Should pharmacists do no more than transfer pills from big bottles to little bottles and then slap a label on it with the prescriber’s directions? That’s how many people think of their job description.
Dennis Miller, R.Ph. is the author of The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets. The entire book is available for download from Amazon for 99 cents. This is his blog on the role of pharmacists.
A reader posted the following comment in reply to my People’s Pharmacy article “12 Reasons Why Pharmacists Don’t Criticize Pharmaceuticals”:
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. People expect too much of pharmacists for things that fall outside of their job description.
Grab the product and slap a label on it.
Should pharmacists 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. Apparently this reader feels that this is all that pharmacists should do.
Many pharmacy customers ask
“Why does it take so long to put a few pills in a bottle?”
Or “Why does it take so long to transfer a few pills from a big bottle to a little bottle?”
Or “Why does it take so long to slap a label on my refill for birth control pills?”
Or “Why does it take so long to slap a label on a tube of cream since the cream is already in the tube?”
Drive-thru windows send the wrong message.
Many pharmacy customers seem to think that the existence of drive-thru windows at drug stores means that prescriptions should be filled as quickly as hamburger orders at McDonald’s. And many pharmacy customers seem to think they can just “dash into the drug store to have their prescriptions filled” after shopping at the nearby grocery store.
“I’ve got ice cream sitting in my car!”
During the summer, these customers often exclaim “I’ve got ice cream sitting in my car!” Apparently this warrants putting this customer’s prescriptions ahead of all others. Customers with ice cream in their car should immediately be moved to the front of the line. Why isn’t that obvious to pharmacy staff?
Many pharmacy customers seem to think that continually clearing their throat, clanking their keys on the counter, or honking their horn at the drive-thru will expedite the filling of their prescriptions. Unfortunately many pharmacy customers evaluate pharmacists based on one criterion only: the speed with which he/she fills prescriptions. Why isn’t that the only important element of the job description?
A growth industry: lawsuits against pharmacists
Many people are totally unaware of pharmacists’ responsibilities today. Pharmacists are being sued for failure to warn about serious side effects that patients/customers might experience. Pharmacists are being sued for failure to catch serious drug interactions or contraindications. Pharmacists are being sued for failure to catch dosages that are unreasonably high or low. Pharmacists are being sued for failure to catch drug allergies (penicillin, sulfa, etc.). Pharmacists are being sued for failure to screen patients’ excessive use of controlled substances before filling such prescriptions. Pharmacists are being sued when patients become addicted to controlled substances. Pharmacists are being sued for their own mistakes or for technicians’ mistakes such as putting the wrong pill in the bottle, typing the wrong directions on the label, etc. If a pharmacist’s entire job description is simply counting out pills, they wouldn’t be liable for such errors.
Pharmacist sentenced to prison for an error causing the death of young Ohio girl
Emily Jerry, a two-year old girl, died after a hospital pharmacist failed to catch a technician’s error in compounding an intravenous chemotherapy solution. An Ohio grand jury indicted the pharmacist for manslaughter and reckless homicide but declined to indict the technician. The error occurred in 2006 at Rainbow Babies & Children’s Hospital. Emily died three days after receiving the improperly compounded medication. The pharmacist who failed to catch the technician’s error was sentenced to–and actually served–time in prison. The settlement was for seven million dollars. (Reid Paul, “Former pharmacist indicted for manslaughter after med error,” Drug Topics, Sept. 17, 2007, p. 10. See also emilyjerryfoundation.org)
Jury awards $140 million after prescription error leads to woman’s death
The following case describes the largest jury award that I am aware of as a result of a pharmacy mistake. This case involves a prescription dictated by a physician at an Alabama hospital that was transcribed incorrectly as a result of outsourcing the transcription to India. Yes, you read that correctly. The prescription was dictated by a physician at an Alabama hospital and it was outsourced to India to be transcribed.
“Jury Awards $140 Million After Prescription Error Leads to Woman’s Death,”
Kevin Connolly, December 19, 2012 https://www.drugwatch.com/news/2012/12/19/jury-awards-140-million-prescription-error-death/
A jury in Baldwin County, Ala., has awarded $140 million to the family of a woman with diabetes who died as a result of a prescription error. The hospital and three other firms were ordered to pay the family of Sharron Juno, who died in 2008 at the age of 59 after she was given 10 times the amount of insulin required.
It’s not an isolated case. Every year in the United States, approximately 1.3 million injuries and at least one death every day are associated with medication errors.
Outsourcing Error has Fatal Consequence
On March 18, 2008, Juno was discharged from Thomas Hospital, and her doctor dictated instructions for follow-up care at a rehab facility. The prescription order was incorrectly transcribed in India, calling for 80 units of insulin rather than eight. The medication caused an irreparable brain injury, followed by cardiopulmonary arrest, and Juno died on March 27, 2008.
According to lawyers representing Juno’s family, Thomas Hospital began outsourcing transcription services in 2007 to save money — and continued to do so for two years following Juno’s death.
Chain drug store pharmacists’ job descriptions are terrifyingly absurd.
One of my most frequent thoughts working as a pharmacist at chain drug stores (I’m now retired) was that my job is terrifyingly absurd. Pharmacists dispense potentially deadly drugs and yet the only thing that our customers care about is how fast we fill their prescriptions.
An immoral business model based on understaffing
I suspect that a huge number of chain pharmacists feel the same way I do. Our employer has chosen an immoral business model based on understaffing. Understaffing increases profits by forcing everyone to work at maximum output for their entire shift. But understaffing unquestionably increases pharmacy mistakes.
How does chain corporate management respond to this criticism? Chain spokesmen absurdly claim that patient safety is the chain’s number one concern. Chain spokesmen counter the criticism of understaffing by claiming that mistakes also occur at times when things are slow in the pharmacy.
The insurers for the big chains pay out huge settlements for people harmed by pharmacy mistakes (often in the millions of dollars) and typically require a gag clause in the settlement so that the person harmed by the error (or his/her survivors) does not disclose details of the case or settlement.
It’s cheaper to pay settlements than to have safe staffing levels.
Many pharmacists feel that chain corporate management has made the cold calculation that settlements for pharmacy mistakes are simply a cost of doing business, no different from payroll, leases, janitorial services, licenses, electric bill, water bill, phone bill, grounds keeping, etc.
Chain corporate management has determined that it’s more profitable to base their operations on an immoral business model (understaffing) and then compensate customers harmed by the inevitable errors, rather than provide adequate staffing for the safe filling of prescriptions. If the pharmacy staff where you have your prescriptions filled appears very stressed, you can bet that the chance of mistakes is significantly elevated.
Do you need a college degree to be a pharmacist?
Pharmacy customers have a wide range of views about pharmacists’ duties. For example, a customer once asked me, “Do you have to go to college to do this kind of work?” I assume he was asking whether a college degree is required to be a pharmacist.
Do you need a doctorate to be competent?
In fact, for the last few decades, the entry level degree for becoming a pharmacist is a doctorate.
There is considerable debate regarding the reason why pharmacy schools and some pharmacy associations pushed for the adoption of a doctorate as the entry level degree. When I graduated from pharmacy school in 1975, the entry level degree required a total of 5 years of college. Now the entry level degree (a doctorate) typically requires six years.
Pharmacy schools have a vested interest in the switch to a 6-year degree because the additional year increases revenue to the pharmacy school and university and it feeds the egos of pharmacy professors. The justification for the 6-year degree was explained as follows: Drugs are becoming more complicated each year so pharmacists need more education to understand these drugs and to be competent in dispensing and counseling about these drugs. The requirement for a doctorate was also seen as bolstering the case that pharmacists should be compensated for counseling about medications.
Critics say that the requirement for a 6-year degree was simply a power grab or a desire by pharmacists to be seen on the same level as physicians and dentists whose entry level degree is a doctorate (M.D, D.O., D.D.S)
Are pharmacists no different from Shipt or Instacart shoppers?
During the pandemic, I have had groceries delivered to my home. Do you view pharmacists as akin to store shoppers (e.g., Shipt, Instacart, etc.) who simply grab products from shelves? Or do you feel that pharmacists perform valuable tasks (like provide counseling on medications) in addition to grabbing products from shelves?
There’s no future in dispensing drugs.
Pharmacists want to be seen as professionals who provide a service beyond simply filling prescriptions. Pharmacists want to be able to bill for cognitive services (giving advice on proper use of prescription drugs) in addition to dispensing the medication.
Many pharmacists feel that there’s no future in dispensing drugs because the insurance companies and pharmacy benefit managers have so much power. These entities are continually decreasing the reimbursement or dispensing fee that pharmacists receive from filling prescriptions. Pharmacists fear a scenario in which our future livelihood is tied to ever-diminishing reimbursements from insurance companies.
Are drug leaflets better than in-person counseling?
The reader who commented on my Peoples Pharmacy article stated “Patients should read and understand the circulars that come with medications.” Do you feel that you can learn everything you need to know about medications by reading the circular? Do you think that pharmacists should be competent to answer questions from customers about pharmaceuticals? Or should all questions about pharmaceuticals be directed at the physicians who prescribed the drugs? Do patients actually read those circulars and follow up with questions about things they don’t understand?
Do other health professionals have time to counsel you about medications?
Does your physician have the time or desire to inform you about all the drugs he/she prescribes? And with dangerously low levels of staffing at chain drug stores, does your pharmacist have the time to counsel you about medications? Does your pharmacist’s counseling consist of a very short sound bite like “Be sure to finish the antibiotic” or “This drug may make you drowsy. Be careful if you’re driving.”
Do you want to be able to discuss with your pharmacist things like the best time to take your medication, what to do if you miss a dose, any foods that need to be avoided, and possibly your observation that a generic drug you’re taking doesn’t seem to be as effective as the name brand? Do you think that belongs in the pharmacist’s job description?
How many side effects should pharmacists warn about?
If you ask a pharmacist about possible side effects from a drug your doctor has prescribed, should the pharmacist just list the most common, or does the pharmacist have a duty to mention the most serious also? Would a pharmacist mentioning too many side effects cause you to be less likely to take that drug?
Do you find value in having a local pharmacist with whom you can speak in person? Or are you satisfied with speaking with a mail-order pharmacist by phone? Or are printed leaflets sufficient for your needs?
Do pharmacists simply transfer pills from big bottles to little bottles?
How much value do you find in pharmacists’ counseling you about your medications? Should pharmacists stick to their “job description” and simply transfer pills from big bottles to little bottles, and then slap a label on it? Or do you find that your pharmacist adds value to the prescription by counseling you about your medications and answering your questions?
Should pharmacists counsel you on ways to prevent disease?
Most of the prescriptions that pharmacists fill are to treat preventable diseases of modern civilization. Given that fact, would you be offended if your pharmacist offered suggestions regarding how you could prevent the conditions that your drugs are treating?
Certainly doctors would not be happy with advice from pharmacists that questions the need for the drugs the doctor prescribed. And certainly pharmacists’ employers would not be happy with people taking fewer medications.
Do you discard your drug leaflets as soon as you return home?
I suspect that most pharmacists have heard customers (more likely male in my experience) say, “I throw those leaflets away as soon as I get home.” To me, that statement strongly suggests someone who doesn’t place any value in pharmacists’ counseling or anything else that pharmacists do.
All drugs have a risk/benefit ratio.
My reaction to such comments is that this person has a very naive understanding of pharmaceuticals. Pharmaceuticals are very potent substances that can do much good, but they can also cause significant harm from adverse drug effects. Throwing away drug leaflets is not, in my opinion, a smart thing to do.
Patients need to read extensively about all the drugs they take.
In my opinion, patients/customers should read widely about each drug their doctor prescribes, and ask lots of questions to both the prescribing physician and your pharmacist. I wish that chain drug stores provided adequate staffing so that pharmacists would have time to answer your questions with the detail that they deserve.
Do you agree with an expanded role for pharmacists?
Should pharmacists become more deeply involved in discussing medications with customers? Should pharmacists be watchdogs to assure that there are no serious drug interactions, contraindications, drug allergies, incorrect dosages, etc.? Or should pharmacists do what this People’s Pharmacy reader seemed to suggest? Should pharmacists stick to their most elemental job description and do no more than transfer pills from big bottles to little bottles and then slap a label on it with the prescriber’s directions?
Dennis Miller, R.Ph. is the author of The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets. The entire book is available for download from Amazon for 99 cents.
