Dear new RPh's and techs,
A post for my retail pharmacy people and those insomniacs whose insurance refuses to pay for sleep pills.
Just about the middle of last year, I started to notice that refills for zolpidem, generic Ambien, was being rejected for a prior authorization. This means that the insurance company wants to talk to the doctor to make sure that the patient really, really needs the medicine. What it really means is that insurance companies are the spawn of the devil and don't want to pay for anything.
A quick note about insurance companies: their business model is to take regular premiums from their customers and find ways to NOT pay out claims. One of the sneaky ways they do this is to send out brand new cards every year so that they can expire the old ones and hopefully not pay for a refill. In doing so, they make my job sucky for a few months out of the year, even more than usual with having to deal with insurance.
Most of the time though, their prior authorizations (PA) are well founded: rejecting an ADHD med for a kid who is 4 years old (my goodness, are we going to pump 1 year-olds with Ritalin next because they cry too much? wait a minute, we do! *sad face*), rejecting Cambia(R) because it's glorified ground-up diclofenac*, and rejecting Nexium(R) because it's basically rehashed omeprazole whose patent had run out**.
To these situations, I must say to the insurance co's, 'Nicely done. If I had more time to talk to the doctors to convince them to use medicines judiciously, I'd do the same. But since I'm here to dispense drugs pursuant to a prescription, I'd really wish that you'd make my life easier and just approve the medicine for a $200 copay so I can tell the patient to take it or leave it or take it up with their insurance/doctor. Because a PA makes it look like the pharmacy is being withholding, when it is in fact, you who are the angry wife (who is withholding of the marital obligation). Thank you.'
But I just don't understand when they reject meds which are comparatively dirt cheap (in the $40 range). Branded Lamisil tablets used to be prohibitively expensive, but the generic isn't too bad. Come on, guys! Let the old dude have it for his onychomycosis! Or when they rejected generic zolpidem when they had paid for it the first couple of months.
But then I remembered the lecture I gave on sleep disorders shortly after I graduated***: Ambien is FDA-approved for 'short-term treatment of insomnia characterized by difficulties with sleep initiation. Ambien has been shown to decrease sleep latency for up to 35 days in controlled clinical studies.'
Bingo! The resident medical 'expert' at the insurance department picked up on the little bit of important information (the package insert that accompanies the drug bottle), and found a great reason to reject refills of Ambien. 'Dear Dr. so-and-so: As you can see from the package insert, Ambien (Zolpidem) is not approved for treatment lasting longer than 35 days. Thank you.'
Anyone with any bit of reason (even insurance companies) knows that Ambien doesn't simply stop working after 35 days because the drug isn't approved for long-term treatment. It simply meant that Sanofi-Aventis didn't have the money to run the trial longer or were afraid that the sleep-inducing effects would wear off after 35 days and would lead to not-so-good-looking clinical results. As such, the drug is FDA-labeled for short-term treatment and now insurance companies have a perfectly valid reason to reject a claim using a prior authorization.
They could run longer trials now, but they won't because Ambien is generic, so they couldn't re-coop their expenses.
--
So why know all of this? Because it is always better to explain to customers how it really isn't your fault. When you pass the buck to other folks, preferably drug or insurance companies, customers can get angry at them instead of at you. By the way, don't pass the blame to their doctor, because they may really like their doctor or their doctor may call and chew you out.
'Why is my insurance not paying for my medicine?'
*Smile* 'Well, sir. Ambien is not approved for long-term treatment of insomnia. Though I realize that you've been using it for years now, the original studies approving the medicine was only for short-term treatment. I think the insurance company wants to run this by with your doctor and make sure that there isn't a better way to treat your insomnia.'
Congratulations! The customer is no longer angry at you, and thinks you're pretty swell for your insurance knowledge. He shakes your hand, happily pays the ~$40 for the cash price of Ambien, and will take it up himself with his doctor/insurance.
Based on a true story.
Incidentally, you could also recommend the customer to get a prescription for Temazepam (generic Restoril) which is only about $20 per month without insurance.
--
*I wanted to tell the patient to get a prescription for diclofenac 50 mg, buy a mortar and pestle, grind the pills up herself to put in water, and save $200 for 5 friggin packets!
**Please explain this to me: Omeprazole 20 mg and Nexium 40 mg are the most commonly dispensed strengths. We are made to believe that the S-enantiomer is supposedly the more active (or only active) component of the racemic mixture, and/or that it has less side effects. Therefore, if Omeprazole 20 mg contains 10 mg of the S-enantiomer (Nexium) and 10 mg of the R-enantiomer, wouldn't the equivalent strength of Omeprazole 20 mg be Nexium 10 mg?
So why does AstraZeneca market Nexium 40 mg which would be in essence, a four-fold increase in strength vs Omeprazole 20 mg (Prilosec, which they made)? Don't give me some BS about how there are fewer side effects so you could give a higher dose--show me a person who was taken off omeprazole for side effects and I'll show you a hypochondriac.
***Excuse the not-so-subtle reference to my genius :)
Thursday, September 30
Wednesday, September 29
Death of AIM
Dear harried folks,
The truly wonderful thing about being done with school is the freedom to do and not do whatever the hell you want. If the only thing I do besides work is to sleep all day and night on my 7 off, I could very well do that. It's not at all productive, but who cares? Sleep to me is akin to another activity that starts with 's', which is to say it's immensely pleasurable.
And being virtually stress-free, I've begun to understand the ideal of single-tasking, that you do best when you focus your entire attention on a single task at a time. It is a luxury that I daresay few people have in the workforce when most have to bring their work home. At the pharmacy, you multitask for your whole shift, but when you leave, you get to leave everything there. And thankfully your salary isn't tied into your performance (there is incentive pay, but it pales in comparison to the base salary and for the most part isn't worth stressing over*). That's one of the greatest perks of my job: when I leave, I leave.
Related to this myth of multitasking, which you can read a review of the book here by Dave Crenshaw, is that I've pretty much stopped using AIM, or AOL Instant Messenger. I found that the people I really wanted to chat with aren't on there, and the ones that I don't want to chat with would annoyingly pop in ('hey wats up?' 'nothin much, chillin' ...5 minutes pass, aZnHaVoc04** has signed off ) when I'm reading my favorite blog, Ball Don't Lie, which introduced me to my favorite NBA comic-strip blog, Garbage Time All-Stars***. I think most of the screen names I had on there were from high school when instant messaging was the rage.
The last time I signed on was probably over 6 months ago, and that was because I was helping a friend shop for something and we needed to paste links to websites. People whom I talk to on a regular basis have my phone number and they have phones which are capable of making phone calls and sending text messages. Some also have the ability to send email on their devices, which is even better. When I do get messages and calls, I know that the person on the other end really wants or needs to communicate with me and isn't simply bored and I'm 'available' because I'm signed on.
When I talk to someone now, I try to put effort to connect to what they are trying to say as much as possible (but I can't help it sometimes if I'm distracted because they're hot). Because no one really listens anymore. Not really. But everyone wants to talk.
My feeling is that all this new media has created more noise instead of more communication. We cannot decide what is important or we waste too much time parsing through all the nonsense.
It'd be cool if we were to write letters using quill pens and inkwells on unlined parchment and sealed our letters with hot, red wax using our crest and gave the mailboy a shilling or shekel to hand deliver to our closest friends and mortal enemies. And we'd wait patiently the next day and wonder ever so heartbreakingly why she hasn't responded yet to our latest sincere behest. To only receive a note two days later from the fair maiden's womanservant that 'the lady has gone out riding (horseback, not bareback) with Sir what's-his-face and won't be back for a fortnight.' To which you'd respond with, 'Ah, the tiresome wench! How she irks me so!'
I swear I haven't been watching the x-rated remake called Mr. Prejudice's Pride. These are some of the random thoughts that float through my head on a daily basis.
But the point I'm trying to make using a poor metaphor of Victorian novels is that people really cared and put thought into what they're trying to say (at least I would hope so). They had writing desks, a piece of furniture designed for just writing! They didn't use crackberries to tweet while on the john in 140 characters or less.
So along with eliminating all the empty calories in my diet (with the exception of tasty single malt scotch, which no one should define as empty simply because it is alcohol), I am eliminating the empty communication in my life.
It reminds me of one of the closing lines from a Supernatural episode: 'You're all so connected...but you've never been so alone.'
How true.
--
*Imagine if bonuses were large like those finance CEOs: there might be misfills everywhere when pharmacists are pressured to increase numbers. But corporate execs would never do that because retail pharmacist salaries are insane as it is.
**Not the actual screenname, but pretty close. Not mines of course. I'm too classy for that.
***This was when Tracy McGrady was out with 'back spasms' and Von Wafer was actually a decent stand-in.
The truly wonderful thing about being done with school is the freedom to do and not do whatever the hell you want. If the only thing I do besides work is to sleep all day and night on my 7 off, I could very well do that. It's not at all productive, but who cares? Sleep to me is akin to another activity that starts with 's', which is to say it's immensely pleasurable.
And being virtually stress-free, I've begun to understand the ideal of single-tasking, that you do best when you focus your entire attention on a single task at a time. It is a luxury that I daresay few people have in the workforce when most have to bring their work home. At the pharmacy, you multitask for your whole shift, but when you leave, you get to leave everything there. And thankfully your salary isn't tied into your performance (there is incentive pay, but it pales in comparison to the base salary and for the most part isn't worth stressing over*). That's one of the greatest perks of my job: when I leave, I leave.
Related to this myth of multitasking, which you can read a review of the book here by Dave Crenshaw, is that I've pretty much stopped using AIM, or AOL Instant Messenger. I found that the people I really wanted to chat with aren't on there, and the ones that I don't want to chat with would annoyingly pop in ('hey wats up?' 'nothin much, chillin' ...5 minutes pass, aZnHaVoc04** has signed off ) when I'm reading my favorite blog, Ball Don't Lie, which introduced me to my favorite NBA comic-strip blog, Garbage Time All-Stars***. I think most of the screen names I had on there were from high school when instant messaging was the rage.
The last time I signed on was probably over 6 months ago, and that was because I was helping a friend shop for something and we needed to paste links to websites. People whom I talk to on a regular basis have my phone number and they have phones which are capable of making phone calls and sending text messages. Some also have the ability to send email on their devices, which is even better. When I do get messages and calls, I know that the person on the other end really wants or needs to communicate with me and isn't simply bored and I'm 'available' because I'm signed on.
When I talk to someone now, I try to put effort to connect to what they are trying to say as much as possible (but I can't help it sometimes if I'm distracted because they're hot). Because no one really listens anymore. Not really. But everyone wants to talk.
My feeling is that all this new media has created more noise instead of more communication. We cannot decide what is important or we waste too much time parsing through all the nonsense.
It'd be cool if we were to write letters using quill pens and inkwells on unlined parchment and sealed our letters with hot, red wax using our crest and gave the mailboy a shilling or shekel to hand deliver to our closest friends and mortal enemies. And we'd wait patiently the next day and wonder ever so heartbreakingly why she hasn't responded yet to our latest sincere behest. To only receive a note two days later from the fair maiden's womanservant that 'the lady has gone out riding (horseback, not bareback) with Sir what's-his-face and won't be back for a fortnight.' To which you'd respond with, 'Ah, the tiresome wench! How she irks me so!'
I swear I haven't been watching the x-rated remake called Mr. Prejudice's Pride. These are some of the random thoughts that float through my head on a daily basis.
But the point I'm trying to make using a poor metaphor of Victorian novels is that people really cared and put thought into what they're trying to say (at least I would hope so). They had writing desks, a piece of furniture designed for just writing! They didn't use crackberries to tweet while on the john in 140 characters or less.
So along with eliminating all the empty calories in my diet (with the exception of tasty single malt scotch, which no one should define as empty simply because it is alcohol), I am eliminating the empty communication in my life.
It reminds me of one of the closing lines from a Supernatural episode: 'You're all so connected...but you've never been so alone.'
How true.
--
*Imagine if bonuses were large like those finance CEOs: there might be misfills everywhere when pharmacists are pressured to increase numbers. But corporate execs would never do that because retail pharmacist salaries are insane as it is.
**Not the actual screenname, but pretty close. Not mines of course. I'm too classy for that.
***This was when Tracy McGrady was out with 'back spasms' and Von Wafer was actually a decent stand-in.
Tuesday, September 28
Po-po Predicament
Dear 5-0,
I have to think that the only people who love (traffic) cops are friends/family of cops. And even they only love the cop(s) that they know. Because people usually dislike those who have authority over them.
And cops can pull you over for any reason, and are in fact pressured to pull you over to increase their numbers/metrics. That's not cool, but This American Life is cool, liberal-ish cool. This 'cold front' hitting the Gulf Coast is mildly cool, but Ira Glass & crew are uber-cool. Anyway, check out their weekly podcast.
Not like it matters to me much. Since I hardly speed because I find my Corolla sitting on 14" starts to creak and shake above 70mph. And I find the gas mileage is insane when put on cruise control at 60mph (yes, I'm the jerk in the right hand lane chilling at 60mph, listening to podcasts on long drives because I like to not have to be on the lookout for cops sitting under bridges or just over hills).
But when I start to hit the greater Houston metro area, I turn off my cruise control and start driving attentively aggressive like everyone else. Because if you're doing 60 on a Houston freeway and it's not rush hour, you're bound to almost get slammed by some large truck bearing the flag of Texas and/or Mexico. Or an old caddy driven by grandma. Or a Lexus LS driven by Asian grandma. Or Charger/300 driven by middle-aged African-Americans. Or Infiniti Gs/Nissan Zs driven by Asian males. Of which, the latter two groups are rolling on glimmering dubs or dubs+.
But at least you don't have to worry too much about the nicer sports cars because the drivers care too much about their whips to get into accidents with your jalopy. When they cut you off, they know that they're not in any risk of messing their paint job--if you get distracted/pissed and wreck your car, then that's your fault. That's just my take, since I'm hopefully going to be upgrading my vehicle soon.
--
So when US-59 turns into 3 lanes somewhere around Grand Parkway, I turn off the aforementioned cruise control, because [stuff] starts to get stupid with these idiot drivers. I caress and careen the steering wheel and the car, respectively, to avoid the speeders and the tortoises. I check out the cop sitting under the bridge in his light-grey 'POLICE' on white cruiser--Impalas (and moderately priced American cars) without rims are dead giveaways. I take the Beltway exit and check the rearview to make sure the 'Scalade behind me slows down a bit while he's checking out his shades in the mirror. Some people can be so narcissistic, not that I'd know anything about that (end sarcasm).
Then I take the first exit off the Beltway because it's the last free exit. I still haven't gotten the EZ tag yet, which I really should, considering I'm not poor anymore and can afford the couple bucks to avoid those atrocious Beltway feeder lights (which are synced so that you hit every damn one no matter how fast/slow you drive). My parents paid upwards of $10 to cross a bridge in NYC when we lived there; I should feel thankful to pay a buck-fifty to avoid some traffic lights.
And then just after the Hwy 288 intersection, I get a bit of amusement. Just some background about this tollroad: the Beltway 8, aka Sam Houston Tollway, completely encircles the greater Houston Metro. It costs about $1.50 to make it through an 1/8 of the circuit which is around $12 to make a complete revolution, which would take you a couple of hours (though I don't know why you'd do that except if you were a Nascar fan). The feeder, or frontage road, which runs adjacent to the tollway, is completely free, but depending on the section can have a crapload of lights. With the exception of going over the Houston Ship Channel and some other spots (I assume), you can use the frontage road and just pay with your time wasted on the lights. That is, it's free if you've got some time to kill.
Houstonians have made it a habit of killing time and the environment to save some coin. So the Beltway feeder can be packed at times. And it's only 2 lanes which wouldn't be a problem if people followed the generally accepted rules of a 2 lane highway, which the Beltway feeder mimics: slower traffic to the right, left lane for passing only.
I think in smaller towns and country roads, left-lane-for-passing-only is a law and you can get ticketed. But not in Houston of course. So all the time I see jerks driving the speed limit in BOTH lanes next to each other, not letting people pass for a good couple of miles. I've decided that it's usually because they're not paying attention to their surroundings, and not because they're vindictive a-holes. Chalk it up to my naivete or hope for humanity.
So when it happened this time around, I wasn't surprised. I just turned up Katy Perry's Teenage Dream on the radio ('yea girl, I think you're pretty without any makeup on, now can I put my hands on you in your skin-tight jeans? ;)') to turn down my frustration. But then I noticed the cause of this vehicular rudeness: a cop car.
I pass by a speed limit sign: 50 mph. I look at my odometer: 50 mph. I look at the cars: 50 mph, deduced by using relational physics. In redneck speak: 'He goin 50 cuz I'm goin 50 and I ain't passin em like Dale Earnhardt.'
And the cop just tailed them for a few miles, and finally got to his turn off the feeder. He seemed pissed because he got halfway into the left lane, but then decided that the other car wasn't going to speed up or slow down either. And it's not like he could pull them over for any moving violation: they were obeying the law--50 mph. But the cop knew and the two cars in front of him knew and I knew that everyone drives 65 on the feeder if they're under 65 (years old).
That's that. I guess this would be a Seinfeld-like post, an episode about nothing.
I have to think that the only people who love (traffic) cops are friends/family of cops. And even they only love the cop(s) that they know. Because people usually dislike those who have authority over them.
And cops can pull you over for any reason, and are in fact pressured to pull you over to increase their numbers/metrics. That's not cool, but This American Life is cool, liberal-ish cool. This 'cold front' hitting the Gulf Coast is mildly cool, but Ira Glass & crew are uber-cool. Anyway, check out their weekly podcast.
Not like it matters to me much. Since I hardly speed because I find my Corolla sitting on 14" starts to creak and shake above 70mph. And I find the gas mileage is insane when put on cruise control at 60mph (yes, I'm the jerk in the right hand lane chilling at 60mph, listening to podcasts on long drives because I like to not have to be on the lookout for cops sitting under bridges or just over hills).
But when I start to hit the greater Houston metro area, I turn off my cruise control and start driving attentively aggressive like everyone else. Because if you're doing 60 on a Houston freeway and it's not rush hour, you're bound to almost get slammed by some large truck bearing the flag of Texas and/or Mexico. Or an old caddy driven by grandma. Or a Lexus LS driven by Asian grandma. Or Charger/300 driven by middle-aged African-Americans. Or Infiniti Gs/Nissan Zs driven by Asian males. Of which, the latter two groups are rolling on glimmering dubs or dubs+.
But at least you don't have to worry too much about the nicer sports cars because the drivers care too much about their whips to get into accidents with your jalopy. When they cut you off, they know that they're not in any risk of messing their paint job--if you get distracted/pissed and wreck your car, then that's your fault. That's just my take, since I'm hopefully going to be upgrading my vehicle soon.
--
So when US-59 turns into 3 lanes somewhere around Grand Parkway, I turn off the aforementioned cruise control, because [stuff] starts to get stupid with these idiot drivers. I caress and careen the steering wheel and the car, respectively, to avoid the speeders and the tortoises. I check out the cop sitting under the bridge in his light-grey 'POLICE' on white cruiser--Impalas (and moderately priced American cars) without rims are dead giveaways. I take the Beltway exit and check the rearview to make sure the 'Scalade behind me slows down a bit while he's checking out his shades in the mirror. Some people can be so narcissistic, not that I'd know anything about that (end sarcasm).
Then I take the first exit off the Beltway because it's the last free exit. I still haven't gotten the EZ tag yet, which I really should, considering I'm not poor anymore and can afford the couple bucks to avoid those atrocious Beltway feeder lights (which are synced so that you hit every damn one no matter how fast/slow you drive). My parents paid upwards of $10 to cross a bridge in NYC when we lived there; I should feel thankful to pay a buck-fifty to avoid some traffic lights.
And then just after the Hwy 288 intersection, I get a bit of amusement. Just some background about this tollroad: the Beltway 8, aka Sam Houston Tollway, completely encircles the greater Houston Metro. It costs about $1.50 to make it through an 1/8 of the circuit which is around $12 to make a complete revolution, which would take you a couple of hours (though I don't know why you'd do that except if you were a Nascar fan). The feeder, or frontage road, which runs adjacent to the tollway, is completely free, but depending on the section can have a crapload of lights. With the exception of going over the Houston Ship Channel and some other spots (I assume), you can use the frontage road and just pay with your time wasted on the lights. That is, it's free if you've got some time to kill.
Houstonians have made it a habit of killing time and the environment to save some coin. So the Beltway feeder can be packed at times. And it's only 2 lanes which wouldn't be a problem if people followed the generally accepted rules of a 2 lane highway, which the Beltway feeder mimics: slower traffic to the right, left lane for passing only.
I think in smaller towns and country roads, left-lane-for-passing-only is a law and you can get ticketed. But not in Houston of course. So all the time I see jerks driving the speed limit in BOTH lanes next to each other, not letting people pass for a good couple of miles. I've decided that it's usually because they're not paying attention to their surroundings, and not because they're vindictive a-holes. Chalk it up to my naivete or hope for humanity.
So when it happened this time around, I wasn't surprised. I just turned up Katy Perry's Teenage Dream on the radio ('yea girl, I think you're pretty without any makeup on, now can I put my hands on you in your skin-tight jeans? ;)') to turn down my frustration. But then I noticed the cause of this vehicular rudeness: a cop car.
I pass by a speed limit sign: 50 mph. I look at my odometer: 50 mph. I look at the cars: 50 mph, deduced by using relational physics. In redneck speak: 'He goin 50 cuz I'm goin 50 and I ain't passin em like Dale Earnhardt.'
And the cop just tailed them for a few miles, and finally got to his turn off the feeder. He seemed pissed because he got halfway into the left lane, but then decided that the other car wasn't going to speed up or slow down either. And it's not like he could pull them over for any moving violation: they were obeying the law--50 mph. But the cop knew and the two cars in front of him knew and I knew that everyone drives 65 on the feeder if they're under 65 (years old).
That's that. I guess this would be a Seinfeld-like post, an episode about nothing.
Friday, September 17
Esquire Survey of American Men
Dear the metrosexual,
A shorter post today.
A couple of years ago, I had a discussion with a good friend of mine about which magazine subscription to get for general manliness (as in how to be man, not how to get men). In a way, it reminded me of the Superbad opener where Michael Cera and Jonah Hill describe the perks/downsides of subscriptions to particular porn websites. Except ours was a serious discussion and not a debate between the post-pubescent absurd. (Since we all know that [website expunged] has the best stuff for free!)
We narrowed down the choices between GQ, Esquire, and Men's Health, all very nicely put together magazines. Maxim et al did not make the cut since we're classy guys.
'Men's Health has articles on workout regimens and stuff. It also has some nutritional primers in addition to how to dress.' 'Yes, but GQ and Esquire go into more detail about fashion and accessories.' As you can see, the conversation was graduate level in its complexity and simplicity.
I'm not quite sure how we manage to not drown in the reflecting pool while admiring our Narcissus-ine qualities. He got married, and it's working for him. I drink, and I guess that helps.
Joking aside, those magazines really have some good articles in addition to the stuff pandering to men's baser instincts. There was a Fall guide in GQ I recently perused about the closet essentials. I knew most of the stuff on watches (I prefer slim and elegant vs the cheap, chunky monstrosities that some guys choose to sport), but the guide on mixing & matching colors and textures was truly enlightening. It takes confidence to fly in the face of the color wheel once you've learned what colors work and don't work together.
And at least for guys, you can get a few essentials in high quality and then mix everything else in. There's almost no need to redo an entire closet; just pick a staple, add some flair, and walk confidently knowing that you're worth a million bucks. Because at least to some girls in the world, you are worth that or even more. Excuse the hopeless romantic. -5 man cards.
--
This morning on the Today Show, there was a segment about a survey done by Esquire of 20 and 50 year old men. Of course they hyped it up and advertised it for about 2 hours before actually getting to the interview with the editor (or whomever), and it was almost kind of worth it.
On the segment, they played up how it seems that 20 year olds may have a more conservative lean towards relationships and such. They cited 2 survey questions in which more 20 year olds than 50 yo said that 'divorce was never an option' and that they (20 yo) preferred their wives to be stay at home moms. After reading through the survey myself, I think the subtle difference was overdone. People love to cite proof which contradicts common opinion/knowledge (that 20 yo are out sticking their members in anything that moves).
But weak evidence aside, I've noticed personally that in my generation of early 20 year olds, there seems to be a higher frequency of commitment vs the dudes in their late 20s. Five of my friends are married, and more are dropping like flies. One of them is even having a kid. (This is a sample size of college graduates or soon to be college graduates in the South). If this trend continues, the CDC will have to get involved.
It is all quite a bit upsetting to me, as you can well imagine. Even if one feels that one is making a good decision by being promiscuous (or, more accurately, having the option to be promiscuous), when one's friends are all enjoying (or succumbing) to the married life, one starts to reconsider one's lifestyle.
Don't hate me, but I think the only mistake Tiger Woods made was to get married when he wasn't ready. If he was single, who would care about his multiple sex partners and his slight deviance towards sadism? And it's not like he had to get married to get action--this dude's going to be worth a billion bucks by swinging at a stationary object.
So I'm guessing commit if it works for you? Otherwise, hold off until you're sure? I am Catholic so there's the whole if-you-divorce-you're-going-to-hell-because-of-the-hardness-of-your-heart thing.
Anyway, read the survey if you're bored. Chime in if you're irate at my Tiger Woods' comment.
Tuesday, September 14
Luxury of Portability
Dear pocket pooch owners,
There is something to be said for being so portable that you can carry all your life's possessions on a handkerchief tied to a pole set on your shoulder, like in those old cartoons of Tom & Jerry.
In the modern era, there's so much that is put on possessions. I fantasize that in the olden days, people didn't have much stuff so they could literally pack up like the guy in the picture and move on to the next town to work for their daily bread.
But it has become almost impossible to do that comfortably in the latter part of the past century. You have to have identity documents, Social Security number, birth certificate, a mailing address, past references, more than a couple of outfits, etc, etc. Then there are the computers and TVs and other creature comforts to bring along.
But in this century, everything has been downsized to the point that it has become almost practical to live off the clothes on your back and your smartphone in your pocket. I would know: I live out of a suitcase with just my dress clothes for work and my trusty Droid smartphone which has me eternally linked to the outside world.
Most of the furniture I had bought for my apartment in Dallas sits disassembled in various closets at my parents' house. The only recurring bills I have are that of the extended stay hotel I frequent every other week for work and the $50 I give my parents monthly for being on their phone plan. Everything else has been virtually distilled to online access, like email, work stuff, banking, investments, etc. Pretty much the only physical mail I get comes from my alma mater asking me for money. (Sorry school, now that I've crossed the economic chasm, I'm trying to widen it, not close it!)
This past week, I didn't use my laptop once since I didn't have to. The web browser on my phone is capable enough to do pretty much everything I need except play Flash* videos and print documents. And I can even track my fantasy football team! If the next iteration of the iPad is good enough, I may even be able to dispose of my laptop (though it would be hard to touchtype reliably on a non-physical keyboard).
And it is so refreshing to have become so portable since I've always hated to move. My parents and I moved around so much as a kid that I've grown to despise the sight of Uhaul and Ryder trucks. It meant that we'd have to pack and carry all the junk we've accumulated to another place, unpack the junk, accumulate more junk, and rinse & repeat. And it would always be stupid stuff like an old mattress that would give me back problems or a pieces of scrap wood and tubing that Dad thought might be useful in random situations. In our garage right now, there are about 15 motors from old scrap washing machines that my parents thought can be sold eventually, dozens of boxes from old appliances of which some of the appliances are gone, medical textbooks from the 1980s that Dad thinks might still be useful (as if there have been zero advances in the last 30 years), and several pieces of broken lawn equipment among many, many other things worth hardly nothing. I'd estimate that everything sitting in the garage right now would be worth less than $500 altogether. But they refuse to let it go, and they pawn it off on each other: 'It's your mother who wants to keep all the stuff.' 'It's your father. If I throw it away, he'll be mad.'
I think it is because they're packrats that my brother and I became anti-packrats. My brother was first--he boasts he can put everything he really needed in his car and would be good to go in a day or so, and I believe him. And I think I can do the same now. I have realized the error of my ways when I unwittingly and prematurely committed myself to living in Dallas.
It took me 3 trips with my car and once with a friend's pickup truck to move all the stuff I'd accumulated in my 6 months there, and I honestly didn't think there was all that much to bring back. But there was. And it was all very depressing to see the trophies of my independence being raked back to pile up in my parents' house.
The dining/living area during my last week in Dallas. Not usually this messy! Notice empty bottles of Patron and Goose sitting by the fireplace :)
There is something to be said for being so portable that you can carry all your life's possessions on a handkerchief tied to a pole set on your shoulder, like in those old cartoons of Tom & Jerry.
In the modern era, there's so much that is put on possessions. I fantasize that in the olden days, people didn't have much stuff so they could literally pack up like the guy in the picture and move on to the next town to work for their daily bread.
But it has become almost impossible to do that comfortably in the latter part of the past century. You have to have identity documents, Social Security number, birth certificate, a mailing address, past references, more than a couple of outfits, etc, etc. Then there are the computers and TVs and other creature comforts to bring along.
But in this century, everything has been downsized to the point that it has become almost practical to live off the clothes on your back and your smartphone in your pocket. I would know: I live out of a suitcase with just my dress clothes for work and my trusty Droid smartphone which has me eternally linked to the outside world.
Most of the furniture I had bought for my apartment in Dallas sits disassembled in various closets at my parents' house. The only recurring bills I have are that of the extended stay hotel I frequent every other week for work and the $50 I give my parents monthly for being on their phone plan. Everything else has been virtually distilled to online access, like email, work stuff, banking, investments, etc. Pretty much the only physical mail I get comes from my alma mater asking me for money. (Sorry school, now that I've crossed the economic chasm, I'm trying to widen it, not close it!)
This past week, I didn't use my laptop once since I didn't have to. The web browser on my phone is capable enough to do pretty much everything I need except play Flash* videos and print documents. And I can even track my fantasy football team! If the next iteration of the iPad is good enough, I may even be able to dispose of my laptop (though it would be hard to touchtype reliably on a non-physical keyboard).
And it is so refreshing to have become so portable since I've always hated to move. My parents and I moved around so much as a kid that I've grown to despise the sight of Uhaul and Ryder trucks. It meant that we'd have to pack and carry all the junk we've accumulated to another place, unpack the junk, accumulate more junk, and rinse & repeat. And it would always be stupid stuff like an old mattress that would give me back problems or a pieces of scrap wood and tubing that Dad thought might be useful in random situations. In our garage right now, there are about 15 motors from old scrap washing machines that my parents thought can be sold eventually, dozens of boxes from old appliances of which some of the appliances are gone, medical textbooks from the 1980s that Dad thinks might still be useful (as if there have been zero advances in the last 30 years), and several pieces of broken lawn equipment among many, many other things worth hardly nothing. I'd estimate that everything sitting in the garage right now would be worth less than $500 altogether. But they refuse to let it go, and they pawn it off on each other: 'It's your mother who wants to keep all the stuff.' 'It's your father. If I throw it away, he'll be mad.'
I think it is because they're packrats that my brother and I became anti-packrats. My brother was first--he boasts he can put everything he really needed in his car and would be good to go in a day or so, and I believe him. And I think I can do the same now. I have realized the error of my ways when I unwittingly and prematurely committed myself to living in Dallas.
It took me 3 trips with my car and once with a friend's pickup truck to move all the stuff I'd accumulated in my 6 months there, and I honestly didn't think there was all that much to bring back. But there was. And it was all very depressing to see the trophies of my independence being raked back to pile up in my parents' house.
The dining/living area during my last week in Dallas. Not usually this messy! Notice empty bottles of Patron and Goose sitting by the fireplace :)
But that's life I suppose. The original title of this post had been, 'Have Gucci and Prada, will travel,' but that's not true. I don't travel with them (watch & wallet, respectively) because I'm afraid I might lose them or attract the wrong attention. Instead, I have my keys, a Slimmy wallet with bare essentials, phone, a Citizen Eco-Drive, and a suitcase with just enough clothes. On longer trips, I bring a laptop, but that's pretty much it.
I go in, do my work, get out, and get paid. Almost like a professional mercenary. And it is so liberating not to be tied down to physical things.
If the job goes south and I lose my job again, no worries. It will take me less than an hour to pack up and go. I'm already torn. (Excuse my penchant for female pop ballads. I promise I'm straight!). And I don't believe in the born-again movement--Innocence once lost can never be reclaimed.
--
*seriously, what's this deal with Flash not supported on most smartphones? Is it the phone OS programmers or Adobe that's holding up progress?
I go in, do my work, get out, and get paid. Almost like a professional mercenary. And it is so liberating not to be tied down to physical things.
If the job goes south and I lose my job again, no worries. It will take me less than an hour to pack up and go. I'm already torn. (Excuse my penchant for female pop ballads. I promise I'm straight!). And I don't believe in the born-again movement--Innocence once lost can never be reclaimed.
--
*seriously, what's this deal with Flash not supported on most smartphones? Is it the phone OS programmers or Adobe that's holding up progress?
Practicing Scared Pharmacy
Dear poker degenerates,
About a month ago, I was playing 1-2 No Limit Hold Em at Winstar, a casino just a few miles north of the Texas-Oklahoma border. The Winstar poker room happens to be one of the few redeeming things about the Okie state*. The deck was hitting me in the mouth that night, meaning I was catching everything. On one hand, I flopped a boat, sixes over jacks, when my opponent flopped trips (6-6 vs J-9, flop J-J-6), and I proceeded to take the guy’s money. On another, I flopped top two-pair and made a really stupid all-in move out of turn, raising an additional $160 on a $100 bet ($260 total). Fortunately, the guy behind me folded a flopped straight because he respected my tight-aggressive play, and the initial raiser didn’t hit his draw. That sent the folder on tilt, and he berated me with stuff like, ‘I really hand it to you…not many people would have had the guts (sarcasm for ‘stupidity’) to raise all-in with two-pair.’
Then a few hands later, I completed a nut straight draw (Broadway) against the tilter’s flopped set and took the rest of his stack, sending him out the casino door. I had started the night losing my initial $200 buy-in, but scrambled up to $560 with my last bill. But with the cards I had that night, a better player would have made so much more. I was playing scared poker, and it cost me additional winnings.
This was the microcosm hand for the night: I was dealt J-9s on the button with two horrible players sitting to my left in the blinds. The first guy played loose-aggressive slop poker, pretty much continuation betting with any 2 cards after the flop. He bet and folded out of turn, insulted the dealers, and even folded a few hands when he could have checked his cards. The guy to his left was pretty much an open book: he bet his made hands, called his draws, and folded his mess. Easy pickings: I raised to $7 pretty much every time I had the button, and this time I had my favorite hand.
They both call as I lick my chops. The flop comes, and it takes all my power not to drool all over the cards: Q-10-8 rainbow. I flopped the nuts with my J-9, which is the best 5-card hand given the cards on the table. My brother calls it the hon bi, which is literally translated from Vietnamese as ‘the marbles’. They both check, and I make a sizeable value bet, about three-fourths of the pot, hoping that one of them would call. They both do, which made me a little anxious. I put the loose guy on a draw, and the tight guy on top pair, overpair, or a set. A 5 came on the turn. They check, I bet more this time, and they both call again. Now I’m thinking that one of them likely had a set on the flop. The river came. Another 5, a scare card for me. Again they check in front of me. Amateurs love to slowplay. They love to reveal the winning hand and rub it in your face. And I had a belief that at least one of them had turned his set into a boat with the river 5, and this was enough to make me check behind them.
I turn over my flopped straight, and they both muck their hands. Though I don’t know what they truly had, I’d probably say the loose guy had a busted draw (K-J) and was paying me off, and the tight guy had top pair, top kicker (A-Q). And somehow I didn’t make more money after flopping the nut straight. While I was replaying the hand in my head, reviewing all the action, the guy on my right, a solid 19-year old Asian (it’s an Indian casino with a lower gambling age) with a diamond stud in his left ear, needled me with, ‘Dude, why didn’t you bet the river? You had it!’
‘The 5 was a scare card. I thought at least one of them made a full house.’
He considers, agrees silently to himself, and then tries to set me on tilt, ‘So what? Are you playing scared poker?’
I shrugged and smiled. I was winning, and I didn’t care. Looking back, I realize that I had given them odds (at least one of them) to draw out on me. And the odds of them having the boat were slim since they both would have raised (or check-raised) me if they had flopped a set.
Scared poker is my current M.O., and I'm working hard to change that. To triple barrel your nothing against an opponent's something; that is mostly genius and sometimes gross stupidity.
--
Poker is simpler than life in that poker boils down to the chips in front of you. A correct decision nets more chips. A correct decision could also mean less lost chips, which is equally as important. Like life, it is a game of incomplete information; we have to make decisions based on what we know, however little that is. And if we consistently make good decisions, we will make more money in the long run. It is a game which rewards good play and punishes bad play. Therefore, it is a just game. People who complain about bad beats and others' poor play are just not applying themselves.
But life is far more difficult than poker, which is itself an extremely complex game. And it is fraught with injustice: how is playing professional sports worth 100x more than teaching kids how to read and write. Or how is rapping/singing about degrading acts which are performed with semen rewarded better than doing research which paves the way for the cure for HIV/AIDS?
And to set ‘justice’ even more off kilter, we have allowed frivolous lawsuits to dictate our lifestyles. It’s common sense that your coffee should be hot; do you need a warning saying that it could cause you injury if spilled?
What affect me personally are all these inane commercials with ambulance chasers asking people if they’ve suffered injury from medicines. If people read the warnings, there really shouldn’t be anything to complain about: there are risks inherent with any medicine. If Accutane(R) can cause DEATH (suicidal ideation), why are people suing about upset stomachs and diarrhea? As such, there is tremendous risk of not covering your backside as a healthcare professional.
And for myself at least, there is little upside to exposing yourself to liability. In the past 10 years or so, there was some study done in some pediatric journal which purported that common over-the-counter remedies were useless for kids under 6 years. Since then, most manufacturers have removed the dosing for kids under 6. Some pediatricians will swear at you up and down for recommending those medicines while other peds docs will call you an idiot for refusing to recommend them. PharmDs are technically doctors and self-proclaimed ‘medication experts’, and so I guess we do have authority to supersede drug manufacturer labeling. But it's not like I get paid any extra when I make a recommendation which might expose me to a lawsuit if something bad happens.
I know if I recommend common OTC remedies for kids outside of the packaging recommendations (which is ill-advised), most kids will probably end up fine. Their parents will have the placebo effect of giving their kids something to help with the sniffles even though those medicines may not have any effect at all (so the study says) and has absolutely no effect on the curing the true sickness. But heaven forbid if one of those kids decompensates and croaks. Then the parents, their lawyers, and the late local news will be on my ass for recommending the damn drug.
‘We have here ‘doctor’ Nguyen who had recommended a medicine which specifically said not to be used in children under 6. ‘Doctor’ Nguyen, what do you have to say for yourself now that this innocent child is irreparably injured?’
‘You are all absolute idiots. Thank you malpractice insurance for covering my behind. You asked for my professional opinion, and I gave it, and now you're suing me for it. Next time, go Google it, and then sue yourselves.’
No thanks! What do I say on a daily basis? ‘There is nothing labeled for kids under 6 (or 4 or 2 years, depending on the medicine). You can ask your physician about it, and if they recommend it, then I can show you where it is. But I cannot recommend anything outside the package recommendation as I could lose my license.’ If you’re not comfortable doing something, say that you could lose your license--that works pretty well.
One of my friends says that I’m being a coward, that he’d rather help 100 people in need while exposing himself to potential liability, than intentionally being unhelpful like myself. And that’s fine. To each his/her own. I personally like having a license. And it’s far less likely that I’d be sued for refusing to recommend something than for recommending something off-label.
--
In real poker played in casinos, you can only bet and lose what is in front of you. If some guy bets $1,000, and you only have $200 on the table, then you can go all-in to win the $200 part of his $1,000 bet. You don't have to fold or throw in your car keys as they do in the TV shows and movies. In the case of my flopped straight, it would have been the right move (in hindsight) to go all-in as those players had a history of calling with second best hands. In the unlikely case that one of them had the full house, I would have only lost a couple hundred.
In life you can lose so much more, your entire livelihood depending on the lawyer who's suing you. My friend can go ahead and bet all-in with his weak straight. Eventually, one of his opponents will have made a boat and take away all his money, the clothes off his back, and the food from his kids' mouths.
Me? I got bills to pay, and so I practice scared pharmacy.
--
*Why is it that neighbors are so mean to each other or are deemed ‘rivals’? Is proximity like when your bro/sis invade your personal space while in the backseat on long roadtrips?
About a month ago, I was playing 1-2 No Limit Hold Em at Winstar, a casino just a few miles north of the Texas-Oklahoma border. The Winstar poker room happens to be one of the few redeeming things about the Okie state*. The deck was hitting me in the mouth that night, meaning I was catching everything. On one hand, I flopped a boat, sixes over jacks, when my opponent flopped trips (6-6 vs J-9, flop J-J-6), and I proceeded to take the guy’s money. On another, I flopped top two-pair and made a really stupid all-in move out of turn, raising an additional $160 on a $100 bet ($260 total). Fortunately, the guy behind me folded a flopped straight because he respected my tight-aggressive play, and the initial raiser didn’t hit his draw. That sent the folder on tilt, and he berated me with stuff like, ‘I really hand it to you…not many people would have had the guts (sarcasm for ‘stupidity’) to raise all-in with two-pair.’
Then a few hands later, I completed a nut straight draw (Broadway) against the tilter’s flopped set and took the rest of his stack, sending him out the casino door. I had started the night losing my initial $200 buy-in, but scrambled up to $560 with my last bill. But with the cards I had that night, a better player would have made so much more. I was playing scared poker, and it cost me additional winnings.
This was the microcosm hand for the night: I was dealt J-9s on the button with two horrible players sitting to my left in the blinds. The first guy played loose-aggressive slop poker, pretty much continuation betting with any 2 cards after the flop. He bet and folded out of turn, insulted the dealers, and even folded a few hands when he could have checked his cards. The guy to his left was pretty much an open book: he bet his made hands, called his draws, and folded his mess. Easy pickings: I raised to $7 pretty much every time I had the button, and this time I had my favorite hand.
They both call as I lick my chops. The flop comes, and it takes all my power not to drool all over the cards: Q-10-8 rainbow. I flopped the nuts with my J-9, which is the best 5-card hand given the cards on the table. My brother calls it the hon bi, which is literally translated from Vietnamese as ‘the marbles’. They both check, and I make a sizeable value bet, about three-fourths of the pot, hoping that one of them would call. They both do, which made me a little anxious. I put the loose guy on a draw, and the tight guy on top pair, overpair, or a set. A 5 came on the turn. They check, I bet more this time, and they both call again. Now I’m thinking that one of them likely had a set on the flop. The river came. Another 5, a scare card for me. Again they check in front of me. Amateurs love to slowplay. They love to reveal the winning hand and rub it in your face. And I had a belief that at least one of them had turned his set into a boat with the river 5, and this was enough to make me check behind them.
I turn over my flopped straight, and they both muck their hands. Though I don’t know what they truly had, I’d probably say the loose guy had a busted draw (K-J) and was paying me off, and the tight guy had top pair, top kicker (A-Q). And somehow I didn’t make more money after flopping the nut straight. While I was replaying the hand in my head, reviewing all the action, the guy on my right, a solid 19-year old Asian (it’s an Indian casino with a lower gambling age) with a diamond stud in his left ear, needled me with, ‘Dude, why didn’t you bet the river? You had it!’
‘The 5 was a scare card. I thought at least one of them made a full house.’
He considers, agrees silently to himself, and then tries to set me on tilt, ‘So what? Are you playing scared poker?’
I shrugged and smiled. I was winning, and I didn’t care. Looking back, I realize that I had given them odds (at least one of them) to draw out on me. And the odds of them having the boat were slim since they both would have raised (or check-raised) me if they had flopped a set.
Scared poker is my current M.O., and I'm working hard to change that. To triple barrel your nothing against an opponent's something; that is mostly genius and sometimes gross stupidity.
--
Poker is simpler than life in that poker boils down to the chips in front of you. A correct decision nets more chips. A correct decision could also mean less lost chips, which is equally as important. Like life, it is a game of incomplete information; we have to make decisions based on what we know, however little that is. And if we consistently make good decisions, we will make more money in the long run. It is a game which rewards good play and punishes bad play. Therefore, it is a just game. People who complain about bad beats and others' poor play are just not applying themselves.
But life is far more difficult than poker, which is itself an extremely complex game. And it is fraught with injustice: how is playing professional sports worth 100x more than teaching kids how to read and write. Or how is rapping/singing about degrading acts which are performed with semen rewarded better than doing research which paves the way for the cure for HIV/AIDS?
And to set ‘justice’ even more off kilter, we have allowed frivolous lawsuits to dictate our lifestyles. It’s common sense that your coffee should be hot; do you need a warning saying that it could cause you injury if spilled?
What affect me personally are all these inane commercials with ambulance chasers asking people if they’ve suffered injury from medicines. If people read the warnings, there really shouldn’t be anything to complain about: there are risks inherent with any medicine. If Accutane(R) can cause DEATH (suicidal ideation), why are people suing about upset stomachs and diarrhea? As such, there is tremendous risk of not covering your backside as a healthcare professional.
And for myself at least, there is little upside to exposing yourself to liability. In the past 10 years or so, there was some study done in some pediatric journal which purported that common over-the-counter remedies were useless for kids under 6 years. Since then, most manufacturers have removed the dosing for kids under 6. Some pediatricians will swear at you up and down for recommending those medicines while other peds docs will call you an idiot for refusing to recommend them. PharmDs are technically doctors and self-proclaimed ‘medication experts’, and so I guess we do have authority to supersede drug manufacturer labeling. But it's not like I get paid any extra when I make a recommendation which might expose me to a lawsuit if something bad happens.
I know if I recommend common OTC remedies for kids outside of the packaging recommendations (which is ill-advised), most kids will probably end up fine. Their parents will have the placebo effect of giving their kids something to help with the sniffles even though those medicines may not have any effect at all (so the study says) and has absolutely no effect on the curing the true sickness. But heaven forbid if one of those kids decompensates and croaks. Then the parents, their lawyers, and the late local news will be on my ass for recommending the damn drug.
‘We have here ‘doctor’ Nguyen who had recommended a medicine which specifically said not to be used in children under 6. ‘Doctor’ Nguyen, what do you have to say for yourself now that this innocent child is irreparably injured?’
‘You are all absolute idiots. Thank you malpractice insurance for covering my behind. You asked for my professional opinion, and I gave it, and now you're suing me for it. Next time, go Google it, and then sue yourselves.’
No thanks! What do I say on a daily basis? ‘There is nothing labeled for kids under 6 (or 4 or 2 years, depending on the medicine). You can ask your physician about it, and if they recommend it, then I can show you where it is. But I cannot recommend anything outside the package recommendation as I could lose my license.’ If you’re not comfortable doing something, say that you could lose your license--that works pretty well.
One of my friends says that I’m being a coward, that he’d rather help 100 people in need while exposing himself to potential liability, than intentionally being unhelpful like myself. And that’s fine. To each his/her own. I personally like having a license. And it’s far less likely that I’d be sued for refusing to recommend something than for recommending something off-label.
--
In real poker played in casinos, you can only bet and lose what is in front of you. If some guy bets $1,000, and you only have $200 on the table, then you can go all-in to win the $200 part of his $1,000 bet. You don't have to fold or throw in your car keys as they do in the TV shows and movies. In the case of my flopped straight, it would have been the right move (in hindsight) to go all-in as those players had a history of calling with second best hands. In the unlikely case that one of them had the full house, I would have only lost a couple hundred.
In life you can lose so much more, your entire livelihood depending on the lawyer who's suing you. My friend can go ahead and bet all-in with his weak straight. Eventually, one of his opponents will have made a boat and take away all his money, the clothes off his back, and the food from his kids' mouths.
Me? I got bills to pay, and so I practice scared pharmacy.
--
*Why is it that neighbors are so mean to each other or are deemed ‘rivals’? Is proximity like when your bro/sis invade your personal space while in the backseat on long roadtrips?
Sunday, September 5
[Buttocks] Out of You and Me
Dear cliche users,
If I ever hear someone say that stupid phrase, 'Don't assume: you make an ass out of you and me,' I'm going to advise them to put on their most expensive outfit, go to the bad side of town, and walk from liquor store to liquor store flashing $100 dollar bills. See how far that gets them. Or they just can assume that it would probably be a bad idea.
You have to assume, you have the right to assume, and you have to take things for granted. You don't wonder in the middle of the night whether the sun will come out tomorrow or if the sky will be blue; you naturally assume it to happen because it's always happened that way. For those philosophers out there, you're not going to question every damn little thing; you'd go absolutely insane! If you have to question whether each table exists in and of itself, you'd end up eating your lunch on your lap (or does that exist? or does your lunch? or do you?).
Okay, I'm reaching the point of hyperbole. Fine. But I do get tired of people saying I generalize too much or assume too many things. That, I would contend, is the essence of my efficient thought process, the source of my intelligence. I ignore things which I feel don't matter, and I assume things which I judge can be assumed to be true. Then I distill the facts, and make a decision which happens to be correct more often than not. If I ignore what shouldn't have been ignored or assume that which should not be assumed, then I factor it in the next go-around.
People go wrong when they assume things incorrectly, thus leading to false conclusions. Or they assume racist/prejudicial ideas and voice them and get in trouble, ie Michael Richards & Mel Gibson. Caution: link contains excessive use of the n-word.
Good assumption: If you must have racist ideas, it's generally not a good idea to say them in public where people are videotaping you to be put on Youtube.
The more things that can be assumed and the more things that can be ignored, the better and more efficient the decision will be (and the more decisions you can make). That does not necessarily mean that the decision will be more accurate, just more efficient. I don't strive to be perfect in my thought; my quest is to be right the vast majority of the time. I quit going for 100s on grades a while back because perfection hindered progress.
I don't bring this up because I'm irritated that someone attacked my mode of reasoning and logic (to be right a lot of the time rather than all of the time); I bring it up because my OCD has recently flared up rather unexpectedly, and it has been quite frustrating.
To explain, I don't touch light switches or wash my hands to an excessive amount. I do like my things to be clean, in right angles, undamaged, orderly, controlled, etc. But that makes sense to me because it's efficient; I don't have to search for things because I know where they are because they have a place. Moving my stuff or damaging it will certainly piss me off, but it won't be the end of my world.
The weirdest thing, until recently, was that if I was uncertain whether I had locked my car, I'd walk back to check even if it was an entire parking lot. This only happens once every few months. And it is really just paranoia from living in Houston rather than OCD.
The truly OCD thing that has come up deals with the verification of prescriptions. For non-pharmacy folks, pharmacists get paid primarily to verify that a prescription has been filled correctly and that there aren't any major/severe interactions. This is required by law, but the law does not dictate how you're supposed to do it. You can make some hand gestures or pray or chant or trust that your techs did everything correct, but ultimately if the prescription is wrong, you're liable.
Depending on the error, you can be fined, your license can be reprimanded, you can be put on probation, and in the most severe of cases, it can even be revoked, though I've only heard of revocations for unethical things like stealing narcotics or deliberate falsifications (insurance fraud), not for an error in good faith. It's not like in It's a Wonderful Life where the druggist* becomes a bum because he misfilled a prescription for the little kid; if you make an honest mistake, they're probably not going to take away your livelihood. Probably not (again with my assumptions).
But people are another thing. They will sue sue sue like there's no tomorrow. Lawyers find ways to sue for stupid stuff that is already on the drug information sheet. Reglan: 'May cause tardive dyskinesia'. Lawyers think, 'that sounds really bad, so I can probably sue for it!' Accutane: 'May cause death, among other things'. The ambulance chasers, after reviewing the 10 pages of side effects: 'Aha! You didn't say GI side effects! Gotcha!'
So don't misfill. Because it can be potentially bad for the patient as well as very bad for you.
--
Over the past year of being a pharmacist, I've developed my own process for verification. And fortunately, I have not misfilled of my own accord as far as I know. For me, the last step of verification is to make sure that what is in the vial is what it is supposed to be. This means opening the vial and comparing it to the picture on the computer screen or with the stock bottle it came from.
This usually isn't a problem because I fill most of the prescriptions I verify since I work alone at night. And so that last step of comparing pills is generally trivial for me since I trust in my work.
Until now. Nothing has happened; there hasn't been a misfill or even a close misfill. I have found that when I have too much time on my hands, I start to doubt in the certainty of my efficient process. In my thoughts and decision-making, I aim to be most efficient, not most accurate. But as a pharmacist, I aim to be most accurate first, since they don't take your license away for being too slow. When there are several prescriptions waiting, I temper my obsession with being 100% accurate with the necessity to get them out quickly.
On the final step, I check about 3 tablets directly, and then make sure all the rest have the same relative shape and color. Then I close the vial and shake the bottle to see if it's about the right quantity (30 vs 90-day supplies). Easy peasy.
But in the dead of night, I've spent up to 2 minutes doing that last check which should only take 5 seconds max. Open, check, close, shake. Open, check, close, shake. Repeat until I get frustrated.
It's like turning a light switch on and off. It is safe to assume that when you flick the switch, it will work (even though it may potentially not work); you don't have to check 10 million times. I tell myself the same thing with the verification, and it's gotten better. It seems to be really bad when I'm tired, which will happen when you voluntarily work 23 12-hr shifts in a row.
All logic fades, and I'm left with my basest instinct to be right.
--
*not to be confused with a date-rapist, this is the old-school term for pharmacist
If I ever hear someone say that stupid phrase, 'Don't assume: you make an ass out of you and me,' I'm going to advise them to put on their most expensive outfit, go to the bad side of town, and walk from liquor store to liquor store flashing $100 dollar bills. See how far that gets them. Or they just can assume that it would probably be a bad idea.
You have to assume, you have the right to assume, and you have to take things for granted. You don't wonder in the middle of the night whether the sun will come out tomorrow or if the sky will be blue; you naturally assume it to happen because it's always happened that way. For those philosophers out there, you're not going to question every damn little thing; you'd go absolutely insane! If you have to question whether each table exists in and of itself, you'd end up eating your lunch on your lap (or does that exist? or does your lunch? or do you?).
Okay, I'm reaching the point of hyperbole. Fine. But I do get tired of people saying I generalize too much or assume too many things. That, I would contend, is the essence of my efficient thought process, the source of my intelligence. I ignore things which I feel don't matter, and I assume things which I judge can be assumed to be true. Then I distill the facts, and make a decision which happens to be correct more often than not. If I ignore what shouldn't have been ignored or assume that which should not be assumed, then I factor it in the next go-around.
People go wrong when they assume things incorrectly, thus leading to false conclusions. Or they assume racist/prejudicial ideas and voice them and get in trouble, ie Michael Richards & Mel Gibson. Caution: link contains excessive use of the n-word.
Good assumption: If you must have racist ideas, it's generally not a good idea to say them in public where people are videotaping you to be put on Youtube.
The more things that can be assumed and the more things that can be ignored, the better and more efficient the decision will be (and the more decisions you can make). That does not necessarily mean that the decision will be more accurate, just more efficient. I don't strive to be perfect in my thought; my quest is to be right the vast majority of the time. I quit going for 100s on grades a while back because perfection hindered progress.
I don't bring this up because I'm irritated that someone attacked my mode of reasoning and logic (to be right a lot of the time rather than all of the time); I bring it up because my OCD has recently flared up rather unexpectedly, and it has been quite frustrating.
To explain, I don't touch light switches or wash my hands to an excessive amount. I do like my things to be clean, in right angles, undamaged, orderly, controlled, etc. But that makes sense to me because it's efficient; I don't have to search for things because I know where they are because they have a place. Moving my stuff or damaging it will certainly piss me off, but it won't be the end of my world.
The weirdest thing, until recently, was that if I was uncertain whether I had locked my car, I'd walk back to check even if it was an entire parking lot. This only happens once every few months. And it is really just paranoia from living in Houston rather than OCD.
The truly OCD thing that has come up deals with the verification of prescriptions. For non-pharmacy folks, pharmacists get paid primarily to verify that a prescription has been filled correctly and that there aren't any major/severe interactions. This is required by law, but the law does not dictate how you're supposed to do it. You can make some hand gestures or pray or chant or trust that your techs did everything correct, but ultimately if the prescription is wrong, you're liable.
Depending on the error, you can be fined, your license can be reprimanded, you can be put on probation, and in the most severe of cases, it can even be revoked, though I've only heard of revocations for unethical things like stealing narcotics or deliberate falsifications (insurance fraud), not for an error in good faith. It's not like in It's a Wonderful Life where the druggist* becomes a bum because he misfilled a prescription for the little kid; if you make an honest mistake, they're probably not going to take away your livelihood. Probably not (again with my assumptions).
But people are another thing. They will sue sue sue like there's no tomorrow. Lawyers find ways to sue for stupid stuff that is already on the drug information sheet. Reglan: 'May cause tardive dyskinesia'. Lawyers think, 'that sounds really bad, so I can probably sue for it!' Accutane: 'May cause death, among other things'. The ambulance chasers, after reviewing the 10 pages of side effects: 'Aha! You didn't say GI side effects! Gotcha!'
So don't misfill. Because it can be potentially bad for the patient as well as very bad for you.
--
Over the past year of being a pharmacist, I've developed my own process for verification. And fortunately, I have not misfilled of my own accord as far as I know. For me, the last step of verification is to make sure that what is in the vial is what it is supposed to be. This means opening the vial and comparing it to the picture on the computer screen or with the stock bottle it came from.
This usually isn't a problem because I fill most of the prescriptions I verify since I work alone at night. And so that last step of comparing pills is generally trivial for me since I trust in my work.
Until now. Nothing has happened; there hasn't been a misfill or even a close misfill. I have found that when I have too much time on my hands, I start to doubt in the certainty of my efficient process. In my thoughts and decision-making, I aim to be most efficient, not most accurate. But as a pharmacist, I aim to be most accurate first, since they don't take your license away for being too slow. When there are several prescriptions waiting, I temper my obsession with being 100% accurate with the necessity to get them out quickly.
On the final step, I check about 3 tablets directly, and then make sure all the rest have the same relative shape and color. Then I close the vial and shake the bottle to see if it's about the right quantity (30 vs 90-day supplies). Easy peasy.
But in the dead of night, I've spent up to 2 minutes doing that last check which should only take 5 seconds max. Open, check, close, shake. Open, check, close, shake. Repeat until I get frustrated.
It's like turning a light switch on and off. It is safe to assume that when you flick the switch, it will work (even though it may potentially not work); you don't have to check 10 million times. I tell myself the same thing with the verification, and it's gotten better. It seems to be really bad when I'm tired, which will happen when you voluntarily work 23 12-hr shifts in a row.
All logic fades, and I'm left with my basest instinct to be right.
--
*not to be confused with a date-rapist, this is the old-school term for pharmacist
Wednesday, September 1
Music for Any Occasion
Dear Hooked-on-Phonics,
I can never be too confident when I spell 'occasion' (see above title). I rely on Firefox's trusty spell-check feature to put red squiggly lines when I'm being ESL* which I catch myself doing more often then I'd like, such as dropping the 's' off of verbs when the subject is singular and dropping prepositions, ie 'she like the way mi** sound like F-O-B.' But even with technology, the trend is going more towards Jersey Shore and less towards proper English. Oh well.
--
The great thing about working in Victoria is that it's only a couple hours away from Houston. 97.9 the BOXX extends to just about 30 miles out of town, so I have to endure just half an hr of Victoria Top 40 before I heard Bun B's hot new single: Trillionaire (Explicit). Damn Bun B hits it hard, even without Pimp (RIP). T-Pain ain't no slouch neither. When I got to town I heard a screwed (slowed up) version of Twista, but even at half-speed he's still unintelligible to me. So what is this? Have I abandoned my 2pac for some club trash (not saying Bun makes club trash per se, but most of the stuff on the radio is club trash)? Neva homey!
Just things are different now. I'm out of poverty. I'm out of the prison of my own mind. Life could be better, but life is good. I can complain but that's only because complaining comes naturally to our species. So when I bang 'Me Against the World,' it's just not the same anymore. Because it's not me against anybody; it is just me against the imagined boundaries I've put up for myself. Of course I'll never play pro basketball, but everything else is within the realm of possibility.
So I'm starting to listen to more rainbows, sunshine, and honeydews. More Sheryl Crow, less Eminem (who was sorta depressing to listen to). More Colbie Calliat, less Bone Thugs. Etc, etc.
And I guess that's just growing up. And I guess that's why successful musicians make so much money (even more than me!): they create mirrors for emotions, to help clarify and resolve ephemeral thoughts into the spoken and sung word.. (put more words here...)
--
I woke up after 5 hrs of sleep, and since I didn't have any sedative/hypnotics that I dispense on a regular basis, I was forced to find non-pharmacological ways to get tired again. And after that last little bit about music as mirrors to focus thoughts, I'm mentally spent. So good night (again)!
--
*English is Second Language
**mi is a pronoun for 'I' that Viet people came up with because the original pronouns had more emotional connotations. The Viet language is very relational (as in pertaining to relationships) and to use the pronoun 'I' without relating it to the person you're speaking to may mean that you're pissed off at them. Same with the word 'you.' In a way, it's kind of like speaking in the third person: So to say 'I love you' to Mama, it would be literally translate to 'Child loves Mama.' To say it to a girl, it would translate to 'Man loves woman.' Don't ask me why.
I can never be too confident when I spell 'occasion' (see above title). I rely on Firefox's trusty spell-check feature to put red squiggly lines when I'm being ESL* which I catch myself doing more often then I'd like, such as dropping the 's' off of verbs when the subject is singular and dropping prepositions, ie 'she like the way mi** sound like F-O-B.' But even with technology, the trend is going more towards Jersey Shore and less towards proper English. Oh well.
--
The great thing about working in Victoria is that it's only a couple hours away from Houston. 97.9 the BOXX extends to just about 30 miles out of town, so I have to endure just half an hr of Victoria Top 40 before I heard Bun B's hot new single: Trillionaire (Explicit). Damn Bun B hits it hard, even without Pimp (RIP). T-Pain ain't no slouch neither. When I got to town I heard a screwed (slowed up) version of Twista, but even at half-speed he's still unintelligible to me. So what is this? Have I abandoned my 2pac for some club trash (not saying Bun makes club trash per se, but most of the stuff on the radio is club trash)? Neva homey!
Just things are different now. I'm out of poverty. I'm out of the prison of my own mind. Life could be better, but life is good. I can complain but that's only because complaining comes naturally to our species. So when I bang 'Me Against the World,' it's just not the same anymore. Because it's not me against anybody; it is just me against the imagined boundaries I've put up for myself. Of course I'll never play pro basketball, but everything else is within the realm of possibility.
So I'm starting to listen to more rainbows, sunshine, and honeydews. More Sheryl Crow, less Eminem (who was sorta depressing to listen to). More Colbie Calliat, less Bone Thugs. Etc, etc.
And I guess that's just growing up. And I guess that's why successful musicians make so much money (even more than me!): they create mirrors for emotions, to help clarify and resolve ephemeral thoughts into the spoken and sung word.. (put more words here...)
--
I woke up after 5 hrs of sleep, and since I didn't have any sedative/hypnotics that I dispense on a regular basis, I was forced to find non-pharmacological ways to get tired again. And after that last little bit about music as mirrors to focus thoughts, I'm mentally spent. So good night (again)!
--
*English is Second Language
**mi is a pronoun for 'I' that Viet people came up with because the original pronouns had more emotional connotations. The Viet language is very relational (as in pertaining to relationships) and to use the pronoun 'I' without relating it to the person you're speaking to may mean that you're pissed off at them. Same with the word 'you.' In a way, it's kind of like speaking in the third person: So to say 'I love you' to Mama, it would be literally translate to 'Child loves Mama.' To say it to a girl, it would translate to 'Man loves woman.' Don't ask me why.
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