From tonight's work shift. This phone call left me thinking.
"Hello, thank you for calling CorpoPharmacy, this is N.B., how can I help you?"
[shrill old woman's voice] "What's the name of that disease that's going around, it's killing lots of people and everyone is getting it?"
"Um...I'm...what?"
"You know! It's that disease, everyone has it..."
"Do you...er..."
"Why can't you just tell me what it is!?"
"Ma'am, you're being very vague. I don't actually know what you're asking."
"Everyone's getting it!"
"...do you have some idea as to what causes it?"
"NO! Nobody knows what causes it!"
"Er, no, I meant...how does it spread? Animal bites..."
[she cuts me off] "NO! You get it, it's spreading, it affects your brain, and you forget things!"
"...Alzheimer's?"
"YES!" *click*
Showing posts with label pure WTF. Show all posts
Showing posts with label pure WTF. Show all posts
Tuesday, October 7, 2008
Sunday, September 7, 2008
Bizarro Health Savings Account
So the company I work for automatically lists items as "FSA eligible" if they are commonly covered by a flexible spending account for health purchases, sometimes known as an HSA. An HSA, if you're not familiar with the concept, is essentially a "bank" of money that you pay into (often with each paycheck). This money is tax-free, but you can only use it to pay for your medical expenses. Some plans allow your unspent dollars to roll-over at the end of the year, whereas others do not, leading to a last-minute spending frenzy. Most HSA plans allow you to spend the dollars you have on any health-related purchase, but there are always exceptions. As a general rule, it's safe to assume that standard over-the-counter products are probably covered, so those last-minute spending frenzies usually turn into people buying more aspirin and bandages than they are ever going to use just so that the money doesn't disappear unspent.
Anyway, at my store, both the register and the customer's receipt specifically note items that are eligible purchases; the customer can keep the receipt in the event that there is a dispute with the insurance company. This also allows the customer to just swipe their HSA card and have eligible items paid for while ineligible items remain unpaid. This saves the cashier from having to ring the items up separately if the customer wants to pay for some items that are eligible and some that are not.
There used to be an occasional problem where ineligible items would get rung up with an HSA debit card by mistake. Ultimately the consumer would get an audit from their insurance company bitching at them about trying to use their HSA to pay for bread and greeting cards. A recent update to the system actually prevents the register from accepting an HSA card for items that the register does not recognize as eligible; the cashier will get an error message saying that the customer needs to use a different form of payment.
So imagine my surprise today when Mucinex and Benadryl didn't ring up as FSA-eligible items. That was odd, and potentially noteworthy, but not that strange. It was conceivable that recent policies had changed to prohibit consumers from buying OTC items without a prescription.
Then Oscillococcinum rang up as FSA-eligible and I stared at the register screen in disbelief.
To make a long story short, "Oscillo" is a homeopathically-prepared dilution of the organs of a muscovy duck. It is a "200C" dilution, which is impressive even by homeopathic standards; the original formula has been successively diluted in a 1/100 ratio 200 times, meaning that the ultimate concentration of duck organ solution is 1 with 400 zeroes following it. This is four times the estimated number of molecules in the known universe, so the probability that the resulting solution contains any of the original "duck molecules" is basically nil unless somehow we have an entire universe filled with "Oscillo." Not that that's a problem for devoted believers in homeopathy. The preparation is touted by its manufacturer as a remedy for "the flu." You know, an illness that actually kills people from time to time.
So let's get this straight. According to the computer system at work, your insurance company is more likely to let you spend your tax-free savings on fake medicine than real medicine. In fact, the register would not let me charge a box of Benadryl to this guy's HSA because it considered the drug "an ineligible purchase."
See why I used the word "bizarro" in the post title?
Anyway, at my store, both the register and the customer's receipt specifically note items that are eligible purchases; the customer can keep the receipt in the event that there is a dispute with the insurance company. This also allows the customer to just swipe their HSA card and have eligible items paid for while ineligible items remain unpaid. This saves the cashier from having to ring the items up separately if the customer wants to pay for some items that are eligible and some that are not.
There used to be an occasional problem where ineligible items would get rung up with an HSA debit card by mistake. Ultimately the consumer would get an audit from their insurance company bitching at them about trying to use their HSA to pay for bread and greeting cards. A recent update to the system actually prevents the register from accepting an HSA card for items that the register does not recognize as eligible; the cashier will get an error message saying that the customer needs to use a different form of payment.
So imagine my surprise today when Mucinex and Benadryl didn't ring up as FSA-eligible items. That was odd, and potentially noteworthy, but not that strange. It was conceivable that recent policies had changed to prohibit consumers from buying OTC items without a prescription.
Then Oscillococcinum rang up as FSA-eligible and I stared at the register screen in disbelief.
To make a long story short, "Oscillo" is a homeopathically-prepared dilution of the organs of a muscovy duck. It is a "200C" dilution, which is impressive even by homeopathic standards; the original formula has been successively diluted in a 1/100 ratio 200 times, meaning that the ultimate concentration of duck organ solution is 1 with 400 zeroes following it. This is four times the estimated number of molecules in the known universe, so the probability that the resulting solution contains any of the original "duck molecules" is basically nil unless somehow we have an entire universe filled with "Oscillo." Not that that's a problem for devoted believers in homeopathy. The preparation is touted by its manufacturer as a remedy for "the flu." You know, an illness that actually kills people from time to time.
So let's get this straight. According to the computer system at work, your insurance company is more likely to let you spend your tax-free savings on fake medicine than real medicine. In fact, the register would not let me charge a box of Benadryl to this guy's HSA because it considered the drug "an ineligible purchase."
See why I used the word "bizarro" in the post title?
Friday, September 5, 2008
Two Birds, One Stone
Jack Davis, Democratic congressional candidate from New York, has some amazingly unique ideas about how to solve his city's problems:
That's just BRILLIANT! Let's buy this man a Guinness! It gets better.
So wait. The average hourly wage of an illegal immigrant is $5.45. Oh, man! If we just stop illegals from working for less-than-minimum-wage by giving those jobs to black youth they will give up and go home! Especially if they came all the way to New York. I wonder if he can get federal money to start some cotton plantations?
Even if you agree with him on other issues, you have to wonder what planet he's living on when he starts proposing these kinds of plans.
(In case you're curious about his stance on other issues: He's not sure which presidential candidate has a better health care plan, thinks global warming is due to solar irradiation increases [I am really tired of hearing this argument], and is pro-drilling in Alaska.)
“We have a huge unemployment problem with black youth in our cities,” Davis told the Tonawanda News recently. “Put them on buses, take them out there [to the farms] and pay them a decent wage; they will work.”
That's just BRILLIANT! Let's buy this man a Guinness! It gets better.
“If we take away the magnet of good-paying jobs from illegals, they’ll go home,” Davis said in an interview with The Buffalo News this week. “If they can’t make a good living here, they’ll go home.”
So wait. The average hourly wage of an illegal immigrant is $5.45. Oh, man! If we just stop illegals from working for less-than-minimum-wage by giving those jobs to black youth they will give up and go home! Especially if they came all the way to New York. I wonder if he can get federal money to start some cotton plantations?
Even if you agree with him on other issues, you have to wonder what planet he's living on when he starts proposing these kinds of plans.
(In case you're curious about his stance on other issues: He's not sure which presidential candidate has a better health care plan, thinks global warming is due to solar irradiation increases [I am really tired of hearing this argument], and is pro-drilling in Alaska.)
Thank You, Orac, or: A Little Knowledge
This is what happens when people who know absolutely nothing about how to do science get their hands on a little bit of scientific data. An excerpt from Orac's post:
Orac, know that if I could, I would have your children. You've probably already found someone else to do that by now, assuming you want them, and I lack the essential plumbing, but the offer stands in some sort of metaphysical context.
According to Mrs. Janak, less than one milligram of histidine is going to cause nausea, vomiting, and irritable bowel syndrome. Mrs. Janak needs to learn some units before she embarrasses herself by posting such burning stupid to the web. But she's just getting warmed up. She fixates on an observation that histidine is involved in the regulation of of trace minerals and concludes that getting all that histidine (remember, 0.78 mg worth, to be precise!) must somehow mess up the body's metabolism of heavy metals and cause heavy metal poisoning.
Orac, know that if I could, I would have your children. You've probably already found someone else to do that by now, assuming you want them, and I lack the essential plumbing, but the offer stands in some sort of metaphysical context.
Monday, April 7, 2008
At Least He Didn't Need any Narcan
This is what happens when I get too busy to catch up on blogs for a few days--I miss gems like this post on the Bad Idea Blog.
"Zero tolerance" policies in schools have always been taken to positively baffling conclusions. However, they certainly fulfill their function--allowing school teachers and administrators to resolve every problem that might come up via knee-jerk reactions without having to think or reason. Some of the policies occasionally make sense at the most fundamental level, but they inevitably get stretched way beyond reasonable limits:
Student expelled for bringing a butter knife to school.
Another student expelled for possessing Tylenol. Tylenol!
Boy expelled for having two soft pellet guns in his car. What were "school authorities" doing searching his car in the first place?
It's no wonder schools have so much trouble imparting the merits of critical thinking to their students--their administrators don't seem to get it, either.
Zero Tolerance has struck again: eight-year-old Eathan Harris was recently suspended for the dastardly crime of realizing that Sharpie markers smelled sort of neat.
"Zero tolerance" policies in schools have always been taken to positively baffling conclusions. However, they certainly fulfill their function--allowing school teachers and administrators to resolve every problem that might come up via knee-jerk reactions without having to think or reason. Some of the policies occasionally make sense at the most fundamental level, but they inevitably get stretched way beyond reasonable limits:
Student expelled for bringing a butter knife to school.
Another student expelled for possessing Tylenol. Tylenol!
Boy expelled for having two soft pellet guns in his car. What were "school authorities" doing searching his car in the first place?
It's no wonder schools have so much trouble imparting the merits of critical thinking to their students--their administrators don't seem to get it, either.
Wednesday, March 12, 2008
I Thoroughly Apologize
A good deal of scotch and Sapporo later, I've come to the conclusion that it may, in fact, be time to post another work rant, because today officially made absolutely no sense whatsoever. As I've noted before, I don't typically post work rants, just because so many other pharmbloggers do it better than I do, but my egregious lack of content of late has me digging for things to post. I could honestly throw out some words of praise for the Purdue Pharmaceuticals rep I talked to today, or go into a long monologue about antibiotics, but I'll save that for a time when my blood-alcohol content is considerably lower.
The short story is that I dealt with the biggest jerk in the universe today.
The slightly longer story is that today I was "greeted" by a middle-aged man with salt-and-pepper hair, probably in his 50's or early 60's, presenting a prescription for prednisone. Sure. Easy. Prednisone. When do you want to pick this up?
"Right away," he says. "Also, I filled a script here two weeks ago for two weeks' worth of medication. I want it back."
"You want the prescription?" I was somewhat confused. "I want you to transfer it." "That's easy, just have the pharmacy call us." "Great," he said. "Transfer them to Canada."
Yes. Canada. The whole country.
"Er." As you may or may not know, once you fill a prescription, it is no longer yours. It is a legal document retained by the pharmacy, a contract between you, your doctor, and the pharmacist that you have been issued a specific medication for a specific purpose. You cannot get it back. It must be kept, filed, stamped, and otherwise notarized, presumably kept in a box somewhere in someone's pharmacy basement for at least seven years. Furthermore, there is no logical reason to want it back. Any other pharmacy can call for a copy and take your script. Canada, however, is apparently one big pharmacy and it can do whatever it damn well pleases.
At this point, the pharmacist noted that it was a matter of federal law that we had to retain his prescription. He was not happy about this, and the pharmacist suggested that he write his congressman.
There was a lot of shouting. I believe I was called a crook. I was told that I should be ashamed of myself for being part of the American pharmaceutical company's great scam, the price-gouging mafia of American drug stores, and all sorts of other general nastiness. I, apparently, am a terrible human being for charging this guy less than $20 for medications intended to prevent his blood pressure from skyrocketing and causing him to stroke out. Maybe we can blame the prednisone for his mental instability. Other customers joked about how nuts this guy was. The customer threatened to contact a lawyer unless we returned his prescriptions. We later noted, somewhat nervously, that it would have surprised none of us if he had jumped the counter or pulled a gun.
I quipped that should he have done so, a lawyer would've been provided for him, should he have been unable to afford one.
"Do you want THIS prescription filled here--and now? Not in Canada?" I wanted to make damn sure that he wanted his prednisone from an American pharmacy. He did.
The customer left the store, fuming. He came back five minutes later. "It's your lucky day!" he said, handing the pharmacist a slip of paper, a receipt from a Canadian mail-order pharmacy with a phone number and information for him. "Call this pharmacy and transfer my stuff there," he said. So the pharmacist called the number later. He was told to call a different number. He called that number and someone hung up on him. It was then that he noticed a number listed for a "United States Canada Mail-Order Service" at the bottom of the label. He called that number.
He got the patient. Apparently, the patient owns a company that imports and ships medications from Canada. GO FIGURE.
In any event, Canada wound up getting his prescriptions. Some specific Canadian pharmacy, that is, which is apparently legal albeit suspect, in the sense that the FDA has officially ruled that importing medications from Canada is "illegal." The Canadian pharmacy claims they do no billing, so none of us have any idea what the meds cost when imported. No one where I work plans to touch the situation with a ten-foot pole.
As an aside, physicians who read my blog? Don't sign your prescriptions "dispense as written." Just don't. Your patients want the cheaper generic. Your pharmacists want to dispense the cheaper generic. And don't refuse to permit substitution when we call you and tell you the patient wants generic, it's $10 versus $70. And for the love of all that is holy, don't sign antibiotics brand-name only. Do you really think there's that much variation between brand and generic Omnicef?
The short story is that I dealt with the biggest jerk in the universe today.
The slightly longer story is that today I was "greeted" by a middle-aged man with salt-and-pepper hair, probably in his 50's or early 60's, presenting a prescription for prednisone. Sure. Easy. Prednisone. When do you want to pick this up?
"Right away," he says. "Also, I filled a script here two weeks ago for two weeks' worth of medication. I want it back."
"You want the prescription?" I was somewhat confused. "I want you to transfer it." "That's easy, just have the pharmacy call us." "Great," he said. "Transfer them to Canada."
Yes. Canada. The whole country.
"Er." As you may or may not know, once you fill a prescription, it is no longer yours. It is a legal document retained by the pharmacy, a contract between you, your doctor, and the pharmacist that you have been issued a specific medication for a specific purpose. You cannot get it back. It must be kept, filed, stamped, and otherwise notarized, presumably kept in a box somewhere in someone's pharmacy basement for at least seven years. Furthermore, there is no logical reason to want it back. Any other pharmacy can call for a copy and take your script. Canada, however, is apparently one big pharmacy and it can do whatever it damn well pleases.
At this point, the pharmacist noted that it was a matter of federal law that we had to retain his prescription. He was not happy about this, and the pharmacist suggested that he write his congressman.
There was a lot of shouting. I believe I was called a crook. I was told that I should be ashamed of myself for being part of the American pharmaceutical company's great scam, the price-gouging mafia of American drug stores, and all sorts of other general nastiness. I, apparently, am a terrible human being for charging this guy less than $20 for medications intended to prevent his blood pressure from skyrocketing and causing him to stroke out. Maybe we can blame the prednisone for his mental instability. Other customers joked about how nuts this guy was. The customer threatened to contact a lawyer unless we returned his prescriptions. We later noted, somewhat nervously, that it would have surprised none of us if he had jumped the counter or pulled a gun.
I quipped that should he have done so, a lawyer would've been provided for him, should he have been unable to afford one.
"Do you want THIS prescription filled here--and now? Not in Canada?" I wanted to make damn sure that he wanted his prednisone from an American pharmacy. He did.
The customer left the store, fuming. He came back five minutes later. "It's your lucky day!" he said, handing the pharmacist a slip of paper, a receipt from a Canadian mail-order pharmacy with a phone number and information for him. "Call this pharmacy and transfer my stuff there," he said. So the pharmacist called the number later. He was told to call a different number. He called that number and someone hung up on him. It was then that he noticed a number listed for a "United States Canada Mail-Order Service" at the bottom of the label. He called that number.
He got the patient. Apparently, the patient owns a company that imports and ships medications from Canada. GO FIGURE.
In any event, Canada wound up getting his prescriptions. Some specific Canadian pharmacy, that is, which is apparently legal albeit suspect, in the sense that the FDA has officially ruled that importing medications from Canada is "illegal." The Canadian pharmacy claims they do no billing, so none of us have any idea what the meds cost when imported. No one where I work plans to touch the situation with a ten-foot pole.
As an aside, physicians who read my blog? Don't sign your prescriptions "dispense as written." Just don't. Your patients want the cheaper generic. Your pharmacists want to dispense the cheaper generic. And don't refuse to permit substitution when we call you and tell you the patient wants generic, it's $10 versus $70. And for the love of all that is holy, don't sign antibiotics brand-name only. Do you really think there's that much variation between brand and generic Omnicef?
Friday, March 7, 2008
Nothing I Can Say Will Top This
Orac's Friday Dose of Woo for the week has left me so jaw-droppingly stupefied that I can say absolutely nothing that will top his post.
Someone claims to have discovered the Philospher's Stone.
Not only that, but it will give you god-like powers. In fact, the only ability you don't get, as far as I can discern, is the ability to turn undead, which would arguably be useless unless somebody discovers a way to create zombies over the weekend. Maybe Big Pharma will unleash the T-virus and we'll all be totally screwed. Who knows.
That makes me wonder. Would "zombies" created by the T-virus actually be affected by turn undead? After all, they're technically living, just infected with a pathogen that alters their physiology, kind of like the zombies in 28 Days Later. This is going to be on my mind for the rest of the day.
Someone claims to have discovered the Philospher's Stone.
Not only that, but it will give you god-like powers. In fact, the only ability you don't get, as far as I can discern, is the ability to turn undead, which would arguably be useless unless somebody discovers a way to create zombies over the weekend. Maybe Big Pharma will unleash the T-virus and we'll all be totally screwed. Who knows.
That makes me wonder. Would "zombies" created by the T-virus actually be affected by turn undead? After all, they're technically living, just infected with a pathogen that alters their physiology, kind of like the zombies in 28 Days Later. This is going to be on my mind for the rest of the day.
Saturday, February 23, 2008
Paging William Shatner
Normally, I don't post work rants, because I feel like that subject has been well-covered in the blogosphere. But today's "pill-counting action," to steal a phrase from the Drugmonkey, concluded with a jaw-dropping exchange that ties into some of the stuff I've been covering lately. Diabetes, that is.
I missed the initial exchange between the woman at the counter and the pharmacist. "Hey, N.B.," he said, "she needs some insulin and some syringes. Can you get her set up?" He went off to do something else. I confirmed the type of insulin in question (Humulin 70/30 mix, which is available without a prescription). I asked how many vials she wanted. "I dunno, how much are they? I'm getting tired of having to go to the pharmacy all the time, maybe I'll get a bunch." About $40. She decided she only wanted one.
"What kind of syringes do you need?" "I dunno," she said. Hmm. Perhaps her doctor sent her here with no patient counseling whatsoever, although he would've at least written her a script. "Alright, how many units do you use?"
She looked confused by this question. "I think 30. Three times a day."
This is an absolutely ridiculous amount of 70/30 for a newly-diagnosed diabetic to be using. I'd estimate she weighed less than 130 pounds; half that amount would've been reasonable. And Humulin 70/30 is an intermediate-acting insulin, so that many doses/day was outrageous. Also, the idea that she would be unsure as to how much insulin to use was mindblowing.
The pharmacist stepped over to me as I was digging around for syringes and suggested (quietly) that we go ahead and give her 40 syringes--no more--because he was convinced she was just going to pitch the insulin and use the syringes for something else. I have commented before on how I don't have a problem with providing syringes and needles to drug users because in my state I'm not liable for what they do when they leave the pharmacy as long as I follow proper sale protocols and the person has a valid photo ID. Alright. 40 syringes.
"Should I get one of these meters?" She was referring to the blood glucose meters, of course. "Yes," I said, "you should have one. How often does your doctor want you to test your blood sugar?"
"I don't know," she said, "this isn't really for me, it's for my boyfriend, he's never done this before." If she was just trying to get syringes, she could've come up with something less elaborate. There was certainly no need to buy a glucometer. I was pretty sure at this point she did, indeed, have a boyfriend with diabetes who needed insulin.
This is bad territory. Now I am not counseling my patient. I am counseling my patient's (slightly loopy) messenger.
"How often should he check his sugar?"
"Well," I told her, "it depends on what your physican wants you to do, but usually at least twice a day, more often if you're trying to monitor changes in blood sugar closely."
This is the part where we entered the Pharmacy Twilight Zone.
"So, how much insulin is he supposed to use?"
I refrained from falling over in shock. "Er. How much did your physician say to use?"
She seemingly ignored this question. "What if he takes his sugar, what should it be? What's high? What's normal?" "Depends on whether he's eaten recently, among other factors. Usually, if he hasn't eaten in a long time, it should be pretty low, like 80-120. Did the doctor tell him what his goals were?"
"So he should check his sugar and if it's above that he should take insulin?"
I was starting to get the impression at this point that this boyfriend of hers had never, in fact, seen a doctor about his diabetes. Or, perhaps, he had seen a doctor once, ignored everything he was told, went home and told his girlfriend that he had diabetes and needed insulin, and set off a bizarre chain reaction that somehow ended with "I can get a random pharmacist to sell me insulin, confirm the diganosis of diabetes, and prescribe an appropriate insulin regimen for a patient he will never see again."
Note to the reader. THIS IS WRONG.
"Yeah," she continued, "he doesn't pay attention to stuff, he can't do this himself, so I'm trying to take care of it. I'm goin' to go to nursing school, I gotta understand this stuff, I know about checking blood sugar. He can't do this stuff himself, you know how boys are."
I just blinked at her. "Uh."
"Well, some of em' anyway."
I'm not sure who to blame for this scenario. Opponents to universal health care? A careless physician? I don't think the blame belongs to a doctor. Her boyfriend came in a couple minutes later. He had no clear idea of what was going on. Apparently he knew he needed insulin--and that was it. He remarked that the insulin and glucometer were expensive. "It'd be cheaper to get the other medicine," he said. "Yeah, well," replied his girlfriend agitatedly, "you're too disorganized to do that, so we have to waste the money like this."
She produced a one-hundred dollar bill to pay her tab, at which point I requested a photo ID for the syringes. She didn't have one. He didn't either.
"We'll just use the syringes we've got at home," she said. They took the insulin and the glucometer and left the store. The pharmacist and I stood and stared at each other in total shock. We were both completely baffled by the exchange. I am moderately concerned that he's going to go home, overdose himself on insulin, and wind up in the ER, convulsing and in shock. If it had been my call, I wouldn't have sold them the insulin, but the pharmacist didn't have a problem with it. This was the most confusing exchange I'd ever had with a "patient." I had a distinct notion that both of these people were like cats without whiskers, perpetually caught behind the refridgerator, and I had just let them leave the store with a bottle of something that could easily result in an unintentional lethal overdose if used improperly.
I kind of hope these people never breed. The cynical part of me thinks that this problem will short itself out in short order when this guy removes himself from the gene pool.
I missed the initial exchange between the woman at the counter and the pharmacist. "Hey, N.B.," he said, "she needs some insulin and some syringes. Can you get her set up?" He went off to do something else. I confirmed the type of insulin in question (Humulin 70/30 mix, which is available without a prescription). I asked how many vials she wanted. "I dunno, how much are they? I'm getting tired of having to go to the pharmacy all the time, maybe I'll get a bunch." About $40. She decided she only wanted one.
"What kind of syringes do you need?" "I dunno," she said. Hmm. Perhaps her doctor sent her here with no patient counseling whatsoever, although he would've at least written her a script. "Alright, how many units do you use?"
She looked confused by this question. "I think 30. Three times a day."
This is an absolutely ridiculous amount of 70/30 for a newly-diagnosed diabetic to be using. I'd estimate she weighed less than 130 pounds; half that amount would've been reasonable. And Humulin 70/30 is an intermediate-acting insulin, so that many doses/day was outrageous. Also, the idea that she would be unsure as to how much insulin to use was mindblowing.
The pharmacist stepped over to me as I was digging around for syringes and suggested (quietly) that we go ahead and give her 40 syringes--no more--because he was convinced she was just going to pitch the insulin and use the syringes for something else. I have commented before on how I don't have a problem with providing syringes and needles to drug users because in my state I'm not liable for what they do when they leave the pharmacy as long as I follow proper sale protocols and the person has a valid photo ID. Alright. 40 syringes.
"Should I get one of these meters?" She was referring to the blood glucose meters, of course. "Yes," I said, "you should have one. How often does your doctor want you to test your blood sugar?"
"I don't know," she said, "this isn't really for me, it's for my boyfriend, he's never done this before." If she was just trying to get syringes, she could've come up with something less elaborate. There was certainly no need to buy a glucometer. I was pretty sure at this point she did, indeed, have a boyfriend with diabetes who needed insulin.
This is bad territory. Now I am not counseling my patient. I am counseling my patient's (slightly loopy) messenger.
"How often should he check his sugar?"
"Well," I told her, "it depends on what your physican wants you to do, but usually at least twice a day, more often if you're trying to monitor changes in blood sugar closely."
This is the part where we entered the Pharmacy Twilight Zone.
"So, how much insulin is he supposed to use?"
I refrained from falling over in shock. "Er. How much did your physician say to use?"
She seemingly ignored this question. "What if he takes his sugar, what should it be? What's high? What's normal?" "Depends on whether he's eaten recently, among other factors. Usually, if he hasn't eaten in a long time, it should be pretty low, like 80-120. Did the doctor tell him what his goals were?"
"So he should check his sugar and if it's above that he should take insulin?"
I was starting to get the impression at this point that this boyfriend of hers had never, in fact, seen a doctor about his diabetes. Or, perhaps, he had seen a doctor once, ignored everything he was told, went home and told his girlfriend that he had diabetes and needed insulin, and set off a bizarre chain reaction that somehow ended with "I can get a random pharmacist to sell me insulin, confirm the diganosis of diabetes, and prescribe an appropriate insulin regimen for a patient he will never see again."
Note to the reader. THIS IS WRONG.
"Yeah," she continued, "he doesn't pay attention to stuff, he can't do this himself, so I'm trying to take care of it. I'm goin' to go to nursing school, I gotta understand this stuff, I know about checking blood sugar. He can't do this stuff himself, you know how boys are."
I just blinked at her. "Uh."
"Well, some of em' anyway."
I'm not sure who to blame for this scenario. Opponents to universal health care? A careless physician? I don't think the blame belongs to a doctor. Her boyfriend came in a couple minutes later. He had no clear idea of what was going on. Apparently he knew he needed insulin--and that was it. He remarked that the insulin and glucometer were expensive. "It'd be cheaper to get the other medicine," he said. "Yeah, well," replied his girlfriend agitatedly, "you're too disorganized to do that, so we have to waste the money like this."
She produced a one-hundred dollar bill to pay her tab, at which point I requested a photo ID for the syringes. She didn't have one. He didn't either.
"We'll just use the syringes we've got at home," she said. They took the insulin and the glucometer and left the store. The pharmacist and I stood and stared at each other in total shock. We were both completely baffled by the exchange. I am moderately concerned that he's going to go home, overdose himself on insulin, and wind up in the ER, convulsing and in shock. If it had been my call, I wouldn't have sold them the insulin, but the pharmacist didn't have a problem with it. This was the most confusing exchange I'd ever had with a "patient." I had a distinct notion that both of these people were like cats without whiskers, perpetually caught behind the refridgerator, and I had just let them leave the store with a bottle of something that could easily result in an unintentional lethal overdose if used improperly.
I kind of hope these people never breed. The cynical part of me thinks that this problem will short itself out in short order when this guy removes himself from the gene pool.
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