A retail pharmacist examines the consequences of working in a fishbowl

December 11, 2009

Doctors don't do it. Attorneys don't do it. Physical therapists, insurance agents, title agents, audiologist, and nurse practitioners don't do it. Who came up with the fishbowl model of retail pharmacy anyway?

Key Points

Let's address the safety issue first. Compared to other healthcare professionals, pharmacists answer and make more telephone calls, give more FREE professional advice, and ring more cash registers. They personally re-bill and adjudicate insurance claims, and they may deal with more drug abuse/law enforcement issues.

They do all this while supervising cashiers/technicians dealing with client/patient ("customer" in retail lingo) complaints, putting up orders, making orders, performing corporate paperwork according to company policies and procedures, waiting on "customers" at the drive-through, and ... oh, I forgot ... reading, interpreting, and checking the accuracy of prescriptions.

Did I leave anything out? Yes.

As evidenced by the above, any of these distractions can individually or collectively lead to a misfill error. However, there's another factor to consider: the fishbowl issue. In many instances, all these things take place in an open physical environment filled with background noise: telephones ringing, overhead intercoms sounding, and cash registers ringing, as well as the constant distractions of interacting with others, whether staff or pharmacy patrons, further interrupting the prescription filling process and leading to an increased chance of error.

Some operations are addressing these issues by designing pharmacies that physically set the pharmacist apart from many of these distractions, providing some control over their work environment that still allows for the counseling of patients and more efficient processing of prescriptions, a necessity in light of the workload.

But what about the others? How many retail pharmacists deal with prescription fraud and abuse on a daily basis? Prescription drug abuse is common and growing. Does your pharmacy have narcotics and other abused drugs in plain sight of potential drug abusers or criminals who could come back later and rob you at gunpoint? How many of us know of pharmacies that have been robbed at gunpoint or burglarized? In Jacksonville, Florida, my hometown, a pharmacist was shot a few years back because a patient had to wait too long for a prescription. Safety is a real issue for both patients and pharmacy staff in many current retail models.

Walk into many local pharmacies. What do you see in the prescription department? Staff unseen from the shoulders down, looking down, seemingly doing nothing! At least that's what it looks like to a pharmacy patron. In other professions, staff may be stationary much of the time, usually seated, but clients assume they are professionally engaged. What gives? They are not in a fishbowl! Access to them is limited and privacy is preserved, for both staff and clientele.

Yes, pharmacies have "privacy" areas for consultations. But are these really private and professional-looking, compared to other professional environments? No.

And what about communications between pharmacy staff members? How many of us have received a complaint from a pharmacy patron about an overheard conversation between pharmacy staff that had nothing to do with the patron or which the patron misheard?

I remember an incident that took place many years ago during a slow spell in a busy pharmacy where I was interning. I was talking to my preceptor about Phil Niekro, one of the great knuckle-ball pitchers of our time, and a person near the pharmacy misinterpreted the conversation and complained to the corporate office that racial slurs against customers were being used in the pharmacy.

How will changing the model help retail practice? How will it serve a retail chain executive making corporate decisions? For one thing, future pharmacy students may be attracted to the company when they graduate, instead of running as fast as they can from retail because of the professional environment.When staffing is better in the stores, the pharmacist will be able to spend more time in one location, dispensing professional services, which will create a more loyal clientele. And happier professional employees will stay with the job longer, so turnover and therefore personnel costs will be lower. As for safety, the company will be more protected from misfill lawsuits and employees more protected from the occasional deranged or criminal individual seeking to cause harm.

Michael J. Schuh, BS, PharmD, RPh, is a clinical pharmacist in Jacksonville, Florida. He can be reached at SchwaRx1@comcast.net