Pharmacists swear an oath to do no harm. But what about patients? Should they be responsible for their behavior toward us?
Cynthia Cooper“First do no harm.” That was the credo given to me when I graduated from pharmacy school. It implied that I now wielded a degree of power as a practicing pharmacist. I took it to heart.
Pharmacists vow not to harm patients. Our calling is to help them. But should this intention be entirely one-sided? Recent events in my professional life have left me wondering whether any responsibility lies with patients not to harm their pharmacists.
Here’s my story.
I was working the Sunday weekend shift at the retail pharmacy. This was usually a low-key two-day affair that provided a respite from the weekday hustle and bustle. The patient, whom I’ll call "Betty Wiskowski," a woman born in the early 1950s, came into the pharmacy accompanied by a pre-teen boy and a teenage girl.
I asked for the usual information: her name, the number of prescriptions she was expecting to pick up, etc.
Betty answered me adequately and I started the checkout process. She wandered off during my scanning and cash register routine, then eventually wandered back and asked whether she had any insulin ready. I checked the meds that were waiting for her and, not seeing an insulin prescription in her bag, went to a nearby computer to check her profile. I found an active prescription for Lantus vials that had not been dispensed since December 2014 and processed it to fill.
The copay was sizeable, and I mentioned it to Betty. She asked whether I had used her insurance. I checked her third-party set-up and saw that she didn't have active third-party insurance. We had been using one of three “discount” plans available for patients with no active insurance coverage (despite Obamacare, they do exist!).
I asked Betty whether she had her insurance card with her. She dug through her wallet and gave me her card. I updated her third-party information and reprocessed the Lantus prescription. The copay was slightly less than the “discount” copay.
After hearing the amount of her copay, Betty wanted to know why the prescription was still so pricey. I gave her my best guess: This was the first time Betty had used her prescription coverage in 2015, and the large copay was probably being applied toward a deductible.
Betty replied that she still wanted the insulin, so I finished filling the prescription and headed back to the checkout area.
Betty was apparently taken aback that we (the pharmacy?) had not used her prescription coverage for her prescriptions before. I reviewed her “discount” copays for her other prescriptions; they were all approximately $5 for a month’s supply.
I explained that we had not been given her new insurance information previously and had used the lowest discount program available (and had not charged her a “cash” price) and reassured her that her third-party information was now updated.
Betty was adamant that she had paid a “cash price” (not a discounted price) before.
At that point I was not sure where the conversation was headed or what benefit could be had by pursuing the cash vs. discount discussion. I told Betty that that was okay and I was not going to argue with her, then resumed the checkout process.
At that point Betty looked at me and said, “That's right and I know it! You know, you should just go back to Africa anyway, you're just a nigger!"
I stopped and looked at Betty. I looked at the kids she had brought with her. They stood at the counter, looking as though nothing out of the ordinary had just occurred.
Mentally, I ran through my options. Reach across the counter and give Betty a quick and thorough “beat down.” Laugh off Betty's comments in the interest of not upsetting her further. Call for help from store management and have her “gently” escorted from the pharmacy counter.
I opted for No. 3. I called the clerk at the service desk and asked for management to come to the pharmacy to help me with a patient. I then explained to Betty that she had two options: return to the pharmacy the following day (Monday), when I would not be working, or have her prescriptions transferred to another pharmacy where she could pick them up.
Betty and the kids wasted no time telling me, “You can’t do that!”
The clerk reached the pharmacy relatively quickly and I gave him a quick rundown of the situation. He took Betty to a nearby aisle, where she proceeded to become even more vehement about the places I should go, etc. Then she headed back to the pharmacy counter to continue her tirade. Flustered, the service desk clerk beat a hasty retreat.
I could see the situation was not improving.
At that point I called 911, trying to speak with the dispatcher while Betty was yelling in the background, “You’d better not be calling 911!”
The police officers arrived within five minutes and, following the service clerk's procedure, one officer took Betty and the kids down a nearby aisle, while another officer stayed at the pharmacy counter and took my statement.
I gave the officer a brief statement and then had to tend to a couple of other patients who wanted to pick up their prescriptions.
By this time, the store manager had joined the police officers, Betty, and the kids . I continued to concentrate and check out the other waiting patients.
A few minutes after my last patients had been checked out and left the pharmacy counter, I noticed the officers leading Betty and the kids away from the pharmacy area. The officer who had taken my statement earlier returned to the pharmacy and apologized to me for the experience I had just endured. He reassured me that the situation was under control and I thanked him for his help.
The store manager returned to the pharmacy with his assistant. He asked me to write a brief account of the encounter and leave it with his assistant. I filled a few more Sunday afternoon prescriptions, typed my account of the day's events (and left a copy with the assisting manager), and went home.
I will readily admit that I felt an immediate sense of shock (as though I had been physically hit), anger, and disbelief when Betty decided to “play the race card.” At some point, however, the reality of the situation kicked in and I realized that it was up to me how I would react. My awareness that the dynamics of the situation involved not only Betty and me, but also the two kids with her, heavily influenced my reaction.
I was not trying to teach Betty a lesson. But I felt I had a responsibility to somehow send a message to two (seemingly) unreachable kids that Betty's behavior was totally and completely unacceptable.
Betty had somehow reached a point in her life where she thought words like hers were acceptable. How then could I let the kids accompanying Betty know that her words were wrong and very hurtful? Calling the service desk clerk was a first step, but ultimately, calling 911 was the only true step I could have taken to get my message across.
We are all bombarded on a daily basis with accounts of young black men being shot dead by the police, of black-on-black violence, of the hopelessness of the “black experience” in the face of the danger present in our society as a whole. But it does not necessarily manifest itself in our workplace, in our profession as pharmacists.
How do we account for it? In the year 2015, we are all supposed to be in a better place; our mothers and fathers, aunts and uncles, grandparents all fought for our country to be in a better place. But seemingly, we are not - the Bettys survive and continue to spew their own inner ugliness into our lives.
My brief encounter with Betty forced me to choose: fight, laugh, or call for help. My decision to call for help was my way of bearing witness and my attempt to reflect the definition of right and wrong to the kids who accompanied Betty on that Sunday afternoon.
It was also, I believe, the only way I could ultimately help myself stand up as an African-American, as a female, and as a pharmacist, and let Betty know that what she did was not right.
As pharmacists - of any background - who are mindful of the injunction to “do no harm,” we do our best, every day, in the best and worst of times. In this situation, what would you have done?
Cynthia Cooperis a retail pharmacist in rural Wyoming. E-mail her at firstname.lastname@example.org.