I had an interesting conversation with an executive at work the other day. And the words that came out of her mouth were quite telling.
It happened a couple of weeks ago. The flu shot administration frenzy was just starting to hit us full steam.
The store I was working at that day received a surprise visit. A vice president within one of my company’s many divisions stopped by during one of her visits to our area.
I was working with another pharmacist at the time and the two of us chatted with this VIP about the flu hitting our area early this year and how we were busy with flu shots.
After I made a comment about local emergency departments already seeing cases of the flu, She said what I feared upper management thought all along. She told the three of us working that day “I hate to say it, but the flu is good for business!”
I stopped what I was working on at the time and glanced back at the other pharmacist on duty. The glance he gave me back must have been the same glare I reciprocated to him.
We didn’t say a word, and soon after this executive was off to do whatever else those people do with their day. But when she was gone, the other pharmacist complained to me about her sentiment.
It does seem cold and callous to view the seasonal flu outbreaks as a business opportunity. In her defense, I’m sure she didn’t mean what she said the way it came across to those of us that heard the comment. At least I hope not.
But the reality is that community pharmacy is now dominated by a handful of large players. They tend to look more at spread sheets and numbers and forget the fact that people are sick and we are not merely numbers on a report but actual people.
I’m not going to celebrate an illness that claims thousands of lives every year even if it brings big business to my employer and my profession. I recognize that getting the flu is a miserable experience. And it could even kill you.
Most of the time the official words that come from large community pharmacy chain executives regarding the flu reference serving the community or supplying a needed vaccination service. Their messages are as prepared as your average politician’s public statements.
But on that day, one executive let slip how I suspect many retail pharmacy executives really feel about the flu. The reality is that the flu spells big business for community pharmacies. And that business translates into big profits.
What bothers me the most about what this executive said was the company I was with at the time. I was working with a pharmacist who was relatively new to my employer. I can’t imagine what his thoughts were regarding his new employer after hearing comments like that from one of our divisional vice presidents.
This really demonstrates the battle community pharmacists have with their employers about perspective. Pharmacists are trained to think clinically, and our focus is more patient care oriented.
Large corporations are more business oriented. They are more concerned with the Xs and Os of profits, inventories, and balance sheets.
And while it’s true pharmacists can’t simply ignore the business side of retail pharmacy, isn’t it also true that the chains can’t disregard the human aspect of our business? This battle to balance opposing reference points plays out day after day in pharmacies eveywhere.
I hope that particular vice president can look past the dollars and realize that the flu is a serious public health threat. And I hope pharmacists can balance their patient focused backgrounds with the need to keep a business running efficiently enough to keep its doors opened and everyone’s job secure.
Sometimes the truth hurts though. Even if it slips out unintentionally in the form of a passing comment.
The Redheaded Pharmacist
It’s amazing how your perception of the profession of pharmacy changes as you gain experience. You start to see things you didn’t notice before. Or maybe, you notice things you just didn’t want to see before?
I remember earlier in my career. When I first became a licensed pharmacist, the job would occasionally keep me up at night.
Today the stresses of community pharmacy can still cause me sleepless nights. But the root causes of those fits of insomnia have expanded.
When I first started checking prescriptions as a licensed pharmacist my focus was very internal. I was so worried about making a misfill or harming a patient. A couple of times I actually called back to work just to verify some little detail with a particular prescription was correct.
The funny thing about that admission is the fact that the veteran pharmacist I worked with at the time understood. I wasn’t treated as if I was some kind of anomaly. What I was going through was expected as a new practitioner.
For me, it was so easy to put on my blinders and think about my own little pharmacy world. I rarely expanded my focus to anything bigger than my own career. I was happy to be employed and to experience positive cash flow!
When I first started working I didn’t much consider all of the outside forces that could impact my ability to do my job. You could call it the delusion of control. I only needed to make sure my prescriptions were correct and that my pharmacy wasn’t making mistakes. My patients were doing fine so wasn’t the whole profession OK?
It was so easy to get caught up in the work of being a pharmacist that I forgot about what it meant to be one in the first place. I didn’t see the bigger picture. I didn’t think bigger than myself.
The good news is that after you get some experience, some of the anxiety about making mistakes subsides. You gain confidence in your abilities and knowledge. Misfills seem more likely a result of carelessness as much as a personal inability or shortcoming. You start to question the factors that could result in a mistake or even encourage them.
And then you realize there is a bigger picture to the profession. You realize that forces much bigger than yourself are working in ways you never dreamed or feared to influence your ability and even desire to do your job.
It is this realization that has made me think a little differently now. I pay attention to the news more than before. I try to stay informed and even dare to contribute in some small ways. I see the connections that things can have with my ability to do my job. And it’s because I bother to look.
That’s really one of the only pieces of advice I can give to pharmacy students. Learn to look at the profession with lenses bigger than yourself. It will serve you well as the forces of change impact your pharmacy career.
I think we’d all be better served thinking a little bigger than ourselves. The issues and challenges we face will be much easier to tackle as a group project rather than a bunch of independent studies.
It’s time to see the forest AND the trees. It’s time to think big, and then think bigger.
The Redheaded Pharmacist
The American Medical Association (AMA) just concluded their Annual Meeting of the House of Delegates in Chicago on Wednesday, June 19th. And it seems as if the profession of pharmacy was a topic of conversation.
According to the AMAWire, one of the points of discussion for the delegates this year was pharmacist inquiries with practitioners to verify controlled substances. This is the statement they released in response that you will find on the AMA’s website:
The AMA delegates “Issued a warning against “inappropriate inquiries” from pharmacies to verify the medical rationale behind prescriptions and diagnoses, calling them unwarranted interference with the practice of medicine.”
Forgive me for being a bit confused about the last part of that statement. I’ve always been under the impression that the duty of a pharmacist was to ensure prescriptions were written for a legitimate medical condition in the course of a practitioner’s normal scope of practice.
If we are being accused of interference, shall we then be relieved of all responsibilities toward ensuring the best interests of our patients? Are we not the drug expert profession that is the last stop in the chain of treatment from provider to the patient?
Pharmacists are reacting to the AMA’s statements with a fair amount of anger. I can definitely understand this sentiment. We aren’t being treated as healthcare professionals. We are being treated as if we’re some sort of force preventing physicians from effectively treating patients.
In reality, nothing could be further from the truth. Pharmacists exist to work with prescribers, not against them. We are here to help them and to be an insurance policy against drug misadventures.
We look to improve outcomes and strive for ways to utilize medicines properly while minimizing adverse events or other unwanted negative outcomes. This is why the apparent hostility from the AMA confuses me.
There are a couple of problems with the AMA’s assumptions that I will outline below.
1. The AMA brought this on themselves. I’m sorry to say, but the reason for all the inquiries from pharmacies is the rampant inappropriate prescribing of controlled substances. Those so called “pain clinics” that are now all too common do raise concerns. Pharmacies are being forced to re-evaluate filling policies. Pharmacists must heighten scrutiny of all controlled prescriptions as a result of loose prescribing habits. Our concerns are a byproduct of the current prescribing tendencies in America.
2. The AMA’s hostility is misdirected. I can understand your desire to stand up for your place in the healthcare system. However, if you look for the real culprits who question your professional judgement, you will find that they aren’t pharmacists. It is the insurance industry and the pharmacy benefit management world. How many times has a pharmacy called a prescriber because of a prior authorization issue? How many times does a prescription insurance claim rejection include suggested alternative therapies? How often does the average doctor change therapy simply because their patient’s insurance plan will not cover a particular drug?
3. Pharmacists don’t have a choice. We are the last line of defense against medication related adverse effects. We have a moral and professional duty to question something if it doesn’t look right. We aren’t calling prescribers to question their judgement. We are calling to protect our patients. We are calling to do our jobs! Learning why a pharmacist inquires about a prescription is very important for the AMA. We should be partners in the patient care process.
4. Pharmacists are not robots. We can’t be expected to blindly fill any and all prescriptions without questioning their merit. We are healthcare professionals. We are responsible for the prescriptions that leave our pharmacies. We are responsible for the safety of the patients we serve. If there is no expectation for the use of professional judgement by pharmacists, then we should not be held legally responsible for the potential negative outcomes.
The only conclusion I can derive as to why pharmacist inquiries were even a topic of discussion at this AMA meeting was the perception that our profession was somehow infringing on the medical profession. And that simply isn’t true.
I ask the AMA to take a good look at the profession of pharmacy. Then I will ask you to do the same with the health insurance and pharmacy benefit management industries. If you do that you will find the source of the true interference to the practice of medicine. And I’ll give you a hint, it isn’t the profession of pharmacy!
The Redheaded Pharmacist
It’s nice to get away from work every once in a while. But returning can be a real eye opener.
I recently enjoyed one of those “forgot your password” vacations. I took a couple of weeks off to go on a trip with my wife.
My hesitation remembering my password during that first work session back told me I had completely blocked pharmacy out of my mind during my vacation. And that is exactly what a vacation should be.
The funny thing is that you forget little aspects about work during a longer break. The constant standing, the constant rushing, and the wondering about your next meal doesn’t happen on vacation. You eat when you are hungry.
But as I reported back for my first shifts, I had simple little reminders of what I left behind for weeks. Work became a reality once again.
The first clue that I wasn’t in some warm country enjoying a relaxing breakfast with my wife was a reaction I received from a patient dropping off some new prescriptions. Her reaction to me telling her that four new prescriptions would take 20 minutes was simply “it will be that long?”
My legs also reminded me that standing all day isn’t so easy. I had conveniently forgotten about the fatigue that a long day at work can bring.
But most of all, I forgot about the patients. The human wild cards that make retail pharmacy a sort of real life “luck of the draw.” Some patients are wonderful to see, while others make you wish you were somewhere else.
And yes, some woman yelled at me for five minutes about a co-pay she wasn’t expecting or a vacation over-ride she didn’t get from her insurance company. One thing is for sure, I did not miss this scapegoat role.
But in a way it was good to get back to work. The tendency to be lazy while on vacation is almost unavoidable. Getting back to work brought back a sense of structure and purpose to me.
I also didn’t think or write about work. Hence the silence on this blog for weeks.
It was a necessary silence. I was starting to struggle with my writing. Call it part writer’s block and part apathy. Whatever it was, it was affecting my ability to sit down and write posts.
But it’s good to be back working. And it’s also good to be writing again. I needed a break from both but now I’m ready for more.
As that one patient complained about her wait time, I couldn’t help but say to myself “welcome back” with as much sarcasm as you can muster talking to yourself. I’d almost swear some unseen person actually said the words to me at that moment.
It was a simple reminder of what I had briefly escaped while enjoying an extended vacation. And as weird as it is to admit, it was also a reminder of what I had missed.
The Redheaded Pharmacist
My mother deserves so much of the credit for any success I’ve enjoyed in my life. Today is one of those days where I step back and really think about her impact on my life.
Mothers just don’t get enough credit for everything they do. Their influence on the lives of their children are immeasurable.
My mom deserves some sort of medal of honor for all she put up with between myself and my brother growing up. Two boys full of energy are about as much as one mom can handle. Yet she handled the task of raising us with grace and strength.
She definitely deserves credit for helping me become a pharmacist. There were times I wanted to quit pharmacy school and just give up. I’m sure a lot of us have gone through some moments like that as we met the challenges that pharmacy school throws our way.
But it was those times that my mother, among others, was there to encourage me to continue. I’m just not sure I would have been able to finish on my own.
My mom would actually make a good pharmacist herself. Her compassion, kindness, and ability to listen to others would serve her well in the profession. Patients would appreciate her honesty and hard work. She would treat everyone like family.
But today to me isn’t about my pharmacy career. Today isn’t about the job of pharmacist that can frustrate me at times. Today is about the woman who helped me to get to the point where I could find out what pharmacy was like first hand.
So thanks mom. That is the simplest way I can articulate all that I’d like to say to you. My mom has helped this pharmacists through lots of good times and bad.
But today it is her day. Happy Mother’s Day mom! I hope all the mothers out there have a great day.
The Redheaded Pharmacist