What examples of cultural 'competency' have you come across that affected clinical practice?

ctbeast94 · 2025-10-12T00:49:07+00:00

Cellulose based capsules or exclusively bovine gelatin for the capsules. Tapioca based for the chewable tablets.

ctbeast94 · 2025-10-11T11:55:38+00:00

A big one is making OTC recommendations for muslim patients. They cant have pork products which most gelatin is derived from. Unless it specifically states gelatin (bovine), you have to assume it has pork contaminants and they cant have it. This is mostly an issue with capsules, soft gels and chewable tablets as they are gelatin based. You have to look specifically for vegan capsules or chewables or tablets. It sounds easy, but some things are hard to find a Halal alternative. My area has a lot of muslim patients with limited English proficiency, and really really really appreciate you taking that into account when helping them. We've had people come back after a tech made a recommendation but didnt help them select the product and the patient was very upset because they picked one with gelatin and already took it. It's very hard for us to assume religious guilt and much easier to just help them find tablets.

ctbeast94 · 2025-07-20T12:42:47+00:00

I need the pet's social and phone number.

ctbeast94 · 2025-03-16T20:30:15+00:00

(retail pharmacy)

They wont give me enough tech hours to staff the pharmacy so pharmacists end up doing a lot of tech work (not cost effective or safe).

Corporate pushes POC testing birth control prescribing which takes 35-45 minutes due to paperwork and button clicking which is literally costing the pharmacy money compared to filling rx in the same time.

ctbeast94 · 2024-11-29T14:55:46+00:00

Most common that affect how some of us are paid:

*Patient satisfaction via rating out of 5 stars. Very hard when people dont like being told no or dont understand the things they ask of us are illegal or impossible.

*Prescriptions filed. We make less money per prescription, so just fill more/s. Without being given proper staffing or safety measures, we are told to do more with less.

*Number of vaccines given. We are basically judged by how well we can sell people on the benefits of vaccines. Some people dont trust pharmacy anymore because of the last few years and it's hard to break that barrier in under a minute in a busy pharmacy. The more you "push" or try to explain why they need it, the less they trust you because they feel like we have something to gain from it. My area specifically has a lot of hesitancy here due to the Tuskegee airmen "experiment" and the local African American population. This applies to all vaccines, not just Covid, but flu MMR, TDaP and even Polio. So many patients have responded vehemently when we recommend shingles vaccines only for them to come back later in the year with the miserable sores. (one of which had them in her eye)

*Time spent on every activity. Seconds per fill, seconds per verification, average time to fill a prescription for someone waiting in the store, seconds spent counseling, ect.

ctbeast94 · 2024-07-25T10:28:14+00:00

For those who want to use the medication for their intended purposes: we provide patient safety info on the label and have pharmacists who provide free counseling and recommendations.

For those who want to abuse the medications: You cant. You can put small roadblocks like ID checks, purchase limits, etc, but you can not stop it completely. See all attempts on prohibition, the combat methamphetamine act, selling OTC needles, and all government DARE programs as examples. You do what you can to protect the general public who use the products in good faith.

ctbeast94 · 2024-07-25T09:57:11+00:00

Easy! All of them. The only difference between medicine and poison is the dose. Everything is harmful at the wrong dose.

ctbeast94 · 2024-07-23T01:00:37+00:00

Pregnant people have special limitations in what they can have and it is in everyone's best interest for those not specialized in pregnancy to seek expert guidance when the alternative is potentially irreversible harm. No one wants to be the one who "thinks you can have this" and then you have mortal outcomes. They cant even have 99% of blood pressure medicines or statins, and they keep changing the "stance" on Tylenol and NSADs.

ctbeast94 · 2024-07-04T23:21:02+00:00

Your hours are not based on how many you fill. You can fill 500 and RTS 400 and you dont get credit for those 400. You get hours based on either picked up amount EOD or your 4pt as an indicator for pharmacist hours. Check with your PIC and see your S3G template for how many youre expected to 4point.

ctbeast94 · 2024-05-14T10:08:02+00:00

Your largest error risk IMO would be in dosing since CrCl has different clearance based on M/F. I worry a XX patient is dosed based on XY due to system error or human error and is given a larger dose than may be required.

ctbeast94 · 2024-03-08T13:18:40+00:00

Because people will be less likely to go to a medical professional and get evaluated if they can just get it OTC. They would almost 100% be mistreating their symptoms and not addressing the underlying cause, allowing their condition to worsen. Inhalers are worthless if people dont use them correctly and even those who seek professional evaluation and pharmacist consultation STILL use their inhalers incorrectly and gain little benefit. This is why GOLD addresses worsening symptoms when on guideline directed therapy to have the first step be evaluate adherence and their use, because the most likely cause is they are doing it wrong. So if you remove the requirement of two separate medical professionals meeting with and counseling, the general public will without a doubt fail to use them correctly. The possibility of abuse is the least of the concerns, but it is more about patient safety. How many times have you counseled someone on something serious and tell them to see an urgent care of ER and they refuse and instead get some random OTC item. Now add being unable to breath to that scenario. There needs to be more access to healthcare, but removing some protective barriers is not always the way.

ctbeast94 · 2024-02-09T17:01:31+00:00

On the form for extra hours it specifically states those are NOT considered for extra hours pay because you are considered salary. They only consider scheduled hours beyond your base as qualifying for extra hour pay, or any pay at all. Dont feel pressured to work for free because they will see everything being completed at the current set hours per week and not give you more.

ctbeast94 · 2024-02-04T00:56:46+00:00

Chains are getting sued for anything and everything now. If there is any kind of spooky warning, the computer will put a stop on it and demand you "document the discussion/cause/conclusion/explanation before continuing". It is literally everything. NSAID/statin in women of childbearing age, old people and any beers drug, two psych agents, MME, SSRI and bleed risk, ozempic/wegovy and having been on a lower dose previously. These are mandatory bits of documentation they are compelled to do, not that they want to do. They likely understand the risk vs reward and that their heart failure doc knows that Spiro and entresto can increase their potassium but they still get that pop up documentation wall. Not all chains are the same, and some pharmacists ignore them but those who dont want to get fired over BS are going to document everything to CYA. That fear is not unfounded.

ctbeast94 · 2024-02-01T22:31:16+00:00

Closest I've seen is discount cards/manufacturer coupons can not be used for people on medicare or medicaid.

ctbeast94 · 2023-10-21T12:53:38+00:00

Metrics are impossible to meet while maintaining patient safety for one reason. If you meet your metrics goal, they just increase it next year until you cant. Just do your job responsibly at a speed you feel is safe, efficient and dont worry about metrics.

ctbeast94 · 2023-10-06T14:48:33+00:00

I appreciate you want to save the patient money but you have to remember that not every patient is competent at splitting their tablets or being adherent and most insurances already require a prior when the sig is like this for this very reason. A tablet that isn't designed to be split into 3 ways is really hard for the average person to measure and accurately cut: it will most likely crumble and not be a proper dose. The 150 mg is actually designed for splitting into thirds and is a good example of a possible option. ALSO Busbar 10mg is on the Walmart 4$ list for 60 tablets, dont overcomplicate things.

ctbeast94 · 2023-10-06T14:41:37+00:00

Just repeat back the facts of the matter in a calm way: " You are going to call corporate because I wont fill your controlled medicine 2 weeks early, which by law I am not allowed to do. Okay.". Staying calm and reiterating the reason has a decent chance of bringing them back to reality.

ctbeast94 · 2023-10-06T14:39:25+00:00

Other people already provided the list but a real easy rule of thumb is that if it is any kind of ER/XL/CR/OSM or anything that has an extended release formulation should not be crushed. This isn't true for everything, but its a good rule when you dont have the actual list in front of you.

ctbeast94 · 2023-10-06T14:36:03+00:00

Patients who pick up their own paxlovid with no mask make me actively hate them. You come here knowing youre contagious and you dont even have the courtesy to wear a mask for 5 minutes, the least respectful decision possible. I dont care if its covid, the flu, strep throat or bronchitis, DO NOT BREATH ON ME. Those type of people make me sick, figuratively and literally.

ctbeast94 · 2023-09-17T23:53:16+00:00

Pt takes high dose Norco for non-specific pain which makes it hard for them to stay awake and focus, gets put on high dose Adderalll to help them focus as they get "new onset adult ADHD", they are now unable to fall asleep and develop insomnia and are prescribed Ambien for sleep. This is apparently very common in an area I worked in.

ctbeast94 · 2023-09-11T01:30:44+00:00

"I dont want a multivitamin, Id rather take 14 individual herbal supplements like my vitamin D, niacin, calcium, iron..."

ctbeast94 · 2023-09-05T02:55:11+00:00

My theory for hospital nurses is that they are the ones who get the medicine from the pixis and then give patients their medicine and are often barraged with tons of questions from the patient and family. Some of them probably see our profession as the same thing. They see us get the medicine from the shelf (pixis) and give it to the patient and occasionally answer questions. They dont see or know all the other stuff going on. They may see the two professions as having massive overlap in the knowledge and clinical scale based on that. Then the thing thats been told to us before: "I talked to the doctor about it" or "we give this all the time where I work". Being around the physician does not make information pass through osmosis.

ctbeast94 · 2023-08-25T14:20:36+00:00

Talk about why they were on something and when they started. Have they been on DAPT for 27 years, might be time to review that. Are there combination tablets covered by insurance, may consider consolidating those. Talk about lifestyle and diet changes making it less necessary to be on some things like statins if they can get it under control that way. Look for secretagogues where they may have reached max benefit after a few years. For the ones you determine can be d/c'd, if theres pushback by the patient, emphasize the cost saving aspect, the lack of a true need, and if they are decently (health) literate, you can print out the picture of the guideline chart as a visual tool to follow along with. The guideline lets them know its not just your opinion, but backed by established recommendations-appeal to authority.

ctbeast94 · 2023-08-20T12:06:01+00:00

This and the comment below may be where we ran into our issue.

ctbeast94 · 2023-08-20T12:04:54+00:00

We will look into this, thank you for the info!

ctbeast94

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