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.
What Do You Know About Your Pharmacist?
Many pharmacy customers know that there is wide variation in the “quality” of pharmacists. Some pharmacy customers, perhaps those who don’t have a lot of interaction with pharmacists, may feel that one pharmacist is as good as the next, that there is a generic quality to pharmacists.
The fact is that pharmacists span a wide range of traits and competencies. For example:
–Some pharmacists love advising customers about medications and find it to be the most fulfilling part of their job. Other pharmacists hate contact with customers.
–When customers ask the pharmacist for a recommendation for a non-prescription product for cough, cold, sore throat, constipation, rash, hemorrhoids, diarrhea, etc., some pharmacists will make every effort to ask that customer any pertinent questions (like whether that customer is taking medications for blood pressure which could affect the choice of products for colds).
–Despite dangerously low staffing in the pharmacy, some pharmacists will make every effort to walk with the customer to the sales floor and directly point out the product he/she recommends for that customer. Other pharmacists, when confronted with a request for a recommendation for a non-prescription product, will simply say something to the customer like, “I recommend Sudafed. It’s on aisle one.”
–Some pharmacists have a much lower threshold for phoning physicians when there is some question about a medication that physician has prescribed. For example, some pharmacists phone physicians’ offices about potential drug interactions far more than other pharmacists.
–Some pharmacists provide excellent counseling about medications. Other pharmacists feel that patient counseling is a ritual which can be satisfied by throwing a few words at customers.
–Some pharmacists are exceedingly careful in filling prescriptions. Other pharmacists are remarkably reckless and don’t seem to realize the extent of harm that can result from a pharmacy mistake nor the huge potential liability for that mistake.
The Biggest Shock for Pharmacy Interns:
Perhaps the biggest shock for pharmacy students working as interns in pharmacies is seeing the amazing speed with which prescriptions are filled. That was certainly my reaction when I worked as an intern in pharmacies during my summer breaks when I was in pharmacy school.
I remember that I was thinking something like,
“The speed with which we fill prescriptions sure looks dangerous to me. I must be overreacting because surely a big corporation like a chain drug store would not expose itself to such huge liability and patient harm from pharmacy mistakes.”
It was only later after gaining some perspective on the situation that I realized that such speed and recklessness are par for the course for chain drug stores. That’s because the chain store business model is based on understaffing to increase profits. Understaffing forces pharmacists and techs to work at maximum output for their entire shift.
Variations in Attitudes Among Pharmacists Toward Pharmacy Mistakes:
Some pharmacists are exceedingly careful in filling prescriptions and rarely make mistakes. Other pharmacists make a remarkable number of errors and seem to have a surprisingly laid-back attitude toward those errors.
Settlements for Pharmacy Mistakes Are Simply a Cost of Doing Business:
Some pharmacists are devastated when they make a mistake. Other pharmacists easily slough it off by making a (legitimate) observation about pharmacy practice.
Here’s an example:
“Well, what do you expect? The big chain drug stores run their operations recklessly by choosing understaffing as their business model for profitability. The big chains would rather have pharmacists sling out prescriptions at lightning speed and then compensate those customers harmed by the inevitable pharmacy mistakes. The big chains would rather do this than provide adequate staffing for the safe filling of prescriptions. The big chains seem to view settlements for pharmacy mistakes as simply a cost of doing business, no different from the water bill, the electric bill, the phone bill, janitorial services, payroll, license for selling alcoholic beverages, pharmacy license, lease expenses, landscaping expenses, cost of inventory, etc.”
A Young Pharmacist Who Was an Accident Waiting to Happen:
I worked with a newly minted pharmacist for a while in one drug store. He was quickly gaining a reputation as a serious accident waiting to happen. He made a remarkable number of errors.
I recall that one morning, two separate unrelated customers returned to the pharmacy questioning why the pills they got were different from what they were accustomed to getting. Perhaps the customers wondered whether they had received a generic from a different manufacturer. It turns out that both people had received the wrong drug from that careless pharmacist, i.e., drugs that were completely unrelated to what should have been dispensed.
After a few months, this pharmacist went to work for a competitor, i.e., another national drug store chain. This chain was known to fly its pharmacists who had made too many errors to their corporate headquarters in a distant state for a couple of days. The purpose was a refresher course in preventing pharmacy mistakes for pharmacists in urgent need of such re-training.
I knew another pharmacist who had worked with this pharmacist for a while. She commented to me that this pharmacist was so bad that his family would need to start forwarding his mail to him because he needed to stay there for a long time for a complete overhaul.
Do Pharmacists Report Mistakes Made by our Colleagues?
You might wonder why other pharmacists didn’t report him to management as soon as his error-prone ways became evident. That’s certainly a valid point. Some chains have strict policies about reporting mistakes to district managers or corporate level management.
Chain store corporate management would blame the individual pharmacist in order to deflect criticism away from the corporation
At that time, we rarely reported pharmacy mistakes (unless they resulted in serious harm) because all pharmacists seemed to feel that we work for such a reckless corporation in which mistakes are inevitable. We don’t want to report mistakes made by other pharmacists because the tables could easily be turned on us if we make a mistake.
So, at least during that time period in my career, pharmacists rarely reported their own errors or those of a colleague to corporate management. Our attitude was that corporate management would blame the individual pharmacist for the mistake rather than blame the reckless business model of the corporation based on filling prescriptions at lightning speed and compensating customers harmed by pharmacy mistakes. The chain drug store model based on understaffing makes pharmacy mistakes inevitable.
As I said, pharmacists’ attitudes and concerns about making pharmacy mistakes span a wide range. Some pharmacists are absolutely terrified about making a serious pharmacy mistake and harming the customer and being sued as a result and possibly losing their pharmacy license. Other pharmacists seem to have a remarkably laid-back attitude toward pharmacy mistakes, seemingly oblivious to the tremendous potential liability with each prescription they fill.
How did pharmacists in this latter category graduate from pharmacy school with what seems like such a laid-back attitude toward pharmacy mistakes? Didn’t their courses in pharmacy law make them aware of how high the stakes are with each medication we dispense?
Pharmacists often wake up in the middle of the night worrying about a specific prescription they filled on their previous shift:
Conscientious pharmacists sometimes wake up in the middle of the night asking themselves whether they actually verified a prescription that stands out in their mind.
For example, they may be lying in bed in the middle of the night thinking,
“Mrs. Jones was in today but I don’t remember actually verifying the prescriptions filled by our technicians for her. Is it possible that those prescriptions were filled and bagged without my verification?”
It is not rare that, for example, a pharmacist will phone the pharmacist on duty in the morning and ask that pharmacist to verify whether the medication name entered into the pharmacy computer for Mrs. Jones matches the hard copy of the prescription or the version that was scanned into the pharmacy computer.
I felt that I needed to remake my entire approach to life to one of being extremely conscientious.
As a result of seeing the ease with which pharmacy mistakes occur, I became much more careful in many aspects of my life away from the drug store. For example, I became much more careful while going through intersections while driving my car and looking both ways. When backing my car out of a parking space at a shopping center, I became much more careful in making sure that there were no cars approaching me. Whenever I walked out of my apartment, I became obsessed that I remembered to check that I had locked the door. I became obsessed with making sure that I turned off the burners on the kitchen stove.
My worry about making pharmacy mistakes may have caused me to overreact by trying to remake my entire life into a person who doesn’t make mistakes. My view was that I can’t be relaxed about things like driving a car on a highway, backing out of parking spaces, locking the door to my apartment, and turning off the kitchen stove and then expect to be careful as soon as I walk into the drug store. A careful person is careful in everything he/she does, not just at work. My view is that it’s impossible to be carefree outside the drug store and then instantaneously become a careful person at work.
One of the biggest joys of retirement is not having to worry about making a serious pharmacy mistake, harming that person, and then being sued
There is a motto among chain store pharmacists that goes something like this, “A bad day in retirement is better than a good day working at a chain drug store.”
My Own Mistake Involving Prozac and Paxil:
I made a few mistakes myself during my career. For example, one day I dispensed Prozac to a female customer rather than Paxil. These are both similar in that they are both SSRI-type antidepressants that begin with the letter “P”. The customer returned the next day. She came to the pharmacy department and asked me why her antidepressant medication looked different from what she was accustomed to getting.
She asked me
“What is that medication in my bottle?”
This scenario is, of course, the worst part of being a pharmacist. Our customers trust us to fill their prescriptions correctly and, in this case, I failed miserably. I felt terrible and admitted that I had made a mistake. She looked at me like I was a worthless person who was a threat to the public safety and that I had no right to be a pharmacist. Little did she know that I was a pharmacist who is extremely worried about pharmacy mistakes. She seemed to feel that I was simply a reckless pharmacist who needed to leave the profession.
A Pharmacy Mistake Can Haunt a Pharmacist for Months or Years:
Those pharmacists who worry obsessively about pharmacy mistakes are devastated when we make mistakes ourselves. It can be a huge blow to our ego which causes us to question our self-worth. Our pain from the pharmacy mistake can linger for days or weeks or months. My mistake with Prozac/Paxil has remained vivid in my mind decades later even though it was a relatively minor mistake in comparison to those pharmacy mistakes that result in multi-million-dollar settlements as a result of serious injury or death to the pharmacy customer.
Final Words:
Some pharmacists say that any pharmacist who claims he/she never made a mistake during his/her career is lying.
The public seems to have little appreciation for how stressful a pharmacist’s job can be. As a pharmacy customer, you should always remember that pharmacists dispense potent medications which often have the power to do much good but can also cause great harm.
Serious pharmacy mistakes occur far more often than you realize. Rushing your pharmacist increases the likelihood of a serious pharmacy mistake. Pharmacy mistakes range from those that are very minor to those that are deadly.
Even though there may be a subdued atmosphere in the pharmacy, or even if the pharmacy staff seems to be extremely harried, keep in mind that the pharmacy department at chain drug stores can be a pressure cooker because of the tremendous expectations on pharmacists to fill prescriptions quickly even though the pharmacy is dangerously understaffed.
Pharmacists sometimes fill prescriptions for people with obsessive-compulsive behaviors such as excessive handwashing. In my opinion, you should want a pharmacist who is compulsively obsessed with accuracy in filling your prescriptions. But, of course, you have no way of knowing whether your pharmacist is extremely careful or remarkably reckless. A relentless attention to accuracy takes a heavy toll on your pharmacist’s psyche, but it may save your life.
You may be interested in a previous article I wrote for The People’s Pharmacy titled “Who Makes More Mistakes—Bank Tellers or Pharmacists?”
Pharmacists fill a never-ending tsunami of prescriptions, at lightning-fast speed, in dangerously understaffed chain drug stores, for customers who are often amazingly rude and impatient, for largely preventable diseases of modern civilization. It’s no wonder that many pharmacists view so much of the world of pills as absurd. Filling prescriptions resembles a fast-paced video game in which one wrong move can result in disaster. In many ways, I view pharmacies at chain drug stores as a boiling cauldron of absurdity which exacts a heavy cost on the emotional well-being of pharmacists.
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.
