a pharmacist at work behind the counter of a pharmacy, mistake, atenolol shortage, ethical question

Most pharmacists receive a nice paycheck, so any claim that they are disillusioned is unlikely to garner much sympathy. But understanding the reasons why pharmacists are disillusioned may help you to better comprehend the world of pills and, more importantly, help you avoid harm.

As a result of my commentaries in the popular pharmacists’ magazine Drug Topics over the last 18 years, I’ve received a huge number of e-mails from pharmacists saying that they’d leave the profession tomorrow if they could find-or were capable of doing-anything else that pays as well. Many pharmacists are not recommending that their children major in pharmacy in college.

Why are so many pharmacists disheartened?

1. Our health care system has so little to do with health.

Many pharmacists have sent me e-mails bemoaning the fact that our health care system has little obvious relationship to health. In my opinion, if you were to ask a large number of pharmacists what is the best way to improve the health of their customers, the vast majority would NOT say something like: increase access to drugs, expand the utilization of drugs, improve the prescribing of drugs, decrease the cost of drugs, expedite the approval of new drugs, spur the development of new drugs, etc. Instead, I believe the vast majority of pharmacists would say something like: If people would just eat better, lose weight and, in general, take better care of themselves, they wouldn’t need to take so many pills.

This e-mail is typical of many I’ve received from disillusioned pharmacists:

I recently retired from the chain drugstore business, mostly because I just could not stand it anymore. Lack of staff, unreasonable working conditions and workload, and the sense that we are handing out pills like hamburgers made working no longer a pleasure. It was frustrating dealing with the public, who have been more or less brain-washed into thinking that every new pill coming down the pike is just what they should have, never mind whether or not it would really do them good or might even be harmful to them.

“The military-industrial complex has nothing on the medical insurance-manufacturers-chain stores complex that has bamboozled and scared the public into believing that all these drugs and medical care are necessary and good for them. We are becoming a nation of legalized drug addicts subjugated by an un-healthcare industry focused on how much money they can extract from our wallets. We hear all the time about how the USA has the best healthcare in the world, yet now it is coming to light that we really, really DON’T, given the miserable conditions many of us live in, when healthcare costs eat up most of our assets as we age, and the end is nowhere in sight.”

Many pharmacists are disillusioned feeling that what they do every day at work is not the best way to make people healthy. Many pharmacists believe that pills are not necessarily the best road to health, and that major changes in our customers’ diet and lifestyles would be more effective than pills. Consequently, spending our days slinging out prescriptions at warp speed is deeply unfulfilling and contrary to the reasons we became pharmacists.

Even though many (perhaps most) pharmacists would place non-drug measures at the top of their list of the most important things for people to do to improve their health, our medical system essentially gives only lip service to non-drug measures. This quick-fix pill-for-every-ill orientation of our heath care system is unrealistic but profitable. Disease prevention gets so little attention because there’s no money in prevention.

Take cancer, for example. Why does our health care system give priority to treating cancer rather than preventing it? The Merck Manual (17th edition, pp. 2591-2592) essentially states that up to 90% of cancer is preventable: “Environmental or nutritional factors probably account for up to 90% of human cancers. These factors include smoking; diet; and exposure to sunlight, chemicals, and drugs. Genetic, viral, and radiation factors may cause the rest.” Yet there is little attention to helping people change their diets or exposures before they are diagnosed with colorectal cancer or melanoma.

2. Pharmacy schools misrepresent the real world.

In my opinion, a big reason for pharmacists’ cynicism is the yawning gap between our expectations from pharmacy school and our subsequent experiences in the real world. Many pharmacists have told me that they’d like to initiate a class action lawsuit against this nation’s pharmacy schools for misrepresenting what this profession is like in the real world.

Pharmacy students are taught to be drug experts who advise the public about the proper use of medications. The problem is that, in the real world, the big chains are interested only in activities that are financially lucrative. Counseling customers on appropriate drug use is not reimbursed, so it is not valued. Many pharmacists feel that the only thing that the big chains care about is how fast they fill prescriptions. These employers view patient counseling about medications primarily as a drag on productivity.

The schools of pharmacy teach a mechanistic and reductionist view of health that removes Homo sapiens from any connection to the natural world. According to this model, health is directly proportional to the per capita consumption of pharmaceuticals. The infinite number of social, cultural, political, psychological, economic, environmental, nutritional/dietary and lifestyle factors in the causation of human disease are essentially ignored in favor of a remarkably narrow molecular and cellular focus.

3. Pharmacies are systematically understaffed.

Pharmacists are disillusioned because their employers have chosen a business model based on understaffing. Understaffing increases profitability by forcing everyone to work at maximum output, but this business model has many adverse consequences.

Understaffing means that pharmacists don’t have time to call physicians as often as we should to clarify questionable doses, inappropriate directions, poorly legible handwriting, and potential drug interactions. Understaffing means that pharmacists very often don’t have time to answer customers’ questions as thoroughly as we would like. Understaffing means that prescriptions are just a blur on an assembly line. The consequences are that there are far too many pharmacy mistakes and that too many patients/customers are poorly informed about the medications they take.

4. Pharmacy mistakes are common.

Pharmacy mistakes are shockingly common in chain drug stores today. This will continue until the costs of settlements for harm caused by pharmacy mistakes exceeds the cost of adequate staffing in the pharmacy.

At this point, it seems that big chains have made the cold calculation that it is more profitable to have pharmacists sling out prescriptions at lightning speed and compensate customers who discover they have been harmed by pharmacy mistakes than to provide adequate staffing so that prescriptions can be filled safely and double-checked as they should be.

The sad reality is that adequate staffing hurts the chains’ bottom line. It is more profitable to understaff pharmacies and require all employees (pharmacists and techs) to work at breakneck pace even though this inevitably contributes to mistakes.

5. State boards of pharmacy are unresponsive.

The widespread occurrence of pharmacy mistakes has been one of the hottest topics in pharmacy magazines for many years. Many pharmacists feel that state boards of pharmacy are failing miserably in their duty to protect the public safety. As one example, the state boards of pharmacy should mandate adequate drug store staffing so that prescriptions can be filled safely.

Pharmacists are disillusioned because the state boards of pharmacy seem to be intimidated by the immense legal and political clout of the mighty chain drug stores. The big pharmacy chains are not shy about lobbying state legislatures to override any regulation that state boards of pharmacy champion for adequate staffing levels.

Consequently, state boards of pharmacy pass the buck by claiming that staffing levels are an employer/employee issue that should be left to the private sector. In contrast, pharmacists feel passionately that staffing levels are a public safety issue that desperately needs board of pharmacy intervention.

6. Industrial production metrics are used to assess pharmacists’ performance.

Chain drug stores use industrial production metrics to evaluate pharmacists rather than metrics based on improvements in human health. The big chains use metrics such as how much time it takes to finish a prescription once it’s entered into the pharmacy computer, the number of prescriptions filled per hour, and the staffing levels utilized in the process.

Pharmacists would laugh at the assertion that the big chains actually care about the health of our customers. For example, the big chains do not have any metrics to evaluate pharmacists based on things like how often we call physicians to clarify potential problems with prescriptions.

7. Customers are impatient.

Pharmacy customers make things worse by judging their pharmacists based solely on how rapidly they fill prescriptions. Customers are very impatient and usually don’t seem to realize the importance of pharmacists phoning prescribers to clear up anything that is questionable. They may say things like: “I dropped off my prescriptions before going to the grocery store and expected them to be ready when I returned. I have ice cream sitting in my car. What’s the problem?”

Pharmacists would like customers to have enough insight to realize the importance of our checking with physicians about potential drug interactions, inappropriate or unclear directions, contraindications, drug allergies, unusually high or low doses, therapy duplication, etc. Unfortunately, the customers also fail to recognize the value of medication counseling. As a result, pharmacists and patients may never have the opportunity to develop a personal relationship and build trust.

8. Arrogant and unappreciative physicians complicate the pharmacists’ job.

Physicians are often ungrateful and rude when pharmacists make calls about prescription questions. Too many physicians seem to view our calls as nuisances, rather than as pharmacists’ efforts to protect customers and to prevent liability in the event that a customer suffers harm. Having to play telephone tag or wait on a return call that never comes can interfere with “productivity” as well as delay the delivery of a prescription to the customer.

9. The American Pharmacists Association has abdicated responsibility.

Many pharmacists have tremendous disdain for our leading professional organization, the American Pharmacists Association. Pharmacists are disgusted that APhA has never made issues like safe staffing levels and better working conditions (meal and bathroom breaks, etc.) a priority. APhA has been inexplicably and inexcusably missing in action in this critical fight.

10. The Food and Drug Administration has not exercised appropriate judgment.

Many pharmacists perceive the FDA as too willing to approve drugs that clearly don’t meet the layman’s definition of “safe and effective.” In addition, many pharmacists are disillusioned that the FDA allows direct-to-consumer drug advertising. They feel that these advertisements pressure physicians to prescribe medications that are often unnecessary. Only the USA and New Zealand allow direct-to-consumer advertising of prescription drugs.

Why Should You Care?

The fact that pharmacists are disillusioned is a symptom of our sick health care system. The big chain drug stores have chosen understaffing as a profitable business model. Why should you care? Because understaffing absolutely increases the frequency of pharmacy mistakes. Many pharmacy mistakes have little impact on your health. On the other hand, some pharmacy mistakes are deadly.

Pharmacists are disillusioned because Big Pharma lobbies Congress to pressure the Food and Drug Administration to expedite drug approvals. Easing up on approval standards can result in drugs that are unsafe, barely effective, or even counterproductive.

Drugs are heavily advertised on television with the goal to convince you to ask your physician whether “Drug X” is right for you. Too often these wonder drugs are little more than copycats of existing drugs. An older drug or a non-drug approach might actually be superior, but how would you know?

Pharmacists are disillusioned because our health care system gives only lip service to the prevention of disease. Many believe that lifestyle changes and a diet of whole (unprocessed) foods can very often be a better approach than pills. Instead, however, business pressures conspire to promote drug use instead.

This is why I believe that the underlying reasons for pharmacists’ disillusionment have a very real and direct impact on your health and safety.

About the Author:

The author, Dennis Miller, is a retired chain store pharmacist living in Delray Beach, Florida. He welcomes feedback at dmiller1952@aol.com. You can also post a comment below.

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  1. Diane

    Government run health care is not a perfect answer, but this isn’t utopia. It is the best system on earth right now because it eliminates the greed factor by eliminating big business. There should not be a profit in healthcare. Insurance companies should not be involved. Drs should be salaried government employees. Drug companies would not be allowed to advertise publicly.
    Visit a not poor country that has National Health care and see for your self how much better care those citizens receive. Our hospitals have become shameful conglomerates, gobbling each other up along with every private medical practice in town. Big business totally controls health care; FDA; University medical schools,; drugs.; and the worst,Our
    Congressmen!! I worked 47 years in Health care. So glad I retired 12 years ago before it became unbearable.

  2. vincent natali

    as a retired doctor, I agree totally with this essay. “A pill for every ill” I have spoken many times. A quick fix. No effort on patient’s part. An industry driven by profits. The medical-industrial complex makes the military-industrial complex look like small potatoes. Congressmen beholden to wealthy men and corporations for the millions needed for elections. A “moneyocracy”. Not much chance they will stand up to their donors to make needed corrections. Sad.

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