It's the most wonderful time...

One of my favorite times of the year is Christmas Break.  It's a nice respite from school and allows for more time to work.  When school is in session, I don't have the opportunity to work a lot and it's nice to be able to do so during this time when everyone is in such a great mood.  It has been extraordinarily busy this week (some of our biggest days in the last 5 years in terms of sales), but that's a good thing.  It's good for business and it makes the days go by faster. 

With the increased volume of people coming and going, I have been doing just about every task in the store that needs to be done at one time or another.  That's one of the things I think is so cool about the independent pharmacy business model and our customer service attitude.  We (employees) aren't locked in to a certain role or task.  Yes, we each have our primary responsibilities, but when it gets busy, we all pull together to do what needs to be done for the customers who are there.  In the last week I have sold gifts and jewelry, walked around the store helping people find things and offering shopping baskets, answered questions on the phone that I wouldn't have usually (about casserole dishes and princess earbuds, etc.), and many other things that don't usually fall under the "pharmacist intern" job description.  But when the holiday season is here and the demand falls more towards gifts and seasonal items, that's where we all spend more of our time.

I can't speak with full knowledge, not shopping at any of the chain stores, but I don't think that you get the personal service when you shop at some of those big box stores/pharmacies.  Little things that we do such as walking someone to a product rather than pointing, providing gift wrapping, allowing gift purchases in the pharmacy, grabbing something from the shelf for someone in the drive-through who can't find a parking space, or inviting people in a long line to come to the pharmacy registers to pay, are easy to do but mean a lot for people who are especially busy getting ready for Christmas.  That extra service is what sets us apart from the rubber-stamp mediocre pharmacies on every street corner and is why we have such a loyal customer base. 

People are also in a really good mood around this time of year.  Most of the people who have come in this week have been especially jolly and even if they aren't, a simple "Merry Christmas" brings a smile to their face as you complete a transaction.  (Yes, I say "Merry Christmas" to people instead of "Happy Holidays.")  There are still a few that can't be satisfied as usual, though.  I had an interesting comment from an elderly lady who was being especially crabby and blaming us for her doctor not phoning in her prescription, one that I don't think I'll get again.  After filling her prescription and returning to sell it to her, she apologized: "sorry, I'm not usually this much of a bitch."  Her words, not mine.  I was still a little annoyed at how rude she was at first, but I was taken aback by her unusual apology and couldn't help but laugh once she left.

I have a day off tomorrow, which is good because I don't have any shopping done yet.  I browsed Northgate Mall and the U. Village for an entire day on Sunday and found nothing but a wallet and shirt for myself.  Hopefully tomorrow will be a bit more fruitful since it's the last opportunity to shop, as I work Christmas Eve (that's a good thing, though…my favorite day of the year to work). 

In other news, I made two technology additions to my life this week, one of which was Hulu Plus.  I don't have cable, and I figure that Hulu Plus will be a good way to watch the few current TV shows I like, and even with a few commercials, $8/month isn't too bad for on-demand television.  I also got a twitter account, though I haven't "tweeted" yet.  One of my best friends broke down and got a twitter, so I figured I should jump on the bandwagon too.  I don't care about the lives of most celebrities, but some of them have funny things to say from time to time, so it will be worth some occasional entertainment if nothing else.

Gotta love Medicare...

One of the more irksome parts of my job is dealing with difficult insurance companies, as I do the billing for things that aren't automatic through our prescription software.  The two that are most difficult to interact with and are the most frustrating are Medicare and Medicaid.  One of the biggest chunks of time I spend with that stuff is dealing with Medicare billing for things like test strips, lancets, catheters, etc.  We had to go through a huge accreditation process to be able to bill for those things and since then, it seems like it's getting worse and worse.  The worst part is the documentation they require, but I'll go into that later.  My newest gripe with them is their process for reversing claims.  With prescription drugs, you can simply reverse the billing through the computer and everything happens in a matter of seconds.  Try that for Medicare, though, and you get a message that says "this claim cannot be reversed because it has already been captured by Medicare."  Great…  But, like every government organization, they have a form for every job. 

One situation that would require this form is if we refill someone's test strips then they end up going to long-term care or decide they don't want them after all.  Before anything can happen, the claim has to be processed and paid, which can take 2-3 weeks.  Then, when the claim is paid, I have to fill out a full-page form documenting the payment.  To do this, I basically copy information off the stuff that Medicare just sent me, so I can send it back to them.  Good use of time, right?  There is an option for "immediate offset" where you don't have to send a check, but they just subtract the reversal amount from a future payment.  I select that, then fax the form back.  Then, I wait about a month.  Typical turn-around time for Medicare/Medicaid paperwork…  I did this for the first time a few months ago, so I didn't know what to expect.  When they finally responded, I got a letter saying something like this: Our information indicates that the patient did not receive this product/service.  Therefore you have been overpaid and must remit this amount immediately to avoid incurring interest.

Duh! The information they speak of is the form that I sent THEM telling them that the patient didn't get their test strips for whatever reason.  So basically, I filled out all this paperwork telling them to please take back their money and then got a letter insinuating that I knowingly billed for services not rendered and they somehow found out about it.  It's kind of like situations I've heard of elsewhere where the boss asks for an overview of some procedure that an employee has come up with to complete a task then comes back saying "this is how you need to be doing things."  Well of course it is!  That's what has been going on all along and what the employee just passed on to the supervisor.  I think it must just be a power issue.

It's very nice to be on a break from school.  I am working almost every day, but no matter how my time is spent, I'm much more content when school is out of session.  I've been able to spend time with some friends, catch up on a couple TV shows, and learn how to crochet.  Plus I just watched A Christmas Carol for the first time.  I'd seen some animated version a long time ago but had never seen the real movie version.  I tried to go shopping today, but didn't end up finding any Christmas gifts (besides the new wallet and shirt I found for myself…)  Maybe tomorrow…

Stoicism and Equanimity

I just watched an online lecture for a class about Stoic Philosophy (so credit for most of what I'm going to say goes to Dr. Hansten).  Now, I'm not usually one to dwell on things like philosophy, but I think the Stoics have a lot of good ideas.  I didn't even realize that I employ some of their tenets in my life, and now that I know more about this school of thought, I think I might try to consciously employ more of them.

Being a stoic thinker is being a realist.  There are people out there who are jerks, and unpleasant things are going to happen sometimes, but the important thing is to realize in advance that you will encounter these things and these people.  If you consider this ahead of time, when you encounter that rude driver, for instance, the expectation that he's going to cut you off will make it not as surprising or irritating when he does.  Another stoic belief is that if something distresses you, it's not that thing itself, but your impression of it.  You may not have control over what happens to you, but you do have control over how you deal with it.  Don't turn adverse events into something negative; make the best of it.  One example of a stoic is Phillip Verheyen who had to have his leg amputated in the 17^th century.  Instead of getting upset about it, he seized the opportunity and dissected his leg, becoming the man to name the Achilles tendon.  This is an extreme example (and slightly gruesome for some, perhaps) but the message of turning adversity into advantage is a good one.

Another stoic belief is that the most important characteristic to have is virtue, or integrity.  Being just, unselfish, truthful, and even-tempered should be not just something you do from time to time, but a habit.  Stoics also believe in simplicity.  The path to happiness is not through riches, but through integrity.  Riches can bring temporary joy or happiness, but you get used to it pretty quickly and in the end are no happier than before.  If fame or fortune does become a part of your life, though, it is important to maintain your humility.  Furthermore, it is crucial to show equanimity (mental calmness and composure) in the face of adversity.  For example, if someone has bad breath, it doesn't do much good to get angry about it, since it's so trivial.  The quote that popped into my mind with this piece of stoic philosophy is from Bill Murray's speech in "Meatballs:" "It just doesn't matter!, It just doesn't matter!..."

Perhaps the most important stoic tenet is what they call the "sphere of choice."  This is what you get when you divide the elements of life into things you can control and things you cannot.  Focusing on that "sphere" of the things you can change is what will bring contentment to life.  Since you can't change the past, it doesn't do you any good to agonize over mistakes you made.  Simply learn from them and move on.  To a true stoic, minor annoyances don't cause anger.  Major setbacks might elicit the same emotional reaction as anyone, but over time, these principles can be applied to the problem so that rash emotions don't persist, but a positive spin on things can be maintained and equanimity is what prevails.  Something more well-known that is completely in line with stoic thought is the serenity prayer:

            Grant me the serenity to accept the things I cannot change;

            Courage to change the things I can;

            And the wisdom to know the difference.

I think that the stoics have it right.  There's no sense in wasting time on things that cannot be changed or getting upset over small annoyances.  In most situations that seem undesirable at first, lessons can be learned or positive aspects can be extracted so that in the end, you're left with a sense of calmness and composure.  I think that living life with all of these thoughts in mind will make you a happier person (and more pleasant to be around).  Now I'm not advocating being optimistic to a sickening level, but just being realistic and not dwelling on the negatives.  Who knew…? I'm a stoic and I didn't even know it…

Hang Up and Live

Cell phones are great, but they're becoming so much a part of people's lives that they are forgetting about other parts of their lives, such as common courtesy and watching where they're going.  One of the things that grinds my gears most at work is when a customer is on their phone.  There's a time and a place to have long, personal phone conversations and when you're picking up your prescription isn't one of those times or places.  If I'm giving my full attention to you, I expect you to at least give me more than a minimal sliver of your attention.  It's just rude, plus it takes longer to conduct the transaction as I have to wait for them to acknowledge their next step in the process.  When someone's brain is on a phone conversation, it takes significantly longer for them to realize when it's time to sign their receipt, when it's time to walk away, etc.

My preference is to not wait on that person who is talking on his or her phone.  If there's someone else waiting or something else I could be doing, I'll say (politely) "I'll wait until you're done with your phone call."  This isn't possible sometimes, though.  With the addition of the drive through, I have seen a lot more of this divided attention.  People are on their phone while driving and sometimes even on super-loud-speakerphone mode so I can hear the person on the other end better then the person in front of me.  In this case, I can't really let someone else in front of them, but I don't even try to ask them how they're doing or tell them to have a good evening because I know they aren't paying any attention to what I'm saying; just going through the motions.  Even worse than continuing their phone call is when they actually apologize to the person on the other end for interrupting their ever-so-important call to be inconvenienced by me trying to explain their medication to them.

My other gripe with cell phones is when people find it more important to text than to watch where they're going.  You see this all over campus, especially.  Someone has their earbuds in and their full attention is on their phone.  It's just annoying when you have to dart out of their way.  Sometimes I don't, though, until they are close to running into me and notice at the last second.  It's kind of mean, but it's fun for me and maybe they'll "pull over" to the side of the walkway the next time they need to read a text.  They do have one advantage, though.  When confronted by a guy in Red Square handing out literature or bibles or the like, you can use the texter as a moving human shield to avoid being accosted!

Finals are coming up very soon.  In less than a week, I will be free (to work), but I have a lot of learning to do between now and then.  This will be interesting with an 8 hour shift tomorrow and a work party on Saturday, but I'm not all that worried (…yet.  Talk to me again on Sunday night).  The good thing is I've finished listening to all of the Harry Potter audiobooks so I won't be distracted by that.  The two biggies are back to back on Monday then another one on Tuesday.  Not much separation, but I guess that means they'll be over sooner.  Always look on the bright side of life, I guess…

No such thing as a stupid question?

Many teachers will say that there are no stupid questions.  This is false.  Anyone who has taken a college class knows the feeling when that one "question guy" raises his hand.  You think to yourself "NO! Put your hand down!" and once they are called on and start talking, you just keep saying "shut up, shut up, shut up…" in your head until they are done.  I have had the (mis)fortune to have a number of these people in classes over the years and they come in all different forms.  There are those who are out to prove their intelligence, those who are a little slow on the uptake, and those who are just plain oblivious.  If only they had a guide that they could consult before raising their hand that would tell them when it's appropriate to raise their hand, interrupt class, and waste the class's time.  Following are a few reasons that one should not raise his or her hand.  They're all inspired by real people and many of them happen on a daily basis.

• If you weren't paying attention and are about to ask about something that was just clearly and completely covered, ask your neighbor, don't raise your hand.
  
• If the professor misspoke in a way that was completely obvious to everyone in the class, didn't cause any widespread confusion, and the only thing correcting him will accomplish is to waste time, don't raise your hand.
  
• If you're about to ask a question to which you have a full understanding of the answer and are only asking it to show how much more you know than the professor does, don't raise your hand.  After all, your classmates are not paying the University to hear random, unrelated bits of knowledge you have from your previous graduate studies.
  
• If you're going to ask a question then talk to your neighbor when it is answered, don't raise your hand. (This especially applies to clarification questions about things everyone else understands.)
  
• If your question goes into depth about some minute detail that is off-base from the main point of the lecture, don't raise your hand.  This is what office hours are for.
  
• If you didn't understand something and only got around to wondering about it fifteen minutes after it was covered, don't raise your hand.  You missed your chance.  Stay after class and ask.
  
• If you just want to add your personal opinion to that of a professor who is an expert in his or her field, and you are not an expert in that field as well, don't raise your hand.
  
• If you have asked more than a few questions in the last hour (comprising a majority of the questions asked in total), don't raise your hand.  Either you don't understand the material or you want far more depth than the lecture is designed to go into.  Find a time to meet with the professor outside of class.
  
• If you can't see the board and can't take notes fast enough to get everything as the professor speaks, don't raise your hand to ask "what does that say," especially when he just read it aloud.  Sit closer or look off a friend's notes.
  
• If your question incorporates the phrase, in whole or in part, "could you repeat everything you just said?" don't raise your hand.  You should have been paying better attention so you could ask a more pointed question.
  
• If the professor made a joke and you missed it or didn't understand, don't raise your hand.  Again, that's what the people sitting next to you are for.

Professors handle these situations in a few different ways.  Many of them say "good question" and answer it fully.  This is sometimes frustrating as it is a waste of time for those who are paying attention and who have at least an average intelligence level.  The second part of the majority just answer them hastily and move on.  My favorites, though, are the snarky ones.  I had one professor who refused to call on a particular student (a know-it-all type) after one too many outrageous questions.  To one, he responded "That is far beyond the spectrum of this class and I am not going to answer it.  I would be happy to talk to you during my office hours."  Another favorite of mine is when a particular Med Chem professor who, when asked a stupid question, would just start laughing and tell that student it was a stupid question, laughing all through his completely sarcastic answer.  All I have to say in conclusion is: when in doubt, keep quiet and ask after class or send the professor an email.  I know this quotation doesn't fit the situation completely, but I really like it: "It's better to remain silent and be thought a fool than to open your mouth and remove all doubt."

Customer Loyalty

Loyalty is important, especially when the subject is retail businesses.  With the ever-growing corporate conglomerates taking over family-owned and independent businesses, the loyal customer base is what keeps them alive.  I have worked for an independent business for 8 years, and I have seen both sides: the truly loyal, and those who just use us when it's convenient. 

When I need to go the store to get something, I generally choose the small store or the one that is less of a corporate chain.  I think this is in small part due to my own and my family's history in family-owned business, but the main factor is the service I get.  In general, a smaller store is going to give you more attention, better knowledge of their products, and a friendlier attitude.  One example that comes up a lot is hardware.  It is about the same distance from my apartment to either Home Depot or the Maple Leaf Ace.  I know that if I go to Home Depot, I will usually find exactly what I'm looking for and it may be at a lower price, yet I still go to Ace.  Why?  The things that Ace offers outweigh any benefit of Home Depot.  Yes, I need to go to a large store sometimes (buying lots of lumber for instance) but I try to go to Ace (or McLendon's – shout out to the Woodinville and Port Orchard stores!) whenever I can.  They may not have exactly the product I'm looking for, but their knowledgeable staff will help me find something that will do the job (and I have found that they carry a lot more than you'd expect for such a small store).  Not only that, the level and quality of service is far superior.  Everyone is happy to greet you as you come in, and there is always someone available to help if you have a question or need to locate something.  I once had three different people come to help me at once and they had to figure out who was going to answer my questions.  In the large stores, it's like pulling teeth to even get someone to acknowledge you.  I've even seen employees dart out of an aisle to avoid having to help a customer.  These customer service strengths are the reason that I will continue to give my business to small stores with good service every time I have the opportunity.

It is frustrating to me when people come into the pharmacy and are obviously "using" us just because it's convenient.  Some of them get their prescriptions from a mail-order company because they can save a little money.  But when they need advice, need a prescription filled quickly, or need a few days to get them through because the mail hadn't come yet, they come to us.  I am more than happy to bend over backward for our loyal customers.  However, it irks me when I have to go to extra lengths to accommodate these fair-weather customers, especially when lengthy calls to their insurance companies are involved.  Plus, when they call or come in to ask a drug question, we give them our time and dedication only to get nothing in return just because we can't offer $4 generics or super discounts.  It's really too bad that some people play the system like this.  They should either choose to give us their business and maybe pay a little more for high-quality service or settle for a competitor's crappy service to save a buck.  I'd like to say you can't have your cake and eat it too, but they do in this case. 

On the other side of the coin, it always brightens my day when customers' loyalty is evident.  One example is the families that have been coming to the store for a long time.  Many customers have come into the store since before many of the current employees started working (half a century for some).  We also have a few families who have four generations as current customers.  We also have those who move far away and still get their prescriptions from us (Alaska, Montana, etc.)  Some people go South seasonally, but rather than transferring their prescriptions to a local pharmacy they choose to have us mail them because they want to continue to give us their business.  Sometimes a particular product is in short supply.  We offer to send people to another pharmacy to get it filled right away, but it's always nice to hear them say "no thanks, I can wait a couple days; I'd rather get it filled here."  All of these examples of loyalty are fueled by these customers' appreciation for the quality of service that we provide. 

When choosing where to buy something, the decision should be made not on how much you'll save (within reason…major purchases should still include comparison shopping) or the few minutes you might save by not driving a little out of the way, but on the quality and history of service you've received at some of the smaller competitors.  When you find a place that meets your needs and provides consistently excellent service, stay loyal to them, because that loyalty is what keeps them going.

Thank You, Come Again

I have noticed that an increasing number of places (mainly food places that lie somewhere between fast food and restaurants) require all their employees to thank the customer as they exit.  It is a good customer service practice to thank the customer, but the way these places do it is completely misguided.  When I finish a transaction somewhere, I expect that the cashier or whoever is helping me says "thank you" or "have a nice day" but when it is forced, or at some places is required, I'd rather them just not say anything. 

One place that I've seen this for a long time is a pizza chain.  I do like their pizza and their service is generally very good, but they do have that problem of the forced thank-you.  When a customer leaves, the person at the counter says something like "pizzas going out" and everyone else in the place says "thank you," in a sort of monotonous unison.  Sure, it would be nice if a few people showed their appreciation of the customer's business, but when they are prompted to do it for every single person that comes in, it gets really impersonal and is pretty meaningless.  I would much rather have the one person waiting on me thank me or wish me a good day in a sincere way. 

I was at a place that did this on Saturday, too.  It was a sushi restaurant that offers both take-out and sit-down dining.  Every time the bell at the front door rang to indicate that someone was exiting, the whole staff said something all together.  Some of them spoke Japanese, some English, and they all said different things so the conglomeration of voices was usually quite unintelligible.  Again, a sincere "thank you" from the cashier would have meant a lot more than the disjointed (and probably management-mandated) remarks from the rest of the staff.  (These types of gestures remind me of when parents tell a kid to say "thank you" or "sorry"
 when they don't want to, and it is obvious that it is forced and not sincere.)  I'm not sure what they teach in retail management classes, but as a consumer, quality of sentiments is much more meaningful to me than quantity.

Thanksgiving weekend was a nice break from school.  I started the weekend without any plans, but as I heard from more and more people who were home from school for the holiday or who also didn't have plans, I ended up not having any free time.  It was nice to see everyone, some of whom I hadn't had the chance to talk to very much since the beginning of the quarter.  I also saw J. Edgar, the first movie I'd seen in a theater in well over a year.  It was a very good movie; good acting and directing, and showed a side to the FBI's history (and Hoover's personal life) that I hadn't known much about.  All-in-all, it was a busy but relaxing weekend, which makes going back to school for these last three weeks all that more dreadful.  But Christmas break will come soon enough…

Thanksgiving

I just got back from a lovely Thanksgiving dinner at my aunt and uncle's house.  Thanksgiving is one of my favorite holidays because it is an excuse for the family to get together and enjoy each other's company, plus there's always great food.  This year we had the usual foods, including turkey (of course), green bean casserole (with honey bunches of oats on top instead of corn flakes), brussels sprouts with bacon bits, stuffing, potatoes, and gravy made from the turkey drippings.  A couple new things this year were a Quinoa casserole-type dish that my sister made (very tasty) and a different pumpkin pie recipe.  The spices were a bit different than usual plus the crust was to die for.  It was made with half vodka in place of water, which allows for a moister crust when rolling it out, but then it bakes out, leaving no flavor and making the crust with just the right amount of fluff.  Overall, a fantastic dinner.  I made an appetizer (with the help of Martha Stewart) of a blend of cheeses, formed into a log, covered in roasted pistachio nuts.  It took about 2 hours to make (which included shelling and chopping about a pound of nuts) but turned out great.

One thing we do every Thanksgiving is the Christmas grab-bag.  It can be called other things, like Secret Santa, etc. but basically, each person draws a name from a hat (we actually used a top hat this year) of a person to buy a gift for.  It is a little complicated, since the only rule is that you cannot select yourself or any member of your household.  With one family of five, we usually have to draw a couple times to get it right.  Amazingly, though, this year we got it right in one try.  This was after we got the rules straight, though.  My grandpa's sense of humor (when we can't tell if he's kidding sometimes – he's a master of timing and keeping a straight face) is always a highlight of family gatherings.  He played along as if he didn't understand the rules and it took us three or four minutes before we realized he had us in a "who's on first"-type circular conversation about who he was allowed to draw out of that hat.  For the second year in a row, I didn't draw my cousin Daniel (who I drew almost every year before that, only to buy him "dangerous" gifts like knives or zippo lighters).

My youngest cousin had the idea this year to make a "family turkey," which was a turkey she drew, to which we each added a feather that said what we were thankful for.  I had a slight deja-vu moment when we read them aloud after dinner, reminding me of when John Lithgow's character's family did this on Dexter, but since there was no serial-killer vibe, all was good. 

I hope all my friends and the family who wasn't there had a good Thanksgiving.  If not a good visit with family, then at least a nice break from work or school.  It's sure nice to have a long weekend.  Who knows, maybe I'll even start getting ready for Christmas, my favorite time of the year.  We already have the stuff to make the first batch of fruitcake (good fruitcake, not like the bad reputation it usually gets) and pretty soon it will be time to start making cookies.  I think I made at least 20 dozen last year; I don't know if that will be possible again, while working full time over break, but we'll see…

Your brain gets smart but your head gets dumb

One class I am taking right now involves reading 3 or 4 studies or journal articles each week then writing a summary of the strengths and limitations of each.  Then, in class, one student presents the article over 10 minutes, then we discuss it.  This could be a good way to learn how to critically analyze the primary literature, but it seems to be just a waste of time.  We have to read the articles as preparation for the discussion, yet we are also forced to sit through a ten minute presentation over the article.  It feels very redundant.  The presentations are usually pretty bad, too.  Many people write a good outline, but then just read it, almost word-for-word.  The only thing worse than listening to someone do a presentation word-for-word is having a copy of the outline in front of you so you can see all the things they misread or present incorrectly.

The organization of this class is also very higgledy-piggledy.  There seems to be a disconnect between the lead instructor/"course master" (I have always thought this term to be pretty funny – makes me think of a Darth Vader- or Voldermort-type arrangement) and the people who lead each discussion section.  Expectations are often unclear and only given to students hours before a deadline or just after the assignment has been turned in.  As someone who is so compulsive about organization, this bothers me to no end.  I'm just glad I got the section leader who is most lax about assignments.  As long as we get the gist of the assignment, we get close to full marks.  Other sections' assignments get nit-picked for each little technicality.  I feel bad for them, but I can't complain since I'm not in that boat. 

I had to give a presentation today about a review article on Chemotherapy-Induced Nausea and Vomiting.  For some background, we just got done with a grueling 4 weeks of lectures on Chemotherapy and an exam (mere hours before I prepared this presentation) that was 22 pages long.  The outline we are supposed to use to present our articles is designed for such things as randomized-controlled-trials, which are much more complicated that this article I was assigned to present (which was just an overview of a topic).  So the last thing I wanted to do after a solid weekend of studying and a long exam was to read an article giving basic information about a topic for which I had already memorized all of the guidelines.  I managed to write my presentation outline without even reading the article.  I thank the IB program in high school for teaching me that skill (when I mastered the art of participating in discussions and writing papers about books I hadn't read).  I don't feel too bad about not reading the article, though, since last week when someone asked a complicated question about one of those studies we were supposed to have read, our instructor admitted that she "ran out of time and didn’t actually read it."  I can't see any reason that I should read all these articles when the instructor isn't going to take the time to do the same.

It's too bad that this class was such a combination of useless busywork, circular discussions, and wasted time, since the subject matter could actually be useful in the future.  I did learn some things about how to evaluate the scientific literature, but I think I could have learned a lot more with a better-designed course that was founded on better organization and inter-instructor communication.  Throughout the quarter, I felt like I learned nothing and that the only purpose the course served was to drive me crazy, but looking back, I guess I did get a little smarter.

One more paper to write and 5 more hours of class until Thanksgiving…I can't wait for 4:30 tomorrow afternoon!

E-Prescriptions: A good thing?

As we move into the future of computers and the internet (I know, that started a long time ago, but it's a long process, especially when lawmaking is involved), it is becoming more and more common for doctors to send prescriptions to pharmacies online.  Originally, the only way to transmit a prescription was via a hand-carried piece of paper or a direct phone call.  Then, faxing prescriptions became commonplace.  This is still one of the most widely-used methods of transmission, especially for refills.  But now, doctors can instantly send prescriptions to be filled without depending on outdated facsimile technology or encountering the possibility of a hard-copy prescription being lost (or modified) on the way to the pharmacy.  Seems like a good idea, right?  It is.  But there are quite a few issues with the system.

The first issue is the ease at which a doctor can submit a prescription.  They can pick a drug from a menu, enter directions, and press "send."  They can also approve refill requests with the press of a button.  These things that make it easier and faster for the doctor also increase the possibility for error.  I received an e-prescription last week that was for a routine medication for a patient that had been on it for a long time.  I started to enter it, but then looked at the date.  It said it was written 07/24/2009.  The patient was due for a refill and the doctor had sent five or six other prescriptions at the same time (with the correct date), but I called to verify the prescription.  The nurse said they didn't receive our request for that refill and that she did not send authorization.  Yet somehow, I had, in my hand, a prescription sent 11/17/2011, but written over two years earlier.  It seems they inadvertently pushed a "refill" button on an old prescription and unknowingly sent it to us.  I caught it because of the date, but if the date had been auto-entered as today, I surely would not have noticed anything out of the ordinary and it could have resulted in a prescription being dispensed that the doctor did not mean to request. 

The other issue with the ease of use is drug selection.  I haven't seen it as much recently (maybe they have made some improvement to this part of the process), but sometimes we get an e-script for a drug that seems really odd.  When we call to verify, they say they actually meant to order the drug that is listed one line earlier or later, alphabetically.  They can apparently pick drugs from drop-down menus and if they simply click a little too high or low, it could result in a major error.

The second issue is the lack of clarity in directions.  This is sometimes a source for a good laugh, but is also sometimes worrisome.  Most of the time, the directions are clear enough that we can interpret them, but they're not what they say they are.  I'll give an example of an eyedrop e-script I got last week: the directions said to insert 4 capsules in the right eye four times a day for a week.  It also said I was to dispense 1,000 mL.  I can't imagine inserting a capsule in my eye, let alone 16/day.  Plus this is the first time I have heard of dispensing a liter of eye drops at once (they usually come in sizes from 2.5-15mL).  It got a good laugh out of everyone in the pharmacy and I could make sense of what they probably meant, but if they can make an error this big without noticing, it must be very easy to make a smaller error that may not be caught and ultimately result in harm to the patient.

E-prescriptions are also supposed to be a step towards becoming less dependent on paper.  However, we are required to keep paper copies of all the prescriptions we fill, so it doesn't do the "paperless society" much good for the doctor to save a piece of paper when we just have to print it out anyway.  Also, there's a feature where we can import the data from the e-script right into the pharmacy software, but by the time you correct all the little errors it is faster just to enter it from scratch.  For example, directions that intend to say "take one tablet daily" may come across as "1 PO QD by oral route daily (tablet)" which you have to clear completely out and enter directions that can be easily read.  Also, when you correct something, it clears what used to be there, so you have nothing to refer to if you forget what it said originally.  Thus, printing it out is necessary for one more reason and no paper has been saved.

E-prescriptions are a good idea and are an improvement over faxes in many ways.  They are not dependent on cleanliness of the scanner or quality of the printer, and don't have to wait for an open phone line, so can be transmitted much faster and reliably.  However, we still have a long way to go in improving software and designing better safety measures and double-checks to ensure that what is being dispensed is just what the doctor ordered.

Courteous, Cheerful, and Friendly

Why is it so hard for some people to be courteous?  I understand that everyone isn't in a good mood every day, but even when you're having the worst of days, it is still usually possible to manage the "please" and "thank you" that most of us were taught to use from a young age.

One of the things that I do at work is transferring prescriptions between pharmacies.  This is a process between two pharmacists (or interns) and I would think that at least some professional courtesy would be shown, or maybe even some friendliness.  I have noticed a trend that many chain pharmacists do not show this basic courtesy when calling another pharmacy.  I got a call last night that started with (in an abrupt tone) "This is Costco.  I need a transfer."  I gave the pharmacist on the other end the information he needed as he asked for everything in as few words as possible.  There was not a hint of cheer or anything friendly in his voice, and the call ended with an unenthusiastic "thanks."  (I don't mean to single out one pharmacy, as this happens with many other chains; Costco is just the one I spoke to last night.  I also don't mean to generalize without foundation, but it is a definite trend; the same process is much different between most independents.) Would it have been so hard for him to start the call by saying something like "Hi, this is so-and-so from Costco in Woodinville.  I would like a transfer, please." or ending the call by saying "thank you" sincerely or wishing me to have a good evening?

There is also sometimes a lack of courtesy with customers.  Whether someone comes up to the counter or drives up to the window, I always greet them with a sincere "hello" or "good evening."  About one time out of three, the person just barks their last name, indicating that they have a prescription to pick up.  It doesn't take much more effort to say, cordially, "Hi, I have a prescription to pick up for so-and-so."  There are also those who I have never seen smile, throughout the many years they have been coming in.  I wonder how people, like that, who are never cheerful or friendly can live a happy life.  Or maybe they don't.  Obviously they were never scouts...  I just continue to be courteous, cheerful, and friendly with them, even if they never are in return, and appreciate the majority of people who still remember the basic sincerity of "please" and "thank you."

Sometimes when I deal with someone who just doesn't seem capable of smiling or exchanging basic pleasantries, I think of this poem we learned in preschool:

        How d'ya dootee, how d'ya dootee, how d'ya do today?
        Do you live where you used to live, or have you shifted away?
        I'm sorry you're so disagreeable, I only stopped to say...
        How d'ya dootee, how d'ya dootee, how d'ya do today?

Where did the work ethic go?

I was being rung up at QFC last night by a guy about my age who was the only store employee to be seen.  A line was forming behind me (apparently the 9:30pm rush) and no other cashiers were to be seen.  I made some comment about that and he said, "do you ever look around and notice you're the only one working?"  I smiled and agreed as I get that feeling all too frequently.

I've noticed, since I started working, that many people don't have much of a work ethic.  I have always thought that when I was being paid to work, that is what I should be doing.  Sounds pretty obvious, but apparently it's not to some.  When it's slow, especially in the late evenings, it isn't uncommon to see someone doing something completely unrelated to work: checking email, chatting with a co-worker, etc.  I'm not saying you can't have a conversation with a coworker about something other than work, but it is possible to multitask, even if it's just something mindless, like filing, that needs to be done.  This kind of thing is frustrating to those of us who work hard from the time we start a shift to the time we are off.   It makes more work for us, plus we are both getting paid comparable amounts of money but not doing nearly comparable amounts of work.  Also, it is very annoying to be waiting for help when you go to a store and you have to wait for someone's conversation about their new shoes to end before they even acknowledge your presence.

I'm thankful to work at a place where this work ethic deficiency is rare.  Most of the people I work with are fantastic, which is part of what makes my job so enjoyable.  It's too bad, though, that this problem is spreading.  More and more people at different places you go just don't have the motivation to get to work on time, to do the job they're there to do, to search for other tasks when their regular duties are complete, or to go out of their way to help the customer.  It's too bad that so many of today's kids are being raised to be lazy; I'm just glad there are places to work like Camp Parsons that can teach you how to be a useful member of society and a hard worker.

As an aside, I started rereading all of the Harry Potter books last week.  Listening to them, actually, at the suggestion of my favorite Harry Potter expert (there you go, Chris, you've been mentioned).  The audio books do have a couple advantages over reading: I don't have to carry the heavy book everywhere and can listen while I drive around or walk through campus.  Also, I have the tendency to read more quickly during exciting parts of books and miss details.  Plus, Stephen Fry's voice is just delightful.  I just hope that I still pass my classes while listening to the books for such a large portion of the day.  I guess if I could pass the first midterm while watching the entire series of Scrubs the first half of the quarter, I can manage this…

Is classroom technology really an improvement?

One of the biggest problems I have had with school in the last 5+ years is the misuse of and overreliance on powerpoint and other "newer" technology.  Don't get me wrong, PowerPoint is a great tool for doing presentations that require visual aids, but that is not what it's being used for.  I've noticed more and more, though, that many teachers who use powerpoint rely on it as their only source of lecture material and hardly add anything.  I find it very frustrating when I go to a class with the printed slides in hand only to find that someone is going to stand in front of us for hours on end and simply read or paraphrase what they have already given us in advance.  That defeats the purpose of even attending these lectures, since the same knowledge can be gained by sitting at home and reading it myself.  The best use of PowerPoint I have seen is when either a very basic outline is put on the screen or even just the visual aids (photos, graphs, tables, etc.) are put up with no explanation.  That explanation should come from the instructor himself.

I find that I learn more from professors who use the "old fashioned" method of teaching, with just notes for themselves and a blank overhead projector.  They will often give us a very rough outline of their discussion with background information and figures too complicated to draw ourselves, but the bulk of the relevant information comes from their lecture itself.  That way, they can teach us something beyond what is in their outline or notes and we actually get something out of coming to class.

The overhead projector is really a useful tool and it is sad to me that the University is encouraging professors not to use it any more.  It can be written on directly as well as can be used to display figures printed on transparencies in advance.   The only thing that can go wrong is a burned-out lamp, which is an easy fix and doesn't happen all that often.  With computers, projectors and screens that automatically raise and lower themselves, laser pointers, and document cameras, there are too many components to go awry, which they often do.  To make matters worse, it is only once in a blue moon that a teacher comes along who actually knows how to plug their computer in and get the image to display on the first try, let alone troubleshoot projector or computer problems.  Most of them can't even get the microphone or lights to turn on properly.

There is one class that stands out in making me lose all confidence in its instructors.  The first lecture started more than fifteen minutes late because they couldn't get the PowerPoint presentation to display in full-screen mode on the projection screen.  After many reboots and a delayed visit from IT Services, they got it running, but lost more than a quarter of the lecture time and didn't ever cover the material that they had to skip.  They were literally unable to give the introductory lecture for this course without their prized PowerPoint presentation.  That really says something about their preparedness for the class and their knowledge of the material beyond what they had mindlessly entered into the slides.  For the second lecture, they tried to use audience response devices ("clickers") for pre-lecture questions.  When they finally got that working (after 15 minutes), they didn't contribute in the slightest to the discussion, and again, a large chunk of time was wasted.  Regardless, the material they did cover was all written on the slides, and nothing was added.  I haven't been to that class since the second lecture.  I just refer to the presentations they post on the website and haven't missed a beat with quizzes or assignments.  

Just one quick note about SmartBoards... 

They had just started installing these $30,000+ devices in classrooms as I finished high school, and one of my current classrooms is the host to a brand new one this year.  For anyone who hasn't had the honor of basking in this device's technological glory (that was total sarcasm, by the way...), it is basically a glorified white board that is connected to a computer.  Because the instructors don't know how to use them, they can't even write or erase with the special expensive pens.  When they finally get the pens to work, they are non-responsive and have the ability to turn even the best penmanship into chicken-scratch.  So rather than a white board that could be used to write and draw, we have this expensive and currently useless piece of metal and plastic that can't even do that most of the time.  So this is where our god-awful high tuition is going...  (Besides, in replacing the old white board, they left unpainted sections of the wall and unfilled gaping screw holes, so now that wall looks atrocious...)

PowerPoint has been more of a hindrance than a help except in the rare cases that a professor understands its intended use and how to utilize it properly.  The only thing accomplished by all this technology (except in a few exceptions) is a crutch that mediocre instructors can use to skate by, lecture after lecture, without really doing any more than reading something off a screen.  Why do we pay so much in tuition and devote so much time just to listen to these people read to us?  I probably sound like an old person, but let's just stick to the basics and stop trying to bite off more technology than we can chew.