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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Abby on December 20, 1999, at 21:40:00
This post was prompted by Noa's post about her
rotten weekend and her experience at the pharmacy.
I was also reminded of someone else's post on the
stigma of lithium.
I got a psychiatrist to prescribe me a low dose of lithium because of a family history of bipolarity and some mild manic symptoms along with growing resistance to Zoloft--pr at least a lack of consistency.
When I went to pick up the prescription, the pharmacist asked me whether I had any questions etc., but he would not say lithium, even though for other customers he had not refrained from mentioning the name of their medication, and he seemed to have no problem saying Zoloft. It wasn't such a big deal, but it was a bit akward, and I tried to be veruy matter of fact about it. This particular pharmacist always struck me as fairly well-informed. He's independent and supplies a small hospital where there are several physician practice groups. He has several signs up about herbs and drug interactions, and right before he helped me he was counseling someone on herbal and vitamin approaches to coldsores. (The man's physician had only said that they flared up when you were under stress.)
The pharmacist seemed to be thinking that there must be something strange about someone who was taking lithium.
The handouts from pharmacists, based, I believe,
on what the FDA has approved the medicine for, say
only that Lithium is an anti-manic agent;
there's nothing about its role as an
antidepressant. He was not in any way
inappropriate, but almost too correct which was a
bit akward. Just wondered what others'
experiences were.Abby
Posted by ChrisK on December 21, 1999, at 4:35:11
In reply to How well informed do you think your pharmacist is?, posted by Abby on December 20, 1999, at 21:40:00
I have two pharmacists who are both good in their own way. The first grew up next door to me and is the same age as me (36). He knows my family history and when I ask him questions about the combos that I have taken he is quite knowledgable. The one area he was lax in was the herbal supplements and remedies I was taking when I had some liver problems. He definitely comes from the school of trusting manufactured drugs over herbals.
My current pharmacist always researches anything new that I try. The last time when I was put on Zyprexa he hadn't had much experience with it but did his own research in order to answer any questions (I found this out later). When I see him in the store for other reasons he always asks about any side effects I may be having without specifically mentioning the meds I am taking. I've never been around when he verbalized any med that anybody was having filled. He is very good about confidentiality.
Of course, with that said I happened to luck out with these two. One knows me from the time I was 5 and the other just happened to be at the one drug store closest to my house.
Unfortunately in some areas there still is the stigma of taking antidepressants and I would hope that any pharmacist would be discreet about talking about your meds in front of other customers. It may not be his stereotype as much as the people around you at the time.
Posted by JohnL on December 22, 1999, at 2:34:49
In reply to How well informed do you think your pharmacist is?, posted by Abby on December 20, 1999, at 21:40:00
My pharmacists don't demonstrate any knowledge about drugs. But they are fast and courteous. I can walk in anytime and walk out with my filled prescription in ten minutes max.
My pdoc once prescribed Vivactil for me because it is the only non-sedating activating tricyclic. The pharmacist told me it is a tricyclic and will make me drowsy. Obviously she hadn't done her homework.
They could care less what my prescription is for. They've never given me a funny look for anything, such as Lithium or Naltrexone or Pindolol or whatever. There was a period when I tried a bunch of different things but couldn't take the side effects in the first days, so one week after the next I was coming in with another prescription. They don't care. I think it would be cool though to know a pharmacist who is really into it and could discuss various tricks of the trade that other people are doing. JohnL
Posted by NHGrandma on December 22, 1999, at 3:55:40
In reply to Re: How well informed do you think your pharmacist is?, posted by JohnL on December 22, 1999, at 2:34:49
> My pdoc once prescribed Vivactil for me because it is the only non-sedating activating tricyclic. The pharmacist told me it is a tricyclic and will make me drowsy. Obviously she hadn't done her homework.
>
JohnL, Why aren't you sleeping? Why am I not sleeping? 4-5 hours max is not enough for my body. Didn't you take Neurontin at one time? I'm wondering if I should try it next for sleep. Every time I go for therapy the next 3-5 nights are filled with nightmares. Then they taper off and it is just early morning insomnia. I suppose I could take more Xanax now but I have to go to airport at 6:30 (in 2 hours.) Ambien would put me right back to sleep but also guarantee a crying spell next day. Trust me. I have experimented many times with it.
Thanks for listening. Guess I am just wondering what help Neurontin might be as pdoc seems to be leaning toward that next--after weaning me off Effexor XR. I am down to 37.5.
Also wondering if the last 3 years on antidepressants just covered up the need to be doning work in therapy. Stuff like childhood sexual abuse and the effects of it on my life. Seems puzzling that talking about it for the first time after many years can be so distressing. Until the depression set in 4 years ago I thought I functioned without typical SA symptoms. Pdoc thinks therapy can help boundary setting but meds are needed for anxiety, etc.more than exploring past. Therapist thinks working through content of nightmares will decrease need for meds. Who is right? Would Neurontin just enable more deadening? Or would it give better sleep and more consistent daytime functioning?Hope you were able to go back to sleep. I think I'll just get busy. I'm praying for the right answer before my next appointment with both Drs. next week.
I trusted pdoc for three years and the Effexor just added problems. Just started therapy and now it is adding problems. I'm willing to go through problems to get results, though. I miss Toby's input. He helped a lot. Gave a lot of info on EMDR and would you believe it--my new therapist is trained in EMDR. My nightmares seem like an EMDR experience.
Sorry for rambling. Do you charge $70/45min to read? lol.
Posted by S. Suggs on December 22, 1999, at 5:22:38
In reply to Re: How well informed do you think your pharmacist is?, posted by JohnL on December 22, 1999, at 2:34:49
The good old days are passing by. On average, most pharmacist work in chain drug stores, ie wal-mart, CVS. They have a quota of rx's to fill daily, odd since they cannot stand on the street and wave in the traffic. The independent pharmacist are becomming a thing of the past. They (and some chain pharmacist still do) provided more time with the customer, not only with the meds, but asking how the family is doing etc... The chains are so aggressive (pricing,usually) that it has forced many independents out of business. For ex. a CVS will pop up across the street from a very successful independent store for 30-40 years and shortly thereafter with much success, buy the store (customer list) out. Sad situ. Sorry to ramble, Blessings,
S. Suggs
Posted by dove on December 22, 1999, at 10:04:35
In reply to Re: How well informed do you think your pharmacist is?, posted by S. Suggs on December 22, 1999, at 5:22:38
How about on every bottle of Adderall filled, the pharmacist mentions the sedating effects and even puts a special label on the bottle warning that this medication will make you drowsy. The ritalin bottles have a warning about sharing the med with anyone, but nothing warning about sleepiness while taking it. Bizarre.
My pharmacist knows me too well I think, and I have actually heard her discussing my med-combo's with the woman who runs the cash register. Even harder for me is the fact that she is the mother of one of my husband's close friends, yikes. Hopefully she doesn't mention my name too many times, as I live in a town of like 5,000 people max.
rambling dove :-)
Posted by saint james on December 22, 1999, at 17:59:47
In reply to How well informed do you think your pharmacist is?, posted by Abby on December 20, 1999, at 21:40:00
I would say that most Rx'es are to busy to even notice if you are given a bad combo of meds.
james
Posted by Abby on December 22, 1999, at 21:45:43
In reply to Re: How well informed do you think your pharmacist is?, posted by S. Suggs on December 22, 1999, at 5:22:38
> The good old days are passing by. On average, most pharmacist work in chain drug stores, ie wal-mart, CVS. They have a quota of rx's to fill daily, odd since they cannot stand on the street and wave in the traffic. The independent pharmacist are becomming a thing of the past. They (and some chain pharmacist still do) provided more time with the customer, not only with the meds, but asking how the family is doing etc... The chains are so aggressive (pricing,usually) that it has forced many independents out of business. For ex. a CVS will pop up across the street from a very successful independent store for 30-40 years and shortly thereafter with much success, buy the store (customer list) out. Sad situ. Sorry to ramble, Blessings,
>
> S. SuggsHow funny that you say this, because I've generally found most
independents cheaper. I'm not sure what pharmacist training requires,
but you do need to be liocensed in something.I've had prescriptions filled in the UK, and they're pretty careful over
there. Boots particularly has a tendency to behave as though it were a
a quasi-governmental organization. Sometimes I find this annoying,
because I usually know more about the drug than the pharmacist does.
There everything, including advil and tylenol, somes in little sealed
packets like cold medicine. So, all the pharmacist does is print a
label w the Dr.'s name and dosage etc.I said something to my father once about how in the U.S. they have to
transfer pills from a large bottle; he said that they don't, because for
one medication he had specifically requested the original packaging.
Basically they come in bottles, like the ones for samples, already
prepackaged. The pharmacist then switches it to those orange bottles
with the pharmacist's cap. It's just busy-work. It shouldn't ever take
them longer than 10 minutes.Abby
Posted by Noa on December 22, 1999, at 23:51:21
In reply to Re: the death of the independent pharmacy, posted by Abby on December 22, 1999, at 21:45:43
I would guess that what takes the most time in filling a prescription is getting the coverage approved by the insurance, completing the requisite documentation, etc.
BTW, 2 anecdotes about independents (not meant to be representative, in any way):
1. I moved into this apartment just about two months before an independent pharmacy in the adjacent mini-strip closed. It was so incredibly convenient, even had a post-office "outpost". Why did it close? HUGE scandal. One of the pharmacists employed there had been convicted of carrying on a stolen medication racket for years. He worked with a partner who was a hospital employee, who would steal medications from hospitals. They would repackage them and sell them to customers. I believe they were also selling the wrong medications to customers, and were selling out-dated medications repackaged as new.
2. I used to work in a neighborhood that has an independent pharmacy that has a fiercely loyal local following. The neighborhood also had, just a block or so away from the drug store, one of the last remaining independent movie houses, built, I think in the late 1940's, which was still a single screen, one large hall. Sadly, the movie theatre went the way of all the others and closed, and it was announced that CVS was going to move in and renovate the building. The neighborhood went ballistic. There were intense drives to prevent CVS from moving in. The neighbors rallied to hold public protests, appear at council meetings, send out petitions, etc. People were concerned about traffic and parking, were angered about losing the theatre, and about the loss of one of the last independent theatres, a landmark that they were proud of. And, they were very concerned about what might happen to the independent pharmacy. They shouted and leafletted, and petitioned for months. To no avail. The CVS moved in, and for the first few months had very little business. It was practically a sign of "treason" to be seen entering the CVS. After a while, of course, the CVS started making some inroads. They donated some space in their building and some computers, to an adjacent school. Resistance died down a bit. Of course, there are still many locals who are adamant about continuing the boycott, but their numbers are eroding as time goes on. And, the independent pharmacy has managed to stay in business. Why? For several reasons. The pharmacists is knowledgable, takes the time to talk to people, and has carved out a niche for himself by specializing in vitamins, herbs and supplements in addition to medications. He participates in some of the major prescription plans and keeps his prices competetive.
Posted by S. Suggs on December 23, 1999, at 7:44:29
In reply to Re: the death of the independent pharmacy, posted by Abby on December 22, 1999, at 21:45:43
Good points Abby. There are some situations where the independents are cheaper, only because they know they have to in order to survive. These folks diversify into diabetic supplies and home health items. Another source of money to be made is on generics (chain and independents) and toothpaste etc... The profit margin margin is much higher on generics and therefore are suggested frequently. The chains are famous for saying you saved "x" amount. In reality, the question to ask the pharmacist is "how much more did you make on this generic vs. brand", should be fun to watch his/her answer. Blessings,
S. Suggs
Posted by S. Suggs on December 23, 1999, at 7:52:46
In reply to Re: the death of the independent pharmacy, posted by Noa on December 22, 1999, at 23:51:21
Noa, what a story! You have some great points. It's all about service, providing emotional support with the customer and letting them know you really are concerned about them. When a pharmacist gets caught up in the time crunch with filling the bottles and doing all the paperwork for insurance, I can see how they do not have time for serious support in much need by the customer. The pharmacist really in a lot of situations has no control. But as mentioned in previous post, there are a lot of uncalled for actions which drive the customer to another store. Competition is a good thing! Blessings,
S. Suggs
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