Wednesday, May 9, 2007

Retail Pharmacy Rant

At the ripe ole age of 24, I have eight years of retail pharmacy experience. I have worked in various positions within the pharmacy field from working in a district office to working behind the counter (in a store). Last year, my being a college student and the fact one of my bosses was a royal jerk, I transitioned from the district office back to a store. At first I was unhappy and angry about the change; however, most of the unhappiness and anger stemmed from my being screwed over. I was going to write once I got over the anger I started enjoying being on the counter again, but I honestly think it was being on the counter, having the interaction with people and being able to help patients, is what got me over the negative feelings/emotions. (The wonderful coworkers I have probably helped too!)

Pharmacy staffs tend to receive a lot of negative attention; seven out of ten patients always seem to blame their pharmacy before they will blame their doctor's office, insurance company, and especially before the blame falls on the person looking in the mirror. With this in mind, it sure didn't help when Dateline aired its one sided special on pharmacy errors. If you didn't see the special, well, I'm glad, but I'm sure you can look it up on the Dateline website.

There is so much I want to write, so please bare with me. I don't even know where to begin, but I must vent.

PATIENCE: I think problems stem with patients being impatient. Seinfield once joked that pharmacy is simply taking pills from a large bottle and placing them in a small bottle-- if only that were true! There is more to pharmacy than a bunch of people behind a counter counting pills.

TASKS: The pharmacy staff and especially the pharmacist have a lot to deal with on a daily basis. People come in to drop off prescriptions to be filled, speak to personnel via the phone to have prescriptions filled, people use an automated system to have prescriptions filled, and they can email refills in. Doctors basically have the same options; however, new prescriptions can be faxed in from a doctor's office. An important fact to note is that only a pharmacist or an intern can transcribe prescriptions from a doctor's office.

Not all calls are requests to fill prescriptions. People have questions, oh yes do they have questions. We receive questions that range from:
"The label on my bottle says I don't have any refills; is that really true?" to
"I found a white pill in my daughter's bedroom. Is she taking Vicodin?" to
"What's the name of that shop next door to you guys?" to
"Can you spell tourette's syndrome? I want to know because --insert a ten minute story that has nothing to do with pharmacy at all--" to
"I'm taking Coumadin, and I need to take something over the counter for pain. Can you recommend something?" to
"What is the best medication over the counter for a cough?" to the spring classic,
"What can I use to treat my poison oak/ivy?"
Most of the questions, well the serious & medical ones, have to be answered by a pharmacist or an intern.

Questions are also asked by patients when they pick up a prescription. Some of the same questions I listed are asked by patients in the store. And still, these questions must be answered by a pharmacist or an intern. (Hope you're keeping a mental tally of all the tasks of a pharmacist.)

All of the prescriptions filled must be checked by a pharmacist-- no interns allowed on this one. At times your pharmacist might need to check with your doctor, while as a patient you become frustrated with your pharmacy since your wait time is increased, the pharmacist can be saving you from something slight or your life. I've seen numerous doctors miss a patient's drug allergy; however, the pharmacist or a member of the pharmacy team caught it. Remember, this kind of situation only works when YOU provide your pharmacy team with your allergies. I can't even count the times I've been yelled at for asking a patient for allergies-- people seem to forget a person can develop an allergy at any point in his/her life.

Put all of the patient care aside for a moment-- a pharmacy is a business, and pharmacists are the bosses in the pharmacy. Pharmacists have to deal with hiring, training, firing, and scheduling associates. They are ultimately responsible for inventory management and tons of tasks that come down from corporate-- failure to complete tasks or have poor inventory management can result in a pharmacist being written up, no matter if the pharmacist does an excellent job in the filling and counseling portions of the job.

INSURANCE: There are THOUSANDS of insurance plans. It is impossible for any person to know the details of every plan, so you should not expect your pharmacy staff to develop ESP to provide you with the information. The average insurance company lists the names of medications that are preferred and non-preferred on their website. Take advantage of the information on your insurance company's website; take it with you to your doctor's appointment.

If your insurance does not cover a medication or requires a prior authorization before the medication will be covered, it is NOT the fault of your pharmacy staff. Unfortunately, your pharmacy staff has to relay the bad news, but they shouldn't be punished for it. If you need a prior authorization follow up with your doctor's office after the pharmacy has contacted them; let them know you are in the loop because it typically speeds up the process. Beware that insurance companies love to misplace completed prior authorizations, so it might take a couple of tries.

TECHNICIANS: Pharmacy technicians are the cornerstone of a pharmacy. Every pharmacist I have ever worked with will tell you he/she couldn't do it without his/her techs. Dateline mentioned that some techs are in high school and portrayed high school techs as a sin. Well, hate to break it to Dateline but I did an awesome job as a tech when I was in high school-- such a good job that my district manager had me visiting other pharmacies on the weekend to prep them for inventories. It isn't age that matters; it is maturity, and a thorough interview will screen for proper maturity. But in any case, most pharmacies now require techs to be 18 years or older.

Most techs receive on the job training. Yes, there are tech certificates that one can earn from attending classes, but the difference in pay for someone getting on the job experience vs. someone who went through a program isn't much, typically fifty cents. Would you pay a few thousand for a fifty cent pay difference? Your average tech makes $11 an hour. Do you think that attracts America's best and brightest?

Techs do have the option to take a national exam to become a Nationally Certified Technician. Most pharmacies reimburse techs when they pass the national exam and implement a fifty cent raise. Remember the fifty cent raise I mentioned in the above paragraph; the reason it is implemented is because after taking the courses the tech students must take the national exam.

REMEMBER: A pharmacist has a tremendous amount of responsibility upon his/her shoulders since a pharmacist is caring for thousands of people while each person only has to look over him/herself (and possibly other family members). Take some responsibility for yourself and ask all members of your health care team, from doctor's office to pharmacy, questions.

It wouldn't hurt to remember that your pharmacist is someone who completed five to eight years of college to earn his/her degree, not someone who walks on water.

I have more I want to post, but I'll want for another day!


Sibille said...

I really liked this post, very interesting. I think it's easy to forget how many different things pharmacists need to know and that although they are not doctors, people still expect them to know tons of medical stuff.

I try to always be friendly with people in shops/offices/etc and ask question in a manner that is not rude, even if I'm upset about something, and also to say thank you etc when they were exceptionally helpful.

I must admit that it really makes me angry when people are rude though (talking about rude without reason here), because it is their job to be helpful and answer questions. Their have been times in the past where I have made comments or even asked to speak to a person's manager.

Manifestress said...

I've never mentioned this before - my previous husband's dad is a retired pharmacist, and my former husband grew up in the business - doing everything from sweeping the floor to delivering scripts (yes, they did that!)

I have a tremendous respect for my former father-in-law, and of course he is the one everyone in the family calls for advice when they are sick.

Anonymous said...

Just getting around to reading your recent entries...
oh dear--- this sounds like folks treat you all in the Pharm-Biz pretty poorly...
I usually go out of my way if I get excellent service(I typically write a letter of thanks to a manager/supervisor--I've done this with home-repair folks, and retail salespersons, and teachers...)
if I receive poor or unfriendly service, I typically say NOTHING...
Hang in there, and remember MOST folks truly appreciate your hardwork!

Brian said...

Superb post. I am 66, an age I
would not have reached had it not
been for (in the human realm)
parental love, and the love of
other humans, especially health
professionals. On the home page
of a site I no longer have, I
placed a thank you note to them.
Your words here are a sign to me I
need to find that note and place it on my present site. Thank you.

Brian Salchert

Karen said...

I am a current rural retail pharmacist and I truly enjoyed this post. Our small town pharmacy still fills 300 scripts per day and the whole process is sometimes simplified by the media etc. I rarely actually count the pills on the prescriptions I check but I prefer that so I can give it a thorough final check. We take our job seriously and sometimes we are the only accessible health care professional when people need it most. I try my hardest to be an advocate for the patient when trying to get the right medication therapy approved by insurance. This is what the modern day pharmacist does- solve problems, with insurances, drug reviews and when to make the right decisions on emergency care. Thanks for everyones support for the pharmacists around the country, and a friendly understanding patient always make my day and if I can make a difference in their health care I feel like I'm doing my job well.

Anonymous said...

You're wrong about them not being doctors. Older pharmacists who got their degree years ago only had to get a Bachelors degree. Now it's becoming mandatory that Pharmacists get their Pharm D (Doctors of Medicine). So, they are doctors. Pharmacists are Doctors of medicine, and MD's are Doctors of Diagnosing.

Dustin said...

to Anonymous,

Oh, I am very much aware that most pharmacists have earned their PharmD AKA Doctor of Pharmacy degree; however, a lot of patients in GA who I have interacted with, bring scripts to a pharmacy often forgetting that a pharmacist can't change the medication without a physician's authorization.

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