My Rant Against Retail Pharmacists for Constantly Making Clinical Errors

[winter32842]

I am sorry retail Pharmacists because I know this post is going to offend you. First of all, I know there are some smart retail Pharmacists. This post should not generalize all retail Pharmacists.

I am a hospital Pharmacist. I check my family members' medication profiles. Retail Pharmacists make so many clinical errors. It seem like they always fill medications and never question anything. I caught so many clinical errors made by retail Pharmacists (both for my family members and hospital patients). I think, hospital pharmacists are more careful about making clinical errors. For some reason, retail Pharmacists don't care about clinical errors; they just keep filling as is. If retail Pharmacists don't care about clinical errors, then there is no difference between Pharmacists checking medication orders and technician checking medication orders. If I made any of these errors listed below, I would have got written up for them. My family members are safe because I check my family's medications but what about all the other patients? Who check their medication profile?

Here are some couple of recent errors they made retail Pharmacists:

Today: Pharmacist filled both flovent inhaler and advair inhaler at the same time. There is a duplication of therapy as both contains fluticasone. In this case, advair was discontinued by the doctor when he started my mom on the flovent. The pharmacist was not aware of discontinuation of advair, that's fine but she should have clarified it before filling both at the same time.

One of my patient was taking both warfarin and pradexa at the same time for days. We called the doctor and doctor said warfarin should have been discontinued. Pharmacist got lucky that the patient did not bleed.

One of my family member is allergic to sulfa (reaction = rash), Pharmacist verified Bactrim DS without even calling the doctor. The allergy was listed in the pharmacy profile. I called the doctor and the doctor missed the Sulfa allergy. He changed the medication to cipro.

Retail Pharmacists never ask to update the allergies.for any of my family members. I have to tell them.

There are more mistakes but I can not remember a lot of them. Those 3 incidents are very recent.

What should I do about today's mistake? Should I tell the Pharmacy manager, Walgreen or the Pharmacy board?

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[zelman]

I am sorry retail Pharmacists because I know this post is going to offend you. First of all, I know there are some smart retail Pharmacists. This post should not generalize all retail Pharmacists.

I am a hospital Pharmacist. I check my family members' medication profiles. Retail Pharmacists make so many clinical errors. It seem like they always fill medications and never question anything. I caught so many clinical errors made by retail Pharmacists (both for my family members and hospital patients). I think, hospital pharmacists are more careful about making clinical errors. For some reason, retail Pharmacists don't care about clinical errors; they just keep filling as is. If retail Pharmacists don't care about clinical errors, then there is no difference between Pharmacists checking medication orders and technician checking medication orders. If I made any of these errors listed below, I would have got written up for them. My family members are safe because I check my family's medications but what about all the other patients? Who check their medication profile?

Here are some couple of recent errors they made retail Pharmacists:

Today: Pharmacist filled both flovent inhaler and advair inhaler at the same time. There is a duplication of therapy as both contains fluticasone. In this case, advair was discontinued by the doctor when he started my mom on the flovent. The pharmacist was not aware of discontinuation of advair, that's fine but she should have clarified it before filling both at the same time.

One of my patient was taking both warfarin and pradexa at the same time for days. We called the doctor and doctor said warfarin should have been discontinued. Pharmacist got lucky that the patient did not bleed.

One of my family member is allergic to sulfa (reaction = rash), Pharmacist verified Bactrim DS without even calling the doctor. The allergy was listed in the pharmacy profile. I called the doctor and the doctor missed the Sulfa allergy. He changed the medication to cipro.

Retail Pharmacists never ask to update the allergies.for any of my family members. I have to tell them.

There are more mistakes but I can not remember a lot of them. Those 3 incidents are very recent.

What should I do about today's mistake? Should I tell the Pharmacy manager, Walgreen or the Pharmacy board?

They probably need a new physician.

 

[doublehh03]

The physicians your family members/patients have also seem to make a lot of errors also.

 

[winter32842]

They probably need a new physician.

Pharmacists make the big bucks because they check doctor's work. They should be able to catch easy mistakes like those ones. Like I said in my first post: if retail Pharmacists don't care about clinical errors, then there is no difference between Pharmacists checking medication orders and technician checking medication orders. They both can give the right medications. Anyway, I believe, the first two cases were more of Pharmacist mistakes than doctor's mistakes.

 

[BKpharm]

You are right, it's def the pharmacist job but I think you might need to put ur shoes in the retail pharmacist position and see how quickly they work and how much work is being done per second. Big chains are not allowing us as pharmacists to ve time to go to the bathroom.. Still no excuses but it's only going to get worse if the pharmacist doing tech jobs bec tech hours are cut..

 

[BKpharm]

I can tell you, at cvs.verifying is like 20 percent of your time.. The rest of the time is tech work and filling up paperwork like daily observations and huddle and other things

 

[doublehh03]

Pharmacists make the big bucks because they check doctor's work. They should be able to catch easy mistakes like those ones. Like I said in my first post: if retail Pharmacists don't care about clinical errors, then there is no difference between Pharmacists checking medication orders and technician checking medication orders. They both can give the right medications. Anyway, I believe, the first two cases were more of Pharmacist mistakes than doctor's mistakes.

It's a collaborative effort. If you work in the hospital, you should know.

Pharmacists will miss stuff that doctors will catch. Doctors will miss stuff pharmacists will catch. They're checking each other.

In this case, whoever the doctors and pharmacists are that your mom/patients are, change them. The doctors are doing a poor job of telling the patients of changes and teaching them about what new drugs they will be on, along with point blank missing a huge allergy. The pharmacists are not catching duplication of therapy.

So instead of blaming the pharmacists entirely, you should advise your mother/patients to switch their PCPs and pharmacies.

 

[BidingMyTime]

When I work retail, I catch errors pretty much every shift. The real limitation retail pharmacists have is that they don't have access to the patients medical history (in the vast majority of pharmacies), and most patients are completely clueless.

Today: Pharmacist filled both flovent inhaler and advair inhaler at the same time. There is a duplication of therapy as both contains fluticasone. In this case, advair was discontinued by the doctor when he started my mom on the flovent. The pharmacist was not aware of discontinuation of advair, that's fine but she should have clarified it before filling both at the same time.

Yes, the pharmacist should have clarified it. Are you sure no one talked to your mom? Obviously your mom refilled both, so what would your mom have told the pharmacist if she had talked to her? What if your mom says, yes I'm supposed to take both, or as many patients say when I talk to them about these duplications "I've already talked to my doctor about it, and he wants me on both." Which isn't unheard of, its not uncommon for a doctor to tell the patient to use something like Advair during their bad seasons, and then use Flovent during the rest of the year, of course, the doctor seldom indicates this on the script, we have to take the patients word for it. (whether or not this is the best therapy is a whole 'nother issue, my point is, its not unusual in the period between seasons to see people filling similar inhalers, but they aren't using them together.) What do you think the retail pharmacist should do if its after hours and the patient is insistent on wanting both prescriptions? What I do, unless its something that will put the patient in the hospital, I dispense both and then follow up with their doctor in the morning.

One of my patient was taking both warfarin and pradexa at the same time for days. We called the doctor and doctor said warfarin should have been discontinued. Pharmacist got lucky that the patient did not bleed.

Was there anything to indicate that the patient may have been being switched from one to the other, & continuing on both for a short time (ie the scripts were for less than a full supply)? If the pharmacist really filled a full months supply of both at the same fill, that is a big miss that should have been caught. But is that what happened? Or did the pharmacist fill the warfarin, and then a week later the patient comes back and gets their Pradexa, and then the patient keeps taking both, because the patient forgot they were supposed to stop their warfarin.) What happens to me if I see a situation like this, I will ask the patient " you have a new RX for Pradexa, did the doctor tell you to stop taking your warfarin?" The patient will answer 1) no I'm supposed to be on both (unlikely, at which point I delve futher) or 2) no, but I'll call my doctor tomorrow and ask him (we know that won't happen) or 3) yes, he told me to stop (but its a patient who says yes to everything, because they are listening to the pharmacist & they just want to get out, so the pharmacist mistakenly thinks they are stopping the warfarin, but the patient keeps taking it)

One of my family member is allergic to sulfa (reaction = rash), Pharmacist verified Bactrim DS without even calling the doctor. The allergy was listed in the pharmacy profile. I called the doctor and the doctor missed the Sulfa allergy. He changed the medication to cipro.

This is bad if this was missed. Had the pharmacist talked to your family member about it? And what did the family member actually tell the pharmacist (not what your family member told you they told the pharmacist.) Here is my experience with allergies, dr orders sulfa, pt has an allergy. I ask the patient "I see you have a sulfa allergy, your doctor ordered a sulfa antibiotic, did you discuss your allergy with him?" the patient will answer back 1) I'm not allergic to sulfa, that is wrong, take that off my profile (even though they are the one who told us they had a sulfa allergy) or 2) yes, I'm highly allergic to Sulfa, but I can take Bactrim without a problem (I get this answer more than you would think...).
Not to mention getting an accurate allergy history from an older person is very hard. Often they will say "I have a lot of allergies.", I will say "can you tell me your allergies, or do you have a list of them?", pt will say "no, but my doctor knows about my allergies, so it doesn't matter if you know them." (never mind the fact that when I call a doctor about an allergy, 95% of the time he says the patient told him they didn't have any allergies.)

Retail Pharmacists never ask to update the allergies.for any of my family members. I have to tell them.

Well, this is true, considering how hard it is to get the allergies out of a patient the first time they come to the pharmacy, no we do not ask them if they have any new allergies every time they come in for a refill every other day. That is not reasonable and will only make the patients mad at us.

What should I do about today's mistake? Should I tell the Pharmacy manager, Walgreen or the Pharmacy board?

Yes, you should let the pharmacy manager know. If there is a problem with a certain pharmacist or with the system, then the problem can't be fixed if no one tells them. Everyone (even you) makes errors, so its quite possible these errors happened just the way you describe them. I can't help that suspect though, there is more to the situation, only 1 of the errors you describe seem clearly cut an error (the allergy), the others you did not provide enough information to know what really happened.

The pharmacy board? Really? Does your hospital report you to the pharmacy board every time you make an error? But sure, go ahead. The board is used to dealing with complaints from people and they will add your complaint to their already back-logged list to follow up on. Unless there is a pattern of complaints about 1 pharmacist or 1 store, nothing will be done other than a cursory visit (at least for the kind of complaints you have.)

 

[confettiflyer]

One of my patient was taking both warfarin and pradexa at the same time for days. We called the doctor and doctor said warfarin should have been discontinued. Pharmacist got lucky that the patient did not bleed.

I'm curious about this one...did the pharmacist actually FILL both warfarin and Pradaxa? Or did the patient show up with a new Pradaxa script, have it filled, and went home thinking they should be taking both? Huge difference. The former is a major medical error propagated by the pharmacist, the latter is an error of omission, and I can understand if the busy retail pharmacist didn't have time to call around and investigate...a busy retail pharmacist can make the assumption that the patient was instructed in the office to stop taking warfarin.

 

[confettiflyer]

This is a dumb question, but how to do retail pharmacies handle medication errors internally? Are there investigative teams that look into things, train/retrain pharmacists as necessary? Statistics compiled on individual pharmacists and or any actions/plan of corrections that are instituted when this or that pharmacist commits varying degrees of errors?

I'm seriously asking because I have no idea. I live in hospital-world over here.

 

[zelman]

Pharmacists make the big bucks because they check doctor's work. They should be able to catch easy mistakes like those ones. Like I said in my first post: if retail Pharmacists don't care about clinical errors, then there is no difference between Pharmacists checking medication orders and technician checking medication orders. They both can give the right medications. Anyway, I believe, the first two cases were more of Pharmacist mistakes than doctor's mistakes.

You don't have any information about the process. You only know what the outcome was. Often I will get an asinine e-Rx from a physician (like "Druginol 6mg - take two 5mg tablets every 4 hours for 12 days - dispense #3 tablets"). Calls to the physician result in:
a) no answer
b) person answering phone has never heard of prescriber
c) a voicemail never responded to
d) a voicemail responded to 12-96 hours later
e) person answers phone and says "let me check...[hold for 5 minutes]...the doctor wants [the same thing the e-Rx says because they are reading the same thing you are and not actually asking the prescriber]"
f) a conversation with the provider
Most of those result in the stupid outcomes you've observed. As said above, given zero access to any information beyond whatever was scribbled on a prescription pad, we then ask the patient if they were told to take a duplicate therapy or if they've taken a med before without allergic reaction and have no option other than believing them.

It's possible that the pharmacist was at fault, but we have no information one way or the other.

 

[zelman]

This is a dumb question, but how to do retail pharmacies handle medication errors internally? Are there investigative teams that look into things, train/retrain pharmacists as necessary? Statistics compiled on individual pharmacists and or any actions/plan of corrections that are instituted when this or that pharmacist commits varying degrees of errors?

I'm seriously asking because I have no idea. I live in hospital-world over here.

Yes. All of these things to varying extents depending on the chain. Walmart is big on retraining (I think?) and CVS is big on double-secret probation.

 

[Deja]

yeah, the duplication of therapy thing, a lot of pharmacist misses it... I don't get why, it's probably the easist thing to catch when verifying besides the other basics like names and directions (at least for rite aid computer system)... I constantly catching those mistakes esp from floaters

also the resons given by bidingmytime on how or why this happened are very likely... then again some pharmacist i noticed will fill anything

also if you fill your medication at indepedent pharmacies, they do not check for clinical interactions...maybe its just that one pharmacy...I "worked" at an independent for 2 hours, and they literally just check what the doctors wrote on the hard copy and fill the med... not checking the computer, so no interaction alerts or duplication of therapy alerts... also they have no way of checking hard copy for refills cz they dont use the computer when checking and doesn't scan the image, so if a mistake was made on the first fill, well no one would know....maybe i'm wrong cz i was only there for 2 hours and checked maybe 10 prescriptions

 

[Dr Wario]

Just FYI, I verify on average 45 rx/hr (approx 7 of those will be CII) plus getting phones, doing paperwork, managing technicians, answering stupid questions and giving flu shots. At this pace I am lucky that the patient gets what is on the script, let alone doing a clinical review to make sure they d/ced flovent. Some of us don't have the time to sit in a chair all day and have so little work that they need to fill the time by surfing the net and gossiping.

By the way, was your mom the stupid hag that was yelling in my store about why her script was taking more than five minutes, "all you have to do is slap a label on it!" Customers are the ones who made retail what it is, they voted with their feet and money that what they want is not quality, but speed and cheap.

 

[WVUPharm2007]

I can rant on about some stupid hospital pharmacists, too. Run of the mill hospital pharmacist isn't really that hard of a job itself. Hell, where I used to work they let vanc troughs below 10 just go unadjusted simply because an ID physician didn't think it was necessary to increase the dose. They had the worst ID specialist I've ever seen in my life. That seems pretty stupid and exponentially more dangerous than anything you mentioned, yet it happened. A physician that doesn't know what they are doing with a pharmacist that passes the buck to them can produce some amazingly stupid things.

 

[WVUPharm2007]

This is a dumb question, but how to do retail pharmacies handle medication errors internally? Are there investigative teams that look into things, train/retrain pharmacists as necessary? Statistics compiled on individual pharmacists and or any actions/plan of corrections that are instituted when this or that pharmacist commits varying degrees of errors?

I'm seriously asking because I have no idea. I live in hospital-world over here.

A major error is written up, sent to corporate, and the pharmacist recieves some sort of training. We had new grad get an Rx for 750mg of tramadol for a child...and she filled it. It was deemed too far over the not acceptable line and she was let go.

 

[Sunshine98]

How about when we do take take the time to call a Dr's office that someone will be there to actually take the time to answer our question so we can avoid it? How hard is it to look at a chart for verification? Instead Im shoved to an answering machine, the phone rings off the hook, or as in yesterday's case someone asking me "What do you think?" To which my response was, Im not allowed to override anything without confirmation from a Dr. (As in this case he wrote for a strength that didn't exist). I have a ton of scripts that either need a prior authorization or have questions on that patients cant get because no one in a Dr's office can give me an answer.

 

[sosoo]

medication error is killing more ppl than car accidents. we already know that. CVS has already notified all pharmacists of that. though CVS will continue to be the cause of those deaths by continuing to reduce our tech hours. without proper staffing it is what it is.

 

[M0df]

What Zelman said.

Most of the time when you call doctor, you rarely get to speak to one within appropriate time frame. You also tend to deal with a lot of middlemen and who knows if 'Dr. said it is ok' message is really from a doctor. I leave a note on the label for the pharmacist to be called when the patient is picking up the script for consultation. That works for me as long as I feel information from the patient is enough on that particular interaction.

My issue comes with any of the automatic refill options. I wouldn't refill a script when it is on readyfill and I see potential change in therapy.

 

[Ackj]

My issue comes with any of the automatic refill options. I wouldn't refill a script when it is on readyfill and I see potential change in therapy.

This is a big cause of the duplicate therapies. Although, not only automatic refills, patients can call them in themselves. The fact that retail nearly never receives orders to d/c a med is a major problem. Doctor wrote an rx 364 days ago? Still valid to fill, never mind that it may be horribly inappropriate for the patient today.

The Advair/flovent issue, and pradaxa/warfarin issue, I see them playing out in the exact same way: Patient has an rx for med #1. A few weeks later they drop off a new rx for med #2. Of course we assume this is a change in therapy, talk to the patient about the new med, etc. Some time goes by, we get a refill request for med #1 again. It's a refill, so it's not going to get as close of attention as a new rx will, and it's not going to be flagged for consultation because they've had it before. Did the doc change their therapy back? We don't know. All we have in this case is the patient requesting a refill.

If rx #2 had written "start med #2 d/c med #1" this wouldn't happen. But it didn't say that, and rx #1 is just as valid to fill as rx #2.

 

[confettiflyer]

Damn, reading this makes me appreciate being able to reach a physician within a few mins to clarify something, or that I can hunt them down and corner them at a nurse's station or unit.

I'd probably flip **** dealing with answering machines and MA's all day long.

That said, I completely agree with WVU...incompetent physician + rubber stamp pharmacist = epic medication errors to the nth degree.

 

[sakigt]

As a hospital Pharmacist I verify some crappy orders that on the face of it dont make too much sense (ie: goofy patient taking a statin on one day of the week only, carvedilol IR once daily, etc etc) that are usually home meds. I verify the orders but I always put a clarification note somewhere so that someone who comes behind me can see my thought process.

Its a little unfair to make a face judgement without the underlying info but since theyre family members you probably have a decent amount of info. The duplicate blood thinners issue is a biggie everywhere, there really should be a difference when the warning pops up. Its the same for xarelto and lovenox as it is for xarelto and aspirin. Talk about warning fatigue....

I had an interesting case last night:

Script was for metoprolol (no salt) 25mg once daily

On the bottle: metoprolol (no salt) 25mg once daily

When I finally did a pill ID search I discovered it was tartrate.... DIdnt even know you could dispense without the salt info.... Didnt know if it was ok to choose your own salt either (hell it may have been clarified for all I know).

 

[BenJammin]

Another uppity hospital pharmacist trying to put themselves above retail. This is why we can't have a national organization representing all of us. Back on topic, I catch clinical errors all the time in the hospital. My resident physicians do the same stuff on a weekly basis: order amoxicillin with penicillin allergy, bactrim q8h, converting norco 10/325 1 q8h to morphine 30 mg q4 IV, and discharging with warfarin before we even get an INR to see what they should be placed on are just the tip of the iceberg. Can you place blame on the retail pharmacist? Yes but when you point the finger, three point back at you. Time to look at what the hell the physician thinks he's doing.

 

[PumpkinSmasher]

I know retail pharmacists are busy and do not have time to do the thorough review that they would like to when checking prescriptions. I order a lot of e-script medications in the ambcare setting, mostly chronic disease medications. I always add notes to the retail pharmacist to inform them of increase, decrease, addition, switch, etc. If I stopping stopping NPH and switching to glargine, I will note "please discontinue/deactivate NPH and start glargine". I also do my best to put indications on all medications.

The retail pharmacists in my area always tell me they appreciate the extra information.

 

[WVUPharm2007]

As a hospital Pharmacist I verify some crappy orders that on the face of it dont make too much sense (ie: goofy patient taking a statin on one day of the week only, carvedilol IR once daily, etc etc) that are usually home meds. I verify the orders but I always put a clarification note somewhere so that someone who comes behind me can see my thought process.

Its a little unfair to make a face judgement without the underlying info but since theyre family members you probably have a decent amount of info. The duplicate blood thinners issue is a biggie everywhere, there really should be a difference when the warning pops up. Its the same for xarelto and lovenox as it is for xarelto and aspirin. Talk about warning fatigue....

I had an interesting case last night:

Script was for metoprolol (no salt) 25mg once daily

On the bottle: metoprolol (no salt) 25mg once daily

When I finally did a pill ID search I discovered it was tartrate.... DIdnt even know you could dispense without the salt info.... Didnt know if it was ok to choose your own salt either (hell it may have been clarified for all I know).

You'll get a kick out of his blog post I wrote back in the day.

 

[SpartanLaser]

Hospital pharmacist don't get crazy metrics or timers like retail pharmacists. Furthermore, a patient may use multiple pharmacies and mail order. There is no way u can call every pharmacy the pt has ever gone to to make an updated med list while under the 15 minute timer like how clinical pharmacists can have all the time in the world. Go work in retail fool before u cast judgement!

 

[genesis09]

One of my favorite prescriptions of all time
Lantus vial
Instructions: use per sliding scale.
quantity: qs for 1 month.

Of course it was a Saturday when I got this script and patient didn't understand why I couldn't fill it.

 

[ancienbon]

Hospital pharmacist don't get crazy metrics or timers like retail pharmacists. Furthermore, a patient may use multiple pharmacies and mail order. There is no way u can call every pharmacy the pt has ever gone to to make an updated med list while under the 15 minute timer like how clinical pharmacists can have all the time in the world. Go work in retail fool before u cast judgement!

Could not say it any better. The op does not know how busy a cvs retail pharmacist can be. Yesterday I filled 500 scripts from 8 to 9 pm by myself. .... It is crazy.

 

[SpartanLaser]

My DM wants to move me to a nice 1500 script/wk store. Though i would have to go from floater to PIC......worth it?

 

[MatCauthon]

It isn't just retail pharmacists that make clinical errors. I remember doing my inpatient rotations. Some of the older staff pharmacists were getting pushed into doing clinical/staff hybrid jobs. They didn't know very much. I remember one of them asked me to explain CYP drug interactions because she didn't understand it. How is she supposed to do clinical reviews if she doesn't even understand CYP drug interactions?

Retail pharmacists do have an extremely difficult job, but that still isn't an excuse for not providing good patient care. It is too bad that CVS and other companies are forcing scripts to be verified in such a short period of time. Profile review should, ideally, be a part of every single verification (including refills). However, I usually need an extra 10-15 seconds for profile review. Some companies, like Walgreens, were pushing for rxs to be verified in around 7-10 seconds from what I have heard based on Power discussions. That just doesn't seem like enough time for retail pharmacists to correctly process drug interactions, make counseling notes, and find duplicates.

 

[SpartanLaser]

7-10 seconds seems insane even for walgreens.....

Find some proof, leak that to the public, and it would raise an outcry among patients!

 

[Estrace]

Spend a day working as a retail pharmacist before you can judge us. Not only do you not have the time, you are being pull in 10 different directions all at the same time. I can't even get 5 mins to myself to get rxs left on my voicemail without interruption. The amount of C2 checks I do in a day is ridiculous and your techs want you to leave everything you're doing and attend to their needs first. Actually, when you're just standing there in front of the computer trying to concentrate during verification, some techs will look at you like you're not helping them. Enjoy your gig as a hospital pharmacist and leave retail pharmacists alone. Even some patients can be very stubborn. I remember calling a lady for NTT consultation and she told me to stop bothering her because its her doctor job to monitor her therapy and not me. She told me that my job is just to dispense her meds, period! I like NTT calls because it allows us to talk to patients about things we potentially missed when they picked up the medication. Errors like the ones you listed can be caught during NTT calls.

 

[Whereismynorco]

http://forums.studentdoctor.net/threads/15-mins-or-less-guaranteed-or-5-gift-card.802469/

Any one remember this......... thank god they dropped it but it was terrible back then

 

[BenJammin]

Whatever happened to the "Play my game, did I say your name" scheme allegedly from CVS?

 

[confettiflyer]

Being busy isn't an excuse to f*ck up.

 

[gwarm01]

Retail pharmacists are so busy that they don't have time to thoroughly review patient profiles and handle the clinical side of their job. Meanwhile, some hospital pharmacists have so much time on their hand that they have no concept of what is an appropriate use of their time. I work with one pharmacist who will spend the greater part of their 8 hour shift doing PubMed searches for PRN Tylenol doses or other insignificant issues. Meanwhile, the order queue will begin to back up. Other pharmacists will have to pick up the slack. The nurse has already pulled the med from the Pyxis and now the patient has been discharged. It can be frustrating working with someone who wants to pretend they are being paid to do literature review.

I don't know what the point of that rant was.

 

[fauxden]

Let me bring this to a reddit level discussion:

OP is a douche