A reader compares pharmacists to grocery store checkers. She doesn’t want advice from either one.
Dennis Miller, R.Ph. is a retired chain store pharmacist. His book, The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets, can be downloaded in its entirety at Amazon for 99 cents.
A reader named Mary compares pharmacists to grocery store checkers
As a result of a recent article I wrote for The People’s Pharmacy titled “Was I a Hypocrite as a Pharmacist?”, a reader named Mary posted a comment that, in my opinion, captures the view of many pharmacy customers toward pharmacists and the role they should—or should not—play in our healthcare system.
Mary compares pharmacists to grocery store checkout staff. She says that she doesn’t want advice from either one (pharmacists or grocery store cashiers). She says it’s not their role. She says that I exaggerate the importance of pharmacists in my article. She sees pharmacists as drug dispensers whose only job is to dispense drugs and find any mistakes in doctors’ prescriptions.
“I think the pharmacist is exaggerating his importance. The relationship is between doctor and patient. His role is to dispense what the doctor and patient have agreed to as treatment. It is not his role to intervene, oversee or judge what meds a patient has been prescribed. If there has been an honest mistake in prescribing, of course say so. I suffer from a chronic illness and you would not believe the incidents reported in our support group where a pharmacist has been a disruptor in providing meds. The pharmacist role is to provide. I don’t want the checker at the grocery commenting on my food purchases if they may be unhealthy. Not their role.”
A reader named Barb comments that pharmacists’ sole job is to dispense prescriptions safely
In response to my commentary in The People’s Pharmacy on June 27, 2024, titled “Pharmacists Don’t Seem to be Troubled by These Critically Important Issues,” a reader named Barb posted the following comment on Facebook:
“The pharmacist’s sole job is to dispense my meds safely. They need to know about allergies, drug interactions and indications for drugs. They have no other role in my medical care.”
In my opinion, this is the kind of comment that someone would make who is naïve about pharmaceuticals and the pharmaceutical industry. This reader seems to have a very negative attitude towards pharmacists. She seems to be saying that she’s not interested in hearing anything from pharmacists other than issues regarding drug allergies and drug interactions. That would tend to upset a lot of pharmacists who feel that we have a lot of useful and valuable information for our customers.
A reader named Frank says that pharmacists should stick to their “job description
As a result of a previous article I wrote for Peoples Pharmacy titled “12 Reasons Why Pharmacists Don’t Criticize Pharmaceuticals,” a reader named Frank posted the following comment:
“The scope of pharmacists should be limited to filling and dispensing prescriptions only. Patients should be seeing and talking to their family doctors instead. Patients should read and understand the circulars that come with medications. Outside of their job descriptions, too often high expectations of pharmacists are made.”
A pharmacist named Rick says pharmacy customers “told me to just be quiet and fill their pills”
In response to my commentary titled “Pharmacists Don’t Seem to Be Troubled by these Critically Important Issues,” a pharmacist named Rick posted the following comment in which he says that he has raised with pharmacy customers many of the points I mentioned in my article. He says that some of his customers “told me to just be quiet and fill their pills.”
“I would bring these many points you have mentioned to my pharmacy clients. Basically they admitted they were too lazy to make the required lifestyle changes and that it was just easier to take the pills. Others told me to just be quiet and fill their pills, as their doctor knew best. And as we know, my job depended on filling as many prescriptions as possible because the company didn’t make money if people didn’t fill their prescriptions. Very frustrating to say the least. So glad when I was able to retire.”
Existential Crisis in the Profession of Pharmacy:
In my opinion, these comments reflect the dilemma faced by pharmacists. There is a major crisis in the profession of pharmacy. It goes to the heart of what it means to be a pharmacist. Pharmacy schools and pharmacists’ professional organizations have concluded that there’s no future in dispensing drugs, given the power of insurance companies to continually decrease the dispensing fee.
Pharmacy students and pharmacists have been told that the only future is in providing advice about medications, not in the act of filling prescriptions. With decreasing dispensing fees, chain drug stores decrease their staffing levels to try to remain profitable
Understaffing Has Become the Business Model for Chain Drug Stores:
Understaffing forces everyone to work at maximum output for their entire shift. But understaffing unquestionably increases pharmacy mistakes. There are far more mistakes in pharmacies across America than you would believe.
Can pharmacists transform themselves from drug dispensers to drug advisors?
The concept of transforming pharmacists from drug dispensers to drug advisors appeals to many pharmacists due to the fact that the business of dispensing drugs becomes less profitable each year as insurance companies become more powerful. The huge insurance companies represent an existential threat to the financial survival of pharmacists.
There are two major problems with the concept of pharmacists as drug advisors rather than drug dispensers. First, the big chains are strongly opposed. The big chains do not believe that they have any responsibility to educate the public about medications. The big chains do not see any financial gain in educating customers about pharmaceuticals. Second, a large segment of the public is not interested in being counseled by pharmacists about medications. These pharmacy customers want pharmacists to just shut up and fill prescriptions as rapidly as possible.
Should pharmacists be your guide to pharmaceuticals?
Do you believe that pharmacists should be your guide to the world of pharmaceuticals like a financial advisor is for your money and investments? Of course, not all guides and advisors provide good or useful advice. Do you believe that physicians should tell you everything you need to know about drugs? Do you feel that pharmacists should just fill prescriptions and keep their personal opinions and advice about drugs to themselves? Do you feel that your physician has enough time to adequately inform you about the drugs he/she prescribes? Is our assembly-line medical system conducive to informing patients about medications?
The future of the pharmacy profession lies in patient counseling?
Some pharmacy customers see their pharmacist as a valued source of drug information. Other pharmacy customers see pharmacists as automatons whose only responsibility is to accurately dispense whatever drugs physicians prescribe, check for drug interactions, drug allergies, and whether the prescribed dose is in the ballpark.
That encapsulates the battle being waged in the profession of pharmacy. Given the fact that profit margins are decreasing from filling prescriptions, pharmacy schools are hammering into the heads of pharmacy students a belief that the future of the profession lies in patient counseling, i.e., verbally advising customers face-to-face about their medications.
Pharmacy schools are graduating the kinds of pharmacists that the big chains despise
Pharmacy school professors see that there’s no future for pharmacists as strictly dispensers of drugs. In response, they have this message for students: “We’re preparing you for your job in the future: patient counseling. It’s up to you to figure out how to implement this new model.”
Pharmacy school professors must be living on another planet
The reality is that pharmacy professors have created an idealistic model for pharmacists and expect pharmacists to figure out a way to have this model accepted by the big chains. As a result, chain store pharmacists very often comment sarcastically to other pharmacists that pharmacy school professors must be living on another planet.
The big chains view the pharmacist counseling model as financially nonviable
The pharmacy school professors don’t seem to understand how strongly the big chains are opposed to a model based on pharmacist counseling. The big chains view such a model as definitely financially nonviable. In fact, the corporate level bosses have complete disdain for pharmacists who spend more than a few seconds counseling customers about medications.
Chain store corporate management wants fast pharmacists, not pharmacists who are good at educating the public about medications.
The big chains would like to turn pharmacists into blue collar workers
The big chains greatly prefer pharmacists who like the business side of pharmacy rather than the professional side. The big chains are, in fact, doing everything they can to discard the professional side of pharmacy and turn a white-collar job (i.e., pharmacist) into a blue collar one where pharmacists are paid for their labor, not for their advice about medications.
Even though many pharmacy customers evaluate pharmacists based on the amount of time those pharmacists spend answering customer questions, the big chains evaluate pharmacists based on how fast they fill prescriptions.
Many pharmacy customers view pharmacies like fast food
Many pharmacy customers have very little interest in receiving advice about medications from pharmacists. These customers view pharmacists as dispensing a product which is no different from any product in the marketplace. These customers perhaps view pharmacists as no different from clerks dispensing hamburgers at McDonald’s. These are the type of customer who prefer the speed that drive-thru windows represent rather than the professional aspects of pharmacy that face-to-face discussions with pharmacists represent.
Pharmacists do much more than transfer pills from big bottles to little bottles
Many of our customers see pharmacists as only pill dispensers. There is a widespread belief that all pharmacists do is fill prescriptions. Pharmacists would disagree with the perception that our job description consists merely of transferring pills from big bottles to little ones as fast as we can.
Customers expect speed in filling prescriptions but won’t hesitate to sue us if we make a mistake
Pharmacists face tremendous liability for failure to check for drug interactions, contraindications, drug allergies, for failure to make sure that the prescribed dose is in the ballpark, and obviously for failure to dispense the exact medication ordered along with the correct directions (once a day, twice a day, every 4 hours, etc.).
With decreasing profit margins in the business of dispensing drugs, many pharmacists yearn to move away from the drudgery of dispensing drugs and become advisors about pharmaceuticals. “Patient counseling” is their mantra. Even though many customers see pharmacists as simply pill dispensers, there are many other customers who see pharmacists as a useful source of information about pharmaceuticals. The problem is that the big chains don’t see the “patient counseling” model as financially viable.
Corporate management views pharmacist counseling as a huge drag on productivity
In their advertising, corporate management for the big drug store chains encourages customers to speak with their pharmacist. The reality is that these corporate bosses don’t really want pharmacists to spend time speaking with customers because that takes pharmacists away from filling prescriptions and checking the work done by technicians.
Corporate management fears mail order pharmacies
Corporate management wants the public to believe that face-to-face contact with pharmacists is beneficial because pharmacists have useful information to impart to customers. The reality is that corporate management encourages face-to-face contact with pharmacists only to discourage people from using mail order pharmacies. That is, unless the drug store chain owns a mail order facility.
Customers who ask pesky questions about drug safety slow the pharmacy assembly line
In my ideal world, pharmacists would be your educator about the corruption, deception, and dishonesty in the world of pills. In the real world, pharmacists too often function as cheerleaders for pills because that’s what the big chains want and because customers have been programmed by drug advertisements on TV to expect a quick-fix pill for every ill.
When pharmacists maintain a positive attitude toward pills in response to customer questions, it expedites the filling of prescriptions. It is very time-consuming when customers monopolize our time by asking pesky questions about the risks of pharmaceuticals.
Customers who aren’t interested in the risk vs benefit debate are naïve about pharmaceuticals
In my opinion, the public has a very poor understanding of the risks vs. benefits debate regarding pharmaceuticals. In my opinion, any pharmacy customer who accepts Big Pharma’s narrative about pharmaceuticals at face value is incredibly reckless. In my opinion, customers who say they aren’t interested in pharmacists’ opinion about the safety of pills are extremely naïve about the risks of pharmaceuticals.
In my opinion, pharmacy customers need to arm themselves with as much information about drugs from any sources they trust. Use your pharmacist if you trust him or her to give you unbiased information. If you don’t think your pharmacist provides the kinds of answers you’re looking for, then utilize Internet sites that are reputable.
Big fines by FDA don’t seem to decrease Pharma’s dishonesty
In my opinion, if customers realized how frequently pharmaceutical companies are fined by the FDA for dishonesty, those customers would not accept Pharma’s narrative without asking a lot of questions. In my opinion, being fined by the FDA is just a cost of doing business for Big Pharma. Huge fines don’t seem to have any effect in causing drug companies to be honest.
The healthcare corporations have no more integrity than any other industry
One would think that because pharmaceuticals are used for human health, companies marketing these products would feel a tremendous responsibility for honesty and integrity. In my opinion, these companies use the public’s presumptions of integrity and honesty to exploit consumers even more.
In my opinion, the pharmaceutical industry is just as corrupt as the oil industry, the insurance industry, the tobacco industry, the financial services industry, the major food processors, car salesmen, and the politicians who accept campaign contributions from Big Pharma.
Grab the product and slap a label on it
Should pharmacists’ responsibilities be limited to simply going to their pharmacy shelves and grabbing whatever medication a physician prescribes and slapping a label on it with the doctor’s directions? Many people, in fact, think that is all that pharmacists do. Many people think that it is all pharmacists should be allowed to do.
Like any business or profession, there is tremendous range in the quality of pharmacists
I agree that many pharmacists do a poor job counseling customers about medications. There are very many pharmacists who have no desire to read books—or teach their customers—about the deep corruption in the pharmaceutical industry and the huge debate surrounding the safety and effectiveness of drugs. I can easily see how customers could be dismissive toward anything these pharmacists have to say. But there are indeed many pharmacists who are serious people who take their job seriously and who feel they have an ethical duty to be transparent about pharmaceuticals.
“The A-Team” vs. “Skid Row”
I once mentioned to a pharmacist my opinion that I viewed half of my pharmacy school classmates as serious students and the other half as doing the absolute least they could to graduate. This pharmacist attended a different pharmacy school but he said he viewed his classmates the same way. He said that half of his classmates were known as “The A-Team” (presumably referring to the action-adventure TV series that ran on NBC from 1983 to 1987) and the other half were known as “Skid-Row.”
Many pharmacists dislike interacting with customers and patient counseling
Many pharmacists hate customer contact and don’t feel that it is our job to educate the public about the risks and benefits of pills. Many pharmacists view most customer questions as naïve or stupid. That is, of course, because most of our customers did not attend pharmacy school or medical school.
Does your physician adequately inform you about the drugs he/she prescribes?
Ideally your physician will tell you everything you need to know about the drugs he/she prescribes. But in our assembly line medical system based on herding people like cattle, that rarely happens. So, in my opinion, the public should be appreciative of any information that their pharmacist shares with them about their prescribed medications. The reality is that with dangerously understaffed pharmacies at chain drug stores, there simply isn’t enough time for pharmacists to have detailed discussions with customers.
Even though some pharmacy customers don’t seem to see much value in speaking with pharmacists, many customers do indeed ask pharmacists a lot of questions. For example, some customers say something like this to their pharmacist, “I don’t really like to take prescription drugs. But my doctor says I need this. What do you think?” The customer is asking the pharmacist about the safety and effectiveness of a drug the doctor has prescribed.
Pharmacists need to align themselves with science and distance themselves from marketing
If pharmacists expect the public to view pharmacy as driven by science, then we need to shed our reputation for being cheerleaders for whatever drugs doctors prescribe. To the extent that the public relies on pharmacists for balanced and unbiased information about pills, I believe that pharmacists need to move themselves to a closer allegiance with science and distance themselves from what appears to be acquiescence with Pharma’s marketing circus.
Of course, some pharmacy customers have no interest in their pharmacist’s opinion regarding pharmaceuticals. These customers seem to feel that all important information about medications should come from their doctors. I wrote a commentary for The People’s Pharmacy titled, “Just Shut Up and Fill Prescriptions.”
Pressure to be positive about pills
Pharmacists feel subtle yet powerful pressure from our corporate bosses to be positive about the pills we dispense. Our corporate bosses won’t tolerate a pharmacist who uses his position in chain drug stores as a platform for promoting prevention rather than pills. Pharmacists realize that we’re being paid to move pills, not to teach our customers how to be healthy so they won’t need so many (or any) pills.
Do pharmacists have a duty to counsel about the possibility of serious side effects?
Pharmacists surely influence customers’ views toward pharmaceuticals by mentioning only one or two side effects during counseling even though there may be 50 to 200 listed in the official prescribing information. Pharmacists influence customers’ views toward pills by mentioning only so-called “mild” or common side effects like nausea, vomiting, diarrhea, upset stomach, headache, constipation, dizziness, drowsiness, insomnia, dry mouth, etc. Is that being fair and honest with our customers?
Pharmacists do not mention serious side effects like lupus, aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, Stevens Johnson syndrome, hallucinations, rhabdomyolysis, heart rhythm abnormalities, internal bleeding, suicidal thoughts or ideations, heart attack, stroke, and death.
Are pharmacists complicit with Pharma in promoting a rosy view of drugs?
Do our customers have a right to be verbally informed about the possibility of serious side effects? Does the practice of not informing customers about the possibility of serious side effects make pharmacists complicit with Pharma in promoting an overly positive attitude toward pills?
Don’t scare the patient about possible risks from drugs
Physicians and pharmacists seem to accept the proposition that the need for a prescribed medication supersedes the need to be entirely transparent about the risks and thus potentially scaring the customer away from ostensibly needed medication.
But what if the medication only treats symptoms? What if the medication treats a condition that should more logically be prevented with dietary and lifestyle changes? This sounds to me like health professionals being complicit in a medical system that is focused on profits rather than the prevention of disease.
Some pharmacy customers are amazingly unconcerned about the risks of pharmaceuticals
Some pharmacy customers are extremely interested in (and concerned about) drug side effects. Other pharmacy customers reflexively dismiss the significance of side effects. For example, when these latter pharmacy customers are handed the drug leaflet that accompanies each new prescription, they make comments to the pharmacist like, “Yeah, the side effects occur in only one person in a million but the government [FDA] requires that those side effects be listed. I throw those leaflets away as soon as I get home!”
Other customers complain that FDA’s involvement in regulating drugs means we live in a nanny state. Are you capable of determining the safety and effectiveness of pharmaceuticals on your own? Do you value the input of pharmacists? Or should we just shut up and fill prescriptions?
Dennis Miller, R.Ph. is a retired chain store pharmacist. His book, The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets, can be downloaded in its entirety at Amazon for 99 cents.
