Jay Sochoka, RPh, BSPharm, CIP

Before I started my pharmacy rotations, the last job I held was bartending at a golf course. Believe it or not, it really helped prepare me for my career as a pharmacist.

Being a bartender is so similar to being a pharmacist that I am often tempted to put out a tip jar at work. Think about it for a second: both jobs require standing behind a counter for the whole shift, compounding concoctions while paying attention to ratios, dispensing sometimes mind-altering substances, and most important of all, just listening to somebody and perhaps offering a bit of advice.

While this is a tongue-in-cheek look at my employment history, it addresses a very important point. Listening to patients talk can benefit them more than anything I can dispense them.

I have had patients break down and sob in my arms on more than one occasion about a cancer diagnosis, the horrid loss of a child, or the stress of being a long-term caregiver, just to name a few. When this happens, I usually wipe a tear or 2 out of my own eyes.

I am sick of independent pharmacies advertising how personal their care is compared with the “you are a number and a dollar sign” view of chain retail pharmacy. Speaking for myself, I can say that this is a huge pile of rubbish. There are many patients who I consider extended family, and when bad things happen to them, I get upset.

A patient I had been taking care of since I started at my store 15 years ago had been diagnosed with cancer, and the outlook was not good. He was a fantastic patient and friend. He always gave us a day to fill his maintenance medications, and at least once a month, he would bring the pharmacy staff a dozen donuts.

When family members started to pick up his prescriptions, we started to get worried. I was working one Thursday, and someone wanted to see me in the drive-thru. It was my patient and he didn’t look good. The cancer was winning.

He waved to me, and I waved back. I thought he was waving hello, but when I read his obituary the following Monday, I realized he was saying goodbye.

Whether you are bartending or playing pharmacist, you make friends on the other side of the counter. Sometimes, all you can offer are your ears, arms, and sympathies. That may just be the best medicine there is.

Jay Sochoka, RPh, is going to mix a drink.

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Before I started my pharmacy rotations, the last job I held was bartending at a golf course. Believe it or not, it really helped prepare me for my career as a pharmacist.


Making Friends Across the Counter

My first professional pharmacy rotation was high-volume community pharmacy at the Thomas Jefferson University Hospital Apothecary. They were filling 500 scripts a day on a God-awful software program by today’s standards, getting patients out in 30 minutes or less, and not getting anybody killed. Moreover, they only filled scripts for Jefferson doctors, patients, students, and employees. If they had taken outside scripts, the workload would have been totally unmanageable.

The operation ran like a Rolex meeting for the Steelers’ dynasty teams, and quarterbacking the operation was Scott Kuhn, RPh. He showed me exactly what the little old bachelor of pharmacy degree could do in a boiler room setting, and he taught me the equation of efficiency + accuracy = quality—a mantra that is now 21 years old.

Although I only spent 4 weeks with Dr. Kuhn, I learned a lot. When I misfilled an alprazolam script with clonazepam, he let me know in no uncertain terms that I had just killed a patient. While it probably was not a fatal mistake for toxicity reasons, the patient could have gotten dizzy, mismanaged a flight of stairs, and suffered a fatal conclusion. From that moment on, I have had a healthy fear of my profession.

Thanks to Dr. Kuhn, I also developed a healthy fear of microscopic life and sub-life forms, namely bacteria and viruses. One morning, he ran by the profile of a patient who was one course fail of antibiotics away from going to the hospital for an IV. In his disgust, he said, “People who say that humans have no natural enemies are forgetting about bacteria and viruses. One day, they will be the only things left.”

To this day, I believe him. Bacteria and viruses evolve faster than we can keep up. Eventually, every antibiotic we have will be as powerful as oral penicillin 50 mg. In the big picture, our antiviral therapy is sketchy at best. In 25 years, nothing has even come close to resembling an HIV vaccine. If there was, I would be dispensing it already, and now—get this&mdash;Ebola has made it onto American soil. Why someone has not blamed President Obama for this yet is beyond me.

It actually is not his fault this time. Instead, I would say the hospital that let Patient Zero go home with a course of antibiotics after he said he had been in Liberia might have a glove in it. I’m surprised that, at the words “in Liberia,” plastic sheeting did not automatically canvas the examination room, sirens did not wail and buzz, and red lights did not start spinning as 2 men in black and a team in hazmat suits showed up.

If you have children, consider guiding them into a career in immunology or biotech, because they will always have a job. The United States’ involvement in Ebola’s eradication has escalated exponentially. We will soon have a wartime economy against an enemy that we can’t even see. I expect to be administering your Ebola vaccine as soon as it clears the FDA.

We will soon have a wartime economy against an enemy that we can't even see.

Healthy Fear of Ebola in America

It all went to the dogs on the first day that a physician and chemist accepted profit for their services. When quality of wallet took precedence over quality of life, the healing arts suffered for it.

Today, corporations own huge chunks of the health care system. Hospitals, pharmacies, and third-party insurance companies abound with corporate logos and a singular focus: more profit.

In corporate pharmacy, it’s all about how many prescriptions a pharmacist can fill with as little help as possible. When a pharmacist is distracted by other jobs aside from drug utilization review and quality control and assurance, patient care is compromised. It takes a individual with extreme concentration skills, a great staff, and a touch of obsessive compulsive disorder to do 450 prescriptions a day while squeezing in 20 flu shots without making a grievous error.

There are 2 kinds of pharmacies: the quick and the dead. If you are not running at full throttle from open to close—squeezing as much profit as you can into that day&mdash;then you are doing it wrong and will probably get yourself a conference call. The pressure to fill every legitimate prescription in corporate pharmacy is what keeps the oxycodone addicts coming back. If I had my own pharmacy, I swear that I would not stock narcotics and amphetamines. While there are patients who absolutely require the medication for legitimate purposes, there is a certain portion of the clientele that absolutely do not.

Considering the profession, pharmacists have a part in the rate of opioid addiction, but they do not play as big of a role as certain physicians. In medicine, there are bigger candy men than Willy Wonka. For just a few minutes of work, they make $150 cash and give patients ridiculous doses of pharmaceutical joy that keep them coming back every month. If you get hooked on those drugs, they have a maintenance narcotic license to keep you on buprenorphine/naloxone sublingual products for eternity.

Narcotic prescribing and dispensing is an egregious mess and, as I said in my last column, 

reclassifying hydrocodone won’t change things

. A colleague of mine noted that if access to hydrocodone is restricted and the drug becomes more expensive than legitimate therapies, then the reclassification could actually make heroin abuse more prevalent.

Health care is a hot mess, and I don’t see it getting better anytime soon. We made our bed, and now we have to sleep in it. If we are going to keep score with the quantity of services, then we need to increase their quality. It might cut into the profit structure somewhat, but it needs to be done. Lives depend on it.

When quality of wallet takes precedence over quality of life, the healing arts suffer for it.

Corporate Pharmacy Distracts Opioid Dispensing

Twenty years ago, at the Philadelphia College of Pharmacy, I was taught to trust no one when it came to dispensing controlled substance prescriptions, especially for opiates like oxycodone and soon-to-be-reclassified hydrocodone. I was told to be suspicious of every patient, make sure all of my ducks were in a row on the hard copy, and never let a forgery go by.

As hard as you try, you get burned in this business. When I think of all the pharmaceutical garbage that has made it onto the street, due to a really good forgery passing me by, I literally want to cry.

A few days ago, it hit a new low for me. An individual brought in a prescription for 120 oxycodone 15 mg that was completely legitimate, but the person seemed way too polite. If you are trying to act like we are fraternity brothers when I have never met you before, then I don’t trust you. I could just smell the shadiness on this person.

The prescription was dated to be filled the next day. I was offered assurance that someone in the pharmacy knew this individual was going away the next day and said we would accommodate the situation by filling it. Strike two. A first-day cashier would know enough to never say that, or to punt the call to the pharmacist. The individual then left the pharmacy, taking back the script.

Lo and behold, the next afternoon, the same individual returned with a smile—and the script. Strike three. What was that about going away the next day?

So, this person stood in front of me with a big smile and a script so legitimate that if it were fake, they almost deserved to get it for the work put into perfecting the handwritten signature. I put it through the insurance, and no overuse warnings were returned from the insurance company. I felt a little more comfortable about filling the script, since cash is such a dead giveaway. After I filled it, the person—who still seemed shady to me&mdash;went away happily.

A few hours later, a hysterical mother called to tell me that the same shady person supposedly sold her child some of the tablets. I instantly felt queasy. I would have preferred a non-fatal misfill call over that, so I called the police and filed a report.

The next day, the mother called back saying her child had made up the whole thing and actually bought them from a friend who stole them from the kid’s mother. I did not believe her in the least, but I didn’t have a leg to stand on. How did that kid provide a name and know the pharmacy? Without a leg to stand on, I had to let it go.

I hate the thought of having this happen again, yet it will. Reclassifying hydrocodone will not stop the drug from being filled legitimately and sold illegally. As the late O.J. Simpson defender Johnny Cochrane would have said, “If the script’s legit, you must fill it.”

Jay Sochoka, RPh, is feeling sick over this.  

Reclassifying hydrocodone will not stop the drug from being filled legitimately and sold illegally.