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12 Behind-the-Scenes Secrets of Pharmacists

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Though they often toil in retail settings next to candy bars and magazine racks, pharmacists are fully accredited medical professionals who process, check, and consult on the roughly 4.3 billion prescriptions physicians write every year.

To find out more about life behind the apothecary counter, mental_floss spoke with a few of the men and women in the nifty white smocks about frustrating quotas, illegible handwriting, and why you might see a little mayonnaise smeared on your pill bottle.  

1. THEY STOP DOCTORS FROM KILLING YOU.

Jason—he prefers not to reveal his last name—has been a retail pharmacist in the Midwest for more than 20 years. When he hears complaints about slow service from patients who think of the chain stores as glorified drive-throughs for prescriptions, he sighs.

“It’s not just putting pills in a bottle,” he says. “With a prescription, there’s a good likelihood of there being wrong information. We catch interactions that could kill you.” On an average day, Jason might see 200 orders. He estimates 10 to 15 percent contain errors in quantity, instructions, or dosing that need to be corrected by phoning the physician.

2. THEY USUALLY HAVE ABOUT 15 MINUTES TO ACCOMPLISH THAT.

Owing to the volume of prescriptions processed by major chains like CVS and Walgreens, the one or two staff pharmacists on the clock have precious little time to spare. While pharmacy technicians can count pills and perform other tasks, only the pharmacist can double-check a medication is accurate before it’s turned over. “We have a time limit,” says Aaron, a retail pharmacist in Texas. “Reports get printed out at the end of the week and we get reprimanded for not meeting metrics. People ask if there’s anything they need to know about their medication. Yes, lots, but I only have a few seconds to give you the highlights.”

3. DECIPHERING A DOCTOR’S HANDWRITING IS LIKE CRACKING A CODE.

One course not taught in pharmacy school: how to decipher the frenzied scribbling of your neighborhood physician. “You’re expected to learn it on the job,” Jason says. “You learn traits. Some doctors don’t learn any Roman numeral besides ‘I,’ so 11 of them means '11.' It’s like a puzzle.” Sometimes Jason will phone the doctor’s office to crack the secret of a handwriting habit. “The funny thing is, you can move 10 minutes away to another side of town and have to learn a whole new set of patterns.”

4. THEY OFTEN DON’T GET A LUNCH BREAK.

After graduating pharmacy school, Megan spent a little over a year at a retail pharmacy counter. “It was pretty much the worst year of my life,” she says, citing the fast-food pace of the job as a deterrent to continuing. How fast? Orders typically come in so quickly that pharmacists don’t take a lunch break. They have to eat portable meals or snacks while standing. “You don’t really get any breaks unless you take it upon yourself. Labor laws don’t apply. Employers aren’t saying we can’t, but when you’re in the weeds, it’s hard to make it actually happen.”

5. THEY HAVE FLU SHOT QUOTAS.

While it’s no secret pharmacies love to promote flu shots, the even harder sell is happening behind the scenes. “When [chains] found out they could get reimbursed by Medicare and make $15 a shot, it went from, ‘Let’s offer it,’ to becoming mandatory," Jason says. "Baby on the way? Get a flu shot. On the subway a lot? Get a flu shot.” Pharmacists who fall below parity risk having a percentage of their annual bonus taken away.

6. THEY WISH YOU’D STOP HANDING THEM DIRTY PRESCRIPTIONS.

Like sweaty money coming from a sock, prescriptions of vague origin can be repulsive to the person who has to handle them. “People hand you paper that looks like it’s been through a garbage disposal and act like it’s no problem,” Megan says. As a courtesy, try to avoid spilling food, water, or blood on your prescription. (She’s seen them all.)

7. THEY HATE ELECTRONIC PRESCRIPTIONS.

According to Jason, they don’t reduce errors—they just make them more legible. “There are over 200 systems in my state alone,” he says. With no continuity, “There’s a real disconnect.” Doctors don’t always understand the drop-down menu—advising patients to take a cream “one tablet daily,” for example—and patients think their medication will be ready in seconds. It won’t. “Imagine 100 people in your office sending you an email at once, then coming in and asking, ‘Did you read it yet?’”

8. DEFINITELY READ THE PAMPHLET. (JUST DON’T LET IT SCARE YOU.)

Many consumers have adopted a management system for the drug information document that typically gets stapled to every prescription bag: They toss it in the garbage. This is not wise. “I stress for patients to read it,” Aaron says, citing time constraints at the pharmacy. But he also cautions not to let the list of possible side effects scare you. “The side effects aren’t listed by how often they occurred in a clinical trial. 1 percent is different from 10 percent. You might see ‘psychosis’ and not know it happened in point-five percent of patients.”

9. THEY SOMETIMES DROP PILLS ON THE FLOOR. THEN YOU EAT THEM.

“It’s not supposed to happen,” Megan says. “The counting trays have a lip, but stuff still falls on the floor. Then it’s considered an adulterated drug and people aren’t supposed to put it back in the bottle, but it happens anyway.”

10. THEY KEEP NOTES ON YOUR BEHAVIOR.

Most pharmacy software has a prompt that lets pharmacists and technicians make a note when a customer is behaving oddly or is otherwise circumspect. “Some people have the same issue every month,” Aaron says. “They get a narcotic and insist we miscounted and gave them 10 fewer pills than prescribed, even if it was a sealed bottle.” Push your luck—one man got so irate having to wait at a drive-through he began filming on his phone, which is a privacy violation—and you can find yourself banned.

11. YOU’LL BE SEEING MORE OF THEM IN HOSPITALS.

Megan left retail to become a hospital pharmacist. “The last year of pharmacy school, you’re rounding with a medical team at a hospital,” she says. “To have all that knowledge in the wheelhouse and go to a fast-food type environment, I didn’t like it. I want to use those clinical skills. We go into a room and visit with a patient and can manage drug regimens." 

12. THEY TECHNICALLY DON’T NEED A PRESCRIPTION TO HELP YOU.

Not on an official prescription pad, anyway. “A pad is just a guide, with space for names and birth dates,” Jason says. “A doctor can technically write something down on a napkin and we have to honor it.” They will, however, still call the office to verify.

All images courtesy of iStock.

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Here's How to Tell If You Damaged Your Eyes Watching the Eclipse
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Amid the total solar eclipse craze, experts repeatedly warned spectators not to watch the rare phenomenon on August 21 with their naked eyes. But if you caught a peek sans glasses, pinhole projector, or protective filter, you may be wondering if your peepers were damaged. (After the sky show, "my eyes hurt" spiked as a Google search, so you’re not alone.)

While the sun doesn’t technically harm your eyes any more than usual during a solar eclipse, it can be easier to gaze at the glowing orb when the moon covers it. And looking directly at the sun—even briefly—can damage a spot in the retina called the fovea, which ensures clear central vision. This leads to a condition called solar retinopathy.

You won’t initially feel any pain if your eyes were damaged, as our retinas don’t have  pain receptors. But according to Live Science, symptoms of solar retinopathy can arise within hours (typically around 12 hours after sun exposure), and can include blurred or distorted vision, light sensitivity, a blind spot in one or both eyes, or changes in the way you see color (a condition called chromatopsia).

These symptoms can improve over several months to a year, but some people may experience lingering problems, like a small blind spot in their field of vision. Others may suffer permanent damage.

That said, if you only looked at the sun for a moment, you’re probably fine. “If you look at it for a second or two, nothing will happen," Jacob Chung, chief of ophthalmology at New Jersey's Englewood Hospital, told USA TODAY. "Five seconds, I'm not sure, but 10 seconds is probably too long, and 20 seconds is definitely too long."

However, if you did gaze at the sun for too long and you believe you may have damaged your eyes, get a professional opinion, stat. “Seeing an optometrist is faster than getting to see an ophthalmologist,” Ralph Chou, a professor emeritus of optometry and vision science at the University of Waterloo, in Ontario, Canada, told NPR. “If there is damage, the optometrist would refer the individual to the ophthalmologist for further assessment and management in any case.”

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New Test Can Differentiate Between Tick-borne Illnesses
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Time is of the essence in diagnosing and treating Lyme disease and other tick-borne illnesses. Fortunately, one new test may be able to help. A report on the test was published in the journal Science Translational Medicine.

Ticks and the diseases they carry are on the rise. One 2016 study found deer ticks—the species that carries Lyme disease—in more than half of the counties in the United States.

The two most common tick-borne illnesses in the U.S. are Lyme disease and southern tick-associated rash illness (STARI). Although their initial symptoms can be the same, they’re caused by different pathogens; Lyme disease comes from infection with the bacterium Borrelia burgdorferi. We don’t know what causes STARI.

"It is extremely important to be able to tell a patient they have Lyme disease as early as possible so they can be treated as quickly as possible," microbiologist and first author Claudia Molins of the CDC said in a statement. "Most Lyme disease infections are successfully treated with a two- to three-week course of oral antibiotics." Infections that aren't treated can lead to fevers, facial paralysis, heart palpitations, nerve pain, arthritis, short-term memory loss, and inflammation of the brain and spinal cord.

But to date, scientists have yet to create an accurate, consistent early test for Lyme disease, which means people must often wait until they’re very ill. And it’s hard to test for the STARI pathogen when we don’t know what it is.

One team of researchers led by experts at Colorado State University was determined to find a better way. They realized that, rather than looking for pathogens, they could look at the way a person’s body responded to the pathogens.

They analyzed blood samples from patients with both early-stage Lyme disease and STARI. Their results showed that while all patients’ immune systems had mounted a response, the nature of that response was different.

"We have found that all of these infections and diseases are associated with an inflammatory response, but the alteration of the immune response, and the metabolic profiles aren't all the same," senior author John Belisle of CSU said.

Two distinct profiles emerged. The team had found physical evidence, or biomarkers, for each illness: a way to tell one disease from another.

Belisle notes that there’s still plenty of work to do.

"The focus of our efforts is to develop a test that has a much greater sensitivity, and maintains that same level of specificity," Belisle said. "We don't want people to receive unnecessary treatment if they don't have Lyme disease, but we want to identify those who have the disease as quickly as possible."

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