Saturday, November 28, 2009

Shoppers Drug Mart Politics

Usually, when a company asks an employee to take over a position that has been held by the same person for many many years, that new employee should adapt to their new environment and staff, right? Well, not if you're talking about Shoppers Drug Mart.

Last night I worked relief in a Shoppers Drug Mart (SDM) that has a new "Associate Owner" (slash "sucker"). The staff filled me in on all the gossip. The old Associate left the store to take on a cushy head office job. And the new guy comes into the new store for not even 2 weeks and has already started digging his own grave.

You think that as the new guy and new boss of a pretty large and decent staff, you'd want to keep them on your good side. But not this genius. He comes in and as one of his first acts of business, he decides to end the store's methadone program!! WTF?!?! Those meth patients are trying to get clean, and you walk in and mess everything up!! Of course, I'm working the first full day after they started telling their patients that they're going to have to find a new methadone store. Thanks asshole, now I'm working until midnight with a bunch of pissed off recovering drug addicts and the staff and I are getting an ear full.

So, why would this idiot choose to take over a store where there's methadone if he's to big of a pussy to deal with it? My guess: he's an idiot. But, an even better question: Why would SDM let a new associate take over a new store and start changing things around so drastically? My guess: they're idiots. But he's all they've got, and they're all he's got. Why? Say it with me: They're all idiots!

The whole situation gets worse because the staff are the ones telling the patients that they are closing the program and so the staff are getting yelled at. And who do the staff blame? The new guy. The idiot. And head office. The idiots.

This isn't an isolated incident. Every time I go to a SDM, there's some sort of political nonsense pissing all the store level staff off. Listen up Shoppers: don't piss off your store-level staff. They are your bread and butter...not the stupid idiots at head office in their cushy desk jobs with fancy offices and furniture (I've seen the fancy head office by the way).

So, what did I do? Naturally, I stirred shit up. I told the nice ladies, the technicians, to be empowered. I told them to say something to the new guy. And if that doesn't work, then speak to their regional manager. Worst case, get the pissed of patients to complain to head office and if necessary, complain to the college.

Call me a shit disturber. Seriously, call me that. Because that's what I am.

All Shoppers stores have issues. And the issues are typically all the same.

Too bad this hugely successful company are not smart enough to recognize it and do something about it. It's only a matter of time before it all comes crashing down.

Sunday, November 22, 2009

Opening a new pharmacy

So, all this work makes me wonder if it's time.

Is it time to consider opening my own pharmacy?

What's the deal with new pharmacies nowadays anyways? How does one compete for business with the likes of Shoppers Drug Mart and Rexall (and the slowly being phased out, Pharma Plus)? Is it stupid to think I can compete for the pharmacy business? And without a medical clinic in my back pocket, is it stupid to think I will survive?

Now what types of things am I thinking about? Well, location, location, location. Where the heck would I open? The area I live is pretty saturated with chains, independents, banners, and other types of pharmacies. So how far do I want to open a business from my home? What's reasonable?

And what would my pharmacy look like and what would I sell? What are people looking for in an independent store? What do you think? How much money and inventory do I need? And how much time and planning should I allow for?

What about past relationships? Do I worry that people I used to work for/with will get upset if I open within a certain distance of them? I'm not one to burn bridges, but seriously, space is finite.

And how does a pharmacist market themselves once open? I mean, you can't leave the store during business hours, so how do you go visit doctors when they're more likely to be able to meet with you? Or do I dig my financial hole deeper and hire someone to cover me when I call on docs? Its a catch-22.

So, anyone out there have any tips or advice for me? Any good resources?

Anyone done it already and want to get in on this action? Or know anyone who wants to do it?

Is this the start of a new thought process? Or is this just a timely blog that will fall by the waist side in an hour?

I predict this is the start of something massive.

Saturday, November 14, 2009

Hint hint, nudge nudge...

Anyone into compounding?

I've done my share...actually, much more than the average. I'm trained in non-sterile and aseptic compounding, and I really enjoy it.

There's much more brain cells being used with each prescription compounded than a typical rx filled. I mean, there's calculations, technique, stability, sterility, QA, etc. etc. Not just count, check, counsel. I feel more complete and more professional satisfied when I've actually done something that requires my expensive brain cells. I mean even a good DUR identification is better than just checking an inhaler refill. Wait, unless you're at the tail end of a 14 hour shift and you're feeling light headed because all the blood has rushed to your feet from standing forever.

So compounding, for those who don't know is the art of customizing medications for the patient to suit their needs. In Canada, its much less of a big deal than in the States. We only have "guidelines", nothing legislated about the standards a pharmacy must maintain if/when compounding. So yes, that means no USP 795 or USP 797. But like most things, Canada (or each province one-by-one) will eventually adopt the US standards and call it slightly different (just so people think they thought of it on their own).

What does that mean right now. It means compounding in Canada is like the Wild West! Anyone can do whatever the heck they want under any circumstance - although most don't. There are some who are pushing the envelope. Most pharmacists have enough respect for their patients that they do follow the guidelines, but some don't and think its okay to bend the rules once in a while and enter the gray area.

What is the gray area? Well, it's kind of gray.

So, compounding pharmacies aren't as prominent as in the US, but I foresee it going that way. Should I hop on that train? I'd love to, but it would be nice to have someone who has done it before and has the experience and $$ to help.

Know anyone?

Friday, November 13, 2009

The wrong way in a one way...

Whats the deal with drive thru pharmacies? (feeling like seinfeld right about now)

I know the concept has taken off in many places. Whatever, I still don't love it...that's speaking from the guy behind the window. I mean, I love the Tim Horton's drive through (by the way, that's an amazing Canadian coffee and donut and sandwich etc. place...if you're in the States, google it...or visit it in NYC).

So tonight I'm working in a store that has a drive-thru window. Its my first time. Its kind of cool for the first 2 customers, but once you have a line up at the drop-off and the pick-up counters, who the heck needs another line up of people staring through a window at us too? So, now there's 3 lineups, all wanting a piece of me. Oh wait, there goes the phone too.

Some guy pulls into the drive-thru lane, the wrong way. The wrong way!! I mean, there's gotta be a few dozen signs and even markings on the pavement letting you know the right way to do it. So this is what is said when the guy in the passenger seat, now closest to the window, pulls up:

Me: Hi, you drove through the wrong way.

Guy in the passenger seat: Well I'm not driving.

In my head: #$%@#!%@#$%@#!!!!!!!!!

Anyways, my point is that no matter what you do in a pharmacy to make people's lives easier, there will always be a select few messing it up for everyone else.

Where did this whole idea start anyways? Probably in the States somewhere. And like everything else, someone in Canada had to eventually follow. Now they're all trying to keep up with eachother. It's hilarious watching these companies compete with eachother. I'm no marketing genious or anything, but isn't the idea of these big box stores to get people IN the store? If they can get what they need by driving it up and taking time and attention away from the customers in the store who are probably spending more "per basket" at the end of the day, why do the big guys care so much about pleasing these people? Am I going to have to break out the "would you like fries with that?" line in the future? If that happens, I'll probably just actually go and serve least I'll be doing what I'm there to do. And not, going the wrong way down a one way.

Thursday, November 12, 2009

Men are pigs

I have many great stories from my days of working in an area of Toronto, known primarily as the gay area. I am not gay, but I can confidently say that of all the places across Ontario I've worked as a pharmacist, this area is my favourite. Not only because it hosts some of the friendliest people and some of the most taboo everythings, but also because it has provided me with some of the best stories.

For example, I began working there as an intern. Early in my rotation, and not quite as confident and knowledgeable as I am today, I was working away in the busy dispensary. Along comes some guy who starts staring at me from in front of the counter. It took me a moment to notice because I was diligently rechecking my work. When I finally looked up, this is how the conversation went:

Me: Hi, can I help you?

Guy: Are you "The Canadian Pharmacist"? (sorry, I'm leaving out names for a reason)

Me: Ya, that's me.

Guy: Oh....(smirk)....I got an email about you from a friend... (bigger smirk)

Me: ....?.... (awkward blank stare)

Guy: He told me to come check out the new pharmacist (still smirking)

Me: (back to work)

I'm not really sure if a blog is the best way to get that story across, but I can honestly say that was the first time I ever thought to myself, and with good reason: "Men are pigs". I've heard stories about relationship woes between guys and heard stories of same-sex weddings.

I have lots more stories about dudes hitting on me. I won't lie, its a big confidence booster when you get hit on frequently. Call it what you will, I'm the best damn pharmacist some of those guys ever had the pleasure of being counseled by!

Wednesday, November 11, 2009

Are Bioidentical Hormones Safe?

So, I'm cutting and pasting an article for people who don't want to log into Medscape. I'm pretty sure this could be frowned upon, but I'm referencing it.
This isn't exactly how I saw myself using this blog, but hey, why not use it for whatever I want?

From Medscape Nurses > Ask the Experts
Are Bioidentical Hormones Safe?
Susan J. Wysocki, RN-C, NP, FAANP
Published: 11/02/2009


Many patients ask me to prescribe compounded hormones, which they believe are safer. Some bring in saliva test results, and complicated charts and graphs with a suggested prescription attached. How should I respond?

Response from Susan J. Wysocki, RNC, NP, FAANP
President and CEO, National Association of Nurse Practitioners in Women's Health, Washington, DC

There is no evidence that so-called bioidentical hormones compounded in a pharmacy are safer than other hormone products. Furthermore, unlike insulin or thyroid hormone, female hormones cannot be titrated to customize a formula for an individual woman.[1] Female hormone levels are very dynamic and no single measurement can capture what the hormone levels might be the next day or even later on the same day. In some circumstances, blood levels may help a clinician understand why a woman might not be responding to therapy.[1] Overall, however, the woman herself is her own best "bioassay" for determining whether she needs hormonal therapy or when the dosage should be adjusted. Listening to her describe her menopausal symptoms and how well she has responded to therapy gives the clinician the best idea of what is going on in the target tissues.

In January of 2008 the FDA sent warnings to a number of large compounders of bioidentical hormone replacement therapy (BHRT) products, expressing concern about these manufacturers' claims about the safety, effectiveness, and superiority of their products. In that same memo, the US Food and Drug Administration (FDA) warned about the use of estriol, a weak estrogen that has not been approved by the FDA for use in any product.[2] Nevertheless, countless Websites, celebrities, other individuals, and pharmacies continue to make claims about BHRT. The FDA considers the term BHRT a marketing term.

Saliva tests are not a valid measure of female hormone levels. Female hormones that are found in saliva do not reflect what might be going on in the target tissues -- including the brain, the bones, etc.[2] It is in my opinion that these tests and products are a waste of money that would be better spent on something like a massage. Again, listening to a woman and what she says about her symptoms is the best way to "titrate" female hormones.

There are several issues about which clinicians should be aware. First of all, compounded products do not come with the class labeling that is mandated for any other menopausal hormone product, including warnings, black box, and other information. The absence of this label places on clinicians the burden of describing to the patient and documenting all these warnings. Second, there is no guarantee of the contents or purity of the compounded products. There is not enough oversight by the FDA to inspect all compounding pharmacies to determine if their products contain what they claim to contain.

Overall, there are no studies that demonstrate the superiority of any hormone product over another -- compounded or not. The labels for all FDA- approved menopausal hormones are the same. There are some intriguing data from a case-controlled study of transdermal estrogens (not a compounded product) that suggest that there are fewer associated risks for blood clots even among women who are at higher risk for blood clots.[3] The results are biologically plausible because of the lack of first-pass liver effect. However, as intriguing as these data are, I caution clinicians about making any absolute statements about the safety of transdermals. We need more data.

A wide variety of FDA-approved products is available to American women. These include oral forms, various transdermal forms, and a systemic vaginal ring. A wide range of doses is available. Many products fit the definition of bioidentical as used by the compounding pharmacies. Most of these products are covered by insurance. Compounding is very legitimate when a patient cannot take or tolerate FDA-approved medicines.

Ultimately, the clinician's job is to help the menopausal woman ameliorate her symptoms, feel well, and have a good quality of life. The current range of FDA- approved options meets the needs of most women. Compounding claims have been a marketing ploy to seduce women and clinicians into taking or prescribing something for which the evidence of benefit is lacking.

A Welcoming Counsel.

For starters: this is my first blog, so thanks for reading.

I'm not really sure how these things are supposed to work, so I plan on just writing about all things Pharmacy and Pharmacist...and maybe even things that aren't really.

For those who haven't thought much about the profession of pharmacy, it's probably time you did. We all know you've been into a pharmacy at some point or another - even if you sell out and go to Wal-Mart, Shoppers Drug Mart, or large grocery stores for your pharmacy-related stuff, you still have been to a pharmacy. (Don't even get me started on the negative effect Shoppers Drug Mart has on the profession of pharmacy - that will come soon). And even if you just grabbed cough syrup, eye drops, or picked up your grandmother's prescriptions, you probably have noticed the common theme in these pharmacies - the pharmacy counter. And if you have been unlike the typical consumer, you may have even looked past the busy dispensary counter and seen a head or two bobbing around frantically from phone to counter and back to the phone. Somewhere back there, amidst all that seemingly organized chaos, there is a pharmacist.

We are primary healthcare professionals. We have all been to University for a 4 year pharmacy degree - and in most cases, we also earned another bachelor degree prior to entering pharmacy school. Myself, I have 2 university degrees over 7 years.

Why start a blog now? Well, why not? People blog about anything and everything. I have lots to say and the people close to me just can't handle listening to it anymore. So this is more of a vice in letting me discuss my thoughts, frustrations, and whatever with whoever chooses to listen.

Things may get nasty. I may even divulge some of the industries best kept secrets. Like what really happens if a pill falls on the floor? Or, is the pharmacist judging you for having gonorrhea? The answer to that second question, is probably yes, by the way.

Stay tuned...I will try and be Mr. Oldman thanks to the stool softener I gave him last week.

Have a nice day.