Saturday, September 29, 2012

What could doctors do to make the pharmacist's life easier?

I was reading the comments over at The Angry Pharmacist's blog (not safe for work or the faint of heart) and there was one from a med student/resident/I don't really understand all the levels of training for MDs but I'm sure I will by the end of rotations asking how docs could make pharmacists' lives easier.  I figured I'd write that blog post since The Angry Pharmacist is a busy dude and I like procrastinating (big scary test x2 this week, one mostly a surprise, oh joy).

What I really want all doctors to know about working well with community pharmacists:

1. Your computer system only sends prescriptions to ours.  It doesn't send a message saying, "Oops! That was a mistake and I cancelled it here in the patient's chart."  You could call us, or you could make a note on a second e-prescription saying "this is correct, do not fill the other one."  Doing nothing but cancelling the order in the patient's chart just makes everyone frustrated that we have to call to clarify something.

2. Your computer system really ONLY sends prescriptions to ours.  We have no information on what you're treating or what dose change you may or may not have made (on purpose or by accident).  There are a couple easy solutions to this: add a diagnosis to your sigs (that's the part of the prescription that says "Take one tablet every day") by adding the words "for [hypertension or blood pressure or cholesterol or being crazy or mood]" to the end.  We like that. Patients love it.  Good idea.  Additional solution: make notes on the rx (that's shorthand for prescription, fyi) that say: "note dose increase to ___" or something.

3. Ask us.  We know stuff about medications and can help with just about any medication-related question.  We also have all the best resources for looking stuff up about medications, so let us do our jobs.  We see patients at all hours of the day so we have heard every stupid question ever (I promise).  Your question is not stupid, and you look infinitely smarter asking us before just deciding to write an rx without knowing what you're doing and having us call you to figure out what on Earth you were thinking.

4. Don't think we're calling you stupid if you make a mistake and we call to inquire about it.  Mistakes happen to people and doctors are still people, last I checked.  We just want to know what you actually meant so nobody gets hurt.

5. If you're doing something strange for some reason (unusual dosing for example or adjusting the dose for an organ transplant the patient just had and somehow didn't tell us about), and you aren't sure it will translate properly or your e-prescribing software is grouchy/making you angry or whatever, CALL US.  We are your colleagues.  We want to work together.  If you explain it on the phone to us, we'll get it right or ask you questions until we get it right.

6. We offer this thing called "medication therapy management" for patients who are having a bad time keeping their medications and/or health together.  Refer people to us and then call us or fax us to tell us you recommended it to them.  It's a great deal for everyone: we know lots about medications and can figure out what's going on and suggest changes to you, your patient gets someone to talk to about all the things they forget/are too scared to ask about when they see you, and the insurance company probably (most of the time) saves money in the long run.

7. We think working in teams with you is awesome and would love more clinical data access, and we could share with you if your patients are actually getting their prescriptions filled, and if it's on time or not each month.  Is your clinic hiring a pharmacist? We would love that job and could save you time by doing the grunt work "what medication should we give this patient?" part of visits and patients money by finding them a medication that's a good fit for them from the start.

8. ASK US.  We mean that.  We try when calling to suggest something instead if the patient is allergic or the insurance won't pay.  If you ask, we can tell you.

9. Pharmacists are largely PharmDs (or really wicked experienced and smart RPhs [registered pharmacists]).  We know our stuff.  Don't scoff at our recommendations.  We keep up on guidelines and literature too and we want to do what's in the patient's best interest.

10. Did I mention asking us questions and actually talking to us?  And that e-prescribing is 100% one way from your computer to ours?  Remember just those two things and you are set to be our new favorite MD (and we totally have favorites in the pharmacy, in case you didn't know).

Wednesday, September 26, 2012

Baby names!

The kid has a historically popular but now just about unknown name.  I'm very torn as to whether we ought to try to match weirdness levels for Little Monster or go with something that matches thematically (which is to say, the kid's name is a noun and there's a lot of related nouns to choose from).  And does it even matter if we choose a name before meeting Little Monster anyway?  I mean, I guess I'd feel kinda like we're further neglecting Little Monster if we didn't have a carefully thought-out name well in advance.  I think we'd picked the kid's name before we even got married and her male counter-name not long after we were married.  Poor baby doesn't get as much attention as the kid and is still negative 20-some weeks...

In that spirit, girl name suggestions?  Or suggestions of places to look for some?  Or most hated girl name or naming trend?  Or any TV/literary characters with names to be avoided as I kind of live in a pop-culture vacuum?

Monday, September 24, 2012

And now for something completely different...

The light and cheery stuff!

The little monster (ok, so the spouse says I should pick a better name for proto-baby, but hey. I'm the boss of this blog and I'll dub proto-baby little monster if I want) is a wiggle worm.  When I wake up in the middle of the night, I have trouble getting back to sleep because I'm being fluttered at, usually for 10-20 minutes.  Sometimes it makes me cry I'm so excited and confused and nervous and excited again.  Also being fluttered at, which makes it really hard to get comfortable.

Sciatica and I are arch-nemeses.  I have an arthritic hip and lately the sciatica has been making my good leg numb so it is awful.  I even nearly crashed when I couldn't put any weight on the numb/sciatic side and had been walking around a table.  Whoops!

Tomorrow we're going on a tour of the snazzy remodeled school where the kid will start kindergarten next fall.  I'm going to cry the whole time, I'm sure.  My hormones are very into crying lately.  Who cries during Live Free or Die Hard except a pregnant person?

Yesterday the kid insisted on watching Cute Roulette videos for a half hour and I spilled a half glass of lemonade on myself making room for her to sit next to me, only I had no idea how bad the damage was and tried to leave for the store with sopping wet pants.  The spouse caught me and made me change just in time.

Speaking of pants, I bought a pair of maternity pants and they are the greatest thing ever right now.  Although one seam wasn't sewn with enough allowance and has now pulled apart, I can fix that.  Awesome pants! That fit!  Without using the Bella Band to hold them up! Yay!

We misplaced our slow cooker when we moved so we got a shiny new one, which we're arguing we needed anyway since we're trying to cook for the week on the weekend and it's easier to do all the prep at once and then wait around while everything cooks.

This seems to be a bad year for rutabagas which isn't a big deal for anyone but me because they are all I really want to eat right now.  Baked rutabagas with noodles and cheese sauce (maybe some peas in there too), potato leek rutabaga soup, pasties, nom.  And no rutabagas!  I'm getting desperate and may have my inner city sibling check out a bigger farmer's market to see if there are good ones around and have them shipped to me.  (For the uninitiated, rutabagas are like squash in consistency when cooked well, only sweeter and less grainy, and they are sometimes called Swedes.  I will admit to being enough Swede myself that it's probably one of my very favorite foods, despite its reputation for being tough.  You need to buy ones not larger than two fists together or even smaller for the best flavor and texture, and the wax and outer layer should get cut off.)

Thursday, September 20, 2012

Infertility, you thief

This month's PAIL theme post is about the loss that the infertility experience brings.  I've been mulling for weeks about it because it's a really emotional and fraught topic.

I decided that the thing I miss most about life before infertility and diagnosis is my sister in law.  This takes a little back story, so bear with me.

I think that the spouse's sibling and his wife are probably not going to have children at all.  I'm not sure why not, but it seems to be because they can't agree on whether or not or when to have them.  If I can guess accurately from watching them interact, it started with him being freaked about babies for whatever reason, continued with watching a few friends get divorced with small children in the balance, and has certainly included close observation of a family friend who got married because they were pregnant only to rapidly have a terrible split.

In this light, about 5 years ago, my sister in law was pretty excited first that we were going to start trying and then that we were pregnant.  I haven't asked, but I think she often thinks she'd like a child or two of her own but it's a complicated deal and after so many years of the debate, I imagine it's gotten old and it's easier to let it go.  I get that.  That's where we were about more biological children before the surprise pregnancy.  You can only hang onto heartache so long before you have to let it go.

We were about as close as we've ever been during the first chunk of my pregnancy with the kid.  We emailed, we joked, all that.  Then I had my appendix out and got the "very likely PCOS, probably it will be hard for you to get pregnant again" news (at the same time, while I was pretty drugged and still very sore and in the hospital, thanks great timing fairy!) along with the "and now you're a moderate risk pregnancy, so don't take anything for granted" message...  It was also midterms and my uncle was dying and I totally shut out everything but the next thing in front of me.  I shut out just about everyone too.  Yeah, I still occasionally had something to say to my sister in law, but it wasn't much.  I hardly had anything to say to myself.

And the kid arrived, later than expected but relatively healthy at first.  When she was a week old, she choked while nursing and got to spend a night in the hospital for observation to make sure there was no apnea going on.  Somehow it totally slipped our minds to tell our families about what was up, and I know it really upset my sister in law.  I think she felt slighted or something.  Honestly, we hadn't slept in a week and with the kid in the capable hands of nurses for the night, we were way too busy sleeping to do anything else.  Then it was back to the grind and a lot of trying to figure out what on earth we were doing.

Enter the post-kid phase where we started thinking about kid 2.  All that trusting, things will go really well and be perfect naivete had gone out the window when I had my appendix (well, actually an intestinal adhesion caused by scarring from ovarian cysts AND my sneaky appendix for good measure) out.  I was scared things wouldn't work out.  And then they didn't! Three times in a row!  It was a pretty disheartening thing, and we decided we'd keep it quiet.  We decided we'd not involve everyone in what could be so unpleasant and painful.

I don't know all of why my sister in law and her husband have decided on no children.  For all I know, it's because they've secretly and quietly had miscarriages too.  But my decision to be so secretive with all of my pain has put more distance between us, and I'm not sure how we can possibly bridge that gap now.  I lost a relationship to all the grief and stress and worry, and I suppose I could get about rebuilding it but it would be a long road and I just don't know if I have it in me to try.

Tuesday, September 18, 2012

Wishing all the best for Team Zoll #3!

So I tromp around blogs a great deal, and as I've said before, Keiko Zoll writes a really awesome one about infertility over at The Infertility Voice.  I found it some time ago when I was in a place to figure we'd never get pregnant on our own (and hey, look at that surprise fetus hanging around... hmm...) and I'm an avid reader.  Every time I stop over, I really enjoy the banner. "We are what 1 in 8 looks like.  This is what hope can feel like. Where our infertility stories matters."  That's a very comforting thing to consider in the isolation of infertility and loss.  1 in 8 is a whole lot of people.  That is someone you know, probably several someones.

Anyway, my adoration of Keiko's blog aside, this post is a shout out for good thoughts, prayers, all that jazz for Keiko and Larry as they get ready for their donor egg cycle with embryo transfer coming up soon.  Miracles totally happen (kid #2 is clear evidence of that) and I'm over in my quiet bloggy corner here cheering you on.  Yay for Team Zoll #3!  Yay for successful IVF and a lovely, uneventful pregnancy to come!  Thanks for your awesome work for the community, Keiko.  It means a lot to so many of us who don't have many words to say so often enough.

So, all very few of you readers, if you would, keep Keiko, Larry, and their donor in your prayers/thoughts in the days to come that everything goes smoothly and happily and successfully!

Monday, September 10, 2012


Today seems to be a day for crying jags.  This is now the third one, and really, for close to zero real cause.  I'm caught up for the most part on school stuff (aside from getting assignments properly into my calendar, which I will get finished tonight), there's still clean laundry and some clean dishes.  I'm interested in food for dinner, which is good.

Doctor visit today with the new doctor was fine and everything looks good.  Yipes!  The very last excuse to all of this hunkering and hiding is resoundingly gone.  The baby alien was visible on the in-office ultrasound, wiggling like crazy.

In the realm of entertaining items, I lost 3 pounds since my last doctor's visit 4 weeks ago.  It's been a weird year, that's for sure.  I have never before done nothing and lost weight, let alone continued to lose weight for more than a month or two, and now we're at 25 total pounds (which is totally not enough to put me back into the realm of healthy, but still. Something is something).  But I still have to do an early glucose test. blech.

I think I'll slink off to get a chocolate malt and cry some more so I've gotten the crying out of the way before the kid gets picked up from preschool.  Oh man.  We have to figure out how to explain to her that pretty close to everything has to/is going to change... sheesh.  At least she'll be skipping excited for several months.

Thursday, September 6, 2012

Plan B

As I may have mentioned, I read a lot of blogs.  I read a wide range from very conservative mommy bloggers to very liberal, and that's on purpose.  I try not to get myself into an internet echo chamber where I read things that validate me and only those things.  I try to be mindful that the world is so much bigger than me and my ideas about life.  One of my very favorites is Keiko's blog The Infertility Voice.  Recently she wrote this great post about women supporting each other and abortion rights and I figured I'd better chime in.

Anyway, one of the things that inevitably comes up during pharmacy school is Plan B.  It's a single dose medication that's designed to prevent ovulation or maybe prevent implantation of a fertilized egg (although we only suspect this, we don't actually know for sure it prevents implantation).  I personally am pretty sure abortion is immoral and I am pretty sure I'd never have one, based on my faith.  Preventing ovulation isn't causing an abortion though!  Totally different thing going on there.  My school has a stance of "we just won't talk about it" and other than the basic safety counseling things, we didn't.

In many if not all states, there are laws saying that a pharmacist has the right to refuse to dispense a medication based on her/his conscience.  This mostly means it's legal for Wal-mart to not carry Plan B (and maybe not any oral contraceptives, I don't know for sure).  It means that it's legal for any pharmacist to refuse to sell a medication whose use they disagree with on moral grounds.  Personally, if I ever own a pharmacy, it means I won't stock or dispense weight loss medications because they don't work very well and often cause other health problems.  Probably.  OK, I jest.  I'd probably carry them but counsel patients that they don't really work so probably aren't worth the money.

It annoys me to no end that this "conscience clause" is legal.  I think that if you choose the profession, it isn't your place to inflict your morals on your patients.  I think that once we take the Oath of the Pharmacist we commit to providing healthcare for every patient, no matter how I feel about the care the patient is getting.  How do I know if the pregnant 15 year old is promiscuous?  Maybe she's married.  How do I know why someone is taking Plan B unless it's being dispensed with what I'll call a rape cocktail (meds to prevent HIV, gonorrhea, chlamydia, etc)?  I'm not the prescriber and I shouldn't be inflicting my faith-based judgements on patients.  Plan B is over the counter, so yes, the pharmacist is the only person between the medication and the patient.  It is still not my job to decide things for the patient.  I'll determine if it's safe and appropriate for the patient, but it isn't my job to decide the ethics because my ethical decisions are not based on my patient's ethics. 

So for me, I think if you're going to be a pharmacist, you need to know that it includes dispensing contraception, and if you don't want to dispense it, work in a hospital and it happens less often or become a dentist and it will never be an issue.  Keep your conscience to yourself, thanks.

Wednesday, September 5, 2012


Aside from my stroller obsession, I'm really obsessed about deciding things RIGHT NOW.  I may, for example, after my next doctor's visit next week, start looking for childcare and running the numbers to see what kind of childcare is most affordable.  I'm pretty sure where the kid goes to preschool/daycare won't have an infant opening until at least this time next year, so that's out.

Other things I've demanded we decide on right now: cloth diapers (assuming we can get the childcare to also do cloth), probably just one carseat rather than a baby bucket and another carseat (and I love the Evenflo Symphony so that's a no-decision decision), and no co-sleeping (although we'll probably do a mini-crib in our room again since that seemed to work out all right before).  Also we probably do need a double stroller and since the kid is still fairly string-bean shaped, she's under the weight limit for most doubles.

We've discussed nursing again, and the spouse is all for it.  I am not, but I decided not to push too much yet.  I wasn't a big fan of nursing, it hurt like crazy for the first two months, and I felt like a milk bar and pillow rather than a parent for about 6 months.  Yes, yes, I know.  It will be easier to pump since I can be at home (probably) and pump while watching lectures.  Nursing is best, blah blah blah.  No late night bottle fumbling, no trying to get it just the right temperature, all that jazz.  While we did successfully nurse with formula only once that first day in the hospital for a total of 13 months, I'm not convinced I want to do it again.  It might be easier this time, I assume it would be, but I really hated having to be the one up in the middle of the night AGAIN with a howling baby.  I suppose I'm having colic flashbacks and I'm imagining that formula might fix the colic that probably resulted from my diet including cow's milk (which we discovered the kid was allergic to once she got to trying it on her own at about 7 months old).  BUT what if kid 2 is also allergic to cow's milk?  Then the formula costs a zillion dollars and contains all sorts of weirdness.

I suppose that in the interest of sleep, nursing is the way to go.  The kitchen is downstairs and I can't imagine it will be safe for us to be going up and down the stairs at night while sleep deprived. 

Thoughts?  Have I mentioned my hatred of indecision? That's why I'm trying to get all this deciding out of the way before too long so I don't have to second guess myself again.