JP at large: We're at the bottom of the funnel


We're at the bottom of the healthcare funnel, whether we like it or not. Being at the front line, we see many patients who have been marginalized by our society, our culture, and our medical system. They're simply not equipped to navigate through the complexities of the healthcare scheme.

Very few made it to the bottom of the funnel where I used to work in Vermont. Stowe is a ski resort with high-end hotels and spa-advertising resorts. I rarely got the chance to counsel in Stowe, especially concerning OTCs. Locals were well educated, wealthy, and knew exactly what they wanted, so mind your own business, Mr. Druggist. I learned very fast that brand-name dispensing was not to be questioned. I ached to counsel. It is what makes me a pharmacist and not just a dispenser.

The daughter of a very famous spy novel author got her prescriptions filled at the beginning of each month. I told her how much money she could save with the generics. "I want the real thing, Jim." She was gentle compared with the haughty dismissals I usually got. A family of four, with limited resources, in Texas City could eat fairly well for a month on the sum she spent for two Rxs.

I sat down beside her and asked, "Maribelle, don't you have a Medicare Part D plan?"

"I got Medicare, Mr. Jim. My medicine is free." I think she was hoping beyond hope. She couldn't even easily part with the $4 for her glyburide ... at Wal-Mart prices.

I drew a deep breath. I had to tell this bad news to people every week. "Maribelle, this red, white, and blue card is not for medicine."

This is heart-breaking. These people have a hopeless person's faith that the system will take care of them. The system has failed. These people do not know how to navigate through the system. They are victims of the system.

I practically begged Maribelle to bring in a nephew or a neighbor, someone who was Internet savvy. I told her she had only a few weeks of drug coverage left. I was less soul-healthy as I returned to the counter.

You may wonder: Why is this my responsibility? Why should I care? Well, hard heart or not, the pharmacist has always been at the end of the funnel to clean up the mess. It is damn hard to get out of the way.

THE AUTHOR is a community pharmacist who lives in Galveston, Texas. You can e-mail him at
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