World's Most Unappreciated Profession: The Pharmacy Technician
World's Most Unappreciated Profession: The Pharmacy Technician
If you watch a lot of reality programming, then you know that a lot of under appreciated professions are being highlighted by shows such as "World's Dirtiest Jobs," "World's Most Dangerous Jobs," and "The Deadliest Catch." I would like to suggest a new reality series called "World's Most Misunderstood Jobs." One of those jobs would be that of the Pharmacy Technician who works in community pharmacy.
There are few professions that come with greater responsibility and less respect than that of the Pharmacy Tech. It is a profession which requires a good working knowledge of medications, both by brand and generic name, extensive computer skills, knowledge of laws governing privacy (Hipaa), controlled substance laws, (including pseudoephedrine, aka Sudafed, alcohol, and tobacco laws), as well as excellent math skills, a pleasant demeanor, and an ability to be in three places at once, in order to meet the needs of the patients and the Pharmacist.
A good Pharmacy Technician can process up to two hundred prescriptions a day, while simultaneously waiting on customers at the intake window, the cash register and the drive-up window. In addition, he or she must put away all medications used in processing, file all new prescription forms, return all prescriptions which have not been picked up within ten days, deal with insurance issues, order new medications, keep track of inventory, especially as it involves narcotics, and help the customers in the store find the bobby pins. They do all this for about $9.00-$11.00 an hour (the average starting pay).
I went to school to learn how to be a Pharmacy Technician. Most community colleges now offer courses for this profession. The cost is roughly $1200 (books included) depending on where you go. If you go on to become Nationally Certified, the price of the test runs approximately $160. National certification allows the technician (in some states) to write prescriptions given over the phone by a doctor, and to take transfers from other pharmacies.
I loved being a Pharmacy Technician. I took pride in being a part of a health care team. I loved working with insurance companies to help people to get their much-needed medication. I loved that I could help someone in pain get their medication in a timely fashion. I also enjoyed helping the elderly find the resources to pick out the best Medicare part D program for their needs. I cautioned patients about the use of anti-biotics while on birth control, or when spending time in the sun, or the mixing of aspirin based products with Coumadin.
Unfortunately, for all my training and expertise, to the general public, I was just a cashier with a uniform and a pretty name tag. To the company for whom I worked, my job status was one step higher than the vitamin specialist, which was one step higher than the front end cashier, neither of which jobs required any specialized training.
For those of you who may not know this, it is the pharmacy technician who fills your prescription. They take the prescription form(s) from the patient at the intake window, then pull the drug(s) from the shelf. They then process the prescription(s) in the computer, complete with labeling instructions and warnings, and bill the insurance company. Then they count out the tablets, put them in the bottle(s), and put the label(s) on. Then it goes to the pharmacist to be checked for accuracy.
All the while this is being done, the pharmacy technician is also waiting on the customers at the register, taking in more prescriptions, processing refills on the telephone, and waiting on customers at the drive-thru window. We tell all of our customers that the wait time will be twenty minutes. Almost to a person, they say the same thing. "What, to put a few pills in a bottle?" In fact, an actual prescription start to finish would take about five minutes. The additional fifteen is to handle all the interruptions while doing it, as well as the time it takes the pharmacist to check it. Often, it gets so busy that one prescription could take as much as half an hour. This usually occurs when people decide at the register that they want to change their insurance, add another prescription to the one they're picking up, decide they want brand instead of generic, or have a cart full of groceries they wish to buy along with their prescription.
Sometimes, customers try to refill their prescription early, but the insurance won't pay for it. Then, it is our job to explain to them that it is too soon. One day at the window, I had to explain to a patient that it was too soon to refill her insulin. "But, I don't have any more." she cried, "What am I going to do?" I checked her file. She received ten milliliters, just ten days ago. I calculated the number of units she was supposed to be taking and divided it by the number of units in a ten-milliliter bottle. By my reckoning, she had more than enough to last the month. I went back to the window. "You should have plenty left." I say, "Has there been a change in your dose?"
"No, I've been taking it exactly as I always have." she says.
"Tell you what," I say, "go home and look in the back of the refrigerator. I'm guessing it's buried back there somewhere. If you don't find it, call me right away and I'll call the insurance company to see if I can get you an override due to lost medication."
She left the window very upset, but later that evening, she called to say that she found her medication right there in the refrigerator, behind the orange juice.
Technicians deal with a lot of sick people. When we go to the take-in window, we never know what we'll be confronted with: A person whose child has just been diagnosed with leukemia, a woman whose husband just had a heart attack and needs ten prescriptions filled before he can come home from the hospital, people with AIDS, who have upward of twelve prescriptions which need to be filled right away. Then there are kids with ear infections, pink-eye, pneumonia, asthma, bronchitis, gastroenteritis, people who have had teeth extracted, arms, hands and feet stitched up, all standing there in pain, waiting for anti-biotics and pain medication. We take their prescriptions, start pulling the medications and begin processing the prescriptions while they wait.
Meanwhile, the phone keeps ringing, the fax keeps trilling, the drive-thru keeps dinging, and the people are lining up at the register. Pharmacies are always notoriously understaffed. They base their technician hours only on the number of prescriptions filled. They do not take into consideration, the number of pick-ups we have, the number of important questions (Where are the rest rooms? Where would I find hair dye? Is acetaminophen as good as Tylenol?), which we must answer, the number of complaints (The rest room is filthy. Why don't you have the sale items you advertise? Can I get a rain check?) we have to deal with, or the insensitivity of people who insist on bringing their full carts to our register to avoid standing in line up front.
Every time a pharmacy technician leaves his or her computer, a prescription is not being completed. Worse, by the time the technician gets back to it she no longer remembers where she was and has to waste precious time figuring out what she was doing. Then the phone rings. Someone wants a refill, they're only ten minutes away. "Can you have it done by the time I get there?"
No," I say, "it'll be at least an hour."
"Unacceptable," she says, "I'm on my way to Boston, and I need to bring it with
me."
"Ma'am, I have ten prescriptions that I am doing right now for people who have already been waiting twenty minutes. I really must put their needs first."
"I've been coming to your store for fifteen years." she says, "I'll be there in ten minutes and it had better be ready or I'm taking my business elsewhere." Click.
I stop what I'm doing, run to get the medication, print the label, count the pills and throw the label on. Then I mark it Priority' and hand it to the Pharmacist for checking. Then I go back to filling the ten prescriptions for the people waiting in the store.
All of this is not happening in a vacuum, of course. There is usually at least one other technician working as well, but she, too, is dealing with exactly the same situations. If I'm at the drive-thru, she's at the register; If I'm at the take-in window, she is at the drive-thru. She has priority orders' and telephone calls just as I do. There is only so much we can do to help each other.
I now have five of the ten prescriptions I was doing, done. It has already taken half an hour. The people who are waiting are beginning to pace and get restless. Mercifully, the drive-thru has stopped dinging, and no one is currently picking up at the register. I am able to finish off the remaining five prescriptions in about fifteen minutes. After counting, bottling and labeling, I pass them on to the Pharmacist. Then I go out to the waiting room, apologize for the delay, and tell them it will be just a few more minutes. They are very nice people and thank me for letting them know.
Once their prescriptions are checked, I call them to the register and cash them out. They hand me their money, accept their change, then turn to the pharmacist and thank him so much for doing those for them. The Pharmacist says "You're Welcome. Have a nice day." And me? I go back to my computer and work on more prescriptions for which I will receive no credit.
One of the biggest misconceptions people have about pharmacies in general is that, if there are no people around, it must not be busy. Wrong. From the moment the store opens, until it closes, our computer screens are filled with refills that have been phoned or e-mailed in via the automated system, automatic refills (a service most pharmacies now provide for persons on maintenance medications, and refills that had been previously deferred due to early refill. In addition, people call us constantly for refills, and the fax machine never stops bringing in new prescriptions written by doctors and faxed over. If we didn't have a single customer all day, we would still fill more than a hundred prescriptions a day.
Every label that goes on every bottle states clearly the date the prescription was filled, the number of refills remaining, the expiration date of the pills, and the expiration date of the prescription. In general, all prescriptions are good for one year, the exception being any controlled substance, which depending on the state is usually about six months. The date of any prescription is the date on which the Doctor writes it.
In spite of all the information we provide on every bottle, we still have people who become absolutely furious when they discover that they have no refills left or that their prescription has expired. We've tried everything from warning them at the register that this is their last refill, to circling the refill and expiration date info, and still they do not look.
"I have to have that medication," one angry man says, "now what do you intend to do about this?"
"I'll send a fax to your doctor," I reply, "but to expedite things, it might be a good idea for you to call him, too."
"I can't do that." he says, "My doctor isn't going to talk to me. He's too busy."
"I'll fax the doctor and hopefully he'll get back to us today."
"If he doesn't you'd better call him. I'm out of pills and I need them."
What's worse than them not reading the bottom of the bottle is when they read it wrong.
"It says right here I have six more refills." an angry woman screams at me pointing to the bottom of the bottle.
"Yes, ma'am," I say pointing to the rest of the line, "but the prescription expired last month."
"I don't understand," she says, "it clearly says I have six more refills."
"But, the prescription is only good for one year from the date it was written." I point to the original fill date. "You see, this prescription was written one year ago last month. It doesn't matter how many refills you have left if the prescription has expired."
"That makes no sense." she says. "Just give me the bottle. I'm taking my business elsewhere."
When my half-hour lunch break comes, (the only break I get), I punch out and head to my car to eat my lunch, listen to the radio, soak up some sun, and just decompress for half an hour. We have a break room, but I prefer to remove myself from the premises, so I don't have to hear the phones ringing, the fax trilling, and the drive-thru dinging. It is the only time all day when I am allowed to sit. It feels so good to just sit for a while. After lunch, I punch in and go straight to work again.
By the end of the day, every muscle in my body aches. My feet and legs burn from standing and walking between windows and shelves of medications, seventy or eighty times a day, my neck and shoulders are locked up from standing in front of the computer screen, and my arms and hands are stiff from typing all day. When I get into my car to go home, I am in a complete vegetative state. One minute I'm in the parking lot at work and the next minute, I'm at home with no recollection of how I got there.
I would like to make a few suggestions to Pharmacy customers which will make our job easier and their experience more pleasant.
1) Don't wait until you are out of your maintenance medications to refill them. Call or E-mail your refill at least two days in advance.
2) Unless it is an emergency, please don't opt to wait for your prescription. It makes it difficult for us to get the medications for the urgently needy in a timely fashion.
3) Do not ask us to find the bathrooms, or the hair dye, or shampoo for you. That is what the front end people are paid to do.
4) Bring to us any and all over-the-counter meds that you are buying or the embarrassing personal items, but please do not burden us with your other shopping items. The more time we spend at the register, the less time we have to fill prescriptions.
5) Read your label. If your prescription has run out, be aware that we must fax your doctor to get a new prescription. Bring it in a couple of days before you run out.
6) Present your new insurance card when you drop off your prescription. They are not credit cards. If you wait until you pick up your prescription, we will have to re-do the prescription billing and re-check the prescription. This will take at least ten minutes.
7) If you are coming up to visit our quaint little town, please pack all of your medications first. You wouldn't leave home without clean underwear, don't leave home without your medications.
8) If there is a problem with your insurance, please don't shoot the messenger. Read your prescription plan. It will tell you which medications are covered and which will need prior authorization from your physician. The pharmacy cannot request a prior authorization; only your doctor can. It is a process which takes a minimum of 24 hours and can be much more quickly rectified if you keep after him or her to submit it. That same plan will also tell you which medications will cost you more than the standard co-pay. Remember, we are not setting the price you pay at the register, your insurance company determines the amount of co-pay you must pay.
9) Know what medications you are taking. We understand that you may not be able to pronounce it well, but a bad pronunciation, followed by a description of what the medication is for will help us to find it for you in your profile. Do not describe the pill. There are many manufacturers for every generic and they do not all look the same.
10) Do not call us from your car and expect us to be able to fill your prescription by the time you get here. Call from your home and allow at least an hour for pick-up. Remember that we have sick people in the store waiting for their medication. We cannot simply abandon their prescriptions in order that you may just breeze through the drive-thru without waiting.
11) Controlled class II drugs (Percocet, Morphine, Adderall, Ritalin, etc.) may not be refilled. You must have a new prescription for every fill. Some states even regulate the amount of pills you may receive per fill, regardless of what the doctor writes. Again, don't shoot the messenger. They are called controlled substances for a reason.
12) The drive-thru is for medications only. You can not get your bread, milk cigarettes or over-the-counter medications there. You must come inside to do your shopping.
13) Your pharmacist is not a doctor. Do not take him away from his work to ask him medical questions. Call your doctor. He is trained for medication advice, not medical advice.
Finally, I would like to say that, every once in a while, thank your Pharmacy Technician for the work that he or she does. Any good pharmacist will tell you, he could not do his job, if we do not do ours.
.
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