You laughing at me?

August 11, 2008

None of us wants to admit that there could be violence in practicing our profession.

I worked at a pharmacy where being threatened was not rare. Every Thursday I expected to have to put up with the same verbal abuse, same bad language, and the same menace from the same guy before noon. The patient consistently wanted his generics for Norco 10/325, Xanax 2 mg, and Soma 350 mg filled one day before his pharmacy benefit manager (PBM) would pay.

"Ray, your insurance company won't pay until tomorrow." This was the recurring discourse every Thursday. I would tell him that he was a day early, and we would argue. I didn't like it, but I had learned to expect it and even chuckled about it. It was a harmless inconvenience. There was nothing to be alarmed about. Until there was.

My voice was light. "It just seems humorous that we have this same conversation every Thursday."

Ray referred to me with a common insult noun. It starts with an "a", ends with an "e," and he prefaced it with the words: You are a big. "You laughing about this?"

"No, Ray, I would never laugh about this." It was not funny in the ha-ha sense, but it was funny in the creepy sense. It happened every Thursday.

"I don't like you, man," Ray said menacingly, "I think I'm gonna come down there and kick your ass, cut you up a little." He raised his voice. "You won't give me my drugs. That's against the law."

At that point, I hung up the telephone and went back to work. It wasn't over for me, however. I checked for Ray every time the front door opened to see if the cutter was coming after me.

I left that job and did not think about Ray or threats or verbal abuse until I received an e-mail from a young female pharmacist who can't stop worrying. This is an excerpt of what she wrote:

A few hours ago a male entered my pharmacy workplace and became very angry that his prescription was not ready and his insurance was not billed. I began to overhear him tag-teaming with another male patient. I heard him say, to the delight of his pal, "I am going to shoot that bitch." I'm going out to the car and get my Glock. It is ridiculous that you have to wait an hour to get a prescription filled."

His tag-team buddy "woo-hooed" and replied, "Let me know the day you are going to come in and do it, so I can make sure I don't come in here that day." He laughed out loud, "I'd like to see it, but I'm on parole."

This pharmacist went on to talk about violence being a part of the practice of pharmacy. I never thought about it like that. I didn't classify intimidation or threats or bullying as violence. Once I realized that I had compartmentalized violent incidents into a save-for-later file that I never looked at, I've changed my mind. There is too much violence in the everyday practice of pharmacy.

I know a technician who worked where there was a large clientele of drug seekers with prescriptions from pain clinics. Cash customers. Big profits. She was constantly bombarded with F-bombs when a prescription was denied because it was only eight days of a 30-day supply. It wasn't her call, but the cowardly lion pharmacist let her do the dirty work.

A very mean drug seeker coldly promised the technician that he would be waiting by her car at closing time. It was an empty threat, but the unlucky tech finished the day with cramps and diarrhea. The drug seeker was nowhere in sight at closing, but he had planted the chance of violence in her head. She is now a waitress at a nice restaurant.

Violence runs from an intensity of feeling or expression to brute physical force that is meant to injure somebody. None of us wants to admit that there could be violence in practicing our profession. I certainly did not want to admit such an embarrassment. After the e-mail from the frightened young pharmacist, I've taken a look at the save-for-later file. It is chock-full. Over flowing whether I like it or not.

THE AUTHOR is a community pharmacist who lives in Galveston, Texas. You can e-mail him at jpgakis@hotmail.com
and cc us at drugtopics@advanstar.com
. You can also check out his Web site at http://www.jimplagakis.com.