Viewpoint: Should a pharmacist admit fault after a dispensing error?

June 16, 2008

The author has mixed feelings about whether pharmacists should apologize to patients after they make a drug error.

Some industry leaders have recommended that we should immediately fess up after we make a drug error. Let me make the case why I don't think the issue is quite that simple.

I happened to be visiting my stepfather when he noticed that half the pills in one of his Rx bottles looked strange. It turns out that his chain pharmacist had mistakenly dispensed Glucophage (for Type 2 diabetes) instead of Toprol XL (for blood pressure). I told my stepfather that I would like to accompany him when he asked the pharmacist what happened. During my stepfather's conversation with the pharmacist, I never identified myself as a pharmacist. The pharmacist who made the mistake was not on duty, but the pharmacist-in-charge spoke carefully. He told my stepfather, "I'm sorry for the inconvenience." He did not say, "I'm sorry for the error." I confess that I probably would have handled the situation similarly.

The issue of whether pharmacists should admit an error and apologize to the customer is extremely controversial to pharmacists in the trenches. Several years ago at a day-long meeting of about two dozen pharmacists in my chain's local district, our supervisor and his boss said that we should admit errors to customers and apologize. During our lunch break that day, the half-dozen pharmacists sitting around my table discussed this issue. A couple of older pharmacists said they had never done it that way before and they didn't want to start now. The implied best way to handle errors was to try to obfuscate the whole thing by claiming, for example, that the drug is a generic. Thus, we could say that the drug is "made by a different company, but we'll give you the one you had before." Let me stress that we do correct the error.

So why would my employer suggest that we admit fault to the customer and apologize? At our table, we concluded that the corporation was trying to protect itself by isolating us on a limb and then, if necessary, cutting off that limb. We figured that the chain would endeavor to get rid of us through various means or transfer us to a different town if the dispensing error were so serious that it received widespread publicity in our community. As a result, most of the pharmacists I know are not eager to apologize to customers.

I wouldn't necessarily mind saying I'm sorry in the following manner: "On behalf of (Walgreens, CVS, Safeway, Wal-Mart, Rite Aid, etc.), I apologize for the error." But this is precisely the opposite of what our employer wants. Our employer wants us to blame ourselves as individual pharmacists rather than fault the corporation for the understaffing that guarantees that errors will occur.

Why should all the blame be directed at the pharmacist when he is often simply the victim of a dangerously understaffed pharmacy? Are you at fault when the store you're working in has poorly trained techs or no techs at all? Are you to blame for the fact that your employer intentionally understaffs pharmacies to increase profitability? I simply have a hard time admitting fault for an error in which there are factors beyond my control. It is shameful that pharmacists are not given enough staffing for the safe filling of prescriptions.

If you are an independent owner and you dispensed the wrong medication, perhaps you have a greater responsibility to admit fault. After all, you have the power to determine staffing levels in your pharmacy. In contrast, employee pharmacists who work for the big chains are powerless to set tech staffing levels. By admitting fault, will we increase the likelihood of the customer initiating a lawsuit?

I am not angry at the pharmacist who dispensed the wrong drug to my stepfather. I know that the McDonald's model of pharmacy makes errors like this inevitable. Nevertheless, we all know pharmacists who are an accident waiting to happen. If the pharmacist responsible for the error in my stepfather's case was simply reckless, a forgiving attitude would probably not be deserved.

THE AUTHOR, a community pharmacist who practices in Delray Beach, Fla., encourages feedback at dmiller1952@aol.com
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