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Pharmacy practice may be changing on many levels, but this pharmacist's vivid word-pictures remind us that some basic issues have never gone away.
This article is a response to the Viewpoint article by Drilon Saliu and Jennifer Goldman-Levine published in the July 2011 issue of Drug Topics (“Pharmacy profession needs major overhaul NOW,” www.drugtopics.com/NOW)
Saliu and Goldman-Levine are correct about the rigorous training that pharmacists receive. It was the same in my day. The major problem was not the toughness of the curriculum designed to give us the expertise to practice pharmacy. Rather, it was the poor introduction to what the real world of pharmacy held in store.
The PharmD degree was a new concept back then. (Yes, penicillin had been discovered by the time I was studying pharmacy. The new miracle drug? Keflex. But I digress.)
Back then, the PharmD was a voluntary degree. Those who opted to go that route and add another year to their studies at the University of Florida actually fulfilled their internship at the College of Pharmacy. Few, if any, ever worked in a real “drugstore” setting. Upon graduation, they went on to teach or work for APhA or some state or local pharmacy organization without ever setting foot inside a community pharmacy. Yet they were the “experts” in the field, advising the rest of us how to practice our profession.
“The Rodney Dangerfields of healthcare”
I love this headline. This isn’t what went wrong, but rather what has always been wrong.
In my day, store owners were pharmacists, but used the filling of prescriptions as a draw to get customers into their stores. While they waited for their prescriptions to be filled, hopefully they would buy things. There was really no interest in their general health, just in their money.
Take wait times. I used to give an idea of the potential wait time by telling customers how many prescriptions I had to fill before getting to theirs. (And this estimate was only if I wasn’t interrupted). I was soon admonished to tell everyone that the wait was 5 minutes. I don’t know about you, but if I am told the wait is 5 minutes, and 20 minutes later I am told the wait is 5 minutes, I’d be upset.
Rodney Dangerfield said, ”I get no respect …” We didn’t respect ourselves! We had to please the customer. Be everywhere at once. Answer phones. Ring up Mrs. Smith’s bottle of brandy at the pharmacy register so no one would know. All this and still be able to fill the prescriptions of 10 different people in the same 5 minutes. We had one doctor who routinely wrote as many as 7 prescriptions on the same blank. Let’s do some math. 7 X 5 = 35. Yet I was supposed to fill all these and the three other prescriptions in front of Mr. Brown’s in the same 5 minutes.
Speaking of doctors, they were God. You never questioned them. If Mrs. Jones wanted her expired Valium prescription refilled, you filled it without “bothering” the doctor with a phone call.
Many pharmacies provided the more important doctors in their area with a dedicated telephone line and phone. Heaven forbid, the doctor should get a busy signal when he called. This phone would ring and before you could say hello, the doctor would be rattling off the prescriptions and then hang up just as abruptly. The veteran pharmacists used to delight at the inability of the newly graduated interns and pharmacists to get all the information. Oh, they reveled in the humiliation of us rookies when we had to call the doctor back. No one seemed to care about what would happen to the patient if the information were transcribed incorrectly.
We’re going to hate ourselves in 30 years
We had placed ourselves at the bottom of the totem pole. We humiliated ourselves and the practice of pharmacy. Promising the biggest scoop of ice cream for the smallest nickel. Promising impossibly short wait times. Undercutting each other on the prices of prescriptions. We couldn’t be higher-priced, we couldn’t be closed, or our customers would go somewhere else. Customers took advantage of that fact.Insurance companies also took advantage of our lack of self-respect. They dictated what they would reimburse us. Rather than bargain as a group, we signed up eagerly; we had to make sure our customers didn’t go somewhere else. “This is not the way,” I thought to myself. “We’re going to hate ourselves in 30 years.
So what’s wrong?
What’s wrong is what has always been wrong. Our lack of self-respect has been preyed upon and exploited. In this computer age, a pharmacist can push out prescriptions at a phenomenal rate. This leaves no time for patient consultation. The chance for errors is increased. When I questioned the potential decrease in quality of patient care, I was terminated.
At my age, and with my history of campaigning against the exploitation of pharmacists, I doubt whether there will be any takers for my services. But I have more stories, and I will relay them if Drug Topics readers wish me to. I just hope that those entering the field will continue to act with dignity in the best interest of the practice of pharmacy.
John Lemberger has retired after 35 years of pharmacy practice in Wisconsin and Florida. He currently resides in Granville, Wisconsin. You can e-mail him at firstname.lastname@example.org,