Quick Hit: The decision to be indecisive

Have you ever had something on your plate that just won’t go away because someone is “thinking about it” or trying to “justify it”? Sure you have. I know I have. I always wonder what the person is thinking about when it takes months to make a decision. Doesn’t the information you have to make the decision become outdated when you wait that long? I for one, can’t think about anything that long because it gives me a headache. And sometimes you simply can’t justify something; it’s a leap of faith.

One thing is for certain, if you’re waiting for the right moment, the moment will never come. Decisions don’t need to be right or wrong, they simply need to be made. Heaven forbid you make a bad call on something. I seriously doubt anyone has gone through life mistake free. If you never make a mistake you’re not trying hard enough in my opinion. Heck, I’d go as far as to say that some of the most valuable lessons I’ve learned have been from my failures. Sure, the failures sting a little, but that’s what helps one learn from the process.

I believe fear is the cornerstone of indecisiveness; fear of making the wrong decision. Choosing to not make a decision is, in itself, a decision. Unfortunately it’s a decision that people repeat time and time again without learning from the mistake of not choosing. The only way to learn to make good decisions is through the experience gained from making bad decisions. Kind of a circular argument, I know. Go figure.

According to Albert  Camus “life is the sum of all your choices.” So what does that say about your life if you don’t make any decisions? Not much.

As Staff Sergeant Nantz so eloquently put it in the movie Battle Los Angeles, “You can go right. You can go left. I don’t give a damn. Just make a decision”.

Is robotic surgery cost-effective? Depends on who you ask.

imageI thought this was very interesting. Dueling robots?

This is where pharmacy is with robotics. We should conduct a little research into their cost-effectiveness versus accuracy and speed. Know what I mean?

The articles below come from Current Opinion in Urology, Jan 2012; 22(1)

Article 1 Pages 61-65

Is robotic surgery cost-effective: yes.

PURPOSE OF REVIEW: With the expanding use of new technology in the treatment of clinically localized prostate cancer (PCa), the financial burden on the healthcare system and the individual has been important. Robotics offer many potential advantages to the surgeon and the patient. We assessed the potential cost-effectiveness of robotics in urological surgery and performed a comparative cost analysis with respect to other potential treatment modalities.

RECENT FINDINGS: The direct and indirect costs of purchasing, maintaining, and operating the robot must be compared to alternatives in treatment of localized PCa. Some expanding technologies including intensity-modulated radiation therapy are significantly more expensive than robotic surgery. Furthermore, the benefits of robotics including decreased length of stay and return to work are considerable and must be measured when evaluating its cost-effectiveness.

SUMMARY: Robot-assisted laparoscopic surgery comes at a high cost but can become cost-effective in mostly high-volume centers with high-volume surgeons. The device when utilized to its maximum potential and with eventual market-driven competition can become affordable.

Article 2 Pages 66-69

Is robotic surgery cost-effective: no.

PURPOSE OF REVIEW: Utilization of robotic surgery has increased dramatically in recent years, but there are significant cost implications to acquisition and utilization of robots. This review will evaluate the cost-effectiveness of using robotics in urologic surgery.

RECENT FINDINGS: This study will evaluate studies comparing outcomes for open, laparoscopic and robotic procedures as well as costs associated with these procedures.

SUMMARY: Current studies have not found the robotic approaches to be cost-effective. In order for the robot to be cost-effective, there needs to be an improvement in efficacy over alternative approaches and a decrease in costs of the robot or instrumentation.

ASHP Midyear 2011–Parting thoughts


The ASHP Midyear 2011 Conference basically concluded for me today. I’d like to evaluate the meeting, but honestly have very little to say. This was my first year working in the role of Product Manager for a vendor, and not acting as an “attendee”, i.e I was here for work. The conference took on an entirely different feel this year as I wasn’t able to attend any of the sessions. For the most part I was stuck in the company booth playing the role of demo jockey. It was a strange feeling to say the least. I tried to follow the Twitter stream (#ashpmidyear) a bit, but finally relented and gave up.

Continue reading ASHP Midyear 2011–Parting thoughts

A look back on one year as a product manager

About a year ago I left the comforts of the pharmacy and struck out into the world of product management. It’s not all that dramatic really. I simply thought I needed a change so I jumped over to the dark side and went to work for a company that builds pharmacy automation and technology. Why not, I love pharmacy technology. The move made perfect sense to me at the time.

Continue reading A look back on one year as a product manager

Fluted Filter Paper

I grabbed a coffee filter this morning to make a pot of coffee – something I’ve done hundreds of times – when I had a moment of nostalgia. The coffee filter took me back to my days in organic chemistry class in college when I used to create my own fluted filters for gravity filtration. I can’t tell you why I had the flashback. Perhaps it’s my body trying to deal with the 50 pounds of food I’ve ingested over the past couple of days; who knows.

Fluting filter paper is common practice in high school and college chemistry labs across the country. The process is done to increase the speed of the filtration process and give one a larger surface area onto which to collect the sample. Pretty low tech, but cool nonetheless. 

MedVantx launches medication adherence program

EMR Daily News:

MedVantx, Inc., has announced the deployment of its patent pending Patient Profile™ patient medication and adherence reporting engine across its network of 3,600 high prescribing primary care providers participating in the Company’s integrated program of initial free medication therapy, adherence management and home delivery program. This new program utilizes the Company’s proprietary automated ATM like sample management system (“MedStart™“) and an integrated secure web reporting portal to provide physicians visibility to their patients’ adherence to chronic medication therapy…

The MedStart™ system automates the traditional sampling process for the physician; captures physician sampling data for inclusion in the patients’ claims history medical record and provides consumers access to highly relevant drug and disease state educational materials. Since patients don’t always get prescriptions filled, physicians can enhance adherence by providing their patients with initial therapy and better informational tools to manage their conditions right from the office…


Now with the availability of the MedVantx Patient Profile™, physicians are able to view data about how patients, on an individual basis, are complying with their prescribed medication treatments.  By showing exactly when a patient fills prescriptions, physicians can detect late refills, gaps in medication fulfillment, discontinued treatments and more to accurately access and improve patient compliance.

Interesting concept. I often wonder if simply getting rid of chain and grocery store pharmacies, and going back to neighborhood community practices would be the best way to improve patient medication compliance. I’ve worked in chain, grocery store and community pharmacies and have always felt that the small community practice knows their patients best and provides the best patient care when it comes to medication management. Something to think about anyway.

More on the system mentioned above can be found at the MedVantx website.

Taber’s Medical Dictionary for Android and iOS

It looks like Taber’s is available for Android and iOS. I don’t often reach for a medical dictionary, but on that rare occasion I do it’s nice to have one laying around.

Would you rather have a five pound paper volume sitting at home on your shelf or an electronic version with you at all time taking up nothing more than a little space on your smartphone or tablet? That’s a rhetorical question really, because it’s a no-brainer.

Dear USBMIS Software User:

Taber’s Cyclopedic Medical Dictionary, 21st Edition is now available for iPad! Taber’s is also avilable for iPhone, Android phones, and Android tablets.

iPad and iPhone Users
View in iTunes

Note: If you already own the iPhone version and use the same iTunes account on your iPad, then the iPad version is free.

Android Phone and Tablet Users
View in Android Market

The Taber’s Cyclopedic Medical Dictionary app includes:

  • Cyclopedic entries that offer more than just definitions.
  • 60,000 reader-friendly definitions.
  • 3,000 brand-new terms and 7,000 revised terms.
  • Over 1,000 full-color illustrations.
  • More than 600 Patient Care Statements.
  • Caution Statements with easy-to-find icons.
  • Dozens of Allied Health and Nursing Appendices.

USBMIS Development Team

Fatal overdose of KCL caused by poor handwriting, lack of diligence

imageISMP Medication Safety Alert: “A nursing home resident died from cardiac arrest after receiving a 10-fold overdose of oral potassium chloride because an order for 8 mEq was misinterpreted by several facility staff members as 80 mEq.” – A poorly handwritten order was a contributing factor to the error. What’s really scary about this error is that an 80 mEq dose of KCL is big, but not unheard of. I’ve entered orders for 80 mEq of oral potassium, however never for a nursing home patient. According to the ISMP Alert “[t]he pharmacist dispensing this medication to the nursing home recognized this was an "unusually high dose" but confirmed it was "correct" by calling the nursing home and speaking with one of the nurses.”

Some simple things that could have prevented this error include some type of CPOE system, a healthy dose of clinical decision support software and pharmacy access to laboratory data. Any one of these could have made the difference.

One other thing worth mentioning. Orders for oral KCL greater that 40 mEq per dose are typically accompanied by instructions for a set number of doses, i.e. 80 mEq po daily x2 doses for hypokalemia. It’s a simple thing, but could be the difference between electrolyte correction and death. In this particular instance the patient received the dose for 8 days before succumbing to hyperkalemia. 


image taken from ISMP Medication Safety Alert, Nov. 3, 2011, Vol 16, Issue 22

The joy of being a cartoon pharmacist

Pharmacists don’t exactly come to mind when you think of notable characters on TV. That’s why I felt compelled to post the short transcript below. It comes from Mort Goldman, owner of Goldman’s Pharmacy on the Family Guy cartoon series as he stands in front of a school class discussing his job as a pharmacist. It’s pretty funny. I tried to find a video clip, but couldn’t. In this case the written word doesn’t do it justice.

Mort: On the whole, I enjoy my job as a pharmacist. In fact, many of my customers are your mommies and daddies. Jimmy Hopkins, your mother had awful postpartum depression after you were born. And Danielle, your father had bad, very bad hemorrhoids that stung him unmerciful. Oh, they were awful. They were like stinky little balloons. And I gave him some special ointment and he hurt so bad that he had to apply it in the car with his sock. Thank you.

Boy: Cool! I want to be a pharmacist!

Boy 2: Oh, yeah!


Family Guy Episode: Mr. Saturday Knight - Aired on Tuesday, Jun 08, 2010

Hmm, retail pharmacy still sucks? Go figure

Jim Plagakis:

The rules of the game as they are designed by CVS and Rite-Aid make the game unwinnable unless you are going to operate as a glorified technician.  It must be downright painful for pharmacists with high personal standards and respect for professional ethics.  I can understand the bitterness.  I can understand the feelings of despair.  I can see the anger.  Just don’t forget:

It’s the JOB, Stupid.  There is nothing wrong with the PROFESSION.

Jim’s post rings home for many pharmacists that live in the retail world. Not the community pharmacy world, which is entirely different, but the retail world.

Continue reading Hmm, retail pharmacy still sucks? Go figure