to go to sleep every night.

    Yes, Mr. Pharmacist, I believe that is actually the point of my taking sleep meds. This is a problem…why?

    You’d think that pharmacists wouldn’t be so anti-medication, but often this is not the case.

  11. It’s fucking prescribed. You made the informed choice to fill that prescription. Therefore, yes, you need it.

    It shouldn’t be that hard.
    .-= amandaw´s last blog ..A Saturday sketch =-.

  12. I got lectured once by a pharmacist (at a civilian commercial pharmacy: Walgreens, as it happens) who felt that I shouldn’t be taking vicodin daily for pain management. I wasn’t on any other opioid pain management; the pharmacist simply felt that opioid pain management was unnecessary. What was I taking it for? Fibromyalgia? Other patients of that pharmacists had fibromyalgia and they didn’t need vicodin for pain management they used exercise non-narcotic meds whatever.

    Yes pharmacist. Thank you pharmacist. I’ll keep that in mind pharmacist. I appreciate the advice pharmacist.

    I got my meds eventually, had a good shake in the parking lot, and switched pharmacies. Made sure the new pharmacy knew why I was bringing them my business. It hasn’t been a problem with the new people but I’m always worried.
    .-= kaninchenzero´s last blog ..Re: Trust Me =-.

  13. Thats when you look at them with disdain and say “actually it’s an antiseizure drug that’s supposed to be an improvement on gabapentin. Give me my medication”. (Bonus points for throwing mechanisms of action & half lives at them. I do this).

    And @jonquil, I’ve had pharmacists tell me I don’t need multiple seizure medications. Then I’ve asked them for the magic one that hits all the involved mechanisms (listing them off, because I am a terrible human being *grin*) and they stopped. Sort of.

  14. Had that pharmacist really never heard of breakthrough pain before? Honestly, either he was an incredibly uneducated or incredibly biased pharmacist, neither of which is a good thing. Many (many many many many) pain patients have their main pain medication and at least one other pain med for breakthrough pain, and/or other pain meds for specific different types of pain.

    Me? I have six different pain medications prescribed to me on a regular basis. There is the time-released morphine which I take the same dose of every day and every night. There is the ibuprofen for the specifically inflammatory type pain, which I take at least a baseline dose of every day and every night with occasionally an extra one during the day as needed. There is the darvocet for breakthrough pain during the day since that doesn’t cause me any drowsiness, which I can either take none of or 2-3 doses of per day as needed. There is the oxycodone for breakthrough pain at night since it does cause me drowsiness, which I can take none of or 1-2 doses of at bedtime as needed. There are the lidodern patches which help a specific type and area of back pain that I take as needed. And then there is the migraine medication which I take as needed.

    I’ve never had a pharmacist balk at any of it, although I know my primary care doctor would not prescribe me any of that if something were to happen to the doctor who treats my fibromyalgia because she has come out and told me she thinks I’m on too many meds but she doesn’t (thankfully) interfere with his treatment since he is the specialist.

    What the pharmacists do sometimes balk at are the multiple sleep meds I take. I take one that is also an anti-depressant because it helps boost both my other anti-depressants and my other sleep meds but doesn’t do enough on it’s own to take just it. So I also take triazolam and ambien – not at the same time! But to keep me from building up tolerances to either drug, I switch on and off – three nights on one and three nights on the other. The pharmacists sometimes don’t pick up on the fact that there are only half a month’s worth in each bottle if I get them filled at the same time and freak out a little bit. But even then, when I explain the situation to them, they fill it no problem.

    Pharmacists are definitely there, in part, to make sure the doctor hasn’t messed something up and we’re getting a safe amount and combo of our meds. They should be checking on these things. But they are not the doctor nor are they the patient, so they should absolutely not be making judgments about what a patient is allowed to get unless it is clearly contraindicated or a mistake by the prescribing doctor. Like, yea, if I had a full month’s worth of both of those strong sleep meds, they should be alarmed and check into that! But vicodin as breakthrough pain med along with a time released pain med?? That should absolutely not be an issue unless the pharmacist is super uneducated or incredibly biased against pain patients. In which case, he really shouldn’t BE a pharmacist, imo.

  15. There are days I hate living in a tiny little town where everyone knows you, and then I read conversations like this one. Thank gawds that my two pharmacists – a husband and wife team that really look out for me and my sister – are calm, reasonable people. If they feel that the prescription is dangerous or too much, they come out from behind the barrier and talk with us. We reassure them that yes, we are aware it’s a lot, but we can handle it and more importantly, need it to function. AND THEY UNDERSTAND AND FILL THE ‘SCRIPTS. Glorious day!

    That never would’ve happened back in the city. Hell, the doctors in the city would never even consider writing us pain ‘scripts, even though my sister suffers from level 8 to level 10 migraines every single day, and I have lower back pain so bad I can barely walk sometimes. But nope. Some ibuprofen will clear us right up. Sure.

    Ugh, this reminds me of all the ER trips spent begging them to give my sister something stronger than toradol for pain. Makes me want to cry thinking about.

  16. Oh, your pharmacist might know my pharmacist! When I picked up my last bottle of Percocet, I had to do a consultation with the pharmacist. Pharmacist asked, “Do you know why your doctor prescribed this?”

    I answered — correctly — “It’s for menstrual pain.” (In the future, I will say, “For the management of endometriosis and adenomyosis” and maybe throw in a few more big words if I can find them.)

    The pharmacist frowned and went, “No. You don’t need Percocet for menstrual pain.”

    I thank the powers that be that this was one of the times where I had enough clarity of thought to say, “You can call my doctor to verify if you want.”

    Which, interestingly, the pharmacist declined to do. I’m not sure why — It seems that we’re so very fortunate to have pharmacists to tell us which medications we need and do not need. I’m not sure why I bother with a doctor at all.

    Oh, wait… is it because after 14 years of searching, I’ve finally found a doctor who spends sufficient time with me, addresses my concerns, and takes me seriously — all of which, by the way, the pharmacist did not do?

  17. Actually having worked at a well-respected pharmacy school a few years, I can tell you that customer interaction is maybe 5 contact hours of the 5 year curriculum.Working with patients is something they are supposed to pick up in the 1000 hours of community pharmacy hours (meaning retail) they do on their own time or during the 9 months of 5 week rotations. No one at the college actually checks to see that they know how to treat a human being with respect. We just hope that their preceptor (rotation supervisor) or staff pharmacist teaches it. It’s kind of a pet peeve of mine actually.

  18. CP: You don’t need vicodin with a time released pain medication.

    Ugh, this is pretty much the same thing I get but with Gabapentin and OxyContin every time I have to go to a different pharmacist from one of the two in my town – even more so when I need to fill my prescription for OxyNorm too, which I use for breakthrough pain. “Why are you prescribed both types of Oxycodone, and do you know why?” Because most of the time OxyContin dose I’m on is enough and I’d rather only be stoned out of my gourd when absolutely necessary.

    Pharmacists are great for their intended role – dispensing medication, checking for prescribing mistakes and contraindications, giving health advice and giving the appropriate non-prescription but pharmacist-controlled meds for minor ailments such as common colds, and advising when things warrant a doctor’s attention. But when they start acting like they know better than a doctor and a patient who have been dealing with long-term health issues as a team for a while, it’s just annoying.

  19. Your pharmacist and the small-town civilian pharmacist that I deal with at college must know each other. The man’s occasionally decent-ish, like the time that he held my vicodin hostage for a week because my insurance was on the fritz and he wouldn’t let me pay for it out of pocket. Because I was obviously in pain, he let me take three of my pills with me. Oh wait, that’s right, that’s not actually decent. That’s keeping the meds I need to function from me.

    The other fun one was that he recently lectured me about the fact that I shouldn’t take the birth control he filled for me because it interferes with other meds I’m on. In front of everyone in the store, quite loudly, and said, “Well, I think you’re just going to have to be a girl who uses a different type of contraception.” Amazingly, I’ve never been on bc for contraception dude, only as medication for PCOS and then-unidentified hormone issues. (But I have severe migraines that mean that I cannot take this med.) And yet, he did not acknowledge that if I didn’t have Awesome!Pharmacy on speed dial, and double-check *everything* this pharmacist prescribes, we would not have caught his screw-up. Thank gods Awesome!Pharmacy doesn’t mind the fact that I call from 5000 miles away and ask them questions.

    (If anyone’s ever in Anchorage, Alaska, there is an independently owned pharmacy that will, if you explain very nicely the first time you go in, not judge you forever after. And if you have questions about new meds, they will answer. And call your doctor for you, if need be.)

  20. “And @jonquil, I’ve had pharmacists tell me I don’t need multiple seizure medications. ”

    This is what I get for assuming. Of *course* people with all disabilities get policed, not just pain disabilities. I apologize.

    I just went through U.S. incoming international customs and a hand-search (what fun!) and I’d been careful to have my doctor provide me with a written letter saying “I have prescribed morphine” as well as keeping ALL my prescription meds in their original containers. The hand-searcher said “All those drugs are yours?” I said “Unfortunately, yes” and got on through. A different hand-searcher and who knows?

  21. This actually reminds me of something that happened with my mom. She got a new doctor, and asked me to go to the appointment with her. The doctor prescribed her something (I can’t remember if it was an anti psychotic or an anti anxiety med), to which my mom replied “I can’t take that, it gives me severe heart palpitations.” To which the doctor said “Well, not all of your records have arrived yet. I have no proof of that, SO TAKE IT ANYWAY.” My mom reluctantly agreed, then took the script to the pharmacist (who we’re friends with).
    Pharmacist says immediately: “You can’t take this, it contraindicates with one of your other meds and will give you severe heart palpitations.” My mom: “I know. I told her.” The pharmacist gets on the phone and chews the doctor out for about 5 minutes.
    I love my mom’s pharmacist. Mom’s STILL looking for a doctor who will listen to her though. Maybe one great day she’ll actually find one. WTF kind of doctor A.) prescribes a med before all the records have arrived yet and B.) out and out says “I DON’T BELIEVE YOU.” when his patient tells him her experience with a drug.

    Oh wait. Sounds exactly like I doctor I once had.

    Sorry for the rant.

  22. @ A S – Damn. “You’re just the patient, so I’m not going to listen to you”? (If I waited for a doctor to go through all my records before doing anything, I’d run out of Bollywood movies to watch and those are 3 hours long!)

    I’m glad the pharmacist helped – because it’s more important if a Medical Professional says it, then you know, you with your body.

    And also I can’t say how happy I am that you went with her. If you went back, the doctor may deny it. You’re on the chair next to her, hello, I heard it all. *steely glare*

  23. Hey Everyone!

    Thanks for all of the comments! We just moved to a new apartment and the internets are not yet working! I will have access tomorrow night (Seoul Standard or whatever time) and should be able to respond more specifically to all of you! Apologies for the delay.

    I should let you know that the real fun happens when I refill my Topamax and Pregabalin at the same time. Being on TWO anti-seizure meds at the same time almost makes the CP’s head ‘asplode. I swear I am disabled just for the fun alone! WHEEE!

    LOVE and HUGS to you all!

    OYD

  24. Ahh this is way too familiar. Ableism at it’s most blatantly obvious. Yet, we give them their jobs…

    Sometimes I remind them, when they try to tell me I cannot have my only pain medication. I have doctors that worry i do not take enough medication but they understand that I have been severely over medicated and will be in pain no matter what so I will deal with my break through pain as best I can and the pain i always have. My function level doesn’t go up with more anyway.

    The last time a pharmacist tried this crap was at the local hospital where I see my pain meds doctor, my usual person was out sick. My doctor there hates working with other pharmtechs because of their behavior. So, I called on my cellphone and had the doctor tell them, “I wrote the prescription, fill it.” We changed pharmacies. He helped me find a competent location.

    i love my doctor, he’s competent, caring, and doesn’t discount a single thing i tell him. Freaks me out every time. He even appreciates that my service cat is not a dog.

  25. My favorite medication story? When we moved to a new state six months ago, I took my partner’s prescriptions to the pharmacy. Since it is a pharmacy at the medical clinic where the doctor works, I had to give her medication allergies. I told the pharmacy tech the four medications that she is allergic to. Well, last month the doctor wanted to prescribe one of them to my partner. My partner reminded the doc of her allergy, and the doc dismissed her concern. We figured the pharmacist would catch it, and as the pharmacy is affiliated with the clinic, would request a replacement. What did the pharmacy do? Deleted the medication from her list of allergies and filled it! Magically since the last time she was there, her list of allergies was reduced from four to three medications! There’s some great health care for you.

  26. Wow this is amazing to see so many comments I can relate to. I have fibromyalgia, chronic neck/back problems from a serious car acc. 20+ years ago, I’ve had thyroid cancer, and numerous other health issues. I just got thrown out of my medical clinic today as a patient, as my nurse practitioner feels I have betrayed her trust due to family members picking up my ambien, which sometimes has been in an other state due to my travel schedule. Yes I too have dealt with Walgreens in the past with no problem, but now I’m wondering if they have ‘rules’ on sleep meds. I take Neurontin for the fibromyalgia, flexoril to help with sleep, along with Ambien since my sleep issues have increased in the past year or so. At times I’ve paid cash to purchase enough Ambien to cover the month, as I’m only allowed 20 days at a time. But maybe it was time to change clinics after 8 years anyhow, but I feel it was done rather abruptly and mishandled . Oh yes and last week during my check up I was asked if I had a gun in the house. I said no, when I should’ve answered ‘why are you asking me that question’? I had also added jokingly, ‘its an idea though’. Hmm that might not have helped me.

  27. Artiste – that sucks about the NP.

    You’d think you could sign a form saying X, Y, and Z can pick up things when I can’t. Obviously not “schedule X” drugs…

    Slightly OT – I don’t have fibro (or maybe I do, I don’t know) but we think it’s nerve pain. I tried neurontin and don’t remember much about it, except it didn’t work. (Lyrica had the memorable horrible side effects.)

    So um, if you’re comfortable answering this, how is it working for you?